To study peculiar features of daily AP rhythm and profile in men with cardiovascular risk factors residing in the Far North.
The study included 115 servicemen divided into 3 groups (hypertensive disease (HD), hypertonic type neurocirculatory asthenia (NCA) and risk factor of cardiovascular diseases other than AH). HD was diagnosed based on multiple AP measurements and 24-hr monitoring.
HD was associated with elevated mean AP, load indices and AP variability All patients had pathological type of morning dynamics. Normal daily rhythm of systolic AP (SAP) was documented in 66.1% of the patients with HD and in 68% with cardiovascular risk factors without AH. Normal daily rhythm ofdiastolic AP (DAP) was recorded in 63.5% of the patients with HD and in 72% with cardiovascular risk factors without AH. In group 2, normal daily rhythms of SAP and DAP were found in 44 and 56% of the cases respectively.
Men residing in the Far North under conditions of anomalous photoperiod need medicamentous correction of AP regardless of AH type. Ambulatory BP monitoring should be preferred for the assessment of the efficacy of antihypertensive therapy.
Diabetic retinopathy is accompanied by disturbances in retinal blood flow, which is assumed to be related to the diabetic metabolic dysregulation. It has previously been shown that normoinsulinemic hyperglycemia has no effect on the diameter of retinal arterioles at rest and during an increase in the arterial blood pressure induced by isometric exercise. However, the influence of hyperinsulinemia on this response has not been studied in detail. In seven normal persons, the diameter response of retinal arterioles to an increased blood pressure induced by isometric exercise, to stimulation with flickering light, and to the combination of these stimuli was studied during euglycemic normoinsulinemia (protocol N) on one examination day, and euglycemic hyperinsulinemia (protocol H) on another examination day. Isometric exercise induced significant contraction of retinal arterioles at all examinations, but during a repeated examination the diameter response was significantly reduced in the test persons following the N protocol and increased in the persons following the H protocol. Flicker stimulation induced a significant dilatation of retinal arterioles at all examinations, and the response was significantly higher during a repeated examination, irrespective of the insulin level. Repeated exposure to isometric exercise reduces contraction, whereas repeated exposure to flickering light increases dilatation of retinal arterioles in vivo. Hyperinsulinemia increases contraction of retinal arterioles induced by isometric exercise.
Cardiovascular arousal is associated with patterned cortical activity changes. Head-down-tilt bed rest (HDBR) dimishes the baroreflex-mediated cardiac control. The present study tested the hypothesis that HDBR deconditioning would modify the forebrain organization for heart rate (HR) control during baroreflex unloading. Heart rate variability (HRV), blood pressure and plasma hormones were analysed at rest, whereas HR and cortical autonomic activation patterns (functional magnetic resonance imaging) were measured during graded and randomly assigned lower body negative pressure treatments (LBNP, -15 and -35 mmHg) both before (Pre) and after (Post) a 24 h HDBR protocol (study 1; n = 8). An additional group was tested before and following diuretic-induced hypovolaemia (study 2; n = 9; spironolactone, 100 mg day(-1) for 3 days) that mimicked the plasma volume lost during HDBR (-15% in both studies; P
The article is concerned with modern methods of assessment of arterial hypertension in patients with metabolic syndrome and characteristics of modern antihypertensive drugs and its combinations necessary for the elderly. The authors gave their own example of treatment of more than 2000 patients with arterial hypertension and metabolic syndrome.
The values of arterial blood pressure according to the Yakutsk population screening at the age of 60 and older have been studied. The average values of systolic arterial pressure (both sexes--148, men--145, women--151 mm Hg) are higher than normal values specified by Society of Cardiology of Russian Federation. Long-living persons show its decrease that is more marked in men. The average values of diastolic arterial pressure (both sexes--87, men--88, women--87 mm Hg) correspond to the category of high normal pressure and are decreasing with age to more extent in men than in women. The average values of pulse pressure in elderly and senile age are higher than normal values (both sexes--61, men--57, women--64 mm Hg) with a tendency to grow by 90 years old. Differences in arterial blood pressure levels are educed in gerontic persons depending on presence of abdominal obesity, hypercholesterolemia, hyperglycemia, smoking and family anamnesis with cases of hypertension.
It is difficult to identify the patients who will respond to fluid therapy, but the arterial waveform-derived variables have reasonably predictive values for fluid responsiveness. However, the patient must fulfil a number of prerequisites for these variables to be valid. We assessed the proportion of intensive care unit (ICU) patients with shock who at the time of resuscitation fulfilled the prerequisites for using the arterial waveform-derived variables.
This was a prospective cohort study performed at six ICUs. The study included consecutive adult patients with shock (20 patients per ICU) who received fluid resuscitation on the first day of shock. The fulfilment or not of the prerequisites (sedation, sinus rhythm and controlled ventilation with tidal volumes > 7 ml/kg) was registered at the time of the first fluid resuscitation episode and at fluid resuscitation episodes during the following days.
A total of 119 patients with a median age of 68 years (interquartile range: 56-76 years) were included. At the time of the first fluid resuscitation, 82% (95% confidence interval (CI): 74-87) of the patients had sinus rhythm, 77% (95% CI: 69-84) were sedated, 55% (95% CI: 46-65) were on controlled ventilation and 50% (95% CI: 39-61) received tidal volumes of more than 7 ml/kg. Only 23% (95% CI: 14-33) of the patients fulfilled all four prerequisites.
Less than a quarter of the ICU patients with shock fulfilled all the prerequisites for the use of arterial waveform-derived variables to predict fluid responsiveness. Thus, these variables may be of limited use during resuscitation in the ICU.
To examine the effect of balloon pulmonary angioplasty (BPA) on chronic thromboembolic pulmonary hypertension (CTEPH) in patients with inoperable disease or persistent pulmonary hypertension after pulmonary endarterectomy.
Observational cohort study.
Referred patients with inoperable or persistent CTEPH.
Twenty consecutive CTEPH patients (10 females), aged 60±10 years.
Right heart catheterisation, functional capacity (cardiopulmonary exercise testing (CPET) and NYHA class) and blood sampled biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T examined at the time of diagnosis and repeated in all patients 3 months after the last BPA.
Seventy-three catheterisations were performed with 18.6±6.1 BPAs per patient on segmental and subsegmental arteries. Two deaths occurred following the first BPA, with an overall 10% periprocedural death rate. Reperfusion oedema complicated seven procedures. Comparisons before and after BPA showed significant haemodynamic improvements, including decreased mean pulmonary artery pressure (mPAP) (45±11 mm Hg vs 33±10 mm Hg; p
Short- and long-term exposures to cold increase blood pressure and may explain the higher wintertime cardiovascular morbidity and mortality. Hypertensive subjects may be more susceptible to adverse cold-related cardiovascular health effects. The aim of our study was to assess the effect of short-term cold exposure on central aortic blood pressure among untreated hypertensive men.
We conducted a population-based recruitment of 41 hypertensive men and a control group of 20 men without hypertension (aged 55-65 years) who underwent whole-body cold exposure (15-minute exposure to temperature -10 °C, wind 3 m/s, winter clothes). Central aortic blood pressure, augmentation index, and subendocardial viability ratio were measured by radial artery applanation tonometry.
Short-term cold exposure increased the central aortic blood pressure similarly both in both hypertensive men, from 130/93 to 162/107 mm Hg (P
We sought to investigate associations between central hemodynamic parameters (estimated from radial pulse wave analyses (PWAs)), cardiovascular disease (CVD), and albuminuria in type 1 diabetes.
We conducted an observational study of 636 type 1 diabetes patients. Central hemodynamics were measured by PWA as central aortic systolic pressure (CASP), central aortic pulse pressure (CPP), central aortic diastolic pressure (CADP), and subendocardial viability ratio (SEVR). CVD included revascularization, myocardial infarction, peripheral arterial disease, and stroke. Albuminuria was urinary albumin excretion rate =30 mg/24 hours. We computed standardized odds ratios (ORs) adjusted for sex, age, mean arterial pressure (MAP), heart rate, height, estimated glomerular filtration rate, glycated hemoglobin (HbA1c) total cholesterol, antihypertensive medication, and smoking. At follow-up, development of end-stage renal disease (ESRD) and mortality was traced through electronic medical records.
Patients were aged a mean of 54±13 years, and 289 (45%) were women. The mean ± SD was 118±17 mm Hg for CASP, 75±10 mm Hg for CADP, 43±14 mm Hg for CPP, and 150±32 for SEVR. In fully adjusted models, increased CASP and CPP and decreased CADP and SEVR were associated with presence of CVD (n = 132; P = 0.02) and presence of albuminuria (n = 335; P
The aim of the study was to elucidate dynamics of the incidence of arterial hypertension (AH), 2 type diabetes mellitus (DM), and obesity as the main risk factor of these conditions, combinations between them and certain circulation disorders in the patients admitted to our clinic from 2003 to 2011. We analysed 25,451 case histories. Patients were regarded as having AH, DM, obesity, coronary heart disease, cardiac rhythm disturbances and cerebovascular disorders if they had verified diagnosis of nosological forms corresponding to the respective ICD-10 codes. Their occurrence was calculatedfor 3 three-year periods with reference to the mean age of the patients in different groups. It was shown that increased incidence of AH in the above time periods was associated with the enhanced occurrence of combination of AH and obesity or AH, obesity and DM. Similarly, the increased incidence of DM was associated with the enhanced occurrence of combination DM, AH, and obesity. A significant increase of the mean age was documented only in women with AH and obesity and in men with AH or AH plus obesity. The presence of DM in AH patients had no appreciable effect on the frequency of cerebrovascular pathology that increased in the presence ofAH with obesity.