2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

High-intensity circuit training improves cognitive performance independent of changes in sBDNF levels in active college students

High-intensity circuit training (HICT) is an exercise modality converging aerobic and resistance exercises executed at high-intensity interspersed by recovery periods. During the HICT, the participants use their body weight as resistance. The impact of HICT on metabolic and cardiovascular markers has been reported, the effect of HICT on brain function remains unknown. The current study was focus to evaluate the impact of 24 HICT sessions on the serum BDNF (sBDNF) levels and cognition skills in young adults. Fifteen college students (22.1 ± 5.3 yr.) were randomly assigned to a control (CTRL) (n = 7) or a HICT (n = 8) group. The CTRL group continued their daily activities without restricting their physical activities, the HICT group carried out 24 HICT sessions. The sBDNF levels of all participants pre- and post-HICT intervention were determined by ELISA method. Visual memory, verbal memory, semantic verbal fluency, and attention were evaluated with specific neuropsychological tests. The heart rate variability (HRV) was recorded at rest in the supine position (5 min) for both groups at the beginning of the HICT program and 24 h after the intervention. The sBDNF levels increased in both groups at the end of the study (p < 0.0001). Visual memory (delayed recall) and long-term verbal memory significantly improved after HICT (p < 0.01). The HRV was unchanged by HICT. In conclusion, HICT might be a feasible method to improve cognition abilities in active young adults, and it is becoming a good option for college students since the intervention did not induce physiological stress in the participants.

Race/Ethnicity and Other Predictors of Early-Onset Type 2 Diabetes Mellitus in the US Population

OBJECTIVES

Among US adults aged 20 + years in the USA with previously diagnosed type 2 diabetes mellitus (T2DM), we aimed to estimate the prevalence of early-onset T2DM (onset at age < 50.5 years) and to test associations between early-onset T2DM and race/ethnicity, and other hypothesized predictors.

METHODS

We pooled data from the annual National Health and Nutrition Examination Surveys (NHANES) over the years 2001 through 2018. We tested hypotheses of association and identified predictors using stepwise logistic regression analysis, and 11 supervised machine learning classification algorithms.

RESULTS

After appropriate weighting, we estimated that among adults in the USA aged 20 + years with previously diagnosed T2DM, the prevalence of early-onset was 52.9% (95% confidence intervals, 49.6 to 56.2%). Among Non-Hispanic Whites (NHW) the prevalence was 48.6% (95% CI, 44.6 to 52.6%), among Non-Hispanic Blacks: 56.9% (95% CI, 51.8 to 62.0%), among Hispanics: 62.7% (95% CI, 53.2 to 72.3%). In the final multivariable logistic regression model, the top-3 markers predicting early-onset T2DM in males were NHB ethnicity (OR = 2.97; 95% CI: 2.24-3.95) > tobacco smoking (OR = 2.79; 95% CI: 2.18-3.58) > high education level (OR = 1.65; 95% CI: 1.27-2.14) in males. In females, the ranking was tobacco smoking (OR = 2.59; 95% CI: 1.90-3.53) > Hispanic ethnicity (OR = 1.49; 95% CI: 1.08-2.05) > obesity (OR = 1.30; 95% CI: 0.91-1.86) in females. The acculturation score emerged from the machine learning approach as the dominant marker explaining the race disparity in early-onset T2DM.

CONCLUSIONS

The prevalence of early-onset T2DM was higher among NHB and Hispanic people, than among NHW people. Independently of race/ethnicity, acculturation, tobacco smoking, education level, marital status, obesity, and hypertension were also predictive.

Gut microbiota contributes to obstructive sleep apnea-induced hypertension by gut-heart axis in mice

BACKGROUND

The gut microbiome has been closely linked to obstructive sleep apnea (OSA)-associated hypertension (HTN). However, its precise role in the pathogenesis of OSA-induced HTN remains unclear.

METHODS

To clarify the causal relationship between gut dysbiosis and OSA-related HTN, C57BL6J mice were randomly assigned to four groups. Each group underwent fecal microbiota transplantation from healthy individuals (control), OSA patients (OSA group), OSA patients with pre-hypertension (OSA-pHTN group), or OSA patients with HTN (OSA-HTN group). The pro-hypertensive effects of the OSA gut microbiota were verified, and the composition and function of the gut microbiota were compared using 16S rDNA gene sequencing. Additionally, the gut microbiota-related lipopolysaccharide (LPS)/ Toll-like receptor 4 (TLR4)/nuclear factor-kappaB (NF-κB) pathway in aortic tissues was investigated.

RESULTS

Fecal microbiota transplantation induced increased systolic blood pressure and aortic injury in mice from the OSA, OSA-pHTN and OSA-HTN groups, whereas no significant injury was observed in the control group. These three groups exhibited dysbiosis and impaired intestinal barrier function as evidenced by a reduction in Akkermansia and decreased expression of zonula occludens-1 and Occludin proteins. In addition, LPS, TLR4 and phosphorylated NF-κB expression were increased in aortic tissue from the three groups, and immunofluorescence showed a significant upregulation of TLR4 expression in aortic endothelial cells compared to controls.

CONCLUSION

This study demonstrates the pro-hypertensive effects of gut microbiota in OSA, mediated through the gut-derived LPS/TLR4/NF-κB pathway. These findings may guide the development of therapeutic strategies focused on restoring gut microbiome homeostasis.

Temporal patterns of cognitive decline after hypertension onset among middle-aged and older adults in China

Individuals with prevalent hypertension are at an increased risk of developing dementia and tend to exhibit lower cognitive function. However, the magnitude of cognitive change following the onset of new hypertension remains uncertain. A cohort of 7949 adults aged 45 and older without hypertension at baseline was followed prospectively for 7 years. Cognitive assessments were conducted initially (wave 1) and at least once between wave 2 (2013) and wave 4 (2018). Cognitive function was evaluated using a global cognition score, derived as a composite measure from four distinct cognitive tests. Linear mixed-effects models were employed to estimate the changes in cognitive function at the onset of hypertension (intercept change) and the subsequent rate of cognitive decline (slope change) over the follow-up period. The models accounted for pre-hypertension cognitive trajectories and participant-specific factors, with interaction terms included for antihypertensive medication, age and educational level. Of the 7949 participants, 1993 (25.07%, mean age 58.8 ± 8.84 years, 48.0% male) developed new-onset hypertension. Both groups-those without hypertension and those with new-onset hypertension-experienced annual cognitive decline during the follow-up period. The onset of hypertension was not associated with an acute decrease in global cognition or performance on the four cognitive tests. However, after the onset of hypertension, participants exhibited a statistically significant accelerated decline in global cognition (- 0.029 SD/year; 95% CI - 0.043 to - 0.015; p < 0.001), attention and calculation (- 0.022 SD/year; 95% CI - 0.040 to - 0.004; p = 0.017), and orientation (- 0.022 SD/year; 95% CI - 0.038 to - 0.005; p = 0.010). No significant changes were observed in episodic memory (- 0.009 SD/year; 95% CI - 0.028 to 0.010; p = 0.346) or visuospatial abilities (- 0.013 SD/year; 95% CI - 0.032 to 0.006; p = 0.185). Interaction analyses indicated that the use of antihypertensive medication, age, and educational level moderated the extent of global cognitive decline post-hypertension onset. The onset of new hypertension was not associated with an immediate decline in cognitive function compared to individuals without hypertension. However, it was linked to more rapid declines in global cognition, orientation, and attention and calculation abilities over time. These findings underscore the potential importance of hypertension prevention for maintaining long-term brain health.

Impact of COPD and sarcopenia on all-cause and respiratory mortality in US adults: NHANES 1999-2018

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) and sarcopenia (SAR) are major public health problems in aging societies, as they share common pathophysiological mechanisms and are associated with serious health consequences. We estimated the impact of COPD and SAR on all-cause and respiratory mortalities in the US adult population.

METHODS

The study analyzed data from the National Health and Nutrition Examination Surveys (NHANES), a representative sample of the US population. Participants aged 20 years or older who had reported whole-body dual X-ray absorptiometry data and data required for the diagnosis of COPD were included. Participants were divided into four groups based on the presence of COPD and SAR.

RESULTS

Compared to the COPD-/SAR - group, the COPD-/SAR+, COPD+/SAR-, and COPD+/SAR + groups all demonstrated increased all-cause mortality with Hazard Ratios (HRs) of 1.33 (95% CI 1.20-1.48), 1.51 (95% CI 1.21-1.88), and 1.87 (95% CI 1.32-2.66), respectively. In addition, both the COPD+/SAR - and COPD+/SAR + groups demonstrated increased respiratory mortality with HRs of 5.16 (95% CI 2.96-9.01), and 8.69 (95% CI 3.95-19.1) compared to the COPD-/SAR - group.

CONCLUSIONS

The coexistence of COPD and SAR additively increased the risk of all-cause and respiratory mortality. Individuals with one of these diseases may need to be treated more carefully to prevent the development of the other disease and thus reduce mortality.

Diagnosis of Hypertensive Disorders in Pregnancy: Hypertensive Disorders in Pregnancy

Hypertensive disorders of pregnancy, including chronic hypertension, superimposed preeclampsia, gestational hypertension, and preeclampsia, affect 10-20% of pregnancies and are a significant cause of maternal and perinatal mortality. The incidence of these disorders is rising due to factors such as advanced maternal age, obesity, assisted reproductive technology, and increased rates of preexisting comorbidities. Differentiating pregnancy-associated hypertension from pre-existing chronic hypertension is challenging, as the overlap between the two may be broadening due to the changing demographics of the pregnant population. This review critically evaluated the evidence regarding the current time periods recommended to make a diagnosis of a hypertensive disorder of pregnancy. We noted no evidence to support the arbitrary 4-hour time period or any particular time period for diagnosis of hypertensive disorders in pregnancy. In addition, there is no clear definition of what is considered persistent or sustained blood pressure elevations in blood pressure. Every effort should be made to ensure accurate diagnosis of new onset elevated blood pressures during pregnancy prior to labeling the patient with the diagnosis and thus recommending serial maternal and fetal testing and delivery at or before 37 weeks' gestation.

Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement

Obesity rates have surged since 1990 worldwide. This rise is paralleled by increases in pathological processes affecting organs such as the heart, liver, and kidneys, here termed systemic metabolic disorders (SMDs). For clinical management of SMD, the European Atherosclerosis Society proposes a pathophysiology-based system comprising three stages: Stage 1, where metabolic abnormalities such as dysfunctional adiposity and dyslipidaemia occur without detectable organ damage; Stage 2, which involves early organ damage manifested as Type 2 diabetes, asymptomatic diastolic dysfunction, metabolic-associated steatohepatitis (MASH), and chronic kidney disease (CKD); and Stage 3, characterized by more advanced organ damage affecting multiple organs. Various forms of high-risk obesity, driven by maintained positive energy balance, are the most common cause of SMD, leading to ectopic lipid accumulation and insulin resistance. This progression affects various organs, promoting comorbidities such as hypertension and atherogenic dyslipidaemia. Genetic factors influence SMD susceptibility, and ethnic disparities in SMD are attributable to genetic and socioeconomic factors. Key SMD features include insulin resistance, inflammation, pre-diabetes, Type 2 diabetes, MASH, hypertension, CKD, atherogenic dyslipidaemia, and heart failure. Management strategies involve lifestyle changes, pharmacotherapy, and metabolic surgery in severe cases, with emerging treatments focusing on genetic approaches. The staging system provides a structured approach to understanding and addressing the multi-faceted nature of SMD, which is crucial for improving health outcomes. Categorization of SMD abnormalities by presence and progression is aimed to improve awareness of a multi-system trait and encourage a tailored and global approach to treatment, ultimately aiming to reduce the burden of obesity-related comorbidities.

Placental epigenetic age and adolescent blood pressure: the Extremely Low Gestational Age Newborn cohort

BACKGROUND

We examined the association between placental epigenetic gestational age (eGA) acceleration and adolescent systolic blood pressure (SBP) in a cohort born extremely preterm.

METHODS

Study participants were a subset of the Extremely Low Gestational Age Newborn cohort (born <28 weeks' gestation) who had placental DNA methylation quantified and had SBP measured during adolescent follow-up. eGA acceleration was calculated as the residual from the regression of predicted placental eGA (using the Robust Placental Clock) onto chronological gestational age. Unadjusted and adjusted mixed effects models were used to test the association between eGA acceleration and adolescent SBP. We also tested the interaction of eGA acceleration and sex on SBP.

RESULTS

In the overall sample (N = 193), we found no association between placental eGA acceleration and adolescent SBP. When interaction between eGA acceleration and sex was tested, males had a 3.6 mmHg increase in SBP (95% CI 0.9, 6.4; p = 0.01) for every 1-week acceleration in eGA after adjusting for confounders.

CONCLUSION

Placental eGA acceleration is associated with SBP increase in adolescent males but not females born extremely preterm, supporting the hypothesis that placental eGA could be evaluated as a risk biomarker for childhood cardiovascular outcomes.

IMPACT

This study examines the association between placental epigenetic gestational age (eGA) and adolescent blood pressure. For every 1-week acceleration in placental eGA, adolescent males born extremely preterm had a 3.6 mmHg increase in systolic blood pressure (95% CI 0.9, 6.4; p = 0.01) after adjusting for confounders. The same association was not seen in females or the overall cohort. Our sex-specific finding supports the hypothesis that differences in placental eGA are associated with childhood health. Placental eGA estimation as a tool for identifying children who are at risk for developing elevated blood pressure should be further evaluated in other cohorts.

Racial and Ethnic Differences in Shared Decision Making Among Patients With Hypertension: Results From the RICH LIFE Project

BACKGROUND

Racial and ethnic disparities in hypertension care persist. Shared decision making (SDM) is promoted in hypertension guidelines. However, evidence is lacking on how race, ethnicity, and SDM relate, and the effect of SDM on hypertension control in diverse groups. We aimed to explore the relationships among SDM, blood pressure (BP), race and ethnicity, and other decision-making factors in patients with hypertension.

METHODS AND RESULTS

Longitudinal analysis of data from the RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) project's participants (n=1426) with uncontrolled hypertension was performed using descriptive statistics, linear regression, and generalized estimating equations. Participants were middle-aged (mean age 60±11.6 years), predominantly women (59.4%, 847), non-Latino Black (59%, 844), and high school graduates or below (65%, 931). The mean SDM score was 7.2±2.6 out of 9, and the mean baseline systolic and diastolic BP were 152.2±12.0 and 85.3±12.1 mm Hg. Non-Latino Black people had 0.14 points higher mean SDM score (P<0.001) than non-Latino White people. Systolic BP reduction over 12 months was greater with a higher SDM mean score (β=-0.42, P=0.035). Baseline characteristics associated with SDM included more than high school education (β=-0.08, P=0.045), hypertension knowledge (β=-0.05, P=0.046), considering taking BP medication as very important (β=0.06, P=0.022), and patient activation (β=0.09, P=0.001).

CONCLUSIONS

There was greater BP reduction for patients with higher SDM score at follow-up, and associations between SDM and race and ethnicity, education, hypertension knowledge and attitude, and patient activation. Future research should further explore SDM differences among racial and ethnic groups to better align hypertension care with patients' needs.

Gestational weight gain, cardiometabolic health, and long-term weight retention at 17 years post delivery

OBJECTIVE

High gestational weight gain (GWG) is positively associated with acute postpartum adiposity, long-term postpartum weight retention (LPPWR), and later cardiometabolic health, but whether associations persist into midlife remains unknown.

METHODS

Among Black and Dominican women from a prospective cohort (N = 210), GWG adherence to 2009 Institute of Medicine (IOM) guidelines and restricted cubic spline GWG z scores were calculated. At 17 years post delivery, weight, height, waist circumference (WC), systolic and diastolic blood pressure, fat mass (FM), and fat-free mass were measured. Linear and logistic regression estimated associations between GWG and long-term postpartum outcomes, adjusting for covariates.

RESULTS

Over one-half (60%) of participants had GWG above IOM guidelines. At 17 years, mean (SD) BMI was 31.2 (6.7) kg/m2. GWG above IOM guidelines was positively associated with 17-year FM (β = 5.11 kg; 95% CI: 2.35-7.88), WC (β = 4.95 cm; 95% CI: 2.07-7.83), and LPPWR from prepregnancy to 17 years (β = 6.10 kg; 95% CI: 2.46-9.75), but not with blood pressure. Positive associations were also observed between GWG z scores and body fat percentage, FM, fat-free mass, WC, and LPPWR.

CONCLUSIONS

As women age into midlife, high GWG continues to be associated with higher adiposity, as well as weight gain more than 6 kg above prepregnancy weight, compared with those who gain within or below IOM guidelines.

Pathophysiology and blood pressure measurements of hypertension in the elderly

Hypertension is a serious concern among the elderly, posing health risks and treatment challenges. In the first part of this review, we explore the pathophysiological mechanisms linking hypertension and aging, focusing on physiological changes such as arterial stiffening, in autonomic nervous system dysfunction, disruption of the renin-angiotensin-aldosterone system, aging-induced alterations in renal function, and the impact of salt-sensitive hypertension. The mnemonic "King/A+++/Hermès" aids in recalling the pathophysiology of aging-related hypertension. Accurate blood pressure measurements are important to determine the prognosis and treatment in the elderly; however, obtaining reliable measurement data in this population is not always easy, as changes in cardiovascular structure and hemodynamics with aging may lead to increased blood pressure variability. In the second part of this review, we evaluate the effectiveness of blood pressure monitoring in older adults, emphasizing the importance of precise measurements. We also assess the efficacy of home and ambulatory monitoring, discuss orthostatic hypotension and orthostatic hypertension, outline challenges in measuring blood pressure in individuals with atrial fibrillation, and explore the impact of aging on measurement errors. We conclude that understanding the interplay between hypertension and aging, coupled with precise blood pressure monitoring strategies tailored for older adults, is essential for effective management and to improve overall cardiovascular health in the elderly population.

Influence of various legwear during arterial stiffness measurement

Carotid-femoral pulse wave velocity (cfPWV) is widely used to measure arterial stiffness. The type of legwear worn by participants during the measurement may introduce variabilities because different fabric materials and thicknesses may disturb arterial waveforms. Therefore, we investigated the impact of common legwear on cfPWV measured using tonometry and oscillometry. We studied 50 adults (36 women) varying widely in age (19-78 years). We evaluated cfPWV using two commonly used devices that detect femoral pulses using tonometric and cuff-based oscillometric sensors. The participants wore thin medical shorts as the reference condition, khaki pants, sweatpants, and athletic shorts, with an optional bare skin condition (optimum control) with 10 min of rest between measurements. Both devices produced similar cfPWV among different legwear with no significant systematic differences. The range of cfPWV was 647-649 cm/s for the tonometric device and 482-500 cm/s for the oscillometric device across different types of legwear. Mean values of cfPWV measured with a bare skin condition did not differ significantly from other legwear. No data output rates were 13% for khaki, 6% for sweatpants, 3% for medical shorts, athletic shorts, and bare skin using the tonometry while the oscillometric device had a 0% no data output rate among all conditions. We concluded that relatively thin legwear did not appear to affect arterial stiffness as assessed by cfPWV. However, stiffer legwear, such as khaki pants, presents a challenge to detect femoral pulses when using a tonometric sensor.

Blood pressure variability and cardiovascular risk assessment using machine learning clustering after arteriovenous fistula creation in hemodialysis patients

INTRODUCTION

Hypertension (HTN) is highly prevalent among patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), uncontrolled HTN as well as high blood pressure variability (BPV) can significantly impact cardiovascular health. This study aims to understand the impact of BPV in patients with ESKD following arteriovenous fistula (AVF) creation for hemodialysis, to better understand its association with age, sex, BMI, and cardiovascular risk.

METHODS

A retrospective analysis was conducted on 83 patients who underwent AVF creation between February 2019 and October 2020 at University of Miami Hospital. During 20 months, blood pressure measurements were collected from medical records at four different times during AVF access creation process, and BPV was quantified using machine learning clustering techniques.

RESULTS

The study identified three distinct clusters among the 83 patients with ESKD who underwent AVF creation. Cluster 1 (n = 28) was characterized by high blood pressure variability, with a mean systolic blood pressure standard deviation of 16.2 mmHg. This cluster exhibited a significantly higher cardiovascular risk rate of 42.9% compared to Cluster 2 (n = 30) and Cluster 3 (n = 25), which had lower variability with mean systolic blood pressure standard deviations of 10.3 and 8.7 mmHg, respectively, and cardiovascular risk rates of 16.7% and 12.0%. Age, sex, and BMI did not differ significantly across the clusters.

CONCLUSION

This study underscores the association between blood pressure variability and the increased risk of cardiovascular events, including myocardial infraction, stroke or heart failure in patients with ESKD undergoing AVF creation. Our findings highlight the critical need for vigilant monitoring of blood pressure fluctuations in this population and demonstrate how these variations are influenced by individual demographic factors. Further research is needed to develop targeted interventions to mitigate this risk.

The value of optic nerve sheath measurement in patients presenting to the emergency department with hypertensive crisis

To evaluate whether bedside ultrasonographic measurement of optic nerve sheath diameter (ONSD) can assist in the diagnosis of hypertensive emergency and predict hospitalization in patients presenting to the emergency department (ED) with hypertensive crisis. This prospective observational study enrolled adult patients presenting with systolic BP > 180 mm Hg and/or diastolic BP > 120 mm Hg. ONSD was measured on admission and repeated after blood pressure was reduced to target levels. Diagnostic performance was assessed using ROC analysis. A total of 112 patients with hypertensive crisis were included, and 22.3% (n = 25) were diagnosed with hypertensive emergency. The mean ONSD in these patients (5.99 ± 0.65 mm) was significantly higher than in those with hypertensive urgency (5.11 ± 0.57 mm) (P < .001). Among 31 hospitalized patients, the mean ONSD (5.83 ± 0.71 mm) was also significantly higher than in those not hospitalized (5.11 ± 0.57 mm) (P < .001). ROC analysis showed good diagnostic performance for predicting hypertensive emergency, with the optimal ONSD cutoff identified as 5.8 mm (sensitivity: 68%, specificity: 93.1%, +LR: 9.86, -LR: 0.34). ONSD measurement is a rapid, noninvasive tool that may aid in early identification of hypertensive emergency and in predicting hospital admission. Its routine use in the ED could facilitate timely intervention and decision-making.

A study protocol to engage religious leaders to reduce blood pressure in Tanzanian communities: A cluster randomized trial

BACKGROUND

Most people with hypertension in Sub-Saharan Africa are unaware of their status. Low perceived need for hypertension screening, low trust in biomedical health care, unhealthy norms for diet and exercise, and prioritization of spiritual over physical health are key barriers to blood pressure (BP) control in Tanzanian communities. We seek to determine whether engaging religious leaders to screen for hypertension and educate communities on cardiovascular health can lead to a sustained community BP reduction.

METHODS

This trial aims to determine the efficacy of an intervention that engages religious leaders to reduce BP in Tanzanian communities. After refinement of the intervention following pilot testing, a hybrid type I randomized control trial will be conducted across 20 rural communities (10 intervention and 10 control communities). The intervention will consist of educational sessions for religious leaders, equipping them to provide community cardiovascular health teachings, and BP screening organized jointly by religious leaders and health care workers. We will measure the reduction in mean community BP and changes in hypertension awareness and treatment, diet, physical activity, body mass index, and waist circumference after one year. Key elements that contribute to the intervention's implementation and effectiveness to strengthen its adoption and broader use during and after the intervention up to 24 months will be evaluated.

DISCUSSION

Community-level barriers to BP control inhibit awareness and treatment of hypertension in Tanzania. Through innovative partnerships with trusted religious leaders, we seek to study an intervention with the potential to reduce BP and improve overall community health.

Twenty years population-based trends in prevalence, awareness, treatment, and control of hypertension in Geneva, Switzerland

Objective

Hypertension is a leading cause of cardiovascular disease and affects about 1.3 billion adults worldwide. Despite interventions, awareness and control remain suboptimal and might have worsened due to the COVID-19 pandemic. This population-based study examines 20-year trends in hypertension prevalence, awareness, treatment, and control in Geneva, Switzerland (2005-2023).

Methods

This is a year-trends population-based study (Bus Sante) ongoing in Geneva, Switzerland. Data collected in this study were between 2005 and 2023. Hypertension trends and prevalence were stratified by sex, age, education, and income. Multivariable regression models adjusted for sociodemographic and health factors identified determinants of outcomes.

Results

Overall, 11,278 individuals participated. Hypertension prevalence decreased from 38.9 % to 35.2 %, with greater reductions in individuals with primary education (-6.1 %) and low income (-6.1 %). Awareness remained stable with time. Uncontrolled hypertension decreased (44.9 % to 42.2 %, p = 0.01), with improvements in lower socioeconomic groups, and individuals with diabetes. Older women were more likely to have untreated (+16.1 %) and uncontrolled hypertension, while younger men exhibited higher unawareness rates (57.7 %). Having a doctor visit in the past 12 months was not associated with increased awareness.

Conclusions

Hypertension prevalence and control improved overall, with reduced socioeconomic disparities. However, some groups remain at risk and primary care is essential for better screening, awareness, treatment, and control of hypertension.

Assessing blood pressure changes and hypertension-related outcomes in patients with migraine treated with erenumab: A systematic review and meta-analysis

OBJECTIVES/BACKGROUND

We aimed to systematically review and summarize evidence on the effects of erenumab on systemic blood pressure (BP) in patients with migraine (International Prospective Register of Systematic Reviews ID: CRD42024571056). US Prescribing Information for erenumab was updated to include the potential risk of hypertension, although randomized trials did not link it previously. The association of this monoclonal antibody with an elevated vascular risk remains uncertain.

METHODS

Embase, PubMed, and the Cochrane databases were searched up to June 18, 2024 for studies examining the impact of erenumab on BP in patients with migraine. I2 statistics and prediction intervals (PIs) were applied to assess heterogeneity, and sensitivity and subgroup analyses were used to explore it. Data were collected using mean difference (MD) or proportion of events. The risk of bias of the included studies was assessed with the Cochrane Risk of Bias tool.

RESULTS

Systolic (MD = 0.86, 95% confidence interval [CI] = -1.02 to 2.73, p = 0.370, I2 = 63%) and diastolic (MD = 1.33, 95% CI = -0.05 to 2.72, p = 0.060, I2 = 69%) BP measures did not significantly differ between after and before erenumab treatment. This lack of significant difference persisted at 3 and 12 months. The leave-one-out technique did not change heterogeneity. The proportion of participants presenting worsening BP appears to be 22.04% (95% CI = 11.12-38.98, PI = 0.54-93.60), with 56.40% corresponding to nonhypertensive individuals at baseline. The incidence of patients starting antihypertensive medications during the study was 3.96% (95% CI = 1.30-11.42, PI = 0.02-90.04), of which 62.88% corresponded to nonhypertensive patients at baseline.

CONCLUSION

We did not find an association of erenumab with significant increases in systemic BP. There is a considerable degree of fragility in the current evidence available. The decision to prescribe erenumab, especially for patients with multiple comorbidities and risk factors for hypertension, must be made weighing the risks and benefits. Further studies are needed to confirm these findings.

Risk-directed management of chronic kidney disease

The timely and rational institution of therapy is a key step towards reducing the global burden of chronic kidney disease (CKD). CKD is a heterogeneous entity with varied aetiologies and diverse trajectories, which include risk of kidney failure but also cardiovascular events and death. Developments in the past decade include substantial progress in CKD risk prediction, driven in part by the accumulation of electronic health records data. In addition, large randomized clinical trials have demonstrated the effectiveness of sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide 1 receptor agonists and mineralocorticoid receptor antagonists in reducing adverse events in CKD, greatly expanding the options for effective therapy. Alongside angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, these classes of medication have been proposed to be the four pillars of CKD pharmacotherapy. However, all of these drug classes are underutilized, even in individuals at high risk. Leveraging prognostic estimates to guide therapy could help clinicians to prescribe CKD-related therapies to those who are most likely to benefit from their use. Risk-based CKD management thus aligns patient risk and care, allowing the prioritization of absolute benefit in determining therapeutic selection and timing. Here, we discuss CKD prognosis tools, evidence-based management and prognosis-guided therapies.

Changes in blood pressure, medication adherence, and cardiovascular-related health care use associated with the 2018 angiotensin receptor blocker recalls and drug shortages among patients with hypertension

BACKGROUND

One of the largest-ever retail drug shortages began in 2018 when several angiotensin II receptor blockers (ARBs) for treating hypertension, heart failure, and chronic kidney disease-valsartan, losartan, and irbesartan-were recalled for carcinogenic impurities. The long-term consequences of the ARB shortages and whether certain groups experienced more adverse outcomes is unknown.

OBJECTIVE

To evaluate changes in adherence and health outcomes after ARB recalls and to identify patients who experienced greater changes in access and adverse clinical outcomes.

METHODS

Using an integrated claims and electronic health record dataset and a difference-in-differences design, we evaluated changes in the proportion of days covered (PDC) for ARBs and similar drugs (angiotensin-converting enzyme inhibitors [ACE-Is]), uncontrolled blood pressure, major cardiovascular event (MACE)-related acute care visits, and all-cause ambulatory care visits in the 12 months before vs 18 months after recalls for valsartan, losartan, and irbesartan users vs patients taking similar, nonrecalled drugs (ACE-Is, nonrecalled ARBs). Triple-difference models characterized heterogeneous associations by pre-recall patient demographic (race, ethnicity, age), clinical (baseline indication, mental health conditions), and adherence variables.

RESULTS

Adjusting for pre-recall patient characteristics, we observed no significant changes in PDC for ARBs and ACE-Is (combined), uncontrolled blood pressure, or ambulatory care visits among 86,507 recalled ARB users vs 123,583 comparison drug users in the 18 months after the recalls. Following the recalls, medication switches increased on average by an additional 2.08 percentage points (p.p.) per quarter (95% CI = 2.01-2.15) for recalled ARB vs comparison drug users, a 195.9% relative increase. We observed the most switches in the 90-day period immediately after valsartan's recall (difference-in-difference: 9.48 p.p.; 95% CI = 9.36-9.59; relative change = 892%). Cumulatively, 55.2% of valsartan, 7.6% of losartan, and 18.9% of irbesartan users switched medications after 18 months. We observed an increase in the proportion of recalled ARB vs comparison patients who experienced medication gaps exceeding 30 days (1.13 p.p. per quarter on average; 95% CI = 0.97-1.30), which was most apparent after approximately 15 months (5 quarters). Although MACE-related acute care visits did not change in the quarter (90 days) immediately after valsartan's recall, we observed an increase of 1.40 additional visits per 1,000 recalled ARB vs comparison drug patients in each subsequent quarter, a 9.3% relative increase. Results were similar across most subgroups.

CONCLUSIONS

The 2018 ARB recalls were associated with immediate changes in antihypertension medication use. Many patients transitioned to alternative medications. Although overall impacts on clinical outcomes were minimal and not statistically significant, small increases in medication gaps and MACE-related acute care visits among some patients occurred after more than 1 year. The ARB recalls may have been associated with fewer adverse events than other recent shortages owing to the widespread availability of alternative treatments in the same or similar drug class.

Effects of Continuous Positive Airway Pressure on Central and Peripheral Blood Pressure in Patients with Uncontrolled Hypertension and Obstructive Sleep Apnea: The Randomized Controlled MORPHEOS Clinical Trial

Rationale: Previous studies evaluating the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) among patients with obstructive sleep apnea (OSA) showed variable results. Moreover, several studies recruited patients with normal or controlled BP, and compliance with antihypertensive drug treatment was not monitored. In addition, very few studies investigated central BP in this scenario. Objectives: To evaluate whether OSA treatment is able to reduce central and peripheral BP in patients with uncontrolled hypertension (HTN) despite well-documented use of antihypertensive treatment. Methods: MORPHEOS is a multicenter randomized controlled trial designed to evaluate the effects of CPAP or placebo (nasal dilator strips [NDSs]) for 6 months in patients with moderate to severe OSA and uncontrolled HTN on office BP, ambulatory BP monitoring (ABPM), and central BP (coprimary endpoints). Uncontrolled HTN was defined by at least one abnormal parameter on ABPM after 1 month and ⩾80% adherence to medication based on a pill count. Pill counts, adherence to CPAP or NDS, and office BP were determined once per week in the first month and monthly thereafter. Results: A total of 123 patients completed the study (NDS, n = 64; CPAP, n = 59). The two groups were similar at baseline. Adherence to NDS (⩾80%) and CPAP (⩾4 hours per night) were 98.3% and 81.7%, respectively. Compared with NDSs, office systolic BP (Δ = -10 ± 16 mm Hg; P < 0.001) and diastolic BP (Δ = -7 ± 12 mm Hg; P = 0.001) were reduced significantly in the CPAP group. Despite the BP-lowering effect of CPAP not reaching statistical significance for the ABPM parameters, the rate of 24-hour ABPM control (<130/80 mm Hg) was higher in the CPAP group than in the NDS group (40.7% vs. 20%; P = 0.024). Central diastolic BP was reduced significantly (Δ = -6 ± 9 mm Hg; adjusted P = 0.029). Conclusions: CPAP improves the rates of BP control in patients with OSA and uncontrolled HTN with regular use of medications. Clinical trial registered with www.clinicaltrials.gov (NCT02270658).

Acute Effect of High-Intensity Interval Exercise on Blood Pressure in Females Living with Type 2 Diabetes and Hypertension

BACKGROUND

The acute effects of high-intensity interval training (HIIT) on blood pressure (BP) may depend on the exercise protocol performed.

PURPOSE

To compare the acute effect of high- and low-volume HIIT on post-exercise and ambulatory BP in untrained older females diagnosed with both type 2 diabetes and hypertension.

METHODS

Fifteen females (69 (65-74) yr) completed a crossover study with three experimental conditions: 1) REST (35 min in sitting position); 2) HIIT10 (10 × 1 min at 90% heart rate max (HRmax)), and 3) HIIT4 (4 × 4 min at 90% HRmax). After each experimental condition, BP was measured under controlled (4 h) and in subsequent free-living conditions (20 h).

RESULTS

In the controlled post-condition 4-h period, no significant interaction (time-condition) was observed for all BP parameters ( P ≥ 0.082). Similarly, during the subsequent 20-h free-living ambulatory monitoring (diurnal and nocturnal), no differences between conditions were detected ( P ≥ 0.094). A significant reduction in nighttime pulse pressure was observed in both HIIT4 and HIIT10 compared with REST (46 (44-50), 45 (42-53) vs 50 (45-57) mm Hg, respectively; P ≤ 0.018) with no differences between HIIT conditions ( P = 0.316). Changes in nocturnal systolic BP approached but did not reach statistical significance ( P = 0.068).

CONCLUSIONS

This study suggests that in untrained older females living with type 2 diabetes and hypertension, the HIIT10 and HIIT4 protocols have very limited to no acute effect on post-exercise and ambulatory BP. The fact that the vast majority of participants had well-controlled office and ambulatory BP values as well as low cardiorespiratory fitness could explain these findings.

Trends and Disparities in Heart Failure Mortality Among Hypertensive Older Adults in the United States: A 22-Year Retrospective Study

Hypertension (HTN) is a significant risk factor for heart failure (HF), and both significantly contribute to cardiovascular mortality. This study aims to examine trends and disparities in HF-related mortality among hypertensive older adults (≥65 years) in the United States from 1999 to 2020. Centers for Disease Control and Prevention-Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) database data were analyzed, focusing on HTN as the underlying cause and HF as the contributing cause of death. Age-adjusted mortality rates (AAMRs) and crude rates were stratified by gender, race/ethnicity, age groups, urban-rural status, and geographic regions. The Joinpoint regression program was used to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs). A total of 259 079 HF-related deaths occurred among hypertensive older adults, with an overall AAMR increase from 11.27 in 1999 to 41.05 in 2020, indicating a clear upward trend (AAPC: 5.51%). Females had higher AAMRs (28.57) than males (25.56); however, males showed a steeper rise in mortality (AAPC: 6.15% vs. 5.23%). Non-Hispanic Blacks had the highest AAMR (43.99), while NH Whites exhibited the most significant increase (AAPC: 5.92%). Mortality rates were highest in the West (AAMR: 34.57) and lowest in the Northeast (21.44). Non-metropolitan areas had a higher AAMR than metropolitan areas (30.69 vs. 26.52). These findings emphasize the necessity for targeted interventions to diminish disparities and tackle increasing mortality rates in vulnerable populations, especially among women, NH Blacks, individuals in the West, and those living in non-metropolitan areas.

Acute ischemic stroke: A guideline-based overview of evaluation and management

ABSTRACT

Stroke is the fifth most common cause of death in the United States, and projections suggest that its incidence will increase in the coming decade. Of all stroke cases, 85% are caused by vascular occlusion, resulting in infarction to the brain, in a condition more specifically known as acute ischemic stroke (AIS). The American Heart Association (AHA)/American Stroke Association (ASA) guideline addresses early management of AIS for providers' use in ensuring rapid evaluation and imaging for patients suspected to be affected. The guideline also aids providers in determining and delivering the most appropriate interventions upon AIS diagnosis. This article reviews the AHA/ASA AIS guideline and highlights key components of care, such as patient evaluation, criteria for fibrinolysis and mechanical thrombectomy, postacute care, and hospital discharge with secondary prevention measures.

Impact of intensive blood pressure control on kidney outcomes

PURPOSE OF REVIEW

Hypertension has long been recognized as a modifiable risk factor for cardiovascular events. However, the role of intensive blood pressure (BP) control in preventing kidney disease progression continues to be debated. This review will provide a brief update on the evidence in support of or against the intensive control of BP on kidney outcomes in patient with chronic kidney disease (CKD), focusing particularly on trial-grade evidence.

RECENT FINDINGS

Recently, three large trials conducted in China compared the effects of intensive BP control in adults with cardiovascular risk factors. All three trials demonstrated that intensive BP control confers cardiovascular benefits, but mixed results were noted in terms of the risk of adverse kidney outcomes. In individual-level meta-analyses of six trials of different BP control strategies in patients with CKD, intensive BP control appeared to reduce the risk of kidney replacement therapy in those with CKD stage 4-5, but not in patients with CKD stage 3.

SUMMARY

Most guidelines continue to recommend a systolic BP target of 120-130 mmHg for patients with CKD given the cardiovascular benefits observed in trials of intensive BP control, though there are some signals of potential risks to the kidney with this BP treatment strategy.

Exercise Training Modalities in Young and Middle-Aged Adults With Prehypertension or Hypertension: A Systematic Review and Network Meta-Analysis

Aims

The question of how to choose the right type of exercise to lower blood pressure and cardiovascular risk factors in people worldwide with high blood pressure is not yet fully understood. Thus, the aim of this study was to investigate the effects of various exercise training on blood pressure and cardiovascular risk factors among young and middle-aged adults with prehypertension or hypertension.

Design

Systematic review and network meta-analysis.

Methods

We searched five electronic databases to identify randomized controlled trials that compare exercise training versus a sedentary or sham control group in young and middle-aged adults with prehypertension or hypertension. Review Manager 5.3, Stata15.0, and R4.2.1 software estimated the efficacy of exercise training modalities.

Results

We included 19 eligible articles with 1590 participants to assess five exercise trainings. Our findings indicated that low-middle intensity aerobic exercise (mean difference (MD) = -8.08, 95% confidence interval (CI) = -13.58, -2.58) was superior to all exercise strategies (high-intensity aerobic exercise: MD = -6.53, 95% CI = -12.51, -0.56; high-intensity resistance exercise: MD = -4.95, 95% CI = -11.07, 1.17; low-middle-intensity resistance exercise: MD = -3.49, 95% CI = -12.36, 5.39) compared with control group in lowering systolic blood pressure. Compared with the control strategy, high-intensity resistance exercise (MD = -4.75, 95% CI = -8.00, -1.50), high-intensity aerobic exercise (MD = -4.27, 95% CI = -7.08, -1.45) could lower diastolic blood pressure. The effects of different exercise patterns on cardiovascular risk factors, the results indicated that only low-middle-intensity aerobic exercise significantly improved body mass index (MD = -0.55, 95% CI = -7.08, -1.45), total cholesterol (MD = -19.07, 95% CI = -36.42, -1.72), triglycerides (MD = -14.32, 95% CI = -23.16, -5.48), high-density lipoprotein (MD = 2.29, 95% CI = 0.85, 3.73), and low-density lipoprotein (MD = -13.90, 95% CI = -22.18, -5.63). In addition, no intervention affects heart rate.

Conclusion

Compared with other types of exercise, aerobic exercise can significantly improve systolic blood pressure, while high-intensity resistance or aerobic exercise may significantly improve diastolic blood pressure. In addition, AE-LM is effective in the reduction of risk factors that are contributors to the development of cardiovascular disease. Therefore, this study provides strong evidence to support the selection of appropriate exercise modalities for hypertensive patients.

Aspartate/alanine aminotransferase ratio and development of chronic kidney disease in non-diabetic men and women: a population-based longitudinal study in Kagawa, Japan

BACKGROUND

The relationship between serum aspartate/alanine aminotransferase ratio (AST/ALT) and subsequent development of chronic kidney disease (CKD) in non-diabetic Asian adults has not yet been fully investigated in longitudinal studies.

METHODS

The study included all middle-aged and older non-diabetic Japanese citizens who received health check-ups in Zentsuji, Kagawa, Japan (1998-2023). AST/ALT was classified into three categories: < 1.0 (reference), 1.0- < 1.5, and ≥ 1.5. CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m2. The Weibull accelerated failure time model was used to examine the association between AST/ALT categories and subsequent CKD onset because the proportional hazards assumption was violated.

RESULTS

Of 6309 men and 9192 women, 2966 men and 4395 women remained in the final cohort. After a mean follow-up of 7.50 years for men and 8.34 years for women, 33.7% of men and 34.0% of women developed CKD. Women had higher AST/ALT than men. In women, a dose-response relationship was observed, with a 9% shorter survival time to CKD onset for AST/ALT ≥ 1.5 compared with AST/ALT < 1.0. In contrast, men had a shorter survival time to CKD onset by point estimates, but the 95% confidence intervals crossed 1 in all models.

CONCLUSIONS

In this study comparing the risks of CKD development in non-diabetic men and women by AST/ALT levels, a dose-response relationship was only observed in women. Differences in the distribution of AST/ALT by sex may have affected the results. Therefore, in non-diabetic Japanese women, AST/ALT may be used as an indicator of future CKD development.

Evaluation of Enhanced External Counter Pulsation (EECP) as an Alternative Treatment Modality for Hypertension: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluate the efficacy of enhanced external counterpulsation (EECP) in reducing blood pressure among hypertensive patients. From an initial 323 articles, 37 studies involving 1504 patients met the inclusion criteria, with 11 included in the meta-analysis. EECP therapy durations ranged from 0.75 to 36.5 hours, with the majority around 35 hours. Meta-analysis revealed a significant reduction in systolic blood pressure (SBP) [mean difference (MD), -7.85 mm Hg; 95% CI, -9.59 to -6.11; P < 0.00001; I2 = 0%]. Diastolic blood pressure (DBP) also showed a significant decrease (MD, -3.94 mm Hg; 95% CI, -5.56 to -2.33; P < 0.00001; I2 = 45%). Mean arterial pressure did not significantly change (MD, -3.08 mm Hg; 95% CI, -7.51 to 1.34; P = 0.17; I2 = 77%). Funnel plots and statistical tests indicated no significant publication bias for SBP or DBP changes. EECP therapy significantly reduces both SBP and DBP in hypertensive patients, suggesting its potential as an effective adjunctive treatment for hypertension. However, the effect on mean arterial pressure remains inconclusive. The therapy's noninvasive nature, coupled with its demonstrated efficacy, supports broader clinical application. Further research with larger sample sizes and standardized protocols is necessary to better understand the mechanisms behind EECP and its long-term benefits in hypertension management.

Endovascular Treatment Options for Chronic Dissections

Aortic dissections are classified based on the location of the entry tear. A major concern in chronic aortic dissections is aneurysmal degeneration. Aneurysmal degeneration can lead to aortic expansion and potentially death. False lumen patency is a predictor of outcomes in type B aortic dissections. Thoracic endovascular aortic repair (TEVAR) can be used to treat chronic aortic dissections. TEVAR aims to occlude the false lumen to promote thrombosis and favorable aortic remodeling. However, its benefit may be limited in chronic dissection. Several techniques have been developed to treat chronic dissections with TEVAR.

Self-Monitoring of Blood Pressure and Feedback via Mobile App in Treatment of Uncontrolled Hypertension: The SMART-BP Randomized Clinical Trial

OBJECTIVE

To evaluate the effects of mobile apps with tailored recommendations on changes in blood pressure (BP) and drug adherence.

PATIENTS AND METHODS

This study is a randomized, open-label, multicenter trial to evaluate the efficacy of self-monitoring of BP (SMBP) with a mobile application-based feedback algorithm (SMBP app with feedback) compared with SMBP alone. Patients with uncontrolled hypertension aged 19 years or older were randomly assigned. In the control group, the patients only measured their BP at home using the mobile app combined with a Bluetooth BP monitor and received standard care, whereas in the intervention group, the patients could also receive alerts for BP measurement and additional recommendations from the app using a feedback algorithm in response to the obtained BP value. The primary end point was the change in mean home systolic BP at 24 weeks.

RESULTS

From September 1, 2019, through July 8, 2020, 184 patients were randomized into 2 groups: SMBP app with feedback (n=97) and SMBP alone (n=87). At 24 weeks, the mean ± SD home systolic BP reduction from baseline was significantly greater in the SMBP app with feedback group than in the SMBP alone group (-22.4±13.5 vs -17.2±13.3 mm Hg; P=.02). The SMBP app with feedback group had higher drug adherence and proportion of adherence of 95% or greater than the SMBP alone group.

CONCLUSION

The SMBP app with feedback is superior to SMBP alone in terms of systolic BP reduction and improved drug adherence in patients with hypertension. Given the high cost of traditional interventions between patients and health care professionals, feedback through mobile apps could potentially be a useful tool in the management of hypertension.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT04470284.

Admission systolic blood pressure and short-term outcomes after dual antiplatelet therapy in patients with minor ischemic stroke or transient ischemic attack

Background

Elevated baseline systolic blood pressure (SBP) was associated with poor outcomes following dual antiplatelet therapy (DAPT) in patients with non-cardioembolic minor ischemic stroke (MIS) or high-risk transient ischemic attack (TIA) in clinical trials.

Objectives

We aimed to assess the impact of admission SBP on the short-term outcomes after DAPT in patients with non-cardioembolic MIS or high-risk TIA.

Methods

We performed an inverse probability weighted (IPW) analysis from a prospective multicentric real-world study (READAPT) including patients with non-cardioembolic MIS (National Institute of Health Stroke Scale of 0-5) or high-risk TIA (ABCD2 ⩾4) who initiated DAPT within 48 h of symptom onset. The primary effectiveness outcome was the 90-day risk of new ischemic stroke or other vascular events. The secondary effectiveness outcomes were the 90-day modified Rankin Scale score ordinal shift, vascular and all-cause mortality, 24-h early neurological improvement or deterioration. The safety outcomes included the 90-day risk of moderate-to-severe and any bleedings, symptomatic intracranial hemorrhage, and 24-h hemorrhagic transformation. We used Cox proportional hazards regression with restricted cubic splines to model the continuous relationship between SBP and the hazard ratio (HR) of new vascular events. We selected SBP = 124 mm Hg as cut-off point for the IPW weighting. Outcomes were compared using Cox and generalized logistic regression analyses, adjusted for residual confounders.

Results

From 2278 patients in the READAPT cohort, we included 1291 MIS or high-risk TIAs (mean age 70.6 ± 11.4 years; 65.8% males). After IPW, patients with admission SBP ⩾124 mm Hg versus <124 mm Hg had a significantly higher risk of 90-day ischemic stroke or other vascular events (adjusted HR: 2.14 (95% CI 1.07%-4.98%); p = 0.033) and of 24-h early neurological deterioration (adjusted risk difference: 1.91% (95% CI 0.60%-3.41%); p = 0.006). The overall risk of safety outcomes was low, although patients with SBP ⩾124 mm Hg on admission showed higher rates of 90-day moderate-to-severe and any bleeding events (adjusted risk difference: 1.24% (95% CI 0.38%-2.14%); p = 0.004 and 6.18% (95% CI 4.19%-8.16%); p < 0.001; respectively), as well as of 24-h hemorrhagic transformation (adjusted risk difference: 1.57% (95% CI 0.60%-2.55%); p = 0.001). Subgroup analysis showed a significant interaction between admission SBP, sex, and time to DAPT start in predicting 90-day new vascular events (p for interaction <0.001 and 0.007, respectively).

Conclusion

In patients with non-cardioembolic MIS or high-risk TIA, higher levels of admission SBP may be associated with an increased risk of new vascular events, early neurological deterioration, and bleeding after DAPT use. Future studies should further investigate if optimizing blood pressure management may further improve prognosis.

Arterial Hypertension and Associated Risk Factors in Kazakhstan: An Analysis of Blood Pressure Screening Results from May Measurement Month 2021-2023

INTRODUCTION

May Measurement Month (MMM) is a global campaign with the aim to improve awareness of arterial hypertension (AH). Kazakhstan participated in the campaign in 2021, 2022 and 2023.

METHODS

During the cross-sectional 2021-2023 MMM surveys, volunteer adults (≥ 18 years) from cities in Kazakhstan had their blood pressure (BP) measured three times in a seated position, and received a questionnaire on their demographics, lifestyle and medical history. In those not receiving antihypertensive treatment, AH was defined as a mean systolic and/or diastolic BP ≥ 140/90 mmHg.

RESULTS

A total of 8231 individuals took part in the survey, with 1805 participants in 2021, 2410 participants in 2022 and 4016 participants in 2023. The prevalence of AH was estimated to be 37% in 2021 and 45% in 2022 and 2023. Of those identified as having AH, 51-70% were aware that they had the condition. Among those who were aware that they had AH, 68-91% were receiving antihypertensive therapy. However, 70-82% of treated participants were only receiving one to two drugs. BP was controlled to < 140/90 mmHg in 43-50% of treated participants and to < 130/80 mmHg in 15-16%.

CONCLUSION

The 2021, 2022 and 2023 MMM campaigns showed that high proportion of AH, a low level of AH awareness and inadequate BP control in Kazakhstan. Programs are needed to increase awareness of the risks of high BP and to improve the diagnosis and effective treatment of AH.

Non-use of dentures after tooth loss is associated with elevated sodium/potassium ratios in older adults: a retrospective cohort study

Objective

An elevated sodium-to-potassium (Na/K) ratio in urine increases the risk of hypertension. Tooth loss in older adults can lead to a diminished nutritional state, including alterations in the Na/K ratio. However, the relationship between denture use and changes in the Na/K ratio among individuals with tooth loss has not been sufficiently explored. This study examined whether denture use modifies the association between tooth loss and changes in the Na/K ratio.

Methods

Surveys in 2016 and 2018 included 473 older adults. The Na/K ratio was measured using spot urine tests. A dental hygienist evaluated the number of teeth and the use of dentures. We used generalized linear models to analyze the combined effect of the number of teeth and denture use on changes in the Na/K ratio.

Results

Participants without dentures in the 0-19 teeth group showed a significant association with changes in the Na/K ratio (B = 0.635; 95% confidence interval = 0.038, 1.232) compared to those with ≥28 teeth, but denture users with 0-19 teeth did not show significant association. No significant association with changes in the Na/K ratio was observed in denture users and non-users with 20-27 teeth.

Conclusion

In non-denture users with fewer than 20 teeth, the Na/K ratio was markedly elevated, but in denture users with fewer than 20 teeth it was not significant. These findings highlight the importance of promoting denture use in older adults with few remaining teeth to maintain their Na/K balance.

Optimizing Blood Pressure Control: A Randomized Comparative Trial of Losartan/Chlorthalidone vs. Losartan/Hydrochlorothiazide

INTRODUCTION

Cardiovascular diseases are a leading cause of global mortality, with hypertension as a major risk factor. Low control rates are often attributed to monotherapy, while evidence and clinical guidelines support the effectiveness of combination therapies. This study aimed to evaluate blood pressure changes and the achievement of target levels in patients treated with losartan/chlorthalidone (L/C) compared to losartan/hydrochlorothiazide (L/H).

METHODS

A randomized, double-blind, prospective, multicenter clinical trial was conducted. Patients were assigned to one of two treatment groups, starting with a lower dose (50/12.5 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide). Blood pressure was evaluated at 30 days, and patients not meeting therapeutic goals were escalated to a higher dose (100/50 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide) and followed until the study end (60 days).

RESULTS

The study recruited 163 patients (83 for losartan/chlorthalidone [L/C] group and 80 for the losartan/hydrochlorothiazide [L/H] group), with a mean age of 53.1 years. Both treatment groups demonstrated significant reductions in systolic and diastolic blood pressure, with L/C achieving an average reduction in systolic blood pressure (SBP) of - 24.6 mmHg and - 13.3 mmHg for diastolic blood pressure (DBP), while L/H had reductions of - 25.3-mmHg and - 11.5 mmHg, respectively. The L/C group exhibited a higher likelihood of achieving blood pressure goals compared to the L/H. Adverse events were comparable between groups and were mostly mild.

CONCLUSIONS

The study showed that both combinations are effective for hypertension, with losartan/chlorthalidone demonstrating greater efficacy in reducing diastolic blood pressure and achieving target levels. Both treatments exhibited similar and favorable safety profiles.

CLINICAL TRIALS REGISTRATION

NCT04927299. Registered August 6, 2021- https://clinicaltrials.gov/study/NCT04927299.

Primary care physicians' perceptions of hypertension management in Qatar: A qualitative study using the theoretical domains framework

Antihypertensive medications are known to reduce the incidence of hypertension complications. While the benefits of these medications are recognized, the factors influencing the prescribing practices of primary care physicians in Qatar have not been assessed. This study investigated Qatar primary care physicians' experiences, practices, and perceptions regarding hypertension management. The study further evaluated the factors that influence their prescribing behaviors and identified strategies for improving hypertension management in primary healthcare settings. A qualitative case study was conducted through one-to-one semi-structured interviews with physicians practicing at the 31 Primary Health Care Corporation (PHCC) centers in Qatar. Due to the small population size, there was no need for sample size calculation and whole population sampling was used (N=179). Physician leads at each PHCC center helped identify eligible participants. Study information were shared via email and interested candidates were contacted to arrange for interviews at their convenience. The interview guide questions were designed based on the 14 domains of the Theoretical Domains Framework (TDF) of behavior change. Interviews were conducted virtually and transcribed verbatim. Thematic analysis was undertaken using inductive and deductive approaches. Twelve themes emerged, including physicians' knowledge, skills, goals and role in hypertension management, confidence about prescribing decisions, optimism that prescriptions yield positive results, methods to ensure the appropriateness of prescriptions, emotions, and experiences when prescribing antihypertensives, perceived barriers, and facilitators when prescribing and social influences. Strategies for improving hypertension management were also suggested. In conclusion, multiple factors were identified that affect participants' antihypertensive prescribing. Further research is needed to evaluate the suggested strategies' effectiveness and to explore other improvements.

Hypertension in atherosclerotic cardiovascular disease: insights into epidemiology, management strategies, and outcomes

PURPOSE OF REVIEW

To provide a comprehensive review of hypertension among patients with atherosclerotic vascular disease. Although there is significant alignment in treatment goals and strategies, blood pressure targets and therapies differ among atherosclerosis in varying vascular territories. Hypertension is a prominent risk factor for the development and amplification of atherosclerosis, as well as the cause of significant downstream morbidity and mortality.

RECENT FINDINGS

Hypertension is the greatest contributor to population attributable cardiovascular risk. Hypertension accelerates the development of atherosclerotic cardiovascular disease (ASCVD), and treatment of hypertension is a central tenet to managing ASCVD. Patients with ASCVD often merit a multidisciplinary approach, require multiple specialists and medications, and may suffer from additional consequences of therapy due to multimorbidity. Significant arterial stenoses may lead to unintended consequences of antihypertensive therapy. Further, there have been recent advances in the interventional management of hypertension, including techniques like renal denervation.

SUMMARY

In recent years, there have been significant changes in management guidelines of hypertension and peripheral arterial disease, new evidence in coronary artery disease, and simultaneously there's been an evolution in interventional management of hypertension, such as renal denervation. We provide an update on hypertension treatment in atherosclerotic disease among different vascular beds.

Comparison of Esmolol and Nicardipine treatment in hypertensive acute ıschemic stroke patients

The most important risk factor in ischaemic stroke patients is hypertension (HT). Blood pressure regulation has an important role in hypertensive acute ischaemic stroke patients (AIS). In this study, we planned to compare the efficacy of nicardipine and esmolol infusion on blood pressure control and clinical outcome in hypertensive AIS patients. The study is a retrospective, cross-sectional study. It includes hypertensive AIS patients admitted to the emergency department. Target blood pressure, time to reach target blood pressure, discharge modified Rankin Scale (mRS), intracranial haemorrhage according to The European Cooperative Acute Stroke Study (ECASS II) and 30-day mortality of patients who were started Nicardipine or Esmolol within the indication were determined and mortality and morbidity of the two groups were compared. The study included 82 acute ischaemic stroke patients who were hypertensive at presentation. The mean age of the patients was 72 years (39-93). No difference was observed between the Nicardipine (n = 40) and Esmolol (n = 42) groups in terms of sociodemographic data, vital functions and clinical status (National Institutes of Health Stroke Scale - NIHSS) at admission. The target blood pressure levels were reached faster and more effectively in the Nicardipine group than in the Esmolol group (p < 0.001). No difference was observed between the two groups in terms of mRS, ECASS II scores and 30-day mortality. Nicardipine is more effective than Esmolol in blood pressure control in AIS patients who are candidates for invasive procedures such as thrombolysis and thrombectomy. The fact that there is no difference in mortality and morbidity between the two drugs suggests that Esmolol can also be used in selected patients.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a predictor of all cause and cardiovascular mortality in United States adults with NAFLD: a prospective cohort study

BACKGROUND

The non-HDL cholesterol to HDL cholesterol ratio (NHHR) is a novel composite lipid index. However, its relationship with mortality, particularly in individuals with non-alcoholic fatty liver disease (NAFLD), remains unclear. The aim of this study was to explore the association between NHHR and both all-cause and cardiovascular mortality in adults with NAFLD in the United States.

METHODS

This study included 12,648 adult participants with NAFLD from the National Health and Nutrition Examination Survey (NHANES) database (1999-2018). Multivariate Cox proportional hazards models and restricted cubic spline (RCS) methods were employed to assess all-cause and cardiovascular mortality. Subgroup analyses were performed to verify the consistency of these associations.

RESULTS

Over a median follow-up of 99.27 months, 1,659 participants died from all causes, including 460 from cardiovascular disease. RCS analysis revealed a U-shaped relationship between NHHR and all-cause mortality, no association was found between NHHR and cardiovascular mortality. The inflection points for all-cause mortality were 2.67. Subgroup analysis showed that a stronger association between NHHR and all-cause mortality in those with diabetes(P = 0.048).

CONCLUSIONS

NHHR is associated with all-cause mortality in NAFLD patients, with distinct non-linear relationships, while it is not associated with cardiovascular mortality. NHHR monitoring may be valuable for assessing mortality risk, particularly in those with diabetes.

Cuffless Blood Pressure Measurement Devices-International Perspectives on Accuracy and Clinical Use: A Narrative Review

Importance

Hypertension is a primary modifiable risk factor for cardiovascular death and disability. Accurate blood pressure (BP) measurement is essential for the diagnosis and treatment of hypertension. Conventional BP measurement with cuff devices is recommended but difficult for patients to perform due to inconvenience, discomfort, and challenges with appropriate cuff sizing and measurement protocols. The emergence of cuffless BP devices provides an opportunity to address many of these problems, including inconvenience, patient comfort, positional requirements, and continuous measurement.

Observations

Cuffless BP measurement devices are appealing to patients and clinicians, but validation of these technologies is essential before they can be deployed for clinical use. Key issues that remain include accuracy with risk of undertreatment or overtreatment, equitable access for low- and middle-income countries and minoritized populations, data privacy concerns, and how the devices will be deployed in clinical practice.

Conclusions

Clinicians and patients should only use validated BP cuff devices until cuffless BP measurement devices are appropriately tested and validated.

Intensive blood pressure-lowering treatment to prevent cardiovascular events in patients with diabetes: a systematic review and meta-analysis

The effect of intensive blood pressure (BP) reduction on the prevention of cardiovascular events in patients with diabetes remains unclear. This study evaluated the impact of intensive BP-lowering on cardiovascular events in patients with diabetes compared to standard treatment. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, comparing intensive treatment (target systolic BP < 130 mmHg or diastolic BP < 80 mmHg) with standard treatment in patients with diabetes. Eligible studies were identified through Ovid MEDLINE, Cochrane Library, and Ichushi. Outcomes included cardiovascular events, coronary artery disease, stroke, all-cause and cardiovascular death, and serious adverse events. Data were analyzed using a random-effects model. Sensitivity analyses were performed to assess the effects of systolic and diastolic BP targets separately. The search identified eight eligible trials comprising 16634 patients with diabetes. Intensive BP-lowering treatment significantly reduced cardiovascular events (risk ratio: 0.848; 95% confidence interval: 0.760, 0.947) and stroke (risk ratio: 0.705; 95% confidence interval: 0.541, 0.918), but not coronary artery disease or all-cause death in analyses including J-DOIT3 trial. Sensitivity analyses showed that DBP-targeted treatment was not associated with the risk of cardiovascular events. Incorporating the latest RCT strengthened the association between intensive treatment and reduced coronary artery disease risk, without significantly increasing the risk of serious adverse events. These findings recommend an intensive BP-lowering strategy targeting SBP < 130 mmHg or DBP < 80 mmHg to prevent cardiovascular events, particularly stroke, in patients with diabetes.

Novel approaches in antihypertensive pharmacotherapeutics

PURPOSE OF REVIEW

The management of hypertension remains suboptimal despite the widespread use of multiple antihypertensive medication groups. We hereby aim to evaluate the novel therapeutic approaches for the management of hypertension.

RECENT FINDINGS

As the decline in SBP and/or DBP is associated with a significant decline in major adverse cardiovascular events and all-cause mortality, the optimal management of hypertension is at most importance. The high prevalence of resistant hypertension, approximately 10% of hypertensive population, remains a major concern associated with high morbidity and mortality. Recently, multiple novel pharmacotherapeutic approaches have been implicated in the management of hypertension on various pathophysiological mechanisms, including aldosterone synthetase inhibitors, RNA-based therapies such as antisense oligonucleotides and small-interfering RNA, atrial natriuretic peptide analogs, dual endothelin antagonists, intestinal sodium-hydrogen exchanger-3 inhibitors, compound 17b and nonsteroidal mineralocorticoid receptor antagonists.

SUMMARY

Pharmacotherapeutic management options for hypertension is a growing field of research with potential clinical implications for multiple agents in upcoming years. Such novel approaches have the potential to improve clinical outcomes of hypertension management.

Mediating role of triglyceride glucose-related index in the associations of composite dietary antioxidant index with cardiovascular disease and mortality in older adults with hypertension: a national cohort study

Background

This research investigates the relationships between the composite dietary antioxidant index (CDAI) and the likelihood of cardiovascular disease (CVD) and mortality in older adults with hypertension. Utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the potential mediating role of the triglyceride-glucose (TyG) index in these relationships.

Methods

A cohort of 5,276 participants, aged 65 years or older and diagnosed with hypertension, was extracted from the NHANES database. The main outcomes examined were the odds of CVD and mortality, utilizing data from the National Center for Health Statistics (NCHS). Multivariate logistic regression models were utilized to evaluate the relationship between CDAI and CVD. Cox proportional hazards regression models and Kaplan-Meier survival curves were utilized to analyze the relationship between CDAI and mortality. Mediation analysis was conducted to assess the potential intermediary role of TyG-related indicators-specifically TyG, TyG-BMI, TyG-WC, and TyG-WHtR- in the connection between CDAI and mortality.

Results

The mean CDAI for the study participants was 1.88 ± 3.90, and the average age was 74.15 ± 5.96 years. During an average follow-up duration of 109.51 months, 4,712 cases of CVD and 725 recorded deaths were observed. In the fully adjusted models, CDAI showed a negative association with both CVD (Odds Ratio [OR] = 0.94, 95% Confidence Interval [CI] = 0.92-0.97) and mortality (Hazard Ratio [HR] = 0.95, 95% CI = 0.93-0.97). Mediation analysis indicated that the TyG-BMI, TyG-WC, and TyG-WHtR indices accounted for 33.1%, 34.3%, and 19.1% of the relationship between CDAI and mortality, respectively.

Conclusion

A higher CDAI demonstrated an inverse association with both CVD and mortality in elderly hypertensive individuals. The relationship was partially mediated by TyG-related indices, indicating that increased antioxidant intake may lead to improved health outcomes and a decreased risk of poor prognosis in this population.

Use of Quadruple Therapy in the Management of Hypertension: A Systematic Review of Randomized Controlled Trials

Background and objectives: Hypertension remains a leading global cause of cardiovascular morbidity and mortality, with suboptimal blood pressure (BP) control despite available treatments. Monotherapy often fails to achieve target BP, necessitating combination therapies. Quadruple low-dose combination therapy (quadpill) has emerged as a potential strategy to enhance efficacy while minimizing side effects. This systematic review evaluates the effectiveness and safety of quadpill therapy compared to standard monotherapy and dual therapy. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus from inception till January 2025 for randomized controlled trials (RCTs) investigating quadruple therapy in hypertensive patients. Studies comparing quadpill therapy with monotherapy, dual therapy, or placebo were included. Data on BP reduction, achievement of target BP, and adverse events were extracted and analyzed. The Cochrane Risk of Bias tool (RoB-2) was used to assess study quality. Results: Five RCTs were included in the current systematic review. Quadpill therapy resulted in greater reductions in systolic BP (SBP and diastolic BP (DBP) compared to monotherapy and dual therapy across all time points. The proportion of patients achieving target BP (<140/90 mmHg) was significantly higher in the quadpill group. The safety profile was favorable, with adverse event rates comparable to those in monotherapy and dual therapy groups. Notable adverse effects included mild dizziness, edema, and biochemical alterations (elevated fasting glucose and uric acid levels), but these did not lead to significant treatment discontinuation. Conclusions: Quadruple low-dose combination therapy is a promising approach for improving BP control while maintaining a favorable safety profile. Early initiation of quadpill therapy could mitigate treatment inertia and improve long-term cardiovascular outcomes.

Weight-adjusted-waist index is associated with urinary albumin-creatinine ratio in normal body mass index adults: a cross-sectional study from NHANES 2001-2018

Obesity promotes chronic kidney disease and albuminuria. Whether weight-adjusted-waist index (WWI) is correlated with albuminuria reflected by urinary albumin-to-creatinine ratio (UACR) in normal body mass index (BMI) population and the effect of hypertension and hyperglycemia on the association remain unclear. This cross-sectional study included adults with complete WWI and UACR data in the National Health and Nutrition Examination Survey (NHANES) database from 2001 to 2018. WWI was defined as waist circumference (WC) divided by the square root of weight. Linear regression, restricted cubic splines (RCS) curve and logistic regression were performed to evaluate the relationship between WWI and albuminuria risk. The relationship in different blood pressure and glucose subgroups were further investigated. 10,105 participants were finally included. The prevalence of albuminuria was 5.05%. WWI in albuminuria group was higher. RCS curve analysis showed the relationship between WWI and albuminuria risk increased linearly in patients with hypertension or hyperglycemia, while a U-shaped curve relationship in normoglycemic or non-hypertensive individuals. Logistic regression results indicated increased WWI was an independent risk factor for albuminuria reflected by UACR in normal BMI population even after adjusting for confounding factors, especially in males. When patients only had hypertension with normal blood glucose, WWI was still independently associated with albuminuria. Elevated WWI increased albuminuria risk in normal BMI adults, especially in males and patients with hypertension or hyperglycemia, even in hypertension patients without hyperglycemia. Assessment of WWI to identify early renal dysfunction should be emphasized.

Impact of diabetes mellitus on 30-day mortality among acute stroke patients in northern Tanzania

BACKGROUND

Among acute stroke patients (ASPs), diabetes mellitus (DM) is associated with a higher risk of death, functional dependency, and recurrence. This study aimed to determine the impact of DM on the 30-day mortality among admitted ASPs in northern Tanzania.

MATERIALS AND METHODS

This was a hospital-based prospective cohort study performed among ASPs with and without DM who were admitted to Kilimanjaro Christian Medical Centre from November 2022 to May2023. ASPs were followed for 30 days after the onset of an acute stroke to identify the primary outcome, which was all-cause mortality. Descriptive statistics, logistic regression, and survival analysis were conducted.

RESULTS

Out of 213 ASP, 82 (38.5%) had DM. The overall crude mortality rate was 46.9%. ASPs with DM had a higher mortality rate of 53.7% compared with those without DM (42.7%). A higher proportion of acute stroke patients with DM (84.1%) had a poor outcome (mRS 3-6) (p = 0.038). DM was statistically non-significant for 30-day mortality (aHR 1.56; 95% CI: 0.73-3.32; p = 0.252). However, fever (p = 0.005), severe admission Glasgow coma scale (p = 0.005), severe stroke (p = 0.008), elevated serum creatinine (p = 0.008), and an abnormal respiratory pattern (p = 0.042), were predictors of 30-day mortality.

CONCLUSION

This study demonstrated a high mortality in ASPs. Although DM did not have a significant impact on 30-day mortality, other factors, such as altered mental state, stroke severity, fever, elevated creatinine, and abnormal respiration, need to be accounted for that may have a significant impact on the mortality in ASPs. These findings highlight the significant burden of DM in stroke patients and underscore the importance of early diagnosis and treatment of ASPs, in the hopes of improving clinical practice and guidelines and reducing morbidity and mortality in Tanzania.

Influence of cuff size on the accuracy of supine blood pressure measurement

OBJECTIVE

The discrepancy in blood pressure (BP) measurements while in a supine position using an upper-arm automated sphygmomanometer equipped with cuffs of varying sizes remains unresolved.

METHODS

In this single-center, randomized crossover trial, a total of 223 inpatients from the Affiliated Hospital of Putian University were enrolled between August and September 2023. Three sets of triplicate BP measurements were obtained while the participants were in a supine position using an automated sphygmomanometer with randomly assigned appropriately sized, undersized, or oversized BP cuffs.

RESULTS

The average age of the subjects was 65.1 ± 18.4 years, with 109 (48.9%) being male and 78 (35%) having coexisting hypertension. Based on the measured mid-arm circumference, a small-sized, regular-sized, and large-sized BP cuff was deemed appropriate for 50, 113, and 60 participants, respectively. In patients requiring small-sized cuffs, the use of regular and large-sized cuffs resulted in a significant reduction in systolic BP by -4.0 [95% confidence interval (CI): -9.8 to 1.9] mmHg and -6.9 (95% CI: -8.0 to -5.8) mmHg, respectively, as well as diastolic BP by -3.4 (95% CI: -8.0 to 1.2) mmHg and -4.1 (95% CI: -5.3 to 2.8) mmHg, respectively. In contrast, among patients requiring large-sized cuffs, the use of small and regular-sized cuffs increased systolic BP by 6.2 (95% CI: 4.2 to 8.2) mmHg and 2.3 (95% CI: -1.4 to 6.1) mmHg, respectively, and diastolic BP increased by 2.6 (95% CI: 1.5 to 3.7) mmHg and 0.2 (95% CI: -4.7 to 5.2) mmHg, respectively.

CONCLUSION

Our findings suggest that miscuffing affects supine BP measured by an automated sphygmomanometer.

Hypothalamic Gliosis Is Associated With Multiple Cardiovascular Disease Risk Factors in the Framingham Heart Study

BACKGROUND

Hypothalamic gliosis is mechanistically linked to obesity and insulin resistance in rodent models. We tested cross-sectional associations between radiologic measures of hypothalamic gliosis in humans and clinically relevant cardiovascular disease risk factors, as well as prevalent coronary heart disease.

METHODS AND RESULTS

Using brain magnetic resonance imaging from FHS (Framingham Heart Study) participants (N=867; mean age, 55 years; 55% women), T2-signal intensities were extracted bilaterally from the region of interest in the mediobasal hypothalamus (MBH) and reference regions in the amygdala and putamen. T2-signal ratios were created in which greater relative T2-signal intensity suggests gliosis. The primary measure compared MBH with amygdala (MBH/amygdala). Outcomes were body mass index, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting triglycerides, and the presence of hypertension (n=449), diabetes (n=66), metabolic syndrome (n=254), or coronary heart disease (n=25). Statistical testing was performed using linear or logistic regression. Greater MBH/amygdala T2-signal ratios were associated with higher body mass index (P<0.001), higher fasting triglycerides (P<0.001), lower high-density lipoprotein cholesterol (P=0.034), and presence of hypertension (P=0.0088), and the latter 2 were independent of body mass index. Findings for diabetes were mixed, whereas metabolic syndrome was strongly associated with greater MBH/amygdala T2-signal ratios (P<0.001). T2-signal ratios were not associated with prevalent coronary heart disease (all P>0.05), but CIs were wide.

CONCLUSIONS

Using a well-established study of cardiovascular disease development, we found evidence linking hypothalamic gliosis to multiple cardiovascular disease risk factors, independent of adiposity. Our results highlight the need to consider central nervous system mechanisms to understand and improve cardiometabolic health.

Post-isometric exercise hypotension occurs irrespective of muscle mass in adults with hypertension: A randomized clinical trial

OBJECTIVE

Isometric exercise can be an alternative approach to lowering blood pressure in individuals with hypertension. However, it is uncertain whether the muscle mass involved can influence Post-Exercise Hypotension (PEH). Thus, the authors evaluate the acute effect of an isometric exercise session with a Small Muscle Mass (SMM) and a Large Muscle Mass (LMM) on Systolic (SBP) and Diastolic (DBP) blood pressure in individuals with hypertension.

METHOD

Randomized clinical trial with 36 volunteers aged 40‒70y with hypertension allocated into (n = 12/group): control group (no exercise), SMM group (bilateral isometric handgrip contractions using a hydraulic handheld dynamometer), and LMM group (bilateral isometric full knee extension on a leg extension machine). Both exercise interventions consisted of 4 × 2 min of bilateral contraction at 30 % of the individual's maximum capacity. The authors used 24-hour Ambulatory Blood Pressure Monitoring (ABPM) after the interventions. One-way ANOVA or Generalized Estimation Equations (GEE) were used to test for potential differences (p < 0.05).

RESULTS

The authors found no increase in SBP/DBP immediately after the interventions. However, 24 h ABPM revealed lower SBP post-intervention in the SMM group (Δ-4.1 mmHg; p = 0.044) and the LMM group (Δ-5.6 mmHg; p = 0.040) compared to the control group, with no difference between these groups. DBP did not change over a period of 24 h ABPM.

CONCLUSIONS

In conclusion, isometric exercise-induced PEH assessed by 24 h ABPM regardless of the muscle mass involved. This study shows that both interventions may contribute to lowering blood pressure in individuals with hypertension.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov; ID NCT03982758.