Relationship Between Blood Pressure and Heart Rate Circadian Rhythms in Normotensive and Hypertensive Subjects

This paper focuses on the relationship between blood pressure (BP) and heart rate (HR) during 24 hours in 423 normotensive (NO) and 205 hypertensive (HE) subjects. Although considerable knowledge has been gained about BP and HR signals, their relationship over 24 hours has never been completely described. By using a Holter Blood Pressure Monitor, it was possible to record BP and HR for 24 hours. Systolic, Diastolic and Mean BP in both NO and HE subjects showed four different time intervals presenting well-defined trends The results demonstrated that changes in HR present closely parallel changes in BP with a marked reduction of both signals during nocturnal rest. On the contrary, in the period between 15:30 and 19:30, HR and BP showed an inverse relationship with decreasing heart rate and increasing blood pressure

Managing patients taking novel oral anticoagulants (NOAs) in dentistry: A discussion paper on clinical implications

Background The aim of this paper is to contribute to the discussion on how to approach patients taking new orally administered anticoagulants (NOAs) dabigatran etexilate (a direct thrombin inhibitor), rivaroxaban and apixaban (factor Xa inhibitors), before, during and after dental treatment in light of the more recent knowledges. Discussion In dentistry and oral surgery, the major concerns in treatment of patients taking direct thrombin inhibitors and factor Xa inhibitors is the risk of haemorrhage and the absence of a specific reversal agent. The degree of renal function, the complexity of the surgical procedure and the patient\u2019s risk of bleeding due to other concomitant causes, are the most important factors to consider during surgical dental treatment of patients taking NOAs. For patients requiring simple dental extraction or minor oral surgery procedures, interruption of NOA is not generally necessary, while an higher control of bleeding and discontinuation of the drug (at least 24 h) should be requested before invasive surgical procedures, depending on renal functionality. Summary The clinician has to consider that the number of patients taking NOAs is rapidly increasing. Since available data are not sufficient to establish an evidence-based dental management, the dentist must use caution and attention when treating patients taking dabigatran, rivaroxaban and apixaban

Influence of hypertension and other risk factors on the onset of sublingual varices

Background: Sublingual varices (SV) are dilatations of tortuous veins that increased with age. Previous studies showed that this pathology could be correlated to some risk factors such as hypertension, age, gender and diabetes mellitus. In this study we evaluated, on a large number of subjects, the relationship between SV and different grades of hypertension as well as some risk factors extending the analysis to new risk factors such as dyslipidemia, obesity and antihypertensive therapy, modelling a possible dependence of SV on all these factors.Methods: In the study 1008 subjects, 284 with and 724 without SV, were examined. The blood pressure was measured in office condition and, to exclude subjects with white coat syndrome or masked hypertension, also using a 24 h Holter pressure monitor. Hypertensive subjects were divided in resistant, drugs controlled (compensated) and patients with prior unknown hypertension (new diagnosed) groups. The presence or absence of SV as well as of the risk factors was assessed clinically. We tested the influence of age on the presence of SV by using the chi-square test and the relation between each risk factor and SV by the Cochran-Mantel-Haenszel test. Finally, we carried out a multivariate regression tree analysis in order to predict the presence of SV.Results: We confirmed the influence of age on SV and found a significant relationship between SV and both the compensated and resistant hypertension grades. We highlighted a relationship between SV and dyslipidemia in subjects with new diagnosed hypertension, and between SV and smoking in subjects with compensated hypertension grade. The regression tree showed a classification accuracy of about 75% using as variables hypertension grades, age and antihypertensive treatment.Conclusions: We confirmed the SV dependence on age, resistant hypertension and smoking, highlighting a new association with dyslipidemia in new diagnosed hypertensive subjects and new relations depending on the hypertension grades. Thus, the SV inspection could be used to suggest a lipidologist as well as a hypertension specialist visit for a pharmacological and pressure check particularly in subjects presenting SV and dyslipidemia. However, further parameters are to be considered to improve the sensitivity of the prognostic tree model

Validation of the italian translation of the affective neuroscience personality scales

Summary.-The theoretical perspective on affective neuroscience advanced by Panksepp, identified six basic innate affective systems: the SEEK, FEAR, ANGER, SADNESS, PLAY, and CARE systems. (3) It has been proposed that the fundamental elements of human personality and its variants may be based on the different expressions of these basic emotional systems and their combinations. A self-report inventory, the Affective Neuroscience Personality Scales (ANPS), has been devised with the aim of studying and evaluating personality from this perspective. This study reports data on the initial validation of ANPS Italian translation on a sample of 418 adult participants. Descriptive statistics for each scale were calculated, assessing also their internal consistency, as a measure of reliability and factorial validity. Acceptable internal consistency was found in all but one scale (SADNESS), and a second-order factor analysis identified a more general affective feature of personality hinging on relational characteristics, independent of the dimensions of general positive and negative affect

Ambulatory blood pressure monitoring versus office blood pressure measurement: Are there sex differences?

The accurate measurement of blood pressure (BP) is an important prerequisite for the reliable diagnosis and efficient management of hypertension and other medical conditions. Office Blood Pressure Measurement (OBP) is a technique performed in-office with the sphygmomanometer, while Ambulatory Blood Pressure Monitoring (ABPM) is a technique that measures blood pressure during 24h. The BP fluctuations also depend on other factors such as physical activity, temperature, mood, age, sex, any pathologies, a hormonal activity that may intrinsically influence the differences between OBP and ABPM. The aim of this study is to examine the possible influence of sex on the discrepancies between OBP and ABPM in 872 subjects with known or suspected hypertension. A significant correlation was observed between OBP and ABPM mean values calculated during the day, night and 24h (ABPMday, ABPMnight, ABPM24h) in both groups (p<0.0001). The main finding of this study is that no difference between sexes was observed in the relation between OBP and mean ABMP values except between systolic OBP and systolic ABPM during the night. In addition, this study showed a moderate correlation between BPs obtained with the two approaches with a great dispersion around the regression line which suggests that the two approaches cannot be used interchangeably

Circadian blood pressure pattern in positive drug responsive hypertensives, hypertensives and normotensives, and gender influences.

Circadian rhythm is a characteristic behavior of human physiology and it is known that, in healthy subjects, blood pressure (BP) increases during the day and decreases during the night, as a result of sleep-wake changes. Some studies highlighted that female had lower office BP values than male and this should be considered for define the threshold of hypertension. With the introduction of the Holter Blood Pressure Measurement, it has been possible to record the blood pressure for 24 hours. This innovation allowed to analyze the circadian Blood pressure pattern (CBPP) and some studies identified the differences between normotensives and hypertensives subjects. In this study, we examined the circadian pattern in positive drug responsive hypertensive patients in respect of negative ones and of normotensive subjects and the differences due to gender. The results demonstrated that positive drug responsive hypertensive patients had the same circadian blood pressure pattern as normotensives. Moreover, the difference in circadian blood pressure values between male and female was about 2-4 mmHg