Effects of Vitamin C and/or E Supplementation on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes: A Systematic Review and Subgroup Meta-analysis.

The clinical efficacy of purple passion fruit peel extract (a flavonoid-rich dietary supplement) in reducing cardiovascular risk factors in adult type 2 diabetic subjects was investigated in a randomized, double-blind, placebo-controlled trial. Forty-one subjects were randomly assigned to receive a daily dose of purple passion fruit (220 mg) or a matched placebo for 16 weeks. Body mass index, blood pressure, fasting and postprandial blood glucose, glycated hemoglobin, and lipid profile were determined at baseline and at monthly intervals. A significant reduction in systolic blood pressure and fasting blood glucose was observed following administration of purple passion fruit ( P < .05). Purple passion fruit was well tolerated, and no adverse events were reported. These data suggest that purple passion fruit supplementation for 16 weeks in type 2 diabetics results in a significant reduction in systolic blood pressure and fasting blood glucose, indicating that purple passion fruit is safe and well tolerated by diabetics.

AHA 2012: Prevention a key focus of meeting

Aim. To study the antihypertensive and hypolipidemic effect of therapy based on perindopril, including its combinations, and rosuvastatin in real clinical practice.Material and methods. Analysis of the medical records of patients observed for hypertension (HT) and treated with perindopril, amlodipine and rosuvastatin in the multicenter nonintervention SYNERGY study was performed. Patients with established diagnosis of HT and registered elevated cholesterol blood level were included into the study. The drugs were prescribed by doctors in different doses. Data on the disease history, physical status, blood pressure (BP) measurements, and lipid blood levels were taken from the patient's medical records.Results. 1736 patients (53% of women) with the mean age of 58.7 years were included into the analysis. 1322 patients (76.2%) previously received antihypertensive therapy, and 807 (46.5%) – lipid-lowering therapy. Reduction in systolic and diastolic BP, low density cholesterol blood level was found at the end of the study in all study groups s (p<0.05). This demonstrated an adequate antihypertensive and lipid-lowering effect of the applied treatment regimens. The average decrease in systolic BP was from 20.5 to 41.4 mm Hg, and this in diastolic BP – from 8.8 to 22.2 mm Hg. The maximum reduction in systolic BP was found in the group of perindopril 8 mg+amlodipine 10 mg+rosuvastatin 5 mg (41.4 mm Hg), and this in diastolic BP – in the group of perindopril 8 mg+rosuvastatin 10 mg. The mean decrease in low density cholesterol blood level was from 0.74 mmol/L in the group of perindopril 4 mg+amlodipine 10 mg+rosuvastatin 5 mg up to 1.75 mmol/l in the group of perindopril 8 mg+amlodipine 10 mg+rosuvastatin 20 mgConclusion: Therapy with perindopril, amlodipine and rosuvastatin resulted in significant reduction in BP and low-density cholesterol blood level in all the treatment groups. The study of the efficacy of combined therapy in patients with HT and dyslipidemia in real clinical practice makes it possible to evaluate the potential contribution of pharmacotherapy in reducing the risk of cardiovascular complications.

An Evidence-Based Review of Exercise and Metabolic Syndrome

Introduction: Globally, only 13.8% of adults with hypertension have controlled blood pressure (BP). Effective strategies are needed to overcome barriers to BP control. The overall objective is to determine the comparative-effectiveness of implementation strategies to reduce BP in adults with hypertension. Methods: We searched Medline and Embase (through November 2015) for randomized controlled trials of implementation strategies targeting barriers to hypertension control compared to usual care. One hundred trials with 48,070 hypertensive participants met our eligibility criteria and were included in this analysis. These trials were grouped by intervention strategy, and the effects of the intervention on BP change were combined using random effects models. Results: Multi-component team-based care with and without non-physician providers titrating medications had the greatest reduction in systolic and diastolic BP. Health coaching, home BP monitoring, and a combination of the two also resulted in significant reductions in BP. Few studies of BP audit and feedback and clinical decision support systems were available, and they did not result in significant reductions in systolic BP. Provider training did not significantly reduce BP. Conclusions: Team-based collaborative care is the most effective strategy for BP control among patients with hypertension. In addition, health coaching and home BP monitoring are useful patient-level strategies for hypertension control. These strategies should be prioritized in future BP control efforts.

Poster presentations

This clinical advisory statement from the Coordinating Committee of the National High Blood Pressure Education Program is intended to advance and clarify the recommendations of the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI, 1997).1 The advisory addresses several interrelated issues about blood pressure (BP) that affect people approaching the later decades of life. On the basis of the wealth of currently available evidence, the committee now recommends a major paradigm shift in urging that systolic BP become the major criterion for diagnosis, staging, and therapeutic management of hypertension, particularly in middle-aged and older Americans. Several lines of strong evidence support the initiative to emphasize systolic BP. Pathophysiologically, there are strong associations among aging, increased stiffness of large arteries, increased systolic BP, increased pulse pressure, and the prevalence of cardiac and vascular disease. Epidemiologically, isolated systolic hypertension is the most common form of hypertension and is present in approximately two thirds of hypertensive individuals >60 years of age. Diagnostically, classification and staging of hypertension are more precise when systolic rather than diastolic BP is used as the principal criterion. Risk stratification for major complications of hypertension (stroke, myocardial infarction, heart failure, and kidney failure) is actually confounded by the use of diastolic BP; in older people with systolic hypertension, diastolic BP is inversely related to cardiovascular risk. Clinical benefits of treatment of isolated systolic hypertension include reductions in stroke, myocardial infarction, heart failure, kidney failure, and overall cardiovascular disease morbidity and mortality. Currently, only 1 in 4 Americans with hypertension falls below JNC VI–recommended values of 140/90 mm Hg in uncomplicated hypertension or 130/85 mm Hg in individuals with kidney disease or diabetes. Hypertension control rates are poorest in older people, primarily as a result of inadequate …

This uncontrolled pre-post study aimed to assess changes in blood lipid profiles and blood pressure resulting from a 2-month consumption of Sacha Inchi Oil (SIO) (Plukenetia volubilis). Investigating the effects of SIO on Malaysians is essential for tailoring interventions to the local context, considering genetic, cultural, and dietary differences. A total of 13 adult participants, comprising 8 males and 5 females aged 35 to 74 years old, took part in this intervention study. Each participant was instructed to consume 2 softgels daily, with each softgel containing 530 mg of SIO. Blood lipid profiles and blood pressure were measured at baseline and at the end of the 2-month period, utilizing venipuncture for blood tests and a sphygmomanometer for blood pressure assessment. The results indicated a significant reduction in Systolic Blood Pressure (SBP) levels following SIO supplementation (2 softgels daily) (p<0.05). However, there were no notable improvements in Diastolic Blood Pressure (DBP), Total Cholesterol (TC), Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C), and Triglycerides (TG) after the 2-month supplementation. In conclusion, the daily supplementation of 2 softgels of SIO (1,060 mg) for 2 months demonstrated a beneficial effect on blood pressure, particularly in reducing SBP. These findings serve as preliminary data for future research into the potential health benefits of SIO in the Malaysian population.

How much exercise is required to reduce blood pressure in essential hypertensives: a dose–response study

Home Blood Pressure Telemonitoring With Remote Hypertension Management in a Rural and Low-Income Population.

This study aims to verify the efficacy of exercise programs designed to prevent and treat hypertension-induced cardiovascular disease (CVD) by analyzing the effects of a 6-month active aerobic exercise program, administered to prehypertensive elderly women, on reducing the risk of developing CVD by enhancing their physical fitness level and improving the detailed markers of high-density lipoprotein cholesterol (HDL-C) and inflammatory markers. We assigned the elderly women (≥65 years) recruited into normal blood pressure (120–129/80–84; NBP, n = 18) and high-normal blood pressure (130–139/85–89; HNBP, n = 12) groups according to the European guidelines for the management of arterial hypertension. The exercise program was made up of combined workouts of elastic band resistance exercise and aerobics with dance music. The program took place three times a week for six months, with each session lasting 60 min. We measured pre- and post-intervention body composition, blood pressure, physical fitness level, blood lipids profile, HDL-C, SAA, TNF-α, IL-6, IL-4, IL-15, CRP, and HSP70 and calculated the Framingham risk scores for comparison. A significant post-intervention reduction in the mean systolic blood pressure (SBP) was observed in the HNBP group (p < 0.001), with significant increase in HDL-C (p < 0.01) and significant decrease in serum amyloid A (SAA) concentration (p < 0.01). A significant improvement in physical fitness factors such as physical efficiency index (PEI) was also observed in the HNBP group (p < 0.05). The post-intervention TNF-α, IL-6, and SAA concentrations were more significantly lower in the HNBP than in the NBP group (p < 0.05). Compared to the baseline values, a significant decrease in SAA concentration (p < 0.01) and significant increase in HSP70 concentration (p < 0.001) were observed in the HNBP group. The HNBP group’s 10-year CVD risk was also significantly reduced (p < 0.05). The pre–post differences in SBP and DBP were significantly correlated with those in the anti-inflammatory markers IL-4 and IL-15 (p < 0.01). In conclusion, the 6-month active aerobic exercise program of moderate intensity administered to prehypertensive elderly women (≥65 years) had the effect of reducing the 10-year CVD risk through a substantial reduction in SBP, overall physical fitness improvement, increase in HDL-C, decrease in SAA concentration, and substantial decrease in inflammatory biomarkers. It was also confirmed that an increase in anti-inflammatory markers, which showed a small range of increase with respect to the decrease in blood pressure, may have a major effect.

The effect of tea intake on blood pressure (BP) is controversial. We performed a meta-analysis of randomised controlled trials to determine the changes in systolic and diastolic BP due to the intake of black and green tea. A systematic search was conducted in MEDLINE, EMBASE and the Cochrane Controlled Trials Register up to May 2014. The weighted mean difference was calculated for net changes in systolic and diastolic BP using fixed-effects or random-effects models. Previously defined subgroup analyses were performed to explore the influence of study characteristics. A total of twenty-five eligible studies with 1476 subjects were selected. The acute intake of tea had no effects on systolic and diastolic BP. However, after long-term tea intake, the pooled mean systolic and diastolic BP were lower by -1·8 (95% CI -2·4, -1·1) and -1·4 (95% CI -2·2, -0·6)mmHg, respectively. When stratified by type of tea, green tea significantly reduced systolic BP by 2·1 (95% CI -2·9, -1·2)mmHg and decreased diastolic BP by 1·7 (95% CI -2·9, -0·5)mmHg, and black tea showed a reduction in systolic BP of 1·4 (95% CI -2·4, -0·4)mmHg and a decrease in diastolic BP of 1·1 (95% CI -1·9, -0·2)mmHg. The subgroup analyses showed that the BP-lowering effect was apparent in subjects who consumed tea more than 12 weeks (systolic BP -2·6 (95% CI -3·5, -1·7)mmHg and diastolic BP -2·2 (95% CI -3·0, -1·3)mmHg, both P<0·001). The present findings suggest that long-term (≥12 weeks) ingestion of tea could result in a significant reduction in systolic and diastolic BP.

To compare obese with normal and overweight type 2 diabetic patients regarding body mass index (BMI) and cardiovascular risk factors, and to analyse changes in weight versus risk factors. A cross-sectional study of 44 042 type 2 patients, and a 6-year prospective study of 4468 type 2 patients. Obese patients (BMI > or = 30 kg m(-2)), 37% of all patients, had high frequencies of hypertension (88%), hyperlipidaemia (81%) and microalbuminuria (29%). Only 11% had blood pressure <130/80 mmHg. Their ratio of triglycerides to HDL cholesterol was considerably elevated, whilst the mean total and LDL cholesterol were similar as in normal weight subjects. Obese patients had elevated odds ratios for hypertension, hyperlipidaemia and microalbuminuria: 2.1, 1.8 and 1.4 in the cross-sectional study, similarly confirmed in the prospective 6-year study. BMI was an independent predictor of these risk factors (P < 0.001), although only slightly associated with HbA1c and not with total or LDL cholesterol. A change in BMI during the prospective study was related to a change in HbA1c in patients treated with diet and oral hypoglycaemic agents (OHAs) but not with insulin. In all patients, an increase in BMI was related to the development of hypertension, and a change in BMI to change in blood pressure, also mostly confirmed when treated with diet, OHAs or insulin. The high frequencies of risk factors in obese type 2 patients implies an increased risk of cardiovascular disease and the need for therapeutic measures. The paradox that hypoglycaemic treatment accompanied by weight gain may increase cardiovascular risk factors seems to be verified here concerning hypertension but not concerning microalbuminuria.

Background: Hypertensive disorder in pregnancy is one of the most common complications of pregnancy worldwide. It is associated with maternal mortality and morbidity as well as perinatal mortality. Antihypertensive drugs are often used to lower blood pressure with the aim of preventing its progression to adverse outcomes for the mother and the fetus. The risk of developing severe hypertension is reduced to half by using antihypertensive medications. Studies have been done using various antihypertensive in hypertensive disorders of pregnancy. But there are very few studied comparing nifedipine and methyldopa in hypertensive disorders of pregnancy where majority of the studies are evaluated for short duration. Hence we have undertaken this study to compare the efficacy and safety of methyldopa and nifedipine in patient with moderate gestational hypertension. Methods: This is a prospective observational study where pregnant patients with moderate gestational hypertension either on oral nifedipine 10 mg t.i.d. or on methyl-dopa 250 mg t.i.d. were enrolled during 6 month period. Data at week one and week four were observed along with side effects. Reduction in systolic and diastolic blood pressure from baseline and occurrence of side effects were studied. The statistical significance was at P &lt; 0.05. Results: The mean reduction of systolic/diastolic BP with methyldopa in four weeks was 17/13 mmHg as compared to nifedipine being 18.5/14.5 in four week. There was significant reduction in systolic blood pressure in nifedipine group compared to methyldopa group at four weeks (p-0.04). Both treatments were well tolerated with minimal side effects. Conclusions: Methyldopa and Nifedipine are equally effective in controlling blood pressure in moderate gestational hypertension with minimal side effects. However, nifedipine can be preferred over methyldopa as it showed significant reduction in systolic blood pressure at four weeks.

Effects of medical therapies on retinopathy progression in type 2 diabetes: Is blood pressure control the lower the better?