Discussion on the zero-calibration and the zero line in the measurement of central venous pressure and invasive arterial blood pressure / 中华危重病急救医学

Objective:To figure out the timing of zeroing and the location of the zero line in the central venous pressure (CVP) monitoring and invasive arterial blood pressure (IBP) monitoring, and to provide scientific and accurate data for patients management.Methods:The liquid vessel models were used to simulate the pressure measurement process of the continuous pressure monitoring system. Based on the theory of fluid mechanics and the knowledge of blood pressure physiology and cardiovascular anatomy, the composition and influencing factors of the pressure in the fluid-filled catheter system during the zeroing and placing the transducer in the zero line of CVP and IBP, were analyzed.Results:The pressure in the liquid-filled catheter system was composed of atmospheric pressure, the pressure of pumping bag, the gravity of the water column (the vertical distance between the liquid level of Murphy's dropper and pressure transducer, ΔH), and the resistance of tube wall. This pressure value is set as a pressure of 0 mmHg (1 mmHg ≈ 0.133 kPa). In the process of pressure measurement, when the pressure transducer was placed at a horizontal position of 10 cm below the highest liquid level of the vessel, the pressure measured at different catheter tip positions was all 10 cmH 2O (1 cmH 2O ≈ 0.098 kPa); When the pressure transducer was placed at the horizontal position of the highest liquid level of the vessel, the measured pressure is 0 mmHg. Conclusion:Zeroing should repeatedly be performed only when one or more conditions (atmospheric pressure, pressure of pumping bag, gravity of ΔH water column and resistance of tube wall) are changed. In the measurement process, the pressure transducer should be placed at the zero line position at any time to eliminate the influence of hydrostatic pressure and to ensure the objective and accurate value.

Invasive arterial blood pressure monitoring improves the prognosis of patients with sepsis / 中华急诊医学杂志

Objective:To evaluate the effect of invasive arterial blood pressure (IBP) monitoring on the prognosis of patients with sepsis.Methods:Patients with sepsis from the MIMIC-Ⅳ database were collected and divided into IBP and non-invasive blood pressure monitoring (NIBP) groups according to whether IBP monitoring was performed. Baseline variables that were considered clinically relevant or showed a univariate relationship with the outcome were entered into a multivariate logistic regression model as covariates.Propensity score matching(PSM) and inverse probability of treatment weighing(IPTW) were used to adjust confounders to ensure the robustness of findings.Subgroup analysis were conducted to evaluate the effect of differences in IBP onset and duration on outcome.Results:The 28-day mortality is lower in IBP group compared with NIBP group( OR=0.54, 95% CI 0.46-0.62, P<0.001), the conclusion maintain robust after PSM and IPTW.Then we conducted a series of logistic regression regarding to different initial IBP time(<24 h,24 h-48 h,>48 h) and the initial IBP time within 24 h showed the same results compared to primary outcoms( OR=0.42, 95% CI: 0.36-0.49, P<0.001). IBP duration varied (≤1day, ≤2days, ≤3days, ≤4days, >4days) all showed a statistically significant association with decreased 28-day mortality in the IBP group. Conclusions:IBP is associated with decreased 28-day mortality in patients with sepsis, and the optimal time of IBP is within 24 hours.

Pressão arterial sistólica em cães anestesiados: concordância entre mensurações por dois métodos não invasivos / Systolic blood pressure in anesthetized dogs: agreement between measurements by two noninvasive monitors

The oscillometric monitor is a noninvasive method used for measuring blood pressure in dogs and cats. Despite widely used, there is a large variability in the accuracy of oscillometric monitors, which may also be influenced by the location of the blood pressure cuff. The Doppler ultrasound is another non-invasive method that was shown to measure blood pressure with good accuracy and precision in small animals. The present study aimed to determine the agreement between systolic arterial pressure (SAP) measured by the Prolife P12 oscillometric monitor with 2 cuff locations and the Doppler ultrasound in anesthetized dogs. Dogs scheduled for routine anesthetic procedures were included in the study, which was carried out in 2 phases. In Phase 1, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor with the cuff placed at the thoracic limb for both methods. In Phase 2, SAP values measured by the Doppler were compared with those measured by the Prolife P12 monitor, with the cuff placed at the thoracic limb for the Doppler and at the base of the tail for the P12. The cuff width corresponded to approximately 40% of limb or tail circumference. On all occasions, 3 consecutive measurements of SAP were recorded, followed by a single measurement of SAP by the P12, and then other 3 measurements were performed with the Doppler. The arithmetic mean of the 6 SAP measurements with the Doppler was compared with the SAP value measured by the P12 monitor (paired measurements). Agreement between SAP values measured by the Doppler and the P12 monitor was analyzed by the Bland Altman method for calculation of the bias (Doppler - P12) and standard deviation (SD) of the bias. The percentages of differences between the methods with an error ≤ 10 mmHg and ≤ 20 mmHg and Pearson's correlation coefficients were also calculated. Results were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of noninvasive blood pressure methods. A total of 33 dogs were included in Phase 1 and 15 were included in Phase 2. During Phases 1 and 2, 179 and 87 paired measurements were recorded, respectively. Most of the measurements were recorded during normotension (SAP = 90-130 mmHg): 113/179 in Phase 1 and 52/87 in Phase 2. The bias (± SD) for Phases 1 and 2 were -2.7 ± 14.1 mmHg and 7.2 ± 25.8 mmHg. The percentages of differences ≤ 10 mmHg and ≤ 20 mmHg were: Phase 1, 61% and 83%; Phase 2, 41% and 70%. Correlation coefficients were 0.81 and 0.67 for Phases 1 and 2, respectively. According to the ACVIM criteria, maximum values accepted for bias are 10 ± 15 mmHg, the percentages of differences ≤ 10 mmHg and ≤ 20 mmHg should be ≥ 50% and ≥ 80%, respectively, and the correlation coefficient should be ≥ 0.9. When the blood pressure cuff was placed at the thoracic limb, SAP values measured by the P12 monitor met most of the ACVIM criteria, demonstrating good agreement with SAP values measured by the Doppler. The only requirement not met was the correlation coefficient which was 0.81 whereas the recommended is ≥ 0.9. Conversely, when the cuff was placed at the base of the tail, SAP values measured by the P12 monitor did not meet most of the ACVIM criteria indicating that, in anesthetized dogs, SAP measurements with the P12 monitor should be performed with the cuff placed at the thoracic limb. One limitation of this study was that most measurements fell in the normotensive range and the results should not be extrapolated for hypotensive and hypertensive conditions. In conclusion, the Prolife P12 oscillometric monitor demonstrated good agreement with SAP values measured by the Doppler and provides acceptable values in normotensive anesthetized dogs.(AU)

Qual o melhor horário da tomada da medicação anti-hipertensiva? / What is the best time to take antihypertensive medication?

A hipertensão arterial é a principal causa de morte precoce no mundo. Existem diversos fatores que contribuem para sua variação dentro da fisiologia do ritmo circadiano, e que exercem forte impacto sobre o controle da pressão arterial (PA). Os valores da PA sofrem interferência de acordo com o horário da medida. Nas primeiras horas da manhã PAS aumenta rapidamente em 20 a 25 mmHg e a PAD em 10 a 15 mmHg. As drogas anti-hipertensivas, sofrem diversas influências na sua absorção, metabolização e excreção dependentes do ritmo circadiano e de suas propriedades físico-químicas. O ciclo circadiano exerce grande impacto no controle da PA, e apenas modificando o horário das prescrições, seguindo o ritmo circadiano, talvez seja possível obter melhor controle pressórico com menor dose da medicação, reduzindo assim, as possíveis reações adversas

Hypertension is the leading cause of early death worldwide. Several factors contribute to its variation within the physiology of circadian rhythm, and these factors have a strong impact on blood pressure (BP) control. BP values are influenced by the measurement time. In the early hours of the morning, SBP increases rapidly by 20 to 25 mmHg and DBP by 10 to 15 mmHg. Antihypertensive drugs suffer from a variety of influences on their absorption, metabolism and excretion, depending on the circadian rhythm and its physical-chemical properties. The circadian cycle has a great impact on BP control, and only by changing the schedule of prescriptions, following the circadian rhythm, it may be possible to obtain better pressure control with a lower dose of medication, thus reducing potential adverse reactions

The accuracy of the Innovo Deluxe Fingertip Pulse Oximeter perfusion index in predicting hypotension during balanced general anesthesia induction – A prospective observational study / The Health Sciences Journal

INTRODUCTION@#Balanced general anesthesia technique is a popular choice for induction because it can minimize potential side effects from individual drugs when otherwise used alone. However, hypotension is still a common occurrence during induction. Perfusion Index (PI) has been used as a measure of systemic vascular resistance and has shown to predict hypotension after regional anesthesia and propofol induction. This study aimed to determine whether baseline PI can predict hypotension following balanced general anesthesia induction and determine a cut-off value where hypotension is expected to occur.@*METHODS@#Thirty-five ASA I/II adults for elective surgery under general anesthesia were enrolled. Heart rate, blood pressure and PI were measured every minute from baseline to 5 minutes following induction and 10 minutes after endotracheal intubation. Hypotension was defined as fall in systolic BP (SBP) by >30% of baseline and/or mean arterial pressure (MAP) to <60 mmHg. Severe hypotension (MAP of <55 mm Hg) was treated. @*RESULTS@#No hypotension was observed in the first 5 minutes. Within 10 minutes, hypotension occurred in 8.6% by SBP criterion and 2.6% by MAP criterion. Within 15 minutes, hypotension was seen in 5.7% by SBP and MAP criterion, respectively. PI showed very low (r < 0.2) to low (r = 0.2 to 0.39), negative to positive and insignificant correlation (p > 0.05) with hypotension whether using SBP or MAP criterion and whether observed at 10 or 15 minutes of anesthesia induction. The Area under the ROC curve is 0.397, 95% CI [0 .126, 0.667], p = 0.431.@*CONCLUSION@#This study lends inconclusive evidence on the usefulness of Innovo Deluxe Fingertip Pulse Oximeter with Plethysmograph and Perfusion Index to predict intraoperative hypotension following balanced general anesthesia induction for this sample of patients. However, there was a positive, moderate (r=0.538, 0.501 and 0.469) and significant (p<0.05) correlation between perfusion index and SBP, Diastolic BP and MAP, respectively.

Electronic APPS in assessing risk and monitoring of patients with arterial hypertension

The medical social significance of the arterial hypertension (AH) in the world is determined by its high prevalence, which allows to call it a non-infectious pandemic of today. The AH still remains the most common chronic disease that triggers the cardiovascular continuum, significantly reduces the body's adaptive capacity, worsens the living standards for people of socially minded age, and represents the leading global risk of increased cardiovascular mortality. The purpose of the study was comparison of informative value of various methods for measuring the arterial blood pressure (ABP) (office-based, home-based using electronic apps, and daily) in order to improve the risk assessment of the condition and monitoring the treatment efficiency for the AH patients. The method of qualitative and quantitative analysis of scientific literature and public online sources was used in the study. It has been established that the ABP analysis is an important tool to prevent the negative consequences of the AH. The results of the experimental study have revealed that hourly home-based ABP monitoring using a mobile electronic app is more informative than monitoring at long intervals, and provides information which is close to the average daily indicators obtained in the daily ABP monitoring.

To Evaluate the Effectiveness of Magnesium Sulphate as an Agent to induce Hypotensive Anaesthesia in Lumbar Spine Surgery. A Prospective Randomized, Placebo-Control Study

Introduction: This randomized placebo controlled study wasdesigned to evaluate the effectiveness of magnesium sulphateas an agent to induce hypotensive anaesthesia in lumbar spinesurgery.Material and Methods: The study included 100 patients ofboth sexes who were equally distributed in two groups, theGroup Mg(Magnesium sulphate group) and Group C (controlgroup). The Magnesium group received magnesium sulphate40mg/kg administered as a slow IV bolus over a period of 10minutes before induction and 15mg/kg/hr by continuous IVinfusion during surgery. The same volume of isotonic salinewas administered to the control group. Surgical time, heartrate and mean arterial blood pressure was measured.Results: In the magnesium group there was reduction insurgical time (103.54 mins vs 117.34 mins), although theanaesthestic time was 9 minutes longer in the Magnesiumgroup denoting a longer emergence time. The mean arterialpressure and heart rate were significantly reduced inMagnesium group(p<0.005). Postoperative shivering was alsoless in Magnesium group.Conclusion: Magnesium infusion resulted in a steady andsmooth reduction in mean blood pressure and reduced heartrate, with no episodes of severe hypotension. Furthermoremagnesium causes reduction in duration of surgical time andpostoperative shivering

Continuous Monitoring of Arterial Blood Pressure and Pulse: Comparison of Morning and Evening Readings

The research is based on long, regular observations of blood pressure and pulse - the heart rate (more than 18 years). The values of these readings are taken from the diary of self-control, which is kept by a patient, one of the authors of this publication, a man born in 1940. Such effective control over the patient's condition, implemented in our case, ensuring its normal vital activity, makes it possible to investigate the influence of external factors on the hemodynamics of the body and the manifestation of the marked temporal characteristics. A difference between the morning and evening series was noted. The characteristics of evening monitoring readings are more balanced. Spectral analysis allows for a more detailed analysis and comparison of the data. Seven-day component is clearly seen in evening series being modulated with three-year period for the pulse. The morning series are characterized by a “lunar” component with the ~27.35-day period. The absence of a weekly period in the morning readings indicates a rapid (moment of sleep) relaxation of the body from the rhythmic stress of the past day. The manifestation of the "lunar" response can be associated with an increased sensitivity of the body during and after the sleep. The analysis of pulsatile blood pressure, i.e. the difference between SBP and DBP, provides for more options for assessing the state of the body.

Comparison of IV bolus phenylephrine, ephedrine and mephentermine for maintenance of hemodynamic status and its effect on fetal outcome during spinal anesthesia in cesarean section

Background: Maternal hypotension during spinal anesthesia for cesarean section is a persistent problem which can result in adverse maternal and fetal outcome. Aim: Aim of this study was to compare the efficacy of IV bolus phenylephrine, ephedrine and mephentermine for the maintenance of hemodynamic status and its effect on fetal outcome during spinal anesthesia in cesarean section. Materials and Methods: We did prospective randomized double blind study in 60 patients. They were undergoing elective cesarean section under spinal anesthesia and who developed hypotension after subarachnoid block. The patients were randomly divided into three groups of 20 each. Phenylephrine Group (Group P) received Inj. Phenylephrine 100 mcg IV, Group E received Inj. Ephedrine 6 mg IV and Group M received Inj. Mephentermine 6 mg IV bolus. Whenever hypotension occurred, patients received the study drug. After administration of drugs and their consistence Sneha Dokania, Renu Gurung, Ambuj Jain. Comparison of IV bolus phenylephrine, ephedrine and mephentermine for maintenance of hemodynamic status and its effect on fetal outcome during spinal anesthesia in cesarean section. IAIM, 2019; 6(9): 28-36. Page 29 maintenance till end of 60 minutes. Patients were compared with respect to age, weight, duration of surgery, Systolic BP, Diastolic BP, Mean Arterial Pressure and Heart Rate. Results: The rise of systolic, diastolic and mean arterial pressure in Group P was significantly high for first 4min of bolus dose as compared to Group E & Group M (P<0.05). APGAR scores were ≥7 in all the three groups. Conclusion: It was concluded that IV bolus Mephentermine is as effective as Phenylephrine and Ephedrine in maintenance of arterial blood pressure during spinal anesthesia in cesarean section with good neonatal outcome.

Familial history of hypertension-induced impairment on heart rate variability was not observed in strength-trained subjects

Family history of hypertension is an important predictive factor for hypertension and is associated with hemodynamic and autonomic abnormalities. Previous studies reported that strength training might reduce arterial blood pressure (AP), as well as improve heart rate variability (HRV). However, the benefits of strength training in the offspring of hypertensive parents have not been fully evaluated. Here, we analyzed the impact of strength training on hemodynamics and autonomic parameters in offspring of hypertensive subjects. We performed a cross-sectional study with sedentary or physically active offspring of normotensives (S-ON and A-ON) or hypertensives (S-OH and A-OH). We recorded RR interval for analysis of HRV. AP was similar between groups. Sedentary offspring of hypertensives presented impairment of total variance of RR interval, as well as an increase in cardiac sympathovagal balance (S-OH: 4.2±0.7 vs S-ON: 2.8±0.4 and A-ON: 2.4±0.1). In contrast, the strength-trained group with a family history of hypertension did not show such dysfunctions. In conclusion, sedentary offspring of hypertensives, despite displaying no changes in AP, showed reduced HRV, reinforcing the hypothesis that autonomic dysfunctions have been associated with higher risk of hypertension onset. Our findings demonstrated that strength-trained offspring of hypertensives did not present impaired HRV, thus reinforcing the benefits of an active lifestyle in the prevention of early dysfunctions associated with the onset of hypertension in predisposed populations.

Pressão arterial alterada em adolescentes: associação com fatores de risco às doenças cardiovasculares de seus pais / Altered arterial blood pressure in adolescents: association with risk factors to their parents´ cardiovascular diseases

Este estudo teve como objetivo verificar se existe associação entre pressão arterial (PA) alterada em adolescentes com fatores de risco às doenças cardiovasculares de seus pais. Estudo transversal com 859 adolescentes, sendo 479 (55,8%) do sexo feminino, entre dez a 17 anos, estudantes de escolas da rede pública e privada, do município de Santa Cruz do Sul-RS. Considerou-se alteração na PA sistólica e diastólica os casos limítrofes e hipertensão. Foram utilizados os valores de razão de prevalência (RP), por meio da regressão de Poisson. Constatou-se elevado percentual de adolescentes com alteração na PA (19,4%), sendo esta superior entre os adolescentes, cujas mães apresentam hipertensão (RP: 1,09) e histórico de infarto (RP: 1,25). Entre os pais, somente colesterol elevado associou-se com a alteração da PA, nos adolescentes (RP: 1,08). Conclui-se que é elevada a prevalência de PA alterada em escolares, estando esta associada com fatores de risco às doenças cardiovasculares dos pais.

Current analysis verified whether there was any association between altered arterial blood pressure (BP) in adolescents and risk factors for their parents´ cardiovascular diseases. Current transversal analysis involved 859 adolescents, 479 (55.8%) females, aged 10 - 17 years, in government-run and private schools in Santa Cruz do Sul RS Brazil. Borderline and hypertension cases were considered alterations in systolic and diastolic AP. Prevalence ratio (PR) rates were employed by Poisson regression. Results showed high percentage of adolescents with changes in BP (19.4%), which was higher among adolescents with hypertensive mothers (PR: 1.09) and stroke history (PR: 1.25). Only high cholesterol among parents was associated with AP alterations in adolescents (PR: 1.08). High AP in school children is associated with risk factors for parents´ cardiovascular diseases.

Acute hypotensive and diuretic activities of Berberis vulgaris root bark aqueous extract in normal rats

The aim of this study is to investigate the effectiveness of intravenous administration of Berberis vulgaris root bark aqueous extract (BRBD) on the cardiovascular and renal functions of healthy normotensive rats. The different doses of BRBD 1, 10 and 20 mg/kg were administered intravenously (i.v) in normal rats. Blood pressure, diuretic activity and serum renal profile were analyzed. Intravenous injection of BRBD at the different doses of 1, 10 and 20 mg/kg showed a dose-dependent reduction in mean arterial blood pressure (P<0.001). At different doses of 1, 10 and 20 mg/kg, the hypotensive effect remained for more than one hour. Single dose administration of BRBD at doses of 10 and 20 mg/kg caused a significant increase in urine output (P<0.001) as compared to the control rats. Serum renal profile test (albumin, Urea, Uric Acid, creatinine and BUN) did not show any significant alteration. The authors conclude that the BRBD is a potent hypotensive and possesses diuretic potential

Feasibility study on monitoring blood pressure of the superficial temporal artery in neonates / 中华护理杂志

Objective To explore the feasibility of monitoring blood pressure via superficial temporal artery catheterization in neonates,which may provide more ways to monitor arterial blood pressure of neonates.Methods By lottery method,64 neonates from NICU who met inclusion criteria and needed arterial blood pressure monitoring were randomly divided into two groups.Thirty-two cases in the experimental group were treated with superficial temporal artery catheterization,while 32 cases in the control group were treated with radial artery catheterization.The success rate of one-time catheterization,indwelling time of catheter,blood pressure and the rate of complications were compared between two groups.Results There were no significant differences between two groups in the success rate of one-time catheterization,indwelling time of catheter,systolic blood pressure and the rate of complications (P＞0.05).Results showed there was significant difference in diastolic blood pressure between two groups(P＜ 0.05).Conclusion Compared with radial artery blood catheterization,neonatal superficial temporal artery catheterization showed equivalent effect,which made it more convenient for observing condition of neonates.

Feasibility study on monitoring blood pressure of the superficial temporal artery in neonates / 中华护理杂志

Objective To explore the feasibility of monitoring blood pressure via superficial temporal artery catheterization in neonates,which may provide more ways to monitor arterial blood pressure of neonates.Methods By lottery method,64 neonates from NICU who met inclusion criteria and needed arterial blood pressure monitoring were randomly divided into two groups.Thirty-two cases in the experimental group were treated with superficial temporal artery catheterization,while 32 cases in the control group were treated with radial artery catheterization.The success rate of one-time catheterization,indwelling time of catheter,blood pressure and the rate of complications were compared between two groups.Results There were no significant differences between two groups in the success rate of one-time catheterization,indwelling time of catheter,systolic blood pressure and the rate of complications (P＞0.05).Results showed there was significant difference in diastolic blood pressure between two groups(P＜ 0.05).Conclusion Compared with radial artery blood catheterization,neonatal superficial temporal artery catheterization showed equivalent effect,which made it more convenient for observing condition of neonates.

Evaluation of mechanism for antihypertensive and vasorelaxant effects of hexanic and hydroalcoholic extracts of celery seed in normotensive and hypertensive rats

ABSTRACT Celery (Apium graveolens L., Apiaceae) is one of the popular aromatic vegetables and part of the daily diet around the world. In this study, aqueous-ethanolic and hexane extracts of celery seed were prepared and the amount of n-butylphthalide, as an active component, was determined in each extract. Then the effects of hexanic extract on systolic, diastolic, mean arterial blood pressure and heart rate were evaluated in an invasive rat model. The vasodilatory effect and possible mechanisms of above mentioned extracts on aorta ring were also measured. High performance liquid chromatography analysis revealed that hexanic extract contains significantly higher amounts of n-butylphthalide, compared to aqueous-ethanolic extract. The results indicated that hexanic extract significantly decreased the systolic, diastolic, mean arterial blood pressure and heart rate in normotensive and hypertensive rats. Our data revealed that celery seed extract exerts its hypotensive effects through its bradycardic and vasodilatory properties. Moreover, the active components in celery seed extracts could induce their vasodilatory properties through Ca2+ channel blocking activity in endothelial and non-endothelial pathways and particularly by interference with the extra or intracellular calcium.

Relação entre circunferência da cintura e pressão arterial em adolescentes / Relationship bet ween waist circumference and arterial pressure in adolescents

O objetivo do presente estudo é verificar se medidas de Circunferência da Cintura (CC) se relacionam com valores de Pressão Arterial (PA) alterada, em adolescentes. A amostra foi composta por 93 indivíduos (47 masculino e 46 feminino), com idade média = 11,17 anos. Foi aferida a PA, assim como a medida de CC, peso e altura, e os alunos responderam um questionário de caracterização da amostra. A prevalência de CC alterada foi de 53,76%, e de hipertensos foi de 7,53%. O coeficiente de correlação de Pearson foi de r = 0,473 para PAS e CC, e r = 0,419 para PAD e CC, ambos com p = 0,021 (p < 0,05). Os achados demonstram uma correlação fraca (0 < r < 0,50), positiva e significativa (p < 0,05) entre PAS, PAD e CC, indicando que adolescentes que apresentaram PAS e PAD com valores acima dos valores de referência também apresentaram medidas de CC elevadas.

Current study verifies whether Waist Circumference (WC) is related to altered Arterial Pressure (AP) in adolescents. Sample comprised 93 subjects (47 males and 46 females), average age 11.17 years. AP, WC, weight and height were measured. The students answered a questionnaire. Altered WC reached 53.76% of the adolescents and hypertension reached 7.53%. The coefficient of Pearson´s co-relation was r = 0.473 for AP and WC, and r = 0.419 for weight and WC, both with p= 0.021 (p<0.05). Results showed a weak (0 < r < 0.50), positive and significant (p<0.05) co-relationship entre AP, weight and WC, and revealed that adolescents with AP and weight above reference rates also had high WC rates.

High Blood Pressure in Adolescents of Curitiba: Prevalence and Associated Factors / Pressão Arterial Alterada em Adolescentes de Curitiba: Prevalência e Fatores Associados

Abstract Background: Arterial hypertension is a major public health problem and has increased considerably in young individuals in past years. Thus, identifying factors associated with this condition is important to guide intervention strategies in this population. Objective: To determine high blood pressure prevalence and its associated factors in adolescents. Methods: A random sample of 1,242 students enrolled in public schools of the city of Curitiba (PR) was selected. Self-administered questionnaires provided family history of hypertension, daily energy expenditure, smoking habit, daily fat intake, and socioeconomic status. Waist circumference was measured following standardized procedures, and blood pressure was measured with appropriate cuffs in 2 consecutive days to confirm high blood pressure. Relative frequency and confidence interval (95%CI) indicated high blood pressure prevalence. Bivariate and multivariate analyses assessed the association of risk factors with high blood pressure. Results: The high blood pressure prevalence was 18.2% (95%CI 15.2-21.6). Individuals whose both parents had hypertension [odds ratio (OR), 2.22; 95%CI 1.28-3.85] and those with high waist circumference (OR, 2.1; 95%CI 1.34-3.28) had higher chances to develop high blood pressure. Conclusion: Positive family history of hypertension and high waist circumference were associated with high blood pressure in adolescents. These factors are important to guide future interventions in this population.

Resumo Fundamento: A hipertensão arterial é um grave problema de saúde pública e, nos últimos anos, tem aumentado consideravelmente em jovens. A identificação de fatores associados com essa condição é importante para guiar estratégias de intervenção nessa população. Objetivo: Determinar a prevalência e os fatores associados com a pressão arterial alterada em adolescentes. Métodos: Foi selecionada amostra probabilística de 1.242 adolescentes da rede pública de ensino de Curitiba (PR). Por meio de questionários, foram obtidos o histórico familiar de hipertensão, o gasto energético diário, informações sobre tabagismo, o consumo diário de gorduras e a classificação econômica. A circunferência da cintura foi medida por procedimentos padronizados. A pressão arterial foi aferida com manguitos adequados em 2 dias consecutivos para a confirmação da pressão arterial alterada. Frequências relativas e intervalos de confiança (IC95%) indicaram a prevalência de pressão arterial alterada. Regressões logística bivariadas e multivariadas testaram a associação dos fatores de risco com a pressão arterial alterada. Resultados: A prevalência de pressão arterial alterada foi de 18,2% (IC95% 15,2-21,6). Mais chances de pressão arterial alterada foram encontradas nos indivíduos que possuíam ambos os pais com hipertensão arterial [odds ratio (OR), 2,22; IC95% 1,28-3,85] e naqueles com a circunferência da cintura aumentada (OR, 2,1; IC95% 1,34-3,28). Conclusão: O histórico familiar positivo de hipertensão arterial e a circunferência da cintura aumentada estiveram associados a pressão arterial alterada em adolescentes. Esses fatores são importantes para guiar intervenções futuras nessa população.

Estilo de vida influencia variáveis antropométricas e pressão arterial em adultos jovens / Lifest yle affects anthropometric variables and arterial blood pressure in young adults

A composição corporal e a pressão arterial (PA) podem sofrer influências de padrões do estilo de vida (EV). Desse modo, o objetivo deste trabalho foi investigar a influência do EV em variáveis antropométricas e PA em adultos jovens frequentadores de parque de lazer. Cento e quatro indivíduos de ambos os sexos (31±8 anos) responderam o Questionário "Estilo de Vida Fantástico" e foram submetidos a mensurações de PA, circunferência da cintura (CC), massa corporal e estatura para cálculo do índice de massa corporal (IMC). A amostra foi dividida por sexo e estratificada em "Baixo EV" (BEV; 0-69 pontos) e "Alto EV" (AEV; 70-100 pontos). Diferenças foram encontradas quando comparados os estratos BEV vs. AEV para massa corporal (Geral: 74±16 vs. 67±13 kg; Masc: 84±17 vs. 74±13 kg; Fem: 66±10 vs. 61±8 kg; p <0 ,05); IMC (Geral: 27±4 vs. 24±3 kg.m2(-1); Masc: 27±4 vs. 25±4 kg.m2(-1); Fem: 26±4 vs. 24±3 kg.m2(-1); p < 0,05); CC (Geral: 84±1 vs. 79±10 cm; Masc: 91±14 vs. 83±11 cm; p < 0,05); e PA diastólica (Geral: 79±8 vs.73±13 mmHg; Masc: 79±8 vs.71±15 mmHg; Fem: 80±8 vs. 73±12 mmHg; p < 0.05). Foi possível concluir que frequentadores de parque de lazer com BEV apresentam variáveis antropométricas e PA diastólica aumentadas em relação aos que apresentam AEV.

Body composition and arterial blood pressure (AP) are affected by lifestyle (LS). Current research investigates the influence of LS on the anthropometric variables and AP in young adults who frequent a recreation park. One hundred and four subjects of both genders, 31±8 years old, answered the questionnaire "Fantastic Lifestyle" and their blood pressure (AP), waist circumference (HC), body mass and height for Body Mass Index (BMI) were taken. The sample was divided by gender and stratified in "Low LS" (LLS; 0-69 scores) and "High LS" (HLS; 70-100 scores). Differences occurred when LLS vs HLS were compared for body mass (General: 74±16 vs. 67±13 kg; Male: 84±17 vs. 74±13 kg; Female: 66±10 vs. 61±8 kg; p <0.05); BMI (General: 27±4 vs. 24±3 kg.m2(-1); Male: 27±4 vs. 25±4 kg.m2(-1); Female: 26±4 vs. 24±3 kg.m2(-1); p < 0.05); CC (General: 84±1 vs. 79±10 cm; Male: 91±14 vs. 83±11 cm; p < 0.05); diastolic AP (General: 79±8 vs.73±13 mmHg; Male: 79±8 vs.71±15 mmHg; Female: 80±8 vs. 73±12 mmHg; p < 0.05). Results show that people from the recreation park with LLS had altered anthropometric variables and diastolic AP when compared with those of HLS.

Intraoperative anesthetic management in breast cancer patients undergoing free flap breast reconstruction / 中国癌症杂志

Background and purpose:Perioperative anesthetic management is thought to be critical to the success of free flap breast reconstruction. The purpose of this study was to discuss intraoperative fluid, hemodynamic and temperature management in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:From Jun. 2011 to Dec. 2015, 126 patients underwent DIEP lfap breast reconstruction. Postoperative complications were reviewed. Intraoperative fluid infusion rate was analyzed. Mean arterial blood pressure (MAP) and core temperature were measured before induction (T0), after lfap elevation but before lfap transfer (T1), 15 min after flap revascularization (T2), and at the end of surgery (T3).Results:Nine patients developed flap compromised: 7 were salvaged and 2 failed. The mean intraoperative lfuid infusion rate was (5.44±1.66) (mL?kg-1)/h. MAP at T0, T1, T2 and T3 were (87.45±8.90), (74.19±8.63), (74.60±8.71) and (79.62±7.88) mmHg, respectively. Core temperature at T0, T1, T2 and T3 were (36.69±0.14), (36.36±0.18), (36.27±0.14) and (36.21±0.15)℃, respectively. Conclusion:Standard practice focusing on intraoperative lfuid management, hemodynamic adjustment and temperature control in microsurgical reconstruction of the breast should be established to further improve free lfap outcome.

Effect of activin A on regulation of arterial blood pressure by hypothalamic paraventricular nucleus and its mechanism / 吉林大学学报(医学版)

Objective:To investigate the expression of activin A in paraventricular nucleus (PVN)of the WKY rats and its influence in arterial blood pressure,and to clarify the mechanism of activin A in the regulation of arterial blood pressure by PVN.Methods:The WKY rats were selected.The expressions of activin A,ActRⅡA,ActRⅡB,and Smads mRNA in PVN of the WKY rats were measured by RT-PCR.The expression of ActRⅡA protein in PVN was detected by immunohistochemical staining.The microinjection of exogenous activin A into PVN was used to observe the changes of arterial blood pressure.The primary cultured PVN neurons from the WKY rats were divided into control group and activin A group.The mRNA expression levels of ActRⅡA,ActRⅡB,and Smads in the PVN neurons were analyzed by RT-PCR.Results:Activin A,ActRⅡA,ActRⅡB,Smad2 and Smad3 mRNA were expressed in PVN of the WKY rats.The ActRⅡ A protein expression in PVN was further confirmed by immunohistochemical staining.After microinjection of activin A or angiotensin Ⅱ (AgⅡ)into PVN,the mean arterial blood pressure was increased obviously compared with before treatment (P <0.05).Moreover,compared with control group,the expression levels of ActRⅡA and Smad3 mRNA in primary cultured PVN neurons of the rats in vitro were significantly increased (P <0.05).Conclusion:Activin A can regulate the arterial blood pressure in PVN in an autocrine or paracrine manner,which is related to ActRⅡA-Smad3 signal pathway.