Hypertension in the developing world: challenges and opportunities

The association of depressive symptoms with adverse clinical outcomes in hypertension: Data from SPRINT randomized trail

OBJECTIVE

This study intends to explore the effect of depressive symptoms on adverse clinical outcomes in middle-aged and elderly hypertensive patients.

METHODS

This post hoc analysis was conducted using data from the Systolic Blood Pressure Intervention Trial (SPRINT), and we used cox proportional risk regression to examine the relationship between depressive symptoms and adverse clinical outcomes (primary outcome, all-cause mortality, cardiovascular disease(CVD) mortality, heart failure(HF), myocardial infarction(MI), non-myocardial infarction acute coronary syndrome(non-MI ACS)).

RESULTS

In a follow-up study of 9259 participants, we found that depression symptoms was significantly and positively associated with the primary outcome (HR 1.03, 95%CI 1.01-1.05; p for trend = 0.0038), all-cause mortality (HR 1.03, 95%CI 1.01-1.05; p for trend = 0.0308), HF(HR 1.05, 95%CI 1.01-1.08; p for trend = 0.0107), and non-MI ACS(HR 1.06, 95%CI 1.01-1.10; p for trend = 0.0120). Kaplan-Meier survival curves for depression symptoms severity (none, mild, moderate, and above) and adverse clinical outcomes suggested that for all but primary clinical outcomes, the cumulative risk of adverse clinical outcomes increased with increasing depression symptoms severity.

CONCLUSION

For middle-aged and elderly hypertensive patients, depression symptoms exacerbates the risk of adverse clinical outcomes (primary outcome, all-cause mortality, CVD death, MI, HF, and non-MI ACS), and the risk increases with the severity of depression symptoms.

To what extent the weight changes impact the risk of hypertension among menopausal women: insights from Tehran lipid and glucose study

BACKGROUND & AIM

The association between weight change and incident hypertension (HTN) in menopausal women has not been well characterized. This study aimed to determine whether weight changes after menopausal years make a difference in incidents of hypertension.

MATERIALS & METHODS

This population-based study was performed using data collected from Tehran Lipid and Glucose Study cohort (1999-2018). Women who had natural and early menopause were followed up every 3 years. Data gathering was performed through the standard protocol of the study. Statistical analysis was performed using multivariable Cox hazard regression analysis. We used the 'survival' package in the R software version 3.6.0 to fit survival models.

RESULTS

A total of 487 menopausal women met the inclusion criteria; 62.6% had natural menopause and remained had early menopause. Among the participants, 65.5% experienced HTN. The highest proportion of participants had > 5% weight gain, while the lowest had 3-5% weight gain. Either losing body weight (lost > 5%: HR: 0.44; CI 95%, 0.32, 0.62; p < 0.001), (lost 3-5%; HR: 0.47; CI 95%, 0.26, 0.84; p = 0.01), and weight gain > 5% (HR: 0.69; CI 95%, 0.51, 0.91; p = 0.01), were associated with decreased risk of HTN after adjustment for confounders. In this study, weight loss and gain have a protective impact on the development of HTN in subjects. For incident HTN, age (HR: 1.04 (1.01, 1.08), p = 0.004), fasting blood glucose (HR: 1.01, CI 95%:1.00, 1.01; p < 0.001), body mass index (1.02 (1.00, 1.05), p = 0.03) and smoking (1.70 (1.11, 2.58), p = 0.01) were positively associated with HTN.

CONCLUSIONS

Our study indicates the significant association of weight change with hypertension risk in later life among menopausal women.

Efficacy and safety of esaxerenone (CS-3150) in primary hypertension: a meta-analysis

This study aimed to assess the efficacy and safety of esaxerenone (CS-3150) in treating primary hypertension. PubMed (Medline), Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases were searched for articles published until April 18, 2023. The outcomes included were diastolic blood pressure (DBP), systolic blood pressure (SBP), 24 h DBP, 24 h SBP, and adverse events. The meta-analysis was conducted using RevMan 5.3. This study included three trials. CS-3150 5 mg had a greater effect on lowering the SBP, DBP, 24 h SBP, and 24 h DBP than either CS-3150 2.5 mg or eplerenone 50 mg. In contrast, CS-3150 2.5 mg and eplerenone 50 mg showed no significant difference in lowering DBP, SBP, 24 h DBP, and 24 h SBP. Moreover, adverse events occurred at comparable rates in the three groups. CS-3150 (especially CS-3150 5 mg) is an effective and safe treatment for primary hypertension; which can reduce blood pressure and alleviate hypertensive symptoms.

Prevalence, Awareness, Treatment, and Control of Hypertension Among Older Adults in the Philippines

BACKGROUND

Little is known about the current prevalence and management of hypertension among older Filipinos. To address this gap, we examined the prevalence, awareness, treatment, and control of hypertension, as well as their correlates, among older Filipinos.

METHODS

We analyzed a nationally representative survey of Filipinos aged 60 years and older (N = 5 985) in the Philippines. Blood pressure (BP) measurements were taken using a digital BP apparatus. People with hypertension included those with a systolic BP ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg, or those who reported current use of antihypertensive medication. People with undiagnosed hypertension were those who had measured hypertension but had not been diagnosed by a doctor as having hypertension, while people with untreated hypertension were those who had measured hypertension but not taking medication. Among those who were taking antihypertensive medication, respondents with measured hypertension were considered to have uncontrolled BP.

RESULTS

Results showed that 69.1% of older Filipinos had hypertension, but only 61.6% of people with hypertension were aware of their hypertension and 51.5% were untreated. Sociodemographic factors, such as age, sex, education, and living arrangements, were significantly associated with hypertension prevalence, hypertension awareness, lack of treatment for hypertension, and/or suboptimal BP control.

CONCLUSION

We observed a high prevalence of hypertension among older Filipinos and a relatively low level of awareness and treatment of hypertension among them. While there are government efforts to address the growing prevalence of hypertension in the country, more efforts should be made to bring these government programs to older Filipinos.

The In Vitro Inhibitory Activity of Pacaya Palm Rachis versus Dipeptidyl Peptidase-IV, Angiotensin-Converting Enzyme, α-Glucosidase and α-Amylase

The pacaya palm (Chamaedorea tepejilote Liebm) is an important food that is commonly consumed in Mexico and Central America due to its nutritive value. It is also used as a nutraceutical food against some chronic diseases, such as hypertension and hyperglycemia. However, few reports have indicated its possible potential. For this reason, the goal of this research was to evaluate the effects of the enzymatic activity of the pacaya palm inflorescence rachis on both hypertension and hyperglycemia and the effects of thermal treatments on the enzymatic activity. The enzymatic inhibition of ACE (angiotensin-converting enzyme), DPP-IV (dipeptidyl peptidase-IV), α-glucosidase and α-amylase were evaluated, all with powder extracts of pacaya palm inflorescences rachis. The results indicated that thermally treated rachis showed increased enzymatic inhibitory activity against α-amylase and DPP-IV. However, all rachis, both with and without thermal treatment, showed low- or no enzymatic activity against α-glucosidase and ACE. Apparently, the mechanism of action of the antidiabetic effect of rachis is mediated by the inhibition of α-amylase and DPP-IV and does not contribute with a significant effect on enzymes involved in the hypertension mechanism. Finally, the properties of the extract were modified via the extraction method and the temperature tested.

The relationship between depression based on patient health questionaire-9 and cardiovascular mortality in patients with hypertension

BACKGROUND

Depression and hypertension are increasingly prevalent in the U.S., with evidence suggesting significant comorbidity. Despite this, the specific relationship within the U.S. hypertensive population is underexplored. Our study investigates this link using data from the 2007-2014 NHANES database and mortality data from the National Death Index.

METHODS

A total of 8677 participants were included in this cohort study. Depression diagnosis was made based on the Patient Health Questionnaire-9. Hypertension was defined either through a self-reported previous diagnosis, current antihypertensive medication use, or blood pressure exceeding standard thresholds. Cardiovascular disease mortality was determined by mortality recorded with National Death Index on December 31, 2019. The cox proportional hazards regression method was applied to analyze the association of depression with cardiovascular mortality in hypertension.

RESULTS

During an average follow-up of 8.2 years, 599 deaths were confirmed from cardiovascular disease. The association of depression with cardiovascular mortality in hypertension was significantly positive (HR, 1.0263(95%CI = 1.0033, 1.0498), p = 0.0247). In addition, the risk of cardiovascular mortality increased gradually with the severity of depressive symptoms (p for trend =0.0259). This positive relationship was basically stable in different subgroup analyses and sensitivity analyses.

LIMITATIONS

The observational design of our study hinders establishment of a causal relationship. Potential bias due to subjective reporting and the absence of depression treatment data represent limitations, although their impact on the conclusions is deemed minimal.

CONCLUSIONS

Depression is associated with cardiovascular mortality risk in patients with hypertension. The worsening depressive symptoms, the higher risk of cardiovascular mortality.

Hypertension and diabetes patients' perspective of challenges and their coping mechanisms in Mukono and Buikwe districts in Uganda - a qualitative study

Background: In sub-Saharan Africa, the burden of non-communicable diseases is steadily rising amidst a high prevalence of communicable diseases stretching the healthcare system. This study explored hypertension and diabetes patients' perspective of challenges and their coping mechanisms in Mukono and Buikwe districts in Uganda. Methods: This descriptive qualitative study involved four focus group discussions with 26 patients at four selected health facilities. All interviews were audio recorded, transcribed verbatim and data analysed following the thematic content analysis guided by the semantic approach with the aid of Atlas ti 6.0.15 software. Results: Five themes were identified regarding challenges and coping mechanisms of patients in managing their conditions. 1) Inadequate opportunities for diagnosis, with community screening supporting identification of patients. 2) Accessing care came amidst transport challenges, absence of health workers and the lack of essential supplies for monitoring conditions. Patients borrowed transport funds or trekked to health facilities and some formed groups to contribute resources to buy equipment and supplies. 3) Access to medications was affected by frequent drug stockouts at public health facilities which pushed patients to purchase own drugs or obtain these through friends and networks. However, other patients resorted to cheaper herbal remedies. 4) Monitoring and managing conditions was affected by insufficient knowledge and opportunities for self-monitoring. Information from health workers and experiences from peers bridged the knowledge gap while private facilities or community health workers supported self-monitoring. 5) Adopting changes in behaviour was challenging but patients fitted these within their usual routines and mobilised family members to also adopt lifestyle changes while ignoring those they deemed unrealistic. Conclusions: The coping mechanisms patients adopted to manage their chronic conditions reflects self-care initiatives at the individual and community levels which could be reinforced and supplemented to better support and empower patients as steps are taken to address existing challenges.

Body weight, weight change and the risk of cardiovascular disease in patients with hypertension: a primary-care cohort study

BACKGROUND/OBJECTIVES

Obesity and cardiovascular disease (CVD) often co-occur. However, the effects of excessive body weight and weight change on CVD in patients with hypertension are not clearly established. We examined the associations of BMI, weight change and the risk of CVD in patients with hypertension.

SUBJECTS/METHODS

Our Data were drawn from the medical records of primary-care institutions in China. A total of 24,750 patients with valid weight measurements attending primary healthcare centers were included. Body weight were grouped in BMI categories of underweight ( < 18.5 kg/m2), healthy weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2) and obesity ( ≥ 25.0 kg/m2). Weight change over 12 months was divided into: gain >4%, gain 1-4%, stable (-1 to 1%), loss 1-4%, and loss ≥4%. Cox regression analyses were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) between BMI, weight change and the risk of CVD.

RESULTS

After multivariable adjustment, patients with obesity were related to higher risks of CVD (HR = 1.48, 95% CI: 1.19-1.85). Higher risks were seen in participants with loss ≥4% and gain >4% of body weight compared to stable weight (loss ≥4%: HR = 1.33, 95% CI: 1.04-1.70; gain >4%: HR = 1.36, 95% CI: 1.04-1.77).

CONCLUSION

Obesity and weight change of loss ≥4% and gain >4% were related to higher risks of CVD. Close monitoring and appropriate interventions aimed at achieving an optimal weight are needed to prevent adverse cardiovascular outcomes for patients with hypertension.

Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned

BACKGROUND

With improved access to anti-retroviral drugs, persons living with HIV/AIDS (PLWHA) are living longer but with attendant increased risks of non-communicable diseases (NCDs). The increasing burden of NCDs, especially hypertension, could reverse gains attributed to HIV care. Nurses and Community Health Officers (CHO) in Nigeria are cardinal in delivering primary health care. A task-strengthening strategy could enable them to manage hypertension in HIV care settings. This study aimed to assess their knowledge and practice of hypertension management among Healthcare workers (HCWs) and to explore the challenges involved in conducting onsite training during pandemics.

METHODS

Nurses and CHOs in the employment of the Lagos State Primary Health Care Board (LSPHCB), Lagos State, Nigeria, were recruited. They were trained through hybrid (virtual and onsite) modules before study implementation and a series of refresher trainings. A pre-and post-training test survey was administered, followed by qualitative interviews to assess skills and knowledge uptake, the potential barriers and facilitators of task-sharing in hypertension management in HIV clinics, and the lessons learned.

RESULTS

Sixty HCWs participated in the two-day training at baseline. There was a significant improvement in the trainees' knowledge of hypertension management and control. The average score during the pre-test and post-test was 59% and 67.6%, respectively. While about 75% of the participants had a good knowledge of hypertension, its cause, symptoms, and management, 20% had moderate knowledge, and 5% had poor knowledge at baseline. There was also an increase in the mean score between the pre-test and post-test of the refresher training using paired t-tests (P < 0.05). Role-playing and multimedia video use improved the participants' uptake of the training. The primary barrier and facilitator of task sharing strategy in hypertension management reported were poor delineation of duties among HCWs and the existing task shifting at the Primary Healthcare Centres (PHC) level, respectively.

CONCLUSIONS

The task strengthening strategy is relevant in managing hypertension in HIV clinics in Nigeria. The capacity development training for the nurses and CHOs involved in the Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy (TASSH-Nigeria) study yielded the requisite improvement in knowledge uptake, which is a reassurance of the delivery of the project outcomes at the PHCs.

Mixed effects logistic regression analysis of blood pressure among Ghanaians and associated risk factors

Blood pressure (BP) control is a global health issue with an increase in BP beyond the normal BP leading to different stages of hypertension in humans and hence the need to identify risk factors of BP for efficient and effective control. Multiple BP measurement have proven to provide BP readings close to the true BP status of the individual. In this study, we used multiple BP measurement data on 3809 Ghanaians to determine risk factors associated with BP. The data were obtained from World Health Organization study on Global AGEing and Adult Health. We defined high blood pressure (HBP) as [Formula: see text] 130/80 mmHg or normal as [Formula: see text] 130/80 mmHg. We provide summary statistics and also used the Chi-Square test to assess significance of association between HBP versus risk factors of HBP. The aim of this study is to identify risk factors of BP using the mixed effects logistic regression model. Data were analyzed using R version 4.2.2. The results showed that the risk of high blood pressure (HBP) decreases across the three measurement periods. There is reduced risk (OR = 0.274, 95% CI = 0.2008, 0.405) of HBP among male participants relative to female participants. The risk (OR = 2.771, 95% CI = 1.8658, 4.1145) of HBP increased by 2.771-folds among those who are 60 years and above relative to those below the age of 60 years. Those whose work involves/requires vigorous exercise has 1.631-fold increase in the risk (OR = 1.631, 95% CI = 1.1151, 2.3854) of HBP relative to those whose work does not involve vigorous exercise. There is approximately 5-folds increased in the risk (OR = 4.896, 95% CI = 1.9535, 12.2268) of among those who have ever been diagnosed with diabetes. The results also revealed high risk (OR = 1.649, 95%CI = 1.1108, 2.4486) of HBP among those who have formal education. The risk (OR = 1.009, 95% CI = 1.0044, 1.0137) of HBP increases with increasing weight and a reduced risk (OR = 0.996, 95% CI = 0.9921, 0.9993) of HBP with increasing height. We found that sad experience, either mild, moderate or severe, is associated with a reduced risk of HBP. Those who have vegetable servings at least 2 cups per day have increased risk of HBP and those who have fruits servings at least 2 cups per day is associated with a reduced risk of HBP, however this is not statistically significant. To achieve success in BP control, programs should be designed with the aim of reducing weight, educate those with formal eduction on issues relating to HBP. Those whose work requires vigorous exercise are recommended to have regular check-ups to ensure that pressure build-up in the lungs is cleared. SBP is lower for women at young age but continue to increase after menopause as their BP increase becomes salt-sensitive. Hence there is need to give more attention to menopausal women so as to improve BP. Both young and old individuals are recommended to practice regular exercise since this has shown to reduce risk of being overweight or becoming diabetic and reduces the risk of HBP at yong age and old age. Also, to improve blood pressure control, programs for management of blood pressure or hypertension should focus more short stature individuals since such people are more likely to experience HBP.

Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review

Despite the effectiveness of currently available antihypertensive medications, there is still a need for new treatment strategies that are more effective in certain groups of hypertensive and for additional resources to combat hypertension. However, medication non-adherence was previously recognized as a major problem in the treatment of hypertension. The mechanisms behind the positive impacts of lifestyle changes might occur in different ways. In comparison with other studies, the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials. However, in this review, the attitudinal lifestyle modifications and barriers to blood pressure control were elaborated on. An effective method for reducing blood pressure (BP) and preventing cardiovascular events with antihypertensive medications has been outlined. Maintaining healthy lifestyle factors (body mass index, diet, smoking, alcohol consumption, sodium excretion, and sedentary behavior) could lower systolic blood pressure BP by 3.5 mm Hg and reduce the risk of cardiovascular disease (CVD) by about 30%, regardless of genetic susceptibility to hypertension. Conducting a lifestyle intervention using health education could improve lifestyle factors, such as reducing salt, sodium, and fat intake, changing eating habits to include more fruits and vegetables, not smoking, consuming less alcohol, exercising regularly, maintaining healthy body weight, and minimizing stressful conditions. Each behavior could affect BP by modulating visceral fat accumulation, insulin resistance, the renin-angiotensin-aldosterone system, vascular endothelial function, oxidative stress, inflammation, and autonomic function. Evidence of the joint effect of antihypertensive medications and lifestyle reforms suggests a pathway to reduce hypertension.

The Impact of COVID-19 on New Kidney Cancer Diagnosis: Stage and Treatment in Northern Italy

This study aims to evaluate the impact of COVID-19 on new renal carcinoma (RC) diagnoses using data from the Reggio Emilia Cancer Registry in 2018-2020. A total of 293 RCs were registered, with roughly 100 cases yearly. The distribution by age shows a significant decrease in the 30-59 age group (33.7% in 2018, 24.8% in 2019, and 19.8% in 2020). The incidence of Stage I was 59.4%, 46.5%, and 58.2% in 2018, 2019, and 2020, respectively, whereas the Stage II rate had values of 6.9%, 7.9%, and 2.2% in the years 2018, 2019, and 2020, respectively. Slight non-significant variations were observed in Stages III and IV. Surgery was performed in 83.2% of cases in 2018, 78.2% in 2019, and 82.4% in 2020; the surgery distribution by stage showed no significant differences. Chemotherapy showed an increase in 2020, which was statistically significant only for Stage IV. The gender incidence trends over the last 25 years showed an increase in the male sex in the first period; then, a decline was documented, likely due to a decrease in cigarette consumption. In females, the trend was constant. The RC mortality trend significantly dropped in both genders over the entire study period.

Prevalence and predictors of hypertension among adults in Mbarara City, Western Uganda

OBJECTIVE

The study aim was to evaluate the prevalence and predictors of hypertension among an urban adult population in Mbarara city, Western Uganda.

METHODS

We evaluated blood pressure measurements, social demographic and clinical parameters of adults living in Mbarara city, Uganda. These parameters were extracted from medical records of adults who participated in the Uganda World Kidney Day 2020 health screening activities. A total of 302 adults were evaluated for hypertension using the American College of Cardiology/American Heart Association 2017 (blood pressure threshold 130/80 mmHg) and International Society of Hypertension 2020 guidelines (threshold 140/90 mmHg).

RESULTS

The mean age of the participants was 42.5 years (standard deviation: 15.1) and majority were male 195/302 (64.6%). Using American College of Cardiology/American Heart Association 2017 guidelines, 156/302 (51.7%) adults were newly diagnosed with hypertension compared to 68/302 (22.5%) newly diagnosed with hypertension using International Society of Hypertension 2020 guidelines. Only 23/302 (7.6%) were on treatment. Based on American College of Cardiology/American Heart Association 2017 guidelines, age ≥40 years and overweight/obesity were statistically significant predictors of hypertension (p < 0.05 for all) at multivariate analysis. Using the International Society of Hypertension 2020 guidelines, age ≥40 years predicted hypertension.

DISCUSSION

The prevalence of hypertension is high among this urban adult population irrespective of the guidelines used, highlighting the need for hypertension prevention interventions.

Parboiled Germinated Brown Rice Improves Cardiac Structure and Gene Expression in Hypertensive Rats

Hypertension leads to oxidative stress, inflammation, and fibrosis. The suppression of these indicators may be one treatment approach. Parboiled germinated brown rice (PGBR), obtained by steaming germinated Jasmine rice, reduces oxidative stress and inflammation in vivo. PGBR contains more bioactive compounds than brown rice (BR) and white rice (WR). Anti-hypertensive benefits of PGBR have been predicted, but research is lacking. The anti-hypertensive effects of PGBR were investigated in the downstream gene network of hypertension pathogenesis, including the renin-angiotensin system, fibrosis, oxidative stress production, and antioxidant enzymes in N-nitro-L-arginine methyl ester (L-NAME)-induced hypertensive rats. To strengthen our findings, the cardiac structure was also studied. PGBR-exposed rats showed significant reductions in systolic blood pressure (SBP) compared to the hypertensive group. WR did not reduce SBP because of the loss of bioactive compounds during intensive milling. PGBR also reduced the expression of the angiotensin type 1 receptor (AT1R), transforming growth factor-β (TGF-β), and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX4), which contribute to the renin-angiotensin system, fibrosis, and oxidative stress production, respectively. Losartan (Los, an anti-hypertensive drug)-treated rats also exhibited similar gene expression, implying that PGBR may reduce hypertension using the same downstream target as Los. Our data also indicated that PGBR reduced cardiac lesions, such as the cardiomyopathy induced by L-NAME. This is the first report on the anti-hypertensive effects of PGBR in vivo by the suppression of the renin response, fibrosis, and improved cardiac structure.

Assessing the variability and the role of inflammatory cytokines and monocyte chemoattractant protein-1 (MCP-1) in predicting stroke among hypertensives: A case-control study

Background

Atherosclerosis is a complex lipid-driven inflammatory disease in which numerous cell types and inflammatory mediators are involved in the progression of hypertension to stroke. Mediators' markers that could predict the progression of hypertension to stroke are of research importance. We assessed the predictive value of individual and combined cytokines and monocyte chemoattractant protein-1 (MCP-1) among hypertensives with or without stroke.

Methods

In a case-control study, we enrolled 63 cases with stroke and hypertension (HPT-S), 59 stroke-free hypertensives (HPT), and 53 stroke free normotensives as controls (CS). Sociodemographic data and blood samples were collected for the estimation of Interleukin-10 (IL-10), IL-6, IL-8, IL-1β and monocyte chemoattractant protein-1 (MCP-1) using commercially available ELISA kits from Biobase Biotech, Shanghai, China. The Receiver Operator Characteristics (ROC) analysis was used to calculate diagnostic accuracy for cytokines in predicting stroke among hypertensives. A combined bioscore model of IL-10 and MCP-1 was generated to predict stroke among hypertensives. The multiple logistic regression analysis was used to assess the chances of IL-10 and MCP-1 in predicting stroke among hypertensives. Statistical analyses were performed using R-language.

Results

The HPT-S group had significantly higher levels of MCP-1 and IL-10 compared to the HPT and CS groups (p < 0.05). There was no significant difference in IL-1β, IL-8 and IL-6 amongst the three study groups. MCP-1 and IL-10 were predictive of stroke occurrence among hypertensives and were used to develop a bioscore model. An elevated MCP-1 and IL-10 with a bioscore 2 had a predictive accuracy of 0.81, a sensitivity of 0.77 and specificity of 0.84. At a bioscore of 1, the sensitivity and specificity for predicting stroke among hypertensives was 97.0% and 61.0% respectively. In a binary logistic regression, having a bioscore of 1 [aOR = 20.43, 95% CI (2.17-192.62), p = 0.008] or 2 [aOR = 26.00, 95% CI (2.92-231.31), p = 0.003] were significantly associated with stroke occurrence among hypertensives.

Conclusion

Higher levels of IL-10 with a concomitant level of MCP-1 could serve as a good predictor of stroke among hypertensives. Subsequently, MCP-1 may prove useful as a therapeutic target for atherosclerosis in hypertensives. Combined bioscore of MCP-1 and IL-10 could serve as a good predictor of stroke among hypertensives.

Antihypertensive potential of Brassica rapa leaves: An in vitro and in silico approach

Aim: Plants contain many essential constituents and their optimization can result in the discovery of new medicines. One such plant is Brassica rapa that is commonly used as a vegetable to fulfill daily food requirements worldwide. This study intends to screen the phytochemicals, antihypertensive potential, GC-MS, and in silico analysis of the leaves of Brassica rapa.

Methods: Powdered leaves were subjected to proximate analysis followed by estimation of primary metabolites. Extracts were obtained by hot and cold extraction and investigated for secondary metabolites. All crude extracts were screened for their antihypertensive potential using an angiotensin-converting enzyme (ACE) inhibition assay. GC-MS analysis was carried out to standardize the extract, and an antihypertensive metabolite was confirmed using an in silico approach.

Results: Physicochemical evaluation resulted in moisture content (9.10% ± 0.1), total ash value (18.10% ± 0.6), and extractive values (water 9.46% ± 0.5 and alcohol soluble 4.99% ± 0.1), while phytochemical investigation revealed primary metabolites (total proteins 11.90 mg/g ± 0.9; total fats 3.48 mg/g ± 0.5; and total carbohydrates 57.45 mg/g ± 1.2). Methanol extract showed the highest number of secondary metabolites including polyphenols 93.63 mg/g ± 0.6; flavonoids 259.13 mg/g ± 0.6; and polysaccharides 56.63 mg/g ± 1.4, while water extract (70 mg/g ± 2) was rich in glycosaponins. Methanol extract showed the highest antihypertensive potential by inhibiting ACE (79.39%) amongst all extracts, compared to the standard drug captopril, which inhibited 85.81%. Standardization of methanol extract via GC-MS analysis revealed potent phytoconstituents, and a molecular docking study confirmed that oleic acid is the main antihypertensive metabolite.

Conclusion: We conclude that leaves of Brassica rapa can successfully lower hypertension by inhibiting ACE, however; in vivo investigations are required to confirm this antihypertensive activity.

The effect of calcium channel blocker (CCB) treatment on retinal and choroidal vessels in a group of hypertensive patients

PURPOSE

The present study was designed to observe the vasoreactivity in retina and choroid after calcium channel blocker (CCB) treatment in a group of hypertensive patients.

METHOD

The study was based on 56 hypertensive patients (56 eyes) and 56 control subjects (56 eyes). Choroidal scans and the measurement of peripapillary retinal vessel diameters was performed at baseline and optical coherence tomography (OCT) scans were also performed at first month . Subfoveal choroidal thickness (SFCT) and the diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV) were compared between the groups.

RESULTS

The baseline diameters of the STA, ITA were significantly decreased in the patient group compared with the control group (all p < .05). There was a significant increase at first month after the CCB treatment in comparison to baseline measurements (all p < .05). When compared with the controls, the diameter of venules showed a decrease at baseline but was not significant. After the treatment, the diameters of venules were insignificantly increased compared with baseline measurements (p = .178 and p = .275) and there were also no significant differences between the control group and the patient group in first month (all p > .05). The average choroidal thickness measurements of the hypertensive group was lower than the control group (p = .404) and there was a tendency to increase after the treatment (p = .055).

CONCLUSION

This study demonstrates that, treatment with CCB seems to improve retinal arteries and has almost no affect on the choroidal thickness in newly diagnosed hypertensive patients.

Trends in Incidence and Mortality of Kidney Cancer in a Northern Italian Province: An Update to 2020

The aim of this study was to examine the incidence and mortality trends for tumors and cardiovascular disease (CVD) in a province of northern Italy. The study included kidney cancers recorded in the period 1996−2020, divided by sex, age, year of incidence and years from diagnosis. The standardized incidence rate was calculated using the European population, and the Annual Percent Change (APC) was reported. In total, 2331 patients with kidney cancers were identified, mainly males (1504 cases) aged 60−79 years (1240 cases). There were 1257 deaths; there were no differences according sex but there were differences according to age (12.1% among younger adults and 80.4% among 80+). The incidence rate increased in males between 1996 and 2011 (APC = 2.3), while the mortality rate decreased in both males (APC = −3.3%) and females (APC = −4.5%). Comparing the same periods, kidney cancer-specific mortality decreased from 81.8% to 43.7%, while in the same period there was an increasing trend for CVD mortality. Moreover, the risk of CVD mortality increased as we moved away from the diagnosis (from 6.2% to 27.5%, p < 0.01). The same trend was observed for other causes of death (from 12.6% to 32.1%, p < 0.01). Thus, a multidisciplinary approach seems necessary during the follow-up and treatments of patients with kidney cancer.

The prevalence and predictors of cardiovascular diseases in Kherameh cohort study: a population-based study on 10,663 people in southern Iran

BACKGROUND

The prevalence of cardiovascular disease (CVD) is rapidly increasing in the world. The present study aimed to assess the prevalence and Predictors factors of CVD based on the data of Kherameh cohort study.

METHODS

The present cross-sectional, analytical study was done based on the data of Kherameh cohort study, as a branch of the Prospective Epidemiological Studies in Iran (PERSIAN). The participants consisted of 10,663 people aged 40-70 years. CVD was defined as suffering from ischemic heart diseases including heart failure, angina, and myocardial infarction. Logistic regression was used to model and predict the factors related to CVD. Additionally, the age-standardized prevalence rate (ASPR) of CVD was determined using the standard Asian population.

RESULTS

The ASPR of CVD was 10.39% in males (95% CI 10.2-10.6%) and 10.21% in females (95% CI 9.9-10.4%). The prevalence of CVD was higher among the individuals with high blood pressure (58.3%, p < 0.001) as well as among those who smoked (28.3%, p = 0.018), used opium (18.2%, p = 0.039), had high triglyceride levels (31.6%, p = 0.011), were overweight and obese (66.2%, p < 0.001), were unmarried (83.9%, p < 0.001), were illiterate (64.2%, p < 0.001), were unemployed (60.9%, p < 0.001), and suffered from diabetes mellitus (28.1%, p < 0.001). The results of multivariable logistic regression analysis showed that the odds of having CVD was 2.25 times higher among the individuals aged 50-60 years compared to those aged 40-50 years, 1.66 folds higher in opium users than in non-opium users, 1.37 times higher in smokers compared to non-smokers, 2.03 folds higher in regular users of sleeping pills than in non-consumers, and 4.02 times higher in hypertensive individuals than in normotensive ones.

CONCLUSION

The prevalence of CVD was found to be relatively higher in Kherameh (southern Iran) compared to other places. Moreover, old age, obesity, taking sleeping pills, hypertension, drug use, and chronic obstructive pulmonary disease had the highest odds ratios of CVD.

Screening of hypertension, risks, knowledge/awareness in second-cycle schools in Ghana. A national cross-sectional study among students aged 12-22

In Ghana, the management of hypertension in primary health care is a cost-effective way of addressing premature deaths from vascular disorders that include hypertension. There is little or no evidence of large-scale studies on the prevalence, risk, and knowledge/awareness of hypertension in students aged 12-22 years in Ghana. In a cross-sectional study, blood pressure, anthropometric indices, and knowledge/awareness assessment of students at second-cycle schools were recorded from 2018 to 2020 in three regions of Ghana. Multistage cluster sampling was used in selecting regions and the schools. Prevalence of prehypertension and hypertension was categorized by the Joint National Committee 7, where appropriate, chi-square, scatter plots, and correlations were used in showing associations. A total of 3165 students comprising 1776 (56.1%) females and 1389 (43.9%) males participated in this study within three regions of Ghana. The minimum age was 12 years and the maximum age was 22 years. The mean age was 17.21 with standard deviation (SD: 1.59) years. A 95% confidence interval was set for estimations and a P value < 0.05 was set as significant. The prevalence rate of overall hypertension was 19.91% and elevated (prehypertension) was 26.07%. Risk indicators such as weight, BMI, waist circumference, physical activity, and form of the diet were positively correlated with hypertension. Among Ghanaian students currently in second-cycle educational institutions, 19.91% were hypertensive and 26.07% were prehypertensive. This may indicate a probable high prevalence of hypertension in the future adult population if measures are not taken to curb the associated risks.

Lifestyle Modification Practice and Associated Factors Among Diagnosed Hypertensive Patients in Selected Hospitals in Central Gondar Zone

Background

Hypertension is one of the leading causes of disability and death in both developed and developing countries including Ethiopia. Non-communicable diseases account for 42% of deaths in Ethiopia. However, it is still widely undetected and poorly controlled. Hence, this study aims to assess the lifestyle modification practices and related factors of adult hypertensive patients in the central Gondar region of northwestern Ethiopia.

Methods

Institutional based, cross-sectional study was conducted from April 10 up to May 10, 2021. A simple random sampling was used to select 629 study participants. Data were collected by using self-administered and structured questionnaire. Data were entered to EpiData 4.6 and exported to SPSS 20 for further analysis. A multivariable logistic regression analysis was employed to identify the factors associated with lifestyle modification. Adjusted Odds Ratio (AOR) with 95% confidence interval was used to show the strength of association, while a P-value <.05 of was used to declare the significance of association.

Results

The overall prevalence of recommended lifestyle modification in hypertensive patients was 24.2% (95% CI (20.8, 27.5)). Age ⩾65 years (AOR = 0.59, 95% CI: 0.39, 0.88), no formal education (AOR = 0.65, 95% CI: 0.4, 0.97), diagnosis time is 5 to 10 years (AOR = 1.93, 95% CI: 1.11, 3.34), co morbidities (AOR = 0.47, 95% CI: 0.3, 0.73), and rich wealth index (AOR = 1.99, 95% CI: 1.22, 3.27) are is significantly associated with good lifestyle modification practices.

Conclusions

The practice of good lifestyle modifications in the study area was found to be low among the hypertensive patients. Respondents' age, education status, wealth index, duration of diagnosis, and co morbidities were found to be significant factors related to good lifestyle modification practices. Therefore, more attention should be paid to providing nutrition counseling and health promotion to improve the practice of lifestyle modification in patients with hypertension.

Association of dietary calcium, magnesium, sodium, and potassium intake and hypertension: a study on an 8-year dietary intake data from the National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES

There has been an increased interest in determining calcium magnesium, sodium, and potassium's distinct effects on hypertension over the past decade, yet they simultaneously regulate blood pressure. We aimed at examining the association of dietary calcium, magnesium, sodium, and potassium independently and jointly with hypertension using National Health and Nutrition Examination Survey data from 2007 to 2014.

MATERIALS/METHODS

The associations were examined on a large cross-sectional study involving 16684 US adults aged>20 years, using multivariate analyses with logistical models.

RESULTS

Sodium and calcium quartiles assessed alone were not associated with hypertension. Potassium was negatively associated with hypertension in the highest quartile, 0.64 (95% confidence interval [CI], 0.48–0.87). When jointly assessed using the high and low cut-off points, low sodium and corresponding high calcium, magnesium, and potassium intake somewhat reduced the odds of hypertension 0.39 (95% CI, 0.20–0.76). The sodium-to-potassium ratio was positively associated with hypertension in the highest quartile1.50 (95% CI, 1.11–2.02). When potassium was adjusted for sodium intake and sodium-to-potassium ratio assessed among women, increased odds of hypertension were reported in the highest quartile as 2.02 (95% CI, 1.18–3.34) and 1.69 (95% CI, 1.12–2.57), respectively. The association of combined minerals on hypertension using dietary goals established that men meeting the reference intakes for calcium and exceeding for magnesium had reduced odds of hypertension 0.51 (95% CI, 0.30–0.89). Women exceeding the recommendations for both calcium and magnesium had the lower reduced odds of 0.30 (95% CI, 0.10–0.69).

CONCLUSIONS

Our results suggest that the studied minerals' association on hypertension is stronger when jointly assessed, mostly after gender stratification. As compared to men, women increased their risk of hypertension even with a low sodium intake. Women would also reasonably reduce their risk of developing hypertension by increasing calcium and magnesium intake. In comparison, men would somewhat be protected from developing hypertension with calcium intake meeting the dietary goals and magnesium exceeding the nutritional goals.

Cardioprotective effects of phytopigments via multiple signaling pathways

BACKGROUND

Cardiovascular diseases (CVDs) are among the deadliest non-communicable diseases, and millions of dollars are spent every year to combat CVDs. Unfortunately, the multifactorial etiology of CVDs complicates the development of efficient therapeutics. Interestingly, phytopigments show significant pleiotropic cardioprotective effects both in vitro and in vivo.

PURPOSE

This review gives an overview of the cardioprotective effects of phytopigments based on in vitro and in vivo studies as well as clinical trials.

METHODS

A literature-based survey was performed to collect the available data on cardioprotective activities of phytopigments via electronic search engines such as PubMed, Google Scholar, and Scopus.

RESULTS

Different classes of phytopigments such as carotenoids, xanthophylls, flavonoids, anthocyanins, anthraquinones alleviate major CVDs (e.g., cardiac hypertrophy, atherosclerosis, hypertension, cardiotoxicities) via acting on signaling pathways related to AMPK, NF-κB, NRF2, PPARs, AKT, TLRs, MAPK, JAK/STAT, NLRP3, TNF-α, and RA.

CONCLUSION

Phytopigments represent promising candidates to develop novel and effective CVD therapeutics. More randomized, placebo-controlled clinical studies are recommended to establish the clinical efficacy of phytopigments.

Gender-related differences in the modulation of anthropometric, biochemical, and immune markers by physical activity in hypertensive and diabetic individuals

Systemic arterial hypertension (SAH) and type 2 diabetes mellitus (T2DM) compose the two major noncommunicable chronic inflammatory diseases. Physical activity has been shown as a promising complementary approach to control the systemic inflammation. However, it is still unclear whether this modulation is gender-dependent. The objective of this study was evaluate the gender-related influence of physical activity on the inflammatory response and biochemical profile of individuals with SAH and T2DM. An international physical activity questionnaire was applied to 376 individuals diagnosed with SAH and T2DM in order to access their exercises routine and was evaluated the influence of physical activity in biochemical, anthropometrical, and immunological markers involved in these disorders in men and women. Even though active individuals have exhibited lower serum levels of IL-1β, IFN-γ, TNF-α, and IL-17A, the ratios between IL-10 and all inflammatory cytokines were higher in men than in women. Physically active individuals also demonstrated increased HDL/LDL and HDL/VLDL ratios. Moreover, multiple correlations revealed that in active women both IL-10 and TNF-α serum levels positively correlate with fasting glucose levels, and were negatively associated with HDL levels. Our findings suggest that gender-related differences dictate a distinct crosstalk between inflammatory and biochemical markers in physically active 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.

A semi-systematic review on hypertension and dyslipidemia care in Egypt-highlighting evidence gaps and recommendations for better patient outcomes

Background

Both hypertension and dyslipidemia are considered as major modifiable risk factors of cardiovascular diseases (CVDs), and their prevalence in Egypt has increased in recent years. Evidence-based systematic evaluation of data on hypertension and dyslipidemia is critical for effective patient-centric management to reduce the overall risk of CVDs in Egypt. This semi-systematic review aimed to quantify and identify data gaps in the prevalence and distribution of patient journey touchpoints including awareness, screening, diagnosis, treatment, adherence, and control of hypertension and dyslipidemia to provide the basis for research prioritization, practice guidance, and health care reforms in Egypt.

Main body

Structured search was conducted on MEDLINE and Embase to identify articles published in English between January 2010 and December 2019 that reported key patient journey touchpoints in hypertension and dyslipidemia management. Unstructured search was conducted on public or government websites with no date restriction. Data from all sources were extracted and presented descriptively. In total, 22 studies published between 1995 and 2020 on hypertension and dyslipidemia were included in the final analyses. The prevalence of hypertension in Egypt ranged from 12.1 to 59%. Studies reported awareness (37.5% and 43.9%), diagnosis (42% and 64.7%), treatment (24% and 54.1%), and adherence to antihypertensive medication (51.9%) to be low. Furthermore, the percentage of patients who had their blood pressure controlled ranged from 8 to 53.2%. The prevalence of dyslipidemia varied in the general population (range 19.2–36.8%) but was higher in patients with acute coronary syndrome (ACS) (50.9% and 52.5%) and coronary artery disease (58.7%). A national report indicated that 8.6% of the general population was screened for dyslipidemia; however, no data was available on the diagnosis and treatment rates. Among ACS patients, 73.9% were treated for dyslipidemia. Data indicated low levels of medication adherence (59%) among dyslipidemia patients, with overall low control rates ranging from 5.1 to 34.4% depending on CVD risk in populations including ACS patients.

Conclusion

Data on patient journey touchpoints of hypertension and dyslipidemia are limited in Egypt, indicating the need for more systematic and high-quality evidence-based studies covering different aspects of patient-centric management for better management of CVD and its risk factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42506-021-00096-9.

Astaxanthin Ameliorates Blood Pressure in Salt-Induced Prehypertensive Rats Through ROS/MAPK/NF-κB Pathways in the Hypothalamic Paraventricular Nucleus

Astaxanthin (AST) has a variety of biochemical effects, including anti-inflammatory, antioxidative, and antihypertensive functions. The aim of the present study was to determine whether AST ameliorates blood pressure in salt-induced prehypertensive rats by ROS/MAPK/NF-κB pathways in hypothalamic paraventricular nucleus.To explore the central effects of AST on the development of blood pressure, prehypertensive rats were induced by a high-salt diet (HS, 8% NaCl) and its control groups were treated with normal-salt diet (NS, 0.3% NaCl). The Dahl salt-sensitive (S) rats with HS diet for 6 weeks received AST or vehicle by gastric perfusion for 6 weeks. Compared to those with NS diet, rats with HS diet exhibited increased mean arterial pressure (MAP) and heart rate (HR). These increases were associated with higher plasma level of norepinephrine (NE), interleukin 1β (IL-1β), and interleukin 6 (IL-6); elevated PVN level of reactive oxygen species (ROS), NOX2, and NOX4, that of IL-1β, IL-6, monocyte chemotactic protein 1 (MCP-1), tyrosine hydroxylase (TH), phosphorylation extracellular-signal-regulated kinase (p-ERK1/2), phosphorylation Jun N-terminal kinases (p-JNK), nuclear factor-kappa B (NF-κB) activity; and lower levels of IL-10, superoxide dismutase (SOD), and catalase (CAT) in the PVN. In addition, our data demonstrated that chronic AST treatment ameliorated these changes in the HS but not NS diet rats. These data suggested that AST could alleviate prehypertensive response in HS-induced prehypertension through ROS/MAPK/NF-κB pathways in the PVN.

Dietary patterns and blood pressure in Southern Cone of Latin America

BACKGROUND AND AIMS

in the Southern Cone of Latin America, previous studies have shown that blood hypertension is one of the most significant risk factor for cardiovascular disease, and diet plays a fundamental role. We analyzed the cross-sectional relationship between dietary patterns (DP) and blood pressure values in people involved in the CESCAS I Study.

METHODS AND RESULTS

the participants (n = 4626) were derived from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). To define DP, a food-frequency questionnaire was applied and principal component analysis was performed. Blood pressure was determined according to standardized guidelines. A multivariate regression model was developed to determine the association between each DP and blood pressure values, according to the quartile (Q) of adherence to DP. Two predominant DP were detected, Prudent (PDP, higher consumption of fruits, vegetables, legumes, whole grains, fish, seafood and nuts) and Western (WDP, higher consumption of red and processed meats, dressings, sweets, snacks and refined grains). A significant inverse association was found between adherence to PDP and systolic and diastolic blood pressure (-1.85 and -1.29 mmHg for Q4 vs Q1, respectively). Adherence to WDP was positively associated with systolic blood pressure (2.09 mmHg for Q4 vs Q1).

CONCLUSION

the WDP detected in the studied population is positively associated with higher levels of blood pressure, while greater adherence to healthy DP has a positive impact on blood pressure.

Short-term effect of angiotensin-converting enzyme inhibitor on retinal vessel diameter in patients with systemic hypertension

PURPOSE

To determine the retinal vessel diameter changes after angiotensin-converting enzyme (ACE) inhibitor treatment in a group of hypertensive patients.

METHODS

This study included 60 treatment-naive hypertensive patients who were treated with ACE inhibitor. Sixty healthy volunteers served as control group. An optical coherence tomography scan protocol including the measurement of peripapillary retinal vessel diameters was performed at baseline and at 1st month. The diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV), superior nasal artery (SNA), inferior nasal artery (INA), superior nasal vein (SNV) and inferior nasal vein (INV) were statistically compared.

RESULTS

The baseline diameters of the STA, ITA, SNA, and INA were significantly decreased in the patient group compared with the control group (all p < 0.05). There was a significant increase at 1st month after the treatment in comparison to baseline measurements (all p < 0.05). When compared with the controls, only the diameter of SNV showed a significant decrease at baseline (p = 0.031). After the treatment, the diameters of SNV and INV were significantly increased compared with baseline measurements (p = 0.049 and p = 0.035, respectively). There were no significant differences between the control group and the patient group at 1st month (all p > 0.05).

CONCLUSION

Short-term treatment with ACE inhibitor led to a significant improvement in the retinal vessel diameters of patients with hypertension.

Peperomia pellucida (L.) Kunth as an angiotensin-converting enzyme inhibitor in two-kidney, one-clip Goldblatt hypertensive rats

Backgroud

Peperomia pellucida (L.) Kunth has been used widely to treat headache, kidney disease, fever, and hypertension. Previous in vitro studies discovered that the flavonoid-rich extract of this plant has potential hypotensive effects, specifically angiotensin-converting enzyme (ACE)-inhibitory activity. However, there is insufficient scientific evidence to validate the result in vivo.

Purpose

This study investigated the dose dependencies of the effects of the ethyl acetate fraction of the ethanolic extract of this plant on blood pressure and biomarkers associated with the renin–angiotensin–aldosterone systems (RAAS), such as angiotensin II (AII) and the plasma renin concentration (PRC).

Study design

In total, 30 two-kidney, one-clip (2K1C) hypertensive model rats were divided into five groups (n = 6 each): model group, captopril 25 mg/kg BW group, and three different ethyl acetate groups (25, 50, and 100 mg/kg BW). Another six rats comprised the sham group.

Methods

Renal hypertensive rats (RHRs) were generated using stainless steel modification clips. Drugs were administered via oral gavage for 2 consecutive weeks. Blood pressure was measured weekly prior to treatment. Blood samples were collected before treatment and after the last dose to measure AII and PRC. The left kidney was isolated for histopathological examination.

Results

Blood pressure, AII levels, and PRC were elevated after 6 weeks in RHRs. Treatment with captopril and the ethyl acetate fraction of P. pellucida (L.) Kunth decreased blood pressure, AII levels, and PRC. The ethyl acetate fraction at a dose of 50 mg/kg BW had similar ACE-inhibitory effects as captopril. Histopathological examination disclosed coagulative necrosis in clipped kidneys. Impairment was alleviated in a dose-dependent manner by P. pellucida (L.) Kunth, similarly as observed in the captopril group.

Conclusion

P. pellucida (L.) Kunth targets the renin–angiotensin–aldosterone system, which might explain its antihypertensive effects.

Institutional Satisfaction and Anxiety Mediate the Relationship Between Social Support and Depression in Hypertension Patients in Elderly Caring Social Organizations: A Cross-Sectional Study

Background: Depression is a prevalent health condition among hypertension patients in elderly caring social organizations (SOs). Patients with hypertension and depression symptoms have worse health outcomes than those without depression. As the population ages, chronic and mental health issues such as depression of hypertension patients in elderly caring SOs have become prominent. However, the combined effects of social support, institutional satisfaction, and anxiety on depression among hypertension individuals in elderly caring SOs remain unclear. This study aimed to explore the mediating effects of institutional satisfaction and anxiety on the relationship between social support and depression among hypertension patients in elderly caring SOs in Anhui Province, China.

Methods: A cross-sectional study was conducted using a multi-stage stratified random sampling method. A questionnaire was used to collect data on demographic characteristics, the satisfaction of elderly caring SOs, social support, anxiety, and depression. A multiple linear regression model was utilized to investigate depression-related factors, and structural equation modeling (SEM) was employed to examine the relationships between social support, institutional satisfaction, anxiety, and depression among patients with hypertension in elderly caring SOs.

Results: Our results indicated that the mean scores of social support were 20.19 ± 6.98 and 1.92 ± 3.18 for anxiety, and 6.24 ± 5.03 for depression; besides, 33.3% of participants were very satisfied with elderly caring SOs, 48.5% were satisfied, and only 6.0% were dissatisfied or very dissatisfied. Comorbid chronic diseases were significantly associated with depression. Institutional satisfaction was directly negatively related to depression, whereas anxiety was directly positively correlated with depression. Social support had an indirect negative association with depression by the mediating effects of institutional satisfaction and anxiety.

Conclusions: The study highlights the importance of social support in maintaining mental health among hypertension patients residing in elderly caring SOs. To alleviate depression among hypertension patients in elderly caring SOs, strategies that target enhancing social support, institutional satisfaction, and anxiety reduction should be prioritized. More importantly, more attention should be paid to patients with comorbid chronic diseases.

Heme-oxygenase and lipid mediators in obesity and associated cardiometabolic diseases: Therapeutic implications

Obesity-mediated metabolic syndrome remains the leading cause of death worldwide. Among many potential targets for pharmacological intervention, a promising strategy involves the heme oxygenase (HO) system, specifically its inducible form, HO-1. This review collects and updates much of the current knowledge relevant to pharmacology and clinical medicine concerning HO-1 in metabolic diseases and its effect on lipid metabolism. HO-1 has pleotropic effects that collectively reduce inflammation, while increasing vasodilation and insulin and leptin sensitivity. Recent reports indicate that HO-1 with its antioxidants via the effect of bilirubin increases formation of biologically active lipid metabolites such as epoxyeicosatrienoic acid (EET), omega-3 and other polyunsaturated fatty acids (PUFAs). Similarly, HO-1and bilirubin are potential therapeutic targets in the treatment of fat-induced liver diseases. HO-1-mediated upregulation of EET is capable not only of reversing endothelial dysfunction and hypertension, but also of reversing cardiac remodeling, a hallmark of the metabolic syndrome. This process involves browning of white fat tissue (i.e. formation of healthy adipocytes) and reduced lipotoxicity, which otherwise will be toxic to the heart. More importantly, this review examines the activity of EET in biological systems and a series of pathways that explain its mechanism of action and discusses how these might be exploited for potential therapeutic use. We also discuss the link between cardiac ectopic fat deposition and cardiac function in humans, which is similar to that described in obese mice and is regulated by HO-1-EET-PGC1α signaling, a potent negative regulator of the inflammatory adipokine NOV.

Choroidal structural changes and choroidal vascularity index in patients with systemic hypertension

PURPOSE

To assess the impact of systemic hypertension on the choroidal structure and choroidal vascularity index (CVI).

METHODS

This prospective cross-sectional study comprised 50 eyes of 50 treatment-naive hypertensive patients and 50 eyes of 50 healthy subjects. Choroidal thickness (CT) was measured in the subfoveal region, 1500 µm nasal to the fovea, and 1500 µm temporal to the fovea. Binarization of the enhanced depth-optical coherence tomography images was performed with Image-J software. The CT, choroidal area (CA), luminal area (LA), and CVI were compared statistically.

RESULTS

The mean subfoveal, nasal, and temporal CT were decreased in the patient group (p 0.003, 0.026, and 0.001, respectively). The mean CA, LA, and CVI were decreased in the patient group in comparison to controls (p = 0.047, 0.009, and 0.016 respectively). The correlation between the subfoveal CT and systolic blood pressure was significant (r = -0.450, p < 0.001). There was a significant correlation between the systolic blood pressure and CVI (r = -0.401, p < 0.001).

CONCLUSION

The significant decrease in the structural parameters and CVI show that choroid is affected in patients with treatment-naive hypertension.

Mucocutaneous diseases in the combined antiretroviral therapy era: prevalence and spectrum in HIV seropositive children and adolescents in Durban, South Africa

BACKGROUND

Mucocutaneous diseases (MCD) have been commonly described among human immunodeficiency virus (HIV) infected patients before the combined antiretroviral therapy (cART) era. There is limited data on the frequency and type of MCD in the cART era in African children and adolescents. This study aimed to describe the prevalence and spectrum of MCD in South African children and adolescents seropositive for HIV on cART.

METHODS

A cross-sectional study of 310 participants aged 0-19 years attending a public sector ART clinic at King Edward VIII Hospital, Durban, South Africa, was conducted. Demographic, clinical, and laboratory information was obtained from the participants and hospital records. Participants were examined. Data were collated and analyzed with SPSS version 23.

RESULTS

MCD were observed in 77.4% of HIV-infected children. The prevalence was higher among males and adolescents above 16 years old (83.9%). Infectious skin disorders (44.7%) were less common than noninfectious dermatoses (55.3%). More common disorders encountered included generalized pruritus (32.6%), fungal infections (20.9%), and inflammatory (20.4%) and pigmentary (20.4%) skin disorders. Tinea capitis and pedis were the most prevalent fungal infections, while oral candidiasis (0.2%) was the least. Inflammatory skin disorders and dyschromia appeared to be more common than in the pre-cART era.

CONCLUSIONS

While MCD are still common in HIV-infected children and adolescents in the cART era, the pattern and types of disorders have changed to a predominance of non-infectious dermatoses.

Night sleep duration and sleep initiation time with hypertension in Chinese rural population: the Henan Rural Cohort

BACKGROUND

The study was conducted to evaluate the independent dose-response of the night sleep duration and sleep initiation time on hypertension, and to explore their combined effect with hypertension.

METHODS

Participants from the Henan Rural Cohort were enrolled in this study. Information on sleep was collected using the Pittsburgh Sleep Quality Index. Hypertension was defined as systolic blood pressure/diastolic blood pressure ≥140/90 mmHg or self-reported hypertension and current use of anti-hypertensive medicines. Logistic regression and restricted cubic spline were conducted to evaluate the association of night sleep duration and sleep initiation time with hypertension.

RESULTS

Of the 37 317 included participants, 12 333 suffered from hypertension. 14 474 (38.79%) were men and 22 843 (61.21%) were women, the mean age were 57.18 ± 12.10 and 55.24 ± 11.98 in men and women. Compared to reference (7-h), fully adjusted odd ratios (ORs) and 95% confidence interval (CI) of hypertension were 0.91 (0.66-1.25) in <5 h group and 1.74 (1.41-2.16) in ≥10 h among men, respectively. Fully adjusted ORs (95% CIs) for hypertension compared with reference (21:00-22:00) were 1.05 (95% CI 0.78-1.41) in the <20:00 group, 1.52 (1.25-1.85) in ≥24:00 in men. The combined effect of sleep duration and sleep initiation time on hypertension were statistically significant in the category of (≥8 h)/night and ≥24:00 (OR 1.87, 95% CI 1.07-3.25) compared to reference in fully adjusted model among men.

CONCLUSIONS

Long night sleep duration and late sleep initiation time were associated with the higher odds of hypertension, and the sleep duration and sleep initiation time might cumulatively increase the prevalence of hypertension in men.

CLINICAL TRIAL REGISTRATION

The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx? proj=11375.

Prevalence of Hypertension and Associated Factors Among Public Servants in North Wollo Zone, Amhara Region, Ethiopia, 2020

Background

The leading preventable risk factor for premature death and disability worldwide is hypertension. Globally, 31.1% of adults (1.39 billion people) have hypertension and 9.4 million deaths are recorded annually, accounting for 13% of overall mortality.

Objective

The objective of this study is to assess the prevalence of hypertension and associated factors among public servants in North Wollo Zone, Amhara Region, Ethiopia.

Materials and Methods

An institutional-based cross-sectional study was conducted among 627 public servants. To classify candidate variables for multivariable logistic regression, a binary logistic regression model was applied. In order to analyze factors associated with hypertension among participants, all variables with a P-value<0.2 were entered into the multivariable logistic regression model. In order to determine statistical significance, a p value of less than 0.05 was taken. The assumptions of Chi square and multi-collinearity were verified. For model fitness, the Hosmer–Lemeshow goodness-of-fit was checked.

Results

The total hypertension rate was 27.6% (95% CI: 24.1–31.3). The prevalence was higher in males 129 (32.5%) than in females 444 (19.1%). History of diabetes mellitus (AOR= 9.64, 95% CI: 3.20–29.30), age >35 years (AOR= 2.94, 95% CI: 1.91–4.51) and body mass index 25kg/m² and above (AOR= 3.44, 95% CI: 2.21–5.34) have been found to be separately associated with hypertension.

Conclusion and Recommendation

Among public servants in the study setting (study area), hypertension has become a major public health issue. Half of the newly reported cases is hypertensive. The conclusion of this study calls for a more holistic approach to hypertension in terms of hypertension prevention, screening, and proper management.

Association of the Geriatric Nutritional Risk Index with incident hypertension in the older Chinese population: a 6-year cohort study

Background

We examined the association of the Geriatric Nutritional Risk Index (GNRI) with the incidence of hypertension.

Methods

We used data of the China Health and Nutrition Survey in this study. Participants aged ≥60 years were eligible. The GNRI was defined as follows: GNRI = [1.489 × albumin (ALB; g/L)] + [41.7 × (actual weight/ideal weight)]. Participants with systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medication were defined as having hypertension.

Results

This study included 4853 participants, comprising 3612 control participants and 1241 participants with hypertension. The GNRI, ALB, and body mass index (BMI) were significantly associated with higher incidence of hypertension (HR: 1.030, 1.026, and 1.088; 95% CI: 1.020–1.041, 1.008–1.044, and 1.069–1.107, respectively). The GNRI, ALB, and BMI were associated with an earlier age of hypertension onset (β = −0.403, −0.613, and −0.321; 95% CI: −0.493 to −0.314, −0.767 to −0.459, and −0.484 to −0.159, respectively).

Conclusions

A higher GNRI was associated with increased incidence of hypertension. An elevated GNRI was associated with earlier age of hypertension onset.

Exposure to Chinese Famine in the Early Life, Adulthood Obesity Patterns, and the Incidence of Hypertension: A 22-Year Cohort Study

INTRODUCTION

Little is known regarding the joint associations of famine exposure and obesity patterns with the incidence of hypertension.

METHODS

We defined famine exposure cohorts as follows: nonexposure (born between 1962 and 1965), fetal life exposure (born between 1959 and 1961), early childhood exposure (born between 1956 and 1958), midchildhood exposure (born between 1953 and 1955), and late childhood exposure (born between 1949 and 1952). Obesity patterns were defined as follows: G-/A-: subjects without neither general obesity nor abdominal obesity; G+/A- or G-/A+: subjects with either general obesity or abdominal obesity; G+/A+: subjects with both general obesity and abdominal obesity. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg or current treatment with antihypertensive medications.

RESULTS

There were 5,235 individuals participating in this study. In the subjects with general or abdominal obesity, famine exposure was associated with a lower risk of hypertension. In males with G-/A-, famine exposures in the midchildhood (p = 0.048; HR: 0.700; HR 95% CI: 0.491-0.998) and late childhood (p = 0.002; HR: 0.560; HR 95% CI: 0.374-0.840) were associated with a lower incidence of hypertension.

CONCLUSION

The coexistence of famine exposure and obesity patterns was associated with the incidence of hypertension.

Hsa_circ_0037897 may be a risk factor for essential hypertension via hsa-miR-145-5p

Objectives: This study aims to investigate the association between hsa_circ_0037897 and essential hypertension (EH) and to evaluate the diagnostic value of biomarker hsa_circ_0037897 in EH. Methods: This study included 92 EH patients and 92 sex- and age- (±3 years) matched subjects as control. qRT-PCR was performed to measure the expression level of circRNA and miRNA. Logistic regression analysis model was used to assess independent association between hsa_circ_0037897 and EH. Results: The expression level of hsa_circ_0037897 in EH patients was significantly higher (p < .001) compared to the control group, while hsa-miR-145-5p had significantly lower expression(p = .002) than the control group. The area under the ROC curve (AUC) of hsa_circ_0037897 was 0.656. Furthermore, the AUC increased to 0.714 when hsa_circ_0037897 was combined with hsa-miR-145-5p, BMI and smoking. Conclusion: The present results suggested that the high expression of hsa_circ_0037897 may be a risk factor for EH, and hsa_circ_0037897 has certain diagnostic value for EH.

Undiagnosed Depression among Hypertensive Individuals in Gaza: A Cross-sectional Survey from Palestine

BACKGROUND

The aim of this study was to estimate the prevalence and to determine the associated factors of undiagnosed depression amongst hypertensive patients (HTNP) at primary health care centers (PHCC) in Gaza.

METHODS

A cross-sectional survey was conducted including 538 HTNP as a recruitment phase of a clustered randomized controlled trial. Data were collected through face-to-face structured interview, and depression status was assessed by Beck's Depression Inventory (BDI-II). Data were analyzed by STATA version 14 using standard complex survey analyses, accounted for unresponsiveness and clustering approach. Generalized linear regression analysis was performed to assess associations.

RESULTS

The prevalence of undiagnosed clinical depression was 11.6% (95% confidence interval [CI]: 8.1, 16.3). Moreover, prevalence of 15.4% (95% CI: 10.8, 21.6) was found for mild depression symptoms. We found that non-adherence to antihypertensive medications (AHTNM) (β = 0.9, 95% CI: 0.17, 1.7), having more health-care system support (β = 2.8, 95% CI: 1.6, 3.9) and number of AHTNM (β = 1.5, 95% CI: 0.6, 2.5) remain significantly positively associated with BDI-II score. On the other hand, older age (β = -0.1, 95% CI: -0.2, -0.02), having better social support (β = -6.8, 95% CI: -8.9, -4.7) and having stronger patient-doctor relationship (β = -4.1, 95% CI: -6.9, -1.2) kept significantly negative association.

CONCLUSION

The prevalence of undiagnosed depression was about one-quarter of all cases; half of them were moderate to severe. Routine screening of depression status should be a part of the care of HTNP in PHCC.

Coconut Oil Supplementation Does Not Affect Blood Pressure Variability and Oxidative Stress: A Placebo-Controlled Clinical Study in Stage-1 Hypertensive Patients

Exploring an alternative to improve the clinical management of hypertension, we tested the hypothesis that food supplementation with coconut oil (EVCO), alone or combined with aerobic exercise training, could exert an antihypertensive effect (primary outcome) in patients with stage 1 hypertension. Forty-five hypertensive volunteers of both genders participated in a placebo-controlled clinical trial. The volunteers were submitted to 24-hour ambulatory blood pressure monitoring, analysis of blood pressure variability (BPV), measurement of serum malondialdehyde (MDA) and nutritional assessment. Results indicate that EVCO consumption had no adverse effects. The supplementation did not increase the caloric intake compared with placebo, and the dietary constituents were similar between groups, except for the saturated fats, especially lauric acid. The analysis of blood pressure indicated absence of antihypertensive effect of EVCO alone or combined with physical training. Furthermore, no effects on blood pressure variability and oxidative stress were observed in the supplemented hypertensive patients. Thus, despite the results observed in pre-clinical studies, the current clinical study did not provide evidence to support the use of coconut oil as an adjuvant in the management of hypertension in humans.

Chronic Infusion of Astaxanthin Into Hypothalamic Paraventricular Nucleus Modulates Cytokines and Attenuates the Renin-Angiotensin System in Spontaneously Hypertensive Rats

ABSTRACT

Oxidative stress, the renin-angiotensin system (RAS), and inflammation are some of the mechanisms involved in the pathogenesis of hypertension. The aim of this study is to examine the protective effect of the chronic administration of astaxanthin, which is extracted from the shell of crabs and shrimps, into hypothalamic paraventricular nucleus (PVN) in spontaneously hypertensive rats. Animals were randomly assigned to 2 groups and treated with bilateral PVN infusion of astaxanthin or vehicle (artificial cerebrospinal fluid) through osmotic minipumps (Alzet Osmotic Pumps, Model 2004, 0.25 μL/h) for 4 weeks. Spontaneously hypertensive rats had higher mean arterial pressure and plasma level of norepinephrine and proinflammatory cytokine; higher PVN levels of reactive oxygen species, NOX2, NOX4, IL-1β, IL-6, ACE, and AT1-R; and lower PVN levels of IL-10 and Cu/Zn SOD, Mn SOD, ACE2, and Mas receptors than Wistar-Kyoto rats. Our data showed that chronic administration of astaxanthin into PVN attenuated the overexpression of reactive oxygen species, NOX2, NOX4, inflammatory cytokines, and components of RAS within the PVN and suppressed hypertension. The present results revealed that astaxanthin played a role in the brain. Our findings demonstrated that astaxanthin had protective effect on hypertension by improving the balance between inflammatory cytokines and components of RAS.

Personalised 3D Printed Fast-Dissolving Tablets for Managing Hypertensive Crisis: In-Vitro/In-Vivo Studies

Hypertensive crisis (HC) is an emergency health condition which requires an effective management strategy. Over the years, various researchers have developed captopril based fast-dissolving formulations to manage HC; however, primarily, the question of personalisation remains unaddressed. Moreover, commercially these formulations are available as in fixed-dose combinations or strengths, so the titration of dose according to patient's prerequisite is challenging to achieve. The recent emergence of 3D printing technologies has given pharmaceutical scientists a way forward to develop personalised medicines keeping in view patients individual needs. The current project, therefore, is aimed at addressing the limitations as mentioned above by developing fast-dissolving captopril tablets using 3D printing approach. Captopril unloaded (F1) and loaded (F2-F4) filaments were successfully produced with an acceptable drug loading and mechanical properties. Various captopril formulations (F2-F4) were successfully printed using fused deposition modelling technique. The results revealed that the formulations (F2 and F3) containing superdisintegrant had a faster extent of dissolution and in-vivo findings were endorsing these results. The present study has successfully exhibited the utilisation of additive manufacturing approach to mend the gap of personalisation and manufacturing fast-dissolving captopril 3D printed tablets. The procedure adopted in the present study may be used for the development of fused deposition modelling (FDM) based fast-dissolving 3D printed tablets.

Profiling the phyto-constituents of Punica granatum fruits peel extract and accessing its in-vitro antioxidant, anti-diabetic, anti-obesity, and angiotensin-converting enzyme inhibitory properties

This context was investigated to assess the in vitro antioxidant, anti-diabetic, anti-obesity, and angiotensin-converting enzyme (ACE) inhibition traits of Punica granatum fruits peel extract. Initially, among various extracts tested, aqueous and ethanolic peel extracts depicted the presence of diverse phytoconstituents. In vitro antioxidative properties of peel extracts were determined using standard methodologies. Results showed that aqueous and ethanolic extracts had IC₅₀ values of 471.7 and 509.16 μg/mL, respectively in terms of 1,1,diphenyl 2,2,picrylhydrazyl scavenging. Likewise, IC₅₀ values of aqueous and ethanol extract were obtained as 488.76 and 478.47 μg/mL towards the degradation of hydrogen peroxide. The ethanolic extract exhibited the highest inhibition of α-glucosidase by showing activity of 53.34 ± 2.0 to 15.18 ± 1.4 U/L in a dose dependent manner (100–1000 µg/mL). Ethanolic extract was reported as the most active inhibitor of lipase with an IC₅₀ value of 603.50 µg/mL. Ethanolic extract showed increased inhibition of ACE in a concentration dependent manner (100–1000 µg/mL) with IC₅₀ value of 519.45 µg/mL. Fourier transform-infrared spectrum revealed the availability of various functional groups in the ethanolic extract of peel. Gas chromatography-mass spectrometry chromatogram of peel extract illustrated 23 diversified chemical constituents including 1,2,3,4-butanetetrol, Dimethyl sulfone, 9-octadecenamide, and Pentadecanoic acid as predominant compounds. In summary, P. granatum fruits peel extract revealed promising antioxidant, anti-diabetic, anti-obesity, and anti-hypertensive properties.

Association between Selected Dietary Habits and Lipid Profiles of Patients with Cardiovascular Disease

This study evaluated the associations between selected dietary habits and lipid profiles in a group of 800 randomly selected patients hospitalized in the Nitra Cardio Center, Slovakia. Patients were aged 20–101 years (only men, the average age was 61.13 ± 10.47 years). The data necessary for the detection of dietary habits were obtained by a questionnaire method in closed-ended format. Data collection was carried out simultaneously with the somatometric and biochemical examinations of the respondents ensured by the Nitra Cardio Center. The following parameters were evaluated: total cholesterol (T-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and blood glucose. Statistical comparisons between groups were performed using one-way analysis of variance (one-way ANOVA), followed by Tukey’s post hoc test. We detected significant differences (p < 0.05) in the influence of the number of daily meals on T-C and LDL-C, which were higher in men who consumed 1–2 meals compared with 3–4 or 5–6 meals. In the consumption of meat, eggs, and fish, there was no significant effect on the biochemical parameters of blood (p > 0.05). We recorded a significant effect (p < 0.001) on T-C and LDL-C levels between low-fat and whole-fat milk consumption. Except for the impact of fruit consumption on the HDL-C level (p < 0.001), the different frequencies of fruit consumption showed non-significant changes for the lipid profile levels. We detected a significant effect (p = 0.017) of the consumption of vegetables 1–2 times/week on LDL-C in favor of daily consumption. Our results support that monitoring the lipid profile is an important determinant in the prevention and treatment of cardiovascular disease. The conducted research emphasizes the importance of diet dependence on the improvement of the quality of treatment and nutrition of people with this type of disease.

Effects of meat and processed meat consumption on the lipid profile in the population with cardiovascular diseases

Meat represents an important source of high-quality dietary protein for a large proportion of the global population. Also, red meat, in particular, significantly contributes to the intake of a wide range of micronutrients, including iron, zinc, selenium, vitamin D, and vitamin B12. Excessive consumption of meat and meat products is often associated with overconsumption of energy and fat, resulting in excess weight, obesity, and an increased risk of chronic diseases, such as cardiovascular disease and type 2 diabetes. This study aims to evaluate the relationship between meat and processed meat consumption frequencies and lipid profile in a group of 800 randomly selected patients hospitalized in the Cardiocentre Nitra. Patients were 20 – 101 years, (men, the average age was 61.13 ±10.47 years). The data necessary for the detection of dietary habits were obtained by a questionnaire method. Statistical comparisons between groups were made utilizing a one-way analysis of variance (one-way ANOVA) followed by Tukey's post hoc test. Our results show, that most respondents consume meat 1 – 2 times per week, while we did not notice a significant effect (p >0.05) of the type of meat on the lipid profile. The highest T-C, LDL-C, and TG values were seen in men who consume pork 3 – 4 times per week. Statistically significant was only the effect of pork meat on total cholesterol and triglycerides (p <0.05). In the consumption of beef and poultry, there was a non-significant effect on biochemical parameters of blood (p >0.05). We recorded a significant effect (p ˂0.05) of the consumption of frankfurters between consumption 1 – 2 times per week and 3 – 4 times per week. Up to 40.2% of respondents consume salami 3 – 4 times per week, and we recorded a significant effect on LDL levels between consumption 1 – 2 times per week and sometimes (p ˂0.05). Respondents who consume sausage, headcheese, and others products 1 – 2 times a week have non-significant higher T-C, LDL, TG, and lower HDL compared to less frequent consumption. High consumption of meat, mainly pork and processed meat seems to be associated with higher levels of total cholesterol, LDL cholesterol, and triglycerides.

The Role of Lifestyle Factors in Controlling Blood Pressure among Hypertensive Patients in Two Health Facilities in Urban Ghana: A Cross-Sectional Study

Introduction

Despite efforts to combat hypertension by pharmacotherapy, hypertension control rates remain low. Lifestyle modifications of individuals diagnosed with hypertension have prospects for the prevention and control of hypertension. This study assessed the effect of modifiable lifestyle factors on blood pressure control among adults in urban Accra.

Methods

In this cross-sectional study, 360 diagnosed hypertensive patients who were ≥18 years old, selected from two secondary-level referral hospitals in the Greater Accra Region, were interviewed. Demographic information, diet components, and exercise assessments as well as blood pressure measurements were taken. Chi-squared tests and binomial logistic regression were used to determine the association between demographic and lifestyle factors with blood pressure control. Area under the receiver-operator curves (AUROC) was used to identify lifestyle factors predicting optimal blood pressure control among patients diagnosed with hypertension.

Results

Approximately 54.2% of participants had no knowledge of either causes or complications of hypertension. Similarly, 52.5% of patients that had not achieved blood pressure control lacked knowledge of causes or complications of hypertension. Longer time since diagnosis of 2–5 years (AOR = 0.08 (95% CI: 0.01–0.47)) and 6–10 years (AOR = 0.08 (95% CI: 0.01–0.50)) and diets, mainly composed of meat (AOR = 0.13 (95% CI: 0.02–0.70)) and starch (AOR = 0.14 (95% CI: 0.03–0.79)), predicted poor blood pressure control compared to patients diagnosed within a year and diets without meat and starch as main components, respectively. Additionally, engaging in some physical activity of 30 minutes to one hour (AOR = 5.64 (95% CI: 2.08–15.32)) and more than an hour (AOR = 11.38, 95% CI: 2.01–64.47)) predicted blood pressure control.

Conclusion

The study concludes that increased physical activity, abstaining from alcohol and smoking, increased intake of fruits and vegetables, and reduced intake of carbohydrates, meat, and fat have a positive influence on blood pressure control. Lifestyle modifying factors have a key role in complementing pharmacotherapy in hypertension control.

Pharmacotherapy for hyperuricaemia in hypertensive patients

BACKGROUND

This is the second update of this systematic review. High blood pressure represents a major public health problem. Worldwide, approximately one-fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a link between hyperuricaemia and hypertension. Hyperuricaemia affects 25% to 40% of those with untreated hypertension; a much lower prevalence has been reported in those with normotension or in the general population. However, whether lowering serum uric acid (UA) might lower blood pressure (BP), is an unanswered question.

OBJECTIVES

To determine whether UA-lowering agents reduce BP in people with primary hypertension or prehypertension, compared with placebo.

SEARCH METHODS

The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to May 2020: the Cochrane Hypertension Specialised Register, CENTRAL 2018, Issue 12, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched LILACS (1982 to May 2020), and contacted authors of relevant papers regarding further published and unpublished work. The searches had no language or date restrictions.

SELECTION CRITERIA

To be included in this updated review, the studies had to meet the following criteria: 1) randomised or quasi-randomised, with a group assigned to receive a UA-lowering agent and another group assigned to receive placebo; 2) double-blind, single-blind, or open-label; 3) parallel or cross-over trial design; 4) cross-over trials had to have a washout period of at least two weeks; 5) minimum treatment duration of four weeks; 6) participants had to have a diagnosis of essential hypertension or prehypertension plus hyperuricaemia (serum UA greater than 6 mg/dL in women, 7 mg/dL in men, and 5.5 mg/dL in children or adolescents); 7) outcome measures included change in 24-hour ambulatory systolic or diastolic BP, or both; or clinic-measured systolic or diastolic BP, or both.

DATA COLLECTION AND ANALYSIS

The two review authors independently collected the data using a data extraction form, and resolved any disagreements via discussion. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

In this review update, we screened 722 records, selected 26 full-text reports for evaluation. We identified no ongoing studies and did not add any new studies. We included three randomised controlled trials (RCTs), enrolling 211 people with hypertension or prehypertension, plus hyperuricaemia. Low-certainty evidence from three RCTs found inconclusive results between those who received UA-lowering drugs and placebo, in 24-hour ambulatory systolic (MD -6.2 mmHg, 95% CI -12.8 to 0.5) or diastolic BP (-3.9 mmHg, 95% CI -9.2 to 1.4). Low-certainty evidence from two RCTs found that UA-lowering drugs reduced clinic-measured systolic BP (-8.43 mmHg, 95% CI -15.24 to -1.62) but results for clinic-measured diastolic BP were inconclusive (-6.45 mmHg, 95% CI -13.60 to 0.70). High-certainty evidence from three RCTs found that serum UA levels were reduced by 3.1 mg/dL (95% CI 2.4 to 3.8) in the participants that received UA-lowering drugs. Low-certainty evidence from three RCTs found inconclusive results regarding the occurrence of adverse events between those who received UA-lowering drugs and placebo (RR 1.86, 95% CI 0.43 to 8.10).

AUTHORS' CONCLUSIONS

In this updated Cochrane Review, the current RCT data are insufficient to know whether UA-lowering therapy lowers BP. More studies are needed.