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Pheochromocytoma/paraganglioma (PPGL)-related hypercatecholaminemic crisis is a rare lethal condition caused by uncontrolled catecholamine secretion, occasionally leading to critical fluctuation in blood pressure (BP). Emergent transcatheter arterial embolization (TAE) has been employed for spontaneous PPGL rupture, but never, to our knowledge, for critical fluctuation in BP associated with PPGL-related hypercatecholaminemic crisis. We describe here our experience utilizing this method to control critical fluctuation in BP associated with this crisis in a 44-year-old man with an unruptured retroperitoneal paraganglioma. The patient experienced sudden severe left abdominal pain and came to our emergency department, where he exhibited severe fluctuation in BP and underwent laboratory testing that showed hypercatecholaminuria and computed tomography (CT) that revealed a left retroperitoneal tumor with no apparent intra- or retroperitoneal hematoma. We performed emergent TAE from the left inferior phrenic artery using gelatin sponge, which stabilized his BP and relieved his abdominal pain. Histologic examination following elective surgical resection of the tumor confirmed our diagnosis of unruptured retroperitoneal paraganglioma. We believe that TAE represents an important option for the emergent treatment of the critical BP fluctuation associated with PPGL-related hypercatecholaminemic crisis.

Hypotension, blood pressure fluctuation, and endothelial impairment indicate possible additive pathophysiological aspects in the development of posterior reversible encephalopathy syndrome in children on peritoneal dialysis.

Treatment with a combination of norepinephrine and doxazosin was effective in a patient with pheochromocytoma who had blood pressure fluctuation, hypotension, and recurrent syncope. After adrenalectomy, his blood pressure, heart rate, and plasma levels of catecholamines remained normal and stable without any medication. (Level of Difficulty: Beginner.), Graphical abstract, Treatment with a combination of norepinephrine and doxazosin was effective in a patient with pheochromocytoma who had blood pressure fluctuation…

Hypertension or high blood pressure is sometimes called a "silent killer", since it has no warning signs, yet it can lead to life-threatening conditions. The good news is prevention and treatment for hypertension can be done with early diagnosis. So, there is a need for real time monitoring of blood pressure that can be done using Internet of Things (IoT) assisted health monitoring system. The proposed system collects the user’s health parameters using IoT sensors and identifies the stage of hypertension. The vital point of this system is to continuously generate emergency alerts of blood pressure fluctuation and dangerous changes in any other health parameters to hypertensive users on their mobile phones.

Blood pressure (BP) fluctuates widely during the acute phase of stroke. Compared to single BP assessment, patterns of BP over time may have greater power in predicting stroke outcome. This study aims to investigate the effect of BP fluctuation patterns on stroke outcomes in acute ischemic stroke (IS) patients. IS patients within 24 h of onset registered in the BOSS registry between 2012 and 2014 were analyzed. Fluctuation of BP was predefined as the change trend in systolic BP (SBP) from Day 1 to Day 7 after onset and was used to divide patients into groups with sustained high SBP (≥160 mmHg) during the first 7 days (C1); rapid (C2: within the first 2 days) or delayed (C3: after 2 days) decline from high (≥160 mmHg) to low (

Background: White matter lesions (WMLs) are highly prevalent in older adults, and hypertension is one of the main contributors to WMLs. The blood pressure (BP) is regulated by complex underlying mechanisms over multiple time scales, thus the continuous beat-to-beat BP fluctuation is complex. The association between WMLs and hypertension may be manifested as diminished complexity of BP fluctuations. The aim of this pilot study is to explore the relationships between hypertension, BP complexity, and WMLs in older adults.Method: Fifty-three older adults with clinically diagnosed hypertension and 47 age-matched older adults without hypertension completed one MRI scan and one BP recording of 10–15 min when sitting quietly. Their cerebral WMLs were assessed by two neurologists using the Fazekas scale based on brain structural MRI of each of their own. Greater score reflected higher WML grade. The complexity of continuous systolic (SBP) and diastolic (DBP) BP series was quantified using multiscale entropy (MSE). Lower MSE reflected lower complexity.Results: Compared to the non-hypertensive group, hypertensives had significantly greater Fazekas scores (F > 5.3, p < 0.02) and lower SBP and DBP complexity (F > 8.6, p < 0.004). Both within each group (β < −0.42, p < 0.01) and across groups (β < −0.47, p < 0.003), those with lower BP complexity had higher Fazekas score. Moreover, complexity of both SBP and DBP mediated the influence of hypertension on WMLs (indirect effects > 0.25, 95% confidence intervals = 0.06 – 0.50).Conclusion: These results suggest that diminished BP complexity is associated with WMLs and may mediate the influence of hypertension on WMLs. Future longitudinal studies are needed to examine the causal relationship between BP complexity and WMLs.

Background: Hypertension is the most common disease found in the community, not only lowers quality of life, but can be life-threatening. Hypertension is known as heterogeneous group of disease because it can affect anyone from different age groups and various economic classes. One of the non-pharmacological therapy for hypertension is yoga exercises. Research Objectives: To determine the effect of yoga exercises on blood pressure in hypertensive patients in Sumokali village, Candi district, Sidoarjo regency. Research Method: This research method using one group pre test - post test design. The sampling technique used simple random sampling, with population of hypertension patients in Sumokali Village, Candi District of Sidoarjo Regency and a large sample of 18 people according to criteria. Data collection used interval scale and instrument used is observation sheet. This yoga exercise was done for 2 weeks in the morning or afternoon. Result: The result of Paired T-Test test shows that the value of ρ-Value (0,000)

Herein is described a case of neonatal neuroblastoma with cyclic blood pressure fluctuation and elevated catecholamines. The fluctuations stabilized after treatment with α-adrenergic blocker and the perioperative course was uneventful. The possibility of catecholamine-related symptoms including hypertension, heart failure, and blood pressure fluctuations should be considered in the treatment for neuroblastoma; if they are present, treatment with α-blockers is effective.

Authors have collected and analyzed literature data on blood pressure variability. They present the methods of blood pressure variability measurement, clinical value and relationships with target organ damages and risk of presence of cardiovascular events. They collect data about the prognostic value of blood pressure variability and the effects of different antihypertensive drugs on blood pressure variability. They underline that in addition to reduction of blood pressure to target value, it is essential to influence blood pressure fluctuation and decrease blood pressure variability, because blood pressure fluctuation presents a major threat for the hypertensive subjects. Data from national studies are also presented. They welcome that measurement of blood pressure variability has been included in international guidelines.A szerzők összefoglalják és elemzik a vérnyomás-variabilitásról szóló irodalmi adatokat. Bemutatják a vérnyomás-variabilitás mérési típusait, azok klinikai értékét, összefüggésüket a szervi károsodásokkal és a cardiovascularis események megjelenésének kockázatával. Jellemzik a prognosztikai értékre vonatkozó adatokat és áttekintik a különböző antihipertenzív szereknek a vérnyomás-variabilitásra kifejtett hatásait. Véleményük szerint ma már bizonyítottnak tekinthető, hogy a hypertonia kezelése során a vérnyomáscélérték elérése mellett törekedni kell a vérnyomás-variabilitás csökkentésére, a vérnyomás-fluktuáció befolyásolására, mert ez jelenti az egyik legnagyobb veszélyt a hypertoniás egyén számára. Beszámolnak a hazai tapasztalatokról is. Reményteljesnek tartják, hogy a nemzetközi irányelvekben a vérnyomás-variabilitás mérése teret nyert. Orv. Hetil., 2014, 155(42), 1661–1672.

Objectives Blood pressure (BP) abnormalities have been known in Parkinson's disease (PD) patients. The present study aimed at determining how the BPs of PD patients fluctuate in a day. Methods A total of 37 PD patients and 44 OD (other disease) patients, all of who were inpatients, were monitored every 30 min by 24-h ambulatory blood pressure monitoring (ABPM). Results The average systolic BP and the number of patients who showed postprandial hypotension were not different between the two groups. However, occurrence of nocturnal hypertension, BP fluctuation of over 100 mmHg in a day and BP of over 200 mmHg were significantly more frequently observed in the PD patients than in the OD patients. In the PD patients, these parameters were not different between those who were suffering from the disease for less than 10 years and those with the disease for 10 years or longer, as well as between those who had a Hoehn–Yahr staging scale of 2–3 and those with a scale of 4–5. Conclusion Twenty-four-hour ABPM, not BP measurement once a day, enables us to determine the actual BP in PD patients. Although hypotension is a severe risk factor for falling and syncope, we emphasize the importance of monitoring rather hypertension and fluctuating BP in PD patients that may lead to a variety of other undesirable conditions. Management of hypotension, hypertension, and BP fluctuation is an important issue in the future.

We examined the relationship between an early spontaneous type V blood pressure fluctuation and the post-thrombolysis prognosis of patients with acute cerebral infarction. Patients were admitted consecutively. All patients were categorized into the type V blood pressure fluctuation group or non-type V blood pressure group. Their blood pressure was monitored before thrombolysis and until 6 h after thrombolysis. Baseline data and clinical outcomes were compared. Of 170 patients, 43 (25.2%) had an early type V blood pressure fluctuation. The National Institute of Health Stroke Scale (NIHSS) score before thrombolysis and 24 h after thrombolysis and the modified Rankin scale score at 90 days differed significantly between the two groups (P

Background: Migraine is a common disorder characterized by headache attacks frequently accompanied by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported as the probable responsible mechanisms. Because vestibular examination alone does not provide enough information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear. We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric posturography system and our study is the first study in which tetra-ataxiometric static posturography was used to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo. Objective: To investigate balance functions in migraineurs with and without vertigo with a tetra-ataxiometric posturography system. Study Design: Prospective, nonrandomized, controlled study. Setting: Pamukkale University Hospital, Neurology and Physical Therapy and Rehabilitation outpatient clinics. Methods: Sixteen patients with migrainous vertigo, 16 patients with migraine without aura and no vestibular symptoms, and 16 controls were included in the study. Computerized static posturography system was performed and statistical analyses of fall, Fourier, Stability, and Weight distribution indexes were performed. The tetra-ataxiometric posturography device measures vertical pressure fluctuations on 4 independent stable platforms, each placed beneath 2 heels and toe parts of the patient; inputs from these platforms are integrated and processed by a computer digitally. Four separate plates are used and perpendicular pressures of the anterior and posterior feet are measured. Pressure of each force plate is measured and data was analyzed by the software program. Limitations: A very small, non-randomized, and controlled study with the inability to find an answer to the mechanism of involvement of the somatosensorial system and vestibular system in migrainous headaches. Results: The distribution of patients with posturographical abnormalities in the migrainous vertigo group was significantly different than the control group. Distribution of the patients with posturographical abnormalities in the high frequencies of the head-right position was significantly different in the migrainous vertigo group than in the control group and distribution of the patients with posturographical abnormalities in high frequencies of the head-right position was significantly different in the migraine group than in the controls groups. The stability index of the migrainous vertigo group was significantly higher than in the control group when tested on in the neutral-head position with open eyes. Conclusion: In this first study of tetra-ataxiometric static posturography evaluating postural abnormalities in a well-defined population of patients with migrainous vertigo, the central part of the vestibular apparatus would be responsible of postural abnormalities in patients with migraine and migrainous vertigo. Key words: Fall index, migraine, migrainous vertigo, static posturography

Aims and objectives: To explore which sociodemographic and clinical factors could interfere in the parameters of ambulatory blood pressure monitoring and determine the affecting factors of Ambulato ...

BACKGROUND In some stroke patients blood pressure (BP) fluctuates extensively during medical rehabilitation, so the present study investigated the influence of autonomic nervous dysfunction on the change in BP during exercise. METHODS AND RESULTS The subjects consisted of 55 stroke inpatients (males, 29; mean age, 58.8 years old; ischemic/hemorrhagic etiology, 30/25) who were admitted to the Stroke Center within 2 weeks of their first stroke. The control group consisted of 15 age-matched healthy volunteers. The 24-h heart rate (HR) variability (HRV) and BP variability (BPV) were examined, and then the increase and recovery of BP and HR were measured during bicycle ergometer exercise at 4 METs. Components of 24-h HRV (low-frequency power (LF), high-frequency power (HF), LF/HF, and asleep-awake ratio of LF/HF (LF/HF(d-n)) were lower (p < 0.01) and BPV was greater in the stroke group (p < 0.05) than in the control group. There was a negative correlation between BP change during exercise and LF/HF or LF/HF(d-n) (r = -0.43 or r = -0.58, p < 0.01), and a greater increase in systolic BP (102 +/-9.8 mmHg, n = 7) during exercise was observed in stroke patients with lower LF/HF(d-n) (< or = 1.0). CONCLUSIONS Lower HRV in stroke patients may relate to an increase in BP during exercise. HRV is useful for estimating the risk during medical rehabilitation.

Objective The lack of generally accepted diagnostic criteria for neuroleptic malignant syndrome (NMS) impedes research and clinical management of patients receiving antipsychotic medications. The purpose of this study was to develop NMS diagnostic criteria reflecting a broad consensus among clinical knowledge experts, represented by an international multispecialty physician panel. Participants Eleven psychiatrists, 2 neurologists, 2 anesthesiologists, and 2 emergency medicine specialists participated in a formal Delphi consensus procedure. Evidence A core bibliography consisting of 12 prominent, current reviews of the NMS literature was identified by an objective, comprehensive electronic search strategy. Each panel member was given a copy of these references and asked to examine them before commencing the survey process. Consensus process After reviewing the core bibliography, panel members were asked to list any clinical signs or symptoms or diagnostic studies that they believed, on the basis of their knowledge and clinical experience, were useful in making a diagnosis of NMS. In subsequent survey rounds, panel members assigned priority points to these items, and items that failed to receive a minimum priority score were eliminated from the next round. Information about individual panel member responses was fed back to the group anonymously in the form of the group median or mean and the number of members who had ranked or scored each survey item. The a priori consensus endpoint was defined operationally as a change of 10% or less in the mean priority score for any individual item, and an average absolute value change of 5% or less across all items, between consecutive rounds. The survey was conducted from January 2009 through September 2009. Results Consensus was reached on the fifth round regarding the following criteria: recent dopamine antagonist exposure, or dopamine agonist withdrawal; hyperthermia; rigidity; mental status alteration; creatine kinase elevation; sympathetic nervous system lability; tachycardia plus tachypnea; and a negative work-up for other causes. The panel also reached a consensus on the relative importance of these criteria and on the following critical values for quantitative criteria: hyperthermia, > 100.4°F or > 38.0°C on at least 2 occasions; creatine kinase elevation, at least 4 times the upper limit of normal; blood pressure elevation, ≥ 25% above baseline; blood pressure fluctuation, ≥ 20 mm Hg (diastolic) or ≥ 25 mm Hg (systolic) change within 24 hours; tachycardia, ≥ 25% above baseline; and tachypnea, ≥ 50% above baseline. Conclusions These diagnostic criteria significantly advance the field because they represent the consensus of an international multispecialty expert panel, include critical values, provide guidance regarding the relative importance of individual elements, and are less influenced by particular theoretical biases than most previously published criteria. They require validation before being applied in clinical settings.

Background: Cardiovascular morphological changes are often conspicuous in autopsy examination of chronic hemodialysis (HD) patients. On the other hand, the fluctuation pattern in blood pressure (BP) during HD treatment varies from one patient to another. Cardiovascular changes may correlate with clinical findings including BP fluctuation patterns during HD, although no autopsy studies have previously examined this issue. Methods: In this study, 53 autopsies of patients who had been on chronic HD were reviewed. We determined the relationship between BP fluctuation during HD treatment along with stable and cardiovascular morphology, including heart weight, ventricular wall thickness, circumferences of the valves and the severity of aortic arteriosclerosis and coronary stenosis. Patients were divided into 4 groups according to the pattern of BP fluctuation during HD treatment at about 6 months before death: group 1 (n = 13), symptomatic hypotension and/or decline pattern during HD; group 2 (n = 11), continuously high BP during HD treatment; group 3 (n = 17), continuous normal BP during HD treatment, and group 4 (n = 12), continuously low BP without symptomatic hypotension during HD treatment. Results: Heart weight and ventricular wall thickness were greatest in group 2. The scores for aortic arteriosclerosis in groups 1 and 2 were higher than in groups 3 and 4. The coronary stenosis index was significantly higher in group 1 than in the other groups, and that in group 2 was higher than in group 4. Multiple regression analysis showed that age, HD duration and pulse pressure were independent variables for the score of arteriosclerosis, and the decline pattern of BP fluctuation during HD and pulse pressure were independent variables for coronary stenosis index. Conclusions: Our results suggest that certain clinical parameters including BP during HD may reflect cardiovascular morphological changes in stable HD patients, although further examination, such as 24-hour blood pressure measurement is recommended to elucidate the pathophysiology of cardiovascular diseases in HD patients.

Blood pressure variability is clinically relevant because of the evidence that the degree of blood pressure fluctuation may independently contribute to organ damage and to the cardiovascular risk of hypertensive patients. This review will focus on the evidence available to support this concept. As such, data obtained from cross-sectional studies, longitudinal studies in humans and experimental studies in animals will be discussed. The possibility of antagonizing an excessive degree of blood pressure variability by administering drugs to provide a long-lasting and smooth anti hypertensive action will also be discussed, as will the usefulness of mathematical indices aimed at quantifying the homogeneity of the blood pressure reduction by treatment. (C) 2001 Lippincott Williams Wilkins.

Hemodynamic responses, blood gas, and metabolic changes were assessed when large dosages of a pre-mixed solution of adenosine or adenosine triphosphate (ATP) with catecholamine were intravenously administered in the conscious, spontaneously breathing rabbit. The present study offers a simple and effective approach to enabling safe administration of large doses of the potent vasodilators, adenosine or ATP with minimal cardio-respiratory and metabolic changes.

ObjectivesTo develop consensus-based clinical diagnostic criteria for neuroleptic malignant syndrome (NMS).MethodsA 17-member international expert panel of psychiatrists, neurologists, anesthesiologists and emergency medicine specialists was asked to identify clinical features that are most important or valuable in diagnosing NMS; when the feature was quantitative in nature, they were also asked to provide the corresponding critical value. The Delphi technique is a formal consensus procedure that employs a postal survey method to solicit opinions from each panel member, and to feed this information back to the entire panel in the form of anonymous, statistically aggregated data. This iterative process of information exchanges (opinions collected, group responses analyzed, feedback given to panel), or “rounds”, continues until consensus has been reached. In the present study, the predetermined consensus criterion was a round-round mean change of 10% or less for any survey item, and 5% or less across all items.ResultsThe expert panel reached consensus on the following diagnostic criteria in five iterations:(1)exposure to a dopamine antagonist, or dopamine agonist withdrawal, within past 72 hours;(2)hyperthermia;(3)rigidity;(4)mental status alteration;(5)creatine phosphokinase elevation;(6)sympathetic nervous system lability (2 or more of blood pressure elevation, blood pressure fluctuation, diaphoresis, urinary incontinence);(7)tachycardia and tachypnea; and(8)negative work-up for infectious, toxic, metabolic and neurological causes.ConclusionsThese are the first consensus-based diagnostic criteria for NMS, and may be preferred to previous ad hoc approaches to diagnosing this disorder.

In Reply.— We would like to thank JM Perlman and JJ Volpe for their comments on our recent article.1 They were surprised that we did not observe the "excessive" levels of blood pressure fluctuation (coefficient of variation up to 30% or more) which they obtained for cerebral blood flow velocity in infants at greatest risk of developing IVH (Perlman et al2,3). We were surprised by this too; and, as we commented in the discussion, this disparity is difficult to explain.

A total of 22 infants of less than 31 weeks' gestation who were mechanically ventilated for a minimum of 12 hours for respiratory distress syndrome were studied. The coefficient of variation of direct systolic pressure was measured each minute from six to 36 hours of age and averaged per hour after birth with a microcomputer-based system of data collection. At the start of recording, the ultrasound scan appeared normal in each infant, but intraventricular hemorrhage developed in ten infants less than 36 hours of age. Twelve infants remained free of intraventricular hemorrhages. BP fluctuation was greater for a longer proportion of measured time in infants in whom intraventricular hemorrhage did not develop compared with those in whom it did develop P < .05). These findings do not support a causal relationship between BP fluctuation and intraventricular hemorrhage within the range of coefficient of variation studied.

The piqure of Cl. Bernard was performed on the non-anaesthetized dogs, the suprarenal glands of which were either extirpated with out fastening or causing any notable sensory stimulation or previously denedullated. The mean arterial blood pressure and the blood sugar concentration were followed, and the data were compared with the control experiments in which the suprarenals remained wholly uninterfered with, those in the present paper and those in the previous. 1) Generally speaking whether or not the epinephrine secretion is interfered with has no bearing upon the blood pressure fluctuation taking place on puncturing, but great influence on the blood sugar concentration. The piqure hyperglycaemia is definitely reduced when the suprarenals or their medullae are removed. When the epinephrine liberation was eliminated, the piqure also caused in most cases a definite rise of the blood pressure; the heart beat became slow. Occasionally an abrupt and transtiory fall preceded the rise of pressure; this is also observable in the control experiments.

Whole-day ambulatory blood pressure monitoring utilizing a portable non-invasive device (Pressurometer III) was performed in 34 normal subjects undertaking their usual activities at work and at home. To evaluate reproducibility, the monitoring procedure was repeated two to six weeks later in each subject. For all subjects together, the averages of the whole-day systolic or diastolic blood pressures on the two study days were not different from each other. For further analysis, each study day was divided into 12 two-hour periods; within each participant, the highest and lowest two-hour averages for systolic and diastolic blood pressures, and the times at which they occurred, were then identified. For the group as a whole, there were no differences between the two study days in the averages of the highest and lowest blood pressure values; moreover, the averages of the times at which they occurred corresponded closely. The blood pressure amplitudes, defined as the differences between the highest and lowest values during the day for each subject, were also similar on the two study days. Thus, as measured by the highest and lowest points of the circadian blood pressure fluctuations, the whole-day time-blood pressure pattern appears to be reproducible from day to day. Of interest is the fact that the amplitudes correlated closely with the standard deviations (regarded as indices of hour-to-hour variability) of the full 24-hour blood pressure averages, indicating that there might be a relationship between short-term blood pressure changes and the pattern of blood pressure for the day as a whole.

Examination during an episode of transient ischemic attack (TIA) was performed on 121 of 1,307 patients suspected of having a single type of TIA. This examination supported the diagnosis of TIA in 79 patients and contributed to the establishment of a diagnosis other than TIA in 42. Although the examination increased diagnostic reliability, it did not always result in a definite diagnosis. The most common neurologic findings during a TIA were weakness of an arm or side of the face. Important findings not suggested by history included visual defects and blood pressure fluctuation. Also unexpected were the absence of findings such as sensory deficits in the presence of sensory complaints, retinal emboli, and cardiac abnormalities. Severe arteriosclerotic disease was less evident, the attacks were longer and more severe, and monocular blindness was rare. ( JAMA 238:2512-2515, 1977)