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Background: Spinal pain or misalignment is a very common disorder affecting a significant number of populations resulting in substantial disability and economic burden. Various manual therapeutic techniques such as spinal manipulations and mobilizations can be used to treat and manage pain and movement dysfunctions such as spinal mal-alignments and associated complications. These manual therapeutic techniques can affect the cardiovascular parameters.

Objective: The objective of this systematic review and meta-analysis is to assess the effect of spinal manipulation and mobilization on cardiovascular parameters.

Methods: We conducted a systematic review and meta-analysis to assess the effects of spinal mobilization and manipulation on cardiovascular responses. Mean changes in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Quality of the included studies was assessed by PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias.

Results: Results of meta-analysis showed that there was statistically significant decrease in SBP ($\mathrm{\text{MD}}=-4.56$, 95% $\mathrm{\text{CI}}=-9.20$, 0.08; $p\le 0.05$) with moderate heterogeneity ($\mathrm{\text{I}}2=75\%$, $p<0.0002$) in experimental group as compared to control group. There was statistically non-significant decrease in DBP ($\mathrm{\text{MD}}=-1.96$, 95% $\mathrm{\text{CI}}=-4.60$, 0.69; $p=0.15$) with high heterogeneity ($\mathrm{\text{I}}2=91\%$, $p<0.00001$), Change HR was statistically non-significant ($\mathrm{\text{MD}}=-0.24$, 95% $\mathrm{\text{CI}}=-3.59$, 3.11; $p=0.89$) with moderate heterogeneity ($\mathrm{\text{I}}2=60\%$, $p=0.01$). Exclusion of short duration studies in sensitivity analysis revealed a statistically significant change in DBP ($\mathrm{\text{MD}}=-0.94$, 95% $\mathrm{\text{CI}}=-1.85$, $-0.03$; $p=0.04$). However, the result was statistically non-significant for HR after sensitivity analysis.

Conclusion: Spinal manipulations and mobilizations may result in significant decrease of systolic as well as diastolic Blood Pressure.

Investigators collect data and present them in a way that offers the best insight regarding the questions at hand. To facilitate understanding of certain aspects, it may occasionally be useful to rearrange primary data and formulate them as derived variables. For example, the travel distance divided by the invested time yields average velocity (as m/s). Problems may arise when interpreting ratios that fail to have a physical dimension. For example, current TV-sets have a fixed ratio for height and width, implying that we need an additional detail to define its size. Size then is determined by the diagonal, which can be calculated from the two sides using the Pythagorean theorem. Similarly, paired hemodynamic variables may be expressed as ratios. Again, a fixed ratio may refer to a variety of underlying primary data which require consideration if the ratio is unitless. In this survey, we evaluate several derived metrics commonly used in cardiovascular studies, and offer comprehensive analysis strategies.

Traditional arterial tonometry permits noninvasive and continuous recording of the arterial pressure waveform, by applanating a superficial artery supported by a bone. In the paper, we present an arterial tonometer to simultaneously register the blood pressure waveform and the arterial time-varying volume. The tonometer consisted mainly of a chamber filled with a conductive fluid, a flexible diphragm in touch with an artery, and a pressure sensor used to detect the underlying arterial pressure. In addition, four electrodes were in parallel diposed in the chamber, two of them were triggered with a constant-current source, and the voltage difference between the other two inner electrodes was assocated with the amount of change in the arterial volume. The pressure calibration curve performed with a mercury sphygmomanometer showed a fairly linear relationship (r = 0.998) between the tonometer's chamber pressure and the voltage output of the pressure-sensing circuit. The volume calibration was carried out with vessel-like cylinders of various diameters and a linear relationship (r = 0.884) of the change in vessel volume to the voltage output of the volume-sensing circuit was obtained. Clinical testing results revealed that the noninvasive blood pressure measurement with the tonometer was appreciably consistent with the invasive measurement with the catheter-tipped pressure transducer. In summary, the arterial applanation tonometer developed may be used to reliably determine the full arterial blood pressure waveform and the change in the arterial volume, and to make the wall compliance assessment of a superficial artery possible.

The objective of this study is to determine the pressure-dependent compliance of human radial artery in young subjects. The arterial blood pressure and the change in vessel volume of the radial artery in ten normotensive volunteers were simultaneously measured with an arterial tonometer. The arterial global compliance was calculated as the division of change in vessel volume by the difference between the systolic and the diastolic blood pressures. The arterial global compliance measured from the ten young volunteers was found to be 4.645 ± 2.739 uL/mmHg. When the arterial pressure-volume relation was assumed to be of natural logarithm, a correlation coefficient of 0.996 was yielded by curve-fit methods. Similarly, when the arterial compliance-pressure relation was fit in a natural logarithmic form, a correlation coefficient of 0.998 was obtained. In conclusion, the arterial vessel volume varies with the arterial blood pressure logarithmicly and positively, whereas a logarithmic and negative relation between the arterial global compliance and arterial blood pressure is present in human radial arteries. Thus, it is for all time necessary to take the pressure level into account if we want to compare compliance values obtained from distinct physiological situations.

Hypertension is a major risk factor for ischemic cardiovascular disease and cerebrovascular disease, which are respectively the primary and secondary most common causes of morbidity and mortality across the globe. To alleviate the risks of hypertension, there are a number of effective antihypertensive drugs available. However, the optimal treatment blood pressure goal for antihypertensive therapy remains an area of controversy. The results of the recent Systolic Blood Pressure Intervention Trial (SPRINT) trial, which found benefits for intensive lowering of systolic blood pressure, have been debated for several reasons. We aimed to assess the benefits of treating to four different blood pressure targets and to compare our results to those of SPRINT using a method for causal inference called the parametric g formula. We applied this method to blood pressure measurements obtained from the electronic health records of approximately 200,000 patients who visited the Mount Sinai Hospital in New York, NY. We simulated the effect of four clinically relevant dynamic treatment regimes, assessing the effectiveness of treating to four different blood pressure targets: 150 mmHg, 140 mmHg, 130 mmHg, and 120 mmHg. In contrast to current American Heart Association guidelines and in concordance with SPRINT, we find that targeting 120 mmHg systolic blood pressure is significantly associated with decreased incidence of major adverse cardiovascular events. Causal inference methods applied to electronic methods are a powerful and flexible technique and medicine may benefit from their increased usage.