Baseline Blood Pressure Levels Research Articles

Effectiveness of exercise training on arterial stiffness and blood pressure among postmenopausal women: a systematic review and meta-analysis

BackgroundThe acute and long-term benefits of exercise training on cardiovascular health have been well established. The systematic review and meta-analysis aimed to systematically assess the effectiveness of exercise training on arterial stiffness and blood pressure among postmenopausal women with elevated blood pressure.MethodsA comprehensive search was conducted on PubMed, Embase, Web of Science, ProQuest, Cochrane Library, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov website from inception to September 30, 2023, to identify the randomized controlled trials (RCTs), which evaluated the effectiveness of exercise training on arterial stiffness and blood pressure in postmenopausal women. Standardized mean differences (SMD), weighted mean differences (WMD), and 95% confidence intervals (95% CIs) were calculated using random/fixed effects models. Quality assessment was performed using the modified Jadad scale and the Cochrane Risk of Bias Tool. Sensitivity analysis and subgroup analysis were conducted based on drug dosage, treatment duration, and age of administration to further explore potential heterogeneity. Funnel plots were performed to assess publication bias and Begg’s regression test was carried out for funnel plot asymmetry.ResultsTwenty-two RCTs involving 1978 participants were included in the quantitative analysis. The mean quality of eligible studies was 4.2 out of 7 based on the modified Jadad scale. The results indicated that exercise training had a significant effect on reducing brachial-ankle pulse wave velocity [MD = − 0.69, 95%CI (− 1.11, − 0.27), P = 0.001], decreasing augmentation index (AIx) [MD = − 6.00, 95%CI (− 6.39, − 5.61), P < 0.00001] and AIx normalized to a heart rate of 75 beats per minute (AIx@75%) [MD = − 7.01, 95%CI − 7.91 to − 6.12, P < 0.00001], lowering systolic blood pressure [MD = − 6.19, 95%CI − 9.24 to − 3.15, P < 0.0001], diastolic blood pressure [MD = − 3.57, 95%CI (− 6.10, − 1.03), P = 0.006) and pulse pressure [MD = − 8.52, 95%CI (− 16.27, − 0.76), P = 0.03]. Subgroup analysis revealed that baseline blood pressure levels had a large impact on the effect of exercise training.ConclusionsThe systematic review and meta-analysis suggested that exercise training may ameliorate arterial stiffness and reduce blood pressure in postmenopausal women with elevated blood pressure. However, the optimal mode of exercise training that improves arterial stiffness and blood pressure in this population requires further investigation.Systematic review registrationPROSPERO CRD42021211268

Effect of semaglutide on kidney function across different levels of baseline HbA1c, blood pressure, body weight and albuminuria in SUSTAIN 6 and PIONEER 6.

This post-hoc analysis explored the semaglutide effects on eGFR slope by baseline glycemic control, blood pressure (BP), body mass index (BMI), and albuminuria status in people with type 2 diabetes and high cardiovascular risk. Pooled SUSTAIN 6 and PIONEER 6 data were analyzed for change in estimated glomerular filtration (eGFR) slope by baseline HbA1c (<8%/≥8%; <64mmol/mol/≥64mmol/mol), systolic BP (<140/90mmHg/≥140/90mmHg), and BMI (<30kg/m2/≥30kg/m2). SUSTAIN 6 data were analyzed by baseline urinary albumin: creatinine ratio (UACR; <30/30-300/>300mg/g). The estimated absolute treatment differences (ETD) overall in eGFR slope [95% confidence intervals] favored semaglutide versus placebo in the pooled analysis (0.59 [0.29;0.89] mL/min/1.73m2/year) and in SUSTAIN 6 (0.60 [0.24;0.96] mL/min/1.73m2/year); the absolute benefit was consistent across all HbA1c, BP, BMI, and UACR subgroups (all p-interaction>0.5). A clinically meaningful reduction in risk of chronic kidney disease progression was observed with semaglutide versus placebo regardless of HbA1c, BP, BMI, and UACR levels.

Metabolic Score for Insulin Resistance and New-Onset Type 2 Diabetes in a Middle-Aged and Older Adult Population: Nationwide Prospective Cohort Study and Implications for Primary Care.

The metabolic score for insulin resistance (METS-IR) has emerged as a noninsulin-based index for the approximation of insulin resistance (IR), yet longitudinal evidence supporting the utility of METS-IR in the primary prevention of type 2 diabetes mellitus (T2DM) remains limited. We aimed to investigate the longitudinal association between METS-IR, which combines fasting plasma glucose (FPG), lipid profiles, and anthropometrics that can be routinely obtained in resource-limited primary care settings, and the incidence of new-onset T2DM. We conducted a closed-cohort analysis of a nationwide, prospective cohort of 7583 Chinese middle-aged and older adults who were free of T2DM at baseline, sampled from 28 out of 31 provinces in China. We examined the characteristics of participants stratified by elevated blood pressure (BP) at baseline and new-onset T2DM at follow-up. We performed Cox proportional hazard regression analysis to explore associations of baseline METS-IR with incident T2DM in participants overall and in participants stratified by baseline BP. We also applied net reclassification improvement and integrated discrimination improvement to examine the incremental value of METS-IR. During a mean follow-up period of 6.3 years, T2DM occurred in 527 participants, among which two-thirds (332/527, 62.9%; 95% CI 58.7%-67.1%) had baseline FPG<110 mg/dL. A SD unit increase in baseline METS-IR was associated with the first incidence of T2DM (adjusted hazard ratio [aHR] 1.33, 95% CI 1.22-1.45; P<.001) in all participants. We obtained similar results in participants with normal baseline BP (aHR 1.41, 95% CI 1.22-1.62; P<.001) and elevated baseline BP (aHR 1.29, 95% CI 1.16-1.44; P<.001). The predictive capability for incident T2DM was improved by adding METS-IR to FPG. In study participants with new-onset T2DM whose baseline FPG was <126 mg/dL and <110 mg/dL, 62.9% (332/527; 95% CI 60%-65.9%) and 58.1% (193/332; 95% CI 54.3%-61.9%) of participants had baseline METS-IR above the cutoff values, respectively. METS-IR was significantly associated with new-onset T2DM, regardless of baseline BP level. Regular monitoring of METS-IR on top of routine blood glucose in clinical practice may add to the ability to enhance the early identification of primary care populations at risk for T2DM.

Ketonuria as an Indicator of Improvement of Renal Function in Patients with Type 2 Diabetes Receiving SGLT2 Inhibitor Treatment.

We investigated the potential association between ketonuria during treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors and its renoprotective effect in patients with type 2 diabetes. We included 192 patients who had received SGLT2 inhibitors for more than 6 months. After propensity score matching, 52 patients each were allocated into groups with or without ketonuria, respectively. The estimated glomerular filtration rate exhibited a significant improvement only in subjects with ketonuria (without ketonuria: mean difference, -0.02 mL/min/1.73 m2 [95% confidence interval (CI), -3.87 to 3.83 mL/min/1.73 m2] vs. with ketonuria: mean difference, 6.81 mL/min/1.73 m2 [95% CI, 3.16 to 10.46 mL/min/1.73 m2]; P<0.001). Improvement in estimated glomerular filtration rate at 6 months was associated with female sex and lower baseline body weight, blood pressure, and triglyceride levels in patients with ketonuria. In conclusion, the presence of ketonuria was associated with the renoprotective effect of SGLT2 inhibitors, and female sex and the absence of metabolic syndrome components may serve as additional indicators of these medications' substantial renoprotective effects in individuals with ketonuria.

Relationship between changes in late-life blood pressure and the risk of frailty and mortality among older population in China: a cohort study based on CLHLS.

The evidence regarding the effects of blood pressure changes on older individuals remains inconclusive, and the impact of frailty throughout the life course is not known. We investigated the associations of different change patterns of blood pressure during 3-year intervals with frailty and mortality. Participants included 7335 persons from 2008 to 2014 of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Change in blood pressure was calculated as the difference between follow-up and baseline. Frailty was evaluated using a 40-item frailty index. Mortality status was ascertained up to December 31, 2014. The mean age of participants was 82.6 ± 10.7 years. The optimal blood pressure level (SBP, 130-150 mmHg; DBP, 70-90 mmHg) was associated with the lowest risk of frailty while decreasing follow-up SBP and DBP were significantly correlated with frailty. Lower baseline blood pressure levels (SBP < 130 mmHg; DBP < 70 mmHg) were associated with decreased mortality risk when participants increased their blood pressure to optimal levels during follow-up SBP and DBP (0.78, 0.63-0.98), compared to maintaining a steady low SBP (< 130 mmHg) and DBP (< 70 mmHg). For those with DBP around 70-90 mmHg, decreasing follow-up DBP (< 70 mmHg) was associated with higher mortality (1.23, 1.07-1.42) compared to maintaining stable follow-up DBP (70-90 mmHg). These results remain significant after adjusting for frailty. Optimal blood pressure levels were associated with the lowest risk of frailty. The association between lower blood pressure and increased mortality risk persisted even after accounting for frailty. We used a nationally representative longitudinal cohort study by using 2008-2014 of the Chinese Longitudinal Healthy Longevity in China. Change in blood pressure was calculated as the difference between follow-up and baseline. We investigated the associations of different change patterns of blood pressure during 3-year intervals with frailty and mortality.

Abstract 08: Blood Pressure Percentile Charts Better Identify High Risk Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Current guidelines set a static threshold for diagnosis of hypertension based on absolute blood pressure (BP) levels for all ages. However, BP generally increases with age and relative levels tend to track within individuals from young adulthood on. We aimed to determine whether BP percentiles , compared to the current AHA/ACC clinical thresholds for hypertension, are better able to identify young adults at higher risk for future CVD events. Methods: Among 5,115 CARDIA participants (ppts; mean age 25 yrs; 54% female; 51% Black), we used baseline BP level and over 35 years of follow-up for fatal and non-fatal CVD events. We calculated normative BP percentiles for adults aged 18 and older using NHANES by estimating underlying BP among treated individuals combined with observed BP for untreated individuals (Figure). Using these BP Percentile Charts, we calculated the baseline BP percentile for each ppt. Adjusted survival analyses examined the association between BP percentile (in deciles) and incident CVD events over 30 years. C statistics for models using BP percentiles vs those using current guideline-recommended thresholds were compared to determine relative accuracy. Results: At baseline, mean S/DBP was 112/70 mmHg and &lt;1% were on antihypertensive medications. Adjusted HRs for BP percentile decile demonstrated a dose-response effect with increasing risk associated with higher deciles of SBP. Compared to the 5 th decile young adults with SBPs in the highest decile 90-100% (SBP ≥127 for men and ≥120 for women) had a HR of 1.76 (95% CI 1.10-2.83). C statistics for models using BP percentiles were higher than for models using guideline-recommended thresholds (0.724 vs 0.713). No significant association was seen with DBP deciles. Conclusion: BP percentiles are better able to predict future CVD risk in young adults as compared to current age-invariant thresholds. These methods may help to risk stratify young adults and more accurately identify higher risk individuals for early prevention efforts.

Association between baseline office blood pressure level and the incidence and development of long-term frailty in the community-dwelling very elderly with hypertension.

Frailty is the most important risk factor causing disability in the elderly. Hypertension is one of the most common chronic diseases in the elderly and is closely related to frailty, but there is still controversy about the association between blood pressure and frailty. To explore the association between baseline blood pressure level and the incident and development of long-term frailty in the community-dwelling very elderly (i.e., over 80 years old [1]) with hypertension, in order to provide a basis for scientific blood pressure management of very elderly hypertension. In this study, very elderly hypertensive patients who received comprehensive geriatric assessment from January to June 2019 and with complete data were included, and follow-up was conducted from January 1 to February 14, 2023. A total of 330 very elderly individuals with hypertension were enrolled in this study. FRAIL scale was used to evaluate frailty. Binomial logistic regression analysis was used to calculate the OR and 95%CI between baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) levels and long-term incident and development of frailty. The dose-response relationship between baseline office SBP, DBP or PP levels and incident frailty and its development was analyzed by Generalized Additive Model (GAM) using smooth curve fitting and threshold effect analysis. Smooth curve fitting and threshold effect analysis showed that the relationship between baseline office SBP level and incident frailty was U-shaped, with the nadir of the U-shaped curve at 135 mmHg after adjustment. Baseline office SBP, PP level and development frailty was U-shaped and the nadir was 140 mmHg and 77 mmHg. In the community-dwelling very elderly with hypertension, baseline office SBP level had a relationship with long-term incident frailty and its development and PP level had a relationship with long-term development of frailty.

Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities

Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.

Blood pressure levels and adverse cardiovascular outcomes in heart failure: A systematic review and meta-analysis.

Existing data on the association between blood pressure levels and adverse cardiovascular outcomes in patients with heart failure (HF) are inconsistent. The optimal blood pressure targets for patients with HF remain uncertain. This study sought to assess the associations between blood pressure (systolic and diastolic blood pressure, SBP and DBP) levels and adverse cardiovascular disease (CVD) outcomes in patients with HF. A systematic review and meta-analysis were conducted using MEDLINE, Embase, the Cochrane Library, and Web of Science databases up to 5 May 2023. The outcomes of interest included adverse cardiovascular events and all-cause mortality. Pooled relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Forty-three unique observational cohort studies, comprising 120 643 participants with HF, were included. The pooled RRs (95% CIs) for SBP thresholds of ≥140 mmHg vs <140 mmHg were 0.92 (0.83-1.01) for all-cause mortality, 0.83 (0.67-1.04) for CVD death, and 0.98 (0.80-1.21) for HF hospitalization. The pooled RR (95% CI) for SBP thresholds of ≥160 mmHg vs <160 mmHg and all-cause mortality was 0.67 (0.62-0.74). SBP levels below <130, <120, and < 110 mmHg were each associated with an increased risk of various cardiovascular endpoints and all-cause mortality. The pooled RR (95% CI) for DBP thresholds of ≥80 mmHg vs <80 mmHg and all-cause mortality was 0.86 (0.67-1.10). A 10 mmHg increase in SBP or DBP was associated with a reduction in all-cause mortality and other cardiovascular endpoints. The findings suggest that lower and normal baseline SBP levels (<130, <120, and < 110 mmHg) may be associated with future risk of worse outcomes in patients with HF. Optimal baseline blood pressure levels for these patients may lie within the range of ≥140 mmHg for SBP. In the absence of observational studies with repeated blood pressure measurements or definitive trials evaluating optimal blood pressure targets, individualized blood pressure targets based on patients' unique circumstances are warranted in HF management.

Abstract 15280: Does Weight Reduction Drive the Reduction in Blood Pressure in People Living With Obesity Treated With Tirzepatide?: Insights From SURMOUNT-1 Study

Background: Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist indicated for the treatment of type 2 diabetes and in development for chronic weight management. In SURMOUNT-1, in participants with obesity or overweight, TZP 5, 10 and 15 mg reduced body weight (-15 to -20.9%), SBP (-7 to -8.2 mmHg) and DBP (-4.6 to -5.5 mmHg) after 72 weeks of intervention. Aim: To assess the effects of TZP on SBP and DBP by baseline (BL) blood pressure (BP) levels and to evaluate the contribution of weight loss to the effect. Methods: Adults with a BMI ≥30 kg/m2, or ≥27 kg/m2 and ≥ 1 diagnosed weight-related complication, excluding diabetes, received TZP (5, 10, or 15 mg) or placebo (PBO) for 72 weeks. Participants with a valid BL BP value and ≥1 post-BL value were included in the analysis using the efficacy analysis set (excluding off-treatment data). Changes from BL through 72 weeks in SBP and DBP were compared between pooled TZP doses and PBO with mixed models for repeated measures (MMRM) by BL BP levels. The proportion of participants reaching recommended BP thresholds was also evaluated. Post-hoc mediation analyses evaluated the weight-loss dependent, and independent, effects of TZP in SBP and DBP reduction. Results: Regardless of BL BP values, pooled TZP showed consistent SBP and DBP reduction at 72 weeks from BL, relative to PBO (Figure 1a). At 72 weeks, a greater proportion of TZP treated participants achieved recommended SBP and DBP levels than participants treated with PBO (Figure 1b), nearly doubling the proportion of patients with normal BP values. Changes in body weight with SBP (r=0.24) and DBP (r=0.24) were moderately correlated. Mediation analysis indicated that SBP and DBP reductions were primarily mediated through weight loss (77% and 99% respectively). Conclusions: Effects of TZP on blood pressure were consistent regardless of SBP or DBP values at BL, increasing the proportion of patients reaching normal BP levels. Reductions in SBP and DBP were substantially mediated by weight reduction.

FEATURES OF AMBULATORY BLOOD PRESSURE MONITORING WITH DIFFERENT BLOOD PRESSURE PROFILES IN PATIENTS WITH HYPERTENSION DISEASE OF MIDDLE AND ELDERLY AGE

Background. Insufficient night-time reduction of blood pressure (BP) and night hypertension are associated with an increased risk of death regardless of the average daily BP. The study of daily BP profiles is very relevant in patients with hypertension of different age categories due to the high risk of thrombotic complications.&#x0D; Aim: of the study was to determine the peculiarities of ambulatory blood pressure monitoring (ABPM) indices in middle-aged and elderly hypertensive patients depending on the daily BP profile.&#x0D; Materials and methods. ABPM indicators were determined in 125 patients who were divided into 2 groups. 1st group (n=82) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old). In the groups of middle-aged and elderly subjects 2 groups of daily BP profiles were distinguished: "dipper" and "non-dipper".&#x0D; Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily systolic BP (SBP) (mm Hg), the average daly diastolic BP (DBP) (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP.&#x0D; Results. The baseline BP level in the average daily SBP and DBP in middle-aged patients of dipper group was significantly higher by 49,6% and corresponded to 155,9±12,0 mm Hg (p&lt;0,001) and 50,4% and was 97,3±6,1 mm Hg (p&lt;0,01). Similar results are observed in the average BP and the maximal daily SBP and the maximal daily DBP values which were significantly higher than the control group by 21,5% (p&lt;0,05) and equaled 110,0±3,6 mm Hg and 21,3% and amounted to 176,3±23,5 mm Hg (p&lt;0,05) and 23,6% and amounted to 117,0±19,2 mm Hg (p&lt;0,05). The baseline BP level in the average daily and maximal SBP, the average daily DBP and the average BP in patients of non-dipper group was significantly higher by 50,8% (p&lt;0,01) and corresponded to 157,1±12,9 mm Hg and 27,4% and equal to 176,9±24,0 mm Hg (p&lt;0,05), 63,8% and amounted to 106,0±1,0 mm Hg (p&lt;0,05) and 44% and was 124,3±6,8 mm Hg (p&lt;0,05) too. In the surveyed elderly patients only the average daily DBP was significantly different from the corresponding control indicator and was lower by 21,4% (p&lt;0,05) and amounted to 91,5±0,7 mm Hg in dipper and 23,1% (p&lt;0,01) and was 93,5±0,7 mm Hg in non-dipper group.&#x0D; Conclusion. Non-dipper group predominates in the structure of daily BP rhythm in elderly hypertensive patients (62,8% versus 37,2%). The average BP decreases in elderly patients of non-dipper group by 11,1% (p&lt;0,05) reliably to patients of middle age.

Association between blood pressure during 12-28 weeks gestation and pre-eclampsia: predictive value of blood pressure trajectories constructed by latent class growth modeling

Objective: To explore the associations between blood pressure trajectories during pregnancy and risk of future pre-eclampsia in a large cohort enrolling pregnant women at gestational age of ~12 weeks from community hospitals in Tianjin. Latent class growth modeling (LCGM) was used to model the blood pressure trajectories. Methods: This was a large prospective cohort study. The study enrolled pregnant women of ~12 weeks of gestation in 19 community hospitals in Tianjin from November 1, 2016 to May 30, 2018. We obtained related information during 5 antepartum examinations before gestational week 28, i.e., week 12, week 16, week 20, week 24 and week 28. LCGM was used to model longitudinal systolic (SBP) and diastolic blood pressure (DBP) trajectories. For the association study, the predictors were set as SBP and DBP trajectory membership (built separately), the outcome was defined as the occurrence of preeclampsia after 28 weeks of gestation. Results: A total of 5 809 cases with known pregnant outcomes were documented. After excluding 249 cases per exclusion criteria, 5 560 cases with singleton pregnancy were included for final analysis. There were 128 cases preeclampsia and 106 cases gestational hypertension in this cohort. Univariate logistic regression and multivariate logistic regression showed the higher baseline SBP level and DBP level were related with increased risk of preeclampsia. Four distinctive SBP trajectories and DBP trajectories from 12 weeks to 28 weeks of gestation were identified by LCGM. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for SBP latent classification trajectory_ 4 was 4.023 (95%CI: 2.368 to 6.835, P<0.001), and the OR for SBP latent classification trajectory_3 was 1.854 (95%CI: 1.223 to 2.811, P=0.004). Logistic regression showed that: using the DBP latent classification trajectory_1 as the reference group, the OR for DBP latent classification trajectory_4 was 4.100 (95%CI: 2.571 to 6.538, P<0.001), and 2.632 (95%CI: 1.570 to 4.414, P<0.001) for DBP latent classification trajectory_2. After controlling for potential confounders (baseline BMI, being primipara or not, white blood cell counts, hemoglobin level, platelet counts and alanine aminotransferase level), the OR for DBP_traj_4 was 2.527 (95%CI: 1.534 to 4.162, P<0.001), and the OR for DBP_traj_3 was 1.297 (95%CI: 0.790 to 2.128, P=0.303), and 2.238 (95%CI: 1.328 to 3.772, P=0.002) for DBP_traj_2. Therefore, BP trajectories from 12 weeks to 28 weeks identified by LCGM served as novel risk factors that independently associated with the occurrence of preeclampsia. Receiver operating characteristic (ROC) curve analysis showed incremental diagnostic performance by combing baseline blood pressure levels with blood pressure trajectories. Conclusion: By applying LCGM, we for the first time identified distinctive BP trajectories from gestational week 12 to 28, which can independently predict the development of preeclampsia after 28 weeks of gestation.

Expanding the use of salivary cortisol as a non-invasive outpatient test in the dynamic evaluation of suspected adrenal insufficiency.

Adrenal insufficiency (AI) is potentially life-threatening, and accurate diagnosis is crucial. The first-line diagnostic test, the adrenocorticotrophic hormone (ACTH) stimulation test, measures serum total cortisol. However, this is affected in states of altered albumin or cortisol-binding globulin levels, limiting reliability. Salivary cortisol reflects free bioactive cortisol levels and is a promising alternative. However, few studies are available, and heterogenous methodologies limit applicability. This study prospectively recruited 42 outpatients undergoing evaluation for AI, excluding participants with altered cortisol-binding states. Serum (immunoassay) and salivary (liquid chromatography tandem mass spectrometry) cortisol levels were sampled at baseline, 30 min, and 60 min following 250 µg synacthen administration. AI was defined as a peak serum cortisol level <500 nmol/L in accordance with guidelines. The study recruited 21 (50%) participants with AI and 21 without AI. There were no significant differences in baseline characteristics, blood pressure, or sodium levels between groups. Following synacthen stimulation, serum and salivary cortisol levels showed good correlation at all timepoints (R2 = 0.74, P < 0.001), at peak levels (R2 = 0.72, P < 0.001), and at 60 min (R2 = 0.72, P < 0.001). A salivary cortisol cut-off of 16.0 nmol/L had a sensitivity of 90.5% and a specificity of 76.2% for the diagnosis of AI. This study demonstrates a good correlation between serum and salivary cortisol levels during the 250 µg synacthen test. A peak salivary cortisol cut-off of 16.0 nmol/L can be used for the diagnosis of AI. It is a less invasive alternative to evaluate patients with suspected AI. Its potential utility in the diagnosis of AI in patients with altered cortisol-binding states should be further studied.

Clinical Efficacy and Tolerability of Antihypertensive Therapy with Single Pill Combinations of Telmisartan in Patients with Arterial Hypertension in Clinical Practice According to the ON TIME Observational Study

Aim. To assess the clinical outcomes and tolerability of antihypertensive therapy with single pill combinations (SPC) amlodipine + telmisartan and hydrochlorothiazide + telmisartan in clinical practice.Material and methods. Patients with hypertension of grade 1-3 (n=13647; 57.6% women; age 59.3±11.4 years) who received therapy with SPC amlodipine + telmisartan or hydrochlorothiazide + telmisartan were included in an observational multicenter study. Information on complaints, history, previous therapy, history of novel coronavirus infection (COVID-19) during the previous year was obtained. Also, measurement of height, body weight, waist circumference (WC) and hips (HC), office blood pressure (BP) three times with an interval of 4 weeks, completion of questionnaires of satisfaction with therapy using the Likert scale, and assessement of adherence to therapy according to the patient's opinion was performed.Results. A statistically significant decrease in systolic (SBP) and diastolic blood pressure (DBP) was found both in all patients and in the analysis of subgroups according to the grade of hypertension (p&lt;0.001 between visits in all cases). The degree of BP reduction depended on baseline BP levels. The average decrease in SBP/DBP at the 3rd visit for the grade 1 hypertension was 24.5/14.6 mm Hg, for the grade 2 hypertension – 34.4/16.8 mmHg, for the grade 3 hypertension – 49.6/22.1 mmHg (p&lt;0.001 between groups). Target levels of SBP (≤140 mmHg) and DBP (≤90 mmHg) were achieved in 95.3% and 98.1% of patients, respectively. Target levels of SBP (≤130 mmHg) and DBP (≤80 mmHg) were achieved in 74.9% and 78.2% of patients, respectively. WC decreased by 0.5%; HC – by 1.5%; body weight – by 0.42% (p&lt;0.001 in all cases). Scores in patients with a history of COVID-19 did not differ from those in individuals without a history of COVID-19. There were no violations of the therapy regimen during the observation period in 94% of patients. Most doctors and patients were "satisfied" or "completely satisfied" with the clinical effect, convenience and tolerability of therapy. Adverse events occurred in 1.35% of patients.Conclusion. Therapy with SPC amlodipine + telmisartan or hydrochlorothiazide + telmisartan in clinical practice had a high antihypertensive efficacy and had an optimal safety profile. The efficacy of therapy did not depend on the initial grade of hypertension, as well as the past infection with COVID19. The results of the ON TIME study confirm the feasibility of using the SPC amlodipine + telmisartan and hydrochlorothiazide + telmisartan for a wide range of hypertensive patients.

The use of tenoxicam in active axial spondyloarthritis – focus on efficacy and safety

Purpose of the study – to study the efficacy and safety of tenoxicam (Texared®) in patients with active axial spondyloarthritis.Material and methods. The study included 35 patients with active axial spondyloarthritis with BASDAI≥4.0. Patients were given continuous oral tenoxicam (Texared®, Dr. Reddy’s Laboratories) at a dosage of 20 mg/day. Subsequently, 5 patients were excluded from the study due to discontinuation of the drug after 5–10 days of administration. 30 patients were included in the final analysis. Initially and after 30 days, to assess the severity of pain and stiffness, activity, patients filled out questionnaires in electronic form using Google forms, a general assessment of pain in the lower back and the intensity of night pain by the patient, subjective sleep characteristics were carried out. The doctor calculated the BASDAI, ASDAS-CRP, BASMI indices, and evaluated the activity according to the doctor’s opinion. The baseline blood pressure level was determined, and a patient diary was issued for ambulatory blood pressure measurement in the morning/evening for 30 days. After 30 days, the patient’s ambulatory blood pressure control was assessed. At baseline and after 30 days, biochemical blood parameters were studied, including a complete blood and urine test.Results and conclusion. In patients with axial spondyloarthritis with high and very high activity, a positive effect of tenoxicam (Texared®) therapy on disease activity was noted. The effect of Texared® develops with regular use already during the first 2 weeks, and after 4 weeks there is a clear decrease in the severity of pain in the lower back, a decrease in the duration of morning stiffness. The drug is well tolerated, has a favorable safety profile, no serious adverse events and few side effects that do not require discontinuation of therapy.

A systematic review and meta-analyses on the effects of atorvastatin on blood pressure and heart rate.

Considering the inconsistencies in the literature on the atorvastatin effect on blood pressure (BP), we performed these meta-analyses. Through a search of the Excerpta Medica Database (EMBASE), PubMed, and Web of Science databases, 1412 articles were identified, from which 33 randomized clinical trials (RCT) and 44 pre-clinical were selected. Populations from RCT were stratified according to baseline BP and lipid levels. We performed meta-analyses of the effect of atorvastatin on systolic (SBP), diastolic and mean BP; heart rate (HR); HR variability, and baroreflex. Atorvastatin reduced SBP in the overall population (P=0.05 vs. placebo; P=0.03 vs. baseline), in normotensive and hyperlipidaemic (P=0.04 vs. placebo; P=0.0001 vs. baseline) and in hypertensive and hyperlipidaemic (P=0.02 vs. placebo; P=0.008 vs. baseline) individuals in parallel RCT, but it did not affect SBP in normotensive and normolipidaemic individuals (P=0.51 vs. placebo; P=0.4 vs. baseline). Although an effect of atorvastatin was detected in hyperlipidaemic individuals, the meta-regression coefficient for the association of low density lipoprotein (LDL)-cholesterol reduction with SBP reduction in the overall population demonstrated that SBP reduction is not dependent on the changes in LDL-cholesterol. A meta-analysis of preclinical reports demonstrated that SBP was reduced in atorvastatin-treated hypertensive and normolipidaemic rats (spontaneously hypertensive rats: P<0.00001), but not in normotensive and normolipidaemic rats (control rats: P=0.97). Atorvastatin also reduced the HR in spontaneously hypertensive rat. Atorvastatin lowers BP independent of LDL-cholesterol levels. Additional studies are needed to estimate the involvement of the autonomic nervous system in the BP-lowering effect of atorvastatin.

Association of Lipid Levels With the Prevalence of Hypertension in Chinese Women: A Cross-Sectional Study Based on 32 Health Check Centers.

BackgroundDyslipidemia is strongly associated with the development of hypertension. In our previous study, it was shown that elevated TC, LDL-c, and non-HDL-c were associated with the prevalence of hypertension in Chinese men, whereas the relationship between HDL-c and hypertension shifted from no association to a positive association after adjusting for the BMI. To further accumulate epidemiological evidence in Asian women, this study aimed to investigate the relationship between lipid profile and prevalence of hypertension in Chinese adult women.MethodsThis is a cross-sectional study including 54,099 Chinese women aged>20 years at 32 health screening centers in 11 cities from 2010-2016. The original data were obtained from DATADRYAD database (www.datadryad.org). Besides, the overall women were classified into non-hypertensive and hypertensive groups based on baseline blood pressure levels. Differences between the two groups were examined by Man-Whitney test or Chi-square test. Spearman’s correlation coefficient was employed to evaluate the correlation between systolic blood pressure (SBP), diastolic blood pressure (DBP) and lipid profiles. Multivariate logistic regression was performed to estimate the relationship between different lipid levels and the prevalence of hypertension. Odds ratios (ORs) and 95% confidence intervals (CIs) indicated the risk of lipid and hypertension. Bayesian model (BN) model was constructed to further assess the relationship between baseline characteristics and the prevalence of hypertension, as well as the importance of each variable for the prevalence of hypertension.ResultsCompared to the non-hypertensive population, the hypertensive population was older, and had the higher body mass index (BMI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), serum creatinine (Scr), fasting blood glucose (FPG), blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and non-high-density lipoprotein cholesterol (non-HDL-c), but HDL-c and the presence concerning the family history of diabetes were lower. Multivariate logistic regression analysis revealed that TC, LDL-c, and non-HDL-c showed a positive trend with hypertension risk (p for trend < 0.05) whereas TC and HDL-c were not significantly associated with hypertension prevalence. Moreover, each 1 mg/dl increase in TC, LDL, and non-HDL hypertension prevalence increased by 0.2% [1.002 (1.000-1.003)], 0.2% [1.002 (1.000-1.004)], and 0.2% [1.002(1.001-1.004)], respectively. BN suggested that the importance of age, BMI, FPG, non-HDL-c on the prevalence of hypertension was 52.73%, 24.98%, 11.22%, and 2.34%, respectively.ConclusionOverall, in Chinese adult women, TC, LDL-c and non-HDL-c levels were higher and HDL-c level was lower in the hypertensive population, whereas TG did not differ significantly from the non-hypertensive population. Meanwhile, TC, LDL-c, and non-HDL-c were positively associated with prevalence of hypertension, and HDL-c was negatively associated with prevalence of hypertension but became nonsignificant after full adjustment for variables. Moreover, BN model suggested that age, BMI, FPG, and non-HDL-c had a greater effect on the development of hypertension.

Relationship Between Lipid Profiles and Hypertension: A Cross-Sectional Study of 62,957 Chinese Adult Males.

BackgroundPatterns of dyslipidemia and incidence of hypertension have been rarely reported in Asian populations with inconsistent findings. To accumulate further evidence in Asian populations, the study aimed to investigate the relationship between lipid profiles and hypertension in Chinese adult males.MethodsWe conducted a cross-sectional study based on the data from the DATADRYAD database. The overall population was divided into hypertensive and non-hypertensive groups based on baseline blood pressure levels. For continuous variables, Mann-Whitney test was performed between two groups, while Kruskal-Wallis and Dunn tests were used among multiple groups. The chi-square test was carried out for dichotomous variables. Spearman's correlation coefficient was employed to assess the association between systolic blood pressure (SBP), diastolic blood pressure (DBP) and lipid profiles, whereas the relationship between lipid profiles and the incidence of hypertension was evaluated using multivariate logistic regression. The Bayesian network (BN) model was adopted to investigate the relationship between clinical characteristics and hypertension, and the importance of related predictor to the incidence of hypertension was obtained to make conditional probability analysis.ResultsFinally, totally 62,957 participants were included in this study. In the lipid profiles, total cholesterol (TC), low-density cholesterol (LDL-c), and non- high-density lipoprotein cholesterol (non-HDL-c) were higher in the hypertensive population (p <0.001). In the fully multivariate model, for every 1 mg/dl increase in TC, LDL-c and non-HDL, the risk of hypertension increased by 0.2% [1.002 (1.001–1.003)], 0.1% [1.001 (1.000–1.002)], and 0.1% [1.001 (1.000–1.002)]. Meanwhile, HDL-c became positively associated with the incidence of hypertension (p for trend < 0.001) after adjusting for the body mass index (BMI), and 1 mg/dl increment in HDL-c increased the risk of hypertension by 0.2% [1.002 (1.000–1.002)] after fully adjusting for multiple variables. Furthermore, the BN showed that the importance of age, BMI, fasting plasma glucose (FPG), and TC to the effect of hypertension is 43.3, 27.2, 11.8, and 5.1%, respectively.ConclusionElevated TC, LDL-c, and non-HDL-c were related to incidence of hypertension in Chinese adult males, whereas triglycerides (TG) was not significantly associated. The relationship between HDL-c and hypertension incidence shifted from no association to a positive correlation after adjusting for the BMI. Moreover, the BN model displayed that age, the BMI, FPG, and TC were strongly associated with hypertension incidence.

Twenty-Four Hour Blood Pressure Response to Empagliflozin and Its Determinants in Normotensive Non-diabetic Subjects.

BackgroundSodium–glucose co-transport 2 inhibitors (SGLT2i) lower blood pressure (BP) in normotensive subjects and in hypertensive and normotensive diabetic and non-diabetic patients. However, the mechanisms of these BP changes are not fully understood. Therefore, we examined the clinical and biochemical determinants of the BP response to empagliflozin based on 24-h ambulatory BP monitoring.MethodsIn this post-hoc analysis of a double-blind, randomized, placebo-controlled study examining the renal effects of empagliflozin 10 mg vs. placebo in untreated normotensive non-diabetic subjects, the 1-month changes in 24 h ambulatory BP were analyzed in 39 subjects (13 placebo/26 empagliflozin) in regard to changes in biochemical and hormonal parameters.ResultsAt 1 month, empagliflozin 10 mg decreased 24-h systolic (SBP) and diastolic (DBP) BP significantly by −5 ± 7 mmHg (p < 0.001) and −2 ± 6 mmHg (p = 0.03). The effect on SBP and DBP was more pronounced during nighttime (resp. −6 ± 11 mmHg, p = 0.004; −4 ± 7 mmHg, p = 0.007). The main determinants of daytime and nighttime SBP and DBP responses were baseline BP levels (for daytime SBP: coefficient −0.5; adj. R2: 0.36; p = 0.0007; for night-time SBP: coefficient −0.6; adj. R2: 0.33; p = 0.001). Although empaglifozin induced significant biochemical changes, none correlated with blood pressure changes including urinary sodium, lithium, glucose and urate excretion and free water clearance. Plasma renin activity and plasma aldosterone levels increased significantly at 1 month suggesting plasma volume contraction, while plasma metanephrine and copeptin levels remained the same. Renal resistive indexes did not change with empagliflozin.ConclusionSGLT2 inhibition lowers daytime and nighttime ambulatory systolic and diastolic BP in normotensive non-diabetic subjects. Twenty-four jour changes are pronounced and comparable to those described in diabetic or hypertensive subjects. Baseline ambulatory BP was the only identified determinant of systolic and diastolic BP response. This suggests that still other factors than sustained glycosuria or proximal sodium excretion may contribute to the resetting to lower blood pressure levels with SGLT2 inhibition.Clinical Trial Registration:[https://www.clinicaltrials.gov], identifier [NCT03093103].

Detecting primary aldosteronism in Australian primary care: a prospective study.

To assess the identification of primary aldosteronism (PA) in newly diagnosed, treatment-naïve patients with hypertension by screening in primary care. Prospective study. General practices in the South Eastern Melbourne PrimaryHealth Network with at least three general practitioners and general practices elsewhere in Victoria that had referred patients to the Endocrine Hypertension Clinic at Monash Health, 2017-2020. Adults (18-80 years) with newly diagnosed hypertension (measurements of systolic blood pressure >140mmHg or diastolic blood pressure >90mmHg on at least two occasions) and not taking antihypertensive medications were screened for PA by assessing their aldosterone-to-renin ratio (ARR). Participants with two ARR values exceeding 70pmol/mU underwent saline suppression testing at the Endocrine Hypertension Service (Monash Health) to confirm the diagnosis of PA. Prevalence of PA (number of patients with confirmed PA divided by number screened). Sixty-two of 247 screened participants had elevated ARR values on screening (25%); for 35 people (14%; 95% CI, 10-19%), PA was confirmed by saline suppression testing. Baseline characteristics (mean age, sex distribution, median baseline blood pressure levels, and serum potassium concentration) were similar for people with or without PA. PA was diagnosed in 14% of patients with newly diagnosed hypertension screened by GPs, indicating a potential role for GPs in the early detection of an important form of secondary hypertension for which specific therapies are available.