Comparison between the Parks Medical Doppler and the Mano Médical Vet BP Doppler for recording indirect systemic blood pressure in conscious dogs.

Background: The acquisition of systemic blood pressure (SBP) provides valuable information regarding cardiovascular function and tissue perfusion in human and veterinary species. Aim: To evaluate the agreement between Parks Medical Doppler (PMD) and Mano Médical Vet BP (MMVBP) Doppler for assessing SBP in conscious dogs. Methods: 40 client-owned dogs were prospectively enrolled; SBP measurements were acquired by a single operator using the PMD and then the MMVBP. The mean of five consecutive measurements for each device was classified according to target organ damage (TOD) risk scores (1: <140 mmHg; 2: 140-160 mmHg; 3: 160-180 mmHg; 4: ≥ 180 mmHg). Results: Total mean SBP for the devices was not statistically different (p = 0.77). However, the Bland-Altman analysis revealed wide limits of agreement (LoA), with MMVBP slightly underestimating SBP compared to PMD (bias = -0.6 mmHg, 95% LoA: -26.3 to 25.09). Both devices correlated well ( r = 0.8269; p < 0.0001) and had identically acceptable intra-observer repeatability (coefficients of variation = 4.09% for MMVBP and 3.86% for PMD). Four dogs (10%) had a TOD score of 3 by one device but scored <3 with the other. Conclusion: A good agreement and correlation was observed between the PMD and the MMVBP, suggesting that both devices can be used interchangeably for assessment of SBP in conscious dogs. The wide LoA observed between both devices was most likely associated with intraindividual variability in SBP over time.

Presión de perfusión ocular en sujetos sin enfermedad ocular / Ocular Perfusion Pressure in Subjects Without Ocular Disease

Objetivo: Describir el comportamiento de la presión de perfusión ocular en sujetos sin enfermedad ocular. Métodos: Se realizó un estudio descriptivo transversal con sujetos sin enfermedad ocular de la consulta externa de Oftalmología del Hospital Universitario "General Calixto García", entre enero y diciembre de 2019. Resultados: La mediana de presión intraocular del ojo derecho osciló entre 13,0-16,0 mmHg, y del ojo izquierdo entre 13,0-15,5 mmHg, durante todo el estudio. El valor máximo para ambos ojos se obtuvo a las 6:00 a. m. (madrugada). La mediana de presión arterial sistólica osciló entre 129,0-138,5 mmHg, y de diastólica entre 79,5-81,5 mmHg. El valor mínimo de presión arterial diastólica fue 53 mmHg a las 6:00 a. m. La mediana de presión de perfusión ocular del ojo derecho osciló entre 46,4 mmHg (12:00 a. m.) y 50,8 mmHg; y del ojo izquierdo entre 47,3 mmHg (6:00 a. m.) y 51,9 mmHg. El valor mínimo específico de presión de perfusión ocular fue 35 mmHg para ambos ojos, a las 6:00 a. m. Conclusiones: La hipertensión arterial es el antecedente patológico personal más frecuente en la población estudiada y en ocasiones se producen cifras fuera de la normalidad, tanto elevadas como disminuidas, capaces de afectar la presión de perfusión ocular, sobre todo la diastólica baja. Sin embargo, las presiones de perfusión ocular se mantuvieron normales, probablemente, por mecanismos de autorregulación individuales(AU)

Objective: To describe the behavior of ocular perfusion pressure in subjects without ocular disease. Methods: A cross-sectional descriptive study was performed with subjects without ocular disease from the Ophthalmology outpatient clinic of the University Hospital "General Calixto García", between January and December 2019. Results: The median intraocular pressure of the right eye ranged between 13.0-16.0 mmHg, and of the left eye between 13.0-15.5 mmHg, throughout the study. The maximum value for both eyes was obtained at 6:00 a. m. (early morning). The median systolic blood pressure ranged from 129.0-138.5 mmHg, and diastolic from 79.5-81.5 mmHg. The minimum diastolic blood pressure value was 53 mmHg at 6:00 a.m. The median ocular perfusion pressure of the right eye ranged from 46.4 mmHg (12:00 a.m.) to 50.8 mmHg; and of the left eye from 47.3 mmHg (6:00 a.m.) to 51.9 mmHg. The minimum specific ocular perfusion pressure value was 35 mmHg for both eyes, at 6:00 a.m. Conclusions: Arterial hypertension is the most frequent personal pathologic antecedent in the population studied, and both elevated and decreased out-of-normal figures capable of affecting ocular perfusion pressure, especially low diastolic, occasionally occur. However, ocular perfusion pressures remained normal, probably due to individual autoregulatory mechanisms(AU)

Systemic Blood Pressure Variation During a 12-Hour Exposure to Normobaric Hypoxia (4500 m).

This study was aimed at evaluating a potential association between blood pressure variation and acute mountain sickness (AMS) during acute exposure to normobaric hypoxia. A total of 77 healthy subjects (43 males, 34 females) were exposed to a simulated altitude of 4500 m for 12 hours. Peripheral oxygen saturation, heart rate, systemic blood pressure, and Lake Louise AMS scores were recorded before and during (30 minutes, 3, 6, 9, and 12 hours) hypoxic exposure. Blood pressure dips were observed at 3-hour mark. However, systolic blood pressure fell more pronounced from baseline during the initial 30 minutes in normobaric hypoxia (-17.5 vs. -11.0 mmHg, p = 0.01) in subjects suffering from AMS (AMS+; n = 56) than in those remaining unaffected from AMS (AMS-; n = 21); values did not differ between groups over the subsequent time course. Our data may suggest a transient autonomic dysfunction resulting in a more pronounced blood pressure drop during initial hypoxic exposure in AMS+ compared with AMS- subjects.

Cerebral blood flow regulation and cognitive function: a role of arterial baroreflex function.

A strict adequate perfusion pressure via arterial baroreflex for the delivery of oxygen to the tissues of the body is well established; however, the importance of baroreflex for cerebral blood flow (CBF) is unclear. On the other hand, there is convincing evidence for arterial baroreflex function playing an important role in maintaining brain homeostasis, e.g., cerebral metabolism, cerebral hemodynamics, and cognitive function. For example, mild cognitive impairment attenuates the sensitivity of baroreflex, and Alzheimer's disease further decreases it. These clinical findings suggest that CBF and cerebral function are affected by systemic blood pressure regulation via the arterial baroreflex. However, dysfunction of arterial baroreflex is likely to affect CBF regulation as well as the underlying neuronal function, but identifying how this is achieved is arduous since neurological diseases affect systemic as well as cerebral circulation independently. Recent insights into the influence of blood pressure regulation via the arterial baroreflex on cerebral function and blood flow regulation may help elucidate this important question. This review summarizes some update findings regarding direct (autonomic regulation) and indirect (systemic blood pressure regulation) contributions of the arterial baroreflex to the maintenance of cerebral vasculature regulation.

Insulin receptors in the kidneys in health and disease.

Insulin is an important hormone that affects various metabolic processes, including kidney function. Impairment in insulin's action leads to insulin resistance in the target tissue. Besides defects in post-receptor insulin signaling, impairment at the receptor level could significantly affect insulin sensitivity of the target tissue. The kidney is a known target of insulin; however, whether the kidney develops "insulin resistance" is debatable. Regulation of the insulin receptor (IR) expression and its function is very well studied in major metabolic tissues like liver, skeletal muscles, and adipose tissue. The physiological relevance of IRs in the kidney has recently begun to be clarified. The credit goes to studies that showed a wide distribution of IR throughout the nephron segments and their reduced expression in the insulin resistance state. Moreover, altered renal and systemic metabolism observed in mice with targeted deletion of the IR from various epithelial cells of the kidney has strengthened this proposition. In this review, we recapitulate the crucial findings from literature that have expanded our knowledge regarding the significance of the renal IR in normal- and insulin-resistance states.

Differences in the response to periarterial nerve stimulation or exogenous noradrenaline infusion in the mesenteric vascular bed with the intestinal tract harvested from commonly used rat models of hypertension.

Many hypertensive animal models have been developed and used to elucidate the pathophysiology of hypertension and to develop antihypertensive drugs. Among them, the spontaneous hypertensive rat (SHR), deoxycorticosterone acetate (DOCA)-treated and high salt intake rat (DOCA-salt), and high sodium-fed Dahl salt-sensitive rat (HS) models are commonly used. Multiple studies have been conducted, however, elevation in blood pressure in these models due to the reactivity of adrenergic vasoconstriction has not been well characterized in a centralized experiment. In this study, the pressor responses to periarterial nerve stimulation (PNS) or exogenous noradrenaline (NA) infusion were measured in the isolated mesenteric vascular bed with the intestinal tract to investigate the reactivity of mesenteric adrenergic vasoconstriction. The systemic arterial blood pressure of the hypertensive rat models was uniformly elevated compared with their respective controls. However, the changes in perfusion pressure in the mesenteric vascular bed in response to PNS and exogenous NA infusion were quite different depending on the model. The pressor responses to PNS in SHRs and Dahl S HS rats were significantly higher, and those in DOCA-salt rats were significantly lower than those in the controls. The pressor responses to exogenous NA infusion in SHRs were significantly higher, and those in Dahl S HS rats were significantly lower than those in their respective controls. No difference was observed in the pressor responses to the exogenous NA between the DOCA-salt and sham groups. These results demonstrate that the reactivity of adrenergic vasoconstriction is different for each type of experimental hypertensive model rat.

Justification of Increasing the Blood Flow Velocity in the Arteries of the Thyroid Gland in Autoimmune Thyroiditis as a Reflection of Endothelial Changes Due to Inflammatory Status.

OBJECTIVE: The aim of the research was to determine the dependence of the blood flow velocity in the thyroid arteries in patients with Autoimmune Thyroiditis (AIT) on the presence of atherosclerotic carotid disease and the level of systemic blood pressure. METHODS: The research involved 20 patients with AIT in euthyroid state, 30 patients AIT in euthyroid state with stable Coronary Heart Disease (CHD), 30 patients with stable CHD and 30 healthy individuals. Participants of the research were examined using ultrasound of carotid arteries and inferior thyroid arteries. Parameters of blood flow velocity were compared with the level of systemic blood pressure. RESULTS: In AIT peak systolic velocity and resistance index in the inferior thyroid arteries were significantly higher than in healthy individuals and patients with CHD (p<0.05). In patients with CHD velocity parameters in carotid arteries were high, unlike in the healthy individuals and patients with AIT (p<0.05). In patients with AIT without CHD the atherosclerotic changes of carotid arteries were not found. Increased systemic blood pressure was noticed in all patients with CHD without significant differences between groups. CONCLUSION: The value of peak systolic velocity and resistance index of inferior thyroid arteries in autoimmune thyroiditis are noticed even with euthyroidism and do not depend on systemic blood pressure and atherosclerosis of carotid arteries. Increasing the thyroid arterial blood flow velocity parameters should be considered as sign of an active inflammatory period AIT, where advanced fibrosis is not present.

Systemic blood pressure trends and antihypertensive utilization following continuous-flow left ventricular assist device implantation: an analysis of the interagency registry for mechanically assisted circulatory support.

BACKGROUND: Elevated systemic blood pressure (SBP) has been linked to complications in Continuous-flow left ventricular assist devices (CF-LVADs), including stroke and pump thrombosis. We queried Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to describe the response of SBP to CF-LVAD implantation and to delineate contemporary trends in antihypertensive (AH) utilization for patients with these pumps. METHODS: We identified all CF-LVAD implantations in patients older than 18 years from 2006-2014, excluding those whose durations were less than 30 days. Pre-implant patient demographics and characteristics were obtained for each record. SBPs [i.e., mean arterial pressures (MAPs)], AH-use data, and vital status were tabulated, extending up to 5 years following implantation. RESULTS: A total of 10,329 CF-LVAD implantations were included for study. Post-implant, SBPs increased rapidly during the first 3 months but plateaued thereafter; AH utilization mirrored this trend. By 6 months, mean MAPs climbed 12.2% from 77.6 mmHg (95% CI: 77.4-77.8) pre-implantation to 87.1 mmHg (95% CI: 86.7-87.4) and patients required a mean of 1.8 AH medications (95% CI: 1.75-1.78) -a 125% increase from AH use at 1-week post-implantation (0.8 AHs/patient, 95% CI: 0.81-0.83) but a 5.3% decrease from pre-implant utilization (1.9 AHs/patient, 95% CI: 1.90-1.92). Once medication changes stabilized, the most common AH regimens were lone beta blockade (15%, n=720) and a beta blocker plus an ACE inhibitor (14%, n=672). CONCLUSIONS: SBP rises rapidly after CF-LVAD implantation, stabilizing after 3 months, and is matched by concomitant changes in AH utilization; this AH use has increased over consecutive implant years.

Impaired Baroreflex Sensitivity after Bilateral Convulsive Seizures in Patients with Focal Epilepsy.

BACKGROUND: Sudden unexpected death in epilepsy (SUDEP) is probably due to an autonomic failure in the early postictal phase after bilateral convulsive seizures (BCS) in the majority of cases. The baroreflex sensitivity (BRS) is an established and reliable biomarker of autonomic function and sudden cardiac death. OBJECTIVE: To investigate whether postictal BRS depends on seizure type. METHODS: Beat-to-beat systemic blood pressure and heart rate were continuously and non-invasively recorded with the ccNexfin® device in patients with focal epilepsy undergoing video-EEG monitoring. BRS was calculated using the sequence as well as the spectral method. A random mixed linear model was applied to analyze the influence of seizure type on BRS during three different time periods of 15-min length each (interictal, preictal, and postictal). In addition, the possible effects of other factors (hypertension, hemispheric lateralization of ictal activity, epilepsy type, body position, vigilance state) were explored. Data are given as median with interquartile range. RESULTS: A total of 26 seizures of 26 patients were analyzed. In BCS (n = 7), BRS significantly dropped from a preictal value of 15.0 ms/mm Hg (13.0-19.4) and an interictal value of 15.6 ms/mm Hg (12.0-20.4) to 3.1 ms/mm Hg (2.7-10.5) during the postictal period (p < 0.0001) according to the sequence method. This finding was replicated with the spectral method. In contrast, focal seizures (n = 19) did not lead to significant alterations of BRS in the postictal phase. CONCLUSION: Postictal BRS depends on the seizure type and is markedly impaired after BCS. The present study provides further evidence for a disturbed autonomic function following BCS. These findings might be related to cardiovascular failure in the context of SUDEP.

Seizure-related modulation of systemic arterial blood pressure in focal epilepsy.

OBJECTIVE: Cardiorespiratory function alterations are commonly observed with epileptic seizures and may lead to syncope and sudden unexpected death in epilepsy (SUDEP). Although most previous research has focused on controlling heart rate (HR) and respiration, little is known about seizure-related regulation of systemic blood pressure (BP). Herein, we have investigated whether the periictal modulation of systemic BP and HR depends on seizure characteristics. METHODS: Systemic arterial BP, HR, and peripheral capillary oxygen saturation (SPO2 ) were continuously and noninvasively monitored using the ccNexfin device in those epilepsy patients undergoing video-electroencephalography (EEG) telemetry. Data are given as mean ± standard deviation (SD). RESULTS: Forty-five seizures in 37 patients were included. In focal seizures (FS, n = 35), the mean arterial BP (MAP) increased by 33 ± 35% and the HR by 53 ± 44%, whereas the SPO2 remained unaltered. The MAP and HR increases were significantly greater in FS with alterations in consciousness than in those without. For those FS that evolved to bilateral convulsive seizures (BCS, n = 10), all of the ictal recordings were compromised by artifacts. However, 2 min after seizure cessation, the MAP was enhanced by only 16 ± 14% and returned to a baseline slightly below preictal levels after 5 min, whereas the HR was increased by 77 ± 33% and remained elevated throughout the postictal phase. SIGNIFICANCE: Periictal regulation of systemic BP and HR displays distinct patterns depending on the type of seizure with focal onset. These changes were unrelated to alterations in SPO2 . The potential clinical implications of these findings are discussed in the article.

Neurogenic orthostatic hypotension - management update and role of droxidopa.

Orthostatic hypotension (OH) is defined as a significant decrease in blood pressure (BP) during the first 3 minutes of standing or a head up on a tilt table. Symptoms of OH are highly variable, ranging from mild light-headedness to recurrent syncope. OH occurs due to dysfunction of one or more components of various complex mechanisms that interplay closely to maintain BP in a normal range during various physiological and associated disease states. Various biochemical and electrophysiological studies are often undertaken to assess the severity and etiology of OH. In addition to the lifestyle modifications, various medications that stimulate the adrenergic receptors or increase central blood volume are used in patients with OH. Droxidopa is a newer agent that increases the levels of norepinephrine in postganglionic sympathetic neurons. Management strategies for OH are presented, including the mechanism of action of droxidopa and various studies performed to assess its efficacy.

Effects of maxillomandibular advancement on systemic blood pressure in patients with obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is associated with resistant hypertension. We investigated to what extent maxillomandibular advancement affected a patient's blood pressure postoperatively. We retrospectively analysed consecutive patients who had Bimaxillary advancement for OSA at our hospital following referral from the local sleep clinic. We collected relevant data on clinical characteristics and explored the changes in systolic and diastolic blood pressures, as well as mean arterial pressure (MAP) preoperatively, with those taken 6 months following surgery. We identified 51 patients with a mean (SD) age of 44 (8) years and a mean (SD) body mass index of 29 (3.4). Preoperative and postoperative data on blood pressure were available for analysis in 45. The mean (SD) systolic blood pressure was significantly reduced in our sample following surgery (from 131(12.6) to 127 (12.5)mmHg, p<0.001). The mean (SD) reduction in postoperative MAP values in the overall group, approached statistical significance (recorded MAP 96.6(10) to 93.1(8)mmHg, p=0.06). In a subgroup of 10 patients who had established hypertension the reduction in values postoperatively (mean reduction: systolic blood pressure 6 mmHg, diastolic blood pressure 10 mmHg, mean arterial pressure 9 mmHg) was greater than that observed in the overall group. Our results have shown an improvement in systemic blood pressure after maxillomandibular advancement for OSA, particularly in those with established hypertension. The data suggest that in addition to being a highly effective treatment for OSA, this surgery may more effectively lower systemic blood pressure than other treatment modalities.

Vinte anos de hipertensão arterial refratária sem diagnóstico: relato de caso / Twenty years of refractory hypertension without diagnosis: case report

JUSTIFICATIVA E OBJETIVOS: A grande maioria dos pacientes portadores de hipertensão arterial sistêmica (HAS) apresenta a forma primária. O diagnóstico de hipertensão arterial (HA) secundário sempre deve ser considerado, correspondendo à prevalência de até 5% dos pacientes hipertensos.O objetivo deste estudo foi ressaltar a importância do reconhecimento clínico precoce da HA secundária, através de anamnese, observação clínica e exame físico minudentes, no exame médico habitual.RELATO DO CASO: Paciente do sexo feminino, 49 anos, portadora de HA refratária a todos os tratamentos farmacológicos instituídos, com diagnóstico tardio de HA secundária. Como sintomas, apresentava cefaleia e precordialgia associada aos esforços. Foi tratada por quase toda vida como HA primária.CONCLUSÃO: Diagnosticar uma causa específica de HA secundária, embora pouco frequente, apenas com um exame físico e anamnese adequados, pode ser necessário para realizar um tratamento definitivo, resolvendo a hipertensão de difícil controle.Ressalta-se também a importância de uma propedêutica qualificada no pré-operatório para evitar complicações cirúrgicas, pós-cirúrgicas e causas secundárias que necessitem correções.

BACKGROUND AND OBJECTIVES: Although the vast majority of patients with secondary systemic blood pressure (SBP) have the primary form, the diagnosis of secondary hypertension should always be evaluated, corresponding to 5% of hypertensive patients. The aim of this study is to highlight the importance of early clinical recognition of secondary hypertension by accurate history, physical examination and clinical observations in theu sual medical examination.CASE REPORT: Female, 49 year-old patient, with hypertension refractory to all drug treatments, with late diagnosis of secondary hypertension. The symptoms were headache and exercise-related chest pain. She has been treated for primary hypertension almost all her life long.CONCLUSION: Making the diagnosis of a specific cause of secondary hypertension, only with physical examination and history, although uncommon, may be necessary in order to givea definitive treatment, solving difficult-to-control hypertension.We also emphasize the importance of a qualified preoperative workup to prevent surgical, post-surgical complications and secondary causes that require corrections.

Perfil epidemiológico da hipertensão arterial sistêmica em pacientes atendidos em uma instituição de ensino superior / Epidemiological profile of arterial hypertension in patients treated in higher education institution

JUSTIFICATIVA E OBJETIVOS: A hipertensão arterial sistólica (HAS) é um dos mais importantes fatores de risco para doenças cardiovasculares (DCV), porém os índices de controle da doença ainda são baixos provavelmente pela baixa adesão ao tratamento. O objetivo deste estudo foi analisar o perfil epidemiológico da HAS em pacientes atendidos em uma Instituição de Ensino Superior (IES). MÉTODO: Trata-se de estudo descritivo, retrospectivo, através da análise de prontuários de pacientes atendidos no período de janeiro de 2007 a agosto de 2008 no Ambulatório de Cardiologia da UniEVANGÉLICA do Centro Universitário de Anápolis. Foi utilizada média e desvio-padrão para planificação dos dados e posteriormente foram tratados estatisticamente utilizando a ANOVA e pós-teste de Tukey para as variáveis paramétricas. RESULTADOS: Foram analisados 137 prontuários de pacientes com média de idade de 59,23 ± 11,08 anos, sendo 67% do sexo feminino. Os principais fatores de risco para DCV foram sedentarismo 57%, idade acima de 60 anos 52%, sobrepeso 69% e história de DCV na família 36%. Observou-se que apenas 1% dos pacientes em estágio 3 de HAS em relação aos pacientes normotensos, estágios1 e 2 de HAS. Verificou-se também aumento da idade conforme o aumento da sua gravidade (p = 0,026).CONCLUSÃO: A HAS revelou-se um importante problema de saúde pública na população estudada. Os níveis de controle e tratamento foram considerados insatisfatórios, principalmente em pacientes mais graves. Faz-se necessário um controle dos fatores de risco principalmente sedentarismo e obesidade para evitar surgimento de DCV associadas à HAS e uma verificação da estratégia utilizada para obter adesão dos pacientes ao tratamento.

BACKGROUND AND OBJECTIVES: Systemic blood pressure (SBP) is one of the most important risk factors for cardiovascular disease (CVD), but the disease control rates are still low probably due to poor adherence to treatment. The aim of this study was to analyze the epidemiology of SBP in patients treated at a Higher Education Institution (HEI). METHOD: This is a descriptive, retrospective study, by examining records of patients treated between January 2007 and August 2008 at the Clinic of Cardiology UniEVANGÉLICA - University Center of Anápolis. We used mean and standard deviation of the data for planning and then were treated statistically using ANOVA and Tukey post-test for parametric variables. RESULTS: We analyzed medical records of 137 patients with mean age 59.23 ± 11.08 years, 67% were female. The main risk factors for CVD 57% were sedentary, age above 60 years 52%, 69% overweight and a history of CVD in the family 36%. It was observed that only 1% of patients with stage 3 SBP compared to normotensive patients, stage 1 and 2 of SBP. It was also increased with increasing age of the severity of the SBP (p = 0.026).CONCLUSION: SBP proved to be an important public health problem in this population. The levels of control and treatment were considered unsatisfactory, especially in more severe patients. It is necessary to control risk factors mainly sedentary lifestyle and obesity to prevent emergence of CVD associated with SBP and a review of the strategy used to obtain patients adherence to treatment.

Systemic blood pressure,intraocular pressure and primary open-glaucoma: A populationbased study in Shaanxi Province of China / 国际眼科杂志(Guoji Yanke Zazhi)

AIM :To investigate the association of primary open-glaucoma (POAG), intraocular pressure (IOP) and systemic blood pressure in a rural population aged 50 years old or above in Shaanxi Province, China.METHODS: In the population-based, cross-sectional study, 1 775 (83.53%) residents, aged 50 years old or above, from 3 counties of Shaanxi Province, China, undertook an interview with a standard questionnaire and a detailed eye examination, including logarithm of the minimum angle of resolution visual acuity, slit-lamp biomicroscopy, applanation tonometry and dilated fundus examination. Two blood pressure reading in the sitting position were taken. Gonioscopy was performed if a narrower peripheral anterior chamber (less than one fourth of the corneal thickness) was indicated. Automated visual field testing was performed by participants assessed to have suspicion of glaucomatous disc damage or if IOP was 22mmHg or higher.RESULTS: IOP significantly correlated with systemic blood pressure, and both IOP and systolic blood pressure increased significantly with increasing age. No association between POAG and hypertension was found. The frequency of POAG increased significantly with lower diastolic perfusion pressure.CONCLUSION: Data in our study are accordance with those reported in other population-based studies, and confirm that lower diastolic perfusion pressure is a significant risk factor for primary open angle glaucoma.

Should ice-bag be applied to the head of a hypertensive patient with cerebral hemorrhage?

1. The blood pressure reaction to cold stimulus applied to the head was studied in 15 cases hypertension2. In practically all these cases, this cold application caused quite sudden though transitory elevation of the systemic blood pressure, both the systolic and the diastolic3. This cold application also caused no symptoms in 1 case, slight headache in 7 cases, moderate headache in 4 cases, and severe headache in 3 cases. The higher the rise in the blood pressure, the more severe is the headache4. Viewed in the light of these results, the application of ice-bag to the head of a hypertensive patient with cerebral hemorrhage was critically appraised. In this appraisal, it was concluded that this therapeutic measure is unnecessary, unphysiological, and perhaps dangerous.(Summary and Conclusion)

Influence of Obstructive Sleep Apnea on Systemic Blood Pressure, Cardiac Rhythm and the Changes of Urinary Catecholamines Concentration / 결핵

BACKGROUND: The existing data indicate that obstructive sleep apnea syndrome contributes to the development of cardiovascular dysfunction such as systemic hypertension and cardiac arrhythmias, and the cardiovascular dysfunction has a major effect on high long-term mortality rate in obstructive sleep apnea syndrome patients. To a large extent the various studies have helped to clarify the pathophysiology of obstructive sleep apnea, but many basic questions still remain unanswered. METHOD: In this study, the influence of obstructive sleep apnea on systemic blood pressure, cardiac rhythm and urinary catecholamines concentration was evaluated. Over-night polysomnography, 24-hour ambulatory blood pressure and EGG monitoring, and measurement of urinary catecholamines, norepinephrine (UNE) and epinephrine (UEP), during waking and sleep were undertaken in obstructive sleep apnea syndrome patients group (OSAS, n=29) and control group (Gontrol, n=25). RESULTS: 1) In OSAS and Control, UNE and UEP concentrations during sleep were significantly lower than during waking (P20 (n=14), there was a significant difference of heart rates before, during and after apneic events (P<0.01), and these changes of heart rates were correlated with the duration of apnea (P<0.01). The difference of heart rates between apneic and postapneic period (deltaHR) was significantly correlated with the difference of arterial oxygen saturation between before and after apneic event (deltaSaO2) (r=0.223, P<0.001). 5) There was no significant difference in the incidence of cardiac arrhythmias between OSAS and Control. In Control, the incidence of ventricular ectopy during sleep was significantly lower than during waking. But in OSAS, there was no difference between during waking and sleep. CONCLUSION: These results suggested that recurrent hypoxia and arousals from sleep in patients with obstructive sleep apnea syndrome may increase sympathetic nervous system activity, and recurrent hypoxia and increased sympathetic nervous system activity could contribute to the development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac function.