Abstract 69: Distinct Grouping of Systolic Blood Pressure Trajectories During the First 24 Hours After Stroke Admission and Their Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Yong-Jin Cho ◽  
Keun-Sik Hong ◽  
Jun Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Age At Onset ◽  
Stroke Patients ◽  
Vascular Events ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Blood pressure of ischemic stroke patients is a potentially modifiable clinical prognostic factor during acute period. However, BP changes dynamically over time and its temporal variation during acute stage has not received much attention. Methods: From a total of 3795 acute ischemic stroke patients who arrived within 24 hours after onset, we selected 2723 eligible patients who had more than 5 systolic blood pressure (SBP) measurements during 24 hours after arrival. To predict group SBPs for 8 time-points during the first 24 hours, a measured SBP reading was imputed to the nearest missing point. Trajectory grouping of acute stroke patients was estimated using PROC TRAJ, with delta BIC and prespecified modeling parameters. Early neurological deterioration (END) was captured during admission and recurrent vascular events was collected through a structured telephone interview at 1 years after. Results: Of the included cases, mean age at onset was 68 ± 13 year-old. NIHSS score at arrival was median 4 [2, 10] and recanalization treatment was done in 598 (22%). Hypertension was diagnosed in 1930 (71%). Based on 48,445 SBP readings during the first 24 hours after arrival, stroke cases were grouped into 5 distinct SBP trajectories as shown in the Figure: Group 1 (low BP), 17%; Group 2 (stable BP), 41%; Group 3 (rapidly stabilized SBP), 11%; Group 4 (higher SBP), 23%; Group 5 (extremely high SBP without stabilization), 8%. Trajectory grouping was independently associated with END and recurrent vascular events (see Figure). Group 1 had low odds of having END (adjusted OR [95% CI]; 0.62 [0.44-0.87], but Group 4 and 5 showed higher probability of having END (1.34 [1.04-1.73] and 1.76 [1.22-2.51]) and recurrent vascular events until 1 year (1.28 [1.00-1.64] and 1.82 [1.29-2.55]). However, Group 3 had comparable risks with Group 2. Conclusion: It was documented that SBP may successfully grouped into distinct trajectories, which are associated with outcomes after stroke.

scholarly journals The effects of blood pressure reduction on cyclosporine nephrotoxicity in the rat.

1993 ◽  
Vol 3 (12) ◽  
pp. 1892-1899
Author(s):  
R A Lafayette ◽  
G Mayer ◽  
T W Meyer
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Interstitial Fibrosis ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Group 4 ◽  
Cyclosporine Nephrotoxicity ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The effects of blood pressure reduction on cyclosporine nephrotoxicity were studied over 12 months in four groups of rats. Group 1 received no drugs and served as controls. Groups 2, 3, and 4 received cyclosporine (CyA), approximately 9 mg/kg.day, in their food. In addition, Group 3 received enalapril and Group 4 received minoxidil, hydrochlorothiazide, and reserpine. Time-averaged monthly systolic blood pressure was equal in Groups 1 and 2 (136 +/- 1 and 135 +/- 1 mm Hg, respectively). Antihypertensive agents reduced average systolic blood pressure in Groups 3 and 4 (116 +/- 1 and 117 +/- 1 mm Hg, respectively). Morphometric studies showed that 12 months of CyA treatment caused interstitial fibrosis with an increase in the fractional volume of cortical interstitium (VvInt: Group 2, 20 +/- 1%; Group 1, 11 +/- 1%) and a reduction in mean glomerular volume (VG. Group 2, (2.00 +/- 0.06) x 10(6) mu 3; Group 1, (2.48 +/- 0.06) x 10(6) mu 3). These structural changes were accompanied by a significant reduction in GFR (Group 2, 2.27 +/- 0.10 mL/min; Group 1, 2.76 +/- 0.10 mL/min). Cotreatment with enalapril reduced interstitial fibrosis (VvInt, 14 +/- 1%) and maintained VG (2.23 +/- 0.08 x 10(6) mu 3) and GFR (2.56 +/- 0.08 mL/min) at near-normal values in Group 3. In contrast, the combination antihypertensive regimen increased the extent of interstitial fibrosis (VvInt, 24 +/- 1%) and further lowered VG (1.72 +/- 0.05 x 10(6) mu 3) and GFR (1.72 +/- 0.05 mL/min) in Group 4. These results show that sustained treatment with a moderate dose of CyA causes interstitial fibrosis and impairs renal function in rats. The administration of enalapril, but not minoxidil, reserpine, and hydrochlorothiazide, limits renal injury in this model.

scholarly journals Pegvisomant as Monotherapy or Combination Therapy in Somatostatin Refractory Acromegaly

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A523-A524
Author(s):  
Dawid Hordejuk ◽  
Edward Raymond Laws ◽  
Ursula B Kaiser ◽  
Le Min
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Systolic Blood Pressure ◽  
Tumor Size ◽  
Dopamine Agonists ◽  
Group 4 ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background: Pegvisomant, a growth hormone antagonist, has been widely used as monotherapy or combination therapy with somatostatin (SST) analogs and/or dopamine agonists in acromegaly poorly controlled by SST analogs. Limited information is available to compare pegvisomant monotherapy, combination with SST analogs or dopamine agonists, and combination of all three agents. Method: In this retrospective cohort study, we identified 23 patients with SST analog refractory acromegaly who received pegvisomant as monotherapy or in combination with SST analogs and/or dopamine agonists through the Research Patient Data Registry. We divided the patients into four groups: Group 1. pegvisomant alone (n=8); Group 2. pegvisomant plus a SST analog (pasireotide, octreotide or lanreotide) (n=8); Group 3. pegvisomant plus cabergoline (n=5) Group 4. Pegvisomant plus SST analog and dopamine agonist (n=2). We analyzed the changes in IGF-1, HbA1C, ALT and AST, blood pressure, and radiographic tumor size before and 6 months after treatment. Results: In 6 months, the mean IGF-1 level (ng/ml) changed from baseline 482 to 290 and decreased by 40% (P = 0.050) in group 1, changed from baseline 623 to 291 and decreased by 53% (P= 0.003) in group 2, changed from baseline 579 to 367 and decreased by 36% (p = 0.100) in group 3, and decreased 47% from 609 to 326 (P= 0.100) in group 4. The mean systolic blood pressure (mmHg) before and 6 months after treatment changed from 139 to 128 (p = 0.001) in group 1, changed from 130 to 126 (p = 0.553) in group 2, changed from 134 to 126 (p = 0.373) in group 3, and changed from 125 to 127 (p= 0.700) in group 4. Diastolic blood pressure (mmHg) changed from 82 to 76 (P = 0.110) in group 1, changed from 79 to 76 (p = 0.325) in group 2, changed from 80 to 74 (p=0.002) in group 3, and changed from 80 to 75 (p=0.126) in group 4. There were no significant changes in ALT and AST and A1C before and 6 months after treatment in all groups. In terms of radiographic tumor size change before and 6 months after the treatment, there was no change in tumor size in 5 of 5 patients in group 1. In group 2, the tumor size in 4 of 7 remained unchanged but 3 of 7 patients had increased tumor sizes. In group 3, there was no change in tumor size in 3 of 3 patients. In group 4, there was no change in tumor size in 2 of 2 patients. Conclusion: Our results suggest that in somatostain analog refractory acromegaly, combination pegvisomant and a SST analog significantly decreased IGF-1 level although decrease in IGF-1 in pegvisomant monotherapy almost reach statistical significance (P = 0.050). Although there was a trend in decrease of blood pressure in all groups, the decrease reached significant significance in systolic blood pressure in group 1 and diastolic blood pressure in group 3. Finally, except group 2, the tumor size remained unchanged.

scholarly journals Superoxide via Sp3 mechanism increases renal renin activity, renal AT1 receptor function, and blood pressure in rats

2018 ◽  
Vol 315 (5) ◽  
pp. F1478-F1483 ◽  
Author(s):  
Mohammad Saleem ◽  
Xitao Wang ◽  
Indira Pokkunuri ◽  
Mohammad Asghar
Keyword(s):  
Blood Pressure ◽  
Saline Group ◽  
Renin Activity ◽  
Lysine Acetylation ◽  
Group 4 ◽  
Biochemical Studies ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

We tested a hypothesis that superoxide, by inducing Sp3, increases renal renin activity, renal angiotensin II type 1 receptor (AT1R) function, and blood pressure (BP) in rats. Group 1 rats were treated with vehicle, saline. Group 2 rats were treated with superoxide dismutase (SOD) inhibitor diethylthiocarbamate (DETC). Group 3 rats were treated with DETC and an SOD mimetic, tempol. Group 4 rats were treated with tempol only. All four groups of rats were treated for 2 wk then anesthetized, and BP was recorded. Thereafter, diuresis and natriuresis in response to AT1R blocker candesartan were determined. When compared with vehicle rats, BP increased in DETC rats. The increased BP in DETC rats decreased with tempol. Diuresis and natriuresis in response to candesartan increased in controls, and this further increased in DETC rats and decreased with tempol. A second set of four groups of rats underwent the same treatment as above and were anesthetized, and their kidneys were obtained for biochemical studies. The levels of superoxide but not hydrogen peroxide increased, whereas SOD activities decreased further in the renal cortical tissues of DETC rats than vehicle rats. These effects were attenuated with tempol in DETC rats. Moreover, tissue renin activity and abundance of membranous AT1R proteins increased more in DETC rats than vehicle rats, and decreased with tempol in DETC rats. Furthermore, the levels of lysine-acetylated, but not serine-phosphorylated, Sp3 increased more in the nuclei of DETC rats than vehicle rats. The increased levels of Sp3 lysine acetylation decreased in DETC rats with tempol. Taken together, our results suggest that superoxide activates renal Sp3 via lysine acetylation increasing renin activity, AT1R function, and BP in rats.

scholarly journals Changes in retinal vascular diameters in senior and geriatric cats in association with variation in systemic blood pressure

2021 ◽  
pp. 1098612X2199762
Author(s):  
Andra-Elena Enache ◽  
Ursula M Dietrich ◽  
Oscar Drury ◽  
Emanuele Trucco ◽  
Tom MacGillivray ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Target Organ Damage ◽  
Retinal Vessel ◽  
Systemic Blood Pressure ◽  
Risk Indicator ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Objectives Early diagnosis of arterial hypertension is essential to prevent target organ damage. In humans, retinal arteriolar narrowing predicts hypertension. This blinded prospective observational study investigated the retinal vessel diameters in senior and geriatric cats of varying systolic blood pressure (SBP) status and evaluated retinal vascular changes in hypertensive cats after treatment. Methods Cats with a median age of 14 years (range 9.1–22 years) were categorised into five groups: group 1, healthy normotensive (SBP <140 mmHg; n = 40) cats; group 2, pre-hypertensive (SBP 140–160 mmHg; n = 14) cats; group 3, cats with chronic kidney disease (CKD) and normotensive (n = 26); group 4, cats with CKD and pre-hypertensive (n = 13); and group 5, hypertensive cats (SBP >160 mmHg, n = 15). Colour fundus images (Optibrand ClearView) were assessed for hypertensive lesions. Retinal vascular diameters and bifurcation angles were annotated and calculated using the Vascular Assessment and Measurement Platform for Images of the Retina annotation tool (VAMPIRE-AT). When available, measurements were obtained at 3 and 6 months after amlodipine besylate treatment. Results Ten hypertensive cats had retinal lesions, most commonly intraretinal haemorrhages and retinal exudates. Arteriole and venule diameters decreased significantly with increasing age (–0.17 ± 0.05 pixels/year [ P = 0.0004]; –0.19 ± 0.05 pixels/year). Adjusted means ± SEM for arteriole and venule diameter (pixels) were 6.3 ± 0.2 and 8.9 ± 0.2 (group 1); 7.6 ± 0.3 and 10.1 ± 0.4 (group 2); 6.9 ± 0.2 and 9.5 ± 0.3 (group 3); 7.4 ± 0.3 and 10.0 ± 0.4 (group 4); and 7.0 ± 0.3 and 9.8 ± 0.4 (group 5). Group 1 arteriole and venule diameters were significantly lower than those of groups 2 and 4. Group 2 arteriole bifurcation angle was significantly narrower than those of groups 1 and 3. Post-treatment, vessel diameters decreased significantly at 3 and 6 months in seven hypertensive cats. Conclusions and relevance Increased age was associated with reduced vascular diameters. Longitudinal studies are required to assess if vessel diameters are a risk indicator for hypertension in cats.

scholarly journals COMPARISON OF INFLUENCE OF VARIOUS REGIMENS OF DRUG INTAKE ON 24 HOUR bLOOD  PRESSURE, CENTRAL AORTIC PRESSURE AND VASCULAR WALL STIFFNESS IN SYSTEMIC  HYPERTENSION PATIENTS WITH ISCHEMIC STROKE

2018 ◽  
pp. 56-66 ◽  
Author(s):  
V. V. Skibitsky ◽  
A. V. Fendrikova ◽  
S. V. Opolskaya
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Vessel Wall ◽  
Vascular Wall ◽  
Aortic Pressure ◽  
Once Daily ◽  
Wall Stiffness ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To assess and compare the efficacy of combination antihypertension drugs influence with various dosage regimens during 24 hour, on the parameters of daily blood pressure (BP) profile, central aortic pressure (CAP) and vessel wall stiffness in arterial hypertension (AH) patients with ischemic stroke (IS).Material and methods. To the study, 177 AH patients included, with IS within last 4 weeks. All patients were randomized to 3 groups depending on the regimen of antihypertensive drugs combination intake during 24 hours. At baseline and in 12 months of therapy all patients underwent 24 hour BP monitoring (ABPM), CAP measurement and vessel wall stiffness evaluation. Results. In 8 weeks of antihypertension therapy, target pressure level achievement was significantly more common in b. i.d. valsartan (group 3) comparing to once daily in the morning (group 1) or evening (group 2) (p<0,05). In all groups there were statistically significant positive changes in ABPM, CAP and stiffness. Also, in the group 2 there was significantly (p<0,05) more prominent decrease of the main ABPM, CAP and stiffness parameters than in the group 1. Valsartan b. i.d. led to significantly more prominent (p<0,05) improvement of the main ABPM, CAP and stiffness parameters improvement comparing to both variants of its once daily regimens. In 12 months of chronopharmacotherapy, in all groups, there was significant (p<0,05) increase of “dipper” 24 hour BP profile patients. Differences of the groups of “dippers” and “non-dippers” by the 12th month of treatment were significant for 3rd and 1st (p=0,0004), 3rd and 2nd (p=0,04) groups with the benefit for group 3.Conclusion. Two times a day or only evening intake of valsartan with thiazidelike diuretic in the morning facilitated more significant improvement of the main parameters of ABPM, CAP and vascular wall rigidity comparing to just morning intake. B.i.d. valsartan regimen led to significantly (p<0,05) more commonly reached target BP level, improved normalization of 24 hour BP in most of patients, led to more significant improvement of the main ABPM, CAP and vascular stiffness parameters comparing to once daily morning or evening regimen.

scholarly journals Study on the Evaluation of Various Types of Sham Acupuncture Treatments in Hemiplegic Stroke Patients: The Protocol of a Randomized Clinical Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Seungwon Kwon ◽  
Seung-Yeon Cho ◽  
Seong-Uk Park ◽  
Woo-Sang Jung ◽  
Sang-Kwan Moon ◽  
...  
Keyword(s):  
Massachusetts General Hospital ◽  
Sham Acupuncture ◽  
Treatment Session ◽  
Stroke Patients ◽  
Disease Treatment ◽  
Group 4 ◽  
Acupuncture Sensation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background. Various sham acupuncture devices have been developed and used in studies on acupuncture. However, there is controversy on whether these devices act as an appropriate placebo or control. In particular, validation of sham acupuncture has only been performed in studies involving healthy individuals. In this regard, questions on the suitability of various sham acupuncture treatments in studies involving disease treatment remain unanswered. Therefore, in this study, we would like to investigate the most appropriate sham acupuncture in the research on treatment of hemiplegic stroke. Methods. The proposed study is a single-center, prospective, randomized sequence, participant- and assessor-blinded trial with four parallel arms. A total of 90 participants will be randomly assigned to Group 1, Group 2, Group 3, or Group 4 in a 1 : 1 : 1 : 1 ratio. All groups will be treated with Quchi (LI11) for 20 minutes. Group 1 will be treated with verum acupuncture; Group 2, with Park Sham Device; Group 3, with Streitberger’s needle; and Group 4, with insertion- and removal-type devices. Participants will undergo one treatment session. The primary outcome is Bang’s blinding index. Secondary outcomes are the “Discomfort caused by acupuncture therapy” questionnaire and the Massachusetts General Hospital Acupuncture Sensation Scale index. Immediately after the procedure, all participants will also be monitored for adverse events. Discussion. This study will help identify the optimal sham acupuncture device that can be used for clinical studies on acupuncture treatment in hemiplegic stroke patients. This trial is registered with KCT0002622.

scholarly journals Association of early and later depressive symptoms with functional outcome after ischemic stroke

2021 ◽  
Author(s):  
Anna Maria Lopatkiewicz ◽  
Joanna Pera ◽  
Agnieszka Slowik ◽  
Tomasz Dziedzic
Keyword(s):  
Ischemic Stroke ◽  
Depressive Symptoms ◽  
Functional Outcome ◽  
Psychiatric Symptoms ◽  
Post Stroke ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Post-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms. Methods Of 698 enrolled patients with ischemic stroke, we included 335 participants (median age: 68, 48% female) who were assessed for DS both 8 days and 3 months post-stroke. We divided patients into 4 groups: without greater DS (Group 1), only earlier DS (Group 2), only later DS (Group 3), and persistent DS (Group 4). Logistic regression was used to determine the association between DS and 3- and 12-month functional outcome. Results Group 2 was predominantly female and had the highest rate of previous stroke or transient ischemic attack. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms, and cognitive decline. In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64–4.07, P < 0.01 and OR 3.97, 95% CI 2.32–6.76, P < 0.01, respectively) compared with Group 1. Conclusions Different trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

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