253,146 research outputs found

    Hypertension in the elderly. Which are the blood pressure threshold values?

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    Managing blood pressure is often difficult in the elderly, not only because of comorbidities, but also due to vascular remodelling and the changes in the renal and endocrine physiology. The structural and functional arterial modifications lead to impaired vessel’s compliance and increased systolic blood pressure (SBP), often with reduction of diastolic blood pressure (DBP)

    Methods of Blood Pressure Measurement in the ICU*

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    OBJECTIVE:: Minimal clinical research has investigated the significance of different blood pressure monitoring techniques in the ICU and whether systolic vs. mean blood pressures should be targeted in therapeutic protocols and in defining clinical study cohorts. The objectives of this study are to compare real-world invasive arterial blood pressure with noninvasive blood pressure, and to determine if differences between the two techniques have clinical implications. DESIGN:: We conducted a retrospective study comparing invasive arterial blood pressure and noninvasive blood pressure measurements using a large ICU database. We performed pairwise comparison between concurrent measures of invasive arterial blood pressure and noninvasive blood pressure. We studied the association of systolic and mean invasive arterial blood pressure and noninvasive blood pressure with acute kidney injury, and with ICU mortality. SETTING:: Adult intensive care units at a tertiary care hospital. PATIENTS:: Adult patients admitted to intensive care units between 2001 and 2007. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Pairwise analysis of 27,022 simultaneously measured invasive arterial blood pressure/noninvasive blood pressure pairs indicated that noninvasive blood pressure overestimated systolic invasive arterial blood pressure during hypotension. Analysis of acute kidney injury and ICU mortality involved 1,633 and 4,957 patients, respectively. Our results indicated that hypotensive systolic noninvasive blood pressure readings were associated with a higher acute kidney injury prevalence (p = 0.008) and ICU mortality (p < 0.001) than systolic invasive arterial blood pressure in the same range (≤70 mm Hg). Noninvasive blood pressure and invasive arterial blood pressure mean arterial pressures showed better agreement; acute kidney injury prevalence (p = 0.28) and ICU mortality (p = 0.76) associated with hypotensive mean arterial pressure readings (≤60 mm Hg) were independent of measurement technique. CONCLUSIONS:: Clinically significant discrepancies exist between invasive and noninvasive systolic blood pressure measurements during hypotension. Mean blood pressure from both techniques may be interpreted in a consistent manner in assessing patients' prognosis. Our results suggest that mean rather than systolic blood pressure is the pre ferred metric in the ICU to guide therapy.National Institute of Biomedical Imaging and Bioengineering (U.S.) (Grant R01EB001659

    Interleukin-1 regulates multiple atherogenic mechanisms in response to fat feeding

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    Background: Atherosclerosis is an inflammatory process that develops in individuals with known risk factors that include hypertension and hyperlipidaemia, influenced by diet. However, the interplay between diet, inflammatory mechanisms and vascular risk factors requires further research. We hypothesised that interleukin-1 (IL-1) signaling in the vessel wall would raise arterial blood pressure and promote atheroma. Methodology/Principal Findings: Apoe(-/-) and Apoe(-/-)/IL-1R1(-/-) mice were fed high fat diets for 8 weeks, and their blood pressure and atherosclerosis development measured. Apoe(-/-)/IL-R1(-/-) mice had a reduced blood pressure and significantly less atheroma than Apoe(-/-) mice. Selective loss of IL-1 signaling in the vessel wall by bone marrow transplantation also reduced plaque burden (p<0.05). This was associated with an IL-1 mediated loss of endothelium-dependent relaxation and an increase in vessel wall Nox 4. Inhibition of IL-1 restored endothelium-dependent vasodilatation and reduced levels of arterial oxidative stress. Conclusions/Significance: The IL-1 cytokine system links atherogenic environmental stimuli with arterial inflammation, oxidative stress, increased blood pressure and atherosclerosis. This is the first demonstration that inhibition of a single cytokine can block the rise in blood pressure in response to an environmental stimulus. IL-1 inhibition may have profound beneficial effects on atherogenesis in man

    The baroreceptor reflex emanating from the carotid sinus and common carotid artery of the sheep : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Physiology at Massey University

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    The aim of this project was to improve understanding of the role of the common carotid arterial baroreceptor mechanism in controlling peripheral blood pressure in the sheep. The responses to clamping of one or both common carotid arteries were examined under chloralose anaesthesia with the vagus nerves intact and after they had been sectioned. Unilateral clamping of a common carotid artery immediately reduced the mean blood pressure and pulse pressure in the ipsilateral carotid sinus and raised the peripheral mean blood pressure and pulse pressure. The failure of sinus pressures to show any recovery in the clamped vessel suggests that there was minimal flow through anastomoses into the occluded artery. Bilateral clamping of the common carotid arteries reduced the mean blood pressure within both carotid sinuses to a lower level than unilateral clamping, but raised the peripheral mean blood pressure and pulse pressures to a greater degree. This pressor response was interpreted as being due to the larger population of baroreceptors detecting the low carotid sinus pressures during bilateral occlusion. To test whether there was a tendency for common carotid arterial clamping at different levels to produce different reflex responses of peripheral blood pressure, the carotid arteries were occluded at the caudal, mid- and cranial cervical levels. There was a trend towards a greater rise in peripheral mean blood pressure during caudal clamping compared with cranial clamping. This too may be due to a larger population of baroreceptors detecting the low carotid sinus and common carotid arterial pressures and suggests baroreceptors are distributed in regions of the common carotid artery caudal to the sinus. In one third of the sheep, clamping the left common carotid artery caused a greater rise in peripheral mean blood pressure than clampinq of the right vessel. Possible reasons for this include the presence of a larger population of baroreceptors in the left artery than the right and differences in the sensitivity of receptors in the two vessels. The variability of responses to clamping and vagotomy was emphasised by the responses of two sheep in which section of the right vagus nerve totally abolished the reflex response to right common carotid arterial occlusion. Since in these animals neither the size of the baroreceptor population nor its sensitivity appeared to be responsible, a conclusion consistent with the evidence is that the baroreceptors in the vessel were innervated by the recurrent laryngeal or vagus nerves. Overall in the experiments, bilateral vagotomy enhanced the peripheral mean blood pressure and pulse pressure responses to clamping the common carotid arteries in keeping with a loss of the input from the aortic arch and cardio-pulmonary baroreceptors. Histological evidence of the distribution of sensory areas along the common carotid artery was obtained for three discrete areas (A, B and C). It is suggested that baroreceptors located in the common carotid artery may be less sensitive than those in the carotid sinus region because of the low elastin content and lack of tunica medial thinning at the sites of carotid arterial baroreceptor innervation

    Functional optimization of the arterial network

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    We build an evolutionary scenario that explains how some crucial physiological constraints in the arterial network of mammals - i.e. hematocrit, vessels diameters and arterial pressure drops - could have been selected by evolution. We propose that the arterial network evolved while being constrained by its function as an organ. To support this hypothesis, we focus our study on one of the main function of blood network: oxygen supply to the organs. We consider an idealized organ with a given oxygen need and we optimize blood network geometry and hematocrit with the constraint that it must fulfill the organ oxygen need. Our model accounts for the non-Newtonian behavior of blood, its maintenance cost and F\aa hr\ae us effects (decrease in average concentration of red blood cells as the vessel diameters decrease). We show that the mean shear rates (relative velocities of fluid layers) in the tree vessels follow a scaling law related to the multi-scale property of the tree network, and we show that this scaling law drives the behavior of the optimal hematocrit in the tree. We apply our scenario to physiological data and reach results fully compatible with the physiology: we found an optimal hematocrit of 0.43 and an optimal ratio for diameter decrease of about 0.79. Moreover our results show that pressure drops in the arterial network should be regulated in order for oxygen supply to remain optimal, suggesting that the amplitude of the arterial pressure drop may have co-evolved with oxygen needs.Comment: Shorter version, misspelling correctio

    On semi-Classical Questions Related to Signal Analysis

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    This study explores the reconstruction of a signal using spectral quantities associated with some self-adjoint realization of an h-dependent Schr\"odinger operator when the parameter h tends to 0. Theoretical results in semi-classical analysis are proved. Some numerical results are also presented. We first consider as a toy model the sech^2 function. Then we study a real signal given by arterial blood pressure measurements. This approach seems to be very promising in signal analysis. Indeed it provides new spectral quantities that can give relevant information on some signals as it is the case for arterial blood pressure signal

    Observation of arterial blood pressure of the primate AAP-Bio-A-1 Quarterly progress report, 10 Jul. - 9 Oct. 1968

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    Circuits, components, and implant site evaluations for arterial blood pressure analyses on primate
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