scholarly journals Comparison between invasive and non-invasive assessment of blood pressure in hypertensive disorders of pregnancy

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ayman Khairy M. Hassan ◽  
Ayman H. Shaamash ◽  
Asmaa G. Mohamed ◽  
Salwa R. Demitry ◽  
Nady A. Razik
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Strong Positive Correlation ◽  
Hypertensive Disorders Of Pregnancy ◽  
University Hospitals ◽  
Cross Sectional ◽  
Non Invasive ◽  
Hypertensive Disorders ◽  
Significant Difference

Abstract Background The management of hypertensive disorders of pregnancy (HDP) during hospitalization requires an accurate blood pressure (BP) measurement, mainly by invasive intra-arterial reading. Nevertheless, little is known about the precision of non-invasive (NI) central BP measurements in HDP. We aimed to assess the accuracy of NI central BP assessment in comparison to invasive BP measurement in HDP. This cross-sectional study included all patients with HDP that were admitted to university hospitals for high BP control, from December 2018 till December 2019, and 10 healthy matched non-hypertensive controls. Patients were compared for demographic, anthropometric, and echocardiographic data. In all subjects, invasive BP assessment was done by radial arterial cannulation and NI assessment of BP was performed by an oscillometric automated device (Mobil-O-Graph); the comparison was done after initial control of BP. Results One hundred patients were included and divided into 3 groups (pre-existing hypertension (HTN), gestational HTN, and pre-eclampsia). There was no statistically significant difference between NI central and invasive methods in measuring both systolic BP (SBP) (126.39 ± 14.5 vs 127.43 ± 15.3, p = 0.5) and diastolic BP (82.41 ± 9.0 vs 83.78 ± 8.9, p = 0.14) among the total studied population. A strong positive correlation was found between NI central and invasive SBP (r = 0.96, p < 0.001). HDP was associated with an increase in arterial stiffness, left ventricular diastolic dysfunction, and complications. Conclusion Non-invasive measurement of BP using oscillometric automated devices is as accurate as the invasive method, and it is a practical safe method in pregnant women with hypertensive disorders (CTR no. = NCT04303871).

scholarly journals Structural and Functional Changes in Maternal Heart during Pregnancy: An Echocardiographic Study

2017 ◽  
Vol 02 (04) ◽  
pp. 072-076
Author(s):  
Sunanda Kasula ◽  
Sumalatha Beeram ◽  
Ramakrishna Janapati ◽  
Indrani Garre
Keyword(s):  
Blood Pressure ◽  
Gestational Age ◽  
Systolic Function ◽  
Interventricular Septum ◽  
Clinical History ◽  
Left Ventricular ◽  
Two Dimensional ◽  
Cross Sectional ◽  
Functional Changes ◽  
Significant Difference

Abstract Background Pregnancy is associated with profound physiologic alterations in the maternal cardiovascular system. This study aimed to investigate maternal cardiac performance during normal pregnancy by two-dimensional echocardiography parameters and various functional and structural alterations. Methods This was a cross-sectional study of 100 normal pregnant women who attended the antenatal clinic, and all participants had clinical history, physical examination, and 12-lead electrocardiogram. Two-dimensional, M-mode, and Doppler echocardiography was done. Echocardiographic parameters were compared with normal age-matched controls from previously published studies. Results The mean age of the study group was 23.35 ± 3.05 years, mean systolic blood pressure was 110.5 ± 8.69 mm Hg, and mean diastolic blood pressure was 71.6 ± 6.77 mm Hg. There was an increase in left atrial (LA) diameter, left ventricular end diastolic diameter, and interventricular septum (IVS) thickness as gestational age advanced. There was a gradual decrease in E-wave velocity, and E/A ratio increased during the second trimester and decreased during the third trimester. The E-wave deceleration time increased with gestational age There was no statistically significant difference between IVS thickness and E/A ratio (p = 1.000). Conclusion Cardiac chamber dimensions, LV wall thickness, and LA size, most indices of systolic function although within normal range, were significantly higher in pregnant Asian Indian women than in the controls. This study shows that the subtle reduction in myocardial compliance appears as an adaptive response to changes of preload, afterload, and LV geometry.

scholarly journals Association between Grade of Normoalbuminuria and Left Ventricular Diastolic Dysfunction (LVDD) in Hypertensive Population of Gunungsari Village, Pamijahan-Bogor, Indonesia

2019 ◽  
Vol 40 (2) ◽  
Author(s):  
Nur Zamiatun Qomara ◽  
Nani Hersunarti B ◽  
Anwar Santoso
Keyword(s):  
Diastolic Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Vascular Medicine ◽  
Cross Sectional ◽  
Urine Albumin ◽  
Hypertensive Population ◽  
Increased Risk ◽  
Significant Difference ◽  
Ventricular Diastolic Dysfunction

Association between Grade of Normoalbuminuria and Left Ventricular Diastolic Dysfunction (LVDD) in Hypertensive Population of Gunungsari Village, Pamijahan-Bogor, Indonesia Nur Z Qomara MD, Nani Hersunarti MD, Anwar Santoso MDDepartement of Cardiology and Vascular Medicine Faculty of Universitas Indonesia  ABSTRACT  Background: Albuminuria has been considered an important diagnostic marker of decreasing renal function, but lately albuminuria has also been linked to cardiovascular and peripheral vascular disease. Many studies have analyzed the association between micro- or macroalbuminuria and the increased risk of cardiovascular disease, but only few examined the association between normoalbuminuria and cardiovascular disease.Objective: To analyze the association between the degree of normoalbuminuria and the occurrence of left ventricular diastolic dysfunction in hypertensive patients.Method: This is cross-sectional analysis in hypertensive patients. Normoalbuminuric subjects are divided into three tertiles based on the cutoff of Urine-Albumin-Creatinine Ratio (UACR). To evaluate left ventricular function, all subjects undergo echocardiography examination. Left ventricular diastolic dysfunction is positive if more than fifty percent of positive findings are present from the fourth parameters stated in the 2016 American Society of Echocardiography criterias.Results: No significant difference in the occurrence of LVDD was found between the two groups according to age, sex, smoking, dyslipidemia, physical activity, BMI, hypertension therapy and HbA1c, but a significant difference was seen in the UACR tertile of the two group. This study showed that upper-limit normoalbuminuria (third tertile) was associated with the occurrence of LVDD (OR 15.57, 95% CI: 2.88-84.25).Conclusion: This study showed that normoalbuminuria in hypertensive population is associated with left ventricular diastolic dysfunction. Keywords: hypertension, normoalbuminuria, left ventricular diastolic dysfunctio

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

scholarly journals Association between central non-dipping pattern and platelet morphology in adults with type 1 diabetes without cardiovascular disease: a cross-sectional study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michal Kulecki ◽  
Dariusz Naskret ◽  
Mikolaj Kaminski ◽  
Dominika Kasprzak ◽  
Pawel Lachowski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Smoking Status ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Distribution Width ◽  
Non Invasive ◽  
Platelet Morphology ◽  
Oscillometric Device

AbstractThe non-dipping pattern is nighttime systolic blood pressure (SBP) fall of less than 10%. Several studies showed that the non-dipping pattern, increased mean platelet volume (MPV), and platelet distribution width (PDW) are associated with elevated cardiovascular risk. Hypertensives with the non-dipping pattern have higher MPV than the dippers but this relationship was never investigated among people with type 1 diabetes mellitus (T1DM). This study aimed to investigate the association between the central dipping pattern and platelet morphology in T1DM subjects. We measured the central and brachial blood pressure with a validated non-invasive brachial oscillometric device—Arteriograph 24—during twenty-four-hour analysis in T1DM subjects without diagnosed hypertension. The group was divided based on the central dipping pattern for the dippers and the non-dippers. From a total of 62 subjects (32 males) aged 30.1 (25.7–37) years with T1DM duration 15.0 (9.0–20) years, 36 were non-dippers. The non-dipper group had significantly higher MPV (MPV (10.8 [10.3–11.5] vs 10.4 [10.0–10.7] fl; p = 0.041) and PDW (13.2 [11.7–14.9] vs 12.3 [11.7–12.8] fl; p = 0.029) than dipper group. Multivariable logistic regression revealed that MPV (OR 3.74; 95% CI 1.48–9.45; p = 0.005) and PDW (OR 1.91; 95% CI 1.22–3.00; p = 0.005) were positively associated with central non-dipping pattern adjusting for age, sex, smoking status, daily insulin intake, and height. MPV and PDW are positively associated with the central non-dipping pattern among people with T1DM.

scholarly journals The Copenhagen chronic kidney disease echo study (COInCYDE)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Landler ◽  
S Bro ◽  
B Feldt-Rasmussen ◽  
D Hansen ◽  
A.L Kamper ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiac Function ◽  
Left Ventricular ◽  
Funding Source ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Abstract Background The cardiovascular mortality of patients with chronic kidney disease (CKD) is 2–10 times higher than in the average population. Purpose To estimate the prevalence of abnormal cardiac function or structure across the stages CKD 1 to 5nonD. Method Prospective cohort study. Patients with CKD stage 1 to 5 not on dialysis, aged 30 to 75 (n=875) and age-/sex-matched controls (n=173) were enrolled consecutively. All participants underwent a health questionnaire, ECG, morphometric and blood pressure measurements. Blood and urine were analyzed. Echocardiography was performed. Left ventricle (LV) hypertrophy, dilatation, diastolic and systolic dysfunction were defined according to current ESC guidelines. Results 63% of participants were men. Mean age was 58 years (SD 12.6 years). Mean eGFR was 46.7 mL/min/1,73 m (SD 25.8) for patients and 82.3 mL/min/1,73 m (SD 13.4) for controls. The prevalence of elevated blood pressure at physical exam was 89% in patients vs. 53% in controls. Patients were more often smokers and obese. Left ventricular mass index (LVMI) was slightly, albeit insignificantly elevated at CKD stages 1 & 2 vs. in kontrols: 3.1 g/m2, CI: −0.4 to 6.75, p-value 0.08. There was no significant difference in LV-dilatation between patients and controls. Decreasing diastolic and systolic function was observed at CKD stage 3a and later: LVEF decreased 0.95% (CI: −1.5 to −0.2), GLS increased 0.5 (CI: 0.3 to 0.8), and OR for diastolic dysfunction increased 3.2 (CI 1.4 to 7.3) pr. increment CKD stage group. Conclusion In accordance to previous studies, we observe in the CPHCKD cohort study signs of early increase of LVMI in patients with CKD stage 1 & 2. Significant decline in systolic and diastolic cardiac function is apparent already at stage 3 CKD. Figure 1. Estimated GFR vs. GLS & histogram of GLS Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Capital Region of Denmark

Myocardial work analysis in screening of familial dilated cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Triantafyllou ◽  
R Monteiro ◽  
A Protonotarios ◽  
T Gossios ◽  
P Elliott ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Work Efficiency ◽  
Work Analysis ◽  
Significant Difference ◽  
Global Work

Abstract Introduction Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease. Purpose We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes. Methods Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study. Results In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%. G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups. No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%). However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03). Conclusion DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment. Funding Acknowledgement Type of funding source: None

scholarly journals Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xin Li ◽  
Xiaojing Wu ◽  
Muyin Zhang ◽  
Lili Xu ◽  
Guohui Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
High Altitude ◽  
Kidney Injury ◽  
Hypertensive Disorders Of Pregnancy ◽  
Fetal Outcomes ◽  
Uncontrolled Blood Pressure ◽  
Logistic Regression Models ◽  
Hypertensive Disorders ◽  
Term Delivery

Abstract Background Pregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature. Objectives to investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude. Methods 6,512 pregnant women attending the Department of Obstetrics & Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(> 70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed. Results Pr-AKI was identified in 136/6512(2.09 %) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3 %). 4(2.9 %) women died and the majority(86.1 %) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age ≥ 20 weeks. Pre-term delivery occurred in 30(27.3 %) cases and perinatal deaths in 17(15.5 %). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0 and 10.9 % respectively. 16(14.5 %) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3 %). More IUGR(25.0 %) and LBWI(37.8 %) were observed in their infants with a higher risk of admission to NICU(22.0 %). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients. Conclusions Pr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

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