Management of hypertension in patients undergoing surgery

Aronow, Wilbert S.

doi:10.21037/atm.2017.03.54

Cited by 48 publications

(48 citation statements)

References 32 publications

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“…Additionally, the corresponding PDPs reveal that the critical out-of-threshold duration for worse outcome is shorter for hypertension (> ∼70 min) than for hypotension (> ∼150 min). Previous blood pressure management studies have primarily focused on hypotension as a contributor to worse patient outcome 58–60 despite the increased risk of cardiovascular and cerebrovascular complications as a result of hypertension 61 . Notably, the importance of perioperative hypertension for SCI outcome has been observed both clinically and preclinically 26–28,62 ; this is the first analysis to suggest that hypertension is more predictive of worse outcome than hypotension, thus proposing that careful MAP management should strive to avoid hypertension while minimizing hypotension.…”

Section: Discussionmentioning

confidence: 99%

Expert-integrated automated machine learning uncovers hemodynamic predictors in spinal cord injury

Chou

Torres-Espín

Kyritsis

et al. 2021

Preprint

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Automated machine learning (AutoML) is positioned to democratize artificial intelligence (AI) by reducing the amount of human input and ML expertise needed to create prediction models. However, successful translation of ML in biomedicine requires moving beyond optimizing only for prediction accuracy and towards discovering reproducible clinical and biological inferences. Here, we present a model-agnostic framework to reinforce AutoML using strategies and tools of explainable and reproducible AI, including novel metrics for performance precision and feature instability. The framework enables clinicians to interpret AutoML-generated models for clinical and biological verifiability and consequently integrate domain expertise during model development. We applied the framework towards spinal cord injury prognostication and identified a detrimental relationship between intraoperative hypertension and patient outcome. Furthermore, our analysis captured evolving clinical practices such as faster time-to-surgery and blood pressure management that affected clinical model validation. Altogether, we illustrate how augmenting AutoML for inferential reproducibility empowers biomedical discovery and builds trust in AI processes towards effective clinical integration.

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Section: Discussionmentioning

confidence: 99%

Expert-integrated automated machine learning uncovers hemodynamic predictors in spinal cord injury

Chou

Torres-Espín

Kyritsis

et al. 2021

Preprint

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“…In presence of certain stimuli, monocytes secrete extracellular vesicles that promote endothelial inflammation and atherosclerosis progression in both in vivo and in vitro assays (Aronow, 2017). We generated MV from THP-1 under uremic toxins stimulation to mimic inflammation in CKD and to evaluate its effect on VSMC.…”

Section: Discussionmentioning

confidence: 99%

Inflammation, Senescence and MicroRNAs in Chronic Kidney Disease

Carmona

Guerrero

Jiménez

et al. 2020

Front. Cell Dev. Biol.

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Background: Patients with chronic kidney disease (CKD) show a chronic microinflammatory state that promotes premature aging of the vascular system. Currently, there is a growth interest in the search of novel biomarkers related to vascular aging to identify CKD patients at risk to develop cardiovascular complications. Methods: Forty-five CKD patients were divided into three groups according to CKDstages [predialysis (CKD4-5), hemodialysis (HD) and kidney transplantation (KT)]. In all these patients, we evaluated the quantitative changes in microRNAs (miRNAs), CD14+C16++ monocytes number, and microvesicles (MV) concentration [both total MV, and monocytes derived MV (CD14+Annexin V+CD16+)]. To understand the molecular mechanism involved in senescence and osteogenic transdifferentation of vascular smooth muscle cells (VSMC), these cells were stimulated with MV isolated from THP-1 monocytes treated with uremic toxins (txMV). Results: A miRNA array was used to investigate serum miRNAs profile in CKD patients. Reduced expression levels of miRNAs-126-3p,-191-5p and-223-3p were observed in CKD4-5 and HD patients as compared to KT. This down-regulation disappeared after KT, even when lower glomerular filtration rates (eGFR) persisted. Moreover, HD patients had higher percentage of proinflammatory monocytes (CD14+CD16++) and MV derived of proinflammatory monocytes (CD14+Annexin V+CD16+) than the other groups. In vitro studies showed increased expression of osteogenic markers (BMP2 and miRNA-223-3p), expression of cyclin D1, β-galactosidase activity and VSMC size in those cells treated with txMV. Conclusion: CKD patients present a specific circulating miRNAs expression profile associated with the microinflammatory state. Furthermore, microvesicles generated by monocytes treated with uremic toxins induce early senescence and osteogenic markers (BMP2 and miRNA-223-3p) in VSMC.

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“…Marked hypertension with diastolic blood pressure >110 mm Hg is associated with increased risk of complications including MI, arrhythmias, and renal failure. 27 A recent cohort study of more than 250,000 adults in the United Kingdom demonstrated an increase in 30-day postoperative mortality with diastolic blood pressures >90 mm Hg, with the increase in risk directly related to the increase in diastolic blood pressure. 28 This increased risk of complications may be caused by a greater decrease in mean arterial pressure [MAP], with anesthesia induction relative to the patient's normal MAP causing tissue hypoperfusion and subsequent end-organ damage.…”

Section: Hypertensionmentioning

confidence: 99%

Perioperative Cardiac Risk Reduction in Noncardiac Surgery

Ganesh

Kebede

Mueller

et al. 2021

Mayo Clinic Proceedings

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Major adverse cardiovascular events are a significant source of morbidity and mortality in the perioperative setting, estimated to occur in approximately 5% of patients undergoing nonemergent noncardiac surgery. To minimize the incidence and impact of these events, careful attention must be paid to preoperative cardiovascular assessment to identify patients at high risk of cardiovascular complications. Once identified, cardiovascular risk reduction is achieved through optimization of medical conditions, appropriate management of medication, and careful monitoring to allow for early identification ofdand intervention fordany new conditions that would increase the risk of adverse cardiovascular outcomes. The major cardiovascular and anesthesiology societies in the United States, Europe, and Canada have published guidelines for perioperative management of patients undergoing noncardiac surgery. However, since publication of these guidelines, there has been a practice-changing evolution in the medical literature. In this review, we attempt to reconcile the recommendations made in these 3 comprehensive guidelines, while updating recommendations, based on new evidence, when available.

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Management of hypertension in patients undergoing surgery

Cited by 48 publications

References 32 publications

Expert-integrated automated machine learning uncovers hemodynamic predictors in spinal cord injury

Expert-integrated automated machine learning uncovers hemodynamic predictors in spinal cord injury

Inflammation, Senescence and MicroRNAs in Chronic Kidney Disease

Perioperative Cardiac Risk Reduction in Noncardiac Surgery

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