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Lee SH, Kim YJ, Yu GN, Jeon JC, Kim WY. Pulse pressure during the initial resuscitative period in patients with septic shock treated with a protocol-driven resuscitation bundle therapy. Korean J Intern Med 2021; 36:924-931. [PMID: 32811131 PMCID: PMC8273825 DOI: 10.3904/kjim.2020.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. METHODS Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. RESULTS Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality. CONCLUSION PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.
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Affiliation(s)
- Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Na Yu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Cheon Jeon
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Won Young Kim, M.D. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3350 Fax: +82-2-3010-3360 E-mail:
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Analyzing Trio-Anthropometric Predictors of Hypertension: Determining the Susceptibility of Blood Pressure to Sexual Dimorphism in Body Stature. Int J Hypertens 2021; 2021:5129302. [PMID: 33532094 PMCID: PMC7837789 DOI: 10.1155/2021/5129302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/15/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Several studies had suggested that complex body stature could be a risk factor of hypertension. Objectives We aim to correlate body mass index (BMI), waist-hip ratio (WHR), and waist-height ratio (WHtR) of rural dwellers in Afikpo community, Ebonyi State, Nigeria, with blood pressure parameters. Furthermore, we aim to ascertain how each of the anthropometric variables affects blood pressure in men and women, respectively. Materials and Methods A sample of 400 (200 males and 200 females) adults aged 18–89 years were selected for the correlation cross-sectional study. Data for weight, height, waist, and hip circumferences were collected by means of anthropometric measurement protocol with the aid of a calibrated flexible tape and health scale and mercury sphygmomanometer for measurement of blood pressure. A participant was classified as being hypertensive if systolic blood pressure (SBP) was >140 mmHg and diastolic blood pressure (DBP) >90 mmHg. Pulse pressure was recorded as the numeric difference of SBP and DBP. Results The result revealed that male BMI and WHR were higher than those of females while female WHtR was higher than that of males (P < 0.01). The prevalence of hypertension failed to correlate with sex among participants in the study (χ2 = 0.567; P < 0.05). Variation in SBP and DBP of both sexes was dependent on BMI, WHtR, and waist and hip circumference, but not on WHR. The SBP of both sexes and female pulse pressure did correlate with age (P < 0.001). Waist circumference, BMI, and WHtR correctly predicted the variations in SBP, DBP, and pulse pressure. Conclusion The strength of association of BMI, WHtR, and waist girth with SBP and DBP of both sexes was robust and similar, but inconsistent with WHR. Thus, a simple estimation of the trio-anthropometric predictors could serve as a means for routine check or preliminary diagnosis of a patient with hypertension.
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Jokh Chaaya DA, de Souza Nogueira L, de Cassia Gengo E Silva Butcher R, Reboreda JZ, Silva Bonfim AK, Padilha KG. Pulse Pressure and Mortality Risk in Critically Ill Patients. AACN Adv Crit Care 2019; 29:118-125. [PMID: 29875108 DOI: 10.4037/aacnacc2018335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Pulse pressure is a hemodynamic variable easily measured in the intensive care unit. OBJECTIVE To investigate whether pulse pressure is an independent risk factor for mortality in intensive care unit patients. METHODS A retrospective cohort study was carried out in Brazil. Data were collected from medical records of patients admitted to intensive care units from September to December 2012. Pulse pressure was calculated from systolic and diastolic blood pressures recorded during the first 24 hours of stay. RESULTS Records of 529 patients (mean [standard deviation] age 55.0 [17.3] years; 54.4% male, 45.6% female) were analyzed. Risk factors for mortality were age, use of vasoactive drugs, nursing workload, and length of stay in the intensive care unit. Analysis indicated that higher minimum pulse pressures were associated with lower mortality risk. CONCLUSION Pulse pressure was not found to be an independent risk factor for mortality in patients who are critically ill.
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Affiliation(s)
- Dúnia Abou Jokh Chaaya
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Lilia de Souza Nogueira
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Rita de Cassia Gengo E Silva Butcher
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Jéssica Zamora Reboreda
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Ane Karoline Silva Bonfim
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
| | - Katia Grillo Padilha
- Dúnia Abou Jokh Chaaya is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Lilia de Souza Nogueira is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil . Rita de Cassia Gengo e Silva Butcher is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil. Jéssica Zamora Reboreda is a resident, highly complex cardiopneumology, School of Nursing and Heart Institute, University of São Paulo, Brazil. Ane Karoline Silva Bonfim is a PhD student, adult health nursing, School of Nursing, University of São Paulo, Brazil. Katia Grillo Padilha is Professor, Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, Brazil
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Chang JJ, Khorchid Y, Dillard K, Kerro A, Burgess LG, Cherkassky G, Goyal N, Chapple K, Alexandrov AW, Buechner D, Alexandrov AV, Tsivgoulis G. Elevated Pulse Pressure Levels Are Associated With Increased In-Hospital Mortality in Acute Spontaneous Intracerebral Hemorrhage. Am J Hypertens 2017; 30:719-727. [PMID: 28430838 DOI: 10.1093/ajh/hpx025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/31/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Clinical outcome after intracerebral hemorrhage (ICH) remains poor. Definitive phase-3 trials in ICH have failed to demonstrate improved outcomes with intensive systolic blood pressure (SBP) lowering. We sought to determine whether other BP parameters-diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP)-showed an association with clinical outcome in ICH. METHODS We retrospectively analyzed a prospective cohort of 672 patients with spontaneous ICH and documented demographic characteristics, stroke severity, and neuroimaging parameters. Consecutive hourly BP recordings allowed for computation of SBP, DBP, PP, and MAP. Threshold BP values that transitioned patients from survival to death were determined from ROC curves. Using in-hospital mortality as outcome, BP parameters were evaluated with multivariable logistic regression analysis. RESULTS Patients who died during hospitalization had higher mean PP compared to survivors (68.5 ± 16.4 mm Hg vs. 65.4 ± 12.4 mm Hg; P = 0.032). The following admission variables were associated with significantly higher in-hospital mortality (P < 0.001): poorer admission clinical condition, intraventricular hemorrhage, and increased admission normalized hematoma volume. ROC analysis showed that mean PP dichotomized at 72.17 mm Hg, provided a transition point that maximized sensitivity and specific for mortality. The association of this increased dichotomized PP with higher in-hospital mortality was maintained in multivariable logistic regression analysis (odds ratio, 3.0; 95% confidence interval, 1.7-5.3; P < 0.001) adjusting for potential confounders. CONCLUSION Widened PP may be an independent predictor for higher mortality in ICH. This association requires further study.
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Affiliation(s)
- Jason J Chang
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Yasser Khorchid
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kira Dillard
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ali Kerro
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lucia Goodwin Burgess
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Georgy Cherkassky
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kristina Chapple
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anne W Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Australian Catholic University, Sidney, Australia
| | - David Buechner
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon University Hospital", Athens, Greece
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Hägglund O, Sjöqvist I, Linde C, Svensson P, Östergren J. Improvement of blood pressure control and physicians' management over time in patients with coronary artery disease. Blood Press 2016; 25:286-91. [PMID: 27104916 DOI: 10.1080/13102818.2016.1172846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with coronary artery disease (CAD) are at high risk for secondary CV events. Few studies have been performed concerning the physicians' reactions to high BP in patients with manifest CAD. AIMS To compare the prevalence and management of high BP after percutaneous coronary intervention (PCI) in 2011-2012 with that in 2004. MATERIAL AND METHODS We identified 300 consecutive patients from 2011-2012 and 167 from 2004 with a follow-up visit after PCI at a University hospital in Sweden. Their medical records were reviewed to collect BP values and physicians' actions in response to an elevated BP at the follow-up visit. RESULTS The proportion of patients who had their BP documented increased in 2011-2012 (91%) as compared to 2004 (79%). The proportion of patients with a BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic at the follow-up visit decreased from 55% in 2004 to 42% in 2011-2012 (p = 0.014). CONCLUSION BP documentation and control improved from 2004 to 2011-2012 with more patients reaching target BP levels. One of the reasons for the improvements may be the introduction of a secondary preventive unit with cardiovascular specialised nurses who participate in a national quality registry.
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Affiliation(s)
- Oscar Hägglund
- a Karolinska Institutet, Department of Medicine, Internal Medicine Unit and Department of Emergency Medicine , Karolinska University Hospital Solna , Stockholm , Sweden
| | - Ingrid Sjöqvist
- a Karolinska Institutet, Department of Medicine, Internal Medicine Unit and Department of Emergency Medicine , Karolinska University Hospital Solna , Stockholm , Sweden
| | - Cecilia Linde
- b Karolinska Institutet, Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden
| | - Per Svensson
- a Karolinska Institutet, Department of Medicine, Internal Medicine Unit and Department of Emergency Medicine , Karolinska University Hospital Solna , Stockholm , Sweden
| | - Jan Östergren
- a Karolinska Institutet, Department of Medicine, Internal Medicine Unit and Department of Emergency Medicine , Karolinska University Hospital Solna , Stockholm , Sweden
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