Management of hypertensive crises in the elderly

Influence of acute and chronic intermittent hypoxic-hyperoxic exposure prior to aerobic exercise on cardiovascular risk factors in geriatric patients-a randomized controlled trial

Background: Intermittent hypoxic-hyperoxic exposure (IHHE) and aerobic training have been proposed as non-pharmacological interventions to reduce age-related risk factors. However, no study has yet examined the effects of IHHE before aerobic exercise on cardiovascular risk factors in the elderly. Therefore, the aim of this study was to investigate the acute and chronic effects of IHHE prior to aerobic cycling exercise on blood lipid and lipoprotein concentrations as well as blood pressure in geriatric patients. Methods: In a randomized, controlled, and single-blinded trial, thirty geriatric patients (72-94 years) were assigned to two groups: intervention (IG; n = 16) and sham control group (CG; n = 14). Both groups completed 6 weeks of aerobic cycling training, 3 times a week for 20 min per day. The IG and CG were additionally exposed to IHHE or sham IHHE (i.e., normoxia) for 30 min prior to aerobic cycling. Blood samples were taken on three occasions: immediately before the first, ∼10 min after the first, and immediately before the last session. Blood samples were analyzed for total (tCh), high-density (HDL-C), and low-density lipoprotein cholesterol (LDL-C), and triglyceride (Tgl) serum concentration. Resting systolic (SBP) and diastolic blood pressure (DBP) was assessed within 1 week before, during (i.e., at week two and four), and after the interventions. Results: The baseline-adjusted ANCOVA revealed a higher LDL-C concentration in the IG compared to the CG after the first intervention session (ηp 2 = 0.12). For tCh, HDL-C, Tgl, and tCh/HDL-C ratio there were no differences in acute changes between the IG and the CG (ηp 2 ≤ 0.01). With regard to the chronic effects on lipids and lipoproteins, data analysis indicated no differences between groups (ηp 2 ≤ 0.03). The repeated measures ANOVA revealed an interaction effect for SBP (ηp 2 = 0.06) but not for DBP (ηp 2 ≤ 0.01). Within-group post-hoc analysis for the IG indicated a reduction in SBP at post-test (d = 0.05). Conclusion: Applying IHHE prior to aerobic cycling seems to be effective to reduce SBP in geriatric patients after 6 weeks of training. The present study suggests that IHHE prior to aerobic cycling can influence the acute exercise-related responses in LDL-C concentration but did not induce chronic changes in basal lipid or lipoprotein concentrations.

Evaluation of the Effect of the Fibroblast Growth Factor Type 2 (FGF-2) Administration on Placental Gene Expression in a Murine Model of Preeclampsia Induced by L-NAME

The abnormal implantation of the trophoblast during the first trimester of pregnancy precedes the appearance of the clinical manifestations of preeclampsia (PE), which is a hypertensive disorder of pregnancy. In a previous study, which was carried out in a murine model of PE that was induced by NG-nitro-L-arginine methyl ester (L-NAME), we observed that the intravenous administration of fibroblast growth factor 2 (FGF2) had a hypotensive effect, improved the placental weight gain and attenuated the fetal growth restriction, and the morphological findings that were induced by L-NAME in the evaluated tissues were less severe. In this study, we aimed to determine the effect of FGF2 administration on the placental gene expression of the vascular endothelial growth factor (VEGFA), VEGF receptor 2 (VEGFR2), placental growth factor, endoglin (ENG), superoxide dismutase 1 (SOD1), catalase (CAT), thioredoxin (TXN), tumor protein P53 (P53), BCL2 apoptosis regulator, Fas cell surface death receptor (FAS), and caspase 3, in a Sprague Dawley rat PE model, which was induced by L-NAME. The gene expression was determined by a real-time polymerase chain reaction using SYBR green. Taking the vehicle or the L-NAME group as a reference, there was an under expression of placental VEGFA, VEGFR2, ENG, P53, FAS, SOD1, CAT, and TXN genes in the group of L-NAME + FGF2 (p < 0.05). The administration of FGF2 in the murine PE-like model that was induced by L-NAME reduced the effects that were generated by proteinuria and the increased BP, as well as the response of the expression of genes that participate in angiogenesis, apoptosis, and OS. These results have generated valuable information regarding the identification of molecular targets for PE and provide new insights for understanding PE pathogenesis.

Relationship Between Clinical Features and Body Mass Index Among Hypertensive Patients: A Cross-Sectional Study

Objectives

Hypertension is strongly related to body mass index (BMI). Obesity has been the single main contributor to hypertension. Furthermore, the clinical manifestations are normally associated with BMI in hypertensive patients. This study aimed to evaluate the relationship between clinical features and BMI among hypertensive patients in both males and females.

Methodology

A retrospective cross-sectional study was conducted among 296 patients having a self-reported history of hypertension and on anti-hypertensive medication. The study was conducted in the medical outpatient department of a secondary care hospital in Karachi during six months (January 2020 to June 2020). A detailed history was taken from each patient about hypertension-related symptoms, and clinical examination was performed. Blood pressure was measured using a sphygmomanometer with a stethoscope.

Results

Of the 296 patients, 156 (52.2%) were males and 140 (47.3%) were females; 16 (5.4%) of them were underweight, 91 (30.7%) were normal weight, 129 (43.6%) were overweight, and 60 (20.3%) were obese; in addition, 106 (35.8%) reported edema and 71 (24.0%) reported nausea and so on. As far as the association of clinical features and BMI was concerned, our study results showed that only edema (p=0.017) and nausea (p=0.044) were significantly associated with the BMI of the patients. Patients with edema were more likely to be obese than those without edema (29.2% vs. 15.3%), whereas patients with nausea were more likely to be overweight than those without nausea (57.7% vs. 39.1%).

Conclusions

Our study showed that among the clinical features, edema and nausea were significantly associated with the BMI of the patients, whereas the relationship with others was insignificantly related to BMI of the patients in both male and female patients.