Elevated Blood Pressure in Hospitalized Children Predicts True Elevated Blood Pressure Outpatient

OBJECTIVES: To determine if elevated blood pressure (EBP) in hospitalized children accurately predicts EBP outpatient. METHODS: A multicenter retrospective chart review was conducted at a large hospital system in Northeastern United States. Mean blood pressures during hospitalizations were classified as elevated or not elevated, by using the American Academy of Pediatrics (AAP) 2017 parameters. Mean blood pressure was then compared with each patient’s mean blood pressure measured 3 times postdischarge. The data were analyzed to determine if inpatient EBP is an accurate predictor of outpatient EBP. RESULTS: Of 5367 hospitalized children, 656 (12.2%) had EBP inpatient. Inpatient EBP was highly predictive of outpatient EBP, with a positive predictive value of 96% and negative predictive value of 98%. CONCLUSIONS: Diagnosing hospitalized children with EBP, as defined by the AAP 2017 guidelines, accurately predicts true EBP outpatient.

Effects of Yogic practices on cardiovascular system and salivary alpha amylase on Indian healthy jail inmates

Objectives Imprisoned people usually have a poor health status and an increase risk to suffer chronic debilitating conditions, co-infection due to their limitations in physical activity and mental disturbances. This study was carried to find out the health impacts of Yogic practice of Indian healthy jail inmates. Methods It was interventional single group pre-post design study. A total no of 30, Jail inmates including 08 female were participated in this study and practiced Yoga for six months. Body Mass Index, Heart Rate, Blood Pressure, Salivary alpha amylase activity (SAA) a stress marker were assessed before, after three months and after completion of six months of Yogic practice. Results Improvement was noted in all parameters, but significant improvement was noted in systolic blood pressure, diastolic blood pressure, mean blood pressure, double product a index of load in the heart and SAA following Yogic practice in total participants. Significant improvement was also noted in systolic blood pressure, diastolic blood pressure, mean blood pressure, double product a index of load in the heart and SAA following Yogic practice in male group. No significant effect was noted in female group. Conclusions The present study revealed that regular Yogic practice resulted in reduction blood pressure, load in the heart and stress in mail jail inmates, when it is practiced regularly and carefully.

Long-term trends in blood pressure and hypertension in Russia: an analysis of data from 14 health surveys conducted in 1975–2017

Background Hypertension is recognized as an important contributor to high cardiovascular mortality in Russia. A comprehensive analysis of data from Russian studies that measured blood pressure in population-based samples has not been previously undertaken. This study aims to identify trends and patterns in mean blood pressure and the prevalence of hypertension in Russia over the most recent 40 years. Methods We obtained anonymized individual records of blood pressure measurements from 14 surveys conducted in Russia in 1975–2017 relating to a total of 137,687 individuals. For comparative purposes we obtained equivalent data from 4 surveys in the USA and England for 23,864 individuals. A meta-regression on aggregated data adjusted for education was undertaken to estimate time trends in mean systolic and diastolic blood pressure, the prevalence of elevated blood pressure (> 140/90 mmHg), and hypertension (defined as elevated blood pressure and/or the use of blood pressure-lowering) medication. A meta-analysis of pooled individual-level data was used to assess male-female differences in blood pressure and hypertension. Results During the period 1975–2017 mean blood pressure, the prevalence of elevated blood pressure and hypertension remained stable among Russian men. Among Russian women, mean systolic blood pressure decreased at an annual rate of 0.25 mmHg (p < 0.1) at age 35–54 years and by 0.8 mmHg (p < 0.01) at ages 55 and over. The prevalence of elevated blood pressure also decreased by 0.8% per year (p < 0.01), but the prevalence of hypertension remained stable. Mean blood pressure and prevalence of hypertension were higher in Russia compared to the USA and England at all ages and for both sexes. Conclusions In contrast to the generally observed downward trend in elevated blood pressure in many other countries, levels in Russia have changed little over the past 40 years, although there are some positive trends among women. Improved strategies to bring down the high levels of mean blood pressure and hypertension in Russia compared to countries such as England and the USA are important to further reduce the high burden of CVD in Russia.

Effects of chlorpheniramine on emergence agitation after general anesthesia for ureteroscopic stone surgery: a retrospective cohort study

Background: The presence of a urinary catheter, postoperative pain, and postoperative nausea and vomiting are risk factors for emergence agitation (EA). Antimuscarinic agents are primary agents used in the prevention and treatment of urinary catheter-related bladder discomfort. Chlorpheniramine has antimuscarinic, antinociceptive, and antiemetic effects. This retrospective study investigated the role of chlorpheniramine in EA prevention following ureteroscopic stone surgery.Methods: Of 110 adult patients who underwent ureteroscopic stone surgery under general anesthesia between January and December 2019, the medical records of 93 patients were analyzed retrospectively. The patients were divided into control (n = 52) and chlorpheniramine (n = 41) groups according to the receipt of intravenous chlorpheniramine before the induction of anesthesia. The incidence and severity of EA were compared between the groups as primary and secondary endpoints, respectively. The effects of chlorpheniramine on the requirement for inhalation anesthetic (desflurane) during surgery, changes in mean blood pressure and heart rate during emergence, and adverse events were also compared. Results: The incidence (21.2% in the control group, 24.4% in the chlorpheniramine group) and severity of EA did not differ between groups. The intraoperative requirement for desflurane, changes in mean blood pressure and heart rate during emergence, and adverse events were also similar between groups. Conclusion: Chlorpheniramine was not associated with a decrease in EA incidence or severity in patients who underwent ureteroscopic stone surgery.

On the meaning of the mean blood pressure in the clinic

Volhard, who tested the auditory method for determining blood pressure (according to Korotkov y) on a large material of renal diseases, considers it "a method better than which there is nothing better to be desired." Martine, describing it as the Ehret'a way, gives it an edge over other methods.

Observer’s Assessment of Alertness/Sedation-based titration reduces propofol consumption and incidence of hypotension during general anesthesia induction: A randomized controlled trial

Administration of a single propofol bolus dose for anesthesia induction causes hypotension. We included 160 patients (74 males and 86 females; mean age, 42.4 ± 10.7 [range: 18–60] years) with the American Society of Anesthesiologists status I–II undergoing elective surgery under general anesthesia. Using simple randomization, the patients were divided into a conventional group ( n = 80; received 2 mg/kg propofol at a rate of 250 mg/min) and titrated group ( n = 80; received propofol at a rate of 1 mg/kg/min until the Observer's Assessment of Alertness/Sedation scale score reached 1 point). Fentanyl (4 µg/kg) and cisatracurium (0.2 mg/kg) were administered, as appropriate. Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate were recorded at different time points. Propofol consumption, hypotension, and other adverse events were recorded. All the patients were intubated without awareness. Compared with the conventional group, the titrated group showed more stable blood pressure ( p < 0.05), as well as a lower decrease in systolic blood pressure, mean blood pressure at 1 and 3 min, and diastolic blood pressure at 1 min after propofol administration ( p < 0.01). Moreover, compared with the conventional group, the titrated group showed a lower post-intubation hypotension incidence (9 vs. 19 cases; p = 0.04), as well as lower total propofol dosage and propofol dose per kilogram of body weight (93.57 ± 14.40 mg vs. 116.80 ± 22.37 mg and 1.73 ± 0.27 mg/kg vs. 2.02 ± 0.08 mg/kg, respectively, p < 0.01). Compared with conventional propofol usage, titrated propofol administration can reduce the incidence of hypotension and propofol consumption during anesthesia induction.

Analysis of Prognostic Relevance based on Ambulatory Vital Signs Among Pregnancy with Pulmonary Hypertension in the ICU

Purpose: The study seeks to utilise the extensively monitored data to explore the prognostic information in the continuous ambulatory vital signs of the pregnant women with pulmonary hypertension in the ICU, aiming to bring insights to physicians on evaluation and management of these specific patients. Methods: This is a retrospective study of consecutive obstetric patients with PH admitted to ICU of the First Affiliated Hospital of Air Force Military Medical University of China, from January 2011 to May 2020. 92 cases are analysed via time-dependent Cox regression to take account of the dynamic features of vital signs. Results: Seven out of 92 maternal deaths occurred, with most maternal deaths occurring within the first three days of admission to the ICU. The vital signs for the survived are more stable and normally ranged comparing to the death. Three vital signs are identified as risk factors in the maternal in-hospital mortality model: SpO 2 (OR,0.93;95%CI,0.89-0.98), Heart rate(OR, 0.95 ; 95%CI, 0.92-0.99), Mean blood pressure(OR, 1.1 ; 95%CI, 0.98-1). The model performance is justified by the ROC curve with AUC being 0.84. Further exploration showed that the total and the longest consecutive time ratios also affect the outcome. Conclusions: Pregnancy women with PH who dead in hospital experienced long-term abnormal fluctuations in blood pressure, heart rate and blood oxygen during ICU stay. Both dynamic and time ratios reported impacts relating to SpO 2 , heart rate and blood pressure. In general SpO 2 mitigate the hazard. Effects of the heart rate and mean blood pressure should be described combining the time ratios of hypotension and tachycardia.

Serum Sclerostin Is Associated with Peripheral and Central Systolic Blood Pressure in Pediatric Patients with Primary Hypertension

Recent studies showed the significance of the canonical Wnt/beta-catenin pathway and its inhibitor—sclerostin, in the formation of arterial damage, cardiovascular morbidity, and mortality. The study aimed to assess serum sclerostin concentration and its relationship with blood pressure, arterial damage, and calcium-phosphate metabolism in children and adolescents with primary hypertension (PH). Serum sclerostin concentration (pmol/L) was evaluated in 60 pediatric patients with PH and 20 healthy children. In the study group, we also assessed calcium-phosphate metabolism, office peripheral and central blood pressure, 24 h ambulatory blood pressure, and parameters of arterial damage. Serum sclerostin did not differ significantly between patients with PH and the control group (36.6 ± 10.6 vs. 41.0 ± 11.9 (pmol/L), p = 0.119). In the whole study group, sclerostin concentration correlated positively with height Z-score, phosphate, and alkaline phosphatase, and negatively with age, peripheral systolic and mean blood pressure, and central systolic and mean blood pressure. In multivariate analysis, systolic blood pressure (SBP) and height expressed as Z-scores were the significant determinants of serum sclerostin in the studied children: height Z-score (β = 0.224, (95%CI, 0.017–0.430)), SBP Z-score (β = −0.216, (95%CI, −0.417 to −0.016)). In conclusion, our results suggest a significant association between sclerostin and blood pressure in the pediatric population.

Cardiometabolic risk in children and adolescents: mediation analysis of crosssectional study. [Riesgo cardiometabólico en niños y adolescentes: análisis de mediación de un estudio transversal].

The aims of this study were a) to assess whether obesity acts as a mediator between i) cardiorespiratory fitness (CRF) and mean blood pressure; and ii) between between physical activity (PA) and mean blodd pressure in children and adolescents. A cross-sectional study was conducted with a 632 children and adolescents. It was measured mean blood pressure, body mass index, fat mass and waist circumference. CRF and PA was assessing with Course Navette test and ActiGraph. The analysis of the mediation was performed using Process macro for SPSS. The results indicate that obesity acts as a partial mediation in the association between CRF and mean blood pressure in 10-12 years old children (z=from -5.81 to -5.40; all p˂0.000). These results indicate that obesity acts as a complete mediator in the association between PA and mean blood pressure in 10-12 years old children (z=from -4.49 to -1.94; all p˂0.000). Our result reinforces the relevance of prevent weight increse and improve cardiorespiratory fitness level since erly age in children and adolescents to prevent high mean blood pressure. Increasing the level of physical activity can influence on obesity and cardiorespiratory fitness.