What is the significance of Systolic Blood Pressure (SBP)?

From the Guidelines

Systolic blood pressure (SBP) should be maintained below 120 mmHg to minimize the risk of cardiovascular complications, with lifestyle modifications and medication as necessary, according to the most recent guidelines. To achieve this, individuals can adopt lifestyle modifications including reducing sodium intake to less than 2,300 mg daily, exercising regularly (150 minutes of moderate activity weekly), maintaining a healthy weight, limiting alcohol consumption, and avoiding tobacco 1. If medication becomes necessary, first-line options include thiazide diuretics (like hydrochlorothiazide 12.5-25 mg daily), ACE inhibitors (such as lisinopril 10-40 mg daily), ARBs (like losartan 25-100 mg daily), or calcium channel blockers (such as amlodipine 2.5-10 mg daily) 1. Controlling SBP is crucial because elevated levels significantly increase the risk of heart disease, stroke, kidney damage, and other cardiovascular complications by causing arterial damage and increasing cardiac workload over time. In geriatric trauma patients, a prehospital SBP less than 110 mmHg can be a cutoff value for predicting massive transfusion, and an emergency department shock index (SI) greater than 1.0 can be a cutoff value for predicting massive transfusion in patients older than 65 years who are not taking antihypertensives 1. However, the classic definition of hypotension in adults (90 mmHg) is linked to significantly greater mortality in the geriatric population, and a lower threshold for trauma protocol activation is recommended in these patients 1. Overall, maintaining a healthy SBP is essential for preventing cardiovascular complications and improving outcomes in various patient populations. Key points to consider include:

• Maintaining SBP below 120 mmHg to minimize cardiovascular risk
• Adopting lifestyle modifications, such as reducing sodium intake and exercising regularly
• Using medication, such as thiazide diuretics or ACE inhibitors, as necessary
• Considering different cutoff values for SBP and SI in geriatric trauma patients
• Prioritizing lower thresholds for trauma protocol activation in geriatric patients.

From the Research

Definition and Causes of SBP

• Spontaneous bacterial peritonitis (SBP) is defined as bacterial infections that occur in patients with cirrhosis and ascites without any significant intraperitoneal infection, accounting for approximately 10-30% of bacterial infections in hospitalized patients 2.
• SBP develops in patients with liver cirrhosis because bacterial translocations are increased by changes in the intestinal bacteria and mucosal barriers, and the decreased host immune response cannot remove the bacteria and their products 2.
• The most common cause of SBP is Gram-negative bacteria, such as Escherichia coli and Klebsiella species, and infections by Gram-positive bacteria are increasing 2.

Diagnosis of SBP

• SBP is diagnosed by the presence of >250 polymorphonuclear leukocyte/mm3 in ascites after paracentesis 2.
• A diagnostic paracentesis should be performed in all patients with ascites and clinical features with high diagnostic suspicion, such as abdominal pain or tenderness, fever, or altered mental status 3, 4.
• Although literature data abound in identifying new diagnostic markers in serum or ascites, they have not yet been validated, and the final diagnosis requires the analysis of ascites and the presence of > 250 mm3 neutrophil polymorphonuclear (PMN) in ascites 4.

Treatment and Prevention of SBP

• If SBP is diagnosed, empirical antibiotic therapy should be started immediately, and the choice of antibiotic should distinguish between community-acquired infections and nosocomial infections 2, 3.
• Third-generation, broad-spectrum cephalosporins remain a good initial choice for SBP treatment, and alternative antibiotics such as pipercillin-tazobactam should be considered for patients with nosocomial SBP or for patients who fail to improve on traditional antibiotic regimens 3, 5.
• Selective albumin supplementation remains an important adjunct in SBP treatment, and liver transplant evaluation should be undertaken for patients who develop SBP barring contraindications 5.
• Cirrhotic patients with gastrointestinal bleeding or low ascitic protein concentrations should consider primary prevention, and those who recover from SBP should consider secondary prevention 2.