Blood pressure measurement protocol determines hypertension phenotypes in a Middle Eastern population.

Clinic blood pressure (BP) measurement remains a crucial step in managing hypertension. While the number of measures recorded in different settings varies, with typically 1-3 measures, there has been no prior justification for the actual number of measures required. We investigated the pattern of BP variability over 5 consecutive automated readings (R1-R5) and the influence of patient characteristics on this pattern to identify the phenotype of hypertension in a Middle Eastern population. There were 1389 outpatients (51% men, 49% women), age range (18-87 y) who had 5 unattended automated consecutive BP measurements with one-minute intervals using the validated Datascope Mindray Passport V Monitor with the patient blinded from the results. Mean (±SEM) SBP for R1 (136.0 ± 2 mm Hg) was similar to R2 (136.2 ± 2 mm Hg). Thereafter SBP progressively declined till R5 by total of 5.5 mm Hg. The SBP decline was less (4.2 mm Hg) in older (>50 years) vs younger participants (8.1 mm Hg; P < .001) and was blunted in diabetic and hypertensive participants. Overall, 43% of participants had R2 > R1, and 24% additionally had R5 > R1. Age was a strong independent predictor of having both R2 > R1 and R5 > R1, as well as diabetes. Diastolic blood pressure (DBP) decreased by average 2.8 mm Hg from R1 to R5. Females had a 5-fold greater total decline in DBP vs males (P < .001). Using the mean of 5 BP measures resulted in fewer participants being classified as hypertensive (36% of the population) compared to using one measurement (46%), or established BP guidelines which use different combinations of R1-R3 (37%-42%). Our findings in a Middle Eastern population highlight the importance of the BP measurement protocol in combination with patient characteristics in determining whether a patient is diagnosed with hypertension. Protocols that rely on different combinations of only 3 measures (R1-3) will classify more participants as hypertensive, compared to using 5 measures or disregarding a high R2.

Phytochemical and biological investigations of Atriplex semibacata R .BR. growing in Egypt.

The lipid content of Atriplex semibacata growing in Egypt was studied. The unsaponifiable fraction was identified by GLC. A series of hydrocarbons ranging from C(14)- C(28) in addition to cholesterol, stigmasterol and the triterpenoids α and ß - amyrin were identified. GLC analysis of fatty alcohols fraction revealed the presence of six fatty alcohols in which dotriacontanol (C(32)H(66)O) was the major (14.68%). Six compounds (five coumarins and one phenolic acid) were isolated for the first time from A. semibacata. The coumarin constituents isolated from the chloroform and the ethyl acetate fractions of the aqueous alcoholic extract of A. semibacata were identified as scopoletin, umbelliferorne, coumarin, scopolin, 7-methoxy coumarin in addition to a phenolic acid P-coumaric acid. Also, the flavonoidal compounds isolated from the n-butanol fraction of the plant revealed the presence of kaempferol 3-O glucoside and acacetin. Their identity was proved by m.p., TLC, PC, UV and MS analysis. The alcohol extract showed significant antimicrobial activity against G-ve bacteria, moderate activity against G+ve bacteria. On the other hand, the pet. Ether extract showed marked activity against G+ve bacteria and fungi, also the G-ve bacteria was greatly inhibited by the chloroform extract. The different extracts of the plant exhibited no cytotoxic activity against Erlich-ascites carcinoma cells line at the tested concentrations, also showed a strong antioxidant activity using DPPH.