Systolic Blood Pressure Values Research Articles

Group-based Education and monitoring program delivered by community health workers to improve control of high blood pressure in island districts of lake victoria, Uganda

BackgroundIndividuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda.MethodsWe randomly selected 42 of 212 villages. We trained CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥ 18 years to be screened for high BP. We used the World Health Organization’s STEPwise tool to collect data on demographic and behavioral characteristics and BP measurements. High blood pressure was defined as systolic BP (SBP) ≥ 140 mm Hg and/or diastolic BP (DBP) ≥ 90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP.ResultsWe trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD = 29.8) to 149 mmHg (SD = 29.8) (p < 0.001) and mean DBP from 97mmHg (SD = 14.3) to 92mmHg (p < 0.001). GEE showed decreases of -1.133 (SBP) and − 0.543 mmHg (DBP)/fortnight.ConclusionHigh BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.

#2534 Classification of patients with acute kidney damage on the base of blood pressure value as a risk factor using a neural network

Abstract Background and Aims In acute kidney damage, the monitoring of hemodynamic status is best achieved by determining the blood pressure value. It is considered that the values of diastolic blood pressure in young and healthy people are constant from the aorta to the periphery, and the values of systolic and pulse pressure increase from the periphery to the aorta. The frequency of hypertension correlates with the presence of a cardiovascular precipitating risk factor in acute kidney injury, hypertension is also a modifying risk factor in the second and third stages of acute kidney injury, while the presence of hypotension on admission can be a clinical indicator of its cause. In patients with acute kidney damage and in patients with sepsis, the mechanism of autoregulation of mean arterial pressure, which is affected by stroke volume and heart rate, is not effective. The aim of the paper is to examine the classification of hospitalized patients with acute kidney injury based on blood pressure as a risk factor. Method The study included 86 patients over 18 years of age of both sexes (39 men 45.3% and 47 women 54.7%) with an average age of 66.85 ± 15.30 years who were diagnosed with acute kidney injury on admission to hospital treatment. Patients were divided into groups according to the stages of renal insufficiency. The study was designed as a cross-sectional comparative study. The assessment of the existence of acute kidney damage, as well as the determination of the stage of the disease, was based on the diagnostic criteria proposed by the K/DIGO expert group for acute kidney damage. The study did not include patients who had disease progression after acute kidney failure and were treated with dialysis for more than three months. Basic clinical, biochemical and hemodynamic parameters were determined in all subjects at the beginning of treatment, except for the analysis of nitrogen status, which was determined both before and at the end of treatment. During the formation of the neural network (pattern recognition Mat Lab), the parameters of systolic arterial pressure, diastolic arterial pressure normalized by min-max normalization to values from 0 to 1 were included. The data were randomly distributed into three categories: 80% for training, 10% for test, 10% for validation, which means that the parameters of 68 patients were used for training, 9 patients for validation and another 9 patients for the test. The number of input parameters is 33 to 39, while the number of output parameters is 2 in relation to treatment. Formed neural networks with different included blood pressure parameters, structures of 25 neurons in the hidden layer, with 55 and 15 epochs and with accuracy of 97.7% and 90.7% of patient classification. Results Our results show that 40.3% of patients in the third stage of acute kidney injury have hypertension. The lowest average values of systolic (108.44 ± 22.81 mmHg) and diastolic (65.56 ± 15.29 mmHg) blood pressure were experienced by patients in the first stage of acute kidney damage, and the lowest values of mean arterial pressure existed in the second stage of acute kidney damage (68.20 ± 44.96 mmHg) .Statistically significant risk factors for the development of the third stage of acute kidney damage in the multivariate analysis were patients older than 65 years, and mean arterial pressure values less than 65 mmHg. The confusion matrices showed that the classifiers adapted to the minimum and maximum values of systolic, diastolic and mean arterial blood pressure are well adapted and achieve satisfactory accuracy with 97.7% and 90.7%. Conclusion By comparing blood pressure parameters in hospitalized patients in relation to the stage of acute kidney damage, no statistically significant deviations were found. Univariate logistic regression analysis showed that age over 65 was a significant independent risk factor for stage three acute kidney injury, while the multivariate model showed that risk factors for the development of stage three acute kidney injury were patients same age and middle arterial blood pressure less than 65 mmHg. Satisfactory accuracy of formed neural networks when classifying patients during validation training and test was also demonstrated.

#1784 The potential impact of chronic subclinical hypervolemia on left ventricular hypertrophy in children on dialysis: a prospective longitudinal study

Abstract Background and Aims Hypervolemia poses a significant challenge in pediatric patients undergoing dialysis, potentially leading to severe complications such as left ventricular hypertrophy (LVH) and cardiac dysfunction. Accurately assessing fluid status in growing children on dialysis could be particularly difficult, and although several non-invasive methods are emerging, each individual measurement has its own strengths and diagnostic limitations in terms of sensitivity and specificity. To date, only a few studies in children have compared the use of different methods simultaneously to detect fluid status, and none of these have evaluated the potential cardiovascular impact of a prolonged subclinical hypervolemia. The latter can be defined as a condition of euvolemia at clinical assessment but hypervolemia at technical evaluation. We evaluated the role of three methods—lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of inferior vena cava collapsibility index (IVC-CI)—in detecting subclinical hypervolemia and examined the cardiac implications. Method In this prospective observational longitudinal study, we included 23 children (&amp;lt;18 years) who were receiving chronic hemodialysis or peritoneal dialysis at the regional pediatric nephrology center of Meyer University Children's Hospital IRCSS, Florence, Italy, between 01/06/2018 and 01/11/2020. We excluded patients with clinical signs of fluid overload. Each patient underwent a multiparametric evaluation of their fluid status (physical examination, LUS, IVC-CI, BIS) every 2 months, and an echocardiography every six months starting from a baseline evaluation. The LVH was defined as a left ventricular mass index (LVMI) of ≥ 95th percentile or a left ventricular wall-thickness z-score &amp;gt; 2 z-score. We divided the patients into two groups and arbitrarily assigned them to the subclinical hypervolemia (SH) group if they had at least two out of three parameters of fluid overload at different methods (≥5 B-lines at LUS, overhydration normalized to extracellular water “OH/ECW” &amp;gt; 7% at BIS, and/or IVC-CI &amp;lt; 40%) in the absence of clinical signs of fluid overload. The others were included in the euvolemic (EU) group. The overload rate by weight (clinical OH), prescribed by the physician clinically, was calculated as the proportional increase from the dry weight (kg of fluid overload / dry weight in kg × 100). Results The two analyzed groups did not differ regarding gender, age and BSA (Table). The clinical OH was significantly higher in the SH population than in the EU group (2.2 ± 1.84 vs 1.30 ± 2.16%, p &amp;lt; 0.01). In the correlation analysis, we found that clinical OH positively correlated with the number of B-lines by LUS (R = 0.2923, p &amp;lt; 0.001) and OH/ECW by BIS (R = 0.4144, p &amp;lt; 0.001), while there was a negative correlation with IVC-CI (R = −0.2597, p = 0.019). However, each method taken individually (LUS, BIS, and IVC-CI) appeared to be inaccurate in predicting fluid status in several individual cases. Although the frequency of hypertension did not differ between the SH and EU groups, uncontrolled hypertension, treatment-resistant hypertension, and hospital admission for hypertensive crises were more frequent in the SH group, with the latter being statistically significant (67% vs 0%, p &amp;lt; 0.01). Furthermore, in the entire cohort, we observed a significant linear correlation between LVMI values and the average values of pre-HD systolic blood pressure recorded in the prior six months (R2 = 0.16, p = 0.002). It is worth noting that the presence of LVH at the last follow-up was significantly more prevalent in the SH group (75% vs 27%, p = 0.04). Conclusion Chronic subclinical hypervolemia, detected with a multi-method evaluation (including LUS, BIS, and IVC-CI), was significantly correlated with clinical OH and associated with a higher risk of LVH. To mitigate the intrinsic limitations of each technique, adopting two or more methods simultaneously can bypass and minimize the risk of evaluative error in assessing fluid status, and help reduce cardiovascular risk.

#1610 FGF23-mediated hypertension via augmented calcium entry in vascular smooth muscle cells

Abstract Background and Objectives Ongoing studies are shedding light on the potential connection between FGF23 and hypertension. In experimental settings, the administration of recombinant FGF23 in mice has been demonstrated to induce hypertension by elevating serum sodium, along with an increase in NCC receptors in the kidney. Clinical evidences further supports pro-hypertensive effects of high circulating levels of FGF23. Our group has previously demonstrated a direct influence of FGF23 on increased arterial stiffness by inducing a phenotypic transition in vascular smooth muscle cells (VSMCs) from a contractile to a synthetic phenotype. This study aimed comprehensively to evaluate, both in vivo and in vitro, whether FGF23 directly leads to hypertension through the stimulation of intracellular calcium entry in vascular cells. Methods To ascertain whether FGF23 contributes to hypertension through a direct impact on blood vessels, recombinant FGF23 (15 µg/day) was administered for 28 days via Alzet pumps. Blood pressure was meticulously measured in these animals, and we investigated alterations in vascular remodeling and calcium channels, as well as proteins associated with vascular contraction such as Orai1, STIM1, PKD1, SERCA2a, and AGTR1. In vitro experiments included the evaluation of the effect of elevated levels of recombinant FGF23 (2 ng/ml) over 9 days on intracellular calcium entry stimulated by Ang2 (100 nM) or Thapsigargin (2.5 µM). We used the FURA method to conduct these experiments. To elucidate the in vitro pro-hypertensive mechanisms of FGF23, studies were conducted with the administration of inhibitors targeting FGF Receptors 1-3 (AZD4547, 150 nM), FGF Receptor-4 (BLU9931, 10 nM), and Erk1/2 phosphorylation (PD98059, 10 μM). Additionally, changes in Orai1, STIM1, PKD1, SERCA2a, and AGTR1 were also evaluated in these VSMCs. Results After 28 days of recombinant FGF23 treatment, no significant differences were observed in serum sodium levels, yet there was a marked increase in urinary phosphorus excretion. Systolic and diastolic blood pressure values showed a progressive significant elevation in animals exposed to high levels of FGF23. The expression of AGTR1 and PKD1 levels significantly increased after FGF23 administration for 28 days (Figure). However, Orai1 and STIM1 in the thoracic aorta exhibited no significant differences following FGF23 treatment. In VSMCs, the exposure to recombinant FGF23 for 9 days resulted in increased calcium entry upon Ang2 stimulation (Figure). This effect was markedly diminished after inhibiting FGFR1-3 receptors and Erk1/2 phosphorylation (Figure). Notably, the inhibition of FGF23 receptor 4 (FGFR4) had no impact on the calcium entry induced by FGF23 (Figure). While Orai1, STIM1, IP3R, and TRPV5 in VSMCs remained unaffected by recombinant FGF23 administration, PKD1, SERCA2, and AGTR1 levels were significantly elevated compared to control cells (Figure). The addition of Thapsigargin in a Ca2+-free culture medium to VSMCs incubated with recombinant FGF23 for 9 days led to increased Ca2+ efflux from endoplasmic reticulum. Conclusion Elevated levels of FGF23 directly enhanced calcium entry in VSMCs. This effect is mediated by FGFR1-3 receptors, Erk1/2 phosphorylation, and the upregulation of related protein to cell contraction such as SERCA2a, PKD1 or AGTR1. These modifications could be responsible of FGF23-associated hypertension in the experimental model.

Speckle Plethysmograph-Based Blood Pressure Assessment

Continuous non-invasive blood pressure (CNBP) monitoring is of the utmost importance in detecting and managing hypertension, a leading cause of death in the United States. Extensive research has delved into pioneering methods for predicting systolic and diastolic blood pressure values by leveraging pulse arrival time (PAT), the time difference between the proximal and distal signal peaks. The most widely employed pairing involves electrocardiography (ECG) and photoplethysmography (PPG). Possessing similar characteristics in terms of measuring blood flow changes, a recently investigated optical signal known as speckleplethysmography (SPG) showed its stability and high signal-to-noise ratio compared with PPG. Thus, SPG is a potential surrogate to pair with ECG for CNBP estimation. The present study aims to unlock the untapped potential of SPG as a signal for non-invasive blood pressure monitoring based on PAT. To ascertain SPG’s capabilities, eight subjects were enrolled in multiple recording sessions. A third-party device was employed for ECG and PPG measurements, while a commercial device served as the reference for arterial blood pressure (ABP). SPG measurements were obtained using a prototype smartphone-based system. Following the completion of three scenarios—sitting, walking, and running—the subjects’ signals and ABP were recorded to investigate the predictive capacity of systolic blood pressure. The collected data were processed and prepared for machine learning models, including support vector regression and decision tree regression. The models’ effectiveness was evaluated using root-mean-square error and mean absolute percentage error. In most instances, predictions utilizing PATSPG exhibited comparable or superior performance to PATPPG (i.e., SPG Rest ± 12.4 mmHg vs. PPG Rest ± 13.7 mmHg for RSME, and SPG 8% vs. PPG 9% for MAPE). Furthermore, incorporating an additional feature, namely the previous SBP value, resulted in reduced prediction errors for both signals in multiple model configurations (i.e., SPG Rest ± 12.4 mmHg to ±3.7 mmHg for RSME, and SPG Rest 8% to 3% for MAPE). These preliminary tests of SPG underscore the remarkable potential of this novel signal in PAT-based blood pressure predictions. Subsequent studies involving a larger cohort of test subjects and advancements in the SPG acquisition system hold promise for further improving the effectiveness of this newly explored signal in blood pressure monitoring.

Possibilities to increase reliability and accuracy of blood pressure measurement taking into account blood hydrodynamics and biomechanics of processes during compression of shoulder tissues with a pneumatic cuff

Systolic and diastolic BP values are determined guided by measurement signals (Korotkoff tones, oscillations). The source of these signals are hydrodynamic processes occurring in the artery under the influence of cuff pressure on the upper arm. The article is devoted to the study of these processes. The value of body tissues pressure on the artery walls is equal to the value of air pressure in the cuff only at the middle of the cuff and smoothly decreases to zero to its edges. Such non-uniformity of distribution of body tissues pressure on the artery walls is caused by the physical property of elasticity of their shape, which was not taken into account earlier. Therefore, the equality of the value of blood pressure on the artery walls from its inner side and the value of body tissues pressure on the artery walls from its outer side is possible only at one point. At this point, the open part of the artery passes into its constricted part, and the point itself is called the boundary of arterial constriction. The pulsations of blood pressure in the artery caused by the heart cause rhythmic movements of this boundary along the artery. Therefore, the arterial walls open up when the constriction boundary is moved in the distal direction. When the convergence boundary is moved in the proximal direction, the walls of the artery connect. During systole, when the blood pressure exceeds the air pressure in the cuff, the boundary of compression moves distally across the middle of the cuff. At the same time, a blood flow front is formed beyond the middle of the cuff, moving towards the distal edge of the cuff. When this edge is reached, the artery opens across the entire width of the cuff. In the diastole periods following systole, the blood pressure decreases. As a result, the blood pressure drops below the air pressure in the cuff, and the arterial wall at the midpoint of the cuff interconnect again. In this case, there is a re-boundary of constriction moving in the proximal direction. Thus, the hydrodynamics of blood in the artery is completely determined by the movements of the boundary of its compression. This hydrodynamics is substantiated theoretically and confirmed experimentally. It is shown that oscillations of air pressure in the cuff, Korotkoff tones and surface pulse waves are different consequences of a single biomechanical process, which allows us to consider in detail the formation of oscillations, surface pulse waves, as well as to put forward a physically justified version of the Korotkoff tones.

Abstract PO3-11-08: High Risk of Metabolic Dysfunction in Non-Obese Breast Cancer Survivors

Abstract Much literature already depicts the relationship between metabolic syndrome (MS), obesity, and breast cancer. Despite that, up to one-third of non-obese individuals may exhibit undiagnosed MS or metabolic dysfunction, posing an independent cancer risk and worse outcomes even for those with a body mass index (BMI) &amp;lt; 30kg/m². In that manner, our study aims to evaluate the metabolic profile of non-obese women with postmenopausal breast cancer compared to non-obese women without breast cancer. In this cross-sectional clinical study at the State University of São Paulo Medical School - UNESP. The study group (n=130) included women aged ≥ 45 and &amp;lt; 75 years, in amenorrhea for at least 12 months, BMI ≤ 30kg/m2, histological diagnosis of breast cancer, without metastatic disease, and without established cardiovascular disease (CVD). The control group (n=130) comprised women with all the same criteria except for breast cancer diagnosis. The groups were matched by age and menopause time in a ratio of one case to one control (1:1). We aimed to analyze their clinical, biochemical, and oncological data to establish relationships between these groups. We presented the data in tables 1 - 3. The groups showed homogeneity in age, time since menopause, BMI, waist circumference (WC), and cholesterol levels. There was a higher occurrence of MS and hypertension (HTN) among women treated for breast cancer compared to the control group (30.8% vs. 20.0% and 25.4% vs.14.6%, respectively) (p&amp;lt; 0.05). Similarly, a higher percentage of women treated for breast cancer had abnormal values for total cholesterol and glucose (56.2% vs. 43.1% and 29.2% vs. 15.4%, respectively) (p&amp;lt; 0.05). In the analysis of metabolic profile risk-adjusted for age time since menopause and BMI, women treated for breast cancer showed an increased risk for MS (OR=2.76, 95% CI 1.48-5.15), elevated glucose (OR=2.69, 95% CI 1.46-4.96), and HTN (OR=3.03, 95% CI 1.51-6.10). In the evaluation of factors influencing the metabolic profile, women with breast cancer had significantly higher mean values of WC (82.6±8.5 vs. 79.9±6.4 cm, p=0.048), systolic and diastolic blood pressure (129.2±17.1 and 77.7±8.8 mmHg vs. 118.2±15.1 and 73.6±8.8 mmHg, p=0.0002 and p=0.01, respectively), and glucose (99.7±32.5 vs. 86.6±7.6 mg/dL, p=0.0002) compared to control group. We conducted a sub-analysis among women with BMI &amp;lt; 25kg/m² from both groups. Women with breast cancer (n=64) had a higher occurrence of MS compared to women without breast cancer (n=53) (17.2% vs. 1.9%, respectively). Even though this sub-analysis did not reach the minimum number of patients with BMI &amp;lt; 25 kg/m² to achieve p value &amp;lt; 0,05, this analysis reveals a significant difference in MS incidence between the groups (p=0.007). This reinforces the hypothesis that oncological diagnosis substantially affects metabolic health, and therefore, breast cancer patients should receive special attention regarding their metabolic profile, regardless of their BMI. Conclusion: Non-obese women with breast cancer showed a higher risk of MS, HTN, and diabetes, with a worse metabolic profile than non-obese postmenopausal women without breast cancer. These findings suggest that postmenopausal women diagnosed with breast cancer, even in the absence of obesity, exhibit significant metabolic dysfunction characterized by a higher occurrence of MS and its components. The findings highlight the importance of a comprehensive assessment of metabolic health in women with breast cancer, regardless of their body mass index, to ensure appropriate and individualized care for these patients. Table 1 - Comparison of clinical and laboratory characteristics among 130 non-obese postmenopausal women with breast cancer and 130 non-obese postmenopausal women (control) (average values ± standard deviation). Table 2 - Comparison of categorized clinical and laboratory characteristics that influence the metabolic profile between 130 non-obese postmenopausal women with breast cancer and 130 non-obese postmenopausal women (control). Values expressed as number and percentage in parentheses. CA, cancer; WC, waist circumference; MS, metabolic syndrome; HDL, high-density lipoprotein, LDL, low-density lipoprotein; TG, triglycerides. *Significant difference p&amp;lt;0.05 (Chi-square Test). Table 3. Association between the presence of Metabolic Syndrome, and its clinical and laboratory components, among the 130 non-obese postmenopausal women with breast cancer and the 130 non-obese postmenopausal women (control). Values expressed as number and percentage in parentheses. CA, cancer; BP, blood pressure; WC, waist circumference; TG, triglycerides. *Odds ratio (OR) adjusted for age, menopause duration and BMI. **Significant difference if p&amp;lt;0.05 (Logistic Regression). Citation Format: Pedro Paulo Perroni Filho, Daniel Buttros, Eliana Aguiar Petri Nahas. High Risk of Metabolic Dysfunction in Non-Obese Breast Cancer Survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-08.

Impact of seasonal blood pressure changes on visit-to-visit blood pressure variability and related cardiovascular outcomes.

Visit-to-visit blood pressure (BP) variability associates with an increased risk of cardiovascular events. We investigated the role of seasonal BP modifications on the magnitude of BP variability and its impact on cardiovascular risk. In 25 390 patients included in the ONTARGET and TRANSCEND trials, the on-treatment systolic (S) BP values obtained by five visits during the first two years of the trials were grouped according to the month in which they were obtained. SBP differences between winter and summer months were calculated for BP variability quintiles (Qs), as quantified by the coefficient of variation (CV) of on-treatment mean SBP from the five visits. The relationship of BP variability with the risk of cardiovascular events and mortality was assessed by the Cox regression model. SBP was approximately 4 mmHg lower in summer than in winter regardless of confounders. Winter/summer SBP differences contributed significantly to each SBP-CV quintile. Increase of SBP-CV from Q1 to Q5 was associated with a progressive increase in the adjusted hazard ratio (HR) of the primary endpoint of the trials, i.e. morbid and fatal cardiovascular events. This association was even stronger after removal of the effect of seasonality from the calculation of SBP-CV. A similar trend was observed for secondary endpoints. Winter/summer SBP differences significantly contribute to visit-to-visit BP variability. However, this contribution does not participate in the adverse prognostic significance of visit-to-visit BP variations, which seems to be more evident after removal of the BP effects of seasonality from visit-to-visit BP variations.

BLOOD PRESSURE CONTROL IN TERTIARY-CARE HYPERTENSIVE PATIENTS DURING COVID-19 PANDEMIC

Objective: Cardiovascular risk factors distribution during the pandemic suggests worsening of the cardiovascular risk profile of hypertensive patients. At the same time, data on quality of hypertension control during the COVID-19 pandemic are scarce, in Poland. The aim of the study was to analyse the quality of blood pressure (BP) control in a group of patients who required regular control in tertiary care. Design and method: The study included hypertensive patients regularly monitored in tertiary-care out-patient clinic for at least 4 years with at least 2 visits a year prior the analysis. The size of the group was calculated based on the original data of first 50 consecutive records of patients (power of 90%). Records were retrospectively analysed with respect to office blood pressure (oBP) control. Additionally, within-visit BP variability was calculated (difference of maximum and minimum BP from 3 measurements); body weight, age, sex, duration of hypertension, number of visits per year, seasonal BP variability, use of telemedical services, comorbidities and BP-lowering treatment were recorded. Results: The study enrolled 220 patients. The values of systolic BP (sBP) before and after the break in the whole group were 135.8 ± 17.1 mm Hg vs. 137.9 ±19.5 mm Hg; P=0.08, and a diastolic BP (dBP) of 80.3 ±11.4 mm Hg vs. 82.6 ±12.2 mm Hg; p = 0.001. After adjusting for seasonal variation of BP, the respective differences were: sBP: 134.8 ± 16.5 vs. 138.0 ± 19.4; p = 0.03, and dBP: 79.4 ±10.9 vs. 82.2 ± 11.9; p = 0.004. Before 2020, 61.4% of patients were controlled (BP &lt; 140/90 mm Hg), whereas after the pandemic-driven break in regular visits the control rate decreased to 55.5% (p = 0.21). Conclusions: BP control worsened during the COVID-19 pandemic in a group of patients requiring tertiary care for hypertension.

ENDOVASCULAR RADIOFREQUENCY RENAL DENERVATION IN DIFFICULT TO TREAT ARTERIAL HYPERTENSION: A SINGLE CENTER EXPERIENCE

Objective: To assess safety and effectiveness of catheter-based renal denervation (RDN) for reduction of blood pressure (BP) in patients with difficult to treat arterial hypertension. Design and method: Thirtyfive patients selected with difficult to treat arterial hypertension, underwent RDN. Secondary forms of hypertension were excluded, and an appropriate renal artery anatomy was confirmed in all patients. Every patient underwent follow-up at 30 days, and then every 12 months, consisting in clinical examination, office BP measurements, ambulatory blood pressure monitoring, and biochemical analysis. At 12 months tansthoracic echocardiography and renal duplex sonography were performed. Results: The median value of systolic clinic BP decreased from 161 mmHg (25th-75th percentiles 158 - 191) at baseline to 144 mmHg (25th-75th percentiles 136 - 153) at follow up (p= 0.012), and the median value of diastolic clinic BP decreased from 102 mmHg (25th-75th percentiles 94 - 122) at baseline to 90 mmHg (25th-75th percentiles 78 - 99) at follow-up (p= 0.012). The number of medications changed from 5 (range 2-8) at baseline to 3.3 (range 0-6) at follow up. A significant decrease of left ventricular mass index from a median of 160 g/m2 (25th-75th percentiles 147 - 151) at baseline to 126 g/m2 (25th-75th percentiles 107 - 151) at follow-up (p= 0.043) was detected. The renal function did not demonstrate significant changes, however plasma renin activity and HOMA index were significantly reduced. No periprocedural or long term complications were observed. Conclusions: Our data confirm that RDN may constitute an effective and safe therapeutic choice for the treatment of difficult to treat hypertension.

THE ARTERIAL STIFFNESS AS RISK FACTOR FOR THE OCCURRENCE OF ARTERIAL HYPERTENSION IN POSTOPERATIVE CRITICALLY ILL PATIENTS

Objective: The aim of the present study is to investigate the predictive value of arterial stiffness in the occurrence of arterial hypertension in critically ill patients. Also, the study investigates the risk factors of arterial hypertension in ICU patients. Design and method: This is a prospective observational study. The study included postoperative patients who were admitted to the ICU. We collected demographic characteristics of the patients, their clinical characteristics (i.e. hemodynamic status), clinical severity (APACHE II, SOFA score), lifestyle data (i.e. smoking, alcohol, drugs), and medical history (diabetes mellitus, cardiovascular diseases). Arterial stiffness assessment is performed by recording and analyzing the pulse wave in postoperative patients during the first 24 hours of admission to the ICU. The Sphygmocor software was used for pulse wave analysis and IBM SPSS v.27.0 software was used for statistical analysis. Results: The sample of the study consisted of 74 patients. Most of them were males (70.3%) aged 59.3±18.6 yrs and the rest were females (29.7%) aged 63.3±16.9 yrs. Totally, 54.1% of patients had emergency surgery, 60.8% survived and discharged from ICU, 52.7% had arterial hypertension, 70.3% had diabetes mellitus, 58.1% were smoking, and 63.5% had hypercholesterolemia. The APACHE II score of patients was found 21.2±7.2 and the SOFA score 7.5±2.8 The value of peripheral systolic blood pressure (PSBP) was 138.7±19.4 mmHg, peripheral diastolic blood pressure (PDBP) was 67.1±13.2 mmHg, mean peripheral blood pressure (MPBP) was 90.7±14.6 mmHg, pulse pressure (PP) was 53.1±15.3 mmHg and AIX@75 was 22.3±13.1%. Older patients (69.1±14.9 vs. 52.7±17.3, p=0.001), patients with diabetes mellitus (92.3% vs. 7.7%, p=0.001), patients with hypercholesterolemia (92.3% vs. 7.7%, p=0.001), patients with higher value of Albumin (2.9±0.5 vs. 2.5±0.6, p=0.025), and patients with a higher value of AIX@75 (26.8±10.5 vs. 18.3±14.1, p=0.004) had statistically significant higher percentages of arterial hypertension. Higher AIX values are associated with a greater likelihood of arterial hypertension (OR: 1.027; 95%CI: 1.004-1.049, p=0.018). Conclusions: The arterial stiffness is an independent risk factor for arterial hypertension in postoperative critically ill patients.

Comparative study between cuff sizes in the determination of systolic blood pressure, by non-invasive methods in anesthetized dogs

The measurement of systolic blood pressure (SBP) is a variable of paramount importance in clinical routine, obtained and measured according to published guidelines for dogs. The study evaluated the influence of cuff size on the determination of systolic blood pressure (SBP) values in dogs, comparing two non-invasive methods. Eighteen healthy dogs of different breeds and ages were used, clinically evaluated and undergoing elective surgeries. SBP was measured using vascular Doppler and high-definition oscillometric methods during the anesthetic period, using both ideal-sized cuffs and smaller cuffs. The dogs were divided into groups, Group 1 composed of dogs with ideal cuff no. 2, Group 2 dogs with ideal cuff no. 3 and Group 3 ideal cuff no The results showed that smaller cuffs significantly overestimated the mean SBP values compared to the ideal cuff values, regardless of the method used. It was concluded that cuffs with a lower than ideal number overestimate SBP values in anesthetized dogs, regardless of the non-invasive method used.

PM2.5 associates with blood pressure: a Mendelian randomization analysis

ABSTRACT The relationship between fine particulate matter (PM2.5) and blood pressure (BP) is a controversial issue. We conducted a two-sample Mendelian randomization (MR) analysis and identified 58 genome-wide significant single-nucleotide polymorphisms associated with PM2.5 as instrument variables. Inverse-variance weighted (IVW) was used as the primary analysis approach. MR-Egger, weighted median, simple model, and weighted model methods were selected for quality control. We found a significant negative causal association of higher genetically predicted PM2.5 levels with lower systolic BP (SBP), while no causal relationship was identified between PM2.5 and diastolic BP (DBP). For each 1 standard deviation increase in genetically predicted PM2.5 levels, the beta value (95% CI) of SBP was -0.14 (-0.25, -0.03) for IVW (p=0.02), and -0.13 (-0.22, -0.04) for weighted median (p=0.005). Increased PM2.5 concentrations can lead to decreased SBP levels. Our findings provided novel insights into the controversial topic on the causal relationship between PM2.5 and BP.

Pulse pressure is associated with decline in physical function in older adults

ObjectivesThis study examined the associations between pulse pressure, hypertension, and the decline in physical function in a prospective framework. Study designThe Healthy Aging Longitudinal Study tracked a group of Taiwanese adults aged 55 or more over an average of 6.19 years to assess pulse pressure and decline in physical function, including in handgrip strength, gait speed, and 6-min walking distance, at baseline (2009–2013) and in the second phase of assessments (2013−2020). Main outcome measuresPulse pressure was calculated as the difference between systolic and diastolic blood pressure values. Weakness, slowness, and low endurance were defined as decreases of ≥0.23 m/s (one standard deviation) in gait speed, ≥5.08 kg in handgrip strength, and ≥ 57.73 m in a 6-min walk, as determined from baseline to the second phase of assessment. Linear and logistic regressions were employed to evaluate the associations between pulse pressure, hypertension, and decline in physical function. ResultsBaseline pulse pressure was associated with future handgrip strength (beta = −0.017, p = 0.0362), gait speed (beta = −0.001, p < 0.0001), and 6-min walking distance (beta = −0.470, p < 0001). In multivariable models, only handgrip strength (beta = −0.016, p = 0.0135) and walking speed (beta = −0.001, p = 0.0042) remained significantly associated with future pulse pressure. Older adults with high systolic blood pressure (≥140 mmHg) and elevated pulse pressure (≥60 mmHg) exhibited a significantly increased risk of weakness (odds ratio: 1.30, 95 % confidence interval: 1.08–1.58), slowness (1.29, 1.04–1.59), and diminished endurance (1.25, 1.04–1.50) compared with the reference group, who exhibited systolic blood pressure of <140 mmHg and pulse pressure of <60 mmHg. ConclusionsAmong older adults, pulse pressure is associated with a decline in physical function, especially in terms of strength and locomotion.

Combined blood pressure and heart rate trajectories are associated with prognosis in critically ill patients with acute aortic dissection: A group-based multi-trajectory analysis

BackgroundManaging systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) is pivotal in acute aortic dissection (AAD) care. However, no prior studies have jointly analyzed the trajectories of these parameters. This research aimed to characterize their joint longitudinal trajectories and investigate the influence on AAD prognosis. MethodsWe included AAD patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Using group-based multi-trajectory modeling (GBMTM), we identified combined trajectories of SBP, DBP, and HR within the initial 24 h of intensive care unit (ICU) admission. Cox proportional hazard regression, log-binomial regression, and logistic regression were employed to assess the association between trajectory groups and mortality outcomes. ResultsData from 337 patients were analyzed. GBMTM identified five combined trajectory groups. Group 1 featured rapidly declining SBP and DBP with high pulse pressure and low HR; Group 2 showed high to moderate SBP with slight rebound and persistently low HR; Group 3 displayed persistently moderate BP and HR; Group 4 was characterized by moderate blood pressure with persistently high HR; and Group 5 had high to moderate SBP with slight rebound, high but gradually declining DBP, and slightly high HR. Group 3 demonstrated a lower risk of mortality, with an adjusted hazard ratio of 0.32 (95 % CI, 0.14–0.74), and the adjusted relative risks for in-hospital, 30-day, and 1-year mortalities were 0.37 (95 % CI, 0.15–0.87), 0.25 (95 % CI, 0.10–0.62), and 0.41 (95 % CI, 0.22–0.79), respectively. The time-independent C-index curve demonstrated that the multi-trajectory groups had higher C-index values than any univariate trajectory groups or admission values of SBP, DBP, and HR. ConclusionsUtilization of GBMTM can yield data-driven insights to identify distinct subphenotypes in AAD patients. The combined trajectories of SBP, DBP, and HR within 24 h of ICU admission significantly influenced the mortality rate.

Comparison of Hemodynamic Parameters Based on the Administration of Remimazolam or Sevoflurane in Patients under General Anesthesia in the Beach Chair Position: A Single-Blinded Randomized Controlled Trial.

Background: We aimed to evaluate whether the administration of remimazolam as a maintenance agent for general anesthesia affects the occurrence of hypotension compared with sevoflurane when switching to the beach chair position (BCP). Methods: We conducted a prospective randomized controlled trial from June 2023 to October 2023 in adult patients undergoing orthopedic surgery under general anesthesia in the BCP. A total of 78 participants were randomly allocated to the remimazolam (R) or sevoflurane (S) groups. The primary outcome was the incidence of hypotension that occurred immediately after switching to a BCP. The secondary outcomes included differences between the study groups in perioperative blood pressure (BP), heart rate (HR), endotracheal tube extubation time, postoperative complications, and hospital length of stay (LOS). Results: The incidence of hypotension immediately after switching to a BCP was significantly higher in the S group. The risk factors associated with hypotension included sevoflurane administration and a high baseline systolic BP. In the receiver operating characteristic curve analysis for the occurrence of hypotension after the transition to a BCP, the cutoff value for systolic BP was 142 mmHg. The perioperative BP and HR were higher in the R group at several timepoints. Postoperative endotracheal tube extubation time was shorter in the R group. There were no significant differences in the postoperative complications or hospital LOS between the two groups. Conclusions: Remimazolam should be considered as an anesthetic agent to prevent hypotension when switching to BCP, and hypotension may occur frequently in patients with high baseline BP.

Impact of SGLT-2 inhibitors on modifiable cardiovascular risk factors in Romanian patients with type 2 diabetes mellitus.

Modifiable cardiovascular risk factors are high blood pressure, smoking, diabetes, sedentary lifestyle, obesity, and hypercholesterolemia. To investigate the impact of sodium-glucose 2 co-transporter inhibitors (SGLT-2i) on modifiable cardiovascular risk factors in Romanian patients diagnosed with type 2 diabetes mellitus (T2DM). A retrospective study was conducted on 200 Romanian patients with T2DM who were being treated with SGLT-2i, either Dapagliflozin or Empagliflozin. Collected data included demographic characteristics, such as weight, body mass index (BMI), fasting blood glucose (FBG), creatinine, glycated hemoglobin (HbA1c), abdominal circumference (AC), urine albumin-to-creatinine ratio (UACR), systolic blood pressure (SBP), diastolic blood pressure (DBP), C-reactive protein (CRP) and N-terminal pro b-type natriuretic peptide (NT-proBNP). The patients were observed for one year after being treated with SGLT-2i. The mean value of FBG decreased from 180.00mg% (IQR: 154.50-207.00) to 130.00mg% (IQR: 117.50-150.00) (p < 0.001), and the mean of HbA1c values decreased from 8.40% (IQR: 7.98-9.15%) to 7.30% (IQR: 6.90-7.95%) (p < 0.001). We also obtained significant positive effects on body weight, i.e., the weight decreased from 90.50kg (82.00-106.50) to 89.00kg (77.50-100.00) (p = 0.018), BMI from 32.87kg/m2 (29.24-36.45) to 31.00kg/m2 (27.74-34.71) (p < 0.001) and AC from 107.05 (± 16.39) to 102.50 (± 15.11) (p = 0.042). The UACR decreased from 23.98mg/g (19.76-36.85) to 19.39mg/g (1.30-24.29) (p < 0.001). Initially, the median value for SBP was 140.00mmgHg (130.00-160.00), and for DBP was 80.00 mmgHg (72.00-90.00), and one year after treatment, the medium value was 120.00 mmgHg (115.50-130.00) for SBP (p < 0.001), and 72.00 mmgHg (70.00-78.00) for DBP (p < 0.001) The mean CRP values decreased from 68.00mg/dL (56.25-80.25) to 34.00mg/dL (28.12-40.12) (p < 0.001), and the mean NT-proBNP decreased from 146.00pg/mL (122.50-170.50) to 136.00 pg/mL (112.50-160.50) (p = 0.005). Treatment with SGLT-2i in Romanian patients with T2DM has beneficial effects on modifiable cardiovascular risk factors.

A Practical Approach for Ischemic Preconditioning Intervention in Sports: A Pilot Study for Cuff Thigh Occlusion Pressure Estimation Based on Systolic Blood Pressure.

For the ischemic preconditioning (IPC) intervention, the accuracy of the protocol is paramount for mediating its possible ergogenic effects. However, the lack of standardization and widespread use of arbitrary cuff pressures (ranging from 130 to >300 mmHg) have been predominantly observed, potentially affecting the results and compromising the reproducibility of findings. Thus, the purpose of this study was to determine an appropriate cuff pressure during IPC. Seventeen healthy male participants were enrolled in the study. Anthropometric measurements were initially conducted, followed by systolic and diastolic blood pressure measurements. Subsequently, we determined the individual thigh occlusion pressure (TOP) for the right leg using a hand-held Doppler device. Based on these findings, we developed an estimation equation for TOP, considering the current brachial systolic blood pressure (SBP) values. We then conducted a retrospective analysis of its capacity to mediate occlusion. We observed the ability to estimate TOP using the equation (p = 0.01; ES: 0.86), presenting ~6% superiority in absolute values for occlusion compared to direct measurement (TOP equation: 169.9 ± 9.1; TOP direct measured: 161.2 ± 11.1). However, TOP estimation was insufficient to produce complete occlusion in two out of 17 subjects (11.8%). In conclusion, the estimation of TOP incorporating SBP values may offer a valid and practical means for cuff administration during IPC protocols with potential to minimize adverse effects and maximize its positive effects.

Frequency of office blood pressure measurements and the seasonal variability of blood pressure: results of the Hungarian Hypertension Registry

Purpose Hypertension is a major public health problem, thus, its timely and appropriate diagnosis and management are crucial for reducing cardiovascular morbidity and mortality. The aim of the new Hungarian Hypertension Registry is to evaluate the blood pressure measurement practices of general practitioners (GPs), internists and cardiologists in outpatient clinics, as well as to assess the seasonal variability of blood pressure. Materials and methods Omron M3 IT devices were used during four-month periods between October 2018 and April 2023 in GP practices and in hypertension clinics. The blood pressure data were then transmitted online from the monitors’ cuffs to a central database using the Medistance system of Omron. Results Family physicians (n = 2491), and internists/cardiologists (n = 477) participated in the study. A total of 4804 821 blood pressure measurements were taken during 10 four-month evaluation periods. In the ten periods, the daily average number of measurements was between 3.0 and 5.6. Following ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 14, 13.4 and 16.7%, respectively. Altogether 56% of the measurements belonged to stage 1, stage 2 or stage 3 hypertension categories (31.6, 17.1 and 7.4%, respectively). On average, a difference of 5/2 mmHg was observed between winter and summer data in systolic and diastolic blood pressures, respectively. The average systolic blood pressure values were higher in GP practices with more than 2000 patients than in the ones with less than 1500 patients (141.86 mmHg versus 140.02 mmHg, p < 0.05). Conclusion In conclusion, the low daily average number of blood pressure measurements indicates a limited blood pressure screening awareness/capacity in the case of Hungarian family physicians. In GP practices with more patients, blood pressure is usually less well-controlled. These results suggest that the further promotion of home blood pressure monitoring is necessary.

A retrospective, multi-agency ‘target trial emulation’ for the comparison of post-resuscitation epinephrine to norepinephrine

IntroductionEpinephrine and norepinephrine are the two most commonly used prehospital vasopressors in the United States. Prior studies have suggested that use of a post-ROSC epinephrine infusion may be associated with increased rearrest and mortality in comparison to use of norepinephrine. We used target trial emulation methodology to compare the rates of rearrest and mortality between the groups of OHCA patients receiving these vasopressors in the prehospital setting. MethodsAdult (18–80 years of age) non-traumatic OHCA patients in the 2018–2022 ESO Data Collaborative datasets with a documented post-ROSC norepinephrine or epinephrine infusion were included in this study. Logistic regression modeling was used to evaluate the association between vasopressor agent and outcome using two sets of covariables. The first set of covariables included standard Utstein factors, the dispatch to ROSC interval, the ROSC to vasopressor interval, and the follow-up interval. The second set added prehospital systolic blood pressure and SpO2 values. Kaplan-Meier time-to-event analysis was also conducted and the vasopressor groups were compared using a multivariable Cox regression model. ResultsOverall, 1,893 patients treated by 309 EMS agencies were eligible for analysis. 1,010 (53.4%) received an epinephrine infusion and 883 (46.7%) received a norepinephrine infusion as their initial vasopressor. Adjusted analyses did not discover an association between vasopressor agent and rearrest (aOR: 0.93 [0.72, 1.21]) or mortality (aOR: 1.00 [0.59, 1.69]). ConclusionsIn this multi-agency target trial emulation, the use of a post-resuscitation epinephrine infusion was not associated with increased odds of rearrest in comparison to the use of a norepinephrine infusion.