Cardiovascular Effects of Implanted Acrylic Bone Cement

A pilot study has shown that there is usually but not invariably a fall in systemic arterial blood pressure within 90 seconds of implanting acrylic cement into the femoral shaft during hip arthroplasty. There is usually no change in arterial blood pressure on implanting acrylic cement into the acetabulum. The observed hypotension may be due to absorption of monomer or additives into the circulation, but the role of other factors needs investigation.     

Polymer composites for use in orthopedic surgery

Ever since Movin in (1950) and McKee in (1951) introduced the use of acrylic cement for fixation of hip prosthesis components a number of investigators have proposed various hip prosthesis designs using this cement fixation concept (Neale, 1967). This study was undertaken to support the hypothesis that certain dental materials could provide a more satisfactory bone-prosthesis bond than that presently possible with acrylic bone cement.^‡ Two restorative resins were found to have superior strength and resistance to thermal degradation when compared to acrylic bone cement. Tests of acrylic cement combined with apatite fillers suggest that restorative resin-anorganic bone composites would exhibit improved strength and toxicity properties and would also promote improved bonding due to resorption of the surface anorganic bone particles with subsequent bone infiltration and anchorage. Relatively high degradation of acrylic bone cement in accelerated aging tests suggests caution in using this material for implantation.     

雌激素、褪黑素、红细胞源性降压因子降压机制的研究进展

雌激素(estrogen)作为一种重要的类固醇激素,对心血管系统发挥着重要作用,雌激素被认为对心血管系统起着有益的保护作用,临床流行病学研究显示,女性在绝经前或围绝经期的高血压患病率显著低于同龄男性。女性绝经后雌激素缺乏是高血压发病率增加的主要原因之一。褪黑素(Melatonin,Mel)主要是由哺乳动物和人类的松果体产生的一种胺类激素,它的合成受光周期的制约,可使正常动物和人的血压降低,也可对抗病理性的血压升高。红细胞源降压因子(erythrocyte-derived depressing factor,EDDF)是从人的红细胞中提取出一种能够显著降低血压的物质,它不同于迄今已发现的体液中的降压物质,很可能是一种新的内源性血压调节物质。体内物质雌激素、褪黑素、红细胞源性降压因子均可起到降压作用,将可能成为治疗高血压的新靶点。     

Hemodynamic effects of atrial natriuretic hormone

The atrial natriuretic hormone (ANH) alters cardiovascular function independent of changes in body fluid volume. Most investigators agree that ANH decreases mean arterial pressure (MAP). However, although some investigators have observed a decrease in total peripheral resistance in association with the decrease in MAP, a more frequent observation has been decreased cardiac output (CO). The mechanism whereby ANH decreases CO is unknown, but does not appear to be the result of direct myocardial depression, reductions in intravascular or cardiopulmonary volumes, or venodilation. Alterations in skeletal muscle and splanchnic blood flow have been reported by some but not all investigators. Although increases in renal blood flow have been reported, they are transitory and have not been consistently observed by all researchers. The cardiovascular effects of ANH appear to be influenced not only by the dose, but also by the cardiovascular control mechanisms that operate at the time of ANH administration. Non-renin-dependent hypertensive models exhibit a decrease in MAP associated with decreased CO, whereas in renin-dependent animals this hypotension is associated with a decrease in total peripheral resistance.     

Heterogeneity of Prognostic Studies of 24-Hour Blood Pressure Variability: Systematic Review and Meta-Analysis

In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2–7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods.     

The inhibited power motive, type A behavior, and patterns of cardiovascular response during the structured interview and Thematic Apperception Test

The Type A behavior pattern and the inhibited power motive have been implicated in the development of coronary heart disease (CHD). Since it is widely believed that enhanced cardiovascular responsivity may be one mechanism by which individuals develop CHD, the present study examined the relationship of Type A behavior and the inhibited power motive to different patterns of cardiovascular response during two behavioral tasks. Forty-one (24 Type A's, 17 Type B's) male undergraduates underwent the Type A structured interview (SI) and the Thematic Apperception Test (TAT) while a broad range of cardiovascular functions were simultaneously recorded. Different patterns of cardiovascular response were observed during the SI and TAT, and Type A's showed a greater tendency than Type B's to exhibit increased heart rate (HR), systolic blood pressure (SBP), and forearm blood flow (FBF) during the SI and the preparatory phase (but not the story-telling phase) of the TAT. The inhibited power motive was not related to enhanced cardiovascular responsivity during the SI or TAT. The implications of these findings for the development of CHD are discussed.     

Sex Differences in Hypertension: Contribution of the Renin–Angiotensin System

Numerous studies have shown that female human beings exhibit lower blood pressure levels over much of their life span compared with their age-matched counterparts. This sexual dimorphism is apparent in human beings as well as most, if not all, mammals. However, after the onset of menopause blood pressure levels in women increase and become similar to those in men, suggesting an important role of sex hormones in the regulation of blood pressure. The lower blood pressure levels in premenopausal women are associated with a lower risk of development and progression of cardiovascular disease and hypertension compared with age-matched men. This clear female advantage with respect to lower incidence of cardiovascular disease no longer exists after menopause, again highlighting the importance of sex hormones in the pathophysiology of cardiovascular disease in both men and women. In fact, both estrogens and androgens have been implicated in the development of cardiovascular disease and hypertension, with estrogens, in general, being protective and androgens being detrimental. Although the exact mechanisms by which sex hormones contribute to the regulation of cardiovascular function and blood pressure are still being investigated, there is increasing evidence that modulating the activity of locally active hormonal systems is one of the major mechanisms of sex hormone actions in target organs, including the vasculature and kidneys. Indeed, several studies have demonstrated the importance of the interaction between sex hormones and the renin–angiotensin system in regulating cardiovascular function and blood pressure. Furthermore, the differential effects of estrogens and androgens on the expression and activity of the components of the renin–angiotensin system could possibly explain the sex differences in blood pressure levels and the development and progression of cardiovascular disease and hypertension.     

Mathematical shape optimization of hip prosthesis design

The long-term success of artificial-joint replacement depends partly on the chances for acrylic cement failure and interface disruption. These chances can be diminished by an optimal load-transfer mechanism, whereby stress concentrations are avoided. The present paper introduces a method for numerical shape optimization, whereby the finite element method is used iteratively to determine optimal prosthetic designs, which minimize interface stresses. The method is first applied in a simplified one-dimensional model of a cemented femoral stem fixation, using acrylic cement. The results show that 30-70% cement and interface stress reductions can be obtained in principle with an optimized design. Although the actual optimal shape is susceptible to the characteristics of the joint load, the stem length, stem modulus, cement modulus and bone properties, its general geometrical characteristics are consistent, featuring proximal and distal tapers, and a belly-shaped middle region. These general characteristics are confirmed in a more realistic two-dimensional FEM model. It is concluded that this method of shape optimization can provide a meaningful basis for prosthetic design and analysis activities in general.     

Plasma homocysteine concentrations are positively associated with hostility and anger

Homocysteine is a sulphur amino acid that is positively associated with risk of vascular disease. Very few behavioral or psychological factors have been studied in relationship to homocysteine levels, despite the fact that several psychological factors have also been linked with risk for cardiovascular disease. One psychological attribute showing a strong association with risk is hostility, which is prospectively predictive of future cardiovascular disease endpoints. Another related psychological factor is anger expression; coronary heart disease risk is associated with both heightened expression and inhibition of anger. The purpose of this study was to test the relationship of hostility and anger expression with homocysteine concentrations in a sample of healthy, middle-aged men and women. Participants completed the Cook-Medley hostility questionnaire, the Speilberger Anger Expression questionnaire, and had blood taken for the assessment of plasma homocysteine concentrations. Results indicated positive and significant associations between hostility and homocysteine levels for all participants, and positive and significant correlations between anger-in and homocysteine levels for men only. These data are among the first to test the relationship between homocysteine and psychological risk factors for cardiovascular diseases, and suggest one potential mechanism for the increased cardiovascular risk associated with hostility and anger expression.     

Association of ACE I/D polymorphism with cardiovascular risk factors

Since the identification of an insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene, the D allele has been recognized to be associated with cardiovascular disease. Moreover, significant associations of this polymorphism with multiple cardiovascular risk factors have been reported, although some studies failed to detect such associations. In the present study, we investigated the association of the ACE gene polymorphism with the parameters of multiple risk factors in 300 Japanese men who participated in a medical check-up. This investigation detected a significant association of the polymorphism with systolic blood pressure (P=0.007) and diastolic blood pressure (P=0.026), with their highest values in DD subjects and lowest values in II subjects. This significant association is consistent with the proposition that the polymorphism influences blood-pressure variability in men. Furthermore, we investigated the association of the polymorphism with four major disorders (obesity, hyperlipidemia, hypertension, diabetes mellitus) correlated with the risk for cardiovascular disease in the same 300 subjects. This investigation failed to detect any significant association of the polymorphism with each disorder. However, there was a trend that all four disorders were more frequent in ID and DD subjects than in II subjects. We therefore analyzed the association between the ACE gene polymorphism and having at least one of the four disorders in the same population. This analysis detected a significant difference: that ID and DD subjects had at least one of the four disorders more frequently than II subjects (P=0.008; odds ratio=1.89, 95% confidence interval= 1.19-2.99). Taken together, the results of this study are compatible with the proposition that the ACE polymorphism is associated with cardiovascular disease partially mediated through the four disorders in our population.     

Treatment of hypertension with oral taurine: experimental and clinical studies

Summary.  Oral taurine treatment has been studied extensively as a hypotensive agent. Several rat models of hypertension have been used to prove that dietary taurine supplementation can alleviate high blood pressure, among other cardiovascular problems. Experimental models mentioned in this review are the spontaneously hypertensive rat, the DOCA-salt rat, the Dahl-S rat, the renovascular hypertensive rat, the hyperinsulinemic rat and the ethanol-treated rat. The beneficial effects of taurine were also demonstrated in studies involving human subjects suffering essential hypertension. Taurine supplementation of 6 g/day for as little as 7 days resulted in measurable decreases in blood pressure in these patients. In both rat and human studies, the effects of taurine appeared to be dependent on the modulation of an overactive sympathetic system. However, taurine has positive effects on other types of cardiovascular problems and thus may act through more than one mechanism. Received January 8, 2002 Accepted January 18, 2002 Published online August 20, 2002 Acknowledgement The Taisho Pharmaceutical Co. of Tokyo, Japan, is thanked for their financial support to the senior author. Authors' address: Dr. John B. Lombardini, Department of Pharmacology, Texas Tech University Health Sciences Center, Lubbock, U.S.A., E-mail: jbarry. lombardini@ttmc.ttuhsc.edu     

Cardiovascular Effects of Methylmethacrylate Cement

Experiments were carried out on dogs in an attempt to identify the mechanisms underlying the systemic hypotension associated with the application of acrylic cement substances to raw bone surfaces, as in reconstructive hip surgery. Intravenous injection of the liquid component of such cements (monomeric methylmethacrylate) into six dogs produced a significant fall in blood pressure together with an increase in heart rate and cardiac output. This seemed to be due to peripheral vasodilatation caused directly by the monomer and not through the release of histamine. Absorption of free monomer from the mixed cement into the systemic circulation at operation is likely to have the same effect. Precautionary measures can be taken and groups of patients who are especially at risk can be identified, thus reducing the hazards of total hip replacement.     

Mesor-hypertension: hints by chronobiologists

Circadian systems are intermodulated by networks of specialized neural, hormonal and cellular functions, with time structures that are interdependent. In cardiovascular pathophysiology, circadian and ultradian rhythms of clinical interest have been demonstrated. Cardiac output, heart rate, arterial pressure and blood volume are the best known. Systolic and diastolic blood pressure and heart rate have circadian patterns in health and therefore arterial pressure cannot be evaluated by a single measurement during a 24-h span. With correct monitoring for at least 48-h it is possible to detect the mesor-hypertension and the possible amplitude-hypertension that precedes the mesor-hypertension. Prolonged elevation of blood pressure can cause irreparable harm to sensitive tissues. To quantify the damage, the concept of hyperbaric impact has been introduced. This is a measure of the excess load exerted upon the arterial walls. Studies of the beta-blocker penbutolol with correct automatic monitoring have shown the persistence of the physiological circadian variation in the cardiovascular parameters during penbutolol administration. The so-called elimination of the circadian rhythm in blood pressure, which would not really be desirable, was not seen in any of our patients, whose cardiovascular parameters were monitored continuously, day and night, while taking penbutolol. The amplitudes of the rhythms were always prominent. A phase shift, a delay of about 100 degrees, was demonstrated in the heart rate of one 63-year-old mesor-normotensive woman.     

The area postrema: a cardiovascular control centre at the blood-brain interface?

The area postrema (AP) is one of the circumventricular organs of the brain and as such it is highly vascular and lacks the normal blood-brain barrier. Anatomical tracing studies have demonstrated afferent projections to AP originating from the paraventricular nucleus, lateral parabrachial nucleus (l-PBN), nucleus tractus solitarius (NTS), as well as the vagus nerve. AP neurons have been shown to project primarily to l-PBN, and NTS. Receptor localization studies have reported dense aggregations of many specific peptide receptors in AP including those for angiotensin II (ANG), atrial natriuretic peptide (ANP), and endothelin (ET). Electrical stimulation studies have shown that activation of AP neurons at low frequencies (less than 15 Hz) results in decreases in blood pressure and heart rate, while higher frequency (greater than 20 Hz) stimulation causes increases in blood pressure. These low frequency effects on blood pressure and heart rate appear to result from activation of separate components of the autonomic nervous system. Extracellular single unit recordings have identified two functionally separate populations of AP neurons: one responsive to circulating ANG and a second apparently responsive to changes in blood pressure. In addition, AP neurons are activated by increases in circulating ET. Afferent inputs to AP neurons from 1-PBN have separate excitatory (12% of AP neurons) or inhibitory (12% of AP neurons) effects on a relatively small proportion of AP neurons. In contrast, preliminary evidence suggests a much more broadly distributed excitatory input to approximately 70% of tested AP neurons originating from the aortic depressor nerve. These studies provide considerable evidence implicating the AP as a significant neural structure regulating the cardiovascular system.     

The effects of protein intake on blood pressure and cardiovascular disease

PURPOSE OF REVIEW: Investigators, especially those from western countries, have commonly assumed that there is either no association or a direct association of protein intake with elevated blood pressure and atherosclerosis. In contrast, recent observational studies and clinical trials have suggested that increased protein intake, particularly protein from plant sources, might actually reduce blood pressure and prevent cardiovascular disease. RECENT FINDINGS: In epidemiological studies, an increased intake of protein has been associated with lower blood pressure and an attenuated increase in blood pressure over time. Furthermore, such studies also suggest that the beneficial effects of increased protein intake result from an increased consumption of protein from plant rather than animal sources. In several predominantly small trials, an increased intake of soy protein lowered blood pressure. With respect to clinical outcomes, reports from large cohort studies suggest that increased protein intake is associated with a reduced risk of ischemic heart disease and perhaps intraparenchymal hemorrhage. In other reports, a higher protein intake is one characteristic of a dietary pattern associated with a reduced risk of ischemic heart disease. The mechanisms by which protein could exert its beneficial effects include an increased intake of biologically active amino acids, peptides, or highly correlated nutrients. SUMMARY: Recent evidence suggests that an increased intake of protein, particularly plant protein, may lower blood pressure and reduce the risk of cardiovascular disease. However, the data are not sufficiently compelling to advocate an increased consumption of protein.     

Management of raised blood pressure in New Zealand: a discussion document.

A report to the National Advisory Committee on Core Health and Disability Support Services, New Zealand, on the management of raised blood pressure recommends that decisions to treat raised blood pressure should be based primarily on the estimated absolute risk of cardiovascular disease rather than on blood pressure alone. In general, patients with a blood pressure of 150-170 mm Hg systolic or 90-100 mm Hg diastolic, or both, should be given treatment to lower blood pressure if the risk of a major cardiovascular disease event in 10 years is more than about 20%. The results of clinical trials indicate that, at this level of absolute risk, 150 people would require treatment to reduce the annual number of cardiovascular events by about one. Implementation of these recommendations may result in a smaller proportion of people aged under 60, particularly women, receiving treatment but an increased proportion of older people treated. In the absence of specific contraindications, low dose diuretics and low dose beta blockers should be considered for first line treatment, since for only these drug groups is there direct evidence of reduced risk of stroke and coronary disease in people with raised blood pressure.     

Cardiovascular responses induced by endothelin microinjection into area postrema

The recently described endothelium derived constricting factor endothelin (ET) is a 21 amino acid peptide which is the most potent endogenous vasoconstrictor yet described. Binding sites for this peptide have been demonstrated within the circumventricular structures of the brain. One of these structures, the area postrema (AP), has been implicated in central cardiovascular control mechanisms. We have therefore examined the effects of AP microinjection of ET on blood pressure in urethane-anaesthetised rats. Such treatment resulted in dose-dependent biphasic changes in arterial blood pressure (increases followed by decreases). Low doses of ET (0.2-1.0 pmol) induced significant increases (P less than 0.01), and high doses (5.0 pmol) significant decreases (P less than 0.01), while at intermediate concentrations (2.0 pmol) ET caused significant increases (P less than 0.05) followed by significant decreases (P less than 0.01) in mean blood pressure. Other vasoconstrictors were found to be without effect following AP administration, suggesting these changes to be the result of specific action of ET. In contrast, both ET and methoxamine had similar cardiovascular actions when microinjected into regions anatomically adjacent to the AP such as the NTS, indicating that vasoconstriction in these areas induces changes in femoral arterial blood pressure. These data suggest a specific role for ET as a chemical messenger involved in central nervous system control of the cardiovascular system within AP.     

Effect on rat arterial blood pressure of chemically generated peroxyl radicals and protection by antioxidants

Convincing evidence suggests that blood redox changes play a role in the development of various cardiovascular disorders including hypertension. Nutritional antioxidants have been suggested to play a role in cardiovascular disease prevention. In this study, we investigated in vivo changes in rat arterial blood pressure induced by acute exposition to an increased load of peroxyl radicals and by the administration of selected antioxidants after chemically induced oxidative stress. Hydrosoluble and liposoluble peroxyl radicals, generated by 2,2'-azobis-(2-amidinopropane) dihydrochloride and 2,2'-azobis 2,4-di-methylvaleronitrile, induced a dose-dependent decrease in rat blood pressure. All antioxidants tested (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid, vitamin C, glutathione and dithiothreitol) returned peroxyl radical-induced hypotension to normal. Of the various antioxidants tested, glutathione was the most effective in restoring blood pressure after peroxyl radical generation. Treatment of rats with a thiol-chelating agent (N-ethylmaleimide) and an oxidizing agent (5,5'-dithiobis-2-nitrobenzoic) inhibited peroxyl radical-mediated hypotension. Our results suggest that acute exposition to peroxyl radicals have a hypotensive effect on blood pressure and that thiols play an active role in the redox regulation of blood pressure. Other experiments are needed to clarify the role played by oxidative potentials on blood pressure and the mechanism of action of nutritional antioxidants.     

Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial

ObjectivesTo investigate the effect of a computer based clinical decision support system and a risk chart on absolute cardiovascular risk, blood pressure, and prescribing of cardiovascular drugs in hypertensive patients.DesignCluster randomised controlled trial.Setting27 general practices in Avon.Participants614 patients aged between 60 and 79 years with high blood pressure.InterventionsPatients were randomised to computer based clinical decision support system plus cardiovascular risk chart; cardiovascular risk chart alone; or usual care.ResultsPatients in the computer based clinical decision support system and chart only groups were no more likely to have cardiovascular risk reduced to below 10% than patients receiving usual care. Patients in the computer based clinical decision support group were more likely to have a cardiovascular risk ⩾10% than chart only patients, odds ratio 2.3 (95% confidence interval 1.1 to 4.8). The chart only group had significantly lower systolic blood pressure compared with the usual care group (difference in means −4.6 mm Hg (95% confidence interval −8.4 to −0.8)). Reduction of diastolic blood pressure did not differ between the three groups. The chart only group were twice as likely to be prescribed two classes of cardiovascular drugs and over three times as likely to be prescribed three or more classes of drugs compared with the other groups.ConclusionsThe computer based clinical decision support system did not confer any benefit in absolute risk reduction or blood pressure control and requires further development and evaluation before use in clinical care can be recommended. Use of chart guidelines are associated with a potentially important reduction in systolic blood pressure.