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Mao J, Zhang X, Wang C, Peng S. Irisin mitigates salt-sensitive hypertension via regulating renal AMPK-Rac1 pathway. Clin Exp Hypertens 2024; 46:2402258. [PMID: 39277848 DOI: 10.1080/10641963.2024.2402258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Irisin, as a myokine, plays a protective role against cardiovascular disease, including myocardial infarction, atherosclerosis and hypertension. However, whether irisin attenuates salt-sensitive hypertension and the related underlying mechanisms is unknown. METHODS Male Dahl salt-resistant (DSR) and Dahl salt-sensitive (DSS) (12 weeks) rats were fed a high salt diet (8% NaCl) with or without irisin treatment by intraperitoneal injection for 8 weeks. RESULTS Compared with DSR rats, DSS rats showed higher systolic blood pressure (SBP), impaired natriuresis and diuresis and renal dysfunction. In addition, it was accompanied by downregulation of renal p-AMPKα and upregulation of renal RAC1 and nuclear mineralocorticoid receptor (MR). Irisin intervention could significantly up-regulated renal p-AMPKα level and down-regulated renal RAC1-MR signal, thereby improving renal sodium excretion and renal function, and ultimately reducing blood pressure in DSS rats. Ex vivo treatment with irisin reduced the expression of RAC1 and nuclear MR in primary renal distal convoluted tubule cells from DSS rats and the effects of irisin were abolished by cotreatment of compound C (AMPK inhibitor), indicating that the regulation of RAC1-MR signals by irisin depended on the activation of AMPK. CONCLUSIONS Irisin administration lowered salt-sensitive hypertension through regulating RAC1-MR signaling via activation of AMPK, which may be a promising therapeutic approach for salt-sensitive hypertension.
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Affiliation(s)
- Jie Mao
- Department of Nephrology, Chongqing Fuling Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiaocui Zhang
- Department of Nephrology, Chongqing Fuling Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Chunxiang Wang
- Department of Laboratory Animal Center, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Suying Peng
- Department of Nephrology, Chongqing Fuling Hospital, School of Medicine, Chongqing University, Chongqing, China
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Xie H, Fan XF, Shuai WH, Zhong GY. The association between serum folate and elderly diastolic hypertension: results from the NHANES (2007-2018). Blood Press 2024; 33:2380002. [PMID: 39018205 DOI: 10.1080/08037051.2024.2380002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
AIM To explore the association between serum folate concentration and the prevalence of elderly diastolic hypertension. This study aims to identify potential relationships that could inform further research into the mechanisms underlying hypertension management. METHODS Data from six NHANES cycles (2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016, and 2017-2018) were analysed for individuals aged over 60. Weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and restricted cubic spline (RCS) regression explored the serum folate concentration and elderly diastolic hypertension relationship. RESULTS This study included 9,419 participants (4,734 females and 4,685 males) with a mean age of 70.0 ± 7.0 years. Among them, 360 were diagnosed with diastolic hypertension. In the fully adjusted model, there was a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (OR 0.65; 95% CI: 0.52-0.82). When serum folate concentration levels were divided into quartiles (in μg/dL), the ORs for diastolic hypertension corresponding to Q2 (1.29-1.98), Q3 (1.99-3.08), and Q4 (3.09-5.56) levels compared to Q1 (0.18-1.28) were 1.41 (95% CI: 0.60-3.33), 0.48(95% CI: 0.20-1.16), and 0.35 (95% CI: 0.16-0.74), respectively, with a P for trend <.05. Restricted cubic spline plots showed a negative correlation between serum folate concentration and the prevalence of diastolic hypertension (non-linearity: p = .495). Subgroup analysis indicated that the negative correlation between serum folate concentration and the prevalence of diastolic hypertension was more significant in female participants (interaction p = .009). CONCLUSION Higher serum folate concentration is associated with a lower prevalence of diastolic hypertension in the elderly.
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Affiliation(s)
- Hong Xie
- Department of General Medicine, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
| | - Xiao-Feng Fan
- Department of Cardiology, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
| | - Wen-Huan Shuai
- Department of Cardiology, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
| | - Gui-You Zhong
- Department of Cardiology, Zigong Fourth People's Hospital, Zigong, Sichuan, P.R. China
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Liang C, Yang F, Huang X, Zhang L, Wang Y. Deep learning assists early-detection of hypertension-mediated heart change on ECG signals. Hypertens Res 2024:10.1038/s41440-024-01938-7. [PMID: 39394520 DOI: 10.1038/s41440-024-01938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/06/2024] [Accepted: 09/23/2024] [Indexed: 10/13/2024]
Abstract
Arterial hypertension is a major risk factor for cardiovascular diseases. While cardiac ultrasound is a typical way to diagnose hypertension-mediated heart change, it often fails to detect early subtle structural changes. Electrocardiogram(ECG) represents electrical activity of heart muscle, affected by the changes in heart's structure. It is crucial to explore whether ECG can capture slight signals of hypertension-mediated heart change. However, reading ECG records is complex and some signals are too subtle to be captured by cardiologist's visual inspection. In this study, we designed a deep learning model to predict hypertension on ECG signals and then to identify hypertension-associated ECG segments. From The First Affiliated Hospital of Xiamen University, we collected 210,120 10-s 12-lead ECGs using the FX-8322 manufactured by FUKUDA and 812 ECGs using the RAGE-12 manufactured by NALONG. We proposed a deep learning framework, including MML-Net, a multi-branch, multi-scale LSTM neural network to evaluate the potential of ECG signals to detect hypertension, and ECG-XAI, an ECG-oriented wave-alignment AI explanation pipeline to identify hypertension-associated ECG segments. MML-Net achieved an 82% recall and an 87% precision in the testing, and an 80% recall and an 82% precision in the independent testing. In contrast, experienced clinical cardiologists typically attain recall rates ranging from 30 to 50% by visual inspection. The experiments demonstrate that ECG signals are sensitive to slight changes in heart structure caused by hypertension. ECG-XAI detects that R-wave and P-wave are the hypertension-associated ECG segments. The proposed framework has the potential to facilitate early diagnosis of heart change.
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Affiliation(s)
- Chengwei Liang
- Department of Automation, Xiamen University, Xiamen, Fujian, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, Fujian, China
| | - Fan Yang
- Department of Automation, Xiamen University, Xiamen, Fujian, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Big Data Intelligent Analysis and Decision, Xiamen, Fujian, China
| | - Xiaobing Huang
- Fuzhou First General Hospital, Fujian Medical University, Fujian, China
| | - Lijuan Zhang
- The First Affiliation Hospital of Xiamen University, Xiamen University, Xiamen, Fujian, China.
| | - Ying Wang
- Department of Automation, Xiamen University, Xiamen, Fujian, China.
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Big Data Intelligent Analysis and Decision, Xiamen, Fujian, China.
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4
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Kennedy C, Hayes P, Cicero AFG, Dobner S, Le Roux CW, McEvoy JW, Zgaga L, Hennessy M. Semaglutide and blood pressure: an individual patient data meta-analysis. Eur Heart J 2024; 45:4124-4134. [PMID: 39217502 PMCID: PMC11458150 DOI: 10.1093/eurheartj/ehae564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/08/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND AIMS Randomized clinical trials (RCTs) assessing semaglutide reported reductions of systolic blood pressure (SBP) in trial populations with baseline blood pressure in the normotensive range. This study aimed to determine whether this SBP reduction is greater in hypertensive groups. METHODS Individual patient data (IPD) from three RCTs examining the effect of semaglutide 2.4 mg on body weight over 68 weeks were included. Trial participants were categorized according to a hypertension diagnosis, treatment or baseline measurement (HTN), baseline SBP > 130 mmHg (HTN130) or >140 mmHg (HTN140), and those with apparent resistant hypertension (RH). The primary analysis compared the in-trial change in SBP in the semaglutide and placebo arms. Alterations of anti-hypertensive medications were quantified by treatment intensity score and compared between arms. These analyses were performed using analysis of covariance. RESULTS Overall, 3136 participants were included. The difference in SBP change between the treatment (n = 2109) and placebo (n = 1027) groups was -4.95 mmHg [95% confidence interval (CI) -5.86 to -4.05] overall. This difference was -4.78 mmHg (95% CI -5.97 to -3.59) for HTN, -4.93 mmHg (95% CI -6.75 to -3.11) for HTN130, -4.09 mmHg (95% CI -7.12 to -1.06) for HTN140, and -3.16 mmHg (95% CI -8.69-2.37) for RH. Reduction in SBP was mediated substantially by weight loss. The anti-hypertensive treatment intensity score decreased for those on semaglutide compared to placebo (-0.51; 95% CI -0.71 to -0.32). CONCLUSIONS This IPD analysis of three large RCTs found blood pressure reductions with semaglutide in participants with hypertension that were similar to those seen in all trial participants. This finding may in part be due to concurrent reductions to anti-hypertensive medications. These results suggest that semaglutide is a useful adjunctive treatment for patients with hypertension and obesity.
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Affiliation(s)
- Cormac Kennedy
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, Dublin D02 PN40, Ireland
- Wellcome-HRB Clinical Research Facility, St James's Hospital, Dublin D08 NHY1, Ireland
| | - Peter Hayes
- Health Research Institute, University of Limerick, Ireland
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum—University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stephan Dobner
- 3rd Medical Department of Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria
| | - Carel W Le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - John W McEvoy
- University of Galway and National Institute of Prevention and Cardiovascular Health, Galway, Ireland
| | - Lina Zgaga
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Ireland
| | - Martina Hennessy
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, Dublin D02 PN40, Ireland
- Wellcome-HRB Clinical Research Facility, St James's Hospital, Dublin D08 NHY1, Ireland
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Naseem S, Sun L, Qiu J. Stress granules in atherosclerosis: Insights and therapeutic opportunities. Curr Probl Cardiol 2024; 49:102760. [PMID: 39059785 DOI: 10.1016/j.cpcardiol.2024.102760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
Atherosclerosis, a complex inflammatory and metabolic disorder, is the underlying cause of several life-threatening cardiovascular diseases. Stress granules (SG) are biomolecular condensates composed of proteins and mRNA that form in response to stress. Recent studies suggest a potential link between SG and atherosclerosis development. However, there remain gaps in understanding SG role in atherosclerosis development. Here we provide a thorough analysis of the role of SG in atherosclerosis, covering cellular stresses stimulation, core components, and regulatory genes in SG formation. Furthermore, we explore atherosclerosis induced factors such as inflammation, low or oscillatory shear stress (OSS), and oxidative stress (OS) may impact SG formation and then the development of atherosclerotic lesions. We have assessed how changes in SG dynamics impact pro-atherogenic processes like endothelial dysfunction, lipid metabolism, and immune cell recruitment in atherosclerosis. In summary, this review emphasizes the complex interplay between SG and atherosclerosis that could open innovative directions for targeted therapeutic strategies in preventing or treating atherosclerotic cardiovascular diseases.
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Affiliation(s)
- Sahar Naseem
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Lijuan Sun
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Juhui Qiu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China.
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Chen X, Peng S, Liang W, Gan S, Xu Y, Xiang H. Association between community walkability and hypertension: Evidence from the Wuhan Chronic Disease Cohort Study. ENVIRONMENTAL RESEARCH 2024; 263:120071. [PMID: 39362460 DOI: 10.1016/j.envres.2024.120071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/16/2024] [Accepted: 09/25/2024] [Indexed: 10/05/2024]
Abstract
While community walkability is recognized as a key environmental factor for health status, evidence linking it specifically to hypertension is rather limited. To fill the knowledge gap, we concluded a cross-sectional study among 6421 eligible participants from the Wuhan Chronic Disease Cohort. A well-developed algorithm was performed to evaluate community walkability across Wuhan, quantified as Walk Score. We then calculated each participant residential Walk Score using the geographic information system. The logistic and linear regression models were conducted to determine the relationship between walkability, hypertension and blood pressure, respectively. We further performed the mediation analysis to explore potential mechanisms. After adjusting for extra confounders, we observed a higher community walk score was associated with a lower hypertension risk (OR = 0.73; 95% CI: 0.63, 0.84), a lower systolic blood pressure (β = -3.152 mmHg; 95% CI: -4.25, -2.05), a lower diastolic blood pressure (β = -2.237 mmHg; 95% CI: -2.95, -2.53) and a lower mean arterial pressure (β = -2.976 mmHg; 95% CI: -3.75, -2.20). The effect of community walkability on hypertension was partially mediated by body fat rate. Our study indicates a positive correlation between high walkability and a reduced odds of hypertension in China. This highlights the potential role of urban design in hypertension prevention, emphasizes the need for walkability-focused planning strategies to foster healthier communities, and guides future interventions and research to mitigate hypertension.
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Affiliation(s)
- Xinlan Chen
- Department of Global Health, School of Public Health, Wuhan University, Wuhan 430071, Hubei, China; Global Health Institute, Wuhan University, Wuhan 430071, Hubei, China
| | - Shouxin Peng
- Department of Global Health, School of Public Health, Wuhan University, Wuhan 430071, Hubei, China; Global Health Institute, Wuhan University, Wuhan 430071, Hubei, China
| | - Wei Liang
- Department of Global Health, School of Public Health, Wuhan University, Wuhan 430071, Hubei, China; Global Health Institute, Wuhan University, Wuhan 430071, Hubei, China
| | - Siyu Gan
- Department of Global Health, School of Public Health, Wuhan University, Wuhan 430071, Hubei, China; Global Health Institute, Wuhan University, Wuhan 430071, Hubei, China
| | - Yanqing Xu
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan 430079, Hubei, China.
| | - Hao Xiang
- Department of Global Health, School of Public Health, Wuhan University, Wuhan 430071, Hubei, China; Global Health Institute, Wuhan University, Wuhan 430071, Hubei, China.
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Jiang X, Yu W, Chen Z, Li C, Li X, Xu Y, Li F, Gao H, Qian J, Xiong B, Rong S, Chen G, She Q, Huang J. Low-intensity focused ultrasound combined with microbubbles for non-invasive downregulation of rabbit carotid body activity in the treatment of hypertension. Hypertens Res 2024:10.1038/s41440-024-01904-3. [PMID: 39300302 DOI: 10.1038/s41440-024-01904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/26/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024]
Abstract
Targeting the carotid body (CB) is a new approach in treating hypertension. This study investigates the efficacy and safety of ultrasound combined with microbubbles in targeting CB to treat hypertension. Twenty-seven hypertensive rabbits were randomly assigned to three groups: microbubbles only (sham group, n = 11), ultrasound plus microbubbles (LIFU group, n = 11), and bilateral carotid sinus nerve denervation (CSND group, n = 5). Four weeks post-intervention, blood pressure, hypoxic ventilatory response (HVR), blood pressure variability (BPV), heart rate variability (HRV), biochemical indicators, neurohormones, and histopathology were assessed in all groups. The results indicated significant reductions in systolic and diastolic blood pressure in the LIFU and CSND groups post-intervention, along with decreases in BPV, HRV, and catecholamines. HVR results showed a 35.10% reduction in CB activity in the LIFU group compared to the sham group, which was significantly lower than the reduction in the CSND group compared to the sham group (73.85%). Histopathology and transmission electron microscopy confirmed CB damage and cell apoptosis, with immunofluorescence showing a reduction in type I and II cells. In conclusion, LIFU combined with microbubbles can reduce blood pressure by lowering CB and sympathetic nerve activity.
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Affiliation(s)
- Xiujuan Jiang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Institute of Ultrasound Imaging, Department of Ultrasound, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Cardiology, People's Hospital of Santai County, Santai County, Sichuan, China
| | - Wei Yu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Institute of Ultrasound Imaging, Department of Ultrasound, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zijun Chen
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Cardiology, The Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Chaohong Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xingyu Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Xu
- Department of Cardiology, People's Hospital of Santai County, Santai County, Sichuan, China
| | - Fugui Li
- Department of Cardiology, People's Hospital of Santai County, Santai County, Sichuan, China
| | - Hongli Gao
- Department of Cardiology, The Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Qian
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Xiong
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shunkang Rong
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guozhu Chen
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang She
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Institute of Ultrasound Imaging, Department of Ultrasound, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Li J, Zhang X, Jiang Y, Wang H, Gao X, Hu Y, Du B. Research status and frontiers of renal denervation for hypertension: a bibliometric analysis from 2004 to 2023. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:142. [PMID: 39252135 PMCID: PMC11385481 DOI: 10.1186/s41043-024-00626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/16/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Renal Denervation (RDN) is a novel non-pharmacological technique to treat hypertension. This technique lowers blood pressure by blocking the sympathetic nerve fibers around the renal artery, then causing a decrease in system sympathetic nerve excitability. This study aimed to visualize and analyze research hotspots and development trends in the field of RDN for hypertension through bibliometric analysis. METHODS In total, 1479 studies were retrieved on the Web of Science Core Collection (WoSCC) database from 2004 to 2023. Using CiteSpace (6.2.R4) and VOSviewer (1.6.18), visualization maps were generated by relevant literature in the field of RDN for hypertension to demonstrate the research status and frontiers. RESULTS The number of publications was found to be generally increasing. Europe and the United States were the first countries to carry out research on different techniques and related RDN clinical trials. The efficacy and safety of RDN have been repeatedly verified and gained increasing attention. The study involves multiple disciplines, including the cardiovascular system, peripheral vascular disease, and physiological pathology, among others. Research hotspots focus on elucidating the mechanism of RDN in the treatment of hypertension and the advantages of RDN in appliance therapy. Additionally, the research frontiers include improvement of RDN instruments and techniques, as well as exploration of the therapeutic effects of RDN in diseases with increased sympathetic nerve activity. CONCLUSION The research hotspots and frontiers reflect the status and development trend of RDN in hypertension. In the future, it is necessary to strengthen international collaboration and cooperation, conduct long-term clinical studies with a large sample size, and continuously improve RDN technology and devices. These measures will provide new options for more patients with hypertension, thereby improving their quality of life.
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Affiliation(s)
- Jiaran Li
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaohan Zhang
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Jiang
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huan Wang
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiongyi Gao
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Bai Du
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Gao HL, Yang Y, Tian H, Xu SL, Li BW, Fu LY, Liu KL, Shi XL, Kang YM, Yu XJ. Puerarin Alleviates Blood Pressure via Inhibition of ROS/TLR4/NLRP3 Inflammasome Signaling Pathway in the Hypothalamic Paraventricular Nucleus of Salt-Induced Prehypertensive Rats. Nutrients 2024; 16:2580. [PMID: 39203718 PMCID: PMC11356837 DOI: 10.3390/nu16162580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Puerarin is an isoflavone compound isolated from the roots of a leguminous plant, the wild kudzu. Various functional activities of this compound in multiple diseases have been reported. However, the effect and mechanism of puerarin in improving blood pressure remain non-elucidated. PURPOSE The current study was designed to assess the preventive effects of puerarin on the onset and progression of hypertension and to verify the hypothesis that puerarin alleviates blood pressure by inhibiting the ROS/TLR4/NLRP3 inflammasome signaling pathway in the hypothalamic paraventricular nucleus (PVN) of salt-induced prehypertensive rats. METHODS Male Dahl salt-sensitive rats were fed low NaCl salt (3% in drinking water) for the control (NS) group or 8% (HS) to induce prehypertension. Each batch was divided into two group and treated by bilateral PVN microinjection with either artificial cerebrospinal fluid or puerarin through a micro-osmotic pump for 6 weeks. The mean arterial pressure (MAP) was recorded, and samples were collected and analyzed. RESULTS We concluded that puerarin significantly prevented the elevation of blood pressure and effectively alleviated the increase in heart rate caused by high salt. Norepinephrine (NE) in the plasma of salt-induced prehypertensive rats also decreased upon puerarin chronic infusion. Additionally, analysis of the PVN sample revealed that puerarin pretreatment decreased the positive cells and gene level of TLR4 (Toll-like receptor 4), NLRP3, Caspase-1 p10, NOX2, MyD88, NOX4, and proinflammatory cytokines in the PVN. Puerarin pretreatment also decreased NF-κBp65 activity, inhibited oxidative stress, and alleviated inflammatory responses in the PVN. CONCLUSION We conclude that puerarin alleviated blood pressure via inhibition of the ROS/TLR4/NLRP3 inflammasome signaling pathway in the PVN, suggesting the therapeutic potential of puerarin in the prevention of hypertension.
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Affiliation(s)
- Hong-Li Gao
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
| | - Yu Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
- Department of Pharmacology, Basic Medical College, Jiamusi University, Jiamusi 154007, China
| | - Hua Tian
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
- Department of Diagnosis, Shaanxi University of Chinese Medicine, Xi'an 712046, China
| | - Shen-Liang Xu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
| | - Bo-Wen Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
| | - Li-Yan Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
| | - Kai-Li Liu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
| | - Xiao-Lian Shi
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Yu-Ming Kang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
| | - Xiao-Jing Yu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Institute of Cardiovascular Sciences, Translational Medicine Institute, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an 710061, China
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Khan MM, Kirabo A. Long Noncoding RNA MALAT1: Salt-Sensitive Hypertension. Int J Mol Sci 2024; 25:5507. [PMID: 38791545 PMCID: PMC11122212 DOI: 10.3390/ijms25105507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Hypertension stands as the leading global cause of mortality, affecting one billion individuals and serving as a crucial risk indicator for cardiovascular morbidity and mortality. Elevated salt intake triggers inflammation and hypertension by activating antigen-presenting cells (APCs). We found that one of the primary reasons behind this pro-inflammatory response is the epithelial sodium channel (ENaC), responsible for transporting sodium ions into APCs and the activation of NADPH oxidase, leading to increased oxidative stress. Oxidative stress increases lipid peroxidation and the formation of pro-inflammatory isolevuglandins (IsoLG). Long noncoding RNAs (lncRNAs) play a crucial role in regulating gene expression, and MALAT1, broadly expressed across cell types, including blood vessels and inflammatory cells, is also associated with inflammation regulation. In hypertension, the decreased transcriptional activity of nuclear factor erythroid 2-related factor 2 (Nrf2 or Nfe2l2) correlates with heightened oxidative stress in APCs and impaired control of various antioxidant genes. Kelch-like ECH-associated protein 1 (Keap1), an intracellular inhibitor of Nrf2, exhibits elevated levels of hypertension. Sodium, through an increase in Sp1 transcription factor binding at its promoter, upregulates MALAT1 expression. Silencing MALAT1 inhibits sodium-induced Keap1 upregulation, facilitating the nuclear translocation of Nrf2 and subsequent antioxidant gene transcription. Thus, MALAT1, acting via the Keap1-Nrf2 pathway, modulates antioxidant defense in hypertension. This review explores the potential role of the lncRNA MALAT1 in controlling the Keap1-Nrf2-antioxidant defense pathway in salt-induced hypertension. The inhibition of MALAT1 holds therapeutic potential for the progression of salt-induced hypertension and cardiovascular disease (CVD).
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Affiliation(s)
- Mohd Mabood Khan
- Department of Medicine, Preston Research Building, Vanderbilt University Medical Centre, Nashville, TN 37232, USA
| | - Annet Kirabo
- Department of Medicine, Preston Research Building, Vanderbilt University Medical Centre, Nashville, TN 37232, USA
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11
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Node K, Tanaka A. Our mission in the Japanese Society of Hypertension (JSH) Future Plan: a baton-connection from JSH Osaka 2023 to Fukuoka 2024. Hypertens Res 2024; 47:1097-1098. [PMID: 38485777 DOI: 10.1038/s41440-024-01644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/24/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
- President of the 46th annual scientific meeting of the JSH 2024 in Fukuoka, Fukuoka, Japan.
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
- Chief of the secretariat of the 46th annual scientific meeting of the JSH 2024 in Fukuoka, Fukuoka, Japan.
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12
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Wu O, Wu Y, Zhang X, Liu W, Zhang H, Khederzadeh S, Lu X, Zhu XW. Causal effect of interleukin (IL)-6 on blood pressure and hypertension: A mendelian randomization study. Immunogenetics 2024; 76:123-135. [PMID: 38427105 DOI: 10.1007/s00251-024-01332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
To examine whether circulating interleukin-6 (IL-6) levels (CirIL6) have a causal effect on blood pressure using Mendelian randomization (MR) methods. We used data from genome-wide association studies (GWAS) of European ancestry to obtain genetic instruments for circulating IL-6 levels and blood pressure measurements. We applied several robust MR methods to estimate the causal effects and to test for heterogeneity and pleiotropy. We found that circulating IL-6 had a significant positive causal effect on systolic blood pressure (SBP) and pulmonary arterial hypertension (PAH), but not on diastolic blood pressure (DBP) or hypertension. We found that as CirIL6 genetically increased, SBP increased using Inverse Variance Weighted (IVW) method (for ukb-b-20175, β = 0.082 with SE = 0.032, P = 0.011; for ukb-a-360, β = 0.075 with SE = 0.031, P = 0.014) and weighted median (WM) method (for ukb-b-20175, β = 0.061 with SE = 0.022, P = 0.006; for ukb-a-360, β = 0.065 with SE = 0.027, P = 0.014). Moreover, CirIL6 may be associated with an increased risk of PAH using WM method (odds ratio (OR) = 15.503, 95% CI, 1.025-234.525, P = 0.048), but not with IVW method. Our study provides novel evidence that circulating IL-6 has a causal role in the development of SBP and PAH, but not DBP or hypertension. These findings suggest that IL-6 may be a potential therapeutic target for preventing or treating cardiovascular diseases and metabolic disorders. However, more studies are needed to confirm the causal effects of IL-6 on blood pressure and to elucidate the underlying mechanisms and pathways.
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Affiliation(s)
- Ou Wu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, People's Republic of China.
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
| | - Ya Wu
- Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xingyu Zhang
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Wei Liu
- JFIntelligent Healthcare Technology Co., Ltd Building No.5-7, No.699 Tianxiang Avenue, Hi-Tech Zone, Nanchang, Jiangxi Province, People's Republic of China
| | - Hu Zhang
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital Affiliated with Medical College of Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Saber Khederzadeh
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, People's Republic of China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, Zhejiang, People's Republic of China
| | - Xi Lu
- Hangzhou Vocational and Technical College, Hangzhou, Zhejiang, People's Republic of China.
| | - Xiao-Wei Zhu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, People's Republic of China.
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13
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Dzau VJ, Hodgkinson CP. Precision Hypertension. Hypertension 2024; 81:702-708. [PMID: 38112080 DOI: 10.1161/hypertensionaha.123.21710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Hypertension affects >1 billion people worldwide. Complications of hypertension include stroke, renal failure, cardiac hypertrophy, myocardial infarction, and cardiac failure. Despite the development of various antihypertensive drugs, the number of people with uncontrolled hypertension continues to rise. While the lack of compliance associated with frequent side effects to medication is a contributory issue, there has been a failure to consider the diverse nature of hypertensive populations. Instead, we propose that hypertension can only be truly managed by precision. A precision medicine approach would consider each patient's unique factors. In this review, we discuss the progress toward precision medicine for hypertension with more predictiveness and individualization of treatment. We will highlight the advances in data science, omics (genomics, metabolomics, proteomics, etc), artificial intelligence, gene therapy, and gene editing and their application to precision hypertension.
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Affiliation(s)
- Victor J Dzau
- Mandel Center for Hypertension and Atherosclerosis, the Duke Cardiovascular Research Center, Duke University Medical Center, Durham, NC (V.J.D., C.P.H.)
- National Academy of Medicine, Washington, DC (V.J.D.)
| | - Conrad P Hodgkinson
- Mandel Center for Hypertension and Atherosclerosis, the Duke Cardiovascular Research Center, Duke University Medical Center, Durham, NC (V.J.D., C.P.H.)
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Almansouri NE, Awe M, Rajavelu S, Jahnavi K, Shastry R, Hasan A, Hasan H, Lakkimsetti M, AlAbbasi RK, Gutiérrez BC, Haider A. Early Diagnosis of Cardiovascular Diseases in the Era of Artificial Intelligence: An In-Depth Review. Cureus 2024; 16:e55869. [PMID: 38595869 PMCID: PMC11002715 DOI: 10.7759/cureus.55869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/11/2024] Open
Abstract
Cardiovascular diseases (CVDs) are significant health issues that result in high death rates globally. Early detection of cardiovascular events may lower the occurrence of acute myocardial infarction and reduce death rates in people with CVDs. Traditional data analysis is inadequate for managing multidimensional data related to the risk prediction of CVDs, heart attacks, medical image interpretations, therapeutic decision-making, and disease prognosis due to the complex pathological mechanisms and multiple factors involved. Artificial intelligence (AI) is a technology that utilizes advanced computer algorithms to extract information from large databases, and it has been integrated into the medical industry. AI methods have shown the ability to speed up the advancement of diagnosing and treating CVDs such as heart failure, atrial fibrillation, valvular heart disease, hypertrophic cardiomyopathy, congenital heart disease, and more. In clinical settings, AI has shown usefulness in diagnosing cardiovascular illness, improving the efficiency of supporting tools, stratifying and categorizing diseases, and predicting outcomes. Advanced AI algorithms have been intricately designed to analyze intricate relationships within extensive healthcare data, enabling them to tackle more intricate jobs compared to conventional approaches.
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Affiliation(s)
| | - Mishael Awe
- Internal Medicine, Crimea State Medical University named after S.I Georgievsky, Simferopol, UKR
| | - Selvambigay Rajavelu
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Kudapa Jahnavi
- Internal Medicine, Pondicherry Institute of Medical Sciences, Puducherry, IND
| | - Rohan Shastry
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, IND
| | - Ali Hasan
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Hadi Hasan
- Internal Medicine, University of Illinois, Chicago, USA
| | | | | | - Brian Criollo Gutiérrez
- Health Sciences, Instituto Colombiano de Estudios Superiores de Incolda (ICESI) University, Cali, COL
| | - Ali Haider
- Allied Health Sciences, The University of Lahore, Gujrat, PAK
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Alfaqeeh M, Alfian SD, Abdulah R. Factors Associated with Hypertension Among Adults: A Cross-Sectional Analysis of the Indonesian Family Life Survey. Vasc Health Risk Manag 2023; 19:827-836. [PMID: 38108024 PMCID: PMC10723179 DOI: 10.2147/vhrm.s438180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Hypertension (HTN) poses a significant health risk for Indonesia's large population. Underlying factors contributing to this disease are not fully understood at a national level. Therefore, this study aimed to evaluate factors associated with HTN in Indonesia. Patients and Methods This study used data from the Indonesian Family Life Survey-5, a 2014 national cross-sectional population-based survey of individuals aged 15 years and older. The mean arterial pressure (MAP) value was determined from three blood pressure measurements taken by trained nurses using Omron digital sphygmomanometers. The respondent was classified as hypertensive when the MAP value was at least 100. The study summarised the socio-demographic factors (age, gender, marital status, ethnicity and occupation status) and lifestyle habits (smoking, sleep quality, physical activity) with descriptive statistics. The potential associations between these factors and HTN were assessed using logistic regression analysis. The results were reported in terms of odds ratios (OR) with a 95% confidence interval (CI). Results The study included 32,670 respondents; 31.2% of them had HTN. Factors that were more likely associated with HTN were being <65 years old, being married (OR 1.257, 95% CI 1.170-1.352) and being smoker (OR 1.297, 95% CI 1.198-1.404), while being male (OR 0.677, 95% CI: 0.625-0.733) and doing no physical activity (OR 0.870, 95% CI: 0.813-0.930) were less likely to be associated with HTN. Conclusion This study indicates that there are associations between certain socio-demographic factors and lifestyle habits with HTN in Indonesia. This information may help policymakers and healthcare providers to develop effective strategies in order to control HTN in Indonesia, thereby improving the overall health and well-being of the population.
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Affiliation(s)
- Mohammed Alfaqeeh
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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16
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Zare MG, Okati-Aliabad H, Ansari-Moghaddam A, Mohammadi M, Shahraki-Sanavi F. Prevalence and risk factors of pre-hypertension and hypertension among adults in Southeastern Iran: Findings from the baseline survey of the Zahedan adult cohort study. PLoS One 2023; 18:e0295270. [PMID: 38060532 PMCID: PMC10703255 DOI: 10.1371/journal.pone.0295270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Hypertension (HTN) stands as the leading modifiable risk factor for cardiovascular disease(CVD) and premature death globally. Understanding its prevalence and risk factors is essential for effective prevention and management of HTN. This study aimed to investigate the prevalence of Pre-hypertension (pre-HTN), HTN, and its risk factors in adults participating in the Zahedan adult cohort study (ZACS). This cross-sectional study used the baseline data of the ZACS. Ordinal logistic regression analysis was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for potential risk factors. Among the 10,016 participants in this study, 60.89% were women, with an average age of 50.44 ± 9.18 years. The prevalence of pre-HTN and HTN was 42.03% (men 45.44%, women 39.84%) and 18.47% (men 21.09%, women 16.79%), respectively. Being male, older age, having higher socioeconomic status (SES), being overweight and obese, having a family history of HTN, comorbidities such as diabetes and CVD, as well as abnormal blood lipid levels (triglycerides and HDL cholesterol) were the most significant predictors of pre-HTN and HTN. These findings highlight that more than half of the participants in this study exhibit pre-HTN or HTN, placing them at risk for CVD and stroke. Implementing comprehensive preventive strategies tailored to these identified risk factors is imperative to alleviate the disease burden, enhance disease management, and improve HTN treatment and control.
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Affiliation(s)
- Mojtaba Gholami Zare
- Department of Epidemiology, MSc Candidate of Epidemiology, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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17
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Rossios K, Antza C, Kachtsidis V, Kotsis V. The Modern Environment: The New Secondary Cause of Hypertension? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2095. [PMID: 38138198 PMCID: PMC10744418 DOI: 10.3390/medicina59122095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/15/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
The most important risk factor for cardiovascular disease, the leading cause of death worldwide, is hypertension. Although most cases of hypertension are thought to be essential, the multifactorial associations of the environmental influence on blood pressure seem to play an important role and should be more closely investigated. This review attempts to focus on the recent literature that examines the environmental effects on arterial blood pressure and its management. Seasonal variability and the role of ambient temperature, either occupational or recreational noise pollution, as well as obesity due to environment-caused dietary habits, are recognized as important risk factors, affecting the onset as well as the regulation of hypertension. Furthermore, the effects of seasonal fluctuations in blood pressure, noise pollution, and obesity seem to share a similar pathogenesis, and as such to all further react together, leading to increased blood pressure. The activation of the autonomous nervous system plays a key role and causes an increase in stress hormones that generates oxidative stress on the vascular system and, thus, vasoconstriction. In this review, by focusing on the association of the environmental impact with arterial blood pressure, we come to the question of whether most cases of hypertension-if not all-should, indeed, be considered primary or secondary.
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Affiliation(s)
- Konstantinos Rossios
- Cardiology Clinic, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Christina Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
| | - Vasileios Kachtsidis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
| | - Vasilios Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
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18
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Fiscella KA, Sass E, Sridhar SB, Maguire JA, Lashway K, Wong G, Thien A, Thomas M, Bisognano JD, Rosenberg T, Sanders MR, Johnson BA, Polgreen LA. Team-based home blood pressure monitoring for blood pressure equity a protocol for a stepped wedge cluster randomized trial. Contemp Clin Trials 2023; 134:107332. [PMID: 37722482 PMCID: PMC10725081 DOI: 10.1016/j.cct.2023.107332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Home Blood Pressure Monitoring (HBPM) that includes a team with a clinical pharmacist is an evidence-based intervention that improves blood pressure (BP). Yet, strategies for promoting its adoption in primary care are lacking. We developed potentially feasible and sustainable implementation strategies to improve hypertension control and BP equity. METHODS We assessed barriers and facilitators to HBPM and iteratively adapted implementation strategies through key informative interviews and guidance from a multistakeholder stakeholder team involving investigators, clinicians, and practice administration. RESULTS Strategies include: 1) pro-active outreach to patients; 2) provision of BP devices; 3) deployment of automated bidirectional texting to support patients through education messages for patients to transmit their readings to the clinical team; 3) a hypertension visit note template; 4) monthly audit and feedback reports on progress to the team; and 5) training to the patients and teams. We will use a stepped wedge randomized trial to assess RE-AIM outcomes. These are defined as follows Reach: the proportion of eligible patients who agree to participate in the BP texting; Effectiveness: the proportion of eligible patients with their last BP reading <140/90 (six months); Adoption: the proportion of patients invited to the BP texting; Implementation: patients who text their BP reading ≥10 of days per month; and Maintenance: sustained BP control post-intervention (twelve months). We will also examine RE-AIM metrics stratified by race and ethnicity. CONCLUSIONS Findings will inform the impact of strategies for the adoption of team-based HPBM and the impact of the intervention on hypertension control and equity. REGISTRATION DETAILS www. CLINICALTRIALS gov Identifier: NCT05488795.
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Affiliation(s)
- Kevin A Fiscella
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America.
| | - Emma Sass
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America
| | - Soumya B Sridhar
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Jennifer A Maguire
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Katie Lashway
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Geoff Wong
- Nuffield Department of Primary Care, Medical Sciences Division, University of Oxford, United Kingdom
| | - Amy Thien
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Marie Thomas
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America
| | - John D Bisognano
- Department of Medicine, Cardiology Division, University of Michigan, 24 Frank Lloyd Wright Dr. Ste 1300, Lobby A, Ann Arbor, MI 48106, United States of America
| | - Tziporah Rosenberg
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Mechelle R Sanders
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY 14642, United States of America
| | - Linnea A Polgreen
- College of Pharmacy, Iowa University, 340 College of Pharmacy Building, 180 S Grand Ave, Iowa City, IA 5224, United States of America
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Iaccarino G. Editorial: Insights in hypertension: 2022. Front Cardiovasc Med 2023; 10:1264398. [PMID: 37745093 PMCID: PMC10515277 DOI: 10.3389/fcvm.2023.1264398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Guido Iaccarino
- Director of the Interdepartmental Center for Hypertension and Related Conditions, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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20
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Guo S, Ge JX, Liu SN, Zhou JY, Li C, Chen HJ, Chen L, Shen YQ, Zhou QL. Development of a convenient and effective hypertension risk prediction model and exploration of the relationship between Serum Ferritin and Hypertension Risk: a study based on NHANES 2017-March 2020. Front Cardiovasc Med 2023; 10:1224795. [PMID: 37736023 PMCID: PMC10510409 DOI: 10.3389/fcvm.2023.1224795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/28/2023] [Indexed: 09/23/2023] Open
Abstract
Background Hypertension is a major public health problem, and its resulting other cardiovascular diseases are the leading cause of death worldwide. In this study, we constructed a convenient and high-performance hypertension risk prediction model to assist in clinical diagnosis and explore other important influencing factors. Methods We included 8,073 people from NHANES (2017-March 2020), using their 120 features to form the original dataset. After data pre-processing, we removed several redundant features through LASSO regression and correlation analysis. Thirteen commonly used machine learning methods were used to construct prediction models, and then, the methods with better performance were coupled with recursive feature elimination to determine the optimal feature subset. After data balancing through SMOTE, we integrated these better-performing learners to construct a fusion model based for predicting hypertension risk on stacking strategy. In addition, to explore the relationship between serum ferritin and the risk of hypertension, we performed a univariate analysis and divided it into four level groups (Q1 to Q4) by quartiles, with the lowest level group (Q1) as the reference, and performed multiple logistic regression analysis and trend analysis. Results The optimal feature subsets were: age, BMI, waist, SBP, DBP, Cre, UACR, serum ferritin, HbA1C, and doctors recommend reducing salt intake. Compared to other machine learning models, the constructed fusion model showed better predictive performance with precision, accuracy, recall, F1 value and AUC of 0.871, 0.873, 0.871, 0.869 and 0.966, respectively. For the analysis of the relationship between serum ferritin and hypertension, after controlling for all co-variates, OR and 95% CI from Q2 to Q4, compared to Q1, were 1.396 (1.176-1.658), 1.499 (1.254-1.791), and 1.645 (1.360-1.989), respectively, with P < 0.01 and P for trend <0.001. Conclusion The hypertension risk prediction model developed in this study is efficient in predicting hypertension with only 10 low-cost and easily accessible features, which is cost-effective in assisting clinical diagnosis. We also found a trend correlation between serum ferritin levels and the risk of hypertension.
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Affiliation(s)
- Shuang Guo
- Information Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Jiu-Xin Ge
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Shan-Na Liu
- Information Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Jia-Yu Zhou
- Xinjiang Second Medical College, Karamay, China
| | - Chang Li
- Information Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Han-Jie Chen
- Information Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Li Chen
- Information Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yu-Qiang Shen
- Information Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Qing-Li Zhou
- Information Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
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Treciokiene I, Peceliuniene J, Wettermark B, Gulbinovic J, Taxis K. Hypertension management and drug-related problems. A case report of the 23-year history of Mr. Jonas. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100313. [PMID: 37601158 PMCID: PMC10433230 DOI: 10.1016/j.rcsop.2023.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Arterial hypertension is a lifelong disease, which management is recognized as the most effective way to reduce cardiovascular mortality. Even though there is extensive evidence on the benefits of lifestyle modification and antihypertensive treatment, many patients with hypertension do not reach blood pressure targets. This paper aims to review the history of antihypertensive treatment of one patient and identify the drug related problems that occurred over the study period. In this case report, the patient's health record was studied, guidelines checked and a semi-structured interview conducted. Drug related problems were identified and possible pharmacist interventions were introduced. Drug related problems that could have contributed to the lack of hypertension control were adherence, side effects and disease-drug interaction. Identified pharmacists' interventions ranged from managing self-medication, to collaboration with general practitioner to change prescribing, and counselling the patient on medication use, including adherence. Even though the drug related problems were not that serious in the studied case, the patient could have valued from pharmacist intervention.
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Affiliation(s)
- Indre Treciokiene
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Jurate Peceliuniene
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Bjorn Wettermark
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
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22
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Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, Sanner B. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. J Intern Med 2023; 294:251-268. [PMID: 37401044 DOI: 10.1111/joim.13678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
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Affiliation(s)
- G Mancia
- University of Milano-Bicocca, Milan, Italy
| | - F P Cappuccio
- University of Warwick, Warwick Medical School, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - M Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - C Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - R Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - B Sanner
- Department of Internal Medicine, Agaplesion Bethesda, Wuppertal, Germany
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Bayaraa N, Azahar NM, Kitaoka K, Kobayashi Y, Yano Y. African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): a holistic approach for hypertension control in Africa. J Hum Hypertens 2023:10.1038/s41371-023-00845-7. [PMID: 37386123 DOI: 10.1038/s41371-023-00845-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/07/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Nomin Bayaraa
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Division for University Hospital Development, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nazar Mohd Azahar
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Pulau Pinang, Malaysia
| | - Kaori Kitaoka
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Yusuke Kobayashi
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama, Japan
| | - Yuichiro Yano
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan.
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24
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Elahi A, Ali AA, Khan AH, Samad Z, Shahab H, Aziz N, Almas A. Challenges of managing hypertension in Pakistan - a review. Clin Hypertens 2023; 29:17. [PMID: 37316940 DOI: 10.1186/s40885-023-00245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND This review aims to describe existing evidence on the state of hypertension in Pakistan, including the prevalence, associated risk factors, preventive strategies, and challenges in the management of hypertension. METHODS A comprehensive literature search was conducted electronically using PubMed and Google Scholar. Using specific screening methodology, 55 articles were selected to be included. RESULTS We found from this extensive review that several small studies report high prevalence of hypertension but there is a lack of population based prevalence of hypertension in Pakistan. Lifestyle risk factors such as obesity, unhealthy diet, decreased physical activity, low socioeconomic status, and lack of access to care were the main associated factors with hypertension. Lack of blood pressure monitoring practices and medication non-adherence were also linked to uncontrolled hypertension in Pakistan and were more evident in primary care setups. The evidence presented is essential for delineating the burden of the disease, hence allowing for better management of this underserved population. CONCLUSION There is a need for updated surveys to depict the true prevalence and management of hypertension in Pakistan. Cost-effective implementation strategies and policies at the national level are needed for both prevention and control of hypertension.
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Affiliation(s)
| | | | - Aamir Hameed Khan
- Section of Cardiology, Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Zainab Samad
- Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Hunaina Shahab
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Namra Aziz
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Aysha Almas
- Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan.
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25
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Chakraborty S, Lulla A, Cheng X, Yeo JY, Mandal J, Yang T, Mei X, Saha P, Golonka RM, Yeoh BS, Mell B, Jia W, Putluri V, Piyarathna DWB, Putluri N, Sreekumar A, Meyer K, Vijay-Kumar M, Joe B. Conjugated bile acids are nutritionally re-programmable antihypertensive metabolites. J Hypertens 2023; 41:979-994. [PMID: 37071431 PMCID: PMC10158603 DOI: 10.1097/hjh.0000000000003423] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Hypertension is the largest risk factor affecting global mortality. Despite available medications, uncontrolled hypertension is on the rise, whereby there is an urgent need to develop novel and sustainable therapeutics. Because gut microbiota is now recognized as an important entity in blood pressure regulation, one such new avenue is to target the gut-liver axis wherein metabolites are transacted via host-microbiota interactions. Knowledge on which metabolites within the gut-liver axis regulate blood pressure is largely unknown. METHOD To address this, we analyzed bile acid profiles of human, hypertensive and germ-free rat models and report that conjugated bile acids are inversely correlated with blood pressure in humans and rats. RESULTS Notably intervening with taurine or tauro-cholic acid rescued bile acid conjugation and reduced blood pressure in hypertensive rats. Subsequently, untargeted metabolomics uncovered altered energy metabolism following conjugation of bile acids as a mechanism alleviating high blood pressure. CONCLUSION Together this work reveals conjugated bile acids as nutritionally re-programmable anti-hypertensive metabolites.
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Affiliation(s)
- Saroj Chakraborty
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Anju Lulla
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Xi Cheng
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Ji-Youn Yeo
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Juthika Mandal
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Tao Yang
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Xue Mei
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Piu Saha
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Rachel M. Golonka
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Beng San Yeoh
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Blair Mell
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Wei Jia
- University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | | | - Nagireddy Putluri
- Dan L. Duncan Cancer Center, Advanced Technology Core
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Arun Sreekumar
- Dan L. Duncan Cancer Center, Advanced Technology Core
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Katie Meyer
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,USA
| | - Matam Vijay-Kumar
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Bina Joe
- Program in Physiological Genomics, Microbiome Consortium and Center for Hypertension and Precision Medicine, Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
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26
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du Toit C, Tran TQB, Deo N, Aryal S, Lip S, Sykes R, Manandhar I, Sionakidis A, Stevenson L, Pattnaik H, Alsanosi S, Kassi M, Le N, Rostron M, Nichol S, Aman A, Nawaz F, Mehta D, Tummala R, McCallum L, Reddy S, Visweswaran S, Kashyap R, Joe B, Padmanabhan S. Survey and Evaluation of Hypertension Machine Learning Research. J Am Heart Assoc 2023; 12:e027896. [PMID: 37119074 PMCID: PMC10227215 DOI: 10.1161/jaha.122.027896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/27/2023] [Indexed: 04/30/2023]
Abstract
Background Machine learning (ML) is pervasive in all fields of research, from automating tasks to complex decision-making. However, applications in different specialities are variable and generally limited. Like other conditions, the number of studies employing ML in hypertension research is growing rapidly. In this study, we aimed to survey hypertension research using ML, evaluate the reporting quality, and identify barriers to ML's potential to transform hypertension care. Methods and Results The Harmonious Understanding of Machine Learning Analytics Network survey questionnaire was applied to 63 hypertension-related ML research articles published between January 2019 and September 2021. The most common research topics were blood pressure prediction (38%), hypertension (22%), cardiovascular outcomes (6%), blood pressure variability (5%), treatment response (5%), and real-time blood pressure estimation (5%). The reporting quality of the articles was variable. Only 46% of articles described the study population or derivation cohort. Most articles (81%) reported at least 1 performance measure, but only 40% presented any measures of calibration. Compliance with ethics, patient privacy, and data security regulations were mentioned in 30 (48%) of the articles. Only 14% used geographically or temporally distinct validation data sets. Algorithmic bias was not addressed in any of the articles, with only 6 of them acknowledging risk of bias. Conclusions Recent ML research on hypertension is limited to exploratory research and has significant shortcomings in reporting quality, model validation, and algorithmic bias. Our analysis identifies areas for improvement that will help pave the way for the realization of the potential of ML in hypertension and facilitate its adoption.
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Affiliation(s)
- Clea du Toit
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Tran Quoc Bao Tran
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Neha Deo
- Mayo Clinic Alix School of MedicineRochesterMN
| | - Sachin Aryal
- Center for Hypertension and Precision Medicine, Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Stefanie Lip
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Robert Sykes
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Ishan Manandhar
- Center for Hypertension and Precision Medicine, Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | | | - Leah Stevenson
- Center for Hypertension and Precision Medicine, Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | | | - Safaa Alsanosi
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
- Department of Pharmacology and Toxicology, Faculty of MedicineUmm Al Qura UniversityMakkahSaudi Arabia
| | - Maria Kassi
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Ngoc Le
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Maggie Rostron
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Sarah Nichol
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Alisha Aman
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | - Faisal Nawaz
- College of MedicineMohammed Bin Rashid University of Medicine and Health SciencesDubaiUAE
| | - Dhruven Mehta
- Department of Internal MedicineTriStar Centennial Medical Center, HCA HealthcareNashvilleTN
| | - Ramakumar Tummala
- Center for Hypertension and Precision Medicine, Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Linsay McCallum
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
| | | | - Shyam Visweswaran
- Department of Biomedical InformaticsUniversity of PittsburghPittsburghPA
| | - Rahul Kashyap
- Department of Anesthesiology and Critical Care MedicineMayo ClinicRochesterMN
| | - Bina Joe
- Center for Hypertension and Precision Medicine, Department of Physiology and PharmacologyUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Sandosh Padmanabhan
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUnited Kingdom
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27
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Avolio A. The reality and serendipity of cuffless blood pressure monitoring. Hypertens Res 2023:10.1038/s41440-023-01269-z. [PMID: 37016027 DOI: 10.1038/s41440-023-01269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/12/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
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28
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Borkum M, Levin A, Williams J, Bevilacqua M. The Patient-Provider Gap: A Cross-sectional Survey to Understand Barriers and Motivating Factors for Home Blood Pressure Monitoring in a CKD Cohort. Can J Kidney Health Dis 2023; 10:20543581231156850. [PMID: 36814963 PMCID: PMC9940160 DOI: 10.1177/20543581231156850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/07/2023] [Indexed: 02/19/2023] Open
Abstract
Background Blood pressure (BP) management can decrease morbidity and mortality in chronic kidney disease (CKD) patients. Evidence-based hypertension guidelines endorse home BP monitoring (HBPM), and the growing use of virtual health has highlighted the need for HBPM. A comprehensive understanding of HBPM adoption in our province is lacking. Objective To identify the baseline practices, perspectives, barriers, and enablers in both providers and patients in our kidney care clinics regarding HBPM. Ultimately, this will inform the development of a provincial intervention that empowers providers to both increase patient understanding and equip them for accurate and reliable home BP measurement. Design Cross-sectional, descriptive study using online survey methodology. Setting Kidney care clinic network in the province of British Columbia, Canada. Patients or Sample or Participants Kidney care clinic staff and patients who perform HBPM. Methods Data were collected using semi-structured online surveys, one for staff and one for patients and/or caregivers. These surveys were developed by an interdisciplinary working group that included patient partners and addressed some key components of the implementation of an HBPM program (including perceived barriers to uptake, education, and adoption of best practices). Results In all, 46 patients and 43 staff responded to the survey from 16 kidney care clinics. Of the patients 53% were women, and the most common age range was 60 to 69 years (25%); 93% of the staff respondents were women and 63% were nurses. We identified numerous areas of discordance between providers and patients and the need for improvement from the perspective of implementing best practices from hypertension guidelines, both in staff teaching and patient usage of HBPM. Blood pressure targets were not known to 18% of patients and 39% of patients had received a BP target from their kidney care clinic team; 89% of patients had not had their upper arm circumference measured for cuff size. Furthermore, 54% of patients knew what to do when their BP is off-target. All recognized the benefits of HBPM, providers were more likely to perceive anxiety as a barrier relative to patients, and patients were more likely to report expense as a barrier than providers. Limitations This study includes only a single provincial health care system limiting generalizability to other jurisdictions and sampled a small subset of patients and providers. Conclusions The systematic evaluation of education, understanding, implementation of best practices, and barriers and motivating factors for HBPM from both patient and clinician perspectives is an important step in designing strategies to improve the use of HBPM. Given differences in staff and patient perspectives, targeted interventions based on these responses may lead to improved use of HBPM, and ultimately enhance hypertension self-management and BP control in our CKD patients.
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Affiliation(s)
- Megan Borkum
- Division of Nephrology, The University of British Columbia, Vancouver, Canada,Megan Borkum, Division of Nephrology, The University of British Columbia, Room 5273, 2775 Laurel Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Adeera Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada,BC Renal, Vancouver, Canada
| | | | - Micheli Bevilacqua
- Division of Nephrology, The University of British Columbia, Vancouver, Canada,BC Renal, Vancouver, Canada
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29
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Visco V, Izzo C, Mancusi C, Rispoli A, Tedeschi M, Virtuoso N, Giano A, Gioia R, Melfi A, Serio B, Rusciano MR, Di Pietro P, Bramanti A, Galasso G, D’Angelo G, Carrizzo A, Vecchione C, Ciccarelli M. Artificial Intelligence in Hypertension Management: An Ace up Your Sleeve. J Cardiovasc Dev Dis 2023; 10:jcdd10020074. [PMID: 36826570 PMCID: PMC9963880 DOI: 10.3390/jcdd10020074] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored treatment for each patient. Specifically, this article reviews the benefits of AI in AH management, pointing out diagnostic and therapeutic improvements without ignoring the limitations of this innovative scientific approach. Consequently, we conducted a detailed search on AI applications in AH: the articles (quantitative and qualitative) reviewed in this paper were obtained by searching journal databases such as PubMed and subject-specific professional websites, including Google Scholar. The search terms included artificial intelligence, artificial neural network, deep learning, machine learning, big data, arterial hypertension, blood pressure, blood pressure measurement, cardiovascular disease, and personalized medicine. Specifically, AI-based systems could help continuously monitor BP using wearable technologies; in particular, BP can be estimated from a photoplethysmograph (PPG) signal obtained from a smartphone or a smartwatch using DL. Furthermore, thanks to ML algorithms, it is possible to identify new hypertension genes for the early diagnosis of AH and the prevention of complications. Moreover, integrating AI with omics-based technologies will lead to the definition of the trajectory of the hypertensive patient and the use of the most appropriate drug. However, AI is not free from technical issues and biases, such as over/underfitting, the "black-box" nature of many ML algorithms, and patient data privacy. In conclusion, AI-based systems will change clinical practice for AH by identifying patient trajectories for new, personalized care plans and predicting patients' risks and necessary therapy adjustments due to changes in disease progression and/or therapy response.
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Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy
| | - Antonella Rispoli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Michele Tedeschi
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Nicola Virtuoso
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Angelo Giano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Renato Gioia
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Americo Melfi
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Bianca Serio
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Maria Rosaria Rusciano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gianni D’Angelo
- Department of Computer Science, University of Salerno, 84084 Fisciano, Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
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30
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Sykora M, Andelova K, Szeiffova Bacova B, Egan Benova T, Martiskova A, Knezl V, Tribulova N. Hypertension Induces Pro-arrhythmic Cardiac Connexome Disorders: Protective Effects of Treatment. Biomolecules 2023; 13:biom13020330. [PMID: 36830700 PMCID: PMC9953310 DOI: 10.3390/biom13020330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/11/2023] Open
Abstract
Prolonged population aging and unhealthy lifestyles contribute to the progressive prevalence of arterial hypertension. This is accompanied by low-grade inflammation and over time results in heart dysfunction and failure. Hypertension-induced myocardial structural and ion channel remodeling facilitates the development of both atrial and ventricular fibrillation, and these increase the risk of stroke and sudden death. Herein, we elucidate hypertension-induced impairment of "connexome" cardiomyocyte junctions. This complex ensures cell-to-cell adhesion and coupling for electrical and molecular signal propagation. Connexome dysfunction can be a key factor in promoting the occurrence of both cardiac arrhythmias and heart failure. However, the available literature indicates that arterial hypertension treatment can hamper myocardial structural remodeling, hypertrophy and/or fibrosis, and preserve connexome function. This suggests the pleiotropic effects of antihypertensive agents, including anti-inflammatory. Therefore, further research is required to identify specific molecular targets and pathways that will protect connexomes, and it is also necessary to develop new approaches to maintain heart function in patients suffering from primary or pulmonary arterial hypertension.
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Innab A, Kerari A, Alqahtani N, Albloushi M, Alshammari A. Patient activation, adherence to hypertension treatment plans and blood pressure control in Saudi Arabia: a cross-sectional study. BMJ Open 2023; 13:e067862. [PMID: 36697049 PMCID: PMC9884875 DOI: 10.1136/bmjopen-2022-067862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To explore the relationship between patient activation, adherence to hypertension treatment plans, blood pressure control and other important demographic factors. DESIGN A cross-sectional study. SETTING Primary healthcare centres in Riyadh province, Saudi Arabia. PARTICIPANTS A total of 114 adults with hypertension, including 68 men and 46 women. OUTCOME MEASUREMENTS Blood pressure control is achieved if (a) patients under 80 years of age with treated hypertension have blood pressure under 140/90 mm Hg or (b) patients aged 80 years or over with treated hypertension have blood pressure under 150/90 mm Hg. Secondary outcomes included patient activation, adherence to hypertension treatment plans and demographic factors (age, gender, education, income and comorbidity). Data were analysed using Pearson's correlation and multiple regression models. RESULTS 57% (n=66) of participants did not achieve the ideal blood pressure target. Perfect adherence to hypertension treatment plans was significantly associated with lower systolic (r=-0.38, p<0.01) and diastolic blood pressure (r=-0.50, p<0.01). Age was significantly correlated with patient activation (r=-0.20, p<0.05) and diastolic blood pressure (r=-0.33, p<0.01). There was no statistically significant association between Patient Activation Measure, systolic blood pressure and diastolic blood pressure. In the hierarchical regression analysis, adherence to hypertension treatment plans was found to be a significant predictor and explained 15% of the variance in systolic blood pressure (β=-0.36, p<0.001) and 26% of the variance in diastolic blood pressure (β=-0.51, p<0.001). CONCLUSION The individual and family self-management theory can serve as an effective theory for understanding the key factors in achieving ideal blood pressure target. The majority of patients with hypertension reported lower levels of activation and poor blood pressure control. Inadequate adherence to treatment plans was related to poor blood pressure control. This work is pivotal in devising self-management interventions to assist patients in the management of hypertension disease, especially in Saudi Arabia.
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Affiliation(s)
- Adnan Innab
- Nursing Administration and Education Department, King Saud University, Riyadh, Saudi Arabia
| | - Ali Kerari
- Medical Surgical Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Naji Alqahtani
- Nursing Administration and Education Department, King Saud University, Riyadh, Saudi Arabia
| | - Monirah Albloushi
- Medical Surgical Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Alkadi Alshammari
- Community, Psychiatric and Mental Health Nursing, King Saud University, Riyadh, Saudi Arabia
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Horne CE, Stayt LC, Schutz S, Smith CM, Haberstroh A, Bolin LP, Taylor CL, Moosavi SH, Bibbey A. Symptom experiences in hypertension: a mixed methods systematic review. J Hypertens 2023; 41:1-16. [PMID: 36250472 DOI: 10.1097/hjh.0000000000003306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM Understanding patients' hypertension (HTN) symptoms can assist healthcare professionals' awareness of individual, cultural, and behavioral responses and improve diagnostic accuracy to optimize treatment. The purpose of this review was to evaluate and synthesize current literature exploring HTN symptoms. METHODS Databases searched included MEDLINE (PubMed), CINAHL (EBSCO), Scopus, and Web of Science from January 2010 to January 2022. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The McMaster critical review forms were used to determine the quality of both qualitative and quantitative articles. Synthesis of the data was guided by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. RESULTS In total, 41 articles were included, nine qualitative studies and 32 quantitative. The quality of the articles varied. Symptoms included commonly reported symptoms and some less prevalent, including some reporting absence of symptoms. Factors that affected symptoms included culture, beliefs, psychosocial factors, and knowledge. We also found that there may be a bidirectional relationship between symptoms and behaviors that may lead to self-management. CONCLUSION HTN is common and symptoms are frequently reported. HTN management is related to multiple factors. Symptoms continue in a number of individuals after initial diagnosis. Evaluating symptoms after initial diagnosis may help to optimally manage and meet blood pressure guidelines.
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Affiliation(s)
- Carolyn E Horne
- School of Nursing, University of North Carolina - Charlotte, Charlotte, North Carolina, USA
| | - Louise C Stayt
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Susan Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | | | | | - Linda P Bolin
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Catherine L Taylor
- College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | | | - Adam Bibbey
- Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Prevalence and correlates of use of digital technology for managing hypertension among older adults. J Hum Hypertens 2023; 37:80-87. [PMID: 35140353 PMCID: PMC9832211 DOI: 10.1038/s41371-022-00654-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 01/31/2023]
Abstract
Hypertension is prevalent among older adults (60 years and above), but control of blood pressure (BP) remains suboptimal. While there is increasing interest in using digital technology for managing hypertension, information about the extent and potential correlates of such use among older adults remains scant. We assessed the prevalence and correlates of the use of digital technology for managing hypertension among older adults with hypertension. We also investigated if the use of digital technology was associated with BP or hypertension control. The use of digital technology (internet or digital apps) for information about or managing BP or hypertension was assessed among 1729 older adults diagnosed with hypertension participating in a national survey in Singapore. Regression analysis was used to assess the correlates (based on the Unified Theory of Use and Acceptance of Technology), and whether such use was associated with hypertension control or BP values. Digital technology for managing hypertension was used by 7.1% of older adults with hypertension. Those of higher age and with limitations in one or more activities or instrumental activities of daily living were less likely, while those with secondary education and above, and with stronger social network were more likely to use digital technology. There was no association between the use of digital technology and hypertension control. While users of digital technology had lower systolic (by 2.1 mmHg, adjusted p value = 0.12) and diastolic (by 1.6 mmHg, adjusted p value = 0.13) BP than non-users, the differences were not statistically significant. Given its low prevalence, there is potential for increased use of digital technology for managing hypertension among older adults with hypertension in Singapore. Initiatives to increase digital health use should target specific older adult subgroups.
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Preethi KA, Selvakumar SC, Ross K, Sekar D. Therapeutic aspect of microRNA inhibition in various types of hypertension and hypertensive complications. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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35
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Zammit N, Belgacem WB, Ghammam R, Fredj SB, Krifa R, Ouertani M, Maatouk A, Maatoug J, Ghannem H. Screening and health education practices related to cardiovascular risk factors among adults: results of a households survey in Sousse, Tunisia. Sci Rep 2022; 12:18781. [PMID: 36335141 PMCID: PMC9637120 DOI: 10.1038/s41598-022-23600-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022] Open
Abstract
In Tunisia, despite the implementation of national strategies to prevent some of cardiovascular risk factors, these diseases still represent the leading cause of death. The current study aimed to determine the prevalence of cardiovascular risk factors and assess the screening and health education practices related to these factors among the adults of Sousse (Tunisia). A cross-sectional study was conducted in 1000 households in Sousse, Tunisia. To collect data, a team of trained medical doctors administered by interview a pre-tested questionnaire and performed blood pressure and anthropometric measures at the participants' homes. In total, 1977 adults participated in the study. Their mean age was 39.8 (± 13.8) years. The Females/Males sex ratio was 1.5. Weight excess and lack of physical activity were found in 65.4% and 60.7% of participants. Screening for obesity and android obesity were reported by 36.6% and 5.7% of health services users. Advices from a healthcare professional to practice the recommended physical activity and eat healthily were reported by less than a third of these latter. Screening and health education practices related to cardiovascular risk factors should be reinforced in the Tunisian healthcare facilities. The implementation of multisectoral actions is necessary at the national level in order to obtain an environment that promotes a healthy lifestyle.
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Affiliation(s)
- Nawel Zammit
- grid.412791.80000 0004 0508 0097Department of Epidemiology (LR19SP03), Faculty of Medicine of Sousse, Farhat Hached University Hospital, University of Sousse, 4000 Sousse, Tunisia
| | - Waad Ben Belgacem
- grid.412791.80000 0004 0508 0097Department of Epidemiology, Farhat Hached University Hospital, 4000 Sousse, Tunisia
| | - Rim Ghammam
- grid.412791.80000 0004 0508 0097Department of Epidemiology (LR19SP03), Faculty of Medicine of Sousse, Farhat Hached University Hospital, University of Sousse, 4000 Sousse, Tunisia
| | - Sihem Ben Fredj
- grid.412791.80000 0004 0508 0097Department of Epidemiology (LR19SP03), Faculty of Medicine of Sousse, Farhat Hached University Hospital, University of Sousse, 4000 Sousse, Tunisia
| | - Rim Krifa
- grid.412791.80000 0004 0508 0097Department of Epidemiology, Farhat Hached University Hospital, 4000 Sousse, Tunisia
| | - Mohamed Ouertani
- grid.412791.80000 0004 0508 0097Department of Epidemiology, Farhat Hached University Hospital, 4000 Sousse, Tunisia
| | - Amani Maatouk
- grid.412791.80000 0004 0508 0097Department of Epidemiology, Farhat Hached University Hospital, 4000 Sousse, Tunisia
| | - Jihene Maatoug
- grid.412791.80000 0004 0508 0097Department of Epidemiology (LR19SP03), Faculty of Medicine of Sousse, Farhat Hached University Hospital, University of Sousse, 4000 Sousse, Tunisia
| | - Hassen Ghannem
- grid.412791.80000 0004 0508 0097Department of Epidemiology (LR19SP03), Faculty of Medicine of Sousse, Farhat Hached University Hospital, University of Sousse, 4000 Sousse, Tunisia
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Saei Ghare Naz M, Sheidaei A, Azizi F, Ramezani Tehrani F. Gestational diabetes mellitus and hypertensive disorder of pregnancy play as spouse-pair risk factors of diabetes and hypertension: Insights from Tehran Lipid and Glucose Study. J Diabetes Complications 2022; 36:108311. [PMID: 36201894 DOI: 10.1016/j.jdiacomp.2022.108311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/27/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Complicated pregnancies by gestational diabetes mellitus (GDM) and hypertensive disorder of pregnancy (HDP) are relatively common worldwide. The evidence is still inconclusive regarding the role of GDM and HDP as spousal risk factor of diabetes (DM) and hypertension (HTN). This study aimed to determine the spousal risk of development of DM and/or HTN in the context of GDM and/or HDP. METHODS This population-based cohort study involved couples who participated in Tehran Lipid and Glucose Study. A total of 3650 pairs of spouses were identified, and among them, 2820 met the inclusion criteria. Included participants, followed up 3-year intervals visits from 1999 to 2018. All pairs underwent standard data collection. GDM and HDP were the main exposure of interest in females, and DM and HTN were the main outcomes in both females and their spouses. Cox proportional hazard regression models were used for both females and their spouses, adjusting for age, consanguinity, waist-to-height ratio, physical activity, smoking, and parity. RESULTS Of 2820 females, 558 (19.79 %) had histories of GDM or HDP, and 72 (2.55 %) experienced both. Among females who experienced GDM and HDP, 24 (33 %) and 31 (33 %) developed DM and HTN during the follow-up. The corresponding numbers were 89 (16 %) and 191 (34 %) for those who experienced GDM or HPD, and 274 (13 %) and 623 (28 %) for the non-risk factors group. The incidences of DM were 9 (12 %), 100 (18 %), and 373 (17 %) for males whose spouses experienced both GDM and HDP, either one or none of them, respectively. Among males in these groups, 20 (28 %), 150 (27 %), and 630 (29 %) developed HTN, respectively. Females who never had history of GDM and HDP have 34 % (95 % CI: 21, 45) less hazard of being diabetic than their spouses if they have the same age and waist to hip ratio. In cases with histories of both GDM and HDP, the risk of females increases to 3.05 (95 % CI: 1.43, 6.52) times of their spouses. Also, females who had experienced GDM (HR: 3.51, 95 % CI: 2.23, 5.53), or HDP (HR: 2.80, 95 % CI: 1.72, 4.56) were at higher risk of developing DM compared with females who never had GDM or HDP. We found that females with neither GDM nor HDP were more likely than males to be hypertensive in the future by the hazard ratio of 1.21 (95 % CI: 1.06, 1.39). CONCLUSIONS Complicated pregnancies by GDM and/or HDP were associated with increased risk of development DM and HTN in later life of females and their spouses. Further studies are required to confirm these results. Preventive care programs should be considered pregnancy complications as couple-based risk factors for subsequent DM and HTN.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Chung TK, Jeon Y, Hong Y, Hong S, Moon JS, Lee H. Factors affecting the changes in antihypertensive medications in patients with hypertension. Front Cardiovasc Med 2022; 9:999548. [PMID: 36247446 PMCID: PMC9561640 DOI: 10.3389/fcvm.2022.999548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022] Open
Abstract
As frequent changes in anti-hypertensive (HTN) medications may reduce adherence to the treatments, identifying modifiable factors leading to changes in anti-HTN medications can help clinicians optimize treatment strategies for individual patients. We performed this study to explore the pattern of anti-HTN medications and to identify factors that are associated with the changes in anti-HTN medications. To this end, we used a clinical database of Seoul National University Hospital, extracted, transformed, and loaded by the observational medical outcomes partnership common data model. Demographic and all recorded clinical diagnoses, medications, and procedures data of eligible subjects were collected. Of 636 subjects who were eligible for this study, 297 subjects with a record of ≥1 anti-HTN medication changes and other 297 subjects without a record of medication change were selected for the study population. High diastolic blood pressure (adjusted odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.001–1.040, p = 0.040), arrhythmia (adjusted OR: 10.01, 95% CI: 1.86–185.57, p = 0.030), and angina pectoris with antianginal agents (adjusted OR: 4.85, CI: 1.05–23.89, p = 0.046) were associated with the changes in anti-HTN medications, indicating that any patients with these covariates require additional attention to reduce the likelihood of changing anti-HTN medications.
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Affiliation(s)
- Tae Kyu Chung
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
- Center for Convergence Approaches in Drug Development, Seoul, South Korea
| | - Yoomin Jeon
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
- Center for Convergence Approaches in Drug Development, Seoul, South Korea
| | - YeSol Hong
- Center for Convergence Approaches in Drug Development, Seoul, South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Suyeon Hong
- Center for Convergence Approaches in Drug Development, Seoul, South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Jun Sik Moon
- Center for Convergence Approaches in Drug Development, Seoul, South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Howard Lee
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
- Center for Convergence Approaches in Drug Development, Seoul, South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- Advanced Institutes of Convergence Technology, Suwon, South Korea
- *Correspondence: Howard Lee
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38
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Schutte AE. The promise and pitfalls of novel cuffless blood pressure devices. Eur Heart J 2022; 43:4222-4223. [DOI: 10.1093/eurheartj/ehac474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street , Sydney, NSW 2052 , Australia
- The George Institute for Global Health, Level 5/1, King Street, Newtown , NSW 2042 , Australia
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Fan L, Cai J. Integrated hypertension management and national hypertension discipline promotion in China. Chin Med J (Engl) 2022; 135:00029330-990000000-00071. [PMID: 35861305 PMCID: PMC9532026 DOI: 10.1097/cm9.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Luyun Fan
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Cai
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Louca P, Nogal A, Moskal A, Goulding NJ, Shipley MJ, Alkis T, Lindbohm JV, Hu J, Kifer D, Wang N, Chawes B, Rexrode KM, Ben-Shlomo Y, Kivimaki M, Murphy RA, Yu B, Gunter MJ, Suhre K, Lawlor DA, Mangino M, Menni C. Cross-Sectional Blood Metabolite Markers of Hypertension: A Multicohort Analysis of 44,306 Individuals from the COnsortium of METabolomics Studies. Metabolites 2022; 12:601. [PMID: 35888725 PMCID: PMC9324896 DOI: 10.3390/metabo12070601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022] Open
Abstract
Hypertension is the main modifiable risk factor for cardiovascular morbidity and mortality but discovering molecular mechanisms for targeted treatment has been challenging. Here we investigate associations of blood metabolite markers with hypertension by integrating data from nine intercontinental cohorts from the COnsortium of METabolomics Studies. We included 44,306 individuals with circulating metabolites (up to 813). Metabolites were aligned and inverse normalised to allow intra-platform comparison. Logistic models adjusting for covariates were performed in each cohort and results were combined using random-effect inverse-variance meta-analyses adjusting for multiple testing. We further conducted canonical pathway analysis to investigate the pathways underlying the hypertension-associated metabolites. In 12,479 hypertensive cases and 31,827 controls without renal impairment, we identified 38 metabolites, associated with hypertension after adjusting for age, sex, body mass index, ethnicity, and multiple testing. Of these, 32 metabolite associations, predominantly lipid (steroids and fatty acyls) and organic acids (amino-, hydroxy-, and keto-acids) remained after further adjusting for comorbidities and dietary intake. Among the identified metabolites, 5 were novel, including 2 bile acids, 2 glycerophospholipids, and ketoleucine. Pathway analysis further implicates the role of the amino-acids, serine/glycine, and bile acids in hypertension regulation. In the largest cross-sectional hypertension-metabolomics study to date, we identify 32 circulating metabolites (of which 5 novel and 27 confirmed) that are potentially actionable targets for intervention. Further in-vivo studies are needed to identify their specific role in the aetiology or progression of hypertension.
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Affiliation(s)
- Panayiotis Louca
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
| | - Ana Nogal
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
| | - Aurélie Moskal
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France; (A.M.); (M.J.G.)
| | - Neil J. Goulding
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; (N.J.G.); (Y.B.-S.); (D.A.L.)
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - Martin J. Shipley
- Department Epidemiology and Public Health, University College London, London WC1E 7HB, UK; (M.J.S.); (J.V.L.); (M.K.)
| | - Taryn Alkis
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center, Houston, TX 77030, USA; (T.A.); (B.Y.)
| | - Joni V. Lindbohm
- Department Epidemiology and Public Health, University College London, London WC1E 7HB, UK; (M.J.S.); (J.V.L.); (M.K.)
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 20 Helsinki, Finland
| | - Jie Hu
- Division of Women’s Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (J.H.); (K.M.R.)
| | - Domagoj Kifer
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
| | - Ni Wang
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark; (N.W.); (B.C.)
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark; (N.W.); (B.C.)
| | - Kathryn M. Rexrode
- Division of Women’s Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (J.H.); (K.M.R.)
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; (N.J.G.); (Y.B.-S.); (D.A.L.)
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol BS1 2NT, UK
| | - Mika Kivimaki
- Department Epidemiology and Public Health, University College London, London WC1E 7HB, UK; (M.J.S.); (J.V.L.); (M.K.)
| | - Rachel A. Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1G1, Canada
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center, Houston, TX 77030, USA; (T.A.); (B.Y.)
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France; (A.M.); (M.J.G.)
| | - Karsten Suhre
- Department of Biophysics and Physiology, Weill Cornell Medicine-Qatar, Doha 24144, Qatar;
| | - Deborah A. Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; (N.J.G.); (Y.B.-S.); (D.A.L.)
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Bristol NIHR Biomedical Research Centre, University of Bristol, Bristol BS1 2NT, UK
| | - Massimo Mangino
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Foundation Trust, London SE1 9RT, UK
| | - Cristina Menni
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
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Wang H, Liu C, Zhang X, Xiu T, Li P, Zhang W, Zhang W, Wang X, Liu Z, Tang B. Simultaneous fluorescence imaging of Golgi O 2•- and Golgi H 2O 2 in mice with hypertension. Biosens Bioelectron 2022; 213:114480. [PMID: 35738216 DOI: 10.1016/j.bios.2022.114480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Abstract
Hypertensive cardiovascular disease is a persistent threat to public health. Elucidating the pathogenesis of hypertension is expected to provide more highly targeted therapies for patients. To date, reactive oxygen species (ROS) induced endothelial nitric oxide synthase (eNOS) uncoupling are generally considered to be common phenomena in hypertension. However, the critical factor contribute to persistent eNOS uncoupling remains poorly understood. Herein, we established a fluorescence probe, GolROS, for the multicolored and simultaneous detection of Golgi O2•- and H2O2 in situ. We successfully detected increases in Golgi ROS levels in hypertensive mice and evaluated the pharmaceutical effects of various antihypertensive drugs. More importantly, we identified the ROS post-transcriptional modification sites on dihydrofolate reductase (DHFR). Altogether, we propose a novel therapeutic target for hypertension, which will promote the development of new antihypertensive drugs, and also developed an ideal fluorescence probe to study in situ Golgi O2•- and H2O2 changes in various biochemical processes.
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Affiliation(s)
- Hui Wang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China.
| | - Cuifang Liu
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Xiaoting Zhang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Tiancong Xiu
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Ping Li
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China.
| | - Wei Zhang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Wen Zhang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Xin Wang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Zhenzhen Liu
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China
| | - Bo Tang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Minis-try of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institutes of Biomedical Sciences, Shandong Normal University, Jinan, 250014, People's Republic of China.
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Souza Bomfim GH, Musial DC, Rocha K, Jurkiewicz A, Jurkiewicz NH. Red wine but not alcohol consumption improves cardiovascular function and oxidative stress of the hypertensive-SHR and diabetic-STZ rats. Clin Exp Hypertens 2022; 44:573-584. [PMID: 35699125 DOI: 10.1080/10641963.2022.2085737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS This raised the issue of whether in vivo long-term red wine treatment can act as a modulator of these targets. MAIN METHODS We monitored SBP, glucose tolerance, oxidative stress, and cardiovascular function. Aortic and atrial tissues from normotensive-WKY, hypertensive-SHR, and diabetic-STZ animals, chronically exposed to red wine (3.715 ml/kg/v.o/day) or alcohol (12%) for 21-days, were used to measure contractile/relaxation responses by force transducers. Key findings: red wine, but not alcohol, prevented the increase of SBP and hyperglycemic peak. Additionally, was observed prevention of oxidative stress metabolites formation and an improvement in ROS scavenging antioxidant capacity of SHR. We also revealed that red wine intake enhances the endothelium-dependent relaxation, decreases the hypercontractile mediated by angiotensin-II in the aorta, and via β1-adrenoceptors in the atrium. SIGNIFICANCE The long-term consumption of red wine can improve oxidative stress and the functionality of angiotensin-II and β1-adrenoceptors, inspiring new pharmacologic and dietetic therapeutic approaches for the treatment of hypertension and diabetes.Abbreviation Acronyms and/or abbreviations: [Ca2+]cyt = Cytosolic Ca2+ Concentration; ACh = Acetylcholine; ANG II = Angiotensin II; AT1 = ANG II type 1 receptor; AUC = Area Under the Curve; Ca2+ = Calcium; Endo + = Endothelium Intact; Fen = Phenylephrine (1 μM); GTT = Glucose Tolerance Test; ISO = Isoprenaline (isoproterenol); KHN = Krebs-Henseleit Nutrient; LA = Left Atria; LH = Lipid Hydroperoxide; NO = Nitric Oxide; RA = Right Atria; RAS = Renin-Angiotensin System; ROS = Reactive Oxygen Species; SBP = Systolic Blood Pressure; SHR = Spontaneously Hypertensive Rats; STZ = Streptozotocin; WKY = Normotensive Wistar Kyoto Rats.
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Affiliation(s)
- Guilherme Henrique Souza Bomfim
- Department of Molecular Pathobiology, New York University (NYU) College of Dentistry, NY, NY, USA.,Departamento de Farmacologia, Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Diego Castro Musial
- Department of Molecular Pathobiology, New York University (NYU) College of Dentistry, NY, NY, USA
| | - Katiucha Rocha
- Department of Molecular Pathobiology, New York University (NYU) College of Dentistry, NY, NY, USA
| | - Aron Jurkiewicz
- Department of Molecular Pathobiology, New York University (NYU) College of Dentistry, NY, NY, USA
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43
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Li GY, Jiang Y, Zheng Y, Xu W, Zhang Z, Cao Y. Arterial Stiffness Probed by Dynamic Ultrasound Elastography Characterizes Waveform of Blood Pressure. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:1510-1519. [PMID: 34995186 DOI: 10.1109/tmi.2022.3141613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The clinical and economic burdens of cardiovascular diseases pose a global challenge. Growing evidence suggests an early assessment of arterial stiffness can provide insights into the pathogenesis of cardiovascular diseases. However, it remains difficult to quantitatively characterize local arterial stiffness in vivo. Here we utilize guided axial waves continuously excited and detected by ultrasound to probe local blood pressures and mechanical properties of common carotid arteries simultaneously. In a pilot study of 17 healthy volunteers, we observe a ∼ 20 % variation in the group velocities of the guided axial waves (5.16 ± 0.55 m/s in systole and 4.31 ± 0.49 m/s in diastole) induced by the variation of the blood pressures. A linear relationship between the square of group velocity and blood pressure is revealed by the experiments and finite element analysis, which enables us to measure the waveform of the blood pressures by the group velocities. Furthermore, we propose a wavelet analysis-based method to extract the dispersion relations of the guided axial waves. We then determined the shear modulus by fitting the dispersion relations in diastole with the leaky Lamb wave model. The average shear modulus of all the volunteers is 166.3 ± 32.8 kPa. No gender differences are found. This study shows the group velocity and dispersion relation of the guided axial waves can be utilized to probe blood pressure and arterial stiffness locally in a noninvasive manner and thus promising for early diagnosis of cardiovascular diseases.
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Islam SMS, Chow CK, Daryabeygikhotbehsara R, Subedi N, Rawstorn J, Tegegne T, Karmakar C, Siddiqui MU, Lambert G, Maddison R. Wearable cuffless blood pressure monitoring devices: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:323-337. [PMID: 36713001 PMCID: PMC9708022 DOI: 10.1093/ehjdh/ztac021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/11/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023]
Abstract
Aims High blood pressure (BP) is the commonest modifiable cardiovascular risk factor, yet its monitoring remains problematic. Wearable cuffless BP devices offer potential solutions; however, little is known about their validity and utility. We aimed to systematically review the validity, features and clinical use of wearable cuffless BP devices. Methods and results We searched MEDLINE, Embase, IEEE Xplore and the Cochrane Database till December 2019 for studies that reported validating cuffless BP devices. We extracted information about study characteristics, device features, validation processes, and clinical applications. Devices were classified according to their functions and features. We defined devices with a mean systolic BP (SBP) and diastolic BP (DBP) biases of <5 mmHg as valid as a consensus. Our definition of validity did not include assessment of device measurement precision, which is assessed by standard deviation of the mean difference-a critical component of ISO protocol validation criteria. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. A random-effects model meta-analysis was performed to summarise the mean biases for SBP and DBP across studies. Of the 430 studies identified, 16 studies (15 devices, 974 participants) were selected. The majority of devices (81.3%) used photoplethysmography to estimate BP against a reference device; other technologies included tonometry, auscultation and electrocardiogram. In addition to BP and heart rate, some devices also measured night-time BP (n = 5), sleep monitoring (n = 3), oxygen saturation (n = 3), temperature (n = 2) and electrocardiogram (n = 3). Eight devices showed mean biases of <5 mmHg for SBP and DBP compared with a reference device and three devices were commercially available. The meta-analysis showed no statistically significant differences between the wearable and reference devices for SBP (pooled mean difference = 3.42 mmHg, 95% CI: -2.17, 9.01, I2 95.4%) and DBP (pooled mean = 1.16 mmHg, 95% CI: -1.26, 3.58, I2 87.1%). Conclusion Several cuffless BP devices are currently available using different technologies, offering the potential for continuous BP monitoring. The variation in standards and validation protocols limited the comparability of findings across studies and the identification of the most accurate device. Challenges such as validation using standard protocols and in real-life settings must be overcome before they can be recommended for uptake into clinical practice.
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Affiliation(s)
| | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia,The George Institute for Global Health, UNSW, Sydney, Australia,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | | | - Narayan Subedi
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Jonathan Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Teketo Tegegne
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | | | - Muhammad U Siddiqui
- Marshfield Clinic Health System, Rice Lake, USA,George Washington University, Washington, DC, USA
| | - Gavin Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Vic, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
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Song R, Mishra JS, Dangudubiyyam SV, Antony KM, Baker TL, Watters JJ, Kumar S. Gestational Intermittent Hypoxia Induces Sex-Specific Impairment in Endothelial Mechanisms and Sex Steroid Hormone Levels in Male Rat Offspring. Reprod Sci 2022; 29:1531-1541. [PMID: 34550599 PMCID: PMC11157504 DOI: 10.1007/s43032-021-00739-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent during gestation and is linked with adverse fetal outcomes. We examined whether gestational intermittent hypoxia (GIH), the main feature of OSA, leads to sex-specific alterations in cardiovascular function and vascular mechanisms in the offspring. Pregnant rats exposed to intermittent hypoxia or ambient air from gestation days 10 to 21 and their offspring were used for the study. GIH exposure did not affect water and food intake in dams. Compared to controls, the male and female offspring born to GIH dams were smaller in weight by 14% and 12%, respectively, and exhibited catch-up growth. Cardiac function was not affected in either GIH males or females. At 12 weeks of age, blood pressure was increased in GIH males, but not GIH females, compared to their control counterparts. While mesenteric arterial contractile responses to phenylephrine and endothelin were unaffected in GIH males and females, relaxation response to acetylcholine was reduced in GIH males but not GIH females. Relaxation to sodium nitroprusside was unaffected in both GIH males and females. Total eNOS expression was not affected, but phospho(Ser1177)-eNOS levels were decreased in GIH males. eNOS expression and its phosphorylation status were unaffected in GIH females. Serum testosterone and estradiol levels were higher in GIH males but were unaltered in GIH females. Together, these findings suggest that GIH leads to a sex-specific increase in blood pressure in adult male offspring with blunted endothelium-mediated relaxation, decreased eNOS activity, and elevated sex steroid hormone levels.
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Affiliation(s)
- Ruolin Song
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI, 53706, USA
| | - Jay S Mishra
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI, 53706, USA
| | - Sri Vidya Dangudubiyyam
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI, 53706, USA
| | - Kathleen M Antony
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA
| | - Tracy L Baker
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI, 53706, USA
| | - Jyoti J Watters
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI, 53706, USA
| | - Sathish Kumar
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI, 53706, USA.
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA.
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Avolio A, Cox J, Louka K, Shirbani F, Tan I, Qasem A, Butlin M. Challenges Presented by Cuffless Measurement of Blood Pressure if Adopted for Diagnosis and Treatment of Hypertension. Pulse (Basel) 2022; 10:34-45. [PMID: 36660438 PMCID: PMC9843645 DOI: 10.1159/000522660] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 01/22/2023] Open
Abstract
The global health burden presented by hypertension is providing increased motivation for improved means of collection of blood pressure (BP) data. A growing area of research and commercial activity is the use of wearable devices to provide BP data using non-invasive cuffless techniques. The accelerated progress in recent years, particularly relating to connectivity of smartphone technology, has promoted the availability of consumer devices that provide values of BP. The main types of devices are wrist-worn, watch-type devices with sensors that typically record a photoplethysmography (PPG) signal, sometimes also with an electrocardiography (ECG) signal. The general underlying concept of the cuffless BP measurement in most device types is the association of BP and the travel time of the arterial pulse between two locations, determined from the time delay between the ECG and PPG signals. Other methods may involve additional analysis of the PPG waveform features. Experimental data are presented to illustrate the challenges presented by cuffless BP techniques in obtaining reliable BP measurements when the change in BP is caused by different stimuli affecting cardiac and vascular mechanisms. These effects influence the association of the measured and physiological BP change, thus presenting significant challenges and potential limitations in the use of cuffless BP devices for the diagnosis and treatment of hypertension.
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Shah RT, Wang BX. Effectiveness of renal denervation in the treatment of hypertension: a literature review. Clin Hypertens 2022; 28:11. [PMID: 35422052 PMCID: PMC9012033 DOI: 10.1186/s40885-022-00194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter-based renal denervation has been studied as a potential therapeutic option to reduce high blood pressure (BP). Preclinical studies in some experimental models have demonstrated an antihypertensive effect of renal denervation but reports from clinical trials have been mixed METHODS: We performed a literature search using combinations of the key terms 'Cardiovascular diseases, Clinical trial, Pre-clinical trials, Resistant hypertension, Renal denervation, Ablation technique, Radiofrequency ablation, Ultrasound ablation, RADIANCE SOLO, SYMPLICITY HTN, SYPRAL HTN'. The databases searched were PubMed and OVID Medline. RESULTS The initial SYMPLICITY HTN-1 AND HTN-2 clinical trials reported significant decreases in office BP but results from the more robustly designed SYMPLICITY HTN-3 trial, which included sham controls and ambulatory BP monitoring, showed no significant antihypertensive effect. Interest in the use of renal denervation in hypertension was once again sparked by favourable results from the SPYRAL HTN-OFF Med trial CONCLUSION: We provide a thorough, critical analysis of key preclinical and clinical studies investigating the efficacy of catheter-based renal denervation as a treatment for hypertension and highlight future areas for research to allow better translation into clinical practice.
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Affiliation(s)
| | - Brian Xiangzhi Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
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Ferrario CM, Groban L, Wang H, Sun X, VonCannon JL, Wright KN, Ahmad S. The renin–angiotensin system biomolecular cascade: a 2022 update of newer insights and concepts. Kidney Int Suppl (2011) 2022; 12:36-47. [DOI: 10.1016/j.kisu.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022] Open
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Liu G, Fang Q, Ji X, OuYang J, Zhu Y, Wang L, Wang X. Medical expenditure and its influencing factors of patients with hypertension in Shanxi Province, China: a study based on 'System of Health Accounts 2011' and multiple-layer perceptron neural network. BMJ Open 2022; 12:e048396. [PMID: 35241463 PMCID: PMC8895933 DOI: 10.1136/bmjopen-2020-048396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To study the medical expenditure and influencing factors of patients with hypertension in Shanxi Province, China. DESIGN A cross-sectional study. SETTING 1088 medical institutions, including general hospitals, traditional Chinese medicine hospitals, special hospitals, basic medical institutions and public health institutions. PARTICIPANTS 180 441 hypertensive outpatients and 14 763 inpatients from 1 January to 31 December 2017. PRIMARY AND SECONDARY OUTCOME MEASURES Curative care expenditure for hypertension (CCEht) was measured based on System of Health Accounts 2011. Influenced factors were analysed by univariate analysis and multiple layer perceptron neural network. RESULTS In 2017, CCEht was US$307.71 million, accounting for 3.63% of total CCE and 0.14% of gross domestic product (GDP) in Shanxi Province of China. CCE of hypertensive outpatients (CCEht-out) and inpatients (CCEht-in) accounted for 44.49% and 55.51% of CCEht. Drug fee accounted for 81.55% of CCEht-out and 22.50% of CCEht-in, respectively. The top three influencing factors were drug fee, surgical fee and hospitalisation days for inpatients, and drug fee, examination fee and test fee for outpatients. CONCLUSIONS The medical expenditure of hypertension is still heavy for individuals and society. The diagnosis and treatment capacities of primary healthcare system has been enhanced. New rural cooperation medical insurance and urban employee basic medical insurance have a trend of overusing, and the burden of family healthcare expenditure is still heavy. To ease the economic burden of patients with hypertension and improve the efficiency of social resources utilisation, policymakers should pay more attention to key groups, further increase support for primary healthcare system, standardise the treatment and reimbursement of hypertension and incline the reimbursement policy to outpatient service.
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Affiliation(s)
- Guojie Liu
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Quan Fang
- College of Health Management, China Medical University, Shenyang, China
| | - Xinyu Ji
- First Hospital of China Medical University, Shenyang, China
| | - Jing OuYang
- Humanity and Management College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yalan Zhu
- College of Health Management, China Medical University, Shenyang, China
| | - Leying Wang
- First Clinical Department, China Medical University, Shenyang, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, China
- School of Public Health, Xin Jiang Medical University, Urumqi, China
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50
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Advances in the Treatment Strategies in Hypertension: Present and Future. J Cardiovasc Dev Dis 2022; 9:jcdd9030072. [PMID: 35323620 PMCID: PMC8949859 DOI: 10.3390/jcdd9030072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/11/2022] Open
Abstract
Hypertension is the most frequent chronic and non-communicable disease all over the world, with about 1.5 billion affected individuals worldwide. Its impact is currently growing, particularly in low-income countries. Even in high-income countries, hypertension remains largely underdiagnosed and undertreated, with consequent low rates of blood pressure (BP) control. Notwithstanding the large number of clinical observational studies and randomized trials over the past four decades, it is sad to note that in the last few years there has been an impressive paucity of innovative studies. Research focused on BP mechanisms and novel antihypertensive drugs is slowing dramatically. The present review discusses some advances in the management of hypertensive patients, and could play a clinical role in the years to come. First, digital/health technology is expected to be increasingly used, although some crucial points remain (development of non-intrusive and clinically validated devices for ambulatory BP measurement, robust storing systems enabling rapid analysis of accrued data, physician-patient interactions, etc.). Second, several areas should be better outlined with regard to BP diagnosis and treatment targets. Third, from a therapeutic standpoint, existing antihypertensive drugs, which are generally effective and well tolerated, should be better used by exploiting available and novel free and fixed combinations. In particular, spironolactone and other mineral-corticoid receptor antagonists should be used more frequently to improve BP control. In particular, some drugs initially developed for conditions different from hypertension including heart failure and diabetes have demonstrated to lower BP significantly and should therefore be considered. Finally, renal artery denervation is another procedure that has proven effective in the management of hypertension.
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