From the Guidelines
SBP stands for systolic blood pressure, which should be targeted to 130 mmHg in patients with diabetes and less than 130 mmHg if tolerated, but not less than 120 mmHg, as recommended by the 2019 ESC guidelines 1. The goal of targeting SBP to 130 mmHg is to reduce the risk of micro- and macrovascular complications, which is a critical aspect of managing diabetes and hypertension.
- Key points to consider when managing SBP include:
- In older people (aged >65 years), the SBP goal is to a range of 130 - 139 mmHg 1.
- Optimal BP control reduces the risk of micro- and macrovascular complications, emphasizing the importance of proper SBP management 1.
- Guidance on lifestyle changes must be provided for patients with diabetes and hypertension, in addition to medication therapy 1.
- Evidence strongly supports the inclusion of an angiotensin-converting enzyme inhibitor (ACEI), or an angiotensin receptor blocker (ARB) in patients who are intolerant to ACEI, as part of the treatment plan to manage SBP 1. When measuring blood pressure, it's best to be seated quietly for at least 5 minutes beforehand, with your arm supported at heart level, and to take multiple readings over time for accuracy.
- Monitoring SBP is crucial because elevated systolic pressure is a significant risk factor for cardiovascular disease, stroke, and kidney problems, making it essential to track and manage SBP effectively 1.
From the Research
Definition of SBP
- Spontaneous bacterial peritonitis (SBP) is a bacterial infection of ascitic fluid without any intraabdominal, surgically treatable source of infection 2
- SBP is the prototypical ascitic fluid infection occurring in patients with advanced liver disease and ascites 3
- It is a severe and often fatal infection in patients with cirrhosis and ascites 4
Causes and Risk Factors
- Bacterial translocation from the gut to mesenteric lymph nodes, depressed activity of the reticuloendothelial phagocytic system, and decreased antimicrobial capacity of ascitic fluid seem to be the main steps in the pathogenesis of ascitic fluid infection 2
- Acid suppressive and beta-adrenergic antagonist therapies are strongly associated with SBP in at-risk individuals 4
- Patients with low-protein ascites (ascitic fluid total protein < 1g/dL) are at high risk for developing SBP 3
Diagnosis and Treatment
- Diagnosis of ascitic fluid infection is based on clinical suspicion and analysis of ascitic fluid, especially white cell count and culture in blood culture bottles 2
- A third-generation cephalosporin, such as cefotaxime, is the treatment of choice, achieving a cure rate higher than 80% 2, 5
- Nonazotemic patients with nonadvanced, uncomplicated SBP may be treated with oral ofloxacin 2
- Selective intestinal decontamination with oral norfloxacin is extremely useful in preventing SBP in patients that are at high risk for developing SBP 3, 2
Prognosis and Prevention
- The in-hospital mortality rate remains high as a result of complications such as renal failure 5
- Long-term prognosis of SBP patients is poor, and survivors should be considered for liver transplantation 2
- Primary or secondary long-term prophylaxis of SBP also decreases the incidence of SBP, but these patients should be carefully observed for detecting possible infections caused by quinolone-resistant organisms 2