Corinne Trevitt

Elevated Blood Pressure in Offspring Born Premature to Hypertensive Pregnancy: Is Endothelial Dysfunction the Underlying Vascular Mechanism?

Offspring born to mothers with hypertensive pregnancy have higher childhood blood pressure. We hypothesized this relates to prenatally programmed differences in the underlying vascular pathophysiology of the offspring and that these would be most apparent in those born preterm because of severe hypertension. We carried out a 20-year follow-up study of 71 subjects born preterm, 19 to a hypertensive pregnancy and 52 to a normotensive pregnancy. Findings were compared with 38 subjects born at term to uncomplicated pregnancies. Peripheral and central blood pressures were measured, and then central arterial stiffness was assessed by carotid-femoral pulse wave velocity using applanation tonometry. Ultrasound was used to assess flow-mediated endothelial-dependent and independent brachial artery responses and common carotid artery intima-media thickness. Offspring born preterm to either hypertensive or normotensive pregnancy had higher peripheral and central blood pressure compared with full-term born offspring (central mean arterial pressure after preterm hypertensive pregnancy: 84.92±7.0 mm Hg; preterm normotensive pregnancy: 84.13±8.9 mm Hg; full-term pregnancy: 76.24±7.96 mm Hg; P=0.0009). However, underlying vascular phenotype differed. Preterm offspring of normotensive pregnancy had greater arterial stiffness than offspring of hypertensive pregnancy (5.92±0.84 versus 5.42±0.73 m/s; P=0.039), whereas offspring of hypertensive pregnancy had greater carotid intima-media thickness (0.52±0.04 versus 0.48±0.06 mm; P=0.013) and 30% lower flow-mediated dilatation (4.25±4.02% versus 6.79±4.38%; P=0.05). Prematurity is associated with elevated blood pressure in later life. However, predominant underlying vascular phenotype depends on maternal pathology. Targeting endothelial function may be particularly important for primary prevention after hypertension in pregnancy.

Developing a professional identity: Student nurses in the workplace.

Abstract This analysis of the academic and student discourse about learning in the practicum in one Australian pre-registration Bachelor of Nursing course is part of a larger study examining the professional identity of undergraduate students in three professional groups: nursing, teaching and engineering. The focus group discussion of six student nurses reveals that the theories learned in the classroom are only partially useful preparation for the relationships required to work as a nurse in a people-laden workplace; students struggle to create meaning about practices that are not consistent with classroom theory; and students require support as they develop an identity of a nurse through the embodiment of practice work. The findings from this group support the view that the traditional approach to learning, as expressed in the documentation for the final practicum experience, where knowledge is certain, context-free, and disciplinary or subject focused, is insufficient to assist student readiness for the world of work. Recommendations emerging from this analysis are related to the university and provides some evidence for others teaching in nursing programs to reconsider their practices.

Impaired Endothelial Responses in Apparently Healthy Young People Associated With Subclinical Variation in Blood Pressure and Cardiovascular Phenotype

BACKGROUND A phenomenon of endothelial impairment, independent of classical cardiovascular risk factors, has been observed in young people. We identified subjects with persistently reduced, or declining, endothelial function during adolescence and early adulthood, without apparent cardiovascular risk, and investigated the clinical relevance of this finding. METHODS Endothelial vasomotor responses were assessed by brachial artery flow-mediated dilatation (FMD) at age 15 years in 47 subjects (22 males) who returned for a repeated measurement at age 25. Subjects underwent quantification of left ventricular mass (LVM) and function by cardiovascular magnetic resonance, central arterial stiffness by applanation tonometry, and common carotid artery intima-media thickness using ultrasound on their visit at age 25. RESULTS Individuals with low average FMD over 10-year period, although normotensive, had 5 mm Hg higher systolic blood pressure and, significantly greater LVM (73.48 ± 7.73 vs. 56.25 ± 9.54 g/m(2), P = 0.0001), carotid intima-media thickness (cIMT) (0.53 ± 0.06 vs. 0.47 ± 0.04 mm, P = 0.03), and pulse wave velocity (5.97 ± 0.63 vs. 5.29 ± 0.59 m/s, P = 0.02) than those with higher endothelial responses. Subjects with the greatest decline in FMD over 10 years had a significant increase in mean arterial pressure but similar cardiovascular phenotype. CONCLUSION Persistently reduced, or declining, endothelial function during adolescence, in the absence of overt cardiovascular disease, is a sensitive early marker associated with subclinical changes in blood pressure (BP) and an adverse cardiovascular phenotype. The findings highlight the potential importance of endothelial responses during adolescence in primary prevention strategies for hypertension.

‘Just Because I Can't Remember …’ Religiousness in Older People with Dementia

SUMMARY This paper reports part of a pilot study that used spiritual reminiscence techniques to explore issues of religiosity, church attendance and meaning in life of a group of older people with dementia. The study used small groups, individual interviews and participant observation to examine the experience of dementia and the search for meaning used by people with dementia. There were 22 participants from three aged care facilities involved in the project. The majority of participants had been long-term church attendees and could describe how their religion and relationship with God had impacted on their lives. They had few fears for the future and derived considerable meaning in life from their relationships with family. Participants were able to describe early memories and also remember things happening recently in their aged care facility. This would seem to be the opposite of community expectations (and sometimes staff expectations) of older people with dementia.

Aortic distensibility decreases during exercise in normal volunteers

Methods 24 healthy volunteers (17 males, mean age 35) underwent magnetic resonance imaging in the supine and prone position using a 1.5 T CMR system (Siemens) at rest. Imaging was then repeated immediately after 2-6 mins of prone lower limb exercise, and again after 4 minutes of recovery. Aortic cross-sectional area was measured at the ascending aorta and proximal desending aorta (at the level of the bifurcation of the pulmonary artery) and at the descending abdominal aorta (12-14 cm below this plane) throughout the cardiac cycle. BP was measured simultaneously. Aortic distensibility was defined as (maximum aortic area minimum aortic area/minimum aortic area)/ pulse pressure. Two-sided, paired t-tests for preand postexercise distensibility were undertaken using SPSS, and data presented as means with standard deviations.

Spiritual factors in the experience of Alzheimer's disease and other Dementias

Alzheimer’s disease and other dementias raise important questions of personhood and connection for those affected. Finding meaning in the face of dementia is one of the most challenging aspects of dementia; spiritual reminiscence is a way of connecting with those with dementia when their cognitive decline seems to preclude them from participating in a meaningful life. In this chapter a context for spirituality in later life is given through description of the spiritual tasks and process of ageing. This leads to presentation of work based on a mixed methods study of 113 people in residential aged care with a diagnosis of dementia who participated in either six or 24 weeks of weekly sessions of guided spiritual reminiscence (MacKinlay & Trevitt, 2012). Relationship was found to be almost synonymous with meaning for these people. Other important themes identified were vulnerability and transcendence, wisdom, hope, despair, and response to meaning.

055 Elevated blood pressure in offspring born to hypertensive pregnancy: is endothelial dysfunction the underlying vascular mechanism?

Background Mothers with preeclampsia exhibit endothelial damage proportional to the severity of the condition. Higher blood pressure had been observed in their offspring and we hypothesised that this is a result of endothelial dysfunction also being present in the infant. This dysfunction should be greatest in those born premature due to severe preeclampsia and, as prematurity per se is associated with hypertension, we explored whether the underlying vascular phenotype differs from that observed when prematurity is not related to maternal vascular dysfunction. Methods We studied 99 young adults aged 20–30. Seventy-one subjects were born preterm to a hypertensive (27%) or a normotensive pregnancy (73%), and 28 term controls born to uncomplicated pregnancies. Subjects underwent measurements of peripheral (BP) and central blood pressures (cBP). Endothelial dependent (FMD) and endothelial-independent brachial artery responses were assessed by ultrasound. Aortic stiffness was measured by pulse wave velocity (PWV) using applanation tonometry. Results Offspring born premature either to hypertensive or normotensive pregnancy displayed significantly elevated peripheral (DBP 71.79±7.37, 71.61±6.52 vs 64.92±7.05, ANOVA p=0.0003 and MAP 87.93±7.61, 88.07±6.9 vs 81.62±8.06, ANOVA p=0.002) and central blood pressures (cSBP 115.96±10.86, 115.78±10.55 vs 96.71±9.86, ANOVA p<0.0001, cMAP 84.92±7.0, 84.13±8.9 vs 76.24±7.96, ANOVA p=0.0009 and cPPBP 46.56±8.63, 46.94±10.27 vs 30.71±4.82, ANOVA p<0.0001) compared to controls born at term. However, the offspring of hypertensive pregnancy had a distinct vascular phenotype with 40% lower FMD compared to subjects born at term to a normotensive pregnancy (4.25±4.02 vs7.27±5.12, p=0.035) and increased cIMT (0.52±0.04 vs 0.48±0.06, p=0.04). Whereas, those born premature to a normotensive pregnancy had normal endothelial responses but differences in PWV compared to term controls (5.92±0.84 vs 5.56±1.09, p=0.035). Conclusion Prematurity is associated with elevated blood pressure in later life. In offspring of pregnancies complicated by preeclampsia or gestational hypertension, endothelial dysfunction is the predominant vascular phenotype. The findings direct attention towards endothelial dysfunction as a potential target for primary prevention in offspring of pre-eclampsia. Abstract 55 Figure 1 Abstract 55 Figure 2

ENDOTHELIAL FUNCTION DURING ADOLESCENCE PREDICTS LEFT VENTRICULAR MASS IN EARLY ADULT LIFE

Background Left ventricular mass is a powerful independent predictor of mortality and morbidity in adults. Endothelial function may influence cause cardiac hypertrophy through modification of myocardial biology or arterial stiffness. We sought to determine whether endothelial dysfunction during adolescence and early adult life is independently associated with increased left ventricular mass. Methods Thirty healthy normotensive subjects (43% males) underwent assessment of endothelial function by flow mediated dilatation (FMD) of the brachial artery at the age of 15 years using ultrasound. Subjects were followed up at the age of 23–26 years for assessment of left ventricular mass (LVM) by cardiovascular magnetic resonance imaging (Siemens 1.5 T Sonata scanner), adjusted for body surface area (LVMI), and repeated FMD measurements using the same methods. Cardiovascular risk factors including body size, blood pressure, lipid profile, glucose tolerance and smoking were assessed at both time points. Results FMD in early adulthood was significantly related to LVMI (r −0.55, p 0.002). FMD at the age 15 was similarly inversely associated with LVMI 10 years later (r −0.41, p 0.02) with greater endothelial responses related to reduced left ventricular mass. Those with FMD consistently above the mean at both age 15 and 25 had significantly lower LVMI compared to those with FMD below the mean (58 g/m2 vs 68 g/m2 p<0.05). In a multivariate regression model of LVMI, including cardiovascular risk factors, FMD was the main independent predictor of ventricular mass. Conclusion Endothelial responses during adolescence predict left ventricular mass 10 years later and those with consistently high endothelial responses over this time period have the lowest left ventricular mass. Endothelial function may influence cardiac structure in young people in the absence of classic risk factors such as hypertension and obesity. Abstract 75 Figure 1 Abstract 75 Figure 2