Cardiovascular effects of repeated subanaesthetic ketamine infusion in depression

Background: Ketamine produces significant rapid-onset and robust antidepressant effects in patients with major depressive disorder. However, this drug also has transient cardiovascular stimulatory effects, and there are limited data about potential predictors of these cardiovascular effects. Methods: A total of 135 patients with unipolar and bipolar depression received a total of 741 ketamine infusions (0.5 mg/kg over 40 min). Blood pressure and pulse were monitored every 10 min during the infusions and 30 min after the infusions. Depressive, psychotomimetic and dissociative symptom severity was assessed at baseline and 4 hours after each infusion. Results: The maximum blood pressure and pulse values were observed at 30–40 min during infusions. The largest mean systolic/diastolic blood pressure increases were 7.4/6.0 mmHg, and the largest mean pulse increase was 1.9 beats per min. No significant change in blood pressure and pulse was found in the second to sixth infusions compared with the first infusion. Patients who were older (age⩾50 years), hypertensive and receiving infusions while exhibiting dissociative symptoms showed greater maximal changes in systolic and diastolic blood pressure than patients who were younger (age<50 years), normotensive and without dissociative symptoms (all p < 0.05). Hypertensive patients had less elevation of pulse than normotensive patients ( p < 0.05). Ketamine dosage was positively correlated with changes in systolic and diastolic blood pressure (all p < 0.05). Conclusions: Blood pressure and pulse elevations following subanaesthetic ketamine infusions are transient and do not cause serious cardiovascular events. Older age, hypertension, large ketamine dosage and dissociative symptoms may predict increased ketamine-induced cardiovascular effects.

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Abstract 17638: Systemic Cardiovascular Effects of Intravenous Urocortin 2 and Urocortin 3 in Patients with Heart Failure and Healthy Volunteers

Circulation ◽

10.1161/circ.130.suppl_2.17638 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Colin G Stirrat ◽

Sowmya Venkatasubramanian ◽

Tania Pawade ◽

Andrew Mitchell ◽

Anoop Shah ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Cardiac Index ◽

Healthy Volunteers ◽

Diastolic Blood Pressure ◽

Cardiovascular Effects ◽

Peripheral Vascular ◽

Patients With Heart Failure ◽

Group A ◽

Urocortin 3

Introduction: Urocortin 2 (UCN 2) and urocortin 3 (UCN 3) are endogenous peptide hormones with an emerging role in the pathophysiology and treatment of heart failure. For the first time, we examined the systemic cardiovascular effects of both UCN 2 and UCN 3 in healthy volunteers and patients with heart failure. Methods: Seven healthy volunteers (Group A) and nine patients with stable chronic heart failure (Group B, New York Heart Association class II and III, left ventricular ejection fraction <35%) on optimal medical therapy underwent non-invasive oscillometric sphygmomanometry and impedance cardiography during incremental intravenous infusions of sodium nitroprusside (0.15/0.5/1.5 μg/kg/min), UCN 2 (0.16/0.48/1.6 μg/min), UCN 3 (5/15/50 μg/min) and saline placebo in a randomised double blind two-way cross over study. Results: Other than diastolic blood pressure (78 vs 72 mmHg for Group A and B respectively, p<0.05), haemodynamic variables were similar at baseline of each infusion and were unchanged by saline placebo infusion (p>0.05 for all). SNP, UCN2 and UCN 3 infusions increased heart rate and cardiac index, and reduced systolic and diastolic blood pressure and peripheral vascular resistance index (PVRI) in both healthy volunteers and patients with heart failure (p<0.05 for all; see Figure 1). There were no significant differences in the changes in cardiac index or PVRI between healthy volunteers and patients with heart failure during either UCN 2 or UCN 3 infusions (p>0.05). Conclusion: Intravenous UCN 2 and especially UCN 3 increase cardiac output and reduce peripheral vascular resistance. This favourable haemodynamic profile suggests that UCN 2 and UCN 3 hold exciting therapeutic potential for the treatment of acute heart failure.

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Evaluation of the Cardiovascular Effects of Clonidine in Neonates Treated for Neonatal Abstinence Syndrome

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-23.6.473 ◽

2018 ◽

Vol 23 (6) ◽

pp. 473-478

Author(s):

Raymond P. Meddock ◽

Deirdre Bloemer

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Diastolic Blood Pressure ◽

Neonatal Intensive Care ◽

Dose Range ◽

Safety Data ◽

Cardiovascular Effects ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome

OBJECTIVES Neonatal abstinence syndrome (NAS) is characterized by withdrawal symptoms in neonates exposed to legal or illegal substances in utero, and it is often managed with medications such as opiates, phenobarbital, and clonidine. Clonidine use is increasing, but further safety data regarding its use in neonates are warranted. This study evaluated the effects of clonidine on heart rate and blood pressure in neonates treated for NAS at doses up to 24 mcg/kg/day. METHODS A retrospective review via the electronic medical record of infants at least 35 weeks' gestation treated adjunctively with clonidine for NAS in the neonatal intensive care unit at St Elizabeth was conducted. Heart rate, and systolic and diastolic blood pressure were recorded at baseline, while on different dose ranges of clonidine (small: ≤1.5 mcg/kg per dose every 3 hours; medium: >1.5 to 2 mcg/kg per dose every 3 hours; and large: >2 mcg/kg to 3 mcg/kg per dose every 3 hours), and upon discontinuation. RESULTS A total of 64 infants treated with clonidine for NAS between August 2015 and December 2016 were included. Heart rate decreased in all clonidine dose ranges compared with baseline (average reduction of 7 bpm [CI: −12 to −2], 9 bpm [CI: −16 to −2], and 10 bpm [CI: −18 to −1] for the small, medium, and large dose ranges, respectively; p < 0.0001). Systolic and diastolic blood pressure were not significantly different from baseline when infants were receiving any dose of clonidine, except diastolic blood pressure while on medium–dose range clonidine, where diastolic blood pressure was higher than baseline (p = 0.0128). Increases in systolic and diastolic blood pressure were evident upon discontinuation of clonidine (p < 0.0001 and p = 0.0156, respectively). CONCLUSIONS Clonidine doses up to 24 mcg/kg/day are well tolerated in neonates ≥35 weeks' gestation treated for NAS. Any decreases in heart rate are likely clinically insignificant, and increases in blood pressure upon discontinuing clonidine are mild and may be mitigated further with extended discontinuation protocols. Further trials should be conducted to evaluate the long-term safety of clonidine in this population.

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Cardiovascular Effects of Sedative Infusions of Propofol and Midazolam after Spinal Anaesthesia

Anaesthesia and Intensive Care ◽

10.1177/0310057x8801600309 ◽

1988 ◽

Vol 16 (3) ◽

pp. 292-298 ◽

Cited By ~ 15

Author(s):

D. W. Blake ◽

G. Donnan ◽

J. Novella ◽

C. Hackman

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Spinal Anaesthesia ◽

Forearm Blood Flow ◽

Recovery Period ◽

Cardiovascular Effects ◽

Pelvic Surgery ◽

Control Group ◽

Intravenous Sedation ◽

The Difference

The cardiovascular effects of intravenous sedation were studied in fifty patients after spinal anaesthesia for lower limb or pelvic surgery. Twenty patients received propofol (mean dosage 74 (SD 4) μg/kg/min for 0–20 minutes and 51 (SD 7) μg/kg/min for 20–40 minutes), twenty received midazolam (35 μg/kg + 2.54 (SD 0.2) μg/kg/min for 0–20 minutes and 1.35 (SD 0.2) μg/kg/min for 20–40 minutes) and ten patients received saline infusion only. The forearm vasoconstriction in response to the spinal anaesthesia was measured by strain gauge plethysmography. Spinal anaesthesia lowered systolic and diastolic blood pressure by 18 (SED 4) mmHg and 9 (SED 2) mmHg respectively. (SED = standard error of the difference.) This was associated with a 32% decrease in mean forearm blood flow. Propofol and midazolam caused similar additional reductions in systolic and diastolic blood pressure (10 (SED 4) mmHg and 4 (SED 2) mmHg) and a decrease in heart rate (P< 0.005), but forearm vasoconstriction was not altered. In the control group, however, forearm vasoconstriction increased during 40 minutes in theatre (P<0.05). Recovery from propofol was far more rapid than after midazolam and was virtually complete in ten minutes. This was reflected by an increase in blood pressure and in forearm vasoconstriction in the recovery period.

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Underestimation of Sensorimotor Task-Induced Blood-Pressure Changes by Posttask Sphygmomanometry

Perceptual and Motor Skills ◽

10.1177/003151259508100225 ◽

1995 ◽

Vol 81 (2) ◽

pp. 483-490

Author(s):

J. Kugler ◽

C. Milau ◽

T. Traska ◽

N. Schmitz ◽

G. M. Krüskemper

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cuff Pressure ◽

Cardiovascular Effects ◽

Control Group ◽

Cuff Inflation ◽

Task Effects ◽

Pressure Changes

For assessment of cardiovascular effects of sensorimotor work, blood pressure is commonly measured by arm sphygmomanometry. A technique introduced by Penaz makes it feasible to monitor blood pressure noninvasively and continuously from the finger artery which measures give high correlations with intraarterial measurement. This study compared blood-pressure changes induced by a standard sensorimotor task using sphygmomanometry and the Penaz-method. It was investigated whether sphygmomanometrically recorded blood pressure can be used to estimate task-induced blood-pressure changes and whether inflating the cuff to different maximum pressures induces blood-pressure changes. 46 normotensive individuals were randomly assigned to the discomfort group (maximum arm-cuff pressure of 280 mmHg) or to the control group (maximum arm-cuff pressure of 160 mmHg). The experiment consisted of six tasks of 4 min. each. Results indicated that sphygmomanometries underestimated task-induced blood-pressure changes and that phasic systolic and diastolic blood-pressure elevations during the task were leveled off shortly after the end of the task. Effects of ‘cuff-inflation hypertension’ were not found. The Penaz-method appears to be more appropriate than sphygmomanometry if dynamic aspects of blood pressure are of interest.

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Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00930.2009 ◽

2010 ◽

Vol 298 (3) ◽

pp. H1096-H1102 ◽

Cited By ~ 110

Author(s):

Mads Halbirk ◽

Helene Nørrelund ◽

Niels Møller ◽

Jens Juul Holst ◽

Ole Schmitz ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Rate ◽

Diastolic Blood Pressure ◽

Cardiovascular Effects ◽

Tissue Doppler ◽

Metabolic Effects ◽

Left Ventricular Ejection ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 ± 2%, New York Heart Association II and III ( n = 14 and 6) received 48-h GLP-1 (0.7 pmol·kg−1·min−1) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 ± 17 pmol/l vs. 69 ± 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 ± 0.1 mmol/l vs. 5.6 ± 0.1 mmol/l; P < 0.01). Heart rate (67 ± 2 beats/min vs. 65 ± 2 beats/min; P = 0.016) and diastolic blood pressure (71 ± 2 mmHg vs. 68 ± 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 ± 0.1 l·min−1·m−2 vs. 1.7 ± 0.2 l·min−1·m−2; P = 0.54) and LVEF (30 ± 2% vs. 30 ± 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.

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Adverse Cardiovascular Effects of Phenylephrine Eye Drops Combined With Intravenous Atropine

Frontiers in Pharmacology ◽

10.3389/fphar.2020.596539 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qingyu Li ◽

Jianxin Pang ◽

Yang Deng ◽

Shaochong Zhang ◽

Yong Wang ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

General Anesthesia ◽

Diastolic Blood Pressure ◽

Cardiovascular Effects ◽

Eye Drops ◽

Intraocular Surgery ◽

Atropine Treatment ◽

Intravenous Atropine

Background: Phenylephrine and atropine can cause serious adverse effects when applied in combination. We investigated the effect of phenylephrine eye drops combined with intravenous atropine on the cardiovascular system in patients under general anesthesia undergoing intraocular surgery.Methods: The effects of the drugs were observed through clinical study. Thirteen patients undergoing intraocular surgery under general anesthesia were observed in this study; all were injected intravenously with atropine due to the oculocardiac reflex during surgery. To study the combination of drugs, an in vivo study was performed on rats. Seventy-two standard deviation rats that received phenylephrine eye drops and intravenous atropine treatment under general anesthesia were assessed, of which 18 treated with these drugs simultaneously were administered normal saline, neostigmine or esmolol. Blood pressure and heart rate were recorded and analyzed.Findings: The age of the patients ranged from seven to 14 years old with an average age of 10.7 years old, and 11 patients were male. In patients, 5% phenylephrine eye drops combined with intravenous atropine led to a significant heart rate increase and the increase lasted 20 min. The significant increase in diastolic blood pressure and systolic blood pressure lasted for 15 and 25 min, respectively. From five to 25 min after intravenous atropine treatment, the systolic blood pressure and diastolic blood pressure were both more than 20% higher than that at baseline. In rats, the changes in blood pressure and heart rate were independent of the phenylephrine and atropine administration sequence but were related to the administration time interval. The neostigmine group showed a significant decrease in blood pressure after the increase from the administration of phenylephrine and atropine.Interpretation: Phenylephrine eye drops combined with intravenous atropine have obvious cardiovascular effects that can be reversed by neostigmine. This drug combination should be used carefully for ophthalmic surgery, especially in patients with cardio-cerebrovascular diseases.

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Safety and cardiovascular effects of multiple-dose administration of aripiprazole and olanzapine in a randomised clinical trial

10.1101/2020.08.03.20167502 ◽

2020 ◽

Author(s):

Dora Koller ◽

Susana Almenara ◽

Gina Mejia ◽

Miriam Saiz-Rodriguez ◽

Pablo Zubiaur ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Adverse Events ◽

Diastolic Blood Pressure ◽

Adverse Drug Reactions ◽

Plasma Concentrations ◽

Cardiovascular Effects ◽

Randomised Clinical Trial ◽

Drug Reactions ◽

The Difference

Objective: To assess adverse events and safety of aripiprazole and olanzapine treatment. Methods: Twenty-four healthy volunteers receiving 5 daily oral doses of 10 mg aripiprazole and 5 mg olanzapine in a crossover clinical trial were genotyped for 46 polymorphisms in 14 genes by qPCR. Drug plasma concentrations were measured by HPLC-MS/MS. Blood pressure and 12-lead ECG were measured in supine position. Adverse events were also recorded. Results: Aripiprazole decreased diastolic blood pressure on the first day and decreased QTc on the third and fifth day. Olanzapine had a systolic and diastolic blood pressure, heart rate and QTc lowering effect on the first day. Polymorphisms in ADRA2A, COMT, DRD3 and HTR2A genes were significantly associated to these changes. The most frequent adverse drug reactions to aripiprazole were somnolence, headache, insomnia, dizziness, restlessness, palpitations, akathisia and nausea while were somnolence, dizziness, asthenia, constipation, dry mouth, headache and nausea to olanzapine. Additionally, HTR2A, HTR2C, DRD2, DRD3, OPRM1, UGT1A1 and CYP1A2 polymorphisms had a role in the development of adverse drug reactions. Conclusions: Olanzapine induced more cardiovascular changes; however, more adverse drug reactions were registered to aripiprazole. In addition, some polymorphisms may explain the difference in the incidence of these effects among subjects.

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Distinct hemodynamic and renal effects of calcitonin gene-related peptide and calcitonin in men

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1989.257.6.e848 ◽

1989 ◽

Vol 257 (6) ◽

pp. E848-E854 ◽

Cited By ~ 1

Author(s):

M. P. Gnaedinger ◽

D. E. Uehlinger ◽

P. Weidmann ◽

S. G. Sha ◽

R. Muff ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cardiovascular Effects ◽

Fractional Excretion ◽

Calcitonin Gene Related Peptide ◽

Human Calcitonin ◽

Related Peptide ◽

Calcitonin Gene ◽

Excretion Rates ◽

Normal Men

Cardiovascular and renal actions of human calcitonin gene-related peptide II (or beta) (CGRP) and of human calcitonin (CT) infused intravenously for 1 h each (79 and 263 pmol.kg-1.h-1) have been compared in normal men (n = 10 for CGRP, n = 6 for CT and vehicle alone). CGRP lowered diastolic blood pressure by 26% and increased the heart rate by 35% and raised plasma levels of norepinephrine, epinephrine, and dopamine and renin activity (P less than 0.01). The fractional excretion rates (FE) of sodium and chloride were doubled (P less than 0.05-0.01) in the presence of an unaltered glomerular filtration rate. CT, on the other hand, did not affect the diastolic blood pressure, but the stimulation of diuresis and of the FE of sodium and chloride was more pronounced with CT than with CGRP (P less than 0.01). Moreover, CT lowered serum calcium levels and stimulated urinary adenosine 3',5'-cyclic monophosphate and phosphate excretion (P less than 0.01). In conclusion, the cardiovascular effects of CGRP are contrasted by weaker renal tubular actions of the neuropeptide in relation to CT.

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Differences in Brain Waves and Blood Pressure by Listening to Quran-e-Kareem and Music

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v8i1.315 ◽

2019 ◽

Vol 8 (1) ◽

pp. 40-44

Author(s):

Noor -ul-Ain Irfan ◽

Hafsa Atique ◽

Ayesha Taufiq ◽

Asma Irfan

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Sample Selection ◽

Age Groups ◽

Older Age ◽

P Value ◽

Common Belief ◽

Brain Waves ◽

Group A

Background: Quranic recitation and music do not share any features in terms of content besides the use of melodies, but it is a common belief, that both have positive effect on reducing blood pressure and anxiety level of patients. This research investigates and compares the effects of listening to Quranic recitation and soft music on human brain waves especially Alpha and Beta waves by electroencephalogram (EEG) using Power-Lab.Material and Methods: A clinical trial was carried out in the Physiology Department of Islamabad Medical and Dental College. There were 22 participants, divided into two groups (A and B) with 11 participants in each group. Group A included students with ages 20-25 years and Group B comprised of teaching faculty between 40-60 years. All the study participants were Urdu-speaking, Pakistani Muslims having normal hearing. Sample selection was based on non-random convenient sampling. Paired T-test was used to compare means of Alpha and Beta waves amplitude, with p value < 0.05 considered as statistically significant.Results: Listening to Quranic recitation results in greater amplitude of Alpha waves in both younger and older age groups (p=0.01). The cross comparisons of systolic blood pressure at rest and after music for Group A showed significant results (p=0.04) indicating that soft music increases systolic blood pressure in younger people. Diastolic blood pressure comparison proves that it decreases by Tilawat in older age-groups (p<0.05).Conclusion: EEG showed that Quran generates comparatively higher amplitudes of Alpha than Beta waves, which reflects the calmness and relaxation of the participants while listening to Quranic recitation. Furthermore, there was a mild reduction in diastolic blood pressure in older subjects after listening to Quranic recitation.

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Lutein Complex Supplementation Increases Ocular Blood Flow Biomarkers in Healthy Subjects

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000576 ◽

2019 ◽

Vol 89 (1-2) ◽

pp. 5-12

Author(s):

Alon Harris ◽

Brent Siesky ◽

Amelia Huang ◽

Thai Do ◽

Sunu Mathew ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Diastolic Blood Pressure ◽

Healthy Subjects ◽

Ocular Blood Flow ◽

Capillary Blood ◽

Post Treatment ◽

Capillary Blood Flow ◽

Doppler Imaging ◽

Retinal Capillary

Abstract. Introduction: To investigate the effects of a lutein complex supplementation on ocular blood flow in healthy subjects. Materials and Methods: Sixteen healthy female patients (mean age 36.8 ± 12.1 years) were enrolled in this randomized, placebo-controlled, double-blinded, two-period crossover study. Subjects received daily an oral dose of the lutein with synergistic phytochemicals complex (lutein (10 mg), ascorbic acid (500 mg), tocopherols (364 mg), carnosic acid (2.5 mg), zeaxanthin (2 mg), copper (2 mg), with synergistic effects in reducing pro-inflammatory mediators and cytokines when administered together in combination) and placebo during administration periods. Measurements were taken before and after three-week supplementation periods, with crossover visits separated by a three-week washout period. Data analysis included blood pressure, heart rate, intraocular pressure, visual acuity, contrast sensitivity detection, ocular perfusion pressure, confocal scanning laser Doppler imaging of retinal capillary blood flow, and Doppler imaging of the retrobulbar blood vessels. Results: Lutein complex supplementation produced a statistically significant increase in mean superior retinal capillary blood flow, measured in arbitrary units (60, p = 0.0466) and a decrease in the percentage of avascular area in the superior (−0.029, p = 0.0491) and inferior (−0.023, p = 0.0477) retina, as well as reduced systolic (−4.06, p = 0.0295) and diastolic (−3.69, p = 0.0441) blood pressure measured in mmHg from baseline. Data comparison between the two supplement groups revealed a significant decrease in systemic diastolic blood pressure (change from pre- to post-treatment with lutein supplement (mean (SE)): −3.69 (1.68); change from pre- to post-treatment with placebo: 0.31 (2.57); p = 0.0357) and a significant increase in the peak systolic velocity (measured in cm/sec) in the central retinal artery (change from pre- to post-treatment with lutein supplement: 0.36 (0.19); change from pre- to post-treatment with placebo: −0.33 (0.21); p = 0.0384) with lutein complex supplement; data analyses from the placebo group were all non-significant. Discussion: In healthy participants, oral administration of a lutein phytochemicals complex for three weeks produced increased ocular blood flow biomarkers within retinal vascular beds and reduced diastolic blood pressure compared to placebo.

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