2020 International Society of Hypertension Global Hypertension Practice Guidelines

Effect of nebivolol monotherapy or combination therapy on blood pressure levels in patients with hypertension: an updated systematic review and multilevel meta-analysis of 91 randomized controlled trials

AIMS

To systematically appraise and summarize the available evidence from published randomized controlled trials considering the effect of nebivolol on blood pressure in patients with hypertension.

METHODS

Literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis.

RESULTS

In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = - 6.01 mmHg; 95% CI = [- 7.46, - 4.55] and MD = - 5.01 mmHg; 95% CI = [- 5.91, - 4.11], respectively). Moreover, resulted a similar reduction in systolic BP (MD = - 0.22 mmHg; 95% CI = [- 0.91, 0.46]) and a significantly greater reduction in diastolic BP compared to the active comparator (MD = - 0.71 mmHg; 95% CI = [- 1.27, - 0.16]). When considering the effect of nebivolol on 24-hour ambulatory BP, notable reductions were observed compared to placebo. In contrast, compared to the active comparators, there was no significant difference in systolic BP reduction, but a significant reduction in diastolic BP favoring nebivolol. Based on moderator analyses, the impact of nebivolol on the pooled estimates remained independent of the dose of nebivolol, age, male sex, trial duration, body mass index (BMI), baseline diabetes, heart failure, and baseline systolic and diastolic BP.

CONCLUSION

Nebivolol, compared to placebo, showed a significant BP reduction and was non-inferior to other active comparators in terms of BP reduction.

Combined exercise hinders the progression of pulmonary and right heart harmful remodeling in monocrotaline-induced pulmonary arterial hypertension

The aim of this study was to test whether combined physical exercise training of moderate intensity executed during the development of monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH) hinders the progression of pulmonary and right heart harmful functional and structural remodeling in rats. Wistar rats were injected with MCT (60 mg/kg) and after 24 h were exposed to a combined exercise training program: aerobic exercise (treadmill running-60 min/day; 60% of maximum running speed); and resistance exercise (vertical ladder climbing-15 climbs; 60% of maximum carrying load), on alternate days, 5 days/wk, for ∼3 wk. After euthanasia, the lung and right ventricle (RV) were excised and processed for histological, single myocyte, and biochemical analyses. Combined exercise increased the tolerance to physical effort (time until fatigue and relative maximum load) and prevented increases in pulmonary artery resistance (acceleration time (TA)/ejection time (TE)] and reductions in RV function [tricuspid annular plane systolic excursion (TAPSE)]. Moreover, in myocytes isolated from the RV, combined exercise preserved contraction amplitude, as well as contraction and relaxation velocities, and inhibited reductions in the amplitude and maximum speeds to peak and to decay of the intracellular Ca2+ transient. Furthermore, combined exercise avoided RV (RV weight, cardiomyocyte, extracellular matrix, collagen, inflammatory infiltrate, and extracellular matrix) and lung (pulmonary alveoli and alveolar septum) harmful structural remodeling. In addition, combined exercise restricted RV [nitric oxide (NO) and carbonyl protein (CP)] and lung [catalase (CAT), glutathione S-transferase (GST), and NO] oxidative stress. In conclusion, the applied combined exercise regime hinders the progression of pulmonary and right heart functional and structural harmful remodeling in rats with MCT-induced PAH.NEW & NOTEWORTHY This study reveals that combined exercise improves tolerance to physical effort, prevents increases in pulmonary artery resistance, and conserves the right heart function during the progression of pulmonary arterial hypertension. Our analyses show that combined exercise hinders harmful right ventricular and lung structural remodeling and oxidative stress, which reflects in the maintenance of right ventricular myocytes' contractile function by preserving the intracellular calcium cycling. An attenuated progression of the disease impacts positively on its prognosis.

Modifiable risk factors and motivation for lifestyle change of CVD patients starting cardiac rehabilitation: The BENEFIT study

BACKGROUND

To improve lifestyle guidance within cardiac rehabilitation (CR), a comprehensive understanding of the motivation and lifestyle-supporting needs of patients with cardiovascular disease (CVD) is required.

OBJECTIVES

This study's purpose is to evaluate patients' lifestyle and their motivation, self-efficacy and social support for change when starting CR.

METHODS

1782 CVD patients (69 % male, mean age 62 years) from 7 Dutch outpatient CR centers participated between 2020 and 2022. Modifiable risk factors were assessed with a survey and interviews by healthcare professionals during CR intake.

RESULTS

Most patients exhibited an elevated risk in 3-4 domains. Elevated risks were most prominent in domains of (1) waist circumference and BMI (2) physical exercise (3) healthy foods intake and (4) sleep duration. Most patients chose to focus on increasing physical exercise, but about 20 % also wanted to focus on a healthy diet and/or decrease stress levels. Generally, motivation, self-efficacy and social support to reach new lifestyle goals were high. However, patients with an unfavorable risk profile had lower motivation and self-efficacy to work on lifestyle changes, while patients with lower social support had a higher chance to quit the program prematurely.

CONCLUSIONS

Our results underscore the need to begin CR with a comprehensive lifestyle assessment and highlight the importance of offering lifestyle interventions tailored to patients' specific modifiable risk factors and lifestyle-supporting needs, targeting multiple lifestyle domains. Expanding the current scope of CR programs to address diverse patient needs and strengthening support may enhance motivation and adherence and lead to significant long-term benefits for cardiovascular health.

CLINICAL TRIAL REGISTRATION NUMBER

Netherlands Trial Register; registration number NL8443.

Home Blood Pressure Measurements Are Not Performed According to Guidelines and Standardized Education Is Urgently Needed

BACKGROUND

Patient education is needed to perform home blood pressure measurement (HBPM) according to blood pressure (BP) guidelines. It is not known how BP is measured at home and what education is provided, which was the aim of the study.

METHODS

Mixed-methods study among Australian adults who perform HBPM (June to December 2023). Participants completed a 30-item online survey on whether they followed guideline recommendations and the education they received for HBPM. Phone interviews were conducted among a purposive sample to further explore survey topics.

RESULTS

Participants (n=350) were middle-aged (58±16 years; 54% women), and most (n=250, 71%) had hypertension. Guideline recommendations for HBPM were not always followed by survey participants. Most participants measured BP seated (n=316, 90%) with the cuff fitted to a bare arm (n=269, 77%). Only 15% measured BP in the morning and evening (n=54) and 26% averaged the BP readings over 7 days (n=90). Interview participants (n=34) described measuring BP at "different times of the day after doing different things." One-third of participants (n=112, 37%) received education for HBPM, which interview participants described as vague verbal instructions from health care practitioners. Participants who received education did not perform high-quality HBPM. Participants who did not receive education mimicked BP measurement methods of health care practitioners, "I do it the way I've seen them do it."

CONCLUSIONS

HBPM is not performed according to guideline recommendations, and adults who received ad hoc education did not perform high-quality HBPM. These findings highlight a need for effective education to support HBPM for clinical decision-making.

The Effect of Zinc Supplementation on Glycemic, Weight, and Blood Pressure Control in Patients With Type 2 Diabetes Mellitus: A Double-Blind Randomized Controlled Trial

Backgrounds and Aims

Type 2 diabetes and its complications are assumed to be major public health problems globally. Zinc is one of the elements that play a part in insulin secretion and signaling. Therefore, this study seeks the answer to the following question: "What are the effects of 220 mg zinc sulfate supplementation on the weight, blood pressure, and glycemic control of patients with Type 2 diabetes?".

Methods

In this randomized controlled double-blind trial, 79 patients with Type 2 diabetes were allocated into two groups through permuted block randomization method. The study group received two capsules of 220 mg of zinc sulfate containing 50 mg of zinc, and the control group received two capsules of 220 mg of placebo ingredient per week for 12 weeks. At the start and end of the treatment period, the fasting blood glucose (FBG), glycated hemoglobin (HbA1c), zinc level, weight, waist circumference (WC), and blood pressure were measured.

Results

After 12 weeks of follow-up, 72 patients completed the study. There were no significant differences before and after the intervention in the FBG, HbA1c, zinc levels, and WC between the two groups. Intragroup analysis showed that weight and body mass index increased in the intervention group; however, these changes were not significant in comparison to the control group. Also, diastolic blood pressure significantly increased in the control group; however, changes in systolic blood pressure were not significant in both groups.

Conclusion

Taking 220 mg of zinc sulfate supplement twice a week did not show significant benefit for weight, blood pressure, and glycemic control in patients with Type 2 diabetes.

Trial Registration

This trial was registered on the Iranian Registry of Clinical Trials (IRCT) website with code number 29627 on September 18, 2018.

Application of hypertension clinical guidelines among family medicine doctors in primary health care centers in Riyadh City, Saudi Arabia

Background

Effective management of hypertension relies on adherence to evidence-based clinical practice guidelines (CPGs) among healthcare providers. However, adherence to hypertension CPGs and the factors influencing it among primary care physicians in Riyadh, Saudi Arabia, remain poorly understood.

Methodology

This descriptive cross-sectional study aimed to assess the knowledge, application, and determinants of adherence to hypertension CPGs among primary care physicians working in Prince Sultan Military Medical City (PSMMC) and its affiliated primary health care centers in Riyadh, Saudi Arabia. A comprehensive sample of 211 primary care physicians was enrolled, and data were collected using a self-administered questionnaire covering demographic characteristics, adherence to hypertension CPGs, and barriers to guideline application. Descriptive statistics and appropriate statistical tests were used for data analysis.

Results

The demographic profile of participants revealed a comprehensive representation of age, marital status, nationality, job title, qualification, and years of practice. The majority of participants demonstrated acceptable levels of knowledge (76.3%) and application (89.1%) of hypertension CPGs. However, barriers related to patient nonadherence to lifestyle modifications and medications were reported, highlighting challenges in implementing guideline recommendations in clinical practice. Significant associations were found between nationality, job title, qualification, and adherence to CPGs, with non-Saudi nationality and junior physicians exhibiting higher rates of unacceptable knowledge and application. Moreover, differences in adherence were observed among physicians following different hypertension CPGs.

Conclusion

While primary care physicians in Riyadh demonstrate a strong foundation in evidence-based hypertension management, addressing barriers and disparities in adherence to CPGs requires targeted interventions and collaborative efforts. Promoting a culture of evidence-based practice, enhancing patient education and engagement strategies, and fostering collaboration among stakeholders are essential steps toward improving hypertension control and prevention in the region.

Evaluating SCUBE-1 as Predictive Biomarker for Hypertension-Mediated Organ Damage: A Comparative Study

Background

Hypertension-mediated organ damage (HMOD) is a critical complication of hypertension that can present with cardiac, retinal, and renal manifestations and affect patient outcomes. Serum signal peptide, CUB (complement C1r/C1s, Uegf, and Bmp1) domain, and epidermal growth factor-like domain-containing protein 1 (SCUBE-1), a novel biomarker implicated in vascular pathology, shows promise for detecting HMOD. This study aims to explore the relation between SCUBE-1 levels and HMOD in hypertensive patients.

Methods

This cross-sectional study included 115 participants, comprising 79 hypertensive patients and 36 healthy controls. The hypertensive patients were divided into two groups based on HMOD presence. SCUBE-1 levels were measured to evaluate their diagnostic utility in detecting HMOD.

Results

Hypertensive patients exhibited significantly higher SCUBE-1 levels than controls (160.70 ng/mL vs. 75.64 ng/mL, p < 0.001). Among these patients, those with HMOD (cardiac, retinal, and renal) displayed even higher SCUBE-1 levels (311.27 ng/mL, range 137.86-460 ng/mL) compared to those without HMOD (142.53 ng/mL, range 110.56-178.19 ng/mL). Receiver operating characteristic curve analysis indicated that SCUBE-1 levels have significant diagnostic potential for differentiating between hypertensive patients with and without HMOD with area under the curve values of 0.722 for cardiac, 0.761 for retinal, and 0.707 for renal damage.

Conclusions

Our study has revealed that SCUBE-1 levels are significantly elevated in hypertensive patients, particularly those with HMOD. The findings support the potential of SCUBE-1 as a valuable biomarker for predicting organ damage in hypertensive patients.

The effects of morning versus evening high-intensity interval exercise on the magnitude of the morning blood pressure surge

Blood pressure (BP) follows a circadian rhythm, dipping during sleep and surging in the morning. A larger morning BP surge is an independent predictor of cardiovascular events. Acute exercise can produce sustained periods of post-exercise hypotension that last up to 24 h; however, the timing of exercise (morning vs. evening) may influence this response. Whether the timing of exercise influences the morning BP surge remains unknown. The current study investigated the effects of a bout of high-intensity interval exercise (HIIE) performed in the morning versus evening on the magnitude of the morning BP surge in young healthy adults. Twenty-six young, otherwise healthy adults (23 ± 4 years; 15 females) completed a randomized crossover trial where, on different days, they completed a no exercise control visit or performed either morning (0800-1000 h) or evening (1700-1900 h) HIIE. Following each visit, ambulatory BP was assessed in 30 min intervals for 24 hrs. HIIE at either time did not alter the magnitude of the morning BP surge compared to control values (control: 22 ± 5 mmHg; morning exercise: 20 ± 8 mmHg; evening exercise: 22 ± 10 mmHg, P = 0.40) or when grouped separately by sex (visit × sex P = 0.42). A positive correlation existed between Morningness-Eveningness Questionnaire score and the change in nighttime BP following both exercise times (both r = 0.42 and P = 0.04). These findings suggest that HIIE does not attenuate the morning BP surge in young healthy adults and that chronotype can predict nighttime BP responses following HIIE, irrespective of exercise time of day. This study was registered on ClinicalTrials.gov (NCT06702930).

Impact of CGRP monoclonal antibody treatment on blood pressure in patients with migraine: A systematic review and potential clinical implications

BACKGROUND

Monoclonal antibodies targeting calcitonin gene-related peptide (CGRP) or the CGRP-receptor have revolutionized the prevention of migraine. Despite their effectiveness, worries have surfaced regarding potential unwanted cardiovascular effects linked to the vasodilation function of CGRP, suggesting a potential influence on blood pressure (BP).

METHODS

Studies were systematically retrieved from PubMed, Cochrane Database of Systematic Reviews, Web of Science, MEDLINE and EMBASE up to 1 May 2024. We focused on randomized controlled trials and observational cohort or case-control studies examining the impact of anti-CGRP(R)-monoclonal antibodies (mAbs) compared to control treatments on BP in patients with migraine. Two reviewers independently conducted study selection, data extraction and risk of bias assessment.

RESULTS

The literature search yielded 693 articles. After removing duplicates and conducting screening, 22 full-text articles were evaluated, with only four studies meeting the inclusion criteria. Among these, only one study had a low risk of bias and reported elevated BP following initiation of anti-CGRP(R)-mAb treatment.

CONCLUSIONS

Although anti-CGRP(R)-mAbs offer substantial benefits for migraine prevention, the potential risk of increased BP requires attention. Despite the current limited evidence, clinicians are urged to monitor BP of migraine patients undergoing treatment with anti-CGRP(R)-mAbs and to remain aware of the increased risk of cardiovascular events in these patients.

Antihypertensive Medication Category Prescriptions and Blood Pressure Control in African Surinamese and Ghanaian Migrants with Hypertension in Amsterdam, The Netherlands: The HELIUS Study

West African (WA) migrants in Europe have higher hypertension rates than the host populations. For African migrants, guidelines recommend diuretics and/or calcium channel blockers (CCB) for primary cardiovascular disease prevention, but data on antihypertensive medication (AHM) prescription patterns or related hypertension control rates are lacking. We assessed AHM prescription patterns and its relation to hypertension control among hypertensive WA migrants in the Netherlands compared to the host population. Cross-sectional data from WA or Dutch origin participants from the HELIUS study were used. Participants with treated hypertension and without diabetes, cardiovascular disease, or microalbuminuria were selected. We used logistic and linear regression analyses to assess the association between AHM categories and hypertension control rates (systolic blood pressure (BP) ≤ 140 mmHg and diastolic BP ≤ 90 mmHg) and the systolic BP levels. We compared 999 WA participants and 314 Dutch participants. Hypertension control rates were lower in the WA origin compared to Dutch origin participants (44.3% versus 58.0%, p < 0.001). For WA participants, prescription rates for any AHM category were: CCB (54.8%), diuretics (18.5%) beta-blocking agents (27.3%) and renin-angiotensin system blockers (52.6%). Prescription rates were higher for CCB and similar for diuretics compared to the Dutch participants. Neither CCB nor diuretics were associated with better control rates. Compared to Dutch participants, West African participants had similar diuretic prescriptions but significantly higher prescriptions for CCB. However, neither medications was associated with better hypertension control. Future research should explore physician and patient factors to improve hypertension control.

An updated network meta-analysis of non-pharmacological interventions for primary hypertension in adults: insights from recent studies

BACKGROUND

Primary hypertension significantly impacts global cardiovascular health, contributing to increased mortality rates and posing a substantial public health challenge. Recognizing the growing evidence supporting non-pharmacological interventions (NPIs) for controlling primary hypertension, our study employs Network Meta-Analysis (NMA) to comprehensively assess their efficacy.

METHODS

This review updates a prior systematic review by searching for original literature on NPIs for primary hypertension from 2013 to 2024. We conducted a thorough search in eight databases, including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, CNKI, WanFang Data, and Chongqing VIP, identifying potential randomized controlled trials (RCTs) from January 1, 2013, to August 1, 2024. Primary outcomes included the mean changes in blood pressure before and after treatment. Analysis was performed using GeMTC package (R 4.2.3), and Stata 17.0. The confidence of evidence was examined using Confidence in Network Meta-Analysis (CINeMA).

RESULTS

Utilizing NMA, we reviewed 9,189 studies, identifying 54 eligible articles with 5,827 participants. Investigating 22 distinct NPIs, the focus was on changes in systolic and diastolic blood pressure pre and post-treatment. Lifestyle intervention + Tai Chi significantly reduced systolic (-21.75 mm Hg; 95% CI -33.25 to -10.02) and diastolic blood pressure (-13.62 mm Hg; 95% CI -23.14 to -3.71) compared to usual care and other NPIs. Consistency and regression analyses did not reveal significant differences.

CONCLUSION

This review provides a comprehensive evaluation of NPIs for primary hypertension, emphasizing lifestyle + Tai Chi as a preferred NPI. Breathing exercises show potential in lowering systolic blood pressure, and acupuncture + tui na demonstrates effectiveness in reducing diastolic blood pressure, outperforming other interventions. The study reinforces the role of NPIs in managing primary hypertension, providing a foundation for future hypertension research.

Effectiveness of an online food shopping intervention to reduce salt purchases among individuals with hypertension - findings of the SaltSwitch Online Grocery Shopping (OGS) randomised trial

BACKGROUND

Online grocery shopping is a growing source of food purchases in many countries. We investigated the effect of nudging consumers towards purchases of lower sodium products using a web browser extension.

METHODS

This trial was conducted among individuals with hypertension who shopped for their groceries online in Australia. From July 2021 to June 2023, participants were randomised to use the SaltSwitch Online Grocery Shopping web browser extension or continue their usual grocery shopping for 12 weeks. The SaltSwitch extension modified a retailer's online shopping interface to suggest similar but lower sodium alternative products to those initially selected. The primary outcome was the difference in mean sodium density (mg sodium per 1000 kcal of energy) of packaged food purchases between the intervention and control groups.

RESULTS

We randomised 185 participants of average age 56.0 (SD 11.0) years. Most were women (64%), White (89%), had BMI > 25 kg/m2 (91%), and were taking anti-hypertensive medication (83%). Demographic and medical characteristics were similar across the randomised groups. 182 (98%) completed the trial. Over the 12-week intervention, the sodium density of groceries purchased by the intervention group compared to the control group was 204 mg/1000 kcal lower (95%CI, -352 to -56) (P = 0.01). The reduction in sodium density of purchases was apparent in weeks 1-4 and sustained through the end of the trial. 86% of participants in the intervention group made at least one switch to a lower sodium product. There were no detectable effects on blood pressure, spot urine sodium concentration, or other secondary outcomes across the 12-week study period.

CONCLUSIONS

Online shopping platforms provide a novel opportunity to support purchases of lower sodium foods. While the reductions in sodium density of purchases were moderate in size, population health benefits could nonetheless be large if they were sustained over time and at scale, with large and growing numbers of online grocery shoppers and a high prevalence of elevated blood pressure amongst adults.

TRIAL REGISTRATION

ACTRN12621000642886.

Association between prophylactic aspirin use and hypertension using data from NHANES 2011-2018

Aspirin may be necessary for some patients with cardiovascular disease, but previous studies on the use and dosage of aspirin and the association with hypertension have been inadequate. The results of existing studies have been somewhat inconsistent. Our study was designed to assess the association between prophylactic aspirin use and hypertension in U.S. adults. This cross-sectional study analyzed a nationally representative sample of U.S. adults aged 40 and older from the National Health and Nutrition Examination Survey (2011-2018). Aspirin was categorized as no use, low dose (≤ 100 mg), and high dose (> 100 mg). Hypertension was defined as the average of three consecutive blood pressure readings (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg). There were 5297 participants, comprising 52.5% male and 47.4% female. The median age was 64 years (range: 56 to 72) and 3635 individuals were diagnosed with high blood pressure. Among the groups, the incidence of hypertension was 70.2% in the non-aspirin group, 68.3% in the low-dose group, and 68.0% in the high-dose group, with no statistically significant difference observed (p = 0.71). Using a fully adjusted weighted multivariate logistic regression model 4, prophylactic aspirin use was not associated with hypertension [(odds ratio [OR] 1.11; 95% CI (0.89-1.38), (odds ratio [OR] 1.15; 95% CI 0.82-1.61), P = 0.31]. Subgroup analyses, along with sensitivity analyses that excluded patients with diabetes and reclassified aspirin use status, confirmed the findings of the main study. In this nationally representative cohort of U.S. adults, no significant association was found between aspirin use or dosage and the prevalence of hypertension.

Relationship between lipid levels, TyG, TyG-BMI index and hypertension in Tibetan population in Tibet, China based on restricted cubic spline model

BACKGROUND

The prevalence of hypertension among the Tibetan population in Tibet is higher than in other regions of China, and there is a lack of unified epidemiological surveys. This study aims to conduct a standardized epidemiological investigation to assess the current status of hypertension among the Tibetan population, as well as to explore the dose-response relationship between cholesterol (TC), triglyceride glucose index (TyG), triglyceride glucose-body mass index (TyG-BMI), and hypertension in this population.

METHODS

From June 2020 to July 2023, a total of 5042 Tibetans aged 18 to 80 years from three cities and one region in Tibet were randomly sampled for the study. Logistic regression analysis models combined with restricted cubic splines were used to analyze the relationship between LDL-C, TC, TyG, TyG-BMI index, and HTN in the Tibetan population.

RESULTS

(1) The prevalence of HTN in the Tibetan population in Tibet, China, was 32.35%, of which men were slightly higher than women. (2) Age, BMI, fasting blood glucose (FBG), uric acid (UA), TC, triglycerides (TG), LDL-C, homocysteine (Hcy), TyG, and TyG-BMI were higher in HTN populations compared to non-HTN populations (P < 0.05). (3) The risk of HTN was increased in individuals with borderline elevated and elevated LDL-C, borderline elevated TC, the second(Q2), third(Q3), and fourth quartile groups(Q4) of TyG as well as the third(Q3) and fourth quartile groups(Q4) of TyG-BMI. The prevalence risk of HTN gradually increased with elevated levels of LDL-C, TC, TyG, and TyG-BMI (P trend < 0.001). (4) The results of restricted cubic spline analysis showed a nonlinear dose-response relationship between LDL-C, TC, and TyG-BMI and the risk of developing HTN (P < 0.001, P Nonlinear < 0.05), and a linear dose-response relationship between TyG and the risk of developing HTN (P < 0.001, P Nonlinear > 0.05).

CONCLUSION

Higher LDL-C, TC, TyG, and TyG-BMI are risk factors for HTN in the Tibetan population of Tibet, China. Effective prevention can be achieved by controlling lipid and glucose indices.

Postprandial Vascular Effects of a High Potassium Meal in Patients with Treated Hypertension

BACKGROUND

There is compelling evidence of an inverse association between potassium intake and blood pressure (BP). A potential mechanism for this effect may be dietary potassium-mediated augmentation of endothelium-dependent relaxation. To date, studies have investigated potassium intake supplementation over several weeks in healthy volunteers with variable results on vascular function. There is no assessment of the acute vascular effects of potassium supplementation achieved by the ingestion of potassium-rich food in a hypertensive population.

OBJECTIVE

The purpose of this study was to investigate the effect of a high potassium meal on postprandial endothelial function as measured by flow-mediated dilatation (FMD).

METHODS

We performed an investigator-blinded randomized crossover trial in 33 treated hypertensive individuals. Participants consumed both a high (~2400 mg) and low (~543 mg) K+ meal, separated by a one-week washout period. The primary endpoint was endothelial function as assessed by FMD pre-meal and postprandially at 60 and 120 min. Meals were compared at each time point using the Hills-Armitage approach.

RESULTS

33 individuals were included in the study (48% male, mean age 68). In the fasting state (Baseline), and at 60 min postprandial, radial artery FMD was not significantly different between the participants after consumption of either meal (baseline: high K+ 4.2 ± 2% versus Low K+ 2.6 ± 3%, p = 0.93; 60 min: high K+ 3.8 ± 4% versus Low K+ 4.1 ± 3%, p = 0.69). However, at 120 min, FMD tended to be higher in participants after the high K+ meal (5.2 ± 4.1%) than after the low K+ meal (3.9 ± 4.1%) (p = 0.07). There were no differences in participants' radial artery diameter and blood flow between meals.

CONCLUSIONS

This study does not support our hypothesis that a single high K+ meal improves vascular function in individuals with treated hypertension. This does not contradict the clinical evidence relating greater K+ intake with lower BP, but suggests that mechanistic investigations of increased K+ intake through diet alone and its impact on endothelial function as a mediator to reducing BP are complex and not simply due to single nutrient-mediated improvement in vascular function.

Malignant hypertension: current challenges, prevention strategies, and future perspectives

Introduction

Based on office blood pressure (BP) values, hypertension is categorized into three stages: stage 1 (140-159/90-99 mmHg), stage 2 (160-179/100-109 mmHg), and stage 3 (≥180/≥110 mmHg). Malignant hypertension (MHT) is characterized by extreme BP elevation (systolic blood pressure above 200 mmHg and diastolic blood pressure above 130 mmHg) and acute microvascular damage affecting various organs, particularly the retinas, brain, and kidneys.

Objectives

The pathogenesis, predisposing variables, therapy, and preventive strategies for MHT were examined in this review.

Conclusions and recommendations

Malignant hypertension requires prompt and efficient treatment because it is the most severe kind of hypertension that affects target organs. At the same time, there are a number of alternatives available for treating MHT. The International Society of Hypertension 2020 and European Society of Cardiology/European Society of Hypertension 2018 recommendations suggest using labetalol and nicardipine as the first-line choice, with urapidil and nitroprusside serving as alternative medications. Elevated risk of MHT has been linked to many socio-demographic and genetic factors.

Prognostic Role of Neutrophil Percentage-to-Albumin Ratio in Patients with Non-ST-Elevation Myocardial Infarction

Background and Objectives: This study aimed to investigate whether neutrophil percentage-to-albumin ratio (NPAR) levels on admission have prognostic significance regarding one-year major adverse cardiovascular and cerebrovascular events (MACCEs) in non-ST-elevation myocardial infarction (NSTEMI) patients. Materials and Methods: A total of 464 patients aged 59.2 ± 11.6 years constituted the cohort of this retrospectively designed study. Considering a 1-year follow-up period, the patients were divided into two groups: those with MACCEs and those without. The complete blood count, serum C-reactive protein and serum albumin levels were measured at admission. The NPAR, C-reactive protein/albumin ratio (CAR) and systemic immune-inflammation (SII) index were calculated for all patients, and the associations of these inflammatory-based biomarkers with 1-year MACCEs were evaluated. Results: During the 12-month follow-up period, MACCEs were observed in 75 (16.2%) patients, of which 35 (7.5%) patients died. The patients with MACCEs had higher CRP (p < 0.001), a higher percentage of neutrophils (p < 0.001), lower albumin levels (p < 0.001), a higher CAR (p < 0.001), a higher SII index (p = 0.008) and a higher NPAR (p < 0.001). A high anatomical SxSI score, a high low-density lipoprotein cholesterol level, hypoalbuminemia, high neutrophil counts, a high NPAR level and a high CAR level were independent predictors for one-year MACCEs (all p < 0.05). The NPAR (area under the curve [AUC] = 0.775, p < 0.001) and albumin level (AUC = 0.708, p < 0.001) had better and sufficient discriminatory power and predictive accuracy in determining one-year MACCEs, when compared to the neutrophil (AUC = 0.693, p < 0.001), CAR (AUC = 0.639, p < 0.001) and SII index (AUC = 0.660, p < 0.001), in terms of the receiver operating characteristic curve. The DeLong test revealed that the predictive performance of the NPAR was superior to that of the other inflammatory parameters. In particular, individuals with an NPAR value greater than 17.6 were at greater risk of developing MACCEs (p < 0.001). Conclusions: The NPAR can be used as a newly identified promising inflammatory biomarker to predict one-year MACCEs in NSTEMI patients undergoing revascularization therapy.

Clinical practice guideline for the management of hypertension in China

In China, hypertension is the most common chronic non-communicable disease and the most significant risk factor for cardiovascular mortality among urban and rural residents. To standardize the clinical diagnosis and treatment of hypertension and to improve the prevention and control level of hypertension in China, Chinese Society of Cardiology, Chinese Medical Association; Hypertension Committee of Cross-Straits Medicine Exchange Association; Cardiovascular Disease Prevention and Rehabilitation Committee, Chinese Association of Rehabilitation Medicine, jointly collaborated to formulate the Clinical Practice Guideline for Hypertension Management in China. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence and strength of recommendations, and the reporting items for practice guidelines in healthcare (RIGHT) were followed to establish the guideline. Detailed evidence-based recommendations for the diagnosis, evaluation, and treatment of 44 clinical questions in the field of hypertension, including essential and secondary hypertension, have been provided to guide clinical practice.

REGISTRATION

International Practice Guidelines Registry Platform, http://www.guidelines-registry.cn/ , No. IPGRP-2021CN346.

Status of diabetes mellitus in different regions of KSA and update on its management

Background

Complications of diabetes and its associated comorbidities can cause rapid progression of type II diabetes mellitus (T2DM). It comes at high costs and affects a patient's quality of life. We aim to assess T2DM in KSA, including the demographics, medications, complications, and comorbidities, as it remains an integral part of Vision 2030.

Methods

Observational retrospective study was designed spanning five administrative regions of KSA. A total of 638 patients' records were randomly selected from general hospitals and diabetes centers from 2017 to 2020, and the collected were statistically analyzed.

Results

Most (77%) selected patients had uncontrolled diabetes, showing a statistically significant correlation between regions and diabetes control. The Northern, Central, and Southern regions had the highest uncontrolled percentage with less than 20% control, while Western and Eastern regions' control percentages were around 40% of subjects. Eighty percent of the uncontrolled BP patients had uncontrolled diabetes contrasting the 68% of the BP-controlled patients. Biguanides, DPP-4 inhibitors, GLP-1 agonists, Insulin, and SGLT-2 inhibitors are the most common diabetes medications. Metformin was the most prescribed in all regions, followed by DPP4. Results showed that patients used one to four non-diabetes drugs on average. Dispensing of vitamin B complex and statins were higher in diabetes centers than in hospitals. Retinopathy and peripheral neuropathy were the most common complications, while hypertension and ASCVD were the most common comorbidities.

Conclusion

Results showed a poor glycemic control situation in the kingdom that necessitates implementing stricter measures to hinder disease progression and reduce complications and comorbidities. Increasing awareness, training, and monitoring programs with larger sample sizes and broader distribution is highly recommended nationally.

Impact of the COVID-19 pandemic on primary care for hypertension in the UK: a population-based cohort study

OBJECTIVES

To describe the impact of the COVID-19 pandemic on hypertension diagnosis and management in UK primary care.

DESIGN

Population-based cohort study.

SETTING

Over 2000 general practices across the UK contributing to the Clinical Practice Research Datalink.

PARTICIPANTS

A cohort of 23 076 390 patients over 18 years of age and registered with their general practice for at least 1 year between 2011 and 2022, who did not have a previous diagnosis of hypertension. From these patients, a subcohort of 712 461 patients diagnosed with hypertension between 2011 and 2022 was selected.

PRIMARY AND SECONDARY OUTCOME MEASURES

Coprimary outcomes included rates of hypertension diagnosis and rates of antihypertensive treatment initiation, treatment change and blood pressure measurement in patients newly diagnosed with hypertension.

RESULTS

In April 2020, the first month of lockdown, incident hypertension diagnosis rates fell by 65% (95% CI 64% to 67%) compared with historical trends and remained depressed until November 2021, leading to 51 000 fewer diagnoses than expected by March 2022. However, by March 2022, there were 2.6% fewer diagnoses than expected in Scotland, compared with 20%-30% fewer in other UK Nations. Rates of treatment initiation and change fell by 47% (95% CI 43% to 51%) and 36% (95% CI 33% to 38%), respectively, in April 2020. However, initiation rates rebounded above expectations and remained elevated until March 2022. Blood pressure measurements fell by 69% (95% CI 65% to 72%) in April 2020, recovering in February 2021.

CONCLUSIONS

Hypertension diagnosis and management in UK primary care were significantly disrupted during the COVID-19 pandemic. Future studies should investigate the potential clinical implications for the cardiovascular health of the UK population.

Cost-effectiveness of catheter-based radiofrequency renal denervation for the treatment of uncontrolled hypertension: an analysis for the UK based on recent clinical evidence

AIMS

Catheter-based radiofrequency renal denervation (RF RDN) has recently been approved for clinical use in the European Society of Hypertension guidelines and by the US Food and Drug Administration. This study evaluated the lifetime cost-effectiveness of RF RDN using contemporary evidence.

METHODS AND RESULTS

A decision-analytic model based on multivariate risk equations projected clinical events, quality-adjusted life years (QALYs), and costs. The model consisted of seven health states: hypertension alone, myocardial infarction (MI), other symptomatic coronary artery disease, stroke, heart failure (HF), end-stage renal disease, and death. Risk reduction associated with changes in office systolic blood pressure (oSBP) was estimated based on a published meta-regression of hypertension trials. The base case effect size of -4.9 mmHg oSBP (observed vs. sham control) was taken from the SPYRAL HTN-ON MED trial of 337 patients. Costs were based on National Health Service England data. The incremental cost-effectiveness ratio (ICER) was evaluated against the UK National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold of £20 000-30 000 per QALY gained. Extensive scenario and sensitivity analyses were conducted, including the ON-MED subgroup on three medications and pooled effect sizes. RF RDN resulted in a relative risk reduction in clinical events over 10 years (0.80 for stroke, 0.88 for MI, 0.72 for HF), with an increase in health benefit over a patient's lifetime, adding 0.35 QALYs at a cost of £4763, giving an ICER of £13 482 per QALY gained. Findings were robust across tested scenarios.

CONCLUSION

Catheter-based radiofrequency RDN can be a cost-effective strategy for uncontrolled hypertension in the UK, with an ICER substantially below the NICE cost-effectiveness threshold.

Screening for diabetes and hypertension in adult dental patients: the experience in a Nigerian dental center

Objectives

The aim of the present study was to examine the presentation of hypertension and diabetes mellitus in dental patients.

Methods

Dental patients were screened for hypertension and elevated blood sugar using a sphygmomanometer and a glucometer, respectively.

Results

A total of 102 men and 129 women participated in the study. In total, 69 (29.9%) and 20 (8.7%) participants reported a history of hypertension and diabetes mellitus, respectively. Adherence to taking hypertensive and diabetic medications as advised by a clinician was reported by 68.0% and 85.0% of patients with known hypertension and diabetes, respectively, of whom 29.8% had uncontrolled hypertension and 29.4% had high blood sugar in the diabetic range (>200 mg/dl). In patients with no history of these diseases, 42 (25.9%) had elevated blood pressure, while 5 (2.4%) had high blood sugar in the diabetic range. The prevalence of hypertension was 37.3% and high blood sugar in the diabetic range was 5.2% in the sample. Individuals with diabetes were 31 times more likely to have hypertension than those without diabetes (odds ratio = 31.06, 95% confidence interval 5.68-169.98, p ≤ 0.001).

Conclusion

Screening was helpful in the detection of undiagnosed cases and suboptimal control of both diseases in patients. Recommendations for dental practice guidelines include routine screening with mandatory screening for hypertension in patients with diabetes.

Long-acting nifedipine in the management of essential hypertension: a review for cardiologists

Calcium channel antagonists, specifically long-acting nifedipine formulations, play a crucial role in treating hypertension and angina. Originally used for angina, nifedipine has been widely employed as an antihypertensive medication for over 40 years. It offers rapid action and oral bioavailability with minimal maternal or fetal side effects, making it suitable for treating hypertensive crises during pregnancy. However, it can cause a sudden drop in blood pressure and tachycardia. Long-acting formulations, such as gastrointestinal therapeutic systems, gradually release nifedipine over 24 hours, mitigating these issues. This review aims to assess the clinical efficacy and safety of long-acting nifedipine formulations in managing essential hypertension, with a focus on improving blood pressure control and addressing challenges in uncontrolled and resistant hypertension. Furthermore, long-acting nifedipine provides therapeutic advantages beyond hypertension management, showing efficacy in treating comorbid conditions such as chronic kidney disease and diabetes. Global studies support its efficacy, suggesting that a shift toward the use of long-acting nifedipine can help address the global hypertension problem and enhance the quality of life for hypertensive patients.

Association between "Life's Essential 8" cardiovascular health and apparent treatment-resistant hypertension among US adults from the NHANES, 2005 to 2018

Background

The association between healthy lifestyle and American Heart Association (AHA) Life's Essential 8 (LE8) score and apparent treatment-resistant hypertension(aTRH)remains uncertain. We aimed to explore the association between healthy lifestyle and higher LE8 score and apparent treatment-resistant hypertension in the general population.

Methods

Using NHANES data from 2005 to 2018, we included and analyzed information on 7,474 participants eligible for this study. The association between LE8 and aTRH was explored using logistic regression models, and the association between LE8 and antihypertension drugs uncontrolled hypertension was further explored using logistic regression models.

Results

Participants with higher LE8 scores tended to be non-Hispanic white and married or living with a partner; have low income and higher education; and be without Chronic kidney disease (CKD)(all p-values <0.001). Compared to subjects with low CVH, participants with moderate and high CVH exhibited lower risks of 47% and 76%, respectively. After adjusting for covariates, there was no evidence of a nonlinear association between LE8 and aTRH (p for nonlinearity = 0.456). Physical activity (PA), body mass index (BMI), and blood glucose were associated with aTRH (all p-values < 0.05), while diet, nicotine exposure, sleep, and blood lipids were not significantly associated with aTRH. Compared to the low LE8 group, the ORs for the high LE8 group were 0.46 (95% CI, 0.28 to 0.76) and 0.07 (95% CI, 0.02 to 0.20) for uncontrolled hypertension with 1-2 and 3-4 antihypertensive drugs, respectively. In the sensitivity analysis, subgroup analyses were performed on all covariates, and the results remained stable.

Conclusion

In our study, we found a significant association between higher LE8 scores and a lower risk of aTRH. Our findings suggest that implementing various healthy lifestyle practices and managing known cardiovascular risk factors could be a feasible comprehensive preventive approach to aTRH.

Joint association of anti-inflammatory diet and vigorous leisure-time physical activity on all-cause and cardiovascular disease mortality in U.S. adults: findings from NHANES, 2007-2014

PURPOSE

Balanced dietary patterns, sufficient physical activity, and other healthy lifestyle behaviors are increasingly recognized as a complimentary strategy for the prevention of cardiovascular disease (CVD). We aim to explore the joint association of anti-inflammatory diet and vigorous leisure-time physical activity (LTPA) on all-cause and CVD mortality.

METHODS

This retrospective cohort study included 16,068 adults from the National Health and Nutrition Examination Survey (2007-2014). Participants were categorized into four lifestyle patterns based on the inflammatory properties of the diet and the degree of vigorous LTPA: pro-inflammatory diet and insufficient vigorous LTPA (pattern 1), anti-inflammatory diet and insufficient vigorous LTPA (pattern 2), pro-inflammatory diet and sufficient vigorous LTPA (pattern 3), anti-inflammatory diet and sufficient vigorous LTPA (pattern 4). Multivariable Cox proportional hazards models were used to estimate the hazards ratio (HR) and 95% confidence intervals (CI).

RESULTS

Compared to pattern 1, pattern 4 showed an obvious lower risk of all-cause (HR, 0.51; 95% CI 0.32-0.81) and CVD mortality (HR, 0.31; 95% CI 0.12-0.80). In addition, pattern 2 also had a significantly decreased all-cause (0.80; 0.69-0.92) and CVD mortality risk (0.71; 0.53-0.95). However, t there was no significant reduction in all-cause mortality (0.75; 0.54-1.06) and CVD mortality (0.60; 0.32-1.13) among pattern 3. Consistent results were obtained in subgroup and sensitivity analyses.

CONCLUSION

Adhering to the anti-inflammatory diet and sufficient vigorous LTPA was associated with lowest all-cause and CVD mortality. Anti-inflammatory diet can counteract the hazards caused by insufficient vigorous LTPA, while sufficient vigorous LTPA fails to offset the detrimental effect of pro-inflammatory diet.

Bayesian analysis of non-communicable diseases risk factors: a focus on the lower-educated population in Bangladesh

BACKGROUND

This study investigates non-communicable disease (NCD) risk factors, specifically hypertension and diabetes, among Bangladeshi adults with lower educational attainment. With an increasing global burden of NCDs, understanding the dynamics in lower-educated populations becomes crucial for targeted interventions and achieving Sustainable Development Goal 3.4-curtailing premature mortality from non-communicable diseases by one-third by 2030 through prevention and treatment.

METHODS

Utilizing data from the Bangladesh Demographic and Health Survey (2017-2018), a two-stage stratified sampling design identified 7287 lower-educated individuals. Bayesian logistic regression was applied for risk factor analysis.

RESULTS

The prevalence of hypertension and diabetes among lower-educated people was 31% and 9.3%, respectively. NCD prevalence (37.3%) underscored a significant health burden. Factors such as gender, age, wealth status, working status, residence and region showed significant associations with NCDs. Bayesian analysis revealed that females were 1.30 times more likely to develop NCDs, while older age groups demonstrated 4.30 times greater likelihood. Employed individuals exhibited a 43% lower risk. Wealthier households showed higher NCD likelihood and residence in the central region was associated with an 11% lower risk.

CONCLUSIONS

This study highlights the high risk of developing NCDs among lower-educated females, particularly those ≥35 y of age in Bangladesh. Therefore, targeted interventions for this group are critical to reducing NCD risks, supporting national health objectives and advancing progress toward the Sustainable Development Goals.

Association between C-reactive protein-triglyceride glucose index and depressive symptoms in American adults: results from the NHANES 2005 to 2010

BACKGROUND

The novel serum C-reactive protein-triglyceride glucose index (CTI) has been identified as an ideal parameter that integrates inflammation and insulin resistance, which are potential mechanisms underlying depressive symptoms. Our research aimed to investigate the association between CTI and depressive symptoms.

METHODS

Our cross-sectional investigation utilized data from the National Health and Nutrition Examination Survey conducted between 2005 and 2010. The integrated CTI was calculated as 0.412 × Ln (C-reactive protein) (mg/dL) + Ln [triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The severity of depressive symptoms was evaluated through the continuous Patient Health Questionnaire-9 (PHQ-9) scores, and the categorical definition of depressive symptoms (PHQ-9 score ≥ 10) reflected moderate to severe symptoms. Survey-weighted linear and logistic regression models were conducted to establish the correlation between CTI and PHQ-9 scores, and between CTI and depressive symptoms. Moreover, subgroup analyses, interaction tests, and smoothed curve fitting were performed to scrutinize the steadiness of the results.

RESULTS

A total of 5,954 participants were enrolled in our study, including 477 with depressive symptoms and 5,477 without. The results revealed a significant positive relationship between CTI and PHQ-9 scores (β: 0.40, 95% CI: 0.25,0.55, p < 0.001) and depressive symptoms (OR: 1.30, 95% CI: 1.06,1.61, p = 0.02). Additionally, individuals in the fourth quartile of CTI exhibited a higher likelihood of depressive symptoms than those in the first quartile (PHQ-9 score: β: 0.83, 95% CI: 0.39,1.26, p < 0.001; depressive symptoms: OR: 2.00, 95% CI:1.19,3.36, p = 0.01). Smooth curve fitting and subgroup analyses consistently demonstrated the positive relationship.

CONCLUSIONS

Elevated CTI was correlated with a higher risk of depressive symptoms, underscoring CTI as a potential clinical indicator for identifying and stratifying depressive symptoms.

CLINICAL TRIAL NUMBER

Not applicable.

Assessing the impact of acute severe hypertension in the emergency department: A prospective cohort study in Karachi, Pakistan

Acute Severe Hypertension (ASH), presenting as a Hypertensive Emergency (HE) or Hypertensive Urgency (HU), is a frequent reason for emergency department (ED) admissions. This study sought to assess the prevalence of ASH among adult ED patients in Pakistan and investigate all-cause mortality and hospitalization rates over six months. We conducted a prospective single-center cohort study in Karachi, Pakistan, from June 3, 2019, to September 22, 2020. We enrolled all adult male and non-pregnant female patients presenting to the emergency department with a systolic blood pressure of ≥180 mm Hg or diastolic blood pressure of ≥120 mm Hg. Telephonic follow-ups were conducted at one, three-, and six months post-discharge from the hospital. The Cox Regression Model was used to identify the risk factors for mortality. Of 49,431 ED visits during the study period, 1,525 (3.1%) met the inclusion criteria, and 1,161 (76.2%) were enrolled. A total of 356 patients (30.6%) were diagnosed with HE, and 805 (69.2%) with HU. Among follow-up patients, 14.6% with HE and 4.7% with HU experienced mortality within six months. Notably, the risk of mortality was higher in patients aged >65 years (aRR = 1.90, 95% CI = 1.20 to 3.02) and those suffering from stroke (aRR = 2.09, 95% CI = 1.21 to 3.61) or acute kidney injury (aRR = 1.82, 95% CI = 1.09 to 3.04). Conversely, regular blood pressure monitoring (aRR = 0.08, 95% CI = 0.03-0.19) and adherence to antihypertensive medications (aRR = 0.23, 95% CI = 0.09-0.56) significantly lowered the risk HE resulted in heightened mortality at six months, while HU, traditionally deemed benign, also led to substantial morbidity and mortality. This underscores the ED visit for ASH as a crucial opportunity for preventing short-term and longer-term health complications.

Eutectogel-Based Drug Delivery: An Innovative Approach for Atenolol Administration

Background: Hypertension affects 32% of adults worldwide, leading to a significant global consumption of cardiovascular medications. Atenolol, a β-adrenergic receptor blocker, is widely prescribed for cardiovascular diseases such as hypertension, angina pectoris, and myocardial infarction. According to the Biopharmaceutics Classification System (BCS), atenolol belongs to Class III, characterized by high solubility but low permeability. Currently, atenolol is commercially available in oral formulations. Increasing attention is being directed towards developing cost-effective transdermal delivery systems, due to their ease of use and better patient compliance. Eutectogels represent next-generation systems that are attracting great interest in the scientific community. Typically obtained from deep eutectic solvents (DESs) combined with gelling agents, these systems exhibit unique properties due to the intrinsic characteristics of DESs. Methods: In this study, a DES based on choline chloride as a hydrogen bond acceptor (HBA) and propylene glycol as a hydrogen bond donor (HBD) was explored to enhance the topical delivery of atenolol. The solubility of atenolol in the DES was evaluated using spectroscopic and thermodynamic measurements which confirmed the formation of hydrogen bonds between the drug and DES components. Additionally, the safety of the DES was assessed in a cell viability assay. Subsequently, we formulated eutectogels with different concentrations using animal gelatin and Tego Carbomer 140, and characterized these formulations through rheological measurements, swelling percentage, and permeation studies with Franz cells. Results: These novel eutectogels exhibit superior performance over conventional hydrogels, with a release rate of approximately 86% and 51% for Carbomer- and gelatin-based eutectogels, respectively. In contrast, comparable hydrogels released only about 27% and 35%. Conclusions: These findings underscore the promising potential of eutectogels for the transdermal delivery of atenolol.

A study of the difference in biochemical metabolism between patients with unilateral and bilateral upper urinary tract stones

Bilateral upper urinary tract stones are more likely to lead to impairment of renal function, but few biochemical metabolic studies of bilateral upper urinary tract stones have been reported. We collected clinical data from 555 patients with upper urinary tract stones admitted to Beijing Tsinghua Changgung Hospital from June 2020 to June 2024, and divided them into unilateral and bilateral stone groups by CT scans, analysed the metabolic differences between unilateral and bilateral stone groups by statistical methods, and used multifactorial logistic regression analysis to explore the risk factors that might affect the formation of bilateral stones. A total of 281 cases of unilateral and 274 cases of bilateral stones were identified. The proportion of male patients in the bilateral group was higher than that in the unilateral group (P < 0.05). The most prevalent major stone component was calcium oxalate monohydrate (48.1%), with a significantly higher prevalence of cystine stones observed in the bilateral stone group (1.8%) compared to the unilateral stone group (0.4%) (P < 0.05). Blood uric acid, blood BUN, blood creatinine, urine pH, and 24-hour urine output were higher in the bilateral stone group than in the unilateral group (P < 0.05). The most prevalent metabolic abnormality was low urine volume (45.7%). Bilateral stone group had higher proportion of patients with hyperuricemia (P < 0.05). The results of the multivariate logistic regression analysis showed that male gender (OR 1.489, 95% CI 1.028-2.157) and hyperuricemia (OR 1.662, 95% CI 1.113-2.482) were associated with an increased risk of bilateral stone formation (P < 0.05). There are significant differences in biochemical metabolism between unilateral and bilateral upper urinary tract stones. The most common metabolic abnormality in patients with urolithiasis is low urine output, and aggressive water intake is effective in preventing stone formation. For patients with hyperuricemia, a strict dietary regimen is imperative to mitigate the likelihood of bilateral stone formation.

Abdominal fat accumulation increases the risk of high blood pressure: evidence of 47,037 participants from Chinese and US national population surveys

AIMS

This study aims to ascertain whether abdominal fat accumulation evaluated by waist circumference increases the risk of hypertension using the nationwide population.

METHODS

We enrolled 47,037 participants from the China Health and Nutrition Survey (CHNS), China Health and Retirement Longitudinal Study (CHARLS), and National Health, and Nutrition Examination Survey (NHANES). The adjusted logistic regression model was used to examine the relationship between waist circumference and prevalent hypertension. 9445 participants without baseline hypertension from the CHNS and CHARLS were followed up to investigate the association between waist circumference and onset hypertension. The association was evaluated using a Cox regression model and restricted cubic spline. Furthermore, Mendelian randomization was employed to explore causal inferences.

RESULTS

In the baseline survey, waist circumference demonstrated a notable correlation with hypertension, presenting an odds ratio (with 95% confidence intervals) of 1.34 (1.28 ~ 1.40). After a mean follow-up of 3.8 years for participants without baseline hypertension, 2,592 (27.5%) developed hypertension. In the pooled analysis, the Cox regression showed that every 10 cm increase in waist circumference was associated with 20% (95% CI: 13% ~ 27%) elevated risk of new-onset hypertension. Restricted cubic splines indicated a pronounced linear dose-response relationship. A subgroup analysis affirmed the persisting association between waist circumference and hypertension onset even in those with normal BMI. The Mendelian randomization method revealed a significant causative association between waist circumference and hypertension.

CONCLUSION

Elevated waist circumference stands as an independent risk factor for hypertension, even in those with normal BMI. Our results provide evidence supporting the routine measure for waist circumference.

May Measurement Month 2022: results from the global blood pressure screening campaign

INTRODUCTION

Elevated blood pressure (BP) is the major contributor to mortality and disease burden worldwide. May Measurement Month (MMM) is a global BP screening campaign, which aims to raise awareness of BP measurement and provide evidence to inform and influence related health policy.

METHODS

This cross-sectional survey included individuals aged≥18 years recruited through opportunistic sampling at sites in 60 countries during MMM 2022. Each participant had three sitting BP measurements and a questionnaire was completed including demographics, comorbidities and lifestyle factors. Hypertension was defined as a systolic BP≥140 mm Hg and/or a diastolic BP≥90 mm Hg (average of the second and third readings) or taking antihypertensive medication. Multiple imputation was used to estimate BP readings where any participant's BP readings were missing. Linear mixed effects models were used to identify associations between participant characteristics and systolic or diastolic BP.

RESULTS

Of the 715 518 participants surveyed (excluding 50 200 self-measured home BP screenees recruited via the ZOE Health Study app), 257 421 (36.0%) were identified as hypertensive, of whom 57.6% were aware and 49.3% were on antihypertensive medication. Of all participants with hypertension, 26.1% were controlled to <140/90 mm Hg and 12.0% to <130/80 mm Hg. Of those taking antihypertensive medication, 52.7% were taking only one drug class, 52.9% were controlled to <140/90 mm Hg and 24.4% to 130/80 mm Hg. In total, 190 314 (26.6% of total surveyed, 73.9% of hypertensives) participants screened were found to have untreated or inadequately treated hypertension. Only 27.6% of treated hypertensive participants were taking a statin. Substantial coexistence of diabetes, overweight and hypertension was apparent among participants.

CONCLUSIONS

MMM confirms a high global burden of hypertension with low rates of awareness, treatment and control. In the absence of systematic BP screening in many countries, the results from MMM underscore the continued need for BP screening to detect and thereby control raised BP.

Association of vitamin D and bisphenol A levels with cardiovascular risk in an elderly Italian population: results from the InCHIANTI study

Few studies have evaluated the association between circulating levels of 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), and the endocrine disruptor bisphenol A (BPA), with risk of cardiovascular (CV) disease in elderly individuals. This was a cross-sectional study in a subgroup of elderly people from the InCHIANTI Biobank in Italy. We examined the association between circulating serum vitamin D metabolites, 1,25(OH)2D, 25(OH)D, and the endocrine disrupting agent BPA, with an arbitrary CV risk score and the European Society of Cardiology-based 10-year CV risk (SCORE2/SCORE2-OP) using univariate and multiple regression. In 299 individuals, blood samples were tested for serum values of 25(OH)D, 1,25(OH)2D and urinary BPA levels. One hundred eighty individuals (60.2%) were deficient (< 20 ng/ml) in 25(OH)D. Levels of 25(OH)D and 1,25(OH)2D were negatively correlated with CV risk score (p < 0.0001 for both) as well as SCORE2/SCORE2-OP (p < 0.0001 for both) while BPA levels were positively correlated with both CV risk scores (p < 0.0001 for both). In a logistic regression model, male gender (odds ratio; OR: 2.1, 95% CI:1.1-3.8, p = 0.022), obesity (OR:2.8, 95% CI:1.2-6.5, p = 0.016) and BPA levels ≥ 110 ng/dl (OR:20.9, 95% CI:9.4-46.8, p < 0.0001) were associated with deficient levels of 25(OH)D. 1,25(OH)2D levels < 41 ng/dl and 25(OH)D levels < 20 ng/ml were associated with CV risk score ≥ 3 (OR: 4.16, 95% CI: 2.32-7.4, p < 0.0001 and OR: 1.86, 95% CI: 1.02-3.39, p = 0.044) respectively and 1,25(OH)2D levels < 41 ng/dl were associated with SCORE2/SCORE2-OP of ≥ 20% (OR:2.98, 95% CI: 1.7-5.2, p = 0.0001). In this cross-sectional analysis, BPA exposure was associated with significantly reduced levels of vitamin D that in turn were significantly associated with increased CV risk.

The association between serum folate and elderly diastolic hypertension: results from the NHANES (2007-2018)

AIM

To explore the association between serum folate concentration and the prevalence of elderly diastolic hypertension. This study aims to identify potential relationships that could inform further research into the mechanisms underlying hypertension management.

METHODS

Data from six NHANES cycles (2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016, and 2017-2018) were analysed for individuals aged over 60. Weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and restricted cubic spline (RCS) regression explored the serum folate concentration and elderly diastolic hypertension relationship.

RESULTS

This study included 9,419 participants (4,734 females and 4,685 males) with a mean age of 70.0 ± 7.0 years. Among them, 360 were diagnosed with diastolic hypertension. In the fully adjusted model, there was a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (OR 0.65; 95% CI: 0.52-0.82). When serum folate concentration levels were divided into quartiles (in μg/dL), the ORs for diastolic hypertension corresponding to Q2 (1.29-1.98), Q3 (1.99-3.08), and Q4 (3.09-5.56) levels compared to Q1 (0.18-1.28) were 1.41 (95% CI: 0.60-3.33), 0.48(95% CI: 0.20-1.16), and 0.35 (95% CI: 0.16-0.74), respectively, with a P for trend <.05. Restricted cubic spline plots showed a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (non-linearity: p = .495). Subgroup analysis indicated that the negative correlation between serum folate concentration and the prevalence of diastolic hypertension was more significant in female participants (interaction p = .009).

CONCLUSION

Higher serum folate concentration is associated with a lower prevalence of diastolic hypertension in the elderly.

Guidelines-based therapeutic strategies for controlling hypertension in non-controlled hypertensive patients followed by family physicians in primary health care in Portugal: the GPHT-PT study

PURPOSE

In a prospective open study, with intervention, conducted in Primary Health Care Units by General Practitioners (GPs) in Portugal, the effectiveness of a single pill of candesartan/amlodipine (ARB/amlodipine), as the only anti-hypertension (anti-HTN) medication, in adult patients with uncontrolled HTN (BP > 140/or > 90 mm Hg), either previously being treated with anti-HTN monotherapies (Group I), or combinations with hydrochlorothiazide (HCTZ) (Group II), or not receiving medication at all (Group III), was evaluated across 12-weeks after implementation of the new therapeutic measure.

MATERIALS AND METHODS

A total of 118 GPs recruited patients with uncontrolled HTN who met inclusion/exclusion criteria. Participants were assigned, according to severity, one of 3 (morning) fixed combination candesartan/amlodipine dosage (8/5 or 16/5 or 16/10 mg/day) and longitudinally evaluated in 3 visits (v0, v6 and v12 weeks). Office blood pressure was measured in each visit, and control of HTN was defined per guidelines (BP< 140/90 mmHg).

RESULTS

Of the 1234 patients approached, 752 (age 61 ± 10 years, 52% women) participated in the study and were assigned to groups according to previous treatment conditions. The 3 groups exhibited a statistically significant increased control of blood pressure after receiving the fixed combination candesartan/amlodipine dosage. The overall proportion of controlled HTN participants increased from 0,8% at v0 to 82% at v12. The mean arterial blood pressure values decreased from SBP= 159.0 (± 13.0) and DBP= 91.1 (± 9.6) at baseline to SBP= 132,1 (± 11.3) and DBP= 77,5 (± 8.8) at 12 weeks (p < 0.01). Results remained consistent when controlling for age and sex.

CONCLUSION

In patients with uncontrolled HTN, therapeutic measures in accordance with guidelines, with a fixed combination candesartan/amlodipine, allowed to overall achieve HTN control at 12 weeks in 82% of previously uncontrolled HTN patients, reinforcing the advantages of these strategies in primary clinical practice.

The Western and Chinese exercise training for blood pressure reduction among hypertensive patients: An overview of systematic reviews

Hypertension remains the world's leading cause of premature death. Interventions such as exercise, diet modification, and pharmacological therapy remain the mainstay of hypertension treatment. Numerous systematic reviews and meta-analyses demonstrated the effectiveness of western exercises, such as aerobic exercise and resistance exercise, in reducing blood pressure in hypertensive patients. There is recently emerging evidence of blood pressure reduction with Chinese exercises, such as Tai Chi, Baduanjin, and Qigong. The current overview of systematic reviews aims to evaluate the quality and descriptively summarize the evidence for the effectiveness of western and Chinese exercises for hypertension management. Thirty-nine systematic reviews were included in this overview, with 15 of those being on Chinese exercise. Evidence suggests that exercise training, regardless of Western or Chinese exercise, generally reduced both systolic and diastolic blood pressure. High-intensity intermittent training did not further reduce blood pressure when compared to moderate-intensity continuous training. Conflicting results on the effectiveness of blood pressure reduction when comparing Chinese and Western exercise training were observed. This suggests the comparable effectiveness of Chinese exercise training, in particularly Tai Chi, to general or aerobic exercise training in terms of blood pressure reduction. The Chinese exercise modality and intensity may be more suitable for the middle-aged and elderly population.

Effects of dynamic, isometric, and combined resistance training on ambulatory blood pressure in treated men with hypertension: a randomized controlled trial

Ambulatory blood pressure (ABP) monitoring is a widespread recommendation for the diagnosis and management of hypertension. Dynamic resistance training (DRT) and isometric handgrip training (IHT) have been recommended for hypertension treatment, but their effects on ABP have been poorly studied. Additionally, combined dynamic and isometric handgrip resistance training (CRT) could produce an additive effect that has yet to be tested. Thus, this randomized controlled trial was designed to evaluate the effects of DRT, IHT and CRT on mean ABP and ABP variability. Fifty-nine treated men with hypertension were randomly allocated to 1 of four groups: DRT (8 dynamic resistance exercises, 50% of 1RM, 3 sets until moderate fatigue), IHT (4 sets of 2 min of isometric handgrip at 30% of MVC), CRT (DRT + IHT) and control (CON - 30 min of stretching). Interventions occurred 3 times/week for 10 weeks, and ABP was assessed before and after the interventions. ANOVAs and ANCOVAs adjusted for pre-intervention values were employed for analysis. Mean 24-h, awake and asleep BPs did not change in either group throughout the study (all, P > 0.05). Nocturnal BP fall as well as the standard deviation, coefficient of variation and the average real variability of ABP also did not change significantly in either group (all, P < 0.05). Changes in all these parameters adjusted to the pre-intervention values were also similar among the four groups (all, p > 0.05). In treated men with hypertension, 10 weeks of DRT, IHT or CRT does not decrease ABP levels nor change ABP variability.

A cascade of care for diabetes in people living with HIV in a tertiary care center in Mexico City

BACKGROUND

Diabetes affects 4.5% of people living with HIV in Mexico. This study aims to describe the diabetes cascade of care (DMC) in people with HIV in a tertiary center in Mexico City.

METHODS

We conducted a single-center review of people with HIV aged over 18, using medical records of active people enrolled at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) HIV Clinic (HIVC). Our analysis focused on their last visit to describe the DMC, aiming to identify gaps in control goals. We included people who had a consultation within the 12 months preceding May 2020.

RESULTS

Out of the 2072 active people, medical records were available for 2050 (98.9%). Among these, 326 people (15.9%) had fasting glucose (FG) abnormalities, of which 133 (40.7%) had diabetes. The prevalence of diabetes among people with HIV was of 6.4% (133/2050). Regarding the DMC, the following proportions of people achieved control goals: 133/133 (100%) received medical care in the last 12 months, 123/123 (100%) had blood pressure (BP) <140/90 mmHg, 73/132 (55.3%) had LDL cholesterol (c-LDL) <100 mg/dl, 63/132 (47.7%) had FG <130 mg/dl, 50/116 (43.1%) had glycosylated hemoglobin (HbA1c) <7%. ABC goals (HbA1c <7%, c-LDL <100 mg/dl, BP <140/90 mmHg) were met in 28/109 (25.6%) people. 126/133 (94%) people with HIV achieved HIV-viral load <50 copies/mL.

CONCLUSIONS

Despite the high rate of viral suppression among people with HIV and diabetes, significant challenges remain in achieving comprehensive diabetes control. These findings highlight the need for targeted interventions to improve metabolic outcomes and the overall management of diabetes in people with HIV.

Translation, transcultural adaptation, and validation of the Brazilian Portuguese version of the general medication adherence scale (GMAS) in patients with high blood pressure

Objective

To validate the General Medication Adherence Scale (GMAS) in Brazilian Portuguese for hypertensive patients.

Methods

The GMAS-English was translated into Brazilian Portuguese and adapted for cultural appropriateness by a translation process and expert panel. A cross-sectional study was conducted in northeast Brazilian cardiology divisions of public and private hospitals, interviewing hypertensive patients. Reliability was assessed using Cronbach's alpha, intraclass correlation, and Pearson's correlation. Convergent validity was tested against the BMQ using chi-square. Criterion validity was assessed by comparing GMAS with blood pressure control using chi-square.

Results

The GMAS was translated and adapted according to standard procedures. In a validation study with 167 hypertensive patients, Cronbach's alpha was 0.79, and Pearson's correlation showed significant test-retest reliability (p < 0.001). Convergent validity with BMQ was significant (p < 0.001), with 89.4 % sensitivity for behaviors considered adherent (High adherence and good adherence), but between the strata that measure low adherence (Partial adherence, low adherence and very low adherence), the specificity rate was 50 %. Criterion validity between GMAS and blood pressure control was not observed.

Conclusion

The Brazilian Portuguese version of the GMAS exhibited good consistency and reproducibility, modest agreement with BMQ scale and did not demonstrate acceptable criterion validity for hypertensive patients.

Ambulatory blood pressure monitoring profiles in Asia

High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.

Development of a predictive model for the risk of microalbuminuria: comparison of 2 machine learning algorithms

Purpose

To identify the independent risk variables that contribute to the emergence of microalbuminuria(MAU) in type 2 diabetes mellitus(T2DM), to develop two different prediction models, and to show the order of importance of the factors in the better prediction model combined with a SHAP(Shapley Additive exPlanations) plot.

Methods

Retrospective analysis of data from 981 patients with T2DM from March 2021 to March 2023. This dataset included socio-demographic characteristics, disease attributes, and clinical biochemical indicators. After preprocessing and variable screening, the dataset was randomly divided into training and testing sets at a 7:3 ratio. To address class imbalance, the Synthetic Minority Oversampling Technique (SMOTE) was applied to balance the training set. Subsequently, prediction models for MAU were constructed using two algorithms: Random Forest and BP neural network. The performance of these models was evaluated using k-fold cross-validation (k = 5), and metrics such as the area under the ROC curve (AUC), accuracy, precision, recall, specificity, and F1 score were utilized for assessment.

Results

The final variables selected through multifactorial logistic regression analysis were age, BMI, stroke, diabetic retinopathy(DR), diabetic peripheral vascular disease (DPVD), 25 hydroxyvitamin D (25(OH)D), LDL cholesterol, neutrophil-to-lymphocyte ratio (NLR), and glycated haemoglobin (HbA1c) were used to construct the risk prediction models of Random Forest and BP neural network, respectively, and the Random Forest model demonstrated superior overall performance (AUC = 0.87, Accuracy = 0.80, Precision = 0.79, Recall = 0.84, Specificity = 0.76, F1 Score = 0.81). The SHAP feature matrix plot revealed that HbA1c, NLR, and 25(OH)D were the three most significant factors in predicting the development of MAU in T2DM, with 25(OH)D acting as an independent protective factor.

Conclusion

Effective identification of MAU in T2DM, therapeutic strategies for controllable high-risk factors, and prevention or delay of diabetic kidney disease(DKD) can all be achieved with the help of the risk prediction model developed in this study.

Light-chain proximal tubulopathy: a retrospective study from a single Chinese nephrology referral center

Background: Light-chain proximal tubulopathy (LCPT) is a rare disease characterized by the accumulation of monoclonal light chains within proximal tubular cells. This study aimed to investigate the clinical characteristics of LCPT from a single Chinese nephrology referral center.Methods: Patients with kidney biopsy-proven isolated LCPT between 2016 and 2022 at Peking University First Hospital were retrospectively included. Clinical data, kidney pathological type, treatment, and prognosis were analyzed.Results: Nineteen patients were enrolled, the mean age at diagnosis was 57 ± 11 and the sex ratio was 6/13 (female/male). Mean proteinuria was 2.44 ± 1.89 g/24 hr and the mean estimated glomerular filtration rate (eGFR) at the point of biopsy was 59.640 ± 27.449 ml/min/1.73 m2. κ-restriction (84%) was dominant among LCPTs. An abnormal free light chain ratio was observed in 86% of the patients. Proximal tubulopathy with cytoplasmic inclusions accounted for the majority (53%), followed by tubulopathy associated with interstitial inflammation reaction (26%), proximal tubulopathy without cytoplasmic inclusions (16%), and proximal tubulopathy with lysosomal indigestion/constipation (5%). One patient presented with acute kidney injury and 16 patients presented with chronic kidney disease. Regarding follow-up, patients received bortezomib-based or R-CHOP chemotherapy or supportive treatment only. The mean follow-up time was 22 ± 16 months, and the mean eGFR was 63.098 ± 27.439 ml/min/1.73 m2 at the end of follow-up. These patients showed improved or stable kidney function.Conclusions: This is the first case series report of LCPT in four different pathological types in northern China. Clone-targeted chemotherapy may help preserve the kidney function in these patients.

Outpatient management of essential hypertension: a review based on the latest clinical guidelines

Background: Essential hypertension, a prevalent cardiovascular condition, poses a significant health burden worldwide. Based on the latest American clinical guidelines, half of adults in the United States have hypertension. Of these, only about a half are treated and about a quarter are adequately controlled for hypertension. Given its impact on morbidity and mortality, ensuring effective management of high blood pressure is crucial to reduce associated risks and improve patient outcomes.Objective: This review aims to provide a comprehensive and up-to-date summary of the latest cardiology guidelines and evidence-based research on essential hypertension, with a focus on guiding outpatient clinical practice.Methods: The review evaluates both non-pharmacological approaches and pharmacological interventions to offer clinicians practical insights. Notably, it emphasizes the importance of individualized treatment plans tailored to patients' specific risk profiles and comorbidities.Results: By consolidating the latest advancements in hypertension management, this review provides clinicians with an up-to-date reference, offering a nuanced understanding of treatment goals and strategies.Conclusion: Through the incorporation of evidence-based recommendations, healthcare practitioners can optimize patient care, mitigate potential complications, and improve overall outcomes in essential hypertension.

The development of Africa's first unified hypertension management guidelines

Hypertension is a leading cardiovascular risk factor, contributing significantly to morbidity and mortality in Africa. The continent is plagued with a high incidence, coupled with low treatment and control rates. The causes are multifactorial, and among the major causes is an absence of standardized African guidelines for the management of hypertension. Systems of care vary across the continent, with low-income countries having less care than middle-income countries. International guidelines include recommendations for Black populations, but do not account for the cultural and sociodemographic situation of the African. There is therefore the need for African guidelines based on local data to improve the quality of hypertension care. These guidelines will cover the clinical approach to hypertension and its complications at facilities with physicians and nonphysician health workers (NPHW). It will also proffer suggestions for policies to improve the care for patients with hypertension on the continent.

Gene editing of angiotensin for blood pressure management

Arterial hypertension has remained the world's leading cause of morbidity and mortality for more than 20 years. While early Genome-Wide Association Studies raised the hypothesis that a precision medicine approach could be implemented in the treatment of hypertension, the large number of single nucleotide polymorphisms that were found to be associated with blood pressure and their limited impact on the blood pressure values have initially hampered these expectations. With the development and refinement of gene-editing and RNA-based approaches allowing selective and organ-specific modulation of critical systems involved in blood pressure regulation, a renewed interest in genetic treatments for hypertension has emerged. The CRISPR-Cas9 system, antisense oligonucleotides (ASO) and small interfering RNA (siRNA) have been used to specifically target the hepatic angiotensinogen (AGT) production, with the scope of safely but effectively reducing the activation of the renin-angiotensin system, ultimately leading to an effective reduction of the blood pressure with extremely simplified treatment regimens that involve weekly, monthly or even once-in-life injection of the drugs. Among the various approaches, siRNA and ASO that reduce hepatic AGT production are in advanced development, with phase I and II clinical trials showing their safety and effectiveness. In the current manuscript, we review the mode of action of these new approaches to hypertension treatment, discussing the results of the clinical trials and their potential to revolutionize the management of hypertension.

Effect of transcutaneous electrical acupoint stimulation at different frequencies on mild hypertension: A randomized controlled trial

BACKGROUND

Transcutaneous electrical acupoint stimulation (TEAS) may contribute to blood pressure (BP) control, but the evidence remains insufficient. Our objectives were to evaluate the impact of TEAS on hypertension and determine the optimal frequency.

METHODS

A total of 120 hypertensive patients were randomly allocated to the TEAS-2Hz group, TEAS-10Hz group, or usual care control group in a 1:1:1 ratio. All patients were advised to continue their usual antihypertensive regimen. Additionally, patients in the TEAS groups received TEAS therapy 3 times per week for 4 weeks, with a 4-week follow-up.

RESULTS

The primary outcome was the change in systolic BP (SBP) from baseline to week 4. Secondary outcomes included changes in diastolic BP (DBP), mean arterial pressure (MAP), heart rate (HR), heart rate variability (HRV), and 12-item health survey (SF-12) at different time points. Both TEAS groups showed reductions in SBP relative to control (TEAS-2Hz group vs. control, -4.70 mmHg [95 % CI, -7.00 to -2.40 mmHg]; P < 0.001; TEAS-10Hz group vs. control, -8.66 mmHg [95 % CI, -10.97 to -6.36 mmHg]; P < 0.001). TEAS-10Hz provided a significant decrease in SBP than TEAS-2Hz (-3.96 mmHg [95 % CI, -1.66 to -6.26 mmHg]; P< 0.001). TEAS groups also exhibited reductions in DBP, MAP, HR, LF/HF ratio（LF/HF）, very low frequency (VLF), and normalized low frequency (LF norm), and an increase in normalized high frequency (HF norm) than control. No differences were observed among groups in low frequency (LF), high frequency (HF), total power (TP), very low frequency (VLF), and SF-12.

CONCLUSION

TEAS might be a promising adjunctive therapy for hypertension, and the recommended frequency is 10 Hz, which should be confirmed in larger trials.