Blood pressure INDEX

Newman AB, Sutton-Tyrell K, Voget MT, Kuller LH. Morbidity and mortality in hypertensive adults with a Low Ankel/Arm Blood Pressure Index. JAMA 1993 270 487-489. 

An effective HE or cost-effectiveness analysis is designed to answer certain questions, such as Is the treatment effective What will it cost and How do the gains compare with the costs By combining answers to all of these questions, the technique helps decision makers weigh the factors, compare alternative treatments, and decide which treatments are most appropriate for specific situations. Typically, one chooses the option with the least cost per unit of measure gained the results are represented by the ratio of cost to effectiveness (C E). With this type of analysis, called a cost-effectiveness analysis (CEA), various disease end points that are affected by therapy (risk markers, disease severity, death) can be assessed by corresponding indexes of therapeutic outcome (mmHg blood pressure reduction, hospitalizations averted, life years saved, respectively). It is beyond the scope of this chapter to elaborate further on principles of cost-effectiveness analyses. A number of references are available for this purpose [11-13]. 

Several scoring systems are available for assessing the severity of the pneumonia the Pneumonia Severity Index (PSI), Confusion, Urea, Respiratory Rate, and Blood Pressure (CURB), and CURB-65 (those 65 years and older).9,24 Some... 

Norepinephrine is a potent a-adrenergic agent with less pronounced P-adrenergic activity. Doses of 0.01 to 3 mcg/kg per minute can reliably increase blood pressure with small changes in heart rate or cardiac index. Norepinephrine is a more potent agent than dopamine in refractory septic shock.24,27-28... 

The relationship of PbB level to systolic and diastolic blood pressure was determined in a study of 89 Boston policemen (race not specified) (Weiss et al. 1986, 1988). These policemen were under observation for health outcomes related to environmental work exposures (i.e., they had traffic exposure histories). After statistically adjusting for previous systolic blood pressure, body mass index, age, and cigarette smoking, high PbB level ( 30 pg/dL) was a significant (p=0.01) predictor of subsequent elevation in systolic blood pressure of 1.5-11 mm Hg in the working policemen with normal blood pressure. Low PbB level (20-29 pg/dL) was not a predictor of subsequent systolic blood pressure elevations. Diastolic pressure was unrelated to PbB levels. 

Simple correlational analysis of the NHANES II data by Harlan (1988) and Harlan et al. (1985) revealed statistically significant associations between PbB levels and systolic and diastolic blood pressure for both men and women, aged 12-74 years. Statistical analyses controlling for a number of other potentially confounding factors (e.g., age, race, and body mass index), however, indicated significant associations between PbB level and blood pressure only for the men. Based on these analyses, the effect of PbB concentration on blood pressure was estimated to be an increase in blood pressure of 7 mm Hg at PbB levels between 14 and 30 pg/dL. 

A negative correlation was found between PbB and systolic pressure in Belgian men in the Cadmibel study (a cross-sectional population study of the health effects of environmental exposure to cadmium) (Staessen et al. 1991). In this study, blood pressure and urinary cation (positive ions found in the urine, such as sodium, potassium, and calcium) concentration data were obtained from 963 men and 1,019 women multiple stepwise regression analyses were conducted adjusting for age, body mass index, pulse... 

A study of 398 male and 133 female civil servants in London, England, measured blood pressure, PbB, and serum creatinine concentration the study found no correlation between blood pressure and PbB after adjustment for significant covariates, including sex, age, cigarette smoking, alcohol intake, and body mass index in a stepwise multiple regression analysis (Staessen et al. 1990). 

Sodium nitroprusside is a mixed arterial-venous vasodilator that acts directly on vascular smooth muscle to increase cardiac index and decrease venous pressure. Despite its lack of direct inotropic activity, nitroprusside exerts hemodynamic effects that are qualitatively similar to those of dobutamine and milrinone. However, nitroprusside generally decreases PAOP, SVR, and blood pressure more than those agents do. 

Cardiac index and blood pressure must be sufficient to ensure adequate organ perfusion, as assessed by alert mental status, creatinine clearance sufficient to prevent metabolic azotemic complications, hepatic function adequate to maintain synthetic and excretory functions, a stable heart rate and rhythm, absence of ongoing myocardial ischemia or infarction, skeletal muscle and skin blood flow sufficient to prevent ischemic injury, and normal arterial pH (7.34 to 7.47) with a normal serum lactate concentration. These goals are most often achieved with a cardiac index greater than 2.2 L/min/m2, a mean arterial blood pressure greater than 60 mm Hg, and PAOP of 25 mm Hg or greater. 

Dopamine in doses greater than 5 mcg/kg/min is used to support blood pressure and to increase cardiac index. Low dose dopamine (1 to 5 meg/ kg/min) is not effective to increase renal and mesenteric perfusion. 

Dobutamine (in doses of 2 to 20 mcg/kg/min) is an a-adrenergic inotropic agent that many clinicians prefer for improving cardiac output and oxygen delivery. Dobutamine should be considered in severely septic patients with adequate filling pressures and blood pressure but low cardiac index. 

Weight should be monitored monthly for 3 months, then quarterly. Body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile should be monitored at the end of 3 months, then annually. The use of patient self-assessments are encouraged. 

Nekooeian, A.A. and Tabrizchi, R., Effects of adenosine a2 receptor agonist, cgs 21680, on blood pressure, cardiac index and arterial conductance in anaesthetized rats, Eur. J. 

Since GABA-ergic synapses are confined to neural tissues, specific inhibition of central nervous functions can be achieved for instance, there is little change in blood pressure, heart rate, and body temperature. The therapeutic index of benzodiazepines, calculated with reference to the toxic dose producing respiratory depression, is greater than 100 and thus exceeds that of barbiturates and other sedative-hypnotics by more than tenfold. Benzodiazepine intoxication can be treated with a specific antidote (see below). 

A 38-year-old man with a family history of cardiovascular and cerebrovascular disease makes an appointment for a routine physical examination with a physician he has not seen before. He explains that his father died young of a heart attack and that two paternal uncles have suffered strokes in their late 40s. Physical examination reveals yellowish lumps on his eyelids (xanthelasmas, which are often associated with a lipid disorder) and a resting blood pressure of 186/95 mm Hg. There is some excess visceral fat, and his body mass index calculates to 26.5. Total serum cholesterol (476 mg/dL) and triglycerides (288 mg/dL) are elevated and subsequent angiography reveals atherosclerotic restrictions of at least two coronary arteries. 

Dofetilide does not significantly alter the mean arterial blood pressure, cardiac output, cardiac index, stroke volume index, or systemic vascular resistance. There is a slight increase in the delta pressure/delta time (dP/dt) of ventricular myocytes. 

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