Arterial stiffness and subclinical aortic damage of reclassified subjects as stage 1 hypertension according to the new 2017 ACC/AHA blood pressure guidelines

VASA ◽  
2019 ◽  
Vol 48 (3) ◽  
pp. 236-243 ◽  
Author(s):  
Theodore G. Papaioannou ◽  
Evangelos Oikonomou ◽  
George Lazaros ◽  
Evangelia Christoforatou ◽  
Georgia Vogiatzi ◽  
...  

Abstract. Background: The 2017 ACC/AHA blood pressure (BP) guidelines generated controversies due to the new proposed BP cut-off values defining hypertension. We aimed to assess aortic stiffness of subjects who are reclassified as stage 1 hypertensive according to the new guidelines and compare them with the subjects of “elevated BP” category. Patients and methods. Data from the “Corinthia” study, an observational, cross-sectional survey of 2,043 participants were analyzed. Subjects were classified into 4 groups: group A: systolic pressure (SBP) 120–129 and diastolic pressure (DBP) < 80 mmHg, group B: SBP 130–139 or DBP 80–89 mmHg, group B1: SBP 130–139 and DBP < 80 mmHg and group B2: SBP 130–139 and DBP 80–89 mmHg. Aortic stiffness was assessed by carotid-to-femoral pulse wave velocity (PWV). A value of PWV > 10m/s was consider indicative of asymptomatic organ damage while values of PWV exceeded the 90 % percentile for each age group were consider as abnormal. Results: Groups B, B1 and B2 have significantly increased PWV compared to group A, independently from age and other risk factors (PWV: 9.2 ± 2.8 vs 9.4 ± 2.7 vs 8.6 ± 2.5 vs 8.1 ± 2.3 m/s, p < 0.01, respectively). The prevalence of PWV > 10 m/s and abnormal PWV values in group A was significantly lower than the corresponding prevalence in randomly selected, age-matched subjects from group B (13.5 % vs 24.4 %, p = 0.027 and 5.6 % vs 14.2 %, p = 0.022, respectively). Conclusions: The reclassified subjects as stage 1 hypertensive by the new guidelines have a significantly increased aortic stiffness and greater prevalence in asymptomatic aortic damage compared to subjects with elevated BP. This finding may indirectly explain the increased cardiovascular risk of this group.

2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Rivanli Polii ◽  
Joice N.A. Engka ◽  
Ivonny M. Sapulete

Abstract: Sodium is an extracellular fluid cation which is the highest in amount, 35-40% sodium (Na) is found in the body skeleton. The function of sodium is the regulation of fluid volume, the regulation of fluid balance, the regulation of osmolarity, and the regulation of blood pressure. Blood pressure is the force that is needed to keep the blood flowing inside the blood vessel and circulates to reach all the tissues in human body. Blood pressure consists of two components, the systolic pressure and diastolic pressure. According to the study conducted by Riset Kesehatan Dasar on 2007, it was found that the Natuna Islands (coastal areas) has the highest prevalence of hypertension, which is 53,3%, while the highlands of Jayawijaya has the lowest prevalence of hypertension, which is 6,8%. The North Bolaang Mongondow regency, especially West Bolangitang district is an area which is conditioned around the coastal areas. Adolescents, according to WHO, are those aged 12-24 years old. This was an analytical descriptive research is conducted with a cross sectional study design. Afterward, the collected datas are processed using the help of SPSS software. The population is all of the students in SMAN 1 Bolangitang Barat, North Bolaang Mongondow regency and the samples were collected with purposive sampling technique. The results showed that the number of respondents who follow the research were 60 students, consisting 16 boy and 44 girl by spearman’s correlation statistical test.This study shows no correlation between the levels of sodium and blood pressure on adolescents in West Bolangitang district North Bolaang Mongondow regency. Conclusion: there is no correlation between the levels of sodium and blood pressure on adolescents in West Bolangitang district, North Bolaang Mongondow regency. Keywords: sodium, blood pressure, adolescent Abstrak: Natrium ialah kation terbanyak dalam cairan ekstrasel , 35-40% natrium (Na) ada didalam kerangka tubuh. Fungsi natrium untuk mengatur volume cairan, mengatur keseimbangan cairan, mengatur osmolaritas, dan mengatur tekanan darah. Tekanan darah adalah kekuatan yang diperlukan agar darah dapat mengalir di dalam pembuluh darah dan beredar mencapai semua jaringan tubuh manusia. Tekanan darah terdiri atas 2 bagian tekanan sistolik dan tekanan diastolik. Berdasarkan data yang dilakukan Riset Kesehatan Dasar tahun 2007 didapatakan bahwa prevalensi hipertensi tertinggi di Kepulauan Natuna (wilayah pantai) sebanyak 53,3 % sedangkan prevalensi hipertensi terendah di pegunungan jayawijaya sebanyak 6,8%. Kabupaten Bolaang mongondow utara khususnya Kecamatan Bolangitang Barat merupakan suatu wilayah yang terletak disekitaran pesisir pantai, Remaja menurut WHO adalah mereka yang berumur 12-24 tahun. Jenis penelitian ialah deskriptif analitik dengan desain potong lintang. Data diolah dengan menggunakan program SPSS. Populasi ialah semua siswa/i SMAN 1 Bolangitang Barat Kabupaten Bolaang Mongondow Utara dan sampel diambil dengan cara purposive sampling. Hasil uji korelasi Spearman menunjukkan tidak terdapat hubungan antara kadar natrium dengan tekanan darah pada remaja di Kecamatan Bolangitang Barat Kabupaten Bolaang Mongondow Utara. Simpulan: Tidak terdapat hubungan antara kadar natrium dengan tekanan darah pada remaja di Kecamatan Bolangitang Barat Kabupaten Bolaang Mongondow Utara.Kata kunci: natrium, tekanan darah, remaja


2017 ◽  
Vol 4 (4) ◽  
pp. 1218
Author(s):  
Balakrishnan Nadesan ◽  
Mani Madhavan Sachithananthamoorthi ◽  
Sivaraman Thirumalaikumarasamy ◽  
Ezhilarasu Ramalingam

Background: Hypertension is considered as a major health issue in developed as well as developing countries and its possible origin during childhood prompts pediatricians to routinely include measurement of blood pressure (BP) as an integral part of pediatric physical examination. The objectives of the study were to evaluate the normal range of blood pressure in adolescent school going students of 12-16 years, prevalence of hypertension and relationship of BP with variables like age, body mass index (BMI), socioeconomic status and family history of hypertension.Methods: A cross sectional study was undertaken for a period of one year in adolescent school children in age groups between 12-16 years. Detailed clinical examination was done in 1060 adolescent school children and BP was recorded in right upper limb and correlation of BP with BMI, family history of hypertension and diabetes were studied.Results: Mean systolic and diastolic pressure showed linear relationship with age. There was a highly statistically significant difference between mean systolic and diastolic blood pressure between lower and middle socio-economic class. Prevalence of obesity in our study was 1.13%, overweight was 7.83%. Prevalence of hypertension in obese children was 33.33% and in overweight children 18.07%. Family history of hypertension and diabetes carry a significant correlation with elevated systolic and diastolic blood pressure in adolescents.Conclusions: This study revealed that socio economic factors play a significant role in determining the blood pressure of the individual. Children of middle class have significantly elevated mean systolic pressure and mean diastolic pressure than low socio-economic groups. 


2000 ◽  
Vol 92 (1) ◽  
pp. 6-6 ◽  
Author(s):  
Bruce Ben-David ◽  
Roman Frankel ◽  
Tatianna Arzumonov ◽  
Yuri Marchevsky ◽  
Gershon Volpin

Background Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods Twenty patients aged &gt; or = 70 yr undergoing surgical repair of hip fracture were randomized into two groups of 10 patients each. Group A received a spinal anesthetic of bupivacaine 4 mg plus fentanyl 20 microg, and group B received 10 mg bupivacaine. Hypotension was defined as a systolic pressure of &lt; 90 mmHg or a 25% decrease in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 5-10 mg up to a maximum 50 mg, and thereafter by phenylephrine boluses of 100-200 microg. Results All patients had satisfactory anesthesia. One of 10 patients in group A required ephedrine, a single dose of 5 mg. Nine of 10 patients in group B required vasopressor support of blood pressure. Group B patients required an average of 35 mg ephedrine, and two patients required phenylephrine. The lowest recorded systolic, diastolic, and mean blood pressures as fractions of the baseline pressures were, respectively, 81%, 84%, and 85% versus 64%, 69%, and 64% for group A versus group B. Conclusions A "minidose" of 4 mg bupivacaine in combination with 20 microg fentanyl provides spinal anesthesia for surgical repair of hip fracture in the elderly. The minidose combination caused dramatically less hypotension than 10 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure.


Author(s):  
Keshav Saran Agrawal ◽  
Aruna Mahanta

Background: most of the lower segment caesarean sections are done under spinal anesthesia and in more that 80% of the cases, maternal fall in blood pressure can be observed intraoperatively. Throughout history many vasopressor drugs have been evaluated for the treatment. Aim: our research was conducted to compare the effect of phenylephrine with ephedrine given for the prophylaxis of prevention of intraoperative fall in blood pressure in females who are undergoing LSCS. Materials and Methods: a total of 100 cases were considered for our study and were randomly distributed in two groups. Group A cases were administered Phenylephrine while ephedrine was given to group B cases just after spinal anesthesia. Results: most of our study subjects were in the age group of 21-25 years who were in the range of 51-55 kgs. Spinal anesthesia was given by using bupivacaine & block level was checked at 2 & 5 mins. Phenylephrine was found to be superior in control of fall in blood pressure as more than 90% of the cases were brought back to their preoperative levels in less than 4 mins after spinal anesthesia. Whereas in group B, ephedrine took much more time of around 10 mins for control of BP. Conclusion: with proper monitoring of heart rate, phenylephrine is superior to ephedrine in controlling the fall in blood pressure. Keywords: Ephedrine, Phenylephrine, Hypotension, Bradycardia.


Author(s):  
ISAAC CHIJIOKE IBEZIM ◽  
IAN NAYLOR ◽  
ABDULMUMINU ISAH ◽  
NNEKA UCHENNA IGBOELI

Objective: This study determined the level of prescribers’ adherence to the World Health Organization/International Society of Hypertension (WHO/ISH) guidelines for the management of hypertension at the Lagos University Teaching Hospital (LUTH), Nigeria. Methods: This study employed a retrospective cross-sectional design. Two groups were used: Group A (300 patients) were treated before the guidelines review in 2003, while Group B (200 patients) were treated after. The two study groups were compared, and systolic blood pressure of 130 mm Hg or above was taken as the index of hypertension. Results: There were 198 (66%) male patients in Group A, while Group B had 136 (68%) males. The highest age for Group A was 50–59 y for 89 (30%) patients, unlike group B that had 58 (29%) patients in aged 40–49 y as the highest. The highest blood pressure range for patients in Group A was 150–159 mm Hg for 64 (21%) patients, unlike Group B that had 43 (22%) patients as the highest in the same range. Furosemide was present in 282 (24%) prescriptions for group A patients. However, atenolol was present in 61 (20%) prescriptions for the same group. In group B, Furosemide was prescribed in 197 (97%) encounters, while Nifedipine was found in 81(40%) prescriptions. Conclusion: Prescribers at LUTH complied substantially with WHO/ISH guidelines in the management of hypertension. Diuretics and beta-blockers were used before the guideline review. After the review, diuretics and calcium channel blockers were the most frequently prescribed antihypertensives.


Author(s):  
Hitesh Bayan ◽  
Kushal Konwar Sarma ◽  
Gutti Dhananjaya Rao ◽  
Dwijen Kalita ◽  
Devojyoti Dutta ◽  
...  

Background: The study was conducted to evaluate the cardiopulmonary functions in dog under propofol, ketamine and isoflurane anaesthesia premedicated with dexmedetomidine and butorphanol.Methods: Four groups of dogs (A,B,C and D) comprising of six animals in each groups were premedicated with glycopyrrolate @ 0.01 mg/kg, dexmedetomidine @5ìg/kg IV and Butorphanol @ 0.1mg/kg IV. Induction was done with propofol (A and B) and with ketamine (C and D). The anaesthesia was maintained with isoflurane (A and C), propofol (B) and ketamine (D). The cardiopulmonary functions were recorded at 0 minute (before premedication) and 20 minutes, 40 minutes and 60 minutes. Result: The heart rate decreased significantly in Group B while there was a significant gradual increase in heart rate in Group D. A significant decrease in respiratory rate was observed in all the groups with a lowest value in group D. The systolic pressure decreased significantly in Group A, B and C but in Group D, the systolic pressure decreased initially at 20 minute. The diastolic pressure decreased significantly in Group A and Group B and but in group D, the diastolic pressure decreased at 20 minute. A significant decrease in mean arterial pressure was recorded in Group A, B and C. In Group D, a decrease in the mean arterial pressure was noticed at 20 minute. The SpO2 level remained near the base line values with slight variation in Group A and C where as the values remained at lower level from the base line value in Group B and D. The EtCO2 level showed non-significant changes in Group A and C. In Group B and D, the EtCO2 levels increased non-significantly with the highest value recorded in Group D. The ECG parameters remained within the normal limit with slight variation according to the heart rate.


2005 ◽  
Vol 33 (03) ◽  
pp. 357-364 ◽  
Author(s):  
Sang Pil Yun ◽  
Woo Sang Jung ◽  
Seong Uk Park ◽  
Sang Kwan Moon ◽  
Chang Nam Ko ◽  
...  

Hypertension is one of the modifiable risk factors for stroke. Lowering blood pressure is helpful for primary and secondary prevention of stroke. This study is aimed to assess the efficacy of Chunghyul-dan on stroke patients with stage 1 hypertension using 24 hours ambulatory blood pressure monitoring (24ABPM). Forty hospitalized stroke patients with stage 1 hypertension were included in the study and they were randomly assigned into two groups: group A was treated with Chunghyul-dan 1200 mg once a day for 2 weeks, while group B was not. Twelve subjects were dropped out because of unexpected early discharge or data errors, thus the remaining 28 subjects were included in the final analysis (15 in group A and 13 in group B). Blood pressure was monitored every 30 minutes for 24 hours at baseline and 2 weeks after medication. Blood pressure, pulse rate, trough/peak ratio (TPR) [the value calculated by dividing the blood pressure change at trough (22 to 24 hours after drug intake) by the change at peak (2 adjacent hours with a maximal blood pressure reduction between the second and eighth hour after drug intake)] and smoothness index (SI) (the value calculated as the ratio between the average of the 24 hours, treatment-induced blood pressure changes and its standard deviation) were compared to assess the efficacy of Chunghyul-dan. To assess the safety of Chunghyul-dan, any adverse effects during medication period were monitored. There was no significant difference in the baseline assessment between the two groups. Systolic blood pressure was lower in group A than in group B (141.37 ± 8.96 mmHg versus 132.28 ± 9.46 mmHg , P = 0.03), while diastolic blood pressure and pulse rate had no significant difference between the two groups. Systolic TPR and SI was 0.87 and 1.04 in group A, respectively. This suggests that Chunghyul-dan have anti-hypertensive effect on stroke patients with stage 1 hypertension.


2013 ◽  
Vol 25 (1) ◽  
pp. 28-31
Author(s):  
N Habib ◽  
M Rashid ◽  
USN Begum ◽  
N Ahter ◽  
D Akhter

This cross-sectional study was carried out to assess blood pressure parameters among adult male smokers and smokeless tobacco users. For this purpose, 105 male respondents were selected. They were divided into two groups; Group A-consisting of 30 were smokeless tobacco users and group B consisting of 75 smoker patients The participants were selected from medicine outdoor of Dhaka Medical College Hospital. In this study, the mean (±SD) of systolic blood pressure were 154.50±26.793 mm of Hg in Group A and 151.67±19.248 mm of Hg in group B respectively. Statistical analysis was done by unpaired‘t’ test, there were no statistical significant differences (P>0.05) of systolic blood pressure between Group A and Group B. The mean (±SD) of diastolic blood pressure were 96.67±10.933 mm of Hg in Group A and 86.47±14.745 mm of Hg in group B respectively. The mean (± SD) of diastolic blood pressure were significantly higher (P<0.05) in Group A than Group B. DOI: http://dx.doi.org/10.3329/medtoday.v25i1.16066 Medicine Today 2013 Vol.25(1): 28-31


2016 ◽  
Vol 4 (2) ◽  
pp. 21-25
Author(s):  
Nahid Reaz ◽  
Mirza Md Asaduzzaman ◽  
Shahnaj Akter Jahan ◽  
Shafeya Khanam

Background and Objectives: The present cross-sectional study was conducted to determine whether platelet count can predict the severity of preeclampsia (PE) with fair degree of accuracy. Methodology: The study was carried out at Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka between January 2013 to December 2013 on admitted preeclamptic women. Preeclamptic women ranging between 20-35 years, gestational age between 28-40 weeks and systolic pressure 140 mmHg and/or diastolic pressure 90 mmHg with proteinuria were the study population. A total of 96 preeclamptic women meeting the enrollment criteria were included in the study. Of them 76 had severe preeclampsia and 22 had mild preeclampsia. Platelet count below 1,50000/mm3 of blood was considered low in this study. Result: Over one-quarter (27.1%) of the patients were < 20 years, 43.8% (20 - 30) years and 29.2% 30 years old with mean age of the patients being 24.9 years. Over three-quarters (77.1%) of the patients belonged to middle class and 22.9% to lower class. Majority (79.2%) of the women was at term pregnancy with ratio of primigravida and multigravida being roughly 2:3. Eight (8.3%) patients had past history of PET. Over one-third (37.5%) of the patients had systolic blood pressure 160 mmHg and 27.1% had diastolic blood pressure 110 mmHg. About 64% of the patients had anemia and 73% had severe proteinuria (albumin 3+). More than 20% of the severe preeclamptics had low (< 1,50,000 per cu-mm of blood) platelet count as opposed to 9.1% of the mild preeclamptic group. The risk of having low platelet count among severe preeclamptics was found to be more than 2-fold (95% CI = 0.5 -12.1) than their mild preeclamptic counterparts (p = 0.037). Conclusion: The study concluded that, platelet count tends to fall as severity of preeclampsia increases. However, platelet count alone cannot predict the severity of preeclampsia as majority of the severe preeclampsia bears platelet within normal range. Ibrahim Cardiac Med J 2014; 4(2): 21-25


Author(s):  
S. Hiruthick ◽  
K. V. L. Sanjana

Background and Aims: During Cesarean section, hypotension occurs in the most of parturients, following spinal anesthesia. This prospective observational study was undertaken to determine the efficacy of two different Bolus Doses of Phenylephrine for Prevention of Spinal-Induced Hypotension during Cesarean Section. Materials and Methods: A total of 120 parturients undergoing cesarean section were divided into two groups of group A and group B with sixty in each group. Group A received phenylephrine 75 mcg IV bolus, while Group B received phenylephrine 100 mcg IV bolus, immediately after giving spinal anesthesia. For the next 20 minutes, systolic blood pressure (SBP), diastolic blood pressure (DSP), mean arterial pressure (MAP), and heart rate (HR) were recorded every 2 minutes, and APGAR scores at 1 and 5 minutes were recorded. Results: There was no difference between the two groups in terms of preventing hypotension, with 16.6% in Group A and 16.6% in Group B. In the first 2–6 minutes, however, the rise in systolic pressure in Group B was higher than in Group A. Group B (46.66 %) had a higher rate of bradycardia than Group A (25 %). Conclusion: Both phenylephrine dosages were equally effective in preventing hypotension following spinal anesthesia. However, Prophylactic bolus dose of phenylephrine 75 mcg was found to be effective for the management of spinal-induced hypotension and should be preferred over 100 mcg which causes significant bradycardia and reactive hypertension.


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