scholarly journals Influences of Fasting on Stress Response and Withdrawal Symptoms in Habitual Khat Users

2020 ◽  
Vol 27 (1) ◽  
pp. 49-57
Author(s):  
Motohiro Nakajima ◽  
Mustafa al’Absi
Keyword(s):  
Blood Pressure ◽  
Negative Affect ◽  
Stress Responses ◽  
Mental Arithmetic ◽  
Small Sample Size ◽  
Ambulatory Monitoring ◽  
Small Sample ◽  
Withdrawal Symptoms ◽  
Traditional Practice ◽  
Khat Use

<b><i>Background:</i></b> Fasting changes mood and physiological states. Substance use, such as khat use, is prohibited during fasting during Ramadan, a traditional practice among Muslims. Habitual khat use is associated with increased negative affect and altered psychobiological stress responses. Effects of fasting on stress responses, mood, and withdrawal symptoms among khat users have not been examined. <b><i>Methods:</i></b> In this study, 80 individuals completed an ambulatory monitoring period and a laboratory assessment session. Participants who completed the study while fasting during Ramadan were matched by gender and khat use status with participants who completed the study while not fasting. This resulted in 40 participants (12 females and 28 males; 25 khat users and 15 nonusers) in each fasting group. Cardiovascular (blood pressure and heart rate) and subjective measures were collected throughout the laboratory stress session. A mental arithmetic challenge was used to induce stress. In addition, self-reported mood and withdrawal measures were collected multiple times during the ambulatory assessment. <b><i>Results:</i></b> Khat users reported greater negative affect than nonusers. Results from the ambulatory study indicated that withdrawal symptoms were lower during evening hours in the fasting group than in the no-fasting group. Stress-related changes in positive and negative affects were flattened in the fasting group relative to the no-fasting group. Khat users reported reduced blood pressure responses relative to nonusers. <b><i>Conclusion:</i></b> These preliminary results demonstrate that fasting is associated with reduced negative affect and withdrawal symptoms in khat users. Khat use was related to blunted blood pressure stress responses, but this was independent of fasting. Due to the small sample size, these results should be replicated with a large sample and comprehensive stress tasks.

Abstract W P224: Higher Pre-Hospital Blood Pressure Prolongs Door to Needle Thrombolysis Times

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Digvijaya Navalkele ◽  
Chunyan Cai ◽  
Mohammad Rahbar ◽  
Renganayaki Pandurengan ◽  
Tzu-Ching Wu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Sample Size ◽  
Heart Association ◽  
Small Sample ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Intravenous Tissue Plasminogen Activator ◽  
Number Of Patients

Background: Per American Heart Association guidelines, blood pressure (BP) should be < 185/110 to be eligible for intravenous tissue plasminogen activator (tPA). It is shown that door to needle (DTN) time is prolonged in patients who require anti-hypertensive medications prior to thrombolysis in the emergency department (ED). To our knowledge, no studies have focused on pre-hospital BP and its impact on DTN times. We hypothesize that DTN times are longer for patients with higher pre-hospital BP. Methods: We conducted a retrospective review of acute ischemic stroke patients who presented between 1/2010 and 12/2010 to our ED through Emergency Medical Services (EMS) within 3-hrs of symptom onset. Patients were identified from our registry and categorized into two groups: Pre-hospital BP ≥ 185/110 (Pre-hsp HBP) and < 185/110 (Pre-hsp LBP). BP records were abstracted from EMS sheets. Two groups were compared using two-sample t-test or Wilcoxon rank sum test for continuous variables and Chi-square test or Fisher’s exact test for categorical variables. Results: A total of 107 consecutive patients were identified. Out of these, 75 patients (70%) were treated with tPA. Among the patients who received thrombolysis, 35% had pre-hospital BP ≥ 185/110 (n= 26/75). Greater number of patients required anti-hypertensive medications in ED in high BP group compared to low BP group (Pre-hsp HBP n= 14/26, 54%; Pre-hsp LBP n= 13/49, 27%, p < 0.02). Mean door to needle times were significantly higher in Pre-hsp HBP group. (mean ± SD 87.5± 34.2 Vs. 59.7±18.3, p<0.0001). Analysis of patients only within the Pre-hsp HBP group (n= 26) revealed that DTN times were shorter if patients received pre-hsp BP medications compared to patients in the same group who did not receive pre-hsp BP medication (n= 10 vs 16; mean ± SD 76.5 ± 25.7 Vs. 94.3 ± 37.7, p = 0.20) Conclusion: Higher pre-hospital BP is associated with prolonged DTN times and it stays prolonged if pre-hospital high BP remains untreated. Although the later finding was not statistical significant due to small sample size, pre-hospital blood pressure control could be a potential area for improvement to reduce door to needle times in acute ischemic stroke.

scholarly journals Effects of the Dietary Approaches to Stop Hypertension Diet and Sodium Reduction on Blood Pressure in Persons With Diabetes

Hypertension ◽  
2020 ◽  
Author(s):  
Eva Tseng ◽  
Lawrence J. Appel ◽  
Hsien-Chieh Yeh ◽  
Scott J. Pilla ◽  
Edgar R. Miller ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dietary Pattern ◽  
Behavioral Interventions ◽  
Small Sample Size ◽  
Small Sample ◽  
Dietary Sodium ◽  
Sodium Reduction ◽  
Dietary Interventions ◽  
Total N ◽  
Intervention Delivery

Elevated blood pressure and blood pressure-related morbidity are extraordinarily common in persons with diabetes. The Dietary Approaches to Stop Hypertension dietary pattern and dietary sodium reduction are recommended as lifestyle interventions in individuals with diabetes. However, these recommendations have largely been based on studies conducted in persons without diabetes. In this review, we summarize available evidence from trials that tested the effects of these 2 dietary interventions on blood pressure in people with diabetes. Overall, of the 3 trials (total n=151) that tested the effects of the Dietary Approaches to Stop Hypertension dietary pattern in persons with diabetes, 2 trials documented that the Dietary Approaches to Stop Hypertension dietary pattern lowered blood pressure. While 16 trials (total n=445) tested the effects of sodium reduction in persons with diabetes, results were inconsistent, likely because of design limitations, for example, brief duration, small sample size, and low baseline blood pressure levels, as well as differences in the mode of intervention delivery (behavioral interventions, feeding studies, and sodium supplements). In conclusion, there is a substantial need for additional research on the blood pressure lowering effects of the Dietary Approaches to Stop Hypertension diet and sodium reduction in people with diabetes and hypertension, given the high prevalence of hypertension and the dearth of high-quality trials in this population.

Metabolic Syndrome in Bipolar Illness: Patient Concepts and Screening Effectivity

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Guerreiro ◽  
R. Navarro ◽  
D. Telles ◽  
M. Carvalho ◽  
P. Martins ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Small Sample Size ◽  
International Diabetes Federation ◽  
Structured Interview ◽  
Small Sample ◽  
Screening Methods ◽  
Cross Sectional ◽  
Abdominal Perimeter ◽  
Bipolar Patients

Introduction:Metabolic Syndrome (MS) is constituted by a set of specific metabolic alterations being postulated that the main dysfunction is insulin resistance. Estimates point to higher prevalence of MS in bipolar patients, between 30 to 35%. Cost-effective screening methods, not recurring to blood test, have been researched.Objectives:Analyse knowledge and importance given to MS in bipolar patients. Test the viability of MS screening without blood tests.Methodology:Observational, cross-sectional study. Random sample of 15 adult bipolar patients, in euthymic phase. Semi-structured interview, YMRS, HAMD were applied. MS diagnosis investigated according to the International Diabetes Federation (IDF) criteria. MS screening was defined positive if blood pressure ≥ 130/85 or anti-hypertensive medication and abdominal perimeter > 90 in males or > 80 in females. A questionnaire about knowledge, attitudes and concerns on MS was applied.Main results:14 patients completed the investigation protocol. Five (36%) met IDF criteria for metabolic syndrome. Screening sensitivity was 80% and specificity 78%. Twelve patients (80%) were overweigh or obese. Mean IMC in patients that met IDF criteria for MS was 30 while in the other group mean IMC was 26. Only 3 (20%) have ever heard about MS, but the majority of the patients were concerned, in decreasing order, about weight gain, blood pressure cholesterol and hyperglycemia control.Conclusions:Although limited by small sample size, this study strengthens the idea that MS screening can be effective in clinical practice, it also indicates the need to educate BP patients about MS and to prevent overweight.

scholarly journals Who’s the boss: determining the control pathways of cardiovascular and cellular immune responses to acute stress

2018 ◽  
Vol 42 (2) ◽  
pp. 374-379
Author(s):  
Kate M. Edwards ◽  
Nathan B. Morris
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Immune Cells ◽  
Stress Responses ◽  
Immune Cell ◽  
Acute Stress ◽  
Mental Arithmetic ◽  
Cold Pressor ◽  
Autonomic Response ◽  
Blood Pressure Responses

Acute stress responses are known to include increases in heart rate and blood pressure, as well as increases in the number of circulating immune cells, all of which are governed by the autonomic nervous system. This laboratory practical measures cardiovascular and circulating immune cell responses to a passive (cold pressor) and active (mental arithmetic) acute stress task in student participants. The results allow them to examine the different patterns of autonomic response they elicit (approximated by heart rate and blood pressure responses), and knowledge of these responses can then be used to infer the governing autonomic aspect of the increases in circulating immune cells from the results. This activity can be either adapted from teacher-led methods to inquiry, asking students to design the details of the acute stress tasks, or developed by asking students to design a follow-up experiment that could be used to provide direct evidence for their conclusions. Data collected provide a platform for teaching data analysis and interpretation, as well as critical thinking.

scholarly journals Energy drink consumption pattern and the effect of consumption on university students’ blood pressure and heart rate

2019 ◽  
Vol 12 (1) ◽  
pp. 104-119
Author(s):  
K. Nagy ◽  
A. Csomós ◽  
B. Dániel ◽  
Gy. Mara
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
University Students ◽  
Small Sample Size ◽  
Energy Drink ◽  
Small Sample ◽  
Consumption Pattern ◽  
Monthly Basis ◽  
Cross Sectional ◽  
Arterial Blood

Abstract Energy drink (ED) consumption, even mixed with alcohol, is popular among adolescents and young adults. The side effects of ED are attributed to their active ingredients and their cumulated effect. A cross-sectional study to identify university students’ ED consumption habit was realized. A small sample size (n = 10) experiment examining the effect of ED consumption on arterial blood pressure and heart rate was carried out. From the total number of 240 interviewed students, 87.1% consumed ED at least once, and one third of them did so on a monthly basis. Students consume energy drinks mainly for its taste, very rarely for studying. Differences in consumption place preferences were observed between sexes, females preferring bars, while males the dormitory. We have demonstrated the increase of systolic blood pressure (SBP) for one type of energy drink in young and healthy volunteer students. Other changes in blood pressure and heart rate were not observed.

scholarly journals 013 The impact of aggressive blood pressure management in the post-thrombolysis setting

2019 ◽  
Vol 90 (e7) ◽  
pp. A5.2-A5
Author(s):  
Bethan Harper ◽  
Harry McNaughton ◽  
Anna Ranta
Keyword(s):  
Blood Pressure ◽  
Patient Outcomes ◽  
Transition Period ◽  
Small Sample Size ◽  
Bleeding Risk ◽  
Small Sample ◽  
Model Fit ◽  
Stroke Severity ◽  
Baseline Characteristics ◽  
The Impact

IntroductionHigh blood pressure (BP) post-thrombolysis has been associated with an increased rate of bleeding and poorer outcome. We noted frequent BPs of >180 mmHg with a target of keeping BP <180. We tested whether a more aggressive target of SBP <160 mmHg would result in fewer BP protocol violations.MethodsPatients were prospectively captured comparing patients thrombolysed during the 12 months before and 12 months following the introduction of a new more aggressive BP protocol, allowing for a 6 month transition period. Results were adjusted for baseline function and stroke severity using regression analysis.ResultsPre-protocol change 68 and post- 100 patients were thrombolysed. Baseline characteristics were similar between groups. There was a trend for a lower rate of SBPs >180 mmHg (adjusted OR 0.49; 95% CI 0.31–1.1; p=0.097) and a significantly higher rate of SBPs <120 mmHg (adjusted OR 3.06; 95% CI 1.52–6.17; p=0.002) in the aggressive BP protocol group; although events of extreme SBPs (>200 and <100 mmHg) were similar between groups. Favourable outcomes (mRS = 0–2) at 3 months were similar between groups (adjusted OR 1.27; 95% CI 0.58–2.8; p=0.56) as was the rate of symptomatic haemorrhages (adjusted OR 1.26; 95% CI 0.28–5.7; p=0.76). Model fit was improved by adding study group to the model.ConclusionsMore aggressive post-thrombolysis BP management lowered the overall BP, but did not result in improved patient outcomes. Potential explanations include a small sample size, reduced cerebral perfusion off-setting reduced bleeding risk, or high BP being merely an epiphenomenon of worse outcome rather than causative.

scholarly journals Withdrawal Symptoms From E-Cigarette Abstinence Among Adult Never-Smokers: A Pilot Experimental Study

2019 ◽  
Vol 22 (5) ◽  
pp. 740-746 ◽  
Author(s):  
John R Hughes ◽  
Erica N Peters ◽  
Peter W Callas ◽  
Catherine Peasley-Miklus ◽  
Emmanuel Oga ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Sample Size ◽  
Interactive Voice Response ◽  
Small Sample Size ◽  
Small Sample ◽  
Withdrawal Symptoms ◽  
Clinical Trial Registration ◽  
Response System ◽  
Never Smokers ◽  
Regulatory Significance

Abstract Introduction Use of e-cigarettes among never-smokers has substantially increased; yet there are few descriptions of the consequences of such use. We assessed whether adult never-smokers can have withdrawal from cessation of e-cigarettes. Methods In an un-blinded pre-post clinical trial, 30 never-smoker daily e-cigarette users used their own nicotine-containing e-cigarette for 7 days followed by 6 days of biologically confirmed abstinence. Participants monitored symptoms of nicotine withdrawal nightly via an Interactive Voice Response system. They attended three lab visits/week to provide expired carbon monoxide and urine samples to determine compliance. Findings Abstinence increased all the DSM5 symptoms of tobacco withdrawal and this occurred in the majority of participants. The increase in severity of withdrawal was small and rarely impaired functioning. Conclusions Our finding suggests that withdrawal symptoms can occur in never-smokers who stop e-cigarettes abruptly. However, the severity of withdrawal appears to be small and may not be of clinical or regulatory significance. Although our sample size was small and thus replication tests of our results are indicated, it may be prudent to warn never-smokers that withdrawal symptoms may occur. Implications This study indicates that withdrawal symptoms can occur in never-smokers who are daily e-cigarette users. However, the severity of withdrawal from e-cigarette abstinence in never-smokers appears to be small and may not be of clinical or regulatory significance. Given our small sample size, replication of our results is warranted. Nevertheless, it might be prudent to warn never-smokers of addiction to e-cigarettes. Clinical Trial Registration = NCT02825459

Short-term reproducibility of a mental arithmetic stress test

1991 ◽  
Vol 81 (5) ◽  
pp. 593-601 ◽  
Author(s):  
Sverker Jern ◽  
Martin Pilhall ◽  
Christina Jern ◽  
Sven G. Carlsson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Responses ◽  
Mental Arithmetic ◽  
Stress Test ◽  
Plasma Catecholamine ◽  
Subjective Stress ◽  
Stress Levels ◽  
Highly Correlated ◽  
Plasma Catecholamine Concentrations

1. To evaluate the short-term reproducibility of heart rate, oscillometrically determined blood pressure, ante-cubital venous plasma catecholamine concentrations and subjective responses to strictly standardized mental arithmetic, we performed two identical tests 1 h apart in 14 young, healthy and normotensive male subjects (age 22–35 years) 2. Heart rate and blood pressure responses to the two stress tests were highly correlated, when expressed both as correlations between levels attained during stress (rs >0.80 throughout) and as absolute reactivity measures (all rs >0.75). Also, subjective stress responses were highly correlated, when considering both levels during stress and reactivity (r = 0.97 and r = 0.85, respectively). Stress levels of catecholamines were correlated, but the change scores (reactivity) were unrelated. 3. The measurement error sd for heart rate was 2.6 and 3.0 beats/min for reactivity and stress levels, respectively. The corresponding sd for blood pressure ranged between 2.7 and 4.4 mmHg. Subjective stress experience showed an sd of a similar magnitude. The responses of plasma catecholamine concentrations were subject to considerable variability. 4. It is concluded that haemodynamic and subjective stress responses and stress levels during the mental arithmetic stress test show acceptable reproducibility and high test-retest correlations. However, stress-induced changes in venous plasma catecholamine concentrations show low reproducibility.

scholarly journals Cardiovascular risk factors in a child population: The Health Oriented Pedagogical Project (HOPP)

2018 ◽  
Vol 46 (21_suppl) ◽  
pp. 28-37
Author(s):  
Wei Hai Deng ◽  
Morten Lindberg ◽  
Ole Petter Hjelle ◽  
Asgeir Mamen ◽  
Per Morten Fredriksen
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Aerobic Fitness ◽  
Cardiometabolic Risk ◽  
Small Sample Size ◽  
Density Lipoprotein ◽  
Small Sample ◽  
Haemoglobin A1c ◽  
Child Population ◽  
Clustering Of Risk Factors

Aims: The main aim of the present study was to investigate the clustering of risk factors for cardiovascular diseases and metabolic syndrome in a large, healthy representative Norwegian child population. Methods: From a population of 2817, parents of 2297 children agreed to participate. Values of waist circumference (WC), total cholesterol (TC), high-density lipoprotein (HDL), systolic blood pressure (sysBP), haemoglobin-A1c (HbA1c) and Andersen aerobic fitness test were used to test clustering of cardiometabolic risk factors in this sample. Expected distributions of probability for zero to five risk factors are, respectively, 23.7%, 39.6%, 26.4%, 8.8%, 1.5% and 0.1%. A cardiometabolic risk score from zero to five for each individual was derived by adding the number of variables in the least desirable quartile (highest for WC, sysBP, TC and HbA1c; lowest for aerobic fitness and HDL). Results: A risk ratio of 5.8 (95% confidence interval 0.7–46.9) was found for five risk factors, though the small sample size rendered the results non-significant. An explorative analysis combining children with four and five risk factors did not reveal any significant clustering either. Conclusions: No clustering of risk factors was found among Norwegian children aged 6–12 years.

Pharmacist Hypertension Management Quality Review at an Ambulatory Care Clinic

2021 ◽  
pp. 875512252110642
Author(s):  
Kayla Chonko ◽  
Sandra Axtell ◽  
Bianca Mayzel
Keyword(s):  
Blood Pressure ◽  
Ambulatory Care ◽  
Small Sample Size ◽  
Small Sample ◽  
Blood Pressure Goal ◽  
Care Clinic ◽  
Prospective Group ◽  
Collaborative Practice Agreement ◽  
Ambulatory Care Clinic ◽  
The Impact

Background: A reduction of 10 mm Hg in systolic blood pressure (SBP) significantly decreases the risk of major cardiovascular disease events. Pharmacists’ management of blood pressure may assist with this reduction. Objective: Assess the impact of pharmacist management of hypertension via a collaborative practice agreement with physicians in an ambulatory care clinic. Methods: The first phase of this study was a retrospective chart review of physician/nurse hypertension visits from October 2019 to August 2020. The second prospective phase consisted of pharmacist managed hypertension visits from December 2020 to January 2021. The primary outcome was the change in SBP from the beginning to the end of the study period in the prospective group. Secondary outcomes included the proportion of patients achieving their blood pressure goal and the proportion of patients adherent to all antihypertensive medications at their follow-up visits in both groups. This study was institutional review board approved. Results: Forty-seven patients were included and analyzed (24 in the retrospective group and 23 in the prospective group). Patients in the prospective group had an average SBP lowering of 10.83 mm Hg ( P = .0035). Thirteen patients (56.5%) met their blood pressure goal of <130/80 mm Hg in the prospective group, compared to 5 patients (20.8%) in the retrospective group ( P = .012). One adverse event occurred during this study. Limitations included small sample size and short duration of study. Conclusion: Patients had an average SBP lowering of >10 mm Hg. More patients reached a goal blood pressure of <130/80 mm Hg when managed by pharmacists.

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