scholarly journals The Combination of Non-dipper Heart Rate and High Brain Natriuretic Peptide Predicts Cardiovascular Events: The Japan Morning Surge-Home Blood Pressure (J-HOP) Study

2020 ◽  
Vol 33 (5) ◽  
pp. 430-438
Author(s):  
Yukako Ogoyama ◽  
Tomoyuki Kabutoya ◽  
Satoshi Hoshide ◽  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Home Blood Pressure ◽  
Primary Endpoints ◽  
Blood Pressure Study ◽  
The Mean ◽  
The Brain

Abstract BACKGROUND We hypothesized that the association between the dipping heart rate (HR) pattern and cardiovascular (CV) events differs according to the brain natriuretic peptide (BNP) level. METHODS We examined a subgroup of 1,369 patients from the Japan Morning Surge Home Blood Pressure study; these were patients who had CV risk factors and had undergone ambulatory blood pressure (BP) monitoring. HR non-dipping status was defined as (awake HR − sleep HR)/awake HR <0.1, and high BNP was defined as ≥35 pg/ml. We divided the patients into four groups according to their HR dipper status (dipping or non-dipping) and BNP level (normal or high). RESULTS The mean follow-up period was 60 ± 30 months. The primary endpoints were fatal/nonfatal CV events (myocardial infarction, angina pectoris, stroke, hospitalization for heart failure, and aortic dissection). During the follow-up period, 23 patients (2.8%) in the dipper HR with normal BNP group, 8 patients (4.4%) in the non-dipper HR with normal BNP group, 24 patients (9.5%) in the dipper HR with high-BNP group, and 25 patients (21.0%) in the non-dipper HR with high-BNP group suffered primary endpoints (log rank 78.8, P < 0.001). Non-dipper HR was revealed as an independent predictor of CV events (hazard ratio, 2.13; 95% confidence interval, 1.35–3.36; P = 0.001) after adjusting for age, gender and smoking, dyslipidemia, diabetes mellitus, chronic kidney disease, BNP, non-dipper BP, 24-h HR, and 24-h systolic blood pressure. CONCLUSIONS The combination of non-dipper HR and higher BNP was associated with a higher incidence of CV events.

scholarly journals Kidneys extract BNP and NT-proBNP in healthy young men

2005 ◽  
Vol 99 (5) ◽  
pp. 1676-1680 ◽  
Author(s):  
Morten Schou ◽  
Mads K. Dalsgaard ◽  
Otto Clemmesen ◽  
Ellen A. Dawson ◽  
Chie C. Yoshiga ◽  
...  
Keyword(s):  
Heart Rate ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Young Men ◽  
Exercise Heart Rate ◽  
Renal Metabolism ◽  
Cardiac Marker ◽  
Mean Values ◽  
The Mean ◽  
The Brain

Renal metabolism of the cardiac marker NH2-terminal-pro-brain natriuretic peptide (NT-proBNP) has been suggested. Therefore, we determined the renal extraction ratios of NT-proBNP and its bioactive coproduct brain natriuretic peptide (BNP) at rest and during exercise. In addition, the cerebral ratios were evaluated. Ten young healthy men were investigated at baseline, during moderate cycle exercise (heart rate: 140, Borg scale: 14–15), and in the recovery with BNP and NT-proBNP measured from the brachial artery and the jugular and renal veins, and the renal and cerebral extraction ratios (Ext-Ren and Ext-Cer, respectively) were calculated. Cardiac output, stroke volume, heart rate, mean arterial pressures, and estimated glomerular filtration were determined. BNP and NT-proBNP were extracted by the kidneys but not by the brain. We observed no effect of exercise. The mean values (± SE) of Ext-Ren of NT-proBNP were similar (0.19 ± 0.05, 0.21 ± 0.06, and 0.12 ± 0.03, respectively) during the three sessions ( P > 0.05). Also the Ext-Ren of BNP were similar (0.18 ± 0.07, 0.15 ± 0.11, and 0.14 ± 0.06, respectively; P > 0.05). There were no significant differences between Ext-Ren of BNP and NT-proBNP during the three sessions ( P > 0.05). The Ext-Cer of both peptides varied insignificantly between −0.21 ± 0.15 and 0.11 ± 0.08. The renal extraction ratio of both BNP and NT-proBNP is ∼0.15–0.20. There is no cerebral extraction, and short-term moderate exercise does not affect these values. Our findings suggest that the kidneys extract BNP and NT-proBNP to a similar extent in healthy young men.

scholarly journals Home Blood Pressure Control and Drug Prescription Patterns among Thai Hypertensives: A 1-Year Analysis of Telehealth Assisted Instrument in Home Blood Pressure Monitoring Nationwide Pilot Project

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Anut Sakulsupsiri ◽  
Pairoj Chattranukulchai ◽  
Sarawut Siwamogsatham ◽  
Patchaya Boonchayaanant ◽  
Witthawat Naeowong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Channel Blocker ◽  
Blood Pressure Monitoring ◽  
Drug Prescription ◽  
Pilot Project ◽  
Home Blood Pressure ◽  
Pressure Monitoring ◽  
The Mean ◽  
One Year

Background. Several interventions have been proposed to improve hypertension control with various outcomes. The home blood pressure (HBP) measurement is widely accepted for assessing the response to medications. However, the enhancement of blood pressure (BP) control with HBP telemonitoring technology has yet to be studied in Thailand. Objective. To evaluate the attainment of HBP control and drug prescription patterns in Thai hypertensives at one year after initiating the TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project. Methods. A multicenter, prospective study enrolled treated hypertensive adults without prior regular HBPM to obtain monthly self-measured HBP using the same validated, oscillometric telemonitoring devices. The HBP reading was transferred to the clinic via a cloud-based system, so the physicians can adjust the medications at each follow-up visit on a real-life basis. Controlled HBP is defined as having HBP data at one year of follow-up within the defined target range (<135/85 mmHg). Results. A total of 1,177 patients (mean age 58 ± 12.3 years, 59.4% women, 13.1% with diabetes) from 46 hospitals (81.5% primary care centers) were enrolled in the study. The mean clinic BP was 143.9 ± 18.1/84.3 ± 11.9 mmHg while the mean HBP was 134.4 ± 15.3/80.1 ± 9.4 mmHg with 609 (51.8%) patients having HBP reading <135/85 mmHg at enrollment. At one year of follow-up after implementing the HBP telemonitoring, 671 patients (57.0%) achieved HBP control. Patients with uncontrolled HBP had a higher prevalence of dyslipidemia and greater waist circumference than the controlled group. The majority of uncontrolled patients were still prescribed only one (36.0%) or two drugs (34.4%) at the end of the study. The antihypertensive drugs were not uptitrated in 136 (24%) patients with uncontrolled HBP at baseline. Calcium channel blocker was the most prescribed drug class (63.0%) followed by angiotensin-converting enzyme inhibitor (44.8%) while the thiazide-type diuretic was used in 18.9% of patients with controlled HBP and 16.4% in uncontrolled patients. Conclusion. With the implementation of HBP telemonitoring, the BP control rate based on HBP analysis was still low. This is possibly attributed to the therapeutic inertia of healthcare physicians. Calcium channel blocker was the most frequently used agent while the diuretic was underutilized. The long-term clinical benefit of overcoming therapeutic inertia alongside HBP telemonitoring needs to be validated in a future study.

scholarly journals Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study (Preprint)

2018 ◽  
Author(s):  
Paula AM Ogink ◽  
Jelske M de Jong ◽  
Mats Koeneman ◽  
Mariska Weenk ◽  
Lucien JLPG Engelen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Qualitative Interviews ◽  
Blood Pressure Measurement ◽  
Home Blood Pressure ◽  
Strongly Correlated ◽  
User Friendliness ◽  
Validated Questionnaire ◽  
System Usability Scale ◽  
The Mean

BACKGROUND Frequent home blood pressure (BP) measurements result in a better estimation of the true BP. However, traditional cuff-based BP measurements are troublesome for patients. OBJECTIVE This study aimed to evaluate the feasibility of a cuffless device for ambulatory systolic blood pressure (SBP) measurement. METHODS This was a mixed method feasibility study in patients with hypertension. Performance of ambulatory SBPs with the device was analyzed quantitatively by intrauser reproducibility and comparability to a classic home BP monitor. Correct use by the patients was checked with video, and user-friendliness was assessed using a validated questionnaire, the System Usability Scale (SUS). Patient experiences were assessed using qualitative interviews. RESULTS A total of 1020 SBP measurements were performed using the Checkme monitor in 11 patients with hypertension. Duplicate SBPs showed a high intrauser correlation (R=0.86, P<.001). SBPs measured by the Checkme monitor did not correlate well with those of the different home monitors (R=0.47, P=.007). However, the mean SBPs measured by the Checkme and home monitors over the 3-week follow-up were strongly correlated (R=0.75, P=.008). In addition, 36.4% (n=4) of the participants performed the Checkme measurements without any mistakes. The mean SUS score was 86.4 (SD 8.3). The most important facilitator was the ease of using the Checkme monitor. Most important barriers included the absence of diastolic BP and the incidental difficulties in obtaining an SBP result. CONCLUSIONS Given the good intrauser reproducibility, user-friendliness, and patient experience, all of which facilitate patients to perform frequent measurements, cuffless BP monitoring may change the way patients measure their BP at home in the context of ambulant hypertension management.

Different Effects of Two Protocols for Pre-Procedural Analgosedation on Vital Signs in Neonates during and after Endotracheal Intubation

2021 ◽  
Author(s):  
Michael Zemlin ◽  
Horst Buxmann ◽  
Sabine Felgentreff ◽  
Boris Wittekindt ◽  
Sybelle Goedicke-Fritz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Endotracheal Intubation ◽  
Prospective Observational Study ◽  
Vital Signs ◽  
Arterial Blood ◽  
Primary Endpoints ◽  
Secondary Endpoints ◽  
The Mean ◽  
Post Intubation

ABSTRACT Background Analgosedation is often used for endotracheal intubation in neonates, but no consensus exists on the optimal pre-procedural medication. Aims To compare the time to intubation and vital signs during and after intubation in 2 NICUs using different premedication protocols. Methods Prospective observational study in 2 tertiary NICUs, comparing fentanyl and optional vecuronium for elective neonatal endotracheal intubation (NICU-1) with atropine, morphine, midazolam and optional pancuronium (NICU-2). Primary endpoints were: time to intubate and number of intubation attempts; secondary endpoints were: deviations of heart rate, oxygen saturation and blood pressure from baseline until 20 min post intubation. Results 45 and 30 intubations were analyzed in NICU-1 and NICU-2. Time to intubation was longer in NICU-1 (7 min) than in NICU-2 (4 min; p=0.029), but the mean number of intubation attempts did not differ significantly. Bradycardias (34 vs. 1, p<0.001) and hypoxemias (136 vs. 48, p<0.001) were more frequent in NICU-1, and tachycardias (59 vs. 72, p<0.001) more frequent in NICU-2. Mean arterial blood pressure (MAP) increased in NICU-1 (+6.18 mmHg) and decreased in NICU-2 (−5.83 mmHg), whereas mean heart rates (HR) decreased in NICU-1 (−19.29 bpm) and increased in NICU-2 (+15.93 bpm). MAP and HR returned to baseline 6–10 min after intubation in NICU-1 and after 11–15 min and 16–20 min in NICU-2, respectively. Conclusions The two protocols yielded significant differences in the time to intubation and in the extent and duration of physiologic changes during and post-intubation. Short acting drugs should be preferred and vital signs should be closely monitored at least 20 min post intubation. More studies are required to identify analgosedation protocols that minimize potentially harmful events during endotracheal intubation.

Abstract MP13: N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) and Risk of Hypertension in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Julie K Bower ◽  
Mariana Lazo ◽  
Jonathan Rubin ◽  
Kunihiro Matsushita ◽  
Ron C Hoogeveen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Medication Use ◽  
Community Based ◽  
Incident Hypertension ◽  
Increased Risk ◽  
Aric Study

Introduction: Increased plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration reflects cardiac overload and is used to diagnose and stage congestive heart failure. While NT-proBNP exhibits beneficial effects on the cardiovascular system via vasodilatation and diuresis, increased amounts of circulating NT-proBNP also promote release of norepinephrine, which is known to affect blood pressure. Cross-sectional studies report positive associations of NT-pro-BNP with blood pressure, but the prospective association of increased NT-proBNP with risk of hypertension is not well characterized. Thus, the study aim was to evaluate the association of NT-proBNP with incident hypertension in the community-based ARIC Study. Methods: We conducted a prospective cohort analysis of 3,849 participants aged 53-75 years with measured NT-proBNP at ARIC Visit 4 (1996-98) and normal blood pressure; participants with a history of hypertension (medication use or measured BP ≥140/90 mmHg), cardiovascular disease, or heart failure at baseline were excluded. Incident hypertension was defined based on diagnosis or antihypertensive medication use reported during annual follow-up. Results: During a median follow-up of 9 years, there were 2,157 new hypertension cases. There was a significant independent positive association between NT-proBNP levels and risk of hypertension. A 10% increased risk of hypertension was observed per log-unit increase in NT-proBNP (Table). This association was similar among individuals who were normotensive and pre-hypertensive at baseline [HR (95 % CI): 1.08 (1.01-1.15) and 1.11 (1.00-1.24), respectively]. Participants in the highest quartile for NT-proBNP were at 26% increased risk compared to those in the lowest quartile. Conclusions: NT-proBNP is positively associated with incident hypertension in this community-based cohort of middle-aged and older adults. In spite of the vasodilatory effects of increased NT-proBNP, elevated levels predict the development of hypertension.

scholarly journals The effect of acupressure on the level of the blood pressure, respiratory rate, and heart rate in patients with the brain contusion under mechanical ventilation

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Azam Moslehi ◽  
Farokh Yadollahi ◽  
Ali Hasanpour Dehkordi ◽  
Majid Kabiri ◽  
Shahriyar Salehitali
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mechanical Ventilation ◽  
Respiratory Rate ◽  
Statistical Difference ◽  
Intervention Group ◽  
Brain Contusion ◽  
Significant Statistical Difference ◽  
The Mean ◽  
The Brain

Abstract Objectives Injuries induced by the brain trauma from mild to life-threatening therefore prevents these complications need psychological, environmental, and physical support. Acupressure by reduces muscle tension, improves blood circulation and stimulates endorphins secretion naturally reduce pain in these patients therefore the aim of this study was to evaluate effect of acupressure on the level of the blood pressure, respiratory rate, and heart rate in patients with the brain contusion under mechanical ventilation. Methods The present study was a clinical trial with a sample size of 64 brain contusion patients who were selected based on available sampling and then randomly assigned to control and experimental groups. Demographic information and check list of blood pressure, heart rate, and respiratory rate were recorded before intervention in two groups then acupressure at the p6 point for 10 min in both hands at the morning and evening for two consecutive days is done in intervention group while in control group this pressure was applied at the same time point at an inactive point such as thumb hands. After acupressure for both groups, physiological index was measured immediately, half and 1 h after every acupressure. Data were collected using a demographic questionnaire and physiological sheet. Data was analyzed using SPSS 21 software and analytical statistical tests (independent t-test, chi-square, Fisher’s exact test). Results The mean of blood pressure, heart rate, and respiratory rate before acupressure there was no significant statistical difference between two groups (p>0.05). but the mean of two consecutive days of blood pressure, heart rate, and respiratory rate after acupressure in the intervention group than control group was significantly different (p<0/05). Therefore, physiologic index before acupressure than after acupressure in the intervention group was significant statistical difference (p<0.001). The mean difference before the intervention than 12 h after the last intervention between two group was significant statistical difference (p<0/05) which that detected the stability of the effect of acupressure. Conclusions The results indicate that p6 point acupressure in the brain contusion patients under mechanical ventilation has been associated with improved blood pressure, pulse rate, and respiratory rate. While confirmation of these results requires further studies, but use of complementary medicine in recovery the physical condition and strengthening of the effect of nursing care of these patients should be considered.

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