Determinants Of Blood Pressure Research Articles

Blood pressure and vascular determinants of glomerular filtration rate decline in diabetic kidney disease.

In patients with type 2 diabetes and diabetic kidney disease (DKD), explore the relationship between estimated glomerular filtration rate decline (eGFR-d) and simultaneously assessed vascular risk markers including office, ambulatory or central blood pressure, pulse pressure, carotid-femoral pulse wave velocity (PWV), carotid intima-media thickness (IMT) and renal resistive indexes (RRI). At baseline, vascular risk markers were measured in addition to the routine clinical workup. The eGFR-d was based on 2000-2019 creatinine values. Parameters were compared by eGFR-d quartiles. Regression models of eGFR-d and vascular markers were assessed. In total, 135 patients were included. Mean age was 63.8 ± 10.8y, baseline eGFR 60.2 ± 26.4 ml/min/1.73 m2 and urine albumin-creatinine ratio (ACR) 49 ± 108 mg/mmol. Mean eGFR-d was based on 43 ± 39 creatinine values within a time span of 7.0 ± 1.9y. The average yearly eGFR decline was -1.8 ± 3.0 ml/min/1.73 m2 ranging from -5.8 ± 2.3 in the first quartile to +1.4 ± 1.7 in the fourth quartile. Mean 24 h systolic (SBP) and diastolic (DBP) blood pressure were 126 ± 17 and 74 ± 9 mmHg. Mean PWV was 11.8 ± 2.8 m/s, RRI 0.76 ± 0.07 and IMT 0.77 ± 0.21 mm. SBP and pulse pressure correlated with eGFR-d but not DBP. 24 h SBP stood out as a stronger predictor of eGFR-d than office or central SBP. PWV and RRI correlated with eGFR decline in univariate, but not multivariate regression models including 24 SBP and ACR. In this study, eGFR decline was highly variable in patients with type 2 diabetes and DKD. Twenty-four hour SBP provided an added value to the routine measurement of ACR in predicting eGFR decline, whereas PWV and RRI did not.

Contribution of Snacks and Physical Activities to Elevated Blood Pressure of Adolescent Girls in West Java, Indonesia

Introduction: The prevalence of hypertension in Indonesia has continued to increase over the last few years. An unhealthy diet and lack of physical activity can elevate blood pressure, particularly if an unhealthy lifestyle has been followed since adolescence. This study aimed to analyze the correlation between snack consumption and physical activity with blood pressure in adolescent girls. Methods: A cross-sectional study was conducted with 349 adolescent girls from seven Islamic boarding schools in West Java, Indonesia. Data on daily food and snack consumption were obtained by the 24-hour recall for 3 non-consecutive days. Blood pressure was measured using a digital blood pressure instrument, and the results were categorized by age, gender, and height. Linear regression analyses were performed to investigate determinants of blood pressure. Results: A total of 120 (34.4%) of the adolescent girls in the study had hypertension. A majority of girls had inadequate daily intake (energy, fat, carbohydrates, and sodium; only total protein intake met Indonesia’s recommended dietary allowance). Snacks were found to be high in protein, fat, and carbohydrates, with consumption levels above 15%. More than half (61.9%) of the subjects’ daily sodium intake came from snacks. Low-fat intake from snacks was associated with an increase in blood pressure in this study. Daily nutritional intake affecting blood pressure included sodium and total fat intake. Lack of physical activity in adolescent girls was not a risk factor for elevated blood pressure. Conclusion: Fat and sodium intake was associated with elevated blood pressure in adolescent girls.

Determinants of early Post-natal Blood Pressure among Term Healthy Babies Seen in A Tertiary Hospital in Southwest Nigeria

Background: Neonatal blood pressure varies considerably in the early days of life. To correctly interpret blood pressure measurements or predict the expected blood pressure of a newborn, the factors that influence neonatal blood pressure must be taken into consideration. This study aimed to identify the factors that influence blood pressure (BP) in the early neonatal period. Method: This is a sub-analysis of research work on the blood pressure pattern of asphyxiated neonates and apparently healthy neonates. It is a hospital-based observational study that was conducted at the Ekiti State University Teaching Hospital [EKSUTH], Ado-Ekiti, Nigeria. 12 blood pressure readings were taken serially from each baby in the first 24 hours after birth using oscillometric device. Relationships between blood pressure and physical parameters were established using regression analysis. Differences in blood pressure with respect to gender, gestational age, weight categorization, maturity for age, socio-economic status, and civil status were established using independent t-test and analysis of variance where appropriate. Result: 1476 blood pressure readings from 123 healthy newborns were analyzed. The mean (standard deviation) (SD) BP in mmHg on day 1 were 69.5 (6.5), 39.2 (5.1), and 49.3 (4.6) for Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Mean Arterial pressure (MAP) respectively. Systolic blood pressure showed a positive linear relationship with weight (R=0.488, P=0.000) and length (R =0.304, P= 0.001). There were also significant differences in the mean (SD) of SBP with respect to gender (P = 0.015), civil status (P = 0.023), and maternal hypertension (P = 0.043). DBP (P= 0.001) and MAP(P=0.001) also had significant differences with respect to Maternal hypertension. Conclusion: Systolic blood pressure correlated significantly with birth weight and length. Only maternal hypertension had a significant effect on diastolic blood pressure.

Prevalence and Determinants of Elevated Blood Pressure among Children in Rural Kayonza District, Rwanda

Childhood elevated blood pressure (BP) has emerged as a concern for global public health. In Sub-Saharan African countries, where Rwanda is located, there is a scarcity of BP data for both children and adolescents. Elevated blood pressure (EBP) is a neglected issue in children, it can develop in young age and can last into adulthood. This community-based cross-sectional study in rural Kayonza, Rwanda investigated the prevalence and determinants of elevated blood pressure (EBP) in children aged 36 months. Measurements of blood pressure and height were converted to percentiles using World Health Organization standards. Data collection involved face-to-face interviews with a digital questionnaire. OMRON HBP-1320 blood pressure monitor and SECA 213 stadiometer were used. The mean systolic blood pressure was 90.60 mmHg and 58.75 mmHg and standard deviation of 7.60mHg for diastolic blood pressure. Most child's mothers (76%) were farmers, more than half (62.7%) of child mothers attended primary school, and 36.60% were between the ages of 31 and 35. (Mean age: 30.4 years, Stand. Dev.: 4.4, Minimum age: 21 years and Maximum age: 39 years), (53%) of children were males, 38 % were 36 months old (Mean age: 36.9 months, Stand. Dev.: 1.0, Minimum age: 35 months, and Maximum age: 39 months). Elevated BP for children is defined as being prehypertensive and hypertensive; all children with systolic or diastolic blood pressure percentiles of ≥90th to <95th were prehypertensive, while those with systolic or diastolic blood pressure percentiles of ≥95th to 99th and above were hypertensive. The prevalence of elevated BP was 40.4% with 18.6% being prehypertension and 21.8% being hypertension among 3-year-old children in the rural Kayonza district. Of them 72 (97%) children who had elevated blood pressure, their family were using biomass fuel and 71(36.60%) of study children were below the 5th percentile of height which an indicator of short stature, 27(40.91%) among them had elevated blood pressure. Factors like difficulty getting food on daily basis (food insecurity) (AOR=3.75; 95% CI: [1.70-8.27]; p=0.001) and medium monthly family income (AOR= 2.38; 95% CI: [1.07-5.31]; p=0.033) were associated with increased prevalence of elevated BP. No statistically significant was found between elevated blood pressure and prenatal factors. Mobilization and increase community’s awareness on the procedure for measuring children’s BP during routine health visits from 3 years old should be done to prevent this increasingly common health condition which is ignored and in asymptomatic nature. Keywords: Elevated Blood Pressure, Prehypertension, Hypertension, Prenatal Factors, Environmental Factors, Behavioural Factors, Kayonza District, Rwanda.

DETERMINANTS OF OFFICE BLOOD PRESSURE VARIABILITY AND INSTABILITY IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS

Objective: To evaluate the determinants of office blood pressure (BP) variability and instability within a single visit in young individuals. Design and method: Apparently healthy individuals aged 6-25 years referred for elevated blood pressure (BP) were subjected to triplicate office BP measurements in a single visit and 24h ambulatory BP monitoring. BP variability and instability were assessed separately for systolic and diastolic BP using: (i) standard deviation (SD) (ii) coefficient of variation (CV) (iii) average real variability (ARV) (iv) maximum office BP (Max) (v) maximum-minimum office BP difference (MMD) (vi) ratio of difference between 1st-3rd measurement to the average office BP (Relative change). White-coat effect was defined as the difference between office and daytime ambulatory BP. Results: 320 individuals were analyzed (mean age 13.6±3.6 years, 66.8% males, BMI z-score 1.12±0.96, average office BP 122.6±16.6/72.6±10.7 mmHg, 24h ambulatory BP 119.3±11.5/67.8±6.8). Based on office and 24h ambulatory BP, 21.3% of the participants had white-coat hypertension, 8.1% masked and 16.6% sustained hypertension. Age was associated with SD (r = 0.23, p<0.001), CV (r = 0.11, p<0.05), Max (r = 0.54, p<0.001) and MMD (r = 0.23, p<0.001) of office systolic BP, and Max (r = 0.29, p<0.001) and ARV (r = 0.12, p<0.05) of diastolic. In multivariable log-linear regression models [(independent variables: age, sex, BMI z-score, heart rate, office BP, white-coat effect (> = 5/6 mmHg systolic/diastolic, 75th centile)], office BP was an independent determinant for indices of systolic BP variability and instability [SD (↓ = 0.01, p<0.001), ARV (↓ = 0.01, p<0.001), Max (↓ = 0.01, p<0.001), MMD (↓ = 0.01, p<0.001) and Relative change (↓ = 0.001, p<0.05)], and for CV (↓ = -0.06, p<0.001) and Max (↓ = 0.01, p<0.001) of diastolic. White-coat effect was a significant determinant for CV of office systolic BP (↓ = 0.15, p<0.05) and Relative change of office diastolic BP (↓ = 0.03, p<0.05). Conclusions: These results suggest that in healthy children, adolescents, and young adults the indices of office BP variability and instability within the first visit seem to be determined by the level of office BP and the magnitude of the white-coat effect.

Accounting for antihypertensive medication in Mendelian randomization studies of blood pressure: methodological considerations in the Canadian Longitudinal Study on Aging.

Mendelian randomization (MR) studies investigating determinants of blood pressure (BP) do not account for antihypertensive medication consistently, which may explain discrepancies across studies. We performed an MR study of the association between body mass index (BMI) and systolic BP (SBP) using five methods to account for antihypertensive medication and evaluated their impact on the estimation of the causal effect and on the assessment of the invalidity of the instruments used in MR. Baseline and follow-up data on 20 430 participants from the Canadian Longitudinal Study on Aging (CLSA) Comprehensive cohort (2011-2018) were used. The five methods to account for antihypertensive medication in the MR study were: no correction, adjustment for antihypertensive medication as a covariate in models, exclusion of treated individuals, addition of a constant value of 15 mmHg to measured values of SBP in treated individuals, and using hypertension as a binary outcome. The magnitude of the estimated MR causal effect for SBP (mmHg) varied across the methods of accounting for antihypertensive medication effects ranging from 0.68 (effect per 1 kg/m 2 increase in BMI) in scenario adjusting MR models for medication covariate to 1.35 in that adding 15 mmHg to measured SBP in treated individuals. Conversely, the assessment of the validity of the instruments did not differ across methods of accounting for antihypertensive medication. Methods to account for antihypertensive medication in MR studies may affect the estimation of the causal effects and must be selected with caution.

Social Determinants of Health and Uncontrolled Blood Pressure in a National Cohort of Black and White US Adults: the REGARDS Study.

Determining the contribution of social determinants of health (SDOH) to the higher proportion of Black adults with uncontrolled blood pressure (BP) could inform interventions to improve BP control and reduce cardiovascular disease. We analyzed data from 7306 White and 7497 Black US adults taking antihypertensive medication from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003-2007). SDOH were defined using the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Uncontrolled BP was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Among participants taking antihypertensive medication, 25.4% of White and 33.7% of Black participants had uncontrolled BP. The SDOH included in the current analysis mediated the Black-White difference in uncontrolled BP by 33.0% (95% CI, 22.1%-46.8%). SDOH that contributed to excess uncontrolled BP among Black compared with White adults included low annual household income (percent-mediated 15.8% [95% CI, 10.8%-22.8%]), low education (10.5% [5.6%-15.4%]), living in a health professional shortage area (10.4% [6.5%-14.7%]), disadvantaged neighborhood (11.0% [4.4%-18.0%]), and high-poverty zip code (9.7% [3.8%-15.5%]). Together, the neighborhood-domain accounted for 14.1% (95% CI, 5.9%-22.9%), the health care domain accounted for 12.7% (95% CI, 8.4%-17.3%), and the social-context-domain accounted for 3.8% (95% CI, 1.2%-6.6%) of the excess likelihood of uncontrolled BP among Black compared with White adults, respectively. SDOH including low education, low income, living in a health professional shortage area, disadvantaged neighborhood, and high-poverty zip code contributed to the excess likelihood of uncontrolled BP among Black compared with White adults.

Associations of air pollution mixtures with ambulatory blood pressure: The MobiliSense sensor-based study

Air pollution is acknowledged as a determinant of blood pressure (BP), supporting the hypothesis that air pollution, via hypertension and other mechanisms, has detrimental effects on human health. Previous studies evaluating the associations between air pollution exposure and BP did not consider the effect that air pollutant mixtures may have on BP. We investigated the effect of exposure to single species or their synergistic effects as air pollution mixture on ambulatory BP. Using portable sensors, we measured personal concentrations of black carbon (BC), nitrogen dioxide (NO2), nitrogen monoxide (NO), carbon monoxide (CO), ozone (O3), and particles with aerodynamic diameters below 2.5 μm (PM2.5). We simultaneously collected ambulatory BP measurements (30-min intervals, N = 3319) of 221 participants over one day of their lives. Air pollution concentrations were averaged over 5 min to 1 h before each BP measurement, and inhaled doses were estimated across the same exposure windows using estimated ventilation rates. Fixed-effect linear models as well as quantile G-computation techniques were applied to associate air pollutants’ individual and combined effects with BP, adjusting for potential confounders. In mixture models, a quartile increase in air pollutant concentrations (BC, NO2, NO, CO, and O3) in the previous 5 min was associated with a 1.92 mmHg (95% CI: 0.63, 3.20) higher systolic BP (SBP), while 30-min and 1-h exposures were not associated with SBP. However, the effects on diastolic BP (DBP) were inconsistent across exposure windows. Unlike concentration mixtures, inhalation mixtures in the previous 5 min to 1 h were associated with increased SBP. Out-of-home BC and O3 concentrations were more strongly associated with ambulatory BP outcomes than in-home concentrations. In contrast, only the in-home concentration of CO reduced DBP in stratified analyses. This study shows that exposure to a mixture of air pollutants (concentration and inhalation) was associated with elevated SBP.

Kidney and blood pressure regulation-latest evidence for molecular mechanisms.

Hypertension is one of the major health problems leading to the development of cardiovascular diseases. Despite a rapid expansion in global hypertension prevalence, molecular mechanisms leading to hypertension are not fully understood largely due to the complexity of pathogenesis involving several factors. Salt intake is recognized as a leading determinant of blood pressure, since reduced dietary salt intake is related to lower morbidity and mortality, and hypertension in relation to cardiovascular events. Compared with salt-resistant populations, salt-sensitive individuals exhibit high sensitivity in blood pressure responses according to changes in salt intake. In this setting, the kidney plays a major role in the maintenance of blood pressure under the hormonal control of the renin-angiotensin-aldosterone system. In the present review, we summarize the current overview on the molecular mechanisms for modulation of blood pressure associated with renal ion channels/transporters including sodium-hydrogen exchanger isoform 3 (NHE3), Na+-K+-2Cl- cotransporter (NKCC2), sodium-chloride cotransporter (NCC), epithelial sodium channel (ENaC) and pendrin expressed in different nephron segments. In particular, recent studies on experimental animal models with deletion of renal ion channels led to the identification of several crucial physiological mechanisms and molecules involved in hypertension. These findings could further provide a potential for novel therapeutic approaches applicable on human patients with hypertension.

Determinants of blood pressure and blood glucose control in patients with co-morbid hypertension and type 2 diabetes mellitus in Ghana: A hospital-based cross-sectional study.

Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson's chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1-46.8%) had controlled BP, 57.1% (95% CI: 51.7-62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7-26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM.

Classification and Prediction on Hypertension with Blood Pressure Determinants in a Deep Learning Algorithm.

Few studies classified and predicted hypertension using blood pressure (BP)-related determinants in a deep learning algorithm. The objective of this study is to develop a deep learning algorithm for the classification and prediction of hypertension with BP-related factors based on the Korean Genome and Epidemiology Study-Ansan and Ansung baseline survey. We also investigated whether energy intake adjustment is adequate for deep learning algorithms. We constructed a deep neural network (DNN) in which the number of hidden layers and the number of nodes in each hidden layer are experimentally selected, and we trained the DNN to diagnose hypertension using the dataset while varying the energy intake adjustment method in four ways. For comparison, we trained a decision tree in the same way. Experimental results showed that the DNN performs better than the decision tree in all aspects, such as having higher sensitivity, specificity, F1-score, and accuracy. In addition, we found that unlike general machine learning algorithms, including the decision tree, the DNNs perform best when energy intake is not adjusted. The result indicates that energy intake adjustment is not required when using a deep learning algorithm to classify and predict hypertension with BP-related factors.

Cut-off points for anthropometric indices to screen for hypertension among Iranian adults of the Bandare-Kong cohort: a cross-sectional study

BackgroundObesity is one of the major determinants of blood pressure. This study aimed to determine the optimal sex- and age-specific cut-off points of anthropometric indices, including body mass index (BMI), waist circumference (WC), hip circumference (HC), wrist circumference (WrC), waist-hip ratio (WHR), and waist-height ratio (WHtR), to screen for hypertension (HTN) in a cohort of Iranian adults aged 35 to 70 years, and to compare the predictive performance of the indices based on receiver operating characteristic (ROC) curves.MethodsThis population-based study was carried out on the participants aged 35 to 70 years of the Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study, a part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Using the area under the receiver operating characteristic curve (AUC) and Youden's J index, optimal sex- and age-specific cut-off points of the anthropometric indices in association with HTN were calculated.ResultsThis study included a total of 2256 females and 1722 males. HTN was diagnosed in 736 females (32.6%) and 544 males (31.6%). The optimal cut-off of WC for HTN was 90 cm in males and 95 cm in females, with an area under the ROC curve (AUROC) of 0.60 and 0.64, respectively. For HC, the optimal cut-off was 95 cm for males and 108 cm for females (AUROC = 0.54 for both). Moreover, WrC optimal cut-offs were 17 cm for males (AUROC = 0.56) and 15 cm for females (AUROC = 0.57). As for BMI, the optimal cut-off was 25 kg/m2 in males and 27 kg/m2 in females (AUROC of 0.59 and 0.60, respectively). Also, a cut-off of 0.92 was optimal for WHR in males (AUROC = 0.64) and 0.96 in females (AUROC = 0.67). On the other hand, WHtR optimal cut-offs were 0.52 for males and 0.60 for females (AUROC of 0.63 and 0.65, respectively).ConclusionsWHR and WHtR, as anthropometric indices of obesity, were demonstrated to be significant predictors of HTN. Further, we suggest using WHR (cut-off point of 0.92 for males and 0.96 for females) and WHtR (cut-off point of 0.52 for males and 0.60 for females) as measures of preference to predict HTN among the southern Iranian population. Further multicenter longitudinal studies are recommended for a more accurate prediction of HTN.

Evaluate the determinants of blood pressure from intervention for prehypertensive workers

Introduction: The aim of study is to prevent hypertension by Lifestyle Modification. Pre hypertensive adults must have adequate knowledge about the disease condition and the right practice regarding lifestyle modification to prevent hypertension. Hypertension cannot be eliminated because there are no vaccine to prevent the development of hypertension but its incidence can be decreased by reducing its risk factors. Materials and Methods: An Experimental One Group Pre-test Post- test design study was conducted to assess the effectiveness of Intervention on blood pressure of pre hypertensive employees in selected industries. The objectives of the study is to assess an compare the level of blood pressure of pre hypertension employees in selected industries. After pretest of blood pressure, Intervention was given for a period of one weeks. It includes wellness training for a period of 12 hours in each industry. At the end of the 7thweek outcome measures on blood pressure level was measured with the participants. Among the selected 120 samples the Intervention was found to be effective in maintaining blood pressure. Results: There was a highly significant difference between pretest and post test on blood pressure level. Discussion: The study concludes that Intervention is a cost effective method of Blood Pressure control measure that can be practiced at home set up without any equipment The published work is a part of Tamilnadu Dr. MGR Medical University Chennai.

Prevalence and determinants of normal, high-normal and high blood pressure and association with cardiovascular risk in Egypt.

High-normal blood pressure (HNBP) has become associated with a 2-3-fold increase in the risk of developing hypertension. Cardiovascular diseases (CVDs) are independently linked to HNBP. To estimate the prevalence of HNBP, its predictors, and association with CVD risk among a country-representative sample of Egyptian adults. This study draws on data from the most recent Egyptian Health Issues Survey, and includes 13 983 adults aged 18-59 years. Sociodemographic data and anthropometric and blood pressure (BP) measurements were obtained, and the 10-year cardiovascular risk score was calculated using World Health Organization CVD risk charts for participants aged ≥ 40 years. Overall, 15.31% and 21.0% of the study population had HNBP and hypertension, respectively. Compared to people aged 18-30 years, the odds of HNBP were 1.36, 1.67 and 2.39 among those aged 31-40, 41-50 and 51-59 years, respectively. The odds of HNBP were higher among male, overweight and obese adults, and patients with diabetes. The odds of HNBP and hypertension were higher among participants with high WHO CVD risk than those with low WHO CVD risk. HNBP is an alarming risk factor among Egyptian adults because it is strongly associated with CVD risk. Policy-makers should devise long-term, effective strategies for its prevention and control.

MO705: Factors Associated with Uncontrolled Ambulatory Hypertension in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS Hypertension among patients on long-term peritoneal dialysis (PD) is common and remains often inadequately control (Cocchi et al. Prevalence of hypertension in patients on peritoneal dialysis: results of an Italian multicentre study. Nephrol Dial Transplant. 1999; 14(6): 1536–40; Vaios et al.. Assessment and management of hypertension among patients on peritoneal dialysis. Clin J Am Soc Nephrol. 2019; 14(2): 297–305). The aim of the present study was to describe the epidemiology of hypertension using the ‘gold-standard’ method of ambulatory blood pressure monitoring (ABPM) and to identify determinants of inadequate ambulatory blood pressure (BP) control in this high-risk population. METHOD In 140 stable patients receiving PD in four centers of Northern Greece, we performed 24-h ABPM using the oscillometric Mobil-O-Graph device (IEM, Stolberg Germany) (Franssen and Imholz. Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria. Blood Press Monit. 2010; 15(4): 229–31). Hypertension was defined as 24-h ambulatory BP ≥ 130/80 mmHg or current use of at least 1 BP-lowering medication (Williams et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018; 36(10): 1953–2041). The volume status of study participants was assessed with the method of bioimpedance spectroscopy (Fresenius Medical Care, Bad Homburg, Germany). Univariate and multivariate binary logistic regression analysis was performed to identify factors that were independently associated with uncontrolled ambulatory hypertension. RESULTS Ambulatory hypertension was diagnosed in 95% of the patients enrolled in the study. Despite the fact that 96.9% of hypertensives were being treated with an average of 2.4 BP-lowering medications daily, adequate control of 24-h ambulatory BP was achieved in only 38.3% of them. In univariate regression analysis, there was a significant interaction of uncontrolled ambulatory hypertension with the mode of PD, history of cardiovascular disease and smoking status. In multivariate analysis, among variables inserted in the model, the higher overhydration index in bioimpedance spectroscopy [odds ratio (OR): 1.308; 95% confidence interval (CI): 1.023–1.673/L higher overhydration] and the history of cardiovascular disease (OR: 3.069; 95% CI: 1.157–8.140) were the two factors that were associated with higher odds of uncontrolled ambulatory hypertension. In contrast, the presence of residual diuresis ≥ 0.5 L/24 h (OR: 0.304; 95% CI: 0.105–0.881) was the only parameter associated with lower odds of inadequate ambulatory BP control. CONCLUSION Among patients on PD, ambulatory hypertension is highly prevalent and remains often poorly controlled, despite the extensive use of antihypertensive drug therapy. Achievement of adequate volume control and long-term preservation of residual kidney function appear to be two attractive non-pharmacological strategies for optimization of the management of hypertension in this high-risk population.

Validity and cardio-metabolic risk profiles of DNA methylation clocks among adults in south-central C\xf4te d\u2019Ivoire

BackgroundAging populations in Africa face a growing burden of non-communicable diseases (NCDs), contextualized in broad external exposome and weak health systems. These could accelerate aging and shorten lifespan. DNA methylation (DNAm) epigenetic clocks allow investigation of biological aging, and perform well in high-income countries. However, their validity has rarely been tested in low- and middle-income countries. We investigated the performance of epigenetic clocks (as aging biomarkers), and their cardio-metabolic risk profiles among adults in south-central Côte d’Ivoire.ResultsWe derived four measures of epigenetic clocks (i.e., HorvathAge, HannumAge, PhenoAge and GrimAge) and their corresponding epigenetic age acceleration (EAA; Intrinsic, Extrinsic, PhenoAA and GrimAA) using genome-wide DNAm data from 393 participants of the Côte d’Ivoire dual burden of disease study, aged 18–79 years. Epigenetic age exhibited strong correlations (0.83 ≤ Pearson’s r ≤ 0.93) but weaker concordance (0.73 ≤ Lin’s rC ≤ 0.85) with chronological age. Epigenetic clocks optimally predicted chronological age at 32 (HannumAge), 62 (HorvathAge) and 78 (GrimAge) years. Multivariable linear EAA models identified male sex (IEAA, EEAA and GrimAA), lower household wealth (EEAA and PhenoAA), high-risk alcohol intake (PhenoAA and GrimAA), smoking (GrimAA), physical activity (IEAA and GrimAA) and body mass index [BMI] (GrimAA) as independent determinants. Physical activity and BMI exhibited quadratic associations with GrimAA. Illustratively, GrimAge was accelerated in underweight and obese participants. Risk associations of GrimAA were largely driven by age-adjusted DNAm surrogate plasminogen activator inhibitor-1 (DNAmPAI-1) and pack years. Multivariable logistic models of cardio-metabolic phenotypes identified EEAA, PhenoAA and DNAmPAI-1 as determinants of high blood pressure, fasting glucose, triglycerides and metabolic syndrome severity.ConclusionsWe provide evidence validating the applicability of epigenetic clocks as aging biomarkers and potential link between sociodemographic and lifestyle-related factors, and cardio-metabolic health in the underrepresented African population. Future longitudinal studies incorporating broad environmental aspects and age-related clinical outcomes should allow to pinpoint the clinical and public health utility of DNAm clocks as mediators in NCD trajectory, in low- and middle-income countries.

Genetic Architecture of Stroke of Undetermined Source: Overlap with Known Stroke Etiologies and Associations with Modifiable Risk Factors.

Ischemic stroke etiology remains undetermined in 30% of cases. We explored the genetic architecture of stroke classified as undetermined to test if mechanisms and risk factors underlying large-artery atherosclerotic (LAAS), cardioembolic (CES), and small-vessel stroke (SVS) contribute to its pathogenesis. We analyzed genome-wide data from 16,851 ischemic stroke cases and 32,473 controls. Using polygenic risk scores for LAAS, CES, and SVS, we assessed the genetic overlap with stroke of undetermined source and used pairwise genomewide association study (GWAS-PW) to search for shared loci. We then applied Mendelian randomization (MR) to identify potentially causal risk factors of stroke of undetermined source. Genetic risk for LAS, CES, and SVS was associated with stroke of undetermined source pointing to overlap in their genetic architecture. Pairwise analyses revealed 19 shared loci with LAAS, 2 with CES, and 5 with SVS that have been implicated in atherosclerosis-related phenotypes. Genetic liability to both carotid atherosclerosis and atrial fibrillation was associated with stroke of undetermined source, but the association with atrial fibrillation was attenuated after excluding cases with incomplete diagnostic workup. MR analyses showed effects of genetically determinants of blood pressure, diabetes, waist-to-hip ratio, inflammatory pathways (IL-6 signaling, MCP-1/CCL2 levels), and factor XI levels on stroke of undetermined source. Stroke of undetermined source shares genetic and vascular risk factors with other stroke subtypes, especially LAAS, thus highlighting the diagnostic limitations of current subtyping approaches. The potentially causal associations with carotid atherosclerosis and atherosclerotic risk factors might have implications for prevention strategies targeting these mechanisms. ANN NEUROL 2022;91:640-651.

Incidence of Arterial Hypertension in People With Periodontitis and Characterization of the Oral and Subgingival Microbiome: A Study Protocol.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. High blood pressure in particular, continues to increase throughout the global population at an increasingly fast pace. The relationship between arterial hypertension and periodontitis has been recently discussed in the context of its origins and implications. Particularly relevant is the role of the periodontal microbiome linked to persistent local and systemic inflammation, along with other risk factors and social determinants of health. The present protocol will investigate/assess the association between periodontal disease and its microbiome on the onset of hypertension, within a cohort from Mexico City. One thousand two hundred twelve participants will be studied during a 60-month period. Studies will include analysis of periodontal conditions, sampling and sequencing of the salivary and subgingival microbiome, interviews on nutritional and lifestyle habits, social determinants of health, blood pressure and anthropometric measurements. Statistical associations and several classic epidemiology and machine learning approaches will be performed to analyze the data. Implications for the generation of public policy—by early public health interventions or epidemiological surveillance approaches—and for the population empowerment—via the establishment of primary prevention recommendations, highlighting the relationship between oral and cardiovascular health—will be considered. This latter set of interventions will be supported by a carefully planned science communication and health promotion strategy. This study has been registered and approved by the Research and Ethics Committee of the School of Dentistry, Universidad Nacional Autónoma de México (CIE/0308/05/2019) and the National Institute of Genomic Medicine (CEI/2020/12). The umbrella cohort was approved by the Institutional Bioethics Committee of the National Institute of Cardiology-Ignacio Chavez (INC-ICh) under code 13-802.

TRPV4-dependent signaling mechanisms in systemic and pulmonary vasculature.

The delicate balance between constrictor and dilator mechanisms is a vital determinant of blood pressure and blood flow. The maintenance of this balance requires constant communication between different cell-types in the vascular wall. In this regard, the transient receptor potential vanilloid type 4 (TRPV4) ion channel, a Ca2+-permeable non-selective cation channel, has emerged as a crucial regulator of Ca2+-mediated changes in vascular reactivity. Recent studies suggest that TRPV4 channels regulate vasoconstriction and arterial pressure in the systemic and pulmonary vasculature. New emerging data support a dilatory role of endothelial TRPV4 channels, and both constrictor and dilator roles of smooth muscle TRPV4 channels. Moreover, TRPV4 channel activity has been implicated in physiological functions of vascular support cells, such as fibroblasts and pericytes, to assist the sustenance of vascular reactivity in response to changes in intravascular pressure or external stimulation. Importantly, a growing body of evidence connects abnormal TRPV4 channel activity to multiple vascular disorders. This chapter will review the current literature on the cell-type specific roles of vascular TRPV4 channels in regulating physiological function. Additionally, we summarize our understanding of the contribution of abnormal TRPV4 channel activity to various vascular disorders.

Prevalence and Determinants of High Blood Pressure among Adolescents: A School based Study in Rural Area of Hooghly District, West Bengal

Introduction: The World Health Organization has already warned of increasing non-communicable diseases among adolescents as a major public health problem. The importance of this age group also lies in the fact that many serious diseases in adulthood have their roots in adolescence. Method: A pre-designed and pre-tested questionnaire was used in class-room setting to collect information from students regarding presence of risk factors of non-communicable diseases. The respondents were also subjected to anthropometric measurements and blood pressure examination using standard operating procedures. Results: A total of 761 students of class VI-XII participated in the study of which 61.4% were boys and rests were girls. High blood pressure among boys and girls were 19.9% and 22.1% were respectively. In Bivariate analysis age > 15 years (median) (OR= 2.11), fast food intake (>3 times/week) (OR= 1.66), Alcohol consumption (OR= 2.22), less physical activity (OR=1.54), increased body mass index (OR=2.53), significantly associated with high blood pressure. In Multivariate analysis age (AOR= 2.25), fast food intake (AOR= 1.50), Alcohol consumption (OR= 2.23), less physical activity (AOR=1.71), increased body mass index (AOR=2.42) remains significant predictor. Conclusion: Detecting the risk factors of high blood pressure prevalent in the population is of utmost importance to achieve a healthy population. Formulation and dissemination of need--based, culturally acceptable and age appropriate scientific messages for school students should be conducted more proactively. Keywords: Adolescents, Blood pressure, Risk factor, Rural school.