Systolic Blood Pressure

Because blood pressure increases with age during child- hood and adolescence in a curvilinear, rather than in a linear, manner, we divided the childhood systolic blood pressure data for the 493 subjects in the validation sam- ple into 3 age intervals (5–7 years, 8 –13 years, and 14 –18 years of age). These 3 age intervals were chosen to reflect age-blood pressure interactions during the pre- pubertal, pubertal, and postpubertal years. We used lo- gistic regression analysis to relate the first appearance of hypertension or the metabolic syndrome, with or with- out hypertension, at ⱖ 30 years of age to 3 childhood predictors, that is, BMI; EBP, defined as a single mean elevated systolic blood pressure that exceeded age- and gender-specific criteria established in part 1 at any ex- amination within 1 of the 3 age intervals; and recurring EBP, expressed as the proportion of examinations within an age interval in childhood at which systolic blood pressure exceeded criterion values established in part 1. Logistic models were used for the 2 dependent variables, that is, adulthood hypertension and the metabolic syn- drome, with or without hypertension. We analyzed the effects of childhood EBP on hypertension and the met- abolic syndrome, with or without hypertension, inde- pendent of contemporaneous BMI and independent of the age at which hypertension was first diagnosed. The effects of recurrent EBP in childhood on hypertension and the metabolic syndrome, with or without hyperten- sion, in adulthood were also examined independent of contemporaneous BMI values and the age at which hy- pertension was first diagnosed. Analyses were per- formed with SAS software (version 9.0.1; SAS Institute, Cary, NC).

Patients and Methods: A total of 879 HCC patients were included and 151 (17.2%) were diagnosed with DM. Multivariable logistic regression analysis was used to determine the relationship and the results were expressed as adjusted odds ratios (AORs) and their 95% con fi dence intervals (CIs). Considering the effect of potential confounders, sub-group ana- lysis was performed. We would further study the association of systolic blood pressure (SBP) with fasting glucose, and the association between DM duration/treatment and SBP level. Results: Compared with non-diabetic patients, the diabetic patients had increased levels of SBP (133.7±18.5 mmHg vs 128.3±15.2 mmHg, P=0.001) and fasting blood glucose (9.13 ±3.04 mmol/L vs 5.18±1.08 mmol/L, P<0.001), an elder age (58.5±10.2 years vs 55.3±11.2 years, P=0.001), a higher percentage of cirrhosis diagnosis (60.9% vs 48.2%, P=0.004), lower percentages of drinking (18.5% vs 30.8%, P=0.002) and smoking (30.5% vs 43.7%, P=0.003), and decreased levels of GGT (median/interquartile-range 88/53-177 U/L vs 117/ 58-248 U/L, P=0.037), platelet count (121.4±76.6 ×10 9 /L vs 151.2±82.8 ×10 9 /L, P<0.001) and hemoglobin (124.3±25.5 g/L vs 133.6±24.2 g/L, P<0.001). Multivariable analysis showed that, statistically signi fi cant differences were found for SBP ≥ 140 mmHg (AOR=2.101; 95% CI, 1.424 – 3.100; P<0.001), smoking (AOR=0.637; 95% CI, 0.415 – 0.979; P=0.040), hemoglobin (AOR=0.990; 95% CI, 0.983 – 0.998; P=0.010) and platelet count (AOR=0.996; 95% CI, 0.994 – 0.999; P=0.009). For the relationship between SBP and DM, the positive result was supported by most (10/14) of the subgroup analyses.

Tonometry of the radial artery provides an accurate, reproducible, noninvasive assessment of the central PP waveform. Radial artery applanation tonometry (AT) is performed by placing a hand-held tonometer (strain gauge pressure sensor) over the radial artery and apply- ing mild pressure to partially flatten the artery. The ra- dial artery pressure is then transmitted from the vessel to the sensor (strain gauge) and is recorded digitally. A mathematical formula using a fast Fourier transform- ation algorithm, approved by the Food and Drug Admin- istration of the USA, permits derivation and calculation of central systolic blood pressure indices from a periph- eral brachial blood pressure with concomitant recording of a PP wave with radial AT. This provides information on the functional condition of arteries by the Augmenta- tion Index, which calculates the ratio of the reflected wave and the ejection wave [51]. The premise states that the speed at which these waves travel increases as the ri- gidity of the arterial wall increases. Thus, endothelial disorders with reduced function can be detected early by the AT system [55-58].

Antihypertensive drugs reduce cardiovascular events and all-cause mortality in older people, as demon- strated by randomized clinical trials (RCTs) comparing treatment with placebo [5–7]. Because in most of these RCTs the mean achieved systolic blood pressure (SBP) in the intervention group was between 140 and 150 mmHg [5, 6], current guidelines recommend attaining SBP levels <150 mmHg during antihypertensive drug treatment among older people [8, 9]. Studies on lower SBP levels yielded conflicting results regarding cardiovascular protec- tion [10–13]. Furthermore, older people have a higher risk of adverse events, particularly concerning kidney failure and symptomatic hypotension, which may further lead into falls and fractures [14]. Therefore, based on experts’ opinion, current hypertension guidelines state that indi- vidual tolerability should be considered when recom- mending SBP < 140 mmHg [8, 9], and it remains unclear into which level the SBP should be lowered in order to provide the best cardiovascular protection without a sig- nificant increase in serious adverse events in older people. A comprehensive literature review might help clarify current evidence on the subject.

Introduction: Systolic blood pressure is a widely used tool to assess circulatory function in acutely ill patients. The systolic blood pressure limit where a given patient should be considered hypotensive is the subject of debate and recent studies have advocated higher systolic blood pressure thresholds than the traditional 90 mmHg. The aim of this study was to identify the best performing systolic blood pressure thresholds with regards to predicting 7-day mortality and to evaluate the applicability of these in the emergency department as well as in the prehospital setting. Methods: A retrospective, hospital-based cohort study was performed at Odense University Hospital that included all adult patients in the emergency department between 1995 and 2011, all patients transported to the emergency department in ambulances in the period 2012 to 2013, and all patients serviced by the physician-staffed mobile emergency care unit (MECU) in Odense between 2007 and 2013. We used the first recorded systolic blood pressure and the main outcome was 7-day mortality. Best performing thresholds were identified with methods based on receiver operating characteristics (ROC) and multivariate regression. The performance of systolic blood pressure thresholds was evaluated with standard summary statistics for diagnostic tests.

Systolic blood pressure at the first visit between all 4 groups was compared using a Kruskal – Wallis test with a Bonferroni adjusted post-hoc comparison. The rates of change in SBP over time and associations between SBP and biochemical (sodium, chloride, phosphate, total calcium, potassium, creatinine, packed cell volume (PCV), albumin, cholesterol) and clinical (weight, heart rate) variables over time were compared between all groups using a linear mixed effects model with subjects as random effects, and time, group and sex as fixed effects. In the CKD- DH-group and Healthy-DH-group, the actual SBP measurement that resulted in the diagnosis of hypertension was not included in the analysis. In the CKD-NT-group and Healthy-NT-group all available visits were included. Not all cats had all information available at all visits as, in general, blood samples were taken every other visit, but having a SBP measurement was a require- ment for the visit to be included in the models. Change in SBP over time is expressed as Δ mmHg/100 days. A time-dependent Cox proportional hazards model and Kaplan – Meier curves were used to assess the association of the biochemical and clinical vari- ables with the risk of becoming hypertensive. The assumption of proportional hazards was checked for all variables included in the model and cases were censored if they died, were lost to fol- low-up (defined as not seen for > 6 months and not contactable by telephone), or if the study end point was reached. To investi- gate the independent association of the significant variables with SBP (linear mixed model) and the risk of becoming hypertensive (time dependent Cox proportional hazards model), all significant variables at the P < .10 level were included in a multivariable analysis.

In the NHANES cohort, CRP was measured using a high-sensitivity assay with latex-enhanced nephelometry [21]. Three consecutive BP measurements were obtained by certified examiners using a sphygmomanometer after participants had rested quietly while sitting for 5 min [22]. For the analysis, we only included subjects with valid BP readings for all three attempts. In the outpatient population, CRP was measured using the high-sensitivity CRP assay, performed in the clinical laboratories at Part- ners Healthcare using standardized methods [23]. BP is a required measurement at all outpatient visits at Part- ners Healthcare, obtained by trained healthcare pro- viders, and entered as structured data into the EMR. BP values are recorded as systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Methods: In this study, we present a cuff-based technique for automatic measurement of systolic blood pressure, based on photoplethysmographic signals measured simultaneously in fingers of both hands. After inflating the pressure cuff to a level above systolic blood pressure in a relatively slow rate, it is slowly deflated. The cuff pressure for which the photoplethysmographic signal reappeared during the deflation of the pressure-cuff was taken as the systolic blood pressure. The algorithm for the detection of the photoplethysmographic signal involves: (1) determination of the time-segments in which the photoplethysmographic signal distal to the cuff is expected to appear, utilizing the photoplethysmographic signal in the free hand, and (2) discrimination between random fluctuations and photoplethysmographic pattern. The detected pulses in the time-segments were identified as photoplethysmographic pulses if they met two criteria, based on the pulse waveform and on the correlation between the signal in each segment and the signal in the two neighboring segments.

Background: In the recent years, various stud- ies on clinical evaluation of systolic blood pre- ssure recovery (SBPR) as a prognostic tool for diagnosing cardiovascular abnormalities in pa- tients undergoing exercise test has become a subject of an interest. The Purpose of this study is to evaluate the independent relationships of systolic blood pressure recovery (SBPR) with Cardiovascular Variables in healthy Urban adults. Methodology: Normotensive subjects (157 nos.) of both the genders were performed cycle er- gometer exercise at progressive incremental workloads until subjects reached 80% of their age-predicted maximum HR. Blood pressure (BP) was measured before exercise, during ex- ercise, immediately after exercise and subse- quently at 2-minute intervals until recovery to baseline. The ratio of third-minute SBP relative to first-minute post exercise SBP was used as the SBPR variable. Results: Our results indi- cated independent correlations (p < 0.05) be- tween SBPR and age, resting HR, physical ac- tivity and cigarette smoking (r = 0.473; 0.192; –0.262; 0.102 respectively in males and r = 0.113; 0.315; –0.637; 0.104 respectively in females). BMI associated positively (r = 0.106; p < 0.01) with SBPR in males but not in females (r = 0.092), while WC was predictive of SBPR in females (r = 0.212; p < 0.01) but not in males (r = 0.005). Age in men and physical activity in females were the strongest predictors of SBPR. Conclusion: The present findings in which SBPR is associated with risk factors of cardiovascular abnormalities strengthen the previously reported significance of SBPR after exercise test as a prognostic tool for the evaluation of cardiovascular abnormali- ties. Additionally, it may help clinicians to define and interpret the mechanisms behind changes

Abstract: The commonly used techniques for systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurement are the auscultatory Korotkoff-based sphygmoma- nometry and oscillometry. The former technique is relatively accurate but is limited to a physician’s office because its automatic variant is subject to noise artifacts. Consequently, the Korotkoff-based measurement overestimates the blood pressure in some patients due to white coat effect, and because it is a single measurement, it cannot properly represent the variable blood pressure. Automatic oscillometry can be used at home by the patient and is preferred even in clinics. However, the technique’s accuracy is low and errors of 10–15 mmHg are common. Recently, we have developed an automatic technique for SBP mea- surement, based on an arm pressure cuff and a finger photoplethysmographic probe. The technique was found to be significantly more accurate than oscillometry, and comparable to the Korotkoff-based technique, the reference-standard for non-invasive blood pressure measurements. The measurement of SBP is a mainstay for the diagnosis and follow-up of hypertension, which is a major risk factor for several adverse events, mainly cardiovascular. Lowering blood pressure evidently reduces the risk, but excessive lowering can result in hypo- tension and consequently hypoperfusion to vital organs, since blood pressure is the driving force for blood flow. Erroneous measurement by 10 mmHg can lead to a similar unintended reduction of SBP and may adversely affect patients treated to an SBP of 120–130 mmHg. In particular, in elderly patients, unintended excessive reduction of blood pressure due to inaccurate SBP measurement can result in cerebral hypoperfusion and consequent cognitive decline. By using a more accurate technique for automatic SBP measurement (such as the photoplethysmographic-based technique), the optimal blood pressure target can be achieved with lower risk for hypotension and its adverse events.

Albuminuria is a feature of glomerular hypertension and hypertensive renal target organ damage 9, 10 . In keeping with its postulated haemodynamic effects, obesity has been associated with elevated urine albumin excretion in several cohorts 11-13 . Furthermore, the heavy proteinuria and focal segmental glomerulosclerosis of obesity-related glomerulopathy are reminiscent of features attributed to glomerular hypertension in the setting of reduced nephron mass 14, 15 . If obesity sensitizes the kidney to hypertensive injury this effect could be an important contributor to CKD incidence/progression. We hypothesized that a given systolic blood pressure (sBP) increment would be associated with a greater increase in albuminuria in the presence of obesity. We tested this in a representative sample of the US population: the National Health and Nutrition Examination Survey (NHANES) 1999-2010.

As was expected based on clinical experience, our results clearly show that varying blood pressure limits affect the test quality of triage algorithms. The seemingly sound, early ATLS doctrine that the presence of carotid (> 60 mmHg), femoral (> 70 mmHg), and radial pulse (> 80 mmHg) would correlate with a certain systolic blood pressure (SBP) in hypotensive trauma patients [6] was never scientifically proven. One underpowered study, however, claimed high variability in the measurements and showed a certain de- gree of underestimating the real blood pressure [16] by the pulse status. Regarding Body-Mass-Index, pre-existing vascular diseases, or other sources of variability, at given blood pressure levels palpability of pulses may also be grossly affected. Recent studies tried to improve the evi- dence for estimating the blood pressure according to the palpation of pulse [14]. Regardless of whether or not the correlation between pulse and SBP is scientifically proven or not, the creators of triage algorithms included the idea that palpable pulse reflects a certain degree of SBP. What we learned from the present study is that the assumed SBP cutoff is important for the correct assignment of a certain patient to a triage category. One further factor for the patient assignment is the capability of on-scene health care providers to correctly check for the pulse at appropri- ate locations. Accordingly, this implies that the location of where the pulse is palpated, e.g. radial vs. carotid artery, is relevant for the proper performance of the algorithms.

We present a genome-wide association study of a quantitative trait, “ progression of systolic blood pressure in time, ” in which 142 unrelated individuals of the Genetic Analysis Workshop 18 real genotype data were analyzed. Information on systolic blood pressure and other phenotypic covariates was missing at certain time points for a considerable part of the sample. We observed that the dropout process causing missingness is not independent of the initial systolic blood pressure; that is, the data is not missing completely at random. However, after the

done from 8am to 8pm and the 8pm to 8am period was considered nighttime. After this, the average of systolic and diastolic BP was calculated for each hour, for daytime, nighttime and for the 24-hour period. The exam was con- sidered reliable when at least 75% of the measurements were successfully executed. Moreover, it was calculated the nocturnal BP decrease ([diurnal systolic blood pressure - nocturnal systolic blood pressure] × 100/diurnal systolic blood pressure). It was considered normal values of noc- turnal BP decrease greater than 10% (dippers) and patients that showed BP decrease lower than this value were called "nondippers". We used the absolute values of NSBP instead of nocturnal BP fall to divide the subgroups in tertiles because the first variable has a minor coefficient of variation (data not published).

Background: There is great interindividual variation in systolic blood pressure (SBP) as a result of the influences of several factors, including sex, ancestry, smoking status, medication use, and, especially, age. The majority of genetic studies have examined SBP measured cross-sectionally; however, SBP changes over time, and not necessarily in a linear fashion. Therefore, this study conducted a genome-wide association (GWA) study of SBP change trajectories using data available through the Genetic Analysis Workshop 19 (GAW19) of 959 individuals from 20 extended Mexican American families from the San Antonio Family Studies with up to 4 measures of SBP. We performed structural equation modeling (SEM) while taking into account potential genetic effects to identify how, if at all, to include covariates in estimating the SBP change trajectories using a mixture model based latent class growth modeling (LCGM) approach for use in the GWA analyses.

Patients with prolonged neutropenia who are using antifungal agents usually have multiple comorbidities, so it has been difficult to determine which factors cause drops in BP. Generally, sepsis progression is first suspected, but here we showed that SIRS and bacteremia were not risk factors for the BP drop that often follows itraconazole administra- tion. Hypotensive drugs, such as amlodipine, nicardipine, nifedipine, nitroglycerin, labetalol, atenolol, carvedilol, losartan, and fentanyl, can lower SBP, and itraconazole was administered during the initial half-life of such drugs, which could have exacerbated the hypotension. The itraconazole- induced increase in SBP in patients who had hypotension prior to itraconazole administration could have been due to associated interventions, such as fluid challenges or increases Table 2 systolic blood pressure according to the time related to

The concept of breeding values, an individual ’ s phenotypic deviation from the population mean as a result of the sum of the average effects of the genes they carry, is of great importance in livestock, aquaculture, and cash crop industries where emphasis is placed on an individual ’ s potential to pass desirable phenotypes on to the next generation. As breeding or genetic values (as referred to here) cannot be measured directly, estimated genetic values (EGVs) are based on an individual’s own phenotype, phenotype information from relatives, and, increasingly, genetic data. Because EGVs represent additive genetic variation, calculating EGVs in an extended human pedigree is expected to provide a more refined phenotype for genetic analyses. To test the utility of EGVs in genome-wide association, EGVs were calculated for 847 members of 20 extended Mexican American families based on 100 replicates of simulated systolic blood pressure. Calculations were performed in GAUSS to solve a variation on the standard Best Linear Unbiased Predictor (BLUP) mixed model equation with age, sex, and the first 3 principal components of sample-wide genetic variability as fixed effects and the EGV as a random effect distributed around the relationship matrix. Three methods of calculating kinship were considered: expected kinship from pedigree relationships, empirical kinship from common variants, and empirical kinship from both rare and common variants. Genome-wide association analysis was conducted on simulated phenotypes and EGVs using the additive measured genotype approach in the SOLAR software package. The EGV-based approach showed only minimal improvement in power to detect causative loci.

blood pressure after 24 hours of administration of intravenous antihypertensive therapy is nicardipine. The mean systolic blood pressure decreased to 169.79 ± 20.23 mmHg after being given intravenous antihypertensive therapy compared with the mean systolic blood pressure at hospital admission that was 213.67 ± 17.11 mmHg (p <0.001). The results of this study are in accordance with research Yamada et al (2017) who found a decrease in mean systolic blood pressure at admission 180.00 ± 29.30 to 136.60 ± 16.90 after 24 hours of intravenous antihypertensive therapy (p = 0.0061). Nicardipine can cross the blood brain barrier and work as a vasorelax in the smooth muscle of blood vessels in the brain. At acidic pH from ischemic brain tissue, nicardipine is almost 100.00% protected, allowing rapid accumulation of ischemic tissue, local vasodilation, and a decrease in vasospasm that is seen in patients with acute subarachnoid hemorrhage. Although nicardipine is a vasodilator of cerebral blood vessels, it can also dilate arterioles that have little resistance, so there are no significant changes in intracranial volume and intracranial pressure 7,8 . In this study it was found that the mean systolic blood

cause mortality and the bene fi ts were attenuated when SBP was lower than 125 mmHg in patients with DM. Moreover, we found a U-shaped association between SBP and mortality risk in diabetic patients. Data from the LSU Health Care Services Division (LSUHCSD) study of 35,261 patients with type 2 diabetes also showed a U-shaped relationship between SBP and all-cause mor- tality, which was consistent with our fi ndings. 32 However, the LSUHCSD study suggested maintaining SBP at 130 – 150 mmHg, with SBP <120 mmHg and ≥ 160 mmHg both associated with increased risk of all-cause death. When compared to LSUHCSD study, our study suggested a narrower and lower SBP range. Similar asso- ciations between SBP and all-cause mortality (U-shaped) Table 2 Hazard Ratios for All-Cause Mortality According to Systolic Blood Pressure Categories Among Participants with Different Glycemic Status

Background: Elevated systolic blood pressure is more difficult to control than elevated diastolic blood pressure. The objective of this prespecified analysis of the Triple Therapy with Olmesartan Medoxomil, Amlodipine, and Hydrochlorothiazide in Hypertensive Patients Study (TRINITY) was to compare the efficacy of olmesartan medoxomil (OM) 40 mg, amlodipine besylate (AML) 10 mg, and hydrochlorothiazide (HCTZ) 25 mg triple-combination treatment with the component dual-combination treatments in reducing elevated seated systolic blood pressure (SeSBP). Methods: The 12-week TRINITY study randomized participants to either one of the three component dual-combination treatments (OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg) or the triple-combination treatment. The primary outcome of this analysis was the categorical distribution of SeSBP reductions at week 12 from baseline with OM 40 mg/AML 10 mg/HCTZ 25 mg versus the dual-combination treatments.