Diastolic BP

Systolic BP less than 220 mm Hg or diastolic BP less than 120 mm Hg... 

During and after treatment, if diastolic BP is greater than 140 mm Hg... 

Slow continuous infusion - Give at a rate of 3 mL/min (2 mg/min). Continue infusion until satisfactory response is obtained then discontinue infusion and start oral labetalol. Effective IV dose range is 50 to 200 mg, up to 300 mg. Transfer to oral dosing (hospitalized patients) Begin oral dosing when supine diastolic BP begins to rise. Recommended initial dose is 200 mg, then 200 or 400... 

Diastolic BP (DBP), which measures the pressure in the arteries when the heart is at rest, was largely unaffected by the intervention. Systolic BP (SBP), or the maximum pressure exerted when the heart contracts, did change in response to CCM supplementation in most children. The data specifically showed that over 12 weeks, children in the lowest quartile of baseline daily Ca intake (150- < 347 mg/1000 kcal) were affected most significantly by CCM supplementation in terms of a reduction in systolic BP (effect estimate -3.5 mm Hg), whereas children in the highest quartile of baseline daily Ca intake (514- < 882 mg/1000 kcal) demonstrated no appreciable reduction in systolic BP due to CCM supplementation. Children in quartiles two and three of the baseline Ca intake benefited from a CCM-induced reduction in SBP with the effect estimated to be -2.8 mm Hg and -1.3 mm Hg, respectively. The overall trend for the estimated effect of Ca intake on BP across quartiles was highly significant p = 0.009). 

Be alert to excessive vasoconstriction as evidenced by decreased urine output, disproportionate increase in diastolic BP, and increased arrhythmias or heart rate. Slow or temporarily stop the dopamine infusion and notify the physician if excessive vasoconstriction occurs... 

Mechanism of Action A rapid-acting vasodilator. An agonist for Dj -like dopamine receptors also produces vasodilation in coronary, renal, mesenteric, and peripheral arteries, Therapeutic Effect Reduces systolic and diastolic BP and increases heart rate. Pharmacokinetics After IV administration, metabolized in the liver. Primarily excreted in urine. Unknown if removed by hemodialysis, Half-Hfe Approximately 5 min. 

Headache, rash, temporary decrease in diastolic BP with mild reflex tachycardia, short periods of atrial fibrillation (in hyperthyroid patients), marked drop in BP (in hypertensive patients)... 

In a collection of four placebo-controlled trials in hypertension a difference of 4mmHg in terms of mean fall in diastolic bp is to be considered of clinical importance anything less is unimportant. The results, are given in Table 9.2, where gUj and p.2 re the mean reductions in diastolic bp in the active and placebo groups respectively. 

The ideal range for adult BP is 120-140 mmHg systolic and 75-80 mmHg diastolic BP varies over the day and from day to day. 

BP +15.7 and diastolic BP +8.5, thus ehminating the biologic diurnal variation. 

Two studies that compared the interaction of celecoxib with ACE inhibitors found no difference in blood pressure effects compared to placebo [58, 59]. In one study (n=359), the blood pressure (systohc and diastolic) effects of celecoxib 200 mg BID and nabumetone 1 g BID were found to be similar to placebo, but significantly different from ibuprofen 800 mg IID [58]. In the second study (n=178), the effects of celecoxib 400 mg daily and placebo on 24-hour blood pressure in hypertensive patients controlled on hsinopiil 10-40 mg daily was evaluated [59]. No difference between groups was observed in 24-hour ambulatory SBP. The difference between groups in 24-hour diastolic BP was only 1.4 mm Hg. The change from baseline in 24-hour blood pressure (1.8 mm Hg/1.4mm Hg) is less than what has been the effect of NSAIDs on the SBP (defined as an increase >20 mm Hg with an absolute value of >140 mm Hg) reported for traditional NSAIDs in ACE inhibitor-treated patients. On the other hand, co-ad-ministration of rofecoxib 25 mg daily with benazepril 10-40 mg for 4 weeks in patients with mild to moderate... 

Figure 2. Effect of enantiomers 35 and 37 in SHRs (10 mg/kg po). [Diastolic bp was monitored using a tail cuff at 5-10 min intervals following po administration of test compounds in suspension in 1% w/v methylcellulose to groups of 3 SHRs. Standard errors were determined and fell within the limits of the data points.]...

Arterial BP is the measnred pressnre in the arterial wall in millimeters of mercury. Two arterial BP values are typically measured, systolic BP (SBP) and diastolic BP (DBP). SBP is achieved during cardiac contraction and represents the peak valne. DBP is achieved after contraction when the cardiac chambers are filling and represents the nadir value. The difference between SBP and DBP is called the pulse pressure and indicates arterial wall tension. Mean arterial pressnre (MAP) is the average pressure throughout the cardiac cycle of contraction. It is sometimes used clinically to represent overall arterial BP. During a cardiac cycle, two-thirds of the time is spent in diastole and one-third in systole. Therefore, the MAP can be estimated by using the following equation ... 

Dopamine DA is probably not a natural transmitter in periphery but can be released from some sympathetic fibers. When infused, it has dose-dependent actions on DA and adrenoceptors. Low dose increases renal/mesenteric blood flow via Dj activation —> T RBF and GFR. Medium dose t CO (positive inotropy) via (3j activation. Useful in management of shock states. Very high dose causes vasoconstriction—t systolic and diastolic BP via a, activation. 

Answer C. A decrease in mean blood pressure, an increase in pulse pressure, plus a marked increase in heart rate are characteristic of a drug like isoproterenol. PVR and mean BP are decreased because of activation of p2 receptors in the vasculature. Systolic BP decreases less than diastolic BP because of activation of receptors in the heart, leading to an increase in stroke volume, as well as the increase in heart rate. 

The relationship between BP and cardiovascular risk has largely been determined in middle-aged and older people, but above-normal BP in young adulthood is also related to increased long-term cardiovascular and all-cause mortality. Indeed, in people younger than 50 years, diastolic BP level is the major predictor of cardiovascular risk, whereas systolic BP is the major predictor in those older than 60 years. 

Based on the above considerations, it is conceivable that some hemodynamic adjustments (i.e., cardiac output and vascular changes) may also follow primary modifications in metabolic demand. In this context, the decrease in cardiac output and increase in peripheral arterial resistance and diastolic BP in the hypothyroid state may be interpreted as the final result of an adaptive response to the reduction in tissue metabolic activities. 

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