Obesity-related hypertension: epidemiology, pathophysiology, and clinical management

Chinese Visceral Adiposity Index Predict Prehypertension Progression and Regression: A Prospective Cohort Study Involving Middle-Aged and Older Adults

BACKGROUND

Limited data are published on the relationship of the Chinese visceral adiposity index (CVAI) with prehypertension progression or regression. Therefore, we investigated this association through the China Health and Retirement Longitudinal Study.

METHODS

Participants with prehypertension were assigned to two groups according to baseline CVAI, and after 4 years of follow-up, their blood pressure was analyzed for deterioration or improvement. We constructed logistic regression models for assessing the association of CVAI with the progression or regression of prehypertension. A restricted cubic spline (RCS) model was utilized for determining the dose-response association. Subgroup analysis and sensitivity analysis were also conducted.

RESULTS

The study included 2,057 participants with prehypertension. During the follow-up, 695 participants progressed to hypertension, 561 participants regressed to normotension, and 801 participants remained as prehypertensive. An association was observed between a high CVAI value and a higher incidence of progression to hypertension and between a high CVAI value and a lower incidence of regression to normotension (OR = 1.66 and 0.58, 95% CI: 1.35-2.05 and 0.47-0.73, respectively). The RCS model exhibited a linear association between CVAI and prehypertension progression and regression (all P for non-linear > 0.05). The results of the subgroup and sensitivity analyses agreed with those of the primary analysis.

CONCLUSIONS

A significant association was noted between CVAI and prehypertension progression and regression. Thus, as part of the hypertension prevention strategy, monitoring CVAI is crucial in individuals with prehypertension.

Diet to Stop Hypertension: Should Fats be Included?

PURPOSE OF REVIEW

International guidelines emphasize advice to incorporate dietary measures for the prevention and in the management of hypertension. Current data show that modest reductions in weight can have an impact on blood pressure. Reducing salt and marine oils have also shown consistent benefit in reducing blood pressure. Whether other dietary constituents, in particular the amount and type of fat that play important roles in cardiovascular prevention, influence blood pressure sufficiently to be included in the management of hypertension is less certain. In this review, we provide a summary of the most recent findings, with a focus on dietary patterns, fats and other nutrients and their impact on blood pressure and hypertension.

RECENT FINDINGS

Since reducing salt consumption is an established recommendation only corollary dietary advice is subject to the current review. Population studies that have included reliable evaluation of fat intake have indicated almost consistently blood pressure lowering with consumption of marine oils and fats. Results with vegetable oils are inconclusive. However dietary patterns that included total fat reduction and changes in the nature of vegetable fats/oils have suggested beneficial effects on blood pressure. Plant-based foods, dairy foods and yoghurt particularly, may also lower blood pressure irrespective of fat content. Total fat consumption is not directly associated with blood pressure except when it is part of a weight loss diet. Consumption of marine oils has mostly shown moderate blood pressure lowering and possibly greatest effect with docosahexaenoic acid-rich oil.

Associations Between Obesity-Related Gene MC4R rs17782313 Locus Polymorphism and Components of Metabolic Syndrome: A Systematic Review and Meta-Analysis

Objective: It is well established that melanocortin-4 receptor (MC4R) rs17782313 locus polymorphism is associated with increased obesity risk and that obesity is strongly associated with an enhanced risk of all metabolic syndrome (MS) components. Thus, in this study, we examined the association between the MC4R rs17782313 locus polymorphism and the risk of the remaining MS components, namely, diabetes, hypertension, low high-density lipoprotein (HDL), and hypertriglyceridemia. Methods: We performed an extensive literature screening across six scientific databases, namely, PubMed, Embase, Web of Science, Medline, ScienceDirect, CNKI, and WanFang employing a specific search strategy. Eligible studies were selected for inclusion in our meta-analysis, and odds ratio (OR) values and 95% confidence interval (CI) were computed through fixed- or random-effects models to examine correlation strength. In addition, we performed subgroup analyses involving adjustment factors (unadjusted body mass index [BMI], adjusted BMI), race (Caucasian, Asian), and source of controls (population, hospital). Results: Twenty-two eligible studies were selected from 846 articles, involving 28,018 patients and 98,994 normal participants. Based on this meta-analysis, the MC4R rs17782313 locus polymorphism was associated with an augmented risk of diabetes (allele contrast model T vs. C: OR = 1.05, 95% CI = 1.03-1.08; dominant model TT vs. TC + CC: OR = 1.07, 95% CI = 1.03-1.11) and hypertension (dominant model TT vs. TC + CC: OR = 1.16, 95% CI = 1.03-1.31) risk. However, based on this analysis, the MC4R rs17782313 locus polymorphism was not associated with low HDL and hypertriglyceridemia risk. Conclusions: Based on this analysis, the MC4R rs17782313 locus polymorphism is associated with enhanced risks of diabetes and hypertension, while the associations with low HDL and hypertriglyceridemia require further exploration.

Anthropometric markers and their cut-off point for the prediction of hypertension with lifestyle as a risk factor among Chiru tribe of North East India

BACKGROUND

The increased prevalence of obesity, particularly central obesity, is closely associated with many metabolic complexions, including hypertension and diabetes.

OBJECTIVES

The present study investigates the cut-off points of some anthropometric measurements such as body mass index [BMI (kg/m2)], waist circumference [WC (cm)], waist-hip ratio (WHR), and waist-height ratio (WHtR) associated with high blood pressure. It determines the risk factors among the Chiru tribe of North East India.

METHODS

The cross-sectional study was conducted in four villages in the hilly districts of Manipur. For the present study, 416 Chiru adults (209 males and 207 females) aged 20-79 years were included. Anthropometrics and blood pressure were measured using standard procedures. Statistical methods such as chi-square, Pearson correlation, and multivariate logistic regression were employed.

RESULTS

The result indicates that the cut-off values to detect hypertension were 21.83 for BMI, 82.55 for WC, 0.92 for WHR, and 0.53 for WHtR. However, the cut-off values to detect hypertension in females were 23.92 for BMI, 86.48 for WC, 0.94 for WHR, and 0.55 for WHtR. Multivariate logistic regression analysis indicated that hypertension was an independently associated risk factor in both males and females with an age ≥ 50 years (OR = 18.52 and 10.12), physical activity (OR = 0.10 and 0.21), salt intake (OR = 7.81 and 3.36), and smoking (OR = 2.56 and 3.23), respectively.

CONCLUSION

It has been concluded that BMI, WC, WHR, and WHtR values can determine hypertension risk in the Chiru population. Age, smoking, physical activity, and salt intake were independent risk factors associated with high blood pressure.

Heterogeneity of aging and mortality risk among individuals with hypertension: Insights from phenotypic age and phenotypic age acceleration

OBJECTIVES

Hypertension, a key contributor to mortality, is impacted by biological aging. We investigated the relationship between novel biological aging metrics - Phenotypic Age (PA) and Phenotypic Age Acceleration (PAA) - and mortality in individuals with hypertension, exploring the mediating effects of arterial stiffness (estimated Pulse Wave Velocity, ePWV), and Heart/Vascular Age (HVA).

METHODS

Using data from 62,160 National Health and Nutrition Examination Survey (NHANES) participants (1999-2010), we selected 4,228 individuals with hypertension and computed PA, PAA, HVA, and ePWV. Weighted, multivariable Cox regression analysis yielded Hazard Ratios (HRs) relating PA, PAA to mortality, and mediation roles of ePWV, PAA, HVA were evaluated. Mendelian randomization (MR) analysis was employed to investigate causality between genetically inferred PAA and hypertension.

RESULTS

Over a 12-year median follow-up, PA and PAA were tied to increased mortality risks in individuals with hypertension. All-cause mortality hazard ratios per 10-year PA and PAA increments were 1.96 (95% CI, 1.81-2.11) and 1.67 (95% CI, 1.52-1.85), respectively. Cardiovascular mortality HRs were 2.32 (95% CI, 1.97-2.73) and 1.93 (95% CI, 1.65-2.26) for PA and PAA, respectively. ePWV, PAA, and HVA mediated 42%, 30.3%, and 6.9% of PA's impact on mortality, respectively. Mendelian randomization highlighted a causal link between PAA genetics and hypertension (OR = 1.002; 95% CI, 1.000-1.003).

CONCLUSION

PA and PAA, enhancing cardiovascular risk scores by integrating diverse biomarkers, offer vital insights for aging and mortality evaluation in individuals with hypertension, suggesting avenues for intensified aging mitigation and cardiovascular issue prevention. Validations in varied populations and explorations of underlying mechanisms are warranted.

Sex-related association of modifiable risk factors with hypertension: A national cross-sectional study of NHANES 2007-2018

OBJECTIVE

Sex difference is commonly observed in hypertension. We aimed to assess sex differences in the associations of modifiable lifestyle and metabolic risk factors with risk of hypertension.

DESIGN

National cross-sectional population study.

SETTING

Data from the 2007 to 2018 National Health and Nutrition Examination Survey.

PARTICIPANTS

7087 adults aged ≥30 years without a prior history of hypertension.

PRIMARY AND SECONDARY OUTCOME MEASURES

Odds ratios and population attributable fraction (PAF) of hypertension associated with 10 modifiable risk factors: five lifestyle risk factors (current smoking, excess alcohol intake, poor diet, physical inactivity, and unhealthy sleep), and five metabolic risk factors (obesity, diabetes, dyslipidaemia, hyperuricemia, and chronic kidney disease) in women versus men.

RESULTS

Compared with women, men had 84% increased risk of prevalence of hypertension. The sex difference in risk for hypertension is more evident in those aged <60 years (p for interaction <.001). For those aged <60 years the combination of lifestyle risk factors accounted for a PAF of 27.2% in men and 48.8% in women, and the combination of metabolic risk factors accounted for a PAF similarly in men (37.4%) and women (38.2%). For those aged ≥60 years, the PAF of lifestyle risk factors was similar between men and women and the metabolic risk factors accounted for a greater proportion in women (33.0% vs. 14.5% in men).

CONCLUSIONS

Sex differences may exist in the relation and attribution of lifestyle and metabolic risk factors to hypertension, which may have implications for implementing sex-specific strategies to prevent hypertension.

Predictors of Cardiac Autonomic Dysfunction in Obesity-Related Hypertension

INTRODUCTION

Cardiac Autonomic Dysfunction (CAD) is an overlooked cardiovascular risk factor in individuals with obesity-related hypertension. Despite its clinical significance, there is a notable lack of clarity regarding the pathophysiological correlates involved in its onset and progression.

AIM

The present study aimed to identify potential predictors of CAD in obesity-related hypertension.

METHODS

A total of 72 participants (34 men and 38 women) were enrolled. Comprehensive evaluations were conducted, including cardiac autonomic function assessments, body composition estimation and biochemical analysis. Participants were categorized as CAD-positive or CAD-negative based on Ewing's criteria for autonomic dysfunction. Univariate logistic regression analysis was performed to identify potential predictors for CAD. Multivariate logistic regression models were further constructed by adjusting clinically relevant covariates to identify independent predictors of CAD.

RESULTS

Multivariate logistic regression analysis revealed that resting heart rate (HRrest), (odds ratio, confidence interval: 0.85, 0.78-0.93; p = 0.001) and percentage body fat (BF%), (odds ratio, confidence interval: 0.78, 0.64-0.96; p = 0.018) were significant independent predictors of CAD. Receiver Operating Characteristic curve analysis depicted optimal cut-off values for HRrest and BF% as > 74.1 bpm and > 33.6%, respectively. Multicolinearity analysis showed variance inflation factors (VIF) below the cautionary threshold of 3.

CONCLUSIONS

The HRrest and BF% emerged as significant independent predictors of CAD in obesity-related hypertension. Therapeutic strategies should target HRrest < 74.1 bpm and BF% < 33.6% to mitigate CAD risk in this population. Future trials are required to establish causal relationships and may consider additional confounding variables in obesity-related hypertension.

Obesity does not alter vascular function and handgrip exercise hemodynamics in middle-aged patients with hypertension

Lifestyle modification including exercise training is often the first line of defense in the treatment of obesity and hypertension (HTN), however, little is known regarding how these potentially compounding disease states impact vasodilatory and hemodynamic responses at baseline and exercise. Therefore, this study sought to compare the impact of obesity on vascular function and hemodynamics at baseline and during handgrip (HG) exercise among individuals with HTN. Non-obese (13M/7F, 56 ± 16 yr, 25 ± 4 kg/m2) and obese (17M/4F, 50 ± 7 yr, 35 ± 4 kg/m2) middle-aged individuals with HTN forwent antihypertensive medication use for ≥2 wk before assessment of vascular function by brachial artery flow-mediated dilation (FMD) and exercise hemodynamics during progressive HG exercise at 15-30-45% maximal voluntary contraction (MVC). FMD was not different between Non-Obese (4.1 ± 1.7%) and Obese (5.2 ± 1.9%, P = 0.11). Systolic blood pressure (SBP) was elevated by ∼15% during the supine baseline and during HG exercise in the obese group. The blood flow response to HG exercise at 30% and 45% MVC was ∼20% greater (P < 0.05) in the obese group but not different after normalizing for the higher, albeit, nonsignificant differences in workloads (MVC: obese: 24 ± 5 kg, non-obese: 21 ± 5 kg, P = 0.11). Vascular conductance and the brachial artery shear-induced vasodilatory response during HG were not different between groups (P > 0.05). Taken together, despite elevated SBP during HG exercise, obesity does not lead to additional impairments in vascular function and peripheral exercising hemodynamics in patients with HTN. Obesity may not be a contraindication when prescribing exercise for the treatment of HTN among middle-aged adults, however, the elevated SBP should be appropriately monitored.NEW & NOTEWORTHY This study examined vascular function and handgrip exercise hemodynamics in obese and nonobese individuals with hypertension. Obesity, when combined with hypertension, was neither associated with additional vascular function impairments at baseline nor peripheral hemodynamics and vasodilation during exercise compared with nonobese hypertension. Interestingly, systolic blood pressure and pulse pressure were greater in the obese group during supine baseline and exercise. These findings should not be ignored and may be particularly important for rehabilitation strategies.

Childhood Obesity: Insight into Kidney Involvement

This review examines the impact of childhood obesity on the kidney from an epidemiological, pathogenetic, clinical, and pathological perspective, with the aim of providing pediatricians and nephrologists with the most current data on this topic. The prevalence of childhood obesity and chronic kidney disease (CKD) is steadily increasing worldwide, reaching epidemic proportions. While the impact of obesity in children with CKD is less pronounced than in adults, recent studies suggest a similar trend in the child population. This is likely due to the significant association between obesity and the two leading causes of end-stage renal disease (ESRD): diabetes mellitus (DM) and hypertension. Obesity is a complex, systemic disease that reflects interactions between environmental and genetic factors. A key mechanism of kidney damage is related to metabolic syndrome and insulin resistance. Therefore, we can speculate about an adipose tissue-kidney axis in which neurohormonal and immunological mechanisms exacerbate complications resulting from obesity. Adipose tissue, now recognized as an endocrine organ, secretes cytokines called adipokines that may induce adaptive or maladaptive responses in renal cells, leading to kidney fibrosis. The impact of obesity on kidney transplant-related outcomes for both donors and recipients is also significant, making stringent preventive measures critical in the pre- and post-transplant phases. The challenge lies in identifying renal involvement as early as possible, as it is often completely asymptomatic and not detectable through common markers of kidney function. Ongoing research into innovative technologies, such as proteomics and metabolomics, aims to identify new biomarkers and is constantly evolving. Many aspects of pediatric disease progression in the population of children with obesity still require clarification. However, the latest scientific evidence in the field of nephrology offers glimpses into various new perspectives, such as genetic factors, comorbidities, and novel biomarkers. Investigating these aspects early could potentially improve the prognosis of these young patients through new diagnostic and therapeutic strategies. Hence, the aim of this review is to provide a comprehensive exploration of the pathogenetic mechanisms and prevalent pathological patterns of kidney damage observed in children with obesity.

Prevalence of Elevated Blood Pressure and Its Relationship With Anthropometric Risk Factors in Students of a Pre-university Girls' College in Bangalore: A Cross-Sectional Study

Background There is a growing concern regarding elevated blood pressure in adolescence. Children and adolescents with high blood pressure are at risk for adult hypertension. Being overweight and obese are important risk factors for hypertension. This study aimed to determine the prevalence of elevated blood pressure and its association with anthropometric risk factors among students of a pre-university girls' college. Methodology A cross-sectional study was conducted among 337 students at a pre-university girls' college aged 15-19 years in urban Bangalore. A self-administered, semi-structured, pretested questionnaire collected the sociodemographic details, family history, and lifestyle. Height, weight, waist circumference (WC), and hip circumference were measured. Standard cut-off levels were used for body mass index (BMI), WC, waist-hip ratio (WHR), and waist-height ratio (WHtR). Resting blood pressure was determined using a digital blood pressure monitor. It was classified into normotensive, pre-hypertension (>90th to <95th percentile), and hypertension (>95th percentile). Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Pre-hypertension and hypertension were considered as having elevated blood pressure. Results The prevalence of pre-hypertension and hypertension was 21.4% (n = 72, 95% confidence interval (CI) = 17.0-25.7) and 9.8% (n = 33, 95% CI = 6.6-13.0), respectively. The prevalence of overweight was 20.2% (n = 68, 95% CI = 15.9-24.5) and obesity was 12.2% (n = 41, 95% CI = 8.7-15.7). WC, WHR, and WHtR were abnormal in 34.7% (n = 117, 95% CI = 29.6-39.8), 47.5% (n = 160, 95% CI = 42.1-52.8), and 45.7% (n = 154, 95% CI = 50.4-51.0), respectively. There was a statistically significant correlation between systolic blood pressure and BMI (p < 0.001), WC (p < 0.001), and WHtR (p < 0.001), as well as diastolic blood pressure and BMI (p < 0.001), WC (p = 0.008), and WHtR (p = 0.011). Statistically significant differences in mean BMI (p = 0.004), WC (p < 0.001), WHR (p = 0.007), and WHtR (p = 0.001) between normal, pre-hypertensive, and hypertensive students were also noted. Conclusions Pre-hypertension and hypertension are fundamental problems in pre-university girl students. With a similarly increased prevalence of obesity and other anthropometric risk factors, students must be aware of hypertension and its risk factors.

The effectiveness of interventions to reduce cardio-metabolic risk factors among regular street food consumers in Dar es Salaam, Tanzania: The pre-post findings from a cluster randomized trial (Registered by Pan African clinical trial registry with trial # PACTR202208642850935)

INTRODUCTION

The healthy plate model (HPM) is a practical guide to modulate the portion of staple food in main meals, subsequently affecting the risks associated with Non-communicable Diseases include type2 diabetes mellitus (T2DM).

OBJECTIVE

This study investigated the effectiveness of health information and the healthy plate model on cardio-metabolic risk factors, knowledge and attitude towards T2DM prevention measures.

METHODS

A pre-post analysis, as part of a cluster randomized trial with street food vendors and their customers, was implemented in three randomly selected districts in Dar es Salaam, Tanzania. Two vendor-customer clusters each with 15 and more vendors from each district were randomly assigned to receive either T2DM health information only (Intervention package1 [IP1]) or IP1 plus a subsidized meal with vegetables and fruits, following the principles of the HPM (Intervention package2 [IP2]). Within the clusters the participants were informed on the importance of the intervention they received. An intervention period lasted for three months from 1st April to 31st June 2019. We applied Generalized Linear Mixed Models and Bayesian Modelling (for sensitivity analysis) to assess the effectiveness of the interventions.

RESULTS

Overall, 336 (IP2 = 175 and IP1 = 161) out of 560 (280/arm) previous study participants participated in evaluation. Diastolic BP was lower among IP2 participants in the evaluation than baseline AβC = -4.1mmHg (95%CI:-5.42 to -2.76). After adjusting for the interaction between IP2 and age of the consumers, the BMI was significantly lower among IP2 in the evaluation than baseline AβC = -0.7kg/m2 (95%CI: -1.17 to -0.23). With interaction between IP2 and income, BMI was higher in the IP2 in the evaluation than baseline AβC = 0.73kg/m2 (95%CI: 0.08 to 1.38). Systolic and diastolic BP were significantly lower among IP1 in the evaluation than baseline AβC = -3.5mmHg (95%CI:-5.78 to -1.24) and AβC = -5.9mmHg (95%CI:-7.34 to -4.44) respectively. Both the knowledge scores and positive attitudes towards T2DM prevention measures were higher in the evaluation than baseline in both interventions arms.

CONCLUSION

The positive effects on cardio-metabolic risk factors, knowledge and attitude were observed in both intervention arms. Due to interactions between IP2, age and income; designing interventions relating to food and cardio-metabolic risk factors, should consider combining socio-economic factors.

Korean fermented soybean paste (Doenjang) has anti-obesity and anti-hypertensive effects via the renin-angiotensin system (RAS) in high-fat diet-induced obese rats

The health-beneficial outcomes of doenjang, a Korean fermented food have been questioned due to its high salt content; moreover, the detailed underlying mechanisms of its health beneficial effects are not fully investigated. Thus, this study aimed to investigate doenjang's anti-obesity effects, anti-hypertensive effects, and its underlying mechanisms in high-fat diet -induced obesity. Sprague-Dawley rats fed with normal diet (ND), high-fat diet (HD), HD with 8% additive salt (HDS), or HD with doenjang containing 8% salt (HDJ) for 13 weeks. Compared to HD and HDS groups, the HDJ group had lower body and epididymal fat tissue weight gain and showed hypotrophy and hypoplasia. The RAS-related mRNA levels in the adipose tissue, including Renin and Ace were downregulated in the HDJ group compared to HD and HDS groups. Additionally, HDJ groups had significant improvements in systolic blood pressure, serum RAS-associated parameters (e.g., angiotensin II and aldosterone), renal mRNA levels related to RAS (e.g., angiotensin II receptor type 1 and 2), and aldosterone-associated mRNA expressions (e.g., mineralocorticoid receptor) in the kidney of HD-induced obese rats. Most importantly, HDS and HDJ groups showed distinct outcomes regarding adipogenesis and electrolytes metabolism, even though both diets contain a high level of salt. HDS group showed a higher epididymal fat tissue weight, mass, and adipocyte size than HDJ group. In addition, compared with HDJ group, HDS group significantly decreased the release of Na+ and K+ throughout the urine and feces. The present study addresses that doenjang has anti-obesity effects and anti-hypertensive effects by activating RAS in the adipose tissue and kidney, respectively. Additionally, this study also demonstrates that salt in doenjang and the additive salt differently influences adipogenesis and electrolytes metabolism, supporting doenjang has health advantageous effects regardless of its high salt contents.

Effects of cardiac rehabilitation on obese hypertensive patients: A controlled trial

INTRODUCTION

The relationship between obesity and hypertension is clearly known and cardiac rehabilitation (CR) is shown as an effective treatment method in both obese and hypertensive patients. The aim of this study is to reveal the effect of CR on obese hypertensive patients by comparing them with non-obese hypertensive patients.

METHODS

Eighty eligible, volunteer participants with hypertension (SBP ≥140mmHg and/or DBP ≥90mmHg) were enrolled in this study. The patients were divided into 2 groups according to their BMI values: obese (BMI ≥30kg/m2) hypertensive patients and non-obese (BMI <30kg/m2) hypertensive patients. The CR program, in which aerobic exercise training was the main part, was performed on the patients. At the end of the 10-week CR program, the resting SBP and DBP values were measured.

RESULTS

A total of 74 patients (37 obese and 37 non-obese) completed the study. After CR significant improvements were achieved in all evaluated parameters compared to pre-CR values. When the amounts of changes before and after CR were compared, the decrease in SBP was found to be significantly higher in obese patients compared to non-obese patients (p=.003). Higher BMI was associated with more reduction in SBP (r=0.287, p=0.013).

CONCLUSIONS

Exercise-based CR effectively reduced SBP in obese and non-obese hypertensive patients. However, it was more effective in obese patients compared to non-obese patients.

Association of lipid accumulation product and visceral adiposity index with the risk of hypertension among oil workers in Xinjiang, China

Background

To explore the relationship between lipid accumulation product (LAP) and visceral adiposity index (VAI) and hypertension in oil workers and to evaluate the predictive value of hypertension by gender.

Methods

A sample of 2,312 workers aged 18-60 years old with more than one year of service were selected by a whole-group random sampling method in six oil field bases in Karamay City, Xinjiang. Logistic regression combined with restricted cubic spline model was used to analyze the risk of hypertension in different LAP and VAI. The receiver operator characteristic curve (ROC) with different sex LAP and VAI predicting the risk of hypertension were drawn.

Results

(1) There were significant differences in age, smoking, alcohol consumption, hypertension, BMI, WC, WHtR, SBP, DBP, TC, TG, HDL, LDL, FPG and Scr among different gender groups (P < 0.001).The prevalence of hypertension was 10.1%, with 13.9% in men and 3.6% in women. The prevalence of hypertension with different individual characteristics was statistically significant (P < 0.05). (2) Lipid accumulation product and visceral adiposity index were positively associated with hypertension (P < 0.001). The risk of hypertension may increase with the increase of lipid accumulation product and visceral adiposity index. After adjusting for age, sex, BMI, Scr, FPG and other factors, the risk of hypertension in the fourth quartile was (OR = 5.69, 95% CI [2.72-11.8]) and (OR = 3.56, 95% CI [2.03-6.23]) compared with the first quartile of lipid accumulation product and visceral adiposity index. (3) ROC results showed: AUC values of 0.658 (95% CI [0.619-0.696]), 0.614 (95% CI [0.574-0.654]), 0.661 (95% CI [0.620-0.703]) and critical values of 43.25, 1.58, 0.13 for LAP, VAI and combined indicators in men; the AUC values of LAP, VAI and combined indicators for women were 0.787 (95% CI [0.710-0.865]), 0.732 (95% CI [0.640-0.825]), 0.792 (95% CI [0.719-0.864]) and the critical values were 35.73, 1.76 and 0.03. Restricted cubic splines showed a nonlinear dose-response relationship between LAP, VAI, and risk of hypertension prevalence (P < 0.01 for overall trend and P < 0.01 for nonlinearity).

Conclusions

Lipid accumulation product and visceral adiposity index may be risk factors for hypertension in oil workers. LAP and VAI have certain predictive value for hypertension.

Mediation Effect of Obesity on the Association of Age at Menarche With Blood Pressure Among Women in Southwest China

Background Previous studies have been inconsistent about the association between age at menarche and high blood pressure. Little is known about such association across a wide range of menarcheal ages in less developed ethnic minority regions in China. We aimed to explore the association between age at menarche and high blood pressure (BP; ≥140/90 mm Hg) and to examine the mediating effect of obesity and the moderating effect of menopausal status on this association. Methods and Results A total of 45 868 women from the baseline data of the CMEC (China Multi-Ethnic Cohort) were included in this study. Binary logistic regression was used to analyze the relationship between age at menarche and high BP, and the mediation model was used to evaluate the mediating effects of body mass index and waist circumference on the association of age at menarche with high BP. The mean age at enrollment and age at menarche of participants in our study were 49.3 (SD=10.7) and 14.7 (SD=2.1) years, respectively. Late menarche was associated with a lower risk of high BP (odds ratio, 0.831 [95% CI, 0.728-0.950]). The risk of high BP decreased by 3.1% with each year's delay in the onset of menarche (P for trend <0.001). Body mass index and waist circumference could partially mediate the association of age at menarche and high BP with the indirect effect of body mass index (odds ratio, 0.998 [95% CI, 0.997-0.998]) and waist circumference (odds ratio, 0.999 [95% CI, 0.998-0.999]). In addition, the mediation effects were modified by the status of menopause. Conclusions Women with late menarche have a lower risk of high BP, and obesity could be one of the important mediators. Obesity prevention is an efficient strategy to reduce the association between age at menarche and high BP, especially in premenopausal women.

Alpha1A- and Beta3-Adrenoceptors Interplay in Adipose Multipotent Mesenchymal Stromal Cells: A Novel Mechanism of Obesity-Driven Hypertension

Hypertension is a major risk factor for cardiovascular diseases, such as strokes and myocardial infarctions. Nearly 70% of hypertension onsets in adults can be attributed to obesity, primarily due to sympathetic overdrive and the dysregulated renin-angiotensin system. Sympathetic overdrive increases vasoconstriction via α1-adrenoceptor activation on vascular cells. Despite the fact that a sympathetic outflow increases in individuals with obesity, as a rule, there is a cohort of patients with obesity who do not develop hypertension. In this study, we investigated how adrenoceptors' expression and functioning in adipose tissue are affected by obesity-driven hypertension. Here, we demonstrated that α1A is a predominant isoform of α1-adrenoceptors expressed in the adipose tissue of patients with obesity, specifically by multipotent mesenchymal stromal cells (MSCs). These cells respond to prolonged exposure to noradrenaline in the model of sympathetic overdrive through the elevation of α1A-adrenoceptor expression and signaling. The extent of MSCs' response to noradrenaline correlates with a patient's arterial hypertension. scRNAseq analysis revealed that in the model of sympathetic overdrive, the subpopulation of MSCs with contractile phenotype expanded significantly. Elevated α1A-adrenoceptor expression is triggered specifically by beta3-adrenoceptors. These data define a novel pathophysiological mechanism of obesity-driven hypertension by which noradrenaline targets MSCs to increase microvessel constrictor responsivity.

The effects of an acute weight stigma exposure on cardiovascular reactivity among women with obesity and hypertension: A randomized trial

OBJECTIVE

Weight stigma induces cardiovascular health consequences for people with obesity. How stigma affects cardiovascular reactivity in individuals with both obesity and hypertension is not known.

METHODS

In a randomized experiment, we assessed the influence of two video exposures, depicting either weight stigmatizing (STIGMA) or non-stigmatizing (NEUTRAL) scenes, on cardiovascular reactivity [resting blood pressure (BP), heart rate (HR), ambulatory BP (ABP), and ambulatory HR (AHR)], among women with obesity and high BP (HBP; n=24) or normal BP (NBP; n=25). Systolic ABP reactivity was the primary outcome. Laboratory BP and HR were measured before/during/following the videos, and ABP and AHR were measured over 19 hours (10 awake hours, 9 sleep hours) upon leaving the laboratory. A repeated measures ANCOVA tested differences in BP and HR changes from baseline in the laboratory and over ambulatory conditions between the two groups after each video, controlling for body mass index, baseline BP and HR.

RESULTS

Laboratory SBP/DBP increased 5.5+7.3/2.4+8.8mmHg more in women with HBP than NBP following the STIGMA versus NEUTRAL video (Ps<0.05). For the primary outcome, ABP increased more in HBP than NBP over sleep (SBP/DBP=4.2+20.6/4.7+14.2mmHg; Ps<0.05) following the STIGMA versus NEUTRAL video, as did HR during sleep (7.5+15.7bpm more in HBP than NBP; P<0.05).

CONCLUSIONS

Weight stigma increases cardiovascular reactivity among women with obesity and HBP in the laboratory and under ambulatory conditions.

CLINICAL TRIAL REGISTRATION

Registered at ClinicalTrials.gov (Identifier: NCT04161638).

The effect of angiotensin converting enzyme gene insertion/deletion polymorphism on anthropometric and biochemical parameters among hypertension patients: A case-control study from Northwest Ethiopia

INTRODUCTION

The angiotensin-converting enzyme (ACE) gene polymorphism has recently been linked with altered anthropometric and biochemical parameters in hypertensive patients. However, these links are still poorly understood and there is scarce evidence on the topic. Therefore, this study aimed to assess the effect of ACE gene insertion/deletion (I/D) polymorphism on anthropometric and biochemical parameters among essential hypertension patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

MATERIALS AND METHODS

A case-control study with 64 cases and 64 controls was conducted from October 07, 2020, to June 02, 2021. The anthropometric measurements, biochemical parameters, and ACE gene polymorphism were determined using standard operating procedures, enzymatic colorimetric method, and polymerase chain reaction, respectively. A one-way analysis of variance was used to determine the association of genotypes with other study variables. P value < 0.05 was regarded as statistically significant.

RESULT

The systolic/diastolic blood pressure and blood glucose level (P-value<0.05) were significantly higher among study hypertensive patients with the DD genotype. However, anthropometric measures and lipid profiles of cases and controls were not associated with ACE gene polymorphism (P-value>0.05).

CONCLUSION

The DD genotype of the ACE gene polymorphism was found to have a significant association with high blood pressure and blood glucose levels in the study population. Advanced studies with a considerable sample size may be needed to utilize the ACE genotype as a biomarker for the early detection of hypertension-related complications.

Effect of dietary patterns on cardiovascular risk factors in people with type 2 diabetes. A systematic review and network meta-analysis

AIMS

To identify the most effective dietary pattern for improving cardiovascular risk factors in people with type 2 diabetes.

METHODS

PubMed, Embase, the Cochrane library, SCOPUS and Web of Science were systematically searched for randomized controlled trials comparing the effects of dietary patterns on body weight, blood pressure, HbA1c and lipids after 6 and 12 months. Treatment effects were synthesized using Bayesian network meta-analysis. Six-month changes in HbA1c, SBP and LDL-C were used to estimate relative risk reductions (RRR) for cardiovascular events.

RESULTS

Seventy-three RCTs on eight different dietary patterns were included. All reduced body weight and HbA1c after 6 months, with the largest effects from the low carbohydrate (body weight -4.8 kg, 95 %credibility interval (95 %CrI) -6.5;-3.2 kg) and Mediterranean diet (HbA1c -1.0 %, 95 %CrI -15;-0.4 % vs usual diet). There were no significant 6-month blood pressure or lipid effects. Dietary patterns had non-statistically significant 12-months effects. The Mediterranean diet resulted in the largest expected RRR for cardiovascular events: -16 % (95 %CI -31;3.0) vs usual diet.

CONCLUSIONS

In patients with type 2 diabetes, all dietary patterns outperformed usual diet in improving body weight and HbA1c after 6 months and clinically relevant cardiovascular risk reduction could be achieved. There was insufficient evidence to select one optimal dietary pattern.

Effect of plum supplementation on blood pressure, weight indices, and C-reactive protein: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Metabolic syndrome and its components are major health concerns around the world. Among various factors, overweight/obesity, its consequent inflammation, and hypertension are of special importance. Plums are anti-oxidant-rich fruits which have long been investigated for their health benefits. In this systematic review and meta-analysis, we investigated the possible impact of plum supplementation on obesity, inflammation, and blood pressure.

METHODS

All of the major databases (PubMed, Scopus, Cochrane, and Web of Science, Google Scholar and EMBASE) were searched to obtain the articles eligible for the review. Relevant data was extracted for the final analysis. Weighted mean difference (WMD) was obtained using fixed and random effect models. The main outcomes included systolic and diastolic blood pressure, body weight, body mass index (BMI), body fat percentage, waist circumference (WC) and blood C-reactive protein (CRP) levels. The effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI).

RESULTS

Crude search provided 3121 articles, among which 11 were eligible to be included. After crude and subgroup analysis, we were unable to detect any significant impact of plum supplementation on body weight (weight mean difference (WMD) of 0.04 kg; 95% CI: -1.55, 1.63, p = 0.959), BMI (WMD 0.39 kg/m²; 95% CI: -0.11, 0.90, p = 0.125), body fat percentage (WMD = 0.59%; 95% CI: -0.41, 1.59, p = 0.249), waist circumference (WMD = 0.60 cm; 95% CI: -1.83, 3.04, p = 0.627), systolic blood pressure (WMD -1.24 mmHg; 95% CI: -3.08, 0.59, p = 0.185), diastolic blood pressure (WMD -4.32 mmHg (95% CI: -9.29, 0.65, p = 0.089), or inflammation indicated by C-reactive protein (CRP) levels (WMD = 0.23 mg/l; 95% CI: -0.27, 0.73, p = 0.371).

CONCLUSION

Our results show that plum supplementation has no positive effect on factors of metabolic syndrome. We recommend that further research in the form of clinical trials be conducted to make a clear conclusion as of the effectiveness of plum supplementation on parameters of metabolic syndrome.

The prevalence of obesity-related hypertension among middle-aged and older adults in China

Objective

The aim of our study was to assess the prevalence and geographic variation of obesity-related hypertension in China among adults aged 45 years or older.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015. Stratified sample households covered 150 counties/districts and 450 villages/urban communities from 28 provinces by using household questionnaires, clinical measurements, and blood-based bioassays. A multivariable non-conditional logistic regression model was used to analyze the risk factors correlated with obesity-related hypertension.

Results

The prevalence of obesity-related hypertension was 22.7%, ~120 million people, among adults aged 45 years or older in China. For people in the age ranges of 45-54, 55-64, 65-74, and ≥75 years, the prevalence of obesity-related hypertension was 16.7, 24.3, 27, and 26.7%, respectively, and the prevalence of obesity-related hypertension among hypertensive participants was 66.0, 60.9, 54.2, and 47.3%, respectively. Compared with non-obesity-related hypertension, the obesity-related hypertensive patients had a higher prevalence of diabetes mellitus, dyslipidemia, and hyperuricemia (all P < 0.0001). The prevalence of obesity-related hypertension showed a decreasing gradient from north to south and from east to west. Multivariate logistic regression analysis showed that female gender, living in urban areas, diabetes mellitus, dyslipidemia, and hyperuricemia were positively correlated with obesity-related hypertension.

Conclusion

The prevalence of obesity-related hypertension among adults aged 45 years or older was high in China. Among hypertensive participants, older age was negatively correlated with obesity-related hypertension. Obesity-related hypertensive participants are more prone to aggregation of risk factors of atherosclerotic cardiovascular disease.

Association of angiotensin-converting enzyme gene insertion/deletion polymorphisms with risk of hypertension among the Ethiopian population

Introduction

Although the pathophysiological mechanism of hypertension is not fully elucidated yet, a large number of pieces of evidence have shown that genetic alterations in the renin-angiotensin-aldosterone system play a central role. However, the association of insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene with essential hypertension is controversial yet, and there is a limited number of publications among the Ethiopian population. Therefore, this study aimed to determine the association of ACE gene I/D polymorphism with the risk of hypertension among essential hypertension patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

Materials and methods

A case-control study was conducted from October 07, 2020, to June 02, 2021, among hypertensive patients and normotensive control groups at the University of Gondar Comprehensive Specialized Hospital. A structured questionnaire was used to collect socio-demographic data and anthropometric measurements. Five milliliters of blood were drawn from each of the randomly selected 64 hypertensive and 64 normotensive participants for molecular test analysis. Genetic polymorphism of the ACE gene was identified using polymerase chain reaction (PCR) and electrophoresis. Data analysis was done using SPSS version 25.0 software. The strength of association between the genotype and hypertension was estimated through the calculation of adjusted odds ratio and 95% confidence intervals using logistic regression. P-value < 0.05 was considered statistically significant.

Result

The distribution of DD genotypes and D allele of the ACE gene were 48.4% and 63% in essential hypertensive patients, respectively, while it were 29.7% and 42.2% in control subjects respectively. The ACE DD genotype (p-value = 0.005) and D allele (p-value = 0.001) were more frequent among hypertensive patients as compared to controls.

Conclusion

The present study found that the DD genotype and D allele of the ACE gene has had a strong association with a high risk of hypertension in the study population.

Factors affecting the changes in antihypertensive medications in patients with hypertension

As frequent changes in anti-hypertensive (HTN) medications may reduce adherence to the treatments, identifying modifiable factors leading to changes in anti-HTN medications can help clinicians optimize treatment strategies for individual patients. We performed this study to explore the pattern of anti-HTN medications and to identify factors that are associated with the changes in anti-HTN medications. To this end, we used a clinical database of Seoul National University Hospital, extracted, transformed, and loaded by the observational medical outcomes partnership common data model. Demographic and all recorded clinical diagnoses, medications, and procedures data of eligible subjects were collected. Of 636 subjects who were eligible for this study, 297 subjects with a record of ≥1 anti-HTN medication changes and other 297 subjects without a record of medication change were selected for the study population. High diastolic blood pressure (adjusted odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.001–1.040, p = 0.040), arrhythmia (adjusted OR: 10.01, 95% CI: 1.86–185.57, p = 0.030), and angina pectoris with antianginal agents (adjusted OR: 4.85, CI: 1.05–23.89, p = 0.046) were associated with the changes in anti-HTN medications, indicating that any patients with these covariates require additional attention to reduce the likelihood of changing anti-HTN medications.

Prevalence and risk factors of general and abdominal obesity and hypertension in rural and urban residents in Bangladesh: a cross-sectional study

Background

Obesity and hypertension are global health concerns. Both are linked with increased risks of all-cause and cardiovascular mortality. Several early studies reported the prevalence of obesity and hypertension in Bangladeshi adults, but the associated factors in this country population are not clear yet. We aimed to estimate the prevalence and related risk factors of general and abdominal obesity and hypertension in rural and urban adults in Bangladesh.

Methods

In this cross-sectional study, data (n = 1410) was collected on rural (n = 626) and urban (n = 784) adults from eight divisional regions of Bangladesh. Both anthropometric and socio-demographic measurements were recorded in a standardized questionnaire form. General and abdominal obesity were defined based on WHO proposed cut-off values and hypertension was defined by SBP ≥ 140 mmHg and/or, DBP ≥ 90 mmHg and/or, intake of anti-hypertensive drugs at the time of data collection. Multivariable logistic regression analyses were performed to assess the relationship of general and abdominal obesity and hypertension with various factors.

Results

The overall prevalence of general obesity, abdominal obesity and hypertension was 18.2, 41.9 and 30.9%, respectively. The women had a higher prevalence of general obesity (25.2%), abdominal obesity (56.1%) and hypertension (32.3%) compared to the men (12.2, 29.0, and 29.7%, respectively). The prevalence of both general and abdominal obesity was higher in urban participants (21.7 and 46.6%, respectively) than in the rural participants (13.8 and 35.1%, respectively), whereas, the rural participants had a higher prevalence of hypertension (35.1%) compared to the urban participants (27.5%). In geographical region comparison, the prevalence of general and abdominal obesity and hypertension were higher in participants enrolled from Dhaka (30.8%), Khulna (63.6%) and Mymensingh (43.5%) regions, respectively compared to other regions. In regression analysis, increased age, place of residence and less physical activity were positively associated with the increased risk of both types of obesity and hypertension. The analysis also showed a significant positive association between high BMI and an increased risk of hypertension.

Conclusion

This study shows a high prevalence of obesity and hypertension in rural and urban adults. Increased age, inadequate physical activity and place of residence were significant determinants of general and abdominal obesity and hypertension. A comprehensive intervention program focusing on modifiable risk factors such as lifestyles and food habits is needed to increase awareness and prevent the burden of obesity and hypertension in the Bangladeshi population.

The association of MTHFR (rs1801133) with hypertension in an indigenous south African population

Aims: The current study sought to investigate the association between the methylenetetrahydrofolate reductase (MTHFR) variant (rs1801133) and the risk of developing hypertension (HTN) in an indigenous South African population.

Methods: A total of 442 participants (hypertensive, n = 279 and non-hypertensive, n = 163) from the indigenous tribe residing in Mthatha, Eastern Cape (South Africa) were recruited. HTN was defined as a systolic (SBP) and diastolic blood pressure (DBP) of ≥130/80 mmHg following American Heart Association guidelines. The genotyping of MTHFR (rs1801133) was assessed using MassARRAY^® System. Thereafter, the association between rs1801133 in various genetic models and HTN was determined by logistic regression model analysis. Furthermore, the interaction between rs1801133 and selected risk factors on HTN was performed using the open-source multifactor dimensionality reduction (MDR).

Results: The low frequency of the T allele (5%) was also observed when compared with the C allele (95%) in both cases and controls. After adjusting for confounding factors (gender, smoking status, BMI, and blood glucose levels), there were no significant associations were observed between rs1801133 and the risk of HTN in all genetic models: genotypic (OR 0.75, 95% CI 0.29–1.95, p = 0.56), dominant (OR 0.86, 95% CI 0.35–2.16, p = 0.75), co-dominant (OR 1.33, 95% CI 0.51–3.48, p = 0.55) and allelic (OR 0.80, 95% CI 0.49–1.62, p = 0.70) in logistic regression analysis. However, a significant interaction was reported among rs1801133, age, and gender (p < 0.0001) with the risk of HTN.

Conclusion: The present study reports on the lack of association between MTHFR (rs1801133) and the risk of HTN in an indigenous South African tribe. However, an interaction between gender, age, and rs1801133 was observed. Thus, future studies with a large sample size are required to further validate these findings.

Divergence of Chemerin Reduction by an ATS9R Nanoparticle Targeting Adipose Tissue In Vitro vs. In Vivo in the Rat

Nanoparticles (NPs) can enable delivery of a drug to a targeted tissue. Previous studies have shown that an NP utilizing an adipose targeting sequence (ATS) peptide in conjunction with a drug can selectively deliver the drug to mouse adipose tissues, using the prohibitin protein expressed in adipose tissue as the target of the ATS. Adipose tissue is a major source of the adipokine chemerin, a prohypertensive protein. Liver-derived chemerin, the largest source of circulating chemerin, is biologically inactive in blood pressure regulation. Our goal is to understand if chemerin produced in adipose tissue contributes to blood pressure/hypertension. We hypothesize the ATS drug delivery system could be used specifically to reduce the levels of adipose tissue-derived chemerin. We created an NP consisting of an antisense oligonucleotide (ASO) against chemerin and a FITC-labeled ATS with a nine arginine sequence (ATS9R). In vitro studies showed that the ASO is functional when incorporated into an NP with ATS9R as it reduced chemerin mRNA expression in isolated epidydimal (Epi) and retroperitoneal (RP) fat adipocytes from Dahl SS rats. This same NP reduced chemerin in isolated whole fats. However, this NP was unable to selectively deliver the ASO to adipose tissue in vivo; liver delivery was dominant. Varying NP doses, administration route, and the concentration of components constituting the NP showed no improvement in ASO delivery to fats vs. the liver. Further studies are therefore needed to develop the ATS9R system to deliver an ASO to adipose beds in rats.

Single-pill fixed-dose drug combinations to reduce blood pressure: the right pill for the right patient

Arterial hypertension is one of the major causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reduction in blood pressure is essential to reduce individual cardiovascular risk. In daily clinical practice, single-pill fixed-dose combinations of different drug classes are important therapeutic resources that could improve both treatment adherence and cardiovascular risk management by targeting distinct pathophysiological mechanisms. The aim of this practical narrative review is to help physicians choosing the right single-pill fixed-dose combination for the right patient in the daily clinical practice, based on the individual clinical phenotype and cardiovascular risk profile.

Triglyceride-to-glucose index to detect a non-dipping circadian pattern in newly diagnosed hypertensive patients

Introduction: In this investigation, we aimed to explore the relationship between the triglyceride-glucose (TyG) index and the non-dipping blood pressure (BP) pattern in newly diagnosed hypertensive patients. Methods: In this retrospective study, 216 consecutive newly diagnosed hypertensive patients who had undergone 24-hour ambulatory blood pressure (ABPM) monitoring and had not received anti-hypertensive drugs were included. Non-dipping status was evaluated by a 24-h ABPM monitoring in all patients. We categorized the patients into two groups as; dippers (n=104 cases) and non-dippers (n=112 cases). The TyG index was derived from the fasting triglyceride and fasting glucose levels using the formula; ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Results: Non-dipper group had a higher TyG index than the dipper group. The TyG was an independent predictor of non-dipping BP in hypertensive individuals, according to multivariable analysis. The TyG index was negatively associated with a decrease in both systolic and diastolic BP during the nighttime. The ideal cutoff value of the TyG index in detecting non-dipping status was≥9.01 with 74.1% sensitivity and 71.2% specificity. A ROC comparison indicated that the area under the curve value of TyG index was superior to fasting triglyceride, fasting glucose, and homeostasis model assessment of IR (HOMA-IR) in detecting non-dipping BP. Conclusion: The TyG index was an independent predictor of non-dipping status in newly diagnosed hypertensive patients who had undergone 24-hour ABPM monitoring and had not received anti-hypertensive drugs. As a simple and easily obtained parameter, the TyG index can be used to detect such pattern among these patients.

Adrenomedullin Improves Cardiac Remodeling and Function in Obese Rats with Hypertension

This study aimed to determine whether adrenomedullin (ADM, 7.2 μg/kg/day, ip), an important endogenous active peptide, has a protective role in cardiac remodeling and function in obesity-related hypertension (OH) rats. A high-fat diet (HFD) was used to induce OH for 20 weeks. H9c2 cells incubated with palmitate (PA, 200 μM) to mimic high free fatty acid in obesity were used as an in vitro model. In OH rats, ADM not only decreased body weight (BW) and blood pressure (BP) but also improved systemic inflammation and oxidative stress. Moreover, ADM still had a greater inhibitory effect on local inflammation and oxidative stress in the hearts of OH rats, and the same anti-inflammatory and antioxidant effects were also confirmed in PA-treated H9c2 cells. The ADM receptor antagonist or Akt inhibitor effectively attenuated the inhibitory effects of ADM on inflammation and oxidative stress in PA-stimulated H9c2 cells. Furthermore, ADM application effectively normalized heart function, and hematoxylin-eosin and Masson staining and collagen volume fraction results showed that ADM improved cardiac remodeling in hearts of OH rats. ADM attenuated cardiac inflammation and oxidative stress via the receptor-Akt pathway, which involves the improvement of cardiac remodeling and function in OH rats.

Hypertension in obese children is associated with vitamin D deficiency and serotonin dysregulation

Background

Obesity and hypertension represent serious health issues affecting the pediatric population with increasing prevalence. Hypovitaminosis D has been suggested to be associated with arterial hypertension. Serotonin by modulating nitric oxide synthase affect blood pressure regulation. The biological mechanism by which vitamin D specifically regulates serotonin synthesis was recently described. The aim of this paper is to determine the associations between vitamin D, serotonin, and blood pressure in obese children.

Methods

One hundred and seventy-one children were enrolled in the prospective cross-sectional study. Two groups of children divided according to body mass index status to obese (BMI ≥95th percentile; n = 120) and non-obese (n = 51) were set. All children underwent office and ambulatory blood pressure monitoring and biochemical analysis of vitamin D and serotonin. Data on fasting glucose, insulin, HOMA, uric acid, and complete lipid profile were obtained in obese children.

Results

Hypertension was found only in the group of obese children. Compared to the control group, obese children had lower vitamin D and serotonin, especially in winter. The vitamin D seasonality and BMI-SDS were shown as the most significant predictors of systolic blood pressure changes, while diastolic blood pressure was predicted mostly by insulin and serotonin. The presence of hypertension and high-normal blood pressure in obese children was most significantly affected by vitamin D deficiency and increased BMI-SDS.

Conclusions

Dysregulation of vitamin D and serotonin can pose a risk of the onset and development of hypertension in obese children; therefore, their optimization together with reducing body weight may improve the long-term cardiovascular health of these children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03337-8.

Microbial DNA Enrichment Promotes Adrenomedullary Inflammation, Catecholamine Secretion, and Hypertension in Obese Mice

Background

Obesity is an established risk factor for hypertension. Although obesity‐induced gut barrier breach leads to the leakage of various microbiota‐derived products into host circulation and distal organs, the roles of microbiota in mediating the development of obesity‐associated adrenomedullary disorders and hypertension have not been elucidated. We seek to explore the impacts of microbial DNA enrichment on inducing obesity‐related adrenomedullary abnormalities and hypertension.

Methods and Results

Obesity was accompanied by remarkable bacterial DNA accumulation and elevated inflammation in the adrenal glands. Gut microbial DNA containing extracellular vesicles (mEVs) were readily leaked into the bloodstream and infiltrated into the adrenal glands in obese mice, causing microbial DNA enrichment. In lean wild‐type mice, adrenal macrophages expressed CRIg (complement receptor of the immunoglobulin superfamily) that efficiently blocks the infiltration of gut mEVs. In contrast, the adrenal CRIg+ cell population was greatly decreased in obese mice. In lean CRIg^−/− or C3^−/− (complement component 3) mice intravenously injected with gut mEVs, adrenal microbial DNA accumulation elevated adrenal inflammation and norepinephrine secretion, concomitant with hypertension. In addition, microbial DNA promoted inflammatory responses and norepinephrine production in rat pheochromocytoma PC12 cells treated with gut mEVs. Depletion of microbial DNA cargo markedly blunted the effects of gut mEVs. We also validated that activation of cGAS (cyclic GMP‐AMP synthase)/STING (cyclic GMP–AMP receptor stimulator of interferon genes) signaling is required for the ability of microbial DNA to trigger adrenomedullary dysfunctions in both in vivo and in vitro experiments. Restoring CRIg+ cells in obese mice decreased microbial DNA abundance, inflammation, and hypertension.

Conclusions

The leakage of gut mEVs leads to adrenal enrichment of microbial DNA that are pathogenic to induce obesity‐associated adrenomedullary abnormalities and hypertension. Recovering the CRIg+ macrophage population attenuates obesity‐induced adrenomedullary disorders.

Human Gut Microbes Associated with Systolic Blood Pressure

Emerging studies have revealed a strong link between the gut microbiome and several human diseases. Since human gut microbiome mirrors variations in lifestyle and environment, whether associations between disease conditions and gut microbiome are consistent across populations-particularly in communities practicing traditional subsistence strategies whose microbiomes differ markedly from industrialists-remains unknown. Cardiovascular diseases are the leading cause of mortality in India affecting 55 million people, and high blood pressure is one of the primary risk factors for cardiovascular diseases. We examined associations between gut microbiome and blood pressure along with 14 other variables associated with lifestyle, dietary habits, disease conditions, and clinical blood markers in the three Assamese populations. Our analysis reveals a robust link between the gut microbiome diversity and composition and systolic blood pressure. Moreover, several genera previously associated with hypertension in non-Indian populations were also associated with systolic blood pressure in this cohort and these genera were predictors of elevated blood pressure in these populations. These findings confer opportunities to design personalized, preventative, and targeted interventions harnessing the gut microbiome to tackle the burden of cardiovascular diseases in India.

The association of hypertriglyceridemic waist phenotype with hypertension: A cross-sectional study in a Chinese middle aged-old population

The present study aimed to evaluate the relationship between the hypertriglyceridemic waist (HTGW) phenotype and hypertension. We undertook a cross‐sectional study with a sample of 9015 adults from China. The HTGW phenotype was defined as elevated waist circumference (WC) and elevated triglyceride (TG) concentration. Logistic regression analysis was used to evaluate the association between the HTGW phenotype and hypertension. The prevalence of hypertension was significantly higher in individuals with the HTGW phenotype, than in those with the normal waist normal triglyceride (NWNT) phenotype (89.9% vs 75.3%, respectively, P < .001). After adjusting for age, sex, BMI, current smoker, and current alcohol consumption, the HTGW phenotype was associated with hypertension (Odds Ratio (OR)1.53; 95% CI 1.25–1.87). After further adjustment for potential confounders, the HTGW phenotype was still significantly associated with hypertension (adjusted OR1.28; 95% CI 1.04‐1.58) regardless of sex. The subgroup analyses generally revealed similar associations across all subgroups. This study indicated that the HTGW phenotype was strongly associated with hypertension, and blood pressure should be clinically monitored in individuals with the HTGW phenotype. We suggested a combined use of hypertriglyceridemia waist phenotype in identifying participants who are at high risk of hypertension.

E-Selectin Is Associated with Daytime and 24-Hour Diastolic Blood Pressure Variability in Type 2 Diabetes

E-selectin is an endothelial cell adhesion molecule involved in vascular inflammation. Elevated E-selectin has been reported in patients with high blood pressure and diabetes. Given the increasing clinical relevance of parameters derived from ambulatory blood pressure monitoring, further investigation of their relationships with E-selectin is of interest. In this study, we aimed to investigate the association between serum E-selectin, office blood pressure and 24 h ambulatory blood pressure parameters in patients with type 2 diabetes. Blood pressure variability was assessed by computing the standard deviation of mean systolic and diastolic blood pressure separately for daytime and nighttime during 24 h ambulatory blood pressure monitoring in a cohort of patients with type 2 diabetes (n = 132). Additionally, were assessed nighttime systolic dipping and pulse pressure separately for daytime, nighttime, and 24 h. Serum E-selectin was measured using the enzyme-linked immunosorbent assay technique. We found that E-selectin was consistently associated with 24 h diastolic blood pressure variability (r = 0.238; p = 0.019) and daytime diastolic blood pressure variability (r = 0.258; p = 0.012), after adjustment for confounding factors. No association of E-selectin with office blood pressure and other 24 h ambulatory blood pressure parameters was observed. In conclusion, endothelial activation indicated by elevated serum E-selectin is associated with increased ambulatory diastolic blood pressure variability in patients with type 2 diabetes.

A Mixed Comparisons of Aerobic Training With Different Volumes and Intensities of Physical Exercise in Patients With Hypertension: A Systematic Review and Network Meta-Analysis

It is essential for patients with hypertension to effectively reduce and maintain appropriate blood pressure levels. As one of the non-pharmacological and invasive methods, physical exercise seems to improve blood pressure of the patients with hypertension. However, different volumes and intensities of physical exercise on the improvement of hypertension are different. To understand the effects of the type of exercise training on blood pressure and the other health status of patients with hypertension, a network meta-analysis was used to compare the mixed effects of different types of exercise training. This systematic review includes all eligible randomized controlled trials of PubMed, Medline, Cochrane Library, and CINAHL. Twelve studies met the inclusion criteria (n = 846 participants at the end of the study). The results show that a medium-intensity training (MIT) is best in improving the blood pressure of patients with hypertension, while a high-volume high-intensity interval training (HVHIIT) is better in reducing body mass and resting heart rate. In addition, the analysis of the exercise capacity shows that HVHIIT has a better effect on the improvement of patients with hypertension. Noticeably, long-term high-volume and appropriate intensity exercise can effectively improve the health status of patients with hypertension. In short, for patients with high blood pressure, MIT seems to be better at lowering blood pressure, while HVHIIT can better improve exercise ability and physical fitness. However, larger randomized controlled trials with a longer duration than those included in this meta-analysis are needed to confirm these results.

Leg and arm adiposity is inversely associated with diastolic hypertension in young and middle-aged United States adults

BACKGROUND

We sought to determine the association between appendicular adiposity and hypertension, with the purpose of better understanding the role of body fat distribution on blood pressure (BP).

METHODS

We included 7411 adults aged 20 to 59 who were not taking antihypertensives and without cardiovascular disease from the 2011 to 2018 National Health and Nutrition Examination Surveys. Leg & arm adiposity, determined via dual-energy X-ray absorptiometry scans, was defined as percent of total body fat present in legs/arms (leg/total%, arm/total%). Measures were categorized into sex-specific tertiles. We estimated change in BP and odds ratios (ORs) of hypertension (BP ≥ 130/80) and hypertension subtypes using multivariable, survey design-adjusted linear & logistic regression, respectively.

RESULTS

Of the participants, 49% were female, the average (standard deviation) age was 37.4 (0.3) years, and 24% had hypertension. Those in the highest tertile (T3) of leg/total% had 30% decreased adjusted ORs (aOR) of hypertension compared to the lowest tertile (T1; aOR, 0.70; 95% confidence interval [95% CI], 0.55-0.89). This association was not significant for arm/total% (0.89, 0.68-1.17). T3 of leg/total% was associated with 49% lower, 41% lower, and unchanged relative odds of isolated diastolic hypertension (IDH), systolic-diastolic hypertension (SDH), and isolated systolic hypertension (ISH) compared to T1 (IDH: 0.51, 0.37-0.70; SDH: 0.59, 0.43-0.80; ISH: 1.06, 0.70-1.59). For every 10% increase in leg/total%, diastolic BP decreased by an adjusted mean 3.5 mmHg (95% CI, - 4.8 to - 2.2) in males and 1.8 mmHg (95% CI, - 2.8 to - 0.8) in females (P < 0.001 for both).

CONCLUSIONS

A greater proportional distribution of fat around the legs is inversely, independently associated with hypertension, and more specifically, diastolic hypertension (IDH and SDH).

Chinese Visceral Adiposity Index Is More Closely Associated With Hypertension and Prehypertension Than Traditional Adiposity Indices in Chinese Population: Results From the REACTION Study

PURPOSE

The optimal adiposity index that is strongly associated with hypertension or prehypertension remains inconclusive in Chinese population. This study aimed to investigate the relationship between Chinese visceral adiposity index (CVAI) and hypertension and prehypertension, as well as to compare the discriminative power of CVAI, visceral adiposity index (VAI), body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), low-density lipoprotein cholesterol (LDL-C), and waist-to-hip ratio (WHR) with hypertension and prehypertension in Chinese general population.

PATIENTS AND METHODS

A total of 34732 participants from REACTION study were recruited. Multiple logistic regression analyses were performed to detect the association between adiposity indices (CVAI, VAI, BMI, WC, WHtR, WHR, LDL-C) and hypertension and prehypertension.

RESULTS

Multivariate logistic regression analysis showed that compared with other obesity indices, CVAI remained significantly associated with hypertension and prehypertension (Hypertension: odds ratio (OR) 3.475, 95% confidence interval (CI) 3.158-3.824, p<0.001 in total subjects; OR 2.762, 95% CI 2.369-3.221, p<0.001 in men; OR 3.935, 95% CI 3.465-4.469, p<0.001 in women, Prehypertension: OR 2.747, 95% CI 2.460-3.068, p<0.001 in total subjects; OR 2.605, 95% CI 2.176-3.119, p<0.001 in men; OR 2.854, 95% CI 2.465-3.304, p<0.001 in women).In a stratified analysis, CVAI was significantly associated with hypertension and prehypertension at any level of blood glucose, age or estimated glomerular filtration rate(eGFR).

CONCLUSION

CVAI is significantly associated with hypertension and prehypertension. CVAI shows the superior discriminative ability for hypertension and prehypertension compared with VAI, BMI, WC, WHtR, WHR and LDL-C in Chinese general population.

Endothelin receptor blockade blunts the pressor response to acute stress in men and women with obesity

Obesity is associated with dysregulation of the endothelin system. In individuals with obesity, an exaggerated pressor response to acute stress is accompanied by increased circulating endothelin-1 (ET-1). The impact of combined endothelin A/B receptor (ET_A/B) antagonism on the stress-induced pressor response in overweight/obese (OB) individuals is unknown. The objective of this study is to test the hypothesis that treatment with an ET_A/B antagonist (bosentan) would reduce the stress-induced pressor response and arterial stiffness in overweight/obese compared with normal weight (NW) individuals. Forty participants [normal weight (NW): n = 20, body mass index (BMI): 21.7 ± 2.4 kg/m² and overweight/obese (OB): n = 20, BMI: 33.8 ± 8.2 kg/m²] were randomized to placebo or 125 mg of bosentan twice a day (250 mg total) for 3 days. Hemodynamics were assessed before, during, and after a cold pressor test (CPT). Endothelin-1 was assessed at baseline and immediately after CPT. Following a washout period, the same protocol was repeated with the opposite treatment. The change from baseline in mean arterial pressure (MAP) during CPT following bosentan was significantly lower (P = 0.039) in the OB group than in the NW group (OB: 28 ± 12 vs. NW: 34 ± 15 mmHg). These results suggest that ET_A/B antagonism favorably blunts the pressor response to acute stress in overweight/obese individuals.NEW & NOTEWORTHY Findings from our current translational investigation demonstrate that dual endothelin A/B receptor antagonism blunts the pressor response to acute stress in overweight/obese individuals. These results suggest that modulation of the endothelin system may represent a novel therapeutic target to reduce cardiovascular disease (CVD) risk by blunting the stress response in overweight/obese individuals.

Obesity and CKD in Sub-Saharan Africa: A Narrative Review

Obesity is a major public health problem in the developed world, where it has reached an epidemic status over the last few decades. In parallel with this, the prevalence of chronic kidney disease (CKD) has increased. Although obesity is a risk factor for hypertension and diabetes, it is also independently associated with the development and progression of CKD. Two-third of patients with CKD worldwide will be residents of developing countries by the year 2030. Risk factors for CKD are prevalent in the sub-Saharan Africa region; this review discusses the available data regarding the relationship between obesity and CKD. The prevalence of CKD appears to correlate with increasing adiposity in sub-Saharan Africa; however, limited data are currently available, and the analysis of this association is further complicated by a variety of parameters used to define obesity. (eg, body mass index vs waist circumference). Longer, large-scale studies are needed to inform the prevalence and kidney implications of obesity in sub-Saharan Africa.

Apelin expression deficiency in mice contributes to vascular stiffening by extracellular matrix remodeling of the aortic wall

Numerous recent studies have shown that in the continuum of cardiovascular diseases, the measurement of arterial stiffness has powerful predictive value in cardiovascular risk and mortality and that this value is independent of other conventional risk factors, such as age, cholesterol levels, diabetes, smoking, or average blood pressure. Vascular stiffening is often the main cause of arterial hypertension (AHT), which is common in the presence of obesity. However, the mechanisms leading to vascular stiffening, as well as preventive factors, remain unclear. The aim of the present study was to investigate the consequences of apelin deficiency on the vascular stiffening and wall remodeling of aorta in mice. This factor freed by visceral adipose tissue, is known for its homeostasic role in lipid and vascular metabolisms, or again in inflammation. We compared the level of metabolic markers, inflammation of white adipose tissue (WAT), and aortic wall remodeling from functional and structural approaches in apelin-deficient and wild-type (WT) mice. Apelin-deficient mice were generated by knockout of the apelin gene (APL-KO). From 8 mice by groups, aortic stiffness was analyzed by pulse wave velocity measurements and by characterizations of collagen and elastic fibers. Mann-Whitney statistical test determined the significant data (p < 5%) between groups. The APL-KO mice developed inflammation, which was associated with significant remodeling of visceral WAT, such as neutrophil elastase and cathepsin S expressions. In vitro, cathepsin S activity was detected in conditioned medium prepared from adipose tissue of the APL-KO mice, and cathepsin S activity induced high fragmentations of elastic fiber of wild-type aorta, suggesting that the WAT secretome could play a major role in vascular stiffening. In vivo, remodeling of the extracellular matrix (ECM), such as collagen accumulation and elastolysis, was observed in the aortic walls of the APL-KO mice, with the latter associated with high cathepsin S activity. In addition, pulse wave velocity (PWV) and AHT were increased in the APL-KO mice. The latter could explain aortic wall remodeling in the APL-KO mice. The absence of apelin expression, particularly in WAT, modified the adipocyte secretome and facilitated remodeling of the ECM of the aortic wall. Thus, elastolysis of elastic fibers and collagen accumulation contributed to vascular stiffening and AHT. Therefore, apelin expression could be a major element to preserve vascular homeostasis.

Potential implications of angiotensin-converting enzyme 2 blockades on neuroinflammation in SARS-CoV-2 infection

BACKGROUND

Angiotensin-converting enzyme 2 (ACE2) has been reported as a portal for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Consequently, scientific strategies to combat coronavirus disease of 2019 (COVID-19) were targeted to arrest SARS-CoV-2 invasion by blocking ACE2. While blocking ACE2 appears a beneficial approach to treat COVID-19, clinical concerns have been raised primarily due to the various intrinsic roles of ACE2 in neurological functions. Selective reports indicate that angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) upregulate ACE2 levels. ACE2 metabolizes angiotensin II and several peptides, including apelin-13, neurotensin, kinetensin, dynorphin, [des-Arg9] bradykinin, and [Lys-des-Arg9]-bradykinin, which may elicit neuroprotective effects. Since ARBs and ACEIs upregulate ACE2, it may be hypothesized that patients with hypertension receiving ARBs and ACEIs may have higher expression of ACE2 and thus be at a greater risk of severe disease from the SARS-CoV-2 infections. However, recent clinical reports indicate the beneficial role of ARBs/ACEIs in reducing COVID-19 severity. Together, this warrants a further study of the effects of ACE2 blockades in hypertensive patients medicated with ARBs/ACEIs, and their consequential impact on neuronal health. However, the associations between their blockade and any neuroinflammation also warrant further research.

OBJECTIVE

This review collates mechanistic insights into the dichotomous roles of ACE2 in SARS-CoV-2 invasion and neurometabolic functions and the possible impact of ACE2 blockade on neuroinflammation.

CONCLUSION

It has been concluded that ACE2 blockade imposes neuroinflammation.

Diagnostic and Predictive Values of LAP in Hypertension: A Cross-Sectional Study in Chinese Population Older Than 65 Years

This study aimed to investigate the predictive value of lipid accumulation product (LAP) in hypertension in Chinese population older than 65 years. A total of 2092 adults from the communities in Pudong New Area of Shanghai were included in this cross-sectional study. The participants filled in questionnaire and received anthropometric and laboratory examinations. The receiver operating characteristics curve (ROC) was used to analyze the predictive value of different risk factors in hypertension. Results showed that LAP was closely related to hypertension (adjusted OR: 1.011, 95% CI: 1.007-1.015). In females, LAP, fasting blood glucose (FPG), and body mass index (BMI) were associated with hypertension; in males, triglycerides (TG) and waist circumference (WC) were related to hypertension. LAP (AUC = 0.655, 95% CI: 0.632-0.679) was better than neck circumference (NC) and BMI in predicting hypertension. When the cutoff value was 33.5, LAP had the best predictive performance. In males, LAP at 36.72 and 56.76 had the best predictive performance in males (AUC = 0.663, 95% CI: 0.629-0.697) and females (AUC = 0.650, 95% CI: 0.618-0.682), respectively. In conclusion, LAP is a risk factor of hypertension in the elderly. For hypertension, BMI, FPG, and LAP have favorable predictive performance in females, and WC and TG have better predictive performance in males.

Cardiovascular Risk Factors in Children with Obesity, Preventive Diagnostics and Possible Interventions

The increasing burden of obesity plays an essential role in increased cardiovascular morbidity and mortality. The effects of obesity on the cardiovascular system have also been demonstrated in childhood, where prevention is even more important. Obesity is associated with hormonal changes and vascular dysfunction, which eventually lead to hypertension, hyperinsulinemia, chronic kidney disease, dyslipidemia and cardiac dysfunction—all associated with increased cardiovascular risk, leading to potential cardiovascular events in early adulthood. Several preventive strategies are being implemented to reduce the cardiovascular burden in children. This paper presents a comprehensive review of obesity-associated cardiovascular morbidity with the preventive diagnostic workup at our hospital and possible interventions in children.

Perivascular adipose tissue and microvascular endothelial dysfunction in obese mice: Beneficial effects of aerobic exercise in adiponectin receptor (AdipoR1) and peNOSSer1177

In the present study, we aim to investigate the effects of aerobic physical training on perivascular adipose tissue (PVAT)-induced microvascular dysfunction of the femoral artery in obese mice. Microvascular reactivity was evaluated in control sedentary (c-SD), obese sedentary (o-SD) and obese trained (o-TR) male mice (C57BL6/JUnib), in the absence (PVAT-) or the presence (PVAT+) of femoral artery PVAT. We also analyzed protein expression, vascular nitric oxide (NO) production and reactive oxygen species (ROS) generation in PVAT. The blood glucose, triglycerides and total cholesterol levels were increased in the o-SD group, when compared with the c-SD group. The maximal responses and the potency to acetylcholine (ACh) were decreased in PVAT+ compared with PVAT- rings in the o-SD group, accompanied by a decrease in vascular protein expression of peNOS_Ser1177 , Cu/Zn-SOD, leptin receptor (Ob-R) and adiponectin receptor (AdipoR1). The protein expression of leptin increased and that of adiponectin decreased in PVAT. Additionally, vascular NO production was reduced and ROS generation was enhanced in PVAT in the o-SD group. Aerobic exercise training was effective for normalizing ACh relaxation response, vascular NO production and ROS generation in the o-TR group. It partially re-established the vascular protein expression of peNOS_Ser1177 and the PVAT leptin; normalized the vascular Cu/Zn-SOD and AdipoR1 protein expressions. In obese sedentary mice, the presence of PVAT is involved in the process of microvascular dysfunction of the femoral artery in a pathway associated with increased inflammation and ROS generation. The aerobic exercise training normalized the vascular response, the NO production and/or bioavailability and oxidative stress, with improved vascular expressions of Cu/Zn-SOD, peNOS_ser1177 , and AdipoR1.

Trends in the prevalence of hypertension according to severity and phenotype in Chinese adults over two decades (1991-2015)

Until recently, few studies have reported the secular trend and associated factors of hypertension severities and phenotypes in China. In this study, the authors aimed to assess the trend in the prevalence of hypertension according to severity and phenotype in Chinese adults from 1991 to 2015 and to explore potential cardiometabolic factors. From the China Health and Nutrition Survey (CHNS), the authors included 164 682 records of adults (≥18 years). The prevalence of hypertension by severity (stage 1 and stage 2 hypertension) and by phenotype (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic-diastolic hypertension [SDH]), during 1991-2015 was explored. The potential effects of demographic, socioeconomic, geographic, and cardiometabolic factors on hypertension severities and phenotypes were assessed by multivariable logistic regression. During 1991-2015, the overall prevalence of hypertension increased dramatically from 15.7% to 23.3%. For stage 1 and stage 2 hypertension, the age-standardized prevalence increased from 10.1% to 15.6% and from 5.5% to 7.4%, respectively. For ISH and SDH, the age-standardized prevalence rates rose from 3.6% to 6.4% and from 6.9% to 10.4%, respectively. Advanced age and medium/high urbanization were positively associated factors, whereas females, higher educational attainments, and residing in Southern China were negatively associated factors. Additionally, general obesity, central obesity, diabetes, and elevated triglyceride levels were linked to ISH, IDH, and SDH. The present study documents an increasing trend in the prevalence of hypertension, including different severities and phenotypes, among Chinese adults over more than two decades. Efforts for the prevention and management of hypertension are in urgent need in China.

The Clinical Pharmacy Specialists' Role in Antihypertensive Management Surrounding Bariatric Surgery in a Veterans Affairs Population

BACKGROUND

No guidelines exist for de-escalating antihypertensive medications surrounding bariatric surgery. This study analyzed clinical pharmacy specialist (CPS) management of antihypertensive medications in patients undergoing bariatric surgery at a Veterans Affairs medical center.

OBJECTIVES

The primary objective was to describe the CPS role in antihypertensive management surrounding bariatric surgery through evaluation of number of CPS encounters, number and type of antihypertensive medications and medication interventions by CPSs and all other providers, over 5 time periods between a pre-operative assessment and up to 6 months post-operatively.

METHODS

Electronic medical records of patients taking antihypertensive medication who underwent bariatric surgery between 1/1/2014 and 2/27/2018, had primary care through our facility, and at least 1 encounter with a CPS were reviewed.

RESULTS

Forty patients were included out of 221 screened. There were 109 total medication interventions in 37 patients. CPSs provided 60 medication interventions (55% of total interventions) in 26 patients. Mean antihypertensive agents per patient was 2.18 at baseline versus 0.95 at 6-months post-operative. Dihydropyridine calcium channel blockers had the highest discontinuation rate. Thiazide diuretics were most commonly discontinued prior to surgery and angiotensin converting enzyme inhibitors were discontinued more steadily over the study duration. Nineteen patients (48.7%) had blood pressure <140/90 mmHg and were off all antihypertensive medications at the final CPS encounter.

CONCLUSION

The results of this small study support the role of CPSs in antihypertensive medication management surrounding bariatric surgery.

Beneficial Effects of a Perindopril/Indapamide Single-Pill Combination in Hypertensive Patients with Diabetes and/or Obesity or Metabolic Syndrome: A Post Hoc Pooled Analysis of Four Observational Studies

INTRODUCTION

To assess real-life effectiveness of a perindopril/indapamide (Per/Ind) single-pill combination (SPC) in patients with hypertension (HT) and type 2 diabetes mellitus (T2DM), obesity and/or metabolic syndrome (MetS).

METHODS

This post hoc analysis pooled raw data from four large observational studies (FORTISSIMO, FORSAGE, ACES, PICASSO). Patients, most with uncontrolled blood pressure (BP) on previous treatments were switched to Per/Ind (10 mg/2.5 mg) SPC at study entry. Office systolic and diastolic blood pressures (SBP and DBP) were measured at baseline, 1 month and 3 months.

RESULTS

In the overall pooled population (N = 16,763), mean age was 61 ± 12 years, HT duration 11 ± 8 years, and baseline SBP/DBP 162/94 mmHg. T2DM, obesity and MetS were present in 21%, 49% and 27% of patients, respectively. Subgroups had similar mean age and HT duration to the overall population; patients with T2DM were slightly older (64 ± 10 years) with a longer HT duration (13 ± 8 years). Mean BP was approximately 160/95 mmHg in each subgroup. At 1 month, mean SBP decreased by approximately 20 mmHg in the overall population, and by a further 10 mmHg at 3 months. Similar results were observed in the three subgroups, with mean changes from baseline at 3 months of - 28 ± 15/- 13 ± 10 in T2DM; - 30 ± 15/- 14 ± 10 in obesity; and - 31 ± 15/- 15 ± 9 mmHg in MetS. BP decreases were greatest in patients with grade II or grade III HT. BP control rates (< 140/90 mmHg or 140/85 mmHg for T2DM) at 3 months were 59% in T2DM, 67% in obese, and 66% in MetS. No specific safety concerns were raised, particularly concerning ionic (Na, K) or metabolic profiles.

CONCLUSIONS

Switching to Per/Ind SPC led to rapid and effective BP decreases in patients with T2DM, obesity, or MetS. BP control was achieved in 6-7 out of 10 previously treated but uncontrolled patients. Treatment was well tolerated. The results confirm the beneficial effects of a Per/Ind SPC for difficult-to-control patient populations.

Curse or Blessing? Obesity and Income-Related Inequality in the Chinese Labor Force

China owns a huge labor force of around half billion workers in 2018. However, little is known about the prevalence of obesity and the association between obesity and economic status in this special population. By employing the concentration index (CI) and decomposition analysis, this paper addresses this knowledge gap by using the most recent nationally representative dataset. In specific, this study examines the prevalence of obesity and the socioeconomic gradient in the probability of obesity among Chinese workers between 16 and 65. Our results show that the prevalence of obesity is completely different by using a different measure: the overall prevalence of being general obesity (measured by body mass index, BMI ≥ 28) varies by gender and residency from a minimum of 5.88% to a maximum of 9.46%, whereas abdominal obesity (measured by waist circumference, WCmale ≥ 85 cm & WCfemale ≥ 80 cm) prevalence presents a socking level from 64.53% to 67.69%. Moreover, the results show a pro-rich distribution of obesity (general and abdominal) among male workers (CI_BMI = 0.112; CI_WC = 0.057) and a pro-poor distribution among female workers (CI_BMI = −0.141; CI_WC = −0.166). We also find that the direction of the contribution of socioeconomic factors to income-related inequalities in obesity differs by gender. These results have substantial implications for the measurement of socioeconomic inequality in adiposity and for improving health-related policies targeting the Chinese labor force.