Blood Pressure

Background Moxibustion is a traditional East Asian medical therapy that uses the heat generated by burning herbal preparations containing Artemisia vulgaris to stimulate acupuncture points. The aim of this review was to evaluate previously published clinical evidence for the use of moxibustion as a treatment for hypertension. Methods We searched 15 databases without language restrictions from their respective dates of inception until March 2010. We included randomized controlled trials (RCTs) comparing moxibustion to either antihypertensive drugs or no treatment. The risk of bias was assessed for each RCT. Results During the course of our search, we identified 519 relevant articles. A total of 4 RCTs met all the inclusion criteria, two of which failed to report favorable effects of moxibustion on blood pressure (BP) compared to the control (antihypertensive drug treatment alone). However, a third RCT showed significant effects of moxibustion as an adjunct treatment to antihypertensi...

The renin-angiotensin-aldosterone system (RAAS) is important for the development of hypertension, and several antihypertensive drugs target this system. Our aim was to determine whether specific single nucleotide polymorphisms (SNPs) in RAAS genes were related to the blood pressure (BP) lowering effect of antihypertensive treatment. Methods: Patients with mild to moderate primary hypertension and left ventricular hypertrophy were randomized in a double-blind fashion to treatment with either the angiotensin II type 1 receptor antagonist irbesartan (n ϭ 48) or the ␤ 1 -adrenergic receptor blocker atenolol (n ϭ 49) as monotherapy. A microarray-based minisequencing system was used to genotype 30 SNPs in seven genes in the RAAS. These polymorphisms were related to the antihypertensive response after 12 weeks treatment. Results: The BP reductions were similar in the atenolol and the irbesartan groups. Presence of the angiotensinogen (AGT) -6A allele or the AGT 235T allele were both associated with the most pronounced systolic BP response to atenolol treatment (P ϭ .001 when -6 AAϩAG was compared with GG and P ϭ .008 for presence of the 235T variant compared with 235 MM).

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.

Polyphenols are found ubiquitously in plants and their regular consumption has been associated with a reduced risk of a number of chronic diseases, including cancer, cardiovascular disease (CVD) and neurodegenerative disorders. Rather than exerting direct antioxidant effects, the mechanisms by which polyphenols express these beneficial properties appear to involve their interaction with cellular signaling pathways and related machinery that mediate cell function under both normal and pathological conditions. We illustrate that their interactions with two such pathways, the MAP kinase (ERK, JNK, p38) and PI3 kinase/Akt signaling cascades, allow them to impact upon normal and abnormal cell function, thus influencing the cellular processes involved in the initiation and progression of cancer, CVD and neurodegeneration. For example, their ability to activate ERK in neurons leads to a promotion of neuronal survival and cognitive enhancements, both of which influence the progression of Alzheimer's disease, whilst ERK activation by polyphenols in vascular endothelial cells influences nitric oxide production, blood pressure and ultimately CVD risk. The main focus of this review is to provide an overview of the role that polyphenols play in the prevention of cancer, cardiovascular disease and neurodegeneration. We present epidemiological data, human intervention study findings, as well as animal and in vitro studies in support of these actions and in each case we consider how their actions at the cellular level may underpin their physiological effects.

Abstract—The cardiovascular signs and symptoms,of thyroid disease are some of the most profound and clinically relevant findings that accompany,both hyperthyroidism,and hypothyroidism. On the basis of the understanding of the cellular mechanisms of thyroid hormone action on the heart and cardiovascular system, it is possible to explain the changes in cardiac output, cardiac contractility, blood pressure, vascular resistance, and rhythm disturbances

Two angiotensin II (Ang II)–specific receptors, AGTR1 and AGTR2, are expressed in the mammalian brain. Ang II actions on blood pressure regulation, water electrolyte balance, and hormone secretion are primarily mediated by AGTR1. The function of AGTR2 remains unclear. Here, we show that expression of the AGTR2 gene was absent in a female patient with mental retardation (MR) who had a balanced X;7 chromosomal translocation. Additionally, 8 of 590 unrelated male patients with MR were found to have sequence changes in the AGTR2 gene, including one frameshift and three missense mutations. These findings indicate a role for AGTR2 in brain development and cognitive function.

It is common practice in many ophthalmic units to administer multiple applications of 10% phenylephrine in combination with an anti-cholinergic agent to ensure adequate pupil mydriasis prior to routine cataract surgery. Phenylephrine is a pure a-I adrenoreceptor agonist known to produce marked systemic vasocon striction and associated hypertension with occasional profound reflex bradycardia. Many reviews have suggested caution in the use of 10% phenylephrine in the elderly or hypertensive patient. In a prospective, randomised trial we have assessed pupil dilation comparing the efficacy of 10% phenylephrine (53 patients) versus 2.5% phenylephrine (62 patients). When administered in conjunction with 1% cyclopen tolate four times over 1 hour pre-operatively, 2.5% phenylephrine was found to be as effective as 10% phenylephrine in the initiation and maintenance of mydriasis during both extracapsular and phacoemulsi fication cataract extraction.

In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients' motivation to practice self-care. To gauge patients' approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension. This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients' perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed. Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indi...

Background Current risk-stratification systems for patients with acute upper-gastrointestinal bleeding discriminate between patients at high or low risks of dying or rebleeding. We therefore developed and prospectively validated a risk score to identify a patient's need for treatment. Methods Our first study used data from 1748 patients admitted for upper-gastrointestinal haemorrhage. By logistic regression, we derived a risk score that predicts patients' risks of needing blood transfusion or intervention to control bleeding, rebleeding, or dying. From this score, we developed a simplified fast-track screen for use at initial presentation. In a second study, we prospectively validated this score using receiver operating characteristic (ROC) curves-a measure of the validity of a scoring system-and 2 goodness-of-fit testing with data from 197 patients. We also validated the quicker screening tool. Findings We calculated risk scores from patients' admission haemoglobin, blood urea, pulse, and systolic blood pressure, as well as presentation with syncope or melaena, and evidence of hepatic disease or cardiac failure. The score discriminated well with a ROC curve area of 0•92 (95% CI 0•88-0•95). The score was well calibrated for patients needing treatment (p=0•84). Interpretation Our score identified patients at low or high risk of needing treatment to manage their bleeding. This score should assist the clinical management of patients presenting with upper-gastrointestinal haemorrhage, but requires external validation.

The aim was to evaluate the relative importance of an established battery of five function tests used in the assessment of cardiovascular autonomic neuropathy (CAN) in diabetes employing spectral analysis of heart rate variability (HRV) as the reference test. In a populationbased sample of 178 diabetic persons and 194 non-diabetic controls, five function tests (E/I ratio, Valsalva, 30:15 ratio, Orthostatic-BP, and sustained Handgrip) and power spectral analysis of a 24-h Holter recording were carried out. The high-frequency power during nighttime (LnHF NIGHT) was taken to express the parasympathetic function and the daytime low-frequency power (LnLF DAY) to express the sympathetic function. The readings were log transformation when appropriate, age-corrected, and standardized to units of standard deviation. Combinations of the three mainly parasympathetic tests and the two mainly sympathetic tests were computed by averaging the standardized readings. A high value of the mean sum of squares in LnHF NIGHT or LnLF DAY Ð explained in regression analysis Ð was assumed to represent the better test or combination of tests. The three parasympathetic function tests each correlated significantly to LnHF NIGHT. The E/I ratio had a correlation to LnHF NIGHT similar to the combination of the three parasympathetic tests and the combination of all five function tests, whereas Valsalva and 30:15 ratio had a significantly poorer association. Sustained Handgrip-correlated significantly poorer to LnLF DAY compared to Orthostatic BP and the combination of the two sympathetic tests explained a significantly smaller part of the variation in LnLF DAY and LnHF NIGHT than did the combination of all five tests. This study indicates that: (1) no information is gained by adding the sympathetic function tests to the parasympathetic tests, (2) the most informative test is the E/I ratio, (3) and knowledge about the degree of CAN as defined by reduced HRV is not significantly increased when the four other function tests assessed are added to the E/I ratio.

Objectives. To evaluate the possible association between pressure pain sensitivity of the chest bone (PPS) and cardiovascular physiological factors related to persistent stress in connection with a three-month PPS-guided stress-reducing experimental intervention programme. Methods. Forty-two offi ce workers with an elevated PPS (Ն 60 arbitrary units) as a sign of increased level of persistent stress, completed a single-blinded cluster randomized controlled trial. The active treatment was a PPS (self-measurement)-guided stress management programme. Primary endpoints: Blood pressure (BP), heart rate (HR) and work of the heart measured as Pressure-Rate-Product (PRP); Secondary endpoints: Other features of the metabolic syndrome. Results. PPS decreased and changes in PPS after the intervention period were signifi cantly associated with HR, PRP, body mass index (BMI) and visceral fat index (all correlation coeffi cients Ͼ 0.2, p Ͻ 0.05). Compared to the control cluster group, the active cluster group obtained a signifi cant reduction in PPS, Low-density lipoprotein (LDL) cholesterol and total number of elevated risk factors (p Ͻ 0.05). On an individual level, signifi cant and clinically relevant between-group reductions were observed in respect to BP, HR, PRP, total and LDL cholesterol, and total number of elevated risk factors (p Ͻ 0.05). Conclusions. The stress intervention method applied in this study induced a decrease in PPS which was associated with a clinically relevant decrease in resting blood pressure, heart rate, work of the heart and serum cholesterols.

Interest in the development of functions that estimate the likelihood of an individual suffering a future cardiovascular disease (CVD) event has increased in recent times (e.g. Framingham sheets, SCORE-Systematic COronary Risk Estimation, PROCAM, etc.). However, the estimates of absolute risk may show substantial variations between different populations, because of geographical, cultural, social, behavioural and genetic differences, as well as various methodological issues related to the predictive models employed. We sought to calibrate the SCORE equations to the Greek population. We used the SCORE system that offers an estimation of total fatal CVD risk in "high" and "low" CVD risk European countries. The project pulls together a pool of datasets from 12 European countries and 2.7 million person-years of observation. A mathematical procedure to adjust the risk estimates for individual countries was applied, based on local mortality and risk factor prevalence da...

Context: Metformin is widely prescribed to pregnant women with polycystic ovary syndrome (PCOS) in an attempt to reduce pregnancy complications. Metformin is not approved for this indication, and evidence for this practice is lacking. ... Objectives: Our objective was to ...

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Captopril lowers blood pressure without increasing heart rate and plasma norepinephrine, which suggests that this drug may potentiate arterial baroreflexes. In eight subjects with untreated essential hypertension, blood pressure was monitored intraarterially and the effects of baroreceptor stimulation OC deactivation were assessed by measuring (1) the slopes of the relations between increase or reduction in systolic pressure (intravenous phenylephrine or nitroglycerin) and the resulting lengthening or shortening in R-R interval, and (2) the increase or decrease in mean arterial pressure induced by increasing and decreasing carotid transmural pressure (neck chamber). The measurements were made before and after a hypotensive oral dose of captopril(50 mg). Before captopril, the slopes of the R-R interval changes with increase and reduction in systolic pressure were 8 and 4 ms/mm Hg, respectively. The slopes of the mean arterial pressure changes with increase and reduction in carotid transmural pressure were 0.51 and 0.40 mm Hg, respectively. After captopril, the responses to baroreceptor stimulation were unaltered but those to baroreceptor deactivation were augmented. The pressor and heart rate responses to hand-grip and cold exposure were unchanged by captopril. Administration of captopril is accompanied by a baroreflex potentiation which involves the lower portion of the stimulus-response curve of the reflex. This phenomenon (which may originate at the afferent baroreceptor fibers or centrally) may avoid a reduction in the tonic baroreflex influence during captopril-induced hypotension, thus contributing to the hemodynamic effects of the drug.

This study was designed to determine the predictive value of lipid hydroperoxide (LOOH) levels for adverse cardiovascular outcomes in patients with stable coronary artery disease (CAD). Oxidative modification of circulating lipids contributes to inflammation and endothelial dysfunction, which are hallmark features of atherosclerosis. A serum biomarker of oxidation is LOOH, which is a primary product of fatty acid peroxidation. Serum LOOH levels were measured and correlated with clinical events over a 3-year period in 634 patients with angiographic evidence of CAD. Baseline LOOH levels in the highest quartile were associated with hazard ratios of 3.24 (95% confidence interval [CI] 1.86 to 5.65; p = 0.0001) for nonfatal vascular events (n = 149), 1.80 (95% CI 1.13 to 2.88; p = 0.014) for major vascular procedures (n = 139), and 2.23 (95% CI 1.44 to 3.44; p = 0.0003) for all vascular events and procedures. Baseline LOOH levels correlated with serum levels of soluble intercellular adhesion molecule-1 (p = 0.001) and thiobarbituric acid reactive substances (p = 0.001) as well as the mean percent change in stenosis for large segments >50% stenosed (p = 0.048). A multivariate proportional hazards model, adjusted for traditional risk factors and inflammatory markers, showed an independent effect of LOOH on nonfatal vascular events, vascular procedures, and all events or procedures. Amlodipine treatment was associated with reduced cardiovascular events and changes in LOOH levels compared with placebo. Elevated LOOH levels were predictive of nonfatal vascular events and procedures in patients with stable CAD, independent of traditional risk factors and inflammatory markers.

In the US, it is currently estimated that 3% of pregnant women have chronic hypertension, or more than 100,000 pregnant women each year. The aim of our study was to investigate the adaptation of autonomic control during pregnancy based on heart rate variability analysis and to determine whether chronic hypertension during pregnancy has an impact on this adaptation. Sixteen pregnant women with chronic hypertension (CH group; mean age, 30 years; range, 25-33 years) and 35 healthy pregnant women serving as controls (CON group; mean age, 28 years; range, 24-30 years) were recruited for this longitudinal study. Beginning at the 20th week of pregnancy, the women were monitored every 4th week until delivery. For the analysis of heart rate variability, Portapres signals (200 Hz) were recorded for 30 min under resting conditions. Women in the CH group had significantly elevated blood pressure compared to controls (CON, 111 mmHg [105-132]; CH, 140 mmHg [132-148]; p <0.001). An increased heart rate was found in both groups during the second half of pregnancy. Consequently, decreased heart rate variability was observed, but was more pronounced in the CON group. There was a shift in the frequency bands indicated by an elevation of the low-to-high frequency ratio (LF/HF) in both groups due to a decrease in HF, and thus a significant increase in LFn (LF power in normalized units). However, VLF (power of very low frequency range) increased exclusively in the CON pregnancies. Our data showed no significant difference in heart rate variability between the subjects of the CH and CON groups. Longitudinal variations were detectable in normal pregnancies and also, albeit to a lesser degree, in chronic hypertensive pregnant women. Thus, our data indicate that patients with long-term hypertension are still able to respond to the physiological changes occurring during pregnancy.

Use of cuffed oropharyngeal vs laryngeal mask airway in elderly patients Purpose: This study was designed to compare the new cuffed oropharyngeal airway (COPA) to the laryngeal mask airway (LMA) in elderly patients. Methods: In a randomized, controlled study, 80 patients, age ~ 65, ASA I-III, undergoing urology procedures, were managed with either COPA or LMA. Propofol requirements for insertion of the devices, ease of insertion and removal, airway manipulations, mean arterial pressure, heart rate, PETCO 2, SpO 2, peak inspiratory pressure, selection of the appropriate size of the device and leaks, fibreoptic visualization of larynx and complications were studied. l~,stdts: There were more airway manipulations in the COPA group than in the LMA group (40% and 5% respectively) whereas PETCO 2 was higher in the LiVlA group (P <0.05). In 60% of COPA patients the vocal cords could not be visualized but ventilation was adequate in all but two cases. Postoperative sore throat occurred in 20~ of patients with LMA vs 10% with COPA). Bloody secretions on the device were present in two patients managed with LMA. Conclusion: In elderly patients COPA required more airway manipulations than the LMA. Laryngeal mask airway caused more sore throats, but was better for flbreoptic visualisation of the larynx. Both are excellent options when intubation is not indicated/desired. Objectif: La pr6sente &ude a &E men& pour comparer deux appareils utilis& chez des patients ~g~s : la canule oropharyng~e & ballonnet (COPB) et le masque laryng6 (ML). M&hode : Dans une &ude randemis& et contr61~e, on a ins&~ une COPB ou un M L chez 80 patients, ~.g& de 65 ans, ASA I-III, devant subir une intervention urologique. Le propofol n&essaire pendant I'insertion du dispositif, la facilit~ de rinsertion et du retrait, les manipulations requises, la tension art6rielle moyenne, la fr~quence cardiaque, la PETCO2, la SpO 2, la pression inspiratoire de or&e, l'appareil choisi selon la faille approprLae et les fuites, la visualisation fibroscopique du larynx et les complications ont ~t~ 6tudi~s. l~,sultats : l'insertion de la COPB a demand6 plus de manipulations que celle du ML (40 0% et 5 %, respectivement) tandis que la PETCO 2 &ait plus haute avec le ML (P < 0,05). Chez 60 % des patients qui ont regu la COPB, on ne pouvait visualiser les cordes vocales, mais la ventilation 6tait ad6quate chez tous sauf chez deux patients. Des maux de gorge postop&atoires sont survenus chez 20 % des patients avec le ML vs I0 0% avec la COPB). Des s&r~tions sanguinolentes 6taient pr6sentes sur l'appareil de deux patients portant le ML. Conclusion : Chez les patients ~g&, l'insertion de la COPB demande plus de manipulations que celle du ML. Le ML cause davantage de maux de gorge, mais permet une meilleure visualisation fibroscopique du larynx. Les deux dispositifs test6s sont trEs utiles lorsque rintubation n'est pas indiqu6e ou souhait6e.

Myocardial infarction causes a cascade of events, which leads to heart failure, debilitation and death. This study examined possible cardioprotective effect of oleuropein in rats with acute myocardial infarction. Male Sprague-Dawly rats were allocated to five groups: sham, myocardial infarction receiving vehicle, and three myocardial infarction receiving oleuropein at 10, 20, and 30 mg/kg/day for 7 days, and underwent sham operation or coronary ligation. Twenty-four hours later, animals underwent echocardiographic and hemodynamic studies, and infarct areas, serum concentrations of oxidative stress and inflammatory markers were determined. Myocardial infarction group receiving vehicle had significantly lower left ventricular developed and systolic pressures, rate of rise/decrease of left ventricular pressure, stroke volume, ejection fraction and cardiac output, and serum superoxide dismutase and glutathione reductase than those of sham group. Pretreatment with oleuropein prevented the reduction of these variables. Moreover, the group had a significantly higher serum malondialdehyde, interleukin-1b, TNF-a, creatin kinase-MB, and troponin I, lactate dehydrogenase, and infarct area than those of sham group. Pretreatment with oleuropein prevented the increase of these variables. The findings indicate that coronary ligation results in acute myocardial infarction characterized by impaired cardiac function, and oleuropein pretreatment prevented cardiac impairment partly by reducing oxidative stress and release of proinflammatory cytokines.

Recently we demonstrated that centrally administrated melittin, a phospholipase A 2 (PLA 2 ) activator, caused the pressor effect in normotensive, conscious rats. In the present study, we aimed to determine the cardiovascular effect of peripherally injected melittin and the involvement of the central cholinergic system on these effects in the normotensive conscious rats. For this reason, 250, 500 or 1000 mg/kg doses of melittin were injected intraperitoneally to normotensive male Sprague Dawley rats. Melittin produced dose-and time-dependent increases in mean arterial pressure (MAP) and heart rate (HR).

Endothelin (ET) 1 is a potent vasoconstrictor peptide produced by vascular endothelial cells and implicated in various pathophysiologic states involving abnormal vascular tone. Homozygous ET-1 null mice have craniofacial and cardiac malformations that lead to neonatal death. To study the role of ET-1 in adult vascular physiology, we generated a mouse strain (ET-1 flox/flox ;Tie2-Cre mice) in which ET-1 is disrupted specifically in endothelial cells. ET-1 peptide levels in plasma, heart, lung, kidney, and brain homogenates were reduced by 65% to 80% in these mice. mRNA levels for ET receptors were unaltered except that the ET A receptor mRNA was upregulated in the heart. ET-1 flox/flox ;Tie2-Cre mice had mean blood pressures 10 to 12 mm Hg lower than genetic controls. In contrast, the blood pressure of mice systemically heterozygous for the ET-1 null allele (ET-1 dlox/ϩ mice) was unchanged compared with wild-type littermates. Despite the lower basal blood pressure, acute pharmacological responses to angiotensin II, captopril, phenylephrine, bradykinin, N G -nitro-L-arginine methyl ester, and exogenous ET-1 were normal in ET-1 flox/flox ;Tie2-Cre mice. These results support an essential role of endothelial-derived ET-1 in the maintenance of basal vascular tone and blood pressure. Normal pharmacological responses of ET-1 flox/flox ;Tie2-Cre mice suggest that the renin-angiotensin system, the adrenergic system, and NO are not significantly altered by endothelial ET-1. Taken in conjunction with other lines of genetically altered mice, our results provide evidence for a paracrine vasoregulatory pathway mediated by endothelial cell-derived ET-1 acting on the vascular smooth muscle ET A receptor. (Hypertension. 2010;56:121-128.) Key Words: hypertension Ⅲ endothelium Ⅲ ET A Ⅲ ET B Ⅲ cre/loxP Ⅲ blood pressure Ⅲ gene knockout E ndothelin (ET) 1, originally identified as a potent vaso-

Endothelium-dependent responses are impaired in various models of hypertension. The effects of antihypertensive treatment on endothelium-dependent relaxations were studied in Dahl salt-sensitive (DS) and Dahl salt-resistant rats (DR) on a high or low sodium diet. The rats were given either a diet containing 8% NaCI or 0.1% NaCI for 8 weeks or a diet containing 8% NaCI and a combination of reserpine, hydrochlorothiazide, and hydralazine for 8 or 2 weeks. DS on the 8% NaCI diet developed hypertension, while the other rats did not. Antihypertensive therapy for 8 or 2 weeks prevented or reversed hypertension in DS and lowered blood pressure in DR on the 8% NaCI diet. Aortic rings with and without endothelium were suspended in organ chambers for isometric tension recording. In all groups, acetylcholine, adenosine 5'-diphosphate, and thrombin caused endotheliumdependent relaxations. The relaxations in response to all agonists were significantly decreased in DS on 8% NaCI compared to relaxations in the other rats. Antihypertensive treatment for 8 or 2 weeks prevented or reversed the decreased endothelium-dependent relaxations in response to all agonists tested, but not those to the endothelium-independent agonist, sodium nitroprusside. These results suggest that antihypertensive treatment normalizes endothelium-dependent relaxations. This effect of antihypertensive treatment might be important for the prevention of cardiovascular complications in patients with hypertension. (Hypertension 9 [Suppl III]: IIM93- III-197, 1987) KEY WORDS * acetylcholine • adenosine 5'-diphosphate • Dahl rats • norepinephrine sodium nitroprusside • thrombin • thoracic aorta From the Department of Physiology and Biophysics, Mayo Clinic and Foundation, Rochester, and the Renal Section, Veterans

Young CC, Mark JB, White W, DeBree A, Vender JS, Fleming A. Clinical evaluation of continuous noninvasive blood pressure monitoring: accuracy and tracking capabilities. J Clin Monit 1995;11:245-252 ABSTRACT. A continuous, noninvasive device for blood pressure measurement using pulse transit time has been recently introduced. We compared blood pressure measurements determined using this device with simultaneous invasive blood pressure measurements in 35 patients undergoing general endotracheal anesthesia. Data were analyzed for accuracy and tracking ability of the noninvasive technique, and for frequency of unavailable pressure measurements by each method.

A method for delivery of precise doses of smoked cocaine-base to humans. PHARMACOL BIOCHEM BEHAV 36(1) 1-7, 1990.--Despite increasing smoked cocaine-base use, there have been relatively few parametric studies in this area. The major reason for the limited number of studies is the lack of a simple procedure for the administration of precise doses of smoked cocaine-base to human volunteers. This paper describes a new method that allows for the delivery of precise doses of smoked cocaine-base. A complete description of the method and the precision of the administration procedure are presented. Furthermore, a study is described which was undertaken to determine: 1) the reproducibility of peak blood cocaine levels when the same dose of cocaine was given on two separate occasions; and 2) the dose-related effects on smoking topography, biochemical, physiological and subjective measures. Subjects (N = 5) were administered three doses of cocaine-base (10, 20 and 40 mg). Four subjects were given repeated doses of cocaine-base. Subjects were blind to the dose and in most cases randomly assigned to different doses. The results showed: 1) a significant correlation of peak whole blood cocaine concentrations among similar doses within subjects (r = .99); 2) no significant effects of dose on smoking topography; and 3) significant dose effects for whole blood cocaine concentrations, heart rate and systolic blood pressure.

Uninephrectomized rats drinking 1% sodium chloride were given aldosterone (Aldo, 0.75 gg/h, subcutaneous Is.c.I infusion), deoxycorticosterone (DOC, 20 mg/wk, s.c.), corticosterone (B, 2 mg/d, s.c.), or the antiglucocorticoid-antiprogestin RU486 (2 mg/d, s.c.) for 8 wk, and hemodynamic and tissue responses were compared with a non-steroid-treated control group. Aldo and DOC markedly increased systolic BP and caused considerable (40-50%) cardiac hypertrophy; B and RU486 caused neither hypertension nor cardiac hypertrophy. Measurements of ventricular cross-sectional areas showed hypertrophy due to an increase in mass of the left ventricle only. Cardiac hydroxyproline concentration was increased considerably by Aldo and DOC, to a lesser degree by RU486, and not by B. Aldo markedly elevated left ventricular interstitial collagen (2.5-fold vs control, P < 0.01 vs all groups); other steroid treatments also increased interstitial collagen over control (DOC X 1.8-, RU486 X 1.6-, B X 13-fold), with identical responses for right and left ventricles (r = 0.94). A different pattern of perivascular fibrosis was noted; DOC elevated perivascular collagen (2.1-fold vs control, P < 0.01 vs all other groups); RU486 raised levels 1.4-fold vs control, but neither Aldo nor B significantly affected perivascular collagen. These data are consistent with interstitial cardiac fibrosis reflecting type I (mineralocorticoid) receptor occupancy by administered Aldo or DOC, or by elevated endogenous B after type II (glucocorticoid) receptor blockade after RU486 administration; perivascular fibrosis may reflect a composite response after type I receptor agonist/type II glucocorticoid receptor antagonist occupancy. (J. Clin. Invest. 1994.93:2578-2583

In presence of aortic stenosis, a jet is produced downstream of the aortic valve annulus during systole. The vena contracta corresponds to the location where the cross-sectional area of the flow jet is minimal. The maximal transvalvular pressure gradient (TPG(max)) is the difference between the static pressure in the left ventricle and that in the vena contracta. TPG(max) is highly time-dependent over systole and is known to depend upon the transvalvular flow rate, the effective orifice area (EOA) of the aortic valve and the cross-sectional area of the left ventricular outflow tract. However, it is still unclear how these parameters modify the TPG(max) waveform. We thus derived an explicit analytical model to describe the instantaneous TPG(max) across the aortic valve during systole. This theoretical model was validated with in vivo experiments obtained in 19 pigs with supravalvular aortic stenosis. Instantaneous TPG(max) was measured by catheter and its waveform was compared with the one determined from the derived equation. Our results showed a very good concordance between the measured and predicted instantaneous TPG(max). Total relative error and mean absolute error were on average 9.4+/-4.9% and 2.1+/-1.1 mmHg, respectively. The analytical model proposed and validated in this study provides new insight into the behaviour of the TPG(max) and thus of the aortic pressure at the level of vena contracta. Because the static pressure at the coronary inlet is similar to that at the vena contracta, the proposed equation will permit to further examine the impact of aortic stenosis on coronary blood flow.

Channichthyid icefishes of Antarctica are unique among adult vertebrates. All icefish species lack hemoglobin and red blood cells in their circulating blood. All icefishes examined to date also lack the intracellular oxygen-binding protein myoglobin (Mb) in their oxidative skeletal muscles. However, some icefish species do express Mb in their heart ventricles. It is unknown whether Mb in those species in which it is present represents an evolutionary relic or has functional significance. To address this problem, we compared mechanical performance of isolated, perfused hearts from two species of icefish in which Mb is either present (Chionodraco rastrospinosus) or is absent (Chaenocephalus aceratus). Hearts were challenged with increasing afterload (2.5-4.0 kPa) under conditions of defined basal flow (approximately 100 ml.min-1.kg-1), in both the presence and absence of 5 mM sodium nitrite, a Mb poison. Unlike hearts from C. aceratus, which were unable to maintain a constant cardiac ...

The need to monitor patients after they leave the hospital or clinics is of growing concern and doctors may need the facility to monitor certain patients more than others. For example patients with high blood pressure are sometimes fitted with a mobile monitor which can be used to track the patients blood pressure over time. Patients suffering from depression, however, may also need to be monitored to ensure that they are in a happy emotional state. In this paper we introduce an alternative approach to mood detection and tracking based on built-in accelerometer sensors found in common mobile phones. Our method can be seen to compliment the need to monitor such patients allowing for doctors to get in touch with them when their mood has altered. We build a system based on neural networks which takes the gait information and learns the associated mood of the user. This trained model is then used to detect the mood of the individuals. We demonstrate preliminary results on mood detection using a mobile prototype system.

The Utrecht Diabetes Project (UDP) is a shared-care project providing remote diabetologist support for 85 GPs. In the UDP all examinations, performed by the GP, follow standardized procedures, results being sent to the diabetologist. Laboratory results are sent automatically to both GP and diabetologist. To study the composition of the UDP population; completeness of data recording; changes in biochemical variables of UDP patients; and GPs&amp;#39; motives for enrolling them. Data were extracted from the records of 19 GPs and a questionnaire was sent to all UDP GPs. Of 770 patients with Type 2 diabetes, 44% were treated with UDP support, 29% by their GPs alone, and 27% at out-patient clinics. The 336 UDP patients were representative of all UDP patients. Patients older than 75 years were the greater part of those treated by GPs alone; out-patient clinics had more patients with diabetes &amp;gt; 10 years or with complications. UDP patients&amp;#39; records were the most complete. Diabetes regulation, lipid levels and diastolic blood pressure in the UDP patients improved significantly after inclusion in the UDP. GPs tend to seek UDP aid especially for patients who are young, or of recent onset, at risk of macrovascular complications, or needing insulin. Standardized data transfer between GP, diabetologist and laboratory might establish an effective infrastructure for shared diabetes care. Diabet. Med. 18, 459-463 (2001)

Background: Existing studies suggest that music therapy can have favorable effects on hypertension and anxiety. We therefore set out to investigate the effect of Turkish classical music. Objectives: To investigate whether Turkish classical music has positive effects on blood pressures and anxiety levels in elderly patients. Design, setting and subjects: This was a randomized controlled trial performed on 60 hypertensive patients living in a local elderly home in Adana, Turkey. Methods: Following the completion of a socio-demographic form for each patient, Hamilton anxiety scale was applied. Thereafter, the subjects were randomly divided into two equal-size groups and were allowed to either listen to Turkish classical music (music therapy group) or have a resting period (control group) for 25 min. Outcome measures: The primary and secondary outcome measures were blood pressure and Hamilton anxiety scale scores, respectively. Results: The mean reduction in systolic blood pressure was 13.00 mmHg in the music therapy group and 6.50 mmHg in the control group. The baseline adjusted between treatment group difference was not statistically significant (95% CI 6.80-9.36). The median reductions in diastolic blood pressures were 10 mmHg both in the music therapy and control groups. The between treatment group difference was not statistically significant (Mann-Whitney U test, P = 0.839). The mean reduction in HAMA-A was 1.63 in the music therapy group and 0.77 in the control group. The baseline adjusted between treatment group difference was not statistically significant (95% CI 0.82-1.92). Conclusion: The study demonstrated that both Turkish classical music and resting alone have positive effects on blood pressure in patients with hypertension.

Objective: To study the etiology and clinical profile of non-traumatic coma in children and to determine the clinical signs predictive of outcome. Methods: 100 consecutive cases of non-traumatic coma between 2 months to 12 years. Clinical signs studied were temperature, pulse, heart rate, blood pressure, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupillary and corneal reflex, extra ocular movements, motor patterns, seizure types and fundus picture. These were recoded at admission and after 48 hours of hospital stay. Etiology of coma was determined on basis of clinical history, examination and relevant laboratory investigations by the treating physician. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Chi-square test and logistic regression analysis were done to determine predictors of outcome. Results: Etiology of coma in 60% cases was CNS infection (tubercular meningitis-19, encephalitis-18, bacterial meningitis-16, others-7); other causes were toxic-metabolic conditions (19%), status epilepticus (10%), intracranial bleed (7%), and miscellaneous (4%). 65 children survived, 11 were normal, 14 had mild disability, 21 had moderate disability and 14 were severely disabled and dependent. Survival was significantly better in patients with CNS infection (63%) as compared to those with toxic-metabolic causes (27%) and intracranial bleed (43%, P < 0.05). On bivariate analysis age ≤3 years, poor pulse volume, abnormal respiratory pattern and apnoea, abnormal pupillary size and reaction, abnormal extra ocular movements, absent corneal reflex, abnormal motor muscle tone at admission or 48 hours correlated significantly with mortality. Survival was better with increasing GCS (Spearman rho = .32, P < 0.001). On logistic regression age < 3 years, poor pulse volume, absent extraocular movements and papilloedema at admission and 48 hours after admission were independent significant predictors of death. Conclusion: CNS infections were the most common cause of non-traumatic coma in childhood. Simple clinical signs were good predictors of outcome. [Indian J Pediatr 2005; 72 (6) : 467-473]

The reproducibility of heart rate variability (HRV) measures during graded lower body negative pressure (LBNP) have not been studied in sufficient detail. Active college age men (n=14) underwent an orientation exposure and two trials of graded LBNP to presyncope or)100 mmHg, separated by 1 week. Heart rate, stroke volume (impedance cardiography), blood pressure (Finapres), and forearm blood flow were assessed, as was HRV in both time and frequency domains. The trial-to-trial responses to LBNP common to all subjects (LBNP £)60 mmHg and at test termination) showed parallel changes, suggesting similar responses between both trials. Good reproducibility estimates were found for the resting HRV data (lowest: R=0.62 for low frequency/high frequency ratio; highest: R=0.94 for standard deviation of normal R-R intervals). During LBNP, reproducibility estimates varied but were generally similar to that seen at rest. At test termination, they were unacceptably low (R<0.41) for the HRV data assessed in the frequency domain and expressed in absolute units. LBNP tolerance was lower in the first trial [LBNP tolerance index: 404 (21) versus 437 (15) mmHg min)1 ; P<0.05] but the intraclass correlation coefficient was high (R=0.87). These data suggest that (1) HRV responses to submaximal LBNP up to)60 mmHg are consistent across trials, (2) the considerable variability seen in the HRV parameters at maximal LBNP can be reduced by expressing these data in either the time domain or using normalized units in the frequency domain, and (3) cardiovascular responses to sub-and maximal LBNP are reproducible. Data are presented as mean (SEM) unless otherwise stated.

Positive effect of thyroid hormone replacement (THR) on lipid profile is well defined. Effectiveness of THR on lipid profile and function among elderly patients with subclinical hypothyroidism (SCH) has not yet been concluded. This is a population-based cross-sectional study. Twenty-six elderly patients with SCH were compared with 31 patients with clinical hypothyroidism (CH). Before the study neither group had received THR therapy. Data on lipid profile, demographic, functional, and cognitive status were obtained at baseline. SCH was defined as an elevated thyroid-stimulating hormone (TSH) level (>4.67 mU/l) and normal serum free thyroxine (FT 4) level. Total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides (TG) were measured after overnight fast. The level of lower density lipoprotein (LDL) cholesterol was calculated. Both studied groups received levothyroxyne replacement and re-evaluated after 3 months of euthyroidism. Functional and cognitive status were evaluated by the activity of daily living (ADL) and mini mental state evaluation (MMSE), respectively. Participants with SCH did not differ from patients with CH regarding age, gender, cognitive, and functional status, and prevalence of cardiovascular disease (CD) was similar in both groups. Most patients (24/26) with SCH had TSH levels lower than 10 mU/l. Response to THR therapy regarding the improvement of blood levels of TC, LDL, and TG had a non-significant trend, which seemed to be better in patients with SCH than in those with CH. Decreases, TC/HDL and LDL/HDL ratios were greater in patients SCH (p < 0.0001 and p = 0.0004, respectively) than in patients with CH.

Fifty-seven type 2 diabetic patients with metabolic syndrome and on insulin were assessed by a paired analysis before and 6 months after addition of metformin as combination therapy to evaluate the impact of the association on glycemic control, blood pressure, and lipid profile. This was a historical cohort study in which the files of type 2 diabetic patients with metabolic syndrome on insulin were reviewed. The body mass index (BMI), waist circumference, lipid profile, A1C level, fasting blood glucose level, daily dose of NPH insulin, systolic blood pressure, and diastolic blood pressure were assessed in each patient before the start of metformin and 6 months after the initiation of combination therapy. Glycemic control significantly improved (P < 0.001) after the addition of metformin (1404.4 ± 565.5 mg/day), with 14% of the 57 patients reaching A1C levels up to 7%, and 53% reaching values up to 8%. There was a statistically significant reduction (P < 0.05) of total cholesterol (229.0 ± 29.5 to 214.2 ± 25.0 mg/ dL), BMI (30.7 ± 5.4 to 29.0 ± 4.0 kg/m 2), waist circumference (124.6 ± 11.7 to 117.3 ± 9.3 cm), and daily necessity of insulin. The reduction of total cholesterol occurred independently of the reductions of A1C (9.65 ± 1.03 to 8.18 ± 1.01%) and BMI and the reduction of BMI and WC did not interfere with the improvement of A1C. In conclusion, our study showed the efficacy of the administration of metformin and insulin simultaneously without negative effects. No changes were detected in HDL-cholesterol or blood pressure.