Pharmacologic reduction of sympathetic drive increases platelet alpha‐2–receptor number

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109920/1/cptclpt1985217.pd

The importance of hemodynamic considerations in essential hypertension

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Antihypertensive therapy consistently reduces complications from stroke and congestive heart failure, whereas benefits from the treatment of ischemic heart disease events are variable. Several plausible explanations, including hemodynamic hypotheses, have been put forth to account for the failure of treatment to more favorably influence mortality from ischemic heart disease. The effect of hypertension on coronary heart disease is probably much more complex than a simple elevation of arterial pressure. Some of these complexities include the potential separate risks of high total peripheral resistance, high cardiac output, increased myocardial power that reflects pressure times flow, and several structural and functional vascular changes. These factors may act in concert to unfavorably alter the balance between myocardial oxygen supply and demand. Several of these factors will be highlighted in an attempt to offer alternative or adjunctive pathophysiologic examinations for the high-risk subgroups of obesity and the failure of antihypertensive therapy to normalize the rate of coronary heart disease events.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27205/1/0000209.pd

Rétroaction multisources à la suite d’une simulation en réanimation : une étude qualitative

Background: The direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum. Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method. Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes. Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.Contexte : Le contexte imprévisible et contraignant au niveau du temps lors de l’observation directe et de la rétroaction associée sur les compétences en réanimation des apprenants constituent un défi pour un médecin superviseur. La rétroaction multisources (RMS) peut être un moyen de relever ce défi et d'améliorer la qualité des rétroactions fournies aux apprenants. Nous visons à décrire les similitudes et les différences quant à la démarche évaluative auprès de médecins traitants, d’infirmières cliniciennes et de pairs résidents dans le cadre d'un cours de réanimation offert par simulation. Méthodes : Nous avons réalisé une analyse de contenu à partir des rétroactions narratives offertes aux résidents en première année de formation postdoctorale dans deux universités canadiennes dans le cadre d’un cours de réanimation offert par simulation. En plus de l’auto-évaluation, la rétroaction comportait un score de confiance et des commentaires narratifs de la part de médecins superviseurs, d’infirmières cliniciennes et des pairs. Les commentaires ont été transcrits et analysés par thèmes en appliquant la méthode générale de comparaison constante. Résultats : Un consentement pour participer à l’étude a été obtenu auprès des 87 résidents (100 %) qui ont suivi le cours en 2017-2018. Nous avons analysé un total de 223 rétroactions. Quatre thèmes ont émergé à partir des données narratives soit : 1) la communication, 2) le leadership, 3) le comportement, et 4) l’expertise médicale. Alors que les infirmières ont ciblé leurs commentaires sur les soins centrés sur le patient et la communication, les médecins superviseurs ont les ont ciblés sur l’expertise médicale. Les commentaires des pairs étaient les plus positifs. Les auto-évaluations comportaient des commentaires sur chacun des quatre thèmes. Conclusions : Dans le contexte d’un cours de réanimation offert par simulation, la RMS a permis aux apprenants d’obtenir des évaluations narratives selon différentes perspectives. Permettant ainsi une approche plus holistique de rétroaction sur les habiletés en réanimation dans le cadre d’un programme d’évaluation axé sur les compétences

Sensitization of human α 1 ‐ and α 2 ‐adrenergic venous responses by guanadrel sulfate

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109986/1/cptclpt1990190.pd

Trends in Prehypertension and Hypertension Risk Factors in US Adults: 1999-2012.

Prehypertension is associated with increased risk for hypertension and cardiovascular disease. Data are limited on the temporal changes in the prevalence of prehypertension and risk factors for hypertension and cardiovascular disease among US adults with prehypertension. We analyzed data from 30 958 US adults ≥20 years of age who participated in the National Health and Nutrition Examination Surveys between 1999 and 2012. Using the mean of 3 blood pressure (BP) measurements from a study examination, prehypertension was defined as systolic BP of 120 to 139 mm Hg and diastolic BP <90 mm Hg or diastolic BP of 80 to 89 mm Hg and systolic BP <140 mm Hg among participants not taking antihypertensive medication. Between 1999-2000 and 2011-2012, the percentage of US adults with prehypertension decreased from 31.2% to 28.2% (P trend=0.007). During this time period, the prevalence of several risk factors for cardiovascular disease and incident hypertension increased among US adults with prehypertension, including prediabetes (9.6% to 21.6%), diabetes mellitus (6.0% to 8.5%), overweight (33.5% to 37.3%), and obesity (30.6% to 35.2%). There was a nonstatistically significant increase in no weekly leisure-time physical activity (40.0% to 43.9%). Also, the prevalence of adhering to the Dietary Approaches to Stop Hypertension eating pattern decreased (18.4% to 11.9%). In contrast, there was a nonstatistically significant decline in current smoking (25.9% to 23.2%). In conclusion, the prevalence of prehypertension has decreased modestly since 1999-2000. Population-level approaches directed at adults with prehypertension are needed to improve risk factors to prevent hypertension and cardiovascular disease

Comparative effects of overweight on cardiovascular risk in younger versus older men

The relation of age and body mass index (BMI) to atherosclerosis risk factors was examined in 357 men. Older (>=45 years) men had higher (p 2) increased risk factors more in men younger than 45 years (n = 187). In younger men, those with higher BMIs had a greater prevalence, respectively, of blood pressure 140/90 mm Hg (35.2 vs 11.2%, p 110 [mu]U/ml (28.2 vs 9.5%, p < 0.001). In contrast, among older men, the prevalence of elevated blood pressure, cholesterol, triglycerides and glucose values was not significantly greater in the subgroup with high BMI. However, elevations of fasting (19.6 vs 6.4%, p < 0.05) and 1-hour insulin (29.3 vs 11.5%, p < 0.01) values were more common among older men with higher BMIs. Data indicate that older men have greater values for several cardiovascular risk factors than do younger men. Overweight increases the prevalence of cardiovascular risk factors more in younger men.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29483/1/0000569.pd

The impact of metabolic syndrome on metabolic, pro-inflammatory and prothrombotic markers according to the presence of high blood pressure criterion

OBJECTIVES: We explored whether high blood pressure is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome. METHODS: We evaluated 135 consecutive overweight/obese patients. From this group, we selected 75 patients who were not under the regular use of medications for metabolic syndrome as defined by the current Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults criteria. The patients were divided into metabolic syndrome with and without high blood pressure criteria (≥130/≥85 mmHg). RESULTS: Compared to the 45 metabolic syndrome patients without high blood pressure, the 30 patients with metabolic syndrome and high blood pressure had significantly higher glucose, insulin, homeostasis model assessment insulin resistance index, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, uric acid and creatinine values; in contrast, these patients had significantly lower high-density lipoprotein-cholesterol values. Metabolic syndrome patients with high blood pressure also had significantly higher levels of retinol-binding protein 4, plasminogen activator inhibitor 1, interleukin 6 and monocyte chemoattractant protein 1 and lower levels of adiponectin. Moreover, patients with metabolic syndrome and high blood pressure had increased surrogate markers of sympathetic activity and decreased baroreflex sensitivity. Logistic regression analysis showed that high-density lipoprotein, retinol-binding protein 4 and plasminogen activator inhibitor-1 levels were independently associated with metabolic syndrome patients with high blood pressure. There is a strong trend for an independent association between metabolic syndrome patients with high blood pressure and glucose levels. CONCLUSIONS: High blood pressure, which may be related to the autonomic dysfunction, is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome

Importance of overweight in studies of left ventricular hypertrophy and diastolic function in mild systemic hypertension

The relations of Metropolitan Life Insurance Co. Relative Weight values and blood pressure (BP) to minimal forearm vascular resistance, ventricular septal and posterior wall thickness, left ventricular (LV) mass index and cardiac diastolic function were assessed in 31 men, 37 +/- 2 (mean +/-standard error of the mean) years of age. Eighteen patients with untreated mild hypertension were compared with 13 normotensive control subjects of similar age and weight. The hypertensives had higher clinic (137 +/-3/96 +/- 2 vs 121 +/-4/81 +/- 3 mm Hg, p 2). Furthermore, diastolic peak filling rate, an index of LV diastolic function, was virtually identical in the 2 groups (2.71 +/- 0.14 vs 2.69 +/- 0.07 liters/s, difference not significant). Correlates of peak filling rate included relative weight (r = -0.62, p The results suggest that relative weight is an important determinant of diastolic function and LV dimensions. These findings highlight the importance of controlling for weight in comparative studies of cardiovascular structure and function.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27747/1/0000139.pd