The pathogenesis of delirium in critically ill patients is multifactorial. How hypotension and hypoxemia affect brain function and whether they can promote delirium remains unclear. A high cumulative positive fluid balance may also have a negative effect on brain function and promote delirium. We hypothesized that delirium would be more likely to develop in patients with low systemic arterial pressure, hypoxemia and a higher positive fluid balance, and investigated these associations in a prospective observational cohort study in patients with shock. After initial resuscitation, episodes of hypotension, defined as a mean arterial pressure (MAP) <65 mmHg or diastolic pressure <60 mmHg, and hypoxemia, defined as peripheral oxygen saturation (SpO2) <90% for more than one minute or any arterial oxygen concentration (PaO2) <90 mmHg, were recorded during the first 5 days of the ICU stay. Fluid balance was evaluated daily and the 5-day cumulative fluid balance recorded. Delirium was assessed using the Confusion Assessment Method for the ICU. A total of 252 patients were admitted with shock during the study period; 185 (73%) developed delirium. Patients who developed delirium also had more episodes of hypotension with a low MAP (p = 0.013) or diastolic pressure (p = 0.018) during the first five days of the ICU stay than those who did not. Patients with a higher cumulative fluid balance during the same period were also more likely to develop delirium (p = 0.01); there was no significant difference in the occurrence of hypoxemia between groups. Joint modeling, combining a linear-mixed model and an adjusted Cox survival model showed that low diastolic pressure (alpha effect = -0.058±0.0013, p = 0.043) and a positive cumulative fluid balance (alpha effect = 0.04±0.003, p = 0.021) were independently associated with delirium. In conclusion, low diastolic pressure and a cumulative positive fluid balance but not hypoxemia were independently associated with development of delirium in patients with shock.

The fetal fibronectin test should not be used as a screening test for asymptomatic women. For high-risk asymptomatic women, and especially for women with multiple pregnancies, the performance of the fetal fibronectin test was also too low to be clinically relevant. Consensual use as a diagnostic tool for women with suspected preterm labor, the best use policy probably still depends on local contingencies, future cost-effectiveness analysis, and comparison with other more recent available biochemical markers.

Positive family history of hypertension (FHϩ) is thought to be a risk factor for future development of hypertension (HT) in normotensive subjects. Little is known on whether FHϩ is a risk factor for progression of HT in subjects with mildly elevated blood pressure (BP). Therefore, we studied the predictive value of FHϩ for the development of established HT in a cohort of young borderline to mild hypertensives.The study was carried out in 787 subjects (560 males) who took part in the multicenter HARVEST study. Subjects 18 to 45 years old with stage 1 HT, who never took antihypertensive therapy, were enrolled. End point was defined as a BP requiring antihypertensive therapy according to BHS guidelines. In all subjects, ambulatory BP monitoring was performed at baseline and during follow-up. Data were adjusted for age, gender, BMI, lifestyle factors at baseline and changes in these variables over time. Mean follow-up duration was 70Ϯ2 months.At baseline, FHϩ subjects (nϭ463), had slightly higher office BP (146.2Ϯ0.5/94.5Ϯ0.3 vs 144.9Ϯ0.6/93.7Ϯ0.4 mmHg, pϭ.09/.055, respectively) and ambulatory 24h BP (131.9Ϯ0.5/82.3Ϯ0.4 vs 129.8Ϯ0.6/ 81.4Ϯ0.5 mmHg, pϭ0.012/ns, respectively) in comparison with FHsubjects (nϭ324). The prevalence of white coat HT, defined as ambulatory daytime BPϽ135/85 mmHg, was higher in FH-subjects (29.3% vs 22.8%, respectively, pϽ0.05). During follow-up, 249 subjects reached the end-point. Of these, 29% were FHϩ and 36% were FH-(pϭ0.035). Changes in clinic BP, weight, smoking and alcohol use during the 6 years of observation did not differ according to FH status. The increase in 24h BP over time was slightly though non significantly greater in FH-than FHϩ subjects (SBP, 6.4Ϯ1.2 vs 3.9Ϯ1.1 mmHg, DBP, 4.6Ϯ0.8 vs 3.3Ϯ0.7 mmHg, respectively). Multivariable Cox proportional hazard model indicated that FHϩ status was associated with a 28% reduction in relative risk of reaching the end-point (CI, 0.566-0.992, pϽ0.05).These results indicate that sustained HT is more common in FHϩ than FHstage 1 hypertensives. However, FHϩ is not a risk factor for progression of HT either assessed with clinic or ambulatory BP. In subjects studied with ambulatory BP monitoring, FH status does not provide additional information for identifying patients who may benefit from early antihypertensive treatment.Key Words: Family history, longitudinal, progression of hypertension The purpose of this study was the evaluation of the predictive value of ambulatory BP monitoring (ABPM) for the development of drug-treated hypertension in subjects with high-normal BP (HNBP: Ն130/85 and Ͻ140/90 mmHg). P-57 AMBULATORY MONITORING IN SUBJECTS WITH HIGH-NORMAL BLOOD PRESSUREWe studied 127 subjects (69 M, 58 F, age 50Ϯ14 years): 59 subjects (26 M, 33 F, age 51Ϯ13 years) had normal BP (NBP: Ͻ130/85 mmHg; average office BP 122/77Ϯ 7/6 mmHg), 68 subjects (43 M, 25 F, age 49Ϯ 15 years) had systolic and/or diastolic HNBP (average office BP: 135/84Ϯ 4/5 mmHg). In the HNBP group there was a statistically significant (pϽ0.01) higher prevalence of overw...

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