Systolic Blood Pressure Variability Research Articles

Effects of Achieving Rapid, Intensive, and Sustained Blood Pressure Reduction in Intracerebral Hemorrhage Expansion and Functional Outcome.

The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained maintenance of an intensive systolic BP (SBP) target with radiologic, clinical, and functional outcomes. Rapid, Intensive, and Sustained BP lowering in Acute ICH (RAINS) was a multicenter, prospective, observational cohort study of adult patients with ICH <6 hours and SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers during a 4.5-year period. Patients underwent baseline and 24-hour CT scans and 24-hour noninvasive BP monitoring. BP was managed under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mm Hg), and sustained (target stability for 24 hours) BP protocol. SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours (primary outcome), early neurologic deterioration (END, 24-hour increase in NIH Stroke Scale score ≥4), and 90-day ordinal modified Rankin scale (mRS) score. Analyses were adjusted by age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension. We included 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male). Hematoma expansion occurred in 70/274 (25.6%) patients, END in 58/291 (19.9%), and the median 90-day mRS score was 4 (interquartile range, 2-5). SBP target achievement ≤60 minutes (178/312 [57.1%]) associated with a lower risk of hematoma expansion (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.23-0.77), lower END rate (aOR 0.43, 95% CI 0.23-0.80), and lower 90-day mRS scores (aOR 0.48, 95% CI 0.32-0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not related to expansion (aOR 0.99, 95% CI 0.95-1.04) but associated with higher END rate (aOR 1.15, 95% CI 1.09-1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04-1.10). Among patients with acute ICH, achieving an intensive SBP target within 60 minutes was associated with lower hematoma expansion risk. Rapid SBP reduction and stable sustention within 24 hours were related to improved clinical and functional outcomes. These findings warrant the design of randomized clinical trials examining the impact of effectively achieving rapid, intensive, and sustained BP control on hematoma expansion. This study provides Class III evidence that in adults with spontaneous ICH and initial SBP ≥150 mm Hg, lowering SBP to <140 mm Hg within the first hour and maintaining this for 24 hours is associated with decreased hematoma expansion.

Blood pressure variability in acute stroke: Risk factors and association with functional outcomes at 1 month.

Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability. INTERSTROKE is an international case-control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1-month follow-up, and logistic regression was used to identify risk factors for blood pressure variability. Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03-1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04-1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability. Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinary sodium excretion.

Relationship between visit-to-visit blood pressure variability and depressive mood in Korean primary care patients

BackgroundHigh blood pressure variability (BPV) increases the risk of cardiovascular disease and may be better prognostic factor than blood pressure. Depressive mood is a common symptom among patients visiting primary care. This study aimed to investigate the association between depressive mood and high BPV among Korean primary care patients.MethodsThe Family Cohort Study in Primary Care (FACTS), conducted from April 2009 to November 2017, utilized a prospective cohort of Korean primary care patients, with a median follow-up period of 7.25 years. Depressive mood was assessed as a score of 21 points or more on the Korean-type Center for Epidemiologic Studies Depression scale. BP was measured at the initial visit and first and second follow-up visit. Visit-to visit SBP variability was analyzed using four metrics: intra-individual standard deviation, coefficient of variation, variation independent of mean, and average real variability. Logistic regression analysis was used to estimate the association of high BPV with depressive mood and other variables.ResultsAmong 371 participants, 43 (11.6%) had depressive mood based on depression scores. Older age (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.01–1.07) were associated with high SBP variability regardless of taking antihypertensive medication. Among participants taking antihypertensive medication, those with depressive mood had twice the risk of high SBP variability compared with those who did not (OR: 2.95, 95% CI: 1.06–8.20).ConclusionsDepressive mood was associated with high visit-to-visit SBP variability in primary care patients taking antihypertensive medication, potentially indicating increased cardiovascular risk. Primary care physicians should therefore closely monitor BPV in patients with depressive symptoms and provide appropriate interventions.

A Single Bout of Prolonged Sitting Augments Very Short-Term Blood Pressure Variability.

More habitual time spent engaging in prolonged sedentary behaviours increases the risk of developing hypertension. Beat-by-beat systolic (SBPV) and diastolic blood pressure variability (DBPV) are more pronounced in persons with hypertension and may be an early manifestation of blood pressure dysregulation. We tested the hypothesis that a single bout of prolonged sitting augments very short-term SBPV and DBPV. The secondary aim was to explore sex differences in prolonged sitting-induced increases in SBPV and DBPV. Thirty-three adults (22.9±1.9 years; 17 females) completed a single, 3-hr bout of prolonged sitting with beat-by-beat arterial pressure determined at baseline, 1.5-hr, and 3-hr via finger photoplethysmography. There were no sex differences observed for baseline brachial SBP (males: 122±10 mmHg; females: 111±9 mmHg), SBPV (males: 1.87±0.63 mmHg; females: 1.51±0.38 mmHg), DBP (males: 68±6 mmHg; females: 66±8 mmHg), or DBPV (males: 1.40±0.41 mmHg; females: 1.27±0.32 mmHg) (all, p>0.41). In the pooled sample, baseline SBPV (1.68±0.54 mmHg) remained unchanged after 1.5-hr (1.80±0.60 mmHg; p=0.59), but increased after 3.0-hr (1.84±0.52 mmHg; p=0.01). This post-sitting increase was driven by males (p=0.009), with no difference observed in females (p=1.00). Similarly, baseline DBPV (1.33±0.36 mmHg) was similar after 1.5-hr (1.42±0.41 mmHg; p=0.72) but was increased at 3-hr (1.50±0.34 mmHg; p=0.02). However, no sex differences in DBPV (all, p>0.07) were observed across the time points. In young, normotensive adults, a single bout of prolonged sitting augmented beat-by-beat blood pressure variability, which may provide a link between uninterrupted sitting and the development of blood pressure dysregulation.

Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity

Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown. To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types-ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)-and explore how these associations vary by race and ethnicity. Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years. Time-dependent cumulative mean SBP. The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH. Among 40 016 participants, 38 167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0% were women; 25.0% were Black, 8.9% were Hispanic of any race, and 66.2% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10-mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95% CI, 1.18-1.23]), IS (HR, 1.20 [95% CI, 1.17-1.22]), and ICH (HR, 1.31 [95% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95% CI, 0.99-1.29]; P = .06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95% CI, 1.09-1.33]) and ICH (HR, 1.67 [95% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident stroke and stroke type. The findings of this cohort study suggest that cumulative mean SBP was associated with incident stroke type, but the associations did not differ by race and ethnicity. Culturally informed stroke prevention programs should address modifiable risk factors such as SBP along with social determinants of health and structural inequities in society.

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.

Association between trajectories of systolic blood pressure and frailty outcome in middle-aged and older adults

ObjectivesThe association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty. DesignCohort study with a 7-year follow-up. SETTING AND PARTICIPANTSData were derived from 4 waves (2011, 2013, 2015 and 2018) of the China Health and Retirement Longitudinal Study and 6168 participants aged ≥45 years were included in the study. MethodsThe frailty index (FI) was constructed based on 40 scored items, with FI ≥ 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Furthermore, we also investigated the relationship between mean SBP and systolic blood pressure variability (SBPV) and frailty. Results6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled “T2” and “T4” were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty. ConclusionsHigher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.

Antihypertensive Drugs Affect the Association of Systolic Blood Pressure Variability with Outcomes in Patients with Acute Stroke who had Successful Recanalization after Endovascular Treatment.

Blood pressure variability (BPV) was associated with the clinical outcomes in patients with acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) after endovascular treatment (EVT). This study aimed to investigate whether the use of antihypertensive drugs could affect this association in patients with AIS-LVO after EVT. We retrospectively screened consecutive patients with AIS-LVO who had successful recanalization after EVT and calculated their systolic BPV (SBPV) during the first 24 h after EVT using eight statistical methodologies based on previously published literature. Poor outcome was defined as a modified Rankin Scale score of 3-6 at 90 days. Logistic regression analysis was performed to assess this association, and different prediction models were constructed to assess the effect of the use of antihypertensive drugs. A total of 214 patients were finally included, including 92 (43.0%) with good outcomes, and 136 (63.6%) who received antihypertensive drugs. SBPV indicators were significantly lower in patients with good outcomes versus those with poor outcomes. The logistic analysis showed that all SBPV indicators were consistently associated with poor outcomes (odds ratio, 1.031-1.282, all P＜0.05) in all populations, which was confirmed in patients not using antihypertensive drugs. However, no SBPV indicator was found to be associated with poor outcomes in patients using antihypertensive drugs. Receiver operating characteristic curves showed that the area under the curve (AUC) was larger in the model adjusting for antihypertensive drugs (AUC 0.774-0.783) compared with the one not adjusted for antihypertensive drugs (AUC 0.739-0.754). In the anterior circulation of patients with AIS-LVO who had successful recanalization after EVT, the utilization of antihypertensive drugs may have some impact on the relationship between SBPV and clinical outcomes.

Construction of Risk Prediction Model of Type 2 Diabetic Kidney Disease Based on Deep Learning.

This study aimed to develop a diabetic kidney disease (DKD) prediction model using long short term memory (LSTM) neural network and evaluate its performance using accuracy, precision, recall, and area under the curve (AUC) of the receiver operating characteristic (ROC) curve. The study identified DKD risk factors through literature review and physician focus group, and collected 7 years of data from 6,040 type 2 diabetes mellitus patients based on the risk factors. Pytorch was used to build the LSTM neural network, with 70% of the data used for training and the other 30% for testing. Three models were established to examine the impact of glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), and pulse pressure (PP) variabilities on the model's performance. The developed model achieved an accuracy of 83% and an AUC of 0.83. When the risk factor of HbA1c variability, SBP variability, or PP variability was removed one by one, the accuracy of each model was significantly lower than that of the optimal model, with an accuracy of 78% (P<0.001), 79% (P<0.001), and 81% (P<0.001), respectively. The AUC of ROC was also significantly lower for each model, with values of 0.72 (P<0.001), 0.75 (P<0.001), and 0.77 (P<0.05). The developed DKD risk predictive model using LSTM neural networks demonstrated high accuracy and AUC value. When HbA1c, SBP, and PP variabilities were added to the model as featured characteristics, the model's performance was greatly improved.

Combined effect of time in target range and variability of systolic blood pressure on cardiovascular outcomes and mortality in patients with hypertension: A prospective cohort study.

Time in target range (TTR) and blood pressure variability (BPV) of systolic blood pressure (SBP) are independent risk factors for major adverse cardiovascular events (MACE) and all-cause mortality in hypertensive patients. However, the association of the combination of low TTR and high BPV of SBP with the risk of MACE and all-cause mortality is unclear. This study sought to investigate the combined effect of the TTR and BPV on the risk of MACE and all-cause mortality in patients with hypertension. A total of 11 496 hypertensive patients from the Kailuan cohort study were included in our study. All participants were divided into four groups according to their TTR and BPV levels. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) and 95% confidence interval (CI) for incident MACE and all-cause mortality. During a median follow-up of 5.64 years, 839 MACEs (included 99 cases of myocardial infarction, 591 cases of stroke, and 191 cases of heart failure) and 621 deaths occurred. Compared with the high-TTR and low-BPV group, the HRs (95% CI) of MACE and all-cause mortality were 1.309 (1.025-1.671) and 1.842 (1.373-2.473) for the high-TTR and high-BPV group, 1.692 (1.347-2.125) and 1.731 (1.298-2.309) for the low-TTR & low-BPV group, 2.132 (1.728-2.629) and 2.247 (1.722-2.932) for the low-TTR & high-BPV group. Our study suggests that the combination of low TTR and high BPV of SBP was associated with a higher risk of MACE and all-cause mortality in patients with hypertension.

Exploring the Preoperative Fasting and Perioperative Hemodynamic variability in Elective Surgery Under General Anesthesia

Background: It is usual practice all over the world to abstain from eating or drinking before surgery. Currently, the preferred protocol, according to the American Society of Anesthesiologists guidelines, is the 6-4-2 hour No Per Os protocol for solid, milk, and clear fluids respectively, although it is not universally applicable. Extended fasting may intensify negative outcomes including hemodynamic fluctuations. Hemodynamic stability stands as cornerstone in perioperative care as fluctuation can have serious consequences. This study aim was to explore current prevalence of preoperative fasting and hemodynamic fluctuations in elective surgery under general anesthesia. Methods: A six-month Cross-sectional comparative study was conducted on 200 patients at Mardan Medical Complex (MMC) approved by the Ethical Committee, Bacha Khan Medical College (BKMC) Mardan. The data was collected through patient interview in preoperative, medical records, and monitoring perioperatively. SPSS software statistical analysis was conducted using repeated measures ANOVA to assess perioperative changes in these parameters. Test statistics, including p-value were computed to determine the significance of hemodynamic variability. Results: All patients underwent prolonged fasting, with a mean fluid fasting time of 10.33 hours (SD=1.07) and an average solid fasting time of 10.34 hours (SD=1.11). There was a gradual minor drop-in heart rate (HR) from induction to the recovery phase, with statistical significance of 0.02, while no statistically significant variability in mean systolic and diastolic blood pressure was recorded. Conclusion: The study found that patients were undergoing midnight fasting, with a mean duration of 10.33 hrs. Perioperative hemodynamics showed minor decreases in heart rate from the induction to the recovery phase, with statistical significance of 0.02. Our study contributes to the ongoing discourse on preoperative fasting practices and perioperative hemodynamics.

Understanding Hematoma Risk: Study of Patient and Perioperative Factors in a Large Cohort of Young Women Undergoing Reduction Mammaplasty.

Despite high satisfaction rates, reduction mammaplasty can have complications such as hematoma. Factors such as age, tobacco use, and comorbidities are known contributors, whereas the influence of race, BMI, certain medications, and blood pressure (BP) remain contentious. This study investigates hematoma risk factors in young women undergoing reduction mammaplasty. A retrospective review was conducted including all female patients who underwent bilateral reduction mammaplasty at a single institution between 2012 and 2022. Data on demographics, BMI, medical comorbidities, surgical techniques, medications, and perioperative BP were collected. Differences between patients who developed a hematoma and those who did not were assessed using chi-square, Fisher's exact, and t -tests. The relationship between perioperative BP and hematoma formation was assessed using logistic regression. Of 1,754 consecutive patients, 3% developed postoperative hematoma of any kind, with 1.8% returning to the operating room. Age (odds ratio [OR] 1.14, p = 0.01) and ketorolac use (OR 3.93, p = 0.01) were associated with hematoma development. Controlling for baseline BP, each 10 mmHg incremental increase in peak intraoperative BP (systolic BP [SBP]: OR 1.24, p = 0.03; mean arterial pressure: OR 1.24, p = 0.01) and postoperative BP (SBP: OR 1.41, p = 0.01; mean arterial pressure: OR 1.49, p = 0.01) escalated the odds of hematoma. Postoperative SBP variability also incrementally increased hematoma odds (OR 1.48, p < 0.01). Other factors, including race and surgical technique, were not significantly influential. Age, ketorolac use, and intra- and postoperative BP peaks and variability are risk factors for hematoma in reduction mammaplasty. This emphasizes the importance of perioperative BP management and optimizing pain management protocols.

Blood pressure variability assessed by office, home, and ambulatory measurements before and during antihypertensive drug treatment: a sub-analysis of the REVERENT randomized trial.

Blood pressure (BP) variability (BPV) can be assessed using office (OBP), home (HBP), or ambulatory BP (ABP) measurements. This analysis investigated the association and agreement between OBP, HBP, and ABP measurements for BPV assessment at baseline and 10 weeks after initiating antihypertensive drug therapy. Untreated hypertensive patients with elevated BPV were randomized to receive an angiotensin-converting enzyme inhibitor (ramipril) or a calcium channel blocker (nifedipine GITS) in a 10-week, open-label, blinded-end point study. BPV was assessed using standard deviation (SD) and coefficient of variation (CV) (reading-to-reading analyses). Data from 146 participants from three research centers (Athens/Greece; Milan/Italy; Shanghai/China) were analyzed [mean age 53 ± 10 (SD) years, male individuals 60%, baseline systolic OBP, HBP, and 24 h ABP 144 ± 9, 138 ± 10, and 143 ± 10 mmHg, respectively]. Post-treatment minus pre-treatment systolic CV difference was: OBP: 0.3%, P = 0.28; HBP: -0.2%, P = 0.20; 24 h ABP: 1.1%, P < 0.001. Home and ambulatory (not office) BPV indices presented weak-to-moderate correlation, both before and during treatment (range of coefficients 0.04-0.33). The correlation coefficient between systolic HBP CV and awake ABP CV was 0.21 and 0.28 before and during treatment, respectively (P < 0.05/< 0.001, respectively). Home and ambulatory (not office) BPV indices presented slight to fair agreement (range 64-73%) in detecting participants with high systolic BPV (top quartile of respective distributions) both before and during treatment (kappa range 0.04-0.27). These data showed a weak-to-moderate association between out-of-office (but not office) BPV indices both before and during BP-lowering treatment, with reasonable agreement in detecting individuals with high BPV. Out-of-office BP measurements provide more similar and consistent BPV information than office measurements.

Arterial hypertension in the Arctic: the role of stress and autonomic dysfunction, gender differences

Introduction. Psychological stress and autonomic dysfunction are recognized as risk factors for cardiovascular diseases, but they affect cardiovascular risk differently in men and women.Aim: To study gender differences in factors influencing the probability of detecting arterial hypertension (AH) from the perspective of the role of stress, autonomic dysfunction and nonspecific inflammation in rotational shift workers in the Arctic region.Material and Methods. In the medical unit of the gas production company “Gazprom dobycha Yamburg” (polar settlement of Yamburg, 68°21’40”N) we simultaneously examined 99 men and 81 women with AH 1,2 degree of AH and normotensive persons comparable in age (p = 0.450), work experience in the Arctic (p = 0.956), number of years of rotational shift work (p = 0.824), level of office systolic (SBP) (p = 0.251) and diastolic blood pressure (DBP) (p = 0.579). Questionnaires were used to determine the level of general stress (PSM25 scale), occupational stress (Vaisman questionnaire); assessment of autonomic nervous system (ANS) function (Wayne A.M. questionnaire); 24-hour blood pressure monitoring was performed; biochemical blood test for biomarkers of inflammation, cortisol, brain natriuretic peptide precursor, homocysteine, folliclestimulating hormone was carrued out.Results. Vegetative manifestations (asthenization, increased fatigue, meteorological dependence, headaches) were significantly more often observed in women. Among men with AH, individuals with high levels of neuropsychological tension predominated, every fifth M had a high level of occupational stress. The median scores on the Wayne A.M. questionnaire were significantly higher in women, regardless of BP, and moderate ANS disorders were significantly more prevalent. According to logistic regression data, a significant effect on the probability of AH in men was the number of stress scores (OR = 1.050; 1.029–1.171, p = 0.001), indicators of nocturnal DBP variability (OR = 1.295; 1.109–1.511, p = 0.001) and nonspecific inflammation: rise in high-sensitivity C-reactive protein (hs-CRP) increased the probability of AH by 1.5 times (OR = 1.532; 1.212–1.937, p = 0.001), IL-1β – by 7 times (OR = 7.275; 3.235–16.361, p = 0.001). The probability of AH in women increased by the values of the daily variability of SBP (OR = 1.154; 1.019–1.306, p = 0.024), hs-CRP by 1.5 times (OR = 1.479; 1.226–1.783, p = 0.001), tumor necrosis factor-alpha (TNF-α) (OR = 1.111; 1.001–1.244, p = 0.044), level of IL-6 increased the probability of AH by 1.7 times (OR = 1.676; 1.149–2.958, p = 0.035), the number of scores on ANS questionnaire had a significant effect (OR = 1.055; 1.006–1.107, p = 0.026).Conclusion. In the conditions of the rotational shift work in the Arctic, gender differences were revealed in the stress perception and the severity of ANS dysfunction with a clear relationship between stress, inflammation and AH in men. ANS dysfunction in women was a trigger of nonspecific inflammation and AH. The identified gender differences will help to reveal vulnerable groups among men and women and develop targeted interventions for individuals in the Arctic region.

Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation of elderly patients undergoing ERCP

BackgroundProper sedation of patients, particularly elderly individuals, who are more susceptible to sedation-related complications, is of significant importance in endoscopic retrograde cholangiopancreatography (ERCP). This study aims to assess the safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation in elderly patients undergoing ERCP, compared to a group of middle-aged patients.MethodsThe medical records of 610 patients with common bile duct stones who underwent elective ERCP under deep sedation with a three-drug regimen, including midazolam, alfentanil, and propofol at Shandong Provincial Third Hospital from January 2023 to September 2023 were retrospectively reviewed in this study. Patients were categorized into three groups: middle-aged (50–64 years, n = 202), elderly (65–79 years, n = 216), and very elderly (≥ 80 years, n = 192). Intraoperative vital signs and complications were compared among these groups.ResultsThe three groups showed no significant difference in terms of intraoperative variation of systolic blood pressure (P = 0.291), diastolic blood pressure (P = 0.737), heart rate (P = 0.107), peripheral oxygen saturation (P = 0.188), bispectral index (P = 0.158), and the occurrence of sedation-related adverse events including hypotension (P = 0.170) and hypoxemia (P = 0.423).ConclusionThe results suggest that a low-dose three-drug regimen consisting of midazolam, alfentanil, and propofol seems safe and effective for deep sedation of elderly and very elderly patients undergoing ERCP procedures. However, further studies are required to verify these findings and clarify the benefits and risks of this method.

Interdialytic home systolic blood pressure variability increases all-cause mortality in hemodialysis patients.

The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown. We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all-cause mortality among individuals undergoing MHD. A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all-cause death. Kaplan-Meier analysis was used to assess the relationship between long-term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis. The risk of cardiac death and all-cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all-cause mortality in Tertile 2 and Tertile 3 were 3.13 (p = .026) and 3.24 (p = .021), respectively, after adjustment for a series of covariates. The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.

Changes in cardiovascular autonomic control induced by chronic inhibition of acetylcholinesterase during pyridostigmine or donepezil treatment of spontaneously hypertensive rats

Chronic treatment with acetylcholinesterase inhibitors may be a promising therapeutic strategy for treatment of cardiovascular diseases. The aim of our study was to analyze the changes in blood pressure (BP) and heart rate (HR) during 14 days of treatment with two different acetylcholinesterase inhibitors – pyridostigmine (PYR) having only peripheral effects or donepezil (DON) with both peripheral and central effects. In addition, we studied their effects on the cardiovascular response to restraint stress and on sympathovagal control of HR in normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). SHR were characterized by elevated BP and increased low-frequency component of systolic BP variability (LF-SBPV), but their cardiac vagal tone and HR variability (HRV) were reduced compared with WKY. Chronic treatment with either acetylcholinesterase inhibitor decreased HR and increased HRV in both strains. PYR treatment slightly decreased BP and LF-SBPV in the dark phase of the day. Neither drug significantly altered BP response to stress, but PYR attenuated HR increase during restraint stress. Regarding sympathovagal balance, acute methylatropine administration caused a greater increase of HR in WKY than in SHR. Chronic PYR or DON treatment enhanced HRV and HR response to methylatropine (vagal tone) in WKY, whereas PYR but not DON treatment potentiated HRV and vagal tone in SHR. In conclusion, vagal tone was lower in SHR compared with WKY, but was enhanced by chronic PYR treatment in both strains. Thus, chronic peripheral, but not central, acetylcholinesterase inhibition has major effects on HR and its variability in both normotensive and hypertensive rats.

Prognostic Relevance of Short-Term Blood Pressure Variability. The Spanish ABPM Registry.

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, with all-cause and cardiovascular mortality in a large cohort of patients with hypertension. We selected 59 124 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry from 2004 to 2014 (median follow-up: 9.7 years). Systolic and diastolic BP SD and coefficient of variation from daytime and nighttime, weighted SD, weighted coefficient of variation, average real variability (mean of differences between consecutive readings), and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through baseline 24-hour ambulatory BP monitoring. Association with all-cause and cardiovascular mortality were assessed by Cox regression models adjusted for clinical confounders and BP. Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In adjusted models systolic and diastolic daytime and weighted SD and coefficient of variation, average real variability, as well as systolic nighttime SD and BP variability ratio were all significantly associated with all-cause and cardiovascular mortality. Hazard ratios for 1-SD increase in the systolic components ranged from 1.05 to 1.12 for all-cause mortality and from 1.07 to 1.17 for cardiovascular mortality. A daytime SD≥13 mm Hg, a nighttime and a weighted SD≥12 mm Hg, and an average real variability ≥10 mm Hg, all systolic, were independently associated with mortality. Short-term blood pressure variability shows a relatively weak but significant association with all-cause and cardiovascular mortality in patients with hypertension.

Peculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disordersPeculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disorders

Background. The purpose of our work was to reveal the dependence of changes in the cognitive sphere on the peculiarities of the daily profile of blood pressure (BP) and heart activity in patients with arrhythmias. Materials and methods. We examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing, a study of the daily BP profile and heart activity. Hemodynamic status was assessed by daily BP and ECG monitoring. Average daily, average daytime and nighttime systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) were evaluated. The analysis of spectral indicators of heart rate variability was performed to assess the state of the autonomic nervous system. Correlations of hemodynamic indicators with the results of neuropsychological testing were determined. Results. In patients with cognitive disorders (CD), there was an increase in SBP in all periods of the day, most pronounced in patients with moderate CD (p = 0.049). In patients with mild CD and without CD, there were no significant intergroup differences in the level of average daily, daytime and night SBP, DBP and pulse pressure (p &gt; 0.05). Patients with moderate CD had significantly higher SBP and time index of SBP at the expense of average daytime and average night values of these indicators compared to those without CD (p &lt; 0.05). During the active period of the day, time index of DBP was significantly higher in patients with moderate CD (p = 0.002) who also had an increase in average daily, daytime and night SBP variability compared to participants without CD (p = 0.041). The differences between the groups were not significant in terms of DBP variability (р = 0.07). In 61 (54 %) patients with CD, non-dipper SBP prevailed in the structure of disorders of the daily BP profile, with the highest indicators in moderate CD (55.6 %). The presence of adverse daily DBP profiles — night-peaker (6.2 %) and over-dipper (8.8 %), which prevailed in patients with moderate CD, is hidden behind normal indicators of the daily BP index. Increased average SBP24 (odds ratio (OR) = 3.26, 95% confidence interval (CI): 1.45–5.35, p &lt; 0.001), DBP24 (OR = 3.06, 95% CI: 1.41–4.79, p &lt; 0.001), average HR24 (OR = 2.67, 95% CI: 1.32–4.14, p &lt; 0.001), average SBP24 variability (OR = 2.13, 95% CI: 1.11–3.32, p &lt; 0.001) are the main factors of central hemodynamic disorders that increase the risk of developing CD in patients with arrhythmias. Conclusions. The identified associations between cognitive dysfunction, indicators of daily BP monitoring and heart activity are important in the context of their comprehensive accounting for optimizing an individualized approach to patient management and predicting the development of CD.

Significance of blood pressure variability in normotensive individuals as a risk factor of developing hypertension

Purpose Visit-to-visit blood pressure variability is a strong predictor of the incidence of cardiovascular events and target organ damage due to hypertension. The present study investigated whether year-to-year blood pressure variability predicts the risk of hypertension in the Japanese general population. Materials and methods This study analysed 2806 normotensive individuals who participated in our physical check-up program for five years in a row from 2008 to 2013. The average, standard deviation, coefficient of variation, average real variability, and highest value of systolic blood pressure in the five consecutive visits were determined and used as baseline data. The participants were followed up for the next 6 years with the development of ‘high blood pressure’, an average blood pressure level of ≥140/90 mmHg or the use of antihypertensive medications, as the endpoint. Result During follow-up, ‘high blood pressure’ developed in 389 participants (13.9%, 29.5 per 1 000 person-years). The incidence increased across the quartiles of standard deviation and average real variability, while the average and highest systolic blood pressure had the most prominent impact on the development of ‘high blood pressure’. Multivariate logistic regression analysis adjusted for possible risk factors indicated that the average, standard deviation, average real variability, and highest blood pressure, but not the coefficient of variation of systolic blood pressure, were significant predictors of ‘high blood pressure’. Conclusion Increased year-to-year blood pressure variability predicts the risk of hypertension in the general normotensive population. The highest blood pressure in the preceding years may also be a strong predictor of the risk of hypertension.