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1.
Medicine (Baltimore) ; 100(16): e25621, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879733

RESUMEN

ABSTRACT: This study aimed to investigate the effects of the basic treatment for heart failure and sequential treatment with rh-brain natriuretic peptide (rhBNP) alone or the combination of rhBNP and sacubitril/valsartan. Cardiac structure, pulmonary artery pressure, inflammation and oxidative stress in patients with acute heart failure were evaluated.Three hundred patients with acute heart failure were included. According to the random number table method, the patients were divided into 3 groups of 100 patients per group: the standard treatment group (treated with an angiotensin-converting enzyme inhibitor, ß receptor blocker, and corticosteroid antagonist), rhBNP group (basic treatment combined with rhBNP) and sequential treatment group (basic treatment for heart failure combined with rhBNP followed by sacubitril/valsartan). The changes in NT-probrain natriuretic peptide (BNP) levels, cardiac troponin T (cTnT) levels, cardiac structure, pulmonary artery pressure, and the levels inflammatory factors and oxidative stress factors were compared among the 3 groups at 1, 4, 12, and 36 weeks after treatment.The sequential treatment group displayed superior outcomes than the standard treatment group and the rhBNP group in terms of left atrium diameter, left ventricular end diastolic volume, left ventricular ejection fraction, pulmonary artery pressure, NT-proBNP levels, and cTnT levels, which respond to damage to the heart structure and myocardium. This result may be related to the decreased levels of inflammatory factors and the correction of oxidative stress imbalance.Sacubitril/valsartan significantly reduce the serum levels of inflammatory factors in patients with acute heart failure while decreasing the levels of oxidizing factors and increasing the levels of antioxidant factors. These changes may be one of the explanations for the better cardiac structure and better pulmonary artery pressure observed in the sequential treatment group.


Asunto(s)
Aminobutiratos/administración & dosificación , Antagonistas de Receptores de Angiotensina/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Péptido Natriurético Encefálico/administración & dosificación , Tetrazoles/administración & dosificación , Enfermedad Aguda , Antagonistas Adrenérgicos beta/administración & dosificación , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Presión Arterial/efectos de los fármacos , Biomarcadores/sangre , Combinación de Medicamentos , Quimioterapia Combinada , Femenino , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/fisiopatología , Antagonistas de Hormonas/administración & dosificación , Humanos , Inflamación , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana Edad , Miocardio/patología , Estrés Oxidativo/efectos de los fármacos , Arteria Pulmonar/fisiopatología , Volumen Sistólico/efectos de los fármacos , Resultado del Tratamiento , Troponina T/sangre
2.
Sensors (Basel) ; 21(5)2021 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-33800106

RESUMEN

Blood pressure (BP) monitoring has significant importance in the treatment of hypertension and different cardiovascular health diseases. As photoplethysmogram (PPG) signals can be recorded non-invasively, research has been highly conducted to measure BP using PPG recently. In this paper, we propose a U-net deep learning architecture that uses fingertip PPG signal as input to estimate arterial BP (ABP) waveform non-invasively. From this waveform, we have also measured systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP). The proposed method was evaluated on a subset of 100 subjects from two publicly available databases: MIMIC and MIMIC-III. The predicted ABP waveforms correlated highly with the reference waveforms and we have obtained an average Pearson's correlation coefficient of 0.993. The mean absolute error is 3.68 ± 4.42 mmHg for SBP, 1.97 ± 2.92 mmHg for DBP, and 2.17 ± 3.06 mmHg for MAP which satisfy the requirements of the Association for the Advancement of Medical Instrumentation (AAMI) standard and obtain grade A according to the British Hypertension Society (BHS) standard. The results show that the proposed method is an efficient process to estimate ABP waveform directly using fingertip PPG.


Asunto(s)
Hipertensión , Fotopletismografía , Presión Arterial , Presión Sanguínea , Determinación de la Presión Sanguínea , Humanos , Hipertensión/diagnóstico
3.
Rev Med Liege ; 76(4): 221-223, 2021 Apr.
Artículo en Francés | MEDLINE | ID: mdl-33830683

RESUMEN

Prolonged standing or even sitting position can induce a fall in arterial blood pressure because of gravity that provokes a blood volume sequestration in lower limbs. Such a phenomenon may be associated with orthostatic dizziness or sometimes syncope. We present the image of a continuous monitoring using a Finometer® of systolic blood pressure and heart rate. Crossing legs while in sitting position allows immediate increase of arterial blood pressure. This pathophysiological mechanism explains why numerous people cross legs in sitting position, for instance during a prolonged meeting, in an auditorium or in a movie theater. This common phenomenon has potential diagnostic, therapeutic and prognostic implications.


Asunto(s)
Presión Arterial , Hipotensión Ortostática , Presión Sanguínea , Humanos , Hipotensión Ortostática/diagnóstico , Pierna , Postura , Sedestación
4.
Am J Physiol Heart Circ Physiol ; 320(4): H1712-H1723, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33666502

RESUMEN

Uterine spiral artery remodeling (UAR) is essential for placental perfusion and fetal development. A defect in UAR underpins placental ischemia disorders, e.g., preeclampsia, that result in maternal systemic vascular endothelial dysfunction and hypertension. We have established a model of impaired UAR by prematurely elevating maternal serum estradiol levels during the first trimester of baboon pregnancy. However, it is unknown whether this experimental paradigm is associated with maternal vascular endothelial dysfunction. Therefore, in the present study baboons were administered estradiol on days 25-59 of gestation to suppress UAR and maternal vascular function determined on day 165 (term = 184 days) peripherally and in skeletal muscle, which accounts for over 40% of body mass and 25% of resting systemic vascular resistance. Maternal serum sFlt-1 levels were 2.5-fold higher (P < 0.05), and skeletal muscle arteriolar endothelial nitric oxide synthase (eNOS) protein expression and luminal area, and skeletal muscle capillary density were 30-50% lower (P < 0.05) in UAR suppressed baboons. Coinciding with these changes in eNOS expression, luminal area, and capillary density, maternal brachial artery flow-mediated dilation and volume flow were 70% and 55% lower (P < 0.05), respectively, and mean arterial blood pressure 29% higher (P < 0.01) in UAR defective baboons. In summary, maternal vascular function was disrupted in a baboon model of impaired UAR. These results highlight the translational impact of this primate model and relevance to adverse conditions of human pregnancy underpinned by improper uterine artery transformation.NEW & NOTEWORTHY Maternal vascular dysfunction is a hallmark of abnormal human pregnancy, particularly early-onset preeclampsia, elicited by impaired UAR. The present study makes the novel discovery that maternal systemic vascular dysfunction was induced in a baboon experimental model of impaired UAR. This study highlights the translational relevance of this nonhuman primate model to adverse conditions of human pregnancy underpinned by defective UAR.


Asunto(s)
Presión Arterial , Arteria Braquial/fisiopatología , Hipertensión Inducida en el Embarazo/fisiopatología , Microvasos/fisiopatología , Músculo Esquelético/irrigación sanguínea , Arteria Uterina/fisiopatología , Remodelación Vascular , Vasodilatación , Animales , Arteria Braquial/metabolismo , Modelos Animales de Enfermedad , Estradiol/análogos & derivados , Femenino , Edad Gestacional , Hipertensión Inducida en el Embarazo/inducido químicamente , Hipertensión Inducida en el Embarazo/metabolismo , Microvasos/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico Sintasa de Tipo III/metabolismo , Estrés Oxidativo , Papio anubis , Embarazo , Primer Trimestre del Embarazo , Arteria Uterina/metabolismo , Receptor 1 de Factores de Crecimiento Endotelial Vascular/sangre
5.
Rev. cuba. med ; 60(1): e1547, tab
Artículo en Español | LILACS, CUMED | ID: biblio-1156556

RESUMEN

Introducción: La vulnerabilidad cardiometabólica por adiposidad corporal puede ser un indicador de utilidad durante el embarazo y después del parto, en la prevención de eventos cardiovasculares. Objetivo: Describir posibles asociaciones de la vulnerabilidad cardiometabólica por adiposidad corporal con cambios de la presión arterial en el posparto a corto plazo. Métodos: Se realizó un estudio observacional descriptivo transversal en el período enero 2017-agosto 2018, en 119 mujeres pertenecientes al policlínico Chiqui Gómez Lubián. Se aplicó la prueba de peso sostenido, se determinó la media y desviación estándar de la presión arterial sistólica, diastólica y media calculada; en reposo y dos minutos después de la primera medición. Se analizaron los cambios cuantitativos de la presión arterial en reposo y con estimulación física posterior, según vulnerabilidad cardiometabólica por adiposidad corporal, 18 meses después del parto. Se clasificaron las mujeres en tres grupos según su respuesta vascular ante la estimulación física, evaluada por los cambios de la presión arterial: normorreactivas, hiperreactivas y con respuesta hipertensiva. Se aplicó la prueba de Kruskal-Wallis para la comparación de muestras independientes. Resultados: Incremento de los valores medios de presión arterial en mujeres con VGlobal Extrema AGA/CA (PAD, PAS_2min, PAD_2min y PAM-2min) y con VAGI (TAS Y TAM). De las mujeres con respuesta hiperreactiva, 36,4 por ciento tenía VAGI y el 45,5 por ciento con VAGA. El único caso con respuesta hipertensiva tenía VGlobal Extrema AGA/CA. Conclusiones: La caracterización temprana de la vulnerabilidad cardiometabólica por adiposidad corporal puede alertar sobre cambios en la reactividad vascular la cual conduce a eventos cardiovasculares posteriores(AU)


Introduction: Cardiometabolic vulnerability due to body fat can be a useful indicator during pregnancy and after delivery, in the prevention of cardiovascular events. Objective: To describe possible associations of cardiometabolic vulnerability due to body adiposity with changes in blood pressure in the short-term postpartum. Methods: A cross-sectional descriptive observational study was carried out from January 2017 to August 2018, in 119 women at Chiqui Gómez Lubián community clinic. The sustained weight test was applied, the mean and standard deviation of the calculated systolic, diastolic and mean arterial pressure were determined at rest and two minutes after the first reading. The quantitative changes in blood pressure at rest and with subsequent physical stimulation were analyzed, according to cardiometabolic vulnerability due to body fat, 18 months after delivery. These women were classified into three groups according to their vascular response to physical stimulation, evaluated by changes in blood pressure: normoreactive, hyperreactive and with a hypertensive response. The Kruskal-Wallis test was applied for the comparison of independent samples. Results: Increase in mean blood pressure values in women with VGlobal Extrema AGA / CA (DBP, PAS_2min, DBP_2min and MAP-2min) and with VAGI (TAS and TAM). 36.4 percent of the women with a hyperreactive response, had VAGI and 45.5 percent had VAGA. The only case with a hypertensive response had VGlobal Extrema AGA / CA. Conclusions: The early characterization of cardiometabolic vulnerability due to body adiposity can alert about changes in vascular reactivity which leads to later cardiovascular events(AU)


Asunto(s)
Humanos , Femenino , Periodo Posparto , Vulnerabilidad en Salud , Adiposidad , Presión Arterial , Epidemiología Descriptiva , Estudios Transversales , Estudio Observacional
6.
Rev. cuba. med ; 60(1): e1509, tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1156555

RESUMEN

Introducción: La enfermedad arterial periférica es bien conocida como predictor de morbilidad y mortalidad cardiovascular y cerebrovascular, de ahí la importancia de reconocer sus factores de riesgo. Objetivo: Determinar los factores de riesgo asociados a la enfermedad arterial periférica en pacientes diagnosticados por el índice tobillo brazo. Métodos: Se realizó un estudio observacional analítico transversal, entre el 1ro de septiembre y 30 de noviembre de 2019. El universo fue de 290 pacientes, se trabajó con una muestra de 120, determinada por un muestreo aleatorio simple. Se emplearon estadígrafos descriptivos e inferenciales: prueba t de Student, el odds ratio de prevalencia y la regresión logística binomial. Resultados: Fueron categorizados con índice tobillo brazo < 0,9 un total de 43 pacientes (35,8 por ciento). La media de edad de la población fue de 58,43 ± 16,69. El sexo femenino predominó con 61 pacientes (50,8 por ciento). El índice de masa corporal promedio fue de 24,29 ± 3,29 kg/m2. La hipertensión arterial fue el factor de riesgo más frecuente presentándose en 67,5 por ciento de los pacientes. Se identificaron como factores de riesgo de índice tobillo brazo < 0,9 a la edad ≥ 60 años (OR: 6,41; IC 95 por ciento: 2,04-20,1; p=0,001); la hipertensión arterial (OR: 2,99; IC 95 por ciento: 1,02-8,73; p=0,045); la diabetes mellitus (OR: 3,89; IC 95 por ciento: 1,34-11,3; p=0,012) y la dislipidemia (OR: 4,35; IC 95 por ciento: 1,27-14,8; p=0,019). Conclusiones: La edad avanzada, la hipertensión arterial, la diabetes mellitus y la dislipidemia constituyeron factores de riesgo asociados a la enfermedad arterial periférica(AU)


Introduction: Peripheral arterial disease is well known as a predictor of cardiovascular and cerebrovascular morbidity and mortality, hence the importance of recognizing its risk factors. Objective: To determine the risk factors associated with peripheral arterial disease in patients diagnosed by the ankle brachial index. Methods: A cross-sectional analytical observational study was carried out from September 1 to November 30, 2019. The universe consisted of 290 patients, a sample of 120 was used, determined by simple random sampling. Descriptive and inferential statistics were used: Student's t test, prevalence odds ratio, and binomial logistic regression. Results: A total of 43 patients (35.8%) were categorized with ankle brachial index <0.9. The mean age of the population was 58.43 ± 16.69. The female sex predominated with 61 patients (50.8 percent). The average body mass index was 24.29 ± 3.29 kg / m2. Hypertension was the most frequent risk factor in 67.5 percent of the patients. Risk factors were identified in ankle brachial index <0.9 at age ≥60 years (OR: 6.41; 95 percent CI: 2.04-20.1; p = 0.001); arterial hypertension (OR: 2.99; 95 percent CI: 1.02-8.73; p = 0.045); diabetes mellitus (OR: 3.89; 95 percent CI: 1.34-11.3; p = 0.012) and dyslipidemia (OR: 4.35; 95 percent CI: 1.27-14.8; p = 0.019). Conclusions: Advanced age, arterial hypertension, diabetes mellitus and dyslipidemia were risk factors associated with peripheral arterial disease(AU)


Asunto(s)
Humanos , Masculino , Femenino , Factores de Riesgo , Dislipidemias/epidemiología , Índice Tobillo Braquial/métodos , Enfermedad Arterial Periférica/diagnóstico , Presión Arterial , Estudios Transversales , Estudio Observacional
7.
Medicine (Baltimore) ; 100(11): e25152, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726000

RESUMEN

ABSTRACT: Noninvasive continuous arterial pressure monitoring may be clinically useful in patients who require continuous blood pressure monitoring in situations where arterial catheter placement is limited. Many previous studies on the accuracy of the noninvasive continuous blood pressure monitoring method reported various results. However, there is no research on the effectiveness of noninvasive arterial pressure monitoring during one-lung ventilation. The purpose of this study was to compare arterial blood pressure obtained through invasive method and noninvasive method by using ClearSight during one-lung ventilation.In this retrospective observational study, a total of 26 patients undergoing one-lung ventilation for thoracic surgery at a single institution between March and July 2019 were recruited. All patients in this study were cannulated on their radial artery to measure continuously invasive blood pressures and applied ClearSight on the ipsilateral side of the cannulated arm. We compared and analyzed the agreement and trendability of blood pressure recorded with invasive and noninvasive methods during one-lung ventilation.Blood pressure and pulse rate showed a narrower limit of agreement with a percentage error value of around 30%. In addition, the tracking ability of each measurement could be determined by the concordance rate, all of which were below acceptable limits (92%).In noninvasive arterial blood pressure monitoring using ClearSight, mean blood pressure and pulse rate show acceptable agreement with the invasive method.


Asunto(s)
Determinación de la Presión Sanguínea/instrumentación , Monitores de Presión Sanguínea/estadística & datos numéricos , Monitoreo Intraoperatorio/instrumentación , Ventilación Unipulmonar , Procedimientos Quirúrgicos Torácicos , Anciano , Presión Arterial , Determinación de la Presión Sanguínea/métodos , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Arteria Radial/fisiopatología , Reproducibilidad de los Resultados , Estudios Retrospectivos
8.
BMC Geriatr ; 21(1): 148, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33648443

RESUMEN

BACKGROUND: Orthostatic hypotension (OH) in geriatric patients frequently involves a component of autonomic failure (AF). The combination of OH with nocturnal hypertension (NHT) is indicative of AF, which is described as pure (PAF), when neurologic symptoms are absent, or as multisystem atrophy (MSA), when combined with motor disturbance (Parkinsonism or Parkinson disease). CASE PRESENTATION: An 87-year-old man presented with long-lasting OH. He frequently fell, causing several fractures, and he developed heart failure. Blood pressure (BP) registration revealed a reversal of the day-night rhythm with NHT. An 18-FDG PET brain CT scan showed cerebellar hypometabolism, indicating MSA. CONCLUSIONS: This case demonstrates the use of continuous BP registration in geriatric patients with OH for diagnosing NHT. It illustrates the usefulness of 18-FDG PET brain CT scan to specify the nature of the AF. The case also illustrates the difficulty of managing the combination of OH and NHT.


Asunto(s)
Enfermedades del Sistema Nervioso Autónomo , Hipotensión Ortostática , Atrofia de Múltiples Sistemas , Anciano , Anciano de 80 o más Años , Presión Arterial , Presión Sanguínea , Humanos , Hipotensión Ortostática/diagnóstico , Masculino
9.
Georgian Med News ; (310): 107-112, 2021 Jan.
Artículo en Ruso | MEDLINE | ID: mdl-33658418

RESUMEN

For the purpose of research and comparative analysis of the features of cerebral blood flow, determined by the ultrasonic duplex scanning (USDS) method, in persons with clinical signs of chronic cerebral venous dysfunction syndrome and different levels of arterial pressure (AP), ultrasound of the head and neck was performed in 104 patients. 78 people - the main group (MG), where patients were selected for clinical signs of the presence of chronic cerebral venous dysfunction syndrome (CCVDS) and different blood pressure levels, were divided into 3 clinical groups: 33 people - people with high blood pressure (157.2±12,2/98.3±4.2) - hypertensive patients; 24 people with labile blood pressure with predominantly normal average blood pressure (125.23±12.2/82.22±4.14) - conditional normotonics; 21 people with low blood pressure (100.32±7.23/65.45±6.4) were hypotonic. Also, 26 patients of the comparison group were recruited - people without clinical signs of CCVDS and different levels of blood pressure, distributed according to the same principle: hypertensive patients - 8 people, normotonic patients - 13 people, hypotensive patients - 5 people. The total age of the patients ranged from 35 to 65 years (mean age 53.60±10.27 years). Among the patients there were 82 women and 22 men. Statistical comparison was performed using Fisher's exact test. The mean velocity indices of cerebral blood flow with varying degrees of reliability, depending on the level of arterial pressure, differed in patients with chronic cerebral venous dysfunction syndrome versus the indices of the comparison groups. The presence of clinical signs of CCVDS in people with different blood pressure levels was accompanied by a significant slowdown in blood flow in most cerebral arteries and a significant acceleration in the Rosenthal vein compared with patients without clinical manifestations of venous dysfunction and with the same arterial pressure. Attention was drawn to the fact that in persons with increased blood pressure, in contrast to the rest of the patients, a statistically significant acceleration of the linear blood flow velocity in vertebral artery at the level of the second cervical vertebra (VA2) was observed (p<0.05). In the subgroups of hypertensive patients with CCVDS, the mean linear blood flow velocity with a significant difference was twice less than the comparison group: a significant decrease in velocity parameters was only in the middle cerebral arteriasis (MCA) basins on both sides (p<0.01, p<0.05 on the right and left, respectively) and on the left in the pools posterior cerebral artery (PCA), VA2, a significant increase in blood flow (p<0.01, p<0.05) - in the veins of Rosenthal (VR). This discrepancy can be explained by the fact that hypertensive patients from the comparison group, that is, without clinical symptoms of CCVDS, already have subclinical manifestations of CCVDS, as evidenced by changes in the USDS indicators.


Asunto(s)
Presión Arterial , Hemodinámica , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Circulación Cerebrovascular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Ultrasonografía
11.
Am J Physiol Heart Circ Physiol ; 320(4): H1526-H1534, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33577434

RESUMEN

Use of electronic cigarettes is rapidly increasing among youth and young adults, but little is known regarding the long-term cardiopulmonary health impacts of these nicotine-containing devices. Our group has previously demonstrated that chronic, inhaled nicotine induces pulmonary hypertension (PH) and right ventricular (RV) remodeling in mice. These changes were associated with upregulated RV angiotensin-converting enzyme (ACE). Angiotensin II receptor blockers (ARBs) have been shown to reverse cigarette smoking-induced PH in rats. ACE inhibitor and ARB use in a large retrospective cohort of patients with PH is associated with improved survival. Here, we utilized losartan (an ARB specific for angiotensin II type 1 receptor) to further explore nicotine-induced PH. Male C57BL/6 mice received nicotine vapor for 12 h/day, and exposure was assessed using serum cotinine to achieve levels comparable to human smokers or electronic cigarette users. Mice were exposed to nicotine for 8 wk and a subset was treated with losartan via an osmotic minipump. Cardiac function was assessed using echocardiography and catheterization. Although nicotine exposure increased angiotensin II in the RV and lung, this finding was nonsignificant. Chronic, inhaled nicotine significantly increased RV systolic pressure and RV free wall thickness versus air control. These parameters were significantly lower in mice receiving both nicotine and losartan. Nicotine significantly increased RV internal diameter, with no differences seen between the nicotine and nicotine-losartan group. Neither nicotine nor losartan affected left ventricular structure or function. These findings provide the first evidence that antagonism of the angiotensin II type 1 receptor can ameliorate chronic, inhaled nicotine-induced PH and RV remodeling.NEW & NOTEWORTHY Chronic, inhaled nicotine causes pulmonary hypertension and right ventricular remodeling in mice. Treatment with losartan, an angiotensin II type 1 receptor antagonist, ameliorates nicotine-induced pulmonary hypertension and right ventricular remodeling. This novel finding provides preclinical evidence for the use of renin-angiotensin system-based therapies in the treatment of pulmonary hypertension, particularly in patients with a history of tobacco-product use.


Asunto(s)
Presión Arterial , Cigarrillo Electrónico a Vapor , Hipertensión Pulmonar/metabolismo , Hipertrofia Ventricular Derecha/metabolismo , Nicotina , Arteria Pulmonar/metabolismo , Receptor de Angiotensina Tipo 1/metabolismo , Función Ventricular Derecha , Remodelación Ventricular , Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacología , Animales , Presión Arterial/efectos de los fármacos , Modelos Animales de Enfermedad , Hipertensión Pulmonar/inducido químicamente , Hipertensión Pulmonar/fisiopatología , Hipertensión Pulmonar/prevención & control , Hipertrofia Ventricular Derecha/inducido químicamente , Hipertrofia Ventricular Derecha/patología , Hipertrofia Ventricular Derecha/prevención & control , Exposición por Inhalación , Losartán/farmacología , Masculino , Ratones Endogámicos C57BL , Arteria Pulmonar/efectos de los fármacos , Arteria Pulmonar/fisiopatología , Receptor de Angiotensina Tipo 1/efectos de los fármacos , Transducción de Señal , Factores de Tiempo , Función Ventricular Derecha/efectos de los fármacos , Remodelación Ventricular/efectos de los fármacos
12.
Am J Physiol Heart Circ Physiol ; 320(4): H1601-H1608, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33606582

RESUMEN

Central systolic blood pressure (cSBP, the peak of the central waveform) is usually regarded as the determinant of peripheral systolic blood pressure with amplification of peripheral systolic blood pressure (pSBP) measured with reference to cSBP. However, the earlier portion of the central waveform up to the first systolic shoulder (P1) may be the major determinant of pSBP. We performed in silico simulation studies and examined previously acquired experimental data (n = 131) in which peripheral and central blood pressure waveforms had been acquired both invasively and noninvasively to examine the determinants of pSBP. Measurements were made at baseline and during perturbation of hemodynamics by inotropic and vasoactive drugs. In silico simulations using a central-to-peripheral transfer function demonstrated that pSBP is dependent on P1 and the rate of change (dP/dt) of central pressure up to the time of P1 but not cSBP. In computational simulations, peripheral reflection in the radial artery was closely related to dP/dt, and 97% of the variability in amplification as measured with reference to P1 was explained by dP/dt. In vivo, amplification of pSBP over P1 was correlated with dP/dt (R > 0.75, P < 0.0001 for all data sets), and P1 and dP/dt were independently correlated with pSBP, explaining 90% of the variability in pSBP. We conclude that P1 and dP/dt are major determinants of pSBP and that pSBP and cSBP are, in part, determined by different cardiac, central, and peripheral vascular properties.NEW & NOTEWORTHY Peripheral systolic BP is determined mainly by the first shoulder and the rate of rise of the central systolic blood pressure waveform rather than the peak of this waveform (central systolic BP). Peripheral and central systolic blood pressure are determined by different cardiac and vascular properties.


Asunto(s)
Presión Arterial , Arterias/fisiopatología , Determinación de la Presión Sanguínea , Hipertensión/diagnóstico , Modelos Cardiovasculares , Función Ventricular Izquierda , Adulto , Anciano , Estudios de Casos y Controles , Simulación por Computador , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Análisis Numérico Asistido por Computador , Valor Predictivo de las Pruebas , Sístole , Factores de Tiempo
13.
Am J Physiol Regul Integr Comp Physiol ; 320(4): R452-R466, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33533312

RESUMEN

The large changes in mean arterial blood pressure (MABP) and cerebral blood flow velocity (CBFV) induced by squat-stand maneuvers (SSM) make this approach particularly suited for studying dynamic cerebral autoregulation (CA). However, the role of other systemic determinants of CBFV has not been described and could provide alternative physiological interpretations of SSM results. In 32 healthy subjects (16 female), continuous recordings of MABP (Finometer), bilateral CBFV (transcranial Doppler, MCA), end-tidal CO2 (EtCO2; capnography), and heart rate (HR; electrocardiogram) were performed for 5 min standing at rest, and during 15 SSM at the frequency of 0.05 Hz. A time-domain, multivariate dynamic model estimated the CBFV variance explained by different inputs, corresponding to significant contributions from MABP (P < 0.00001), EtCO2 (P < 0.0001), and HR (P = 0.041). The autoregulation index (ARI; range 0-9) was estimated from the CBFV response to a step change in MABP. At rest, ARI values (typically 5.7) were independent of the number of model inputs, but during SSM, ARI was reduced compared with baseline (P < 0.0001), and the three input model yielded lower values for the right and left MCA (3.4 ± 1.2, 3.1 ± 1.3) when compared with the single-input MABP-CBFV model (4.1 ± 1.1, 3.9 ± 1.0; P < 0.0001). The high coherence of the MABP-CBFV transfer function at 0.05 Hz (typically 0.98) was considerably reduced (around 0.71-0.73; P < 0.0001) when the contribution of CBFV covariates was taken into account. Not taking into consideration other determinants of CBFV, in addition to MABP, could be misleading and introduce biases in physiological and clinical studies.


Asunto(s)
Encéfalo/irrigación sanguínea , Circulación Cerebrovascular , Ejercicio Físico/fisiología , Adaptación Fisiológica , Adulto , Anciano , Presión Arterial , Velocidad del Flujo Sanguíneo , Femenino , Voluntarios Sanos , Frecuencia Cardíaca , Homeostasis , Humanos , Masculino , Persona de Mediana Edad , Postura , Posición de Pie , Factores de Tiempo , Adulto Joven
14.
Nutr Metab Cardiovasc Dis ; 31(4): 1081-1086, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33618921

RESUMEN

BACKGROUNDS AND AIMS: Hypertension is a risk factor for renal, cardiovascular and cerebrovascular diseases. It is responsible for a large proportion of overall morbidity and mortality every year. Hypertension-mediated organ damage is largely not reversible. For these reasons, prevention has primary importance: sensibilization of population on hypertension-related consequences is essential for therapeutic adherence and reduction of unhealthy lifestyle behaviour. This study aimed to evaluate awareness about hypertension among community pharmacies customers. METHODS AND RESULTS: A questionnaire about hypertension was collected by 2731 customers from 94 community pharmacies in North West Italy, during a hypertension screening program. Hypertension awareness was unsatisfactory in a large proportion of the sample, with only 15% of subjects having an overall good level of knowledge. Furthermore, lower awareness was associated to higher blood pressure values (132/79 ± 19/11 mmHg vs 128/78 ± 18/10 mmHg, p < 0.001) and subjects resulted hypertensive or uncontrolled despite antihypertensive therapy, presented worse questionnaire scores (4.7 ± 1.9 vs 4.9 ± 2.0, p = 0.03). CONCLUSION: Knowledge about hypertension is largely unsatisfactory among population. Community pharmacies may play as a setting for health education and hypertension screening.


Asunto(s)
Servicios Comunitarios de Farmacia , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud , Hipertensión , Adulto , Anciano , Antihipertensivos/uso terapéutico , Presión Arterial , Femenino , Estilo de Vida Saludable , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Hipertensión/terapia , Italia , Masculino , Persona de Mediana Edad , Servicios Preventivos de Salud , Medición de Riesgo , Factores de Riesgo , Conducta de Reducción del Riesgo , Encuestas y Cuestionarios
15.
Medicine (Baltimore) ; 100(3): e24359, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546071

RESUMEN

ABSTRACT: High polyunsaturated fatty acids (PUFAs) intake is recommended for primary and secondary prevention of cardiovascular disease (CVD). However, the association of PUFAs with blood pressure (BP) is still controversial. In the present study, two-sample Mendelian randomization (MR) analysis was performed to investigate the causal relationship of PUFAs with BP, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP).Genetic instruments and summary statistics for two-sample MR analysis were obtained from 3 large-scale genome-wide association studies (GWASs). Eight single nucleotide polymorphisms (SNPs) significantly (P < 5 × 10-8) related to 6 PUFAs were used as instrumental variables. Conventional inverse-variance weighted method was adopted to evaluate the causality of PUFAs with BP; the Weighted Median, MR-egger, and Leave-one-out method were used for sensitivity analyses.As a result, there was no evidence of a causal association between all PUFAs and SBP. In addition, arachidonic acid (AA, ß = -0.04, P < .001) and eicosapentaenoic acid (EPA, ß = -0.47, P = .02) were negatively associated with DBP, while linoleic acid (LA, ß = 0.03, P = .005) and α-linolenic acid (ALA, ß = 3.83, P < .001) were positively associated with DBP. There was no evidence of a causal relationship between either docosapentaenoic acid (DPA) or docosahexaenoic acid (DHA) with DBP.In conclusion, a genetic predisposition to plasma polyunsaturated fatty acid (PUFA) had a divergent effect on DBP, independent of SBP. It suggested that it is helpful for lower DBP level to supplemental intake of AA and EPA or promote the conversion of LA and ALA to AA and EPA respectively, which need to be further validated with randomized controlled studies.


Asunto(s)
Presión Arterial/fisiología , Ácidos Grasos Insaturados/análisis , Ácido Araquidónico/análisis , Ácido Araquidónico/sangre , Ácido Eicosapentaenoico/análisis , Ácido Eicosapentaenoico/sangre , Ácidos Grasos Insaturados/sangre , Femenino , Humanos , Masculino , Análisis de la Aleatorización Mendeliana , Factores de Riesgo
16.
Nutr. hosp ; 38(1): 139-145, ene.-feb. 2021. tab, graf
Artículo en Inglés | IBECS | ID: ibc-198850

RESUMEN

INTRODUCTION: fibromyalgia (FM) is a chronic rheumatic disorder that is related to high levels of cholesterol, high values of diastolic pressure, higher waist-to-hip-ratio (WHR), and higher body mass index. OBJECTIVES: the aim of this study was to evaluate the effects of Ganoderma lucidum (GL) and Ceratonia siliqua (CS) on blood parameters and anthropometrical measures in women with fibromyalgia. METHODS: a double-blind randomized pilot trial was carried out. One group took 6 g/day of micro-milled carpophore powder of GL for 6 weeks, while the second group took the same dose of CS flour. Fasting glucose, cholesterol, triglycerides levels, weight, fat mass, muscular mass, waisthip ratio, and blood pressure were assessed. RESULTS: our results did not show any statistically significant differences in any of the outcome measures, even if there was a CS tendency to reduce fasting glucose levels and increase WHR. CONCLUSIONS: our results did not support the utility of both GL and CS as nutritional supplements to control blood parameters and anthropometric measures as assessed in women with fibromyalgia. Due to the limitations of the research, additional studies will be necessary to confirm our findings


INTRODUCCIÓN: la fibromialgia (FM) es una afección reumática crónica que está relacionada con altos niveles de colesterol, altos valores de presión diastólica, una mayor relación cintura-cadera y un mayor índice de masa corporal. OBJETIVOS: el objetivo de este estudio fue evaluar los efectos de Ganoderma lucidum (GL) y Ceratonia siliqua (CS) sobre los parámetros sanguíneos y antropométricos de mujeres con fibromialgia. MÉTODOS: se realizó un ensayo piloto aleatorizado con doble ciego. Un grupo tomó 6 g/día de carpóforos micromolidos de GL durante 6 semanas, mientras que el segundo grupo tomó la misma dosis de harina de CS. Se evaluaron los niveles de glucosa, colesterol y triglicéridos, el peso, la masa grasa, la masa muscular, la relación cintura-cadera y la presión arterial. RESULTADOS: los resultados no han evidenciado ninguna diferencia estadísticamente significativa entre el GL y la CS en ninguna de las medidas analizadas, aunque hubo tendencia de la CS a reducir los niveles de glucosa y aumentar la relación cintura-cadera. CONCLUSIONES: los resultados obtenidos indican que la suplementación de la dieta con GL y CS no tiene efectos positivos sobre los parámetros sanguíneos y antropométricos analizados en las mujeres con fibromialgia. Debido a las limitaciones del estudio, será necesario confirmar estos datos con ulteriores investigaciones


Asunto(s)
Humanos , Femenino , Reishi , Fabaceae , Glucemia , Metabolismo de los Lípidos , Composición Corporal , Fibromialgia/diagnóstico , Fibromialgia/fisiopatología , Colesterol , Relación Cintura-Cadera , Índice de Masa Corporal , Método Doble Ciego , Presión Arterial , Antropometría
17.
J Anesth ; 35(2): 189-196, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33427971

RESUMEN

PURPOSE: Invasive arterial blood pressure (IAP) and noninvasive blood pressure (NIBP) measurements are both common methods. Recently, a new method of error grid analysis was proposed to compare blood pressure obtained using two measurement methods. This study aimed to compare IAP and NIBP measurements using the error grid analysis and investigate potential confounding factors affecting the discrepancies between IAP and NIBP. METHODS: Adult patients who underwent general anesthesia in the supine position with both IAP and NIBP measurements were retrospectively investigated. The error grid analyses were performed to compare IAP and NIBP. In the error grid analysis, the clinical relevance of the discrepancies between IAP and NIBP was evaluated and classified into five zones from no risk (A) to dangerous risk (E). RESULTS: Overall, data of 1934 IAP/NIBP measurement pairs from 100 patients were collected. The error grid analysis revealed that the proportions of zones A-E for systolic blood pressure were 96.4%, 3.5%, 0.05%, 0%, and 0%, respectively. In contrast, the proportions for mean blood pressure were 82.5%, 16.7%, 0.8%, 0%, and 0%, respectively. The multiple regression analysis revealed that continuous phenylephrine administration (p = 0.016) and age (p = 0.044) were the significant factors of an increased clinical risk of the differences in mean blood pressure. CONCLUSIONS: The error grid analysis indicated that the differences between IAP and NIBP for mean blood pressure were not clinically acceptable and had the risk of leading to unnecessary treatments. Continuous phenylephrine administration and age were the significant factors of an increased clinical risk of the discrepancies between IAP and NIBP.


Asunto(s)
Presión Arterial , Determinación de la Presión Sanguínea , Adulto , Presión Sanguínea , Humanos , Estudios Retrospectivos , Gestión de Riesgos
18.
Am J Physiol Regul Integr Comp Physiol ; 320(3): R297-R306, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33407017

RESUMEN

Recent evidence indicates a crucial role for G protein-coupled estrogen receptor 1 (GPER1) in the maintenance of cardiovascular and kidney health in females. The current study tested whether GPER1 activation ameliorates hypertension and kidney damage in female Dahl salt-sensitive (SS) rats fed a high-salt (HS) diet. Adult female rats were implanted with telemetry transmitters for monitoring blood pressure and osmotic minipumps releasing G1 (selective GPER1 agonist, 400 µg/kg/day ip) or vehicle. Two weeks after pump implantation, rats were shifted from a normal-salt (NS) diet (0.4% NaCl) to a matched HS diet (4.0% NaCl) for 2 wk. Twenty-four hour urine samples were collected during both diet periods and urinary markers of kidney injury were assessed. Histological assessment of kidney injury was conducted after the 2-wk HS diet period. Compared with values during the NS diet, 24-h mean arterial pressure markedly increased in response to HS, reaching similar values in vehicle-treated and G1-treated rats. HS also significantly increased urinary excretion of protein, albumin, nephrin (podocyte damage marker), and KIM-1 (proximal tubule injury marker) in vehicle-treated rats. Importantly, G1 treatment prevented the HS-induced proteinuria, albuminuria, and increase in KIM-1 excretion but not nephrinuria. Histological analysis revealed that HS-induced glomerular damage did not differ between groups. However, G1 treatment preserved proximal tubule brush-border integrity in HS-fed rats. Collectively, our data suggest that GPER1 activation protects against HS-induced proteinuria and albuminuria in female Dahl SS rats by preserving proximal tubule brush-border integrity in a blood pressure-independent manner.


Asunto(s)
Albuminuria/prevención & control , Ciclopentanos/farmacología , Enfermedades Renales/prevención & control , Glomérulos Renales/efectos de los fármacos , Túbulos Renales Proximales/efectos de los fármacos , Quinolinas/farmacología , Receptores Acoplados a Proteínas G/agonistas , Albuminuria/etiología , Albuminuria/metabolismo , Albuminuria/patología , Animales , Presión Arterial , Moléculas de Adhesión Celular/metabolismo , Modelos Animales de Enfermedad , Femenino , Hipertensión/etiología , Hipertensión/fisiopatología , Enfermedades Renales/etiología , Enfermedades Renales/metabolismo , Enfermedades Renales/patología , Glomérulos Renales/metabolismo , Glomérulos Renales/patología , Túbulos Renales Proximales/metabolismo , Túbulos Renales Proximales/patología , Ratas Endogámicas Dahl , Receptores Acoplados a Proteínas G/metabolismo , Transducción de Señal , Cloruro de Sodio Dietético
19.
Am J Physiol Heart Circ Physiol ; 320(3): H1055-H1065, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33449849

RESUMEN

Pannexin 1 (Panx1) channels export ATP and may contribute to increased concentration of the vasodilator ATP in plasma during hypoxia in vivo. We hypothesized that Panx1 channels and associated ATP export contribute to hypoxic vasodilation, a mechanism that facilitates the matching of oxygen delivery to metabolic demand of tissue. Male and female mice devoid of Panx1 (Panx1-/-) and wild-type controls (WT) were anesthetized, mechanically ventilated, and instrumented with a carotid artery catheter or femoral artery flow transducer for hemodynamic and plasma ATP monitoring during inhalation of 21% (normoxia) or 10% oxygen (hypoxia). ATP export from WT vs. Panx1-/-erythrocytes (RBC) was determined ex vivo via tonometer experimentation across progressive deoxygenation. Mean arterial pressure (MAP) was similar in Panx1-/- (n = 6) and WT (n = 6) mice in normoxia, but the decrease in MAP in hypoxia seen in WT was attenuated in Panx1-/- mice (-16 ± 9% vs. -2 ± 8%; P < 0.05). Hindlimb blood flow (HBF) was significantly lower in Panx1-/- (n = 6) vs. WT (n = 6) basally, and increased in WT but not Panx1-/- mice during hypoxia (8 ± 6% vs. -10 ± 13%; P < 0.05). Estimation of hindlimb vascular conductance using data from the MAP and HBF experiments showed an average response of 28% for WT vs. -9% for Panx1-/- mice. Mean venous plasma ATP during hypoxia was 57% lower in Panx1-/- (n = 6) vs. WT mice (n = 6; P < 0.05). Mean hypoxia-induced ATP export from RBCs from Panx1-/- mice (n = 8) was 82% lower than that from WT (n = 8; P < 0.05). Panx1 channels participate in hemodynamic responses consistent with hypoxic vasodilation by regulating hypoxia-sensitive extracellular ATP levels in blood.NEW & NOTEWORTHY Export of vasodilator ATP from red blood cells requires pannexin 1. Blood plasma ATP elevations in response to hypoxia in mice require pannexin 1. Hemodynamic responses to hypoxia are accompanied by increased plasma ATP in mice in vivo and require pannexin 1.


Asunto(s)
Adenosina Trifosfato/sangre , Conexinas/sangre , Eritrocitos/metabolismo , Hemodinámica , Miembro Posterior/irrigación sanguínea , Hipoxia/sangre , Proteínas del Tejido Nervioso/sangre , Oxígeno/sangre , Animales , Presión Arterial , Conexinas/deficiencia , Conexinas/genética , Modelos Animales de Enfermedad , Femenino , Frecuencia Cardíaca , Hiperemia/sangre , Hiperemia/genética , Hiperemia/fisiopatología , Hipotensión/sangre , Hipotensión/genética , Hipotensión/fisiopatología , Hipoxia/genética , Hipoxia/fisiopatología , Masculino , Ratones Endogámicos C57BL , Ratones Noqueados , Proteínas del Tejido Nervioso/deficiencia , Proteínas del Tejido Nervioso/genética , Flujo Sanguíneo Regional , Vasodilatación
20.
Am J Physiol Heart Circ Physiol ; 320(3): H1102-H1111, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33416460

RESUMEN

Residential proximity to greenness is associated with a lower risk of cardiovascular disease (CVD) and all-cause mortality. However, it is unclear whether the beneficial effects of greenness are linked to a reduction in the effects of ambient air pollutants. We measured arterial stiffness in 73 participants with moderate to high CVD risk. Average levels of ambient PM2.5 and ozone were calculated from local monitoring stations. Residential greenness was estimated using satellite-derived normalized difference vegetation index (NDVI) for a 200-m and 1-km radius around each participant's home. Participants were 51% female, average age of 52 yr, and 79% had diagnosed hypertension. In multiple linear regression models, residential NDVI was negatively associated with augmentation index (-3.8% per 0.1 NDVI). Ambient levels of PM2.5 [per interquartile range (IQR) of 6.9 µg/m3] were positively associated with augmentation pressure (3.1 mmHg), pulse pressure (5.9 mmHg), and aortic systolic pressure (8.1 mmHg). Ozone (per IQR of 0.03 ppm) was positively associated with augmentation index (5.5%), augmentation pressure (3.1 mmHg), and aortic systolic pressure (10 mmHg). In areas of low greenness, both PM2.5 and ozone were positively associated with pulse pressure. Additionally, ozone was positively associated with augmentation pressure and systolic blood pressure. However, in areas of high greenness, there was no significant association between indices of arterial stiffness with either PM2.5 or ozone. Residential proximity to greenness is associated with lower values of arterial stiffness. Residential greenness may mitigate the adverse effects of PM2.5 and ozone on arterial stiffness.NEW & NOTEWORTHY Previous studies have linked proximity to green spaces with lower cardiovascular disease risk. However, the mechanisms underlying the salutary effects of green areas are not known. In our study of participants at risk of cardiovascular disease, we found that arterial stiffness was positively associated with short-term exposure to PM2.5, PM10, and ozone and inversely associated with greenness. The association between pollution and arterial stiffness was attenuated in areas of high greenness, suggesting that living green neighborhoods can lessen the adverse cardiovascular effects of air pollution.


Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Enfermedades Cardiovasculares/prevención & control , Exposición a Riesgos Ambientales/efectos adversos , Hemodinámica , Salud Urbana , Urbanización , Rigidez Vascular , Adulto , Anciano , Anciano de 80 o más Años , Presión Arterial , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Planificación de Ciudades , Femenino , Humanos , Kentucky , Masculino , Persona de Mediana Edad , Ozono/efectos adversos , Material Particulado/efectos adversos , Factores Protectores , Características de la Residencia , Medición de Riesgo , Factores de Riesgo , Adulto Joven
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