Category: Blood pressure

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There are set processes in which storyboards are created for instance for films and animations either for study or for educational purposes. Being skeletons that give a step-by-step view of what is expected for any given procedure; storyboards become centrally important tools that assist the understanding of complex procedures that would otherwise be reserved for professionals and academicians alone.

For this assignment, the concept of storyboards is used as a lesson for how to take blood pressure and in doing so, the paper will discuss details of the importance of consistent taking of readings of ones blood pressure as well as discussing some of the equipment that are used in the process of taking and checking blood pressure. This means that this storyboard will be a lesson dubbed: Taking Blood Pressure.

Introduction Page

Before delving into the processes that were arrived at in the making of the storyboard fort taking blood pressure, it is appropriate first of all to briefly describe what exactly is meant by storyboarding process. The creation of this storyboard is created in a number of steps so as to come up with a creative and useful thing.

The history of storyboards has been that they can be created either by hand or other designers have used digitized computer programs to draw and design them (Struijk, Mathews & Loupas, 2008). For the case that the storyboard is created by hand, the practice has been that the first step is to get a template which may either be downloaded or drawn manually.

For cases where the designers and producers require details in their designs that are of greater content, storyboard artists usually prepare the storyboards either by a way of hand or by using special programs that are used to draw storyboards in two dimensions (Struijk, Mathews & Loupas, 2008).

There are other software that may be used to create superior storyboards that contain greater details that express the exact intentions of the story as presented by the producer and director of the film or animation. After properly preparing these storyboards, they are usually presented to the given project management which forwards to its cinematographer who sees that what has been created achieves the vision and intentions of the director (Struijk, Mathews & Loupas, 2008).

Having briefly discussed what storyboards are and how they are created, the next important area of discussion is the subject of the storyboard taken for this paper and this is Taking Blood Pressure. First of all, blood pressure is a human condition which medically is generally described as the pressure that builds in the blood vessels due to the blood circulating in them after being pumped by the heart.

The heart usually pumps in two basic ways that creates moments of highest pressure called the systolic pressure and one that creates moments of the lowest pressure called the diastolic pressure in the blood vessels (Booth, 2007). This pressure is highest in the blood vessels that are closest to the heart and continually decreases slowly as the blood flows further from the heart. This decrease is caused by the resistance of the walls of these blood vessels such as arteries as the blood flows in them.

The body vessels that carry blood around the body usually decrease in size systematically as they approach specific organs where the blood is to deliver its products of respiration and these final blood vessels are usually tiny and therefore when blood enters them, its pressure reduces substantially such that by the time the blood is circulating back to the heart through the veins, its pressure barely moves it back to the heart for the process to begin again.

Valves are features of veins which prevent back flow of blood when a person is standing upright since the pressure in these veins is usually significantly low (Booth, 2007).

It is observable from the foregoing explanation that when there is a problem with the blood pressure, it may lead to catastrophic problems for someone since this pressure is imperative to be sufficient to carry the blood around the body but again not too much to injure (and at times burst) the arterial walls.

It is common practice to take the blood pressure of a person from the brachial artery which is usually located on the inside of the elbow since this is among the most sensitive parts of a human body that reflects the most accurate arterial pressure of a person. This pressure is usually expressed as a fraction of the systolic pressure over the diastolic pressure in millimeters of mercury (mmHg) such as 138/87.

It is very important to ensure that ones blood pressure is regularly checked to ensure that it is within the medically safe region since when it is not put in check, it may lead to hypertension which is a condition where the arterial blood pressure is too high that it risks causing heart diseases and other related diseases that may lead to abrupt death.

According to Booth (2007), the generally accepted blood pressure reading that are considered normal in the medical world usually range around 120 over 80 where the first number is the systolic reading and the second number is the diastolic reading written as a fraction as earlier on indicated (Booth, 2007).

It is generally considered that pre-hypertensive states are observed when ones pressure is anywhere between 120 and 139 over anywhere between 80 and 89 and high blood pressure (hypertension) is considered when ones reading clocks anywhere between 140 and 159 over anywhere between 90 and 99 (Booth, 2007).

There are critical phases of hypertension where patients record readings as high as 160 and above over 100 and above and usually these stages are so critical that death may occur very easily through heart attacks and related conditions.

It is however appropriate to mention that merely having elevated blood pressure readings does not necessary mean that one has hypertension since there are other factors that may lead to elevated blood pressure readings and this factors include times where the immune system is low caused by illness or an infection or even due to stress (Booth, 2007).

This notwithstanding, it is very important to keep close track of ones blood pressure since there are basically no known symptoms that can distinctively be said to the signs of high blood pressure or other related blood pressure conditions. Known symptoms at time as usually as mild as simply having difficult in sleeping, dry mouth or even emotional upsets.

The commonest symptom however that is observed in all blood pressure patients is having headaches and even this is not a final pointer of hypertension as there are just as many who experience excruciating headaches and yet do not suffer from hypertension (Booth, 2007). This means that it is imperative to get medical advice whenever there is something that is feared to be blood pressure related rather than merely speculating about it.

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There are different parts of a human body that are generally prone to blood pressure related problems which makes it very important to be careful with how this pressure is observed and monitored. The two commonest conditions that result in blood pressure are high blood pressure (hypertension) and low blood pressure (hypotension) conditions.

This notwithstanding, any pressure resisting blood flow in the arteries strains the arterial walls and that only has its potential risks that cannot be overlooked. High pressure against the blood flow usually increases the rate at which the heart has to work to meet the same demand of body organs of the supply of blood and this usually leads to unhealthy tissues called atheroma to grow within the walls of the arteries.

Continued increased blood pressure causes the heart muscles to overgrow with additional tissues that make it generally weak and this becomes a prime recipe for strokes, heart failures, heart attacks and what is called arterial aneurysms; a major cause of chronic renal failure (Booth, 2007).

On the contrary, hypotension is not usually a big medical bother unless it reaches critical levels that cause dizziness and/or fainting (Booth, 2007). This happens when the arterial pressure reduces so much to a critical level where the perfusion of the brain is changed to become extremely decreased which means that there is insufficient supply of blood to it.

This should however not be confused by orthostatic hypotension which is a condition where gravity in some cases reduces blood pressure significantly when someone stands up from a sitting position and in the process may experience dizziness as a result of reduced cardiac output due to reduced stroke volume. Other causes of hypotension include sepsis, blood loss, eating disorders like anorexia nervosa, and hormonal abnormalities like the case of Addisons disease and among others (Booth, 2007).

There are different ways that are used in taking blood pressure and this can be either at home (for personal regular checkups) or in a hospital (in the event that there is real concern to warrant medical attention).

All of these procedures, taking of the readings is usually simply done by using special equipment that when strapped to different parts of the body (especially the inner side of an arm around the elbow point or on the tip of a finger) show the readings of the blood displayed as a fraction with the systolic reading presented over the diastolic reading (Booth, 2007).

Some of the common equipment that are used include the aneroid monitor which has a dial gauge that shows reading via a pointer and the other common one is the digital blood pressure monitor which can either have automatic or manual cuffs and usually has an in-built stethoscope that helps it to flash its reading on a digital screen (Booth, 2007).

Another equipment that is used in hospitals is the sphygmomanometer which uses the height of a mercury column to indicate its readings that are given in millimeters of mercury (mmHg). The figure below shows some of these equipments.

Figure 1. Types of Equipment that are used to measure blood pressure

Enabling Objectives

The following are the enabling objectives for lesson on taking Blood Pressure.

• Simplicity  it was desirable to ensure that the lesson that is presented is simple to follow and understand for ease of design and production.
• Cost effectiveness  this is an objective that required that the storyboards cost as compared to its quality and usage measures up to a given margin that is meaningful and rational.
• Relevance  this was an objective that required that the storyboard is relevant for the purpose for which it is designed which was to work as a lesson for taking blood pressure readings.
• Social interactiveness  this objective was to ensure that the lesson was acceptable in the cases of its diverse audience were critical about it. It was intended to identify with the social networks of the persons that would be reached by it.

Instructional Unit

The following are four core questions that are presented to gauge the understanding of this lesson to anyone who partakes in it. They are true of false questions.

1. Blood Pressure is a condition that is difficult to observe and one that does not have distinct symptoms.
   1. True
   2. False
2. The process of taking blood pressure requires professional training and therefore people with such knowledge cannot take blood pressure readings.
   1. True
   2. False
3. Anytime there is a slight deviation in the blood pressure taken is an indication that there is either hypertension or hypotension and therefore one needs get serious medical attention.
   1. True
   2. False
4. Blood pressure is a condition that when left to get to critical levels can become lethal and even cause death through strokes, heat failures and heart attacks.
   1. True
   2. False

References

Booth, J. (2007). A Short History of Blood Pressure Measurement. Proceedings of the Royal Society of Medicine, 70(11), 793799.

Struijk, P., Mathews, V.J., & Loupas, T. (2008). Blood Pressure Estimation in the Human Fetal Descending Aorta. Ultrasound Obstet Gynecol 32(5), 673681.

In the present article, Nguyen, Tran, and Duoos (2016) briefly describe the results of the research they conducted to study the influence of magnesium in comparison with potassium supplementation on SBP during aerobic-cycling exercise. They point to the gap in the studies concerning potassium and magnesium supplementation and address the effects of the new approach without emphasizing the expected outcomes.

The study was carried out objectively: magnesium and potassium capsules were distributed blindly and randomly, and the control and experiment groups were present (Nguyen et al., 2016). In the process of the research, heart rates at rest, posttest, and recovery were measured and recorded. However, the fact that the subjects themselves were responsible for registering their potassium and magnesium taking gives ground to be more careful in the assessment of the results.

The researchers describe the method and point out that a two-sampled t-test was done to compare pretest and posttest results within each supplementation group (Nguyen et al., 2016). According to the authors, a considerable difference between the two groups was registered via a one-way analysis of variance. The researchers conclude that potassium supplementation proves to lower exercise BP to a large extent in contrast with the pretest and posttest rates.

The article is laconic and, to some extent, lacks details. Although the main points are covered, one still needs more explanation of the key points. The theoretical part also seems necessary. It was probably the volume of the article that imposed some limitations. In this regard, the article may be considered satisfactory for those who need concise information about the usage of magnesium and potassium. Besides, this article may be used to understand the current trends in potassium supplementation and blood pressure research.

References

Nguyen, T. M., Tran, A., & Duoos, B. A. (2016). Exercise blood pressure response to magnesium versus potassium supplementation. Research Quarterly for Exercise and Sport, 87(S2), A9-A10.

INTRODUCTION

Obesity has been studied for years and is still being studied today (2). The leading cause of mortality worldwide is cardiovascular diseases, hypertension and diabetes, and this is associated with obesity. There are many contributing factors to obesity than one would think. Some of the health issues that could be life threatening are hypertension, diabetes, coronary disease, heart failure, etc. (2). Obesity is the most common health disorder in the United States, and affects the majority of adults in the country (5).

Obesity has many causes that do not have a single explanation, but there are factors that are associated with obesity like; Ethnicity, social economic status, region of residence, season, and urban living (5). Obesity ultimately results from an imbalance between energy intake and energy expenditure, meaning not being able to burn calories as fast as they are being consumed (3).

MATERIALS AND METHODS

Upon researching the APUS Library about Obesity and its causes and effects on hypertension, the topic, “Obesity: Causes and Effects on High Blood Pressure” came into thought. During this research process, 5 articles and 1 graph were selected to provide the information needed to complete this essay. This study reflects information about hypertensive patients that were followed up on at an outpatient clinic and had a documented history of chronic high blood pressure without any causes or underlying issues (1). The study is conducted by The Cardiology Branch of the National Heart, Lung, and Blood Institute (NHLBI).

This study was on 27 hypertensive patients and 28 healthy patients and was designed to investigate the vivo vasoconstrictor activity of ET-1 (endothelin receptor) in hypertension (1). Patients were not taking any medications and any that were being taken was stopped 2 weeks before the study. Volunteers that were normal are selected as a control group and matched with patients of approximate race, gender, and age (1). The studies were performed in the mornings, in a room with the temperature of 76°F and participants was asked to not drink alcohol or caffeine for 24 hours before the studies (1). Each study had an infusion of drugs into the brachial artery and measurement of the response of the forearm vasculature by use of strain-gauge venous occlusion plethysmography. The blood pressure was recorded directly from this arterial catheter.

Graph 1 Bars show FBF responses to BQ-123 according to BMI in normotensive subjects (right panel) and hypertensive patients (left panel). Values (each is average of 6 measurements taken every 10 minutes during drug infusion) represent mean+SEM. Probability values refer to changes in FBF from baseline during selective ET blockade by 1-way ANOVA for related measures (1).

Many studies have found a relationship between obesity and hypertension (4). These studies investigate the linkages of being overweight and health issues caused by the obesity. Hypertension is a massive relation and is life threatening to say the least. Obese individuals have many commonalities, like; depression, lack of activity, pain, sicknesses, loss of sexual desire, etc. (5). These linkages are studied to find common grounds and helpful information to hopefully assist in reducing obesity and hypertension along with it. The study listed above covers just one side of the many studies out there.

RESULTS

Arterial pressure and heart rate did not drastically change after infusion of any of the drugs used in the study. The findings indicated that the drug effects were limited to the infused forearm. ET-1 caused a significant vasoconstrictor response in both obese normotensive and hypertensive subjects (1). There are many lines of reasoning that suggest a potential role of the activated ET-1 in the pathophysiology of complication of obesity-related hypertension (1).

CONCLUSION

The main finding of the study is that blockade of ET-1 receptors results in important vasodilation in overweight and obese subjects, but not in lean hypertensive subjects. It doesn’t determine any significant hemodynamic change in normotensive controlled subjects, irrespective of their body mass (1).

I consider high blood pressure to be the main health disease in Bahrain. One third of Bahrainis are having this disease whereas 15% of Bahrainis have diabetes. High blood pressure can develop different heart diseases, which are in high percentage in Bahrain too, and therefore causes death. Which makes the disease more dangerous is that it has no symptoms that is why it is called silent killer. Reasons for this high percentage are the fact that most of the Bahrainis have close relative with the disease and their life style with lack of exercise and eating salty food.

I have observed 3 problems with high blood pressure patients in Bahrain. First is that many of them doesn’t change their lifestyle even after discovering the disease. Second is that many of them never admit that they have disease and ignore what doctors tell them. Third that many of them doesn’t take medicines described by the doctor but try to use traditional medicines.

I can help to alleviate the problem by trying to make people aware about the danger of the disease in events and social media. I will change my lifestyle to healthy life style then I will convince my friends and family to do so. I will check for blood pressure disease for all the patient even if they came for different disease so that I can discover the disease before it is too late.

Some doctors consider medicine as a business, which is very big ethical problem. In developed countries some of them try to make the highest profit by asking for unnecessary checks or letting the patient stay in the hospital for extra days or other tricks. In developing countries, the problem is bigger as some doctors will not treat patients even if in emergency just because patient cannot pay the hospital fees. To avoid this problem, I aiming to work in government hospitals where it is free of charge for patient.

Another ethical problem is that some doctors don’t do their job perfectly that cause medical errors. The aim of medical treatment is to save lives but if it is not done with care it can cause reverse result. To minimize the error I will not start the treatment unless I am confident that what I will do is right. And during treatment I will focus in my work and try to work as perfect as possible.

The following experiment is one that involves the repeated contraction of muscles in the forearm in order to obtain data of the maximal grip strength and the factors that affect it. Muscles are a type of connective tissue that are attached to the bone by tendons and to each other by ligaments, and the tissue responsible for movement. The muscles that this experiment is focusing on are the muscles in the forearm which is mainly made up of skeletal muscles. Skeletal muscles ordinarily have an extensive blood supply as muscles typically have an intricate system of capillaries that transport blood from a few larger veins or possibly a central artery. In addition, skeletal muscles are able to generate movement through 2 main mechanisms, the mechanical and the electrical that work together in order for contraction and relaxation to occur. The nervous system is generally responsible for the skeletal muscle’s voluntary movement according to. The type of muscle contractions taking place in this experiment is known as isometric contraction, which occurs when the length of the muscle remains the same and there is a force generated (tension that increases) in the muscle without placing any strain on the joints.

Skeletal muscles are mainly composed of many muscle fibres that are long and round, known as fascicles. These fascicles are then sub composed of many muscle fibre cells made up of myofibrils and a cellular membrane known as the sarcolemma as well as many organelles mainly mitochondria that are needed to produce ATP for movement of the muscle. Each muscle is connected to its own somatic nerves as well as its own specific artery and vein to supply blood and oxygen to the muscle. The myofilaments contain sections called sarcomeres that are made up of 2 main proteins, namely actin and myosin. During relaxation the actin and myosin myofilaments do not touch. This is due to the Actin being blocked by tropomyosin and troponin. When the brain sends an action potential to the motor neuron that’s connected to the muscle cell the receptors which are sodium channels open thus flooding the cell with sodium creating a gradient. Stored calcium ions from the sarcoplasmic reticulum is released into the cell via protein pumps and ATP is released from the mitochondria. The calcium ions bind to the troponin which then pulls the tropomyosin away from the actin sites. The myosin breaks down the ATP into ADP and Pi (a singular phosphate) and causing it to stretch. It then attaches to the actin and pulls it slightly causing the ADP and Pi to be released and allowing an ATP molecule to bind to the myosin thus releasing the myosin from the actin. This cycle of repeated muscle contraction is known as the sliding filament model.

During full body exercise blood pressure generally increases. This is because during exercise there is an increase in the amount of carbon dioxide in the blood which are detected by chemoreceptors, which send signals to the brain specifically the medulla oblongata which regulates many homeostatic functions such as respiration and heart function. It sends an impulse into the sinoatrial node through the sympathetic nervous system to increase the heart rate therefore increasing cardiac output. This is done to increase the amount of oxygen in the muscles during aerobic respiration, Baroreceptors in the blood that detect the change in heart rate increase the blood pressure via vasodilation (widening of the blood vessels) to allow more blood to be carried.

Doing any repetitive exercise, the muscles being used will experience muscle fatigue which is reduction in their capacity to do work. This may be due to the production of lactic acid when anaerobic respiration takes place and there is significant ATP depletion with little ATP production.

The aims of this experiment are as follows: Aim 1-Examine the feasibility of using a large cohort of investigators to collect data for a force fatigue curve in grip strength protocol, Aim 2- Establish the effect of this grip strength protocol on the blood pressure response, Aim 3- Examine the association between maximal grip strength and fat free mass.

Moreover, the hypotheses of this experiment were: Hypothesis 1- Using large cohorts of investigators to collect data is feasible, Hypothesis 2- Repeated Grip strength will cause an increase in blood pressure, Hypothesis 3- A higher maximum grip strength will be achieved by those that have higher fat free mass.

Equipment: sphygmomanometer (used to measure blood pressure), scale (used to measure weight), stadiometer (used to measure height), omron handheld body fat analyser (used to measure body fat percentage), dynamometer (used to measure grip strength), stopwatch (to measure time).

Procedure: Initially volunteer’s blood pressure is taken at rest while seated, from their dominant arm that was later used for the grip strength segment. The blood pressure cuff was placed on the participants upper arm (just above the elbow) ensuring that it is not covered by any thick clothing/material and as close to the skin as possible. The cuff was secured on to arm by tightening it and wrapping it around the arm, whilst ensuring that the lead was positioned facing toward the inner elbow in order to be closest to the brachial artery (for accurate data), while the participants arm rested on a table so that it was parallel to their heart. Blood pressure (systolic and diastolic) as well as heart rate was recorded. Participants’ shoes were removed and their weight (in kg) was recorded using a scale and their height taken (in cm) using a stadiometer. The shoes were removed to ensure that there was no extra height added by them. In addition, any extra heavy clothing such as jackets or anything that may add extra weight to the volunteer was also removed before their weight was taken from the scale. Finally, the participants age, height and weight were input into the handheld body fat analyser before being held up horizontally in front of the participant (by the participant) while seated, their body fat was measured by the machine, and the data was recorded. A Par-Q form with 7 questions was filled out by the volunteers to ensure that anyone with a relevant health condition did not take place in the experiment if it would be a risk to their health, and prevent the data being collected from being skewed.

The experiment began while the volunteer was seated in an upright position holding the dynamometer in their dominant hand while their arms were positioned straight down (vertically). The participant then squeezed the dynamometer at maximum strength and the measurement recorded into a table. This was repeated every 30 seconds using a stopwatch and recording the data for 10 minutes. 21 measurements of maximal isometric grip strength were recorded in total (participant was instructed to use maximum strength when gripping the dynamometer).

Lastly immediately post the experiment the volunteer’s blood pressure was taken again using the same dominant arm used to grip the dynamometer and the results were recorded.

The results below (figure 1) show that grip strength for most of the participants remained mainly linear, as the time increased there wasn’t much change in the mean hand grip strength.

The results in Figure 1 are mainly linear showing that there wasn’t much change in the mean grip strength over time. This may be due to a variety of reasons, for example this specific protocol did not account for the difference in data due to gender (male/female grip strength) which could have shown different results. In addition, factors such as age were not accounted for in this protocol which can affect the data as seen in (Charlton et al., 2015) which showed that both right- and left-hand overall grip strength decreases with age. It also didn’t account for the variation in hand sizes and how much the fingers were spread out in order to achieve maximum control of dynamometer. As a result of having many uncontrolled variables in this protocol the results in Figure 1 were unable to be matched with any other published work. Consequently Hypothesis 1 could only be achieved if the protocol was adjusted and accounted for the many dependant variables.

The developmental origins of health and disease theory posits that early life experiences may be associated with adult chronic disease development, including obesity and cardiovascular diseases. Consequently, there has been interest in the associations between birth weight, body composition and chronic diseases, such as hypertension. At the 64th Annual Conference of the Caribbean Public Health Agency in 2017 it was noted that the Caribbean is in the midst of a childhood obesity epidemic with statistics showing that at least one in every 5 children carry unhealthy weight and is at risk for developing non-communicable diseases consequently, there has been a resurgence of interest in the associations between birth weight, body composition and chronic diseases, such as hypertension. The Caribbean Public Health Agency in 2017 noted that the Caribbean is in the midst of a childhood obesity epidemic with statistics showing that at least one in every 5 children carry unhealthy weight and is at risk for developing non-communicable diseases. Human growth during the first two years of life, that is, during infancy is a period of rapid postnatal growth which is not only accompanied by quantitative changes in body size but also major changes in body composition and it represents the best time for obesity prevention and other non-communicable diseases (NCDs) and their adverse consequences. Therefore, identification of effective early-life intervention targeting these modifiable factors is critical for paediatric, as well as adult obesity prevention and other NCD. However, few studies have examined the relationship between birth weight and body composition in one-year infants. While there are challenges to the birth weight hypothesis as a major contributor to the development of hypertension, in particular the consistently positive relationship of body weight with blood pressure (BP) throughout childhood and adulthood, substantial work has been done in this area of research and overall trends suggest a consistent relationship being that lower birth weight results in higher blood. This study will focus on the association between birth weight and body composition as well as the association of birth weight and blood pressure in one-year infants.

Problem Statement: An understanding of body composition in this early age group may be important in understanding human health and disease. Body composition can be divided into fat mass and fat-free mass. Early life factors such as birth weight have been suggested to play an important role in the development of various metabolic conditions A Birth weight of less than 2500g and over 4000g has shown to be associated with an increase in certain chronic adult disease, here is however there is a paucity of studies examining these relationships in children one year of age including obesity and hypertension, and so, there may be a possibility that these association may be evident from as early as one year of age.

Purpose Statement: The purpose of this study is to investigate if there is an association between birth weight and body composition as well as blood pressure in one-year old infants. A two-component model of body composition divides the body into a fat component and fat-free component. Body fat is the most variable constituent of the body. These associations will be examined by using the indirect methods of skin fold thickness and bio electrical impedance (BIA). Both methods will be used to calculate fat mass (FM) and fat free mass (FFM) or lean mass. The results of this study may indicate that there may be an association evident from as early as one year of age.

Significance of the Study: There is substantial evidence that the first 1000 days of an infant’s life is an important and plastic period during which events and exposures can have significant effects on a child’s development and his or her risk of many chronic non-communicable diseases later in life, including obesity, hypertension, and type 2 diabetes. (Moore, Arefadib, Deery, & West, 2017). This period is therefore an important time for monitoring and intervention for the prevention of ill health later on in life. The aim of this study is to investigate the association between birth weight and body composition as well as blood pressure in infants at one year old. Evidence of association between these factors at an early age may aid in developing preventative strategies to combat the development of non-communicable disease in later life.

The aim of this study is investigating the association between birth weight and body composition at one-year old as well as the association of birth weight and blood pressure in the infants. This study population will be infants living in Kingston and St. Andrew at one year of age.

Research Objectives

1. To measure body composition in one-year old infants using BIA and skinfold thickness measurements.

2. To measure blood pressure in one-year old infants.

3. To perform anthropometric measurements in one-year old infants.

4. To explore the influence of birthweight on body composition and blood pressure at year old.

5. To explore the association, of body composition and blood pressure at one year old

Research Questions

1. Is there a relationship between birth weight and body composition at one year of age?

2. Is there a relationship between birth weight and blood pressure at one year of age?

3. Is there a relationship between body composition and blood pressure at one year of age?

Operational Definitions

Birth weight – is the first weight of new-born obtained after birth. For live births, birth weight should preferably be measured within the first hour of life, before significant postnatal weight loss has occurred.

Low birth weight – Low birth weight has been defined by the World Health Organization (WHO) as weight at birth of less than 2,500 grams (5.5 pounds).

Body composition – The percentage of fat, bone and muscle in the body, of which fat is of greatest interest.

Fat Free Mass (FFM)- Fat-free mass is used to describe all of the tissues in the body that are not adipose (fat) tissue. Fat-free body mass includes most of your body’s vital tissues and cells.

Fat Mass (FM)- The portion of the human body that is composed strictly of fat.

Blood pressure- blood pressure refers to the pressure of the blood within the arteries. It is produced primarily by the contraction of the heart muscle. Blood pressure measurement is recorded by two numbers. The first (systolic pressure) is measured after the heart contracts and is highest. The second (diastolic pressure) is measured before the heart contracts and lowest Elevation of blood pressure is called ‘hypertension.

A variety of methods have been developed for assessing body composition in infants, including isotopic determination of the total body water (the amount of water present in the body), radiography, potassium counting, bioelectrical impedance; where resistance and reactance are measured, anthropometry and others. These various techniques and models of assessing body composition in infants, the body is portioned into level and compartments where each level and its components are distinct. In these methods the body is divided into atomic, cellular, molecular, tissue-organ and whole body levels, each level is then divided into components of fat mass (FM), fat free mass(FFM), total body water (TBW), total protein(TPro), total potassium (K), etc. Practical means of measuring body composition in infants employ non-invasive and indirect methods. Two-compartment models at the molecular level divide the body into FM and FFM, such that TBW is the sum of FM and FFM. Body composition in children using this two-compartment model assessed by the indirect methods of skinfold thickness and bioelectrical impedance have been validated my many studies. These are the methods which will be employed in this study, thus, this literature review will be limited to what is published on body composition measure by these indirect methods This literature review will be organised by three themes, the relationship between birth weight and body composition in infants, the relationship between birthweight and blood pressure in infants and the overall relationship between all three variables. Methods employing a two-compartment model will be reviewed.

The interpretation of body composition has considered the important role of birth weight (BW); however, the body of literature report conflicting relationship. Normal birth weight for at term delivery, as defined by the World Health Organization is 2500-4200g. Singhal et al.(2003) in their study carried out in London provided evidence that birthweight does determine proportion of FM . Using skinfold-thickness measurement and bioelectrical impedance analysis 78 adolescents aged 13–16 years the study found that an increase in birth weight of one standard deviation was significantly associated with a 0.9–1.4-kg (2–3%) increase in FFM in adolescents, but birth weight showed no correlation with TBW. The study further compared these findings with that of 86 younger children and found that although the correlations were same for FFM, there was a positive correlation between birth weight and TBW in this younger age group. (Singhal, Wells, Cole, Fewtrell, & Lucas, 2003). Also using skinfold thickness measurements results from The Generation R Study carried out in 2009 showed that birth weight was inversely associated with truncal/peripheral fat ratio (p < 0.01) but not with relative body fat in early infancy. These findings of Singhal et al among younger children are consistent with the findings of the Brazilian Cohort study involving 486 children, 5 to 9 years of age and are also consistent with a cohort study among 176 Jamaican children, 9‒12 years of age in which body composition was assessed using bioelectrical impedance analysis (Taylor-Bryan, Badaloo, Boyne, Osmond, & Forrester, 2018). Further to evidence positive association relationships of birthweight with FFM and FM in children, Nsamba in 2019 using anthropometry and BIA showed that birthweight was associated with Fat mass index with a regression coefficient of 0.66, the study included 177 children aged 10-11 years and was carried out in Uganda.

In contrast to birth weight being associated to Fat mass J. Kagura, et. Al in their 2012 study found birth weight to be associated with Fat free mass, in that A one z-score increase in birth weight was associated with a 1051 g increase in lean mass. Koon and others also in the Birth Weight, Nutritional Status and Body Composition among Malaysian Children Aged 7 to 10 Years, found Birth weight has weak correlation (r =0.22,p < 0.01) (POH, 2013).Santos et al. showed no associated between birth weight and body composition, 7-year-old children they studied; however, this study did not consider gestational age, as a possible confounder.

Medical research has clearly established the relationship between birth weight, body composition and the prevalence of certain diseases in adults such as type 2 diabetes mellitus (T2DM), hypertension, hyperlipidaemia, metabolic syndrome, coronary artery disease (CAD), and certain types of cancer (National Heart, Lung, and Blood Institute, 1998). Diseases that were once considered to be “adult” diseases are now the diagnoses of many children and adolescents. Childhood blood pressure(BP) has been found to be a predictor of NCDs in young adults and adults alike, multiple studies have also suggested that birth weight may be one of the important determining factors of BP later in life.(Järvelin et al., 2004). Bonita Falkner did an extensive review of epidemiological data and found that overall, there tends to be a small but consistent relationship of lower birth weight with higher blood pressure (BP). For each kilogram increase in birth weight, the systolic BP is 1 to 2 mm Hg lower (Falkner, 2002). Lower birth weight is therefore shown to be associated with higher BP. In support of the findings of the previous study, one Longitudinal study of postnatal growth where blood pressure was measured half yearly from age 1 carried out in Jamaica showed that systolic blood pressure fell by 1.4 mm Hg for every 1-kg increase in birth weight (95% CI 0.2 to 2.7, P=0.02) and by 1.2 mm Hg.36. (Thame et al., 2000). In support of the findings from the Thame study and others mentioned. Woelk et.al in their ‘Birthweight and blood pressure among children in Harare, Zimbabwe’ study (1997) found that systolic blood pressure (SBP) was inversely associated with birthweight in the 756 children studied.(Woelk, Emanuel, Weiss, & Psaty, 1998). A weak inverse relationship between birth weight and blood pressure was observed Primataesta and others when they studied children aged 5 to 15 years in 2005 in England again supporting the inverse birthweight blood pressure relationship seen in other studies (Edvardsson, Steinthorsdottir, Eliasdottir, Indridason, & Palsson, 2012).

Blood pressure levels in children has also shown to be impacted by body composition (Lauer, Burns, & Clarke, 1985; Sinaiko, 1996) Wilks et. al (1999) in their large cross-sectional study of 2332 Jamaican children proved that BP in was associated with measures of FM and FFM with Pearson’s correlation coefficients ranging from 0.27 to 0.96 across age ranges. (Wilks et al.,1999). Another study carried out by Pamela Gaskins in Barbados showed that in children Fat mass was associated with diastolic blood pressure (DBP) but not systolic blood pressure (SBP) in some children and FFM was associated with both DBP and SBP in others overall showing that body composition impacts blood pressure in children. (Gaskin et al., 2015).

Overall, these results suggest conflicting relationship between birth weight and body composition measure such as FFM and total body mass and these differences in results may be age related. Furthermore, birth weight with blood pressure literature shows generally that the lower the birth weight the higher the systolic blood pressure, literature also shows that body composition and blood pressure in children are correlated. However, there is a paucity of studies examining these relationships in children one year of age.

Renal sodium reabsorption is a tightly regulated mechanism controlling the body volume and consequently, blood pressure. Various genetic mutations giving rise to salt-wasting disorders have been identified on proteins responsible for sodium reabsorption, including those of NCC in the distal convoluted tubule (DCT). However, not only increased sodium in the urine, patients of such disorders are commonly characterized by hypomagnesemia. Moreover, the putative magnesium sensor in the DCT, CNNM2, has also been associated with blood pressure regulation. These indicate that the magnesium and sodium transport are linked in the DCT. In this study, we aim to analyze how CNNM2 and NCC are connected in the context of blood pressure regulation. We hypothesize that CNNM2 affects the activity of NCC via its trafficking and/or its phosphorylation. To study this, we performed phosphorylation and cell surface biotinylation assay on NCC using HEK293 cells in the presence of an active or inactive form of CNNM2. We also established the T-REx Flp-In YFP-mKate HEK293 cell line for NCC functional assay using the live cell imaging ROPER technique. Phosphorylation assay revealed that inactivation of CNNM2 does not alter the phosphorylation cascade of NCC. This result suggests that NCC might be regulated by CNNM2 via another axis, for example through the trafficking pathway to the cell membrane.

Hypertension continues to be one of the most life-threatening medical conditions globally with around 9.4 million deaths each year. In the body, blood pressure is regulated by numerous organ systems in the body, including the kidney. The kidney controls blood pressure through the regulation of body volume and accordingly, sodium content in the body which is primarily excreted through this axis. Nephrons, the functional units of the kidneys, determine the composition of urine by blood filtration and continuous processing of different electrolytes and water along the renal tubules. The amount of residue and fluid processed differ in different tubular sections and are influenced by many factors. For instance, sodium reabsorption in the distal convoluted tubule (DCT) is heavily affected by aldosterone through phosphorylation of the thiazide-sensitive Na-Cl cotransporter (NCC) by the WNKs kinases and thereby activating it.

Electrolyte transport holds a crucial role in the kidney where a multitude of ion channels are expressed. Genetic mutations on such channels which give rise to electrolyte imbalance known as tubular disorders have been identified. Among these, salt-wasting disorders such as Gitelman and EAST/SeSAME syndrome are of most prevalence. Interestingly, hypomagnesemia is often described in patients with such disorders, suggesting a link between the different renal ion transports. In the DCT, magnesium transport is a highly regulated mechanism where the apical transient receptor potential melastatin 6 (TRPM6) regulates its reabsorption and the solute carrier family 41 member 1 (SLC41A1) extrudes it on the basal membrane. Numerous other magnesiotropic proteins, including cyclin M2 (CNNM2), have been proposed to indirectly, if not directly, regulate magnesium transport as deleterious mutations of such proteins resulted in hypomagnesemia in patients.

48-hour post-transfection, HEK293 cells were washed once with PBS. After that, cells were incubated either in pre-warmed isotonic buffer (NaCl 135 mM, KCl 5 mM, CaCl2 0.5 mM, MgCl2 0.5 mM, Na2HPO4 0.5 mM, Na2SO4 0.5 mM, HEPES/Tris 15 mM, pH 7.4) or hypotonic buffer (Na-gluconate 67.5 mM, K-gluconate 2.5 mM, CaCl2 0.25 mM, MgCl2 0.25 mM, Na2HPO4 0.5 mM, Na2SO4 0.5 mM, HEPES 7.5 mM, pH 7.4) at 37°C for 30 minutes. Cells were then lysed on ice to be subsequently used for SDS-PAGE and immunoblotting.

NCC is a membrane protein whose activity is largely determined by various post-translational modifications. One of such activities is regulated by WNKs kinases through phosphorylation. Thus, to assess if CNNM2 modulates NCC activity, we co-transfected HEK293 cells with NCC and either wild-type or T568I mutant CNNM2. Mutation at this specific site is recognized to significantly decrease the activity of CNNM2. Next, we pre-treated the cells with either isotonic or hypotonic low chloride (Cl-) buffer as the hypotonic condition is known to stimulate the NCC phosphorylation. We also took along one condition to be treated with thiazide, the inhibitor of NCC. Immunoblot analysis revealed that NCC phosphorylation at threonine position 58 (pNCC T58) relative to the total NCC fraction (tNCC) is not modulated by the presence of functional or dysfunctional CNNM2, suggesting that CNNM2 does not affect the phosphorylation cascade of NCC (Figure 1A, B). Of note, we observe that phosphorylation level of NCC in the presence of CNNM2 slightly decreased although the total NCC is not changed compared to single transfection with NCC. Therefore, it might be of importance to further identify if CNNM2 affects the trafficking pathway of NCC to the cell membrane.

Some people ask ‘ What is hypertension?’ or ‘ What effect does it have on our body?’ Well, Hypertension is when the force of blood against the artery walls get so high it causes a bunch of problems all over our bodies. Sounds complicated, right? Mainly all hypertension is high blood pressure that causes our blood to rise over the artery’s wall. Here are some more things to know about Hypertension:

Hypertension can cause A LOT of symptoms by itself. It can cause fatigue or confusion, memory loss, heart attacks, chest pain, severe headaches and a lot more other symptoms.

This disease can also cause a lot of disadvantages to our lives. There are many ways you can reduce the risk of hypertension by exercising more, reduce eating a lot of salt, sleep more and many others. To do this it takes us to change how and what we do with our lives and health, if you don’t try’ to reduce the risk these are some things that could happen if you don’t take action, you could have a heart disease, vision damage, kidney disease and many other things.

This disease also has a lot of interesting facts. Many people in the world have hypertension, more than you think would have it, around 29% of people have hypertension. Which is about 75 million people worldwide, that would mean every 1 out of every 3 adults have a chance of getting it. Although both males and females have a chance of getting this disease, women are more than likely to get hypertension than men are around the age of 55 or above. Which would be about 32% of adults.

Another interesting fact is this disease is known as the ‘ Silent Killer’ because it can take months or even years to see symptoms show up, sometimes symptoms might not even show up at all. Another fact is that it causes about 360,000 casualties a year, that would have to be 1,000 casualties a day for the numbers to be that high, That’s a lot of people to die each day.

The last thing about hypertension is how to treat it, it seems impossible to treat a disease like this, but there are really simple ways to treat it. A couple ways you can is by sleeping more, exercising, eating healthier foods, relaxing and not being stressed, limit tobacco use, and limit how much salt you digest. If you can do these simple things each day, it will decrease your high blood pressure or risk of getting hypertension. The most extraordinary characteristic about this disease is how no symptoms show up, it might take months or years to see any sign show, then no symptoms might show. Which can lead to having a fatal heart attack, stroke, or having a disability if you don’t find signs early enough you could have big risk of dying.

Now you know all the facts about hypertension and what the symptoms are, how to treat them, facts about the disease, how it affects people’s lives, and how many people are affected by it.

Hypertension is one of leading illnesses in America: one out of every three Americans has this traitor disease. If you have blood pressure which is higher than normal, stroke and heart attack is only an inch closer, and you may never know when it hits you. There are hardly any high blood pressure symptoms to look out for, that’s why it helps to always be at check for your blood pressure regularly.

If you have parents, relatives or family members with high blood pressure, then you better be careful. Having high blood pressure is even tougher to deal with than the acquired cases. If you feel you’ve inherited your H B from your family, then you better exert extra effort in getting rid of it.

If you are reading this, then you most likely have to tell your relatives or family members to read this, too. It’s always best to work for a common cause with a group, even better with a family. Below are some of the guidelines on how to eliminate hypertension in your family.

• Exercise- Probably the best way to eliminate high blood pressure. If your hypertension is inherited, exercise becomes a must-do. For those who are overweight, they can try low-to-mid energy impact exercises to not raise the heart rate dramatically. Also, it’s best to be exercising with the family for company.
• Lose that Weight- Extra weight is nothing but trouble, so you have to get rid of it and fast. It is highly important that you keep your diet healthy. Reducing your weight is not also healthy, but it also improves your physical attributes, too. It helps to have a family regulating the food around the house.
• Avoid Stress- Stressful situations raise the blood pressure dramatically. Piles of paperwork, a family emergency, or tension in the area can lead to a more serious development. To get rid of it, have a sense of humor, relax and do not overly stress yourself. Having a good atmosphere at home can remedy your stress, that’s why it really helps if you have good family ties.
• Avoid Sodium- Avoid eating too much food that is high in sodium. Sodium cause the arteries to swell up, or make the blood thicker than normal, which makes it more difficult for the heart to pump blood, and in turn, strains the heart.
• Avoid Smoking- Smoking is never good. It stiffens the arteries, pollutes your lungs, and many more. If you want to live a longer life, you better stop smoking. Same goes for your relatives, too.
• Consult your doctor regularly- The key to victory against diseases and ailments is a good medical advice from the people who really know about these medical conditions: the doctors. They know what to do best and will keep you at check in your progress. It also helps if you take prescribed medicine, to hasten your recovery.

It is really tough battling hypertension, most especially the inherited ones, but if you as a family battle that problem, nothing can go wrong.

INTRODUCTION

High blood pressure is one of the most common old age health issues and is one of the major risk factors for cardiovascular diseases. People over the age of 65 suffer mostly from isolated systolic hypertension with increased pulse pressure, resulting from loss of arterial elasticity. There are two types essential hypertension and secondary hypertension. There are a number of pathophysiological mechanisms of a permanent increase in BP in old age, similarly to younger age. In old age. Hypertension management is the single most effective tool available for reducing old-age disabilities. Many cardiovascular and kidney disorders and diabetes are more likely to rise with age related to hypertension.

DEFINATION

Hypertension is generally characterized by a chronic elevation above a certain threshold value of the systemic arterial pressure. However, growing evidence suggests that the risk of cardiovascular (CV) associated with blood pressure elevation (BP) above approximately systolic blood pressure (SBP) of 140 mmHg or greater, diastolic blood pressure (DBP) of 90 mmHg or greater. Hypertension is a progressive syndrome of the CV that results from diverse etiologies. Early syndrome markers are often present prior to experiencing BP elevation; thus, hypertension cannot be identified solely by distinct BP thresholds. Progression is closely correlated with heart and vascular functional and structural disorders that damage the heart, kidneys, brain, vasculature, and other organs and lead to premature morbidity and death.  Stages of hypertension:- Staging a cycle of disease such as hypertension is an evaluation of the degree to which the disease has advanced at a given time.

CAUSES

The cause of the hypertension is often unknown. In many cases it is the result of a condition underlying it. That is not due to any primary or critical hypertension disorder or illness. When an underlying disorder is causing blood to raise pressure, doctor call this secondary hypertension. Primary hypertension can be caused by many factors: 1) Blood plasma volume 2) Hormone activity in people who manage blood volume and pressure using medication 3) Factors on the environment, such as stress and lack of exercise (life style). Secondary hypertension has different causes and is another health condition that is complicated. Chronic kidney disease (CKD) is a common cause of high blood pressure because the kidneys do not filter out fluid any longer. This excess fluid leads to hypertension. Conditions that can lead to hypertension include: 1) diabetes, 2) due to kidney problems and nerve damage kidney disease 3) pheochromocytoma, a rare cancer of an adrenal gland Cushing syndrome that corticosteroid drugs can cause 4) congenital adrenal hyperplasia, 5) hyperthyroidism.

PATHOPHYSIOLOGY

There are a variety of pathophysiological pathways, close to the younger generation, for a lasting rise in BP in old age. Vascular changes play a crucial and causal role in old age, especially the large elastic-type central arteries, which usually have an elastic structure. Loss of this feature is common for older people with hypertension. Systolic blood pressure increases and diastolic blood pressure decreases or remains unchanged, i.e. changes in heart rate and frequency of single systolic hypertension. Morphological changes arise mostly in the vascular medium, where collagen continues to get older and elastin decreases with age. The volume factor is also added, in addition to a decreased vascular compliance. The aorta lengthens, has a larger diameter, and contains greater blood flow. The aorta’s greater capacity contributes to its decreased ability to evacuate blood to the periphery. That systolic BP reflects a greater strain of the left ventricle-an increased afterload-and as a result, the functional and morphological changes take place. Left ventricular hypertrophy is observed more commonly in hypertensive elderly people than in other hypertensive groups; this is also a logical result of a long-term increase in blood pressure. Another common improvement is the decreased baroreflex sensitivity which can lead to orthostatic hypotension in elderly people. It is also one of the key mechanisms that cause increased variation of blood pressure of old age. Changes in renal function (loss of glomeruli, reduced blood flow) contribute to deterioration of salt balance and thus blood pressure is prone to sodium intake in old age. Another common shift is the reduction in plasma renin activity with age, with the decrease in renin activity being more pronounced in older hypertensive than in normotonics. And hypertension in old age is, therefore, usually weak. The decrease is thought to be attributable to hyaline degeneration of afferent arterioles in the kidney and decreased reactivity of β-adrenergic juxtaglomerular receptors. Another contributing factor to orthostatic hypotension is the decreased response of renin to upright position. [2]

SIGNS AND SYMPTOMS

Hypertensive Urgency: Can be completely asymptomatic (silent killer) and can be symptomatic as: severe headache, shortness of breath, epistaxis, and severe anxiety while signs: elevated BP on consecutive readings. Hypertensive Emergencies: Symptoms: as fatigue , loss of conscious , vision problems, chest pain, difficulty breathing, irregular heartbeat, blurry vision, Nausea, vomiting (cerebral edema) while signs : Retinal hemorrhages, exudates, or papilledema, renal involvement (malignant nephrosclerosis) with AKI, proteinuria, hematuria, cerebral edema :-seizures and coma , pulmonary edema, myocardial infarction, hemorrhagic Stroke, lacunar infarcts. [3]

INVESTIGATION

Patients with mild to moderate hypertension need only a clear schedule of investigations, particularly if first-degree relatives have a history of stroke or hypertension. Tests are important for profiling other cardiovascular risk factors and for detecting target organ damage with only minimal secondary hypertension screening. Careful history, physical examination, repeated measurements of blood pressure over months, and body mass index measurements, random cholesterol, routine blood chemistry and urinalysis using impregnated paper strips are all required. [4]

Pharmacological treatment in general

We should take into account the evidence gathered from broad trials when selecting a pharmacological treatment for a specific patient. In addition, account must be taken of the associated diseases of the patient and if they occur after any of the preparations evidence side effects .We currently have 5 classes of essential antihypertensive medications, for which it has been shown that their long-term administration contributes to a decrease in the occurrence of cardiovascular problems, in addition to a decrease in blood pressure. However, there are variations in the use of individual classes (and individual preparations) in the treatment of hypertension in old age.

COMPLICATIONS

Hypertension can cause long-term complications as atherosclerosis, in which plaque develops on blood walls vessels that narrowed them. This narrowing makes hypertension worse, since the heart needs to pump harder to get the blood circulating. Atherosclerosis linked to hypertension can lead to heart failure and heart attacks aneurysm. The hypertension creates a greater pressure load on the heart to induce the hypertrophy of the left ventricle, as the left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy, or abnormal bulge in the wall of an artery that can burst kidney failure stroke amputation hypertensive retinopathies in the eye, which can lead to blindness. [8]

CONCLUSION

Hypertension is generally characterized by a chronic elevation above a certain threshold value of the systemic arterial pressure. It is a major cause of morbidity and mortality, and needs to be treated. It has 3 main stages, most of its causes related to life style and daily routine so life style modification should always be encouraged in all Hypertensive patients. There are a variety of pathophysiological pathways, close to the younger generation, for a lasting rise in BP in old age. Vascular changes play a crucial and causal role in old age, especially the large elastic-type central arteries, which usually have an elastic structure. Loss of this feature is common for older people with hypertension. Hypertension is called silent killer it could be asymptomatic. It can be investigated by home measurement by sphygmomanometer and laboratory tests. Hypertension management is the single most effective tool available for reducing old-age disabilities by non-pharmacological treatment and pharmacological one. Hypertension can cause long-term complications as atherosclerosis Regular blood pressure monitoring can help people avoid these more severe complications.