Blood Pressure Assessment Research Articles

MAY MEASURE MONTH 2022 IN ITALY: RESULTS OF A NATIONWIDE SURVEY

Objective: By affecting approximately 45% of the world's population, hypertension is the main risk factor for cardiovascular diseases (CVD). Of note, only half of hypertensive patients manage to have good blood pressure (BP) control. Relevant reasons for the persistence of uncontrolled BP during treatment are lack of compliance on the patients’ side, and therapeutic inertia on physicians’ side. Design and method: During the global BP screening campaign “May Measure Month” (MMM) (May 1st to July 31st, 2022), a nationwide, cross-sectional, opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults >= 18 years to raise awareness of the health issues surrounding high BP. A questionnaire on demographic/clinical features and questions on the use of fixed-dose single-pills for the treatment of hypertension was administered. BP was measured with standard procedures. Results: A total of 1612 participants (mean age 60.0±15.41 years; 44.7% women) were enrolled. Their mean BP was 128.5±18.1/77.1±10.4 mmHg. About one in two participants was sedentary, or overweight/obese, or hypertensive. 55.5% individuals with complete BP assessment had uncontrolled hypertension; not being on a fixed-dose combination of antihypertensive drugs and not measuring their BP at home were common features in this setting. Self-reported adherence to BP medications was similar between individuals with controlled and uncontrolled BP (95% vs 95.5%). Conclusions: This survey identified a certain degree of therapeutic inertia and poor patients’ involvement in the therapeutic process and its monitoring in the examined population, underlining the importance of prevention campaigns to increase risk factors awareness to reduce CV risk.

Assessment of Blood Pressure and Heart Rate Related Variables in Acute Stroke Patients Receiving Intravenous Antihypertensive Medication Infusions.

We performed an analysis of a large intensive care unit electronic database to provide preliminary estimates of various blood pressure parameters in patients with acute stroke receiving intravenous (IV) antihypertensive medication and determine the relationship with in-hospital outcomes. We identified the relationship between pre-treatment and post-treatment systolic blood pressure (SBP) and heart rate (HR)-related variables and in-hospital mortality and acute kidney injury in patients with acute stroke receiving IV clevidipine, nicardipine, or nitroprusside using data provided in the Medical Information Mart for Intensive Care (MIMIC) IV database. A total of 1830 patients were treated with IV clevidipine (n = 64), nicardipine (n = 1623), or nitroprusside (n = 143). The standard deviations [SDs] of pre-treatment SBP (16.3 vs. 13.7, p ≤ 0.001) and post-treatment SBP (15.4 vs. 14.4, p = 0.004) were higher in patients who died compared with those who survived, particularly in patients with intracerebral hemorrhage (ICH). The mean SBP was significantly lower post treatment compared with pre-treatment values for clevidipine (130.7mm Hg vs. 142.5mm Hg, p = 0.006), nicardipine (132.8mm Hg vs. 141.6mm Hg, p ≤ 0.001), and nitroprusside (126.2mm Hg vs. 139.6mm Hg, p ≤ 0.001). There were no differences in mean SDs post treatment compared with pre-treatment values for clevidipine (14.5 vs. 13.5, p = 0.407), nicardipine (14.2 vs. 14.6, p = 0.142), and nitroprusside (14.8 vs. 14.8, p = 0.997). The SDs of pre-treatment and post-treatment SBP were not significantly different in patients with ischemic stroke treated with IV clevidipine, nicardipine, or nitroprusside or for patients with ICH treated with IV clevidipine or nitroprusside. However, patients with ICH treated with IV nicardipine had a significantly higher SD of post-treatment SBP (13.1 vs. 14.2, p = 0.0032). We found that SBP fluctuations were associated with in-hospital mortality in patients with acute stroke. IV antihypertensive medication reduced SBP but did not reduce SBP fluctuations in this observational study. Our results highlight the need for optimizing therapeutic interventions to reduce SBP fluctuations in patients with acute stroke.

A Randomized Controlled Trial to Assess the Effectiveness of Warm Foot Soak Therapy on Reduction of Blood Pressure among Hypertensive Patients

Introduction : Hypertension is known as the “silent killer” because of its uncertain symptom. Therefore, early detection efforts are needed such as regular blood pressure check and effective management. Both Pharmacological and Non-pharmacological management strategies for hypertension. This study aimed to determine the effectiveness of one of the non-pharmacological management : “warm water foot soak therapy” in reduction of blood pressure among hypertensive patients. Method : Experimental study design - Randomized Controlled Trial was conducted among 60 hypertensive patients using convenient sampling technique. Participants were randomly and equally allocated into Experimental and Control group with the help of computer generated randomization list. Sequentially Numbered Opaque Sealed Envelope (SNOSE) were used for allocation concealment. Experimental group received “Warm foot soak therapy” of both feet for 10-15 cm above ankle in warm water of temperature 37-40 degree Celsius for 15 minutes, once a day for 3 consecutive days. Before and after intervention blood pressure assessment were taken in both groups. Data were analyzed using SPSS ver. 27 Result : Homogenity of socio-demographic, clinical and pre-intervention blood pressure among both groups were statistically established using chi-square test (p> 0.05). Paired t test concluded that, warm foot soak therapy were having statistically significant effect on blood pressure ( p < 0.05) and there was a significant reduction in blood pressure among hypertensive patients (p=0.01). The study also discovered that there is no significant association between selected sociodemographic & clinical variables with pre-interventional change in blood pressure except for the dietary pattern (Veg) in both groups & presence of comorbidity (DM) in experimental group among hypertensive patients at level of significance 0.05. Conclusion : The study demonstrated that warm foot soak therapy have an effect on reduction of blood pressure among hypertensive patients.

Non-Invasive Assessment of Micro- and Macrovascular Function after Initiation of JAK Inhibitors in Patients with Rheumatoid Arthritis.

Janus kinase (JAK) inhibitors constitute a novel class of oral biologic disease-modifying antirheumatic drugs for patients with rheumatoid arthritis (RA). However, their use has been associated with increased risk of major cardiovascular events. We investigated whether treatment with JAK inhibitors exerts significant alterations in the micro- and microvasculature in RA patients. Thirteen patients with RA initiating treatment with JAK inhibitors were prospectively studied. Eventually, data from 11 patients who completed the study were analyzed. Procedures were performed at baseline and 3 months after treatment. Nailfold videocapillaroscopy was applied to detect alterations of the dermal capillary network. Participants underwent 24 h ambulatory blood pressure monitoring (Mobil-O-Graph device) for the assessment of blood pressure (both brachial and aortic) and markers of large artery stiffening [pulse wave velocity (PWV), augmentation index] throughout the whole 24 h and the respective day- and nighttime periods. Carotid intima-media thickness was assessed with ultrasound. Three-month treatment with JAK inhibitors was not associated with any differences in brachial and aortic blood pressure, arterial stiffness, and carotid atherosclerosis, with the only exception of nighttime PWV, which was significantly elevated at follow-up. However, three-month treatment with JAK inhibitors induced significant microvascular alterations and increased the total number of capillaroscopic abnormalities. Three-month treatment with JAK inhibitors may exert significant effects on microcirculation as assessed with nailfold videocapillaroscopy, whereas macrovascular structure and function appears largely unaffected. Further research toward this direction may add substantial information to the available literature regarding cardiovascular aspects of JAK inhibitors in RA.

Blood Pressure Control and Associated Factors among Hypertension Comorbid Type 2 Diabetic Patients in Southeast Ethiopia.

Hypertension is the main contributor to the morbidity and mortality of patients with cardiovascular disease. Even though hypertension is very common in comorbid type 2 diabetic patients, it is frequently overlooked. This study aimed to assess blood pressure control and its associated factors among hypertension comorbid type 2 diabetic patients in Bale Zone public hospitals in Southeast Ethiopia. A hospital-based cross-sectional study design was conducted among hypertension comorbid type 2 diabetic patients. The data were collected using an interviewer-administered structured questionnaire and a review of the medical charts of patients. A simple random sampling technique was used to select the study participants. The bivariate and multivariate logistic regression analyses were performed to assess the association between blood pressure control and its associated factors. Independent variables that showed a P < 0.25 in the bivariate analysis was included in the multivariate analysis. Finally, variables with a P < 0.05 were declared statistically significant factors. The total number of participants in the study was 378. The overall magnitude of uncontrolled hypertension among hypertension comorbid diabetic patients was found to be 82.5% (95% CI: 78.7%, 86.4%). Nonadherence to antihypertensive medication (AOR = 2.45, 95% CI: 1.11, 5.39, P = 0.027), duration of hypertension >10 years (AOR = 5.2, 95% CI: 1.27, 21.38, P = 0.022), participants who attended secondary education (AOR = 3.2, 95% CI: 1.18, 8.87, P = 0.023), and being obese (AOR = 4.1, 95% CI: 1.24, 13.49, P = 0.021) were significantly associated with uncontrolled hypertension. Uncontrolled hypertension was found to be high among hypertension comorbid type 2 diabetic patients. Patients' adherence to antihypertensive medication, physical activity, and alcohol abstinence should be maximized. Loss of weight is also crucial, as is the early detection and management of comorbidities.

Ivabradine restores tonic cardiovascular autonomic control and reduces tachycardia, hypertension and left ventricular inflammation in post-weaning protein malnourished rats

Malnutrition results in autonomic imbalance and heart hypertrophy. Overexpression of hyperpolarization-activated cyclic nucleotide-gated channels (HCN) in the left ventricles (LV) is linked to hypertrophied hearts and abnormal myocardium automaticity. Given that ivabradine (IVA) has emerging pleiotropic effects, in addition to the widely known bradycardic response, this study evaluated if IVA treatment could repair the autonomic control and cardiac damages in malnourished rats. Aim: Assess the impact of IVA on tonic cardiovascular autonomic control and its relationship with hemodynamics regulation, LV inflammation, and HCN gene expression in post-weaning protein malnutrition condition. Main methods: After weaning, male rats were divided into control (CG; 22 % protein) and malnourished (MG; 6 % protein) groups. At 35 days, groups were subdivided into CG-PBS, CG-IVA, MG-PBS and MG-IVA (PBS 1 ml/kg or IVA 1 mg/kg) received during 8 days. We performed jugular vein cannulation and electrode implant for drug delivery and ECG registration to assess tonic cardiovascular autonomic control; femoral cannulation for blood pressure (BP) and heart rate (HR) assessment; and LV collection to evaluate ventricular remodeling and HCN gene expression investigation. Key findings: Malnutrition induced BP and HR increases, sympathetic system dominance, and LV remodeling without affecting HCN gene expression. IVA reversed the cardiovascular autonomic imbalance; prevented hypertension and tachycardia; and inhibited the LV inflammatory process and fiber thickening caused by malnutrition. Significance: Our findings suggest that ivabradine protects against malnutrition-mediated cardiovascular damage. Moreover, our results propose these effects were not attributed to HCN expression changes, but rather to IVA pleiotropic effects on autonomic control and inflammation.

Assessment of Nocturnal Blood Pressure: Importance of Determining the Time in Bed-A Pilot Study.

Objectives: Nocturnal blood pressure (BP) monitoring is essential for evaluating cardiovascular risk and guiding treatment decisions. However, the standardized narrow-fixed nighttime period between 10 p.m. and 6 a.m. may not accurately reflect individual sleep schedules. This pilot study aimed to investigate the comparability between the standardized nighttime period and actual time in bed (TIB) regarding BP assessment. Further, our goal was to evaluate the clinical relevance of the observed BP differences. Methods: A total of 30 participants underwent 24 h ambulatory blood pressure monitoring (ABPM). Patient-specific TIB was precisely assessed through an accelerometer and a position sensor from the SOMNOtouch NIBP™ (SOMNOmedics GmbH, Randersacker, Germany). We analysed the effect of considering individual TIB as nighttime instead of the conventional narrow-fixed interval on the resulting nocturnal BP levels and dipping patterns. Results: We observed differences in both systolic and diastolic BP between the standardized nighttime period and the TIB. Furthermore, a notable percentage of patients (27%) changed their dipping pattern classification as a function of the nighttime definition adopted. We found strong correlations between the start (r = 0.75, p < 0.01), as well as the duration (r = -0.42, p = 0.02) of TIB and the changes in dipping pattern classification. Conclusions: Definition of nocturnal period based on the individual TIB leads to clinically relevant changes of nocturnal BP and dipping pattern classifications. TIB is easily detected using a body position sensor and accelerometer. This approach may thus improve the accuracy of cardiovascular risk evaluation and enhance treatment strategies.

Determinants of prolonged baseline blood pressure restoration following autonomic dysreflexia for individuals with spinal cord injuries

Objective This study aimed to identify the determinants affecting the time required for blood pressure (BP) restoration after autonomic dysreflexia (AD) and to propose a new method for BP measurement in individuals with cervical spinal cord injury (SCI) who experience AD. Methods In a prospective, single-center observational study, participants’ bladders were filled with body-temperature saline until reaching cystometric capacity, as confirmed by previous urodynamic studies. Restoration time (RT), defined as the time from the onset of voiding until BP returned to baseline, was measured during the morning voiding session. This session involved the use of a 10F hydrophilic transurethral catheter. Data were then compared with various clinical determinants including demographic, urodynamic, and cystographic variables. Results The study included 29 individuals with cervical SCI. Notable variations in RT were observed among individuals with differing levels of detrusor overactivity (DO) and bladder compliance. An inverse correlation was noted between RT and bladder compliance, whereas positive correlations were identified with maximal detrusor pressure, peak systolic BP (SBP), and the magnitude of BP changes. Factors associated with prolonged RT included injury completeness, bladder trabeculation, vesicoureteral reflux (VUR), DO, and changes in SBP. Conclusions A significant association was found between BP elevation and prolonged RT. Determinants such as the severity of the SCI, bladder trabeculation, VUR, and DO were correlated with prolonged RT, considering their importance in the assessment of baseline BP following AD.

Association between time-of-day for eating, exercise, and sleep with blood pressure in adults with elevated blood pressure or hypertension: a systematic review.

The purpose of this review is to synthesize results from studies examining the association between time-of-day for eating, exercise, and sleep with blood pressure (BP) in adults with elevated BP or hypertension. Six databases were searched for relevant publications from which 789 were identified. Ten studies met inclusion criteria. Four studies examined time-of-day for eating, five examined time-of-day for exercise, and one examined time-of-day for sleep and their associations with BP. Results suggested that later time-of-day for eating ( n = 2/4) and later sleep mid-point ( n = 1/1) were significantly related to higher BP in multivariable models, whereas morning ( n = 3/5) and evening ( n = 4/5) exercise were associated with significantly lower BP. Although this small body of work is limited by a lack of prospective, randomized controlled study designs and underutilization of 24 h ambulatory BP assessment, these results provide preliminary, hypothesis-generating support for the independent role of time-of-day for eating, exercise, and sleep with lower BP.

Impaired kidney function, cerebral small vessel disease and cognitive disorders: the Framingham Heart Study.

It remains unclear whether the relation of chronic kidney disease (CKD) with cognitive dysfunction is independent of blood pressure (BP). We evaluated kidney function in relation to premorbid BP measurements, cerebral small vessel disease (CSVD), and incident mild cognitive impairment (MCI) and dementia in Framingham Offspring Cohort participants. We included Framingham Offspring participants free of dementia, attending an examination during midlife (exam cycle 6, baseline) for ascertainment of kidney function status, with brain magnetic resonance imaging late in life (exam cycles 7-9), cognitive outcome data, and available interim hypertension and BP assessments. We related CKD (estimated glomerular filtration rate <60ml/min/1.73m2) and albuminuria (urine albumin-to-creatinine ratio ≥30mg/g) to CSVD markers and cognitive outcomes using multivariable regression analyses. Among 2604 participants (mean age 67.4±9.2, 64% women, 7% had CKD, and 9% albuminuria), albuminuria was independently associated with covert infarcts [adjusted OR, 1.55 (1.00-2.38); P=0.049] and incident MCI and dementia [adjusted hazard ratio (HR), 1.68 (1.18-2.41); P=0.005 and 1.71, (1.11-2.64); P=0.015, respectively]. CKD was not associated with CSVD markers but was associated with a higher risk of incident dementia [HR, 1.53 (1.02-2.29); P=0.041]. While albuminuria was predictive of the Alzheimer's disease subtype [adjusted HR=1.68, (1.03-2.74); P=0.04), CKD was predictive of vascular dementia [adjusted HR, 2.78 (1.16-6.68); P=0.023]. Kidney disease was associated with CSVD and cognitive disorders in asymptomatic community dwelling participants. The relation was independent of premorbid BP, suggesting that the link between kidney and brain disease may involve additional mechanisms beyond BP-related injury.

Sacubitril/valsartan reversal of left ventricular remodeling is associated with improved hemodynamics in resistant hypertension

BackgroundSacubitril/valsartan (S/V) has been shown to be an effective antihypertensive drug combination. However, its therapeutic effects on blood pressure (BP), hemodynamics, and left ventricular (LV) remodeling in resistant hypertension (RHTN) remain unclear. MethodsEighty-six patients completed this self-control study, during which olmesartan was administered within the first 8 weeks (phase 1), followed by S/V within the second 8 weeks (phase 2), with nifedipine and hydrochlorothiazide taken as background medications. Office BP, echocardiography, and hemodynamics assessment using impedance cardiography were performed at baseline and at the eighth and sixteenth weeks. ResultsThe reduction in office BP was larger in phase 2 than in phase 1 (19.59/11.66 mmHg vs. 2.88/1.15 mmHg). Furthermore, the treatment in phase 2 provided greater reductions in systemic vascular resistance index (SVRI) and thoracic blood saturation ratio (TBR), with differences between the two phases of −226.59 (−1212.80 to 509.55) dyn·s/cm5/m2 and −0.02 (−0.04 to 0.02). Switching from olmesartan to S/V also significantly reduced E/E′, LV mass index, LV end-diastolic volume index, and LV end-systolic volume index (all P < 0.05). Decreases in arterial stiffness, SVRI, and TBR were correlated with changes in indicators of LV remodeling (all P < 0.05). This correlation persisted even after adjusting for confounders including changes in BP. ConclusionsSwitching from olmesartan to S/V effectively lowered BP and reversed ventricular remodeling in RHTN. In addition, hemodynamic improvement was also observed. Changes in hemodynamics played an important role in reversing LV remodeling of S/V, and were independent of its antihypertensive effect.

A novel, proof-of-concept radiofrequency renal denervation strategy to improve procedural efficiency: 12-month results from the SPYRAL DYSTAL pilot study

BackgroundCatheter-based renal sympathetic denervation (RDN) reduced blood pressure (BP) in multiple randomized sham-controlled trials of patients with uncontrolled hypertension (HTN). We tested proof-of-concept for a more selective treatment strategy, exclusively targeting these areas to improve the efficiency of the procedure. MethodsThe SPYRAL DYSTAL Pilot study was designed to mirror the SPYRAL HTN-OFF MED Pivotal study, enabling comparison with a propensity score adjusted active-control group. Patients were antihypertensive medication-free for one month before undergoing BP assessment. Those with office BP of 150–180/>90 mmHg and with an ambulatory systolic BP of 140–170 mmHg were selected to undergo open label treatment, delivering energy only to the distal main renal arteries and first order branches. Patients from DYSTAL were compared with patients who underwent maximized RF RDN treatment in the prior randomized OFF MED trial at 3 months. After 3 months, patients resumed antihypertensive medications as indicated. Safety and efficacy outcomes were assessed post hoc through 12 months. ResultsThe SPYRAL DYSTAL Pilot study treated 56 HTN patients. Baseline office systolic BP (OSBP) and 24-h ambulatory systolic BP (ASBP) were similar between DYSTAL and OFF MED patient groups. The number of ablations (32.3 ± 8.0 vs 46.6 ± 15.3, p < 0.001), procedure time (67 ± 21 min vs 99 ± 36 min; p < 0.001), and contrast volume (173 ± 77 cc vs 208 ± 96 cc; p = 0.014) were significantly lower with the simplified treatment strategy. OSBP and ASBP changes compared with baseline were −9.0 and −1.4 mmHg at 3 months, −20.3 and −13.9 mmHg at 6 months, and −20.3 and −16.6 mmHg at 12 months, respectively. During the medication up-titration phase, BP reductions among DYSTAL patients were similar to reductions observed in OFF MED through 12 months, with comparable number of drugs (1.4 and 1.5 medications, respectively (P=NS)). Two adverse events related to guidewire placement were reported. ConclusionIn this pilot study, focusing ablation treatment on the distal main and proximal branch renal arteries was performed, resulting in fewer RF lesions, and reduced contrast volume and procedure time. Whether BP reductions are similar between a selective vs. maximized RDN approach requires further prospective study.

Effect of Sacha Inchi Oil on Human Blood Pressure and Lipid Profile: A Preliminary Study in Malaysia

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&lt;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.

Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden.

Obstructive sleep apnea is associated with increased blood pressure (BP). Obstructive sleep apnea treatment reduces BP with substantial variability, not explained by the apnea-hypopnea index, partly due to inadequate characterization of obstructive sleep apnea's physiological consequences, such as oxygen desaturation, cardiac autonomic response, and suboptimal treatment efficacy. We sought to examine whether a high baseline heart rate response (ΔHR), a marker of high cardiovascular risk in obstructive sleep apnea, predicts a larger reduction in post-treatment systolic BP (SBP). Furthermore, we aimed to assess the extent to which a reduction in SBP is explained by a treatment-related reduction in hypoxic burden (HB). ΔHR and HB were measured from pretreatment and posttreatment polygraphy, followed by a 24-hour BP assessment in 168 participants treated with continuous positive airway pressure or nocturnal supplemental oxygen from the HeartBEAT study (Heart Biomarker Evaluation in Apnea Treatment). Multiple linear regression models assessed whether high versus mid (reference) ΔHR predicted a larger reduction in SBP (primary outcome) and whether there was an association between treatment-related reductions in SBP and HB. A high versus mid ΔHR predicted improvement in SBP (adjusted estimate, 5.8 [95% CI, 1.0-10.5] mm Hg). Independently, a greater treatment-related reduction in HB was significantly associated with larger reductions in SBP (4.2 [95% CI, 0.9-7.5] mm Hg per 2 SD treatment-related reduction in HB). Participants with substantial versus minimal treatment-related reductions in HB had a 6.5 (95% CI, 2.5-10.4) mm Hg drop in SBP. A high ΔHR predicted a more favorable BP response to therapy. Furthermore, the magnitude of the reduction in BP was partly explained by a greater reduction in HB.

Cardiovascular risk assessment: Missing albuminuria contributing to gender inequality

IntroductionChronic kidney disease (CKD) is associated with high cardiovascular disease (CVD) risk, and requires specific interventions to decreases CVD risk.The guidelines indicate that systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. The European Society Cardiology (ESC) guidelines, he European Renal Association (ERA) Council and the Spanish Society of Nephrology (S.E.N.) in collaboration with 15 Scientific Societies recommend assessing albuminuria in all these populations.We have evaluated current clinical practice regarding the assessment of CVD risk factors (blood pressure, albuminuria, serum cholesterol, glycemia and creatinine) in different adult health user populations, analyzing the results separately for men and women, given recent evidence on gender differences in the recognition, monitoring, and management of CKD. MethodsObservational, retrospective, non-interventional single center study performed in a hospital using Electronic Health Record (EHR) data. ResultsAmong 707,493 healthcare users, 612,619 were adults, and of these 332,943 (54.3%) females; 73,632 (12.0%) had DM and 121,445 (19.8%) hypertension. Mean (SD) age was 68.91±21.4 years; 261,694 (36.9%) were older than 50 years.Only 8522 (1.39%) had undergone albuminuria testing as compared with 264,684 (43.21%) tested for serum creatinine, 140,492 (22.93%) for serum cholesterol, 263,381 (42.99%) for serum glucose, and 226,448 (36.96%) for blood pressure. Albuminuria was the only cardiovascular risk factor assessed more frequently in men than in women.Albuminuria, as other CVD risk factors, was more frequently assessed in patients with DM (6.71% of patients) or hypertension (4.81%), but albuminuria assessment remained suboptimal compared with 58–87% for other cardiovascular risk factors. For adults with diabetes or hypertension, albuminuria was assessed more frequently in men than in women.Albuminuria assessment in those older than 50 years was also suboptimal at 2.24%, as compared with 31–47% for other CVD risk factors.Albuminuria and EGFR are needed to screen for CKD, meaning that a urine test for albumin and creatinine and a serum test for creatinine are needed. To these, we may add assessment of blood pressure, serum cholesterol (for familial hypercholesterolemia) and serum glucose for Diabetes. Albuminuria was the only cardiovascular risk factor that was assessed more frequently in men (up to nearly 60% more frequently), indicating that screening for CKD and CVD risk in women is suboptimal. This result is surprisingly consistent across time and in all age groups. This is the first time that gender disparities in the assessment of albuminuria have been revealed. ConclusionAlbuminuria is assessed infrequently, even in patients with a high cardiovascular risk, especially in women.

Cumulative blood pressure predicts risk of stroke in individuals with type 2 diabetes

AimsTo determine whether cumulative blood pressure (BP) could predict stroke in individuals with type 2 diabetes (T2D). MethodsBP levels at baseline and the initial three visits were obtained from individuals participating in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial who had not experienced a stroke. Cumulative elevations in BP were assessed by adding the weighted mean BP values at various time intervals. The association of cumulative BP with stroke was evaluated by a multivariate-adjusted Cox proportional hazard model analysis. ResultsOverall, 8282 participants were included (62.10% males and 37.90% females; mean age, 62.73 years). With a median follow-up period of 6.36 years, 324 (3.91%) and 305 (3.68%) patients had any and nonfatal stroke events, respectively. Only baseline systolic BP (SBP) independently predicted any stroke after adjustment for potential confounders, whereas cumulative SBP and pulse pressure independently predicted elevated stroke events. A strong dose–response relationship between cumulative BP and stroke was identified, and conventional risk factors combined with cumulative SBP improved prediction efficiency. ConclusionCumulative SBP independently predicts stroke in individuals with T2D and provides an incremental predictive value for stroke compared with baseline BP assessments. Trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620)

Feasibility and outcomes of a community-based, mobile health system-monitored lifestyle intervention in chronic stroke: A pilot study.

People with disabilities face challenges in daily life during the COVID-19 pandemic, including limited access to care, exposure to lifestyle-related diseases, and difficulties in regular exercise. Therefore, it is important to establish health safety nets using Information and Communication Technology (ICT) in communities. This study aimed to develop an m-Health-based personalized lifestyle intervention algorithm targeting high-risk groups of lifestyle-related diseases (including hypertension, diabetes, and obesity) among people with hemiplegic disabilities, and to verify its feasibility. Six people at a high risk of lifestyle-related diseases participated in an 8-week lifestyle intervention using a wearable device and the S-Health program. The self-health management areas included walking, moderate-intensity exercise, weight, blood pressure, blood sugar, diet, calorie intake, heart rate, sobriety, no smoking. Health, physical, psychological, and social changes were measured before and after the study. The intervention had a positive impact on the participants' health, with statistically significant differences found in fasting blood glucose, highest systolic blood pressure, grip strength, and motor function assessment. Quality of life, health-related quality of life, and self-efficacy improved post-intervention. Our findings can be used as preliminary evidence for establishing m-Health-based health safety net systems for people with disabilities who live in communities.

Investigating the Relationship Between Hypertension and Obesity in Schoolchildren From Lower-Middle Socioeconomic Strata in Urban Mumbai.

Background In light of escalating rates of childhood obesity, understanding the gender-specific correlation between body mass index (BMI) and hypertension has become crucial for effective public health interventions. This study investigates the interplay between BMI and hypertension among school-aged children, with a particular emphasis on gender stratification to identify distinct trends. Methodology A cross-sectional study was conducted with a diverse sample of 702 schoolchildren aged 5-16 years from a lower-middle-income school in urban Mumbai. This cohort consisted of 491 boys and 211 girls within the gender subset. BMI was calculated using height and weight measurements, while blood pressure readings determined hypertension prevalence. The children were categorized based on the Indian Academy of Pediatrics (IAP) growth chart BMI calculations and blood pressure percentiles. SPSS Statistics version 23 (IBM Corp., Armonk, NY, USA) was used for data analysis. Data were analyzed using the chi-square test, with p-values <0.05 deemed significant. Results The overall prevalence of overweight was 16.52%, with 15.89% in boys and 18.10% in girls, revealing no significant gender difference (p = 0.487). In terms of obesity, the overall prevalence was 10.83%, with 10.99% in boys and 10.34% in girls, revealing no significant gender difference (p = 0.823). The prevalence of pre-hypertension was 7%, exhibiting a significantly higher prevalence in high BMI males (overweight and obese) versus non-high BMI males (normal and underweight) (p < 0.001); however, no such difference was observed in females (p = 0.289). The prevalence of hypertension was 15.95% with a significantly higher prevalence in high BMI males (overweight and obese) versus non-high BMI males (normal and underweight) (p < 0.001) and high BMI females (overweight and obese) versus non-high BMI females (normal and underweight) (p < 0.001). Hypertension was significantly higher in children with high BMI (overweight and obese) compared to their non-high BMI (normal and underweight) counterparts. Conclusions In lower-middle socioeconomic strata schoolchildren in urban Mumbai, the prevalence of obesity and hypertension was alarmingly high, attributed to shifting lifestyles and unhealthy dietary habits. Hypertension rates were notably elevated among overweight and obese individuals compared to normal and underweight individuals. More than a third of both boys and girls with obesity were diagnosed with hypertension, emphasizing a concerning surge in hypertension cases among children. Prioritizing age-specific blood pressure assessments can facilitate early identification and timely interventions.

Peningkatan Pengetahuan Warga RT 05 RW 01 Pondok Labu Terhadap Alur Pelayanan Penyakit Hipertensi di Fasilitas Kesehatan dan Rumah Sakit

Hypertension, often referred to as the "silent killer," manifests without noticeable symptoms and can lead to serious health complications. It occurs when blood pressure exceeds 130 mmHg systolic and 80 mmHg diastolic. A precursor to conditions such as stroke, heart disease, and kidney failure, hypertension is the leading cause of death worldwide, affecting more than one billion people annually. Prevalence increases with age, potentially reaching 60% in populations over the age of 60. Without preventive measures, the number of hypertension cases worldwide is projected to increase by 20% to 1.5 billion by 2025. This study aims to improve community understanding of the hypertension treatment process within both healthcare facilities and hospitals. Methods This community initiative targeted residents of RT 05 RW 01 in Pondok Labu, Cilandak, South Jakarta. The intervention included educational sessions on hypertension, covering its definition, recommended actions when experiencing it, and elucidating the facilities and procedures involved in seeking healthcare in both primary care and hospital settings. The program consisted of three phases: preparation, implementation, and evaluation. The Results of 15 targeted residents, 11 actively participated in the assessments and educational sessions. The majority were women aged 36 to 55 years. Blood pressure assessments revealed that 54.55% had elevated levels. In addition, 63.64% were classified as overweight based on BMI measurements. The initiative successfully increased community knowledge regarding hypertension and the healthcare processes involved. The study highlights the importance of health education in improving public awareness and emphasizes the need for a holistic approach in managing risk factors such as excess weight. Effective coordination between hospital administration and medical teams is crucial in providing clear information and ensuring timely healthcare services for hypertensive patients.

Biofeedback Endurance Training for Gait Rehabilitation in Parkinson’s Disease: a Non-Randomized Controlled Study

INTRODUCTION. Parkinson’s disease is a disease with the highest rates of disability growth in the neurodegenerative pathology group, with the leading motor symptom — impaired walking and an increased risk of falling. There is evidence that Parkinson’s disease preserves stability for cycling. The issue of extending the effects of cycling training to daily activity, including walking, remains unclear.&#x0D; AIM. To evaluate the effect of a course of endurance training on a cycle ergometer with biofeedback (BFB) on a walking ability of a patient with Parkinson’s disease.&#x0D; MATERIALS AND METHODS. A total of 69 patients with stages 2–3 Parkinson’s disease according to the Hoehn and Yahr Rating Scale were included in the study, group 1: 34 people (60.05 ± 7.07 years) and group 2: 35 patients (61.75 ± 7.53 years). The patients were examined — anamnesis collection: duration of Parkinson disease, presence of arterial hypertension (AH), sports history, medication, assessment of systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), “6-minute walk” test (6MWT), motor function according to the MDS UPDRS scale — part III. The patients of group 1 had daily exercises on a digital bicycle ergometer with BOS for 10 days, the patients of group 2 — therapeutic gymnastics. The therapy was assessed by repeated 6MWT.&#x0D; RESULTS AND DISCUSSION. The Parkinson’s disease duration was longer in the patients of group 1. Concomitant hypertension was in 20 (57 %) patients of group 1 and 16 (47 %) patients of group 2 (p 0.05). 11 people of group 1 and 5 of group 2 had a sports history (p = 0.07). The indicators of SBP and DBP of groups 1 and 2 had normal values during the examination. BMI in both groups corresponded to excess body weight. Patients had risk factors of the modern world: hypertension and overweight. Motor disorders according to the MDS UPDRS — Part III scale were greater in group 1. Despite having serious motor impairments in group 1, after the therapy, the patients demonstrated an increase in the distance traveled in 6 minutes (392.18 ± 96.3 m vs. 476.43 ± 108.08 m; p 0.05), while no changes were found in group 2.&#x0D; CONCLUSION. BOS endurance training on a cycle ergometer is effective for walking rehabilitation of Parkinson’s disease patients.