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BMC Emergency Medicine Aug 2023Septic shock medical treatment relies on a bundle of care including antibiotic therapy and hemodynamic optimisation. Hemodynamic optimisation consists of fluid expansion...
BACKGROUND
Septic shock medical treatment relies on a bundle of care including antibiotic therapy and hemodynamic optimisation. Hemodynamic optimisation consists of fluid expansion and norepinephrine administration aiming to optimise cardiac output to reach a mean arterial pressure of 65mmHg. In the prehospital setting, direct cardiac output assessment is difficult because of the lack of invasive and non-invasive devices. This study aims to assess the relationship between 30-day mortality and (i) initial pulse pressure (iPP) as (ii) pulse pressure variation (dPP) during the prehospital stage among patients cared for SS by a prehospital mobile intensive care unit (MICU).
METHODS
From May 09th, 2016 to December 02nd, 2021, septic shock patients requiring MICU intervention were retrospectively analysed. iPP was calculated as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the first contact between the patient and the MICU team prior to any treatment and, dPP as the difference between the final PP (the difference between SBP and DBP at the end of the prehospital stage) and iPP divided by prehospital duration. To consider cofounders, the propensity score method was used to assess the relationship between (i) iPP < 40mmHg, (ii) positive dPP and 30-day mortality.
RESULTS
Among the 530 patients analysed, pulmonary, digestive, and urinary infections were suspected among 43%, 25% and 17% patients, respectively. The 30-day overall mortality rate reached 31%. Cox regression analysis showed an association between 30-day mortality and (i) iPP < 40mmHg; aHR of 1.61 [1.03-2.51], and (ii) a positive dPP; aHR of 0.56 [0.36-0.88].
CONCLUSION
The current study reports an association between 30-day mortality rate and iPP < 40mmHg and a positive dPP among septic shock patients cared for by a prehospital MICU. A negative dPP could be helpful to identify septic shock with higher risk of poor outcome despite prehospital hemodynamic optimization.
Topics: Humans; Blood Pressure; Retrospective Studies; Shock, Septic; Intensive Care Units; Emergency Medical Services
PubMed: 37626302
DOI: 10.1186/s12873-023-00864-0 -
Journal of Clinical Hypertension... Aug 2021Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long-term risk factor in a random...
Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long-term risk factor in a random cohort of middle-aged participants. The Opera study took place in years 1991-1993, with a 24-h ambulatory blood pressure measurement (ABPM) performed to 900 participants. The end-points were non-fatal and fatal CV events, and deaths of all-causes. Follow-up period, until the first event or until the end of the year 2014, was 21.1 years (mean). Of 900 participants, 22.6% died (29.6% of men/15.6% of women, p<.001). A CV event was experienced by 208 participants (23.1%), 68.3% of them were male (p<.001). High nighttime ambulatory PP predicted independently CV mortality (hazard ratio [HR] 2.60; 95% confidence interval [CI 95%] 1.08-6.31, p=.034) and all-cause mortality in the whole population (HR 1.72; Cl 95% 1.06-2.78, p=.028). In males, both 24-h PP and nighttime PP associated with CV mortality and all-cause mortality (24-h PP HR for CV mortality 2.98; CI 95% 1.11-8.04, p=.031 and all-cause mortality HR 2.40; CI 95% 1.32-4.37, p=.004). Accordingly, nighttime PP; HR for CV mortality 3.13; CI 95% 1.14-8.56, p=.026, and for all-cause mortality HR 2.26; CI 95% 1.29-3.96, p=.004. Cox regression analyses were adjusted by sex, CV risk factors, and appropriate ambulatory mean systolic BP. In our study, high ambulatory nighttime PP was detected as a long-term risk factor for CV and all-cause mortality in middle-aged individuals.
Topics: Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Risk Factors
PubMed: 34216537
DOI: 10.1111/jch.14317 -
Hypertension (Dallas, Tex. : 1979) Feb 2021Observational studies have shown an association between hypertension and atrial fibrillation (AF). Aggressive blood pressure management in patients with known AF reduces...
Observational studies have shown an association between hypertension and atrial fibrillation (AF). Aggressive blood pressure management in patients with known AF reduces overall arrhythmia burden, but it remains unclear whether hypertension is causative for AF. To address this question, this study explored the relationship between genetic predictors of blood pressure and risk of AF. We secondarily explored the relationship between genetically proxied use of antihypertensive drugs and risk of AF. Two-sample Mendelian randomization was performed using an inverse-variance weighted meta-analysis with weighted median Mendelian randomization and Egger intercept tests performed as sensitivity analyses. Summary statistics for systolic blood pressure, diastolic blood pressure, and pulse pressure were obtained from the International Consortium of Blood Pressure and the UK Biobank discovery analysis and AF from the 2018 Atrial Fibrillation Genetics Consortium multiethnic genome-wide association studies. Increases in genetically proxied systolic blood pressure, diastolic blood pressure, or pulse pressure by 10 mm Hg were associated with increased odds of AF (systolic blood pressure: odds ratio [OR], 1.17 [95% CI, 1.11-1.22]; =1×10; diastolic blood pressure: OR, 1.25 [95% CI, 1.16-1.35]; =3×10; pulse pressure: OR, 1.1 [95% CI, 1.0-1.2]; =0.05). Decreases in systolic blood pressure by 10 mm Hg estimated by genetic proxies of antihypertensive medications showed calcium channel blockers (OR, 0.66 [95% CI, 0.57-0.76]; =8×10) and β-blockers (OR, 0.61 [95% CI, 0.46-0.81]; =6×10) decreased the risk of AF. Blood pressure-increasing genetic variants were associated with increased risk of AF, consistent with a causal relationship between blood pressure and AF. These data support the concept that blood pressure reduction with calcium channel blockade or β-blockade could reduce the risk of AF.
Topics: Antihypertensive Agents; Atrial Fibrillation; Biological Specimen Banks; Blood Pressure; Calcium Channel Blockers; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Hypertension; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide; United Kingdom
PubMed: 33390040
DOI: 10.1161/HYPERTENSIONAHA.120.16191 -
Scientific Reports May 2023This study presents a cardiovascular simulator that mimics the human cardiovascular system's physiological structure and properties to reproduce the human blood pressure...
This study presents a cardiovascular simulator that mimics the human cardiovascular system's physiological structure and properties to reproduce the human blood pressure waveform. Systolic, diastolic blood pressures, and its waveform are key indicators of cardiovascular health. The blood pressure waveform is closely related to the pulse wave velocity and the overlap of the forward and reflected pressure waves. The presented cardiovascular simulator includes an artificial aorta made of biomimetic silicone. The artificial aorta has the same shape and stiffness as the human standard and is encased with a compliance chamber. The compliance chamber prevents distortion of the blood pressure waveform from strain-softening by applying extravascular pressure. The blood pressure waveform reproduced by the simulator has a pressure range of 80-120 mmHg, a pulse wave velocity of 6.58 m/s, and an augmentation index of 13.3%. These values are in the middle of the human standard range, and the reproduced blood pressure waveform is similar to that of humans. The errors from the human standard values are less than 1 mmHg for blood pressure, 0.05 m/s for pulse wave velocity, and 3% for augmentation index. The changes in blood pressure waveform according to cardiovascular parameters, including heart rate, stroke volume, and peripheral resistance, were evaluated. The same pressure ranges and trends as in humans were observed for systolic and diastolic blood pressures according to cardiovascular parameters.
Topics: Humans; Blood Pressure; Pulse Wave Analysis; Vascular Resistance; Aorta; Reproduction
PubMed: 37188872
DOI: 10.1038/s41598-023-35055-1 -
Journal of Clinical Hypertension... Dec 2020Systolic (SBP) and diastolic blood pressure (DBP) and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP) is considered...
Systolic (SBP) and diastolic blood pressure (DBP) and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP) is considered as an easily available marker of vascular stiffness and the double product (DP) as a marker of cardiac workload. Therefore, we have examined the predictive value of PP and DP in the Ludwigshafen Risk and Cardiovascular Health study, a monocentric cohort study of 3316 patients referred to coronary angiography. An increase of SBP or PP by 1mmHg increased the risk of CVM with hazard ratios of 1.009 (95% CI, 1.005-1.012) and 1.016 (1.012-1.020), respectively. Increasing DP by 100 mm Hg/min was associated with a 1.010 (1.007-1.013) higher risk of CVM. In patient subgroups with coronary artery disease (CAD) and heart failure (HF), PP and DP predicted CVM better than SBP or MAP. In a multivariate analysis adjusted for sex, BMI, diabetes, eGFR, hazard ratios for CVM for z-standardized PP, DP, SBP, and HR were 1.20, 1.16, 1.12, and 1.14. After adding age to the multivariate analysis, only DP and HR remained significant. We provide evidence that PP and DP are powerful predictors of CVM and all-cause mortality in a CV medium- to high-risk population, especially in patients with CAD and HF. While DP proved to be an independent predictor of cardiovascular and all-cause mortality also in multivariate analysis, PP was no independent predictor in our cohort with widespread antihypertensive treatment (>85%). PP is associated with age, presence of diabetes, obesity, and impaired renal function.
Topics: Antihypertensive Agents; Blood Pressure; Cohort Studies; Humans; Hypertension; Risk Factors
PubMed: 33035393
DOI: 10.1111/jch.14067 -
Sensors (Basel, Switzerland) Apr 2023Traditional cuff-based sphygmomanometers for measuring blood pressure can be uncomfortable and particularly unsuitable to use during sleep. A proposed alternative method...
Traditional cuff-based sphygmomanometers for measuring blood pressure can be uncomfortable and particularly unsuitable to use during sleep. A proposed alternative method uses dynamic changes in the pulse waveform over short intervals and replaces calibration with information from photoplethysmogram (PPG) morphology to provide a calibration-free approach using a single sensor. Results from 30 patients show a high correlation of 73.64% for systolic blood pressure (SBP) and 77.72% for diastolic blood pressure (DBP) between blood pressure estimated with the PPG morphology features and the calibration method. This suggests that the PPG morphology features could replace the calibration stage for a calibration-free method with similar accuracy. Applying the proposed methodology on 200 patients and testing on 25 new patients resulted in a mean error (ME) of -0.31 mmHg, a standard deviation of error (SDE) of 4.89 mmHg, a mean absolute error (MAE) of 3.32 mmHg for DBP and an ME of -4.02 mmHg, an SDE of 10.40 mmHg, and an MAE of 7.41 mmHg for SBP. These results support the potential for using a PPG signal for calibration-free cuffless blood pressure estimation and improving accuracy by adding information from cardiovascular dynamics to different methods in the cuffless blood pressure monitoring field.
Topics: Humans; Blood Pressure; Photoplethysmography; Pulse Wave Analysis; Blood Pressure Determination; Sphygmomanometers
PubMed: 37112490
DOI: 10.3390/s23084145 -
Hypertension (Dallas, Tex. : 1979) Mar 2021Midlife vascular disease increases risk for dementia and effects of vascular dysfunction on brain health differ between men and women. Elevated pulse pressure, a...
Midlife vascular disease increases risk for dementia and effects of vascular dysfunction on brain health differ between men and women. Elevated pulse pressure, a surrogate for arterial stiffness, contributes to cerebrovascular pathology and white matter damage that may advance cognitive aging; however, it remains unclear how associations between pulse pressure and neural integrity differ by sex and age. This study used restriction spectrum imaging to examine associations between pulse pressure and brain microstructure in community-dwelling women (N=88) and men (N=55), aged 56 to 97 (mean, 76.3) years. Restricted isotropic (presumed intracellular), hindered isotropic (presumed extracellular), neurite density, and free water diffusion were computed in white matter tracts and subcortical regions. After adjustment for age and sex, higher pulse pressure correlated with lower restricted isotropic diffusion in global white matter, with more pronounced associations in parahippocampal cingulum, as well as in thalamus and hippocampus. Subgroup analyses demonstrated stronger correlations between pulse pressure and restricted isotropic diffusion in association fibers for participants ≤75 years than for older participants, with stronger effects for women than men of this age group. Microstructure in parahippocampal cingulum and thalamus differed by pulse pressure level regardless of antihypertensive treatment. Increased pulse pressure may lead to widespread injury to white matter and subcortical structures, with greatest vulnerability for women in late middle to early older age. Restriction spectrum imaging could be useful for monitoring microstructural changes indicative of neuronal loss or shrinkage, demyelination, or inflammation that accompany age-related cerebrovascular dysfunction.
Topics: Age Factors; Aged; Aged, 80 and over; Aging; Blood Pressure; Brain; Female; Humans; Independent Living; Male; Middle Aged; Sex Factors; Vascular Stiffness; White Matter
PubMed: 33461315
DOI: 10.1161/HYPERTENSIONAHA.120.16446 -
Neurocritical Care Jun 2023Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile...
BACKGROUND
Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can lead to endothelial dysfunction. We explored the impact of early low pulse pressure on occurrence of acute brain injury (ABI) in VA-ECMO.
METHODS
We conducted a retrospective analysis of adults with VA-ECMO at a tertiary care center between July 2016 and January 2021. Patients underwent standardized multimodal neuromonitoring throughout ECMO support. ABI included intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, cerebral edema, seizure, and brain death. Blood pressures were recorded every 15 min. Low pulse pressure was defined as a median pulse pressure < 20 mm Hg in the first 12 h of ECMO. Multivariable logistic regression was performed to investigate the association between pulse pressure and ABI.
RESULTS
We analyzed 5138 blood pressure measurements from 123 (median age 63; 63% male) VA-ECMO patients (54% peripheral; 46% central cannulation), of whom 41 (33%) experienced ABI. Individual ABIs were as follows: ischemic stroke (n = 18, 15%), hypoxic ischemic brain injury (n = 14, 11%), seizure (n = 8, 7%), intracranial hemorrhage (n = 7, 6%), cerebral edema (n = 7, 6%), and brain death (n = 2, 2%). Fifty-eight (47%) patients had low pulse pressure. In a multivariable model adjusting for preselected covariates, including cannulation strategy (central vs. peripheral), lactate on ECMO day 1, and left ventricle venting strategy, low pulse pressure was independently associated with ABI (adjusted odds ratio 2.57, 95% confidence interval 1.05-6.24). In a model with the same covariates, every 10-mm Hg decrease in pulse pressure was associated with 31% increased odds of ABI (95% confidence interval 1.01-1.68). In a sensitivity analysis model adjusting for systolic pressure, pulse pressure remained significantly associated with ABI.
CONCLUSIONS
Early low pulse pressure (< 20 mm Hg) was associated with ABI in VA-ECMO patients. Low pulse pressure may serve as a marker of ABI risk, which necessitates close neuromonitoring for early detection.
Topics: Adult; Humans; Male; Middle Aged; Female; Retrospective Studies; Extracorporeal Membrane Oxygenation; Blood Pressure; Brain Death; Brain Edema; Seizures; Intracranial Hemorrhages; Brain Injuries; Ischemic Stroke
PubMed: 36167950
DOI: 10.1007/s12028-022-01607-y -
Journal of Diabetes Research 2022To evaluate the effects of variations in systolic blood pressure (SBP) and pulse pressure (PP) on diabetic retinopathy (DR) in patients with type 2 diabetes.
OBJECTIVES
To evaluate the effects of variations in systolic blood pressure (SBP) and pulse pressure (PP) on diabetic retinopathy (DR) in patients with type 2 diabetes.
METHODS
A total of 3275 type 2 diabetes patients without DR at Taiwan Lee's United Clinic from 2002 to 2014 were enrolled in the study. The average age of the patients was 65.5 (±12.2) years, and the follow-up period ranged from 3 to 10 years. Blood pressure variability was defined as the standard deviation (SD) of the average blood pressure values over the entire study period and was calculated for each patient. The mean SD for SBP was 11.16, and a SBP ≥ 130 mmHg (1 mmHg = 0.133 kPa) was defined as high SBP. Based on these data, patients were divided into four groups as follows: group 1 (G1, mean SBP < 130 mmHg, SD of SBP < 11.16 mmHg), group 2 (G2, mean SBP < 130 mmHg, SD ≥ 11.16 mmHg), group 3 (G3, mean SBP ≥ 130 mmHg, SD of SBP < 11.16 mmHg), and group 4 (G4, mean SBP ≥ 130 mmHg, SD ≥ 11.16 mmHg). Based on a mean PP of 80 mmHg with a pulse pressure SD of 6.53 mmHg, the patients were regrouped into four groups designated G1'-G4'.
RESULTS
After adjusting for patient age, sex, and disease course, Cox regression showed that the mean and SD of SBP, pulse pressure, and their SDs were risk factors for DR. After stratifying the patients based on the mean and SD of the SBP, we found that the patients in the G4 group had the highest risk of DR (hazard ratio (HR) = 1.980, 95% CI: 1.716~2.285, < 0.01) and patients in the G1 group had the lowest risk. Patients in the G3 group (HR = 1.409, 95% CI: 1.284~1.546, < 0.01) had a higher risk of DR compared to those in the G2 group (HR = 1.353, 95% CI: 1.116~1.640, < 0.01). After the restratification of patients based on the mean and SD of the pulse pressures, it was found that patients in the G2' group had the highest risk of DR (HR = 2.086, 95% CI: 1.641~2.652, < 0.01), whilst patients in the G1' group had the lowest risk. Also, the risk of DR in the G4' group (HR = 1.507, 95% CI: 1.135~2.000, < 0.01) was higher than that in the G3' group (HR = 1.289, 95% CI: 1.181~1.408, < 0.01).
CONCLUSIONS
Variability in SBP and PP are risk factors for DR in patients with type 2 diabetes. The variability of PP was better able to predict the occurrence of DR than mean pulse pressure.
Topics: Blood Pressure; Child; Child, Preschool; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Humans; Proportional Hazards Models; Risk Factors
PubMed: 35359566
DOI: 10.1155/2022/7876786 -
Journal of Clinical Hypertension... Nov 2022Increasing blood pressure variability (BPV) has been reported to be a strong predictor of cardiovascular events in patients with hypertension. However, the effects of...
Increasing blood pressure variability (BPV) has been reported to be a strong predictor of cardiovascular events in patients with hypertension. However, the effects of BPV in the general population have not been intensively studied. The present study was designed to investigate a possible relationship between year-to-year BPV and hypertensive target organ damage (TOD) in a relatively low-risk general population. A total of 5489 consecutive patients (mean age 58.6 ± 10.7 years) who visited our hospital for an annual physical checkup for five consecutive years during 2008-2013 were enrolled in this study. The average systolic and diastolic blood pressures and pulse pressure were calculated, as well as standard deviation, coefficient of variation, and average real variability in blood pressures. Cross-sectional analysis was conducted and subjects without TOD at baseline (n = 3115) were followed up (median 1827 days) with the endpoint of TOD, defined as left ventricular hypertrophy on electrocardiogram or declining glomerular filtration rate. At baseline, BPV was closely associated with TOD. During follow-up, left ventricular hypertrophy and declining glomerular filtration rate developed in 189 and 400 subjects, respectively. Although the standard deviation for systolic blood pressure and pulse pressure predicted future development of TOD in a univariate analysis, BPV was not a significant determinant of incident TOD in adjusted Cox hazard models. These results suggest that year-to-year BPV is a marker of the presence of TOD in the general population but does not independently predict future TOD.
Topics: Humans; Middle Aged; Aged; Blood Pressure; Hypertension; Blood Pressure Monitoring, Ambulatory; Hypertrophy, Left Ventricular; Cross-Sectional Studies
PubMed: 35708714
DOI: 10.1111/jch.14526