Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Acute Effects of Citrulline Malate Supplementation on Nocturnal Blood Pressure Dipping After Exercise in Hypertensive Patients: A Randomized, Placebo-Controlled Trial

BACKGROUND

Citrulline malate (CM), especially when used in conjunction with physical exercise, has demonstrated potential as a non-pharmacological adjunct in the management of hypertension. Nevertheless, its impact on nocturnal blood pressure dipping remains unexplored.

OBJECTIVE

Evaluate the impact of a single dose of CM on nocturnal blood pressure dipping after exercise in hypertensive individuals.

METHODS

In a double-blind, placebo-controlled, parallel-group clinical trial, twenty hypertensive adults (55 ± 16 years) were randomly assigned to either a CM (6 g) or placebo (6 g of corn starch) group (PLA). Resting blood pressure was measured after a 20-min period of comfortable seating in a calm environment. Both groups underwent 40 min of treadmill running/walking at an intensity of 60-70% of their reserve heart rate, 120 min after ingesting the substances. Ambulatory blood pressure monitoring was employed to measure blood pressure over 24 h.

RESULTS

No significant differences in systolic blood pressure values were observed between the CM and PLA groups at rest, during wakefulness, sleep, or over a 24-h period. However, CM exhibited a significant reduction in diastolic blood pressure in several metrics: delta 24 h (-14 mmHg vs -6 mmHg, p = 0.047), delta wakefulness (-12 mmHg vs -4 mmHg, p = 0.024), percent delta 24 h (-16% vs -6%, p = 0.024), and percent delta wakefulness (-14% vs -4%, p = 0.013). No significant differences were found between CM and PLA in terms of systolic and diastolic nocturnal absolute reductions (-13 mmHg vs -12 mmHg, p = 0.808, and -13 mmHg vs -8 mmHg, p = 0.273, respectively) or nocturnal percentage decrease (-9.9% vs -9.4%, p = 0.844, and -15.3% vs -11.7%, p = 0.399, respectively).

CONCLUSIONS

The study found no significant changes in the post-exercise nocturnal blood pressure dip following a single dose of CM supplementation. However, a notable reduction in diastolic blood pressure was observed during the waking period and over the average 24-h monitoring period.

CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE

ClinicalTrials.gov platform (NCT03378596).

Self-blame, posttraumatic stress, and cardiovascular reactivity among sexual trauma survivors

Although trauma is closely linked with hyperarousal and cardiovascular health, little research has examined the effects of posttraumatic stress symptoms (PTSS) on cardiovascular reactivity to trauma reminders among sexual trauma survivors. One type of negative appraisal after trauma, self-blame, is common after sexual trauma, but its relation to cardiovascular reactivity is unknown. The present study aimed to examine the influence of both PTSS and self-blame on blood pressure and heart rate (HR) reactivity to a trauma reminder. Cardiovascular reactivity was measured before, during, and after a laboratory-based sexual trauma reminder among 72 young adult women who have experienced sexual trauma. Higher PTSS predicted lower diastolic blood pressure (DBP) reactivity during the trauma reminder. Higher levels of self-blame predicted higher HR and systolic blood pressure (SBP) reactivity during and after the trauma reminder. Overall, these findings suggest that survivors of sexual trauma with higher levels of PTSS experience a blunting reaction of DBP when exposed to trauma reminders, as opposed to a more typical cardiovascular stress reaction that may elevate and then extinguish to baseline levels. Meanwhile, individuals with higher levels of self-blame have heightened cardiovascular SBP and HR responses during trauma reminders that do not return to baseline levels, perhaps due to self-blame leading individuals to be more 'on guard' to prevent future threats. Longitudinal studies are needed to explore the potential long-term cardiovascular impacts of heightened self-blame and PTSS and their associated cardiovascular reactivity patterns.

Addressing diabetes by elevating access to nutrition (ADELANTE) - A multi-level approach for improving household food insecurity and glycemic control among Latinos with diabetes: A randomized controlled trial

BACKGROUND

Latinx adults are disproportionately impacted by the interrelated challenges of food insecurity and nutrition sensitive chronic diseases. Food and nutrition insecurity can exacerbate the development and progression of chronic diseases, such as diabetes. Sustainable, effective interventions aimed at improving food insecurity and diabetes management for Latinx populations are needed.

METHODS

This hybrid type 1 trial evaluates the effectiveness of a multi-level intervention that includes a medically supportive food and behavioral lifestyle program on the primary outcome of Hemoglobin A1c (HbA1c) at 6 months. Latinx adults (n = 355) with type 2 diabetes (HbA1c of 6.0-12.0 %), overweight/obesity (BMI > 25 kg/m2), and self-reported risk of food insecurity will be randomized 1:1 to intervention (12 weekly deliveries of vegetables, fruits, and whole-grain foods + culturally-modified behavioral lifestyle program) versus control (food deliveries after a 6-month delay). Outcome asessments will occur at 0, 6 and 12 months, and include HbA1c, dietary intake, psychosocial health outcomes, and diabetes-related stressors. In addition, food insecurity and the impact of the intervention on up to two household members will be measured. Qualitative interviews with patients, healthcare providers, and community partners will be conducted in accordance with Reach, Effectivenes, Adoption, Implementation, and Maintenence (RE-AIM) framework to identify barriers and best practices for future dissemination.

CONCLUSIONS

The ADELANTE trial will provide novel insight to the effectiveness of a multi-level intervention on diabetes-related outcomes in Latinx adults. The mixed-method approach will also identity the reach of this 'Food is Medicine' intervention on additional household members to inform diabetes prevention efforts.

CLINICAL TRIAL REGISTRATION

NCT05228860.

Effects of occlusion pressure on hemodynamic responses recorded by near-infrared spectroscopy across two visits

Ischemic Preconditioning (IPC) has emerged as a promising approach to mitigate the impact of hypoxia on physiological functions. However, the heterogeneity of occlusion pressures for inducing arterial occlusion has led to inconsistent hemodynamic outcomes across studies. This study aims to evaluate the peripheral hemodynamic responses to partial and total blood-flow occlusions on the left arm at rest, using absolute or individualized pressures, on two occasions. Thirty-five young males volunteered to participate in this study. IPC procedure (3 × 7-min) was performed on the left upper arm with cuff pressures at 50 mmHg (G1), 50 mmHg over the systolic blood pressure (SBP + 50 mmHg) (G2) or 250 mmHg (G3). NIRS-derived parameters were assessed for each occlusion and reperfusion phase in the brachioradialis. Results showed a significantly lower magnitude of deoxygenation (TSIAUC) for G1 compared to G2 (-1959.2 ± 1417.4 vs. -10908.1 ± 1607.5, P < 0.001) and G3 -1959.2 ± 1417.4 vs. -11079.3 ± 1828.1, P < 0.001), without differences between G2 and G3. However, G3 showed a significantly faster reoxygenation only for tissue saturation index (TSIslope) compared to G2 (1.3 ± 0.1 vs. 1.0 ± 0.2, P = 0.010), but without differences in the speed of recovery of deoxyhemoglobin [(HHb) slope], or in the magnitude of post-occlusive hyperemia (PORH). Besides TSI reoxygenation speed, G2 and G3 elicit comparable resting hemodynamic responses measured by NIRS. Thus, this study highlights the practicality and effectiveness of using relative occlusion pressures based on systolic blood pressure (SBP) rather than relying on excessively high absolute pressures.

MALAMA: Cultivating Food Sovereignty through Backyard Aquaponics with Native Hawaiian Families

Native Hawaiians were a healthy and robust population who developed a sophisticated food system that was dismantled by colonization. Currently, Native Hawaiians face pervasive health disparities due to the limited access to healthy foods and lifestyles. This study pilot tested a family-based community-driven intervention called MALAMA, which teaches families to build and use a backyard aquaponics system to grow their own food. A total of 21 participants from 10 families completed a three-month curriculum that included a series of hands-on workshops. Participant attendance was recorded and participants completed a behavioral health questionnaire as well as provided clinical indicators at three time points. They also attended a focus group at the end of the curriculum. There was a high level of engagement and no participant attrition. Fruit consumption among all participants significantly increased and there were favorable trends in blood pressure and fish and vegetable consumption. No significant differences were found in the other clinical indicators. Participants found MALAMA to be highly culturally acceptable and identified multiple benefits. Community-driven solutions, such as MALAMA, may be a promising approach to addressing pervasive health disparities and promoting health equity in minority and Indigenous communities.

Vida Sana y Completa: A randomized controlled trial to examine the effectiveness of diabetes prevention with and without medically supportive groceries among Latina women

Latina women have a high prevalence of obesity and obesity-related chronic diseases, such as diabetes. Approximately half of Latinas with obesity will also experience food insecurity, or a lack of access to enough food for an active and healthy life. Food insecurity is a barrier for effective prevention and management of obesity-related chronic diseases. The goal of this type 1 hybrid comparative effectiveness trial is to compare a culturally-tailored diabetes prevention intervention with and without medically supportive groceries. Adult Latina women (n = 412) with obesity (Body Mass Index (BMI) of >30 kg/m2) and food insecurity will be 1:1 randomized to the Vida Sana intervention (control), or to Vida Sana y Completa (intervention plus integrated treatment for food insecurity). Vida Sana is an evidence-based culturally tailored, 12-month diabetes prevention intervention that targets at least 5% weight loss and at least 150 min/week of moderate-to-vigorous physical activity. Participants enrolled in Vida Sana y Completa will also receive 12 weekly deliveries of medically supportive groceries. Those in Vida Sana alone will receive information on local food resources. Participants will be assessed at baseline and every 6 months for 24 months. The primary outcome is weight loss at 12 months. Secondary outcomes include weight loss maintenance, diet quality, and quality of life. Barriers and facilitators of implementation will be assessed using mixed methods according to the Consolidated Framework for Implementation Research. This study will provide critical evidence for addressing the combination of obesity and food insecurity in primary care for diabetes prevention. Trial Registration: NCT052111.

Validation of the Meditech ABPM-06 24-hour blood pressure monitoring system in a pediatric population according to International Organization for Standardization Protocol 81060-2:2018

OBJECTIVE

Ambulatory blood pressure monitoring (ABPM) devices play a crucial role in diagnosing hypertension, not only in adults but also in pediatric patients. ABPM-06, the latest oscillometric device from Meditech Ltd. (Budapest, Hungary), is the focus of this study. The objective was to validate the ABPM-06 device using the International Organization for Standardization (ISO) 81060-2 : 2018 standard.

METHODS

A total of 86 healthy patients, consisting of 34 males and 52 females, aged between 3 and 17 years, were enrolled in this study. During the ambulatory phase, a total of 50 patients were enrolled, with 35 patients falling within the 3- to 12-year-old age range and 15 patients aged between 12 and 17 years. Additionally, for the dynamic test, 36 patients were selected, comprising of 10 individuals aged 3-12 years and 26 patients aged 12-17 years. These patients were recruited from the outpatient clinics of the Department of Pediatrics at Albert Szent-Györgyi University in Szeged, Hungary. The validation process involved utilizing the same-arm sequence protocol, both in resting positions and during stress testing.

RESULTS

The ABPM-06 performed well in both clinical and ambulatory validations. In terms of validation criterion 1, the mean ± SD of the differences between the test device and reference blood pressure readings was -1.3 ± 3.5  mmHg for systolic and -0.1  ± 2.3 mmHg for diastolic, in children under the age of 12 years. For those over the age of 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Regarding the ambulatory validation, for children under 12 years old, the mean ± SD of the differences was -1.3  ± 3.5  mmHg for systolic and -0.1  ± 2.3  mmHg for diastolic. In the age group above 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Both tests successfully met the established criteria regarding the mean and SD values of the differences between the device readings and the observed SBP and DBP measurements.

CONCLUSION

The ABPM-06 oscillometric device fully adheres to the ISO 81060-2 : 2018 standard requirements for ABPM determination in the pediatric population (ages 3-17 years). Consequently, this ABPM device proves to be suitable for effectively managing hypertension in children and adolescents.

Factors Influencing Prevalence, C-reactive Protein Levels, and Lymphocyte Counts in Chronic Obstructive Pulmonary Disease Patients With Metabolic Syndrome

Background This research examined the relationship between C-reactive protein (CRP) levels and lymphocyte counts in individuals with chronic obstructive pulmonary disease (COPD) comparing those with metabolic syndrome (MetS) to those without. Methodology This cross-sectional study involved 100 consecutive COPD patients attending the outpatient wards at the Department of Medicine, Index Medical College, over 18 months. MetS was assessed using the International Diabetes Federation's guidelines. Pulmonary function tests such as spirometry were conducted following the European Respiratory Society's procedures, including measurements of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio. The Global Initiative for Obstructive Lung Disease criteria were employed to evaluate COPD severity using post-bronchodilator FEV1. Results Our results indicated no significant differences in demographics, anthropometrics, or pulmonary function tests between COPD patients with MetS and those without. Average age, height, weight, body mass index, and blood pressure readings were similar between the groups, with no significant variations (p > 0.05). However, the total white blood cell count was significantly higher in the MetS group (9,214 ± 3,161.8 cells/µL) compared to the non-MetS group (6,657.8 ± 4,218 cells/µL, p = 0.001). CRP levels were markedly elevated in 90.9% of MetS patients compared to 21.4% of non-MetS patients. Pulmonary function tests showed no significant differences in pre- and post-bronchodilator FEV1 or FEV1/FVC ratios (p > 0.05). Conclusions The study found that individuals with COPD and MetS have elevated levels of CRP, suggesting that this association exacerbates systemic inflammation and metabolic issues. Furthermore, the risk of MetS in COPD patients did not significantly differ between smokers and non-smokers, indicating that MetS can affect all COPD patients regardless of smoking status. Additionally, more than half of the COPD patients had hypertension, a common comorbidity that reflects the oxidative stress and inflammatory processes shared by both conditions.

Development of a User-Friendly Self-Screening Tool for Assessing Metabolic Syndrome Risk in Youths from Economically Challenged Regions

BACKGROUND

Metabolic syndrome increases the risk of heart disease and diabetes. Early identification and management are crucial, especially in economically challenged regions with limited healthcare access.

AIMS

To develop nomograms for individualized risk estimation for metabolic syndrome in young people from low-income regions.

METHODS

We assessed 496 college students from two Brazilian cities with Gini indices ≤0.56. Of these, 69.9% were female, 65.1% were younger than 20 years, 71.8% were non-white, and 64.3% were enrolled in health-related courses. For external validity, we assessed metabolic syndrome in a subset of 375 students.

RESULTS

We found 10 variables associated with abdominal obesity by logistic regression: age, biological sex, physical education facilities, enrollment in sports competitions during elementary school, grade retention, physical education as the preferred subject, physical education classes per week, and enrollment in sports training in secondary school (score A); adherence to 24 h movement behaviors (B score); and body weight (score C). We designed three nomograms (for scores A, B, and C), all of which showed acceptable performance according to the area under the receiver operating characteristic curve (≥0.70) and calibration (Hosmer-Lemeshow test, p > 0.05). In the external validation, we observed higher predictive capability for the A and B scores, while the C score had lower but still acceptable predictive ability.

CONCLUSIONS

User-friendly self-reported data accurately predict metabolic syndrome among youths from economically challenging areas.

Evaluation of Exposure to Bisphenol Analogs through Canned and Ready-to-Eat Meal Consumption and Their Possible Effects on Blood Pressure and Heart Rate

Bisphenols are endocrine-disrupting chemicals used in plastics and resins for food packaging. This study aimed to evaluate the exposure to bisphenol A (BPA), bisphenol S (BPS), and bisphenol F (BPF) associated with the consumption of fresh, canned, and ready-to-eat meals and determine the effects of bisphenols on blood pressure and heart rate. Forty-eight healthy young adults were recruited for this study, and they were divided into the following three groups: fresh, canned, and ready-to-eat meal groups. Urine samples were collected 2, 4, and 6 h after meal consumption, and blood pressure and heart rate were measured. The consumption of ready-to-eat meals significantly increased urine BPA concentrations compared with canned and fresh meal consumption. No significant difference in BPS and BPF concentrations was observed between the groups. The consumption of ready-to-eat meals was associated with a significant increase in systolic blood pressure and pulse pressure and a marked decrease in diastolic blood pressure and heart rate. No significant differences were noted in blood pressure and heart rate with canned and fresh meal consumption. It can be concluded that total BPA concentration in consumed ready-to-eat meals is high. High BPA intake causes increase in urinary BPA concentrations, which may, in turn, lead to changes in some cardiovascular parameters.

The impact of sphygmomanometer placement and cuff placement on blood pressure measurements

Background

Hypertension is the most significant global risk factor for mortality and morbidity, making standardized blood pressure measurement crucial.

Objectives

To investigate whether the location of blood pressure monitors and the positioning of cuffs yield differing results in blood pressure measurements.

Methods

Patients admitted to the Affiliated Hospital of Jiujiang College between 1 January 2022 and 30 June 2023 were enrolled in this study and randomly allocated into four groups. These groups were defined based on the positioning of monitoring equipment as follows: varied placements of cuffs on automatic blood pressure monitors, different heights for mercury column blood pressure monitors, varied heights for automatic blood pressure monitors, and different orientations for the cuff airbag tubes on electrocardiogram monitors. Blood pressure was measured and recorded for each group, followed by an analysis of the variations in readings across the different setups.

Results

In the first cohort of 763 individuals, mean systolic blood pressure measured at the standard upper arm site was 128.8 ± 10.5 mmHg, compared to 125.3 ± 10.4 mmHg at the elbow fossa. The corresponding diastolic pressures were 79.2 ± 10.7 and 75.0 ± 10.6 mmHg, respectively. The difference in systolic pressure between these positions was significant at 3.48 ± 3.22 mmHg (t₁ = 29.91, p₁ < 0.001) and for diastolic pressure at 4.23 ± 1.31 mmHg (t₂ = 88.98, p₂ < 0.001). For the subsequent groups, involving 253, 312, and 225 individuals, respectively, blood pressure measurements were analyzed and compared across different methods within each group. All p-values exceeded 0.05, indicating no statistically significant differences.

Conclusions

Blood pressure values measured at the elbow fossa position using an upper arm-type automatic sphygmomanometer were found to be lower than those measured at the upper arm position, with a difference of 3.48 mmHg for systolic and 4.23 mmHg for diastolic pressures. It is therefore essential to position the cuff correctly, specifically 2-3 cm above the elbow fossa, when utilizing an upper arm-type automatic sphygmomanometer for blood pressure monitoring. Conversely, the placement of the mercury column sphygmomanometer and the automated sphygmomanometer at varying heights had no significant effect on blood pressure readings. Similarly, the orientation of the electrocardiogram's cuffed balloon tube, whether facing upward or downward, did not influence blood pressure measurement outcomes.

Protocol of the HARMONY study: A culturally relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women

BACKGROUND

African American Women (AAW) are at high risk for stress-related cardiometabolic (CM) conditions including obesity, heart disease, and diabetes. Prior interventions lack attention to culturally-nuanced stress phenomena (Superwoman Schema [SWS], contextualized stress, and network stress), which are positively and significantly associated with unhealthy eating and sedentary behavior.

PURPOSE

The HARMONY Study is designed to test a culturally tailored mindfulness-based stress management intervention to address SWS, contextualized stress, and network stress as potential barriers to adherence to healthy exercise and eating goals. The study will help AAW build on their strengths to promote cardiometabolic health by enhancing positive reappraisal, self-regulation, and self-efficacy as protective factors against chronic stress-inducing biobehavioral morbidity and mortality risk.

METHODS

This two-arm, randomized-controlled trial will test the effects of two group-based, online interventions. HARMONY 1 includes culturally-tailored exercise and nutrition education. HARMONY 2 includes mindfulness-based stress reduction, exercise, and nutrition education. We aim to recruit 200 AAW ≥ 18 years old with CM risk.

RESULTS

Primary outcomes (actigraphy and carotenoid levels) and secondary outcomes (body composition, inflammatory markers, glucose metabolism, and stress) are being collected at baseline and 4-, 8-, and 12-months post-intervention. Intent-to-treat, data analytic approaches will be used to test group differences for the primary outcomes.

DISCUSSION

This study is the first to address culturally-nuanced stress phenomena in AAW (SWS, network stress, and contextualized stress) using culturally-tailored stress management, exercise, and nutrition educational approaches to reduce biobehavioral CM risk among AAW. Quantitative and qualitative results will inform the development of scalable and sustainable CM risk-reduction programming for AAW.

TRIAL REGISTRATION

The Multiple PIs registered the clinical trial (Identifier: NCT04705779) and reporting of summary results in ClinicalTrials.gov in accordance with the NIH Policy on the Dissemination of NIH-Funded Clinical Trial Information, within the required timelines.

Measurement of arterial occlusion pressure using straight and curved blood flow restriction cuffs

Arterial occlusion pressure (AOP) is influenced by the characteristics of the cuff used to measure AOP. Doppler ultrasound was used to measure AOP of the brachial and superficial femoral arteries using straight and curved blood flow restriction cuffs in 21 males and 21 females. Vessel diameter and blood flow were evaluated as independent predictors of AOP. Overall, there were no significant differences in AOP when using the straight and curved cuffs in the brachial (129 mmHg vs. 128 mmHg) or superficial femoral artery (202 mmHg vs. 200 mmHg), respectively. Overall, AOP was greater (p < 0.05) in males than in females in the arm (135 mmHg, 123 mmHg) and leg (211 mmHg, 191 mmHg). Brachial (0.376 mm, 0.323 mm) and superficial femoral (0.547 mm, 0.486 mm) arteries were larger (p = 0.016) in males than in females, respectively. Systolic blood pressure (SBP) and arm circumference were predictive of brachial artery AOP, whereas SBP, diastolic blood pressure, thigh circumference, and vessel diameter were predictive of superficial femoral artery AOP. Straight and curved cuffs are efficacious in the measurement of AOP in the arm and leg. Differences in vessel size may contribute to sex differences in AOP but this requires further investigation.

No Association Between AGT Gene Polymorphisms with Hypertension in a South African Population

Purpose

Hypertension is a leading cause of cardiovascular-related morbidity and mortality worldwide, with a prevalence increasing at an alarming rate in both middle- and low-income countries. Various environmental and genetic factors have been attributed to play a significant role in the increasing prevalence of hypertension. Single nucleotide polymorphisms (SNPs) in the angiotensinogen (AGT) gene are reported to have a significant association with hypertension; however, there are limited studies done on South African populations. Therefore, this case-control study aimed to investigate the association between AGT SNPs (rs2004776, rs3789678, rs5051 and rs7079) with hypertension in a study population of isiXhosa-speaking participants from the Eastern Cape Province in South Africa.

Materials and Methods

The SNPs were genotyped in 250 hypertensive cases and 237 normotensive controls, using TaqMan genotyping assays.

Results

For the SNP rs2004776, the frequency of CC genotype (18.4%) and C allele (44%) in hypertensive cases showed no significant differences (p = 0.52, χ2 = 1.32), when compared to the normotensive control group (CC: 19.8% and C allele: 43%). Similar results were obtained for the genotypic and allelic frequencies between hypertensive cases and normotensive controls for rs3789678 (p = 0.88, χ2=0.26) and rs5051 (p = 0.57, χ2=1.12), and rs7079 (p = 0.33, χ2=2.23). These findings demonstrate that there were no significant associations between the SNPs rs2004776, rs3789678, rs7079, rs5051 with hypertension in our study population.

Conclusion

These findings suggest that AGT gene polymorphisms are not associated with the development of hypertension in the studied population. The present study represents the first genetic report to investigate the AGT gene polymorphisms with hypertension in an isiXhosa-speaking South African population.

Resistance Training to Muscle Failure with Variable Load Intensities: Implications for Post-Exercise Blood Pressure and Heart Rate Variability in Trained Men

Background: The modulation of cardiac sympathovagal balance alters following acute resistance training (RT) sessions. Nevertheless, the precise influence of RT at varying load intensities on this physiological response remains to be fully elucidated. Therefore, the aim of this study was to compare the time course of recovery following low- (40%), moderate- (60%), and high- (80%) load-intensity RT protocols performed up to muscle repetition failure in resistance-trained men. Method: Sixteen young, resistance-trained men (mean age: 21.6 ± 2.5 years, mean height: 175.7 ± 8.9 cm, mean weight: 77.1 ± 11.3 kg) participated in a randomized crossover experimental design involving three sessions, each taken to the point of muscle failure. These sessions were characterized by different load intensities: low (40% of 1-repetition maximum, 1RM), moderate (60% of 1RM), and high (80% of 1RM). The exercise regimen comprised four exercises-back squat (BS), bench press (BnP), barbell row (BR), and shoulder press (SP)-with each exercise consisting of three sets. Throughout each session, heart rate variability (HRV) and blood pressure (BP) parameters were assessed both pre-exercise and during a 40 min post-exercise period, segmented into 10 min intervals for stabilization. Statistical analysis involved the use of a repeated measures ANOVA. Results: It was observed that the 40% and 60% RT sessions resulted in a significantly higher root mean square of successive R-R intervals (RMSSD) value compared to the 80% RT session in the post-exercise recovery process in 30 min (respectively, p = 0.025; p = 0.028) and 40 min (respectively, p = 0.031; p = 0.046), while the 40% and 60% RT sessions produced similar responses. The 40% RT session was significantly higher in the high frequency (HF) value post-exercise in 40 min compared to the 80% RT session (p = 0.045). Conclusions: Our findings suggest that engaging in resistance training (RT) sessions to muscle failure at an intensity of 80% induces acute increases in sympathetic activity, potentially leading to elevated cardiovascular stress. For individuals with normal blood pressure, it is advisable to opt for lighter loads and higher repetition volumes when prescribing RT, as heavier-load RT may carry an increased risk of cardiac-related factors.

ACE Gene I/D Polymorphism and Cardiometabolic Risk Factors: A Cross Sectional Study of Rural Population

The D allele has been identified as being linked to cardiovascular disease since the discovery of an insertion/deletion (I/D) polymorphism in the ACE gene, this polymorphism has been found to have significant associations with a variety of cardiovascular risk factors. Recent findings indicate a rising prevalence of metabolic disorders among rural populations in developing nations. Research on health matters has been predominantly focused on urban populations, with relatively less attention given to their rural counterparts Hence, the present study attempts to estimate the prevalence of ACE gene I/D polymorphism and explore its association with various cardiovascular risk factors among Rural Yadav population from India. In the present study, 207 (Male 47, Female 160) members of the Yadav community participated in the cross-sectional study. All the socio-demographic factors, somatometric (anthropometric) variables, and the intravenous blood was collected and Physiological (blood pressure), and biochemical (fasting glucose and lipid profile) parameters were measured as recommended by the American Heart Association, allele-specific PCR of the ACE gene I/D polymorphism was carried out, the PCR products were genotyped on 2% agarose gel Electrophoresis and ACE gene polymorphism was analysed for its association with various cardiovascular risk factors. Among the analysed individuals, 34 (16.4%) were found to have the II genotype, 58 (28.0%) had the ID genotype, and 115 (55.6%) had the DD genotype. The allele frequency of the I allele was found to be 0.31, and the frequency of the D allele was 0.69. The frequency of the DD genotype was found to be significantly higher among individuals with high TC, high TG, and low non-HDL levels (p value < 0.05). When considered collectively, the findings of this study are consistent with the hypothesis that the DD genotype of ACE polymorphism represents a correlation with cardiovascular disease risk factors in this population.

Quantification of neurovascular compliance with retrospectively gated phase-contrast MRI

OBJECTIVE

Neurovascular compliance (NVC) is the change in the brain's arterial tree blood volume, ΔV, divided by the change in intra-vascular blood pressure, ΔP, during the cardiac cycle. The primary aim of this work was to evaluate the performance of MRI measurement of NVC obtained from time-resolved measurements of internal carotid artery (ICA) and vertebral artery (VA) flow rates. A secondary aim was to explore whether NVC could be estimated from common carotid (CCA) flow in conjunction with prior knowledge of mean ICA and VA fractional flow rates, given the small cross-section of ICA and VA in some populations, in particular small children.

METHODS

ΔV was quantified from the blood flow rate measured at the ICA and VA for actual NVC derivation. It was further estimated from individually measured CCA flow rate and mean flow fractions ICA/CCA and VA/CCA (which could alternatively be obtained from literature data), to yield estimated NVC. Time-resolved blood flow rate in CCA, ICA and VA was obtained via retrospectively-gated 2D PC-MRI at 1.5 T in healthy subjects (N = 16, 8 women, mean age 36 ± 13 years). ΔP was determined via a brachial pressure measurement.

RESULTS

Actual and estimated mean NVC were 27 ± 15 and 38 ± 15 μL/mmHg, respectively, and the two measurements were strongly correlated (r = 0.80; p = 0.0002) with test-retest intra-class correlation coefficients of 0.964 and 0.899.

CONCLUSION

Both methods yielded excellent retest precision. In spite of a large bias, actual and estimated NVC were strongly correlated.

History and evolution of blood pressure measurement

Hypertension is the leading cause of morbidity and mortality worldwide. Hypertension mostly accompanies no symptoms, and therefore blood pressure (BP) measurement is the only way for early recognition and timely treatment. Methods for BP measurement have a long history of development and improvement. Invasive method via arterial cannulation was first proven possible in the 1800's. Subsequent scientific progress led to the development of the auscultatory method, also known as Korotkoff' sound, and the oscillometric method, which enabled clinically available BP measurement. However, hypertension management status is still poor. Globally, less than half of adults are aware of their hypertension diagnosis, and only one-third of them being treated are under control. Novel methods are actively investigated thanks to technological advances such as sensors and machine learning in addition to the clinical needs for easier and more convenient BP measurement. Each method adopts different technologies with its own specific advantages and disadvantages. Promises of novel methods include comprehensive information on out-of-office BP capturing dynamic short-term and long-term fluctuations. However, there are still pitfalls such as the need for regular calibration since most novel methods capture relative BP changes rather than an absolute value. In addition, there is growing concern on their accuracy and precision as conventional validation protocols are inappropriate for cuffless continuous methods. In this article, we provide a comprehensive overview of the past and present of BP measurement methods. Novel and emerging technologies are also introduced with respect to their potential applications and limitations.

Efficacy of Immediate Antihypertensive Treatment in Patients With Acute Ischemic Stroke With Different Blood Pressure Genetic Variants

BACKGROUND

It remains unclear whether blood pressure (BP) genetic variants could modify the efficacy of immediate antihypertensive treatment after acute ischemic stroke. We conducted a secondary analysis of the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) to investigate the effect of early antihypertensive treatment on clinical outcomes among patients with acute ischemic stroke according to 5 BP-associated genetic variants.

METHODS

The CATIS randomized 4071 patients with acute ischemic stroke with elevated systolic BP to receive antihypertensive treatment or discontinue all antihypertensive agents during hospitalization. Randomization was conducted centrally and was stratified by participating hospitals and use of antihypertensive medications. Five BP-associated single nucleotide polymorphisms (rs16849225, rs17030613, rs1173766, rs6825911, and rs35444 in FIGN-GRB14, ST7L-CAPZA1, NPR3, ENPEP, and near TBX3, respectively) were genotyped among 2590 patients. The primary outcome was a combination of death and major disability at 14 days or hospital discharge. A weighted BP genetic risk score was constructed by the 5 single nucleotide polymorphisms.

RESULTS

At 14 days or hospital discharge, the primary outcome was not significantly different between antihypertensive treatment and control groups based on genotype subgroups for all 5 single nucleotide polymorphisms (all P>0.05 for interaction). In addition, the BP genetic risk score did not modify the effect of antihypertensive treatment. The odds ratios (95% CIs) for the primary outcome were 0.95 (0.71-1.26), 1.08 (0.80-1.44), and 0.91 (0.69-1.22) in patients with low, intermediate, and high BP genetic risk score, respectively (P=0.88 for interaction).

CONCLUSIONS

Early antihypertensive treatment had a neutral effect on clinical outcomes among patients with acute ischemic stroke according to 5 BP-associated genetic variants.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.

Cardiac autonomic function is preserved in young adults with major depressive disorder

The prevalence of major depressive disorder (MDD) is highest in young adults and contributes to an increased risk of developing future cardiovascular disease (CVD). However, the underlying mechanisms remain unclear. The studies examining cardiac autonomic function that have included young unmedicated adults with MDD report equivocal findings, and few have considered the potential influence of disease severity or duration. We hypothesized that heart rate variability (HRV) and cardiac baroreflex sensitivity (BRS) would be reduced in young unmedicated adults with MDD (18-30 yr old) compared with healthy nondepressed young adults (HA). We further hypothesized that greater symptom severity would be related to poorer cardiac autonomic function in young adults with MDD. Heart rate and beat-to-beat blood pressure were continuously recorded during 10 min of supine rest to assess HRV and cardiac BRS in 28 HA (17 female, 22 ± 3 yr old) and 37 adults with MDD experiencing current symptoms of mild-to-moderate severity (unmedicated; 28 female, 20 ± 3 yr old). Neither HRV [root mean square of successive differences between normal heartbeats (RMSSD): 63 ± 34 HA vs. 79 ± 36 ms MDD; P = 0.14] nor cardiac BRS (overall gain, 21 ± 10 HA vs. 23 ± 7 ms/mmHg MDD; P = 0.59) were different between groups. In young adults with MDD, there was no association between current depressive symptom severity and either HRV (RMSSD, R2 = 0.004, P = 0.73) or cardiac BRS (overall gain, R2 = 0.02, P = 0.85). Taken together, these data suggest that cardiac autonomic dysfunction may not contribute to elevated cardiovascular risk factor profiles in young unmedicated adults with MDD of mild-to-moderate severity.NEW & NOTEWORTHY This study investigated cardiac autonomic function in young unmedicated adults with major depressive disorder (MDD). The results demonstrated that both heart rate variability and cardiac baroreflex sensitivity were preserved in young unmedicated adults with MDD compared with healthy nondepressed young adults. Furthermore, in young adults with MDD, current depressive symptom severity was not associated with any indices of cardiac autonomic function.

An overview of nutritional factors in the aetiopathogenesis of myocardial fibrosis in great apes

The main cause of mortality in great apes in zoological settings is cardiovascular disease (CVD), affecting all four taxa: chimpanzee (Pan troglodytes), bonobo (Pan paniscus), gorilla (Gorilla spp.) and orangutan (Pongo spp.). Myocardial fibrosis, the most typical histological characterisation of CVD in great apes, is non-specific, making it challenging to understand the aetiopathogenesis. A multifactorial origin of disease is assumed whereby many potential causative factors are directly or indirectly related to the diet, which in wild-living great apes mainly consists of high-fibre, low-carbohydrate and very low-sodium components. Diets of great apes housed in zoological settings are often different compared with the situation in the wild. Moreover, low circulating vitamin D levels have recently been recognised in great apes housed in more northern regions. Evaluation of current supplementation guidelines shows that, despite implementation of different dietary strategies, animals stay vitamin D insufficient. Therefore, recent hypotheses designate vitamin D deficiency as a potential underlying factor in the pathogenesis of myocardial fibrosis. The aim of this literature review is to: (i) examine important differences in nutritional factors between zoological and wild great ape populations; (ii) explain the potential detrimental effects of the highlighted dietary discrepancies on cardiovascular function in great apes; and (iii) elucidate specific nutrition-related pathophysiological mechanisms that may underlie the development of myocardial fibrosis. This information may contribute to understanding the aetiopathogenesis of myocardial fibrosis in great apes and pave the way for future clinical studies and a more preventive approach to great ape CVD management.

Health-related quality of life of type 2 diabetes mellitus patients: A cross-sectional study in the cape coast metropolis

Background and Aim

Type 2 diabetes mellitus (DM) has in recent decades become a global pandemic, accounting for over 90% of DM cases. The study evaluated the health-related quality of life (HrQoL) and identified its determinants among type 2 DM patients at the University of Cape Coast Hospital.

Methods

We conducted our study at the University of Cape Coast Hospital from January to March 2022. The EQ-5D-5L questionnaire was administered to 68 type 2 DM patients. Data were then inputted into Microsoft Excel and analyzed accordingly using IBM SPSS statistical software version 26 and GraphPad Prism 8.

Results

The mean age of the participants was 60.71 ± 12.18 with 55.9% being females. The average systolic, diastolic blood pressure and fasting blood glucose (FBG) of participants were 140.99 ± 22.27, 85 ± 11.14 and 7.97 ± 2.66 respectively. With the EQ-5D-5L scale, participants reported severe to extreme problems mainly in pain/discomfort (19.1%) and mobility (8.8%) dimensions. Approximately 21% (14/68) of patients reported themselves as being in perfect health based on the EQ-5D index score with no significant difference between males and females (p ≥ 0.05). On a scale of 0 to 100, most (26.5%) of the participants rated their general health state at 80. Age was significantly associated with all five dimensions while patients with comorbidities had higher odds of experiencing pain/discomfort and anxiety/depression.

Conclusion

The study reveals that pain/discomfort and anxiety/depression are the most experienced problems among patients with type 2 DM. The HrQoL of type 2 DM patients was also found to be affected by age, comorbidities, systolic and diastolic blood pressure. Therefore, identifying these factors and developing appropriate interventions is crucial for improving patient outcomes and enhancing treatment outcomes.

Access to routine health care and awareness of hypertension status among adults: Results from the National Health and Nutrition Examination Survey, 2011-2018

INTRODUCTION

Hypertension is a growing pandemic affecting over 1 billion people worldwide; about 46% of people with hypertension are unaware.

METHOD

Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were analyzed to assess the relationship between access to a routine place of care and undiagnosed hypertension in adults aged 18 to 64 years old. We defined undiagnosed hypertension as those meeting the 2017 American Heart Association's guidelines for stage 1 or 2 hypertension who reported not being told by their healthcare provider that they had hypertension. We used a multivariable Poisson regression model to assess the relationship between access to a routine place of care and undiagnosed hypertension.

RESULT

The final analytic sample was 5345 hypertensive American adults, with 56% unaware of their status. The results indicate that lack of awareness of hypertension status was highest among those without a routine place of care [PR = 1.20, CI = (1.12-1.29), p < 0.001] compared to those with access to a routine place of care, after adjustment for sociodemographic and clinical characteristics.

CONCLUSION

Access to a routine place of care in a non-emergency department setting is essential to reduce the rate of undiagnosed hypertension among American adults. Policymakers should implement policies to address the shortage of primary care providers and increase access to a routine place of care.

Impact of subtetanic neuromuscular electrical stimulation on cardiac autonomic nervous system in young individuals

BACKGROUND

Although subtetanic neuromuscular electrical stimulation (NMES) has been proposed as an exercise training and/or rehabilitation tool, the impact of NMES on the autonomic nervous system (ANS) is unclear. Thus, we hypothesized that NMES would alter ANS, i.e., increase sympathetic activity and decrease parasympathetic activity, in young individuals.

METHODS

Eighteen healthy young individuals (16 males, mean age: 22 [SD: 4] years, Body Mass Index: 21.7 [2.2] kg/m2) volunteered. Blood pressure (BP), heart rate (HR), and R-R intervals were recorded during 6-minute resting, NMES, and recovery conditions. Short-term heart rate variability analysis of R-R intervals was performed for the frequency and time domains during each condition. Time domain indices included the root mean square of successive R-R interval differences (RMSSD), and the percentage of successive R-R intervals differing by more than 50ms (pRR50%). Frequency domain indices (fast Fourier transform) of R-R intervals included total power (TP), low-frequency (LF) power (0.04-0.15 Hz), and high-frequency (HF) power (0.15-0.4 Hz).

RESULTS

BP was not altered but HR was significantly increased during NMES (P<0.001), and it returned to the resting level at recovery. RMSSD and pRR50 decreased from resting to NMES and returned at recovery conditions (P<0.05, respectively). TP and HF decreased from resting to NMES and returned at recovery conditions (P<0.05, respectively). LF increased from NMES to recovery (P<0.05). The LF/HF ratio showed no significant differences between conditions (P=0.210).

CONCLUSIONS

Cardiac ANS fluctuated by subtetanic NMES without BP elevation in healthy young individuals. Parasympathetic but not sympathetic activity was affected by NMES stimulation.

A paradigm shift from office to home-based blood pressure measurement approaches in kidney transplant recipients

PURPOSE OF REVIEW

The unattended blood pressure (BP) readings from home blood pressure (HBP) monitoring should provide more accurate BP readings than attended BP obtained from office blood pressure (OBP). Here, we review evidence supporting the clinical utility of HBP and automatic remote monitoring of blood pressure (ARM-BP) in kidney transplant recipients (KTR).

RECENT FINDINGS

BP from 24-h ambulatory blood pressure monitoring (24-h ABPM) is higher than but better associated with kidney and cardiovascular outcomes compared to OBP and HBP. While there is discordance of BP readings across different BP measurement methods causing BP misclassification, HBP provides BP readings closer to the readings from the 24-h ABPM than those from OBP. Systolic and diastolic BP is better controlled within 30 days after utilizing ARM-BP.

SUMMARY

Compared to OBP, HBP minimizes the attended effect of OBP, and its readings are closer to the gold standard 24-h ABPM. ARM-BP improves BP control in the short term and trials of longer follow-up duration are required to evaluate sustained clinical benefits in KTR. The paradigm of BP monitoring may shift toward HBP, while OBP may be utilized primarily for KTR who cannot perform HBP for hypertension diagnosis and management.

The implementation of a home-based isometric wall squat intervention using ratings of perceived exertion to select and control exercise intensity: a pilot study in normotensive and pre-hypertensive adults

PURPOSE

Isometric exercise (IE) and isometric wall squat (IWS) training have been shown to be effective methods of reducing arterial blood pressure. However, most IE interventions require methodologies and equipment that could present a barrier to participation. Therefore, this study aimed to examine the effectiveness of an accessible RPE prescribed IWS intervention.

METHODS

Thirty normotensive and pre-hypertensive adults were randomly assigned to a control group or one of two 4-week home-based IWS intervention groups: the first group conducted IWS exercise where intensity was prescribed and monitored using RPE (RPE-EX), whilst the other used a previously validated HR prescription method (HR-EX). Resting and ambulatory heart rate (HR) and blood pressure (BP) were measured pre- and post-intervention.

RESULTS

Minimum clinically important differences (MCID; - 5 mmHg) in SBP and/or DBP were shown in 100% of intervention participants. Statistically significant reductions were shown in resting seated BP (RPE-EX: SBP: - 9 ± 6, DBP: - 6 ± 4, MAP: - 6 ± 3 mmHg; HR-EX: SBP: - 14 ± 6, DBP: - 6 ± 4, MAP: - 8 ± 4 mmHg), supine BP (RPE-EX: SBP: - 8 (- 5), DBP: - 8 (- 7), MAP: - 8 (- 4) mmHg; HR-EX: SBP: - 5 (- 4), MAP - 5 (- 4) mmHg), and ambulatory SBP (RPE-EX: - 8 ± 6 mmHg; HR-EX: - 10 ± 4 mmHg) following the interventions. There were no statistically significant differences between intervention groups in the magnitude of BP reduction.

CONCLUSION

RPE prescribed IWS exercise can provide an effective and more accessible method for reducing BP at home, providing reductions comparable to the current HR-based prescription method.

Integrated analysis of the lncRNA-associated competing endogenous RNA network in salt sensitivity of blood pressure

Accumulating evidence showed that competing endogenous RNA (ceRNA) mechanism plays a pivotal role in salt sensitivity of blood pressure (SSBP). We constructed a ceRNA network based on SSBP-related differently expressed lncRNAs (2), mRNAs (73) and miRNAs (18). Bioinformatic analyses were utilized to analyze network and found network genes participate in biological pathways related to SSBP pathogenesis such as regulation of nitric oxide biosynthetic process (GO:0045,428) and cellular response to cytokine stimulus (GO:0071,345). Fourteen candidate ceRNA pathways were selected from network to perform qRT-PCR validation and found nine RNAs (KCNQ1OT1, SLC8A1-AS1, IL1B, BCL2L11, KCNJ15, CX3CR1, KLF2, hsa-miR-362-5p and hsa-miR-423-5p) differently expressed between salt-sensitive (SS) and salt-resistant (SR) groups (P < 0.05). Four ceRNA pathways were further validated by luciferase reporter assay and found KCNQ1OT1→hsa-miR-362-5p/hsa-miR-423-5p→IL1B pathways may influence the pathogenic mechanism of SS. Our findings suggested the ceRNA pathway and network may affect SS occurrence mainly through endothelial dysfunction and inflammatory activation.

Associations between diet quality and NT-proBNP in U.S. adults, NHANES 1999-2004

Objective

N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is a marker of cardiac wall stress and is a predictor of cardiovascular disease. Higher diet quality is associated with lower risk of cardiovascular disease. The association between diet quality and subclinical cardiovascular disease assessed by NT-proBNP is uncharacterized. We investigated the associations between diet quality, using Healthy Eating Index-2015 (HEI-2015), and NT-proBNP from the National Health and Nutrition Examination Survey (NHANES) 1999-2004.

Methods

We included 9,782 adults from NHANES 1999-2004 without self-reported cardiovascular disease. The HEI-2015 ranges from 0 to 100, with higher scores indicating better diet quality. The HEI-2015 was categorized into sex-specific quintiles. Regression models were used to quantify associations between the overall HEI-2015 score and its 13 components with log-transformed NT-proBNP. The beta coefficients were converted to percent differences.

Results

Among 9,782 participants, mean age was 45 years, 48% were men, and 72% were non-Hispanic White adults. After adjusting for sociodemographic characteristics, lifestyle factors, and medical history, those in the highest vs. lowest HEI-2015 quintile had an 8.5% (95% CI: -14.6% to -2.0%) lower NT-proBNP level. There was a dose-response association between HEI-2015 and NT-proBNP (P value for trend = 0.01). Each 1-unit higher in sodium and added sugars score indicating lower intake was associated with lower NT-proBNP by 7.7% (95% CI: -12.8% to -2.2%) and 6.5% (95% CI: -12.0% to -0.7%), respectively.

Conclusion

Higher diet quality, especially lower intakes of sodium and added sugars, was associated with lower serum levels of NT-proBNP.

Linking Blood Pressure-Associated Emotional Dampening to Trait Empathy

Gradual and sustained increases in resting blood pressure are accompanied by gradual and sustained reductions in the capacity to consciously experience several affective and somatosensory processes. Burgeoning theory suggests that this phenomenon, termed cardiovascular emotional dampening, contributes to heart disease risk by interfering with our ability to effectively respond to environmental demands. Interpersonal relationships are contexts in which this risk cascade likely occurs, but prior researchers have paid little attention to how emotional dampening might influence these relationships. As empathy is a construct used to describe facets of emotion-linked responding that facilitate interpersonal relationships, if emotional dampening influences interpersonal relationships, then we might expect resting blood pressure to covary with measures of empathy as it does with other previously studied aspects of affective responding. We recruited 175 healthy undergraduate college student participants (120 Women; M age = 19.17, SD age = 2.08) to complete a counterbalanced procedure in which we measured resting blood pressure and related it to participants' responses on the Toronto Alexithymia Scale, the Questionnaire of Cognitive and Affective Empathy, and a demographic survey. Bivariate comparisons revealed a significant inverse relationship between average resting systolic blood pressure (SBP) and cognitive empathy, as well as a significant inverse relationship between SBP and affective empathy. Multiple regression analyses revealed that SBP remained a significant predictor of cognitive empathy, but not affective empathy, after controlling for related covariates (i.e., sex, age, and alexithymia). SBP predicted cognitive empathy such that higher SBP was associated with lower cognitive empathy. Thus, people with higher resting blood pressures might experience increased interpersonal distress because of a reduced capacity for empathetic accuracy and perspective-taking. We discuss the implications and future directions of these findings.

Manpower cost for a hypertension health campaign: A cross-sectional study

Introduction

The overall prevalence of hypertension is high, and many people are unaware of their condition. Screening campaigns can effectively identify this group of patients. The study aimed to determine the cost of manpower for a health campaign for detecting undiagnosed hypertension and the prevalence of hypertension.

Method

This cross-sectional study was conducted at two health centres. Sociodemographic characteristics, hypertension and treatment statuses were recorded. Blood pressure (BP) was measured by either doctors or nurses using automated BP machines. The cost of manpower was calculated as the average salaries of manpower during the 3-day health campaign divided by the total number of days. The final sum was the cost of detecting undiagnosed hypertension.

Results

A total of 2009 participants median age = 50 (IQR = 18-91) were included in the study. The overall prevalence of hypertension was 41.4% (n=832). Among the patients with hypertension, 49.2% (n=409) were unaware of their hypertension status. Conversely, 21.1% (n=423) were known to have hypertension, among whom 97.4% (n=412) were on medications. Among those who were on medications, 49% (n=202) had good BP control. The average total cost of manpower during the 3-day health campaign was RM 5019.80 (USD 1059). The cost of detecting an individual with elevated BP was RM 12.27 (USD 2.59).

Conclusion

The prevalence of hypertension and unawareness is high. However, the average cost of manpower to detect an individual with elevated BP is low. Therefore, regular public health campaigns aiming to detect undiagnosed hypertension are recommended.

Trends in the prevalence and economic burden of hypertension and its socioeconomic disparities in rural southwestern China: two repeated cross-sectional studies

OBJECTIVES

This study aimed to analyse trends in the prevalence and economic burden of hypertension and its socioeconomic disparities in rural southwestern China.

DESIGN

Two repeated cross-sectional studies were conducted to collect interview and health examination data among individuals aged ≥35 years in rural Yunnan Province, China.

SETTING

Three rural areas of Yunnan, China.

PARTICIPANTS

We invited 8187 consenting participants in 2010-2011 and 7572 consenting participants in 2020-2021 to undergo interviews and health examinations.

RESULTS

The standardised prevalence of hypertension significantly increased from 26.1% in 2011 to 40.4% in 2021 (p<0.01), and the per capita direct, indirect and disease economic burdens increased from US$1323, US$46 and US$1369 to US$2196, US$49 and US$2244, respectively. In addition to the indirect economic burden, the direct and disease economic burdens increased significantly. The prevalence of hypertension was higher in illiterate population, among participants with low annual household income per capita, and participants with good access to medical services than in their counterparts who had good education, high annual household income per capita and poor access to medical services (all p<0.05). Moreover, the prevalence of hypertension showed a downward trend with improvement in socioeconomic position (SEP) (p<0.05). The per capita direct and disease economic burdens increased most in participants with low SEP, but the per capita indirect economic burden increased most in participants with upper-middle SEP.

CONCLUSIONS

The prevalence and economic burden of hypertension have visibly accelerated in rural Yunnan Province over the 10 years studied, and socioeconomic disparities have been found in the prevalence and economic burden of hypertension. These findings highlight that socioeconomic differentials should be tailored to address the timing of effective interventions for hypertension prevention and control and reduce the economic burden of hypertension in rural southwestern China.

Effectiveness of a dietician-led intervention in reducing glycated haemoglobin among people with type 2 diabetes in Nepal: a single centre, open-label, randomised controlled trial

Background

Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D.

Methods

An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24-64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367.

Findings

Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: -0.80 to -0.16), while it increased in the control group by 0.22 (95% CI: -0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: -1.04 to -0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: -36.12 to -1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group.

Interpretation

The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs.

Funding

The research was funded by the University Grants Commission (UGC), Nepal.

What matters for weight loss in behavioral trials in the Latinx community: Learnings from three randomized controlled trials

BACKGROUND

Nearly half of Latinx adults in the US are obese, making effective weight loss interventions crucial to prevent associated chronic conditions.

OBJECTIVE

To identify factors associated with increased session attendance and clinically significant weight loss among Latinx adults.

PARTICIPANTS

Latinx participants from the Vivamos Activos (n = 207), Vida Sana (n = 191), and HOMBRE (n = 424 Latinx men) randomized clinical trials.

DESIGN

Post-hoc analysis of randomized controlled trial data.

INTERVENTION

Culturally-adapted behavioral weight loss interventions based on the Diabetes Prevention Program among Latinx adults over 12 months.

MAIN OUTCOME MEASURE

Demographic, clinical, and psychosocial predictors of session attendance and 5% weight loss at 12-months.

STATISTICAL ANALYSIS PERFORMED

Bi-variable associations between baseline characteristics and outcomes were tested with chi-square and t-tests. Those with p-value< 0.15 were then included in stepwise logistic regressions.

RESULTS

Participants (N = 822) were middle age with diverse socioeconomic backgrounds. Older age in the Vivamos Activos and Vida Sana trials, and lower acculturation in the HOMBRE trial were significant predictors of increased session attendance. Factors associated with 5% weight loss varied by trials. These included younger age (OR 0.96 95% CI 0.92, 0.99) in Vivamos Activos, higher acculturation (OR 1.88 95% CI 1.05, 3.37) in Vida Sana, and higher education (OR 3.20 95% CI 1.3, 7.03) and greater body image dissatisfaction (OR 1.29, 95% CI 1.04, 1.6), and lower acculturation (0.69 95% CI 0.5, 0.96) in HOMBRE.

CONCLUSIONS

Few and conflicting baseline characteristics were associated with session attendance and clinically significant weight loss, suggesting that alternative approaches to optimizing interventions are needed.

12 weeks of resistance training with progressive intensity improves the diagnostic parameters of sarcopenia in individuals of advanced age

OBJECTIVE

The objective of this study was to evaluate the effects of 12 weeks of resistance training (RT) with progressive intensity on factors associated with sarcopenia in older individuals.

METHODS

A cross-sectional study was conducted with 74 participants (64.27 ± 7.06-y-old) who were divided into a control group (n = 37) and an intervention group (n = 37). The intervention group underwent 12 weeks of RT three times a week, with an initial training of 60% and final training of 85% of one-repetition maximum (1RM). Both groups were evaluated before and after the 12-week training period to assess improvements in strength and physical performance.

RESULTS

The intervention group showed an increase in physical performance, as evidenced by a reduction in the time to perform the Timed Up and Go (TUG) test (p < 0.01) and the Five Times Sit to Stand Test (p < 0.01). Furthermore, the RT proved to be efficient for increasing hand grip and overall muscular strength, as confirmed through the 1RM test. However, the muscle mass index (MMI) and walking speed did not show any significant alterations in both groups.

CONCLUSIONS

In conclusion, 12 weeks of RT with progressive intensity has a positive effect on the diagnostic parameters of sarcopenia, leading to improvements in physical performance and muscular strength while maintaining the MMI.

Bioactive compounds in pomace olive oil modulate the inflammatory response elicited by postprandial triglyceride-rich lipoproteins in BV-2 cells

Modulation of microglial response could be a target to reduce neuroinflammation associated with Alzheimer's disease. In this study, we propose that lipophilic bioactive molecules present in pomace olive oil (POO), transported in triglyceride-rich lipoproteins (TRLs), are able to modulate microglial high-oleic sunflower oil (HOSO, points) or pomace olive oil (POO, stripes). In order to prove this hypothesis, a randomized crossover postprandial trial was performed in 18 healthy young women. POO was assayed in opposition to high-oleic sunflower oil (HOSO), a common dietary oil which shares with POO an almost identical fatty acid composition but lacks certain biomolecules with recognized antioxidant and anti-inflammatory activities. TRLs were isolated from blood at the baseline and 2 and 4 hours postprandially and used to treat BV-2 cells to assess their ability to modulate the microglial function. We found that the intake of POO leads to the constitution of postprandial TRLs that are able to modulate the inflammatory response in microglia compared to HOSO. TRL-derived POO reduced the release of pro-inflammatory cytokines (tumor necrosis factor-α, and interleukins 1β and 6) and nitric oxide and downregulated genes codifying for these cytokines and inducible nitric oxide synthase (iNOS) in BV-2 cells. Moreover, the ingestion of POO by healthy women slightly improved glycemic control and TRL clearance throughout the postprandial phase compared to HOSO. In conclusion, we demonstrated that consuming POO results in postprandial TRLs containing lipophilic bioactive compounds capable of regulating the inflammatory response prompted by microglial activation.

Cardiovascular and health cost impacts of cuff blood pressure underestimation and overestimation of invasive aortic systolic blood pressure

OBJECTIVE

Hypertension management is directed by cuff blood pressure (BP), but this may be inaccurate, potentially influencing cardiovascular disease (CVD) events and health costs. This study aimed to determine the impact on CVD events and related costs of the differences between cuff and invasive SBP.

METHODS

Microsimulations based on Markov modelling over one year were used to determine the differences in the number of CVD events (myocardial infarction or coronary death, stroke, atrial fibrillation or heart failure) predicted by Framingham risk and total CVD health costs based on cuff SBP compared with invasive (aortic) SBP. Modelling was based on international consortium data from 1678 participants undergoing cardiac catheterization and 30 separate studies. Cuff underestimation and overestimation were defined as cuff SBP less than invasive SBP and cuff SBP greater than invasive SBP, respectively.

RESULTS

The proportion of people with cuff SBP underestimation versus overestimation progressively increased as SBP increased. This reached a maximum ratio of 16 : 1 in people with hypertension grades II and III. Both the number of CVD events missed (predominantly stroke, coronary death and myocardial infarction) and associated health costs increased stepwise across levels of SBP control, as cuff SBP underestimation increased. The maximum number of CVD events potentially missed (11.8/1000 patients) and highest costs ($241 300 USD/1000 patients) were seen in people with hypertension grades II and III and with at least 15 mmHg of cuff SBP underestimation.

CONCLUSION

Cuff SBP underestimation can result in potentially preventable CVD events being missed and major increases in health costs. These issues could be remedied with improved cuff SBP accuracy.

Comparison of outcomes for routine versus American Heart Association-recommended technique for blood pressure measurement (CORRECT BP): a randomised cohort study

Background

Optimal clinical care, diagnosis and treatment requires accurate blood pressure (BP) values. The primary objective was to compare BP readings taken while adhering to American Heart Association (AHA) guidelines to those typical of routine clinical care. Specifically studied: the combined effect of feet flat on the floor, back supported, and arm supported with cuff at heart level, while adhering to other guideline recommendations.

Methods

In this prospective, randomised, three-group cohort study, a modified cross-over design was applied in a primary care outpatient office setting in Columbus (OH, USA). Eligible participants were adults (aged ≥18 years) with an arm circumference of ≥18 cm and ≤42 cm who did not have a renal dialysis shunt or a previous or current diagnosis of atrial fibrillation. 150 recruited volunteers meeting the inclusion criteria were randomly randomised into the three groups. Group methodologies were BP readings taken on a fixed-height exam table followed by readings taken in an exam chair with adjustable positioning options (Group A), readings taken in the reverse order, chair then table (Group B), and both sets of readings in the exam chair (Group C). A rest period occurred before each set of readings. Group C was included for the purpose of obtaining an independent estimate of the order effect. The order in which the two types of readings (table vs chair) were taken was randomised. The primary outcome was the difference between the mean of three BP readings taken on the table and the mean of three readings taken in the chair.

Findings

Between September and October, 2022, 150 participants were enrolled in the study; all 150 of whom completed testing: 48 in Group A, 49 in Group B, 53 in Group C. The mean systolic/diastolic BP (SBP/DBP) of readings taken on the table (Group A first readings, Group B second readings) were 7.0/4.5 mmHg higher than those taken in the chair (Group A second readings, Group B first readings); both statistically significant, p < 0.0001. These findings show that AHA-recommended positioning-feet flat on the floor, back supported, arm supported with the BP cuff at heart level-results in substantially lower BP values than improper positioning. The mean SBP/DBP of the first set of readings taken on the chair were 1.6/0.6 mmHg higher than for the second set of readings (Group C, included to estimate order effect).

Interpretation

The observed benefit of proper positioning is sufficient to change the BP classification of several million patients from having hypertension to not having hypertension and therefore avoiding medication and/or intense follow-up.

Funding

Midmark Corporation, Versailles, Ohio, USA.

Cuff Size Variation Across Manufacturers of Home Blood Pressure Devices: A Current Patient Dilemma

BACKGROUND

The American Heart Association (AHA) recommends cuff sizes of blood pressure (BP) monitoring devices based on patient arm circumference, which is critical for accurate BP measurement. This study aimed to assess cuff size variation across validated BP devices and to examine the degree of alignment with the AHA recommendations.

METHODS

Data on home BP devices were obtained from the US BP Validated Device Listing website and listed cuff sizes were compared against AHA recommendations: small adult (22-26 cm), adult (27-34 cm), large (35-44 cm), and extra-large (XL) (45-52 cm).

RESULTS

There were 42 home validated BP devices from 13 manufacturers, and none offered cuffs that were aligned with the AHA recommendations. Over half of the devices (22, 52.4%) were compatible with only a broad-range cuff, generally excluding arm sizes larger than 44 cm. Only 5 devices from 4 manufacturers offered a cuff labeled "XL," and of these, only 3 devices had sizes that covered the AHA XL range. Terminology lacked consistency with manufacturers using: different labels to describe the same-sized cuffs (e.g., 22-42 cm was labeled "integrated," "standard," "adult," "large," and "wide range"); the same labels to describe differently sized cuffs (e.g., cuffs labeled "large" were sized 22-42 cm, 32-38 cm, 32-42 cm, 36-45 cm).

CONCLUSIONS

Manufacturers of US home BP devices employ inconsistent terminologies and thresholds for cuff sizes, and sizes were not aligned with AHA recommendations. This lack of standardization could pose challenges for clinicians and patients attempting to select a properly sized cuff to support hypertension diagnosis and management.

Evaluating High and Low Heart Rate Variability Response and Neurocognitive Performance in Workers: An Exploratory Study

Heart rate variability (HRV) has the potential to be a predicting factor of cognitive performance. The present research aimed to explore the differences in neurocognitive performance of workers with high HRV and low HRV. A total of 48 white-collar workers and 53 blue-collar workers were assessed. An electrocardiogram was used to obtain HRV data, whereby a 10 min baseline and an active (neuropsychological task) recording were taken. Median splits were performed on data to obtain high- and low-HRV groups. The Cambridge Neuropsychological Test Automated Battery, specifically, the spatial working memory, attention-switching task, rapid visual processing, and spatial span were used. Higher HRV (RMSSD and HF) was linked to better neurocognitive performance measures. Interestingly, the blue- and white-collar groups exhibited different correlations and, in some cases, showed an inverse relationship with the same variables. The differences observed in the present study demonstrate the importance of assessing task-dependent HRV parameters.

Longitudinal physical activity patterns and the development of cardiometabolic risk factors during adolescence

PURPOSE

To examine the associations between longitudinal physical activity (PA) patterns and the development of cardiometabolic risk factors from adolescence to young adulthood.

METHODS

This cohort study encompassed 250 participants recruited from sports clubs and schools, and examined at mean age 15 and 19. Device-measured moderate-to-vigorous PA was grouped into five patterns (via a data-driven method, using inactivity maintainers as a reference). The outcomes were: glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), total cholesterol, HDL and LDL cholesterol, triglycerides, blood pressure, and body mass index (BMI). Linear growth curve models were applied with adjustment for sex, age, fruit/vegetable consumption, cigarette/snuff use, and change in the device wear-time.

RESULTS

Insulin and BMI increased among decreasers from moderate to low PA (β for insulin 0.23, 95% CI 0.03-0.46; β for BMI 0.90; CI 0.02-1.78). The concentration of HDL cholesterol decreased (β -0.18, CI -0.31 to -0.05) and that of glucose increased (β 0.18, CI 0.02-0.35) among decreasers from high to moderate PA. By contrast, among increasers, blood pressure declined (systolic β -6.43, CI -12.16 to -0.70; diastolic β -6.72, CI -11.03 to -2.41).

CONCLUSIONS

Already during the transition to young adulthood, changes in PA are associated with changes in cardiometabolic risk factors. Favorable blood pressure changes were found among PA increasers. Unfavorable changes in BMI, insulin, glucose, and HDL cholesterol were found in groups with decreasing PA. The changes were dependent on the baseline PA and the magnitude of the PA decline.

Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine

Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.

Accuracy of cuff blood pressure and systolic blood pressure amplification

Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (ptrend < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.

The effects of the DASH dietary pattern on clinical outcomes and quality of life in adults with uncontrolled asthma: Design and methods of the ALOHA Trial

BACKGROUND

Poor diet quality is an important risk factor for increased asthma prevalence and poor asthma control. To address the question of whether adults with asthma can benefit from following a healthy diet, this trial will test the efficacy and mechanisms of action of a behavioral intervention promoting the Dietary Approaches to Stop Hypertension (DASH) dietary pattern with sodium reduction among patients with uncontrolled asthma.

METHODS

In this 2-arm randomized clinical trial, 320 racially/ethnically and socioeconomically diverse adults with uncontrolled asthma on standard controller therapy will be randomized to either a control or an intervention group and assessed at baseline, 3, 6 and 12 months. Control and intervention participants will receive education on lung health, asthma, and other general health topics; additionally, the intervention group will receive DASH behavioral counseling over 12 months. The primary hypothesis is that the DASH behavioral intervention, compared with the education-only control, will lead to significantly more participants with minimum clinically important improvement (responders) in asthma-specific quality of life at 12 months. Secondary hypotheses will test the intervention effects on other asthma (e.g., asthma control, lung function) and non-asthma outcomes (e.g., quality of life). Additionally, therapeutic (e.g., short chain fatty acids, cytokines) and nutritional biomarkers (e.g., dietary inflammatory index, carotenoids) will be assessed to understand the mechanisms of the intervention effect.

CONCLUSION

This trial can substantially advance asthma care by providing rigorous evidence on the benefits of a behavioral dietary intervention and mechanistic insights into the role of diet quality in asthma.

CLINICALTRIALS

gov #: NCT05251402.

Nutrient intakes from complementary foods are associated with cardiometabolic biomarkers among undernourished Peruvian children

Relatively little is known about how the diet of chronically undernourished children may impact cardiometabolic biomarkers. The objective of this exploratory study was to characterise relationships between dietary patterns and the cardiometabolic profile of 153 3-5-year-old Peruvian children with a high prevalence of chronic undernutrition. We collected monthly dietary recalls from children when they were 9-24 months old. At 3-5 years, additional dietary recalls were collected, and blood pressure, height, weight, subscapular skinfolds and fasting plasma glucose, insulin and lipid profiles were assessed. Nutrient intakes were expressed as average density per 100 kcals (i) from 9 to 24 months and (ii) at follow-up. The treelet transform and sparse reduced rank regress'ion (RRR) were used to summarize nutrient intake data. Linear regression models were then used to compare these factors to cardiometabolic outcomes and anthropometry. Linear regression models adjusting for subscapular skinfold-for-age Z-scores (SSFZ) were then used to test whether observed relationships were mediated by body composition. 26 % of children were stunted at 3-5 years old. Both treelet transform and sparse RRR-derived child dietary factors are related to protein intake and associated with total cholesterol and SSFZ. Associations between dietary factors and insulin were attenuated after adjusting for SSFZ, suggesting that body composition mediated these relationships. Dietary factors in early childhood, influenced by protein intake, are associated with cholesterol profiles, fasting glucose and body fat in a chronically undernourished population.

Paradoxical Associations of Occupational and Nonoccupational Sedentary Behavior With Cardiovascular Disease Risk Measures in Desk Workers

OBJECTIVES

We assessed sedentary behavior (SB) patterns and examined its associations, by domain, with cardiovascular disease (CVD) risk measures in desk workers ( N = 273).

METHODS

Sedentary behavior was measured by activPAL3 and partitioned into occupational and nonoccupational SB. Cardiovascular disease risk measures included blood pressure, pulse wave velocity, heart rate, and heart rate variability. Paired t tests evaluated patterns of SB across domains. Linear regressions estimated associations of occupational and nonoccupational SB with CVD risk measures.

RESULTS

Participants spent 69% of their time in SB; higher proportions were accumulated during occupational versus nonoccupational time. Higher all-domain SB was only associated with higher pulse wave velocity. Paradoxically, greater nonoccupational SB unfavorably associated with CVD risk measures, while higher occupational SB favorably correlated to CVD risk measures.

CONCLUSIONS

Observed paradoxical associations suggest that domain should be considered in efforts to improve cardiovascular health by reducing SB.

Is a combination of individual consultations, text message reminders and interaction with a Facebook page more effective than educational sessions for encouraging university students to increase their physical activity levels?

Background

Physical activity (PA) has been consistently reported as a crucial component of disease prevention and improvement of people's health. Nevertheless, data has evidenced a decline in physical activity levels among adults in Jordan. Although previous behavioral change interventions have documented efficacy in increasing physical activity among adults, the PA levels is low among adults. A new motivational intervention that focuses on changing behavior toward performing the recommended level of physical activity is on need.

Objective

This two-arm single-center randomized controlled trial aimed to measure the efficacy of a multi-component behavioral intervention (including goal setting, self-monitoring, and feed-back) for increasing physical activity levels and self-efficacy for exercise and decreasing body mass index and blood pressure among students at a Jordanian University.

Setting

Philadelphia University in Jordan.

Methods

A behavioral intervention based on individualized consultations, text messages reminders and interaction with a Facebook page was compared with educational sessions in terms of efficacy for increasing physical activity levels among students at Philadelphia University.

Results

The intervention and control groups were comparable at baseline. At 6 months a significant increase was seen in the moderate physical activity and walking levels of the intervention group compared with the control group. The mean change (SD) in total METs of moderate physical activity and walking was 503 (325.20) METs/week in the intervention group and 6 (271.20) METs/week in the control group. The mean change (SD) in steps/day was 3,000 (1,217) steps/day in the intervention group and 876 (1120.23) steps/day in the control group. The difference between mean change of the two groups was very significant at 2,124 (-820 to -563). Self-efficacy for exercise scale significantly increased among the intervention group compared with the control group. In addition, body mass index (BMI) declined from the baseline (Mean: 28.23, SD: 4.82) to 6 months (Mean: 25.36, SD: 5.23) for the intervention group.

Conclusion

Behavioral intervention through multicomponent strategies, alongside the implementation of an advanced communication strategy via phone and social media, is effective for motivating adult students to increase their physical activity levels.

Clinical trial registration

ISRCTN54100536.

Guideline-Adherent Hypertension in Children and Adolescents: A Multi-Institutional Database Analysis from Taiwan

BACKGROUND/AIMS

Childhood-onset hypertension is associated with cardiovascular morbidity and adult mortality. This study aimed to assess guideline-adherent hypertension among Taiwanese youth and the agreement on hypertension between the 2017 American Academy of Pediatrics guidelines and the 2004 Fourth Report.

METHODS

In this cross-sectional study, we collected outpatient blood pressure (OBP) measurements obtained during routine care visits from a large healthcare delivery system between 2009 and 2018 to evaluate the rate of guideline-adherent hypertension and assess patient-related factors of pediatric hypertension.

RESULTS

In total, 12,469 children and adolescents who underwent three separate ≥3 OBP measurements over 33,369 person-years with a total of 95,608 BP measurements in an outpatient setting were analyzed. According to the 2017 American Academy of Pediatrics (AAP) guidelines, the rate of pediatric hypertension in the study setting, which included participants aged 1 to 17 years, ranged from 0.78 to 5.95 per 1000 persons. Although there was perfect agreement between the thresholds of the two guidelines for defining hypertension in the age groups of 1-7, 8-12, and 13-17 years (all κ statistic ≥ 0.85), the use of the AAP threshold classified more adolescents as having hypertension. Children and adolescents with hypertension often had complex chronic diseases and required substantial healthcare services in outpatient, emergency, and inpatient settings.

CONCLUSIONS

The present study provides evidence of guideline-adherent pediatric hypertension and highlights the importance of regularly monitoring blood pressure to identify and manage hypertension in children and adolescents. Further research is required to determine the impact of new thresholds on the detection of target organ damage at a pediatric age.

Short Stature Modifies the Waist-to-height Ratio cut-off Points as an Indicator of Cardiovascular Risk in Mexican Adult Women and Men

BACKGROUND

Waist-to-height ratio (WHtR) is one of the anthropometric measures associated with cardiovascular risk (CVR). However, WHtR cut-off points may vary depending according to population characteristics, including sex and height.

OBJECTIVE

To identify optimal WHtR cut-off points to predict CVR factors by sex in Mexican adults according to height.

MATERIAL AND METHODS

Information from adults >20 years (n = 3550) from the 2016 National Health and Nutrition Survey were analyzed. Prevalence of high WHtR, CVR factors (glucose and insulin, lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and blood pressure were estimated by sex and height (short height <1.60 and <1.50 m in men and women, respectively). The maximum proximity procedure was used to establish the point of maximum simultaneous sensitivity and specificity using the operating characteristic curve of the receiver. The estimates were stratified by sex and height condition.

RESULTS

The WHtR cut-off points identified to predict CVR were higher than those suggested for international use (≥0.5), being significantly higher (p <0.0001) for women (0.61) than for men (0.56). Also, the WHtR cut-off points were higher for short stature (men 0.58 and 0.56, women 0.63 and 0.58, with short and normal stature, respectively).

CONCLUSIONS

The WHtR cut-off points for predicting CVR in the Mexican population were higher than 0.5 in both sexes and it was higher for individuals with short stature. The identified cut-off points may be an additional tool in screening the adult population in Mexico to predict CVR.

Effects of a Home-Based Physical Activity Program on Blood Biomarkers and Health-Related Quality of Life Indices in Saudi Arabian Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial

The purpose of this study was to undertake a randomized control trial examining the effects of a 12-week home-based physical activity program on Saudi Arabian adults with type 2 diabetes. Sixty-four patients with type 2 diabetes mellitus were recruited from the Jazan Diabetes and Endocrinology Center, located in the Jazan region of southwestern Saudi Arabia. Patients were randomly assigned to either control, i.e., usual care (males = 46.9% and females = 53.1%, age  =  45.88 ± 8.51 years, mass  =  76.30 ± 15.16 kg, stature  =  160.59 ± 8.94 cm, body mass index (BMI)  =  29.73 ± 6.24 kg/m², years since diagnosis  =  8.12 ± 6.22 years) or a home-based physical activity (males = 50% and females = 50%, age  =  42.07 ± 9.72 years, mass  =  74.58 ± 13.67 kg, stature  =  158.94 ± 9.38 cm, BMI  =  29.44 ± 4.38 kg/m², years since diagnosis  =  12.17 ± 8.38 years) trial arms. The home-based physical activity group was required to undertake aerobic training by increasing their habitual step count by 2000 steps per day and performing resistance training 3 times per week for 12 weeks. The primary outcome was hemoglobin A1c (HbA1c), and secondary measures of anthropometrics, blood biomarkers, physical fitness, and patient-reported quality of life outcomes pertinent to type 2 diabetes were measured at timepoints, i.e., baseline, 12 weeks, and 24 weeks (follow-up). Intention-to-treat analyses revealed no significant alterations in the primary outcome (control: baseline = 8.71%, 12-weeks = 8.35%, and follow-up = 8.72%; home-based physical activity: baseline = 8.32%, 12-weeks = 8.06%, and follow-up = 8.39%) between trial arms. However, improvements in psychological wellbeing at follow-up measured using the Patient Health Questionnaire-9 were significantly greater in the home-based physical activity group (baseline = 6.84, 12-weeks = 5.96, and follow-up = 5.00) compared to the control (baseline = 6.81, 12-weeks = 5.73, and follow-up = 8.53). No other statistically significant observations were observed. Home-based physical activity is not effective in mediating improvements in HbA1c levels or secondary hematological, blood pressure, anthropometric, or fitness indices. However, given the link between psychological wellbeing and the etiology/progression of disease activity in type 2 diabetes, home-based physical activity may be effective for tertiary disease management. Future trials should examine the efficacy of relative exercise intensities greater than those in the current study.

A Hemodynamic Pulse Wave Simulator Designed for Calibration of Local Pulse Wave Velocities Measurement for Cuffless Techniques

OBJECTIVE

Devices for cuffless blood pressure (BP) measurement have become increasingly widespread in recent years. Non-invasive continuous BP monitor (BPM) devices can diagnose potential hypertensive patients at an early stage; however, these cuffless BPMs require more reliable pulse wave simulation equipment and verification methods. Therefore, we propose a device to simulate human pulse wave signals that can test the accuracy of cuffless BPM devices using pulse wave velocity (PWV).

METHODS

We design and develop a simulator capable of simulating human pulse waves comprising an electromechanical system to simulate the circulatory system and an arm model-embedded arterial phantom. These parts form a pulse wave simulator with hemodynamic characteristics. We use a cuffless device for measuring local PWV as the device under test to measure the PWV of the pulse wave simulator. We then use a hemodynamic model to fit the cuffless BPM and pulse wave simulator results; this model can rapidly calibrate the cuffless BPM's hemodynamic measurement performance.

RESULTS

We first used multiple linear regression (MLR) to generate a cuffless BPM calibration model and then investigated differences between the measured PWV with and without MLR model calibration. The mean absolute error of the studied cuffless BPM without the MLR model is 0.77 m/s, which improves to 0.06 m/s when using the model for calibration. The measurement error of the cuffless BPM at BPs of 100-180 mmHg is 1.7-5.99 mmHg before calibration, which decreases to 0.14-0.48 mmHg after calibration.

CONCLUSION

This study proposes a design of a pulse wave simulator based on hemodynamic characteristics and provides a standard performance verification method for cuffless BPMs that requires only MLR modeling on the cuffless BPM and pulse wave simulator. The pulse wave simulator proposed in this study can be used to quantitively assess the performance of cuffless BPMs. The proposed pulse wave simulator is suitable for mass production for the verification of cuffless BPMs. As cuffless BPMs become increasingly widespread, this study can provide performance testing standards for cuffless devices.