Effects of Atorvastatin on Warfarin-induced Aortic Medial Calcification and Systolic Blood Pressure in Rats

The effect of atorvastatin on warfarin-induced aortic medial calcification and systolic blood pressure （SBP） of rats induced by warfarin was studied. Thirty healthy and adult rats were randomly divided into Warfarin group （n=10）, Atorvastatin group （n=10） and normal control group （n=10）. Caudal arterial pressure of rats was measured once a week, and 4 weeks later, aorta was obtained. Elastic fiber, collagen fiber and calcium accumulation in tunica media of cells were measured by Von Kossa staining. The results showed that warfarin treatment led to elevation of systolic blood pressure and aortic medial calcification. The chronic treatment also increased collagen, but decreased elastin in the aorta. However, the atorvastatin treatment had adverse effects. It was concluded that treatment with atorvastatin presented evidence of blood pressure lowing and calcification reducing. These data demonstrate that atorvastatin protected aortic media from warfarin-induced calcification and elevation of systolic blood pressure.

Understanding the effect of propofol and electrical cardioversion on the systolic blood pressure of emergency department patients with atrial fibrillation

Dear editor, We read with pleasure the well-designed study by Butler et al of electrical cardioversion of emergency department patients with atrial fibrillation. We appreciate their analysis of the distinctives of procedural sedation when employed for this indication. Understanding the dosing adjustments to propofol undertaken by their sedationists will help us more carefully evaluate our own approach to sedating patients undergoing electrical cardioversion of atrial fibrillation.

Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index

Background: In new outpatients, blood pressure should be measured in both arms. A previous study reported that an inter-arm systolic blood pressure difference (ΔSBP) of ≥10 mm Hg is associated with an increased risk of mortality. Aim: The aim was to identify the associations with absolute values of ΔSBP (|ΔSBP|) ≥10 mm Hg. Subjects and Methods: This study included 2481 patients. Patients with a body mass index ≥25 kg/m2 were defined as obese. The group of A was defined as following: ankle-brachial index (ABI) was <0.9 or ≥1.3. ΔSBP was expressed as right arm BP minus left arm BP. |ΔSBP| ≥10 mm Hg were analyzed using multivariate logistic analysis. Results: |ΔSBP| ≥10 mm Hg was found in 6.0% of patients and |ΔSBP| < 5 mm Hg in 80.4%. In multivariate analysis, the odds ratios (ORs) of the associations with |ΔSBP| ≥10 mm Hg were significantly associated with abnormal ABI and obesity regardless of sex and age. Moreover, the OR of the combined effects of abnormal ABI and obesity was higher than that of abnormal ABI and obesity alone. Conclusion: |ΔSBP| ≥10 mm Hg was associated with abnormal ABI and obesity. In a primary care setting, blood pressure should be actively measured in both arms. This study suggests that the associations with |ΔSBP| ≥10 mm Hg may be a useful part of screening for abnormal ABI.

Preliminary study of abnormal increase of postexercise systolic blood pressure in the diagnosis of coronary artery disease

Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.

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.

Central aortic systolic blood pressure can better predict prolonged QRS duration than brachial artery systolic blood pressure in rural community residents

Background Central aortic systolic blood pressure（CASP） has been shown to be a stronger predictor of target-organ damage and cardiovascular events than brachial systolic blood pressure（BSBP）, but there was no data about whether CASP can predict prolonged QRS duration more than BSBP. We examined the association of CASP and BSBP with QRS duration in rural community residents. Methods We retrospectively analyzed 490 rural community residents. Standard resting 12-lead ECG and central aortic blood pressure（CABP） were measured noninvasively in all subjects at baseline. The QRS duration was equal to or more than 120 ms being defined as prolonged QRS duration. Results The prolonged QRS duration group showed higher CASP（139.38 ± 11.67 vs. 135.36 ± 16.22, P = 0.031） and BSBP（136.03 ± 6.74 vs. 124.44 ± 13.01, P 〈 0.001） as compared with controls. Multivariate linear regression analysis showed that CASP, BSBP and heart rate were independently affecting QRS duration. Logistic regression analyses showed that CASP（OR 1.057, 95%CI： 1.027, 1.088, P 〈 0.001）and BSBP（OR 1.056, 95%CI： 1.027, 1.086, P = 0.032） were independent predictors of prolonged QRS duration after adjustment for age, sex, body mass index, heart rate. CASP had a better predictive value for prolonged QRS duration than（AUC： 0.793 vs. 0.601, P 〈 0.001） BSBP. Conclusions Our findings demonstrate that both CASP and BSBP are risks for prolonged QRS duration, but CASP can predict prolonged QRS duration better than BSBP.

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.

Relationship between postoperative mean systolic blood pressure and contrast-induced nephropathy in patients undergoing cardiac catheterization

Background There were few studies to explore the relationship between postoperative mean systolic blood pressure （PMSBP） within 6 h after cardiac catheterization and contrast-induced nephropathy （CIN）. Methods From June 2010 to February 2013, 299 consecutive patients undergoing cardiac catheterization were recruited. Patients were classified into quartiles based on PMSBP （ 〈 112, 112-120, 121-131, and 〉 132 mmHg）. Baseline data, CIN incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between PMSBP and CIN. Results CIN occurred in 26（8.7%） patients. The incidence of CIN in PMSBP quartiles were 15.3% （11/72）, 15.1% （11/73）, 2.4% （2/82） and 2.8% （2/72） （P = 0.001） respectively. There were no significant difference in in-hospital death, renal replacement therapy and intra-aortic balloon pump （IABP） support between the groups （P 〉 0.05）. Univariate logistic regression analysis showed that PMSBP was significantly associated with CIN （OR = 0.956, 95% CI： 0.928-0.986, P = 0.004）. Multivariate logistic regression analysis found that after adjusting baseline estimate glomerular filtration rate, age 〉 75 years and acute myocardial infarction, PMSBP 〈 120 mmHg was still an independent risk factor for CIN （OR = 5.049, 95% CI： 1.820-14.009, P = 0.002）. Conclusions Lower PMSBP was significantly associated with an increased risk of CIN. PMSBP 〈 120 mmHg was an independent risk factor for CIN. Intensive blood-pressure control after cardiac catheterization might increase the risk of CIN.

The association between admission systolic blood pressure and 1-year mortality in patients with non-ST-segment elevation acute coronary syndrome

Background In patients with acute coronary syndrome（ACS）, lower admission systolic blood pressure（SBP）levels infer a worse prognosis. However, the predictive potential of admission SBP on 1-year mortality has not fully elucidated in patients with non-ST-segment elevation ACS（NSTEACS）. Methods We enrolled 1325 patients to investigate the association between admission SBP in patients hospitalized for NSTEACS. We analyzed the association between admission SBP and 1-year mortality. Admission SBP was categorized as low（〈110 mm Hg）, normal（110-140 mm Hg）, high（141-160 mm Hg）, and very high（〉160 mm Hg）. Results Compared with patients with normal admission SBP, those with low SBP had a significantly increased hazard ratios（HRs） for 1-year mortality of 3.03（P〈0.05）, while patients with high and very high admission SBP had no significantly increased HRs for 1-year mortality. Conclusion Low admission SBP, but not elevated admission SBP, is a strong independent predictor of 1-year mortality in patients with NSTEACS.

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.

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.

Exercise Blood Pressure Response and Cardiometabolic Risk Factors in Middle Aged Women: A MONET Group Study

Objective: To investigate if an exaggerated peak exercise systolic blood pressure (peak ESBP) is associated with alteration of cardiometabolic risk factors and predict future resting hypertension in middle aged women. Methods: Data analysis was performed in 95 healthy normotensive premeno-pausal women at baseline and 84 after 5-year follow-up (age, 49.9 ± 1.9 years;BMI, 23.3 ± 2.2 kg/m2;resting BP, 117/73 ± 11.8/7.6 mmHg). Blood pressure was measured at rest and during a progressive exercise test on treadmill. Women were divided into two groups according to their peak ESBP <190 mmHg vs. ≥190 mmHg. Other outcome measures were: cardiorespiratory fitness (VO2 peak), body composition, body fat distribution and fasting plasma lipids, glucose and insulin levels. Results: 15% and 27% of women presented an exaggerated peak ESBP response (≥190 mmHg) at baseline and year 5 respectively. Linear mixed model repeated measures analysis revealed higher values of fasting glucose, resting systolic and diastolic BP in women with an exaggerated peak ESBP (≥190 mmHg) compared to women with a peak ESBP (<190 mmHg). No significant difference was observed between the two groups for VO2 peak, body composition and body fat distribution indices and other cardiometabolic risk factors. Finally, baseline peak ESBP was not a significant risk factor for future resting hypertension (OR: 2.96, 95%CI [0.48 - 18.12];P = 0.24). Conclusion: Our results, despite being non significant, are of great interest because in healthy and active premenopausal women, exaggerated peak ESBP is not predictive of future hypertension after 5-year follow-up throughout menopause transition.

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.

Association between Depression, Pressure Pain Sensitivity, Stress and Autonomous Nervous System Function in Stable Ischemic Heart Disease: Impact of Beta-Adrenergic Receptor Blockade

Background: Depression and ischemic heart disease (IHD) are associated with persistent stress and autonomic nervous system (ANS) dysfunction. The former can be measured by pressure pain sensitivity (PPS) of the sternum, and the latter by the PPS and systolic blood pressure (SBP) response to a tilt table test (TTT). Beta-blocker treatment reduces the efferent beta-adrenergic ANS function, and thus, the physiological stress response. Objective: To test the effect of beta-blockers on changes in depression score in patients with IHD, as well as the influence on persistent stress and ANS dysfunction. Methods: Three months of non-pharmacological intervention aiming at reducing PPS and depression score in patients with stable IHD. Beta-blocker users (N = 102) were compared with non-users (N = 75), with respect to signs of depression measured by the Major Depressive Inventory questionnaire (MDI), resting PPS, and PPS and SBP response to TTT. Results: MDI score decreased 30% in non-users (p = 0.005) compared to 4% (p > 0.1) among users (between-group p = 0.003;effect size = 0.4). Resting PPS decreased in both the groups. Among most vulnerable patients with MDI ≥ 15, reductions in MDI score and resting PPS score correlated in non-users, only (r = 0.69, p = 0.007). Reduction in resting PPS correlated with an increase in PPS and SBP response to TTT. Conclusions: Stress intervention in patients with IHD was anti-depressive in non-users, only. Similarly, the association between the reduction in depression, reduction in persistent stress, and restoration of ANS dysfunction was only seen in non-users, suggesting a central role of beta-adrenergic receptors in the association between these factors.

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.

The effect of acute aerobic exercise on central arterial stiffness,wave reflections,and hemodynamics in adults with diabetes:A randomized cross-over design

Background:Individuals with diabetes have greater central arterial stiffness,wave reflections,and hemodynamics,all of which promote the accelerated cardiovascular pathology seen in this population.Acute aerobic exercise has been shown to be an effective strategy for reducing central arterial stiffness,wave reflections,and hemodynamics in healthy individuals;however,the effects of acute aerobic exercise in reducing these outcomes is not well established in people with diabetes.Recently,implementation of high-intensity interval exercise(HIIE)has shown superior improvements in cardiovascular health outcomes when compared to traditional aerobic exercise.Yet,the effect of HIIE on the aforementioned outcomes in people with diabetes is not known.The purpose of this study was to(i)describe the central arterial stiffness,wave reflections,and hemodynamic responses to a bout of HIIE and moderate-intensity continuous exercise(MICE)in adults with diabetes;and(ii)compare the effects of HIIE and MICE on the aforementioned outcomes.Methods:A total of 24 adult men and women(aged 29-59 years old)with type 1(n=12)and type 2(n=12)diabetes participated in a randomized cross-over study.All participants completed the following protocols:(i)HIIE:cycling for 4×4 min at 85%-95%of heart rate peak(HR_(peak)),interspersed with 3 min of active recovery at 60%-70%HR_(peak);(ii)MICE:33 min of continuous cycling at 60%-70%HR_(peak);and(iii)control(CON):lying quietly in a supine position for 30 min.Results:A significant group￡time effect was found for changes in central systolic blood pressure(F=3.20,p=0.01)with a transient reduction for the HIIE group but not for the MICE or CON groups.There was a significant group￡time effect for changes in augmentation index at a heart rate of 75 beats/min(F=2.32,p=0.04)with a decrease following for HIIE and MICE but not for CON.For all other measures of central arterial stiffness and hemodynamics,no significant changes were observed(p>0.05).Conclusion:A bout of HIIE appears to lead to a greater transient reduction in central systolic blood pressure than the reduction observed following MICE;however,both HIIE and MICE improved augmentation index at a heart rate of 75 beats/min in people with diabetes.There was no significant difference in response to HIIE and MICE in all outcomes.This provides preliminary evidence on the role of HIIE on such outcomes in people with diabetes.

Wavelet and pain rating index for inhalation anesthesia: A randomized controlled trial

BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.

Subclinical Indication of Linkage Between Markers of Skeletal and Cardiovascular Properties

Little is known about early coincidental changes in bone and vascular properties, particularly in the context of skeletal anabolism （puberty） versus relative equilibrium （young adulthood）. We aimed to determine if subclinical markers of vascular function were associated with bone mineral content （BMC） and to evaluate the contribution of systemic factors in healthy females ages 14-42 years. Endothelial function was assessed by flow mediated dilatation （FMD）, arterial stiffness by pulse wave velocity （PWV） and augmentation index （AIx）, blood pressure （BP） by sphygmomanometer, BMC by DXA, and systemic factors by fasting blood draw. General linear models controlled for age, race and height indicated a positive association between systolic BP （SBP） and BMC independent of systemic factors. When stratified by age using 19 years as a cut-point, there was an inverse relationship between AIx75 in adolescents with insulin （P〈0.10） or inflammatory markers （P〈0.10） in statistical models. Conversely, there was a positive relationship between BMC and both PWV and AIx75 in young adults （P〈0.05）. The link between bone and the vasculature may be life stage-dependent. In the context of a less dynamic microenvironment in young adult females, metabolic factors appear to moderate less of an effect of hemodynamic properties on the skeleton relative to adolescents.