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Contour of Pressure and Flow Waves in Arteries
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
These issues are relevant to claims on or implications of “benefits beyond systolic blood pressure lowering” in the HOPE, LIFE, ACCOMPLISH and other clinical trials (Yusuf et al., 2000; Brunner and Gavras, 2002; Dahlöf et al., 2002; Hirata et al., 2005b; Jamerson et al., 2008; Matsui et al., 2009) and have generated brisk correspondence (O'Rourke, 2000b; Mourad et al., 2002; Nichols et al., 2002; Sleight and Yusuf, 2002; Griffin et al., 2003; Kurtz, 2003) (see also Chapter 22). Most recent publications now accept this phenomenon as fact (Borlaug et al., 2014; Redfield et al., 2015; Townsend et al., 2015, 2016; O'Rourke et al., 2016, 2018; Williams et al., 2018; Braunwald, 2015), and it has appeared as a figure in Hurst’s textbook The Heart since 2008. It explains the phenomenon of “Spurious Systolic Hypertension in Youth” (O'Rourke et al., 2000, 2015; Mancia et al., 2013; Palatini et al., 2018) and emerging revised views on apparent elevation of systolic pressure in children and young adults (Adji and O'Rourke, 2021).
A patient with high blood pressure
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
ISH is currently defined as a systolic blood pressure (SBP) <140 mmHg, with a diastolic blood pressure (DBP) <90 mmHg. It was once thought to be relatively benign. However it is now recognised that systolic hypertension, even without diastolic hypertension, is a significant risk factor which, if left untreated, increases morbidity and mortality. It is the most common and the most difficult type of hypertension to treat. The prevalence of ISH increases with age, occurring in 50% of those aged 60 years and over, rising to 75% in those 75 years and over.
Cardiovascular system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
8.6. Causes of systolic hypertension in children includecoarctation of the aorta.complete heart block.acute urinary tract infection.acute glomerulonephritis.neuroblastoma.
Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy
Published in Annals of Medicine, 2023
Qi Guo, Hai-yan Li, Wei-dong Song, Ming Li, Xiao-ke Chen, Hui Liu, Hong-lin Peng, Hai-qiong Yu, Nian Liu, Yan-hong Li, Zhong-dong Lü, Li-hua Liang, Qing-zhou Zhao, Mei Jiang
There is increased recognition of substantial progress in mechanical ventilation. Moreover, higher prevalence of systolic hypertension and higher systolic arterial pressure are undoubted in recent years. As a result, patients with CAP might breathe less rapidly, and systolic arterial pressures of many patients might not drop to less than 90 mm Hg. Therefore, underestimation of mortality might be inevitable were the original cut-off values of severity scoring systems still applied. Consequently, it seems worthwhile to update the criteria thresholds of tachypnea and low blood pressure for pneumonia-specific scores that were proposed years ago, which might orchestrate improvements in predicting mortality and severity in patients with CAP and have implications for more accurate clinical triage decisions.
HLA-G 14 bp In/Del and +3142 C/G genotypes are differentially expressed between patients with grade IV gliomas and controls
Published in International Journal of Neuroscience, 2021
Kênia Cristina S.F. de Magalhães, Karla R. Silva, Nathália A. Gomes, Ibrahim Sadissou, Gérvasio T. Carvalho, Marcelo A. Buzellin, Luciene S. Tafuri, Cristiana B. Nunes, Maurício B. Nunes, Eduardo A. Donadi, Istéfani Luciene da Silva, Renata T. Simões
The sample comprised 65 patients with glioblastoma, of whom 30 (46%) were female and 35 (54%) male. In a total of 98 controls, 55 (56%) were female and 43 (44%) male. The most prevalent comorbidity in our cases was systolic hypertension (SAH) (47.2%) and the most common initial symptoms were headaches (58.5%) and convulsion, especially in grades I and II (33.3% and 50%, respectively). The mean age was 60 ± 1.07 years old in controls, 11.88 ± 1.55 years old in grade I, 38 ± 4.86 years old in grade II and 56.57 ± 1.63 years old in grade IV. A positive correlation was found between tumor grade and age (r = 0.5956; p < 0.001) suggesting that the older the patient is the higher is the grade lesion. Significant difference was found between the age in control and grade I (p < 0.001) and grade II (p = 0.0001) groups. This significance persisted when grade I and grade II groups (p = 0.0004) and the grade IV and grade I (p < 0.0001) and grade II (p = 0.0015) groups were compared. Thus, we decided to exclude the grade I and grade II groups from comparative analysis with controls to avoid age influence in the result. The complete clinicopathological findings of the samples are summarized in Table 1.
Single-pill combinations for hypertension: first line treatment for all?
Published in Current Medical Research and Opinion, 2019
Li Shao, Paul Chan, Brian Tomlinson, Yuzhen Zhang, Zhong-Min Liu
The 2013 ESH/ESC guidelines considered the combination of CCBs and diuretics as one of the five preferred combinations of anti-hypertensive treatments, based on studies such as the Felodipine Event Reduction (FEVER) study16. It has been suggested that, based on the principles of clinical pharmacology, the drugs in this combination may not have additive BP-lowering effects, as the mechanisms of BP reduction have some degree of overlap17. However, the 2018 ESC/ESH Guidelines recommend this combination for initial anti-hypertensive treatment in black patients, and it may be a good choice in other patients with low renin hypertension. Furthermore, both CCBs and diuretics have been recommended individually as preferred treatments for isolated systolic hypertension in the elderly and both drug groups have shown benefits in reduction of cardiovascular events in older patients. The first SPC of CCB and diuretic to become available was the FDC of indapamide sustained release (SR) 1.5 mg with amlodipine 5 mg, which is effective with once daily dosing18. In a study where this was administered to patients whose BP was previously uncontrolled on CCB monotherapy or untreated, the reduction from baseline in systolic BP after 45 days was 28.5 mm Hg (95% CI = 26.4–30.6) and diastolic BP decreased by 15.6 mm Hg (95% CI = 14.5–16.7)19. The treatment was safe and well tolerated.