Significance of blood pressure variability in patients with sepsis

BACKGROUND: This study was undertaken to observe the characteristics of blood pressure variability(BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.METHODS: Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.RESULTS: In patients with APACHE II score>19, the values of systolic blood pressure(SBPV), diasystolic blood pressure(DBPV), non-dipper percentage, cortisol(COR), lactate(LAC), platelet count(PLT) and glucose(GLU) were significantly higher than in those with APACHE II score ≤19(P<0.05), whereas the values of procalcitonin(PCT), white blood cell(WBC), creatinine(Cr), PaO2, C-reactive protein(CRP), adrenocorticotropic hormone(ACTH) and tumor necrosis factor α(TNF-α) were not statistically significant(P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV(P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR(P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT(P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve(ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.CONCLUSIONS: The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

Psychological stress and long-term blood pressure variability of military young males:The cardiorespiratory fitness and hospitalization events in armed forces study

BACKGROUND Acute stress might increase short-term heart rate variability and blood pressure variability(BPV);however,chronic stress would not alter short-term BPV in animal models.AIM To examine the association of psychological stress with long-term BPV in young male humans.METHODS We prospectively examined the association of chronic psychological stress with long-term BPV in 1112 healthy military males,averaged 32.2 years from the cardiorespiratory fitness and hospitalization events in armed forces study in Taiwan.Psychological stress was quantitatively evaluated with the Brief Symptom Rating Scale(BSRS-5),from the least symptom of 0 to the most severe of 20,and the five components of anxiety,insomnia,depression,interpersonal sensitivity,and hostility(the severity score in each component from 0 to 4).Longterm BPV was assessed by standard deviation(SD)for systolic and diastolic blood pressure(SBP and DBP),and average real variability(ARV),defined as the average absolute difference between successive measurements of SBP or DBP,across four visits in the study period from 2012 to 2018(2012-14,2014-15,2015-16,and 2016-18).RESULTS The results of multivariable linear regressions showed that there were no correlations of the BSRS-5 score with SDSBP,SDDBP,ARVSBP,and ARVDBP after adjusting for all the covariates[β(SE):-0.022(0.024),-0.023(0.026),-0.001(0.018),and 0.001(0.020),respectively;P>0.05 for all].In addition,there were also no correlations between each component of the BSRS score and the long-term BPV indexes.CONCLUSION Our findings suggest that chronic psychological stress might not be associated with long-term BPV in military young male humans.

Determinants of Blood Pressure Variability in Individuals with Essential Hypertension: A Survey-Based Study

Background: Blood pressure variability (BPV) in hypertensive patients is implicated as a remarkable feature leading to additional cardiovascular complications. The aim of the study was to identify the determinants influencing BPV among patients with essential hypertension seen at the Cardiology department of the faculty of medicine, University of Alexandria, Egypt. Methods: This was a descriptive cross-sectional hospital-based study conducted from August 2019 to November 2019. All the eligible patients were made to fill out a standard questionnaire to obtain family and personal clinical history and undergo routine physical examination, laboratory tests and 24-hour ambulatory blood pressure monitoring. BPV was summarized as the standard deviation (SD) of all-day systolic and diastolic BP in both normal patients (with SD 11) and abnormal patients (with SD ≥ 11). Results: Out of a total of 114 patients, 18 (15.8%) non-hypertensive patients were included in the control group and the remaining 96 (84.3%) were classified based on the degree of hypertension. BPV in all these patients was found to be significantly related to the male gender, a mild or moderate degree of hypertension, high prevalence of non-dipping, diabetes, use of beta-blockers as antihypertensive medication, heart rate variability, BMI, and increased day-time variability. Conclusion: Variability in blood pressure influenced by different intrinsic and extrinsic factors plays an important role in the management of hypertension. In order to reduce the burden of disease and for a better quality of life for hypertensive patients, it is important that physicians start considering lowering BPV in addition to reducing physiological BP levels.

Metabolic biomarkers and long-term blood pressure variability in military young male adults

BACKGROUND Metabolic syndrome is a cluster of cardiovascular risk factors, including central obesity, high blood pressure, elevated plasma glucose, reduced high-density lipoprotein and elevated triglyceride levels.AIM To investigate the relationship between metabolic biomarkers and long-term blood pressure variability(BPV) in young males.METHODS A cohort of 1112 healthy military males aged 18-40 years from the cardiorespiratory fitness and hospitalization events in armed forces study in eastern Taiwan was prospectively included. The following metabolic biomarkers were used: Waist circumference, serum uric acid(SUA), triglycerides, high density lipoprotein, triglycerides, and fasting glycose. BPV was assessed by average real variability(ARV) and standard deviation(SD) across 4 clinic visits during the study period(2012-14, 2014-15, 2015-16, and 2016-18). Multivariable linear regression analysis was used to determine the association after adjusting for age, body mass index, systolic and diastolic blood pressure(SBP and DBP),lipid profiles, physical activity, alcohol intake and tobacco smoking status.RESULTS In the unadjusted model, waist circumference was significantly and positively correlated with ARVDBP and SDDBP [β(standard errors) = 0.16(0.049) and 0.22(0.065), respectively], as was SUA [β = 0.022(0.009) and 0.038(0.012),respectively]. High-density lipoprotein was negatively correlated with ARVSBP [β=-0.13(0.063)]. There were no associations with the other metabolic biomarkers.In contrast, only SUA was significantly correlated with SDSBP and SDDBP [β = 0.019(0.011) and 0.027(0.010), respectively] in the adjusted model.CONCLUSION Our findings showed that of traditional metabolic biomarkers, SUA had the strongest positive correlation with long-term systolic and diastolic BPV in young male adults, and the clinical relevance needs further investigation.

Day-to-day blood pressure variability predicts poor outcomes following percutaneous coronary intervention:A retrospective study

BACKGROUND For patients with cardiovascular disease,blood pressure variability(BPV),distinct from hypertension,is an important determinant of adverse cardiac events.Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention(PCI)is to this point unclear.AIM To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.METHODS Patients undergoing PCI in a single state in 2017 were studied(n=647).Systolic and diastolic BPV,defined as both the largest change and standard deviation for the 3-60 mo prior to PCI was calculated and patients with more than ten blood pressure measurements in that time were included for analysis(n=471).Adverse outcomes were identified up to a year following the procedure,including major adverse cardiac events(MACE),myocardial infarction,cerebrovascular accident,death,and all-cause hospitalization.RESULTS Visit-to-visit systolic BPV,as measured by both standard deviation and largest change,was higher in patients who had myocardial infarction,were readmitted,or died within one year following PCI.Systolic BPV,as measured by largest change or standard deviation,was higher in patients who had MACE,or readmissions(P<0.05).Diastolic BPV,as measured by largest change,was higher in patients with MACE and readmissions(P<0.05).CONCLUSION As BPV is easily measured and captured in the electronic medical record,these findings describe a novel method of identifying at-risk patients who undergo PCI.Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.

Association of blood pressure variability with target organ damage in older patients with essential hypertension

Background:Although multiple measures of blood pressure variability(BPV)have been proposed,whether they are better than mean blood pressure in predicting target organs is unclear.We aimed to determine the relationship between short term BPV and target organ injury.Methods:This study was a retrospective study,and 635 inpatients in the Department of Cardiology from 2015 to 2020 were selected.We divided participants into four groups on the basis of the quartiles of BPV.One-way analysis of variance was used to compare the differences between the groups,and linear regression was used to analyze the relationship between BPV and target organ damage.Results:The average age of 635 patients was 74.36±6.50 years old.Among them,354 of 627 patients had diminished renal function(56.5%),221of 604 patients had associated left ventricular hypertrophy(36.6%),and 227 of 231 patients had carotid plaque formation(98.3%).The baseline data indicated significant differences in fasting glucose,total cholesterol,low-density lipoprotein,creatinine,glomerular filtration rate,sex,calcium channel blocker use,and the rate of diminished renal function.Multiple linear regression analysis showed that BPV was negatively correlated with renal injury(creatinine:r=0.306,p<0.01;estimated glomerular filtration rate:r=0.058,p<0.01),and BPV is positively correlated with cardiac injury(r=0.083,p<0.01).Elevated BPV was not found to be associated with vascularinjury.Conclusion:Renal function decreases with increasing BPV and left ventricular mass increases with increasing BPV.

Influence of HbA1c on short-term blood pressure variability in type 2 diabetic patients with diabetic nephropathy

The aim of this study was to understand the characteristics of blood pressure(BP)variability in subjects with diabetic nephropathy(DN),and identify the probable predictors affecting BP variability.Fifty-one chronic kidney disease(CKD)-hypertensive patients without diabetes(NDN group)and sixty type 2 diabetic patients with overt DN(DN group)were enrolled in this study.The values of short-term BP variability were obtained from 24 h ambulatory BP monitoring(ABPM).Variance analysis or nonparametric analysis revealed that 24-h systolic BP variability and nighttime systolic BP variability of the DN group were significantly higher than those of the NDN group[(12.23±3.66)vs.(10.74±3.83)mmHg,P<0.05;(11.23±4.82)vs.(9.48±3.69)mmHg,P<0.05].Then the patients of the DN group were divided into two groups according to glycated hemoglobin(HbA1c)level:Group A(HbA1c<7%)and Group B(HbA1c≥7%),and the t-test showed that patients in Group B had larger 24-h diastolic,daytime diastolic,and nighttime systolic/diastolic BP variability compared with Group A.In the DN group,partial correlation analysis revealed that HbA1c exhibited a strong association with 24-h diastolic,daytime diastolic,nighttime systolic and diastolic BP variability(P<0.001,P<0.001,P<0.05,and P<0.001,respectively).Taken together,larger short-term BP variability was detected in hypertensive type 2 diabetic patients with overt nephropathy and renal insufficiency.It may imply that the optimal BP variability level could benefit from a better glycaemic control.

Association between dietary sodium intake and blood pressure variability in Chinese patients with hypertension

Background:The association between dietary sodium intake and blood pressure variability(BPV)in hypertensive patients remains unclear.The objective of this study was to demonstrate whether dietary sodium intake is a predictor of elevated BPV in Chinese patients with hypertension.Methods:A total of 235 patients with essential hypertension were enrolled in the Department of Cardiology,Chinese People’s Liberation Army(PLA)General Hospital in 2018 to 2019,all of whom underwent 24-h ambulatory blood pressure monitoring.BPV was calculated as the standard deviation(SD),coefficient of variation(CV),variation independent of mean(VIM)of blood pressure measurements,respectively,and divided into diurnal systolic BPV(SBPV),diurnal diastolic BPV(DBPV),nocturnal SBPV,and nocturnal DBPV.24-h urine samples were collected to measure 24-h urine sodium excretion,which represents dietary sodium intake.The relationship between dietary sodium intake and BPV was analyzed by using Spearman correlations and multiple linear regression analysis.Results:Nocturnal SBPV-SD,CV,VIM,and nocturnal DBPV-SD in the high urine sodium excretion group were significantly higher than those in the medium and low urine sodium excretion groups,whereas diurnal SBPV-SD,CV,VIM,diurnal DBPV-SD,CV,VIM,and nocturnal DBPV-CV,VIM were not.Using the Spearman correlation analysis,we found a linear correlation between 24-h urine sodium excretion and nocturnal SBPV-SD,CV,VIM(SD,r=0.22,P=0.001;CV,r=0.17,P=0.009;VIM,r=0.16,P=0.020),nocturnal DBPV-SD(r=0.21,P=0.001),respectively.After further adjusting for confounding factors by multiple linear regression,the positive correlations remained between 24-h urine sodium excretion and nocturnal SBPV-SD,CV,VIM(SD,β=0.224,P<0.001;CV,β=0.211,P=0.001;VIM,β=0.213,P=0.001),nocturnal DBPV(SD,β=0.215,P=0.001),respectively.Conclusions:Dietary sodium intake is associated with nocturnal SBPV in Chinese patients with hypertension.

Relationships of coronary artery atherosclerosis severity with blood pressure variability and ankle-brachial index in hypertensive patients

Background Numerous trials showed that blood pressure variability （BPV） plays an important role in triggering acute cardiovascular and cerebrovascular events. However, few studies have clarified the relationship between the coronary artery atherosclerosis severity with BVP and ankle-brachial index （ABI）. There are few studies in which have investigated BPV, ankle-brachial index （ABI）, brachial ankle pulse wave velelocity （baPWV） and severity of coronary angiography（ CAG ） at the same time. Methods Totally 188 hypertensive patients from January 2012 to March 2015 were enrolled in this study. All the cases underwent 24h ambulatory blood pressure monitoring （ABPM）, CAG and ABI. The extent of coronary artery disease was assessed by the Gensini score system. The subjects were divided into four groups： A（ Gensini score=0）, B（Gensini score≤20）, C（ 20〈Gensini score 〈50）, D（Gensini score≥50）. Pearson correlation and stepwise multiple regression were used for analyses. Results Compared with the A and B group, most of blood pressure standard deviation and average ABI of D group were higher （P 〈 0.05）. Correlation analysis indicated that Gensini score was positively correlated with 24h systolic blood pressure standard deviation （24hsbpsd）, day systolic blood pressure standard deviation （dsbpsd） and night systolic blood pressure standard deviation（nsbpsd）; But it was reversely correlated with ABI. ABI was reversely correlated with 24hsbpsd and nsbpsd. Gensini score was positively correlated with 24hsbpsd（P=0.02） and dsbpsd（P〈0.05）, while reversely correlated with ABI（P〈0.05） by multiple linear stepwise regression analysis. Conclusion BPV and ABI are closely related to severity of coronary artery atherosclerosis. They are predictors in patients with coronary artery disease with hypertension.

Exploration of cardiac rehabilitation nursing for elderly patients with myocardial infarction based on individualized cardiac rehabilitation

BACKGROUND Myocardial infarction is a high-risk condition prevalent among the elderly population,often leading to adverse clinical manifestations such as reduced cardiopulmonary function,anxiety,and depression post-surgery.Consequently,cardiac rehabilitation holds immense importance in mitigating these complications.AIM To evaluate the effect of individualized cardiac rehabilitation on blood pressure variability(BPV)and baroreflex sensitivity(BRS)in elderly patients with myocardial infarction.METHODS A cohort of 74 elderly patients diagnosed with myocardial infarction and admitted to our hospital between January 2021 and January 2022 were subjected to random selection.Subsequently,all patients were divided into two groups,namely the research group(n=37)and the control group(n=37),utilizing the number table method.The control group received conventional drug treatment and nursing guidance intervention,while the study group underwent individualized cardiac rehabilitation in addition to the interventions received by the control group.All patients were continuously intervened for 12 wk,and the BPV of these two groups in the 1st wk(T0),the 4th wk(T1)and the 12th wk(T2)were compared,BRS,changes in cardiopulmonary function measures,and adverse cardiovascular events.RESULTS Of 24 h diastolic BPV,24 h systolic BPV,carbon dioxide ventilation equivalent slope of the research group were lower than those of the control group at T1 and T2,BRS,peak heart rate and systolic blood pressure product,1 min heart rate recovery were higher than those of the control group,and the incidence of adverse events in the research group was lower than that of the control group,the difference was statistically significant(P<0.05).CONCLUSION In this study,we found that after individualized cardiac rehabilitation in elderly patients with myocardial infarction,BPV and BRS can be effectively improved,cardiac function is significantly enhanced,and a better prognosis is obtained.

Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome:a randomized,placebo-controlled trial

BACKGROUND： Patients with hypertension coupled with metabolic syndrome （MetS） are among the high risk population in cardiovascular and cerebrovascular diseases. To reduce the prevalence of cardiovascular and cerebrovascular diseases, it is essential to appropriately control b^ood pressure together with other cardiovascular risk factors. OBJECTIVE： The current study was designed to investigate the therapeutic effects on blood pressure, blood pressure variability and other cardiovascular risk factors by giving Yiqi Huaju Formula, a compound traditional Chinese herbal medicine, in addition to routine treatment to hypertensive patients coupled with MetS. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A total of 43 patients with hypertension coupled with MetS were recruited into this study. The enrolled patients were randomly divided into the Chinese herbal formula group （anti-hypertensive drugs plus Yiqi Huaju Formula, CHF） and the control group （anti-hypertensive drugs plus placebo）. The CHF group enrolled 22 patients while the control group received 21 cases. Treatments were given for 12 weeks in both groups. MAIN OUTCOME MEASURES： Parameters examined include 24-hour ambulatory blood pressure monitoring, body mass index, waist circumference, waist-to-hip ratio, homeostatic model assessment for insulin resistance （HOMA-IR）, fasting glycosylated hemoglobin （HbAlc）, fasting plasma glucose, 2-hour postprandial plasma glucose （PPG）, fasting plasma insulin, serum lipid, etc. RESULTS： Compared with the control group, the CHF group had significant improvement （P〈0.01） in anthropometric parameters, FPG, HOMA-IR, blood pressure amplitude, blood pressure variability and blood pressure load. CONCLUSION： This study showed that integrated traditional Chinese and Western medicine treatment can achieve better results in controlling blood pressure as well as other cardiovascular risk factors. The mechanism of controlling of blood pressure may be associated with the improvement of insulin sensitivity due to the Yiqi Huaju intervention. TRIAL REGISTRATION IDENTIFIER： ChiCTR-TRC-11001633.

Autonomic and cardiovascular effects of pentobarbital anesthesia during trigeminal stimulation in cats

Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses;however,the effects of anesthesia with pentobarbital sodium on these responses are unclear.Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate.Increases in systolic blood pressure（SBP） and heart rate（HR） were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg？kg 21 ？h 21.This response was associated with an increase in the low-frequency band of SBP variability（SBP-LF）.As the infusion rate increased to 10 mg？kg 21 ？h 21 or more,decreases in SBP and HR were observed.This response was associated with the reduction of SBP-LF.In conclusion,lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects,depending on the depth of pentobarbital anesthesia.The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.