scholarly journals LO62: Systolic blood pressure is a strong predictive marker for TIA and mild stroke in younger patients

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S49
Author(s):  
C. Sedgwick ◽  
M. Bibok ◽  
N.S. Croteau ◽  
M.L. Lesperance ◽  
R. Balshaw ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Systolic Blood Pressure ◽  
Regression Model ◽  
Older Patients ◽  
Significant Risk ◽  
Younger Patients ◽  
Increased Risk ◽  
Age And Sex

Introduction: Age and systolic blood pressure (SBP) are important predictors of Acute Cerebrovascular Syndrome (ACVS). Yet, the effect of SBP is confounded by age, making its independent contribution to ACVS risk difficult to quantify. Here we use logistic regression to explore the role of SBP in younger and older ED patients. Methods: Data comprised 1019 ED patients (ACVS 70%, 30% non-ACVS) enrolled during a 28-month period of an ongoing prospective, observational, multi-site stroke biomarker study (SpecTRA). We used logistic regression to examine the effects of age, sex, and the age:SBP interaction as predictive markers of the diagnosis of ACVS. Results: Participants (53% male) ranged in age from 18 to 97 years (Q1=58, median=70, Q3=80). SBP ranged from 84 to 248 mmHg (Q1=137, median=154, Q3=174). In our initial regression model, age, sex, SBP and the age:SBP interaction were all significant (p<0.01). Using cubic regression splines for age, sbp and their interaction yields the same conclusion (p<0.01). To better understand the role of SBP in younger vs. older patients, we stratified the sample at the median age (70 years of age). In the younger group (n=510), participants were 55% male, 60% ACVS, and had SBP ranging from 91 to 236 mmHg (Q1=133, median=148, Q3=165). In the older group (n=509), participants were 51% male, 82% ACVS and had SBP ranging from 84 to 248 mmHg (Q1=143, median=159, Q3=179), a shift of approximately 10 mmHg between the groups. The logistic regression model was then fit separately to each group without the age:SBP interaction term. In the younger group, we found SBP to be highly significant (p<0.001), with an odds-ratio (OR) of 1.18 per 10 mmHg (95% CI: 1.10-1.29). In the older group, we found that SBP was not significant (p=0.91), with an OR of 1.00 per 10 mmHg (95% CI: 0.91-1.08). Age and sex were also significant risk factors in the younger group (each p<0.01), though not in the older group (both p>0.07). Conclusion: Our findings suggest that for ED patients suspected of ACVS, SBP is a clinically relevant predictor for younger patients, with higher SBP associated with an increased risk of ACVS, regardless of patient age and sex. SBP does not appear to be a strong predictor for patients over 70. ED physicians can leverage this finding by attributing greater importance to elevated SBP in younger patients than older patients when working toward a clinical suspicion of ACVS.

High Systolic Blood Pressure after Successful Endovascular Treatment Affects Early Functional Outcome in Acute Ischemic Stroke

2017 ◽  
Vol 45 (1-2) ◽  
pp. 18-25 ◽  
Author(s):  
Ilko L. Maier ◽  
Ioannis Tsogkas ◽  
Daniel Behme ◽  
Mathias Bähr ◽  
Michael Knauth ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Systolic Blood Pressure ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Vessel Occlusion ◽  
High Systolic Blood Pressure ◽  
Cerebral Vessel ◽  
Early Functional Outcome

Background: Endovascular treatment (EVT) has been shown to significantly improve functional outcome in patients with acute large cerebral vessel occlusions. To date, no evidence-based recommendations on blood pressure management after successful EVT exist. Previous studies showed an association between high pre-EVT systolic blood pressure (SBP) and functional outcome, but do not answer the question on how to manage blood pressure after successful recanalization. The purpose of this study was to determine the role of blood pressure measurements as a predictor for early functional outcome in patients with successful EVT. Methods: Prospectively derived data from patients with acute large vessel occlusion within the anterior circulation and EVT was analyzed in this monocentric study. Mean systolic- and maximum SBP as well as SBP-peaks have been obtained for the first 24 h after successful EVT. Predictive value of SBP for discharge modified Rankin Scale (mRS) ≤2 has been investigated using logistic regression models. Results: From 168 patients with successful EVT, 74 (44%) had a favorable outcome with an mRS ≤2. Mean- (127 vs. 131 mm Hg, p = 0.035) and maximum SBP (157 vs. 169 mm Hg, p < 0.001) as well as the number of SBP-peaks (0 vs. 1.5, p = 0.004) were lower in patients with favorable outcomes. Multivariable logistic regression showed high mean- and maximum SBP to predict unfavorable outcomes. Cutoff mean SBP was 141 mm Hg and maximum SBP 159 mm Hg. Conclusions: High SBP in the first 24 h after recanalization of acute anterior cerebral vessel occlusions is associated with unfavorable functional outcome. Interventional studies are needed to determine the role of SBP management as a modifiable parameter in the early phase after successful EVT.

High dialysis clearance of drugs predicts intradialytic hypertension in hemodialysis patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tokareva ◽  
N Borovkova ◽  
I Polyakova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Logistic Regression ◽  
Prediction Model ◽  
Beta Blockers ◽  
Significant Risk ◽  
Pressure Rise ◽  
Retrospective Case ◽  
Increased Risk ◽  
Dialysis Vintage

Abstract Introduction/Purpose An acute drop in highly dialyzable antihypertensive drug levels is considered to be one of the pathophysiological mechanisms of blood pressure rise during hemodialysis (HD). The study aimed to assess the prevalence of intradialytic hypertension (ID-HTN) and identify the most significant risk factors of its development. Methods We performed a retrospective case-control single-center study of HD patients from January 1st, 2014 to December 30th, 2016. Baseline evaluation included recording of antihypertensive medications with a focus on dialyzability of drugs. ID-HTN was defined as an increase in systolic blood pressure more than 10 mmHg after HD session. Results We enrolled 131 HD patients (52% males, median age 55.7 [53.5; 58.0] years, dialysis vintage 59.3 [51.8; 66.8] months). 79 patients suffered from ID-HTN. Highly dialyzable drugs were used in 61% of patients, most often – in 68% of cases – in the group of beta-blockers, less often among inhibitors of angiotensin-converting enzyme (32%). ID-HTN was associated with use of beta-blockers (Spearman's rank correlation coefficient (r)=0.212; p=0.015), moxonidine (r=0.313; p=0.001) and highly dialyzable drugs (r=0.440; p&lt;0.0001). Using the identified risk factors, a prediction model for ID-HTN based on logistic regression was constructed: y = −1.015 + 1.720 × highly dialyzed drugs + 0.993 × moxonidine; p = exp (y) / (1 + exp (y)). Table 1 displays actual and predicted values on the sample of HD patients. Conclusion In present study 60% of dialysis patients suffered from ID-HTN. Drugs with high dialysis clearance were widely used (61%) in dialysis population. Highly dialyzable drugs were associated with increased risk of ID-HTN (OR 5.585; 95% CI 2.49–12.54; p&lt;0.0001). The low specificity (65.4%) of the prediction model limits its use in clinical practice. Figure 1 shows the covariate-adjusted ROC curve by logistic regression model. Funding Acknowledgement Type of funding source: None

Blood pressure control in individuals with hypertension who used a digital, personalized nutrition platform (Preprint)

2021 ◽  
Author(s):  
Shivani Bakre ◽  
Benjamin Shea ◽  
Jason Langheier ◽  
Emily A Hu
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Systolic Blood Pressure ◽  
Regression Model ◽  
Diastolic Blood Pressure ◽  
Logistic Regression Model ◽  
New Technologies ◽  
Strong Association ◽  
Absolute Reduction ◽  
Stage 1

BACKGROUND While there is a strong association between adhering to a healthy dietary pattern and reductions in blood pressure, adherence still remains low. New technologies aimed to help facilitate behavior change may have an effect on reducing blood pressure among individuals with hypertension. OBJECTIVE To evaluate characteristics of participants with stage 2 hypertension who used Foodsmart and to assess changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). METHODS We analyzed demographic, dietary, and clinical characteristics collected from 11,934 adults with at least two blood pressure readings who used the Foodsmart platform. Stage 2 hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. We calculated mean changes in blood pressure among participants with stage 2 hypertension and stratified by length of follow-up and the covariates associated with achieving blood pressure levels below stage 2 hypertension. We compared changes in diet quality and weight between participants with stage 2 hypertension at baseline who achieved stage 1 hypertension or below and those who did not. RESULTS We found that 47.2% (5,627/11,934) and 10.6% (1,269/11,934) of the participants with at least two SBP and DBP readings had stage 1 and stage 2 hypertension, respectively, at baseline. Among Foodsmart participants with stage 2 hypertension at baseline, SBP and DBP had an absolute reduction, on average, of 5.6 mmHg and 4.0 mmHg, respectively. 33.0% (419/1,269) of participants with stage 2 hypertension at baseline achieved blood pressure levels below stage 2 hypertension (SBP < 140 mmHg and DBP < 90 mmHg). Using a multivariable ordinal logistic regression model, changes in Nutriscore and weight were statistically significantly associated with changes in blood pressure levels for users with stage 2 hypertension at baseline. Using a multivariable logistic regression model, we found that baseline Nutriscore, change in Nutriscore, and change in weight were all associated with the likelihood of users with stage 2 hypertension at baseline to achieve a lower blood pressure category. Among Foodsmart participants with stage 2 hypertension at baseline, systolic blood pressure and diastolic blood pressure had an absolute reduction, on average, of 5.6 mm Hg and 4.0 mm Hg, respectively. 33.0% (419/1,269) of participants with stage 2 hypertension at baseline achieved blood pressure levels of stage 1 hypertension (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) in their last blood pressure entry. CONCLUSIONS This study evaluated changes in SBP and DBP among users of the Foodsmart platform with hypertension and found that users with stage 2 hypertension, on average, improved their blood pressure levels over time.

scholarly journals Histological chorioamnionitis is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoli Wang ◽  
Haiyuan Li ◽  
Qianqian Zhang ◽  
Qianwen Shen ◽  
Dan Zhu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Multivariate Logistic Regression Model ◽  
Atopic Diseases ◽  
Multivariate Logistic Regression ◽  
Preterm Children ◽  
Increased Risk ◽  
Anthropometric Indexes

Abstract Background Chorioamnionitis is associated with various neonatal short- and long-term morbidities. The effect of chorioamnionitis on premature children’s outcomes remains controversial. The aim of this study is to investigate the relationship between histological chorioamnionitis (HCA) and physiological development, wheezing, and atopic diseases in preterm children. Methods Singleton, preterm children (< 34 weeks), whose mother underwent pathological placental examinations, were retrospectively enrolled and the outcomes were assessed at 24–40 months during follow-up. Wheezing and atopic diseases including eczema, food allergies, and allergic rhinitis were screened by a questionnaire along with medical diagnosis. Anthropometric indexes and blood pressure were measured. Cognitive and behavioural developments were assessed by the Gesell Development and Diagnosis Scale. Blood IgE and routine examination were analyzed with venous blood and serum metabolomic profiling was assessed via liquid chromatography-mass spectrometry (LC-MS). A multivariate logistic regression model was used to estimate the association between HCA and the current outcomes. Results Among the 115 enrolled children, 47 were exposed to HCA. The incidence of wheezing was significantly higher in children exposed to HCA, as 38.30% of children who were exposed to HCA and 16.18% of children who were not had been diagnosed with wheezing. After adjusting for related confounders in the multivariate logistic regression model, there remained a 2.72-fold increased risk of wheezing in children with HCA (adjusted odds ratio, aOR, 2.72; 95% confidence interval, 1.02–7.23). Moreover, 163 differential metabolites, such as butanoic acid, annotemoyin 1 and charine, were identified in the HCA exposed children’s serum. Enrichment analysis revealed that these compounds participated in diverse key metabolomic pathways relating to physical and neuro- developments, including glycerophospholipid, alpha-linolenic acid and choline metabolisms. There were no significant differences in atopic diseases, serum IgE, eosinophils’ level, anthropometric indexes, blood pressure, or cognitive or behavioural developments between the two groups. Conclusion HCA exposure is associated with an increased risk of wheezing in preterm children less than 34 gestational weeks.

scholarly journals 22. Description of Hospitalized Patients with Influenza Vaccine Failure

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S35-S35
Author(s):  
Joanna Kimball ◽  
Yuwei Zhu ◽  
Dayna Wyatt ◽  
Helen Talbot
Keyword(s):  
Logistic Regression ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Older Patients ◽  
Influenza A ◽  
Influenza Season ◽  
Hospitalized Patients ◽  
Vaccine Failure ◽  
Increased Risk ◽  
Immunosuppressed Patients

Abstract Background Despite influenza vaccination, some patients develop illness and require hospitalization. Many factors contribute to vaccine failure, including mismatch of the vaccine and circulating strains, waning immunity, timing of influenza season, age and patient comorbidities such as immune function. This study compared vaccinated, hospitalized patients with and without influenza. Methods This study used 2015–2019 Tennessee data from the US Hospitalized Adult Influenza Vaccine Effectiveness Network database. Enrolled patients were ≥ 18 years vaccinated for the current influenza season and admitted with an acute respiratory illness. Patient or surrogate interviews and medical chart abstractions were performed, and influenza vaccinations were confirmed by vaccine providers. Influenza PCR testing was performed in a research lab. Statistical analyses were performed with STATA and R using Pearson’s chi-squared, Kruskal-Wallis and Wilcoxon rank-sum tests and multivariate logistic regression. Results 1236 patients met study criteria, and 235 (19%) tested positive for influenza. Demographics, vaccines and comorbidities were similar between the two groups (Table 1) except for morbid obesity, which was more common in influenza negative patients (13% vs 8%, p = 0.04), and immunosuppression, which was more common in the influenza positive (63% vs 54%, p = 0.01). Logistic regression analysis demonstrated older patients (OR 1.47, 95% CI 1.03–2.10) and immunosuppressed patients (OR 1.56, 1.15–2.12) were at increased risk for influenza (Table 2 and Figure 1). Immunosuppression also increased the risk for influenza A/H3N2 (OR 1.86, 95% CI 1.25–2.75). A sensitivity analysis was performed on patients who self-reported influenza vaccination for the current season without vaccine verification and demonstrated increased risk of influenza in older adults (OR 1.66, 95% CI 1.16–2.39). Table 1: Demographics of influenza positive versus influenza negative patients in influenza vaccinated, hospitalized patients. Table 2: Logistic regression analyses of vaccinated, hospitalized influenza positive patients; vaccinated, hospitalized patients with influenza A subtypes and self-reported vaccinated, hospitalized influenza positive patients. Figure 1: Predicted Probability of Hospitalization with Influenza, Influenza A/H1N1 and Influenza A/H3N2 in Vaccinated Patients by Age. Conclusion Our study demonstrated an increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of these patients against future influenza illnesses, more effective vaccines are needed, and more research on ring vaccination should be pursued. Disclosures All Authors: No reported disclosures

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

2020 ◽  
Vol 41 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Torsten Schlosshauer ◽  
Marcus Kiehlmann ◽  
Diana Jung ◽  
Robert Sader ◽  
Ulrich M Rieger
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Surgical Technique ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Wound Healing Problems ◽  
Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

Mortality of Public Mental Health Patients: A Singapore Experience

1993 ◽  
Vol 27 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Lionel Chee-Chong Lim ◽  
Li-Ping Sim ◽  
Peak-Chiang Chiam
Keyword(s):  
Mental Health ◽  
General Population ◽  
Older Patients ◽  
Public Mental Health ◽  
Younger Patients ◽  
Standardised Mortality Ratio ◽  
Common Diagnosis ◽  
Mental Health Patients ◽  
Mortality Ratio ◽  
Age And Sex

This study reports the Standardised Mortality Ratio (SMR) by age and sex among public mental health patients in Singapore. The authors also examine the differences between those who were classified as “inpatient deaths” and those who were classified as “outpatient deaths”. Mortality was 5.1 times that of the general population and the SMR was most accentuated in the younger, female patients. Of the 217 deaths documented over two years, schizophrenia was the most common diagnosis. Inpatient deaths (N = 120) occurred in older patients with prior physical illness who died of natural causes. In contrast, outpatient deaths (N = 97) involved younger patients with no previous illness and the majority jumped to their deaths. Mortality studies are necessary in monitoring the efficacy of mental health provisions.

The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

2014 ◽  
Vol 24 (3) ◽  
pp. 219-227 ◽  
Author(s):  
Francisco J Tarazona-Santabalbina ◽  
Juan R Doménech-Pascual ◽  
Ángel Belenguer-Varea A ◽  
Eduardo Rovira Daudi
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Older Patients ◽  
Future Research ◽  
Research Perspectives ◽  
Increased Risk ◽  
Risk Of Falls

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

Abstract 14652: Systolic Blood Pressure Trajectories and Cardiovascular Outcomes in SPRINT

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Charles A German ◽  
Tali Elfassy ◽  
Matthew J Singleton ◽  
Carlos J Rodriguez ◽  
Walter T Ambrosius ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Latent Class ◽  
Stable Group ◽  
Coronary Syndrome ◽  
Average Blood Pressure ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Over Time

Introduction: Blood pressure trajectories have been associated with cardiovascular disease (CVD) in observational studies. It is unclear whether these associations are independent of average blood pressure over time. Methods: We used data from SPRINT to identify systolic blood pressure (SBP) trajectories among a cohort of 8901 participants by incorporating SBP measures during the first 12 months of the trial post randomization. Trajectories were identified using latent class based modeling. Study outcomes included incident CVD, defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death attributable to CVD, and all-cause mortality. Cox proportional hazards models were used to evaluate associations between SBP trajectories and our outcomes of interest. Results: Four distinct SBP trajectories were identified: ‘low decline’ (40%), ‘high decline’ (6%), ‘low stable’ (48%), and ‘high stable’ (5%) (Figure 1). Relative to the low decline group, the low stable group was associated with a 29% increased risk of CVD (HR: 1.29, 95%CI: 1.06-1.57) and the high stable group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95%CI: 1.15-2.68) after baseline multivariable adjustment. Relative to the low stable group, the high stable group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95%CI: 1.05-2.28). When adjusting for average blood pressure across the 12 month time period, there were no significant differences in outcomes. Conclusion: We identified 4 SBP trajectories using data from SPRINT and found differences in the risk of CVD and all-cause mortality after baseline adjustment. However, there were no differences in the risk of these outcomes after adjusting for average blood pressure over time. These results suggest that the pattern of blood pressure control may not be relevant as long as the target blood pressure is achieved.

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