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Sample records for isolated systolic hypertension

  1. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study.

    PubMed

    Ogihara, Toshio; Saruta, Takao; Rakugi, Hiromi; Matsuoka, Hiroaki; Shimamoto, Kazuaki; Shimada, Kazuyuki; Imai, Yutaka; Kikuchi, Kenjiro; Ito, Sadayoshi; Eto, Tanenao; Kimura, Genjiro; Imaizumi, Tsutomu; Takishita, Shuichi; Ueshima, Hirotsugu

    2010-08-01

    In this prospective, randomized, open-label, blinded end point study, we aimed to establish whether strict blood pressure control (<140 mm Hg) is superior to moderate blood pressure control (> or =140 mm Hg to <150 mm Hg) in reducing cardiovascular mortality and morbidity in elderly patients with isolated systolic hypertension. We divided 3260 patients aged 70 to 84 years with isolated systolic hypertension (sitting blood pressure 160 to 199 mm Hg) into 2 groups, according to strict or moderate blood pressure treatment. A composite of cardiovascular events was evaluated for > or =2 years. The strict control (1545 patients) and moderate control (1534 patients) groups were well matched (mean age: 76.1 years; mean blood pressure: 169.5/81.5 mm Hg). Median follow-up was 3.07 years. At 3 years, blood pressure reached 136.6/74.8 mm Hg and 142.0/76.5 mm Hg, respectively. The blood pressure difference between the 2 groups was 5.4/1.7 mm Hg. The overall rate of the primary composite end point was 10.6 per 1000 patient-years in the strict control group and 12.0 per 1000 patient-years in the moderate control group (hazard ratio: 0.89; [95% CI: 0.60 to 1.34]; P=0.38). In summary, blood pressure targets of <140 mm Hg are safely achievable in relatively healthy patients > or = 70 years of age with isolated systolic hypertension, although our trial was underpowered to definitively determine whether strict control was superior to less stringent blood pressure targets. PMID:20530299

  2. Review of isolated systolic hypertension in older adults.

    PubMed

    Kamath, Neetha; Cappuzzo, Kimberly A

    2010-06-01

    A 75-year-old patient comes to a community pharmacy to refill her blood pressure (BP) medications. She approached the pharmacist complaining of a headache and an unusually high BP reading that she had gotten from the automated machine. The patient was unaware of her usual BP, but knew that the reading was unusually high for her. Following evaluation of the patient and after obtaining several high systolic BP readings, the pharmacist appropriately calls for an ambulance. At the hospital, the patient is told she is in need of triple-bypass surgery. After her hospital stay, the patient is now diligent about refilling her BP medications on time and consistently monitors and records her BP at home. Isolated systolic hypertension is a growing concern in older adults, and a large percentage of adults are not appropriately managed. Pharmacists play an active role in educating patients on the importance of high BP monitoring and adherence to minimize the risk of cardiovascular events. PMID:20534408

  3. Identification of phenotypes at risk of transition from diastolic hypertension to isolated systolic hypertension.

    PubMed

    Esposito, R; Izzo, R; Galderisi, M; De Marco, M; Stabile, E; Esposito, G; Trimarco, V; Rozza, F; De Luca, N; de Simone, G

    2016-06-01

    Little is known about the potential progression of hypertensive patients towards isolated systolic hypertension (ISH) and about the phenotypes associated with the development of this condition. Aim of this study was to detect predictors of evolution towards ISH in patients with initial systolic-diastolic hypertension. We selected 7801 hypertensive patients free of prevalent cardiovascular (CV) diseases or severe chronic kidney disease and with at least 6-month follow-up from the Campania Salute Network. During 55±44 months of follow-up, incidence of ISH was 21%. Patients with ISH at the follow-up were significantly older (P<0.0001), had longer duration of hypertension, higher prevalence of diabetes and were more likely to be women (all P<0.0001). They exhibited higher baseline left ventricular mass index (LVMi), arterial stiffness (pulse pressure/stroke index), relative wall thickness (RWT) and carotid intima-media thickness (IMT; all P<0.001). Independent predictors of incident ISH were older age (odds ratio (OR)=1.14/5 years), female gender (OR=1.30), higher baseline systolic blood pressure (OR=1.03/5 mm Hg), lower diastolic blood pressure (OR=0.89/5 mm Hg), longer duration of hypertension (OR=1.08/5 months), higher LVMi (OR=1.02/5 g m(-2.7)), arterial stiffness (OR=2.01), RWT (OR=1.02), IMT (OR=1.19 mm(-1); all P<0.0001), independently of antihypertensive treatment, obesity, diabetes and fasting glucose (P>0.05). Our findings suggest that ISH is a sign of aggravation of the atherosclerotic disease already evident by the target organ damage. Great efforts should be paid to prevent this evolution and prompt aggressive therapy for arterial hypertension should be issued before the onset of target organ damage, to reduce global CV risk. PMID:26355832

  4. Associations between Traffic Noise, Particulate Air Pollution, Hypertension, and Isolated Systolic Hypertension in Adults: The KORA Study

    PubMed Central

    Wolf, Kathrin; Petz, Markus; Heinrich, Joachim; Cyrys, Josef; Peters, Annette

    2014-01-01

    Background: Studies on the association between traffic noise and cardiovascular diseases have rarely considered air pollution as a covariate in the analyses. Isolated systolic hypertension has not yet been in the focus of epidemiological noise research. Methods: The association between traffic noise (road and rail) and the prevalence of hypertension was assessed in two study populations with a total of 4,166 participants 25–74 years of age. Traffic noise (weighted day–night average noise level; LDN) at the facade of the dwellings was derived from noise maps. Annual average PM2.5 mass concentrations at residential addresses were estimated by land-use regression. Hypertension was assessed by blood pressure readings, self-reported doctor-diagnosed hypertension, and antihypertensive drug intake. Results: In the Greater Augsburg, Germany, study population, traffic noise and air pollution were not associated with hypertension. In the City of Augsburg population (n = 1,893), where the exposure assessment was more detailed, the adjusted odds ratio (OR) for a 10-dB(A) increase in noise was 1.16 (95% CI: 1.00, 1.35), and 1.11 (95% CI: 0.94, 1.30) after additional adjustment for PM2.5. The adjusted OR for a 1-μg/m3 increase in PM2.5 was 1.15 (95% CI: 1.02, 1.30), and 1.11 (95% CI: 0.98, 1.27) after additional adjustment for noise. For isolated systolic hypertension, the fully adjusted OR for noise was 1.43 (95% CI: 1.10, 1.86) and for PM2.5 was 1.08 (95% CI: 0.87, 1.34). Conclusions: Traffic noise and PM2.5 were both associated with a higher prevalence of hypertension. Mutually adjusted associations with hypertension were positive but no longer statistically significant. Citation: Babisch W, Wolf K, Petz M, Heinrich J, Cyrys J, Peters A. 2014. Associations between traffic noise, particulate air pollution, hypertension, and isolated systolic hypertension in adults: the KORA Study. Environ Health Perspect 122:492–498; http://dx.doi.org/10.1289/ehp.1306981 PMID:24602804

  5. Isolated Systolic Hypertension in Young and Middle-Aged Adults and 31-Year Risk for Cardiovascular Mortality

    PubMed Central

    Yano, Yuichiro; Stamler, Jeremiah; Garside, Daniel B.; Daviglus, Martha L.; Franklin, Stanley S.; Carnethon, Mercedes R.; Liu, Kiang; Greenland, Philip; Lloyd-Jones, Donald M.

    2016-01-01

    BACKGROUND Isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) ≥140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg, in younger and middle-aged adults is increasing in prevalence. OBJECTIVE The aim of this study was to assess the risk for cardiovascular disease (CVD) with ISH in younger and middle-aged adults. METHODS CVD risks were explored in 15,868 men and 11,213 women 18 to 49 years of age (mean age 34 years) at baseline, 85% non-Hispanic white, free of coronary heart disease (CHD) and antihypertensive therapy, from the Chicago Heart Association Detection Project in Industry study. Participant classifications were as follows: 1) optimal-normal blood pressure (BP) (SBP <130 mm Hg and DBP <85 mm Hg); 2) high-normal BP (130 to 139/85 to 89 mm Hg); 3) ISH; 4) isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg); and 5) systolic diastolic hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg). RESULTS During a 31-year average follow-up period (842,600 person-years), there were 1,728 deaths from CVD, 1,168 from CHD, and 223 from stroke. Cox proportional hazards models were adjusted for age, race, education, body mass index, current smoking, total cholesterol, and diabetes. In men, with optimal-normal BP as the reference stratum, hazard ratios for CVD and CHD mortality risk for those with ISH were 1.23 (95% confidence interval [CI]: 1.03 to 1.46) and 1.28 (95% CI: 1.04 to 1.58), respectively. ISH risks were similar to those with high-normal BP and less than those associated with isolated diastolic hypertension and systolic diastolic hypertension. In women with ISH, hazard ratios for CVD and CHD mortality risk were 1.55 (95% CI: 1.18 to 2.05) and 2.12 (95% CI: 1.49 to 3.01), respectively. ISH risks were higher than in those with high-normal BP or isolated diastolic hypertension and less than those associated with systolic diastolic hypertension. CONCLUSIONS Over long-term follow-up, younger and middle-aged adults with ISH

  6. Predictors of high central blood pressure in young with isolated systolic hypertension

    PubMed Central

    Radchenko, GD; Torbas, OO; Sirenko, Yu M

    2016-01-01

    Objective According to the European Society of Cardiology/European Society of Hypertension 2013 guidelines, evaluation of aortic blood pressure (BP) is needed in young with isolated systolic hypertension (ISH), but using special devices is not common, especially in Ukraine, where only a few centers have these devices. The purpose of our study was to identify the simple clinical predictors for differentiation (with or without elevated aortic systolic BP [SBP]) of the young with ISH without the need for further extensive work-up. Patients and methods The study included 44 young men (mean age: 32.2±1.3 years) with office SBP ≥140 mmHg and office diastolic BP (DBP) <90 mmHg (average: 153.4±2.1 mmHg and 83.4±1.7 mmHg, respectively). The following procedures were performed in all the subjects: body weight and height evaluation; measurement of office SBP, DBP, and heart rate; ambulatory BP monitoring; measurement of pulse wave velocity in arteries of elastic and muscle types and central SBP (cSBP); biochemical blood tests; electrocardiography; echocardiography; and carotid ultrasound investigations. Step-by-step multifactor regression analyses were used for finding the predictors of high cSBP. Results Depending on the cSBP level, all the patients were divided into two groups: first group (n=17), subjects with normal cSBP, and second group (n=27), subjects with elevated cSBP. Patients in the second group were significantly older, with less height and higher body mass index; they had significantly higher levels of office SBP and DBP. Characteristics of target organ damage were within normal limits in both groups and did not differ significantly. Only pulse wave velocity in arteries of elastic type was significantly higher in the second group. The independent predictors of increased cSBP were as follows: height ≤178 cm (β=7.038; P=0.05), body weight ≥91 kg (β=5.53, P=0.033), and the level of office DBP ≥80 mmHg (β=4.43; P=0.05). The presence of two or three of

  7. Prevalence and Trends of Isolated Systolic Hypertension among Korean Adults: the Korea National Health and Nutrition Examination Survey, 1998-2012

    PubMed Central

    Kim, Na Rae

    2015-01-01

    Background and Objectives Systolic and diastolic blood pressure may have different effects on cardiovascular disease, but limited data is available for hypertension subtypes in the Korean population. Thus, the prevalence, and absolute number of hypertension subtypes among Korean adults was estimated. Subjects and Methods The Korea National Health and Nutrition Examination Survey 1998-2012 was used to estimate the prevalence and absolute number of each hypertension subtype among Korean adults aged ≥20 years. Hypertension was classified into four subtypes: treated hypertension (TH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH). Results In 2012, approximately 9.5 million adults were estimated to have hypertension, which consists of 5675671 TH (60.0%), 954253 ISH (10.1%), 1649486 IDH (17.4%), and 1175506 SDH (12.4%). Between 2010 and 2012, the proportion of IDH steadily decreased with age, but ISH increased especially in older ages (≥40). Between 1998 and 2012, TH markedly increased from 1.4 million to 5.7 million while the number of untreated hypertension remained relatively constant. During the same time, the number of hypertensive elderlies increased from 507000 to 2822000 along with rapid ageing of the Korean population. Despite of significant improvement in treatment rate, there are still around 583000 elderlies with untreated hypertension (423000 ISH; 42000 IDH; 118000 SDH) as of 2012. Conclusion Although the prevalence of hypertension has been constant over the last decades, absolute number of people with hypertension has been increasing. Along with the rapid population ageing, the number of elderly hypertension is increasing and the ISH is also becoming more prevalent. PMID:26617652

  8. [Arterial hypertension in special situations: mild, systolic and in pregnancy].

    PubMed

    Luque Otero, M; Fernández Pinilla, C

    1990-01-01

    Mild hypertension is very common, 50% of hypertensives being with their diastolic BP between 90 and 104 mmHg. Many large studies, especially HDFP, had shown not only the deleterious cardiovascular effects of mild hypertension but also the benefits obtained with the therapy. The non-pharmacological approach should be the first step in the treatment of mild hypertension. Isolated systolic hypertension have a high prevalence in the elderly, increasing the cardiovascular morbidity and mortality. Sodium restriction and, if necessary, vasodilators increasing the arterial compliance seem to be the logical approach to treat isolated systolic hypertension. Finally, eclampsia is the most serious complication of pregnancy - induced hypertension. The treatment with bed rest and either betablockers or methyldopa is beneficial. If eclampsia occurs hydralazine, magnesium sulphate or nifedipine should be used. PMID:2186454

  9. Incidence and risk factors of isolated systolic and diastolic hypertension: a 10 year follow-up of the Tehran Lipids and Glucose Study.

    PubMed

    Asgari, Samaneh; Khalili, Davood; Mehrabi, Yadollah; Kazempour-Ardebili, Sara; Azizi, Fereidoun; Hadaegh, Farzad

    2016-06-01

    The objective of this study is to examine the incidence and risk factors of isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) in a Middle Eastern population, during a median follow-up of 9.6 years. In total, 8573 subjects without hypertension, cardiovascular disease and known diabetes were recruited into the study. To calculate the incidence of ISH, those with diastolic blood pressure (DBP) ≥ 90 mmHg during follow-up, and for calculating IDH those with systolic blood pressure (SBP) ≥ 140 mmHg during follow-up, were excluded. During follow-up, 235 new cases of ISH were identified, with a crude incidence rate of 5.7/1000 person-years; the corresponding values for IDH were 470 and 10.9/1000 person-years. Using backward stepwise Cox regression analysis, older age, baseline SBP and body mass index were related to incident ISH. Regarding IDH, younger age, baseline DBP and waist circumference were associated with higher risk, whereas female gender and being married were associated with lower risk (all p < 0.05). The C-statistics for the prediction model were 0.91 for ISH and 0.76 for IDH. In conclusion, after a decade of follow-up of this Iranian population, we found an incidence of about 0.5% and 1% per year for ISH and IDH, respectively. PMID:26643588

  10. Systolic hypertension: an increasing clinical challenge in Asia

    PubMed Central

    Park, Jeong Bae; Kario, Kazuomi; Wang, Ji-Guang

    2015-01-01

    Systolic hypertension, the predominant form of hypertension in patients aged over 50–60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications. PMID:25503845

  11. Effect of oral nitrates on pulse pressure and arterial elasticity in patients aged over 65 years with refractory isolated systolic hypertension: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Isolated systolic hypertension is a highly prevalent disease among the elderly. The little available evidence on the efficacy of nitrates for treating the disease is based on small experimental studies. Methods/design We performed a multicenter, randomized, double-blind, phase III, placebo-controlled trial in 154 patients aged over 65 years with refractory isolated systolic hypertension. Patients were randomized to placebo or 40 mg/day of extended-release isosorbide mononitrate added to standard therapy and titrated to 60 mg/day at week 6 if blood pressure exceeded 140/90 mmHg. The primary objective was to assess the effect on clinical pulse pressure of extended-release isosorbide mononitrate added to standard therapy in patients aged over 65 years with refractory isolated systolic hypertension after 3 months of treatment. The secondary objectives were as follows: to quantify the effect of adding the study drug on central blood pressure and vascular compliance using the augmentation index and pulse wave velocity; to evaluate the safety profile by recording adverse effects (frequency, type, severity) and the percentage of patients who had to withdraw from the trial because of adverse events; to quantify the percentage of patients who reach a clinical systolic blood pressure <140 mmHg or <130 mmHg measured by ambulatory blood pressure monitoring; and to quantify the change in pulse pressure measured by ambulatory blood pressure monitoring. Discussion Few clinical trials have been carried out to test the effect of oral nitrates on isolated systolic hypertension, even though these agents seem to be effective. Treatment with extended-release isosorbide mononitrate could improve control of systolic blood pressure without severe side effects, thus helping to reduce the morbidity and mortality of the disease. Trial registration EUDRACT Number: 2012-002988-10 PMID:24228894

  12. Systolic blood pressure and systolic hypertension in adolescence of atomic bomb survivors exposed in utero.

    PubMed

    Nakashima, Eiji; Akahoshi, Masazumi; Neriishi, Kazuo; Fujiwara, Saeko

    2007-11-01

    Annual medical examinations were conducted during adolescence for the in utero clinical study sample subjects exposed prenatally to the atomic bombs in Hiroshima and Nagasaki. Systolic blood pressure and several anthropometric measurements were recorded during these examinations. For 1014 persons exposed in utero, two types of longitudinal analyses were performed, for a total of 7029 observations (6.93 observations per subject) of systolic blood pressure (continuous data) and systolic hypertension (binary data) for persons aged 9 to 19 years. Body mass index (BMI) and/or body weight were considered in the analyses as potential confounders. For the measurements of systolic blood pressure, the common dose effect was 2.09 mmHg per Gy and was significant (P = 0.017). The dose by trimester interaction was suggestive (P = 0.060). A significant radiation dose effect was found in the second trimester (P = 0.001), with an estimated 4.17 mmHg per Gy, but in the first and third trimesters, radiation dose effects were not significant (P > 0.50). For prevalence of systolic hypertension, the radiation dose effect was significant (P = 0.009); the odds ratio at 1 Gy was 2.23 [95% confidence interval (CI): 1.23, 4.04], and the dose by trimester interaction was not significant (P = 0.778). The dose response of systolic hypertension had no dose threshold, with a threshold point estimate of 0 Gy (95% CI: <0.0, 1.1 Gy). The dose response for systolic blood pressure was most pronounced in the second trimester, the most active organogenesis period for the organs relevant to blood pressure. PMID:17973553

  13. Severe systolic hypertension and the search for safer motherhood.

    PubMed

    Martin, James N

    2016-03-01

    Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of causation. The reduction of severe maternal morbidity and maternal mortality in the hypertensive mother is clearly enhanced by the addition of standard protocols for provider response to severe hypertension, particularly severe systolic hypertension. The program developed in New York State via the Safe Motherhood Initiative promotes the implementation of unit-specific safety bundles, especially one that is focused upon a standardized approach to handling the obstetric emergency of severe hypertension usually associated with preeclampsia/eclampsia. The comprehensive preeclampsia/eclampsia safety bundle as summarized by Drs. Moroz and colleagues is reviewed especially from the perspective of its focus on the timely and specific responses for health care providers to make when severe hypertension is detected in the pregnant patient. Evidence-based guidance to practice considerations and clinical care of patients with preeclampsia/eclampsia is embedded within the program outlined for New York State by Moroz and her District II ACOG colleagues. There is a central focus on timely and appropriate antepartum/postpartum management of severe hypertension, a core concept to lessen maternal risk for cerebral hemorrhage. Ten considerations for further integration into the New York program are suggested. Beyond blood pressure control, there is a need for systematic review of interventions and outcomes over time, attention to possible future variations of the protocol for racial/ethnic patient groups at highest risk for maternal morbidity and mortality, and the identification of biomarker(s) that further specify and quantify risk to the maternal brain and other organ systems when severe hypertension develops. Safer motherhood will happen when evidence for best practice is integrated into systems of care for all

  14. Systolic Blood Pressure Intervention Trial (SPRINT) and Target Systolic Blood Pressure in Future Hypertension Guidelines.

    PubMed

    Egan, Brent M; Li, Jiexiang; Wagner, C Shaun

    2016-08-01

    The Systolic Blood Pressure (SBP, mm Hg) Intervention Trial (SPRINT) showed that targeting SBP <120 mm Hg (intensive treatment, mean SBP: 121.5 mm Hg) versus <140 (standard treatment, mean SBP: 134.6 mm Hg) reduced cardiovascular events 25%. SPRINT has 2 implicit assumptions that could impact future US hypertension guidelines: (1) standard therapy controlled SBP similarly to that in adults with treated hypertension and (2) intensive therapy produced a lower mean SBP than in adults with treated hypertension and SBP <140 mm Hg. To examine these assumptions, US National Health and Nutrition Examination Survey 2009 to 2012 data were analyzed on 3 groups of adults with treated hypertension: group 1 consisted of SPRINT-like participants aged ≥50 years; group 2 consisted of participants all aged ≥18 years; and group 3 consisted of participants aged ≥18 years excluding group 1 but otherwise similar to SPRINT-like participants except high cardiovascular risk. Mean SBPs in groups 1, 2, and 3 were 133.0, 130.1, and 124.6, with 66.2%, 72.2%, and 81.9%, respectively, controlled to SBP <140; 68.3%, 74.8%, and 83.4% of the controlled subset had SBP <130. Mean SBPs in those controlled to <140 were 123.3, 120.9, and 118.9, respectively. Among US adults with treated hypertension, (1) the SPRINT-like group had higher mean SBP than comparison groups, yet lower than SPRINT standard treatment group and (2) among groups 1 to 3 with SBP <140, SBP values were within <3 mm Hg of SPRINT intensive treatment. SPRINT results suggest that treatment should be continued and not reduced when treated SBP is <130, especially for the SPRINT-like subset. Furthermore, increasing the percentage of treated adults with SBP <140 could approximate SPRINT intensive treatment SBP without lowering treatment goals. PMID:27354422

  15. Efficacy of combination therapy for systolic blood pressure in patients with severe systolic hypertension: the Systolic Evaluation of Lotrel Efficacy and Comparative Therapies (SELECT) study.

    PubMed

    Neutel, Joel M; Smith, David H G; Weber, Michael A; Schofield, Lesley; Purkayastha, Das; Gatlin, Marjorie

    2005-11-01

    Systolic hypertension is predominant among patients over 50 years of age, is a more important cardiovascular risk factor than diastolic blood pressure, and is more difficult to control than diastolic blood pressure. Consequently, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends combination therapy as first-line treatment for patients with stage 2 hypertension. In the Systolic Evaluation of Lotrel Efficacy and Comparative Therapies (SELECT) study, 24-hour ambulatory blood pressure monitoring was used to identify patients with systolic hypertension and to determine the impact of 8 weeks of treatment with either amlodipine besylate/benazepril HCl 5/20 mg combination therapy (n=149), amlodipine besylate 5 mg (n=146), or benazepril HCl 20 mg (n=148). Combination therapy was significantly more effective in reducing systolic blood pressure and pulse pressure than either monotherapy (p<0.0001). Significantly greater percentages of patients in the combination group compared with either monotherapy achieved blood pressure control (p<0.0001). Adverse events were low in all three treatment arms, with less peripheral edema in the combination group than in the amlodipine-treated group. The combination of amlodipine besylate/benazepril HCl given to patients with stage 2 systolic hypertension resulted in significantly greater reductions in blood pressure and pulse pressure than those seen with monotherapy and was at least as well tolerated as the separate components. This data supports the recommendation of the JNC 7 for the use of combination therapy in patients with stage 2 hypertension. PMID:16278521

  16. Left ventricular systolic response to exercise in patients with systemic hypertension without left ventricular hypertrophy.

    PubMed

    Christian, T F; Zinsmeister, A R; Miller, T D; Clements, I P; Gibbons, R J

    1990-05-15

    Supine exercise radionuclide angiography was performed in 367 men to assess left ventricular (LV) systolic response to exercise; 58 had systemic hypertension without LV hypertrophy on a resting electrocardiogram and 309 were normotensive. All patients met the following criteria defining a low pretest likelihood of coronary artery disease: age less than 50 years; normal electrocardiographic response to exercise; absence of typical or atypical chest pain; and exercise heart rate greater than 120 beats/min. Patients taking beta-receptor blockers were excluded. There were no significant differences between hypertensive and normotensive groups in peak exercise heart rate, workload or exercise duration. However, hypertensive patients had significantly higher peak exercise systolic blood pressures and peak exercise rate-pressure products. There were no differences between patients with and without hypertension in resting ejection fraction, peak exercise ejection fraction (hypertensive patients 0.71 +/- 0.01, normotensive patients 0.70 +/- 0.05) or change in ejection fraction at peak exercise (hypertensive patients 0.07 +/- 0.01, normotensive patients 0.07 +/- 0.04). Diastolic and systolic ventricular volumes tended to be smaller in the hypertensive patients, but the difference was not statistically significant. The change in systolic volume with exercise was similar in the 2 groups (hypertensive -10 +/- 3 ml/m2, normotensive -10 +/- 1 ml/m2). In the absence of electrocardiographic evidence of LV hypertrophy, systemic hypertension does not influence LV systolic response to exercise. PMID:2140008

  17. [Echocardiographic parameters and systolic times in arterial hypertension in the elderly].

    PubMed

    Pentimone, F; Santoro, G; Giusti, C; Di Bello, V; Cini, G; Del Corso, L

    1989-09-01

    In 40 subjects, 15 mean age 70.7 +/- 5.6 with systolic-diastolic hypertension, 15 mean age 75.5 +/- 6.8 years with systolic hypertension and 10 mean age 73.6 +/- 5.1 normotensive control group we have analyzed with M-mode 2D echocardiography and echophonocardiography the following parameters: diastolic--EDD--and systolic diameter--SD--of left ventricle, diastolic thickness of septum--SSD--and posterior wall--SPPD--of left ventricle, left ventricular ejection fraction--EF--(Theicholtr. formula), radius posterior wall thickness--R/SPPD--, left ventricular mass--LVM--(Devereux' formula), and systolic time intervals (Q-A2, LVET, PEP and PEP/LVET). The differences between groups are: systolic-diastolic hypertensive patients have increased EDD, SPPD and LVM, reduction of EF and increased PEP/LVET ratio in comparison with B and C groups; systolic hypertension doesn't increase EDD; SSD and PEP/LVET increase, while the EF remains within normal limits. In the healthy aged subjects SSD, SPPD and LVM are normal. PMID:2608185

  18. [The influence of citoflavin on molecular mechanisms of hypertensive encephalopathy development in patients with systolic arterial hypertension].

    PubMed

    Kartashova, E A; Romantsov, M G; Sarvilina, I V

    2014-01-01

    The molecular pharmacological effects of cytoflavin in patients with hypertensive encephalopathy (HE) and isolated systolic arterial hypertension (ISAH) have been investigated using the following methods: assessment of complaints, 24-hour arterial pressure monitoring, ultrasound diagnostics including echocardiography, measurement of lipid profiles and coagulograms, and molecular phenotyping by MALDI-TOF/TOF-MS. A combination of cytoflavin administration with standard therapy of HE and ISAH led to the most expressed return development of clinical symptoms, restoration of the hemodynamic, structural, and geometrical parameters of cardiovascular system, and normalization of the indices of lipid profiles and coagulograms in comparison to patients with HE and ISAH, which accepted only standard therapy. Molecular mechanisms of cytoflavin action have been revealed, which include control of the activity of cellular signaling pathways by means of intermolecular interactions. The optimized therapy of HE and ISAH is recommended for clinical application, which assumes a combined use of standard therapy and cytoflavin and provides a geroprotective action upon the cardiovascular system. PMID:25102730

  19. Right Ventricular Systolic Dysfunction Is Common in Hypertensive Heart Failure: A Prospective Study in Sub-Saharan Africa

    PubMed Central

    Ojji, Dike B.; Lecour, Sandrine; Atherton, John J.; Blauwet, Lori A.; Alfa, Jacob; Sliwa, Karen

    2016-01-01

    Introduction Right ventricular (RV) systolic dysfunction is now recognized widely as a strong and independent predictor of adverse outcomes in patients with heart failure (HF). Reduction of RV systolic function more closely predicts impaired exercise tolerance and poor survival than does left ventricular (LV) systolic function. In spite of this, there is a dearth of data on RV function in hypertensive HF which is the commonest form of HF in sub-Saharan Africa. We therefore conducted a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, Nigeria over an 8 year period. Methods Each subject had transthoracic echocardiography performed on them according to the guidelines of American Society of Echocardiography. RV systolic function was defined as a tricuspid annular plane systolic excursion (TAPSE) <15mm using M-mode echocardiography. Results RV systolic dysfunction was identified in 272 (44.5%) of the 611 subjects that were studied. Subjects with TAPSE less than 15mm had worse prognosis compared to those with TAPSE ≥15mm.There was a significant correlation between TAPSE and other adverse prognostic markers including left and right atrial area, LV size, LV mass, LV ejection fraction, restrictive mitral inflow and RV systolic pressure (RVSP). However, LV ejection fraction and right atrial area were the only independent determinants of RV systolic dysfunction. Conclusions Hypertensive HF is a major cause of RV systolic dysfunction even in a population with a low prevalence of coronary artery disease, and RV systolic dysfunction is associated with poor prognosis in hypertensive HF. Detailed assessment of RV function should therefore be part of the echocardiography evaluation of patients with hypertensive HF. PMID:27073856

  20. Very high central aortic systolic pressures in a young hypertensive patient on telmisartan: Is central aortic systolic pressure associated with white coat hypertension?

    PubMed

    Sule, Ashish Anil; Hwang, Teong Hui; Chin, Tay Jam

    2010-01-01

    Central aortic systolic pressure (CASP) is a very well-recognized tool to assess the end organ damage in patients with hypertension. It is known that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers reduce CASP more than some antihypertensives such as beta-blockers. White coat hypertension with CASP has not been described and validated. The present report describes a very anxious 24-year-old patient on telmisartan (an angiotensin receptor blocker), with a very high CASP compared with his peripheral blood pressure (BP). He had a strong family history of hypertension, and was fairly well controlled on 80 mg/day telmisartan, with his BP ranging from 125/80 mmHg to 130/85 mmHg (home BP monitoring). In May 2009, he underwent routine CASP at Tan Tock Seng Hospital (Singapore), and ambulatory BP measurements using a BPro watch (HealthSTATS, Singapore). The patient had a CASP of 132 mmHg at the hospital, but his calculated CASP by ambulatory BP measurement at 1 pm was 120 mmHg. His ambulatory BPs were 137/94 mmHg; thus, hydrochlorothiazide was added for further control. He was advised to repeat CASP measurements on follow-up in six weeks. He followed up on June 18, 2009, and July 30, 2009, and his CASPs were 139 mmHg and 137 mmHg, respectively. He underwent a magnetic resonance aortogram to exclude any obstructive cause for very high CASPs. His magnetic resonance aortogram revealed no evidence of coarctation of the aorta. CASP may have significant variations due to white coat phenomenon. Further 24 h CASP studies are needed to observe whether CASP is subject to white coat phenomenon. PMID:22479144

  1. Late Systolic Central Hypertension as a Predictor of Incident Heart Failure: The Multi‐Ethnic Study of Atherosclerosis

    PubMed Central

    Chirinos, Julio A.; Segers, Patrick; Duprez, Daniel A.; Brumback, Lyndia; Bluemke, David A.; Zamani, Payman; Kronmal, Richard; Vaidya, Dhananjay; Ouyang, Pamela; Townsend, Raymond R.; Jacobs, David R.

    2015-01-01

    Background Experimental studies demonstrate that high aortic pressure in late systole relative to early systole causes greater myocardial remodeling and dysfunction, for any given absolute peak systolic pressure. Methods and Results We tested the hypothesis that late systolic hypertension, defined as the ratio of late (last one third of systole) to early (first two thirds of systole) pressure–time integrals (PTI) of the aortic pressure waveform, independently predicts incident heart failure (HF) in the general population. Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 6124 adults. The late/early systolic PTI ratio (L/ESPTI) was assessed as a predictor of incident HF during median 8.5 years of follow‐up. The L/ESPTI was predictive of incident HF (hazard ratio per 1% increase=1.22; 95% CI=1.15 to 1.29; P<0.0001) even after adjustment for established risk factors for HF (HR=1.23; 95% CI=1.14 to 1.32: P<0.0001). In a multivariate model that included brachial systolic and diastolic blood pressure and other standard risk factors of HF, L/ESPTI was the modifiable factor associated with the greatest improvements in model performance. A high L/ESPTI (>58.38%) was more predictive of HF than the presence of hypertension. After adjustment for each other and various predictors of HF, the HR associated with hypertension was 1.39 (95% CI=0.86 to 2.23; P=0.18), whereas the HR associated with a high L/E was 2.31 (95% CI=1.52 to 3.49; P<0.0001). Conclusions Independently of the absolute level of peak pressure, late systolic hypertension is strongly associated with incident HF in the general population. PMID:25736440

  2. Chronic N(G)-nitro-L-arginine methyl ester-induced hypertension : novel molecular adaptation to systolic load in absence of hypertrophy

    NASA Technical Reports Server (NTRS)

    Bartunek, J.; Weinberg, E. O.; Tajima, M.; Rohrbach, S.; Katz, S. E.; Douglas, P. S.; Lorell, B. H.; Schneider, M. (Principal Investigator)

    2000-01-01

    BACKGROUND: Chronic N(G)-nitro-L-arginine methyl ester (L-NAME), which inhibits nitric oxide synthesis, causes hypertension and would therefore be expected to induce robust cardiac hypertrophy. However, L-NAME has negative metabolic effects on protein synthesis that suppress the increase in left ventricular (LV) mass in response to sustained pressure overload. In the present study, we used L-NAME-induced hypertension to test the hypothesis that adaptation to pressure overload occurs even when hypertrophy is suppressed. METHODS AND RESULTS: Male rats received L-NAME (50 mg. kg(-1). d(-1)) or no drug for 6 weeks. Rats with L-NAME-induced hypertension had levels of systolic wall stress similar to those of rats with aortic stenosis (85+/-19 versus 92+/-16 kdyne/cm). Rats with aortic stenosis developed a nearly 2-fold increase in LV mass compared with controls. In contrast, in the L-NAME rats, no increase in LV mass (1. 00+/-0.03 versus 1.04+/-0.04 g) or hypertrophy of isolated myocytes occurred (3586+/-129 versus 3756+/-135 microm(2)) compared with controls. Nevertheless, chronic pressure overload was not accompanied by the development of heart failure. LV systolic performance was maintained by mechanisms of concentric remodeling (decrease of in vivo LV chamber dimension relative to wall thickness) and augmented myocardial calcium-dependent contractile reserve associated with preserved expression of alpha- and beta-myosin heavy chain isoforms and sarcoplasmic reticulum Ca(2+) ATPase (SERCA-2). CONCLUSIONS: When the expected compensatory hypertrophic response is suppressed during L-NAME-induced hypertension, severe chronic pressure overload is associated with a successful adaptation to maintain systolic performance; this adaptation depends on both LV remodeling and enhanced contractility in response to calcium.

  3. Impairment of pulmonary vascular reserve and right ventricular systolic reserve in pulmonary arterial hypertension

    PubMed Central

    2014-01-01

    Background Exercise capacity is impaired in pulmonary arterial hypertension (PAH). We hypothesized that cardiovascular reserve abnormalities would be associated with impaired hemodynamic response to pharmacological stress and worse outcome in PAH. Methods Eighteen PAH patients (p) group 1 NYHA class II/III and ten controls underwent simultaneous right cardiac catheterization and intravascular ultrasound at rest and during low dose-dobutamine (10 mcg/kg/min) with trendelenburg (DST). We estimated cardiac output (CO), pulmonary vascular resistance (PVR) and capacitance (PC), and PA elastic modulus (EM). We concomitantly measured tricuspid annular plane systolic excursion (TAPSE), RV myocardial peak systolic velocity (Sm) and isovolumic myocardial acceleration (IVA) in PAH patients. Based on the rounded mean + 2 SD of the increase in mPAP in our healthy control group during DST (2.8 + 1.8 mm Hg), PAH p were divided into two groups according to mean PA pressure (mPAP) response during DST, 1: ΔmPAP > 5 mm Hg and 2: ΔmPAP ≤ 5 mm Hg. Cardiovascular reserve was estimated as the change (delta, Δ) during DST compared with rest, including ΔmPAP with respect to ΔCO (ΔmPAP/ΔCO). All patients were prospectively followed up for 2 years. Results PAH p showed significant lower heart rate and CO increase than controls during DST, with a significant mPAP and pulse PAP increase and higher ΔmPAP/ΔCO (p < 0.05). Neither hemodynamic, IVUS and echocardiographic data were different between both PAH groups at rest. In group 1, DST caused a higher ΔEM, ΔmPAP/ΔCO, ΔPVR, and ΔTAPSE than group 2, with a lower IVA increase and a negative ΔSV (p < 0.05). TAPSE correlated with mPAP and RVP (p < 0.05) and, IVA and Sm correlated with CO (p < 0.05). ΔEM correlated with ΔmPAP and ΔIVA with ΔCO (p < 0.05). There were two deaths/pulmonary transplantations in group 1 and one death in group 2 during the follow-up (p > 0.05). Conclusions

  4. Left Ventricular Systolic Function Changes in Primary Hypertension Patients Detected by the Strain of Different Myocardium Layers

    PubMed Central

    Huang, Jun; Yan, Zi-Ning; Rui, Yi-Fei; Fan, Li; Shen, Dan; Chen, Dong-Liang

    2016-01-01

    Abstract This study investigated left ventricular (LV) systolic dysfunction associated with differential strain among myocardial layers in primary hypertension (PH) patients with or without LV hypertrophy (LVH), and normal patients. In 63 PH and 42 healthy patients, two-dimensional speckle tracking echocardiography was used to measure the peak systolic longitudinal and circumferential strain of the myocardial subendocardial, middle and subepicardial layers, and the peak systolic radial strain. To assess LV systolic function, the apical long axis, 4- and 2-chamber views, and parasternal short axis at the basal, middle, and apical levels were acquired by cardiovascular ultrasound (Vivid E9, GE Healthcare, USA). Overall, the pattern in peak systolic longitudinal strain among myocardial layers was subendocardial > middle > subepicardial. In the peak systolic circumferential strain, this was middle > subepicardial > subendocardial. The peak systolic longitudinal strain was normal > NLVH > LVH. Among the groups, the peak systolic circumferential strain at the basal parasternal short-axis level was statistically similar, but at the middle and the apical parasternal short-axis levels were NLVH > normal > LVH. In normal and NLVH patients, the peak radial strain was middle > apical > basal, and in LVH patients was apical > middle > basal. The peak averages of the longitudinal and subendocardial circumferential strains differed significantly when LVH compared with NLVH and normal patients. The systolic function of PH patients was damaged in comparison with normal individuals, which could be detected conveniently and accurately using two-dimensional speckle tracking echocardiography. PMID:26765428

  5. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS).

    PubMed

    2008-12-01

    The benefits of lowering a systolic blood pressure below 140 mmHg in elderly hypertension remain controversial. This study is a prospective, randomized, open-label study with blinded assessment of endpoints to compare the 2-year effect of strict treatment to maintain systolic blood pressure below 140 mmHg with that of mild treatment to maintain systolic blood pressure below 160 but at or above 140 mmHg in elderly hypertensive patients. Patients with essential hypertension (65-85 years old, with a pretreatment systolic blood pressure of above 160 mmHg) were randomly assigned to receive strict treatment (n=2,212) or mild treatment (n=2,206). The baseline drug was efonidipine hydrochloride, a long-acting calcium antagonist. The primary endpoint was the combined incidence of cardiovascular disease and renal failure, and the secondary endpoints were total deaths and any safety problems. Although final blood pressures (systolic/diastolic) were significantly lower in the strict-treatment group compared with the mild-treatment group (135.9/74.8 vs. 145.6/78.1 mmHg; p<0.001), the incidence of the primary endpoint was similar in the two groups (86 patients in each group; p=0.99). Total deaths were 54 in the strict-treatment group vs. 42 in the mild-treatment group (p=0.22), and treatment was withdrawn because of adverse events in 36 patients in each group (p=0.99). An interaction between age and treatment for the primary endpoints (p=0.03) was seen. Complex clinical features associated with aging seem to have obscured the difference in effect between the two treatments. Further studies are needed to assess the optimal treatment strategy for hypertension in the elderly. PMID:19139601

  6. A computational model to predict aortic wall stresses in patients with systolic arterial hypertension.

    PubMed

    Giannakoulas, George; Giannoglou, George; Soulis, Johannes; Farmakis, Thomas; Papadopoulou, Stella; Parcharidis, George; Louridas, George

    2005-01-01

    Computational cardiovascular mechanics has allowed scientists to create complex 3D models for the simulation of cardiovascular problems. Mechanical stress plays a crucial role in the function of the cardiovascular system; stress analysis is a useful tool for the understanding of vascular pathophysiology. By using the spiral CT imaging and computational structural analysis, we present a noninvasive method of wall stress analysis in the normal aorta. The aortic segment was extended from the origin of the inferior mesenteric artery to the aortic bifurcation. The length of this segment was 12 cm, while the maximum transverse diameter was 2.075+/-0.129 cm. A 3D aortic model was constructed based on the CT scan images. The aorta was assumed to have a uniform wall thickness of 1.5mm. The generated unstructured grid, which was used for the structural analysis, consisted of 14,440 hexahedral elements. The wall material was assumed to be hyperelastic, homogeneous, isotropic and nearly incompressible (Poisson ratio=0.45). According to experimental studies, the Young modulus of aortic wall was set equal to 4.66 MPa. The shear stress induced by the blood flow was neglected. A finite-element static structural analysis was performed. Three different cases were examined applying constant intraluminal systolic blood pressures of 120, 180 and 240 mmHg, respectively. The von Mises stress distribution and the displacements of the aortic wall were calculated. Peak wall stress for the normal load case of 120 mmHg was 22.5 N/cm2, while the max displacement was 0.44 mm. The case with the intraluminal pressure of 180 mmHg resulted into peak wall stress of 32 N/cm2 with max displacement 0.59 mm, while for 240 mmHg was 40.6N/cm2, max displacement 0.72 mm. The rise in blood pressure caused all stresses to increase. The pattern of stress distribution and the orientation of the stress were similar for all test cases. A quantitative evaluation of the aortic wall stresses under systolic

  7. Combination treatment with a calcium channel blocker and an angiotensin blocker in a rat systolic heart failure model with hypertension.

    PubMed

    Namba, Masashi; Kim, Shokei; Zhan, Yumei; Nakao, Takafumi; Iwao, Hiroshi

    2002-05-01

    The mechanism and treatment of hypertensive systolic heart failure are not well defined. We compared the effect of an angiotensin-converting enzyme inhibitor (cilazapril, 10 mg/kg), an angiotensin receptor blocker (candesartan, 3 mg/kg), a calcium channel blocker (benidipine, 1, 3 or 6 mg/kg), and the same calcium channel blocker combined with renin-angiotensin blockers on systolic heart failure in Dahl salt-sensitive (DS) rats. DS rats were fed an 8% Na diet from 6 weeks of age and then subjected to the above drug treatments. Benidipine (1 mg/kg), cilazapril, and candesartan had compatible hypotensive effects and similar beneficial effects on cardiac hypertrophy, gene expression, and survival rate. The combination of benidipine with cilazapril or candesartan was found to have no additional beneficial effects on the above parameters, with the exception of a reduction in atrial natriuretic polypeptide gene expression. On the other hand, candesartan normalized serum creatinine, but serum creatinine was unaffected by either benidipine at 1 or 3 mg/kg or cilazapril. Further, the combined use of benidipine and either candesartan or cilazapril resulted in an additional reduction of urinary albumin excretion in DS rats. Thus systolic heart failure in DS rats is mainly mediated by hypertension, while renal dysfunction of DS rats is due to both hypertension and the AT1 receptor itself. These findings suggest that the combination of a calcium channel blocker with an AT1 receptor blocker or ACE inhibitor may be more effective in treating the renal dysfunction associated with systolic heart failure than monotherapy with either agent alone. However, further studies will be needed before reaching any definitive conclusion on the efficacy of this combination therapy in patients with heart failure. PMID:12135327

  8. Isolated Diastolic Hypertension Associated Risk Factors among Chinese in Anhui Province, China

    PubMed Central

    Wang, Yanchun; Xing, Fengjun; Liu, Rongjuan; Liu, Li; Zhu, Yu; Wen, Yufeng; Sun, Wenjie; Song, Ziwei

    2015-01-01

    Objective: To explore potential risk factors of isolated diastolic hypertension (IDH) among young and middle-aged Chinese. Methods: A community-based cross-sectional study was conducted among 338 subjects, aged 25 years and above, using random sampling technique. There were 68 cases of IDH, 46 cases of isolated systolic hypertension (ISH), 89 cases of systolic and diastolic hypertension (SDH), and 135 of subjects with normal blood pressure. Cases and controls were matched on sex by frequency matching. Demographic characteristics, blood pressure and other relevant information were collected.Results: Compared with controls, patients with IDH and ISH had significant higher level of triglyceride, high density lipoprotein, blood glucose and body mass index (BMI) (p < 0.05); while patients with SDH had significantly higher level of total cholesterol, triglyceride, glucose and BMI (p < 0.05). Linear mixed effects model showed that drinking tea, family history of hypertension (FHH), higher blood glucose, triglyceride and low density lipoprotein were related with elevated diastolic blood pressure (DBP) (p < 0.01); HFH, blood glucose, creatinine and BMI have positive effect on systolic blood pressure (SBP) (p < 0.05). Conclusions: Drinking tea, FHH, high levels of triglyceride, high density lipoprotein, blood glucose and BMI are associated with IDH among young and middle-aged Chinese. PMID:25913184

  9. Hypertension Subtypes among Hypertensive Patients in Ibadan

    PubMed Central

    Salako, Babatunde L.; Ogunniyi, Adesola; Cooper, Richard S.

    2014-01-01

    Background. Certain hypertension subtypes have been shown to increase the risk for cardiovascular morbidity and mortality and may be related to specific underlying genetic determinants. Inappropriate characterization of subtypes of hypertension makes efforts at elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the hypertension subtypes among patients with hypertension from South-Western Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was identified using JNCVII definition and was further grouped into four subtypes: controlled hypertension (CH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). Results. Systolic-diastolic hypertension was the most prevalent. Whereas SDH (77.6% versus 73.5%) and IDH (4.9% versus 4.7%) were more prevalent among females, ISH (10.1% versus 6.2%) was higher among males (P = 0.048). Female subjects were more obese (P < 0.0001) and SDH was prevalent among the obese group. Conclusion. Gender and obesity significantly influenced the distribution of the hypertension subtypes. Characterization of hypertension by subtypes in genetic association studies could lead to identification of previously unknown genetic variants involved in the etiology of hypertension. Large-scale studies among various ethnic groups may be needed to confirm these observations. PMID:25389499

  10. Effects of aliskiren- and ramipril-based treatment on central aortic blood pressure in elderly with systolic hypertension: a substudy of AGELESS

    PubMed Central

    Baschiera, Fabio; Chang, William; Brunel, Patrick

    2014-01-01

    Background Systolic hypertension is the most common form of hypertension in elderly patients. There is increasing evidence that measurement of central aortic pressure (CAP) better accounts for cardiovascular risk than brachial blood pressure (BP). The Aliskiren for GEriatric LowEring of SyStolic hypertension (AGELESS) study in elderly patients with systolic hypertension showed that aliskiren-based therapy provided greater reductions in peripheral BP than ramipril-based therapy over 12 and 36 weeks of treatment. Here, we present CAP results in a substudy of elderly patients from the AGELESS study. Methods This was a post hoc analysis of a 36-week, randomized, double-blind, parallel-group, active-controlled, optional-titration study in patients ≥65 years of age with systolic BP ≥140 mmHg. Changes in both central and peripheral BP and pulse pressure (PP) and changes in systolic and PP amplification ratios from baseline to the week 36 end point with aliskiren-based versus ramipril-based therapy were analyzed. Results Of the 901 patients randomized in the overall study, 154 patients (aliskiren, n=78; ramipril, n=76) had CAP data. Numerically comparable reductions were seen for central aortic systolic pressure (CASP) in aliskiren-based therapy (baseline: 143.7±15.0; week 36: −20.3±16.2) compared with ramipril-based therapy (baseline: 147.9±11.9; week 36: −20.7±14.6). However, for the change in central aortic diastolic pressure, the least squares mean between-treatment difference (−3.6 mmHg [95% confidence interval, −6.76, −0.43; P=0.0263]) was in favor of aliskiren, while the other changes were comparable between the two groups with a trend in favor of aliskiren for CASP as well (−2.6 mmHg [95% confidence interval, −7.38, 2.19; P=0.2855)]. Correlation coefficients for change from baseline between CASP and systolic BP and between central aortic pulse pressure and PP (r=0.8, P<0.0001) were highly significant. Conclusion Aliskiren-based therapy

  11. Water aerobics is followed by short-time and immediate systolic blood pressure reduction in overweight and obese hypertensive women.

    PubMed

    Cunha, Raphael Martins; Arsa, Gisela; Neves, Eduardo Borba; Lopes, Lorena Curado; Santana, Fabio; Noleto, Marcelo Vasconcelos; Rolim, Thais I; Lehnen, Alexandre Machado

    2016-07-01

    One exercise training session such as walking, running, and resistance can lead to a decrease in blood pressure in normotensive and hypertensive individuals, but few studies have investigated the effects of exercise training in an aquatic environment for overweight and obese hypertensive individuals. We aimed to assess the acute effects of a water aerobics session on blood pressure changes in pharmacologically treated overweight and obese hypertensive women. A randomized crossover study was carried out with 18 hypertensive women, 10 of them were overweight (54.4 ± 7.9 years; body mass index: 27.8 ± 1.7 kg/m(2)) and eight obese (56.4 ± 6.6 years; body mass index: 33.0 ± 2.0 kg/m(2)). The water aerobics exercise session consisted of a 45-minute training at the intensity of 70%-75% of maximum heart rate adjusted for the aquatic environment. The control group did not enter the pool and did not perform any exercise. We measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) before, immediately after, and every 10 minutes up to 30 minutes after the aerobic exercise or control session. Overall (n = 18), DBP did not change after the water aerobic exercise and control session, and SBP decreased at 10 and 20 minutes postexercise compared to the control session. Among overweight women, SBP decreased at 10 and 20 minutes postexercise. In contrast, among obese women, SBP decreased only at 10 minutes postexercise. SBP variation was -2.68 mm Hg in overweight and -1.24 mm Hg in obese women. In conclusion, the water aerobics session leads to a reduction in SBP, but not in DBP, during 10 and 20 minutes postexercise recovery. Thus, it may be safely prescribed to overweight and obese women. PMID:27245928

  12. Dysregulated Arginine Metabolism and Importance of Compensatory Dimethylarginine Dimethylaminohydrolase-1 in Pulmonary Hypertension Associated with Advanced Systolic Heart Failure

    PubMed Central

    Shao, Zhili; Wang, Zeneng; Shrestha, Kevin; Thakur, Akanksha; Borowski, Allen G.; Sweet, Wendy; Thomas, James D.; Moravec, Christine S.; Hazen, Stanley L.; Tang, W. H. Wilson

    2012-01-01

    Objective To examine the hemodynamic determinants of dysregulated arginine metabolism in patients with acute decompensated heart failure and explore possible mechanism of arginine dysregulation in human heart failure. Background Accumulating methylated arginine metabolites and impaired arginine bioavailability have been associated with heart failure, but the underlying pathophysiology remains unclear. Methods We prospectively determined plasma levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and global arginine bioavailability ratio [GABR=arginine/(ornithine+citrulline)] by tandem mass spectrometry in subjects with advanced decompensated heart failure in the intensive care unit (“ADHF”, n=68) and with stable chronic heart failure (“CHF”, n=57). Results Compared to CHF subjects, plasma ADMA was significantly higher (median[interquartile range]: 1.29 [1.04–1.77] versus 0.87 [0.72–1.05] μM, p<0.0001), and GABR significantly lower (0.90 [0.69–1.22] versus 1.13 [0.92–1.37], p=0.002) in ADHF subjects. Elevated ADMA and diminished GABR were associated with higher systolic pulmonary artery pressure (sPAP) and higher central venous pressure, but not with other clinical or hemodynamic indices. We further observed myocardial levels of dimethylarginine dimethylaminohydrolase-1 (DDAH-1) were increased in CHF without elevated sPAP (<50mmHg), but diminished with elevated sPAP (≥50mmHg, difference with sPAP<50 mmHg, p=0.02). Conclusions Dysregulated arginine metabolism was observed in advanced decompensated heart failure, particularly with pulmonary hypertension and elevated intracardiac filling pressures. Compared to control hearts, we observed higher amounts of ADMA-degradation enzyme DDAH-1 (but similar amounts of ADMA-producing enzyme, PRMT-1) in the human failing myocardium. PMID:22440215

  13. Environmental and Genetic Contribution to Hypertension Prevalence: Data from an Epidemiological Survey on Sardinian Genetic Isolates

    PubMed Central

    Biino, Ginevra; Parati, Gianfranco; Concas, Maria Pina; Adamo, Mauro; Angius, Andrea; Vaccargiu, Simona; Pirastu, Mario

    2013-01-01

    Background and Objectives Hypertension represents a major cause of cardiovascular morbidity and mortality worldwide but its prevalence has been shown to vary in different countries. The reasons for such differences are still matter of debate, the relative contributions given by environmental and genetic factors being still poorly defined. We estimated the current prevalence, distribution and determinants of hypertension in isolated Sardinian populations and also investigated the environmental and genetic contribution to hypertension prevalence taking advantage of the characteristics of such populations. Methods and Results An epidemiological survey with cross-sectional design was carried out measuring blood pressure in 9845 inhabitants of 10 villages of Ogliastra region between 2002 and 2008. Regression analysis for assessing blood pressure determinants and variance component models for estimating heritability were performed. Overall 38.8% of this population had hypertension, its prevalence varying significantly by age, sex and among villages taking into account age and sex structure of their population. About 50% of hypertensives had prior cardiovascular disease. High blood pressure was independently associated with age, obesity related factors, heart rate, total cholesterol, alcohol consumption, low education and smoking status, all these factors contributing more in women than in men. Heritability was 27% for diastolic and 36% for systolic blood pressure, its contribution being significantly higher in men (57%) than in women (46%). Finally, the genetic correlation between systolic and diastolic blood pressure was 0.74, indicating incomplete pleiotropy. Conclusion Genetic factors involved in the expression of blood pressure traits account for about 30% of the phenotypic variance, but seem to play a larger role in men; comorbidities and environmental factors remain of predominant importance, but seem to contribute much more in women. PMID:23527229

  14. Inflammation and oxidative stress caused by nitric oxide synthase uncoupling might lead to left ventricular diastolic and systolic dysfunction in patients with hypertension

    PubMed Central

    Szelényi, Zsuzsanna; Fazakas, Ádám; Szénási, Gábor; Kiss, Melinda; Tegze, Narcis; Fekete, Bertalan Csaba; Nagy, Eszter; Bodó, Imre; Nagy, Bálint; Molvarec, Attila; Patócs, Attila; Pepó, Lilla; Prohászka, Zoltán; Vereckei, András

    2015-01-01

    Objective To investigate the role of oxidative stress, inflammation, hypercoagulability and neuroendocrine activation in the transition of hypertensive heart disease to heart failure with preserved ejection fraction (HFPEF). Methods We performed echocardiography for 112 patients (≥ 60 years old) with normal EF (18 controls and 94 with hypertension), and determined protein carbonylation (PC), and tetrahydrobiopterin (BH4), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), fibrinogen, plasminogen activator inhibitor type-I (PAI-I), von Willebrand factor, chromogranin A (cGA) and B-type natriuretic peptide (BNP) levels from their blood samples. Results We found that 40% (38/94) of the patients with hypertension (HT) had no diastolic dysfunction (HTDD−), and 60% (56/94) had diastolic dysfunction (HTDD+). Compared to the controls, both patient groups had increased PC and BH4, TNF-α, PAI-I and BNP levels, while the HTDD+ group had elevated cGA and CRP levels. Decreased atrial and longitudinal left ventricular (LV) systolic and diastolic myocardial deformation (strain and strain rate) was demonstrated in both patient groups versus the control. Patients whose LV diastolic function deteriorated during the follow-up had elevated PC and IL-6 level compared to their own baseline values, and to the respective values of patients whose LV diastolic function remained unchanged. Oxidative stress, inflammation, BNP and PAI-I levels inversely correlated with LV systolic, diastolic and atrial function. Conclusions In patients with HT and normal EF, the most common HFPEF precursor condition, oxidative stress and inflammation may be responsible for LV systolic, diastolic and atrial dysfunction, which are important determinants of the transition of HT to HFPEF. PMID:25678898

  15. Can Echocardiography, Especially Tricuspid Annular Plane Systolic Excursion Measurement, Predict Pulmonary Hypertension and Improve Prognosis in Patients on Long-Term Dialysis?

    PubMed

    Grabysa, Radosław; Wańkowicz, Zofia

    2015-01-01

    In recent years, increasing attention has been paid to pulmonary hypertension (PH) as a strong and independent risk factor for adverse outcome in the population of patients on long-term dialysis. Published results of observational studies indicate that the problem of PH refers mostly to patients on long-term hemodialysis and is less common in peritoneal dialysis patients. The main cause of this complication is proximal location of the arteriovenous fistula, causing chronically increased cardiac output. This paper presents the usefulness of transthoracic echocardiography (TTE) for measurement of the Tricuspid Annular Plane Systolic Excursion (TAPSE) in the early diagnosis of PH in dialysis patients. Echocardiographic diagnosis of pulmonary hypertension with TTE, especially in the case of HD patients, ensures the selection of the proper location for the first arteriovenous fistula and facilitates the decision to switch to peritoneal dialysis or to accelerate the process of qualification for kidney transplantation. PMID:26697754

  16. Systolic arrays

    SciTech Connect

    Moore, W.R.; McCabe, A.P.H.; Vrquhart, R.B.

    1987-01-01

    Selected Contents of this book are: Efficient Systolic Arrays for the Solution of Toeplitz Systems, The Derivation and Utilization of Bit Level Systolic Array Architectures, an Efficient Systolic Array for Distance Computation Required in a Video-Codec Based Motion-Detection, On Realizations of Least-Squares Estimation and Kalman Filtering by Systolic Arrays, and Comparison of Systolic and SIMD Architectures for Computer Vision Computations.

  17. Newly diagnosed hyperthyroidism in the 25th gestational week of pregnancy presenting with systolic arterial hypertension only.

    PubMed

    Zaveljcina, Janez; Legan, Mateja; Gaberšček, Simona

    2016-05-01

    We present a case of a 30-year-old woman diagnosed with arterial hypertension in the 25th week of pregnancy. Our search for secondary causes of arterial hypertension revealed hyperthyroid Hashimoto's thyroiditis (HT), which was treated with propilthiouracil. Three weeks after delivery, she was normotensive without medication. In the next four months, she developed hypothyroidism and treatment with L-thyroxine was started. In conclusion, in the second half of pregnancy, a hyperthyroid HT can occur - in spite of the well-known amelioration of autoimmune thyroid disorders in that period, and can be the only cause of arterial hypertension. PMID:26979941

  18. Effect of angiotensin receptor blockade on central aortic systolic blood pressure in hypertensive Asians measured using radial tonometry: an open prospective cohort study

    PubMed Central

    Teong, Hui Hwang; Chin, Adeline Mei Lin; Sule, Ashish Anil; Tay, Jam Chin

    2016-01-01

    INTRODUCTION Central aortic systolic pressure (CASP) has been shown to be a stronger predictor of cardiovascular events than brachial blood pressure (BP). Different classes of drugs have differential effects on CASP and brachial BP. This open prospective cohort study aimed to observe changes in CASP (measured using radial tonometry) among hypertensive Asians after 12 weeks of treatment with valsartan, an angiotensin receptor blocker (ARB). METHODS Patients with treatment-naïve hypertension or uncontrolled hypertension who were on non-ARB therapy were eligible for inclusion. Patients with uncontrolled BP (i.e. ≥ 140/90 mmHg) received valsartan for 12 weeks. The patients’ brachial systolic and diastolic BP (SBP and DBP), and CASP changes were monitored using the BPro® watch. RESULTS The mean age of the 44 enrolled patients was 35 years. At baseline, the mean BP and CASP were 150.2/91.4 ± 10.6/9.4 mmHg and 136.3 ± 12.2 mmHg, respectively. Valsartan reduced SBP, DBP and CASP by 14.9 ± 10.7 mmHg, 10.9 ± 8.4 mmHg and 15.3 ± 10.9 mmHg, respectively (all p < 0.001). Every 1.0-mmHg reduction in brachial SBP resulted in a 0.8-mmHg reduction in CASP (p < 0.001). A CASP cut-off of 122.5 mmHg discriminated between controlled and uncontrolled BP (sensitivity 74%, specificity 88%). CONCLUSION Using radial tonometry, we demonstrated good correlation between CASP and brachial SBP reductions after 12 weeks of treatment with valsartan in our study cohort. Correlation analysis between CASP and SBP reductions may be useful for demonstrating whether a drug is able to lower CASP beyond lowering SBP. PMID:26875683

  19. Fixed-Combination Olmesartan/Amlodipine Was Superior to Perindopril + Amlodipine in Reducing Central Systolic Blood Pressure in Hypertensive Patients With Diabetes.

    PubMed

    Ruilope, Luis M

    2016-06-01

    This post hoc analysis from the Sevikar Compared to the Combination of Perindopril Plus Amlodipine on Central Arterial Blood Pressure in Patients With Moderate-to-Severe Hypertension (SEVITENSION) study assessed the efficacy and tolerability of olmesartan (OLM) and amlodipine (AML) in reducing central systolic blood pressure (CSBP) compared with perindopril (PER) plus AML in hypertensive patients with type 2 diabetes. Patients were randomized to OLM/AML 40/10 mg or PER/AML 8/10 mg for 24 weeks. The primary efficacy endpoint was the absolute change in CSBP from baseline to week 24, which was greater with OLM/AML (-13.72±1.14 mm Hg) compared with PER/AML (-10.21±1.11 mm Hg). The between-group difference was -3.51±1.60 mm Hg (95% confidence interval, -6.66 to -0.36 mm Hg) and was within the noninferiority margin (2 mm Hg) as well as the superiority margin (0 mm Hg). In addition, OLM/AML was associated with a higher proportion of patients achieving blood pressure normalization. In hypertensive patients with diabetes, the fixed-dose combination of OLM/AML was superior to PER/AML in reducing CSBP, as well as other secondary endpoints. PMID:26395174

  20. Effect of Group Mindfulness-Based Stress-Reduction Program and Conscious Yoga on Lifestyle, Coping Strategies, and Systolic and Diastolic Blood Pressures in Patients with Hypertension

    PubMed Central

    Nejati, Somayeh; Zahiroddin, Alireza; Afrookhteh, Gita; Rahmani, Soheila; Hoveida, Shahrzad

    2015-01-01

    Background: Healthy lifestyle and ineffective coping strategies are deemed significant variables among patients with hypertension. This study attempted to determine the status of these variables following intervention via the mindfulness-based stress-reduction program (MBSRP) in patients with hypertension. Method: This study was a randomized clinical trial. The study sample, consisting of 30 patients referring to the Hypertension Clinic of Imam Hossein Hospital in 2013, was assigned either to the intervention (recipient of the MBSRP and conscious yoga) or to the control group (recipient of yoga training). The intervention group had 8 training sessions over 8 weeks. Lifestyle and coping strategies as well as blood pressure were measured in the intervention group before intervention and then immediately thereafter and at 2 months' follow-up and were compared to those in the control group at the same time points. Result: The mean age of the patients in the intervention (40% women) and control (53% women) groups was 43.66 ± 5.14 and 43.13 ± 5.04 years, respectively. The results showed that the mean scores of lifestyle (p value < 0.05), emotion-focused coping strategies (p value < 0.001), problem-focused coping strategies (p value < 0.001), diastolic blood pressure (p value < 0.001), and systolic blood pressure (p value < 0.001) were significantly different between the intervention and control groups after the intervention. Conclusion: Applying an intervention based on the MBSRP may further improve the lifestyle and coping strategies of patients with hypertension. PMID:26697087

  1. Characteristics of cardiorespiratory output determining factors among 11-19-year-old boys at rest and during maximal load: Its impact on systolic hypertension.

    PubMed

    Ihász, F; Karsai, I; Kaj, M; Marton, O; Finn, K J; Csányi, T

    2015-09-01

    As consequence of the expansion of sedentary lifestyle among schoolchildren the prevalence of particular symptoms related to decreased cardiorespiratory fitness increases. The purpose of this study was twofolds, on one hand to compare boys in three developmental groups: second childhood (G1), puberty (G2), young adult (G3) and on the other hand to compare groups classified on resting systolic blood pressure (RSBP) to differentiate cardiorespiratory output determining factors both at rest and at maximal load. Randomly selected apparently healthy boys were assessed, all subjects (n = 282) performed an incremental treadmill test until fatigue. Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), and oxygen consumption were measured. Resting HR was higher and resting SBP and DBP were lower in the G1 as compared to G2 and G3 (p < 0.05) but not differed at maximal loads. However indicators of cardiovascular load differed between groups. The oxygen pulse and Q were the lowest in the G1 and increased significantly between groups (p < 0.05). In conclusion based on our data we can suggest that there is an observable development of hypertension associated with maturation and cardiac output determining factors. PMID:26551742

  2. Systolic flow

    SciTech Connect

    Tsay, J.C.; Yuan, S. )

    1990-03-01

    This paper presents a formal algebraic notation to express the global data interacting activities of a systolic array. The notation we use is the generating function. Using generating functions, we can describe the velocity and the moving path of a data stream at any time. Several generating functions can be grouped together to form a systolic flow which can aid the specification, design, and verification of a systolic array.

  3. Thermoase-derived flaxseed protein hydrolysates and membrane ultrafiltration peptide fractions have systolic blood pressure-lowering effects in spontaneously hypertensive rats.

    PubMed

    Nwachukwu, Ifeanyi D; Girgih, Abraham T; Malomo, Sunday A; Onuh, John O; Aluko, Rotimi E

    2014-01-01

    Thermoase-digested flaxseed protein hydrolysate (FPH) samples and ultrafiltration membrane-separated peptide fractions were initially evaluated for in vitro inhibition of angiotensin I-converting enzyme (ACE) and renin activities. The two most active FPH samples and their corresponding peptide fractions were subsequently tested for in vivo antihypertensive activity in spontaneously hypertensive rats (SHR). The FPH produced with 3% thermoase digestion showed the highest ACE- and renin-inhibitory activities. Whereas membrane ultrafiltration resulted in significant (p < 0.05) increases in ACE inhibition by the <1 and 1-3 kDa peptides, only a marginal improvement in renin-inhibitory activity was observed for virtually all the samples after membrane ultrafiltration. The FPH samples and membrane fractions were also effective in lowering systolic blood pressure (SBP) in SHR with the largest effect occurring after oral administration (200 mg/kg body weight) of the 1-3 kDa peptide fraction of the 2.5% FPH and the 3-5 kDa fraction of the 3% FPH. Such potent SBP-lowering capacity indicates the potential of flaxseed protein-derived bioactive peptides as ingredients for the formulation of antihypertensive functional foods and nutraceuticals. PMID:25302619

  4. Thermoase-Derived Flaxseed Protein Hydrolysates and Membrane Ultrafiltration Peptide Fractions Have Systolic Blood Pressure-Lowering Effects in Spontaneously Hypertensive Rats

    PubMed Central

    Nwachukwu, Ifeanyi D.; Girgih, Abraham T.; Malomo, Sunday A.; Onuh, John O.; Aluko, Rotimi E.

    2014-01-01

    Thermoase-digested flaxseed protein hydrolysate (FPH) samples and ultrafiltration membrane-separated peptide fractions were initially evaluated for in vitro inhibition of angiotensin I-converting enzyme (ACE) and renin activities. The two most active FPH samples and their corresponding peptide fractions were subsequently tested for in vivo antihypertensive activity in spontaneously hypertensive rats (SHR). The FPH produced with 3% thermoase digestion showed the highest ACE- and renin-inhibitory activities. Whereas membrane ultrafiltration resulted in significant (p < 0.05) increases in ACE inhibition by the <1 and 1–3 kDa peptides, only a marginal improvement in renin-inhibitory activity was observed for virtually all the samples after membrane ultrafiltration. The FPH samples and membrane fractions were also effective in lowering systolic blood pressure (SBP) in SHR with the largest effect occurring after oral administration (200 mg/kg body weight) of the 1–3 kDa peptide fraction of the 2.5% FPH and the 3–5 kDa fraction of the 3% FPH. Such potent SBP-lowering capacity indicates the potential of flaxseed protein-derived bioactive peptides as ingredients for the formulation of antihypertensive functional foods and nutraceuticals. PMID:25302619

  5. [Gallopamil and chlorthalidone versus atenolol and chlorthalidone in the treatment of obstructive hypertrophic cardiomyopathy in patients with arterial hypertension: polycardiographic evaluation of the systolic and diastolic function of the left ventricle].

    PubMed

    Chieppa, S; Lobascio, C; Brandini, V; Iarussi, D; Giuliani, F; Langella, S; De Simone, R

    1989-08-01

    In 13 patients, affected by hypertrophic obstructive cardiomyopathy (HOCM) and essential hypertension, antihypertensive-efficacy and effects of a new calcium-channel blocker (gallopamil) associated with a diuretic agent (chlorthalidone) on left ventricular systolic and diastolic performance assessed by phonocardiographic methods. The results were compared to those obtained, in the same group of patients, with a selective beta-blocker (atenolol) associated with the same diuretic agent (chlorthalidone). With both therapeutic regimens a statistically significant reduction of systolic and diastolic arterial pressure was observed; both agents were able to reduce hemodynamic gradient in systole which characterize HOCM; however, the treatment with gallopamil plus chlorthalidone determined greater effects on left ventricular diastolic function as compared to the treatment with atenolol plus chlorthalidone; both treatments determined bradycardia. PMID:2605580

  6. Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values.

    PubMed

    van Kessel, Marco; Seaton, David; Chan, Jonathan; Yamada, Akira; Kermeen, Fiona; Butler, Thomas; Sabapathy, Surendran; Morris, Norman

    2016-06-01

    Pulmonary hypertension (PH) is a progressively fatal disease having a significant impact on right ventricular (RV) function, a major determinant of long-term outcome in PH patients. In our clinic we frequently noticed the combination of PH and reduced RV function, but with discordant Tricuspid Annular Plane Systolic Excursion (TAPSE) values. The present study focuses on whether RV free wall strain measured using 2-dimensional speckle-tracking echocardiography is able to predict mortality in this subgroup of PH patients. 57 patients with PH and RV dysfunction (visual echocardiographic assessment of ≥2) and pseudo-normalized TAPSE values (defined as ≥16 mm) were retrospectively evaluated. Patients were divided by RV free -20 % as cut-off value. Follow-up data on all-cause mortality were registered after a median follow-up time of 27.9 ± 1.7 months. RV free of ≥-20 % was predictive of all-cause mortality after a median follow-up time of 27.9 ± 1.7 months (HR 3.76, 95 % CI 1.02-13.92, p = 0.05). RV free ≥-20 % remained a significant predictor of all-cause mortality (HR 4.30, 95 % CI 1.11-16.61, p = 0.04) after adjusting for PH-specific treatment. On the contrary, TAPSE was not a significant predictor of all-cause mortality. RV free wall strain provides prognostic information in patients with PH and RV dysfunction, but with normal TAPSE values. Future studies with larger cohorts, longer follow-up periods and inclusion of more echocardiographic parameters measuring LV and RV function could confirm the strength of RV free ≥-20 % as a predictor of mortality for this subgroup of patients with PH. PMID:26931558

  7. Vascular reactivity of rabbit isolated renal and femoral resistance arteries in renal wrap hypertension.

    PubMed

    Khammy, Makhala M; Angus, James A; Wright, Christine E

    2016-02-15

    In rabbits with cellophane renal wrap hypertension, hindquarter and total vascular resistance changes to pressor and depressor agents are amplified compared to those of normotensive rabbits. The aim of the present study was to evaluate the in vitro pharmacodynamics of hypertensive and normotensive rabbit small artery segments isolated from the renal and hindquarter vascular beds. Using wire myography, the full range (Emax) and sensitivity (EC50) to a range of agonists of segments of renal interlobar (≈ 600 µm i.d.), renal arcuate (≈ 250 µm i.d.) and deep femoral branch (≈ 250 µm i.d.) arteries were assessed under normalised conditions of passive tension. Interlobar arteries from hypertensive rabbits were more sensitive (EC50) than those from normotensive rabbits to noradrenaline (6-fold), methoxamine (3-fold) and angiotensin II (3-fold). Arcuate artery reactivity was largely unaffected by hypertension. Deep femoral arteries from hypertensive rabbits had enhanced sensitivity only to noradrenaline (2-fold) and methoxamine (4-fold). Sensitivity to relaxation by acetylcholine was unaffected by hypertension in all arteries. Deep femoral arteries from hypertensive rabbits were more sensitive to sodium nitroprusside than normotensive counterparts. Adenosine caused little relaxation in renal arteries, but full relaxation in deep femoral arteries, unaltered by hypertension. This study found substantial heterogeneity in the pharmacodynamic profile of vessels isolated from different vascular beds and between arterial segments within the kidney. These profiles were differentially affected by hypertension suggesting that hypertension per se is not a resultant of general vascular dysfunction. PMID:26806799

  8. The relationship of isolated sleep paralysis and panic disorder to hypertension.

    PubMed

    Bell, C C; Hildreth, C J; Jenkins, E J; Carter, C

    1988-03-01

    An hypothesis is proposed that there exists a subgroup of African-American hypertensive patients whose hypertension could have been prevented by the early detection and treatment of easily recognizable symptoms that signal the initiation of the pathophysiologic processes that lead to essential hypertension.A pilot study of 31 patients with elevated blood pressure revealed that 41.9 percent had isolated sleep paralysis, 35.5 percent had panic attacks, and 9.7 percent had panic disorder. These proposed hyperadrenergic phenomena may be related to the development of hypertension in certain individuals. PMID:3351970

  9. A systolic radiation monitoring system

    SciTech Connect

    Shpancer, I.; Kinsner, W.

    1982-12-01

    This paper describes a data acquisition system for radiation monitoring which significantly improves performance over conventional systems by providing higher throughput, elimination of data skew, easier and inexpensive isolation, improved system accuracy, and compact implementation. The novel systolic data acquisition system, including systolic converter, processor and networking was developed to alleviate drawbacks of various conventional data acquisition systems used in radiation monitoring. The system is based on a systolic conversion, processing and networking method amenable to highly integrated vector architecture. The method employs systolic rules which can be developed for a selected problem. The rules for the radiation monitoring problem have been developed so as to apply not only locally but also globally to the systolic network. A form of the network has been implemented and is operational in a nuclear reactor site. Other forms are being implemented and tested for other data skew sensitive problems.

  10. Pulmonary hypertension due to isolated metastatic squamous cell carcinoma thromboemboli.

    PubMed

    Wilson, Michael K; Granger, Emily K; Preda, Veronica A

    2006-04-01

    Pulmonary hypertension as the initial presentation of occult malignancy is extremely rare. The differential diagnosis of pulmonary hypertension due to arterial tumour embolism is often overlooked and deserves contemplation. Our case report details the presentation of cardiorespiratory decompensation from an assumed classic saddle pulmonary embolus in a previously fit, well 80-year-old gentleman. The patient underwent successful pulmonary thromboendarterectomy, however, intraoperatively the specimen was noted to be atypical. This resulted in the surprising definitive diagnosis of thromboembolic pulmonary hypertension secondary to laminated thrombi of metastatic squamous cell tumour emboli. The site of tumour origin was however not histologically apparent and was unable to be elucidated on extensive further investigation. Post-operatively the patient had considerable subjective and functional improvement returning to activities of daily living. He however passed away some 9 months later. PMID:16412689

  11. Timeline of History of Hypertension Treatment

    PubMed Central

    Saklayen, Mohammad G.; Deshpande, Neeraj V.

    2016-01-01

    It is surprising that only about 50 years ago hypertension was considered an essential malady and not a treatable condition. Introduction of thiazide diuretics in late 50s made some headway in successful treatment of hypertension and ambitious multicenter VA co-operative study (phase 1 and 2) started in 1964 for diastolic hypertension ranging between 90 and 129 mmHg and completed by 1971 established for the first time that treating diastolic hypertension reduced CV events such as stroke and heart failure and improved mortality. In the following decade, these results were confirmed for the wider US and non-US population, including women and goal-oriented BP treatment to diastolic 90 became the standard therapy recommendation. But isolated systolic hypertension (accounting for two-thirds of the 70 million hypertensive population in USA alone) was not considered treatable until 1991 when SHEP study (systolic hypertension in elderly program) was completed and showed tremendous benefits of treating systolic BP over 160 mmHg using only a simple regimen using small dose chlorthalidone with addition of atenolol if needed. In the next two decades, ALLHAT and other studies examined the comparability of outcomes with use of different classes and combinations of antihypertensive drugs. Although diastolic BP goal was established as 90 in the late 70s and later confirmed by HOT study, the goal BP for systolic hypertension was not settled until very recently with completion of SPRINT study. ACCORD study showed no significant difference in outcome with sys 140 vs. 120 in diabetics. But recently completed SPRINT study with somewhat similar protocol as in ACCORD but in non-diabetic showed almost one-quarter reduction in all-cause mortality and one-third reduction of CV events with systolic BP goal 120. PMID:26942184

  12. High Prevalence of Isolated Nocturnal Hypertension in Chinese Patients With Chronic Kidney Disease

    PubMed Central

    Wang, Cheng; Deng, Wen-Jie; Gong, Wen-Yu; Zhang, Jun; Tang, Hua; Peng, Hui; Zhang, Qun-Zi; Ye, Zeng-Chun; Lou, Tanqi

    2015-01-01

    Background Isolated nocturnal hypertension (INH) has been studied among the general population and hypertensive patients. However, little insight is available on the prevalence of INH and its role in target-organ damage among patients with chronic kidney disease (CKD). Methods and Results We recruited 1282 CKD patients admitted to our hospital division. Patients were divided into 4 groups: INH; isolated daytime hypertension; day–night sustained; and ambulatory normotension. Multiple linear regression analyses were used to evaluate the correlation between INH and renal/cardiovascular parameters. A total of 262 (20.44%) CKD patients had isolated nocturnal hypertension and 651 (50.78%) had day–night sustained hypertension, whereas only 350 (27.30%) patients showed normotension and 19 (1.48%) had isolated daytime hypertension. Multivariate logistic regression analysis showed that INH was associated mainly with age, estimated glomerular filtration rate, clinic diastolic blood pressure, and that INH was determined only by age, estimated glomerular filtration rate, and clinic diastolic blood pressure. The prevalence of impaired renal function, left ventricular hypertrophy, and carotid intima-media thickness in patients with INH were higher than in normotensive patients (P<0.05), whereas impaired renal function and left ventricular hypertrophy in these patients were lower than patients in the day–night sustained hypertension group (P<0.05). INH was correlated with estimated glomerular filtration rate, left ventricular mass index, and carotid intima-media thickness according to multiple linear regression analyses. Conclusions The prevalence of INH in CKD patients was high, and INH was correlated with target-organ damage in CKD patients. PMID:26089178

  13. Prevalence of isolated diastolic hypertension and associated risk factors among adults in Kanpur, India

    PubMed Central

    Midha, Tanu; Lalchandani, Arati; Nath, Bhola; Kumari, Ranjeeta; Pandey, Umeshwar

    2012-01-01

    Background Isolated diastolic hypertension (IDH) is a largely unrecognized subtype of hypertension, more commonly seen in the younger age group. Aims (1) To determine the prevalence of IDH in the adult population of Kanpur district. (2) To study the associated risk factors of IDH. Methods A community-based cross-sectional study was conducted in 801 subjects, aged 20 years and above, using multistage stratified random sampling technique. Results The prevalence of IDH was 4.5%, which was 6.2% in men and 3.1% in women. A significant proportion of IDH was seen in the 40–49 years age group. Multivariate logistic regression analysis of the associated risk factors showed that gender, physical activity and BMI were significantly associated with IDH. Conclusion Isolated diastolic hypertension is an emerging problem in developing countries. IDH is more common among men, sedentary individuals and those with a higher BMI. PMID:22929820

  14. Hypertension.

    PubMed

    Oparil, S; Calhoun, D A

    1989-03-01

    An estimated 58 million Americans are at increased risk of morbidity and premature death due to high blood pressure (BP) and require some type of therapy or systematic monitoring. This article focuses on recent advances in our understanding of the pathogenesis of hypertension, new approaches to the diagnosis and treatment of secondary hypertension, and current views of the most appropriate nonpharmacologic and pharmacologic therapy for essential hypertension. In view of the extremely high prevalence of the disorder, emphasis is placed on efficient and cost-effective strategies for diagnosing and managing the hypertensive patient. Recent evidence indicates that nonpharmacologic therapy, including dietary potassium and calcium supplements, reduction of salt intake, weight loss for the obese patient, regular exercise, a diet high in fiber and low in cholesterol and saturated fats, smoking cessation, and moderation of alcohol consumption produces significant sustained reductions in BP while reducing overall cardiovascular risk. Accordingly, nonpharmacologic antihypertensive therapy should be included in the treatment of all hypertensive patients. In persons with mild hypertension, nonpharmacologic approaches may adequately reduce BP, thereby avoiding the expense and potential side effects of drug therapy. In patients with more severe hypertension, nonpharmacologic therapy, used in conjunction with pharmacologic therapy, can reduce the dosage of antihypertensive medications necessary for BP control. Patients treated with nonpharmacologic therapy only should be followed closely, and if BP control is not satisfactory, drug therapy should be added. The large number of drugs available for use in hypertension treatment, coupled with our rapidly expanding knowledge of the pathophysiology of hypertension and of the adverse effects of these drugs in individual patient groups, make it possible to individualize antihypertensive treatment. When used as monotherapy, most agents

  15. Hypertension.

    PubMed

    Poulter, Neil R; Prabhakaran, Dorairaj; Caulfield, Mark

    2015-08-22

    Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small. Hence, intervention on key environmental determinants and effective implementation of trial-based therapies are needed. Three-drug combinations can control hypertension in about 90% of patients but only if resources allow identification of patients and drug delivery is affordable. Furthermore, assessment of optimal drug therapy for each ethnic group is needed. PMID:25832858

  16. Reasoning about systolic algorithms

    SciTech Connect

    Purushothaman, S.

    1986-01-01

    Systolic algorithms are a class of parallel algorithms, with small grain concurrency, well suited for implementation in VLSI. They are intended to be implemented as high-performance, computation-bound back-end processors and are characterized by a tesselating interconnection of identical processing elements. This dissertation investigates the problem of providing correctness of systolic algorithms. The following are reported in this dissertation: (1) a methodology for verifying correctness of systolic algorithms based on solving the representation of an algorithm as recurrence equations. The methodology is demonstrated by proving the correctness of a systolic architecture for optimal parenthesization. (2) The implementation of mechanical proofs of correctness of two systolic algorithms, a convolution algorithm and an optimal parenthesization algorithm, using the Boyer-Moore theorem prover. (3) An induction principle for proving correctness of systolic arrays which are modular. Two attendant inference rules, weak equivalence and shift transformation, which capture equivalent behavior of systolic arrays, are also presented.

  17. Perspective on hypertension in the elderly.

    PubMed Central

    Whitcomb, B.; Byyny, R. L.

    1990-01-01

    More than half of elderly men and women have hypertension, leading to a significant risk of increased morbidity and mortality. The cause of hypertension in this age group is unknown. Left ventricular hypertrophy is frequently present, often associated with diastolic dysfunction. Systolic hypertension in the elderly increases the risk of cardiovascular disease, but there are no good data to show that the treatment of isolated systolic hypertension reduces the morbidity or mortality. Good evidence indicates that antihypertensive treatment in this group decreases cardiovascular morbidity and mortality up to age 80, so most elderly hypertensive patients should be treated. An empiric trial of nonpharmacologic therapy can be initiated in those with mild hypertension and no cardiovascular disease, but most patients will require drug therapy. Most elderly hypertensive patients have accompanying illnesses for which they may or may not be taking medications. Some antihypertensive drugs exacerbate coexisting diseases while others augment treatment regimens. Similarly, drugs may interact in a beneficial or adverse way. Finally, drug metabolism is altered by age, leading to problems with toxicity or diminished efficacy. The choice of medication should be based on all such considerations, including the cost and convenience of the drugs available. PMID:2190414

  18. Reasoning about systolic algorithms

    SciTech Connect

    Purushothaman, S.; Subrahmanyam, P.A.

    1988-12-01

    The authors present a methodology for verifying correctness of systolic algorithms. The methodology is based on solving a set of Uniform Recurrence Equations obtained from a description of systolic algorithms as a set of recursive equations. They present an approach to mechanically verify correctness of systolic algorithms, using the Boyer-Moore theorem proven. A mechanical correctness proof of an example from the literature is also presented.

  19. Tricuspid annular plane systolic excursion (TAPSE) can predict the outcome of isolated tricuspid valve surgery in patients with previous cardiac surgery?

    PubMed Central

    Sun, Xiaoning; Zhang, Hongqiang; Aike, Baier; Yang, Shouguo; Yang, Zhaohua; Dong, Lili; Wang, Fanshun

    2016-01-01

    Background Isolated tricuspid valve replacement is rare when performed as a re-operation after a left side operation. It is important to know the factors that determine mortality and morbidity. Tricuspid Annular Plane Systolic Excursion (TAPSE) is a scoring system that is used with non-invasive Doppler echocardiography to determine right ventricular (RV) function. This study analyzed TAPSE scores and adverse outcomes of isolated tricuspid valve surgery in patients with previous cardiac surgery. Methods All patients who underwent tricuspid valve replacement between January 2014 and December 2015 were retrospectively reviewed. Patients having concomitant mitral or aortic valve surgery were excluded. These patients were divided into two groups: TAPSE >14 mm and TAPSE ≤14 mm. In-hospital outcomes were compared. Results A total of 26 patients with severe tricuspid valve regurgitation underwent tricuspid valve replacement. There were 5 males (19.2%) and 21 females (80.8%). The average age at operation was 54.77±9.61 years (range, 27–69 years). There were 16 patients in the TAPSE >14 mm group and 10 patients in the TAPSE ≤14 mm group. The BNP in the TAPSE >14 mm group was significant (TAPSE >14 mm 672.34±229.98 versus TAPSE ≤14 mm 1,054.79±684.69, P=0.03). The median cardiopulmonary bypass (CPB) time and red blood cell (RBC) transfusions in the two groups were not different. The need for prolonged ventilatory support (>48 h) in the two groups was also not different (TAPSE> 14 mm 91.2±12.31 vs. TAPSE ≤14 mm 39.00±36.80, P=0.46). Moreover, hospital stays were similar between the two groups. No differences were found in postoperative renal and respiratory complications. Conclusions It is important to determine the right ventricule function quantitatively. The TAPSE score is an important parameter that determines the cardiac index and right ventricle function. It should be used for the prediction of mortality and morbidity with all the other parameters as a

  20. Report of the Canadian Hypertension Society Consensus Conference: 4. Hypertension in the elderly.

    PubMed Central

    Reeves, R A; Fodor, J G; Gryfe, C I; Patterson, C; Spence, J D

    1993-01-01

    Several knowledge gaps, which made evidence-based guidelines impossible in 1985, have since been filled. There is now unequivocal evidence that treatment of isolated systolic hypertension benefits elderly patients, as does treatment beyond the age of 75 years. Pseudohypertension, although occasionally problematic, is not common and is not a reason to neglect the treatment of elderly patients, including those with isolated systolic hypertension. In general, long-term antihypertensive treatment of the elderly is well tolerated and does not cause important decreases in mental function. Comparative drug studies continue to accumulate; most show no clinically significant general differences between drugs, aside from the somewhat decreased efficacy and tolerability of beta-blockade in elderly patients. As in the young, certain drugs may be preferred in the presence of other conditions--e.g., congestive heart failure or diabetes. PMID:8374844

  1. Designing linear systolic arrays

    SciTech Connect

    Kumar, V.K.P.; Tsai, Y.C. . Dept. of Electrical Engineering)

    1989-12-01

    The authors develop a simple mapping technique to design linear systolic arrays. The basic idea of the technique is to map the computations of a certain class of two-dimensional systolic arrays onto one-dimensional arrays. Using this technique, systolic algorithms are derived for problems such as matrix multiplication and transitive closure on linearly connected arrays of PEs with constant I/O bandwidth. Compared to known designs in the literature, the technique leads to modular systolic arrays with constant hardware in each PE, few control lines, lexicographic data input/output, and improved delay time. The unidirectional flow of control and data in this design assures implementation of the linear array in the known fault models of wafer scale integration.

  2. Predictors of uncontrolled hypertension in the Stroke Belt.

    PubMed

    Dave, Gaurav J; Bibeau, Daniel L; Schulz, Mark R; Aronson, Robert E; Ivanov, Louise L; Black, Adina; Spann, Lapronda

    2013-08-01

    Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self-reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN. PMID:23889718

  3. Protective effect of anti-hypertensive treatment on cognitive function in essential hypertension: analysis of published clinical data.

    PubMed

    Amenta, Francesco; Mignini, Fiorenzo; Rabbia, Franco; Tomassoni, Daniele; Veglio, Franco

    2002-11-15

    Hypertension is a risk factor for stroke and may also contribute to the development of vascular cognitive impairment (VCI) and vascular dementia (VaD). Cognitive complications of hypertension and the influence of anti-hypertensive treatment were underestimated until recently. In this paper, trials investigating the effect of anti-hypertensive treatment on cognitive function were evaluated. Analysis of these studies revealed that until approximately 1990-1995 investigations have assessed primarily if anti-hypertensive treatment impaired cognitive function. Only more recent studies have investigated positive effects on cognition of anti-hypertensive medication. Drugs more extensively evaluated were diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, sartanes and Ca(2+) channel blockers. Available studies have confirmed that elevated diastolic blood pressure or pulse pressure and isolated systolic hypertension play an important role in the development of cognitive impairment. Randomized placebo-controlled trials have provided evidence that reduction of hypertension safely and effectively decreases morbidity and mortality rates and cognitive complications of hypertension. Ca(2+) channel blockers and ACE inhibitors have been shown to be effective and probably better than diuretics and beta-blockers on cognitive domains of hypertension. More extensive investigations could contribute to establishing optimal choice and drug dosage for the treatment of cognitive complications of hypertension. PMID:12417374

  4. Multilocus Family-Based Association Analysis of Seven Candidate Polymorphisms with Essential Hypertension in an African-Derived Semi-Isolated Brazilian Population

    PubMed Central

    Kimura, L.; Angeli, C. B.; Auricchio, M. T. B. M.; Fernandes, G. R.; Pereira, A. C.; Vicente, J. P.; Pereira, T. V.; Mingroni-Netto, R. C.

    2012-01-01

    Background. It has been widely suggested that analyses considering multilocus effects would be crucial to characterize the relationship between gene variability and essential hypertension (EH). Objective. To test for the presence of multilocus effects between/among seven polymorphisms (six genes) on blood pressure-related traits in African-derived semi-isolated Brazilian populations (quilombos). Methods. Analyses were carried out using a family-based design in a sample of 652 participants (97 families). Seven variants were investigated: ACE (rs1799752), AGT (rs669), ADD2 (rs3755351), NOS3 (rs1799983), GNB3 (rs5441 and rs5443), and GRK4 (rs1801058). Sensitivity analyses were further performed under a case-control design with unrelated participants only. Results. None of the investigated variants were associated individually with both systolic and diastolic BP levels (SBP and DBP, respectively) or EH (as a binary outcome). Multifactor dimensionality reduction-based techniques revealed a marginal association of the combined effect of both GNB3 variants on DBP levels in a family-based design (P = 0.040), whereas a putative NOS3-GRK4 interaction also in relation to DBP levels was observed in the case-control design only (P = 0.004). Conclusion. Our results provide limited support for the hypothesis of multilocus effects between/among the studied variants on blood pressure in quilombos. Further larger studies are needed to validate our findings. PMID:23056922

  5. Multilocus family-based association analysis of seven candidate polymorphisms with essential hypertension in an african-derived semi-isolated brazilian population.

    PubMed

    Kimura, L; Angeli, C B; Auricchio, M T B M; Fernandes, G R; Pereira, A C; Vicente, J P; Pereira, T V; Mingroni-Netto, R C

    2012-01-01

    Background. It has been widely suggested that analyses considering multilocus effects would be crucial to characterize the relationship between gene variability and essential hypertension (EH). Objective. To test for the presence of multilocus effects between/among seven polymorphisms (six genes) on blood pressure-related traits in African-derived semi-isolated Brazilian populations (quilombos). Methods. Analyses were carried out using a family-based design in a sample of 652 participants (97 families). Seven variants were investigated: ACE (rs1799752), AGT (rs669), ADD2 (rs3755351), NOS3 (rs1799983), GNB3 (rs5441 and rs5443), and GRK4 (rs1801058). Sensitivity analyses were further performed under a case-control design with unrelated participants only. Results. None of the investigated variants were associated individually with both systolic and diastolic BP levels (SBP and DBP, respectively) or EH (as a binary outcome). Multifactor dimensionality reduction-based techniques revealed a marginal association of the combined effect of both GNB3 variants on DBP levels in a family-based design (P = 0.040), whereas a putative NOS3-GRK4 interaction also in relation to DBP levels was observed in the case-control design only (P = 0.004). Conclusion. Our results provide limited support for the hypothesis of multilocus effects between/among the studied variants on blood pressure in quilombos. Further larger studies are needed to validate our findings. PMID:23056922

  6. Synchronizing large systolic arrays

    SciTech Connect

    Fisher, A.L.; Kung, H.T.

    1982-04-01

    Parallel computing structures consist of many processors operating simultaneously. If a concurrent structure is regular, as in the case of systolic array, it may be convenient to think of all processors as operating in lock step. Totally synchronized systems controlled by central clocks are difficult to implement because of the inevitable problem of clock skews and delays. An alternate means of enforcing necessary synchronization is the use of self-timed, asynchronous schemes, at the cost of increased design complexity and hardware cost. Realizing that different circumstances call for different synchronization methods, this paper provides a spectrum of synchronization models; based on the assumptions made for each model, theoretical lower bounds on clock skew are derived, and appropriate or best-possible synchronization schemes for systolic arrays are proposed. This paper represents a first step towards a systematic study of synchronization problems for large systolic arrays.

  7. IN VITRO EFFECTS OF PARTICULATE MATTER ON AIRWAY EPITHELIAL CELLS ISOLATED FROM CONCENTRATED AIR PARTICLES-EXPOSED SPONTANEOUS HYPERTENSIVE RATS

    EPA Science Inventory

    In vitro effects of particulate matter on airway epithelial cells isolated from concentrated air particles-exposed spontaneous hypertensive rats

    Ines Pagan, Urmila Kodavanti, Paul Evansky, Daniel L Costa and Janice A Dye. U.S. Environmental Protection Agency, ORD, National...

  8. Systolic and semisystolic design

    SciTech Connect

    Leiserson, C.E.

    1983-01-01

    Architectural transformation techniques which can be used to help produce efficient systolic and semisystolic architectures for signal processing, image processing, numerical computation and raster graphics are identified. The transformations include: retiming, slowdown, broadcast and census elimination, coalescing, interlacing, code motion, resetting, register elimination and parallel/serial compromises. All the transformations are at the architectural or algorithmic level, as distinct from the electrical circuit level, and provide high-level tools for a designer. In addition, they provide a step toward automatic compilation of systolic and semisystolic systems. 12 references.

  9. Design of robust systolic algorithms

    SciTech Connect

    Varman, P.J.; Fussell, D.S.

    1983-01-01

    A primary reason for the susceptibility of systolic algorithms to faults is their strong dependence on the interconnection between the processors in a systolic array. A technique to transform any linear systolic algorithm into an equivalent pipelined algorithm that executes on arbitrary trees is presented. 5 references.

  10. Using redundancy for testable and repairable systolic arrays

    SciTech Connect

    Shombert, L.A.

    1985-01-01

    This thesis presents a method of using spares to enhance the reliability and testability of systolic arrays. The method, called roving spares, provides fault detection and fault isolation without interrupting array operation, essentially providing a self testing array. Systolic arrays are defined, and the design space of systolic arrays is identified. The methodology for roving spares on the simplest, but still very powerful, type of systolic array is then derived. Several detailed designs are generated to provide sample data points for analysis. The analysis shows that reliability is increased by factors of two to ten, over a nonredundant array, and that this improvement is achieved at low cost. The testing capability of roving spares does not significantly decrease the reliability benefits of spares. A brief analysis of a more complex systolic array indicates that the benefits achievable for the simple array can be expected for all types of systolic arrays.

  11. Systolic processor for signal processing

    SciTech Connect

    Frank, G.A.; Greenawalt, E.M.; Kulkarni, A.V.

    1982-01-01

    A systolic array is a natural architecture for a high-performance signal processor, in part because of the extensive use of inner-product operations in signal processing. The modularity and simple interconnection of systolic arrays promise to simplify the development of cost-effective, high-performance, special-purpose processors. ESL incorporated has built a proof of concept model of a systolic processor. It is flexible enough to permit experimentation with a variety of algorithms and applications. ESL is exploring the application of systolic processors to image- and signal-processing problems. This paper describes this experimental system and some of its applications to signal processing. ESL is also pursuing new types of systolic architectures, including the VLSI implementation of systolic cells for solving systems of linear equations. These new systolic architectures allow the real-time design of adaptive filters. 14 references.

  12. Isolated nocturnal hypertension and subclinical target organ damage: a systematic review of the literature.

    PubMed

    O'Flynn, Anne Marie; Madden, Jamie M; Russell, Audrey J; Curtin, Ronan J; Kearney, Patricia M

    2015-08-01

    Isolated nocturnal hypertension (INH) is associated with greater mortality and cardiovascular events. Subclinical target organ damage (TOD) is a prognostic marker for cardiovascular events. Our objective is to systematically summarize evidence on the association between INH and subclinical TOD. Observational population studies were considered. INH was defined as nighttime blood pressure (BP) ⩾120 and/or 70 mm Hg with daytime BP <135/85 mm Hg. We systematically searched Pubmed, EMBASE and the Cochrane Library. Abstracts were reviewed by two assessors. Potentially eligible articles were compared with inclusion criteria. The search yielded 954 titles, 13 abstracts were selected for review and four articles fulfilled inclusion criteria. INH was associated with higher ambulatory arterial stiffness index (0.4 unit vs. 0.35 unit, P<0.05), pulse wave velocity (16.2 m s(-1) vs. 14.7 m s(-1), P<0.05), central (140.4% vs. 134.0%, P<0.05) and peripheral (82.6% vs. 76.5%, P<0.01) augmentation index in a Chinese study. In the same population there was no association with left ventricular hypertrophy documented by electrocardiogram. INH was not associated with increased arterial stiffness or left venticular mass index in a Swedish study. An American study demonstrated higher left ventricular mass (152.46 g vs. 136.16 g, P=0.01) and greater odds of left ventricular hypertrophy (odds ratio 3.03, 95% confidence interval 1.02-9.05) in unadjusted analysis. There was no association with proteinuria. Evidence is inconclusive regarding the association between INH and subclinical TOD. Future research should focus on trying to elucidate the mechanisms that generate INH and contribute to the higher mortality associated with this BP pattern. PMID:25832917

  13. Systolic systems: algorithms and complexity

    SciTech Connect

    Chang, J.H.

    1986-01-01

    This thesis has two main contributions. The first is the design of efficient systolic algorithms for solving recurrence equations, dynamic programming problems, scheduling problems, as well as new systolic implementation of data structures such as stacks, queues, priority queues, and dictionary machines. The second major contribution is the investigation of the computational power of systolic arrays in comparison to sequential models and other models of parallel computation.

  14. Bit-level systolic arrays

    SciTech Connect

    De Groot, A.J.

    1989-01-01

    In this dissertation the author considered the design of bit - level systolic arrays where the basic computational unit consists of a simple one - bit logic unit, so that the systolic process is carried out at the level of individual bits. In order to pursue the foregoing research, several areas have been studied. First, the concept of systolic processing has been investigated. Several important algorithms were investigated and put into systolic form using graph-theoretic methods. The bit-level, word-level and block-level systolic arrays which have been designed for these algorithms exhibit linear speedup with respect to the number of processors and exhibit efficiency close to 100%, even with low interprocessor communication bandwidth. Block-level systolic arrays deal with blocks of data with block-level operations and communications. Block-level systolic arrays improve cell efficiency and are more efficient than their word-level counterparts. A comparison of bit-level, word-level and block-level systolic arrays was performed. In order to verify the foregoing theory and analysis a systolic processor called the SPRINT was developed to provide and environment where bit-level, word-level and block-level systolic algorithms could be confirmed by direct implementation rather than by computer simulation. The SPRINT is a supercomputer class, 64-element multiprocessor with a reconfigurable interconnection network. The theory has been confirmed by the execution on the SPRINT of the bit-level, word-level, and block-level systolic algorithms presented in the dissertation.

  15. Activation of Human T Cells in Hypertension: Studies of Humanized Mice and Hypertensive Humans.

    PubMed

    Itani, Hana A; McMaster, William G; Saleh, Mohamed A; Nazarewicz, Rafal R; Mikolajczyk, Tomasz P; Kaszuba, Anna M; Konior, Anna; Prejbisz, Aleksander; Januszewicz, Andrzej; Norlander, Allison E; Chen, Wei; Bonami, Rachel H; Marshall, Andrew F; Poffenberger, Greg; Weyand, Cornelia M; Madhur, Meena S; Moore, Daniel J; Harrison, David G; Guzik, Tomasz J

    2016-07-01

    Emerging evidence supports an important role for T cells in the genesis of hypertension. Because this work has predominantly been performed in experimental animals, we sought to determine whether human T cells are activated in hypertension. We used a humanized mouse model in which the murine immune system is replaced by the human immune system. Angiotensin II increased systolic pressure to 162 versus 116 mm Hg for sham-treated animals. Flow cytometry of thoracic lymph nodes, thoracic aorta, and kidney revealed increased infiltration of human leukocytes (CD45(+)) and T lymphocytes (CD3(+) and CD4(+)) in response to angiotensin II infusion. Interestingly, there was also an increase in the memory T cells (CD3(+)/CD45RO(+)) in the aortas and lymph nodes. Prevention of hypertension using hydralazine and hydrochlorothiazide prevented the accumulation of T cells in these tissues. Studies of isolated human T cells and monocytes indicated that angiotensin II had no direct effect on cytokine production by T cells or the ability of dendritic cells to drive T-cell proliferation. We also observed an increase in circulating interleukin-17A producing CD4(+) T cells and both CD4(+) and CD8(+) T cells that produce interferon-γ in hypertensive compared with normotensive humans. Thus, human T cells become activated and invade critical end-organ tissues in response to hypertension in a humanized mouse model. This response likely reflects the hypertensive milieu encountered in vivo and is not a direct effect of the hormone angiotensin II. PMID:27217403

  16. A systolic array parallelizing compiler

    SciTech Connect

    Tseng, P.S. )

    1990-01-01

    This book presents a completely new approach to the problem of systolic array parallelizing compiler. It describes the AL parallelizing compiler for the Warp systolic array, the first working systolic array parallelizing compiler which can generate efficient parallel code for complete LINPACK routines. This book begins by analyzing the architectural strength of the Warp systolic array. It proposes a model for mapping programs onto the machine and introduces the notion of data relations for optimizing the program mapping. Also presented are successful applications of the AL compiler in matrix computation and image processing. A complete listing of the source program and compiler-generated parallel code are given to clarify the overall picture of the compiler. The book concludes that systolic array parallelizing compiler can produce efficient parallel code, almost identical to what the user would have written by hand.

  17. Pulmonary hypertension

    MedlinePlus

    Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary ...

  18. Systolic architecture for heirarchical clustering

    SciTech Connect

    Ku, L.C.

    1984-01-01

    Several hierarchical clustering methods (including single-linkage complete-linkage, centroid, and absolute overlap methods) are reviewed. The absolute overlap clustering method is selected for the design of systolic architecture mainly due to its simplicity. Two versions of systolic architectures for the absolute overlap hierarchical clustering algorithm are proposed: one-dimensional version that leads to the development of a two dimensional version which fully takes advantage of the underlying data structure of the problems. The two dimensional systolic architecture can achieve a time complexity of O(m + n) in comparison with the conventional computer implementation of a time complexity of O(m/sup 2*/n).

  19. Systolic algorithms and their implementation

    SciTech Connect

    Kung, H.T.

    1984-01-01

    Very high performance computer systems must rely heavily on parallelism since there are severe physical and technological limits on the ultimate speed of any single processor. The systolic array concept developed in the last several years allows effective use of a very large number of processors in parallel. This article illustrates the basic ideas by reviewing a systolic array design for matrix triangularization and describing its use in the on-the-fly updating of Cholesky decomposition of covariance matrices-a crucial computation in adaptive signal processing. Following this are discussions on issues related to the hardware implementation of systolic algorithms in general, and some guidelines for designing systolic algorithms that will be convenient for implementation. 33 references.

  20. Broadcast normalization in systolic design

    SciTech Connect

    Lin, F.C. ); Wu, I.C. )

    1988-11-01

    When a sequential algorithm is directly mapped into an array of processing elements, quite likely data broadcasts are required and their source places vary during the computation. The authors introduce a normalization method to fix the positions of the broadcast sources so that the derived design can be further transformed by retimings into a systolic array. The authors' method is fully illustrated in designing systolic arrays for enumeration sort, solving simultaneous linear equations, and computing transitive closure.

  1. Dynamically Reconfigurable Systolic Array Accelorators

    NASA Technical Reports Server (NTRS)

    Dasu, Aravind (Inventor); Barnes, Robert C. (Inventor)

    2014-01-01

    A polymorphic systolic array framework that works in conjunction with an embedded microprocessor on an FPGA, that allows for dynamic and complimentary scaling of acceleration levels of two algorithms active concurrently on the FPGA. Use is made of systolic arrays and hardware-software co-design to obtain an efficient multi-application acceleration system. The flexible and simple framework allows hosting of a broader range of algorithms and extendable to more complex applications in the area of aerospace embedded systems.

  2. Effects of sex and hypertension subtype on haemodynamics and left ventricular diastolic function in older patients with stage 1 hypertension

    PubMed Central

    Fujimoto, Naoki; Okada, Yoshiyuki; Shibata, Shigeki; Best, Stuart A.; Bivens, Tiffany B.; Levine, Benjamin D.; Fu, Qi

    2013-01-01

    Background Hypertension is associated with cardiovascular stiffening and left ventricular diastolic dysfunction, leading to comorbidities such as heart failure with preserved ejection fraction (HFpEF). It is unknown whether sex and hypertension subtype affect haemodynamics and left ventricular function in older individuals. Methods Ninety-five older patients with Stage 1 hypertension (ambulatory awake SBP135–159 mmHg) and 56 normotensive controls were enrolled. Patients were stratified prospectively into isolated systolic hypertension (ISH, DBP <85 mmHg) or systolic-diastolic hypertension (SDH, DBP ≥85 mmHg). Haemodynamics and Doppler variables including early filling (E) and averaged mitral annular (E′mean) velocities were measured during supine rest. Results Ambulatory awake blood pressures (BPs) were the highest in SDH, whereas supine SBP was similar in both hypertensive groups. No sex difference was observed in supine or ambulatory awake BPs in all groups. Stroke volume was similar among groups within the same sex, but smaller in women. Women exhibited faster E, slower E′mean and greater E/E′mean, whereas no group difference was observed in E within the same sex. In women, E′mean was significantly slower in SDH (5.9 ± 1.6 vs. 7.4 ± 1.1 cm/s, P < 0.01) and ISH (6.6 ± 1.6 cm/s, P = 0.07) than controls, resulting in the highest E/E′mean in SDH. In men, E′mean and E/E′mean were similar among the three groups. Conclusion These results suggest that elderly hypertensive women may have left ventricular early diastolic dysfunction and higher estimated filling pressure, consistent with their susceptibility to HFpEF. Women with SDH seemed to have more left ventricular diastolic dysfunction, which might be explained by the greater cumulative afterload when ambulatory. PMID:24077248

  3. Ambulatory monitoring derived blood pressure variability and cardiovascular risk factors in elderly hypertensive patients.

    PubMed

    Magdás, Annamária; Szilágyi, László; Belényi, Boglárka; Incze, Alexandru

    2014-01-01

    Hypertension in the elderly is characterized by isolated systolic hypertension and high variability, but its clinical significance is not yet fully understood. The goal of this paper was to assess circadian blood pressure variability (BPV) in elderly hypertensives, and to determine its relationship to cardiovascular risk factors. To achieve this goal, a number of 75 inefficiently treated hypertensive patients were studied, 45 elderly, aged over 60 years, 30 middle-aged, younger than 60 years. After 24-hour ambulatory blood pressure monitoring (ABPM), blood pressure (BP) values, pulse pressure (PP), morning surge were compared between the groups. BPV was calculated using average real variability (ARV). The relationships between BPV, pulse pressure, left ventricular mass index (LVMI), and cardiovascular risk factors were assessed in both groups. As a result, it was found that left ventricular mass (p=0.01), PP, morning surge, 24-hour systolic ARV were significantly higher in the elderly group (p<0.05). In both groups, higher 24-hour BPV was associated with an increase in LVMI. In the elderly population 24-hour BPV was positively correlated to increased PP, total cholesterol and triglyceride levels (p<0.05). Moreover, it was concluded that ABPM-derived BP variability index could be an early predictive marker of end-organ damage in hypertension. Its reduction might be an important objective of hypertension management in elderly. PMID:25226958

  4. Hypertension in the elderly

    PubMed Central

    Lionakis, Nikolaos; Mendrinos, Dimitrios; Sanidas, Elias; Favatas, Georgios; Georgopoulou, Maria

    2012-01-01

    The elderly are the most rapidly growing population group in the world. Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age. The risk of coronary artery disease, stroke, congestive heart disease, chronic kidney insufficiency and dementia is also increased in this subgroup of hypertensives. Hypertension in the elderly patients represents a management dilemma to cardiovascular specialists and other practioners. During the last years and before the findings of the Systolic Hypertension in Europe Trial were published, the general medical opinion considered not to decrease blood pressure values similarly to other younger patients, in order to avoid possible ischemic events and poor oxygenation of the organs (brain, heart, kidney). The aim of this review article is to highlight the importance of treating hypertension in aged population in order to improve their quality of life and lower the incidence of the cardiovascular complications. PMID:22655162

  5. Ocular Hypertension

    MedlinePlus

    ... Español Eye Health / Eye Health A-Z Ocular Hypertension Sections What Is Ocular Hypertension? Ocular Hypertension Causes ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Written by: Kierstan Boyd Reviewed by: J Kevin ...

  6. Arterial Wave Reflection and Subclinical Left Ventricular Systolic Dysfunction

    PubMed Central

    Russo, Cesare; Jin, Zhezhen; Takei, Yasuyoshi; Hasegawa, Takuya; Koshaka, Shun; Palmieri, Vittorio; Elkind, Mitchell S.V.; Homma, Shunichi; Sacco, Ralph L.; Di Tullio, Marco R.

    2011-01-01

    Objectives Increased arterial wave reflection is a predictor of cardiovascular events and has been hypothesized to be a cofactor in the pathophysiology of heart failure. Whether increased wave reflection is inversely associated with left ventricular (LV) systolic function in subjects without heart failure is not clear. Methods Arterial wave reflection and LV systolic function were assessed in 301 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using 2-dimensional echocardiography and applanation tonometry of the radial artery to derive central arterial waveform by a validated transfer function. Aortic augmentation index (AIx) and wasted energy index (WEi) were used as indices of wave reflection. LV systolic function was measured by ejection fraction (LVEF) and tissue Doppler imaging (TDI). Mitral annulus peak systolic velocity (Sm), peak longitudinal strain and strain rate were measured. Participants with history of coronary artery disease, atrial fibrillation, LVEF <50% or wall motion abnormalities were excluded. Results Mean age of the study population was 68.3±10.2 years (64.1% women, 65% hypertensive). LV systolic function by TDI was lower with increasing wave reflection, whereas LVEF was not. In multivariate analysis, TDI parameters of LV longitudinal systolic function were significantly and inversely correlated to AIx and WEi (p values from 0.05 to 0.002). Conclusions In a community cohort without heart failure and with normal LVEF, an increased arterial wave reflection was associated with subclinical reduction in LV systolic function assessed by novel TDI techniques. Further studies are needed to investigate the prognostic implications of this relationship. PMID:21169863

  7. Dietary calcium and magnesium supplements in spontaneously hypertensive rats and isolated arterial reactivity.

    PubMed Central

    Mäkynen, H.; Kähönen, M.; Arvola, P.; Wuorela, H.; Vapaatalo, H.; Pörsti, I.

    1995-01-01

    1. High calcium diet attenuates the development of hypertension but an associated undesirable effect is that Mg2+ loss to the urine is enhanced. Therefore, we studied the effects of high calcium diet alone and in combination with increased magnesium intake on blood pressure and arterial function. 2. Forty-eight young spontaneously hypertensive rats (SHR) were allocated into four groups, the dietary contents of Ca2+ and Mg2+ being: 1.1%, 0.2% (SHR); 2.5%, 0.2% (Ca-SHR); 2.5%, 0.8% (CaMg-SHR); and 1.1%, 0.8% (Mg-SHR), respectively. Development of hypertension was followed for 13 weeks, whereafter electrolyte balance, lymphocyte intracellular free calcium ([Ca2+]i), and mesenteric arterial responses in vitro were examined. Forty normotensive Wistar-Kyoto (WKY) rats were investigated in a similar manner. 3. Calcium supplementation comparably attenuated the development of Lypertension during normal and high magnesium intake in SHR, with an associated reduced lymphocyte [Ca2+]i and increased Mg2+ loss to the urine. 4. Endothelium-dependent arterial relaxation to acetylcholine was augmented in Ca-SHR and CaMg-SHR, while the relaxations to isoprenaline and the nitric oxide donor SIN-1 were similar in all SHR groups. Relaxation responses induced by the return of K+ to the organ bath upon precontractions in K(+)-free solution were used to evaluate the function of arterial Na+, K(+)-ATPase. The rate of potassium relaxation was similar in Ca-SHR and CaMg-SHR and faster than in untreated SHR.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8564205

  8. Therapeutic efficacy of a polysaccharide isolated from Cordyceps sinensis on hypertensive rats.

    PubMed

    Xiang, Feixiang; Lin, Liming; Hu, Min; Qi, Xiangqian

    2016-01-01

    This study was aimed to investigate the antihypertensive effect of a polysaccharide fraction from Cordyceps sinensis on spontaneously hypertensive rats (SHR). The CSP1, one component of Cordyceps sinensis polysaccharides (CSP), was obtained after water extraction, deproteinization, de-colorization and purification with DEAE-cellulose 52. And a more homogeneous component CSP1-2 was obtained using Sepharose CL-6B chromatography. CSP1-2 mainly consisted of mannose, glucose and galactose in a molar ratio of about 2:2:1 and its average molecular weight was approximately 2.70×10(4)Da. Pharmacological tests showed that CSP1, in which the CSP1-2 was its main component, had antihypertensive effect by stimulating the secretion of vasodilator NO, decreasing the level of ET-1, epinephrine, noradrenaline and angiotensin II, inhibiting the increase of transforming growth factor β1 (TGF-β1) and lowering the level of inflammatory mediator of C-reactive protein (CRP). These results suggested that CSP1 may possess high potential in treating hypertension. PMID:26432374

  9. Hypertensive leucocytosis.

    PubMed

    Rajkumari, Rolinda; Laishram, Deben; Thiyam, Joshna; Javan, Ng

    2013-04-01

    There are studies showing association of high WBC count with the higher incidence of hypertension though a few are done in the Indian population. The present study was conducted with the view to find any significant increase in total leucocyte count and differential leucocyte count in hypertensive patient Twenty-seven hypertensives with 12 males and 15 females and 27 age and sex matched control subjects (normotensive) were studied. Hypertension was defined when the systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or history of taking antihypertensive medicine. Three blood pressure recordings at an interval of 2 minutes were taken after the patient was made to sit for 30 minutes with a standard mercury sphygmomanometer in the left arm. The disappearance of sound was used for diastolic blood pressure. Blood was drawn into EDTA containing vials. Two separate counts were performed: First for total leucocyte count (TLC) and second for determination of percentage of polymorphonuclear cells. For the TLC, 0.5 part of blood mixed with 10 part of Turk's fluid followed by counting of leucocyte in a counting chamber under light microscope. The percentage of polymorphonuclear leucocyte was performed on a slide after making the slide and staining it with Leishman's stain. The erythrocyte sedimentation rate (ESR) was performed using Wintrobe's methods. The first 1 hour reading on the Wintrobe's tube was taken for analysis. The total leucocyte count (TLC) for the study group as compared to the controls were 7413.70 +/- 735.45 cells/cmm and 5236.30 +/- 528.77 cells/ cmm which was statistically significant. The mean percentage neutrophils were 62.04 +/- 4.99 for study group and 53.00 +/- 3.44 for the controls; the mean percentage lymphocytes for the study group and the controls were 34.37 +/- 4.55 and 39.11 +/- 4.40 respectively. Both the mean percentage neutrophils and lymphocytes showed significant differences. The mean erythrocyte sedimentation rate (ESR) also showed

  10. Recommendations for the treatment of hypertension in elderly people.

    PubMed

    Rubio-Guerra, Alberto F; Duran-Salgado, Montserrat B

    2015-01-01

    High blood pressure is a major cardiovascular risk factor. The prevalence of hypertension increases with aging. As a consequence of changes in arterial wall that leads to arterial stiffness, the majority of elderly patients suffer isolated systolic hypertension. The evidence strongly supports that hypertension in the elderly is associated with an increase in stroke risk and cardiovascular mortality and morbidity. Several trials have shown the benefits of treating hypertension in elderly patients. Even in the very old patients, the use of antihypertensive agents such as calcium channel blockers, thiazide and thiazide-like diuretics, and inhibitors of the renin-angiotensin system reduce the risk of complications in those patients. However, most patients will need two or more drugs to reach the recommended goals. Hypertension in the elderly has special conditions that must be assessed in the evaluation of the patient (as pseudohypertension and white coat hypertension), and issues that may affect the therapeutic choice and the response to treatment, as comorbidities and polypharmacy. PMID:25761106

  11. Systoles in discrete dynamical systems

    NASA Astrophysics Data System (ADS)

    Fernandes, Sara; Grácio, Clara; Ramos, Carlos Correia

    2013-01-01

    The fruitful relationship between Geometry and Graph Theory has been explored by several authors benefiting also the Theory of discrete dynamical systems seen as Markov chains in graphs. In this work we will further explore the relation between these areas, giving a geometrical interpretation of notions from dynamical systems. In particular, we relate the topological entropy with the systole, here defined in the context of discrete dynamical systems. We show that for continuous interval maps the systole is trivial; however, for the class of interval maps with one discontinuity point the systole acquires relevance from the point of view of the dynamical behavior. Moreover, we define the geodesic length spectrum associated to a Markov interval map and we compute the referred spectrum in several examples.

  12. Dynamically Reconfigurable Systolic Array Accelerator

    NASA Technical Reports Server (NTRS)

    Dasu, Aravind; Barnes, Robert

    2012-01-01

    A polymorphic systolic array framework has been developed that works in conjunction with an embedded microprocessor on a field-programmable gate array (FPGA), which allows for dynamic and complimentary scaling of acceleration levels of two algorithms active concurrently on the FPGA. Use is made of systolic arrays and a hardware-software co-design to obtain an efficient multi-application acceleration system. The flexible and simple framework allows hosting of a broader range of algorithms, and is extendable to more complex applications in the area of aerospace embedded systems. FPGA chips can be responsive to realtime demands for changing applications needs, but only if the electronic fabric can respond fast enough. This systolic array framework allows for rapid partial and dynamic reconfiguration of the chip in response to the real-time needs of scalability, and adaptability of executables.

  13. The hypertension of autonomic failure and its treatment

    NASA Technical Reports Server (NTRS)

    Shannon, J.; Jordan, J.; Costa, F.; Robertson, R. M.; Biaggioni, I.

    1997-01-01

    We studied the incidence and severity of supine hypertension in 117 patients with severe primary autonomic failure presenting to a referral center over a 9-year period. Patients were uniformly characterized by disabling orthostatic hypotension, lack of compensatory heart rate increase, abnormal autonomic function tests, and unresponsive plasma norepinephrine. Fifty-four patients had isolated autonomic impairment (pure autonomic failure). Sixty-three patients had central nervous system involvement in addition to autonomic impairment (multiple-system atrophy). Patients were studied off medications, in a metabolic ward, and on a controlled diet containing 150 mEq of sodium. Fifty-six percent of patients had supine diastolic blood pressure > or =90 mm Hg. The prevalence of hypertension was slightly greater in females (63%) than in males (52%). Potential mechanisms responsible for this hypertension were investigated. No correlation was found between blood volume and blood pressure. Similarly, plasma norepinephrine (92+/-15 pg/mL) and plasma renin activity (0.3+/-0.05 ng/mL per hour) were very low in the subset of patients with pure autonomic failure and supine hypertension (mean systolic/diastolic pressure, 177 +/- 6/108 +/- 2 mm Hg, range 167/97 to 219/121). Supine hypertension represents a challenge in the treatment of orthostatic hypotension. We found these patients to be particularly responsive to the hypotensive effects of transdermal nitroglycerin. Doses ranging from 0.025 to 0.1 mg/h decreased systolic blood pressure by 36+/-7 mm Hg and may effectively treat supine hypertension overnight, but the dose should be individualized and used with caution.

  14. [Arterial hypertension as a medical and social problem in the older urban population. The CINDI WHO Program study].

    PubMed

    Kaczmarczyk-Chałas, Krystyna; Kwaśniewska, Magdalena; Pikala, Małgorzata; Drygas, Wojciech

    2008-01-01

    Increasing lifespan and progressive aging of the Polish population results in rising demands on health care. Chronic diseases with a leading position of arterial hypertension (HA) prevail in morbidity rates of adult seniors. The aim of the study is to characterize hypertension in the elderly with regard to other risk factors, complications and therapeutic control. The study was carried out in 2002 within the framework of the CINDI WHO Programme. A total of 1460 persons were randomly selected among residents of Lodz aged > or = 65 years. The response rate was 57%. All participants underwent questionnaire interview, two blood pressure (BP) measurements, anthropometric and physical examination, ECG and laboratory tests. After final verification, we analysed data collected from 828 persons (289 men and 539 women). Mean values of systolic and diastolic BP were 147.6 and 83.6 mmHg, respectively. The increase of systolic BP with age of studied seniors was observed. Hypertension was diagnosed in 669 persons (79% men, 82% women). In most cases there were systolic-diastolic or isolated systolic hypertension. About 60% of seniors with elevated BP declared suffering from HA, while 73% were under antihypertensive treatment. Normalization of BP (< 140/ 90 mmHg) was achieved in 28% of treated patients. Most often prescribed medications were: ACE-inhibitors (51%), beta-blockers (40%), calcium channel blockers (31%) and diuretics (30%). Mean values of plasma lipids and prevalence of lipid disorders were comparable in hypertensive and normotensive persons. Among patients with HA there were significantly smaller percentage of smokers (8.6% vs 18.7%, p < 0.05). The prevalence of obesity, visceral obesity and metabolic syndrome was higher in hypertensive seniors. As a result, incidents of myocardial infarction and morbidity due to coronary artery disease were twice as cantly more often hospitalised and visited family doctors (7 vs 4.6 visits/year) in comparison to normotensive subjects

  15. Arrhythmias and Electrocardiographic Changes in Systolic Heart Failure

    PubMed Central

    Devkota, Ashok; Bakhit, Ahmed; Dufresne, Alix; Oo, Aung Naing; Parajuli, Premraj; Manhas, Saveena

    2016-01-01

    Background: Heart failure is a common condition that that leads to hospitalization. It is associated with various atrial and ventricular arrhythmias. Aim: The aim of this study is to find common arrhythmias and electrocardiographic changes in hospitalized patients who have systolic heart failure. Materials and Methods: This is a retrospective study of medical records, and electrocardiograms (EKGs) of 157 patients admitted to our hospital who had systolic heart failure with ejection fraction (EF) <50% on echocardiogram. Based on EF, the patients were divided into two groups; one with EF ≤ 35% and the other with EF > 35%. Twelve-lead EKG of these patients was studied to identify common arrhythmia and demographic variables; laboratory results were compared to identify the differences. Results: A total of 157 patients with systolic heart failure, 63.7% had an EF ≤ 35%. Hypertension 82.8%, diabetes 49%, coronary artery disease 40.8%, chronic obstructive pulmonary disease or bronchial asthma 22.3%, and stroke 12.1% were common associated co-morbidities. On analysis of EKG, 28.6% had tachycardia, 21.9% had prolonged PR > 200 ms, 16.3% had wide QRS > 120 ms, 70.7% had prolonged corrected QT (QTc), and 42.2% had left axis deviation. The most common arrhythmias were sinus tachycardia and atrial fibrillation/flutter which were found in 14.6% and 13.4%, respectively. The left ventricular hypertrophy was a common abnormality found in 22.4% followed by ventricular premature contractions 18.4%, atrial premature contractions 9.5%, and left bundle branch block 6.1%. Patients with severe systolic heart failure had prolonged QRS (P = 0.02) and prolonged QTc (P = 0.01) as compared to the other group. Conclusions: Sinus tachycardia and atrial fibrillation/flutter were common arrhythmias in patients with systolic heart failure. Patients with severe systolic heart failure had statistically significant prolongation of the QRS duration and QTc interval. PMID:27213140

  16. Design of optimal systolic arrays

    SciTech Connect

    Li, G.J.; Wah, B.W.

    1985-01-01

    Conventional design of systolic arrays is based on the mapping of an algorithm onto an interconnection of processing elements in a VLSI chip. This mapping is done in an ad hoc manner, and the resulting configuration usually represents a feasible but suboptimal design. In this paper, systolic arrays are characterized by three classes of parameters: the velocities of data flows, the spatial distributions of data, and the periods of computation. By relating these parameters in constraint equations that govern the correctness of the design, the design is formulated into an optimization problem. The size of the search space is a polynomial of the problem size, and a methodology to systematically search and reduce this space and to obtain the optimal design is proposed. Some examples of applying the method, including matrix multiplication, finite impulse response filtering, deconvolution, and triangular-matrix inversion, are given. 30 references.

  17. Isolated right-sided varicocele as a salvage pathway for portal hypertension.

    PubMed

    Pinggera, G-M; Herwig, R; Pallwein, L; Frauscher, F; Judmaier, W; Mitterberger, M; Bartsch, G; Mallouhi, A

    2005-06-01

    Retrograde blood flow can occur in the testicular veins and in the pampiniformis plexus in the absence of valves or if the valves are incompetent, resulting in tortuosity and dilatation of the veins. These abnormal alterations in the anatomy of the veins, termed varicoceles, are associated with infertility in the male. Most varicoceles occur on the left. We report the case of a rare isolated right-sided varicocele in a male evaluated for infertility in whom extensive work-up revealed venous anomalies and a spontaneous porto-systemic shunt. In such cases, standard approaches to infertility treatment are fruitless. PMID:15924604

  18. Exercise hypertension: an adverse prognosis?

    PubMed

    Smith, Ryan G; Rubin, Stanley A; Ellestad, Myrvin H

    2009-01-01

    We sought to clarify the prognostic importance of an "exaggerated" or "hypertensive" systolic blood pressure response to exercise during an exercise test. Studies evaluating the prognosis for cardiovascular events and cardiovascular mortality in those with hypertension during exercise testing were systematically reviewed. Fourteen studies were identified. Six studies were of healthy volunteers or hypertensives. Eight studies were in subjects with known or suspected heart disease. Without established heart disease, exercise hypertension predicted cardiovascular events and cardiovascular death. However, two of the six studies included a multivariate analysis; both demonstrated no independent association. Studies in subjects with known or suspected heart disease demonstrated that exercise hypertension predicted fewer cardiac events and lesser mortality or, after multivariate adjustment, no associated risk. In a healthy population, a higher exercise blood pressure may indicate hypertension or prehypertension, instead of normal vascular function, and an associated long-term adverse prognosis. In a population with a high burden of heart disease, the highest risk subjects with the most extensive cardiac disease may not be capable of generating pressure or workload to allow the manifestation of exercise systolic hypertension. By comparison, therefore, those with exercise hypertension have a better prognosis. PMID:20409979

  19. Analysis of systolic and systolic-type arrays

    SciTech Connect

    Jover, J.M.

    1986-01-01

    Synchronous, multiprocessor systems interconnected by fixed links are studied. These special-purpose systems, called systolic-type arrays, perform specific algorithms at a higher throughput rate than the sequential architecture of van Neumann. The main contributions of this thesis are the analysis of systolic-type arrays, and the design of one such complex system. In the analysis problem the topology of the network, the function performed by each processor (including timing information), and the input data streams are given. I/O algorithm performed by the array, and the iteration interval (i.e., the time between two consecutive input samples) are to be determined. Solution to the analysis problem turns out to be based on the simple, at least in retrospect, observation that analysis is the reverse of synthesis (design). In design, the start is with a mathematical algorithm and a representation of it as a signal flow graph (SFG) in which the computations (function evaluations) are presented by delay-free (instantaneous) blocks and the index shifts in the sequences processed by the algorithm are all lumped into so-called z/sup -1/ blocks. In the analysis problem, start is also with a physical implementation described by its computational blocks, their associated processing times, and their interconnections. Also presented is parallel architecture for the measurement update step of the Kalman filter, which estimates a vector parameter.

  20. Association between pregnancy-related hypertension and severity of hypertension.

    PubMed

    Moreira, L B; Gus, M; Nunes, G; Gonçalves, C B C; Martins, J; Wiehe, M; Fuchs, F D

    2009-06-01

    Hypertension in pregnancy is an emerging sex-specific risk factor for cardiovascular disease and may lead to more severe hypertension after pregnancy. The objectives of this study were to investigate the frequency of pregnancy-related hypertension among patients referred to a hypertension clinic and its association with the severity of hypertension and evidence of end-organ damage. In this cross-sectional study, women with hypertension were submitted to a systematic clinical evaluation. The occurrence of pregnancy-related hypertension was investigated by questionnaire. The association between pregnancy-related hypertension and severity of hypertension (stage 2 according to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII)) and end-organ damage was assessed in a logistic regression model. The mean age, systolic and diastolic blood pressure and body mass index (BMI) of the 768 women examined were 51.6+/-12.7 years, 158.2+/-26.6 mm Hg, 93.8+/-14.3 mm Hg and 29.4+/-5.6 kg/m(2), respectively. The proportion of women with pregnancy-related hypertension was 32.9%. It was significantly associated with hypertension at stage 2 (OR: 1.60, 95% CI: 1.14-2.24; P=0.01) after controlling for confounders. The occurrence of a pregnancy-related hypertension was not associated with evidence of optic fundi abnormalities, left ventricular hypertrophy or abnormalities in kidney function. In conclusion, pregnancy-related hypertension is frequent in women referred to a hypertension clinic, and is associated with severe hypertension but not with evidence of end-organ damage. PMID:19020534

  1. Systolic VLSI for Kalman filters

    NASA Technical Reports Server (NTRS)

    Yeh, H.-G.; Chang, J. J.

    1986-01-01

    A novel two-dimensional parallel computing method for real-time Kalman filtering is presented. The mathematical formulation of a Kalman filter algorithm is rearranged to be the type of Faddeev algorithm for generalizing signal processing. The data flow mapping from the Faddeev algorithm to a two-dimensional concurrent computing structure is developed. The architecture of the resulting processor cells is regular, simple, expandable, and therefore naturally suitable for VLSI chip implementation. The computing methodology and the two-dimensional systolic arrays are useful for Kalman filter applications as well as other matrix/vector based algebraic computations.

  2. Precursors of Hypertension: A Review

    PubMed Central

    Thomas, John; Neser, William B.; Thomas, Johniene; Semenya, Kofi; Green, Donald R.

    1983-01-01

    Recent advances in hypertension therapy have been remarkable; however, much less is known about those precursors that facilitate preventive and early intervention measures. This review of the literature indicates that relevant precursors are early elevated casual systolic blood pressures, positive family history, and obesity in females. Additional predisposing or enhancing factors point to high sodium ingestion, heavy smoking, and high socioecologic stress. Evidence for a high-risk hypertensive personality is not conclusive. There is a paucity of longitudinal data on hypertension in the black population. PMID:6864814

  3. Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

    PubMed

    Kaiser, Edelgard Anna; Lotze, Ulrich; Schäfer, Hans Hendrik

    2014-01-01

    Treatment of hypertension in the elderly is expected to become more complex in the coming decades. Based on the current landscape of clinical trials, guideline recommendations remain inconclusive. The present review discusses the latest evidence derived from studies available in 2013 and investigates optimal blood pressure (BP) and preferred treatment substances. Three common archetypes are discussed that hamper the treatment of hypertension in the very elderly. In addition, this paper presents the current recommendations of the NICE 2011, JNC7 2013-update, ESH/ESC 2013, CHEP 2013, JNC8 and ASH/ISH guidelines for elderly patients. Advantages of the six main substance classes, namely diuretics, beta-blockers (BBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRIs) are discussed. Medical and economic implications of drug administration in the very elderly are presented. Avoidance of treatment-related adverse effects has become increasingly relevant. Current substance classes are equally effective, with similar effects on cardiovascular outcomes. Selection of substances should therefore also be based on collateral advantages of drugs that extend beyond BP reduction. The combination of ACEIs and diuretics appears to be favorable in managing systolic/diastolic hypertension. Diuretics are a preferred and cheap combination drug, and the combination with CCBs is recommended for patients with isolated systolic hypertension. ACEIs and CCBs are favorable for patients with dementia, while CCBs and ARBs imply substantial cost savings due to high adherence. PMID:24711696

  4. When an Increase in Central Systolic Pressure Overrides the Benefits of Heart Rate Lowering.

    PubMed

    Messerli, Franz H; Rimoldi, Stefano F; Bangalore, Sripal; Bavishi, Chirag; Laurent, Stephane

    2016-08-16

    An elevated resting heart rate has been unequivocally linked to adverse cardiovascular events. Conversely, a physiologically low heart rate may confer longevity benefits. Moreover, pharmacological heart rate lowering reduces cardiovascular outcomes in patients with heart failure, with the magnitude of the reduction associated with survival benefit. In contrast, pharmacological heart rate lowering paradoxically increases cardiovascular events in hypertension, possibly because it elicits a ventricular-vascular mismatch, leading to increased central systolic blood pressure (BP). By the same hemodynamic mechanism, pharmacological heart rate lowering also engenders an increase in central (aortic) BP in coronary heart disease and, as a consequence, fails to decrease myocardial oxygen consumption. Whether in heart failure, hypertension, or coronary heart disease, or even athletes, heart rate lowering consistently increases central systolic pressure. The increase in central systolic BP is prone to abolish the potential benefits of heart rate lowering interventions, possibly accounting for failure to reduce outcomes in patients with hypertension and coronary artery disease. PMID:27515336

  5. Introduction to systolic algorithms and architectures

    SciTech Connect

    Bentley, J.L.; Kung, H.T.

    1983-01-01

    The authors survey the class of systolic special-purpose computer architectures and algorithms, which are particularly well-suited for implementation in very large scale integrated circuitry (VLSI). They give a brief introduction to systolic arrays for a reader with a broad technical background and some experience in using a computer, but who is not necessarily a computer scientist. In addition they briefly survey the technological advances in VLSI that led to the development of systolic algorithms and architectures. 38 references.

  6. Hypertensive Crisis

    MedlinePlus

    ... while monitoring your blood pressure, you get a systolic reading of 180 mm Hg or higher OR ... is severely elevated [ 180 or higher for your systolic pressure (top number) or 110 or higher for ...

  7. [Status of mild hypertension guidelines in Japan and abroad].

    PubMed

    Matsuoka, Hiroaki

    2008-08-01

    Historically patients with systolic blood pressure level 140 to 159 mmHg or diastolic blood pressure level 90 to 99 mmHg had been defined as mild hypertension. However, the word of mild hypertension is not used in recent guidelines, such as JNC 7 and ESH/ESC 2007, although it is still used in JSH2004 and BHS IV. Patients with mild hypertension in JSH2004 are diagnosed as high risk hypertension if these patients are complicated cardiovascular organ damage, cardiovascular disease, or diabetes mellitus etc. Personally, I think the word of mild hypertension should be changed to another word or applied to patients with low risk hypertension. PMID:18700542

  8. Hypertension in Chronic Glomerulonephritis.

    PubMed

    Ihm, Chun-Gyoo

    2015-12-01

    Chronic glomerulonephritis (GN), which includes focal segmental glomerulosclerosis and proliferative forms of GN such as IgA nephropathy, increases the risk of hypertension. Hypertension in chronic GN is primarily volume dependent, and this increase in blood volume is not related to the deterioration of renal function. Patients with chronic GN become salt sensitive as renal damage including arteriolosclerosis progresses and the consequent renal ischemia causes the stimulation of the intrarenal renin-angiotensin-aldosterone system(RAAS). Overactivity of the sympathetic nervous system also contributes to hypertension in chronic GN. According to the KDIGO guideline, the available evidence indicates that the target BP should be ≤140mmHg systolic and ≤90mmHg diastolic in chronic kidney disease patients without albuminuria. In most patients with an albumin excretion rate of ≥30mg/24 h (i.e., those with both micro-and macroalbuminuria), a lower target of ≤130mmHg systolic and ≤80mmHg diastolic is suggested. The use of agents that block the RAAS system is recommended or suggested in all patients with an albumin excretion rate of ≥30mg/ 24 h. The combination of a RAAS blockade with a calcium channel blocker and a diuretic may be effective in attaining the target BP, and in reducing the amount of urinary protein excretion in patients with chronic GN. PMID:26848302

  9. Augmented Vascular Smooth Muscle Cell Stiffness and Adhesion when Hypertension is Superimposed on Aging

    PubMed Central

    Sehgel, Nancy L.; Sun, Zhe; Hong, Zhongkui; Hunter, William C.; Hill, Michael A.; Vatner, Dorothy E.; Vatner, Stephen F.; Meininger, Gerald A.

    2014-01-01

    Hypertension and aging are both recognized to increase aortic stiffness, but their interactions are not completely understood. Most prior studies have attributed increased aortic stiffness to changes in extracellular matrix proteins that alter mechanical properties of the vascular wall. Alternatively, we hypothesized that a significant component of increased vascular stiffness in hypertension is due to changes in the mechanical and adhesive properties of vascular smooth muscle cells, and that aging would augment the contribution from vascular smooth muscle cells compared to the extracellular matrix. Accordingly, we studied aortic stiffness in young (16 wks) and old (64 wks) spontaneously hypertensive rats and Wistar-Kyoto wild-type controls. Systolic and pulse pressures were significantly increased in young spontaneously hypertensive rats, compared to young Wistar-Kyoto rats, and these continued to rise in old spontaneously hypertensive rats, compared to age-matched controls. Excised aortic ring segments exhibited significantly greater elastic moduli in both young and old spontaneously hypertensive rats vs. Wistar-Kyoto rats. Vascular smooth muscle cells were isolated from the thoracic aorta, and stiffness and adhesion to fibronectin were measured by atomic force microscopy. Hypertension increased both vascular smooth muscle cell stiffness and vascular smooth muscle cell adhesion, and these increases were both augmented with aging. By contrast, hypertension did not affect histological measures of aortic collagen and elastin, which were predominantly changed by aging. This supports the concept that stiffness and adhesive properties of vascular smooth muscle cells are novel mechanisms contributing to the increased aortic stiffness occurring with hypertension superimposed on aging. PMID:25452471

  10. Hypertension management in 2002: where have we been? where might we be going?

    PubMed

    Hansson, Lennart

    2002-10-01

    The term "blood pressure" was coined almost 300 years ago by the man who first measured it, the Reverend Stephen Hales of England. However, our understanding of the pathogenesis and consequences of hypertension, as well as the available treatments for it, have remained greatly limited and inadequate until only the past 30 years. Starting in 1977, reports from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC) have provided regular updates on developments in hypertension management, and have set guidelines for the diagnosis and treatment of hypertension. More than 20 years ago, the JNC stratified blood pressure (BP) levels into categories of mild, moderate, and severe (later renamed stages 1, 2, and 3, respectively). A stepped-care approach to hypertension therapy was originally recommended. With each revised JNC report, there was a reduction in target BP and a growing recognition of the importance of high-normal BP and isolated systolic hypertension. The sixth and most current report of the Joint National Committee, JNC VI, emphasizes treatment of comorbidities of hypertension, sets a lower BP goal (<130/85 mm Hg) for high-risk patients-eg, those with diabetes or renal disease-than for those with uncomplicated hypertension (<140/90 mm Hg), and places a greater emphasis on disease prevention. For the future, the current trend toward lower BP goals suggests that more effective and better tolerated antihypertensive therapies will be needed. Multiple antihypertensive agents used concomitantly will likely be needed to control elevated levels of BP in the majority of hypertensive patients. PMID:12383590

  11. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II – Therapy

    PubMed Central

    Khan, Nadia A; McAlister, Finlay A; Rabkin, Simon W; Padwal, Raj; Feldman, Ross D; Campbell, Norman RC; Leiter, Lawrence A; Lewanczuk, Richard Z; Schiffrin, Ernesto L; Hill, Michael D; Arnold, Malcolm; Moe, Gordon; Campbell, Tavis S; Herbert, Carol; Milot, Alain; Stone, James A; Burgess, Ellen; Hemmelgarn, B; Jones, Charlotte; Larochelle, Pierre; Ogilvie, Richard I; Houlden, Robyn; Herman, Robert J; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce; deChamplain, Jacques; Pylypchuk, George; Logan, Alexander G; Gledhill, Norm; Petrella, Robert; Tobe, Sheldon; Touyz, Rhian M

    2006-01-01

    mellitus or chronic kidney disease (regardless of the degree of proteinuria). Most adults with hypertension require more than one agent to achieve these target BPs. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (in nonblack patients), long-acting calcium channel blockers or angiotensin receptor antagonists. Other agents for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers or angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or in patients without albuminuria, thiazides or dihydropyridine calcium channel blockers) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy. VALIDATION All recommendations were graded according to strength of the evidence and voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95

  12. Portal Hypertension

    MedlinePlus

    ... Chronic Hepatitis C Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD NOTE: This is ... Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension Portal hypertension is abnormally high blood pressure in ...

  13. [Secondary hypertension].

    PubMed

    Yoshida, Yuichi; Shibata, Hirotaka

    2015-11-01

    Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice. PMID:26619670

  14. Hypertensive crisis during pregnancy and postpartum period.

    PubMed

    Too, Gloria T; Hill, James B

    2013-08-01

    Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1-2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients. Maternal assessment should include a thorough history. Fetal assessment should include heart rate tracing, ultrasound for growth and amniotic assessment, and Doppler evaluation if growth restriction is suspected. Initial management of hypertensive emergency (systolic BP >160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia) generally includes the rapid reduction of blood pressure through the use of intravenous antihypertensive medications, with goal systolic blood pressure between 140 mmHg and 150 mmHg and diastolic pressure between 90 mmHg and 100 mmHg. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, nifedipine, and, as a last resort, sodium nitroprusside. Among patients with hypertensive urgency, slower blood pressure reduction can be provided with oral agents. The objective of this article is to review the current understanding, diagnosis, and management of hypertensive crisis during pregnancy and the postpartum period. PMID:23916027

  15. Knowledge, Awareness and Self-Care Practices of Hypertension among Cardiac Hypertensive Patients

    PubMed Central

    Bilal, Muhammad; Haseeb, Abdul; Lashkerwala, Sehan Siraj; Zahid, Ibrahim; Siddiq, Khadijah; Saad, Muhammad; Dar, Mudassir Iqbal; Arshad, Mohammad Hussham; Shahnawaz, Waqas; Ahmed, Bilal; Yaqub, Aimen

    2016-01-01

    Introduction: The most prevalent form of hypertension is systolic blood pressure (SBP) and it is considered to be predisposing risk factor for cardiovascular disease. The objective of the study was to assess self-care practices, knowledge and awareness of hypertension, especially related to SBP among cardiac hypertensive patients. Methodology: A Cross sectional study was conducted on 664 cardiac hypertensive patients, which were selected by non-probability convenience sampling from cardiology outpatient department of three tertiary care hospitals. Face to face interviews were conducted using a pre designed questionnaire. Data was entered and analyzed by SPSS (V17). Results: 81.8%, did not know that hypertension is defined as high blood pressure. 97.1% of the sample population did not know that top measurement of blood pressure was referred to as systolic and only 25.0% correctly recognized normal systolic blood pressure to be less than 140mmHg. 7.4% of the patients consulted their doctor for hypertension once or twice in a month. Risk factor for high blood pressure most commonly identified by the participants was too much salt intake Conclusions: The results state that there is an inadequate general knowledge of hypertension among cardiac patients and they do not recognise the significance of elevated SBP levels. There is a need to initiate programs that create community awareness regarding long term complications of uncontrolled hypertension, particularly elevated SBP levels so that there is an improvement in self-care practices of the cardiacpatients. PMID:26383212

  16. Systolic multiplier for finite fields gf(2/sup m/)

    SciTech Connect

    Yeh, C.S.; Reed, I.S.

    1983-01-01

    A systolic architecture is developed for performing the product-sum computation, ab+c, in the finite field gf(2/sup m/) of 2/sup m/ elements, where a, b and c are arbitrary elements of gf(2/sup m/). The multiplier is a serial-in, serial-out, one-dimensional systolic array. This multiplier for gf(2/sup m/) requires m basic cells. The average time per computation of the multiplier is m time units if a number of computations are computed consecutively. To perform an isolated computation the multiplier requires 3m time units. The architecture is simple and regular and possesses the desirable properties of concurrency and modularity and is well suited for use. 10 references.

  17. A simple versatile method for measuring tail cuff systolic blood pressure in conscious rats.

    PubMed

    Widdop, R E; Li, X C

    1997-09-01

    1. The non-invasive measurement of tail cuff systolic blood pressure in conscious rats is routinely used in long-term cardiovascular studies. There are a number of commercially available tail cuff systems, however, these apparatus are generally expensive and are dedicated for single-task operations. In the present study, a simple method for measuring systolic blood pressure, which requires only minor modifications to the existing hardware found in most cardiovascular laboratories, is described. 2. Systolic blood pressure measurements were made in the conventional manner by determining the systolic blood pressure which coincided with the restoration of the caudal artery pulse. This was achieved by using an inexpensive piezo-electric pulse transducer to detect the pulse, and this was coupled to a standard data-acquisition system (MacLab, ADInstruments) normally set up to record blood pressure. This method was compared with another established tail cuff method, as well as with direct intra-arterial recordings. 3. It was found that the results obtained using both tail cuff systems were in good agreement when systolic blood pressure was measured in Wistar-Kyoto rats and spontaneously hypertensive rats. In addition, systolic blood pressure was measured over 4 weeks in 2K1C rats and sham-operated rats, with both tail cuff methods producing similar results, which were not significantly different from direct intra-arterial recordings in the same animals. 4. Thus, in the present study, with only minor modifications, the same equipment was used for both direct and indirect determinations of systolic blood pressure. This situation differs from other conventional tail cuff systems since these items are designed for a single purpose. Therefore, the current method using piezo-electric sensor/MacLab-technology should be viewed as a relatively simple, flexible and cheap alternative method to measure tail cuff systolic blood pressure in conscious rats. PMID:9337632

  18. SLAPP: A systolic linear algebra parallel processor

    SciTech Connect

    Drake, B.L.; Luk, F.T.; Speiser, J.M.; Symanski, J.J.

    1987-07-01

    Systolic array computer architectures provide a means for fast computation of the linear algebra algorithms that form the building blocks of many signal-processing algorithms, facilitating their real-time computation. For applications to signal processing, the systolic array operates on matrices, an inherently parallel view of the data, using numerical linear algebra algorithms that have been suitably parallelized to efficiently utilize the available hardware. This article describes work currently underway at the Naval Ocean Systems Center, San Diego, California, to build a two-dimensional systolic array, SLAPP, demonstrating efficient and modular parallelization of key matric computations for real-time signal- and image-processing problems.

  19. Matrix computations on systolic-type meshes

    SciTech Connect

    Moreno, J.H.; Lang, T. )

    1990-04-01

    This article focuses on the execution of matrix computations on systolic-type arrays in an application-specific environment. The authors first present an extension to the concept of a systolic cell by incorporating a small, fixed amount of storage inside the cells, and they discuss the trade-offs this storage gives rise to. Then they review different approaches to decomposing (partitioning) large problems, highlighting their bandwidth requirements and their capabilities for using the storage in the cells. Finally, the authors discuss the basic characteristics of methods for the design of systolic-type arrays, describe the multimesh graph (MMG) design method, and illustrate its application to the transitive closure algorithm.

  20. [Hypertensive Disorders in Pregnancy].

    PubMed

    Middeke, Martin

    2016-09-01

    In pregnancy, both mother and fetus benefit from blood pressure in normal ranges. There is discrepancy in the normenclature and thresholds for classification of hypertension in pregnancy and for initiation of antihypertensive treatment in different international guidelines. Systolic and diastolic blood pressure values that are associated with normal outcome are notably lower than any recommended treatment threshold in pregnancy. Tight blood pressure control under 85 mmHg diastolic is save and significantly prevents severe maternal hypertension as could be demonstrated in CHIPS. Close blood pressure monitoring comprising modern methods and devices including telemonitoring allows early recognition of risk developments and optimal guidance of antihypertensive therapy starting early in pregnancy. Only a few pharmacological substances are suitable for antihypertensive treatment in pregnancy. PMID:27598915

  1. Systolic temporal arithmetic: A new formalism for specification, verification, and synthesis of systolic arrays

    SciTech Connect

    Ling, N.

    1989-01-01

    A novel formalism, termed Systolic Temporal Arithmetic (STA), is introduced. It provides necessary constructs to describe arithmetic operations in dynamic environments. The motivation behind the development of STA is to use it for systolic array design at the array architecture level. It is particularly useful for formally specifying systolic array designs, and for formally verifying their correctness with respect to the algorithm specifications. Besides providing value and operation abstractions from the lower level, the formalism exploits unique systolic features such as synchrony, regularity, repeatability, modularity, pipelinability, parallel processing ability, as well as spatial and temporal locality, to provide constructs and verification techniques for simple, efficient, and effective systolic array specification verification. STA overcomes many limitations of current specification and verification techniques. It can be used with lower level formalism for multilevel reasoning of systolic arrays. Application examples are given to show how STA can be applied to specify and verify several different systolic arrays. To present a more unified design environment, STA is also extended to describe systolic array synthesis process. A synthesis procedure for systolic arrays is presented which also includes an algorithm transformation technique developed that can improve the computation time of resulting arrays for suitable algorithms, without much increase in area requirement. Several systolic array synthesis examples are also provided in this dissertation.

  2. Some results concerning linear iterative (systolic) arrays

    SciTech Connect

    Ibarra, O.H.; Palis, M.A.; Kim, S.M.

    1985-05-01

    The authors have shown some new interesting results concerning the properties, power, and limitations of various types of linear iterative (systolic) arrays. The method they employed consisted of finding sequential machine characterizations of these array models, and then using the characterizations to prove the results. Because of the absence of any concurrency and synchronization problems, the authors obtained simple proofs to results which when proved directly on the arrays would seem very difficult. The characterizations, therefore, provide a novel and promising method which can be used to analyze other systolic systems. In the future they hope to extend this methodology to the study of two-dimensional and multidimensional systolic arrays, and other systolic systems with different interconnection networks.

  3. Systolic arrays - From concept to implementation

    SciTech Connect

    Fortes, J.A.B.; Wah, B.W.

    1987-07-01

    Systolic arrays are the result of advances in semiconductor technology and of applications that require extensive throughput. Their realization requires human ingenuity combined with techniques and tools for algorithm development, architecture design, and hardware implementation. Invariably, the first reaction of people who are exposed to the systolic-array concept is one of admiration for the concept's elegance and for its potential for high performance. However, those who next attempt to implement a systolic array for a specific application soon realize that a wealth of subsumed concepts and engineering solutions must be mastered and understood. This special issue attempts to provide insights into the implementation process and to illustrate the different techniques and theories that contribute to the design of systolic arrays.

  4. Implementation and use of systolic array processes

    SciTech Connect

    Kung, H.T.

    1983-01-01

    Major effort are now underway to use systolic array processors in large, real-life applications. The author examines various implementation issues and alternatives, the latter from the viewpoints of flexibility and interconnection topologies. He then identifies some work that is essential to the eventual wide use of systolic array processors, such as the development of building blocks, system support and suitable algorithms. 24 references.

  5. Restructuring for fault-tolerant systolic arrays

    SciTech Connect

    Li, H.F.; Jayakumar, R.; Lam, C.

    1989-02-01

    The problem of restructuring systolic arrays with faulty cells is considered. An approach to derive the required data flow paths and computational sites is proposed. The data skewing requirement, which must be satisfied to find an input schedule, is also discussed. Algorithms to restructure systolic arrays for three different architecture of the processing elements are presented. A systematic method to retime the restructure array using additional programmable delays so that the retimed array satisfies the data skewing requirement is developed.

  6. Systolic acousto-optic binary convolver

    SciTech Connect

    Guilfoyle, P.S.

    1984-01-01

    A novel high speed array processing optical architecture is described. A multichannel acousto-optic binary convolver is architecturally configured as a systolic array processor. The architecture provides a high speed means of matrix/vector multiplications using the digital multiplication via an analog convolution algorithm. This algorithm and a systolic acousto-optic implementation permit the speed of optics to be combined with the accuracy of digital computation. 15 references.

  7. Current diagnosis and management of hypertensive emergency.

    PubMed

    Haas, Andrew R; Marik, Paul E

    2006-01-01

    The appropriate and timely evaluation and treatment of patients with severely elevated blood pressure is essential to avoid serious adverse outcomes. Most importantly, the distinction between a hypertensive emergency (crisis) and urgency needs to be made. A sudden elevation in systolic (SBP) and/or diastolic blood pressure (DBP) that is associated with acute end organ damage (cardiovascular, cerebrovascular, or renal) is defined as a hypertensive crisis or emergency. In contrast, acute elevation in SBP and/or DBP not associated with evidence of end organ damage is defined as hypertensive urgency. In patients with a hypertensive emergency, blood pressure control should be attained as expeditiously as possible with parenteral medications to prevent ongoing and potentially permanent end organ damage. In contrast, with hypertensive urgency, blood pressure control can be achieved with the use of oral medications within 24-48 hours. This paper reviews the management of hypertensive emergencies. PMID:17150051

  8. Renal Oxidative Stress Induced by Long-Term Hyperuricemia Alters Mitochondrial Function and Maintains Systemic Hypertension

    PubMed Central

    Cristóbal-García, Magdalena; García-Arroyo, Fernando E.; Arellano-Buendía, Abraham S.; Madero, Magdalena; Rodríguez-Iturbe, Bernardo; Pedraza-Chaverrí, José; Zazueta, Cecilia; Johnson, Richard J.; Sánchez Lozada, Laura-Gabriela

    2015-01-01

    We addressed if oxidative stress in the renal cortex plays a role in the induction of hypertension and mitochondrial alterations in hyperuricemia. A second objective was to evaluate whether the long-term treatment with the antioxidant Tempol prevents renal oxidative stress, mitochondrial alterations, and systemic hypertension in this model. Long-term (11-12 weeks) and short-term (3 weeks) effects of oxonic acid induced hyperuricemia were studied in rats (OA, 750 mg/kg BW), OA+Allopurinol (AP, 150 mg/L drinking water), OA+Tempol (T, 15 mg/kg BW), or vehicle. Systolic blood pressure, renal blood flow, and vascular resistance were measured. Tubular damage (urine N-acetyl-β-D-glucosaminidase) and oxidative stress markers (lipid and protein oxidation) along with ATP levels were determined in kidney tissue. Oxygen consumption, aconitase activity, and uric acid were evaluated in isolated mitochondria from renal cortex. Short-term hyperuricemia resulted in hypertension without demonstrable renal oxidative stress or mitochondrial dysfunction. Long-term hyperuricemia induced hypertension, renal vasoconstriction, tubular damage, renal cortex oxidative stress, and mitochondrial dysfunction and decreased ATP levels. Treatments with Tempol and allopurinol prevented these alterations. Renal oxidative stress induced by hyperuricemia promoted mitochondrial functional disturbances and decreased ATP content, which represent an additional pathogenic mechanism induced by chronic hyperuricemia. Hyperuricemia-related hypertension occurs before these changes are evident. PMID:25918583

  9. Inbreeding and the genetic complexity of human hypertension.

    PubMed Central

    Rudan, Igor; Smolej-Narancic, Nina; Campbell, Harry; Carothers, Andrew; Wright, Alan; Janicijevic, Branka; Rudan, Pavao

    2003-01-01

    Considerable uncertainty exists regarding the genetic architecture underlying common late-onset human diseases. In particular, the contribution of deleterious recessive alleles has been predicted to be greater for late-onset than for early-onset traits. We have investigated the contribution of recessive alleles to human hypertension by examining the effects of inbreeding on blood pressure (BP) as a quantitative trait in 2760 adult individuals from 25 villages within Croatian island isolates. We found a strong linear relationship between the inbreeding coefficient (F) and both systolic and diastolic BP, indicating that recessive or partially recessive quantitative trait locus (QTL) alleles account for 10-15% of the total variation in BP in this population. An increase in F of 0.01 corresponded to an increase of approximately 3 mm Hg in systolic and 2 mm Hg in diastolic BP. Regression of F on BP indicated that at least several hundred (300-600) recessive QTL contribute to BP variability. A model of the distribution of locus effects suggests that the 8-16 QTL of largest effect together account for a maximum of 25% of the dominance variation, while the remaining 75% of the variation is mediated by QTL of very small effect, unlikely to be detectable using current technologies and sample sizes. We infer that recent inbreeding accounts for 36% of all hypertension in this population. The global impact of inbreeding on hypertension may be substantial since, although inbreeding is declining in Western societies, an estimated 1 billion people globally show rates of consanguineous marriages >20%. PMID:12663539

  10. [Hypertensive emergency and urgence].

    PubMed

    Gegenhuber, Alfons; Lenz, Kurt

    2003-12-01

    DEFINITION, PATHOPHYSIOLOGY, THERAPY: The hypertensive crisis is characterized by a massive, acute rise in blood pressure. Patients with underlying hypertensive disease usually have an increase in systolic blood pressure values > 220 mmHg and diastolic values > 120 mmHg. The severity of the condition, however, is not determined by the absolute blood pressure level but by the magnitude of the acute increase in blood pressure. Thus, in the presence of primarily normotensive baseline values (such as those in eclampsia), even a systolic blood pressure > 170 mmHg may lead to a life-threatening condition. The most important causes are non-compliance (reduction or interruption of therapy), inadequate therapy, endocrine disease, renal (vessel) disease, pregnancy and intoxication (drugs). The management of this condition greatly depends on whether the patient has a hypertensive crisis with organ manifestation (hypertensive emergency) or a crisis without organ manifestation (hypertensive urgency). By documenting the medical history, the medical status and by simple diagnostic procedures, the differential diagnosis can be established at the emergency site within a very short period of time. In the absence of organ manifestations (hypertensive urgency) the patient may have non-specific symptoms such as palpitations, headache, malaise and a general feeling of illness in addition to the increase in blood pressure. In a hypertensive urgency the patient's blood pressure should not be reduced within a few minutes but within a period of 24 to 48 hours. Such adjustment can be achieved on an out-patient basis, however, only if the patient can be followed up adequately for early detection of a renewed attack. In the absence of follow-up facilities, the patient's blood pressure should be reduced over a period of 4 to 6 hours, if necessary in an out-patient emergency service. While intravenous medication is given preference when a rapid effect is desired, oral medication may be used for

  11. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study

    PubMed Central

    Gu, Dongfeng; He, Jiang; Coxson, Pamela G.; Rasmussen, Petra W.; Huang, Chen; Thanataveerat, Anusorn; Tzong, Keane Y.; Xiong, Juyang; Wang, Miao; Zhao, Dong; Goldman, Lee; Moran, Andrew E.

    2015-01-01

    Background Hypertension is China’s leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world’s largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs. Methods and Findings The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35–84 y over 2015–2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140–159/90–99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating

  12. Design and descriptive tools for systolic architectures

    SciTech Connect

    Lewis, P.S.

    1984-01-01

    Automated design and descriptive tools are essential for the practical application of highly parallel special-purpose hardware such as systolic arrays. The use of special-purpose hardware can greatly increase the capabilities of signal processing systems. However, the more limited applications base makes design costs a critical factor in determining technical and economic viability. Systolic systems can be described at several levels of abstraction, each of which has unique descriptive requirements. This paper focuses on the descriptive issues involved at the system architectural level. Tools at this level must bridge the gap between logic- and circuit-oriented computer-aided design tools and algorithmic descriptions of systolic architectures. Traditionally, hardware description languages (HDLs) have been used at this level to describe conventional computer architectures. Systolic architectures, however, have different requirements. This paper examines these requirements and develops a set of criteria for evaluating HDLs. Four popular HDLs are evaluated and their strengths and weaknesses noted. The final section of the paper summarizes ongoing efforts at Los Alamos to develop a systolic array HDL based on the CONLAN family of languages.

  13. Design and descriptive tools for systolic architectures

    SciTech Connect

    Lewis, P.S.

    1984-01-01

    Automated design and descriptive tools are essential for the practical application of highly parallel special-purpose hardware such as systolic arrays. The use of special-purpose hardware can greatly increase the capabilities of signal processing systems. However, the more limited applications base makes design costs a critical factor in determining technical and economic viability. Systolic systems can be described at several levels of abstraction, each of which has unique descriptive requirements. This paper focuses on the descriptive issues involved at the system architectural level. Tools at this level must bridge the gap between logic- and circuit-oriented computer-aided design tools and algorithmic descriptions of systolic architectures. Traditionally, hardware description languages (HDLs) have been used at this level to describe conventional computer architectures. Systolic architectures, however, have different requirements. This paper examines these requirements and develops a set of criteria for evaluating HDLs. Four popular DHLs are evaluated and their strengths and weaknesses noted. The final section of the paper summarizes ongoing efforts at Los Alamos to develop a systolic array HDL based on the CONLAN family of languages. 14 references.

  14. Programming environments for systolic arrays. Technical report

    SciTech Connect

    Snyder, L.

    1986-02-01

    Although a systolic array is often thought of as a hard-wired device, there are many reasons to want to program systolic algorithms. In this paper the problem of providing an efficacious programming environment is addressed. The difficulties of programming complex parallel algorithms are shown to be reduced by using a new concept of a parallel program which maximizes the use of graphical abstractions and minimizes the need for symbolic text. This concept is illustrated by the Poker Parallel Programming Environment which, although designed for a broader class of algorithms, illustrates the main features that a programming environment specialized to systolic computation should have. In the event that the programming environment is for systolic arrays, the programs are parallel and thus impose additional demands on the system such as data formatting, management of multiple process sets, and the specification of data routings. Providing all of these facilities in a single integrated system requires a new concept of parallel program, which, although it is quite different from FORTRAN and PASCAL, is nevertheless easier to use for a systolic array than a conventional programming language. The key to achieving this simplicity is to use graphics so extensively that the resulting programs appear to be dynamic versions of the diagrams presented in textbooks.

  15. Hypertension - overview

    MedlinePlus Videos and Cool Tools

    If left untreated, hypertension can lead to the thickening of arterial walls causing its lumen, or blood passage way, to narrow in diameter. ... the narrowed arterial openings. In addition, people with hypertension may be more susceptible to stroke.

  16. Renovascular hypertension

    MedlinePlus

    Renal hypertension; Hypertension - renovascular; Renal artery occlusion; Stenosis - renal artery; Renal artery stenosis ... Renal artery stenosis is a narrowing or blockage of the arteries that supply blood to the kidneys. The most ...

  17. Renovascular hypertension

    MedlinePlus

    Renal hypertension; Hypertension - renovascular; Renal artery occlusion; Stenosis - renal artery; Renal artery stenosis ... blood pressure to rise. Risk factors for atherosclerosis: High blood pressure Smoking Diabetes High cholesterol Heavy alcohol use Cocaine ...

  18. Systolic temporal arithmetic; A new formalism for specification and verification of systolic arrays

    SciTech Connect

    Ling, N. ); Bayoumi, M.A. )

    1990-08-01

    This paper introduces a novel formalism named systolic temporal arithmetic (STA) suitable for describing arithmetic operations in dynamic environments. The motivation behind the development of STA is to use it for formal specifications and verifications of systolic arrays at the array architecture level. Besides providing value and operation abstraction from the lower level, it also exploits several features of systolic arrays such as synchrony, regularity, repeatability, modularity, pipelinability, parallel processing ability, as well as spatial and temporal locality. STA provides constructs and verification techniques for simple, efficient, and effective systolic array specification and verification. Verification techniques such as mathematical induction are suggested to exploit these systolic array features so as to speedup the process.

  19. On mapping systolic algorithms onto the hypercube

    SciTech Connect

    Ibarra, O.H.; Sohn, S.M. )

    1990-01-01

    Much effort has been devoted toward developing efficient algorithms for systolic arrays. Here the authors consider the problem of mapping these algorithms into efficient algorithms for a fixed-size hypercube architecture. They describe in detail several optimal implementations of algorithms given for one-way one and two-dimensional systolic arrays. Since interprocessor communication is many times slower than local computation in parallel computers built to date, the problem of efficient communication is specifically addressed for these mappings. In order to experimentally validate the technique, five systolic algorithms were mapped in various ways onto a 64-node NCUBE/7 MMD hypercube machine. The algorithms are for the following problems: the shuffle scheduling problem, finite impulse response filtering, linear context-free language recognition, matrix multiplication, and computing the Boolean transitive closure. Experimental evidence indicates that good performance is obtained for the mappings.

  20. QT dispersion in adult hypertensives.

    PubMed Central

    Sani, Isa Muhammad; Solomon, Danbauchi Sulei; Imhogene, Oyati Albert; Ahmad, Alhassan Muhammad; Bala, Garko Sani

    2006-01-01

    Increased QT dispersion is associated with sudden cardiac death in congestive cardiac failure, hypertrophic cardiomyopathy and following myocardial infarction. Patients with hypertension--in particular, those with left ventricular hypertrophy (LVH)--are also at greater risk of sudden cardiac death. We examined whether QT dispersion, which is easily obtained from a routine ECG, correlates with LVH. One-hundred untreated patients with systemic hypertension and 78 normotensives had QT dispersion measured manually from a surface 12-lead electrocardiogram and two-dimensional echocardiography performed to measure interventricular septal thickness, posterior wall thickness and left ventricular internal diameter. Office blood pressure was also recorded. Multivariate analysis demonstrated significant relationships between QT dispersion and office systolic blood pressure, and left ventricular mass index. Manual measurement of QT dispersion might be a simple, noninvasive screening procedure to identify those hypertensives at greatest risk of sudden cardiac death in a third-world country. PMID:16623077

  1. Algorithms for systolic-array synthesis

    SciTech Connect

    Wong, Yiwan.

    1989-01-01

    This dissertation presents efficient algorithms for solving some crucial transformation/optimization problems in the automatic synthesis of systolic arrays from algorithm specifications. The synthesis process consists of two steps. First, the given algorithm specification is transformed into a functionally equivalent form more amenable to systolic array implementation. Then, the computations defined by the equivalent form are assigned for execution on the processors (processor allocation) at different time steps (scheduling), with the objective that the time and space costs of the implementation be minimized. Many computation intensive algorithms, when expressed in their natural form, are unsuitable for systolic array implementations because they contain many-to-one data dependences (data sharing) which cannot be directly realized on processors with bounded fan-out and localized interconnections. A data routing scheme, called data propagation, is proposed which can be implemented as pipelining on a systolic array. It is shown that any data sharing can be transformed into data propagation and that the increase in I/O bandwidth requirement due to such transformation is bounded. Polynomial time procedures are devised for determining the necessary transformations. The time cost of a systolic array implementation of an algorithm is given by the product of two related quantities: the total number of systolic cycles required and the maximum duration of a cycle. It is shown that the scheduling which minimizes the time cost can be determined from solving a discrete optimization problem. Furthermore, the optimization problem is shown to have a bounded solution space, an efficient branch-and-bound method is proposed for determining the optimal solution. The space cost, on the other hand, is defined as the number of processors required for constructing the array.

  2. Ambulatory blood pressure monitoring in hypertensive adolescents.

    PubMed

    Fixler, D E; Wallace, J M; Thornton, W E; Dimmitt, P

    1990-04-01

    The purpose of this study was to determine the ability of ambulatory blood pressure monitoring to identify youths with chronic blood pressure elevation. Nineteen adolescent boys were studied, ten had 5-year average systolic or diastolic pressures above the 95th percentile, nine had normal pressure. A Del Mar Avionics Pressurometer III system recorded an average of 121 readings on each subject. The coefficients of variation for pressure were similar for hypertensive and normotensive individuals. During classes, eight of the ten hypertensive youths had elevated pressures in over half of the measurements. Also during these classes eight of ten hypertensive boys had average systolic or diastolic pressure above the 95th percentile, whereas only one of nine normotensive boys had average pressures above this level. We suggest that schooltime ambulatory pressures may be most useful in classifying the blood pressure trend in a youth. PMID:2346634

  3. Emergency Management of Hypertension in Children

    PubMed Central

    Singh, Dinesh; Akingbola, Olugbenga; Yosypiv, Ihor; El-Dahr, Samir

    2012-01-01

    Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information. PMID:22577545

  4. Refeeding hypertension in dietary obesity

    SciTech Connect

    Ernsberger, P.; Nelson, D.O. )

    1988-01-01

    A novel model of nutritionally induced hypertension in the rat is described. Dietary obesity was produced by providing sweet milk in addition to regular chow, which elicited a 52% increase in caloric intake. Despite 54% greater body weight gain and 139% heavier retroperitoneal fat pads, 120 days of overfeeding failed to increase systolic pressure in the conscious state or mean arterial pressure under urethan anesthesia. In contrast, mild hypertension developed in intermittantly fasted obese animals. The first 4-day supplemented fast was initiated 4 wk after the introduction of sweet milk, when the animals were 47 g overweight relative to chow-fed controls. Thereafter, 4 days of starvation were alternated with 2 wk of refeeding for a total of 4 cycles. A rapid fall in systolic blood pressure accompanied the onset of supplemented fasting and was maintained thereafter. With refeeding, blood pressure rose precipitously, despite poststarvation anorexia. Blood pressure tended to rise slightly over the remainder of the realimentation period. After the 4th supplemented fast, hypertension was sustained during 30 days of refeeding. Cumulative caloric intake in starved-refed rats fell within 2% of that in chow-fed controls. Refeeding hypertension appeared to be due to increased sympathetic nervous activity, since (1) cardiac {beta}-adrenergic receptors were downregulated, as indicated by a 40% decrease in the maximum binding of ({sup 3}H)dihydroalpranolol; and (2) the decrease in heart rate as a result of {beta}-blockade was enhanced. Refeeding hypertension in the dietary obese rat may be a potential animal model for some forms of human obesity-related hypertension.

  5. Synthesis, verification, and optimization of systolic arrays

    SciTech Connect

    Rajopadhye, S.V.

    1986-01-01

    This dissertation addresses the issue of providing a sound theoretical basis for three important issues relating to systolic arrays, namely synthesis, verification, and optimization. Former research has concentrated on analysis of the dependency structure of the computation, and there have been numerous approaches to map this dependency structure onto a locally interconnected network. This study pursues a similar approach, but with a major generalization of the class of problems analyzed. In earlier research, it was essential that the dependencies were expressible as constant vectors (from a point in the domain to the points that it depended on); here they are permitted to be arbitrary linear functions of the point. Theory for synthesizing systolic architectures from such generalized specifications is developed. Also a systematic (mechanizable) approach to the synthesis of systolic architectures that have control signals is presented. In the areas of verification and optimization, a rigorous mathematical framework is presented that permits reasoning about the behavior of systolic arrays as functions on streams of data. Using this approach, the verification of such architectures reduces to the problem of verification of functional program.s

  6. A unified systolic array for adaptive beamforming

    SciTech Connect

    Bojanczyk, A.W.; Luk, F.T. )

    1990-04-01

    The authors present a new algorithm and systolic array for adaptive beamforming. The authors algorithm uses only orthogonal transformations and thus should have better numerical properties. The algorithm can be implemented on one single p {times} p triangular array of programmable processors that offers a throughput of one residual element per cycle.

  7. [Childhood hypertension].

    PubMed

    Takemura, Tsukasa

    2015-11-01

    For accurate diagnosis of childhood hypertension, selection of appropriate manchette size according to the child age and the circumstantial size of upper limb is essentially important. In addition, except for the emergency case of hypertension, repeated measurement of blood pressure would be desirable in several weeks interval. Recently, childhood hypertension might be closely related to the abnormality of maternal gestational period caused by the strict diet and the maternal smoking. Developmental Origins of Health and Disease(DOHaD) theory is now highlighted in the pathogenesis of adulthood hypertension. To prevent hypertension of small-for-date baby in later phase of life, maternal education for child nursing should be conducted. In children, secondary hypertension caused by renal, endocrinologic, or malignant disease is predominant rather than idiopathic hypertension. PMID:26619664

  8. The J-Curve Phenomenon in Hypertension

    PubMed Central

    Kang, Yuan-Yuan; Wang, Ji-Guang

    2016-01-01

    Almost immediately after antihypertensive therapy was proven effective in preventing cardiovascular events, the J-curve issue emerged as a hot topic. The Hypertension Optimal Treatment (HOT) trial attempted to address this question (diastolic blood pressure <80, <85, and <90 mm Hg) but ended up with a post hoc analysis indicating a nadir of 138.5 mm Hg systolic and 82.6 mm Hg diastolic blood pressure. Nevertheless, this observational finding was supported by the results of observational studies in the general population and by post hoc analyses of antihypertensive treatment trials. The currently ongoing Systolic Hypertension Optimal Treatment (SHOT) trial investigates whether the relationship between systolic blood pressure and stroke recurrence is linear or J-shaped by treating systolic blood pressure to <125, <135, and <145 mm Hg in patients with a history of recent stroke. This trial may provide additional but probably inconclusive evidence, because optimal blood pressure might differ between individuals and across outcomes. Nevertheless, a universal beneficial, instead of optimal, level of blood pressure for antihypertensive treatment may exist approximating 130/80 mm Hg and should be investigated by comparing 130/80 mm Hg with 140/90 mm Hg as a target blood pressure in hypertensive patients with the simultaneous use of modern blood pressure measuring techniques, such as home and ambulatory blood pressure monitoring. PMID:27493904

  9. Mesenteric lymphatic vessels adapt to mesenteric venous hypertension by becoming weaker pumps.

    PubMed

    Dongaonkar, R M; Nguyen, T L; Quick, C M; Heaps, C L; Hardy, J; Laine, G A; Wilson, E; Stewart, R H

    2015-03-01

    Lymphangions, the segments of lymphatic vessels between two adjacent lymphatic valves, actively pump lymph. Acute changes in transmural pressure and lymph flow have profound effects on lymphatic pump function in vitro. Chronic changes in pressure and flow in vivo have also been reported to lead to significant changes in lymphangion function. Because changes in pressure and flow are both cause and effect of adaptive processes, characterizing adaptation requires a more fundamental analysis of lymphatic muscle properties. Therefore, the purpose of the present work was to use an intact lymphangion isovolumetric preparation to evaluate changes in mesenteric lymphatic muscle mechanical properties and the intracellular Ca(2+) in response to sustained mesenteric venous hypertension. Bovine mesenteric veins were surgically occluded to create mesenteric venous hypertension. Postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 6) and sham surgery (Sham; n = 6) animals were isolated and evaluated 3 days after the surgery. Spontaneously contracting MVH vessels generated end-systolic active tension and end-diastolic active tension lower than the Sham vessels. Furthermore, steady-state active tension and intracellular Ca(2+) concentration levels in response to KCl stimulation were also significantly lower in MVH vessels compared with those of the Sham vessels. There was no significant difference in passive tension in lymphatic vessels from the two groups. Taken together, these results suggest that following 3 days of mesenteric venous hypertension, postnodal mesenteric lymphatic vessels adapt to become weaker pumps with decreased cytosolic Ca(2+) concentration. PMID:25519727

  10. The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy

    PubMed Central

    Khan, Nadia A; Hemmelgarn, Brenda; Herman, Robert J; Rabkin, Simon W; McAlister, Finlay A; Bell, Chaim M; Touyz, Rhian M; Padwal, Raj; Leiter, Lawrence A; Mahon, Jeff L; Hill, Michael D; Larochelle, Pierre; Feldman, Ross D; Schiffrin, Ernesto L; Campbell, Norman RC; Arnold, Malcolm O; Moe, Gordon; Campbell, Tavis S; Milot, Alain; Stone, James A; Jones, Charlotte; Ogilvie, Richard I; Hamet, Pavel; Fodor, George; Carruthers, George; Burns, Kevin D; Ruzicka, Marcel; deChamplain, Jacques; Pylypchuk, George; Petrella, Robert; Boulanger, Jean-Martin; Trudeau, Luc; Hegele, Robert A; Woo, Vincent; McFarlane, Phil; Vallée, Michel; Howlett, Jonathan; Katzmarzyk, Peter; Tobe, Sheldon; Lewanczuk, Richard Z

    2008-01-01

    the patient’s global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to lower than 140/90 mmHg in all patients, and to lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin-converting enzyme (ACE) inhibitors (in nonblack patients), long-acting calcium channel blockers (CCBs), angiotensin receptor antagonists (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered for initial treatment of hypertension if systolic blood pressure is 20 mmHg above target or if diastolic blood pressure is 10 mmHg above target. Other agents appropriate for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine CCBs or ARBs. In patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred; in patients with protein-uric nondiabetic chronic kidney disease, ACE inhibitors are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension but who do not achieve thresholds for statin therapy

  11. Resistant Hypertension.

    PubMed

    Doroszko, Adrian; Janus, Agnieszka; Szahidewicz-Krupska, Ewa; Mazur, Grzegorz; Derkacz, Arkadiusz

    2016-01-01

    Resistant hypertension is a severe medical condition which is estimated to appear in 9-18% of hypertensive patients. Due to higher cardiovascular risk, this disorder requires special diagnosis and treatment. The heterogeneous etiology, risk factors and comorbidities of resistant hypertension stand in need of sophisticated evaluation to confirm the diagnosis and select the best therapeutic options, which should consider lifestyle modifications as well as pharmacological and interventional treatment. After having excluded pseudohypertension, inappropriate blood pressure measurement and control as well as the white coat effect, suspicion of resistant hypertension requires an analysis of drugs which the hypertensive patient is treated with. According to one definition - ineffective treatment with 3 or more antihypertensive drugs including diuretics makes it possible to diagnose resistant hypertension. A multidrug therapy including angiotensin - converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, diuretics, long-acting calcium channel blockers and mineralocorticoid receptor antagonists has been demonstrated to be effective in resistant hypertension treatment. Nevertheless, optional, innovative therapies, e.g. a renal denervation or baroreflex activation, may create a novel pathway of blood pressure lowering procedures. The right diagnosis of this disease needs to eliminate the secondary causes of resistant hypertension e.g. obstructive sleep apnea, atherosclerosis and renal or hormonal disorders. This paper briefly summarizes the identification of the causes of resistant hypertension and therapeutic strategies, which may contribute to the proper diagnosis and an improvement of the long term management of resistant hypertension. PMID:26935512

  12. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

    PubMed Central

    Lobo, Tasso Julio; Pachon, Carlos Thiene; Pachon, Jose Carlos; Pachon, Enrique Indalecio; Pachon, Maria Zelia; Pachon, Juan Carlos; Santillana, Tomas Guillermo; Zerpa, Juan Carlos; Albornoz, Remy Nelson; Jatene, Adib Domingos

    2015-01-01

    Background Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. Objective To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. Methods Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. Results 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred. Conclusion Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement. PMID:25387404

  13. Oleanolic acid prevents glucocorticoid-induced hypertension in rats.

    PubMed

    Bachhav, Sagar S; Patil, Savita D; Bhutada, Mukesh S; Surana, Sanjay J

    2011-10-01

    The present study was designed to evaluate the antihypertensive activity of oleanolic acid isolated from Viscum articulatum, Burm. (Loranthaceae) in glucocorticoid (dexamethasone)-induced hypertension in rats and to propose a probable mechanism of action for this effect. Male Wistar rats (300-350 g) received dexamethasone (20 μg/kg/day s.c.) or saline (vehicle) for 10 days. In a prevention study, the rats received oleanolic acid (60 mg/kg i.p.) for 5 days, followed by dexamethasone or saline for 10 days. During this period the systolic blood pressure and body weight were evaluated on alternate days. At the end of the experiment, the weight of the thymus gland, plasma nitrate/nitrite (nitric oxide metabolites) concentration and cardiac lipid peroxidation value were determined. Oleanolic acid (60 mg/kg i.p.) significantly prevented a rise in the systolic blood pressure and cardiac lipid peroxidation level after administration of dexamethasone (p < 0.01 and p < 0.05, respectively) without showing any significant effect on the dexamethasone-induced change in body and thymus weights. The decrease in concentration of plasma nitrate/nitrite due to dexamethasone was prevented significantly in the group treated with oleanolic acid (p < 0.05). These findings suggest that oleanolic acid (60 mg/kg i.p.) prevents dexamethasone-induced hypertension in rats, which may be attributed to its antioxidant and nitric oxide releasing action. PMID:21953707

  14. Hypertension in a Brazilian urban slum population.

    PubMed

    Unger, Alon; Felzemburgh, Ridalva D M; Snyder, Robert E; Ribeiro, Guilherme S; Mohr, Sharif; Costa, Vinícius B A; Melendez, Astrid X T O; Reis, Renato B; Santana, Francisco S; Riley, Lee W; Reis, Mitermayer G; Ko, Albert I

    2015-06-01

    Low- and middle-income countries account for the majority of hypertension disease burden. However, little is known about the distribution of this illness within subpopulations of these countries, particularly among those who live in urban informal settlements. A cross-sectional hypertension survey was conducted in 2003 among 5649 adult residents of a slum settlement in the city of Salvador, Brazil. Hypertension was defined as either an elevated arterial systolic (≥140 mmHg) or diastolic (≥90 mmHg) blood pressure. Sex-specific multivariable models of systolic blood pressure were constructed to identify factors associated with elevated blood pressure. The prevalence of hypertension in the population 18 years and older was 21% (1162/5649). Men had 1.2 times the risk of hypertension compared with women (95% confidence intervals (CI), 1.05, 1.36). Increasing age and lack of any schooling, particularly for women, were also significantly associated with elevated blood pressure (p < 0.05). There was also a direct association between men who were black and an elevated blood pressure. Among those who were hypertensive, 65.5% were aware of their condition, and only 36.3% of those aware were actively using anti-hypertensive medications. Men were less likely to be aware of their diagnosis or to use medications (p < 0.01 for both) than women. The prevalence of hypertension in this slum community was lower than reported frequencies in the non-slum population of Brazil and Salvador, yet both disease awareness and treatment frequency were low. Further research on hypertension and other chronic non-communicable diseases in slum populations is urgently needed to guide prevention and treatment efforts in this growing population. PMID:25920334

  15. Bidiagonalization and symmetric tridiagonalization by systolic arrays

    NASA Technical Reports Server (NTRS)

    Schreiber, Robert

    1988-01-01

    A systolic algorithm and an array for bidiagonalization of an nxn matrix in O(nlog(2)n) time, using O(n to the 2nd power) cells are given. Bandedness of the input matrix may be effectively exploited. If the matrix is banded, with p nonzero subdiagonals and q nonzero superdiagonals, then 4nln(p + q) + O(n) clocks and 2n(p + q) + O((p + q) to the 2nd power + n) cells are needed. This is faster than the best previously reported result by the factor log(2)e = 1.44.... Moreover, in contrast to earlier systolic designs, which require the matrix to be preloaded into the array and the result matrix extracted after bidiagonalization, the present arrays are pipelined.

  16. Malignant hypertension

    MedlinePlus

    ... Lippincott Williams & Wilkins; 2009:chap 89. Read More Acute kidney failure Alertness - decreased Angina Heart attack Preeclampsia Pulmonary edema Renovascular hypertension Seizures Stroke Update ...

  17. Mineralocorticoid hypertension

    PubMed Central

    Gupta, Vishal

    2011-01-01

    Hypertension affects about 10 – 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta), aldosterone-producing pathologies (primary aldosteronism – Conns syndrome, familial hyperaldosteronism 1, 2, and 3), non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH) syndrome, congenitalvadrenal hyperplasia), and drugs with mineraocorticoid activity (locorice, carbenoxole therapy) to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy) for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers) and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics). Direct aldosterone synthetase antagonists represent a promising future therapy. PMID:22145132

  18. Pharmacologic analysis of 7-O-ethyl-fangchinoline-induced vasodilation properties in isolated perfused common carotid arteries of Wistar Kyoto rats and spontaneously hypertensive rats.

    PubMed

    Matsuura, M; Zenda, H; Chiba, S

    1991-10-01

    Using the cannula insertion method, we investigated vascular effects of 7-O-ethyl-fangchinoline (TJN-220) derived from tetrandrine in isolated and perfused common carotid arteries of Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). A single dose of TJN-220 caused a vasodilation in a dose-related manner in arteries preconstricted by phenylephrine. The vasodilation was not inhibited by propranolol, a potent beta-adrenoceptor antagonist. A potent alpha-antagonist bunazosin inhibited the vasoconstriction to norepinephrine while TJN-220 did not modify the norepinephrine-induced constriction, indicating TJN-220 had no alpha-blocking activity. A potent calcium entry blocker, diltiazem, markedly attenuated the KCl-induced vasoconstriction, and TJN-220 slightly but significantly attenuated the KCl-induced one in large doses. The vasodilation of TJN-220 was not abolished after removing the endothelium by an intraluminal administration of saponin, although the ACh-induced dilation was completely abolished by it. A comparison of vascular responses in WKY and SHR revealed no significant differences. From these results, it is concluded that 1) a new tetrandrine derivative, TJN-220 has relatively long-lasting vasorelaxant properties, 2) the dilatory effects might not be related to adrenergic, muscarinic or endothelium-dependent mechanisms, and 3) the effects might partially be due to calcium entry antagonistic properties. PMID:1806292

  19. Uric Acid Levels in Normotensive Children of Hypertensive Parents

    PubMed Central

    Yildirim, Ali; Keles, Fatma; Kosger, Pelin; Ozdemir, Gokmen; Ucar, Birsen; Kilic, Zubeyir

    2015-01-01

    This study evaluated uric acid concentrations in normotensive children of parents with hypertension. Eighty normotensive children from families with and without a history of essential hypertension were included. Concentrations of lipid parameters and uric acid were compared. Demographic and anthropometric characteristics were similar in the groups. Systolic and diastolic blood pressure were higher in the normotensive children of parents with hypertension without statistically significant difference (P > 0.05). Uric acid concentrations were higher in the normotensive children of parents with hypertension (4.61 versus 3.57 mg/dL, P < 0.01). Total cholesterol and triglyceride concentrations were similar in the two groups. Systolic and diastolic blood pressure were significantly higher in control children aged >10 years (P < 0.01). Uric acid levels were significantly higher in all children with more pronounced difference after age 10 of years (P < 0.001). Positive correlations were found between the level of serum uric acid and age, body weight, body mass index, and systolic and diastolic blood pressure in the normotensive children of parents. The higher uric acid levels in the normotensive children of hypertensive parents suggest that uric acid may be a predeterminant of hypertension. Monitoring of uric acid levels in these children may allow for prevention or earlier treatment of future hypertension. PMID:26464873

  20. Systolic Time Intervals and New Measurement Methods.

    PubMed

    Tavakolian, Kouhyar

    2016-06-01

    Systolic time intervals have been used to detect and quantify the directional changes of left ventricular function. New methods of recording these cardiac timings, which are less cumbersome, have been recently developed and this has created a renewed interest and novel applications for these cardiac timings. This manuscript reviews these new methods and addresses the potential for the application of these cardiac timings for the diagnosis and prognosis of different cardiac diseases. PMID:27048269

  1. Hardware description languages for systolic architectures

    SciTech Connect

    Lewis, P.S.

    1984-10-01

    Systolic principles can be used to construct special purpose computer systems that achieve high throughput by exploiting algorithmic properties. These principles of regularity, localized communications, and parallel/pipelined execution nicely match the capabilities of integrated circuit technology. Hence, systolic arrays are an attractive method for building high-speed special-purpose hardware to rapidly solve sophisticated problems. However, the use of special-purpose hardware limits the applications base, making fixed costs such as those associated with system design much more critical. Although design costs are in part reduced by the very nature of systolic systems, further reduction can result from the use of automated design and descriptive tools. The design process stretches from the conception of the algorithm and its mapping onto an architecture down to the electronic implementation. In general, a good set of design tools allows the designer to describe, test, and trade off only those factors that are important at that particular point in the design process. A principle requirement in automating the design process is a formal notational mechanism that is capable of providing complete and unambiguous descriptions of the concepts being explored. This notational mechanism then provides a common basis for comparisons between alternate methods and an input mechanism to automated design tools. This thesis identifies the notational features that are necessary for the description of highly parallel, regular architectures such as systolic arrays. A set of language criteria is developed. A number of the more popular HDLs are evaluated using these criteria and their shortcomings noted. 65 references.

  2. Optical systolic array processor using residue arithmetic

    NASA Technical Reports Server (NTRS)

    Jackson, J.; Casasent, D.

    1983-01-01

    The use of residue arithmetic to increase the accuracy and reduce the dynamic range requirements of optical matrix-vector processors is evaluated. It is determined that matrix-vector operations and iterative algorithms can be performed totally in residue notation. A new parallel residue quantizer circuit is developed which significantly improves the performance of the systolic array feedback processor. Results are presented of a computer simulation of this system used to solve a set of three simultaneous equations.

  3. Tomographic image reconstruction using systolic array algorithms

    SciTech Connect

    Azevedo, S.G.; DeGroot, A.J.; Schneberk, D.J.; Brase, J.M.; Martz, H.E.; Jain, A.K.; Current, K.W.; Hurst, P.J.

    1988-12-22

    Image reconstruction for Computed Tomography (CT) is a time consuming operation on current uniprocessor computers and even on array processors. This is particularly true for three-dimensional data sets or for limited-data reconstructions requiring iterative procedures. In these cases, the projection operation (Radon transform) and its inverse (filtered back-projection) are major computational tasks that are performed many times. Multiprocessor computers, especially in systolic array configurations, can provide dramatic improvements in reconstruction times at reasonable costs. An in-house systolic processor, called SPRINT, has been programmed to demonstrate these improved speeds while achieving near 100% efficiency of all processor elements. We report on these results in this paper. In addition, two proposed hardware implementations of a new architecture are shown to have even greater speedup possibilities. One, using standard DSP chips, has been simulated to give a factor of three improvement over SPRINT, while the other, using custom VLSI that is now in the early stages of design, could potentially perform 512/sup 2/ reconstructions at video rates (100 times further speedup). These processors are also interconnected in a systolic array configuration. Experimental and projected results, with future plans, are also reported in this paper. 11 refs., 5 figs., 1 tab.

  4. Blood pressure lowering effect of a pea protein hydrolysate in hypertensive rats and humans.

    PubMed

    Li, Huan; Prairie, Natalie; Udenigwe, Chibuike C; Adebiyi, Abayomi P; Tappia, Paramjit S; Aukema, Harold M; Jones, Peter J H; Aluko, Rotimi E

    2011-09-28

    The blood pressure lowering effect of a pea protein hydrolysate (PPH) that contained <3 kDa peptides, isolated by membrane ultrafiltration from the thermolysin digest of pea protein isolate (PPI), was examined using different rat models of hypertension as well as hypertensive human subjects. The PPH showed weak in vitro activities against renin and angiotensin converting enzyme (ACE) with inhibitory activities of 17 and 19%, respectively, at 1 mg/mL test concentration. Oral administration of the PPH to spontaneously hypertensive rats (SHR) at doses of 100 and 200 mg/kg body weight led to a lowering of hourly systolic blood pressure (SBP), with a maximum reduction of 19 mmHg at 4 h. In contrast, orally administered unhydrolyzed PPI had no blood pressure reducing effect in SHR, suggesting that thermolysin hydrolysis may have been responsible for releasing bioactive peptides from the native protein. Oral administration of the PPH to the Han:SPRD-cy rat (a model of chronic kidney disease) over an 8-week period led to 29 and 25 mmHg reductions in SBP and diastolic blood pressure, respectively. The PPH-fed rats had lower plasma levels of angiotensin II, the major vasopressor involved in development of hypertension, but there was no effect on plasma activity or renal mRNA levels of ACE. However, renal expression of renin mRNA levels was reduced by approximately 50% in the PPH-fed rats, suggesting that reduced renin may be responsible for the reduced levels of angiotensin II. In a 3-week randomized double blind placebo-controlled crossover human intervention trial (7 volunteers), significant (p<0.05) reductions (over placebo) in SBP of 5 and 6 mmHg were obtained in the second and third weeks, respectively, for the PPH group. Therefore, thermolysin derived bioactive peptides from PPH reduced blood pressure in hypertensive rats and human subjects, likely via effects on the renal angiotensin system. PMID:21854068

  5. Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

    PubMed Central

    Ayoub, Amal Mohamed; Keddeas, Viola William; Ali, Yasmin Abdelrazek; El Okl, Reham Atef

    2016-01-01

    BACKGROUND Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. METHODS We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). RESULTS There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson’s method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. CONCLUSION 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention. PMID:27385916

  6. Incidence and Cause of Hypertension During Adrenal Radiofrequency Ablation

    SciTech Connect

    Yamakado, Koichiro Takaki, Haruyuki; Yamada, Tomomi; Yamanaka, Takashi; Uraki, Junji; Kashima, Masataka; Nakatsuka, Atsuhiro; Takeda, Kan

    2012-12-15

    Purpose: To evaluate the incidence and cause of hypertension prospectively during adrenal radiofrequency ablation (RFA). Methods: For this study, approved by our institutional review board, written informed consent was obtained from all patients. Patients who received RFA for adrenal tumors (adrenal ablation) and other abdominal tumors (nonadrenal ablation) were included in this prospective study. Blood pressure was monitored during RFA. Serum adrenal hormone levels including epinephrine, norepinephrine, dopamine, and cortisol levels were measured before and during RFA. The respective incidences of procedural hypertension (systolic blood pressure >200 mmHg) of the two patient groups were compared. Factors correlating with procedural systolic blood pressure were evaluated by regression analysis.ResultsNine patients underwent adrenal RFA and another 9 patients liver (n = 5) and renal (n = 4) RFA. Asymptomatic procedural hypertension that returned to the baseline by injecting calcium blocker was found in 7 (38.9%) of 18 patients. The incidence of procedural hypertension was significantly higher in the adrenal ablation group (66.7%, 6/9) than in the nonadrenal ablation group (11.1%, 1/9, P < 0.0498). Procedural systolic blood pressure was significantly correlated with serum epinephrine (R{sup 2} = 0.68, P < 0.0001) and norepinephrine (R{sup 2} = 0.72, P < 0.0001) levels during RFA. The other adrenal hormones did not show correlation with procedural systolic blood pressure. Conclusion: Hypertension occurs frequently during adrenal RFA because of the release of catecholamine.

  7. [Resistant hypertension].

    PubMed

    Feldstein, Carlos A

    2008-04-01

    Resistant hypertension, defined as a persistent blood pressure over 140/90 mmHg despite the use of three antihypertensive drugs including a diuretic, is unusual. The diagnosis requires ruling out initially pseudoresistance and a lack of compliance with treatment. Ambulatory blood pressure recording allow the recognition of white coat hypertension. When there is a clinical or laboratory suspicion, secondary causes of hypertension should be discarded. Excessive salt intake, the presence of concomitant diseases such as diabetes mellitus, chronic renal disease, obesity, and psychiatric conditions such as panic attacks, anxiety and depression, should also be sought. The presence of target organ damage requires a more aggressive treatment of hypertension. Recent clinical studies indicate that the administration of aldosterone antagonists as a fourth therapeutic line provides significant additional blood pressure reduction, when added to previous antihypertensive regimens in subjects with resistant hypertension. The possible blood pressure lowering effects of prolonged electrical activation of carotid baroreceptors is under investigation. PMID:18769797

  8. The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy

    PubMed Central

    Khan, Nadia A; Hemmelgarn, Brenda; Padwal, Raj; Larochelle, Pierre; Mahon, Jeff L; Lewanczuk, Richard Z; McAlister, Finlay A; Rabkin, Simon W; Hill, Michael D; Feldman, Ross D; Schiffrin, Ernesto L; Campbell, Norman RC; Logan, Alexander G; Arnold, Malcolm; Moe, Gordon; Campbell, Tavis S; Milot, Alain; Stone, James A; Jones, Charlotte; Leiter, Lawrence A; Ogilvie, Richard I; Herman, Robert J; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce; Burns, Kevin D; Ruzicka, Marcel; deChamplain, Jacques; Pylypchuk, George; Gledhill, Norm; Petrella, Robert; Boulanger, Jean-Martin; Trudeau, Luc; Hegele, Robert A; Woo, Vincent; McFarlane, Phil; Touyz, Rhian M; Tobe, Sheldon W

    2007-01-01

    grains and protein from plant sources; and considering stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should take into account each individual’s global atherosclerotic risk, target organ damage and any comorbid conditions: blood pressure should be lowered to lower than 140/90 mmHg in all patients and lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients require more than one agent to achieve these blood pressure targets. In adults without compelling indications for other agents, initial therapy should include thiazide diuretics; other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin-converting enzyme (ACE) inhibitors (except in black patients), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age). First-line therapy for isolated systolic hypertension includes long-acting dihydropyridine CCBs or ARBs. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction, or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor plus diuretic combination is preferred; in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with

  9. Green asparagus (Asparagus officinalis) prevented hypertension by an inhibitory effect on angiotensin-converting enzyme activity in the kidney of spontaneously hypertensive rats.

    PubMed

    Sanae, Matsuda; Yasuo, Aoyagi

    2013-06-12

    Green asparagus (Asparagus officinalis) is known to be rich in functional components. In the present study, spontaneously hypertensive rats (SHR) were used to clarify whether green asparagus prevents hypertension by inhibition of angiotensin-converting enzyme (ACE) activity. Six-week-old male SHR were fed a diet with (AD group) or without (ND group) 5% asparagus for 10 weeks. Systolic blood pressure (SBP) (AD: 159 ± 4.8 mmHg, ND: 192 ± 14.7 mmHg), urinary protein excretion/creatinine excretion, and ACE activity in the kidney were significantly lower in the AD group compared with the ND group. Creatinine clearance was significantly higher in the AD group compared with the ND group. In addition, ACE inhibitory activity was observed in a boiling water extract of asparagus. The ACE inhibitor purified and isolated from asparagus was identified as 2″-hydroxynicotianamine. In conclusion, 2″-hydroxynicotianamine in asparagus may be one of the factors inhibiting ACE activity in the kidney, thus preventing hypertension and preserving renal function. PMID:23647085

  10. The rate of ATP export in the extramitochondrial phase via the adenine nucleotide translocator changes in aging in mitochondria isolated from heart left ventricle of either normotensive or spontaneously hypertensive rats.

    PubMed

    Atlante, Anna; Seccia, Teresa Maria; Marra, Ersilia; Passarella, Salvatore

    2011-10-01

    To find out whether and how deficit of cellular energy supply from mitochondria to cytosol occurs in aging and hypertension, we used mitochondria isolated from 5 to 72 week-old heart left ventricle of either normotensive (WKY) or spontaneous hypertensive (SH) rats as a model system. Measurements were made of the rate of ATP appearance outside mitochondria, due to externally added ADP, as an increase of NADPH absorbance which occurs when ATP is produced in the presence of glucose, hexokinase and glucose-6-phosphate dehydrogenase. Such a rate proved to mirror the function of the adenine nucleotide translocator (ANT) rather than other processes linked to the both oxidative and substrate level phosphorylation. The changes in both Ki for atractyloside and Km for ADP suggest the occurrence of modification of the ANT conformation during aging in which the ANT Vmax was found to decrease in normotensive but to increase under spontaneously hypertension in 24 week-old rats with a subsequent decrease in both cases. ANT function, as investigated in the ADP physiological range (20-60μM), is expected to decrease in normotensive, but to increase in hypertensive rats up to 48 weeks. Later a decrease in the ATP rate of export outside mitochondria should occur in both cases. PMID:21855562

  11. Nifedipine in acute hypertensive emergencies in pregnancy.

    PubMed

    Seabe, S J; Moodley, J; Becker, P

    1989-09-16

    The effect of nifedipine (Adalat; Bayer-Miles)--a calcium channel blocker, which has a well-established place in nonobstetric hypertension--was compared with dihydralazine in 33 primigravidas with severe hypertension of pregnancy. Patients with a diastolic blood pressure greater than 110 mmHg before drug administration were randomly assigned to treatment with either nifedipine or dihydralazine. Both drugs were found to be equally efficacious. Nifedipine, however, showed an earlier onset of action in lowering systolic blood pressure and had the advantage of oral administration. PMID:2781421

  12. Adaptive identification by systolic arrays. Master's thesis

    SciTech Connect

    Willis, P.A.

    1987-12-01

    This thesis is concerned with the implementation of an adaptive-identification algorithm using parallel processing and systolic arrays. In particular, discrete samples of input and output data of a system with uncertain characteristics are used to determine the parameters of its model. The identification algorithm is based on recursive least squares, QR decomposition, and block-processing techniques with covariance resetting. Along similar lines as previous approaches, the identification process is based on the use of Givens rotations. This approach uses the Cordic algorithm for improved numerical efficiency in performing the rotations. Additionally, floating-point and fixed-point arithmetic implementations are compared.

  13. Hypertensive crisis.

    PubMed

    Rubenstein, E B; Escalante, C

    1989-07-01

    Hypertensive crisis is an acute emergency requiring aggressive management. Its incidence has decreased in recent years but still is prevalent in the medical community. From review of past and present treatment regimens, the following recommendations can be considered. (1) In the treatment of malignant hypertension with associated CHF, sodium nitroprusside is still an excellent agent. It has a rapid onset of action and blood pressure can be easily titrated. Nitroglycerin is also another agent that can be used in this situation. (2) In the treatment of malignant hypertension with associated aortic dissection, trimethophan camsylate is the preferred agent. An alternative choice is the combination of nitroprusside and labetalol. (3) In the treatment of malignant hypertension with associated myocardial ischemia, an excellent choice is nitroglycerin. Labetalol also should be considered in this situation. (4) In the treatment of hypertension during pregnancy, hydralazine is still a good choice. Labetalol has also been shown to be efficacious. (5) In the treatment of malignant hypertension with associated cerebral ischemia, the following drugs should be considered: nitroprusside, nitroglycerin, and labetalol. The most important attribute of these agents is that they are nonsedating and rapid in onset. (6) In the treatment of postoperative hypertension the choices best suited are labetalol, enalapril, nitroprusside, and nitroglycerin. These agents are rapid in onset and all can be administered intravenously. PMID:2670090

  14. [Neonatal intermittent hypoxia and hypertension].

    PubMed

    Sukhova, G K; Nozdrachev, A D; Gozal, D

    2009-01-01

    Obstructive apnea during sleep is accompanied by intermittent hypoxia (IH) leading to hypertension and other cardiovascular disturbances. A comparative evaluation of long-term effects of the neonatal IH on the cardiovascular function was performed in normotensive Sprague-Dawley and spontaneously hypertensive rats (SHR). The newborn rats were placed for 30 days to conditions of IH (8 and 21% O2, alternating every 90 s for 12 h/day). Control groups of rats were constantly kept in normoxia. By 6 months, in the spontaneously hypertensive rats submitted to IH at the period of wakefulness there was a statistically significant increase (as compared with control) of the systolic (correspondingly 185.8 +/- 1.7 and 169.9 +/- 1.4 mm Hg, p < 0.01) and diastolic pressure (correspondingly 96.2 +/- 4.9 and 86.0 +/- 2.6 mm Hg, p < 0.01). During sleep, the systolic and diastolic pressure in these rats was higher than in control animals by 10 mm Hg (p < 0.01) and 12 mm Hg (p < 0.01), its decrease during sleep being absent. SHR submitted to IH had an increase in low- to the high-frequency power ratio of the heart rate variability from 0.9 +/- 0.15 to 1.5 +/- 0.17, which indicates a shift of the sympatho-parasympathetic balance in this group towards predominance of the sympathetic component. In the Sprague-Dawley rats submitted to neonatal hypoxia, the above changes were not pronounced. These peculiarities of the hypertensive rats allow establishing connection of the genetic factor with the sympathetic mechanism providing long-term consequences of the neonatal IH for the cardiovascular control in these rats. PMID:19435263

  15. Evaluation of 'partnership care model' in the control of hypertension.

    PubMed

    Mohammadi, Eesa; Abedi, Heidar Ali; Jalali, Farzad; Gofranipour, Fazlolah; Kazemnejad, Anoshirvan

    2006-06-01

    One of the shared common goals of World Hypertension League (WHL) and World Health Organization (WHO) is the control of hypertension. Despite many local and international interventions, the goal has not been achieved. This study evaluated an intervention based on the partnership care model to control hypertension in a rural population in the north of Iran. The results showed that the intervention was effective in decreasing systolic and diastolic blood pressure and in increasing the rate of controlled hypertensives (based on criteria of WHO/WHL). The intervention also had positive effects on health-related quality of life, body mass index, anxiety, high density lipoprotein level and compliance score. Based on these results, the partnership care model is effective in hypertension control and is recommended as a model to replace previous approaches in hypertension control. PMID:16674782

  16. The Preoperative Patient With a Systolic Murmur

    PubMed Central

    Cowie, Brian

    2015-01-01

    Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients. PMID:26705529

  17. Hypertension screening

    NASA Technical Reports Server (NTRS)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  18. Pulmonary Hypertension

    MedlinePlus

    Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have ... and you can develop heart failure. Symptoms of PH include Shortness of breath during routine activity, such ...

  19. Initial emergency department systolic blood pressure predicts left ventricular systolic function in acute decompensated heart failure.

    PubMed

    Styron, Joseph F; Jois-Bilowich, Preeti; Starling, Randall; Hobbs, Robert E; Kontos, Michael C; Pang, Peter S; Peacock, W Frank

    2009-01-01

    Ejection fraction (EF) is often unknown in patients who present with acute decompensated heart failure (ADHF). The objective of this study was to determine whether a patient's systolic blood pressure is associated with their left ventricular EF. This study was a retrospective chart review of all patients admitted to an emergency department (ED) observation unit from January 2002 to December 2004. A low EF was defined as <40%. Among 475 patients, the median age was 72 years, 53% were men, 40% were white, 59% were black, and 59% had a low EF. Patients with low EFs were more likely male ( P<.0001), with prior congestive heart disease ( P<.0001), longer QRS duration ( P<.0001), left bundle branch block ( P<.0001), and higher B-type natriuretic peptide ( P<.0001). The low EF group was less likely to have diabetes ( P<.0001). Adjusted odds ratios for an EF >or=40% were significant at all systolic blood pressure readings >120 mm Hg. Having an ED systolic BP >120 mm Hg is associated with significantly higher rates of preserved left ventricular systolic function in patients with ADHF. PMID:19187401

  20. [Hypertensive retinopathy].

    PubMed

    Genevois, Olivier; Paques, Michel

    2010-01-20

    Acute hypertensive retinopathy should be distinguished from retinal arteriolosclerosis. The presence of microvascular abnormalities in the ocular fundus increases the risk of heart and/or brain attack. At the clinical level, the current classification of chronic hypertensive retinopathy is based on the long-term risk of stroke. In research, a great number of studies are focused on the predictive value of retinal vascular diameters related to the general micro- and macrovascular disease. PMID:20222306

  1. Effects of acute catecholamine depletion on cardiac function in normotensive and spontaneously hypertensive rats

    SciTech Connect

    Sellke, F.; Sadri, F.; Ely, D.

    1986-03-01

    Reserpine(6mg/Kg) was injected IP in Wistar (n = 5, age 10 wks.) and spontaneously hypertensive (SHR) rats (n = 5, age 16 wks.). After 4 hours the hearts were isolated (Langendorff), perfused with Krebs-Henseleit solution and paced at 240/min. Non-injected Wistar (N = 5) and SHR (n = 6) rats were used for controls. Myocardial levels of norepinephrine (NE) and epinephrine (E) were determined with radioenzymatic assay. Left ventricular systolic and distolic pressures were recorded for left ventricular end diastolic volumes (LVEDV) .05 to .40 ml. Despite a marked decrease in tissue levels of NE and E, peak systolic pressure (PSP) increased in reserpine treated normotensive and SHR rats. In isolated control SHR rat hearts (LVEDV = .20 ml), PSP was related to NE by PSP = .0145 (NE) + 93 (r = .819, p < .01). In conclusion, cardiac performance and tissue levels of myocardial catecholamines are correlated in control rats. However, rapid depletion of myocardial catecholamines may result in increased cardiac performance.

  2. Systemic hypertension.

    PubMed

    Elliott, William J

    2007-04-01

    Hypertension is a growing public health problem worldwide. Only 37% of American hypertensives currently have their blood pressures controlled. Hypertension is traditionally diagnosed in the medical office, but both home and ambulatory blood pressure monitoring can help. Lifestyle modifications are recommended for everyone who has higher than "normal" blood pressure (<120/80 mm Hg). Voluminous clinical trial data support beginning drug therapy with low-dose chlorthalidone, unless the patient has a specific indication for a different drug. Additional drugs (typically in the sequence, angiotensin converting-enzyme inhibitor or angiotensin receptor blocker, calcium antagonist, beta-blocker, alpha-blocker, aldosterone antagonist, direct vasodilator, and centrally acting alpha(2)-agonist) can be added to achieve the blood pressure goal (usually <140/90 mm Hg, but <130/80 mm Hg for diabetics and those with chronic kidney disease). Special circumstances exist for treatment of hypertension in pregnancy, in childhood, in the elderly, and in both extremes of blood pressure (pre-hypertension or hypertensive emergencies). PMID:17398315

  3. Pulmonary Hypertension

    PubMed Central

    Newman, John H.

    2005-01-01

    The modern era in cardiopulmonary medicine began in the 1940s, when Cournand and Richards pioneered right-heart catheterization. Until that time, no direct measurement of central vascular pressure had been performed in humans. Right-heart catheterization ignited an explosion of insights into function and dysfunction of the pulmonary circulation, cardiac performance, ventilation–perfusion relationships, lung–heart interactions, valvular function, and congenital heart disease. It marked the beginnings of angiocardiography with its diagnostic implications for diseases of the left heart and peripheral circulation. Pulmonary hypertension was discovered to be the consequence of a large variety of diseases that either raised pressure downstream of the pulmonary capillaries, induced vasoconstriction, increased blood flow to the lung, or obstructed the pulmonary vessels, either by embolism or in situ fibrosis. Hypoxic vasoconstriction was found to be a major cause of acute and chronic pulmonary hypertension, and surprising vasoreactivity of the pulmonary vascular bed was discovered to be present in many cases of severe pulmonary hypertension, initially in mitral stenosis. Diseases as disparate as scleroderma, cystic fibrosis, kyphoscoliosis, sleep apnea, and sickle cell disease were found to have shared consequences in the pulmonary circulation. Some of the achievements of Cournand and Richards and their scientific descendents are discussed in this article, including success in the diagnosis and treatment of idiopathic pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, and management of hypoxic pulmonary hypertension. PMID:15994464

  4. Exposure to fipronil elevates systolic blood pressure and disturbs related biomarkers in plasma of rats.

    PubMed

    Chaguri, Joao Leandro; Godinho, Antonio Francisco; Horta, Daniel França; Gonçalves-Rizzi, Victor Hugo; Possomato-Vieira, Jose Sergio; Nascimento, Regina Aparecida; Dias-Junior, Carlos Alan

    2016-03-01

    Recent reports show that fipronil affects non-target organisms, including environmental species populations and potentially humans. We aimed to examine if fipronil exposure affects the systolic blood pressure and related biomarkers. Thus, fipronil was orally administered to rats (30 mg/kg/day) during 15 days (Fipronil group) or physiological solution (Control group). While fipronil increased significantly the systolic blood pressure (158±13 mmHg), no significant changes were observed in Control group (127±3 mmHg). Significantly, higher levels of fipronil in plasma were observed in Fipronil group (0.46±0.09 μg/mL versus 0.17±0.11 μg/mL in Control group). Fipronil group showed lower weight gain compared with Control group. While fipronil resulted in higher concentrations of endothelin-1, reduced antioxidant capacity and lower levels of circulating matrix metalloproteinase 2 (MMP-2) and nitric oxide (NO) metabolites compared to Control group, no alteration was observed in serum biomarkers of renal and hepatic/biliary functional abilities. Therefore, this study suggests that fipronil causes hypertension and endothelin-1 plays a key role. Also, these findings suggest that reductions of both MMP-2 and NO may contribute with the elevation of systolic blood pressure observed with fipronil. PMID:26773360

  5. Baseline characteristics of African Americans in the Systolic Blood Pressure Intervention Trial.

    PubMed

    Still, Carolyn H; Craven, Timothy E; Freedman, Barry I; Van Buren, Peter N; Sink, Kaycee M; Killeen, Anthony A; Bates, Jeffrey T; Bee, Alberta; Contreras, Gabriel; Oparil, Suzanne; Pedley, Carolyn M; Wall, Barry M; White, Suzanne; Woods, Delia M; Rodriguez, Carlos J; Wright, Jackson T

    2015-09-01

    The Systolic Blood Pressure Intervention Trial (SPRINT) will compare treatment to a systolic blood pressure goal of <120 mm Hg to treatment to the currently recommended goal of <140 mm Hg for effects on incident cardiovascular, renal, and neurologic outcomes including cognitive decline. The objectives of this analysis are to compare baseline characteristics of African American (AA) and non-AA SPRINT participants and explore factors associated with uncontrolled blood pressure (BP) by race. SPRINT enrolled 9361 hypertensive participants aged older than 50 years. This cross-sectional analysis examines sociodemographics, baseline characteristics, and study measures among AAs compared with non-AAs. AAs made up 31% of participants. AAs (compared with non-AAs) were younger and less frequently male, had less education, and were more likely uninsured or covered by Medicaid. In addition, AAs scored lower on the cognitive screening test when compared with non-AAs. Multivariate logistic regression analysis found BP control rates to <140/90 mm Hg were higher for AAs who were male, had higher number of chronic diseases, were on diuretic treatment, and had better medication adherence. SPRINT is well poised to examine the effects of systolic blood pressure targets on clinical outcomes as well as predictors influencing BP control in AAs. PMID:26320890

  6. Prevalence, awareness and risk factors of hypertension in southwest of Iran

    PubMed Central

    Yazdanpanah, Leila; Shahbazian, Hajieh; Shahbazian, Heshmatollah; Latifi, Seyed-Mahmuod

    2015-01-01

    Introduction: Hypertension is an important cause of stroke, heart and kidney disease and these diseases are the cause for about two-thirds of all mortalities around the world. Objectives: The aim of this study was to assess the prevalence, awareness and risk factors of hypertension in Ahvaz, southwest of Iran. Patients and Methods: In this descriptive-analytical study, 944 participants older than 20 years were enrolled. Systolic blood pressure (BP) ≥140 mm Hg, diastolic BP ≥90 mm Hg or the use of antihypertensive medication was considered as hypertension. Systolic BP = 140-159 mm Hg or diastolic BP = 90-99 mm Hg were defined as stage 1, and systolic BP ≥160 mm Hg or diastolic BP ≥100 mm Hg were considered as stage 2 of hypertension. Systolic BP = 120-139 mm Hg and diastolic BP= 80-89 mm Hg were considered as prehypertensive state. Results: The prevalence of hypertension in Ahvaz was 17.58% (95% CI: 15.28-20.14) (males; 45.8%, females; 54.2%). Age-adjusted prevalence of hypertension was 8.6%; age- and sex-adjusted prevalence of hypertension was 3.7%. Seventy-two cases (7.7%) were prehypertensive. The frequency of stage 1 hypertension was 10.8% and stage 2 was 5.7%. Among them, 53.6% were not aware of their disease and 22% of hypertensive cases were controlled. Logistic regression analysis showed that age, metabolic syndrome and family history of hypertension had significant relationship with hypertension. Conclusion: This study showed that, age, metabolic syndrome and family history of disease are risk factors of hypertension in Ahvaz population. About half of patients were unaware of their disease and about 20% had controlled BP. PMID:26060838

  7. Why is control of hypertension in sub-Saharan Africa poor?

    PubMed Central

    Seedat, YK

    2015-01-01

    In sub-Saharan Africa (SSA) in 2010, hypertension (defined as systolic blood pressure ≥ 115 mmHg) was the leading cause of death, increasing 67% since 1990. It was also the sixth leading cause of disability, contributing more than 11 million adjusted life years. In SSA, stroke was the main outcome of uncontrolled hypertension. Poverty is the major underlying factor for hypertension and cardiovascular disease. This article analyses the causes of poor compliance in the treatment of hypertension in SSA and provides suggestions on the treatment of hypertension in a poverty-stricken continent. PMID:26407222

  8. Protective Effect of Salicornia europaea Extracts on High Salt Intake-Induced Vascular Dysfunction and Hypertension.

    PubMed

    Panth, Nisha; Park, Sin-Hee; Kim, Hyun Jung; Kim, Deuk-Hoi; Oak, Min-Ho

    2016-01-01

    High salt intake causes and aggravates arterial hypertension and vascular dysfunction. We investigated the effect of Salicornia europaea extracts (SE) on vascular function and blood pressure. SE constituents were analyzed using high performance liquid chromatography, and SE's effect on vascular function was evaluated in isolated porcine coronary arteries. SE's vascular protective effect was also evaluated in vivo using normotensive and spontaneous hypertensive rats (SHRs). SE mainly contained sodium chloride (55.6%), 5-(hydroxymethyl)furfural, p-coumaric acid, and trans-ferulic acid. High sodium (160 mmol/L) induced vascular dysfunction; however, SE containing the same quantity of sodium did not cause vascular dysfunction. Among the compounds in SE, trans-ferulic acid accounts for the vascular protective effect. Normotensive rats fed a high-salt diet showed significantly increased systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), which decreased significantly in the SE-treated groups. In SHRs, high edible salt intake significantly increased SBP, DBP, and MAP, but SE intake was associated with a significantly lower MAP. Thus, SE did not induce vascular dysfunction, and trans-ferulic acid might be at least partly responsible for the vasoprotective effect of SE. Taken together, SE could be used as an alternative to purified salt to prevent and ameliorate hypertension. PMID:27455235

  9. Protective Effect of Salicornia europaea Extracts on High Salt Intake-Induced Vascular Dysfunction and Hypertension

    PubMed Central

    Panth, Nisha; Park, Sin-Hee; Kim, Hyun Jung; Kim, Deuk-Hoi; Oak, Min-Ho

    2016-01-01

    High salt intake causes and aggravates arterial hypertension and vascular dysfunction. We investigated the effect of Salicornia europaea extracts (SE) on vascular function and blood pressure. SE constituents were analyzed using high performance liquid chromatography, and SE’s effect on vascular function was evaluated in isolated porcine coronary arteries. SE’s vascular protective effect was also evaluated in vivo using normotensive and spontaneous hypertensive rats (SHRs). SE mainly contained sodium chloride (55.6%), 5-(hydroxymethyl)furfural, p-coumaric acid, and trans-ferulic acid. High sodium (160 mmol/L) induced vascular dysfunction; however, SE containing the same quantity of sodium did not cause vascular dysfunction. Among the compounds in SE, trans-ferulic acid accounts for the vascular protective effect. Normotensive rats fed a high-salt diet showed significantly increased systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), which decreased significantly in the SE-treated groups. In SHRs, high edible salt intake significantly increased SBP, DBP, and MAP, but SE intake was associated with a significantly lower MAP. Thus, SE did not induce vascular dysfunction, and trans-ferulic acid might be at least partly responsible for the vasoprotective effect of SE. Taken together, SE could be used as an alternative to purified salt to prevent and ameliorate hypertension. PMID:27455235

  10. Preferable effects of olmesartan/calcium channel blocker to olmesartan/diuretic on blood pressure variability in very elderly hypertension: COLM study subanalysis

    PubMed Central

    Rakugi, Hiromi; Ogihara, Toshio; Saruta, Takao; Kawai, Tatsuo; Saito, Ikuo; Teramukai, Satoshi; Shimada, Kazuyuki; Katayama, Shigehiro; Higaki, Jitsuo; Odawara, Masato; Tanahashi, Norio; Kimura, Genjiroh

    2015-01-01

    Objective: The aims of this subanalysis of the COLM trial [NCT00454662] were to compare visit-to-visit variability (VVV) of blood pressure (BP) between age groups and between two treatment combinations, that is, the angiotensin II receptor blocker, olmesartan combined with a calcium channel blocker (CCB), or a diuretic and to investigate the effect of VVV of BP on cardiovascular events in elderly hypertensive patients. Methods: Hypertensive patients ages 65–84 years with a history of and/or risk factors for cardiovascular disease were randomized to receive treatment with olmesartan along with either a CCB or a diuretic for at least 3 years. This subanalysis comprised 4876 patients who had their office BP measured at least three occasions (median nine occasions) during the follow-up period. VVV of BP was defined by several metrics including the within-individual standard deviation of every visit during the follow-up period. Results: VVV of SBP was larger in the very elderly group (75–84 years) than in the elderly group (65–74 years). VVV of SBP was smaller in the olmesartan along with CCB group than in the olmesartan along with diuretic group, especially in very elderly patients and also isolated systolic hypertensive patients. The incidence rate of primary endpoint increased along with an increment in the SD of SBP in all of the age and treatment groups. Conclusion: VVV of SBP may mediate the preferable effect of combination of angiotensin II receptor blocker along with CCB on cardiovascular events in the very elderly and also isolated systolic hypertensive patients. PMID:26066644

  11. Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study.

    PubMed

    Abdalla, Marwah; Booth, John N; Seals, Samantha R; Spruill, Tanya M; Viera, Anthony J; Diaz, Keith M; Sims, Mario; Muntner, Paul; Shimbo, Daichi

    2016-07-01

    Masked hypertension, defined as nonelevated clinic blood pressure (BP) and elevated out-of-clinic BP may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic BP and masked hypertension using ambulatory BP monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of blacks. Analyses included 317 participants with clinic BP <140/90 mm Hg, complete ambulatory BP monitoring, who were not taking antihypertensive medication at baseline in 2000 to 2004. Masked daytime hypertension was defined as mean daytime blood pressure ≥135/85 mm Hg, masked night-time hypertension as mean night-time BP ≥120/70 mm Hg, and masked 24-hour hypertension as mean 24-hour BP ≥130/80 mm Hg. Incident clinic hypertension, assessed at study visits in 2005 to 2008 and 2009 to 2012, was defined as the first visit with clinic systolic/diastolic BP ≥140/90 mm Hg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked night-time hypertension, and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% confidence interval) of incident clinic hypertension for any masked hypertension and masked daytime, night-time, and 24-hour hypertension were 2.13 (1.51-3.02), 1.79 (1.24-2.60), 2.22 (1.58-3.12), and 1.91 (1.32-2.75), respectively. These findings suggest that ambulatory BP monitoring can identify blacks at increased risk for developing clinic hypertension. PMID:27185746

  12. Hypertensive emergencies.

    PubMed

    Murphy, C

    1995-11-01

    Hypertensive emergencies are uncommon and physiologically diverse. Consequently, it is difficult for most physicians to develop a familiarity with all the different hypertensive crises and with all drugs available for treating them (Table 4). Clinicians should not agonize over which is the perfect therapeutic agent for a particular emergency, but instead, they should focus on scrupulous monitoring and familiarize themselves with a few agents that will serve in most situations. Generally, these agents will be sodium nitroprusside and nitroglycerin. Vigilant neurologic monitoring is mandatory in all hypertensive emergencies. The early symptoms and signs of cerebral hypoperfusion can be vague and subtle, but if recognized, serious complications of therapy can be avoided. Remember, the patient may still be hypertensive. Avoid acute (during the first hour) reductions in MAP of more than 20% whenever possible; subsequent reductions should be gradual. In patients known to have markedly elevated ICP and who need acute reductions in their BP, serious consideration should be given to direct monitoring of the ICP so that CPP can be maintained within safe limits. In general, oral agents should not be used for the treatment of hypertensive emergencies. Intravenous Labetalol and intravenous nicardipine are not suitable for general use in hypertensive emergencies. In special situations (e.g., perioperative hypertension and subarachnoid hemorrhage), however, they may be employed. Their role may expand with further study. Trimethaphan may be superior to nitroprusside for hypertension complicated by elevated ICP or cerebral dysfunction. Realistically, most physicians will continue to use nitroprusside. Intense neurologic monitoring is more important than the specific agent used. Nitroglycerin is the agent of choice for acute ischemic heart disease complicated by severe hypertension; if it fails, use nitroprusside. For aortic dissection, the combination of nitroprusside and IV

  13. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension.

    PubMed

    Leung, Alexander A; Nerenberg, Kara; Daskalopoulou, Stella S; McBrien, Kerry; Zarnke, Kelly B; Dasgupta, Kaberi; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain; Bolli, Peter; Tremblay, Guy; McLean, Donna; Tobe, Sheldon W; Ruzicka, Marcel; Burns, Kevin D; Vallée, Michel; Prasad, G V Ramesh; Lebel, Marcel; Feldman, Ross D; Selby, Peter; Pipe, Andrew; Schiffrin, Ernesto L; McFarlane, Philip A; Oh, Paul; Hegele, Robert A; Khara, Milan; Wilson, Thomas W; Penner, S Brian; Burgess, Ellen; Herman, Robert J; Bacon, Simon L; Rabkin, Simon W; Gilbert, Richard E; Campbell, Tavis S; Grover, Steven; Honos, George; Lindsay, Patrice; Hill, Michael D; Coutts, Shelagh B; Gubitz, Gord; Campbell, Norman R C; Moe, Gordon W; Howlett, Jonathan G; Boulanger, Jean-Martin; Prebtani, Ally; Larochelle, Pierre; Leiter, Lawrence A; Jones, Charlotte; Ogilvie, Richard I; Woo, Vincent; Kaczorowski, Janusz; Trudeau, Luc; Petrella, Robert J; Hiremath, Swapnil; Drouin, Denis; Lavoie, Kim L; Hamet, Pavel; Fodor, George; Grégoire, Jean C; Lewanczuk, Richard; Dresser, George K; Sharma, Mukul; Reid, Debra; Lear, Scott A; Moullec, Gregory; Gupta, Milan; Magee, Laura A; Logan, Alexander G; Harris, Kevin C; Dionne, Janis; Fournier, Anne; Benoit, Geneviève; Feber, Janusz; Poirier, Luc; Padwal, Raj S; Rabi, Doreen M

    2016-05-01

    Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a β-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates. PMID:27118291

  14. Optical systolic solutions of linear algebraic equations

    NASA Technical Reports Server (NTRS)

    Neuman, C. P.; Casasent, D.

    1984-01-01

    The philosophy and data encoding possible in systolic array optical processor (SAOP) were reviewed. The multitude of linear algebraic operations achievable on this architecture is examined. These operations include such linear algebraic algorithms as: matrix-decomposition, direct and indirect solutions, implicit and explicit methods for partial differential equations, eigenvalue and eigenvector calculations, and singular value decomposition. This architecture can be utilized to realize general techniques for solving matrix linear and nonlinear algebraic equations, least mean square error solutions, FIR filters, and nested-loop algorithms for control engineering applications. The data flow and pipelining of operations, design of parallel algorithms and flexible architectures, application of these architectures to computationally intensive physical problems, error source modeling of optical processors, and matching of the computational needs of practical engineering problems to the capabilities of optical processors are emphasized.

  15. Management of Patients With Recovered Systolic Function.

    PubMed

    Basuray, Anupam; Fang, James C

    2016-01-01

    Advancements in the treatment of heart failure (HF) with systolic dysfunction have given rise to a new population of patients with improved ejection fraction (EF). The management of this distinct population is not well described due to a lack of consensus on the definition of myocardial recovery, a scarcity of data on the natural history of these patients, and the absence of focused clinical trials. Moreover, an improvement in EF may have different prognostic and management implications depending on the underlying etiology of cardiomyopathy. This can be challenging for the clinician who is approached by a patient inquiring about a reduction of medical therapy after apparent EF recovery. This review explores management strategies for HF patients with recovered EF in a disease-specific format. PMID:26796969

  16. Singular value decomposition with systolic arrays

    NASA Technical Reports Server (NTRS)

    Ipsen, I. C. F.

    1984-01-01

    Systolic arrays for determining the singular value decomposition of a mxn, m n, matrix A of bandwidth w are presented. After A has been reduced to bidiagonal form B by means of Givens plane rotations, the singular values of B are computed by the Golub-Reinsch iteration. The products of plane rotations form the matrices of left and right singular vectors. Assuming each processor can compute or supply a plane rotation, O(wn) processors accomplish the reduction to bidiagonal form in O(np) steps, where p is the number of superdiagonals. A constant number of processors then determines each singular value in about 6n steps. The singular vectors are computed by rerouting the rotations through the arrays used for the reduction to bidiagonal form, or else along the way by employing another rectangular array of O(wm) processors.

  17. Abnormal Vascular Function and Hypertension in Mice Deficient in Estrogen Receptor β

    NASA Astrophysics Data System (ADS)

    Zhu, Yan; Bian, Zhao; Lu, Ping; Karas, Richard H.; Bao, Lin; Cox, Daniel; Hodgin, Jeffrey; Shaul, Philip W.; Thorén, Peter; Smithies, Oliver; Gustafsson, Jan-Åke; Mendelsohn, Michael E.

    2002-01-01

    Blood vessels express estrogen receptors, but their role in cardiovascular physiology is not well understood. We show that vascular smooth muscle cells and blood vessels from estrogen receptor β (ERβ)-deficient mice exhibit multiple functional abnormalities. In wild-type mouse blood vessels, estrogen attenuates vasoconstriction by an ERβ-mediated increase in inducible nitric oxide synthase expression. In contrast, estrogen augments vasoconstriction in blood vessels from ERβ-deficient mice. Vascular smooth muscle cells isolated from ERβ-deficient mice show multiple abnormalities of ion channel function. Furthermore, ERβ-deficient mice develop sustained systolic and diastolic hypertension as they age. These data support an essential role for ERβ in the regulation of vascular function and blood pressure.

  18. Resistance Training in Spontaneously Hypertensive Rats with Severe Hypertension

    PubMed Central

    Neves, Rodrigo Vanerson Passos; Souza, Michel Kendy; Passos, Clévia Santos; Bacurau, Reury Frank Pereira; Simoes, Herbert Gustavo; Prestes, Jonato; Boim, Mirian Aparecida; Câmara, Niels Olsen Saraiva; Franco, Maria do Carmo Pinho; Moraes, Milton Rocha

    2016-01-01

    Background Resistance training (RT) has been recommended as a non-pharmacological treatment for moderate hypertension. In spite of the important role of exercise intensity on training prescription, there is still no data regarding the effects of RT intensity on severe hypertension (SH). Objective This study examined the effects of two RT protocols (vertical ladder climbing), performed at different overloads of maximal weight carried (MWC), on blood pressure (BP) and muscle strength of spontaneously hypertensive rats (SHR) with SH. Methods Fifteen male SHR [206 ± 10 mmHg of systolic BP (SBP)] and five Wistar Kyoto rats (WKY; 119 ± 10 mmHg of SBP) were divided into 4 groups: sedentary (SED-WKY) and SHR (SED-SHR); RT1-SHR training relative to body weight (~40% of MWC); and RT2-SHR training relative to MWC test (~70% of MWC). Systolic BP and heart rate (HR) were measured weekly using the tail-cuff method. The progression of muscle strength was determined once every fifteen days. The RT consisted of 3 weekly sessions on non-consecutive days for 12-weeks. Results Both RT protocols prevented the increase in SBP (delta - 5 and -7 mmHg, respectively; p > 0.05), whereas SBP of the SED-SHR group increased by 19 mmHg (p < 0.05). There was a decrease in HR only for the RT1 group (p < 0.05). There was a higher increase in strength in the RT2 (140%; p < 0.05) group as compared with RT1 (11%; p > 0.05). Conclusions Our data indicated that both RT protocols were effective in preventing chronic elevation of SBP in SH. Additionally, a higher RT overload induced a greater increase in muscle strength. PMID:26840054

  19. Types of Pulmonary Hypertension

    MedlinePlus

    ... from the NHLBI on Twitter. Types of Pulmonary Hypertension The World Health Organization divides pulmonary hypertension (PH) ... are called pulmonary hypertension.) Group 1 Pulmonary Arterial Hypertension Group 1 PAH includes: PAH that has no ...

  20. Hyperthyroidism and pulmonary hypertension.

    PubMed

    Marvisi, M; Brianti, M; Marani, G; Del Borello, R; Bortesi, M L; Guariglia, A

    2002-04-01

    In recent years, many authors have described several cases revealing an association between hyperthyroidism and pulmonary hypertension (PH). This observational study was designed to evaluate the incidence of PH in hyperthyroidism and was set in a department of internal medicine and pulmonary diseases with an out-patients department of endocrinology. Thirty-four patients, 25 women and nine men, with a mean age of 38 +/- 15 SD years participated. Twenty had Graves' disease and 14 had a nodular goitre. The patients were divided into two equally matched groups: those with a recently diagnosed hyperthyroidism, taking no drugs (group 1; n = 17) and those in a euthyroid state taking methimazole (group 2; n= 17). Transthoracic Doppler echocardiography was performed and systolic pulmonary artery pressurements of (PAPs) was determined by the tricuspid regurgitation method using the Bernoulli equation. Measurements of triiodothyronine, tetraiodothyronine, free thyroxine (Ft4), thyroid-stimulating hormone (TSH) and antithyroglobulin and antimicrosomal antibodies were also taken. We found a mild PH in seven patients of group 1 and in none of group 2. The mean +/- SD systolic pulmonaryartery pressurewas 28.88 +/- 6.41 in group 1 and 22.53 +/- 1.84 ingroup 2 (P<0.0001). A correlation was found between the TSH value and PAPs (r = -082;P < 0.001) and Ft4 and PAPs (r = 0 85; P < 0.001) in group 1. These findings indicate the presence of a frequent association between PH and hyperthyroidism. We suggest that hyperthyroidism be included in the differential diagnosis of PH. PMID:11999999

  1. Effects of Parental Smoking on Exercise Systolic Blood Pressure in Adolescents

    PubMed Central

    Hacke, Claudia; Weisser, Burkhard

    2015-01-01

    Background In adults, exercise blood pressure seems to be more closely related to cardiovascular risk than resting blood pressure; however, few data are available on the effects of familial risk factors, including smoking habits, on exercise blood pressure in adolescents. Methods and Results Blood pressure at rest and during exercise, parental smoking, and other familial risk factors were investigated in 532 adolescents aged 12 to 17 years (14.6±1.5 years) in the Kiel EX.PRESS. (EXercise PRESSure) Study. Exercise blood pressure was determined at 1.5 W/kg body weight using a standardized submaximal cycle ergometer test. Mean resting blood pressure was 113.1±12.8/57.2±7.1 mm Hg, and exercise blood pressure was 149.9±19.8/54.2±8.6 mm Hg. Parental smoking increased exercise systolic blood pressure (+4.0 mm Hg, 3.1 to 4.9; P=0.03) but not resting blood pressure of the subjects (adjusted for age, sex, height, body mass index percentile, fitness). Parental overweight and familial hypertension were related to both higher resting and exercise systolic blood pressure values, whereas associations with an inactive lifestyle and a low educational level of the parents were found only with adolescents’ blood pressure during exercise. The cumulative effect of familial risk factors on exercise systolic blood pressure was more pronounced than on blood pressure at rest. Conclusions Parental smoking might be a novel risk factor for higher blood pressure, especially during exercise. In addition, systolic blood pressure during a submaximal exercise test was more closely associated with familial risk factors than was resting blood pressure, even in adolescents. PMID:25964207

  2. [Portopulmonary hypertension].

    PubMed

    Halank, M; Miehlke, S; Kolditz, M; Hoeffken, G

    2005-07-01

    Patients with portal hypertension may develop pulmonary complications such as hepatopulmonary syndrome (HPS) or portopulmonary hypertension (PPHT). PPHT is defined as elevated pulmonary pressure, elevated pulmonary vascular resistance, a normal pulmonary capillary wedge pressure, and portal hypertension in the absence of other known causes pulmonary hypertension. Various factors such as hyperdynamic circulation, volume overload, and circulating vasoactive mediators are suspected to be involved in the pathogenesis of PPHT. The prognosis of patients with severe PPHT is significantly reduced due to the risk of right heart failure. In patients with moderate to severe PPHT liver transplantation is associated with a significantly increased mortality. The chief symptom of PPHT may be dyspnoe in the presence of typical histomorphological alterations comparable with idiopathic pulmonary hypertension. Continuous intravenous application of prostacyclin is currently regarded as the treatment of choice for patients with severe PPHT. Inhaled prostacyclin or its analogue iloprost or oral treatment with the endothelin-receptor antagonist bosentan may be promising alternatives which should be further investigated in randomized controlled trials. PMID:16001350

  3. Diagnosing hypertension

    PubMed Central

    Gelfer, Mark; Dawes, Martin; Kaczorowski, Janusz; Padwal, Raj; Cloutier, Lyne

    2015-01-01

    Abstract Objective To highlight the 2015 Canadian Hypertension Education Program (CHEP) recommendations for the diagnosis and assessment of hypertension. Quality of evidence A systematic search was performed current to August 2014 by a Cochrane Collaboration librarian using the MEDLINE and PubMed databases. The search results were critically appraised by the CHEP subcommittee on blood pressure (BP) measurement and diagnosis, and evidence-based recommendations were presented to the CHEP Central Review Committee for independent review and grading. Finally, the findings and recommendations were presented to the Recommendations Task Force for discussion, debate, approval, and voting. The main recommendations are based on level II evidence. Main message Based on the most recent evidence, CHEP has made 4 recommendations in 2 broad categories for 2015 to improve BP measurement and the way hypertension is diagnosed. A strong recommendation is made to use electronic BP measurement in the office setting to replace auscultatory BP measurement. For patients with elevated office readings, CHEP is recommending early use of out-of-office BP measurement, preferably ambulatory BP measurement, in order to identify early in the process those patients with white-coat hypertension. Conclusion Improvements in diagnostic accuracy are critical to optimizing hypertension management in Canada. The annual updates provided by CHEP ensure that practitioners have up-to-date evidence-based information to inform practice. PMID:26564654

  4. Recursive least squares estimation and Kalman filtering by systolic arrays

    NASA Technical Reports Server (NTRS)

    Chen, M. J.; Yao, K.

    1988-01-01

    One of the most promising new directions for high-throughput-rate problems is that based on systolic arrays. In this paper, using the matrix-decomposition approach, a systolic Kalman filter is formulated as a modified square-root information filter consisting of a whitening filter followed by a simple least-squares operation based on the systolic QR algorithm. By proper skewing of the input data, a fully pipelined time and measurement update systolic Kalman filter can be achieved with O(n squared) processing cells, resulting in a system throughput rate of O (n).

  5. Risk factors for hypertensive attack during pheochromocytoma resection

    PubMed Central

    Kwon, Se Yun; Lee, Kyung Seop; Lee, Jun Nyung; Ha, Yun-Sok; Choi, Seock Hwan; Kim, Hyun Tae; Kim, Tae-Hwan; Yoo, Eun Sang

    2016-01-01

    Purpose We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge. Materials and Methods Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed. Results In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 µg/d. Conclusions In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma. PMID:27194549

  6. [Relationship of renal cell carcinoma and hypertension].

    PubMed

    Masanauskiene, Edita; Naudziūnas, Albinas; Jankauskiene, Laima; Unikauskas, Alvydas

    2009-01-01

    The morbidity and mortality due to renal cell carcinoma has increased worldwide over the last 30 years. Renal cell carcinoma accounts for about 90-95% of all renal tumors. The mean age of patients with this type of tumor ranges between 50 and 70 years. It is important to note that primary arterial hypertension as well as obesity and smoking are considered as independent risk factors for renal cell carcinoma. The increase in both systolic and diastolic blood pressure as well as the severity of arterial hypertension may have an impact on development of renal cell carcinoma. We describe the case of a 45-year-old male patient with hypertensive crisis. Computed tomography scan revealed renal cell carcinoma, which was confirmed histologically after surgical treatment. PMID:20173406

  7. Complete reversal of hypertensive cardiomyopathy after initiating combined antihypertensive therapy.

    PubMed

    Holl, Marijn J; van de Poll, Sweder W; Michels, Michelle

    2016-01-01

    Hypertensive cardiomyopathy is a common complication of hypertension, with a prevalence ranging from 12% to 26%. It is associated with an increased cardiac mortality and morbidity. Lifestyle changes and antihypertensive therapy usually have a significant, but relatively small effect on left ventricular hypertrophy (LVH), which is associated with a reduction in cardiovascular risk. In this paper, we describe a 39-year-old woman with severe LVH. On transthoracic echocardiogram there was concentric LVH, systolic function was a mildly reduced and there was diastolic dysfunction grade III. After only 6 months of therapy with a combination of antihypertensive agents, the left ventricular mass index was reduced by 29%, systolic function was normal and the diastolic dysfunction improved to grade I. This paper shows that in hypertensive cardiomyopathy, even severe LVH can be completely reversible. PMID:27060071

  8. Pulmonary arterial hypertension

    PubMed Central

    2013-01-01

    Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ≥ 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ≤ 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role

  9. Pulmonary arterial hypertension.

    PubMed

    Montani, David; Günther, Sven; Dorfmüller, Peter; Perros, Frédéric; Girerd, Barbara; Garcia, Gilles; Jaïs, Xavier; Savale, Laurent; Artaud-Macari, Elise; Price, Laura C; Humbert, Marc; Simonneau, Gérald; Sitbon, Olivier

    2013-01-01

    Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should systematically been screened regarding to underlying mutations of BMPR2 gene (bone morphogenetic protein receptor type 2) or more rarely of ACVRL1 (activine receptor-like kinase type 1), ENG (endogline) or Smad8 genes. Pulmonary veno occusive disease and pulmonary capillary hemagiomatosis are individualized and designated as clinical group 1'. Group 2 'Pulmonary hypertension due to left heart diseases' is divided into three sub-groups: systolic dysfonction, diastolic dysfonction and valvular dysfonction. Group 3 'Pulmonary hypertension due to respiratory diseases' includes a heterogenous subgroup of respiratory diseases like PH due to pulmonary fibrosis, COPD, lung emphysema or interstitial lung disease for exemple. Group 4 includes chronic thromboembolic pulmonary hypertension without any distinction of proximal or distal forms. Group 5 regroup PH patients with unclear multifactorial mechanisms. Invasive hemodynamic assessment with right heart catheterization is requested to confirm the definite diagnosis of PH showing a resting mean pulmonary artery pressure (mPAP) of ≥ 25 mmHg and a normal pulmonary capillary wedge pressure (PCWP) of ≤ 15 mmHg. The assessment of PCWP may allow the distinction between pre-capillary and post-capillary PH (PCWP > 15 mmHg). Echocardiography is an important tool in the management of patients with underlying suspicion of PH. The European Society of Cardiology and the European Respiratory Society (ESC-ERS) guidelines specify its role

  10. Audit-based education lowers systolic blood pressure in chronic kidney disease: the Quality Improvement in CKD (QICKD) trial results

    PubMed Central

    de Lusignana, Simon; Gallagher, Hugh; Jones, Simon; Chan, Tom; van Vlymen, Jeremy; Tahir, Aumran; Thomas, Nicola; Jain, Neerja; Dmitrieva, Olga; Rafi, Imran; McGovern, Andrew; Harris, Kevin

    2013-01-01

    Strict control of systolic blood pressure is known to slow progression of chronic kidney disease (CKD). Here we compared audit-based education (ABE) to guidelines and prompts or usual practice in lowering systolic blood pressure in people with CKD. This 2-year cluster randomized trial included 93 volunteer general practices randomized into three arms with 30 ABE practices, 32 with guidelines and prompts, and 31 usual practices. An intervention effect on the primary outcome, systolic blood pressure, was calculated using a multilevel model to predict changes after the intervention. The prevalence of CKD was 7.29% (41,183 of 565,016 patients) with all cardiovascular comorbidities more common in those with CKD. Our models showed that the systolic blood pressure was significantly lowered by 2.41 mm Hg (CI 0.59–4.29 mm Hg), in the ABE practices with an odds ratio of achieving at least a 5 mm Hg reduction in systolic blood pressure of 1.24 (CI 1.05–1.45). Practices exposed to guidelines and prompts produced no significant change compared to usual practice. Male gender, ABE, ischemic heart disease, and congestive heart failure were independently associated with a greater lowering of systolic blood pressure but the converse applied to hypertension and age over 75 years. There were no reports of harm. Thus, individuals receiving ABE are more likely to achieve a lower blood pressure than those receiving only usual practice. The findings should be interpreted with caution due to the wide confidence intervals. PMID:23536132

  11. Design of easily testable and reconfigurable systolic arrays

    SciTech Connect

    Kim, J.H.

    1987-01-01

    Systolic arrays are considered to be preferred architectures for executing linear algebraic operations. In this thesis, easily testable and reconfigurable (ETAR) systolic arrays are studied to achieve the yield enhancement. New 2-D systolic arrays that lend themselves to easy reconfiguration as well as efficient implementations of algorithms are proposed. The 2-D bidirectional and unidirectional systolic arrays proposed are often better architectures than the rectangular and hexagonal systolic arrays proposed earlier, if one considers area, time and reconfigurability. Methods to design linear and 2-D ETAR systolic arrays are proposed. Procedures to design linear and 2-D unidirectional and bidirectional systolic arrays are given. The main feature of the proposed designs is that the COMUs of the PEs in the linear array can all be tested simultaneously. Another feature is that the throughputs of the reconfigured linear unidirectional as well as bidirectional arrays can remain to be equal to those of the fault-free linear arrays. A reconfiguration algorithm for 2-D systolic arrays is also proposed.

  12. Systoles on Heisenberg groups with Carnot-Caratheodory metrics

    SciTech Connect

    Dontsov, V V

    2001-04-30

    The systolic properties of the nilmanifolds N{sup 2n+1} associated with the higher Heisenberg groups H{sub 2n+1} are studied. Effective estimates of the systolic constants {sigma}(N{sup 2n+1}) in the Carnot-Caratheodory geometry, as functions of the parameters defining a uniform lattice on H{sub 2n+1}, are obtained.

  13. Pulmonary Hypertension

    MedlinePlus

    ... Anticoagulants (blood-thinning medicine) Calcium channel blockers Diuretics (water pills) Digoxin Your doctor will decide what type of medicine is right for you. In some cases, people who have pulmonary hypertension need surgical treatment. Surgical treatment options include a lung transplant and ...

  14. Pulmonary Hypertension

    MedlinePlus

    Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have it, the blood ... heart has to work harder to pump the blood through. Over time, your heart weakens and ... of PH include Shortness of breath during routine activity, such ...

  15. Portopulmonary hypertension.

    PubMed

    Lv, Yong; Han, Guohong; Fan, Daiming

    2016-07-01

    Portopulmonary hypertension (PoPH) refers to the condition that pulmonary arterial hypertension (PAH) occur in the stetting of portal hypertension. The development of PoPH is thought to be independent of the severity of portal hypertension or the etiology or severity of liver disease. PoPH results from excessive vasoconstriction, vascular remodeling, and proliferative and thrombotic events within the pulmonary circulation that lead to progressive right ventricular failure and ultimately to death. Untreated PoPH is associated with a poor prognosis. As PoPH is frequently asymptomatic or symptoms are generally non-specific, patients should be actively screened for the presence of PoPH. Two-dimensional transthoracic echocardiography is a useful non-invasive screening tool, but a definitive diagnosis requires invasive hemodynamic confirmation by right heart catheterization. Despite a dearth of randomized, prospective data, an ever-expanding clinical experience shows that patients with PoPH benefit from therapy with PAH-specific medications including with endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and/or prostanoids. Due to high perioperative mortality, transplantation should be avoided in those patients who have severe PoPH that is refractory to medical therapy. PMID:27002212

  16. Pathophysiology and treatment of pulmonary hypertension in sickle cell disease.

    PubMed

    Gordeuk, Victor R; Castro, Oswaldo L; Machado, Roberto F

    2016-02-18

    Pulmonary hypertension affects ∼10% of adult patients with sickle cell disease (SCD), particularly those with the homozygous genotype. An increase in pulmonary artery systolic pressure, estimated noninvasively by echocardiography, helps identify SCD patients at risk for pulmonary hypertension, but definitive diagnosis requires right-heart catheterization. About half of SCD-related pulmonary hypertension patients have precapillary pulmonary hypertension with potential etiologies of (1) a nitric oxide deficiency state and vasculopathy consequent to intravascular hemolysis, (2) chronic pulmonary thromboembolism, or (3) upregulated hypoxic responses secondary to anemia, low O2 saturation, and microvascular obstruction. The remainder have postcapillary pulmonary hypertension secondary to left ventricular dysfunction. Although the pulmonary artery pressure in SCD patients with pulmonary hypertension is only moderately elevated, they have a markedly higher risk of death than patients without pulmonary hypertension. Guidelines for diagnosis and management of SCD-related pulmonary hypertension were published recently by the American Thoracic Society. Management of adults with sickle-related pulmonary hypertension is based on anticoagulation for those with thromboembolism; oxygen therapy for those with low oxygen saturation; treatment of left ventricular failure in those with postcapillary pulmonary hypertension; and hydroxyurea or transfusions to raise the hemoglobin concentration, reduce hemolysis, and prevent vaso-occlusive events that cause additional increases in pulmonary pressure. Randomized trials have not identified drugs to lower pulmonary pressure in SCD patients with precapillary pulmonary hypertension. Patients with hemodynamics of pulmonary arterial hypertension should be referred to specialized centers and considered for treatments known to be effective in other forms of pulmonary arterial hypertension. There have been reports that some of these treatments

  17. Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.

    PubMed

    Petruski-Ivleva, Natalia; Viera, Anthony J; Shimbo, Daichi; Muntner, Paul; Avery, Christy L; Schneider, Andrea L C; Couper, David; Kucharska-Newton, Anna

    2016-06-01

    Elevated blood pressure in midlife contributes significantly to the risk of cardiovascular disease. However, patterns of blood pressure increase may differ among individuals and may result in differential risk. Our goal was to examine the contribution of longitudinal patterns of blood pressure change to incidence of heart failure, coronary heart disease, stroke, and cardiovascular disease mortality. Latent class growth models were used to identify patterns of change in blood pressure across 4 clinical examinations (1987-1998) among 9845 Atherosclerosis Risk in Communities (ARIC) cohort participants (mean age, 53.7 [SD 5.7] years). Patterns of change in systolic blood pressure included slowly and steeply increasing, a decreasing and a sustained elevated blood pressure. Changes in diastolic and mid-blood pressure (½ systolic+½ diastolic) were less pronounced. The association of blood pressure pattern group membership with incidence of clinical outcomes was examined in follow-up from the fourth clinical examination (1996-1998) to December 31, 2011, using Poisson regression models adjusted for demographic and metabolic characteristics, and hypertension medication use. A gradient of rates of all events was observed across the identified patterns. Associations were attenuated after adjustment for covariates. Cumulative systolic blood pressure load, rather than the temporal pattern of change in systolic blood pressure itself, plays a role in determining the risk of cardiovascular disease, in particular, of heart failure and cardiovascular disease mortality, independent of blood pressure level measured at one point in time. PMID:27045024

  18. Effects of curative treatment emphasizing endurance training on the performance and blood pressure of hypertensive and normotensives

    NASA Technical Reports Server (NTRS)

    Worms, F.

    1981-01-01

    The problem of normal values of blood pressure after exercise taking into account the blood pressure at the end of the exercise test is discussed. Hypertensives showed a lower working capacity than normotensives. In normotensives, however, systolic blood pressure at the end of an exercise correlated well with the working capacity. After the endurance cure submaximal blood pressure was markedly lower in hypertensives with a striking dependence on the level of initial values. Systolic blood pressure at the end of an exercise test was not changed significantly. Most probably it is not possible to overcome this malregulation in hypertensives by endurance training alone.

  19. Assessment of right ventricular systolic function by tissue Doppler echocardiography.

    PubMed

    Kjærgaard, Jesper

    2012-03-01

    -massive pulmonary embolism quantifies degree of RV dysfunction, and supports the existence of the McConnell sign of mid-ventricular RV dysfunction. Echocardiographic signs of RV dysfunction are present if > 25% of the pulmonary vascular bed is obstructed. However, Tissue Doppler echocardiography and deformation analysis has no independent value over other clinical and quantitative echocardiographic measures of RV size, pressure and function in these patients [IV and V]. Regional deformation of the RV free wall has significant prognostic importance in a population suspected of first non-massive pulmonary embolism, and is significantly associated with adverse events in patients with proven pulmonary embolism, however, it does not add to the information gained from other quantitative echocardiographic measures of LV and RV function and pressure [VI]. Changes in tissue Doppler based measures of RV systolic function can be used to monitor the effect of selective vasodilation by phosphodiestares-5 inhibition in hypoxic pulmonary hypertension and exercise in normal individuals. Phosphodiestares-5 inhibition by sildenafil may predominantly be effective during hypoxia in resting conditions, and may improve the blunted response in RV contractility seen with exercise in hypoxia [VII]. Reduced RV free wall deformation can be quantified by tissue Doppler echocardiography in patients with confirmed Arrhythmogenic Right Ventricular Cardiomyopathy, but the clinical application of the technique may be limited by considerable overlap with normal values [VIII]. Acute RV volume loading in free pulmonary regurgitation is associated with abrupt geometric changes in the RV structure including significant dilatation, but is well tolerated with only mild reduction in measures of global RV systolic function as estimated by 2D echocardiography in an experimental animal model. Regional RV myocardial function is also only mildly reduced. Also no differences in global or regional RV function can be observed

  20. Systolic array IC for genetic computation

    NASA Technical Reports Server (NTRS)

    Anderson, D.

    1991-01-01

    Measuring similarities between large sequences of genetic information is a formidable task requiring enormous amounts of computer time. Geneticists claim that nearly two months of CRAY-2 time are required to run a single comparison of the known database against the new bases that will be found this year, and more than a CRAY-2 year for next year's genetic discoveries, and so on. The DNA IC, designed at HP-ICBD in cooperation with the California Institute of Technology and the Jet Propulsion Laboratory, is being implemented in order to move the task of genetic comparison onto workstations and personal computers, while vastly improving performance. The chip is a systolic (pumped) array comprised of 16 processors, control logic, and global RAM, totaling 400,000 FETS. At 12 MHz, each chip performs 2.7 billion 16 bit operations per second. Using 35 of these chips in series on one PC board (performing nearly 100 billion operations per second), a sequence of 560 bases can be compared against the eventual total genome of 3 billion bases, in minutes--on a personal computer. While the designed purpose of the DNA chip is for genetic research, other disciplines requiring similarity measurements between strings of 7 bit encoded data could make use of this chip as well. Cryptography and speech recognition are two examples. A mix of full custom design and standard cells, in CMOS34, were used to achieve these goals. Innovative test methods were developed to enhance controllability and observability in the array. This paper describes these techniques as well as the chip's functionality. This chip was designed in the 1989-90 timeframe.

  1. Sinapic Acid Prevents Hypertension and Cardiovascular Remodeling in Pharmacological Model of Nitric Oxide Inhibited Rats

    PubMed Central

    Silambarasan, Thangarasu; Manivannan, Jeganathan; Krishna Priya, Mani; Suganya, Natarajan; Chatterjee, Suvro; Raja, Boobalan

    2014-01-01

    Objectives Hypertensive heart disease is a constellation of abnormalities that includes cardiac fibrosis in response to elevated blood pressure, systolic and diastolic dysfunction. The present study was undertaken to examine the effect of sinapic acid on high blood pressure and cardiovascular remodeling. Methods An experimental hypertensive animal model was induced by L-NAME intake on rats. Sinapic acid (SA) was orally administered at a dose of 10, 20 and 40 mg/kg body weight (b.w.). Blood pressure was measured by tail cuff plethysmography system. Cardiac and vascular function was evaluated by Langendorff isolated heart system and organ bath studies, respectively. Fibrotic remodeling of heart and aorta was assessed by histopathologic analyses. Oxidative stress was measured by biochemical assays. mRNA and protein expressions were assessed by RT-qPCR and western blot, respectively. In order to confirm the protective role of SA on endothelial cells through its antioxidant property, we have utilized the in vitro model of H2O2-induced oxidative stress in EA.hy926 endothelial cells. Results Rats with hypertension showed elevated blood pressure, declined myocardial performance associated with myocardial hypertrophy and fibrosis, diminished vascular response, nitric oxide (NO) metabolites level, elevated markers of oxidative stress (TBARS, LOOH), ACE activity, depleted antioxidant system (SOD, CAT, GPx, reduced GSH), aberrant expression of TGF-β, β-MHC, eNOS mRNAs and eNOS protein. Remarkably, SA attenuated high blood pressure, myocardial, vascular dysfunction, cardiac fibrosis, oxidative stress and ACE activity. Level of NO metabolites, antioxidant system, and altered gene expression were also repaired by SA treatment. Results of in vitro study showed that, SA protects endothelial cells from oxidative stress and enhance the production of NO in a concentration dependent manner. Conclusions Taken together, these results suggest that SA may have beneficial role in the

  2. Heat stress proteins in hypertension

    SciTech Connect

    Malo, D.; Tremblay, J.; Pang, S.C.; Schlager, G.; Hamet, P.

    1986-03-05

    It has been described that spontaneously hypertensive rats (SHR) are more sensitive to an acute environmental heat stress and that cultured cardiomyocytes from neonatal SHR are demonstrated to be more thermosensitive. In addition, chronically heat exposed spontaneously hypertensive mice leads to a decrease of blood pressure in these animals. Heat shock is known to induce the synthesis of a new set of proteins (HSP) in every cell tested. This ubiquitous response seems to be involved in the induction of a thermotolerant state. The synthesis of 70K HSP was observed in lymphocytes isolated from the spleen of chronically heated mice. They used lymphocytes, previously isolated on a ficoll gradient, to evaluate the HSP induction in normotensive (WKY) and hypertensive (SHR) rats. The heat shock was induced by exposing the lymphocytes at 46/sup 0/C during 5 min in a hot water bath. The cells were then labeled with (/sup 75/Se)-methionine, washed, homogenized and separated on 5-30% SDS-polyacrylamide gel. Preliminary results suggest an abnormal pattern of induction of 70K and 90K HSP in hypertension. Heat sensitivity, thermotolerance and expression of HSP may, thus, be related to hypertension.

  3. Study of depression among a sample of hypertensive patients.

    PubMed

    Al Madany, Adel Mohammed; Hassan, Fawzy Hamed; Al-Nabawy, Ali Abdel Fattah; Ramadan, Mohammed Elsayed Mohammed; Ismail, Abd-Allah Ahmed Abd-Allah

    2015-04-01

    Hypertension is one of the commonest diseases worldwide. Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition, which elevated blood pressure in the arteries. This forces the heart to work harder than normal to circulate blood via the blood vessels. Blood pressure is summarized by two measurements, systolic and diastolic, which depend on between beats (diastole). Normal blood pressure at rest is within the range of 100-140 mmHg systolic (top reading) high blood pressure is said to be present if it is persistently at or above 140/90 mmHg of cases are categorized as primary hypertension that means high blood pressure with no obvious underlying medical cause. Updated studies reported associations between depressive symptoms and hypertensive patients. Depression may be an independent diagnosis, it is also possible that depressive symptoms are secondary to chronic illnesses and their associated complex medication regimens, regardless of the diagnosis being primary or secondary, prior reports have demonstrated that depressive symptoms are associated with inadequate blood pressure control and complications of hypertension. PMID:26012236

  4. New methodology for systematic construction of systolic arrays

    SciTech Connect

    Faroughi, N.

    1987-01-01

    Transforming an algorithm, represented by mathematical expressions with uniform and bounded index spaces, into a systolic-array architecture is discussed. Systolic arrays are highly structured architectures tailored to a specific application. They have specific architectural properties such as simple processing elements (cells), simple and regular data and control communication, and local-cell interconnections. The new design method is based on an understanding of the relationship between two highly structured representations of the algorithms: the mathematical expressions and their systolic solutions. The method consists of three major steps: algorithm representation, algorithm model, and architecture specification. The algorithm representation involves the translation of mathematical expressions into a set of equivalent simple computations which are grouped into subsets based on the required set of operations and same type operands. In the algorithm model, the properties of systolic arrays are represented in terms of feature interrelationships. A sub-systolic array is designed separately for each subset of the simple computations. The final array is constructed by joining the sub-systolic arrays. Other architecture specifications, such as data movement and cell count ratio, are determined early in a design process and thus can be used to select systolic solutions that require fewest cells and lowest I/O bandwidth.

  5. Managing hypertension by polyphenols.

    PubMed

    Fernández-Arroyo, Salvador; Camps, Jordi; Menendez, Javier A; Joven, Jorge

    2015-06-01

    Some polyphenols, obtained from plants of broad use, induce a favorable endothelial response in hypertension and beneficial effects in the management of other metabolic cardiovascular risks. Previous studies in our laboratories using the calyces of Hibiscus sabdariffa as a source of polyphenols show that significant effects on hypertension are noticeable in humans only when provided in high amounts. Available data are suggestive in animal models and ex vivo experiments, but data in humans are difficult to acquire. Additionally, and despite the low bioavailability of polyphenols, intervention studies provide evidence for the protective effects of secondary plant metabolites. Assumptions on public health benefits are limited by the lack of scientific knowledge, robust data derived from large randomized clinical trials, and an accurate assessment of the bioactive components provided by common foodstuff. Because it is likely that clinical effects are the result of multiple interactions among different polyphenols rather than the isolated action of unique compounds, to provide polyphenol-rich botanical extracts as dietary supplements is a suggestive option. Unfortunately, the lack of patent perspectives for the pharmaceutical industries and the high cost of production and release for alimentary industries will hamper the performance of the necessary clinical trials. Here we briefly discuss whether and how such limitations may complicate the extensive use of plant-derived products in the management of hypertension and which steps are the necessary to deal with the predictable complexity in a possible clinical practice. PMID:25714729

  6. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy

    PubMed Central

    Rey, E; LeLorier, J; Burgess, E; Lange, I R; Leduc, L

    1997-01-01

    OBJECTIVE: To provide Canadian physicians with evidence-based guidelines for the pharmacologic treatment of hypertensive disorders in pregnancy. OPTIONS: No medication, or treatment with antihypertensive or anticonvulsant drugs. OUTCOMES: Prevention of maternal complications, and prevention of perinatal complications and death. EVIDENCE: Pertinent articles published from 1962 to September 1996 retrieved from the Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews and from MEDLINE; additional articles retrieved through a manual search of bibliographies; and expert opinion. Recommendations were graded according to levels of evidence. VALUES: Maternal and fetal well-being were equally valued, with the belief that treatment side effects should be minimized. BENEFITS, HARMS AND COSTS: Reduction in the rate of adverse perinatal outcomes, including death. Potential side effects of antihypertensive drugs include placental hypoperfusion, intrauterine growth retardation and long-term effects on the infant. RECOMMENDATIONS: A systolic blood pressure greater than 169 mm Hg or a diastolic pressure greater than 109 mm Hg in a pregnant woman should be considered an emergency and pharmacologic treatment with hydralazine, labetalol or nifedipine started. Otherwise, the thresholds at which to start antihypertensive treatment are a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg in women with gestational hypertension without proteinuria or pre-existing hypertension before 28 weeks' gestation, those with gestational hypertension and proteinuria or symptoms at any time during the pregnancy, those with pre-existing hypertension and underlying conditions or target-organ damage, and those with pre-existing hypertension and superimposed gestational hypertension. The thresholds in other circumstances are a systolic pressure of 150 mm Hg or a diastolic pressure of 95 mm Hg. For nonsevere hypertension, methyldopa is the first-line drug; labetalol

  7. Longitudinal Study of Left Ventricular Mass Growth: Comparative Study of Clinic and Ambulatory Systolic Blood Pressure in Chronic Kidney Disease.

    PubMed

    Agarwal, Rajiv

    2016-04-01

    Left ventricular (LV) hypertrophy is an established cardiovascular risk factor, yet little is known about its trajectory in people with chronic kidney disease. The goal of this prospective research study was to describe the trajectory of LV mass index, its relationship with blood pressure (BP), and specifically to compare the relationship of BP measured in the clinic and 24-hour ambulatory BP monitoring with LV mass index. Among 274 veterans with chronic kidney disease followed for over ≤ 4 years, the rate of growth of log LV mass index was inversely related to baseline LV mass index; it was rapid in the first 2 years, and plateaued subsequently. Systolic BP also significantly increased, but linearly, 1.7 mm Hg/y by clinic measurements and 1.8 mm Hg/y by 24-hour ambulatory BP. Cross-sectional and longitudinal associations of both clinic BP and 24-hour ambulatory BP with LV mass index were similar; both BP recording methods were associated with LV mass index and its growth over time. Controlled hypertension, masked uncontrolled hypertension, and uncontrolled hypertension categories had increasing LV mass index when diagnosed by 24-hour ambulatory and awake BP (P<0.05 for linear trend) but not sleep BP. After accounting for clinic BP both at baseline and longitudinally, LV mass index among individuals was additionally predicted by the difference in sleep systolic BP and clinic systolic BP (P=0.032). In conclusion, among people with chronic kidney disease, the growth of LV mass index is rapid. Research-grade clinic BP is useful to assess LV mass index and its growth over time. PMID:26831191

  8. The application of systolic arrays to radar signal processing

    NASA Astrophysics Data System (ADS)

    Spearman, R.; Spracklen, C. T.; Miles, J. H.

    The design of a systolic array processor radar system is examined, and its performance is compared to that of a conventional radar processor. It is shown how systolic arrays can be used to replace the boards of high speed logic normally associated with a high performance radar and to implement all of the normal processing functions associated with such a system. Multifunctional systolic arrays are presented that have the flexibility associated with a general purpose digital processor but the speed associated with fixed function logic arrays.

  9. Prediction of the left ventricular mass from the electrocardiogram in systemic hypertension.

    PubMed

    de Vries, S O; Heesen, W F; Beltman, F W; Kroese, A H; May, J F; Smit, A J; Lie, K I

    1996-05-01

    Although echocardiography provides a reliable method to determine left ventricular (LV) mass, it may not be available in all settings. Numerous electrocardiographic (ECG) criteria for the detection of LV hypertrophy have been developed, but few attempts have been made to predict the LV mass itself from the ECG. In a community-based survey program in the general population, 277 subjects were identified with untreated diastolic hypertension (diastolic blood pressure 95 to 115 mm Hg, 3 occasions) or isolated systolic hypertension (diastolic blood pressure <95 mm Hg and systolic blood pressure 160 to 220 mm Hg, 3 occasions). All subjects underwent ECG and echocardiography on the same day. A multiple linear regression analysis was performed using a random training sample of the data set (n = 185). The independent variables included both ECG and non-ECG variables. The resulting model was used to predict the LV mass in the remainder of the data set, the validation sample (n = 92). Using sex, age, body surface area, the S-voltage in V1 and V4, and the duration of the terminal P in V1 as independent variables, the model explained 45% of the variance (r = 0.67) in the training sample and 42% (r = 0.65) in the validation sample. This result exceeded that of 2 existing ECG models for LV mass (r = 0.40 and 0.41). The correlations between LV mass and combinations of ECG variables used for the detection of LV hypertrophy, such as the Sokolow-Lyon Voltage (r = 0.03) and the Cornell Voltage (r = 0.31), were comparatively low. In settings where echocardiography is not available or is too expensive and time-consuming, prediction of the LV mass from the ECG may offer a valuable alternative. PMID:8644648

  10. Congestive Heart Failure With Apparently Preserved Left Ventricular Systolic Function: A 10-Year Observational Study.

    PubMed

    El-Menyar, Ayman; Shabana, Adel; Arabi, Abdulrahman; Al-Thani, Hassan; Asaad, Nidal; AlBinALi, Hajar; Singh, Rajvir; Gomaa, Mohammed; Gehani, A

    2015-09-01

    We analyzed the clinical presentation and outcomes (from 2003 to 2013) of heart failure (HF) with apparently normal systolic function (HFPEF). Based on the echocardiographic left ventricular ejection fraction (LVEF), patients were divided into 2 groups, group 1 (<50%) and group 2 (≥50%). Of 2212 patients with HF, 20% were in group 2. Patients in group 2 were more likely to be older, females, Arabs, hypertensive, and obese (P = .001). Patients in group 1 were mostly Asians and had more troponin-T positivity (P = .001). Inhospital cardiac arrest, shock, and deaths were significantly greater in group 1. On multivariate analysis, age, ST-segment elevation myocardial infarction, lack of on-admission β-blockers, and angiotensin-converting enzyme inhibitors use were independent predictors of mortality. HFPEF is associated with less mortality compared to those who presented with reduced LVEF. On admission, use of evidence-based medications could in part predict this difference in the hospital outcome. PMID:25248442

  11. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents.

    PubMed

    Lurbe, Empar; Agabiti-Rosei, Enrico; Cruickshank, J Kennedy; Dominiczak, Anna; Erdine, Serap; Hirth, Asle; Invitti, Cecilia; Litwin, Mieczyslaw; Mancia, Giuseppe; Pall, Denes; Rascher, Wolfgang; Redon, Josep; Schaefer, Franz; Seeman, Tomas; Sinha, Manish; Stabouli, Stella; Webb, Nicholas J; Wühl, Elke; Zanchetti, Alberto

    2016-10-01

    Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents. PMID:27467768

  12. [Approach to hypertension in the older population].

    PubMed

    Roca, Francisco Valls

    2014-05-01

    Hypertension is one of the most frequent causes for seeking primary care attention and its prevalence increases with age, affecting 68% of people older than 60 years. Data indicate that the prevalence of hypertense individuals older than 65 years has increased from 48% in 2002 to 58% in 2010. High blood pressure is related to 1 out of every 2 deaths from cardiovascular causes in the Spanish population ≥ 50 years and causes 13.5% of premature deaths worldwide, both in persons with hypertension and in those with high-normal blood pressure. Although few clinical trials have been performed in the older population, especially in the very old, there is evidence that diastolic and systolic blood pressure control reduces cardiovascular morbidity and mortality in older hypertense individuals. Consequently, the updates of the various clinical practice guidelines continue to include among their objectives-with some nuances-good blood pressure control in this population group. The present article reviews new evidence on the approach to hypertension in the elderly, which has modified some of the recommendations made in the clinical practice guidelines of several scientific societies. PMID:25263637

  13. Pre-hypertension: another ‘pseudodisease’?

    PubMed Central

    2013-01-01

    Hypertension is one of the most important and common cardiovascular risk factors. Defining the level at which blood pressure starts causing end-organ damage is challenging, and is not easily answered. The threshold of blood pressure defining hypertension has progressively been reduced over time, from systolic >160 mmHg to >150 mmHg, then to >140 mmHg; and now even blood pressures above 130 to 120 mmHg are labeled as ‘pre-hypertension’ by some expert committees. Are interest groups creating another ‘pseudodisease’ or is this trend scientifically justified? A recent meta-analysis published in BMC Medicine by Huang et al. clearly indicates that pre-hypertension (120 to 140/80 to 90 mmHg) is a significant marker of increased cardiovascular risk. This raises the question as to whether we now need to lower the threshold of ‘hypertension’ (as opposed to ‘pre-hypertension’) to >120/80 mmHg, redefining a significant proportion of currently healthy people as ‘patients’ with an established disease. These data need to be interpreted with some caution. It is controversial whether pre-hypertension is an independent risk factor or just a risk marker and even more controversial whether treatment of pre-hypertension will lower cardiovascular risk. Please see related research: http://www.biomedcentral.com/1741-7015/11/177. PMID:24229371

  14. Hypertension and acute myocardial infarction: an overview.

    PubMed

    Pedrinelli, Roberto; Ballo, Piercarlo; Fiorentini, Cesare; Denti, Silvia; Galderisi, Maurizio; Ganau, Antonello; Germanò, Giuseppe; Innelli, Pasquale; Paini, Anna; Perlini, Stefano; Salvetti, Massimo; Zacà, Valerio

    2012-03-01

    History of hypertension is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart.Antecedent hypertension associates with higher rates of death and morbid events both during the early and long-term course of AMI, particularly if complicated by left ventricular dysfunction and/or congestive heart failure. Renin-angiotensin-aldosterone system blockade, through either angiotensin-converting enzyme inhibition, angiotensin II receptor blockade or aldosterone antagonism, exerts particular benefits in that high-risk hypertensive subgroup.In contrast to the negative implications carried by antecedent hypertension, higher systolic pressure at the onset of chest pain associates with lower mortality within 1 year from coronary occlusion, whereas increased blood pressure recorded after hemodynamic stabilization from the acute ischemic event bears inconsistent relationships with recurring coronary events in the long-term follow-up.Whether antihypertensive treatment in post-AMI hypertensive patients prevents ischemic relapses is uncertain. As a matter of fact, excessive diastolic pressure drops may jeopardize coronary perfusion and predispose to new acute coronary events, although the precise cause-effect mechanisms underlying this phenomenon need further evaluation. PMID:22317927

  15. Abnormal right ventricular relaxation in pulmonary hypertension

    PubMed Central

    La Gerche, Andre; Roberts, Timothy J.; Prior, David L.; MacIsaac, Andrew I.; Burns, Andrew T.

    2015-01-01

    Abstract Left ventricular diastolic dysfunction is a well-described complication of systemic hypertension. However, less is known regarding the effect of chronic pressure overload on right ventricular (RV) diastolic function. We hypothesized that pulmonary hypertension (PHT) is associated with abnormal RV early relaxation and that this would be best shown by invasive pressure measurement. Twenty-five patients undergoing right heart catheterization for investigation of breathlessness and/or suspected PHT were studied. In addition to standard measurements, RV pressure was sampled with a high-fidelity micromanometer, and RV pressure/time curves were analyzed. Patients were divided into a PHT group and a non-PHT group on the basis of a derived mean pulmonary artery systolic pressure of 25 mmHg. Eleven patients were classified to the PHT group. This group had significantly higher RV minimum diastolic pressure ( vs. mmHg, ) and RV end-diastolic pressure (RVEDP; vs. mmHg, ), and RV τ was significantly prolonged ( vs. ms, ). There were strong correlations between RV τ and RV minimum diastolic pressure (, ) and between RV τ and RVEDP (, ). There was a trend toward increased RV contractility (end-systolic elastance) in the PHT group ( vs. mmHg/mL, ) and a correlation between RV systolic pressure and first derivative of maximum pressure change (, ). Stroke volumes were similar. Invasive measures of RV early relaxation are abnormal in patients with PHT, whereas measured contractility is static or increasing, which suggests that diastolic dysfunction may precede systolic dysfunction. Furthermore, there is a strong association between measures of RV relaxation and RV filling pressures. PMID:26064464

  16. Hormones and Hypertension

    MedlinePlus

    Fact Sheet Hormones and Hypertension What is hypertension? Hypertension, or chronic (long-term) high blood pressure, is a main cause of ... tobacco, alcohol, and certain medications play a part. Hormones made in the kidneys and in blood vessels ...

  17. What Causes Pulmonary Hypertension?

    MedlinePlus

    ... from the NHLBI on Twitter. What Causes Pulmonary Hypertension? Pulmonary hypertension (PH) begins with inflammation and changes in the ... different types of PH. Group 1 pulmonary arterial hypertension (PAH) may have no known cause, or the ...

  18. Pulmonary Arterial Hypertension

    MedlinePlus

    ... What Is Pulmonary Hypertension? To understand pulmonary hypertension (PH) it helps to understand how blood ows throughout ... is too high, it is called pulmonary hypertension (PH). How the pressure in the right side of ...

  19. Hypertension and Spina Bifida

    MedlinePlus

    SBA National Resource Center: 800-621-3141 Hypertension A disease that often goes undetected. What is hypertension? Hypertension, also called high blood pressure , is a condition in which the arteries of ...

  20. Nesfatin-1 and Vitamin D levels may be associated with systolic and diastolic blood pressure values and hearth rate in polycystic ovary syndrome

    PubMed Central

    Sahin, Figen Kir; Sahin, Serap Baydur; Ural, Ulku Mete; Cure, Medine Cumhur; Senturk, Senol; Tekin, Yesim Bayoglu; Balik, Gulsah; Cure, Erkan; Yuce, Suleyman; Kirbas, Aynur

    2015-01-01

    Obesity, insulin resistance (IR), inflammation, and hyperandrogenism may lead to polycystic ovary syndrome (PCOS) and hypertension. Nesfatin-1 (N1) may be related to IR, obesity, and hypertension. Furthermore, a vitamin D (VD) deficiency is associated with hypertension and PCOS. We aimed to investigate N1 and VD levels in PCOS that have an effect on systolic and diastolic blood pressure (BP) and heart rate (HR). This study included 54 patients with PCOS and 48 age-body mass index (BMI)-matched healthy controls. PCOS was diagnosed according to clinical practice guidelines. Ferriman-Gallwey scores (FGS) were calculated, while N1, VD, and other hormonal and biochemical parameters were measured for all subjects. Systolic and diastolic BP was measured as well. HR was calculated using an electrocardiogram. The levels of N1 (p < 0.001), high-sensitivity C-reactive protein (hs-CRP) (p = 0.036), homeostasis model assessment as an index of insulin resistance (HOMA-IR) (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) BP and HR (p < 0.001) in the PCOS group were significantly higher than in the control group. However, the VD levels of the PCOS group were lower than the control group (p = 0.004). N1 had a strong positive correlation with BMI, HOMA-IR, hs-CRP, luteinizing hormone, systolic and diastolic BP, and HR. VD levels were negatively correlated with HOMA-IR and luteinizing hormone. Elevated N1 and decreased VD levels may be related to the presence of high-normal BP or hypertension in PCOS subjects. N1 level may be associated with an increased BP due to its relation to inflammation and IR. PMID:26295295

  1. Nesfatin-1 and Vitamin D levels may be associated with systolic and diastolic blood pressure values and hearth rate in polycystic ovary syndrome.

    PubMed

    Sahin, Figen Kir; Sahin, Serap Baydur; Ural, Ulku Mete; Cure, Medine Cumhur; Senturk, Senol; Tekin, Yesim Bayoglu; Balik, Gulsah; Cure, Erkan; Yuce, Suleyman; Kirbas, Aynur

    2015-01-01

    Obesity, insulin resistance (IR), inflammation, and hyperandrogenism may lead to polycystic ovary syndrome (PCOS) and hypertension. Nesfatin-1 (N1) may be related to IR, obesity, and hypertension. Furthermore, a vitamin D (VD) deficiency is associated with hypertension and PCOS. We aimed to investigate N1 and VD levels in PCOS that have an effect on systolic and diastolic blood pressure (BP) and heart rate (HR).This study included 54 patients with PCOS and 48 age-body mass index (BMI)-matched healthy controls. PCOS was diagnosed according to clinical practice guidelines. Ferriman-Gallwey scores (FGS) were calculated, while N1, VD, and other hormonal and biochemical parameters were measured for all subjects. Systolic and diastolic BP was measured as well. HR was calculated using an electrocardiogram.The levels of N1 (p < 0.001), high-sensitivity C-reactive protein (hs-CRP) (p = 0.036), homeostasis model assessment as an index of insulin resistance (HOMA-IR) (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) BP and HR (p < 0.001) in the PCOS group were significantly higher than in the control group. However, the VD levels of the PCOS group were lower than the control group (p = 0.004). N1 had a strong positive correlation with BMI, HOMA-IR, hs-CRP, luteinizing hormone, systolic and diastolic BP, and HR. VD levels were negatively correlated with HOMA-IR and luteinizing hormone.Elevated N1 and decreased VD levels may be related to the presence of high-normal BP or hypertension in PCOS subjects.  N1 level may be associated with an increased BP due to its relation to inflammation and IR. PMID:26295295

  2. Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

    PubMed Central

    2012-01-01

    Background Martorell hypertensive ischemic leg ulcer (Martorell ulcer) is characterized by distinct alterations in the arteriolar wall of subcutaneous vessels, leading to progressive narrowing of the vascular lumen and increase of vascular resistance. These changes are similar to the alterations observed in pulmonary arterioles in patients with chronic pulmonary hypertension (PH). This study was aimed to assess an association between the two disorders. Methods In this case–control study, 14 patients with Martorell ulcer were clinically assessed for the presence of pulmonary hypertension using transthoracic Doppler echocardiography. Data from patients were compared to 28 matched hypertensive controls. Results Systolic pulmonary arterial pressure (sPAP) in patients with Martorell ulcer was significantly higher than in the control group (33.8 ± 16.9 vs 25.3 ± 6.5 mmHg, p = 0.023); the prevalence of pulmonary hypertension was 31% (5/14) in patients and 7% (2/28) in controls (p = 0.031). No differences were seen in left heart size and function between patients and controls. Conclusion This study provides first evidence that subcutaneous arteriolosclerosis, the hallmark of Martorell ulcer, is associated with PH. These findings suggest that patients with Martorell leg ulcer might be at significant risk to develop elevated pulmonary arterial pressure. Patients with leg ulcers who present with dyspnea should be evaluated by echocardiography for the presence of pulmonary hypertension. PMID:22686459

  3. Late systolic click in non-obstructive cardiomyopathy

    PubMed Central

    Mercer, Edward N.; Frye, Robert L.; Giuliani, Emilio R.

    1970-01-01

    Two patients with seriously impaired left ventricular function, abnormal left ventricular conduction on the electrocardiogram, mitral regurgitation, and a very late systolic click are reported. Idiopathic non-obstructive cardiomyopathy seemed to be the cause of the left ventricular dysfunction in both cases. The mitral valve was anatomically normal at the time of operation in one patient, except for dilatation of the annulus, and the mitral regurgitation appeared to be secondary to left ventricular failure. The very late timing of the mitral systolic clicks in these two patients may be related to a large left ventricular end-diastolic volume and impaired left ventricular function, or to an abnormal sequence of excitation of the left ventricle. The timing of the late systolic click in these patients is in contrast to that in patients with mid systolic clicks, hearts of normal size, and little cardiac disability. Images PMID:5470052

  4. Proceedings of the international conference on systolic arrays

    SciTech Connect

    Not Available

    1988-01-01

    The proceedings of this conference are grouped under the following headings: signal processing algorithms; applications; matrix algorithms; applications; architecture; algorithms; mapping methodology; design methodologies and tools; fault-tolerance and testing; hardware implementation; implementation; bit-level systolic systems.

  5. Systematic designs of buffers in macropipelines of systolic arrays

    SciTech Connect

    Wah, B.W.; Aboelaze, M.; Shang, W.

    1988-02-01

    In a macropipeline of systolic arrays, outputs of one systolic array in a given format have to be fed as inputs to another systolic array in a possibly different format. A common memory becomes a bottleneck and limits the number of systolic arrays that can be connected together. In this paper, they study designs of buffers to convert data from one format to another. The minimum number of buffers is determined by a dynamic-programming algorithm with THETA(n/sup 2/) computational complexity, where n is the problem size. A general-purpose converter to convert data from any distribution to any other in a subset of the possible data distribution is also proposed. Last, buffer designs for a macropipeline to perform feature extraction and pattern classification are used to exemplify the design process.

  6. A class of SIMD machines simulated by systolic arrays

    SciTech Connect

    Umeo, H.

    1985-11-01

    In this paper the authors introduce a new subclass of single instruction steam/multiple data stream (SIMD) machines, referred to as a simple SIMD, then consider an implementation of a class of simple SIMD parallel algorithms onto systolic arrays, which have been considered as one candidate for VLSI-based cellular computers. The class of simple SIMD algorithms is so large that it includes many conventional SIMD algorithms, such as sorting, image processing, and graph algorithms. We develop several time-efficient algorithms for the simulations of simple SIMD machines, which have global data communications, by systolic arrays with only local data communications. The systolic simulation theorems enable us to use many conventional SIMD algorithms on the systolic arrays with little loss of time efficiency.

  7. Loewner's conjecture, the Besicovitch barrel, and relative systolic geometry

    SciTech Connect

    Babenko, I K

    2002-04-30

    The paper is devoted to relative systolic geometry on a compact manifold with boundary. Sufficient conditions ensuring the intersystolic rigidity or intersystolic softness of such manifolds are analyzed. Several open questions are formulated.

  8. Systolic s/sup 2/-way merge sort is optimal

    SciTech Connect

    Schmeck, H.; Schroder, H.; Starke, C.

    1989-07-01

    The time complexity of Thompson and Kun's s/sup 2/-way merge sort is analyzed and shown to be asymptotically optimal with respect to the recently improved lower bound on sorting on a mesh-connected n x n array. Furthermore, new lower bounds for systolic sorting are derived. A systolic version of s/sup 2/-way merge sort is systematically constructed and shown to be asymptotically optimal as well.

  9. A virtual zero-time, monolithic systolic sorting array

    SciTech Connect

    Britton, C.L.; Ericson, M.N.; Bouldin, D.W.

    1989-01-01

    A virtual zero-time monolithic sorting chip is described. The chip has a systolic array architecture and implements the ''sinking sort'' algorithm. The basic functional module of the systolic array is detailed and development techniques employed as well as functional simulation and results are presented. Lessons learned and educational significance of the development of this chip at a university are discussed. 3 refs., 4 figs.

  10. Minimum complexity FIR filters and sparse systolic arrays

    SciTech Connect

    Ferrari, L.A.; Sankar, P.V.

    1988-06-01

    The properties of BETA-spline approximation and the integral/derivative properties of convolution lead to efficient algorithms for the implementation of multidimensional FIR filters. The implementations are of minimum time complexity under the Nyquist criterion. The algorithm can easily be implemented using a sparse systolic array architecture. The resulting BETA-spline convolvers have much lower circuit complexity than systolic architectures based on conventional convolution algorithms. A two-dimensional hardware implementation based on simplifications of current architectures is presented.