Abstract P263: Symptomatic Post-Acute SARS-CoV-2-Infection Hypertension Syndrome

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lauren East ◽  
Zainab Mahmoud ◽  
Amanda Verma
Keyword(s):  
Blood Pressure ◽  
Chest Pain ◽  
Vital Signs ◽  
Wilcoxon Test ◽  
Initial Visit ◽  
Office Visits ◽  
Paired Data ◽  
Cardiology Clinic ◽  
Blood Pressures

Introduction: The Post-COVID Cardiology Clinic at Washington University evaluates and treats patients with ongoing cardiovascular symptoms following acute COVID-19 infection. One clinical manifestation seen in the clinic is an increase in blood pressure, with associated symptoms like chest pain. Our investigation aims to describe the increase in blood pressure seen in symptomatic patients presenting to the Post-COVID Cardiology Clinic. Methods: The study employed a retrospective cohort design of consecutive adult patients who presented between September 2020 to May 2021 with cardiovascular symptoms following COVID-19 infection. Demographic information, symptoms, vital signs, and follow-up visit data were collected for the patients. To determine a baseline blood pressure, two blood pressure readings from office visits prior to COVID-19 infection were averaged. The blood pressure values were compared between baseline and cardiology office visits using a non-parametric Wilcoxon test for paired data. Results: One-hundred patients were included in the cohort (mean age 46.4 years (SD 46.4); 81% (81) female). At the initial visit, there was a significant increase in systolic (median 128 mmHg) and diastolic (median 83.5 mmHg) blood pressure from baseline (systolic median 121.5, p=0.029; diastolic median 76, p<0.001). All patients with an increase in blood pressure reported symptoms like chest pain. In the subset of 36 (36%) patients that have followed up, 35 (97%) patients were prescribed a new anti-hypertensive or required an increased dose of a prior anti-hypertensive at their initial visit. Blood pressures at follow-up were not significantly different from baseline (median systolic delta= 1.0mmHg, diastolic delta= -1.0mmHg; p>0.05), and 83% (30) reported improvement in symptoms. Conclusions: Patients presenting with cardiovascular symptoms post-acute COVID-19 show increased blood pressure when compared to blood pressure prior to infection. During subsequent follow-up appointments, patients showed improvement in their blood pressure and symptoms. While the pathophysiology has yet to be determined, it is likely related to the effects of a proinflammatory state, endothelial dysfunction, dysautonomia, or altered effects of the RAAS.

Clinical Comparison of Automatic, Noninvasive Measurements of Blood Pressure in the Forearm and Upper Arm With the Patient Supine or With the Head of the Bed Raised 45°: A Follow-Up Study

2006 ◽  
Vol 15 (2) ◽  
pp. 196-205 ◽  
Author(s):  
Kathleen Schell ◽  
Denise Lyons ◽  
Elisabeth Bradley ◽  
Linda Bucher ◽  
Maureen Seckel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Vital Signs ◽  
Upper Arm ◽  
Mean Values ◽  
Noninvasive Measurements ◽  
Starting Position ◽  
Arm Circumference ◽  
Blood Pressures ◽  
Cuff Size

• Background Noninvasive measurement of blood pressure in the forearm is used when the upper arm is inaccessible and/or when available blood pressure cuffs do not fit a patient’s arm. Evidence supporting this practice is limited. • Objective To compare noninvasive measurements of blood pressure in the forearm and upper arm of medical-surgical inpatients positioned supine and with the head of the bed raised 45°. • Methods Cuff size was selected on the basis of forearm and upper arm circumference and manufacturers’ recommendations. With a Welch Allyn Vital Signs 420 Series monitor, blood pressures were measured in the forearm and then in the upper arm of 221 supine patients with their arms resting at their sides. Patients were repositioned with the head of the bed elevated 45° and after 2 minutes, blood pressures were measured in the upper arm and then the forearm. Starting position was alternated on subsequent subjects. • ResultsPaired t tests revealed significant differences between systolic and diastolic blood pressures measured in the upper arm and forearm with patients supine and with the head of the bed elevated 45°. The Bland-Altman procedure revealed that the distances between the mean values and the limits of agreement were from 15 to 33 mm Hg for individual subjects. • Conclusions Noninvasive measurements of blood pressure in the forearm and upper arm cannot be interchanged in medical-surgical patients who are supine or in patients with the head of the bed elevated 45°.

Abstract P606: Hemodynamic Predictors of Multiple Recurrent Strokes in the Patients With Prior Lacunar Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Alexandra Kvernland ◽  
Alen Delic ◽  
Ka-ho Wong ◽  
Nazanin Sheibani ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Failure Time ◽  
Recurrent Stroke ◽  
Cox Proportional Hazards Model ◽  
Lacunar Stroke ◽  
Blood Pressures ◽  
Recurrent Strokes ◽  
The Mean

Background: Recurrent stroke has higher morbidity and mortality than incident stroke. We evaluated hemodynamic risk factors for multiple recurrent strokes. Methods: We included patients in the SPS3 trial. The primary predictor was the top tertile, compared to the bottom tertile, of the mean systolic blood pressure (mSBP) and blood pressure variability represented as standard deviation (sdSBP) using blood pressures from day 30 of the trial to the end of follow-up. We excluded blood pressures from the first 30 days to reduce confounding from the trial’s intervention. We fit a logistic regression model to ≥2 recurrent strokes from day 30 to the end of follow-up and, to accurately analyze the multiple failure-time data, we ordered the multiple failure events to the Prentice, Williams and Peterson extension of the Cox proportional-hazards model. Results: We included 2,882 patients, of which 223 had a recurrent stroke and 41/223 had ≥2 recurrent strokes for a total of 272 strokes. The mean (SD) number of blood pressure readings was 78.0 (37.4). The etiology of the 272 strokes was 161 (59.2%) lacunar, 22 (8.1%) intracranial atherosclerosis, 10 (3.7%) extracranial atherosclerosis, 24 (8.8%) cardioembolic, and 55 (20.2%) cryptogenic or other. In both unadjusted and adjusted logistic regression models and PWP Cox models, the top tertile of sdSBP was consistently predictive of multiple recurrent strokes, while mSBP was not (Tables 1/2). Conclusions: We found that in patients with an index lacunar stroke, higher SBP variability, but not mean SBP, was predictive of multiple recurrent strokes of varying mechanisms.

Abstract 356: Hypertension Management at the University of Michigan Student Run Free Clinic: Does it Meet National Guidelines?

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Lindsey Gakenheimer ◽  
Hari S Conjeevaram
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Lifestyle Changes ◽  
Uncontrolled Hypertension ◽  
Diabetic Patients ◽  
University Of Michigan ◽  
Initial Visit ◽  
Free Clinic ◽  
The University

Purpose: The University of Michigan Student Run Free Clinic (UMSRFC) provides primary care to uninsured adults in Southeast Michigan. Optimal management of chronic conditions, such as hypertension, is one of the clinic’s primary goals. Our aim was to evaluate UMSRFC’s success in meeting the Centers of Medicare and Medicaid Service’s (CMS’s) goal of blood pressure (BP) within the recommended values for ≥63% of clinic patients diagnosed with hypertension. Methods: A retrospective chart review identified hypertensive patients with at least two UMSRFC visits between April 2012 and July 2013. Age, sex, ethnicity, body mass index, medications, blood pressure (BP), and comorbidities were extracted and stored in an online database. Patients were separated into two groups: those with controlled hypertension (≤140/90 mmHg for systolic/diastolic BP) at their most recent clinic date and those with uncontrolled hypertension (>140/90 mmHg for systolic/diastolic BP) at the most recent clinic visit. Results: Of 43 patients presenting with hypertension, 26 (60.5%) met inclusion criteria. The average age was 52.3 +/- 2.0 years, and 12 (46.2%) were male. The majority (17, 65.4%) of patients self-identified as Caucasian, and 24 (92.4%) were from Southeast Michigan. Follow-up BP was controlled for 17 (65.4%) patients. All 6 (23.1%) patients controlled at initial visit remained controlled at follow-up, and 15 (75%) of those uncontrolled at initial visit were controlled at follow-up. BP control among diabetic patients improved the most: from 1 (16.7%) to 5 (83.3%) (p=0.833) achieving control; statistical insignificance is likely due to sample size. Most patients reduced their BP with the addition of medications, but 2 (7.8%) achieved control with lifestyle changes (eg. reduced salt intake, increased exercise or improved home BP recording adherence) alone. Conclusions: UMSRFC has marginally exceeded CMS’s benchmark with 17 (65.4%) of patients with hypertension having a controlled blood pressure at follow-up. While this result demonstrates that a free clinic working with an uninsured population can provide quality care, UMSRFC will continue to work diligently toward the goal of controlled BP for 100% of patients with hypertension.

Usefulness of Exercise Stress Testing for Prediction of Blood Pressure Trends

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 1071-1075
Author(s):  
David E. Fixler ◽  
W. Pennock Laird ◽  
Kent Dana
Keyword(s):  
Blood Pressure ◽  
Stress Testing ◽  
Isometric Exercise ◽  
Systolic Pressure ◽  
Exercise Stress ◽  
Female Adolescents ◽  
Exercise Stress Testing ◽  
Stress Tests ◽  
Blood Pressures

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.

Evaluating the Situational Specificity of Relaxation in Mild Essential Hypertension

1980 ◽  
Vol 51 (2) ◽  
pp. 667-674
Author(s):  
John E. Martin ◽  
Leonard H. Epstein
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Diastolic Blood Pressure ◽  
Systolic Pressure ◽  
Progressive Relaxation ◽  
Multiple Baseline ◽  
Self Monitoring ◽  
Situational Specificity ◽  
Blood Pressures

A multiple baseline across subject/settings design was employed to assess the specificity of the effects of progressive relaxation in two recently diagnosed, mild hypertensives. Relaxation was implemented successively across laboratory and home settings. In Subject 1, laboratory relaxation was associated with control over diastolic blood pressure, while in Subject 2, control over systolic pressure was observed. Improvements to normotensive levels were observed for both subjects, and the changes were maintained in both settings for Subject 2 at 6- and 12-mo. follow-up. Subject 1 discontinued her medications, relaxation, and self-monitoring of blood pressure, which was associated with an increase in blood pressure during treatment maintenance; however, at 6- and 12-mo. follow-up, both home and laboratory blood pressures were within normotensive range.

scholarly journals Ankle Blood Pressure and Pulse Pressure as Predictors of Cerebrovascular Morbidity and Mortality in a Prospective Follow-Up Study

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Heikki J. Hietanen ◽  
Rauni Pääkkönen ◽  
Veikko Salomaa
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Reference Group ◽  
Morbidity And Mortality ◽  
Abnormal Finding ◽  
Follow Up Study ◽  
Exercise Blood Pressure ◽  
Blood Pressures ◽  
Age And Sex

Background and Objective. We examined the association of elevated ankle blood pressure (ABP), together with exercise blood pressure, with incident cerebrovascular (CV) morbidity and mortality in a prospective follow-up study of 3,808 patients. The results were compared with pulse pressure, another indicator of arterial stiffness.Methods. Patients with normal ankle and exercise brachial blood pressures were taken as the reference group. Pulse pressure was considered as quartiles with the lowest quartile as the reference category.Results. A total of 170 subjects had a CV event during the follow-up. Multivariate adjusted hazard ratio of a CV event was 2.24 (95% CI 1.43–3.52, ) in patients with abnormal ABP. The pulse pressure was significant only in the model adjusted for age and sex.Conclusion. The risk of a future CV event was elevated already in those patients among whom elevated ABP was the only abnormal finding. As a risk marker, ABP is superior to the pulse pressure.

scholarly journals Prospective Pilot Study of Telehealth As Domiciliary Follow-up after Hematopoietic Cell Transplantation during the COVID19 Pandemic

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 35-36
Author(s):  
Alberto Mussetti ◽  
Maria Queralt Salas Gay ◽  
Maria Condom ◽  
Maite Antonio ◽  
Cristian Ochoa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Oxygen Saturation ◽  
Real Time ◽  
Emotional Distress ◽  
Patient Monitoring ◽  
Clinical Symptoms ◽  
Vital Signs ◽  
Clinical Information ◽  
Patient Monitoring System

Introduction An increased risk of mortality has been documented in transplanted patients affected by Coronavirus Disease 2019 (COVID19) with an estimated mortality rate between 20-40%. Multiple efforts are ongoing to control COVID19 pandemic, and clinical practice is being adapted at the same time as the pandemic progresses around the world. To reduce unnecessary in-person appointments has become crucial to minimize hospital exposition. Digital technologies allow us to perform real-time monitoring of patients' clinical status. A real-time patient monitoring system through the use of a smartphone application and wearable devices was implemented at our Center during the COVID19 pandemic. Methods Since March 2020, a real time patient monitoring system was implemented at our HCT program. All consecutive adults patients transplanted between April 2020 and July 2020 were considered for the study. Vital signs and relevant clinical information were reported during 14 consecutive days after being discharged, through the online platform provided by Trilema Fundation (saludencasa.trilema.org, Fundación Trilema, Valencia, Spain). Vital signs (cardiac frequency, blood pressure, oxygen saturation) were measured with validated oxymeters (Onyx II®, Nonin Inc, Plymouth MN USA) and blood pressure monitors (iHealth Track®, Mountain View, CA USA). Temperature was measured through domiciliary thermometers. Patients were educated to measure their respiratory frequency. A checklist of clinical symptoms was filled daily. An analogue visual scale (0-10) to detect potential cases of anxiety or depressive disorders was reported daily. Scores of &gt;6 were evaluated by a psycho-oncologist through videoconference. All the data were reported to the online platform using a smartphone app compatible with iPhone and Android systems. A direct chat between patients and physician was available through the app. Clinical information was daily supervised by an experienced HCT hematologist. Clinical interventions were arranged if significant clinical abnormalities were documented. A hematologist with experience in HCT patients revised all the patients' data daily. Programmed alarms were set in case of any of the following situations: fever &gt;38 oC; oxygen saturation &lt;92%; tachicardia &gt;125/bpm, hypotension (sytolic&lt;90 mmHg, diastolic &gt; 60 mmHg; altered mental status; persistent emesis or diarrhea). Patient´s satisfaction questionnaires were evaluated individually after finalizing the 14-days clinical monitoring. Results During the study period, 21 adults underwent HCT and 16 were s were eligible to be recruited into the study (80% feasibility) with team effort and without additional costs. Reasons for not being enrolled were: language incompatibility (1 patient), no consent (1 patient), not compatible smartphone (3 patients). Of the 16 enrolled patients, median age was 50 (range 22-70 years), 37% were female and 94% had lymphoid diseases. Thirty-eight percent of HCTs were autologous and 62% allogeneic. Of the 16 enrolled patients, 25% were not able to adequately use the app due to inability in using smartphone applications. Of the remaining 12 patients, adherence in reporting study data (number of days reported of the planned 14 days study period) was as follows (average): temperature 89%, oxygen saturation 90%, respiratory frequency 70%, cardiac frequency 85%, blood pressure 89%, symptoms reporting 65%, emotional distress 71%. Automatic alarms were activated only 3 times: twice for the presence of clinical symptoms and once, for emotional distress. A videoconference with the psycho-oncologist was requested by one patient only. The chat service to communicate with hospital personnel was used in 4 patients. Data collected with the digital system helped the clinician to early recognize arterial hypertension (1 patient) and acute cutaneous GVHD grade 1 (1 patient). Only two patients of the whole cohort were readmitted within 14 days from discharge due to grade 4 odynophagia due to HSV1/2 reactivation. Patients´ experiences with telehealth systems are reported in table 1. Conclusion Telehealth monitoring can potentially improve patient's follow-up in terms of both physical and psychological outcomes. Technological problems still represent a barrier to a wider application of telehealth monitoring systems in the medical setting. Disclosures Mussetti: Novartis, Gilead: Honoraria, Research Funding. Sureda Balari:Incyte: Consultancy; Janssen: Consultancy, Honoraria; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; BMS: Speakers Bureau; Roche: Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Sanofi: Consultancy, Honoraria; Gilead/Kite: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau.

scholarly journals Pola Pengobatan Insulin dan Ace - Inhibitor pada Pasien Diabetes Melitus Tipe 2 dengan Hipertensi Terhadap Kontrol Glikemik dan Tekanan Darah

2020 ◽  
Vol 1 (2) ◽  
pp. 34-40
Author(s):  
Chitra Astari
Keyword(s):  
Blood Pressure ◽  
Blood Sugar ◽  
Ace Inhibitor ◽  
Fasting Blood Glucose ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Wilcoxon Test ◽  
Cross Sectional ◽  
Blood Pressures ◽  
Dm Type 2

This research aimed to analyze the insulin and ACE Inhibitor therapy to patients with DM type 2 with hypertension, and giving a picture about the influence on the blood sugar control and blood pressure using the parameter of  fasting blood glucose, HbA1C, and blood pressure. The research was conducted in the  endocrine clinic  of DR. Wahidin Sudirohusodo General Hospital, Makassar,  from 2 May through 12 July, 2016. The research was a Cross-Sectional study with the samples chosen using the evhaustive sampling technique. The types of insulin and antihypertension class ACE inhibitor as revealed by the interviews with the patients. The therapy effects of pre and post interventions were analyzed using the parameter of glycemia, and HbA1C using  the pair sample T-test and blood pressure using Wilcoxon test. The research results indicated that the level of blood sugar after fasting was reduced to 64.08 and the level of HbA1C was reduced to 1.51 with the value of P = 0.000. The parameter of systolic and diastolic blood pressures had equal degradation of 12.56 and 12.32 respectively with value of P = 0.000, meaning P0.05 in statistics.

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