Acute Effects of Virtual Reality Exercise on Young Adults’ Blood Pressure and Feelings

Virtual reality(VR)seems to have the potential to provide opportunities to promote physical activity(PA)in a fun way.This paper aimed to examine the acute effects of three different virtual reality-based exercise bikes on young adults’blood pressure(BP)and feelings compared to a traditional exercise cycling session.Four exercise sessions(immersive VR cycling,two non-immersive VR cycling,and traditional cycling)were completed by 36 young adults(22 females;Mage=23.6 years).BP was measured immediately before and after each session using a BP cuff and exercise-induced feelings were assessed via an established survey immediately after each session.Parti-cipants’previous experience with VR was used as the covariate in the ANCOVA with repeated measures.Signif-icant main effects were observed across cycling sessions for systolic blood pressure[F(2,29)=3.04,p=0.02,(η^(2)=0.38)]and feelings[F(3,32)=7.74,p<0.01,η^(2)=.42].In particular,immersive VR and traditional cycling signif-icantly increased systolic blood pressure compared to the two non-immersive VR sessions.Moreover,immersive VR significantly increased feelings compared to the two non-immersive VR sessions,whereas these two non-immersive VR exercises had significantly greater increased feelings compared to traditional cycling,respectively.Findings suggest immersive VR-based exercise cycling may lead to higher exercise intensities compared to non-immersive VR cycling.Further,immersive VR cycling yielded higher feelings compared to non-immersive VR and traditional cycling.Thus,immersive VR-based exercise can be a fun and physically active health promotion tool among young adults.

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.

Association between Mean Ocular Perfusion Pressure and Diabetic Retinopathy in a Northeastern Chinese Population

Objective To evaluate the association between diabetic retinopathy(DR) and mean ocular perfusion pressure(MOPP) in patients with type 2 diabetes mellitus(T2 DM).Methods Patients from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT), a communitybased prospective cohort study conducted in northeast China, were included in this study. The presence and severity of DR were determined by grading fundus photographs according to the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale. Systolic and diastolic blood pressure(SBP and DBP) were recorded using an electronic sphygmomanometer. Intraocular pressure(IOP) was measured using an iCare rebound tonometer. MOPP was calculated using the formula MOPP = 2/3 [DBP + 1/3(SBP-DBP)]-IOP.Results In total, 1,857 patients who had gradable fundus photography and MOPP data were enrolled in this study. Male patients had a higher MOPP than female patients(52.25 ± 8.75 vs. 50.96 ± 8.74 mmHg, P = 0.002). Overall, both male and female patients with any type of DR, non-proliferative DR(NPDR), or non-sight-threatening DR(non-STDR) had significantly higher MOPP relative to patients without DR. Increased MOPP(per 1 mmHg) was in turn associated with the presence of any type of DR[odds ratio(OR) = 1.03, 95% confidence interval(CI) : 1.02–1.04], NPDR(OR = 1.03 95% CI: 1.02–1.04),and non-STDR(OR = 1.03, 95% CI: 1.01–1.04) after adjusting for confounders. Increased MOPP(per 1 mmHg) was also associated with an increased likelihood of macular edema(OR = 1.02, 95% CI:1.01–1.04).Conclusions The results suggest that increased MOPP was associated with DR and macular edema in northeastern Chinese patients with T2 DM.

Blood Pressure and Heart Rate Measurements Using Photoplethysmography with Modified LRCN

In this study,single-channel photoplethysmography(PPG)signals were used to estimate the heart rate(HR),diastolic blood pressure(DBP),and systolic blood pressure(SBP).A deep learning model was proposed using a long-term recurrent convolutional network(LRCN)modified from a deep learning algorithm,the convolutional neural network model of the modified inception deep learning module,and a long short-term memory network(LSTM)to improve the model’s accuracy of BP and HR measurements.The PPG data of 1,551 patients were obtained from the University of California Irvine Machine Learning Repository.How to design a filter of PPG signals and how to choose the loss functions for deep learning model were also discussed in the study.Finally,the stability of the proposed model was tested using a 10-fold cross-validation,with an MAE±SD of 2.942±5.076 mmHg for SBP,1.747±3.042 mmHg for DBP,and 1.137±2.463 bpm for the HR.Compared with its existing counterparts,the model entailed less computational load and was more accurate in estimating SBP,DBP,and HR.These results established the validity of the model.

Impact of intragastric balloon on blood pressure reduction:A retrospective study in Eastern North Carolina

BACKGROUND Obesity has evolved into a global pandemic.The prevalence of obesity and hypertension in eastern North Carolina are comparable,if not higher,than the national prevalence.In the United States,an estimated 34%of adults have hypertension,the most modifiable risk factor for heart disease and stroke.Lifestyle and pharmacological interventions often do not provide sustained weight loss in obese patients.Bariatric surgery offers an effective weight reduction with short-and long-term health improvements;however,a higher body mass index is associated with higher surgical morbidity and mortality,longer hospitalization,and increasing rates of 30-day readmission due to comorbidities.Intragastric balloon may bridge a critical gap in the treatment of obesity.The objective of this paper is to showcase the impact of endoscopic bariatric therapy on blood pressure reduction.AIM To investigate the impact of intragastric balloon on blood pressure reduction.METHODS A retrospective chart review was conducted from January 1,2016 to January 31,2019 of consecutive adults who received intragastric balloon therapy(IGBT)in a gastroenterology private practice in Eastern North Carolina.The balloon was introduced into the stomach under endoscopic guidance,and while in the region of the gastric body,inflation with saline was performed at increments of 50 mL until target volume between 500 to 650 mL of saline was attained depending on the patient's gastric capacity.No procedural complications were noted during endoscopic placement and removal of the balloon.A cohort study design was used for data analysis.A total of 172 patients had the Orbera^(■)intragastric balloon placed.Of the 172 patients who had IGBT at baseline,11 patients(6.4%)requested early balloon removal due to foreign body sensation(n=1),and/or intolerable gastrointestinal adverse events(n=10).The reported gastrointestinal adverse events were nausea,vomiting,abdominal pain,and diarrhea.Eventually,6-mo follow-up data were available for only 140 patients.As a result,only the 140 available at the 6-mo follow-up were included in the analysis.Univariate,bivariate,and multivariate statistical analyses were performed.Specifically,scatterplots were created to show the relationship between weight and blood pressure,and paired two-sample t-test was carried out to determine if there was a significant reduction in weight before and after the IGBT.Multiple regressions were also performed to examine the association between participants’total body weight and blood pressure.The outcome variables for the multiple regression were systolic and diastolic blood pressure measured as continuous variables.This was followed by logistic regression analyses to determine the association between total body weight and hypertension at 6-mo post-implantation.The outcome variables for the logistic regression were systolic blood pressure–nonhypertensive(140 mmHg or less)or hypertensive(greater than 140 mmHg),and diastolic blood pressure–non-hypertensive(90 mmHg or less)or hypertensive(greater than 90 mmHg).All authors had access to the study data and reviewed and approved the final manuscript.All statistical analyses were done using STATA 14®.RESULTS The study included 15%males and 85%females.50%of the patients were white and just over 22%were non-white,and about 27%declined to give their race.The average baseline patients’weight prior to IGBT was 231.61 Lbs.(SD=46.53 Lbs.).However,the average patients’weight after IGBT at the 6-mo follow-up was 203.88 Lbs.(SD=41.04 Lbs.).Hence,on average,the percent total body weight loss at 6-mo is 11.97 after IGBT.The logistic regression performed revealed that weight(β=0.0140,P<0.000)and age(β=0.0534,P<0.000)are important factors in determining systolic blood pressure after IGBT.None of the other demographic characteristics or indicated comorbidities were found to be significant.CONCLUSION IGBT can be an effective short-term weight reduction modality with a relatively little risk of adverse event.Due to its improvement on systolic blood pressure,IGBT may help reduce cardiovascular risk.

Effects of Almond Milk on Body Measurements and Blood Pressure

In recent years, the demand for almond milk and its sales has increased owing to consumers’ perceptions about its health benefits. Hence, we sought to measure the effect of almond milk on body measurements such as body weight, body mass index and waist and hip circumference, in addition to diastolic and systolic blood pressures. Thirty volunteers of both sexes participated in the study, with a mean age of 23.27 ± 6.20 years. The study was conducted over 4 weeks, and the results showed that daily substitution of one serving of dairy product with one cup (240 ML) of almond milk significantly decreased body weight, body mass index and waist and hip circumference, However, no effects were observed on blood pressures.

Low diastolic blood pressure and adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease: A multicenter cohort study

Background:Although intensively studied in patients with cardiovascular diseases(CVDs),the prognostic value of diastolic blood pressure(DBP)has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).This study aimed to reveal the prognostic value of DBP in AECOPD patients.Methods:Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021.DBP was measured on admission.The primary outcome was all-cause in-hospital mortality;invasive mechanical ventilation and intensive care unit(ICU)admission were secondary outcomes.Least absolute shrinkage and selection operator(LASSO)and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio(HR)and 95%confidence interval(CI)for adverse outcomes.Results:Among 13,633 included patients with AECOPD,197(1.45%)died during their hospital stay.Multivariable Cox regression analysis showed that low DBP on admission(<70 mmHg)was associated with increased risk of in-hospital mortality(HR=2.16,95%CI:1.53–3.05,Z=4.37,P<0.01),invasive mechanical ventilation(HR=1.65,95%CI:1.32–2.05,Z=19.67,P<0.01),and ICU admission(HR=1.45,95%CI:1.24–1.69,Z=22.08,P<0.01)in the overall cohort.Similar findings were observed in subgroups with or without CVDs,except for invasive mechanical ventilation in the subgroup with CVDs.When DBP was further categorized in 5-mmHg increments from<50 mmHg to≥100 mmHg,and 75 to<80 mmHg was taken as reference,HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs;higher DBP was not associated with the risk of in-hospital mortality.Conclusion:Low on-admission DBP,particularly<70 mmHg,was associated with an increased risk of adverse outcomes among inpatients with AECOPD,with or without CVDs,which may serve as a convenient predictor of poor prognosis in these patients.Clinical Trial Registration:Chinese Clinical Trail Registry,No.ChiCTR2100044625.

The effectiveness of physical activity interventions on blood pressure in children and adolescents:A systematic review and network meta-analysis

Background:High blood pressure(BP)is a major contributor to mortality and cardiovascular diseases.Despite the known benefits of exercise for reducing BP,it is crucial to identify the most effective physical activity(PA)intervention.This systematic review and network meta-analysis(NMA)aimed to evaluate the available evidence on the effectiveness of various PA interventions for reducing BP and to determine their hierarchy based on their impact on BP.Methods:A search of PubMed,SPORTDiscus,PsycINFO,Web of Science,CINAHL,Cochrane,and Eric databases was conducted up to December 2022 for this systematic review and NMA.Randomized controlled trials and quasi-experimental studies targeting healthy children and adolescents aged 6-12 years old were included in this study.Only studies that compared controlled and intervention groups using PA or exercise as the major influence were included.We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Three independent investigators performed the literature screening,data extraction,and risk of bias assessment.We used Bayesian arm-based NMA to synthesize the data.The primary outcomes were systolic BP and diastolic BP.We calculated the mean differences(MDs)in systolic BP and diastolic BP before and after treatment.Mean treatment differences were estimated using NMA and random-effect models.Results:We synthesized 27 studies involving 15,220 children and adolescents.PA combined with nutrition and behavior change was the most effective intervention for reducing both systolic BP and diastolic BP(MD=-8.64,95%credible interval(95%CI):-11.44 to-5.84;MD=-6.75,95%CI:-10.44 to-3.11),followed by interventions with multiple components(MD=-1.39,95%CI:-1.94 to-0.84;MD=-2.54,95%CI:-4.89 to-0.29).Conclusion:Our findings suggest that PA interventions incorporating nutrition and behavior change,followed by interventions with multiple components,are most effective for reducing both systolic BP and diastolic BP in children and adolescents.

Diastolic blood pressure lower than 75 mmHg is associated with adverse outcomes in patients with heart failure with preserved ejection fraction induced or exacerbated by atrial fibrillation

Background The effects of diastolic blood pressure(DBP)on prognosis of heart failure with preserved ejection fraction(HFp EF)are still not clear,probably due to the underlying heterogeneity of HFp EF.This study was aimed to evaluate the effects of DBP in patients with atrial fibrillation(AF)-induced or AF-exacerbated HFp EF,which is a clinical syndrome with high homogeneity that has seldom been discussed.Methods In this retrospective cohort study,955 patients diagnosed with AF and HFp EF were screened.Patients with specific underlying cardiovascular diseases or other severe comorbidities were excluded.A total of 191 patients were included.Patients were assigned to one of the two groups:DBP<75 mm Hg or DBP≥75 mm Hg All-cause mortality was taken as primary endpoint,and all-cause re-hospitalization and HF specific re-hospitalization were measured as secondary endpoints.Results The mean follow-up was 49 months.Multiple established clinical risk factors and prognostic biomarkers for heart failure were adjusted.Patients with DBP<75 mm Hg demonstrated higher allcause mortality compared with patients with DBP of≥75 mm Hg[odds ratio(OR):1.669,95%confidence Interval(CI):1.040-2.679,P=0.034).The risk of all-cause re-hospitalization was also increased in the group with DBP<75 mm Hg(OR:1.426,95%CI:1.006-2.022,P=0.047).However,there was no statistically significant difference in the risk of re-hospitalization due to HF between the two groups(OR:1.005,95%CI:0.565-1.787,P=0.986).Conclusions In patients with AF-induced or AF-exacerbated HFp EF,DBP<75 mm Hg was associated with higher all-cause mortality and all-cause re-hospitalization,but was not associated with re-hospitalization due to HF.

Relationship between diastolic blood pressure and adverse outcomes in ST-elevation myocardial infarction undergoing percutaneous coronary intervention

Background Low diastolic blood pressure(DBP)was reported to be associated with reduced coronary blood flow,subclinical myocardial damage,and cardiovascular events. The aim of this study was to explore the impact of low DBP on clinical outcomes in patients with ST-elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI). Methods A total of 1232 patients with STEMI were retrospectively enrolled and divided into two groups according to admission DBP level:≥70 mm Hg(n=817)and < 70 mm Hg(n=415). The relationship between DBP and in-hospital and 1-year adverse events was evaluated.Results In-hospital death occurred in 2.4% of patients. The in-hospital mortality(5.3% vs. 1.0%,P<0.001)and major adverse clinical events(11.1% vs. 7.5%,P=0.033)were significantly higher in patients with a low DBP.DBP <70 mm Hg was associated with in-hospital death(adjusted odds rate=3.31,95%CI:1.36-8.07,P=0.009).Additional significant indicators included eGFR < 60 mL/min/1.73 m^2 and intra aorta balloon pump(IABP)treatment. Seventy-seven(6.3%)patients died in the one-year follow-up. DBP < 70 mm Hg was associated with increased risk of 1-year death(8.9% vs. 4.8%,Log-rank=9.9,P=0.002). Conclusion Low DBP was associated with increased risk of in-hospital and 1-year adverse prognosis in patients with STEMI undergoing PCI,which could be a tool for risk assessment.

Impact of baseline blood pressure on all-cause mortality in patients with atrial fibrillation:results from a multicenter registry study

Background:The ideal blood pressure(BP)target for patients with atrial fibrillation(AF)is still unclear.The present study aimed to assess the effect of the baseline BP on all-cause mortality in patients with AF.Methods:This registry study included 20 emergency centers across China and consecutively enrolled patients with AF from 2008 to 2011.All participants were followed for 1 year±1 month.The primary endpoint was all-cause mortality.Results:During the follow-up,276(13.9%)all-cause deaths occurred.Kaplan-Meier curves showed that a systolic blood pressure(SBP)110 mmHg or>160 mmHg was associated with a higher risk of all-cause mortality(log-rank test,P=0.014),and a diastolic blood pressure(DBP)<70 mmHg was associated with the highest risk of all-cause mortality(log-rank test,P=0.002).After adjusting for confounders,the multivariable Cox regression model suggested that the risk of all-cause mortality was increased in the group with SBP110 mmHg(hazard ratio[HR],1.963;95%confidence interval[CI],1.306-2.951),and DBP<70 mmHg(HR,1.628;95%CI,1.163-2.281).In the restricted cubic splines,relations between baseline SBP or DBP and all-cause mortality showed J-shaped associations(non-linear P<0.001 and P=0.010,respectively).The risk of all-cause mortality notably increased at a lower baseline SBP and DBP.Conclusions:Having a baseline SBP110 mmHg or DBP<70 mmHg was associated with a significantly higher risk of all-cause mortality in patients with AF.An excessively low BP may not be an optimal target for patients with AF.

Effect of Electroacupuncture on Heart Meridian for Change of End-Diastolic Intraventricular Pressure with Myocardial Ischemia in Rabbits

Objective: To explore the relationship between Heart Meridian (HM) and cardiac function. Methods: Thirty rabbits with acute myocardial ischemia resulting from intravenous dripping of pituitrin was established. Electroacupuncture (EA) on the HM and the Lung Meridian (LM) was applied, 3 points for each, and their change of end diastolic intraventricular pressure observed. Results: Obvious difference existed in the improvement of end diastolic intraventricular pressure on the HM and LM with EA treatment. The regulatory action of EA in HM on the cardiac function was significantly better than that of EA in LM. Conclusion: HM was closely related to the cardiac function.

Non-invasive cuffless blood pressure and heart rate monitoring using impedance cardiography

Background Continuous blood pressure(BP)monitoring provides additional information about how changes in BP may correlate with daily activities and sleep patterns.Recommendations from the American Heart Association and American College of Cardiology strongly suggest confirming a diagnosis of hypertension with continuous BP monitoring.Non-invasive and non-intrusive detection of haemodynamic parameters is emerging as a norm,based on self-monitoring wearable medical devices.Researchers have carried out several studies using non-invasive and continuous BP measurements as an alternative to conventional cuff-based measurements.In this work,we proposed a novel method for cuffless estimation of BP using impedance cardiography(ICG).Methods We conducted a single-centre,cross-sectional study of 104 subjects(of whom 30 were categorized as controls and the remaining 74 as the disease group)at the Medical College and Hospital,Kolkata.The disease group consisted of patients with confirmed coronary artery disease,while the individuals in the control group were deemed to be healthy.All subjects underwent electrocardiogram recording by on-duty doctors in order to determine their health status.A custom-made device based on the principle of impedance plethysmography was designed to record impedance changes due to subjects’peripheral blood flow.The device was used to record ICG signals.In this study,we developed a novel auto-adaptive algorithm based on ICG signals for non-invasive,cuffless,continuous monitoring of BP and heart rate.Separate mathematical models were developed for all the estimated parameters(BP and heart rate)for both the study groups(control and disease).The developed models were auto-adaptive and did not require subject-specific calibration.Performance indicators including,𝑟2,error percentage,standard deviation,and mean difference were used to quantify the performance of the models.Results The ICG signal recorded by the device was used to extract features and compute the augmentation index.The calculated augmentation index values showed strong correlations with systolic BP(𝑟=0.99,𝑃<0.05),diastolic BP(𝑟=0.95,𝑃<0.05),and heart rate(𝑟=0.78,𝑃<0.05).The models were also shown to have a high degree of accuracy for systolic and diastolic BP.Error margins were in the range±2.33 and±1.79 mmHg for systolic BP in disease and control subjects,respectively,and±3.60 and±1.82 mmHg for diastolic BP.However,the accuracy was lower in the prediction of heart rate in disease subjects,with a reported𝑟2 value of 0.72 and an error margin of±2.88 beats per min;for healthy subjects,the results were marginally better,with an error margin of±1.82 beats per min.All statistical analyses were performed using MATLAB(R2017a,MathWorks R○,USA).Conclusion In this study,we developed a non-invasive cuffless approach for estimation of systemic peripheral BP and heart rate using ICG.The proposed methodology eliminated any discomfort to patients caused by inflation of the cuff(in the case of cuff-based BP monitoring)or the need to constantly wear a fingertip photoplethysmography device(in the case of cuffless BP monitoring).The results obtained appeared promising and increased the potential scope of ICG for monitoring other haemodynamic parameters related to heart function.

A predictive model of death from cerebrovascular diseases in intensive care units

Objective This study aimed to explore the mortality prediction of patients with cerebrovascular diseases inthe intensive care unit(ICU)by examining the important signals during different periods of admission in theICU,which is considered one of the new topics in the medical field.Several approaches have been proposed forprediction in this area.Each of these methods has been able to predict mortality somewhat,but many of thesetechniques require recording a large amount of data from the patients,where recording all data is not possiblein most cases;at the same time,this study focused only on heart rate variability(HRV)and systolic and diastolicblood pressure.Methods The ICU data used for the challenge were extracted from the Multiparameter Intelligent Monitoring inIntensive Care II(MIMIC-II)Clinical Database.The proposed algorithm was evaluated using data from 88 cerebrovascular ICU patients,48 men and 40 women,during their first 48 hours of ICU stay.The electrocardiogram(ECG)signals are related to lead II,and the sampling frequency is 125 Hz.The time of admission and time ofdeath are labeled in all data.In this study,the mortality prediction in patients with cerebral ischemia is evaluated using the features extracted from the return map generated by the signal of HRV and blood pressure.Topredict the patient’s future condition,the combination of features extracted from the return mapping generatedby the HRV signal,such as angle(𝛼),area(A),and various parameters generated by systolic and diastolic bloodpressure,including DBPMax−Min SBPSD have been used.Also,to select the best feature combination,the geneticalgorithm(GA)and mutual information(MI)methods were used.Paired sample t-test statistical analysis was usedto compare the results of two episodes(death and non-death episodes).The P-value for detecting the significancelevel was considered less than 0.005.Results The results indicate that the new approach presented in this paper can be compared with other methodsor leads to better results.The best combination of features based on GA to achieve maximum predictive accuracywas m(mean),L_(Mean),A,SBP_(SVMax),DBP_(Max-Min).The accuracy,specificity,and sensitivity based on the best featuresobtained from GA were 97.7%,98.9%,and 95.4%for cerebral ischemia disease with a prediction horizon of0.5–1 hour before death.The d-factor for the best feature combination based on the GA model is less than 1(d-factor=0.95).Also,the bracketed by 95 percent prediction uncertainty(95PPU)(%)was obtained at 98.6.Conclusion The combination of HRV and blood pressure signals might increase the accuracy of the predictionof the death episode and reduce the minimum hospitalization time of the patient with cerebrovascular diseasesto determine the future status.

Clinical Study of Western Medicine Combined with Chinese Medicine Based on Syndrome Differentiation in the Patients with Polarized Hypertension

Objective： To investigate the effects and safety of Western medicine combined with Chinese medicine （CM） based on syndrome differentiation in the treatment of elderly polarized hypertension （PHPT）, or isolated systolic hypertension with low diastolic blood pressure （DBP）. Methods： A total of 125 elderly patients with PHPT were randomly assigned to two groups： 59 in the control group treated by Western medicine and 66 in the intervention group treated by Western medicine combined with CM treatment. Based on syndrome differentiation, the patients in the intervention group were further divided into subgroups of yang-qi deficiency and yin-qi deficiency. All subjects were treated with Western medicine of Amlodipine Besylate Tablets and Irbesartan Tablets （or Irbesartan and Hydrochlorothiazide Tablets）, to decrease their systolic blood pressure （SBP） slowly to 125-135 mm Hg in 2-6 weeks. In the intervention group, Shiyiwei Shenqi Capsule （十一味参芪） was given additionally to the subgroup of yang-qi deficiency at the dosage of 3-5 capsules, thrice a day, while Dengzhan Shengmai Capsule （灯盏生脉胶囊） was given additionally to the subgroup of yin-qi deficiency at the dosage of 2 capsules, 2-3 times per day. For all subjects, SBP, pulse pressure （PP）, and DBP were measured before treatment and at the terminal of a 6-week treatment. For subjects in the intervention group, left ventricular ejection fraction （LVEF） was also recorded. Results： After a 6-week treatment, the SBP in the two groups and the PP in the intervention group decreased significantly compared to those before treatment （P〈0.05）, while the PP in the control group showed no significant difference between prior and post-treatment （P〉0.05）. After treatment, the DBP in the control group decreased （P〉0.05）, while the DBP and LVEF in the intervention group showed an increase tendency although it had no statistical significance （P〉0.05）. When subjects in the intervention group were classified further by the course of disease, the DBP and LVEF of subjects whose course of disease were less than 2 years, increased significantly after treatment （P〈0.05）. Conclusion： Western medicine combined with CM treatment based on syndrome differentiation was safer and more effective than Western medicine alone in the treatment of elderly PHPT, because it not only reduced SBP but also improved DBP, which might lower the incidence of the cardiovascular and cerebrovascular events.