Arterial pressure Research Papers - Academia.edu (original) (raw)

To examine the association of body mass index (BMI), triceps skinfold thickness (TST) and percentage body fat (%BF) from bioelectrical impedance analysis (BIA) with blood lipids, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in children. Cross-sectional study was conducted on 1280 schoolchildren aged 8-11 years from the Cuenca province (Spain). Data collection was conducted under standardized conditions, taking several measurements of each variable to enhance accuracy. Analyses were performed using age-adjusted correlation coefficients, and multiple linear regression adjusted for age, BMI, TST and %BF. Correlations between %BF and apolipoprotein (apo) B, total cholesterol, low-density lipoprotein cholesterol (LDL-c), total cholesterol/HDL-c ratio and DBP were higher than those for BMI and TST. In contrast, the correlations between BMI, and apo A-I and SBP were higher than those for %BF and TST. The results were similar across the sexes. The correlations between each of the three measures of body fatness, and blood lipids and blood pressure were highest in children with greatest BMI and %BF. When analyses were adjusted for the three body fatness measures, %BF showed stronger associations than did BMI or TST with blood lipids and blood pressure, with the exception of apo A-I and SBP, which were more closely associated with BMI. %BF from BIA is more strongly associated than either BMI or TST with most of the blood lipid fractions in schoolchildren aged 8-11 years.

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- Epidemiology, Anthropometry, Adipose tissue, Child

We studied healthy supine astronauts on Earth with electrocardiogram, non-invasive arterial pressure, respiratory carbon dioxide concentrations, breathing depth and sympathetic nerve recordings. r The null hypotheses were that heart beat interval fluctuations at usual breathing frequencies are baroreflex mediated, that they persist during apnoea, and that autonomic responses to apnoea result from changes of chemoreceptor, baroreceptor or lung stretch receptor inputs. r R-R interval fluctuations at usual breathing frequencies are unlikely to be baroreflex mediated, and disappear during apnoea. r The subjects' responses to apnoea could not be attributed to changes of central chemoreceptor activity (hypocapnia prevailed); altered arterial baroreceptor input (vagal baroreflex gain declined and muscle sympathetic nerve burst areas, frequencies and probabilities increased, even as arterial pressure climbed to new levels); or altered pulmonary stretch receptor activity (major breathing frequency and tidal volume changes did not alter vagal tone or sympathetic activity). Apnoea responses of healthy subjects may result from changes of central respiratory motoneurone activity.

- by Jay Buckey
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- Carbon Dioxide, Electrocardiography, Autonomic Nervous System, Biological Sciences

Aim. -Diabetic patients defaulting from specialist care have worse metabolic control and complications than those attending regularly. We have compared the clinical characteristics of defaulters and more regular health care attenders on a... more

- by David Simmons
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- Health Care, Complication, Hemodynamics, Blood Pressure

Hypervolemia is a risk factor for left ventricular hypertrophy and hypertension in peritoneal dialysis patients. Icodextrin improves volume control by increasing ultrafiltration in peritoneal dialysis patients. To examine the effects of twice-daily icodextrin administration on blood pressure and left ventricular hypertrophy in peritoneal dialysis patients with hypervolemia and ultrafiltration failure. Administration of icodextrin twice daily resulted in a significant reduction in the left ventricular mass index (LVMI) of patients by the end of the third month (p < 0.05). The reduction in LVMI was also significant for the once-daily icodextrin group (p < 0.05). Mean blood pressure of patients receiving icodextrin twice daily was significantly reduced (p < 0.05). By the end of the third month no significant changes were observed in mean blood pressure of the patients using once-daily icodextrin (p > 0.05). No statistically significant changes were observed in weekly total ...

- by Bulent Tokgoz
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- Treatment Outcome, Ultrafiltration, Echocardiography, Glucose

Few clinical practice guidelines provide management recommendations for acute hypertensive episodes except in the context of specific conditions such as pregnancy and stroke. We performed a systematic search to identify guidelines addressing acute hypertension and appraised the guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) validated quality assessment tool. Two reviewers independently appraised and one extracted key recommendations. Literature on secondary hypertension, hypertension in pregnancy, preeclampsia/eclampsia, stroke, aortic dissection, and pheochromocytoma was excluded. Three guidelines were identified, sponsored by the American College of Emergency Physicians (ACEP), the National Heart, Lung, and Blood Institute (NHLBI), and the European Society of Hypertension (ESH) in conjunction with the European Society of Cardiology (ESC). AGREE II yielded mean domain (%) and overall assessment scores (1-7) as follows: NHLBI: 73%, 5.5; ACEP: 67%...

- by Lydia Bazzano
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- Blood Pressure, Arterial pressure

Simultaneous and accurate recording of arterial blood pressure and ST segment changes is fraught with technical difficulties. We have developed a new system to enable accurate reproduction of the electrocardiogram and intra-arterial blood pressure, using a transducer/perfusion unit conventionally used to study hypertensive subjects, linked to a frequency modulated tape recorder. Detailed methods of digital analysis have been developed to process the data. This system has been used to study 22 patients with arteriographically proven severe obstructive coronary artery disease who suffered frequent attacks of angna. Control data from quantified dynamic exercise in the laboratory were used for comparison with the effects of normal daily activities outside the hospital and to test the hypothesis that "double product" (heart rate x systolic blood pressure) is relevant to the onset of angina in such patients. The most important finding was that both angina and asymptomatic episodes of ST segment depression were invariably accompanied by an increase in heart rate, whereas there was considerable variation in blood pressure changes ranging from an increase to a substantial fall. This suggests that heart rate changes are more important in determining ischaemic episodes than blood pressure. Furthermore, the "double product" was not reproducible during repeated episodes of angina and asymptomatic ischaemia and did not apear to have an important role in the pathogenesis of intermittent myocardial ischaniia in this group of patients.

- by Anthony davies
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- Medicine, Electrocardiography, Blood Pressure, Heart rate

This critique is intended to provide background for the reader to evaluate the relative clinical utilities of brachial cuff systolic blood pressure (SBP) and its derivatives, including pulse pressure, central systolic pressure, central augmentation index (AI), and pulse pressure amplification (PPA). The critical question is whether the newer indicators add sufficient information to justify replacing or augmenting brachial cuff blood pressure (BP) data in research and patient care. Historical context, pathophysiology of variations in pulse wave transmission and reflection, issues related to measurement and model errors, statistical limitations, and clinical correlations are presented, along with new comparative data. Based on this overview, there is no compelling scientific or practical reason to replace cuff SBP with any of the newer indicators in the vast majority of clinical situations. Supplemental value for central SBP may exist in defining patients with exaggerated PPA ("s...

- by Joseph Izzo
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- Hypertension, Clinical Sciences, Vascular Resistance, Brachial artery
- by Shelle Malkmus and +1
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- Kinetics, Locomotion, Pharmacokinetics, DISTRIBUTION

A comparison was made of arterial pressures measured invasively from a radial arterial cannula and non-invasively from the middle finger using the 2300 Finapres (Ohmeda) during induction and maintenance of anaesthesia. Digital outputs of both pressures were captured directly onto computer hard disk; data recorded during flushing of the arterial line were excluded from analysis. We studied 53 patients undergoing cardiac, major vascular and neurosurgical procedures; 17705 comparisons of systolic, diasto/ic and mean pressure were analysed. Overall correlations between Finapres and invasive pressures were poor (r = 0.82, 0.68 and 0.78 for systolic, diastolic and mean pressures, respectively). The Finapres exhibited a high level of accuracy and precision in some recordings. However, patient data sets showed marked variability in average pressure differences (invasive minus Finapres) when examined individually or grouped by operation type. Unexplained variations in pressure difference with time and absolute pressure were observed also. Whilst providing useful beat-to-beat information on arterial pressure trends, the Finapres cannot be recommended as a universal substitute for invasive arterial pressure monitoring.

- by Douglas McNair
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- Blood Pressure, Regression Analysis, Clinical Sciences, General Anesthesia

Psychological procedures, such as self-hypnosis in the form of autogenic training, have been proposed for correcting a deviant, e.g., high blood pressure (BP). In view of the overwhelming evidence for the circadian (CD) stage dependence of any treatment effects, the CD stage dependence of the effects of diaphragmatic breathing (DB) on BP and heart rate (HR) was explored in data from a clinically healthy normotensive subject who, following 3 weeks of ambulatory monitoring as a reference standard, measured BP and HR with a manual monitor at 1-min intervals for 5 min before and after DB (three deep diaphragmatic breaths) and who performed DB for about 2 weeks at about 2-h intervals while awake. The 3-week data series were analyzed by cosinor, involving the least-squares fit of cosine curves with periods of 24, 12 and 168 h. A CD rhythm was detected for BP and HR (P < 0.001 in each case), peaking in the afternoon. Some about-weekly (circaseptan; CS) BP rhythms and 12-h (circasemidian) components were also statistically significant. DB was found to reduce systolic (S) BP. Overall, SBP decreased by 5.9 ± 0.8 mmHg (P < 0.001) and diastolic (D) BP by 1.4 ± 0.8 mmHg (P < 0.005), while HR remained at about the same average. The effect of DB on BP was CD-dependent, the largest response occurring in the afternoon, 2-3 h before the peaks in SBP and DBP found in the reference data of the same subject. There was also a 5-10% decrease in SBP around the weekend (Friday, Saturday and Sunday). The results on a single subject suggest the need to collect similar data on others for optimizing by clock-hour, day of the week, and eventually by the marker rhythms BP and/or HR the best times for DB and other procedures. The personalized best time for people on different work/rest schedules for relaxation may be several hours before their BP has reached its highest point in the 24-h span. HR may serve as a marker for DB timing, but the effect on HR of DB was only of borderline statistical significance in the subject investigated.

- by Germaine Cornélissen
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- Chronobiology, Biomedicine, Japan, Adolescent

Abstract--With a new oscillometric method equipped with a transmittance infrared photoelectric plethysmograph, indirect systolic and mean arterial pressures were measured in 12 normotensive and hypertensive subjects with systolic and mean... more

- by Ken-ichi Yamakoshi
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- Biomedical Engineering, Hypertension, Blood Pressure, Infrared
- by Luisa Prechtl
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- Nursing, Critical Care Medicine, Germany, Prospective studies

Objective: Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease. Methods: In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC Solver  algorithm and were compared with previously established percentiles. Results: The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02). Conclusion: Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.

- by Journal einstein (São Paulo) and +1
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- Adolescent, Child, Cardiovascular Diseases, Arterial pressure

The role of magnesium (Mg) in the pathophysiology and treatment of primary hypertension has been recently identified. To evaluate the effects of Mg supplementation on mild hypertension and quality of life, 83 patients were randomly assigned to receive either placebo (n = 41) or Mg (n = 42) after a placebo run-in phase of 4 weeks. The patients in the Mg group received 266 mg oral Mg oxide daily. All patients underwent periodic measurements of blood pressure (BP) and heart rate and 24-hour noninvasive BP monitoring at the start and end of the study. Serum and urinary electrolytes were also evaluated. To analyze quality of life, all patients completed the questionnaire. Treatment was administered and the measurements of BP were performed in a double-masked fashion. Data demonstrated a significant reduction in systolic BP values at It-week follow-up in patients treated with Mg compared with both the pretreatment values and the values in the placebo group, whereas no difference was found in diastolic pressure. The 24-hour noninvasive monitoring of BP showed no significant differences between the two groups in systolic and diastolic values. The analysis of the questionnaire demonstrated a lower score (indicating a good quality of life) with a Like&type scale at 12-week follow-up in the Mg group (67.58 f 5) than in the placebo group (73.23 f 8), with a corresponding significant improvement in psychosocial variables, general well-being, and work status. A significant difference was also found in the treatment group when the values at follow-up were compared with those at baseline ('73.58 f 6). These results show that Mg oxide positively influences the quality of life, although it exercises only a weak action on arterial BP.

- by Massimo Chello
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- Quality of life, Treatment, Magnesium, Hemodynamics

Background. Hypertension is common, and arterial pressure rhythms are impaired in patients with chronic kidney disease (CKD). Emerging evidence suggests that consideration of excretory function together with proteinuria may provide a more holistic assessment of the extent of derangement in renal function. Methods. To evaluate the independent relationships of estimated GFR and proteinuria with the mean level of and the circadian variation in blood pressure, we evaluated 336 patients, 184 (55%) patients with CKD (eGFR <60 or urine protein/creatinine >0.22) and 152 (45%) without CKD. Results. The mean level of systolic and diastolic BP increased with increasing severity of proteinuria as well as with increasing impairment in GFR. When proteinuria and eGFR were considered together in the same regression model, proteinuria-not eGFR-was related to the severity of hypertension. Non-dipping was present in 52% of those with eGFR >60 and 55% in those with no proteinuria. Non-dipping was seen early in the course of impaired GFR or proteinuria. Adjusted for proteinuria, the odds ratio for non-dipping in those with CKD was 1.71 (95% CI 1.03-2.84, P = 0.036). The odds ratio for non-dipping in those with proteinuria was 1.75 (95% CI 1.00-3.08, P = 0.049) when adjusted for CKD. A cosinor model that evaluates the midline estimating statistic of rhythm (MESOR) and circadian variation revealed that proteinuria was a stronger determinant of MESOR compared to the CKD stage; the CKD stage in addition to proteinuria did not further add to the determination of MESOR. The amplitude of variation was markedly blunted in patients with the earliest stages of derangement in kidney function whether it was assessed by proteinuria or eGFR. Conclusions. These results demonstrate a graded relationship of proteinuria and eGFR with the mean level of BP and a non-graded relationship with circadian variation. Consideration of these two simple tests of renal function may better assist in gauging the severity of hypertension in patients with CKD.

- by Rajiv Agarwal
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- Prospective studies, Blood Pressure, Circadian Rhythm, Clinical Sciences

In earlier studies we found that the threeelement windkessel, although an almost perfect load for isolated heart studies, does not lead to correct estimates of the total arterid paranieters such as the aortic characteristic impedance and total arterial compliance. To overcome this problem we add a fourth element, the total arterial inertance, to the three-element windkessel. The three-and four-element windkessels were tested against an extended model of the systemic circulation. The four-element windkessel described arterial pressure and flow most accurately and the estimated lumped parameters were typically within 10% of the actual values of the arterial system. The three-and four element windkessel model were also fit to in vivo human aortic pressure and flow waves. Again, the four-element windkessel fitted better and the estimated arterial parameter values were closer to values obtained with standard methods.

- by Jean-jacques Meister
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- Cardiology, Arterial pressure

Objective-It is not established whether nocturnal non-dipping of heart rate predicts future cardiovascular disease. We performed this study to test the hypothesis that nocturnal non-dipping of heart rate predicts the risk of incident cardiovascular disease (CVD) independent of nocturnal BP dipping pattern. Methods-Ambulatory blood pressure monitoring was performed in 457 uncomplicated patients, who were being treated or evaluated for hypertension. They were followed for an average of 72 ± 26 months. Non-dipping heart rate was defined as a night/day heart rate ratio greater than 0.90. We chose two outcomes for this analysis: CVD events (defined as stroke, myocardial infarction, or sudden cardiac death), and all-cause mortality. Cox regression analyses (stepwise method) were used to estimate hazard ratios and their 95%CI, after adjusting for covariates. Results-In univariate analysis, increased sleep heart rate and non-dipping of heart rate were associated with increased risk of CVD and all-cause mortality, but awake heart rate was not. In multivariable analyses, heart rate non-dipping status significantly predicted an increased risk of CVD events (hazard ratio=2.37, 95%CI=1.22-4.62, P=0.01), but not for all-cause mortality. Increased 24-hour heart rate was significantly associated with increased risk of all cause mortality (hazard ratio=1.67, 95%CI=1.11-2.51, P=0.01). Conclusions-The risk of future CVD was shown to be 2.4 times as great in those whose heart rate does not exhibit the typical nocturnal decline. The relationship was independent of nondipping of SBP and did not dependent on diabetes status or BP level.

- by Joseph Schwartz
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- Medicine, Prospective studies, Hypertension, Blood Pressure

Introduction.-Contrairement aux effets systémiques de la corticothérapie générale qui sont bien connus, ceux des infiltrations locales de glucocorticoïdes sont peu étudiés. Le but de notre étude est de rechercher les effets systémiques des infiltrations de glucocorticoïdes et de comparer ces effets chez les sujets diabétiques et non diabétiques et selon le siège. Méthodes.-Notre étude a porté sur 29 patients (11 hommes et 18 femmes, âgés de 18 à 86 ans). Dix-huit souffraient de sciatique discale (quatre diabétiques et 14 non-diabétiques) et ont bénéficié de trois infiltrations épidurales de 1,5 ml de cortivazol (soit 5,625 mg de cortivazol, équivalant à 85 mg de prednisone) espacées de trois jours (soit un total d'environ 250 mg d'équivalent prednisone). Onze souffraient de capsulite rétractile (huit diabétiques et trois non-diabétiques) et ont également bénéficié de trois injections d'une même quantité de cortivazol en intraarticulaire, espacées de trois jours (soit un total d'environ 250 mg d'équivalent prednisone). Parmi les patients diabétiques, 16,6 % requéraient une insulinothérapie. Avant la première infiltration (j0), puis à j1, j7 et j21 après la troisième infiltration, nous avons réalisé les examens de laboratoire suivants : cortisolémie et ACTH plasmatique le matin à 8 h, cortisol libre urinaire (CLU) de 24 heures, glycémie à jeun et postprandiale, cholestérol, triglycérides, natrémie et kaliémie. Les patients ont bénéficié d'une mesure de la pression artérielle à chaque visite. Résultats.-La pression artérielle systolique moyenne des 29 patients a cru de manière significative entre j0 (123 ± 10 mmHg), et tant j1 (127 ± 9 mmHg), que j7 (128 ± 10 mmHg). La glycémie post-prandiale des 29 patients a également cru de manière significative entre j0 (7,5 ± 2,9 mmol/l) et j1 (10,1 ± 5,4 mmol/l). Toutefois, les changements sont restés minimes pour les variations tensionnelles, avec un retour à la normale à j21, y compris dans le groupe des diabétiques. En revanche, les variations de glycémie ont été plus marquées et plus durables chez les 12 diabétiques, avec persistance d'une élévation significative de la glycémie post-prandiale à j7 (encore à 13,9 ± 4,8 versus 9,4 ± 3,3 mmol/l à j0). Dans la population générale d'étude et dans les différents groupes, un effondrement de la cortisolémie, de l'ACTH et du CLU à j1 et j7, et se poursuivant à j21, a été observé, sauf dans le groupe infiltrations intra-articulaires, nous avons noté une normalisation plus précoce de la cortisolémie et de l'ACTH à j21. Aucune variation significative n'a été notée pour la glycémie à jeun, la triglycéridémie, la cholestérolémie, la natrémie, la kaliémie et la pression artérielle diastolique.

- by Mongi Touzi
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- Treatment, Glucocorticoids, Arterial pressure

Based on the results of a randomized controlled trial, we examined a model of the mechanisms of efficacy of culturally adapted cognitive-behavior therapy (CBT) for Cambodian refugees with pharmacology-resistant posttraumatic stress disorder (PTSD) and comordid orthostatic panic attacks (PAs). Twelve patients were in the initial treatment condition, 12 in the delayed treatment condition. The patients randomized to CBT had much greater improvement than patients in the waitlist condition on all psychometric measures and on one physiological measure-the systolic blood pressure response to orthostasis (d = 1.31)-as evaluated by repeated-measures MANOVA and planned contrasts. After receiving CBT, the Delayed Treatment Group improved on all measures, including the systolic blood pressure response to orthostasis. The CBT treatment's reduction of PTSD severity was significantly mediated by improvement in orthostatic panic and emotion regulation ability. The current study supports our model of the generation of PTSD in the Cambodian population, and suggests a key role of decreased vagal tone in the generation of orthostatic panic and PTSD in this population. It also suggests that vagal tone is involved in emotion regulation, and that both vagal tone and emotion regulation improve across treatment.

- by Stefan G Hofmann
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- Cambodia, Stress, Treatment Outcome, Emotion Regulation

Objective: The saphenous vein subjected to arterial pressure stretches to its elastic limits and constitutes intimal hyperplasia. Sheathing of the vein graft with pressure-resistant tubing might prolong vein graft patency. Methods: Twenty-one sheep received radial vein grafts or hybrid grafts composed of radial vein, collagen fibrin glue and highly flexible torlen/dacron mesh tubing transplanted into the carotid artery position. Veins were examined with the use of light and electron microscopy. Proliferating cell antigen (Ki-67) stains served as markers of proliferation. Results: The mean wall thickness of both intimal and medial layers was evaluated. The mean intimal wall thickness was 19^11 mm in hybrid grafts vs. 24^7 mm in unsheathed grafts (P , 0:001); 22^6 vs. 26^10 mm (P , 0:001); 23^8 vs. 52^15 mm (P , 0:001); 37^21 vs. 90^31 mm (P , 0:001); 57^31 vs. 104^28 mm (P , 0:001); 58^21 vs. 133^32 mm (P , 0:001); and 72^22 vs. 244^100 mm (P , 0:001) after respectively 5 days, 9 days, 4 weeks, 6 weeks, 8 weeks, 10 weeks and 12 weeks from implantation. Electronic microscope examination of hybrid grafts revealed a smooth endothelial layer with intact nuclei and an intima composed of layers of collagen and muscle fibers. In unsheathed grafts endothelial edema and nuclear destruction were observed. Conclusions: The external vein graft support with mesh tubing reduces intimal and medial layer thickening and cell proliferation in composite vein grafts transplanted in the arterial position.

- by Michał Krejca
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- Electron Microscopy, Stents, Cell Division, Sheep

The role of spironolactone in resistant hypertension management is unclear. The aim of this prospective trial was to evaluate the antihypertensive effect of spironolactone in patients with true resistant hypertension diagnosed by ambulatory blood pressure monitoring. A total of 175 patients had clinical and complementary exams obtained at baseline and received spironolactone in doses of 25 to 100 mg/d. A second ambulatory blood pressure monitoring was performed after a median interval of 7 months. Paired Student t test was used to assess differences in blood pressure before and during spironolactone administration, and multivariate analysis adjusted for age, sex, and number of antihypertensive drugs to assess the predictors of blood pressure fall. There were mean reductions of 16 and 9 mm Hg, respectively, in 24-hour systolic and diastolic blood pressures (95% CIs: 13 to 18 and 7 to 10 mm Hg; PϽ0.001). Office systolic blood pressure and diastolic blood pressure also decreased (14 and 7 mm Hg). Controlled ambulatory blood pressure was reached in 48% of patients. Factors associated with better response were higher waist circumference, lower aortic pulse wave velocity, and lower serum potassium. No association with plasma aldosterone or aldosterone:renin ratio was found. Adverse effects were observed in 13 patients (7.4%). A third ambulatory blood pressure monitoring performed in 78 patients after a median of 15 months confirmed the persistence of the spironolactone effect. In conclusion, spironolactone administration to true resistant hypertensive patients is safe and effective in decreasing blood pressure, especially in those with abdominal obesity and lower arterial stiffness. Its addition to an antihypertensive regimen as the fourth or fifth drug is recommended. (Hypertension. 2010;55:147-152.

- by Fábio Souza
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- Linear models, Multivariate Analysis, Prospective studies, Hypertension

Objective: Soluble fms-like tyrosine kinase (sFlt)-1-e15a, a primate-specific sFlt-1-isoform most abundant in the human placenta in preeclampsia, can induce preeclampsia in mice. This study compared the effects of full-length human (h)sFlt-1-e15a with those of truncated mouse (m)sFlt-1(1-3) used in previous preeclampsia studies on pregnancy outcome and clinical symptoms in preeclampsia.

- by Nandor Gabor Than
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- Engineering, Physics, Chemistry, Biology

The rostral ventromedial medulla (RVMM) is a sympathoexcitatory area. However, little is known about its efferent projections. In this study, biotinylated dextran amine (BDA) or Phaseolus vulgaris leucoagglutinin (PHA-L) were used to investigate the medullary and spinal cord projections from pressor sites in RVMM. Initially, RVMM was systematically explored in urethane-anesthetized rats using microinjection of L-glutamate for sites that elicited increases in arterial pressure. A pressor area was identified that included the rostral magnocellular reticular and rostral lateral paragigantocellular reticular nuclei. In the second series of experiments, BDA or PHA-L was iontophoretically injected into RVMM pressor sites. Anterograde labeling was observed throughout the brainstem and spinal cord, bilaterally, but with an ipsilateral predominance. Dense labeling was observed within the nucleus of the solitary tract (NTS); the greatest density of labeling was observed in the caudal dorsolateral, medial, and ventrolateral subnuclei. Additionally, light to moderately dense labeling was found within the nucleus substantia gelatinosus and commissural nucleus. In the nucleus ambiguus/ventrolateral medullary (Amb/VLM) region, the density of labeling was greatest in caudal regions. Within Amb, most of the labeling was localized to its external formation. Anterograde labeling was also found throughout the spinal cord. In the thoracolumbar segments, dense axonal labeling was observed within the dorsolateral funiculus. These labeled axons innervated the intermediolateral nucleus and the central autonomic area. Taken together, these data suggest that RVMM neurons elicit increases in sympathetic activity by likely providing a direct excitatory input to spinal sympathetic preganglionic neurons, and by a direct inhibitory input to medullary cardioinhibitory and depressor areas.

- by John Ciriello
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- Zoology, Brain Mapping, Blood Pressure, Spinal Cord

Previous research suggests that the experience of abuse and neglect in childhood has negative implications for physical health in adulthood. Using data from the Minnesota Longitudinal Study of Risk and Adaptation (N = 115), the present research examined the predictive significance of childhood physical abuse, sexual abuse, and physical/cognitive neglect for multilevel assessments of physical health at midlife (age 37-39 years), including biomarkers of cardiometabolic risk, self-reports of quality of health, and a number of health problems. Analyses revealed that childhood physical/cognitive neglect, but not physical or sexual abuse, predicted all three health outcomes in middle adulthood, even when controlling for demographic risk factors and adult health maintenance behaviors. We discuss possible explanations for the unique significance of neglect in this study and suggest future research that could clarify previous findings regarding the differential impact of different types of a...

- by Michelle Englund
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- Cognitive Science, Health Behavior, Adolescent, Metabolic syndrome

We have attempted to synthesize findings dealing with four types of respiratory system influences on sympathetic outflow in the human. First, a powerful lung volume-dependent modulation of muscle sympathetic nerve activity (MSNA) occurs within each respiratory cycle showing late-inspiratory inhibition and late-expiratory excitation. Secondly, in the intact human, neither reductions in spontaneous respiratory motor output nor voluntary near-maximum increases in central respiratory motor output and inspiratory effort, per sec, influence MSNA modulation within a breath, MSNA total activity or limb vascular conductance. Thirdly, carotid chemoreceptor stimuli markedly increase total MSNA; but most of the MSNA response to chemoreceptor activation appears to be mediated independently of increased central respiratory motor output. Fourthly, repeated fatiguing contractions of the diaphragm or expiratory muscles in the human show a metaboreflex mediated time-dependent increase in MSNA and reduced vascular conductance and blood flow in the resting limb. Recent evidence suggests that these respiratory influences contribute significantly to sympathetic vasomotor outflow and to the distribution of systemic vascular conductances and blood flow in the exercising human.

- by Claudette Croix
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- Electrophysiology, Respiratory Physiology, Medicine, Hemodynamics
- by RONALD M HARPER
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- Endocrinology, Genetics, Cardiology, Hematology

Objective-Data from the Multiple Risk Factor Intervention Trial (MRFIT) show an independent direct association between starch intake and blood pressure (BP) in American men at higher risk of coronary heart disease (CHD). Cross-sectional INTERMAP data were used to assess relations of dietary starch intake to BP in men and women from four countries. Methods-Data include 83 nutrients from four multi-pass 24-h dietary recalls and two timed 24h urine collections; eight BP readings; and questionnaire data, for 4,680 participants ages 40-59 yr from 17 population samples in Japan, People's Republic of China, United Kingdom, and United States of America. Results-In multiple linear regression analyses-adjusted for urinary sodium, urinary potassium, consumption of alcohol, cholesterol, saturated fatty acids, polyunsaturated fatty acids, calcium, and other variables-starch intake higher by two standard deviations (14.1% kJ) was associated with systolic/diastolic BP differences of −1.0/−0.9 mm Hg (p =0.09, p <0.05). Results were similar with additional control for fibre, magnesium, or phosphorus; reduced to −0.5/−0.7 mm Hg (p =0.47, p =0.13) with separate adjustment for vegetable protein. Findings were similar for all INTERMAP men, for American men, and for American men at higher CHD risk.

- by Chiang-Ching Huang
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- Epidemiology, Life Sciences, Starch, Medicine

Both antioxidant supplementation and exercise training have been identified as interventions which may reduce oxidative stress and thus improve cardiovascular health, but the interaction of these interventions on arterial BP (blood pressure) and vascular function has not been studied in older humans. Thus in six older (71±2 years) mildly hypertensive men, arterial BP was evaluated non-invasively at rest and during small muscle mass (knee-extensor) exercise with and without a pharmacological dose of oral antioxidants (vitamins C and E, and α-lipoic acid). The efficacy of the antioxidant intervention to decrease the plasma free radical concentration was verified via EPR (electron paramagnetic resonance) spectroscopy, while changes in endothelial function in response to exercise training and antioxidant administration were evaluated via FMD (flow-mediated vasodilation). Subjects were re-evaluated after a 6-week aerobic exercise training programme. Prior to training, acute antioxidant a...

- by A. Uberoi
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- Free Radicals, Evolution, Medicine, Free Radical
- by Timothy Moss
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- Cognitive Science, Carbon Dioxide, Aging, Birth Weight
- by George Taffet
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- Aging, Medicine, Growth Hormone, Mice

Implementation barriers for extracorporeal life support in out-of-hospital cardiac arrest (OHCA) include initiation delay and candidate selection. We explored ischemia duration, cardiopulmonary resuscitation (CPR) duration, and physiologic variables that discriminated animals with return of spontaneous circulation (ROSC). We instrumented eight female swine (31.9 +/- 9.8 kg) with femoral artery and external jugular vein cannula. After 8 (n = 4) or 15 (n = 4) minutes ventricular fibrillation (VF), animals received 30, 40, 50, or 60 minutes of CPR and then drugs (.6 U/kg vasopressin, .1 mg/kg epinephrine, .1 mg/kg propranolol, sodium bicarbonate as indicated) after 5 minutes of CPR. Extracorporeal membrane oxygenation (ECMO) flow rate was 3 L/min < or =2 hours and then 1.5 L/min < or =2 hours before weaning. Animals were defibrillated (150 J biphasic) > or =15 minutes ECMO. Primary outcome for successful resuscitation was ROSC (organized rhythm with systolic blood pressure &gt...

Although sauna bathing causes various acute, transient cardiovascular and hormonal changes, it is well tolerated by most healthy adults and children. Sauna bathing does not influence fertility and is safe during the uncomplicated pregnancies of healthy women. Some studies have suggested that long-term sauna bathing may help lower blood pressure in patients with hypertension and improve the left ventricular ejection fraction in patients with chronic congestive heart failure, but additional data are needed to confirm these findings. The transient improvements in pulmonary function that occur in the sauna may provide some relief to patients with asthma and chronic bronchitis. Sauna bathing may also alleviate pain and improve joint mobility in patients with rheumatic disease. Although sauna bathing does not cause drying of the skin-and may even benefit patients with psoriasis-sweating may increase itching in patients with atopic dermatitis. Contraindications to sauna bathing include unstable angina pectoris, recent myocardial infarction, and severe aortic stenosis. Sauna bathing is safe, however, for most people with coronary heart disease with stable angina pectoris or old myocardial infarction. Very few acute myocardial infarctions and sudden deaths occur in saunas, but alcohol consumption during sauna bathing increases the risk of hypotension, arrhythmia, and sudden death, and should be avoided.

- by Samer Ellahham
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- Fertility, Complication, Congestive Heart Failure, Blood Pressure

Background and aims: Hypovolemia after bowel preparation as well as capnoperitoneum (CP) may compromise hemodynamic function during laparoscopic colonic surgery. A fall in arterial pressure after induction of anesthesia is often answered by generous fluid administration, which might impair "fast-track" rehabilitation. Intraoperative assessment of the needed infusion volume is difficult because of a lack of data regarding the volume status in these patients. Patients and methods: Nineteen patients scheduled for laparoscopic colonic surgery after bowel preparation were prospectively monitored using the PULSION COLD Z-021 system and central venous catheter. Intrathoracic blood volume index (ITBVI), mean arterial pressure (MAP), cardiac index (CI), central venous pressure (CVP), and heart rate (HR) were measured after induction of anesthesia (M1), during CP in head-down position with an intra-abdominal pressure (IAP) of 20 mmHg (M2) and 12 mmHg (M3). Results: Although MAP (87 mmHg), HR (64 min −1), and CVP (8 mmHg) were within normal ranges at the induction of surgery, ITBVI (834 ml m −2), and CI (2.66 l m −2) were decreased, indicating a relative hypovolemia. CP with 12 mmHg increased ITBVI (p<0.05) and CI (p<0.01), while an IAP of 20 mmHg reduced CI (p<0.05) compared to 12 mmHg (M3). Mean infusion during the measurements was 1,355 ml. Conclusion: Combination of CP with 12 mmHg, head-down position, and infusion of 1,500 ml fluids compensated relative hypovolemia during colonic surgery. With conventional monitoring, intravascular volume status might be underestimated after traditional preoperative care.

- by Oliver Haase
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- Demography, Surgery, Gastroenterology, Hemodynamics

Hydroxylation of 25(OH)D to 1,25-dihydroxyvitamin D and signaling through the vitamin D receptor occur in various tissues not traditionally involved in calcium homeostasis. Laboratory studies indicate that 1,25-dihydroxyvitamin D suppresses renin expression and vascular smooth muscle cell proliferation; clinical studies demonstrate an inverse association between ultraviolet radiation, a surrogate marker for vitamin D synthesis, and blood pressure. We prospectively studied the independent association between measured plasma 25-hydroxyvitamin D [25(OH)D] levels and risk of incident hypertension and also the association between predicted plasma 25(OH)D levels and risk of incident hypertension. Two prospective cohort studies including 613 men from the Health Professionals’ Follow-Up Study and 1198 women from the Nurses’ Health Study with measured 25(OH)D levels were followed for 4 to 8 years. In addition, 2 prospective cohort studies including 38 388 men and 77 531 women with predicted ...

- by Heike Bischoff-ferrari
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- Epidemiology, Calcium, Comparative Study, Blood Pressure

Sympathetically mediated renal vasoconstriction may contribute to the pathogenesis of hypertension in older adults, but empirical data in support of this concept are lacking. In 10 young (26 ± 1 yr) and 11 older (67 ± 2 yr) subjects, we quantified acute hemodynamic responses to three sympathoexcitatory stimuli: local cooling of the forehead, cold pressor test (CPT), and voluntary apnea. We hypothesized that all stimuli would increase mean arterial blood pressure (MAP) and renal vascular resistance index (RVRI) and that aging would augment these effects. Beat-by-beat MAP, heart rate (HR), and renal blood flow velocity (from Doppler) were measured in the supine posture, and changes from baseline were compared between groups. In response to 1°C forehead cooling, aging was associated with an augmented MAP (20 ± 3 vs. 6 ± 2 mmHg) and RVRI (35 ± 6 vs. 16 ± 9%) but not HR. In older adults, there was a positive correlation between the cold-induced pressor response and forehead pain (R = 0.7...

- by JL Mast
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- Pain, Aging, Medicine, Biological Sciences

Introducción y desarrollo. Durante el sueño, el control de la respiración pasa de ser un acto semivoluntario a convertirse en una actividad de autorregulación de máxima prioridad biológica. Los trastornos respiratorios del sueño se centran en el síndrome de apnea/ hipopnea obstructiva del sueño generalmente asociado a roncopatía. El mecanismo fundamental causante del trastorno es el fallo de la dilatación tónica de los músculos faríngeos durante el sueño, aunque hay factores contribuyentes como la obesidad y la micrognatia; que ocasionan anoxia transitoria. La prevalencia de la apnea del sueño (apnea-hipopnea) en la población general se ha fijado entre el 2-4% en mujeres y el 4-8% en hombres. La apnea del sueño eleva la presión arterial, aumenta el riesgo de enfermedad cardiovascular y cerebrovascular, causa somnolencia excesiva y disminuye la calidad de vida de los pacientes que la sufren. Conclusiones. La polisomnografía permite el diagnóstico de apnea del sueño y da paso al tratamiento con aparatos de presión positiva de la vía aérea, que es el método más eficaz y generalizado de tratamiento. Existe evidencia creciente de que el tratamiento sostenido de la apnea del sueño disminuye el riesgo de complicaciones vasculares, además de mejorar la calidad de vida y disminuir la somnolencia diurna. Palabras clave. Apnea del sueño. Somnolencia excesiva. Roncopatia. Summary. Introduction and development. During sleep, control of breathing shifts from being a semi-voluntary action to become a self-regulation activity of the highest biological priority. The most frequent breathing disorders during sleep are related to obstructive of sleep apnea hipopnea syndrome, generally associated to snoring. The fundamental mechanism cause of the upheaval is the failure of the tonic expansion of faríngeos muscles during the dream, although micrognatia are factors contributors like the obesity; that they cause transitory anoxia. The prevalence of sleep apnea (apnea-hypopnea) in the general population has been, estimated to be between 2-4% in females and 4-8% in males. Sleep apnea raises arterial pressure, increases the risk of cardiovascular and cerebrovascular disease, causes excessive sleepiness and diminishes the quality of life of patients affected by it. Conclusions. Polysomnography allows sleep apnea to be diagnosed so that treatment can then be started using continuous positive airway pressure devices, which is the most effective and widespread form of treatment. There is a growing body of evidence to suggest that sustained treatment of sleep apnea lowers the risk of vascular complications, as well as improving the quality of life and reducing daytime sleepiness Key words. Sleep apnea. Excessive sleepiness. Snoring.

- by Rosalia Hernandez
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- Quality of life, Sleep Apnea, Cerebrovascular Disease, General Population

Background: Arterial hypertension and dyslipidemia are modifiable cardiovascular risk factors. The multiplicative effect of these risk factors may worsen the atherogenic index of an individual. The objective of this study was to determine the pattern and prevalence of dyslipidemia in newly presenting Nigerians with arterial hypertension, as well as determine some of its correlates. Methods: This cross-sectional study compared 115 newly presenting, age-and sex-matched individuals with arterial hypertension with 115 normotensive individuals. Fasting lipids, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting plasma glucose were estimated. Results: Patients with arterial hypertension had higher body mass index (t=7.64; P=0.000), TC (t=2.95; P=0.006), and HDL-C (t=-5.18; P=0.000). The most common dyslipidemia was low HDL-C, found in both the hypertensive (44.3%) and normotensive (20.9%) patients. The prevalence of dyslipidemia in hypertensives and controls was 64% and 39%, respectively. In hypertensive patients, TC correlated positively to diastolic blood pressure (r=0.218; P=0.0019). other positive correlates include LDL-C and age (r=0.217; P=0.020) and fasting plasma glucose (r=0.202; P=0.030) and body mass index (r=0.209; P=0.025). Among normotensive controls, TC correlated positively with LDL-C (r=0.63; P=0.000) but correlated negatively with tri glycerides (r=-0.30; P=0.001). Conclusion: Lipid abnormalities are common in newly presenting Nigerians with arterial hypertension. Screening of these risk factors, promotion of healthy lifestyle, and the institution of therapy is desirable to reduce their multiplicative effects.

- by Aisha Abubakar Abdullahi
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- Nigeria, Lipids, Hypertension, Risk factors

Sustained hypertension induces renovascular remodeling by altering extracellular matrix (ECM) components. Matrix metalloproteinases (MMPs) are Zn-dependent enzymes that regulate ECM turnover in concert with their inhibitors, tissue inhibitors of metalloproteinases, TIMPs. Increased MMP-2 & -9 have been implicated in hypertensive complications; however, the contribution of individual MMPs/TIMPs in renal remodeling has not been fully elucidated. The purpose of this study was to determine the effect of TIMP2 deficiency and thus MMP-2 on Ang-II induced renal remodeling. C57BL/6J (WT) and TIMP2 knockout mice were infused with Angiotensin-II (Ang-II) at 250 ng. kg -1 . min -1 for 4 weeks. Blood pressure was measured weekly and end-point laser Doppler flowmetry was done to assess cortical blood flow. Immunohistochemical staining was performed for collagen and elastin analyses. The activity of MMP-9, and -2 was determined by Gelatin zymography. Ang-II induced similar elevation in mean blood pressure in TIMP2 -/and WT mice. In TIMP2 -/mice, Ang-II treatment was associated with a greater reduction in renal cortical blood flow and barium angiography demonstrated decreased vascular density compared to Ang-II treated WT mice. Peri-glomerular and vascular collagen deposition was increased and elastin content was decreased causing increased wall-to-lumen ratio in TIMP2 -/mice compared to WT mice receiving Ang-II. Ang-II increased the expression and activity of MMP-9 predominantly in TIMP2 -/mice than in WT mice. These results suggest that TIMP2 deficiency exacerbates renovascular remodeling in agonist induced hypertension by a mechanism which may, in part, be attributed to increased activity of MMP-9.

- by Eleanor Lederer
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- Kidney, Hypertension, Collagen, Mice

Markers of temporal changes in central blood volume are required to non-invasively detect hemorrhage and the onset of hemorrhagic shock. Recent work suggests that pulse pressure may be such a marker. A new approach to tracking blood pressure, and pulse pressure specifically is presented that is based on a new form of pulse pressure wave analysis called Pulse Decomposition Analysis (PDA). The premise of the PDA model is that the peripheral arterial pressure pulse is a superposition of five individual component pressure pulses, the first of which is due to the left ventricular ejection from the heart while the remaining component pressure pulses are reflections and re-reflections that originate from only two reflection sites within the central arteries. The hypothesis examined here is that the PDA parameter T13, the timing delay between the first and third component pulses, correlates with pulse pressure.T13 was monitored along with blood pressure, as determined by an automatic cuff a...

- by Anita Cote
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- Physics, Medicine, Biomedical, Blood Pressure

The members of the COHORTS group are listed in the Acknowledgements.

- by santosh bhargava
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- Epidemiology, Anthropometry, Biology, Developing Countries

Obesity is a complex disorder characterized by the accumulation of excess adipose tissue. Discovery of the hormone leptin in 1994 catalyzed the field of obesity research by demonstrating the existence of an afferent hormonal signal from adipose tissue to the central nervous system. Leptin the product of the ob gene is a proteohormone with a molecular mass of 16 kDa that is thought to play a key role in the regulation of body weight. Leptin increases energy expenditure by enhancing sympathic nervous activity and lypolysis. It also suppresses appetite by acting on the hypothalamus. In recent years the potential participation of leptin has been reported to increase arterial pressure and heart rate by peripherally or centrally mediated mechanisms. The finding that leptin is linked to heart disease risk, strongly suggests that fat may be important in heart disease risk. Leptin deficiency and resistance to the effects of leptin are each associated with weight gain. Leptin resistance is much more common than leptin deficiency in human obesity. There are receptors for leptin on the endothelium and on vascular smooth muscle cells. Accordingly, leptin can exert receptor mediated influence on vessel tone and growth. In cell culture, leptin stimulates vascular smooth muscle proliferation. Vascular calcification is also accelerate by leptin in experimental models. Additionally, leptin induces oxidative stress in endothelial cells. Accordingly, it is possible that the high level of leptin observed in obesity could contribute to its adverse effects on cardiovascular health. Diet and exercise have been shown to reduce leptin levels regardless of weight loss. Exercise training induced reduction in leptin levels have been attributed to alterations in energy balance, improvements in insulin sensitivity alterations in lipid metabolism and unknown factors. This article considers leptin function and the impact that exercise has on blood leptin concentrations.

- by N. Rahnama
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- Cell Culture, Adipose tissue, Heart rate, Energy Balance

The arterial baroreceptors are known to be sensitive to changes in pressure but there are no known sensors in the cardiovascular system for changes in flow. We tested the hypothesis that changes in flow at constant pressure alter carotid sinus multi-unit nerve activity. In anesthetized dogs with vascularly isolated carotid sinuses, increases in flow at constant pressure resulted in increases in carotid sinus nerve activity in relation to the increase in flow. The increased activity during flow was not caused by an increase in strain of the sinus wall but was directly related to the increase in shear stress (36.6 +/- 11.7% increase in activity per dyne/cm2; 1 dyne = 0.1 MN). The pressure threshold of single baroreceptor units was determined during a slow pressure ramp with and without flow. Flow caused a significant decrease in pressure threshold from 81.1 +/- 6.1 mmHg (1 mmHg = 1.333 x 10(2) Pa) in the absence of flow to 69.3 +/- 5.7 mmHg with flow. We conclude that there are arteri...

- by George Hajduczok
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- Rheology, Multidisciplinary, Dogs, Mechanoreceptors

Objective. To measure anthropometric indicators of body composition by electric bioimpedence, as well as physical activity, blood glucose and arterial pressure in rural people over 60 years of age. Material and methods. A total of 54 subjects over 60 years old were selected by intentional nonprobabilistic sampling. They were subjected to a standardized protocol to measure anthropometric indicators, body composition by electric bioimpedance (EBI), and physical activity was determined by an activity questionnaire. Arterial pressure and glucose tolerance levels were also measured. Analysis included Student's t test to detect differences by sex and the association of physical activity, body composition and other variables by simple linear regression and Pearson's correlation coefficient. Results. Physical activity correlated negatively with percent fat (r=-0.36; p= 0.007) and diastolic (r=-0.36; p= 0.006) and systolic blood pressure (r=-0.32; p= 0.018), and body mass index with post dose glucose (r= 0.31; p= 0.024). Conclusions. Physical activity in this age group may have a favorable impact with respect to the mentioned health indicators.

- by Heliodoro Mateo
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- Anthropometry, Physical Activity, Blood Glucose, Body Composition

Serum aldosterone is a causative factor for various metabolic and cardiovascular disorders. Low-density lipoprotein (LDL) is a major cholesterol source for aldosterone steroidogenesis; however, the effect of oxidative modification of LDL on aldosterone release is not known. We studied the effect of hypochlorite-oxidized LDL (oxLDL) on adrenal aldosterone secretion. LDL (native LDL (natLDL)) was obtained from healthy volunteers and oxidatively modified in vitro. NCI-H295R cells were stimulated with natLDL and oxLDL, and the aldosterone release was quantified by radioimmunoassay. Molecular changes were studied with western blot analysis and quantitative RT-PCR analysis. NatLDL and oxLDL caused dose-dependent increase in aldosterone release up to threefold. However, the stimulatory effects of modified LDL on aldosterone secretion decreased with increasing degree of LDL oxidation. 24-h incubations with natLDL, mild- and medium-oxidized LDL sensitized the adrenocortical cells to subseque...

- by Sarama Saha
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- RNA, STEROIDS, Western blotting, Cell line

The aim of this study was to evaluate pulmonary hypertension (PH) in 852 childhood-onset systemic lupus erythematosus (cSLE) patients. This was a large multicenter study conducted in 10 Pediatric Rheumatology Services of São Paulo state, Brazil. PH was defined as systolic pulmonary artery pressure [35 mmHg and/or measurement of the mean pulmonary artery pressure [25 mmHg and/or diastolic pressure [15 mmHg by transthoracic echocardiogram. Demographic data, clinical manifestations, disease activity score (SLEDAI-2K), disease damage score (SLICC/ACR-DI) and treatments were also evaluated. Statistical analysis was performed using Bonferroni correction (p \ 0.002). PH was observed in 17/852 (2%) cSLE patients. Effort dyspnea occurred in 3/17, chest pain in 1/17 and right ventricle dysfunction in 3/17 cSLE patients. None had pulmonary thromboembolism or antiphospholipid syndrome. Further comparison between 17 cSLE with PH and 85 cSLE control patients without PH with similar disease duration [15 (0-151) vs. 15 (0-153) months, p = 0.448], evaluated at the last visit, revealed higher frequencies of fever (47 vs. 9%, p \ 0.001), reticuloendothelial manifestations (41 vs. 7%, p \ 0.001) and serositis (35 vs. 5%, p = 0.001) in the former group. Frequencies of renal and neuropsychiatric involvements and antiphospholipid syndrome, as well as the median of SLEDAI-2K and SLICC/ACR-DI scores, were comparable in both groups (p [ 0.002). Normal transthoracic echocardiography was evidenced in 9/17 (53%), with median cSLE duration of 17.5 months (1-40) after PH standard treatment. PH was a rare manifestation of cSLE occurring in the first two years of disease. The majority of patients were asymptomatic with mild lupus manifestations. The underlying mechanism seemed not to be related to pulmonary thromboembolism and/or antiphospholipid syndrome.

- by Simone lotufo
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- Brazil, Adolescent, Pulmonary Hypertension, Pediatric Cardiology

Recently indicators associated with health-related physical fitness have been interpreted using criterion-referenced standards. A health-related criterion-referenced standard represents a desirable level to good health status and reduced disease risk that should be attainable by the adolescents. The present study was designed to evaluate the validity of the cutoff points associated with the Physical Best criterion-referenced standard in the identification of adolescents with and without cardiovascular disease risk factors. A total of 281 adolescents (157 girls and 124 boys) varying in age from 15 to 18 years was used in the study. Information on the health-related physical fitness was obtained by means of morphological indicators (body mass index and sum of two skinfolds: triceps and subscapular) and tests of motor performance (sitand-reach, sit-ups and mile run). Cardiovascular disease risk factors included body fat content, cardiorespiratory fitness, levels of arterial pressure and of plasma lipid-lipoprotein concentration. Estimates of sensitivity, specificity, positive predictive value and efficiency were used to describe the relative validity. The results showed that the sensitivity ranged approximately from 20% to 70%, and the specificity ranged from 30% to 85%. Morphological indicators may correctly identify three out of four adolescents with cardiovascular disease risk factors. Cutoff points associated with motor performance tests were characterized generally by low levels of sensitivity and corresponding high rates of false-negatives. In conclusion, the findings of study suggest that, independently of the cutoff points used, body mass index and sum of skinfold thickness were reasonable alternatives for cardiovascular disease risk factors screening in adolescents.

- by Decio Barbosa
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- Health Promotion, Cardiovascular disease, Medicine, Body Mass Index

Neurovascular coupling refers to the link between an increase in neural activity in response to a task and an increase in cerebral blood flow denoted “functional hyperemia.” Recent work on postural tachycardia syndrome indicated that increased oscillatory cerebral blood flow velocity (CBFv) was associated with reduced functional hyperemia. We hypothesized that a reduction in functional hyperemia could be causally produced in healthy volunteers by using oscillations in lower body negative pressure (OLBNP) to force oscillations in CBFv. CBFv was measured by transcranial Doppler ultrasound of the left middle cerebral artery. We used passive arm flexion applied during eight periodic 60-s flexion/60-s relaxation epochs to produce 120-s periodic changes in functional hyperemia (at 0.0083 Hz). We used −30 mmHg of OLBNP at 0.03, 0.05, and 0.10 Hz, the range for cerebral autoregulation, and measured spectral power of CBFv at all frequencies. Arm flexion power performed without OLBNP was comp...

- by Julian Stewart
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- Physiology, Medicine, Hemodynamics, Young Adult

Study objective: We determine the proportion of patients with increased emergency department (ED) blood pressure and no history of hypertension who have persistently increased blood pressure at home, describe characteristics associated with sustained blood pressure increase, and examine the relationship between pain and anxiety and the change in blood pressure after ED discharge. Methods: This was a prospective cohort study. Patients with no history of hypertension and 2 blood pressure measurements of at least 140/90 mm Hg who were treated in an urban ED were enrolled, provided with home blood pressure monitors, and asked to take their blood pressure twice a day for 1 week. Outcome measures were increased mean home blood pressure (140/90 mm Hg or greater), and correlations between ED anxiety (Spielberger State Anxiety Scale) or pain (10-point scale) and the change in blood pressure after discharge. Potential relevant predictors were recorded and a multivariate model was constructed to assess the relationship between these predictors and increased home blood pressure. Results: 189 patients were enrolled and 156 returned the monitors and completed the protocol. Increased mean home blood pressure was present in 79 of 156 (51%) patients and was associated with older age and being black. Of patients with ED blood pressures meeting criteria for stage I hypertension, 6% had home blood pressures meeting stage II hypertension, 36% stage I, and 52% prehypertension, and 6% had normal blood pressure For patients with ED blood pressures meeting stage II criteria, the corresponding percentages were 28%, 31%, 33%, and 8%, respectively. The difference between home and ED systolic blood pressures was not associated with anxiety (rϭ-.03; Pϭ.69) and showed a slight association with pain in the opposite direction from what was expected (rϭ.18; Pϭ.03). Conclusion: Patients without diagnosed hypertension and increased ED blood pressures often have persistently increased home blood pressures, which does not appear to be related to pain or anxiety in the ED.

- by james adams
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- Pain, Self Care, Anxiety, Multivariate Analysis

To provide a model close to the human heart, and to study intrinsic cardiac function at the same time as electromechanical coupling, we developed a magnetic resonance (MR)-compatible set-up of isolated working perfused pig hearts. Hearts from pigs (40kg, N=20) and sheep (N=1) were blood-perfused ex vivo in the working mode with and without loaded right ventricle (RV), for 80 minutes. Cardiac function was assessed i) by measuring left intraventricular pressure, and ii) left ventricular ejection fraction (LVEF), aortic and mitral valve dynamics, and native T1-mapping with MR imaging (1.5 Tesla). Potential myocardial alterations were assessed at the end of ex vivo perfusion from late-Gadolinium enhancement T1-mapping. The ex vivo cardiac function was stable across the 80 minutes of perfusion. Aortic flow and LV-dP/dtmin were significantly higher (P<0.05) in hearts perfused with loaded RV, without differences for heart rate, maximal and minimal LV pressure, LV-dP/dtmax, LVEF and kine...

- by Bruno Quesson
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- Physiology, Kinetics, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy