Association of nocturnal subconjunctival hemorrhage and non-dipper blood pressure pattern: A benign clue for serious diseases

2021 ◽  
pp. 112067212110709
Author(s):  
Feyza Çalış Karanfil ◽  
Mustafa Karanfil ◽  
Yasin Toklu
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Heart Rate ◽  
Blood Pressure Monitoring ◽  
Strong Association ◽  
Blood Parameters ◽  
Masked Hypertension ◽  
Pressure Pattern ◽  
Subconjunctival Hemorrhage ◽  
Artery Disease

Purpose To evaluate the association between non-dipper blood pressure pattern and subconjunctival hemorrhage (SCH). Methods Twenty-seven consecutive patients with nocturnal SCH and 27 age, sex-matched controls were enrolled. Demographic, blood parameters, office blood pressure measurements, 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. Results Mean diastolic blood pressure (DBP) for nighttime (65.03 ± 7.1 vs. 70.78 ± 10.5, p: 0.22), mean heart rate for nighttime (64.54 ± 8.26 vs. 69.93 ± 9.85, p: 0.034), Minimum Systolic Blood pressure(SBP) and DBP values for nighttime (92.44 ± 9.72 vs. 99.44 ± 10.66, p:0.015 and 51.15 ± 8.31 vs. 57.7 ± 11.2, p: 0.018) were higher, nocturnal fall ratio of SBP and DBP were significantly lower in the SCH ( + ) group compared to SCH (-) group (5.38 ± 8.39 vs. 10.34 ± 6.08, p: 0.016 and 4.26 ± 8.92 vs. 13.78 ± 6.97, p < 0001 respectively). Ten patients (37%) in the SCH (-) group and 18 patients (66.7%) in the SCH ( + ) group were non-dippers (p: 0.029). Mean daytime SBP and DBP were higher compared to office measurements of 4 patients (14.8%) in the SCH (-) group and 11 patients (40.7%) in the SCH ( + ) group (p: 0.033) Conclusion SCH had a strong association with non-dipper blood pressure pattern, higher nocturnal heart rate and masked hypertension which are precursors of myocardial infarction, stroke and renal failure. So, SCH should be considered as a clue for serious diseases such as coronary artery disease, myocardial infarction, stroke and patients should be evaluated for ABPM.

Small, Oral Dose of Clonidine Reduces the Incidence of Intraoperative Myocardial Ischemia in Patients Having Vascular Surgery

1996 ◽  
Vol 85 (4) ◽  
pp. 706-712 ◽  
Author(s):  
Klaus-Dieter Stuhmeier ◽  
Bernd Mainzer ◽  
Jochen Cierpka ◽  
Wilhelm Sandmann ◽  
Jorg Tarnow
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Oral Dose ◽  
Fluid Volume ◽  
Arterial Blood ◽  
Artery Disease

Background Most new perioperative myocardial ischemic episodes occur in the absence of hypertension or tachycardia. The ability of alpha 2-adrenoceptor agonists to inhibit central sympathetic outflow may benefit patients with coronary artery disease by increasing the myocardial oxygen supply and -demand ratio. Methods A randomized double-blind study design was used in 297 patients scheduled to have elective vascular surgical procedures to evaluate the effects of 2 micrograms/kg-1 oral clonidine (n = 145) or placebo (n = 152) on the incidence of perioperative myocardial ischemic episodes, myocardial infarction, and cardiac death. Continuous real-time S-T segment trend analysis (lead II and V5) was performed during anesthesia and surgery and correlated with arterial blood pressure and heart rate before and during ischemic events. Dose requirements for vasoactive and antiischemic drugs to control blood pressure and heart rate as well as episodes of myocardial ischemia (i.e., catecholamines, beta-adrenoceptor antagonists, nitrates, and systemic vasodilators) and fluid volume load were recorded. Results Administration of clonidine reduced the incidence of perioperative myocardial ischemic episodes from 39% (59 of 152) to 24% (35 of 145) (P &lt; 0.01). Hemodynamic patterns, percentage of ischemic time, and the number of ischemic episodes per patient did not differ. Nonfatal myocardial infarction developed after operation in four patients receiving placebo compared with none receiving clonidine (day 2 to 21; P = 0.07). The incidence of fatal cardiac events (1 vs. 2) was not different. Dose requirements for vasoactive and antiischemic drugs did not differ between the groups, but the amount of presurgical fluid volume was slightly greater in patients receiving clonidine (951 +/- 388 vs. 867 +/- 381 ml; P &lt; 0.03). Conclusion A small oral dose of clonidine, given prophylactically, can reduce the incidence of perioperative myocardial ischemic episodes without affecting hemodynamic stability in patients with suspected or documented coronary artery disease.

scholarly journals The effectiveness of treatment of patients with stable coronary heart disease and concomitant arterial hypertension: the results of a multicenter study PRESTOL

2019 ◽  
Vol 26 (1) ◽  
pp. 19-30 ◽  
Author(s):  
M. I. Lutai ◽  
I. P. Golikova
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Fixed Combination ◽  
Inclusion Criteria ◽  
Artery Disease

The aim – to evaluate the profile of patients with coronary heart disease (CHD) and concomitant arterial hypertension (AH) who were administered bisoprolol as part of previous therapy, but did not reach normal levels of heart rate and blood pressure; to estimate the percentage of getting to recommended levels of heart rate, blood pressure and treatment adherence in patients after 4 weeks of using the fixed-dose combination of bisoprolol/perindopril with a correction of doses. Materials and methods. The study involved 170 cardiologists from various regions of Ukraine. Each researcher selected 15 consecutive outpatients with coronary heart disease who came for a regular visit. Inclusion criteria: age over 18 years old, blood pressure above 140/90 mm Hg, heart rate above 60 bpm, bisoprolol as part of antihypertensive therapy in the last ≥ 3 months. The study included two visits. At each visit, the patient’s objective status was assessed; an individual questionnaire with office systolic and diastolic blood pressure, heart rate, ECG data, clinical manifestations of CHD, risk factors, lifestyle features, concomitant diseases, current therapy was filled out. Medication adherence was also evaluated, the therapy was corrected if necessary and the presence of side effects and adverse events was registered. Results and discussion. 2785 patient questionnaires were provided by doctors, 2394 (86 %) of them met the inclusion criteria. The mean age of the patients was 61.4 years, men – 57.1 %, women – 42.9 %. The diagnosis of coronary artery disease was based on: chest pain – 751 (31.7 %), a history of documented myocardial infarction – 1281 (53.5 %), coronary ventriculography (VHR) – 735 (30.7 %), revascularization (CABG/stenting) – 474 (19.8 %) patients. The use of a fixed combination of previously taken drugs (perindopril, bisoprolol) for 4 weeks allows to reduce heart rate and blood pressure effectively (heart rate ≤ 70 bpm reached 84.9 % of patients, blood pressure ≤ 140/90 mm Hg – 86.9 %), to reduce the number of angina attacks from 4.4 to 2.6 per week and the need for nitroglycerin from 4.8 to 2.7 tablets per week, to improve therapy adherence in 66.5 % of patients. Conclusions. The study demonstrated that the use of the fixed combination of bisoprolol and perindopril in patients with coronary artery disease and concomitant hypertension, including those who had myocardial revascularization and myocardial infarction in anamnesis, helps to improve treatment efficacy, to achieve recommended levels of blood pressure and heart rate, to increase adherence to therapy.

Feasibility of hybrid telerehabilitation as component of a novel comprehensive care program after acute myocardial infarction in a one-year follow-up preliminary experience of a single center

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
E Piotrowicz ◽  
P Orzechowski ◽  
I Kowalik ◽  
R Piotrowicz
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Functional Capacity ◽  
Care Program ◽  
Comprehensive Care ◽  
Monitoring Center ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Health Fund Background. A novel comprehensive care program after acute myocardial infarction (AMI) „KOS-zawał" was implemented in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid telerehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of this program. The purpose of the pilot study was to evaluate a feasibility, safety and patients’ acceptance of HTR as component of a novel care program after AMI and to assess mortality in a one-year follow-up. Methods The study included 55 patients (LVEF 55.6 ± 6.8%; aged 57.5 ± 10.5 years). Patients underwent a 5-week HTR based on Nordic walking, consisting of an initial stage (1 week) conducted within an outpatient center and a basic stage (4-week) home-based telerehabilitation five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise training. The influence on physical capacity was assessed by comparing changes in functional capacity (METs) from the beginning and the end of HTR. Patients filled in a questionnaire in order to assess their acceptance of HTR at the end of telerehabilitation. Results HTR resulted in a significant improvement in functional capacity and workload duration in exercise test (Table). Safety: there were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the monitoring center. Prognosis all patients survived in a one-year follow-up. Conclusions Hybrid telerehabilitation is a feasible, safe form of rehabilitation, well accepted by patients. There were no deaths in a one-year follow-up. Outcomes before and after HTR Before telerehabilitation After telerehabilitation P Exercise time [s] 381.5 ± 92.0 513.7 ± 120.2 &lt;0.001 Maximal workload [MET] 7.9 ± 1.8 10.1 ± 2.3 &lt;0.001 Heart rate rest [bpm] 68.6 ± 12.0 66.6 ± 10.9 0.123 Heart rate max effort [bpm] 119.7 ± 15.9 131.0 ± 20.1 &lt;0.001 SBP rest [mmHg] 115.6 ± 14.8 117.7 ± 13.8 0.295 DBP rest [mmHg] 74.3 ± 9.2 76.2 ± 7.3 0.079 SBP max effort [mm Hg] 159.5 ± 25.7 170.7 ± 25.5 0.003 DBP max effort [mm Hg] 84.5 ± 9.2 87.2 ± 9.3 0.043 SBP systolic blood pressure, DBP diastolic blood pressure.

scholarly journals Current obesity was associated with hypertension in children born very low birth weight

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Chompoonut Limratchapong ◽  
Pracha Nuntnarumit ◽  
Wischuri Paksi ◽  
Kwanchai Pirojsakul
Keyword(s):  
Blood Pressure ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Blood Pressure Monitoring ◽  
Developed Countries ◽  
Masked Hypertension ◽  
Normal Birth ◽  
The Developed Countries ◽  
Hypertension In Children

Abstract Objectives Previous studies from the developed countries showed that children born very low birth weight have a higher risk of hypertension compared with that of the normal birth weight controls. However, studies regarding the prevalence of hypertension in such children from the developing countries are scarce. This study aimed to identify the perinatal and postnatal factors associated with hypertension in children born very low birth weight. Results Forty-six children aged ≥ 6 years from the VLBW cohort of Ramathibodi Hospital, Bangkok, Thailand underwent the ambulatory blood pressure monitoring. The prevalence of hypertension was 15.2% (7/46). The hypertension group had a significant higher BMI z-score at 3 years of age (0.90 ± 1.44 vs − 0.45 ± 1.47, p = 0.045) and a greater proportion of current obesity (42% vs 2.5%, p < 0.01) compared to those in the normotensive group. Multivariate analysis revealed that current obesity was associated with hypertension (OR 34.77, 95%CI 1.814–666.5). Among 36 children with normal office blood pressure, four children (11.1%) had high blood pressure uncovered by ABPM, called “masked hypertension”. Office systolic blood pressure at the 85th percentile was the greatest predictor for masked hypertension with a sensitivity of 75% and a specificity of 81.2%.

Ambulatory Blood Pressure Recordings in Children and Adolescents

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 180-184
Author(s):  
Gregory A. Harshfield ◽  
Bruce S. Alpert ◽  
Derrick A. Pulliam ◽  
Grant W. Somes ◽  
Dawn K. Wilson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Reference Data ◽  
Blood Pressure Monitoring ◽  
Age Groups ◽  
Specific Reference ◽  
Pressure Monitoring ◽  
Black And White

Objective. To provide reference data for ambulatory blood pressure monitoring (ABPM) and to determine the influence of age, sex, and race on these values. Methods. ABPM was performed on 300 healthy, normotensive boys and girls between the ages of 10 and 18 years, including 160 boys and 140 girls, of whom 149 were white and 151 were black. Mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) while awake and during sleep were calculated for black and white boys and girls aged 10 to 12 years, 13 to 15 years, and 16 to 18 years. Results. Boys compared with girls 10 to 12 years of age had higher mean (±SD) SBP (115 ± 9 vs 112 ± 9 mm Hg; P &lt; .01) and DBP (67 ± 7 vs 65 ± 5 mm Hg; P &lt; .01) while awake. Boys compared to girls 13 to 15 years of age had higher SBP while awake (116 ± 11 vs 112 ± 8 mm Hg; P &lt; .01). Boys compared with girls 16 to 18 years of age had higher SBP while awake (125 ± 12 vs 111 ± 9 mm Hg; P &lt; .01) and during sleep (116 ± 11 vs 106 ± 9 mm Hg). Comparisons within sex showed similar changes with age for boys and girls. Blacks compared with whites 13 to 15 years of age had higher SBP during sleep (109 ± 11 vs 105 ± 10 mm Hg; P &lt; .01), and blacks compared with whites 16 to 18 years of age had higher DBP during sleep (66 ± 7 vs 58 ± 6 mm Hg; P &lt; .01). Comparisons across age groups within race showed that blacks 16 to 18 years of age had higher SBP during sleep than blacks 10 to 12 years of age (109 ± 11 vs 104 ± 10 mm Hg), and higher DBP during sleep (66 ± 7 mm Hg; P &lt; .01) than blacks 10 to 12 years of age (61 ± 7 mm Hg; P &lt; .01) and 13 to 15 years of age (61 ± 8; P &lt; .01 mm Hg). The changes with age were not significant for white subjects. Conclusion. These results provide age-specific reference data for ABPM in youths. These values differ by sex (boys more than girls) and race (Blacks more than Whites).

Acute hypertensive crisis due to newly diagnosed pheochromocytoma in the ninth decade of life: an unusual presentation

2021 ◽  
Vol 14 (2) ◽  
pp. e239433
Author(s):  
Carmen Cartwright ◽  
Peter Ucciferro ◽  
Catherine Anastasopoulou
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Adrenal Mass ◽  
Hypertensive Crisis ◽  
Surgical Removal ◽  
Newly Diagnosed ◽  
Alpha Blockade ◽  
Artery Disease ◽  
Biochemical Testing ◽  
High Index Of Suspicion

The patient is an 85-year-old man with multiple comorbidities, including hypertension and coronary artery disease with recent myocardial infarction who underwent cardiac catheterisation. During the procedure, the patient developed profound hypertensive crisis with flash pulmonary oedema, requiring significant intervention for blood pressure (BP) control. His crisis was also marked by wide excursions in his BP. The patient was found to have a large left adrenal mass measuring 9.4×8.7×8.1 cm, with biochemical testing confirming the suspicion of pheochromocytoma. Alpha-blockade was started prior to availability of lab results due to high index of suspicion. Surgical removal, the mainstay of treatment, has yet to transpire as he has no family, and due to his underlying dementia, he was not felt to have capacity for decision-making at the time of diagnosis. The case elucidates the vast presentations of this tumour, the means of diagnosis and the difficulties of treatment.

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