Systolic Pressure Variability Research Articles

Fluid Responsiveness Predictability in Immediate Postoperative Pediatric Cardiac Surgery. Is the Old Slandered Central Venous Pressure Back Again?

Acute low cardiac output (CO) is a frequent scenario in pediatric cardiac intensive care units (PCICU). While fluid responsiveness has been studied extensively, literature is scarce for the immediate postoperative congenital heart surgery population admitted to PCICUs. This study analyzed the utility of hemodynamic, bedside ultrasound, and Doppler parameters for prediction of fluid responsiveness in infants and neonates in the immediate postoperative cardiac surgery period. A prospective observational study. University affiliated, tertiary care hospital, PCICU. Immediate postoperative pediatric patients displaying a presumed hypovolemic low CO state were included. A clinical, arterial derived, hemodynamic, sonographic, Doppler-based, and echocardiographic parameter assessment was performed, followed by a fluid bolus therapy. Fifteen to 20 cc/kg crystalloid fluid bolus. Fluid responsiveness was defined as an increase in cardiac index >10% by echocardiography. Of 52 patients, 34 (65%) were fluid responsive. Arterial systolic pressure variation, continuous-Doppler preload parameters, and inferior vena-cava distensibility index (IVCDI) by bedside ultrasound all failed to predict fluid responsiveness. Dynamic central venous pressure (CVP) change yielded a significant but modest fluid responsiveness predictability of area under the curve 0.654 (P = 0.0375). In a distinct population of mechanically ventilated, young, pediatric cardiac patients in the immediate postoperative period, SPV, USCOM preload parameters, as well as IVC-based parameters by bedside ultrasound failed to predict fluid responsiveness. Dynamic CVP change over several hours was the only parameter that yielded significant but modest fluid responsiveness predictability.

Comparison between pulse pressure variation and systolic pressure variation measured from a peripheral artery for accurately predicting fluid responsiveness in mechanically ventilated dogs

ObjectiveTo compare pulse pressure variation (PPV) and systolic pressure variation (SPV) measured from a peripheral artery to predict fluid responsiveness in anesthetized healthy dogs. Study designProspective study. AnimalsA total of 39 dogs (13.8–26.8 kg) anesthetized with isoflurane for elective ovariohysterectomy. MethodsVentilation was controlled (tidal volume 12 mL kg–1; 40% inspiratory pause). PPV and SPV were recorded from a dorsal pedal artery catheter using an automated algorithm. A fluid challenge (FC) with lactated Ringer’s solution (20 mL kg–1 over 15 minutes) was administered once (21 animals) or twice (18 animals) before surgery. Increases in transpulmonary thermodilution stroke volume index > 15% from values recorded before each FC defined responders to volume expansion. Final fluid responsiveness status was based on the response to single FC or second FC. Predictive ability of PPV and SPV was compared by receiver operating characteristic (ROC) curve analysis and by the range of cut-off values associated with uncertain results (gray zone). ResultsAll animals after the single FC were responders; all animals administered two FCs were nonresponders after the second FC. The area under the ROC curve (AUROC) of PPV (0.968) did not differ from that of SPV (0.937) (p = 0.45). Best cut-off thresholds to discriminate responders from nonresponders were >11.7% (PPV) and >7.4 mmHg (SPV). The gray zone of PPV and SPV was 8.2–14.6% and 7.0–7.4 mmHg, respectively. The percentage of animals with PPV and SPV values within the gray zone was less for SPV (10.2%) than for PPV (30.8%). Conclusions and clinical relevancePPV and SPV obtained from the dorsal pedal artery are useful predictors of fluid responsiveness in dogs. Using an automated algorithm, SPV may more accurately predict fluid responsiveness than PPV, with responders identifiable by PPV > 14.6% and SPV > 7.4 mmHg.

BLOOD PRESSURE VARIATION IS DEPENDENT ON THE BALANCE OF SYMPATHETIC AND PARASYMPATHETIC ACTIVITY

Objective: Blood pressure variability is an independent risk factor for cardiovascular complications in hypertension. There were reports that sympathetic nervous system was involved in the regulation of blood pressure, whereas beta-blocker was not involved in blood pressure variability. Therefore, the relationship between autonomic nervous system and blood pressure variability is unclear. We reported the usefulness of the pupillary function test as an index of sympathetic and parasympathetic nerves. In the present study, we clarify how the autonomic nervous system is related to blood pressure variability using the pupillary function test. Design and method: For 23 patients undergoing outpatient visits, blood pressure and heart rate variability factors were measured at 14 consecutive outpatient visits. The coefficient of variation of systolic blood pressure, diastolic blood pressure, and heart rate was calculated. In the pupillary function test, mydriatic velocity was used as an index of sympathetic nerve function, and miotic speed was used as an index of para-sympathetic function. Results: The average age is 66 ± 6 years old. The coefficient of variation for systolic blood pressure, diastolic blood pressure, and heart rate was 5.57 ± 2.13, 6.78 ± 2.96 and 6.73 ± 2.79, respectively. Mydriatic velocity and contraction velocity were 3.29 ± 0.79 ms and 1.69 ± 0.58 ms. Variation coefficient of systolic blood pressure, diastolic blood pressure and heart rate were not significantly correlated with mydriatic and miotic velocity. On the other hand, there was a significant negative correlation between coefficient of variation of systolic blood pressure, diastolic blood pressure and heart rate and ratio of mydriatic and miotic velocity. Conclusions: Visit-to-visit variability of systolic pressure, diastolic pressure and the heart rate was not related to sympathetic or parasympathetic activity alone but balance between both are involved in these variabilities.

THE EFFECT OF THYROID HORMONE NORMALIZATION ON AMBULATORY BLOOD PRESSURE MONITORING IN HYPOTHYROID PATIENTS

Objective: It is well known that thyroid hormones regulate cardiovascular function. Thyroid disease is extremely common with a prevalence of 9–15% in the general population. The aim of our study was to assess the effects of thyroid hormones on the changes of blood pressure and pulse wave in a cohort of hypothyroid patients. Design and method: a total of 24 patients with severe hypothyroidism were enrolled in this study. Follow-up data are available for 11 patients, after normalization of their thyroid hormone profile. At baseline and after normalization of thyroid hormone profile, patients underwent an ABPM and an arterial tonometry. Data were analyzed with the statistical software R (version 3.0.3). In particular, patients were compared by Wilcoxon test for paired data, as they didn’t have normal gaussian distributions. Results: hypothyroid patients presented with overt thyroid disease (TSH 58,66 ± 47,50). Our preliminary data show that after euthyroidism restoration (TSH 2,21 ± 1,21), there weren’t any variations in global systolic and diastolic blood pressure, meanwhile their variability was reduced. In particular, this was observed for global sistolic variability (p value 0.05) and there was a decrease with borderline significance of global diastolic variability (p value 0.06). We did not observe any difference in terms of mean arterial pressure, PWV, and the other pulse wave analysis parameters Conclusions: our preliminary data suggest that euthyroidism restoration with levothyroxine can significantly reduce blood pressure variability in hypothyroid patients. This confirms the importance of thyroid hormones for blood pressure control.

Normal Variations in Blood Pressure in Ambulatory Blood Pressure Measurements

Aim: Hypertension is very common in primary care patients. The diagnosis of hypertension is made by office measurements and home blood pressure measurements. The aim of this study was to define the normal variation levels of blood pressure in individuals in primary care by using ambulatory blood pressure measurement. Methods: This study was performed in primary care. Individuals who had no hypertension history were included in the study. Subjects were evaluated by using three office measurements, seven days home blood pressure measurements and 24 hours ambulatory blood pressure measurement. The ambulatory blood pressure gave us the variations in blood pressure values. Results: The study started in January 2018 and ended in May 2018. Of the 47 subjects, 70.2% were women and 29.8% were men. The mean age was 41.63±12.00. The most common educational level was elementary school graduates. The most common occupation was housewives. Of the participants, 84.2% were married. At ambulatory blood pressure measurements, 34.0% of the subjects had mean systolic blood pressures 24 hours between 120-129 mmHg. Of the diastolic blood pressure 24 hours mean values, 15.3% had values between 80-89, where 51.0% were between the 71-79 mmHg groups. The mean value of 24 hours variation in systolic blood pressure was 15.75±18.59 (median=11.40, min=8.80, max=106.00). The 24 hours variation in the mean values of diastolic blood pressures was 12.12±10.90 (median=9.70, min=6.80, max=64.00). Conclusion: The results of this study demonstrated that there were high levels of variations in normal blood pressures, which could show candidates for hypertension. Keywords: ambulatory monitoring, blood pressure, variability, primary care

Постнавантажувальна динаміка варіабельності артеріального тиску на кожному серцевому скороченні у висококваліфікованих атлетів

Using Spiroarteriocardiorhythmography (SACR), 202 highly qualified male athletes, aged 22.6 ± 2.8 years, representing acyclic sports: martial arts (karate, taekwondo, kickboxing, boxing, freestyle wrestling, Greco-Roman wrestling, judo, sambo) and games (water polo, football) were examined. Sports experience was 10.3 ± 3.1 years. All studies were carried out in the pre-competition period. In accordance with the design, the examination with the use of SACR were carried out three times: in the morning, on an empty stomach, in a sitting position on the day of training (G1), immediately (in the first 5-7 minutes) after training (G2) and the next day in the morning after sleep (G3). The duration of each registration was 2 minutes. The spectral parameters of the variability of systolic (SBPV) and diastolic (DBPV) pressure and their derivatives – baroreceptor sensitivity (BR) and indices of heart rate centralization (ICHR), systolic (ICSBP) and diastolic (ICDBP) pressures were determined.

Safety and Cost-Effectiveness of Interscalene Brachial Plexus Block With Sedation in Reverse Total Shoulder Replacement.

AimsTo investigate the safety and cost-effectiveness of interscalene brachial plexus block/regional anaesthesia (ISB-RA) in patients undergoing reverse total shoulder replacement.Patients and methodsThis retrospective study included 15 patients with symptomatic rotator cuff arthropathy who underwent reverse total shoulder arthroplasty (rTSA) under ISB-RA without general anaesthesia in the beach chair position from 2010 to 2018. The mean patient age was 77 years (range 59-82 years). Patients had associated medical comorbidities: American Society of Anesthesiologists (ASA) grade 2-4. Assessed parameters were: duration of anaesthesia, intra-operative systolic blood pressure variation, sedation and vasopressor use, duration of post-operative recovery, recovery scores, length of stay, and complications. A robust cost analysis was also performed.ResultsThe mean (range) duration of anaesthesia was 38.66 (20-60) min. Maximum and minimum intra-operative systolic blood pressure ranges were 130-210 and 75-145 mmHg, respectively (mean [range] drop, 74.13 [33-125] mmHg). Mean (range) propofol dose was 1.74 (1-3.0) mg/kg/h. The Median (interquartile range) post-operative recovery time was 30 (20-50) min. The mean (range) postoperative recovery score (local scale, range 5-28 where lower values are superior) was 5.2 (5-8). The mean (range) length of stay was 8 (1-20 days); the two included patients with ASA grade 2 were both discharged within 24 hours. One patient with predisposing history developed pneumonia; however, there were no complications related to ISB-RA. The mean (range) cost per patient was £101.36 (£59.80-£132.20).ConclusionsOur data demonstrate that rTSA under ISB-RA is safe, comfortable, and cost-effective. Notably, patients with ASA grade 2 who underwent rTSA under ISB-RA had a reduced length of stay and were discharged within 24 hours.Clinical relevance rTSA under ISB-RA is potentially a safe, cost-effective, and viable alternative for patients with multiple comorbidities.

Intraoperative Assessment of Fluid Responsiveness in Normotensive Dogs under Isoflurane Anaesthesia.

The aim of this study was to evaluate the incidence of fluid responsiveness (FR) to a fluid challenge (FC) in normotensive dogs under anaesthesia. The accuracy of pulse pressure variation (PPV), systolic pressure variation (SPV), stroke volume variation (SVV), and plethysmographic variability index (PVI) for predicting FR was also evaluated. Dogs were anaesthetised with methadone, propofol, and inhaled isoflurane in oxygen, under volume-controlled mechanical ventilation. FC was performed by the administration of 5 mL/kg of Ringer’s lactate within 5 min. Cardiac index (CI; L/min/m2), PPV, (%), SVV (%), SPV (%), and PVI (%) were registered before and after FC. Data were analysed with ANOVA and ROC tests (p < 0.05). Fluid responsiveness was defined as 15% increase in CI. Eighty dogs completed the study. Fifty (62.5%) were responders and 30 (37.5%) were nonresponders. The PPV, PVI, SPV, and SVV cut-off values (AUC, p) for discriminating responders from nonresponders were PPV >13.8% (0.979, <0.001), PVI >14% (0.956, <0.001), SPV >4.1% (0.793, <0.001), and SVV >14.7% (0.729, <0.001), respectively. Up to 62.5% of normotensive dogs under inhalant anaesthesia may be fluid responders. PPV and PVI have better diagnostic accuracy to predict FR, compared to SPV and SVV.

Comparison of the Efficacy of Different Arterial Waveform-derived Variables (Pulse Pressure Variation, Stroke Volume Variation, Systolic Pressure Variation) for Fluid Responsiveness in Hemodynamically Unstable Mechanically Ventilated Critically Ill Patients.

IntroductionThis study was conducted to assess fluid responsiveness in critically ill patients to avoid various complications of fluid overload.Material and methodsThis study was done in an ICU of a tertiary care hospital after approval from the institute ethical committee over 18 months. A total of 54 consenting adult patients were included in the study. Patients were hemodynamically unstable requiring mechanical ventilation, had acute circulatory failure, or those with at least one clinical sign of inadequate tissue perfusion. All patients were ventilated using tidal volume of 6–8 mL/kg, RR—12–15/minutes, positive end expiratory pressure (PEEP)—5 cm of water, and plateau pressure was kept below 30 cm water. They were sedated throughout the study. The arterial line and the central venous catheter were placed and connected to Vigileo-FloTrac transducer (Edward Lifesciences). Patients were classified into responder and nonresponder groups on the basis of the cardiac index (CI) after fluid challenge of 10 mL/kg of normal saline over 30 minutes. Pulse pressure variation (PPV), stroke volume variation (SVV), and systolic pressure variation (SPV) were assessed and compared at baseline, 30 minutes, and 60 minutes.ResultsIn our study we found that PPV and SVV were significantly lower among responders than nonresponders at 30 minutes and insignificant at 60 minutes. Stroke volume variation was 10.28 ± 1.76 in the responder compared to 12.28 ± 4.42 (p = 0.02) at 30 minutes and PPV was 15.28 ± 6.94 in responders while it was 20.03 ± 4.35 in nonresponders (p = 0.01). We found SPV was insignificant at all time periods among both groups.ConclusionWe can conclude that initial assessment for fluid responsiveness in critically ill mechanically ventilated patients should be based on PPV and SVV to prevent complications of fluid overload and their consequences.How to cite this articleKumar N, Malviya D, Nath SS, Rastogi S, Upadhyay V. Comparison of the Efficacy of Different Arterial Waveform-derived Variables (Pulse Pressure Variation, Stroke Volume Variation, Systolic Pressure Variation) for Fluid Responsiveness in Hemodynamically Unstable Mechanically Ventilated Critically Ill Patients. Indian J Crit Care Med 2021;25(1):48–53.

Association of Blood Pressure Variability and Diuretics With Cardiovascular Events in Patients With Chronic Kidney Disease Stages 1-5.

Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular events in the general population. Data are scarce in chronic kidney disease. We hypothesized that BPV would be associated with cardiovascular outcomes, death, and end-stage kidney disease (ESKD) and that diuretics would modify these associations in patients with chronic kidney disease. We studied US Veterans with nondialysis chronic kidney disease stages 1-5 and hypertension on nondiuretic antihypertensive monotherapy. At the time of second antihypertensive agent prescription, we propensity-matched for exposure to a loop or thiazide diuretic versus any other antihypertensive. BPV was defined as the coefficient of variation of systolic blood pressure over 6 months after second agent prescription. Cox proportional hazards regression measured associations of BPV with a primary cardiovascular event composite (fatal or nonfatal myocardial infarction or ischemic stroke; heart failure hospitalization). Secondary outcomes included all-cause death, each primary outcome component, end-stage kidney disease, and cardiovascular death. There were 31 394 participants in each group. BPV was associated with composite cardiovascular events, hazard ratio (95% CI) at second, third, fourth, and fifth versus first quintile: 1.79 (1.53-2.11), 2.32 (1.99-2.71), 2.60 (2.24-3.02), and 3.12 (2.68-3.62). Diuretics attenuated associations between the fourth and fifth BPV quintiles with composite events (Pinteraction=0.03 and 0.04, respectively). BPV was associated with all secondary outcomes except end-stage kidney disease, with no diuretic interactions. BPV was associated with cardiovascular events and death but not end-stage kidney disease in patients with chronic kidney disease, with attenuated associations with cardiovascular events in the diuretic-treated group at high BPV quintiles. Future studies should investigate whether other antihypertensive classes modify these risks.

Intradialytic systolic blood pressure variation can predict long-term mortality in patients on maintenance hemodialysis.

It is unclear which time-points of intradialytic blood pressure (BP) best predict prognosis. Thus, it is important to assess the association between different time-points of intradialytic BP and prognosis in clinical practice. We recruited patients who underwent hemodialysis from January 2014 to June 2014. Data about dialysis were collected, including intradialytic BP. Cox regression analysis was performed to examine the association between different time-points of intradialytic BP and clinical events, with a follow-up through December 31, 2019. The primary endpoint was all-cause mortality. A total of 216 patients were recruitedand 62 (30.7%) patients died (6.1 per 100-person year)during the follow-up. Intradialytic SBP varied greatly in fatalities. Univariate and multivariate Cox regression models indicated that the adjusted hazard ratio for death was 1.80 and 5.06 when intradialytic systolic blood pressure (SBP) variation was analyzed in increments of 20mmHg. Furthermore, we divided intradialytic SBP variation into three categories: < 15mmHg, 15 ~ 30mmHg, ≥ 30mmHg. Kaplan-Meier analysis indicated that both all-cause mortality and cardiovascular mortality increased significantly for patients with intradialytic SBP variation over 30mmHg (P = 0.006 and 0.021). Univariate and multivariate Cox regression models indicated that the adjusted hazard ratio for death was 3.78 and 12.62 as intradialytic SBP variation ≥ 30mmHg vs. intradialytic SBP variation < 15mmHg. Intradialytic SBP variation, rather than BP of specific intradialytic time-points, has the potential to predict long-term mortality in hemodialysis patients. BP stability is crucial for patients' prognosis.

The recent effects of small dose of folic acid on lipoprotein-associated phospholipase A2 and systolic blood pressure variability in coronary heart disease patients with hyperhomocysteinemia

To Investigate the recent effects of small dose of folic acid on lipoprotein-associated phospholipase A2 (LP-PLA2) and systolic blood pressure variability in coronary heart disease (CHD) patients with hyperhomocysteinemia.In this prospective cohort study, a total of 167 CHD patients with hyperhomocysteinemia were consecutively enrolled, and they were divided into Group A (without folic acid intervention, n = 99), Group B (with 0.4 mg of folic acid intervention, n = 34), Group C (0.8 mg of folic acid intervention, n = 34). General information, fasting blood glucose, and blood lipid, folic acid, homocysteine, Lp-PLA2, and blood pressure variability were compared among 3 groups. The above indicators were reviewed after 3 months of treatment.There were no statistically significant differences of age, gender, blood pressure, incidence of type 2 diabetes mellitus, fasting blood glucose, folic acid, homocysteine, Lp-PLA2, total cholesterol, 3 acyl glycerin, apolipoprotein B, lipoprotein (a), high density lipoprotein cholesterol, and low density lipoprotein cholesterol were found among 3 groups (P > .05); however, after being treated for 3 months, there was statistically significant difference in folic acid among 3 groups (P < .05), there was statistically significant difference in apolipoprotein A between Group A and Group B (t = 0.505, P = .039), and also between Group A and Group C (t = 0.052, P = .017). There were statistically significant differences in Lp-PLA2 (t = 24.320, P = .016) and systolic blood pressure variability (t = 0.154, P = .018) between Group A and Group C.For CHD patients with hyperhomocysteinemia, the higher dose (0.8 mg) of folic acid supplement was beneficial for increasing the apolipoprotein A, reducing the Lp-PLA2, and improving the systolic blood pressure variation, which might help to improve the prognosis in these patients.

Impacto de um programa de intervenção escolar randomizado sobre os níveis de pressão arterial

Abstract Objectives: to evaluate the impact of a health program performed in a school setting on the blood pressure levels of schoolchildren in the public school system in Vitória/ES-Brazil. Methods: a randomized community trial was performed with 237 schoolchildren (6 to 12 years) from two public schools, randomly defined as the intervention and control school. Participants of the intervention group attended 11 education sessions over 4 months (July to October 2014). To test for differences between groups, the chi-square (categorical variables), and the paired t test or Wilcoxon (continuous variables) was used. The rate of variation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) throughout the follow-up, according to allocation group, was evaluated using linear generalized models for time-repeated measures. Results: there was a reduction in the means of SBP (0.5 mmHg) and DBP (0.6 mmHg) in the intervention group and an increase in the control group, with a significant difference in the BP variation between groups over the follow-up period (p&lt;0.05). Conclusion: a low-cost and easily implemented intervention may be one of the factors associated with the lowest blood pressure levels in the group studied, and reproduction in a school environment is feasible.

Abstract 16476: Visit-to-Visit Blood Pressure Variability is Associated With Incident Frailty: The Multidomain Alzheimer Preventive Trial (MAPT)

Introduction: Visit-to-visit blood pressure variability (BPV) has been associated with greater cardiovascular and all-cause mortality, cognitive impairment, and incident dementia. It may also represent a decline in homeostatic mechanisms in blood pressure (BP) regulation associated with frailty, one of the most problematic expression of population aging. Hypothesis: We hypothesized that visit-to-visit systolic (SBPV), diastolic (DBPV), mean arterial (MAPV) and pulse pressure (PPV) variability are associated with greater incident frailty. Methods: We included 1,394 non-frail community-dwelling participants aged ≥ 70 years from the Multidomain Alzheimer Preventive Trial (MAPT) who underwent repeated clinical examinations over a 5-year follow-up period. SBPV, DBPV, MAPV and PPV were evaluated using standard deviation, coefficient of variation (CV), average real variability, successive variation, variation independent of mean and residual standard deviation. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses. Results: Higher SBPV was significantly associated with increased risk of incident frailty (1-sd increase of CV: HR = 1.18, 95% CI [1.02-1.37], p=0.03) after adjustment for demographics, body mass index, stroke, ischemic heart disease, diabetes, heart failure, antihypertensive drugs, systolic BP, MAPT intervention groups and baseline pre-frail status. Similar results were observed with all indicators of variability. DBPV and MAPV were not associated with incident frailty (p=0.6 and p=0.2, respectively). Interestingly, higher PPV was also associated with a greater risk of developing frailty over time (1-sd increase of CV: HR = 1.17, 95% CI [1.01-1.35], p=0.03). Conclusion: Independently of BP, higher SBPV and PPV are major clinical predictors of incident frailty. Our findings support the concept of BP physiological dysregulation underlying the frail state and suggest that controlling BP instability could be a promising interventional target in preventing frailty.

Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Background: The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population. Methods: Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included. Results: A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07–1.19; p < 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10–1.22; p < 0.001) mortality. In the stratified analysis of systolic BPV, interdialytic systolic BPV, rather than 44-h ambulatory systolic BPV or intradialytic systolic BPV, was identified to be related to both all-cause (HR: 1.11; 95% CI: 1.05–1.17; p = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06–1.22; p < 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause (p = 0.01) and cardiovascular (p = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01–1.17; p = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52–1.42; p = 0.56). Conclusions: This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).

Effect of Blood Pressure Variability During the Acute Period of Subarachnoid Hemorrhage on Functional Outcomes.

The association of blood pressure variation with poor outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is unknown. To evaluate the association of systolic blood pressure (SBP) variation and clinical outcomes in aSAH. We conducted a retrospective chart review of all aSAH patients treated at an academic institution between 2007 and 2016. Patient demographics, aSAH characteristics, and blood pressure observations for the first 24 h of admission in 4-h intervals were obtained. SBP variability metrics assessed were mean, standard deviation, maximum, minimum, peak, trough, coefficient of variation, and successive variation. The primary outcome was a composite of the modified Rankin scale as good (0-2) or poor (3-6) at last follow-up. Comparisons between outcome groups were performed. Logistic regression models for each significant SBP metric controlling for potential confounders were constructed. The study population was 202 patients. The mean age was 57 yr; 66% were female. The median follow-up time was 18 mo; 57 (29%) patients had a poor outcome. Patients with poor outcomes had higher standard deviation (17.1 vs 14.7 mmHg, P=.01), peak (23.5 vs 20.0 mmHg, P=.02), trough (22.6 vs 19.2 mmHg, P<.01), coefficient of variation (13.9 vs 11.8 mmHg, P<.01), and lower minimum SBP (101.4 vs 108.4, P<.01). The logistic regression showed that every 1-mmHg increase in the minimum SBP increased the odds of good outcomes (odds ratio=1.03; 95% CI=1.001-1.064; P=.04). Models including other SBP metrics were not significant. Hypotension was found to be independently associated with poor outcomes in patients with aSAH.

Influence of TEVAR on blood pressure in subacute type B aortic dissection (TBAD) patients with refractory and non-refractory arterial hypertension

Aim of this study was to compare the modifications of systemic blood pressure in patients with subacute type b aortic dissection (TBAD) and refractory (rHTN) and non-refractory arterial hypertension (N-rHTN) treated by thoracic endovascular aortic repair (TEVAR). Patients were divided into two groups, rHTN defined as blood pressure >140/90 mmHg with ≥5 antihypertensive drugs and patients with N-rHTN. Primary endpoint was the variation of mean systolic, diastolic and overall pressure (MSP, MDP and MAP) before and after antihypertensive treatment or TEVAR. Secondary endpoints were the 30-days mortality. Fifty-seven patients were included in this study. Of the 44 Patients of the TEVAR group 21 were included in the N-rHTN group. The MSP before and after surgery for the N-rHTN group was 130 (±10 SD) and 111 (±22 SD) mmHg, P=0.01. In the rHTN group 164 (±17 SD) and 118 (±17 SD) mmHg (P=0.01). The reduction of MSP was greater in the rHTN group (P=0.01). The MAP before and after the TEVAR for the N-rHTN group was 90 (±10 SD) and 74 (±12 SD) mmHg (P=0.01), in the rHTN group 111 (±14 SD) and 70 (±9 SD) mmHg (P=0.01). The overall mortality rate group was 2.2% (1/44). TEVAR for TBAD appears to positively affect blood pressure in patients with rHTN and N-rHTN.

Impact of Arterial Blood Pressure on Ultrasound Hemodynamic Assessment of Aortic Valve Stenosis Severity

Aortic stenosis (AS) severity assessment is based on several indices. Aortic valve area (AVA) is subject to inaccuracies inherent to the measurement method, while velocities and gradients depend on hemodynamic status. There is controversy as to whether blood pressure directly affects common indices of AS severity. The study objective was to assess the effect of systolic blood pressure (SBP) variation on AS indices, in a clinical setting. A prospective, single-center study included 100 patients with at least moderately severe AS with preserved left ventricle ejection fraction. Patients underwent ultrasound examination during which AS severity indices were collected, with three hemodynamic conditions: (1) low SBP: <120mm Hg; (2) intermediate SBP: between 120 and 150mm Hg; (3) high SBP: ≥150mm Hg. For each patient, SBP profiles were obtained by injection of isosorbide dinitrate or phenylephrine. At baseline state, 59% presented a mean gradient (Gmean)≥40mm Hg, 44% a peak aortic jet velocity (Vpeak) ≥4m/sec, 66% a dimensionless index (DI) ≤0.25, and 87% an indexed AVA (AVAi)≤0.6cm2/m2. Compared with intermediate and low SBP, high SBP induced a significant decrease in Gmean (39±12 vs 43±12 and 47±12mm Hg, respectively; P<.05) and in Vpeak (3.8±0.6 vs 4.0±0.6 and 4.2±0.6mm Hg; P<.05). Compared with the baseline measures, in 16% of patients with an initial Gmean< 40mm Hg, gradient rose above 40mm Hg after optimization of the afterload (low SBP; P<.05). Conversely, DI and AVAi did not vary with changes in hemodynamic conditions. Flow rate, not stroke volume was found to impact Gmean and Vpeak but not AVA and DI (P<.05). Hemodynamic conditions may affect the AS ultrasound assessment. High SBP, or afterload, leads to an underestimation of AS severity when based on gradients and velocities. Systolic blood pressure monitoring and control are crucial during AS ultrasound assessment.

Frailty Score and Renal Function Impairment in Elderly Patients with Hypertension: A Correlation Study

To explore the correlation between frailty score and renal function impairment of elderly patients with hypertension. A total of 124 patients admitted to the Hefei Hospital Affiliated to Anhui Medical University/Hefei Second People’s Hospital between October 2017 and January 2019 with hypertension complicated with frailty were included. Patients with hypertension were divided into the Observation Group and Control Group (62 patients each). The blood pressure variability rate, renal function, and frailty score were compared between the two groups. Furthermore, the correlation between frailty score and renal function index was analyzed. The variations in the 24-h systolic and 24-h diastolic blood pressure in the Observation Group were significantly higher than those in the Control Group (P &lt; 0.05). Levels of cystatin C, homocysteine, urea nitrogen, creatinine, and uric acid were all higher in the Observation Group than in the Control Group, with the difference being statistically significant (P &lt; 0.05). Meanwhile, no statistical difference was observed between urea nitrogen/creatinine and hypersensitive CRP (P &gt; 0.05). Pearson partial correlation analyses showed that the weakness score was positively correlated with systolic pressure variation percentage, diastolic pressure variation percentage, homocysteine, cystatin C, creatinine, and urea nitrogen (P &lt; 0.05). The scores of various dimensions of weakness obtained via further regression analyses showed that the scores of physical frailties were positively correlated with homocysteine and cystatin C (P &lt; 0.05). Multivariate analysis showed that frailty score, percentage of diastolic blood pressure variation, and physical weakness were independent factors affecting cystatin C level (P &lt; 0.05). The rate of blood pressure variability is higher and renal function damage is more common in elderly hypertension patients with frailty. Frailty score, percentage of diastolic pressure variation, and physical weakness were independent risk factors affecting renal function.

Blood Pressure Variability and Severity of Early Prognosis in Patients with Acute Pontine Infarction.

Background Increased blood pressure (BP) variability may worsen the prognosis of stroke. This study aimed at investigating the association between BP variability and early functional prognosis in patients with pontine infarction. Methods According to types of pontine infarction, all the 137 patients were divided into two groups: 70 patients with paramedian pontine infarction (PPI) and 67 patients with deep pontine infarction (DPI). Common risk factors, 24-hour continuous blood pressure monitoring data, and the coefficient of variation were collected after admission in the hospital. Functional outcomes were evaluated with modified Rankin scale (mRS) at 3 months after discharge (favorable outcome: mRS scores ≤ 2; poor outcome: mRS scores > 2). Results The level of Glu, HbA1c, LDL, and NIHSS scores in the PPI group was significantly higher than that in the DPI group, and the concentration of blood uric acid was lower in the PPI group. Diastolic pressure in the PPI group is significantly higher than that in the DPI group, and coefficient of variation (CV) of systolic pressure in PPI is higher when compared with DPI ((88.77 ± 1.71) mmHg vs. (80.74 ± 1.31) mmHg; (11.54 ± 0.35) vs. (10.24 ± 0.25)). In multivariate analyses, the CV of systolic pressure, diastolic pressure, NIHSS scores, and the paramedian pontine infarction was independently associated with 3-month clinical outcome (OR = 1.94, 95% CI = 1.252–2.994, P=0.003; OR = 1.08, 95% CI = 1.002–1.166, P=0.04; OR = 1.58, 95% CI = 1.164–2.159, P=0.003; OR = 9.87, 95% CI = 1.045–32.193, P=0.04). Conclusion In conclusion, increased 24-hour (BP) variability, NIHSS scores, and paramedian pontine were associated with early poor prognosis in patients with acute pontine infarction.