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Adnan I. Qureshi - One of the best experts on this subject based on the ideXlab platform.
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Ultra-Early Blood Pressure Reduction Attenuates Hematoma Growth and Improves Outcome in Intracerebral Hemorrhage.
Annals of neurology, 2020Co-Authors: Andrew D. Warren, Adnan I. Qureshi, Andrea Morotti, Guido J. Falcone, Kevin N. Sheth, Ashkan Shoamanesh, Dar Dowlatshahi, Anand Viswanathan, Joshua N. GoldsteinAbstract:Objective The aim was to investigate whether intensive blood Pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH) patients who received intravenous nicardipine treatment ≤2 hours after onset of symptoms. Methods A post-hoc exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial was performed. This was a multicenter, international, open-label, randomized clinical trial, in which patients with primary ICH were allocated to intensive versus standard blood Pressure treatment with nicardipine ≤4.5 hours after onset of symptoms. We have included 913 patients with complete imaging and follow-up data in the present analysis. Results Among the 913 included patients, 354 (38.7%) had intravenous nicardipine treatment initiated within 2 hours. In this subgroup of patients treated within 2 hours, the frequency of ICH expansion was significantly lower in the intensive blood Pressure Reduction group compared with the standard treatment group (p = 0.02). Multivariable analysis showed that ultra-early intensive blood Pressure treatment was associated with a decreased risk of hematoma growth (odds ratio, 0.56; 95% confidence interval [CI], 0.34-0.92; p = 0.02), higher rate of functional independence (odds ratio, 2.17; 95% CI, 1.28-3.68; p = 0.004), and good outcome (odds ratio, 1.68; 95% CI, 1.01-2.83; p = 0.048) at 90 days. Ultra-early intensive blood Pressure Reduction was associated with a favorable shift in modified Rankin Scale score distribution at 3 months (p = 0.04). Interpretation In a subgroup of ICH patients with elevated blood Pressure given intravenous nicardipine ≤2 hours after onset of symptoms, intensive blood Pressure Reduction was associated with reduced hematoma growth and improved functional outcome. ANN NEUROL 2020;88:388-395.
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Systolic Blood Pressure Reduction and Risk of Acute Renal Injury in Patients with Intracerebral Hemorrhage
The American Journal of Medicine, 2012Co-Authors: Adnan I. Qureshi, Yuko Y. Palesch, Renee H. Martin, Jill Novitzke, Salvador Cruz Flores, As’ad Ehtisham, Joshua N. Goldstein, Jawad F. Kirmani, Haitham M. Hussein, M. Fareed K. SuriAbstract:Abstract Background Aggressive systolic blood Pressure Reduction may precipitate acute renal injury because of underlying hypertensive nephropathy in patients with intracerebral hemorrhage. The study's objective was to determine the rate and determinants of acute renal injury during acute hospitalization among subjects with intracerebral hemorrhage using a post hoc analysis of a multicenter prospective study. Methods Subjects with intracerebral hemorrhage and elevated systolic blood Pressure of 170 mm Hg or greater who presented within 6 hours of symptom onset and underwent treatment of acute hypertensive response and fluid management as per study and local protocols, respectively. Acute renal injury was defined post hoc using the criteria used in Acute Kidney Injury Network classifications within 72 hours of admission. Descriptive statistics and standard statistical tests were used to characterize and evaluate the effect of systolic blood Pressure Reduction parameters (relative to initial systolic blood Pressure) and average maximum hourly dose of nicardipine on the occurrence of acute renal injury. Results A total of 60 subjects were recruited (57% were men; mean age of 62.0±15.1 years). Five subjects (9%) had stage I acute renal injury according to the Acute Kidney Injury Network criteria. None of the subjects had stage II or III acute renal injury. The serum creatinine course for the first 3 days suggested that the peak elevation of creatinine was seen at 18, 30, 57, 58, and 71 hours after baseline measurements in these 5 subjects, all of which except for the first one were beyond the protocol-specified treatment period. The incidences of neurologic deterioration and symptomatic hematoma expansion were significantly greater in the subjects with stage I renal impairment. The systolic blood Pressure Reduction parameters (in particular, the area under the curve depicting the 24-hour systolic blood Pressure summary statistic) and the higher average maximum hourly nicardipine dose were strongly associated with stage I renal impairment. Conclusions Although acute renal injury is infrequent and mild among subjects with intracerebral hemorrhage undergoing systolic blood Pressure Reduction, a trend in association between systolic blood Pressure Reduction and renal impairment was observed in this small study. Therefore, it is important to carefully monitor the renal function when administering treatment to reduce systolic blood Pressure in patients with intracerebral hemorrhage.
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Blood Pressure Reduction in secondary stroke prevention.
Continuum (Minneapolis Minn.), 2011Co-Authors: Adnan I. Qureshi, Biggya L. SapkotaAbstract:PURPOSE OF REVIEW: : Risk factor modification plays an important role in recurrent stroke prevention. These modifiable risk factors tend to cluster in stroke patients, but for a significant subgroup the only identifiable risk factor is high blood Pressure or chronic hypertension. This article reviews the current evidence for management of blood Pressure in secondary stroke prevention. RECENT FINDINGS: : Over the years, data from primary prevention trials have shown that antihypertensive drug treatment reduces the risk of first stroke by 32%. Similarly, various secondary prevention studies have shown a relative risk Reduction in recurrent strokes of up to 30%. These trials have also shown that the impact of blood Pressure Reduction in stroke prevention is similar in patients with hypertension and patients without hypertension, and larger Reductions in systolic blood Pressure were associated with greater Reduction in risk of recurrent stroke. SUMMARY: : Although it is clear from the current evidence that long-term blood Pressure control is one of the most important interventions for secondary stroke prevention, the optimal management of blood Pressure in the immediate poststroke period is not well defined.
Paul C. Johnson - One of the best experts on this subject based on the ideXlab platform.
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Diameter changes in skeletal muscle venules during arterial Pressure Reduction.
American journal of physiology. Heart and circulatory physiology, 2000Co-Authors: Jeffrey J. Bishop, Patricia R. Nance, Aleksander S. Popel, Marcos Intaglietta, Paul C. JohnsonAbstract:Previous studies in skeletal muscle have shown a substantial (>100%) increase in venous vascular resistance with arterial Pressure Reduction to 40 mmHg, but a microcirculatory study showed no signi...
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Arteriolar network response to Pressure Reduction during sympathetic nerve stimulation in cat skeletal muscle
American Journal of Physiology-Heart and Circulatory Physiology, 1994Co-Authors: Peipei Ping, Paul C. JohnsonAbstract:Previous studies in this laboratory have shown that autoregulation of blood flow and dilation of midsized (second-order) arterioles were significantly enhanced during sympathetic nerve stimulation of cat sartorius muscle apparently because of a greater myogenic response of the arterioles. Quite typically, blood flow increased with arterial Pressure Reduction to 80, 60, and 40 mmHg (superregulation) during sympathetic nerve stimulation. To determine the contribution of the various orders of arterioles to the enhanced autoregulation, we measured diameters in all orders of arterioles and measured red cell velocity in first-, second-, and third-order arterioles. Without sympathetic nerve stimulation, all orders of arterioles except the first order dilated to Pressure Reduction, but flow autoregulation was weak. With sympathetic nerve stimulation, arteriolar dilation to Pressure Reduction was significantly enhanced in all six orders of arterioles, and flow rose significantly. The resistance change in the arteriolar network during Pressure Reduction as calculated from diameter changes was greatest in third- and fourth-order arterioles. Experimentally determined flow changes to Pressure Reduction and to sympathetic nerve stimulation were quantitatively similar to those predicted from diameter changes in a model of the arteriolar network. Calculated wall shear stress (from viscosity and shear rate) for first-, second-, and third-order arterioles decreased during Pressure Reduction with and without sympathetic nerve stimulation. We concluded that endothelium-mediated dilation due to shear stress would tend to oppose autoregulation of blood flow to a similar degree under both circumstances.
Michael Schulzer - One of the best experts on this subject based on the ideXlab platform.
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The effectiveness of intraocular Pressure Reduction in the treatment of normal-tension glaucoma
American journal of ophthalmology, 1998Co-Authors: Douglas R. Anderson, Stephen M. Drance, Michael SchulzerAbstract:In a companion paper, we determined that intraocular Pressure is part of the pathogenesis of normal-tension glaucoma by analyzing the effect of a 30% intraocular Pressure Reduction on the subsequent course of the disease. We report an intent-to-treat analysis of the study data to determine the effectiveness of Pressure Reduction. One eligible eye of 145 subjects with normal-tension glaucoma was randomized either to no treatment (control) or to a 30% intraocular Pressure Reduction from baseline. To be eligible for randomization, the normal-tension glaucoma eyes had to show documented progression of field defects or a new disk hemorrhage or had to have field defects that threatened fixation when first presented for the study. Survival analysis compared time to progression of all randomly assigned patients during the course of follow-up from the initial baseline at randomization. In a separate analysis, data of patients developing cataracts were censored at the time that cataract produced 2 lines of Snellen visual acuity loss. Visual field progression occurred at indistinguishable rates in the Pressure-lowered (22/66) and the untreated control (31/79) arms of the study (P = .21). In an analysis with data censored when cataract affected visual acuity, visual field progression was significantly more common in the untreated group (21/79) compared with the treated group (8/66). An overall survival analysis showed a survival of 80% in the treated arm and of 60% in the control arm at 3 years, and 80% in the treated arm and 40% in the controls at 5 years. The Kaplan-Meier curves were significantly different (P = .0018). The analyses gave different results because of a higher incidence of cataract in the group that underwent filtration surgery. The favorable effect of intraocular Pressure Reduction on progression of visual change in normal-tension glaucoma was only found when the impact of cataracts on visual field progression, produced largely by surgery, was removed. Lowering intraocular Pressure without producing cataracts is beneficial. Because not all untreated patients progressed, the natural history of normal-tension glaucoma must be considered before embarking on intraocular Pressure Reduction with therapy apt to exacerbate cataract formation unless normal-tension glaucoma threatens serious visual loss.
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Intraocular Pressure Reduction in Normal-tension Glaucoma Patients
Ophthalmology, 1992Co-Authors: Michael Schulzer, Douglas R. Anderson, P. J. Airaksinen, Wallace L.m. Alward, Marcel Amyot, Gordon Balazsi, P. Blondeau, L.f. Cashwell, John S. Cohen, Daniel Christian DesjardinsAbstract:Background: In a collaborative study, patients with untreated normal-tension glaucoma were randomly assigned to a marked intraocular Pressure Reduction group or to a no therapy group. It was anticipated that medical therapy and laser trabeculoplasty would generally not achieve adequate Pressure lowering and that fistulizing surgery would be required. This hypothesis was examined using current observations in the study. Methods: Patients randomized to the therapy group had a Pressure Reduction of at least 30% from their last prerandomization level. This was achieved within 6 months by means of fistulizing surgery or with pilocarpine and/or laser trabeculoplasty. Betablockers and adrenergic agonists were excluded from both eyes. Results: Of 30 patients with documented stable 30% Pressure Reduction, 17 (57%) achieved this with topical medication and/or laser trabeculoplasty: 8 with pilocarpine alone, 2 with laser trabeculoplasty alone, and 7 with laser trabeculoplasty after initial topical medication. The remaining 13 (43%) patients required a single fistulizing procedure. There was no statistically significant difference between the mean follow-up time for the nonfistulized group (533.8 ± 437.6 days) and for the fistulized group (502.7 ± 344.7 days). Both treatment groups had similar baseline profiles. Conclusion: Marked Pressure Reduction can be achieved and maintained on a longterm basis by means other than fistulizing surgery in a large proportion of patients with untreated normal-tension glaucoma.
Joanne M. Foody - One of the best experts on this subject based on the ideXlab platform.
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Blood Pressure Reduction in the primary and secondary prevention of stroke.
Current vascular pharmacology, 2006Co-Authors: Seth I. Sokol, John R Kapoor, Joanne M. FoodyAbstract:Control of hypertension is well established for the primary prevention of stroke. Prior studies, on the other hand, conflict over whether hypertension remains a risk factor for recurrent stroke and if blood Pressure Reduction is associated with better outcomes in this subset of patients. We review current evidence regarding the role of BP lowering for primary and secondary prevention of stroke. Current evidence amassed from both primary and secondary prevention trials demonstrate that BP Reduction is a crucial common element in overall Reduction of stroke risk.
Hongshun Yang - One of the best experts on this subject based on the ideXlab platform.
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Effects of Pressure Reduction rate on quality and ultrastructure of iceberg lettuce after vacuum cooling and storage
Postharvest Biology and Technology, 2004Co-Authors: Guoping Feng, Hongshun YangAbstract:A study was conducted to determine if the Pressure Reduction rate in a vacuum cooler would have an effect on the physical and chemical quality characteristics as well as the ultrastructure of iceberg lettuce after cooling and storage. Three different Pressure Reduction rates were taken to cool iceberg lettuce in a vacuum cooler. Subsequently, vacuum cooled lettuce were stored at 1 °C and 85% relative humidity (RH) for 2 weeks. The changes of mass, firmness, ascorbic acid, chlorophyll, catalase, and ultrastructure were measured throughout the storage period to decide the quality variation induced by different Pressure Reduction rates. The results of physical and chemical tests agreed well with the result of transmission electron microscopy (TEM), which showed that the moderate Pressure Reduction rate achieved the maximum values of tissue firmness, ascorbic acid and catalase. Membrane systems observed by TEM under the moderate Pressure Reduction rate were kept intact compared to the other two Pressure Reduction rates. The moderate Pressure Reduction rate achieved the best quality and shelf-life of iceberg lettuce.
