Multifactorial evaluation of blood pressure fall upon hospitalization in essential hypertensive patients

1987 ◽  
Vol 73 (2) ◽  
pp. 135-141 ◽  
Author(s):  
Hikaru Nishimura ◽  
Akinori Nishioka ◽  
Shinichiro Kubo ◽  
Michihiro Suwa ◽  
Masaya Kino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Systolic Blood Pressure ◽  
Left Ventricular ◽  
Lower Systolic Blood Pressure ◽  
Group I ◽  
Blood Pressure Fall ◽  
Group Ii ◽  
Pressure Fall

1. Studies were prospectively performed on 72 hospitalized patients with essential hypertension. Blood pressure was normalized within 1 week of admission in 33 patients (group I), but did not decrease in 39 patients (group II). To determine the factors that differentiate group I from group II, cardio-renal haemodynamic and endocrinological indices were evaluated using multivariate analysis. 2. Systolic, diastolic and mean blood pressures on admission were higher in group II (P < 0.001), whose optic fundi showed more severe changes (P < 0.001). Although group II had greater left ventricular posterior wall thickness (P < 0.02), left ventricular mass index (P < 0.05) and systemic vascular resistance (P < 0.01) on echocardiography, their cardiac index and ejection fraction were comparable with those of group I. 3. Renal blood flow (P < 0.05) and glomerular filtration rate (P < 0.01) were lower in group II than in group I. Renal vascular resistance was more elevated (P < 0.01) in group II than in group I. 4. After severe sodium depletion and ambulation, group I showed a greater increase in plasma noradrenaline and adrenaline (P < 0.05). On multivariate analysis, those with lower systolic blood pressure, better renal function and more reactive sympathetic nervous system were discriminated as group I. 5. These data suggest that group I patients have lower systolic blood pressure on admission, greater sympathetic reactivity and better renal function, all of which contribute to their spontaneous blood pressure fall after admission.

scholarly journals A Comparative Study of Bisoprolol with Carvedilol on LV Systolic Function in Patients with Chronic Heart Failure

2018 ◽  
Vol 14 (1) ◽  
pp. 3-8
Author(s):  
Mohammad Ashraf Hossain ◽  
Khurshed Ahmed ◽  
Md Faisal Ibn Kabir ◽  
Md Fakhrul Islam Khaled ◽  
Rakibul H Rashed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Group I ◽  
End Systolic Volume ◽  
Group Ii

Background: Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Recent data suggest that beta-blockers are beneficial in patients with CHF. Among β-blocker class of drugs, bisoprolol is a highly selective β1-adrenergic receptor blocker whereas Carvedilol is non-selective. Many large-scale trials have confirmed that both these β-blockers are superior to placebo and other β-blockers. This study was designed to compare the effects of carvedilol and bisoprolol in patients with chronic HF in a single center.Methods: It was a quasi experimental study. A total of 288 cases of heart failure were selected by purposive sampling, from January 2017 to June 2017. Each patient was allocated into either of the two groups, and was continued receiving treatment with either bisoprolol (Group-I) or carvedilol (Group-II). Each patient was evaluated clinically and echocardiographically at the beginning of treatment (baseline) and at the end of 3rd month. Echocardiography was performed to find out change in left ventricular systolic function.Result: After 3 months of treatment, ejection fraction was found higher in the bisoprolol group (42.6 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 8.4% in bisoprolol group and 4.1% in carvedilol group. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (3.2±0.1 in group I versus 2.3±0.5 in group II; P<0.05) occurred after 3 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (10.1±3.2 versus 6.1±6.4; P=0.101) and left ventricular diastolic diameter (1.7±0.8 versus 1.3±0.8; P=0.081) between groups. Three months after treatment, heart rate was reduced in the bisoprolol group from 87.7±9 to 74.5±8.1 and carvedilol group from 88.8±9.1 to 80.1±8.7. Differences in heart rate responses between 2 groups were not statistically significant (P=0.113). Assessment of blood pressure three months later of treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both group but difference between two groups were statistically non significant (p>0.05).Conclusion: In this study, bisoprolol was superior to carvedilol in increasing left-ventricular ejection fraction, improving left ventricular end systolic volume and left ventricular end systolic diameter but no significant difference was observed in LV end diastolic volume, LV end diastolic diameter, heart rate and blood pressure.University Heart Journal Vol. 14, No. 1, Jan 2018; 3-8

scholarly journals Post Carotid Endarterectomy Hypertension

1980 ◽  
Vol 8 (2) ◽  
pp. 190-194 ◽  
Author(s):  
M. J. Davies ◽  
K. D. Cronin
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Carotid Endarterectomy ◽  
Diastolic Blood Pressure ◽  
Pulse Rate ◽  
Rate Increase ◽  
Blood Pressure Fall ◽  
Pressure Changes ◽  
Intraoperative Hypertension ◽  
Pressure Fall

Blood pressure changes following carotid endarterectomy were studied in 39 patients undergoing 42 carotid endarterectomies, in order to establish the incidence of hypertension and to study the use of hydrallazine for its treatment. Hypertension occurred in 28 cases (66%) and was treated with intravenous hydrallazine in a dose of 20 ±8 mg; this resulted in a systolic blood pressure fall of 46 ±22 mmHg, diastolic blood pressure fall of 24 ± 12 mmHg, mean blood pressure fall of 31 ± 15 mmHg, and a pulse rate increase of 7 ±9 beats per minute. Hydrallazine is a safe, effective drug for the treatment of intraoperative hypertension.

Decreased nocturnal systolic blood pressure fall in older subjects with depression

2009 ◽  
Vol 21 (4-5) ◽  
pp. 292-297 ◽  
Author(s):  
Angelo Scuteri ◽  
Gianfranco Spalletta ◽  
Marcello Cangelosi ◽  
Walter Gianni ◽  
Antonio Assisi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Pressure Fall ◽  
Older Subjects ◽  
Pressure Fall

scholarly journals Moxonidine-based combination antihypertensive therapy in patients with metabolic syndrome

2012 ◽  
Vol 11 (3) ◽  
pp. 36-46
Author(s):  
E. V. Tishina ◽  
V. B. Mychka ◽  
M. A. Saidova
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Combination Therapy ◽  
Interventricular Septum ◽  
Visceral Obesity ◽  
Left Ventricular ◽  
Group Iii ◽  
Urine Albumin ◽  
Group I ◽  
Group Ii

Aim. To assess the effects of moxonidine-based combination therapy on clinical status, laboratory parameters, and target organs in patients with metabolic syndrome (MS). Material and methods. In total, 60 MS patients with Stage 1-2 arterial hypertension (AH) were randomised into 3 groups. Group I was administered moxonidine (0,2-0,4 mg/d) and amlodipine (5-10 mg/d); Group II received moxonidine (0,2-0,4 mg/d) and hydrochlorothiazide (12,5 mg/d); Group III was treated with moxonidine (0,2-0,4 mg/d) and enalapril (10-20 mg/d). At baseline and after 24 weeks of treatment, the following characteristics were assessed: waist circumference (WC), body mass index (BMI), 24-hour blood pressure monitoring (BMP) parameters, left ventricular myocardial mass index (LVMMI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) of early diastolic velocity, peak Em velocity at interventricular septum and lateral wall levels, E/Em ratio (myocardial tissue Doppler echocardiography), pulse wave velocity (PWV) between descending aorta and aortic bifurcation levels (ultrasound method), and stiffness index β of ascending aorta. In addition, lipid, carbohydrate, and purine metabolism parameters were assessed; glomerular filtration rate (GFR) was calculated (MDRD method); and urine albumin levels were measured. Results. In Group I (moxonidine + amlodipine), target blood pressure (BP) levels were achieved in 70% of the patients. Systolic BP (SBP) levels, LVMMI, and DT decreased by 19,3±11,4 mm Hg, 4,4 g/m2 (p=0,09), and 10,6 ms (p<0,05), respectively. The increase in E/A ratio and Em annular velocity (Em av) reached 0,4 (p<0,05) and 1,4 cm/s (p<0,05), respectively, while E/Em av ratio decreased by 0,8 (p<0,05), and PWV decreased by 1,6 ms (p<0,05). The BMI decrease reached 0,7 kg/m2 (p<0,05). In Group II (moxonidine + hydrochlorothiazide), target BP levels were achieved in 40% of the participants, with a decrease in SBP levels by 14,7 mm Hg (p<0,05). DT was reduced by 9,4 ms (p<0,05), E/A ratio increased by 0,1 (p<0,05), while PWV, BMI, and GFR decreased by 1,3 m/s (p<0,05), 0,8 kg/m2 (p<0,05), and 5,6 ml/min/1,73 m2 (p<0,05), respectively. In Group III (moxonidine + enalapril), 60% of the patients achieved target BP levels, and SBP levels were reduced by 21,1 mm Hg (p<0,05). LVMMI decreased by 5,1 g/m2 (p<0,05), Em av increased by 0,3 cm/s (p<0,05), while the respective reduction in PWV, WC, and BMI reached 1,1 m/s (p<0,05), 1,8 cm (p<0,05), and 0,5 kg/m2 (p<0,05). All three groups demonstrated a significant reduction in urine albumin levels. Conclusion. The moxonidine-based combination therapy effectively reduced the levels of BP and urine albumin. The combination of moxonidine with amlodipine or enalapril improved cardiac structure and function, as well as renal excretory function. The combination of moxonidine and hydrochlorothiazide, however, negatively affected renal excretion. All three variants of combination therapy were metabolically neutral and demonstrated beneficial effects on visceral obesity.

scholarly journals A prospective comparative efficacy of azilsartan and telmisartan in hypertensive patients

2020 ◽  
Vol 9 (8) ◽  
pp. 1232
Author(s):  
Velvizhy R. ◽  
Johan Pandian J.
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Joint National Committee ◽  
National Committee ◽  
Upper Respiratory Tract ◽  
Group I ◽  
Group Ii ◽  
The Difference ◽  
Gandhi Medical College

Background: Hypertension (HT) is defined as either a sustained systolic blood pressure of greater than 140 mmHg or a sustained diastolic blood pressure of greater than 90 mmHg, according to joint national committee (JNC VIII) on hypertension.Methods: A prospective, open, randomized parallel group comparative study of AZL versus telmisartan was done in patients of stage-I HT. The study included 80 patients, 40 in each group (group I and group II) coming to the Department of Pharmacology, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Pondicherry from January 2016 to December 2017. The study was conducted over 8 weeks. Group-I, patients received azilsartan 40-80 mg per day in divided doses and group-II, patients received telmisartan 40-80 mg per day in divided doses according to severity of hypertension.Results: Patients receiving AZL 40 mg and telmisartan 40 mg showed a significant fall (p<0.05) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 4 weeks and 8 weeks, when compared to baseline. The difference in SBP and DBP between group I (AZL) and II (telmisartan) was statistically significant at 4 weeks (p<0.05) and was highly significant at 8 weeks (p<0.001). Adverse effects such as nasopharyngitis, upper respiratory tract infection, gastroenteritis, headache, dizziness, and fatigue were reported with both drugs.Conclusions: Reduction of BP with AZL was more as compared to telmisartan at 4 weeks and 8 weeks. Safety and tolerability were similar in both groups.

P4548Early drop in systolic blood pressure and worsening renal function in the elderly acute heart failure: how does heart rate interact?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Takeuchi ◽  
M Nagai ◽  
K Dote ◽  
M Kato ◽  
N Oda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
The Elderly ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Worsening Renal Function

Abstract Background Renal dysfunction is a frequent finding in patients hospitalized for acute heart failure (AHF). Worsening renal function (WRF) during hospitalization was found to be related with a poor outcome independently of baseline renal function. Early drop in systolic blood pressure (SBP) has shown to predict WRF in AHF. However, there have been few studies that reported the impact of on-admission heart rate (HR) on the relationship between early SBP drop and WRF in the elderly AHF. Purpose We assessed the hypothesis that early SBP drop predict WRF in the elderly patients with AHF, and investigated that on-admission HR might have an interaction with that relationship. Methods SBP and HR were measured on admission and 6 times during 48 hours in the 245 elderly AHF inpatients (82.9±6.0 years old, male 49.4%). WRF was defined as a serum creatinine increase of ≥0.3 mg/dL by Day 5. Early drop in SBP was calculated as the difference between admission and the lowest value measured during the first 48 hour of hospitalization. Results Early SBP drop (51.3 vs 32.5mmHg, p<0.01) and on-admission HR (79.3 vs 89.6bpm, p<0.05) were significantly different between the group with WRF (n=36) and the group without WRF (n=209). In the multiple logistic regression analysis adjusted for the confounders including age, gender, hypertension, left ventricular ejection fraction, total cholesterol, BNP, baseline creatinine, beta-blockade use, intravenous loop diuretic, isosorbide dinitrate and carperitide use, early SBP drop (OR: 1.003, 95% CI: 1.003–1.03, p<0.04) and on-admission HR (OR: 0.98, 95% CI: 0.96–0.99, p<0.01) were significantly associated with WRF. The interaction term of early SBP drop by on-admission HR did not have a significant association with WRF (p=0.3). Conclusions In the elderly AHF patients, exaggerated early SBP drop and lower on-admission HR were shown as significant independent predictors of WRF. These two factors were additively associated with WRF. Too much reduction in SBP and that in HR might be harmful to renal circulation in AHF.

scholarly journals Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation

2014 ◽  
Vol 52 (194) ◽  
pp. 775-779 ◽  
Author(s):  
Pradeep Kumar Rajbhandari
Keyword(s):  
Blood Pressure ◽  
Stress Response ◽  
Tracheal Intubation ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Systemic Hypertension ◽  
Sympathetic Response ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Introduction: Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. In individuals with systemic hypertension, coronary artery disease, cerebrovascular disease and intracranial aneurysm, the effect of this transient sympathetic response can evoke life threatening conditions like pulmonary oedema, cardiac failure and cerebrovascular haemorrhage. Methods: Patients were randomly divided into two groups, 30 in each group. Group I received 50 mg of esmolol and group II received lignocaine 2 mg/kg. Haemodynamic parameters like pulse, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured before induction of anaesthesia, immediately after intubation then at intervals of one minute, three minutes, five minutes, seven minutes and 10 minutes. Results: There was no significant difference in demographic or base line vital signs between two groups (Table 1). The mean systolic blood pressure increased on laryngoscopy and tracheal intubation by 15 mmHg in the group I whereas in group II it was 17.4 mmHg. There was a significant rise in diastolic blood pressure (DBP) in both the groups, but the rise was lesser in group II than in group I. Conclusion: Both esmolol and lignocaine were not effective in attenuating hemodynamic stress response to laryngoscopy and tracheal intubation; however esmolol was superior to lignocaine in blunting the stress response.  Keywords: esmolol; intubation; laryngoscopy; lignocaine; stress response.  

scholarly journals Effects of weight loss on the cardiac parameters of obese dogs

2010 ◽  
Vol 30 (2) ◽  
pp. 167-171 ◽  
Author(s):  
Gláucia B.P. Neto ◽  
Márcio A. Brunetto ◽  
Marlos G. Sousa ◽  
Aulus C. Carciofi ◽  
Aparecido A. Camacho
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Body Weight ◽  
Companion Animals ◽  
Left Ventricular ◽  
Weight Loss Program ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii

Obesity is one of the most frequent nutritional problems in companion animals and can lead to severe health problems in dogs and cats, such as cardiovascular diseases. This research aimed to evaluate the structural and functional cardiac changes after weight loss in obese dogs. Eighteen obese healthy dogs were assigned into three different groups, according with their initial body weight: Group I (dogs up to 15 kg), Group II (dogs weighing between 15.1 and 30 kg), and Group III (dogs weighing over 30 kg). The animals were submitted to a caloric restriction weight-loss program until they lose 15% of the body weight. The M-mode echocardiogram, electrocardiogram, and blood pressure evaluations were performed before the diet has started and after the dogs have reached the target weight. Data showed a decrease in left ventricular free wall thickness during diastole and systole in Group III, decrease in the systolic blood pressure in Group III, and also in the mean blood pressure in Group II. It was possible to conclude that the weight loss program can reverse structural cardiac changes such as left ventricle eccentric hypertrophy in dogs weighing more than 30 kg, and decrease the arterial blood pressure in obese dogs.

Comparison of Closed-loop Controlled Administration of Propofol Using Bispectral Index as the Controlled Variable versus “Standard Practice” Controlled Administration

2001 ◽  
Vol 95 (1) ◽  
pp. 6-17 ◽  
Author(s):  
Michel M. R. F. Struys ◽  
Tom De Smet ◽  
Linda F. M. Versichelen ◽  
Stijn Van de Velde ◽  
Rudy Van den Broecke ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Control System ◽  
Systolic Blood Pressure ◽  
Bispectral Index ◽  
Closed Loop ◽  
Loop System ◽  
Closed Loop System ◽  
Model Based ◽  
Group I ◽  
Group Ii

Background This report describes a new closed-loop control system for propofol that uses the Bispectral Index (BIS) as the controlled variable in a patient-individualized, adaptive, model-based control system, and compares this system with manually controlled administration of propofol using hemodynamic and somatic changes to guide anesthesia. Methods Twenty female patients, American Society of Anesthesiologists physical status I or II, who were scheduled for gynecologic laparotomy were included to receive propofolremifentanil anesthesia. In group I, propofol was titrated using a BIS-guided, model-based, closed-loop system. The BIS target was set at 50. In group II, propofol was titrated using classical hemodynamic signs of (in)adequate anesthesia. Performance of control during induction and maintenance of anesthesia were compared between both groups using BIS as the controlled variable in group I and the reference variable in group II, and, conversely, the systolic blood pressure as the controlled variable in group II and the reference variable in group I. At the end of anesthesia, recovery profiles between groups were compared. Results Although patients undergoing manual induction of anesthesia in group II at 300 ml/h reached a BIS level of 50 faster than patients undergoing open-loop, computer-controlled induction in group I, manual induction caused a more pronounced initial overshoot of the BIS target. This resulted in a more pronounced decrease in blood pressure in group II. During the maintenance phase, better control of BIS and systolic blood pressure was found in group I compared with group II. Recovery was faster in group I. Conclusion A closed-loop system for propofol administration using the BIS as a controlled variable together with a model-based controller is clinically acceptable during general anesthesia.

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