Current Guidelines for Hypertension: Important Highlights for Clinical Practice

In 2007 the European Society of Hypertension, the American Heart Association and the International Society of Hypertension-World Health Organization published new guidelines for the management of hypertension. According to these new guidelines, drug treatment is recommended in all subjects with consistent elevation of blood pressure above 140 mmHg systolic and/or 90 mmHg diastolic. In high-risk subjects, treatment initiation is indicated in lower blood pressure levels (systolic above 130 mmHg and/or diastolic above 85 mmHg). The higher the blood pressure level the sooner the treatment is commenced, with emphasis being placed on the critical role of combination pharmacotherapy in order to achieve optimal blood pressure control.. The implementation of the new guidelines is expected to achieve more effective cardiovascular protection in hypertensive patients

2013 European Guidelines for Hypertension Management

In June 2013 the European Society of Hypertension (ESH) / European Society of Cardiology (ESC) published new guidelines for the management of hypertension. These are the first European Guidelines for hypertension developed by applying a strict “evidence-based” approach using a grading system for the level of evidence and the strength of recommendations. Several recommendations in the new guidelines deserve careful consideration because they change the way that hypertension is managed is routine clinical practice.

Quantifying Muscle Fatigue of the Low Back during Repetitive Load Lifting Using Lyapunov Analysis

Background: Occupational low back disorders are often associated with exposure to work-related physical risk factors such as muscle fatigue in the low back.Objective: The objective of this study was to investigate the possible relationship between the divergence of the kinematic trajectories of the low back system and the different stages of fatigue during the execution of a repetitive lifting task.Methods: The patterns of the low back system were recorded using markers on specific vertebras during the repetitive load lifting from the floor to a 0.75 m height table. The maximum Lyapunov exponent, λmax of the recorded patterns was calculated from the x and y coordinates of the lower back markers using the algorithm proposed by Wolf.Results: The results of the λmax values determined three different sections of muscle fatigue which were also in agreement with the Borg’s clinical scale of perceived fatigue results. The assessment of the λmax values between the three different sections showed a descriptive point where the muscle fatigue accumulation may have resulted in a change of the low back control.Conclusion: Lyapunov exponent methodology could be a reliable methodology for ergonomists to provide an index to design the work/rest ratio ergonomically

Positive linear regression between left ventricular contraction duration and plasma aldosterone levels in healthy anesthetized rabbits. A hypothesis generating relationship for a new action of aldostrerone

Introduction: Aldosterone (Aldo), besides its genomic renal and cardiac effects [cardiac fibrosis and left ventricular (LV) enlargement], elicits also various rapid nongenomically mediated effects such as increase of myocardial monophasic action potential duration within minutes after intravenous application.Methods: Investigating the effects of endogenous vasoactive substances on cardiovascular and hormonal parameters in 25 healthy anesthetized New Zealand White male rabbits, a serendipitous positive correlation between LV contraction duration and plasma Aldo levels came to our attention. From LV pressure (LVP) tracings (taken invasively), maximal and minimal change over time in LVP (LVmaxdp/dt and LVmindp/dt) and Δd (time interval between LVmaxdp/dt and LVmindp/dt = LV contraction duration) were estimated.Results: A positive linear regression was found between Aldo (measured by RIA) and Δd (Δd = 0.1126 + 0.00019, r = 0.47, p = 0.018). Stepwise regression analysis demonstrated that peripheral blood pressure and Aldo were the most important determinants of Δd and that the effect of Aldo was independent of confounding factors.Conclusion: Since electrical and mechanical events in cardiac muscle overlap in time, it may be speculated that the nongenomically-mediated increase in monophasic action potential duration by Aldo could result in increase of myocardial contraction duration, a hypothesis supported indirectly by the found regression

Cost and safety optimisation in 'Berlin' type retaining walls

Studies for earth retaining wall structures provide engineers with the values for the response of design characteristics which represents the stability and the required budget for the completion of a project. Fundamental theories guide engineers to combinations of design variables values. These values have a direct relation to the responses of the earth retaining wall structure. The requirement of this analysis is that there is no proven technique which ensures the best combination of design variables for the simultaneous optimisation of safety factor and overall cost of a project. This paper presents an integration of the desirability analysis which provides the multivariate optimisation with the performance of few experimental runs based on statistical tools and finite elements methodology. The methodology provides a 24% higher safety factor and 50% lower overall cost comparing to the results of an experienced foundation engineering company

Relationship of 24-hour ambulatory blood pressure and heart rate with markers of hepatic function in cirrhotic patients

<p>Abstract</p> <p>Background</p> <p>There is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease. This study investigated whether non-invasive 24-hour ambulatory blood pressure and heart rate are more closely associated with markers of liver disease severity than conventional office measurements.</p> <p>Methods</p> <p>Ambulatory patients with cirrhosis underwent office blood pressure and heart rate measurements, 24-hour ambulatory blood pressure monitoring and blood laboratory tests.</p> <p>Results</p> <p>Fifty-one patients (32 men, mean age 57.4 ± 11.3 years) completed the study. Twenty six patients had compensated liver cirrhosis (group A) and 25 patients had more advanced liver disease (group B). Group A and B patients differed significantly both in ambulatory asleep diastolic blood pressure (p < 0.05) and office diastolic blood pressure (p < 0.01), which were lower in more advanced liver disease. Office blood pressure and heart rate correlations were similar to or even stronger than ambulatory ones. Ambulatory blood pressure and heart rate awake-asleep variation (dipping) showed a relatively flat pattern as markers of liver dysfunction were deteriorating. The strongest correlations were found with both ambulatory and office heart rate, which increased as indicators of severity of liver disease were worsening.</p> <p>Conclusions</p> <p>Heart rate seems to be a more reliable marker of ongoing liver dysfunction than blood pressure. Evaluation of blood pressure and heart rate with 24-hour ambulatory measurement does not seem to offer more information than conventional office measurements.</p

A dynamical systems investigation of lower extremity coordination during running over obstacles

Objective. To investigate intralimb coordination during running over a level surface and over obstacles of three different heights. Design. The phasing relationships between the foot and leg motions in the frontal plane, and the shank and thigh motions in the sagittal plane were used to compare patterns of coordination. Background. The coordinated actions of lower extremity segments are necessary to absorb the impact forces generated during running. The behavioral patterns of these segments can be studied under changing task demands using analysis techniques from the Dynamical Systems Theory. Methods. Ten subjects ran at their self-selected pace under four conditions: over a level surface and over obstacles of different heights (5%, 10%, 15% of their standing height). A force platform was used to record impact forces during landing after obstacle clearance, while kinematics were collected using a two-camera system. Results. The increases in obstacle height resulted in significant changes in impact forces (34% increase between the two extreme conditions) and more in-phase relationships between the segments during early stance. No changes were observed in the variability of the phasing relationships. Conclusions. The coordination changes observed might be compensatory strategies aimed to reduce forces and potential injury. However, since the impact forces still increased significantly, it is also possible that the observed changes might be at-risk movement patterns predisposing runners to injury. Relevance Tools from the Dynamical Systems Theory, such as intralimb coordination, can be used as a way to evaluate running mechanics so that comparisons can be made to various patient populations in subsequent studies. This approach might be a viable alternative to examine questions in therapeutics

Psychosocial and cognitive function in children with nephrotic syndrome: association with disease and treatment variables

BackgroundTo investigate possible differences in emotional/behavioral problems and cognitive function in children with nephrotic syndrome compared to healthy controls and to examine the effect of disease-specific and steroid treatment-specific characteristics on the abovementioned variables. MethodsForty-one patients with nephrotic syndrome (23 boys, age range: 4.4-15.2 years) and 42 sex- and age-matched healthy control subjects (20 boys, age range: 4.1-13.4 years) were enrolled in the study. Disease (severity, age of diagnosis, duration) and steroid treatment (total duration, present methylprednisolone dose and duration of present dose) data were collected. In order to assess children’s emotional/behavioral problems, the Child Behavior Checklist was administered. The Wechsler Intelligence Scale for Children – Third Edition was administered to assess Full-Scale, Verbal, and Performance intelligence quotient (IQ) scores. ResultsThe patients presented with more internalizing problems (P = 0.015), including withdrawal (P = 0.012) and somatic complaints (P = 0 .011), but not more anxiety/depression or externalizing problems. A significant association was found between severity of disease and somatic complaints (P = 0.017) as well as externalizing problems (P = 0.030). Years of illness were significantly more in those presenting with abnormal anxiety/depression (P = 0.011). Duration of steroid medication was significantly higher among those presenting with abnormal anxiety/depression (P = 0.011) and externalizing problems (P = 0.039). IQ was not associated significantly with disease or steroid treatment variables. ConclusionsPsychosocial factors and outcomes may be important correlates of children’s nephrotic syndrome and potential targets of thorough assessment and treatment

Nonvalidated home blood pressure devices dominate the online marketplace in Australia: major implications for cardiovascular risk management

Self-home blood pressure (BP) monitoring is recommended to guide clinical decisions on hypertension and is used worldwide for cardiovascular risk management. People usually make their own decisions when purchasing BP devices, which can be made online. If patients purchase nonvalidated devices (those not proven accurate according to internationally accepted standards), hypertension management may be based on inaccurate readings resulting in under- or over-diagnosis or treatment. This study aimed to evaluate the number, type, percentage validated, and cost of home BP devices available online. A search of online businesses selling devices for home BP monitoring was conducted. Multinational companies make worldwide deliveries, so searches were restricted to BP devices available for one nation (Australia) as an example of device availability through the global online marketplace. Validation status of BP devices was determined according to established protocols. Fifty nine online businesses, selling 972 unique BP devices were identified. These included 278 upper-arm cuff devices (18.3% validated), 162 wrist-cuff devices (8.0% validated), and 532 wrist-band wearables (0% validated). Most BP devices (92.4%) were stocked by international e-commerce businesses (eg, eBay, Amazon), but only 5.5% were validated. Validated cuff BP devices were more expensive than nonvalidated devices: median (interquartile range) of 101.1 (75.0–151.5) versus 67.4 (30.4–112.8) Australian Dollars. Nonvalidated BP devices dominate the online marketplace and are sold at lower cost than validated ones, which is a major barrier to accurate home BP monitoring and cardiovascular risk management. Before purchasing a BP device, people should check it has been validated at https://www.stridebp.org

Global Blood Pressure Screening During the Covid-19 Pandemic: Results From the May Measurement Month 2021 Campaign

BACKGROUND: Raised blood pressure (BP) remains the biggest risk factor contributing to the global burden of disease and mortality, despite the COVID-19 pandemic. May Measurement Month (MMM), an annual global screening campaign aims to highlight the importance of BP measurement by evaluating global awareness, treatment and control rates among adults with hypertension. In 2021, we assessed the global burden of these rates during the COVID-19 pandemic. METHODS: Screening sites were set up in 54 countries between May and November 2021 and screenees were recruited by convenience sampling. Three sitting BPs were measured, and a questionnaire completed including demographic, lifestyle and clinical data. Hypertension was defined as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. Multiple imputation was used to impute the average BP when readings were missing. RESULTS: Of the 642 057 screenees, 225 882 (35.2%) were classified as hypertensive, of whom 56.8% were aware, and 50.3% were on antihypertensive medication. Of those on treatment, 53.9% had controlled BP (\u3c140/90 mmHg). Awareness, treatment and control rates were lower than those reported in MMM campaigns before the COVID-19 pandemic. Minimal changes were apparent among those testing positive for, or being vaccinated against COVID-19. Of those on antihypertensive medication, 94.7% reported no change in their treatment because of the COVID-19 pandemic. CONCLUSION: The high yield of untreated or inadequately treated hypertension in MMM 2021 confirms the need for systematic BP screening where it does not currently exist