The global epidemiology of hypertension

Prevalence and management of hypertension in Turner syndrome: data from the International Turner Syndrome (I-TS) registry

Introduction

Cardiovascular disease is the most common cause of death in Turner syndrome (TS) for which arterial hypertension has a direct influence and is a key modifiable risk factor.

Objective

To investigate the prevalence and patterns of hypertension diagnosis and management in adult patients with TS who are registered in a large international multicentre database (TS-HTN study).

Methods

Retrospective multicentre observational study of patients aged ≥18 years included in the I-TS (International-TS) registry (2020-2022), using registry and participating centre-collected data.

Results

Twelve international centres participated, including 182 patients with a median age of 28 years (IQR 23-37.2). Arterial hypertension was recorded in 13.2% (n = 24). The median age at hypertension diagnosis was 27 years (range 10-56), with 92% aged less than 50 years at diagnosis. The majority (75%) were classified as primary hypertension (n = 18). In binomial regression analysis, higher body mass index was the only parameter significantly associated with the occurrence of hypertension (B = 1.487, P = 0.004). Among patients with aortic disease (n = 9), 50% had systolic BP ≥ 130 mmHg and 66.6% had diastolic BP ≥ 80 mmHg during the last clinic review. Angiotensin-converting enzyme inhibitors were the most common (n = 16) medication prescribed, followed by angiotensin receptor blockers (n = 6), beta-blockers (n = 6) and calcium channel blockers (n = 6).

Conclusions

Arterial hypertension is common in TS and occurs at a young age. Overweight/obesity was a notable risk factor for hypertension. The frequency of suboptimal BP control among high-risk patients highlights the importance of increased awareness and TS-specific consensus guidance on management.

CCL11 (Eotaxin) Promotes the Advancement of Aging-Related Cardiovascular Diseases

Aging-related diseases, such as cardiovascular diseases (CVDs), neurodegeneration, cancer, etc., have become important factors that threaten the lifespans of older individuals. A chronic inflammatory response is closely related to aging-related diseases. Establishing inflammatory aging clock (iAGE, deep-learning methods on blood immune biomarkers to construct a metric for age-related chronic inflammation) successfully predicted the positive correlation between several factors, including serum C-C-motif chemokine ligand 11 (CCL11) and aging-related diseases. Recently, the role and mechanism of CCL11, an eosinophilic chemokine, in neurodegenerative diseases have been widely reported. Additionally, many research studies have shown a positive correlation with CVDs, but the underlying mechanism remains unknown. This review focuses on the relationship between chronic inflammation and aging. The role of CCL11 will be discussed and summarized in relation to aging-related diseases, especially CVDs.

Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India

Hypertension is one of the most prevalent NCDs in the world. Its prevalence is especially high among the elderly, a demographic group on the rise in low and middle income countries. Extant medical literature calls for early detection to prevent aggravation of problems when old. In this paper, we investigate whether diagnosis of hypertension among adults aged 45 and above, is correlated with geographic access to primary public healthcare services, after accounting for a rich set of potentially confounding covariates. Our study focuses on rural India where access to public primary health services is especially poor but hypertension rates are high. Using the first wave of the Longitudinal Ageing Survey of India (LASI) 2017-19, we find that hypertensive adults belonging to poor households, face a distance cost of public primary health facilities and are 8 percent less likely to be aware of their hypertension when Primary Health Centres are 10 km away. Since almost 10 percent of villages in India are at least 10 km away from PHCs, this exclusionary effect is significant. Our analysis suggests that even though public primary facilities are poorly staffed and managed in India, and private care is popular, geographical expansion of public primary facilities can still play an active role in NCDs and public primary health financing should take heed of the need for such expansion.

Diabetes Mellitus and Hyperlipidemia Status Among Hypertensive Patients in the Community and Influencing Factors Analysis of Blood Pressure Control

To evaluate the prevalence of type 2 diabetes mellitus (T2DM) and hyperlipidemia in hypertensive patients in South China and assess the relationship between these comorbidities and blood pressure control to develop targeted strategies for hypertension management. Data from the 2020 Guangzhou National Basic Public Health Service Program were analyzed using Chi-square tests, t-tests, and logistic regression with R 4.1.2. Among 275,789 hypertensive patients, the blood pressure control rate was 51.51%. The prevalence of T2DM and hyperlipidemia comorbidities was 12.79%, with 12.78% for T2DM alone, 33.54% for hyperlipidemia alone, and 40.89% with no comorbidities. Blood pressure control rates significantly differed by comorbidity (p < 0.05): 52.84% for those without T2DM/hyperlipidemia, 54.18%, 49.25% for T2DM or hyperlipidemia alone, and 50.52% for both conditions. Multivariate analysis indicated a lower blood pressure control rate in patients with hyperlipidemia alone (OR = 1.144) or both T2DM and hyperlipidemia (OR = 1.082), and a higher rate in those with T2DM alone (OR = 0.936). Subgroup analysis revealed that males, older age, higher education, obesity, alcohol use, lack of physical activity, and poor medication adherence were associated with lower control rates. This study found a high prevalence of diabetes and hyperlipidemia among hypertensive patients in Guangzhou. Additionally, hypertensive patients with hyperlipidemia had poorer blood pressure control compared to other diabetic patients. Key factors such as obesity, being overweight, and unhealthy lifestyle choices significantly impact blood pressure management in this population. Therefore, comprehensive measures should be implemented to integrate lipid management into community health efforts and to effectively control blood pressure levels among hypertensive patients.

Correlations Between Endothelial Function and Right Ventricular Performance in Primary Hypertension

Background

This study aims to elucidate the correlation between endothelial function and both cardiac structure and function in patients newly diagnosed with primary (essential) grade 1 hypertension.

Methods

We retrospectively reviewed clinical and echocardiographic data from 109 patients attending a cardiology outpatient clinic from January to December 2022. All subjects underwent comprehensive laboratory tests including lipid profile, glucose, electrolytes, and high-sensitivity C-reactive protein, alongside echocardiography to assess cardiac function. A subset of 34 patients underwent flow-mediated dilation (FMD) testing to evaluate endothelial function, and the results categorized them into normal (FMD ≥ 6%) and reduced (FMD < 6%) endothelial function groups.

Results

The study found no significant differences in baseline demographic or clinical parameters between groups. Age was negatively correlated with FMD values, indicating decreased endothelial function with advancing age. The normal endothelial function group demonstrated better diastolic and systolic parameters and lower right ventricular Tei indices compared to the reduced function group. Additionally, there was a significant negative correlation between the right ventricular Tei index and FMD values.

Conclusions

Endothelial function is associated with right ventricular performance in patients with primary (essential) grade 1 systemic hypertension. Improved endothelial function is associated with better overall cardiac performance. Further studies with age-matched controls are necessary to confirm these findings and determine the independent effects of hypertension on cardiac function.

Increased adherence to the DASH dietary pattern in community dwelling older adults: Findings from two National Health and Nutrition Surveys

OBJECTIVES

To assess adherence to the Dietary Approaches to Stop Hypertension (DASH) diet over a decade among community-dwelling older adults, with and without hypertension and to examine associated factors.

STUDY DESIGN

Cross-sectional study.

METHODS

Data from two cross-sectional Israel National Health and Nutrition Surveys (NHNS) for older adults, from 2005 to 2006 (NHNS1) and 2014-2015 (NHNS2) were analysed. Trained personnel conducted face-to-face interviews and collected demographic, health, and lifestyle data, along with anthropometric measurements. Adherence to the DASH diet was determined from a single 24-h dietary recall using Mellen's DASH score. Logistic regression analyses were applied to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for high DASH adherence (scores ≥4.5) versus low adherence (scores <4.5). Individual nutrient targets of the DASH diet were also assessed.

RESULTS

The dataset was comprised of 1722 participants from NHNS1 and 916 from NHNS2. Following adjustment for potential confounders, the OR for DASH adherence among participants in NHNS2 was 1.65 (95 % CI 1.34-2.04) compared to NHNS1. NHNS2 participants reported better adherence to DASH nutrient recommendations for saturated fatty acids, total fat, protein, dietary fibre, and calcium among individuals with and without hypertension. No statistically significant differences were found for cholesterol, potassium, and sodium target intakes between surveys.

CONCLUSIONS

A positive trend towards healthier dietary patterns was identified among both the hypertensive and non-hypertensive older adults over a 10-year period. This underscores the importance of ongoing monitoring to appropriately address changing population needs and promote healthy dietary practices.

Sleep quality and hypertension in an indigenous African population: a cross-sectional investigation from the COMBAT-CVDs study

Hypertension is a major risk factor for cardiovascular events worldwide, and little is known about its association with sleep quality (SQ) among Africans. We evaluated the association of SQ with hypertension among adults in Ibadan, Nigeria. In Ibadan and its suburbs, we identified 3635 participants in the door-to-door Community-based Investigation of the Risk Factors for Cardiovascular Diseases (COMBAT-CVDs) study. SQ was self-reported, and SQ scores were classified by the tertile distribution in this sample as good (<9), moderate (10-18), and poor (≥19), and hypertension was defined as one of the following conditions: systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or prior diagnosis by a certified health professional or current use of blood pressure-lowering drugs. Using good SQ as a reference, logistic regression models were used to estimate the multivariable-adjusted odds ratio and 95% confidence interval (CI) for odds of hypertension by tertiles of SQ scores in a two-sided test at p < 0.05. In all, 1182 (32.5%) had poor SQ, 903 (24.8%) had hypertension, and the mean(±SD) age was 35.3 ± 15.2 years in this sample. The multivariable-adjusted odds of hypertension by tertiles of SQ scores (using good SQ as reference) were OR: 1.13 (95% CI: 0.92, 1.38) for moderate SQ, and OR: 1.29 (95% CI: 1.05, 1.59) for poor SQ; P for trend = 0.06 after adjusting for relevant covariates. Poor SQ is associated with higher odds of hypertension in this sample. The imperative of culturally sensitive interventions to improve SQ would be promising in managing poor sleep-associated hypertension burden in this population.

Burden of Cardio-Cerebrovascular and Renal Diseases Attributable to Systolic Hypertension in France in 2021

BACKGROUND

Hypertension is the most common chronic disease and a major modifiable risk factor for cardio-cerebrovascular and renal diseases. This study estimated the national burden of hypertension, defined as systolic blood pressure ≥140 mm Hg, on morbidity and mortality in 2021 in France.

METHODS

For all diseases causally associated with hypertension (cardiovascular diseases, chronic kidney diseases, and dementia), the number and proportion of cases attributable to hypertension in adults aged ≥35 years were estimated using population attributable fractions. Age- and sex-specific population attributable fractions were computed using the distribution of hypertension in the French population. These population attributable fractions were applied to nationwide statistics for mortality, hospitalizations, disease prevalence, years of life lost, years of life lived with disability, and disability-adjusted years of life.

RESULTS

The largest population attributable fractions were for ischemic heart disease and hemorrhagic stroke, with over 40% of cases attributable to hypertension. Overall, more than 385 000 patients were hospitalized due to hypertension, with 3.7 million hospitalizations and 6.2 million hospital days (all hospitalizations, including 3.4 million for chronic kidney disease) and including 390 000 overnight hospitalization. In 2021, more than 1.15 million individuals lived with ischemic heart disease attributable to hypertension, 1.26 million with chronic kidney diseases, and 358 033 with heart failure. Among 184 059 annual deaths from cardiovascular diseases, dementia, and chronic kidney diseases, 30% (55 280 deaths) were attributable to hypertension. Hypertension accounted for 8.5% of all deaths and 498 052 years of life lost.

CONCLUSIONS

In France, despite near-universal health coverage and free health care access, the burden attributable to hypertension remains high.

Joint exposure to multiple air pollutants and residual cardiovascular risk in hypertension

BACKGROUND

Despite the widespread availability of antihypertensive medications, residual cardiovascular risk of hypertension remained high. Limited studies have investigated the link between air pollution, particularly joint exposure to multiple air pollutants, with residual cardiovascular risk of hypertension.

METHODS

1981 hypertensive patients (≥ 18 years) from an ongoing longitudinal cohort in China, were enrolled between 2013 and 2019. Using high-quality datasets from China, the ground-level air pollutants concentrations, including PM2.5, PM2.5-10, SO2, O3, CO and NO2, at each participant's residence were calculated. The relationships between individual and multiple air pollutants with the residual cardiovascular risk were assessed by Cox proportional hazards models, air pollution score analyses and Bayesian Kernel Machine Regression model.

RESULTS

Over an average follow-up period of 2.24 years (SD, 1.25), 706 hypertensive patients developed cardiovascular disease. In the single-pollutant analysis, higher concentrations of PM2.5, PM2.5-10, SO2 and CO were linked to increased residual cardiovascular risk. The air pollution score analyses and Bayesian kernel machine regression suggested that combined exposure to multiple air pollutants had a positive association with the residual cardiovascular risk, and NO2 played a dominant role. With higher NO2 concentrations, the hazard ratio of individual pollutants to residual cardiovascular risk increased.

CONCLUSIONS

Prolonged exposure to a mixture of various air pollutants is linked to elevated residual cardiovascular risk in individuals with hypertension. Apart from taking antihypertensive medication and adopting healthy lifestyle behaviors, hypertensive patients should lower air pollutant exposure to decrease residual cardiovascular risk.

Assessing the efficacy of renal denervation in patients with resistant arterial hypertension : Systematic review and meta-analysis

BACKGROUND

Renal denervation (RDN) is an innovative procedure designed to regulate the renal sympathetic nervous system for the control of arterial hypertension (HTN). RDN has emerged as an alternative for patients with resistant HTN. However, the clinical efficacy of RDN remains incompletely elucidated.

METHODS

PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing the use of RDN with sham procedure or pharmacological treatment in patients with resistant HTN. Statistical analyses were performed using R Studio 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was examined with the Cochran Q test I2 statistics. Mean difference (MD) with 95% confidence interval (CI) were pooled across trials. P values of <0.05 were considered statistically significant. The primary outcomes of interest were changes from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum creatinine.

RESULTS

Twenty-one RCTs comprising 3345 patients were included in this meta-analysis, whereby 2004 (59.91%) received renal denervation and 1341 (40.09%) received pharmacological treatment or sham procedure. Follow-up ranged from 2 to 48 months. Compared to control group, RDN significantly reduced SBP (MD -3.53 mm Hg; 95% CI -5.94 to -1.12; p = 0.004; I2 = 74%) and DBP (MD -1.48 mm Hg; 95% CI -2.56 to -0.40; p = 0.007; I2 = 51%). Regarding serum creatinine (MD -2.51; 95% CI -7.90 to 2.87; p = 0.36; I2 = 40%), there was no significant difference between RDN and control groups.

CONCLUSION

In this meta-analysis of RCTs of patients with resistant HTN, RDN was associated with a reduction in SBP and DBP compared to sham procedure or pharmacological treatment.

Exploring hypertension-linked diseases: a comprehensive review of innovative drug combinations with enhanced therapeutic potential

Hypertension, a prevalent cardiovascular condition affecting a substantial portion of the global population, remains a formidable health challenge associated with a multitude of complications. This review article provides a comprehensive examination of hypertension, its various complications, and the emergence of a novel management technique that shows promising potential in transforming the therapeutic landscape. Over the years, conventional treatment approaches, encompassing lifestyle modifications, dietary interventions, and pharmacotherapy, have been the mainstay in managing hypertension. However, these strategies fall short in achieving optimal blood pressure control and preventing complications in a significant number of patients. Consequently, the medical community has ventured into exploring innovative management techniques to tackle this unmet medical need. The focal point of this review centers on the emergence of a new management technique for hypertension that exhibits promise in preclinical and clinical studies. The latest research findings shed light on the efficacy and safety of this innovative approach, which encompasses pharmaceutical agents, medical devices, and non-invasive interventions. Through critical analysis and discussion, we explore the potential impact of these novel strategies on hypertension management and patient outcomes. In conclusion, this review article provides a comprehensive overview of hypertension, its complications, and the promising emergence of innovative management techniques. By acknowledging the complexity of hypertension and the potential of new therapeutic avenues, we aspire to pave the way for improved patient care, enhanced quality of life, and ultimately, the mitigation of hypertension-related morbidity and mortality.

Walnut peptide relieves hypertension and associated kidney and heart injury by regulating the renin-angiotensin-aldosterone system and intestinal microbiota

BACKGROUND

Hypertension is a chronic disease with high morbidity and mortality. Previously, we screened a walnut meal peptide FDWLR (PEP) with significant angiotensin-converting enzyme inhibitory activity. The present study further investigated the anti-hypertensive effects of PEP in vivo using spontaneously hypertensive rats.

RESULTS

The results indicated that PEP reduced blood pressure and the indices in the renin-angiotensin-aldosterone system (RAAS) including angiotensin-converting enzyme (ACE) (decreased by 15.36%), angiotensin II (Ang II) (decreased by 31.56%), angiotensinogen (AGT) (decreased by 58.84%) and aldosterone (ALD) (decreased by 18.27%), whereas NO levels increased by 54.96%. The pathological analysis showed that PEP relieved cardiac and renal damage. PEP also alleviated oxidative stress, inflammation and fibrosis in the heart and kidney. Mechanistically, PEP mitigated cardiac and renal damage by simultaneously regulating ACE-Ang II-AT1R and the ACE2-Ang (1-7)-MAS axis. Additionally, PEP increased the levels of short chain fatty acids by 224.16% and improved gut microbiota by increasing the abundance of Prevotella, Phascolarctobacterium, Clostridium_sensu_stricto and Bifidobacterium, at the same time as decreasing Bacteroides and Alistipes abundances.

CONCLUSION

This study indicated that PEP prevented hypertension and associated heart and kidney damage by modulating the RAAS system and gut microbiota, which is valuable in guiding future development and optimal utilization of walnut meal. © 2024 Society of Chemical Industry.

Community-based model for management and follow-up by non-physician healthcare workers to improve awareness, treatment, and control of hypertension: The COTRACO study protocol

Introduction

Cardiovascular diseases are the leading cause of death and morbidity worldwide, with a significantly higher burden in low- and middle-income countries. Hypertension, a major risk factor for cardiovascular morbidity and mortality, remains under-diagnosed and poorly controlled, especially in regions such as Latin America. The HOPE-4 study demonstrated that the involvement of non-physician health workers (NPHWs), the use of standardized treatment algorithms, the provision of free antihypertensive drugs and home follow-up can significantly improve hypertension control and reduce cardiovascular risk, as demonstrated in Colombia and Malaysia. On this basis, the COTRACO study aims to address the barriers to hypertension treatment in low- and middle-income countries by implementing a similar standardized treatment approach delivered by non-specialist health workers.

Methodology

The COTRACO study is a quasi-experimental, parallel-group, non-randomized, before-and-after study. A community-based model will be implemented in 600 patients in Colombia and the Dominican Republic, involving NPHWs to: 1) apply standardized treatment algorithms, 2) promote adherence to healthy lifestyles, and 3) provide standardized pharmacological treatment. Propensity Score Matching will be used to select 300 patients in Chile and 1200 in Spain for comparison with standard care in these populations.

Expected outcomes

The primary outcome at 12 months of follow-up is the percentage of patients achieving controlled hypertension (defined as systolic BP < 140 mmHg and diastolic BP < 90 mmHg, or < 130 mmHg, and diastolic BP < 80 mmHg for diabetic patients), ensuring it is not inferior to that achieved in the control countries. Secondary outcomes include changes in BP levels, cholesterol levels, BMI, handgrip strength, waist-to-hip ratio, smoking status, Interheart risk score, diet, and physical activity at 6 and 12 months.

Recommendations

If this model demonstrates superior outcomes compared to usual care, it is recommended that health authorities in low- and middle-income regions adopt and implement this approach. Using non-medical health professionals, standardized treatment algorithms and free access to antihypertensive medications, these regions can significantly improve awareness, diagnosis and management of hypertension. This strategy has the potential to reduce cardiovascular morbidity and mortality, thereby improving overall public health outcomes.

Exploring the effects of Tianma Gouteng granules on L-NAME-induced hypertensive rats based on 16S rDNA gene sequencing and metabolomics

Background

A growing number of studies have shown that hypertension symptoms are closely related to intestinal flora. The body's metabolites are closely related to disease states. Tianma Gouteng Granules (TG), a traditional Chinese medicine compound, has been proven to be an effective compound for the treatment of hypertension by traditional Chinese medicine diagnosis, but the target and therapeutic mechanism of TG on hypertension are still unclear.

Aim of the study

We explored the mechanism of action of TG on hypertension by 16S rDNA gene sequencing and non-targeted metabolomics, verified the correlation between hypertension and intestinal flora, searched for potential markers of intestinal flora, and screened for the correlation between different flora and different metabolites, which facilitates a more scientific and reasonable guidance for the administration of TG.

Materials and methods

The hypertensive model rats were induced by L-NAME. After drug administration, 16S rDNA gene sequencing and non-targeted metabolomics were applied to detect and analyze the intestinal flora and fecal metabolites of the rats in each group. The Spearman coefficient method was used to construct the interactions system of different flora and metabolites, which explore the potential mechanism of TG treatment hypertension.

Results

After TG administration, the symptoms of hypertension were significantly reduced to normal in SD rats.16S rDNA gene sequencing and non-targeted metabolomics screened for differential flora p_Actinobacteriota, o_Micrococcaceae, f_ Micrococcales, g_Rothias_Rothia_unclassified, etc. and differential metabolites such as L-Alanine and Hydroxyprolyl-Leucine. TG treatment of hypertension was found to be associated with vitamin B6 metabolic pathway and lipid metabolic pathway.

Conclusions

TG can treat hypertension by affecting differential strains and differential metabolites, providing a scientific basis for guiding the rational use of TG.

Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes

The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk.

Global regional and national burden of intracerebral hemorrhage between 1990 and 2021

Intracerebral hemorrhage (ICH) represents one of the most devastating forms of stroke, characterized by spontaneous bleeding into the brain parenchyma. This neurological emergency carries a substantial burden of mortality and long-term disability worldwide. A comprehensive understanding of ICH's evolving global impact from 1990 to 2021 remains essential for healthcare planning and resource allocation. We conducted a systematic analysis of ICH burden utilizing data from the Global Burden of Disease (GBD) Study 2021. Key epidemiological indicators were extracted, including prevalence, incidence, mortality, and disability-adjusted life-years (DALYs). Temporal trends were quantified through estimated annual percentage changes (EAPCs) in age-standardized rates of prevalence (ASPR), incidence (ASIR), mortality (ASDR), and DALYs across the study period. The association between disease burden and socioeconomic development was examined using the sociodemographic index (SDI) as a metric of societal development. This analytical framework enabled assessment of ICH burden across global, regional, and national scales while accounting for demographic and socioeconomic variations. From 1990 to 2021, while absolute ICH cases increased globally, age-standardized incidence rates declined. Our novel geographic analysis revealed East Asia bearing the highest burden, with Eastern Europe showing the highest age-standardized rates. Gender analysis identified distinct age-specific patterns, with males above 35 showing higher risk, particularly in Eastern Europe, while South Asia demonstrated minimal gender differences. Our innovative analysis during COVID-19 revealed healthcare system strength significantly impacted ICH outcomes, with well-resourced countries maintaining better outcomes. Regional risk factor assessment showed varying impacts of high systolic blood pressure across regions, highest in Southern Sub-Saharan Africa and lowest in Oceania. Future projections through 2030 indicate improving survival rates in most regions, except in low-income areas, highlighting persistent healthcare disparities. While the absolute number of ICH cases, deaths, and DALYs increased globally from 1990 to 2021, age-standardized rates showed a decreasing trend. This suggests improvements in prevention and management strategies over time. However, the burden of ICH remains substantial and unevenly distributed across regions, with lower SDI areas facing a disproportionately higher burden. These findings highlight the need for targeted interventions and resource allocation, particularly in regions with higher ICH burden, to further reduce the global impact of this devastating condition.

Formulation and Evaluation of Polymeric Spherical Agglomerates-Based Porous Orodispersible Tablets of Cilnidipine

Background/Objectives: Cilnidipine (CIL) is a calcium channel blocker that exhibits low bioavailability (~13%) due to poor aqueous solubility and extensive pre-systemic gut wall metabolism. The current study aimed to enhance the oral bioavailability of CIL by formulation of polymeric spherical agglomerates (CILSAs)-based orodispersible tablets (ODTs). Methods: Eight different batches of CILSAs were prepared by a crystallo-co-agglomeration technique using different proportions of hydrophilic polymers like hydroxy propyl methyl cellulose E50, polyvinyl pyrrolidone K30, or polyethylene glycol (PEG) 6000 as carriers. Fourier transform infrared spectroscopy (FTIR) of CILSAs proved the chemical integrity of CIL in SAs, while scanning electron microscopy revealed the spherical shape of CILSAs. Results: Differential scanning calorimetry and powder X-ray diffraction studies confirmed that CIL was rendered more amorphous in CILSAs. CILSAs displayed good flow behavior, high percentage yield, and high drug loads. The batch F4 composed of PEG 6000 emerged as the optimized batch as it displayed high percentage dissolution efficiency (57.01 ± 0.01%), which was significantly greater (p < 0.001) compared to CIL (26.27 ± 0.06%). The optimized formulation of CILSAs was directly compressed into ODTs that were rendered porous by vacuum drying. The optimized formulation of porous ODTs (T3) displayed low friability (0.28 ± 0.03%), short disintegration time (6.26 ± 0.29 s), and quicker dissolution (94.16 ± 1.41% in 60 min) as compared to marketed tablet Cildipin® 10 mg (85 ± 2.3%). Conclusions: Thus, porous ODTs of CILSAs can rapidly release the drug, bypass gut metabolism, enhance oral bioavailability, and improve CIL's therapeutic effectiveness for angina and hypertension.

The association between age at menarche (AAM) and cardiovascular disease (CVD) risk factors in the MASHAD cohort study

Age at menarche may be associated with cardiovascular disease risk factors in different ethnic groups. The purpose of this study was to identify the association of cardiovascular disease (CVD) risk factors with age at menarche (AAM) in Mashhad, the second biggest city in Iran. This was a cross- sectional study based on cohort data of 2353 women (35-65 years) from Mashhad, Iran for whom the age at menarche was reported. Baseline demographic, anthropometric data, and biochemical profiles were also collected. The levels of depression and anxiety were evaluated using a validated Persian version of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Multiple logistic regression models were used to examine the association between age at menarche with CVD risk factors. Anthropometric parameters, short stature, prevalence of diabetes, and CVD risk were significantly higher in women who were younger at menarche (AAM) in comparison to women with an older AAM. Women with a menstruating age of 11 years had a significantly higher weight (P < 0.001), higher BMI (P < 0.001), lower waist circumference (WC) (P = 0.004), higher hip circumference (HC) (P < 0.001) and higher waist-to-thigh ratio (WTR) (P < 0.001) than women with an AAM of ≥ 15 years. University-educated women and employed women were most likely to have menarche at ≥ 15 years (P < 0.001 and P = 0.012 respectively. In girls who menstruated at age ≤ 11 years old, the odds of having a BMI > 28.7 kg/m2, WC > 96 cm, HC > 105 cm and WTR > 61.96 were higher than girls who menstruated at 13 years old. The odds of height > 155 cm was higher in girls with menarche age of ≥ 15 than 13 years and the odds of having depression scores greater than 12 was lower in menarche age group of ≥ 15 years. The girls with menstruation age of 12 years had higher odds of having diabetes mellitus and HC > 105 cm than girls with menstruation age of 13 years. The odds of demi span exceeded 74 cm and height > 155 cm were higher in girls with menarche age of 14 than 13 years. AAM may be a useful factor to identify women at greater risk of CVD to implement appropriate preventive measures.

A comprehensive review on selenium and blood pressure: Recent advances and research perspectives

BACKGROUND

Globally, approximately 31.1 % of adults are affected by hypertension(HTN), and there is currently no effective treatment for this condition. Selenium (Se), an essential trace element in the human body, has been shown to play a role in various biological processes, including anti-inflammation, antioxidative stress, anti-ferroptosis, and regulation of immune response. Research suggests that Se may have potential hypotensive effects.

OBJECTIVE

This review aims to comprehensively investigate the relationship between Se and blood pressure(BP), elucidate the mechanisms through which Se influences BP, and explore its prospective applications in clinical practice.

METHODS

We conducted a systematic search on PubMed for a thorough review of articles concerning the relationship between Se and BP, as well as the mechanisms by which Se may lower BP.

RESULTS AND CONCLUSIONS

Although some findings indicate that Se might increase BP, its anti-inflammatory, anti-oxidant, anti-vascular remodeling, anti-atherosclerotic, anti-ferroptosis, and regulation of immune response effects suggest that maintaining an appropriate level of Se may contribute to BP reduction and possibly lower the risk of pregnancy-induced hypertension(PIH). While Se shows promise in the management of HTN, further exploration is necessary for its development. Future studies should clarify the mechanisms involved and identify relevant targets through clinical research, which may provide adjunctive therapies for HTN.

Age group classification based on optical measurement of brain pulsation using machine learning

Optical techniques, such as functional near-infrared spectroscopy (fNIRS), contain high potential for the development of non-invasive wearable systems for evaluating cerebral vascular condition in aging, due to their portability and ability to monitor real-time changes in cerebral hemodynamics. In this study, thirty-six healthy adults were measured by single channel fNIRS to explore differences between two age groups using machine learning (ML). The subjects, measured during functional magnetic resonance imaging (fMRI) at Oulu University Hospital, were divided into young (age ≤ 32) and elderly (age ≥ 57) groups. Brain pulses were extracted from fNIRS using a single 830 nm wavelength. Four feature sets were derived from log-normal parameters estimated by pulse decomposition algorithm. ML experiments utilized support vector machines and random forest learners, along with maximum relevance minimum redundancy and principal component analysis for feature selection. Performance with increasing sample size was estimated using learning curve method. The best mean balanced accuracies for each feature set were over 75% (75.9%, 76.4%, 79.3%, 76.9%), indicating the pulse features containing age related information. Learning curves indicated stable classification performance with increasing sample size. The results demonstrate the potential of using single channel fNIRS in the analysis of aging.

Impact of triglyceride-glucose index on risk of cardiovascular disease among non-diabetic hypertension patients: a 10-year prospective cohort study

BACKGROUND

Triglyceride-glucose (TyG) index was regarded as a cost-efficient and reliable clinical surrogate marker for insulin resistance (IR), which was significantly correlated with cardiovascular disease (CVD). However, the TyG index and incident CVD in non-diabetic hypertension patients remains uncertain. The aim of study was to explore the impact of TyG index level and variability on risk of CVD among non-diabetic hypertension patients.

METHODS

A total of 9313 hypertensive patients without diabetes aged 30-70 years in Jiangsu Province who participated in the baseline survey from January 2010 to December 2010 and were followed up to May 2020 were included in this study. The TyG index was calculated as ln [fasting triglyceride (TG) (mg/dl) × fasting plasma glucose (FPG) (mg/dl)/2] and variation degree was calculated as the TyG index at first year follow-up (2011) minus that at baseline (2010). Cox proportional analysis regression and restricted cubic spline were used to investigate the association between TyG index level as well as variability and CVD risk.

RESULTS

Of 9313 included participants, 5423(58.23%) were female. During a mean follow-up of 8.32 ± 1.43 years, 890(9.56%) CVD events was identified. Cox regression analysis showed that with the highest TyG index in Q4 group at baseline, the incidence of CVD risk increased by 33.6% after adjustment for multiple confounders compared to Q1 group. Compared with TyG index variation degree 0 ~ < 1, the hazard ratios (HR) and 95% confidence interval (CI) respectively in < 0, 1 ~ < 2 and 2 ~ were 0.326(0.276, 0.384), 3.216(2.697,3.835) and 4.225(3.359,5.314). The restricted cubic spline indicated that there was a non-linear dose-response relationship between the change degree of TyG and risk of CVD. Similar results were obtained by subgroup analysis and sensitivity analysis.

CONCLUSION

Elevated TyG index may be used as a surrogate for IR and help optimize risk stratification of CVD as well as prevention and management.

Prevalence, aetiology, and service mapping of dementia in rural Uganda. Part of DEPEND Uganda (Dementia Epidemiology, unmet Need and co-Developing Solutions in Uganda)

Background

Dementia prevalence in low- and middle-income countries is increasing, yet epidemiological data from African populations remain scarce. Crucial risk factors differ in Africa from more intensively studied global areas, including a higher burden of cerebrovascular disease and HIV, but lower rates of other risk factors like physical inactivity.Understanding dementia aetiology in African settings has been limited by the expensive and invasive nature of biomarker testing. This study leverages developments in blood-based and retinal imaging biomarker technology to examine the drivers of dementia in older Ugandans.People with dementia have complex needs benefiting from multi-dimensional support. Understanding current services will allow identification of barriers and opportunities to strengthen support available to people with dementia and their families.

Methods

The study is nested within the General Population Cohort run by the Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Research Unit. All adults aged 60+ (around 1400) are undergoing brief cognitive screening.In Part 1, cohort participants are selected based on screening scores to undergo detailed cognitive assessment, using methods developed by the 10/66 Dementia Research Group. Part 2 is a case control study of people with and without dementia using antecedent data, questionnaires, physical assessment, retinal imaging, and Alzheimer's blood-based biomarkers. We will also compare disability, frailty, quality of life, and social engagement in people with and without dementia.Part 3 assesses current formal support structures for people with dementia through review of publicly available literature and expert interviews.

Conclusions

This is the first study in Africa using blood-based and retinal imaging biomarkers to examine pathological processes underlying dementia, and systematically map services available for people with dementia. This paves the way for effective policy strategies and further focused research regarding both dementia prevention and support for affected people and their families.

Key Updates to the 2024 ESC Hypertension Guidelines and Future Perspectives

Hypertension remains a critical global health challenge, significantly contributing to cardiovascular morbidity and mortality despite advancements in treatment. The 2024 ESC hypertension guidelines address persistent gaps in hypertension management by emphasizing comprehensive strategies encompassing early detection, socioeconomic barriers, lifestyle interventions, and personalized care. Enhanced screening protocols, including home and ambulatory blood pressure monitoring, aim for accurate diagnosis and risk stratification. Lifestyle recommendations now prioritize reducing sodium intake, increasing potassium consumption, and integrating tailored exercise regimens. Pharmacological updates advocate for single-pill combinations and stringent BP targets (<130/80 mmHg), emphasizing the benefits of sodium-glucose cotransporter-2 inhibitors for specific comorbidities. Minimally invasive therapies like renal denervation are explored for resistant hypertension, while digital tools such as telehealth and mobile applications enhance patient engagement and adherence. This multifaceted, patient-centered approach provides a roadmap for optimizing BP control, reducing cardiovascular risks, and addressing the complexities of hypertension in diverse populations.

Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023

Background

Research on Minorities' Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns of education among minoritized groups. However, few studies have tested the relevance of MDRs in American Indian and Alaska Native (AIAN) populations compared to non-Hispanic White adults.

Objectives

This study aimed to examine the strength of the inverse association between educational attainment and hypertension prevalence, hypothesizing that the protective effect of education on hypertension risk is reduced among AIAN adults relative to non-Hispanic Whites.

Methods

Using data from the 2023 National Health Interview Survey (NHIS), we analyzed a nationally representative sample of adults aged 18 and older. Logistic regression models examined the association between educational attainment and self-reported hypertension diagnosis, stratified by racial/ethnic group (AIAN vs. non-Hispanic White). Models were adjusted for key covariates, including age, gender, income, and insurance status.

Results

Higher educational attainment was associated with a lower prevalence of hypertension in the combined sample of AIAN and non-Hispanic White adults. However, this protective association was significantly weaker among AIAN adults compared to non-Hispanic White adults, as evidenced by a significant interaction between race and education.

Conclusion

AIAN adults exhibit a higher prevalence of hypertension even at higher levels of educational attainment compared to non-Hispanic White adults, supporting the relevance of MDRs for AIAN populations. This finding underscores the need for public health interventions that address structural barriers and contextual factors unique to AIAN populations. Policies focused solely on educational access may be insufficient to reduce hypertension risk among AIAN adults without addressing broader social and structural inequities.

Causal Inference for Hypertension Prediction With Wearable E lectrocardiogram and P hotoplethysmogram Signals: Feasibility Study

Background

Hypertension is a leading cause of cardiovascular disease and premature death worldwide, and it puts a heavy burden on the healthcare system. Therefore, it is very important to detect and evaluate hypertension and related cardiovascular events to enable early prevention, detection, and management. Hypertension can be detected in a timely manner with cardiac signals, such as through an electrocardiogram (ECG) and photoplethysmogram (PPG) , which can be observed via wearable sensors. Most previous studies predicted hypertension from ECG and PPG signals with extracted features that are correlated with hypertension. However, correlation is sometimes unreliable and may be affected by confounding factors .

Objective

The aim of this study was to investigate the feasibility of predicting the risk of hypertension by exploring features that are causally related to hypertension via causal inference methods. Additionally, we paid special attention to and verified the reliability and effectiveness of causality compared to correlation.

Methods

We used a large public dataset from the Aurora Project , which was conducted by Microsoft Research. The dataset included diverse individuals who were balanced in terms of gender, age, and the condition of hypertension, with their ECG and PPG signals simultaneously acquired with wrist -worn wearable devices. We first extracted 205 features from the ECG and PPG signals, calculated 6 statistical metrics for these 205 features, and selected some valuable features out of the 205 features under each statistical metric. Then, 6 causal graphs of the selected features for each kind of statistical metric and hypertension were constructed with the equivalent greedy search algorithm. We further fused the 6 causal graphs into 1 causal graph and identified features that were causally related to hypertension from the causal graph . Finally, we used these features to detect hypertension via machine learning algorithms.

Results

We validated the proposed method on 405 subjects. We identified 24 causal features that were associated with hypertension. The causal features could detect hypertension with an accuracy of 89%, precision of 92 % , and recall of 82%, which outperformed detection with correlation features (accuracy of 85%, precision of 88 % , and recall of 77%).

Conclusions

The results indicated that the causal inference -based approach can potentially clarify the mechanism of hypertension detection with noninvasive signals and effectively detect hypertension. It also reveal ed that causality can be more reliable and effective than correlation for hypertension detection and other application scenarios.

Socioeconomic inequality in hypertension and its determinants in people over 60 years in Fasa, southern Iran: a Blinder-Oaxaca decomposition

BACKGROUND

Hypertension (HTN) is well-known as a major risk factor for various noncommunicable diseases. Evidence indicates a link between socioeconomic status and the likelihood of developing HTN. A thorough comprehension of the inequalities in HTN is crucial for implementing evidence-based interventions. This study aimed to assess the socioeconomic disparities in HTN among people aged 60 and older in Fasa County, located in southern Iran.

METHODS

A total of 1,632 seniors, aged 60 and above, were included in the analysis, with data obtained from the Fasa Adults Cohort Study (FACS). Initially, we utilized both simple and multiple logistic regression models to investigate the associations between HTN and the determinant variables. The Blinder‒Oaxaca decomposition method was used to decompose the disparity between the impoverished and the wealthy.

RESULTS

The research indicated that elderly individuals with a higher risk of developing HTN were notably linked to factors such as socioeconomic status, education level, a history of coronary artery disease, employment status, smoking habits, body mass index (BMI), waist‒hip ratio (WHR), and physical activity (p < 0.05). The decomposition model revealed a significant gap in HTN rate between rich and poor individuals, with those in the lower income bracket having a 7.59% higher rate of HTN (p = 0.001). Additionally, the leading factors contributing to the greatest disparities in HTN among older adults from different socioeconomic backgrounds include education level (33.07%), employment status (12.78%), BMI (12.25%), physical activity (-15.02%), and WHR (-9.22%).

CONCLUSIONS

The decomposition model illustrated a significant disparity in HTN rates among various socioeconomic groups, with a higher rate observed in the lower-income demographic. The analysis revealed that a substantial part of the explained gap can be attributed to factors including education level, employment status, WHR, BMI, and level of physical activity. Nonetheless, a considerable portion of HTN inequality among older adults remains unexplained by the model, highlighting the necessity for additional research that includes a wider variety of factors and variables to gain a deeper insight into the root causes of these disparities.

Nature and prevalence of long-term conditions in people with intellectual disability: retrospective longitudinal population-based study

OBJECTIVE

Explore the nature and prevalence of long-term conditions in individuals with intellectual disability.

DESIGN

Retrospective longitudinal population-based study.

SETTING

Primary and secondary care data across the population of Wales with the Secure Anonymised Information Linkage (SAIL) Databank.

PARTICIPANTS

14 323 individuals were identified during the study date period 1 January 2000 to 31 December 2021 using the following inclusion criteria: 18 or older, alive at the cohort start date, a resident of Wales, with a primary care registration at a SAIL providing general practice with available records and a recorded diagnosis of intellectual disability. Once individuals were identified, health records were observed from birth.

RESULTS

13 069 individuals had a recorded diagnosis of intellectual disability and at least one long-term condition, reflecting 91.25% of the population. Demographic data from the SAIL dataset reveal that the study population is predominantly White, with low levels of representation of non-White ethnic groups. In the cohort, a larger proportion of patients live in the most deprived areas of Wales (22.30%), with fewer individuals in less deprived categories. Mental illness was identified as the most prevalent of the identified long-term conditions, whereby 30.91% of the population had a recorded diagnosis of a mental illness which was chronic. For many common conditions, including epilepsy, thyroid disorders, upper gastrointestinal disorders, chronic kidney disease and diabetes, there was an overall trend of higher prevalence rates in the intellectual disability cohort when compared with the general population. The prevalence of hypertension was lower in individuals with intellectual disability. Chronic constipation, chronic diarrhoea and insomnia were examples of long-term conditions added as relevant to individuals with intellectual disability. Notable differences in the distribution of long-term conditions were observed when comparing across sex and age groups. The number of long-term conditions increases with age. Conditions which may usually be expected to emerge later in life are present in younger age groups, such as diabetes, hypertension and chronic arthritis. When hospital episodes were analysed, epilepsy, diabetes, chronic airway disease and mental illness were commonly treated conditions during hospital admission across both sexes. Conditions which were less prevalent in the intellectual disability cohort, but which were treated during ≥6% of total hospital admissions include cancer, cardiac arrhythmias and cerebral palsy.

CONCLUSIONS

This study establishes a range of 40 relevant long-term conditions for people with intellectual disability through an iterative process, which included a review of the available literature and a series of discussions with a Professional Advisory Panel and Patient and Public Involvement groups of this research project. The findings of the study reinforce the high prevalence and early emergence of long-term conditions in the intellectual disability cohort. It also demonstrates the difference in the range of conditions when compared with the general population. There were differences in long-term conditions when separated by sex and age. Long-term conditions which commonly require treatment in hospitals were also revealed. Further work is required to translate the findings of this study into actionable insights. Clusters of multiple long-term conditions, trajectories, outcomes and risk factors should be explored to optimise the understanding and longitudinal care of individuals with intellectual disabilities and long-term conditions.

Medication adherence and blood pressure control in treated hypertensive patients: first follow-up findings from the PREDIcT-HTN study in Northern Bangladesh

INTRODUCTION

Adherence to antihypertensive medication is crucial to control blood pressure (BP) and hypertension management outcomes. In Bangladesh, as in many other countries, poor adherence to medication represents a challenge to effective hypertension management. This study aims to investigate the prevalence and relationship between medication adherence and BP management among hypertensive patients in Bangladesh.

METHODS

The PREDIcT-HTN study in Northern Bangladesh aims to evaluate major adverse clinical events in treated hypertensive patients. The study involves 2643 hypertensive patients from a medical center, with data collected through baseline information and yearly follow-ups until 2025. The first follow-up visit was conducted between January and March 2021. Following the 2020 ISH-global hypertension guideline, patients were classified as having controlled BP, grade-I, or grade-II uncontrolled BP. Patients were divided into three groups (good, moderate, and poor) based on their 9-item Hill-Bone medication adherence scale. A multinomial regression analysis was conducted to identify the association between medication adherence and BP control after adjusting potential confounders.

RESULTS

Analysis of 2276 hypertensive patients (mean age 51.31 ± 11.58 years) revealed that 36.1% had grade-I and 24.2% had grade-II uncontrolled hypertension. Most patients (78%) displayed moderate adherence, and 15% showed poor medication adherence. Certain patient subgroups had higher rates of poor adherence: females (17.1%) compared to males (12.2%), rural residents (22.4%) compared to city-dwellers (12.2%), and newly diagnosed patients (17.2%) compared to those diagnosed 2-5 years earlier (12.6%). Multivariable analysis found a strong association between medication adherence and BP control. Compared to poor adherence, moderate adherence (relative risk ratio (RRR):0.50, 95%CI:0.36-0.68) and good adherence (RRR:0.56, 95%CI:0.35-0.91) were associated with better control. Increasing age, rural living, and uncontrolled hypertension were also linked. Comorbidities worsened BP control, and managing multiple medications contributed to poor adherence and grade-II hypertension in patients.

CONCLUSION

The high prevalence of uncontrolled hypertension in Bangladesh underscores the need for improved treatment strategies. Addressing medication adherence is essential for better BP control, with particular attention needed for women, rural residents, and newly diagnosed individuals. A comprehensive approach is warranted, including strategies to enhance adherence, early diagnosis, personalized treatment, and simplified medication regimens. These efforts align with the UN's 2030 SDGs, emphasizing targeted interventions for equitable healthcare access and outcomes.

Spirituality-Based Intervention in Hypertension: EFfects on Blood PrEssure and EndotheliaL Function-FEEL Trial Results

Background

Emerging evidence suggests that spirituality improves patient outcomes, however, this has undergone only limited evaluation in randomized trials. Hypertension is a major cause of cardiovascular morbidity and mortality worldwide.

Objectives

To evaluate whether a spirituality-based intervention, compared to a control group, can reduce blood pressure (BP) and improve endothelial function after 12 weeks in patients with mild or moderate hypertension (HTN).

Methods

Open randomized controlled trial of adults with stage I or II hypertension. Following baseline evaluation, including lifestyle questionnaires, and measurements of office and central blood pressure (BP), home blood pressure monitoring (HBPM) and flow mediated dilation (FMD), patients were randomized to a spirituality-based intervention, which included training for forgiveness, gratitude, optimism, and life purpose delivered by daily WhatsApp communications, or to the control group (CG). Main outcomes were between group difference in change from baseline to 12 weeks in office and central BP, HBPM and FMD, using t-tests, analyses of covariance (ANCOVA) adjusting for baseline differences, and, in addition, missing data imputation as a sensitivity analysis.

Results

Fifty-one patients were randomized to spirituality-based intervention and 49 to control group. Baseline characteristics were well balanced between groups. Spirituality training, compared with control, improved 7.6 mmHg office systolic blood pressure (SBP), 4.1 mmHg central SBP and 4.1 percentage points FMD. Compared to control group, t-test demonstrated statistical significance for office SBP (-7.04 mmHg, p = 0.047) and FMD (7.46 percentage points, p < 0.001), and ANCOVA adjustment for baseline differences showed statistical significance for central SBP (-6.99 mmHg, p = 0.038) and FFMD (7.95 percentage points, p < 0.001) There was no significant effect on HBPM.

Conclusion

A spirituality-based intervention was associated with improved control of office SBP and FMD. These findings will be prospectively evaluated in a nationwide larger and well-powered RCT.

Machine learning analysis of emerging risk factors for early-onset hypertension in the Tlalpan 2020 cohort

Introduction

Hypertension is a significant public health concern. Several relevant risk factors have been identified. However, since it is a complex condition with broad variability and strong dependence on environmental and lifestyle factors, current risk factors only account for a fraction of the observed prevalence. This study aims to investigate the emerging early-onset hypertension risk factors using a data-driven approach by implementing machine learning models within a well-established cohort in Mexico City, comprising initially 2,500 healthy adults aged 18 to 50 years.

Methods

Hypertensive individuals were newly diagnosed during 6,000 person-years, and normotensive individuals were those who, during the same time, remained without exceeding 140 mm Hg in systolic blood pressure and/or diastolic blood pressure of 90 mm Hg. Data on sociodemographic, lifestyle, anthropometric, clinical, and biochemical variables were collected through standardized questionnaires as well as clinical and laboratory assessments. Extreme Gradient Boosting (XGBoost), Logistic Regression (LG) and Support Vector Machines (SVM) were employed to evaluate the relationship between these factors and hypertension risk.

Results

The Random Forest (RF) Importance Percent was calculated to assess the structural relevance of each variable in the model, while Shapley Additive Explanations (SHAP) analysis quantified both the average impact and direction of each feature on individual predictions. Additionally, odds ratios were calculated to express the size and direction of influence for each variable, and a sex-stratified analysis was conducted to identify any gender-specific risk factors.

Discussion

This nested study provides evidence that sleep disorders, a sedentary lifestyle, consumption of high-fat foods, and energy drinks are potentially modifiable risk factors for hypertension in a Mexico City cohort of young and relatively healthy adults. These findings underscore the importance of addressing these factors in hypertension prevention and management strategies.

Additive interaction of conjoint tobacco smoking and heavy drinking on hypertension prevalence in rural Uganda: a community-based cross-sectional study

BACKGROUND

The prevalence of hypertension is high in Uganda, which places a significant burden on an already strained healthcare system. The behavioural risk factors, such as unhealthy diet, tobacco use, physical inactivity, and heavy drinking, contribute to hypertension development and complications. This study explored the associations of combined tobacco smoking and heavy alcohol consumption with existing hypertension in a community-based cross-sectional study conducted in two rural districts of Uganda.

METHODS

We analysed data collected between December 2018 and January 2019 from 4,372 adults aged 25-70 from 3,689 random households in the Mukono and Buikwe districts, Uganda. Using logistic regression, crude, and adjusted odds ratios were calculated to describe the associations between participant characteristics, smoking, drinking behaviours, and high blood pressure (HBP). To determine effect modification due to combined tobacco smoking and heavy drinking, the relative excess risk due to interaction (RERI) was computed. All analyses were performed via R programming software version 4.2.3.

RESULTS

HBP was prevalent in 23% of the participants. Smokers were 1.36 times more likely to have HBP than non-smokers (Crude OR, 1.36; 95% CI, 1.04-1.76). Compared with non-drinkers, moderate alcohol drinkers were 1.45 times more likely to have HBP (AOR, 1.45; 95% CI, 1.18-1.79), and heavy drinkers were 2.53 times more likely to have HBP (AOR, 2.53; 95% CI, 1.92-3.32). The RERI indicated an additive interaction effect between smoking and heavy drinking, with conjoint smokers and heavy drinkers having 45% higher odds of having HBP than the summation of the individual risk due to smoking and heavy drinking.

CONCLUSION

Tobacco smoke interacts with heavy alcohol consumption to increase the risk of increased blood pressure (BP) when it cooccurs. Integrated intervention strategies targeting both smoking and heavy drinking are essential for reducing the incidence of hypertension in rural Uganda.

Dietary flaxseed: Cardiometabolic benefits and its role in promoting healthy aging

Flaxseed, a rich source of omega-3 polyunsaturated fatty acid alpha-linolenic acid (ALA), lignans, and soluble fiber, has attracted attention for its potential to improve multiple cardiometabolic risk factors. While its benefits are well-recognized, comprehensive evaluations of its direct impact on clinical outcomes, such as the prevention or progression of cardiometabolic diseases, remain limited. Additionally, its potential to support healthy aging and longevity through fundamental biological mechanisms has not been fully elucidated. This review synthesizes existing research on flaxseed supplementation, highlighting its effects on cardiometabolic risk factors and outcomes, the underlying biological mechanisms, and its broader implications for health promotion and aging. Findings demonstrate that flaxseed supplementation significantly improves several cardiometabolic risk factors, including body weight, body mass index, lipid levels, blood pressure, glycemic measures, markers of inflammation (e.g., C-reactive protein and interleukin-6), oxidative stress, and liver enzymes. Blood pressure reductions range from approximately 2 to 15 mmHg for systolic blood pressure and 1 to 7 mmHg for diastolic blood pressure, with the magnitude influenced by dose, duration, and baseline risk profiles. While direct evidence linking flaxseed to the prevention of hypertension, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, type 2 diabetes, chronic kidney disease, and cardiovascular disease is limited, its bioactive components-ALA, lignans, and fiber-are strongly associated with reduced risks of these conditions. The benefits of flaxseed are mediated through multiple pathways, including anti-inflammatory and antioxidant effects, improved lipid levels, improved glucose metabolism and insulin sensitivity, modulation of gut microbiota, and enhanced vascular health. Beyond cardiometabolic outcomes, flaxseed may influence key biological processes relevant to aging, underscoring its potential to promote healthy aging and longevity. Optimal cardiometabolic benefits appear to be achieved with ground whole flaxseed at doses of ≥ 30 g/day for at least 12 weeks, particularly among individuals at high cardiometabolic risk. Future research should focus on elucidating flaxseed's mechanisms of action, clarifying its role in disease prevention, and refining dietary recommendations to harness its potential for cardiometabolic health and aging interventions.

Blood Pressure Management Strategies and Podocyte Health

Hypertension (HTN) is one of the key global cardiovascular risk factors, which is tightly linked to kidney health and disease development. Podocytes, glomerular epithelial cells that play a pivotal role in maintenance of the renal filtration barrier, are significantly affected by increased glomerular capillary pressure in HTN. Damage or loss of these cells causes proteinuria, which marks the initiation of the HTN-driven renal damage. It goes without saying that effective blood pressure (BP) management should not only mitigate cardiovascular risks but also preserve renal function by protecting podocyte integrity. This review offers a comprehensive examination of current BP management strategies and their implications for podocyte structure and function and emphasizes strategies for the reduction of proteinuria in HTN. We explore primary and secondary antihypertensive agents, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and diuretics, as well as newer therapies (sodium-glucose cotransporter-2 blocking and endothelin receptor antagonism), emphasizing their mechanistic roles in safeguarding podocytes and curtailing proteinuria.

The Effect of the Concurrent Use of Angiotensin-Converting Enzyme Inhibitors or Receptor Blockers on Toxicity and Outcomes in Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis

Background/Objectives: ACEIs protect against radiation pneumonitis by reducing angiotensin II production, oxidative stress, and inflammation. This study highlights the significance of concurrent angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) use in radiotherapy by evaluating its impact on radiotherapy-related side effects and survival outcomes, addressing the gap in existing research and providing insights to guide clinical practice in oncology. Methods: The literature was retrieved from the MEDLINE, EMBASE, Web of Science, and Scopus databases from January 2000 to October 2024. Studies on adults (≥18 years) with histologically confirmed cancer, receiving ACEIs or ARBs during radiotherapy, were included. Radiotherapy-related side effects and clinical outcomes were analysed using odds ratios (ORs) and 95% confidence intervals (95%CIs), comparing ACEI/ARB users to non-users. Differences in the median survival time, recurrence, and death rates were also calculated. Results: Sixteen studies (14 cohort studies and two randomised trials) were included. ACEI users exhibited a 50% reduction in the risk of ≥grade 2 radiation pneumonitis (OR: 0.50, 95%CI: 0.32-0.77) in lung cancer and significant reductions in the odds of proctitis (80%, OR: 0.20, 95%CI: 0.12-0.33), haematuria (75%, OR: 0.25, 95%CI: 0.16-0.41), and rectal bleeding (61%, OR: 0.39, 95%CI: 0.30-0.51) in prostate cancer. ACEI/ARB users showed reduced symptomatic radiation necrosis in brain metastases and better 6-month functional independence in supratentorial glioblastoma. Among six studies reporting survival, ACEI/ARB users had longer median survival in early-stage non-small-cell lung cancer and glioblastoma but shorter survival in small cell lung cancer and brain metastases. ARB users had inconsistent survival rates for lung cancer. The varying survival outcomes suggest that ACEIs/ARBs have different effects depending on the cancer type and stage, potentially influenced by cancer-specific factors, treatment protocols, or disease progression. Conclusions: ACEI use is associated with a reduction in radiation pneumonitis, but evidence for other radiotherapy-related toxicity and survival outcomes remains inconsistent across cancer types and severities. Further research should carefully control for confounders.

Interindividual Variability Response to Resistance and High-Intensity Interval Training on Blood Pressure Reduction in Hypertensive Older Adults

BACKGROUND

This study evaluated the effects of resistance training (RT) and high-intensity interval training (HIIT) on systolic (SBP) and diastolic blood pressure (DBP) in hypertensive older adults undergoing pharmacological therapy over four and eight weeks. We compared the efficacy of RT and HIIT in reducing non-responders (NRs) between weeks 4 and 8 and analyzed time-course adaptations in NRs and responders (Rs).

METHODS

Thirty-nine participants were randomized into RT-G (n = 13), HIIT-G (n = 13), or control (CG, n = 13) groups. RT utilized elastic bands, and HIIT involved cycle ergometers, with three weekly 30 min sessions for 8 weeks. SBP and DBP were measured before intervention and at weeks 4 and 8, respectively. Individual responses were classified as NRs or Rs using the Hopkins method (SDIR = √[SDExp2-SDCon2]). Time-course adaptations were evaluated.

RESULTS

Both the RT-G and HIIT-G reduced SBP at 8 weeks (RT-G: -13 mmHg; [ES: 1.12]; HIIT-G: -12 mmHg [ES: 0.8]; both p < 0.05). The proportion of NRs for SBP decreased from 46% to 38% in RT-G and 69% to 46% in HIIT-G. Rs showed a peak SBP reduction at 4 weeks (-14.7 and -25.5 mmHg), stabilizing by week 8 (-22.8 and -19.6 mmHg) in RT-G and HIIT-G, respectively.

CONCLUSION

Eight weeks of RT and HIIT effectively reduced SBP and NR prevalence, with time-course adaptations favoring Rs.

Inflammation mediates the adverse effects of urinary phthalate exposure on metabolic disease risk: Results from NHANES 2005-2016

BACKGROUND

Phthalates are a category of chemicals commonly utilized in various industrial applications and everyday products. Their associations with health issues remains a significant concern. Although some studies have suggested associations between phthalates and metabolic diseases, the current understanding of the associations is still limited, especially the lack of effects of mixed exposure.

METHODS

This cross-sectional study included information from 9217 participants in National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. Multivariate logistic regression was used to explore the associations between single phthalate exposure and obesity and its complications. Weighted quantile sum (WQS) regression and Quantile G-Computation (Qgcomp) models were used to further analyze the associations between mixed phthalate exposure and obesity and its complications. Mediated analysis was used to explore the mediating role of immune cells in the relationship between phthalate exposure and obesity and its complications.

RESULTS

MiBP, MCOP and MBzP were associated with an increased risk of obesity. MiBP and MCOP were associated with an increased risk of abdominal obesity. MCNP, MCOP, MEHHP, MEOHP and MECPP were positively associated with T2DM. Mixed phthalate exposure was positively associated with obesity and T2DM. Monocytes mediated the effects of MiBP, MEHP and MBzP on obesity, explaining 7.94 %, -2.32 % and 6.69% of the total effect, respectively.

CONCLUSIONS

This study revealed a significant association between mixed phthalate exposure and obesity and its complications, underlining the importance of considering the interactions of these compounds. The synergistic effects of multiple phthalates may exacerbate health risks.

Deep Learning-Driven Optimization of Antihypertensive Properties from Whey Protein Hydrolysates: A Multienzyme Approach

This study utilized deep learning to optimize antihypertensive peptides from whey protein hydrolysate. Using the Large Language Models (LLMs), we identified an optimal multienzyme combination (MC5) with an ACE inhibition rate of 89.08% at a concentration of 1 mg/mL, significantly higher than single-enzyme hydrolysis. MC5 (1 mg/mL) exhibited excellent biological stability, with the ACE inhibition decreasing by only 6.87% after simulated digestion. In in vivo experiments, MC5 reduced the systolic and diastolic blood pressure of hypertensive rats to 125.00 and 89.00 mmHg, respectively. MC5 significantly lowered inflammatory markers (TNF-α and IL-6) and increased antioxidant enzyme activity (SOD, GSH-Px, GR, and CAT). Compared to the MC group, the MC5 group showed significantly reduced serum renin and ET-1 levels by 1.25-fold and 1.04-fold, respectively, while serum NO content increased by 3.15-fold. Furthermore, molecular docking revealed four potent peptides (LPEW, LKPTPEGDL, LNYW, and LLL) with high ACE binding affinity. This approach demonstrated the potential of combining computational methods with traditional hydrolysis processes to develop effective dietary interventions for hypertension.

Self-Care Behavior Based on Knowledge of Patients with Hypertension: A Cross-Sectional Study

Background

Adequate self-care behavior is an important factor in controlling hypertension to reduce the number of complications. A patient's knowledge about hypertension can influence their self-care behavior in practice.

Purpose

The aim of this study was to identify self-care behaviors among hypertension patients based on their knowledge.

Patients and Methods

This descriptive correlational study was conducted on patients with hypertension in primary care. The sample was selected using purposive sampling, with a one-month data collection period yielding 115 samples. The Hypertension Self-Care Profile instrument was used to assess self-care behavior while the Knowledge on Hypertension instrument was utilized to evaluate knowledge. The characteristics variable was analyzed using descriptive statistics, while the correlation between self-care behavior and knowledge was evaluated using spearman rank correlation.

Results

Most participants had favorable attitudes towards self-care (53%), and they had adequate knowledge about hypertension (53.9%). Patients with favorable behavior and adequate knowledge were 52.5%, while patients with unfavorable behavior and inadequate knowledge were 63.0%. This study found no significant association between self-care behavior and knowledge (p = 0.099, r = 0.155).

Conclusion

Despite most participants demonstrated favorable attitudes and adequate knowledge regarding hypertension self-care, a significant association between these variables was not identified. This suggests that knowledge alone may not be a sufficient predictor of self-care behavior in this population and further research is required to understand the complex factors influencing self-care adherence and develop effective interventions to improve patient outcomes.

Small Interfering RNA Therapy for the Management and Prevention of Hypertension

PURPOSE OF REVIEW

To review currently existing knowledge on a new type of antihypertensive treatment, small interfering RNA (siRNA) targeting hepatic angiotensinogen.

RECENT FINDINGS

Targeting angiotensinogen synthesis in the liver with siRNA allows reaching a suppression of renin-angiotensin system (RAS) activity for up to 6 months after 1 injection. This might revolutionize antihypertensive treatment, as it could overcome non-adherence, the major reason for inadequate blood pressure control. Animal data support that its effects on blood pressure and end-organ damage are fully comparable to those of classical RAS blockers, and phase I and II clinical trials confirm its antihypertensive effectiveness and long-term action. Although its side effect profile is placebo-like, its long-term effects also pose a threat in patients who require immediate restoration of RAS activity, like in shock. Here tools are being developed, called REVERSIR, that allow immediate annihilation of the siRNA effect in the liver. One subcutaneous injection of angiotensinogen siRNA lowers blood pressure for 6 months without severe side effects. The decrease in angiotensinogen and blood pressure can be reversed with a drug called REVERSIR if needed.

Evaluation of hypertension knowledge and its association with medication adherence among hypertensive patients attending primary health centers: a cross-sectional study from eastern Saudi Arabia

Background and aim

The global healthcare system acknowledged the crucial role of disease knowledge in health outcomes and improving quality of life among patients with chronic disease. A lack of adequate knowledge and understanding of hypertension, its symptoms, and available treatments can lead to poor treatment outcomes. The present study aimed to determine the level of hypertension knowledge and associated factors among hypertensive patients. Furthermore, we evaluated the correlation between levels of knowledge and medication adherence among them.

Methods

The present study was carried out among 406 hypertensive patients attending different primary health centers in Hafr Al Batin, Saudi Arabia. Participants' hypertension-related knowledge was evaluated using the validated hypertension knowledge-level scale, and adherence practice was evaluated using the medication adherence and refill scale. We categorized the knowledge score into low, medium, and high, according to Bloom's criteria. We applied Spearman's correlation test to find the strength and direction of the correlation between hypertension-related knowledge and medication adherence. Furthermore, we used binomial logistic regression analysis to find the associated factors of the low hypertension-related knowledge among the patients.

Results

Of the studied patients, only 10.3% demonstrated a high level of knowledge, and the highest knowledge levels were observed in the domains of complications (x ¯  = 4.39, standard deviation [SD] = 1.20) and lifestyle (x ¯ = 3.13, SD = 0.69), while knowledge about drug compliance (x ¯  = 0.62, SD = 0.98) was the lowest. A statistically significant positive correlation was observed between knowledge and adherence regarding hypertension (rho = 0.268, p = 0.001) among study participants. We observed that marital status (p = 0.032), income (p = 0.042), and absence of chronic diseases (p = 0.001) are associated factors for low hypertension-related knowledge.

Conclusion

The study findings highlight a moderate level of knowledge about hypertension among patients, with significant gaps in drug compliance understanding. The positive correlation between knowledge and medication adherence underscores the need for better hypertension education at primary health centers. Furthermore, it is recommended that future prospective studies be conducted within various cultural contexts.

Global burden and attributable risk factors of inflammatory cardiomyopathy and myocarditis from 1990 to 2019

BACKGROUND

Our understanding of the global burden distribution of inflammatory cardiomyopathy and myocarditis is very limited.

OBJECTIVE

To comprehensively assess the global burden distribution and attributable risk factors of inflammatory cardiomyopathy and myocarditis from 1990 to 2019.

METHODS

We extracted the data on death, disability-adjusted life years (DALY), and age-standardized rate (ASR) of inflammatory cardiomyopathy and myocarditis from the 2019 Global Burden of Disease (GBD) study, including the comprehensive data and the data classified by age/sex. Evaluate the epidemic trend by calculating the estimated annual percentage change (EAPC) of the above variables. This paper discusses the spatial differences from four aspects: global, five socio-demographic index regions, 21 GBD regions, and 204 countries and regions. We also estimated the risk factors attributable to inflammatory cardiomyopathy and myocarditis-related deaths.

RESULTS

In 2019, the global death toll from inflammatory cardiomyopathy and myocarditis was 340,349, and the age-standardized mortality rate (ASDR) was 4.40/100,000, of which the elderly and men were the majority. Although ASR has decreased in developed areas, inflammatory cardiomyopathy and myocarditis are still important health problems in those relatively underdeveloped areas. Similar DALYs burden pattern of inflammatory cardiomyopathy and myocarditis was also observed during the study period. Globally, among men over 60 and women over 65, the proportion of deaths caused by high systolic blood pressure in 2019 was higher than that in 1990.

CONCLUSIONS

Inflammatory cardiomyopathy and myocarditis are still important global public health problems. The changing pattern of the burden of inflammatory cardiomyopathy and myocarditis varies with location, age, and sex, so it is essential to improve resource allocation to formulate more effective and targeted prevention strategies. In addition, the control of blood pressure should be emphasized.

Associations of daily step count with all-cause mortality and cardiovascular mortality in hypertensive US adults: a cohort study from NHANES 2005-2006

BACKGROUND

The health benefits of physical activity, including walking, are well-established, but the relationship between daily step count and mortality in hypertensive populations remains underexplored. This study investigates the association between daily step count and both all-cause and cardiovascular mortality in hypertensive American adults.

METHODS

We used data from the National Health and Nutrition Examination Survey 2005-2006, including 1,629 hypertensive participants with accelerometer-measured step counts. Cox proportional hazards models and restricted cubic spline regression were employed to assess the associations between daily step count and mortality outcomes. Analyses were adjusted for demographics, lifestyle factors, and comorbidities.

RESULTS

Over an average follow-up of 12.57 years, 370 deaths occurred, of which 177 were due to cardiovascular causes. We observed non-linear associations between daily step count and mortality. Mortality risks were significantly reduced with step counts to 8,250 steps/day for all-cause mortality and 9,700 steps/day for cardiovascular mortality. Beyond these thresholds, the benefits plateaued.

CONCLUSION

Increasing daily step count is associated with reduced all-cause and cardiovascular mortality in hypertensive individuals, with optimal benefits observed below 8,250 and 9,700 daily steps, respectively. Moderate levels of physical activity provide substantial health benefits, highlighting the importance of setting realistic and attainable activity goals for hypertensive populations.

Exploring the potential association between serum selenium and hypertension in obese adult males in the United States

Previous studies on the correlation between serum selenium and hypertension have yielded inconsistent results. Our previous analysis of participants from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 indicated that elevated serum selenium concentrations were associated with an increased risk of metabolic abnormalities in obese individuals, with the primary effect being on blood pressure in males. The aim of this study was to further elucidate the relationship between serum selenium and the risk of hypertension in obese males. In this study, we examined the correlation between serum selenium concentrations and hypertension in 2,585 male participants with a body mass index (BMI) ≥ 30 kg/m2 aged between 20 and 80 years from the 2011-2018 NHANES database. The associations between serum selenium levels and hypertension were evaluated through weighted generalized linear regression analyses. To examine the saturation threshold effect between serum selenium and hypertension, a generalized additive model (GAM) and a two-piecewise linear regression model were employed. Furthermore, the saturation threshold effect was evaluated separately in subgroups stratified by BMI and age. The weighted prevalence of hypertension (51.84%) was slightly higher than that of nonhypertension (48.16%) in the participants included in this study. After rigorous adjustment for sociodemographic, physical, and laboratory test covariates, the weighted odds ratio (OR) of hypertension increased by 103% for every 1 standard deviation (SD) increase (approximately 24.41 µg) in the serum selenium concentration in participants assigned to the highest serum selenium group (weighted OR = 2.03; 95% CI = 1.24-3.32; P = 0.013). A calculation was subsequently performed to determine the saturation threshold effect of selenium on hypertension among participants in the medium and highest selenium concentration subgroups. The findings indicated that participants with serum selenium concentrations exceeding the saturation threshold (2.56 µM) demonstrated an elevated risk of developing hypertension (weighted OR = 9.58; 95% CI = 2.74-33.46; P = 0.000) in comparison to those with serum selenium concentrations below the threshold. Subgroup analyses demonstrated that serum selenium concentrations exceeding the saturation threshold were associated with an increased risk of hypertension in participants with a BMI ≤ 35 kg/m2 (weighted OR = 9.11; 95% CI = 1.43-58.24; P = 0.030) or those aged less than 55 years or younger (weighted OR = 8.37; 95% CI = 1.71-40.94; P = 0.014). For obese adult males who require additional selenium supplementation to enhancing their overall health and well-being, it is strongly recommended that the serum selenium concentrations be monitored throughout the course of supplementation to ensure that they remain within the relatively safe range (approximately less than 215.75 µg/L).

Non-Contact Optical Blood Pressure Biometry Using AI-Based Analysis of Non-Mydriatic Fundus Imaging

Background

This study was developed to determine whether a machine learning model could be developed to assess blood pressure with accuracy comparable to arm cuff measurements.

Methods

A deep learning model was developed based on the UK Biobank dataset and was trained to detect both systolic and diastolic pressure. The hypothesis was formulated after data collection and before the development of the model. Comparison was conducted between arm cuff measurements, as ground truth, and results from the model, using Mean Absolute Error, Mean Squared Error, and Coefficient of Determination (R^2).

Results

Systolic pressure was measured with 9.81 Mean Absolute Error, 165.13 Mean Squared Error and 0.36 R^2. Diastolic pressure was measured with 6.00 Mean Absolute Error, 58.21 and 0.30 R^2.

Conclusions

This model improves on existing research and shows errors comparable to the variability of hand cuff measurements. The use of fundus images to assess blood pressure may be more indicative of long-term hypertension. Additional trials in clinical settings may be necessary, as well as additional prospective studies to validate results.

Special Issue: "New Trends in Diabetes, Hypertension, and Cardiovascular Diseases-2nd Edition"

Cardiovascular diseases (CVDs) encompass a range of conditions affecting both the heart (e.g., coronary heart disease and heart failure [1]) and blood vessels (e.g., cerebrovascular disease [2] and peripheral artery disease [3]) [...].

Prognostic nutritional index as a predictor of cardiovascular and all-cause mortality in American adults with hypertension: results from the NHANES database

Background

Few studies have examined the relationship between nutritional status, as assessed by the Prognostic Nutrition Index (PNI), and incident cardiovascular mortality and all-cause mortality, particularly in hypertensive patients. This study aimed to examine the association between PNI and cardiovascular mortality and all-cause mortality in Americans with hypertension.

Methods

Data from this retrospective cohort study were obtained from the National Health and Nutrition Examination (NHANES) 1999-2016. Using data of The NHANES Public-Use Linked Mortality Files to assess all-cause mortality (ACM) and cardiovascular mortality (CVM). After excluding participants younger than 18 years, without hypertension, and with missing follow-up data, a total of 18,189 cases were included in this study. Persons with hypertension were divided by PNI into 4 groups: Q1 (PNI < 49.0), Q2 (PNI: 49.0-52.5), Q3 (PNI: 52.5-55.5), and Q4 (PNI > 55.5). We used the Cox proportional hazard regression model to explore the predictive role of PNI on ACM and CVM in American adults with hypertension. Restricted cubic spline (RCS) curves to investigate the existence of a dose-response linear relationship between them.

Result

During a median follow-up period of 89 months, a total of 1,444 (7.94%) cardiovascular deaths occurred and 5,171 (28.43%) all-cause deaths occurred. Multifactorial COX regression analysis showed all-cause mortality [hazard ratio (HR): 0.584, 95% CI: 0.523-0.652, p < 0.001] and cardiovascular mortality (HR: 0.435, 95% CI: 0.349-0.541, p < 0.001) associated with Q4 group risk of malnutrition in PNI compared to Q1 group. RCS curves showed a nonlinear relationship between PNI and all-cause mortality and cardiovascular mortality (both non-linear p < 0.001).

Conclusions

Lower PNI levels are associated with mortality in patients with hypertension. PNI may be a predictor of all-cause mortality and cardiovascular mortality risk in patients with hypertension.

Association Between Triglyceride Glucose Index and Hypertension According to Different Diagnostic Criteria

Objective

To explore the association between triglyceride glucose index (TyG) and hypertension under different diagnostic thresholds.

Methods

This study analyzed data from routine occupational health examinations conducted at the First Affiliated Hospital of Xi'an Jiaotong University in 2019. TyG and TyG-BMI, indicators of insulin resistance (IR), were calculated using triglyceride (TG), fasting blood glucose (FPG), and body mass index (BMI). Hypertension was defined by thresholds of 140/90 mmHg and 130/80 mmHg. Logistic regression models were employed to investigate the association between TyG and hypertension.

Results

Among 4028 subjects, after adjusting for covariates, the risk of hypertension (diagnosed by 140/90 mmHg) was 2.87 times higher (OR=2.87, 95% CI: 2.11-3.91) in the Q4 group of TyG compared to the Q1 group. Similarly, the risk was 8.03 times higher (OR=8.03, 95% CI: 5.05-12.75) in the Q4 group of TyG-BMI than in the Q1 group. Furthermore, the risk of hypertension (diagnosed by 130/80 mmHg) was 2.93 times higher (OR=2.93, 95% CI: 2.34-3.68) in the Q4 group of TyG compared to the Q1 group, and 7.12 times higher (OR=7.12, 95% CI: 5.08-9.99) in the Q4 group of TyG-BMI than in the Q1 group. The restricted cubic spline further showed a dose-response relationship between TyG/ TyG-BMI and hypertension. In the population with a BMI of 24.0-27.9 kg/m2, the risk of developing hypertension (diagnosed by 140/90 mmHg) in the Q4 group of TyG was 2.79 times higher (OR=2.79, 95% CI: 1.67-4.66), while the Q4 group with TyG had a 3.07 times greater risk of hypertension (diagnosed by 130/80 mmHg) than the Q1 group (OR=3.07, 95% CI: 2.05-4.60).

Conclusion

TyG is an independent risk factor for hypertension across different thresholds, showing a clear dose-response relationship. BMI may influence this association, emphasizing the importance of managing insulin resistance early to aid hypertension prevention.

Relationship of Chronic Stress and Hypertension with Bone Resorption

Background/Objectives: Chronic exposure to stress has been considered a risk factor for hypertension, which is also associated with increased bone resorption. This review aimed to investigate the effect of acute and chronic stress, associated with hypertension, on the skeletal system. Methods: A comprehensive search was conducted across multiple databases, focusing on peer-reviewed articles published in English. We include experimental, clinical, and peer-reviewed studies focused on the relationship between stress, hypertension, and bone resorption. Searches were conducted in MEDLINE via PubMed, Embase and Scopus, with the last search completed on 10 September 2024. Results: The main topics include situations that favor bone loss, such as psychological stress, which can lead to osteoporotic fractures through immunological and endocrine mechanisms. The relationship between psychological stress and loss of bone density, as in osteoporosis, occurs due to the reduction in the number of osteoblasts and loss in the balance between physiological formation/resorption. Conclusions: Chronic stress significantly affects cardiovascular health and bone resorption. This narrative review study highlights the vulnerability of the skeletal system, along with the cardiovascular system, to prolonged stress, emphasizing the need for multidisciplinary strategies in preventing stress-related conditions. Effective stress management can help reduce the risks of cardiovascular disease and bone resorption, emphasizing their role in comprehensive health care.

Supplementation with Standardized Green/Black or White Tea Extracts Attenuates Hypertension and Ischemia-Reperfusion-Induced Myocardial Damage in Mice Infused with Angiotensin II

Arterial hypertension has a high prevalence in the population and is considered both a cardiovascular disease and an important risk factor for the development of other cardiovascular diseases. Tea consumption shows antihypertensive effects due to its composition in terms of bioactive substances such as flavan-3-ols and xanthines. The aim of this study was to assess the possible beneficial effects of two tea extracts, one of white tea (ADM® White Tea; WTE) and another one composed of a mixture of black tea and green tea (ADM® Tea Complex; CTE), on the cardiovascular alterations induced by angiotensin II (AngII) infusion in mice. For this purpose, four groups of C57BL/6J male mice were used: (1) mice fed on a standard diet for 8 weeks and infused with saline for the last 4 weeks (controls); (2) mice fed on a standard diet for 8 weeks and infused with AngII for the last 4 weeks (AngII); (3) mice fed on a standard diet supplemented with 1.6% WTE and infused with AngII for the last 4 weeks (AngII + WTE); (4) mice fed on a standard diet supplemented with 1.6% TC and infused with AngII for the last 4 weeks (AngII + CTE). Both tea extracts exerted anti-inflammatory and antioxidant effects in arterial tissue and reduced AngII-induced endothelial dysfunction in aorta segments. Moreover, supplementation with WTE or CTE reduced the Ang-II-induced overexpression of AT1R and increased AngII-induced downregulation of AT2R in arterial tissue. However, only supplementation with CTE significantly increased the circulating levels of angiotensin 1-7 and reduced systolic blood pressure. In the heart, supplementation with both tea extracts attenuated AngII-induced cardiac hypertrophy and reduced ischemia-reperfusion-induced oxidative stress and apoptosis in myocardial tissue. In conclusion, supplementation with WTE or CTE attenuates AngII-induced cardiovascular damage through their anti-inflammatory, antioxidant, and antiapoptotic effects. In addition, supplementation with CTE also exerts antihypertensive effects, and so it may constitute an avenue through which to support cardiovascular health.