Blood Pressure Levels Research Articles

Telehealth innovations for cardiovascular disease management

Telehealth innovations and wearable technologies are revolutionizing the management of cardiovascular diseases (CVD), providing patients with more accessible and continuous care. The integration of remote monitoring tools and mobile health applications allows for real-time tracking of vital signs, such as heart rate, blood pressure, and oxygen levels, enabling early detection of abnormalities and timely medical interventions. These technologies empower patients to actively participate in their own health management, encouraging adherence to prescribed lifestyle changes, such as increased physical activity and improved dietary habits, which are essential for preventing and controlling CVD. Wearable devices, such as smartwatches and fitness trackers, play a critical role in the continuous monitoring of cardiovascular health. Combined with telehealth platforms, they offer personalized insights and facilitate communication between patients and healthcare providers, enhancing care coordination. This leads to improved patient outcomes, particularly in managing chronic conditions like hypertension and heart failure, where early intervention is key to preventing complications. Additionally, telehealth solutions reduce the need for frequent in-person visits, cutting healthcare costs and making care more convenient and accessible for patients in remote or underserved areas. As telehealth and wearable technologies continue to advance, they hold the potential to further transform cardiovascular care, contributing to more efficient healthcare delivery and better management of cardiovascular risk factors.

Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database.

Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS. We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure. From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21-1.63]; p < 0.001, 1.71 [1.39-2.10]; p < 0.001, respectively, compared to referential blood pressure range).Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16-4.73]; p = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds. There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.

Assessment of Knowledge About High Blood Pressure Among Syrians

Hypertension, often referred to the silent killer, is a prevalent health issue that impacts more than a billion individuals worldwide. The purpose of this study was to investigate the understanding of hypertension among Syrian individuals. 104 individuals filled out surveys. Females made up 64.4% of the group that was surveyed. 28.8% of the participants in the study were between the ages of 46 and 60. More than half of the participants had a study or a work related to the medicinal field. The participants showed good medication adherence where the score of accurate responses to the questions regarding medication compliance was very high. Most participants were familiar with the normal values of blood pressure levels and were optimistic about the possibility of treating the condition. A good percentage of individuals surveyed stated that smoking and obesity are contributing factors to developing high blood pressure. Most participants believed that consuming fatty foods raises plasma cholesterol levels. Participants had a good overall understanding of high blood pressure. However, they still need improvement in medical information about high blood pressure to enhance compliance with treatments.

Effect of nebivolol monotherapy or combination therapy on blood pressure levels in patients with hypertension: an updated systematic review and multilevel meta-analysis of 91 randomized controlled trials.

To systematically appraise and summarize the available evidence from published randomized controlled trials considering the effect of nebivolol on blood pressure in patients with hypertension. Literature search was performed through Medline (via PubMed), Cochrane Library and Scopus until December 15, 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis. In total, 7,737 participants with hypertension, who were treated with nebivolol, were analyzed across 91 RCTs. Nebivolol was associated with significantly greater reduction in office systolic and diastolic BP compared to placebo (MD = - 6.01 mmHg; 95% CI = [- 7.46, - 4.55] and MD = - 5.01 mmHg; 95% CI = [- 5.91, - 4.11], respectively). Moreover, resulted a similar reduction in systolic BP (MD = - 0.22 mmHg; 95% CI = [- 0.91, 0.46]) and a significantly greater reduction in diastolic BP compared to the active comparator (MD = - 0.71 mmHg; 95% CI = [- 1.27, - 0.16]). When considering the effect of nebivolol on 24-hour ambulatory BP, notable reductions were observed compared to placebo. In contrast, compared to the active comparators, there was no significant difference in systolic BP reduction, but a significant reduction in diastolic BP favoring nebivolol. Based on moderator analyses, the impact of nebivolol on the pooled estimates remained independent of the dose of nebivolol, age, male sex, trial duration, body mass index (BMI), baseline diabetes, heart failure, and baseline systolic and diastolic BP. Nebivolol, compared to placebo, showed a significant BP reduction and was non-inferior to other active comparators in terms of BP reduction.

The Effect of Mindfulness and Spiritual Combination Breathing Exercises towards Anxiety, Depression and Blood Pressure of Ischemic Stroke Patients

Background: Ischemic stroke causes serious ongoing problems in the lives of sufferers, including biological, psychological and spiritual changes so that comprehensive and multidisciplinary nursing care is necessary. Purpose: The purpose of this research is to analyze the effect of Mindfulness and Spiritual Combination Breathing Exercises towards anxiety, depression and blood pressure of ischemic stroke patients. Methods: This research is a quantitative research that uses a quasy experimental research design with a pretest - posttest control group design approach. The population of all ischemic stroke patients at RSAU dr. M.Munir Lanud Abdulrachman Saleh Malang as many as 108 people. The sample size is 50 respondents. The sampling technique is purposive sampling. The intervention group was given a combination of Mindfulness and SpiritualityBreathing Exerciseswithin 10-15 minutes 2 times a day for 5 days and the control group was given intervention according to hospital standards. Analysis used the Manova test with a significant p value &lt;0.05. Results: The results of the study using the Manova test showed that there was a significant effect between anxiety, depression and blood pressure after giving the Combination of Spiritual Mindfulness and Breathing Exercise sshowed that p value = 0.000, with the highest partial Eta Squared value of 0.643 anxiety followed by 0.579 depression and 0.263 blood pressure. Conclusion: A combination of Spiritual Mindfulness and Breathing Exercises effectively reduce the level of anxiety, depression and blood pressure of ischemic stroke patients.

Expanding access to non-communicable disease screening in war-affected communities in Ukraine

Abstract Background Non-communicable diseases (NCDs) account for 91% of premature deaths in Ukraine. However, NCD screening lags among young people and across the entire population. The ongoing war has exacerbated barriers to NCD screening due to damaged infrastructure, understaffed medical facilities, and health system deterioration. Intervention/response To improve screening, diagnosis, and care, in March 2023 the PATH-led, USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project established community level health access points (HAPs) in five conflict-affected communities. STBCEU procured screening tools (tannometers, glucometers, portable ECGs) for common NCDs, printed informational materials, trained 143 specialists, designed a reporting system, and facilitated monitoring visits to 77 HAPs. Results By the end of 2023, the project equipped 113 HAPs in the five communities, and 102 of them initiated NCD screening. From January-March 2024, 1,694 people under 40 years old were screened for NCDs. Among 1,488 blood pressure measurements, 143 cases had high readings (9.6 ±1.5%), 90 (62.9%) of which were first-time diagnoses, and 53 (37.1%) treatment monitoring. Glucose levels were measured 809 times, with elevated levels in 44 cases (5.4 ±1.5%), 30 (68.2%) of which were first-time diagnoses, and 14 (31.8%) treatment monitoring. Additionally, 1,144 mental health consultations were provided. Conclusions This initiative represented a first in Ukraine: per national requirements, young people have not historically been screened for NCDs. Expanding NCD screening in war-affected communities has demonstrated substantial early success, with significant detection of high blood pressure and elevated glucose levels among people under 40. This proactive, cost-effective intervention underscores the need for accessible, community-level health interventions in crisis settings and showcases a scalable model for integrating NCD screening into emergency health response frameworks. Key messages • The implementation of community-level NCD screening has shown early success in detecting high blood pressure and elevated glucose levels among people under 40. • Cost-effective NCD screening underscores the need for accessible, community health interventions, providing a scalable model for integrating NCD screening into emergency health response.

Exploring the efficacy of al-hijamah (wet cupping) in managing hypertension and dyslipidemia among indonesian population: a meta-analysis

Background: In Indonesia, wet cupping therapy has been thoroughly investigated as a treatment for hypertension and dyslipidemia. Nevertheless, the outcomes across these studies are contradictory. Objectives: To appraise the effectiveness of wet cupping therapy in the management of hypertension and dyslipidemia among the Indonesian population. Methods: We examined papers sourced from Google Scholar, the Indonesian Scientific Journal Database, and Garba Rujukan Digital until September 5, 2020. These papers investigated blood pressure and lipid profile levels both pre- and post-wet cupping treatment. The collective data underwent Z-test analysis to assess associations. Results: In total, we included 26 papers examining the correlation between wet cupping therapy and blood pressure, as well as 16 papers assessing lipid profile levels. Our combined analysis revealed significantly reduced systolic blood pressure (MD: 13.86; 95% CI: 10.01, 17.71), diastolic blood pressure (MD: 6.31; 95% CI: 3.84, 8.79), and lower total cholesterol levels (MD: 21.56; 95% CI: 10.32, 32.80]) in the post-treatment group compared to the pre-treatment group. However, we were unable to elucidate the impact of wet cupping therapy on the concentrations of low-density lipoprotein and triglyceride. Conclusions: Wet cupping therapy exhibits potential efficacy in reducing blood pressure and total cholesterol levels among individuals in Indonesia. Keyword: blood pressure, dyslipidemia, hypertension, lipid profile, wet cupping therapy

Effectiveness of Chest Physiotherapy toward Tuberculosis (TBC) Patient to Overcome Ineffective Airway Clearance in Dieng Inpatient Room of dr. Abdoer Rahem Hospital Situbondo: A Case Report

Tuberculosis is an infectious and potentially fatal disease in worldwide, caused by lungs inflammation due to Mycobacterium bacteria infection. Tuberculosis patient experiences coughing with phlegm, shortness of breath or dyspnea, accumulation of exudate or sputum. Excessive of sputum accumulated can lead to obstruction of breath way and increase lungs infection that related to ineffective airway clearance. Chest physiotherapy can be intervention of nursing to overcome ineffective airway clearance that helps in clearing accumulated sputum and improving oxygen saturation. This scientific work uses a case report method that describes the case of Tuberculosis patient with main problem of nursing that was called ineffective airway clearance. The sampling was consecutive sampling but only one patient included in the case. The sample of study was Mrs. M, 32 years old who had Tuberculosis patient with ineffective airway clearance. The research was conducted twice daily for 3 days began from December 21st, 2023, to December 23rd, 2023, in the Dieng Inpatient Room of dr. Abdoer Rahem Hospital Situbondo. Intervention was done in two sessions, that were morning and afternoon. Based on observations, there was no significant difference on blood pressure level, but there were decreasing pulse rate, decreasing respiratory rate, increasing oxygen saturation value, and improving ability of sputum production post intervention Chest Physiotherapy on the third day. The application of Chest Physiotherapy quietly helped in expelling phlegm and improving respiratory status.

Double-sided effect of selenium on blood lipids: A dose-response meta-analysis

Abstract Background Selenium, a trace element with both nutritional and toxicological properties, has been suggested to increase cardiovascular risk, particularly concerning diabetes and blood pressure levels. However, the impact of selenium exposure on the risk of dyslipidemia remains uncertain. This meta-analysis explored the shape of the relation between selenium exposure and its effects on lipid profiles in the most relevant experimental human studies, randomized controlled trials (RCTs). Materials and methods The review was registered in PROSPERO (ID: CRD42022380432). Through a bibliographic search conducted on PubMed, Web of Science, Embase, and the Cochrane Library, we identified RCTs investigating the impact of selenium supplementation on lipid profile. We then compared the results between intervention and control groups and, whenever possible, evaluated the non-linear relationship using a dose-response approach. Results We could include 26 RCTs involving different populations, i.e. healthy individuals, pregnant women, and subjects with health conditions such as cardiovascular diseases and Alzheimer’s dementia. Study endpoints were levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. Our dose-response analysis indicated that selenium supplementation exceeding 200 µg/day adversely affected total cholesterol, HDL, and triglyceride levels. Hence, a threshold for such a detrimental effect of selenium was observed on total and HDL cholesterol and triglycerides, while opposite and inconsistent results emerged for levels below 200 µg/day and for LDL-cholesterol. Blood selenium levels at the end of the studies were positively associated with adverse effects on all endpoints. Conclusions This first dose-response meta-analysis of the effects of selenium on blood lipids highlights the potentially adverse effects of this trace element, in the amount and the chemical forms used in the trials. Key messages • Elevated selenium levels correlated with adverse effects on lipid profile. • Selenium doses exceeding 200 µg/day showed adverse effects on total and HDL cholesterol and triglycerides levels.

Evaluation of renal functional reserve in patients with preserved renal function and coronary microvascular disease

Abstract Background/introduction Renal Functional Reserve (RFR) stands as a subject of significant scientific discussion,holding promise as a diagnostic tool for early detection of subclinical renal disorders. Literature establishes a link between chronic kidney disease &amp; cardiovascular disease (CVD). Purpose This study aims to assess RFR in patients with coronary microvascular dysfunction (CMD), while maintaining preserved renal function (eGFR≥60ml/min/1.73m2 by CKD-EPI criteria)&amp;proteinuria&amp;lt;400mg/24hr. The investigation seeks to provide insights into the nuanced relationship between renal function&amp;CMD, offering potential early indicators of CVD. Methods This is a single-center, prospective study enrolling patients with CMD. In the absence of significant coronary artery disease, functional coronary circulation assessment was performed. Coronary flow reserve (CFR) &amp; index of microvascular resistance (IMR) were measured invasively with bolus thermodilution technique. In all participants, RFR was estimated by endogenous creatinine clearance after oral protein load (cooked meal, 1.2gr/kg). Normal RFR was defined as≥30 ml/min/1.73m2. Also, patients with CMD were offered 24-hour Ambulatory Blood Pressure Monitoring (ABPM). Results A total of 25 participants have been enrolled so far in study: 11 without CMD - control group [7 female, 64%, mean age: 52.9±8.8 years) &amp; 14 with CMD – CMD group (11 female, 79%, mean age: 53.5±10,3 years). CMD patients were classified into 2 groups, structural &amp; functional endotype (CFR&amp;lt;2.5 &amp; IMR≥25 were considered abnormal). The RFR value for CMD &amp; control group is 7.4±6.3 vs 36.3±5.8 ml/min/1.73m2 respectively (p&amp;lt;0.05). This difference between groups remained statistically significant after controlling for confounding factors. It was found that RFR value for functional &amp; structural CMD endotype was 3.8±2.6 &amp; 9.6±7,2 ml/min/1.73m2 respectively (p=0.06). Furthermore, no statistical significance was found between RFR and IMR, CFR indices. According to data from ABPM, there were no significant differences in ambulatory blood pressure (both systolic and diastolic) between the two endotypes of CMD, as well as no relationship with RFR was observed. However, the proportion of non-dipping BP pattern was significantly higher in functional CMD endotype (p&amp;lt;0.05). It was not found correlation between RFR &amp; non-dipping phenotype. Conclusions Impaired RFR is evident across all individuals experiencing microvascular angina. Furthermore, those with functional CMD exhibit a diminished RFR when compared with their counterparts with structural CMD. RFR does not exhibit a correlation with blood pressure levels or the absence of a nocturnal dipping pattern. In light of the hypothesis asserting that appraising renal functional reserve serves as an early diagnostic measure for subclinical renal disorders, promptly recognizing individuals with distinct phenotypes could facilitate tailoring therapeutic interventions on an individual basis.Functional Coronary AngiogramCMD group baseline characteristics

Association analysis between an epigenetic alcohol risk score and blood pressure

BackgroundEpigenome‐wide association studies have identified multiple DNA methylation sites (CpGs) associated with alcohol consumption, an important lifestyle risk factor for cardiovascular diseases. This study aimed to test the hypothesis that an alcohol consumption epigenetic risk score (ERS) is associated with blood pressure (BP) traits.ResultsWe implemented an ERS based on a previously reported epigenetic signature of 144 alcohol-associated CpGs in meta-analysis of participants of European ancestry. We found a one-unit increment of ERS was associated with eleven drinks of alcohol consumed per day, on average, across several cohorts (p < 0.0001). We examined the association of the ERS with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension (HTN) in 3,898 Framingham Heart Study (FHS) participants. Cross-sectional analyses in FHS revealed that a one-unit increment of the ERS was associated with 1.93 mm Hg higher SBP (p = 4.64E−07), 0.68 mm Hg higher DBP (p = 0.006), and an odds ratio of 1.78 for HTN (p < 2E−16). Meta-analysis of the cross-sectional association of the ERS with BP traits in eight independent external cohorts (n = 11,544) showed similar relationships with BP levels, i.e., a one-unit increase in ERS was associated with 0.74 mm Hg (p = 0.002) higher SBP and 0.50 mm Hg (p = 0.0006) higher DBP, but not with HTN. Longitudinal analyses in FHS (n = 3260) and five independent external cohorts (n = 4021) showed that the baseline ERS was not associated with a change in BP over time or with incident HTN.ConclusionsOur findings demonstrate that the ERS has potential clinical utility in assessing lifestyle factors related to cardiovascular risk, especially when self-reported behavioral data (e.g., alcohol consumption) are unreliable or unavailable.Graphic

Impact of blood pressure control on the risk of stroke and mortality in patients with atrial fibrillation across different ages: a nationwide population-based study

Abstract Background High blood pressure in patients with atrial fibrillation (AF) is strongly associated with adverse outcomes, including stroke and death. The impact of blood pressure (BP) control on stroke and mortality rates among different age groups in patients with AF has not been extensively studied. Purpose To examine the impact of blood pressure on stroke and death in AF patients by age group. Methods Based on data from the Korean National Health Insurance Service database, we enrolled 194,302 patients newly diagnosed with AF between January 2009 and December 2016, who underwent health check-ups within two years. We divided patients into four groups based on age: 40-49 years, 50-59 years, 60-69 years, and 70 years and above, to analyze the primary outcome based on the level of BP control within each group. BP control was categorized into five levels. Patients with systolic BP (SBP)&amp;lt;120 mmHg and diastolic BP (DBP)&amp;lt;80 mmHg (Level 1), 120≤SBP&amp;lt;130 mmHg and DBP&amp;lt;80 mmHg (level 2), 130≤SBP&amp;lt;140 mmHg and 80≤DBP&amp;lt;90 mmHg (Level 3), 140≤SBP&amp;lt;160 mmHg and 90≤DBP&amp;lt;100 mmHg (Level 4), and patients with SBP≥160 mmHg and DBP ≥100 mmHg (Level 5). We also divided patients into five groups based according to their SBP levels. We analyzed the occurrence of stroke and death based on the level of BP control within each age group. Results Among a total of 194,302 patients, 55,142 (28%) were included in Level 1, 24,925 (13 %) in Level 2, 88,020 (46%) in Level 3, 23,179 (12%) in Level 4, and 3,036 (1%) in Level 5, categorized by blood pressure. During a median follow-up of 5.2±2.4 years, 14,409 patients had an incident stroke (incidence rate, 14.2 per 1000 person-years), and 27,230 patients died (incidence rate, 25.8 per 1000 person-years). The lowest incidence of stroke was in the group with 120≤SBP&amp;lt;130 mmHg and DBP&amp;lt;80 mmHg (Level 2) across most age groups (Figure). Stroke risk significantly increased with BP levels above 160/100 mmHg, and BP≥140/90 mmHg was associated with stroke occurrence from the age of 50 onwards. Higher SBP (160 mmHg) was consistently associated with a higher incidence of stroke across all ages (HR 1.32, 95% confidence interval (CI) 1.22-1.43 compared to SBP&amp;lt;100 mmHg). Mortality incidence was also lowest in Level 2, and a trend of gradually increasing mortality was observed as BP levels rise above this level. (Figure). Especially when SBP exceeded 160 mmHg, the probability of death also significantly increased across all age groups below 70 years old. Conclusion Uncontrolled hypertension (especially SBP&amp;gt;160 mmHg) was associated with higher risks of stroke and mortality in patients with AF. This association is notably more significant in the middle-aged group, specifically those between 40 and 59 years old, compared to older age groups. Therefore, particularly in middle-aged groups, it is crucial to emphasize adequate blood pressure control in patients with AF.Figure_DeathFigure_Stroke

Cumulative effect of lifetime smoking history on arterial stiffness and subclinical atherosclerosis in patients with arterial hypertension

Abstract Introduction Although the effect of smoking status on blood pressure (BP) changes is well known an adverse association between cumulative smoke exposure (by pack-years) and functional and structural changes in arteries of patients with high BP has not been consistently demonstrated. Aim of the study was to explore the contributions of cumulative smoke exposure to the vascular consequences of arterial hypertension. Methods Indices of vascular function and structure including carotid-femoral pulse wave velocity (PWV), augmentation index (AIx) and carotid intima media thickness (cIMT) were measured in 485 adults aged less than 60 years old without a history of cardiovascular disease. The cohort was divided into three groups according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP &amp;lt;130 and DBP &amp;lt;85 mmHg, n=242), high normal (130≤SBP&amp;lt;140 or DBP 85≤DBP&amp;lt;90mmHg, n=96), and hypertension (SBP≥140 or DBP≥90mmHg, n=147). The cohort was subdivided according to pack-years of smoking history as never smokers (0.0 pack-years), light smokers (&amp;lt;20 pack-years), moderate smokers (20-40 pack-years), and heavy smokers (&amp;gt; 40 pack-years). Results The three BP groups had similar age and metabolic parameters (body mass index, fasting blood glucose and LDL-C). Figure shows PWV, AIx and carotid IMT by smoking exposure, stratified by BP level. The lowest PWV level was observed in never smokers with normal BP; whereas heavy smokers with hypertension exhibited the highest PWV. Also of note, heavy smokers with normal BP exhibited comparable PWV to light and never smokers with hypertension. Furthermore, in smokers with more than 20 pack-years tobacco exposure, PWV was higher among patients with high normal BP compared to subjects with normal BP (all P&amp;lt;0.01). In contrast to the monotonic increases in PWV and AIx by BP and pack-years smoking history, carotid IMT was generally similar among BP groups on the basis of cumulative exposure category. This finding may indicate a plateau in subclinical atherosclerotic burden over cumulative tobacco exposure for all BP categories. Conclusion Tobacco cumulative exposure adversely modify the effect of BP on arterial stiffness. Given that most adults who smoke start before the age 18 years, efforts to promote smoking cessation should continue to target younger adults with high BP.BP, tobacco exposure-vascular changes

The importance of taste salt sensitivity in the development of kidney damage in patients with high-risked arterial hypertension

Abstract Purpose of the study to evaluate the diagnostic significance of determining taste salt sensitivity in kidney damage development in patients with high-risked arterial hypertension. Material and methods The study included 1021 patients with arterial hypertension (AH), 60% women, 40% men, aged 58.05±7.95 years. All patients underwent the R.Henkin test to determine the threshold of taste sensitivity to table salt in the family polyclinics of Aral Sea region. All patients underwent a complete blood count, a complete urinalysis, biochemical tests, determination of serum creatinine with calculation of glomerular filtration rate, microalbuminuria, urine albumin-to-creatinine ratio and uric acid level. Results Low and medium thresholds of taste salt sensitivity were determined in 149 patients (14.6%, group 1), the average NaCl concentration was 0.15±0.02%. A high threshold of taste salt sensitivity was detected in 872 patients (85.4%, group 2), the average NaCl concentration was 0.64±0.57% (p=0.0001). Patients of the 1st and 2nd groups differed in the level of systolic and diastolic blood pressure (SBP and DBP): 150.8±10.0 mmHg. versus 172.0±16.7 mmHg. p=0.0001 for SBP, 91.4±3.8 mmHg versus 100.7±10.13 mmHg, p=0.0001 for DBP in the 1st and 2nd groups respectively. At the same time, there was a noticeable direct correlation between hemodynamic parameters – SBP / DBP and NaCl concentration in the test for determining the taste sensitivity to table salt threshold (r = 0.646; r = 0.610, respectively). As a result, were detected significantly differences in GFR: 97.22±11.42 versus 70.33±16.56 (p=0.0001); MAU: 58.64±35.45 vs. 215.9±126.65 (p=0.0001); albumin to creatinine ratio: 47.88±42.73 vs. 268.46±261.05 (p=0.0001); uric acid: 227.67±43.75 vs. 337.17±86.52 (p=0.0001), for 1st and 2nd groups respectively. Conclusion A high threshold of taste salt sensitivity, determined by the R.Henken method, is associated with the level of SBP, DBP, markers of kidney damage and the level of uric acid, which increases the diagnostic significance of determining taste salt sensitivity in patients with hypertension.

Alterations of gut microbiome profiles as potential markers in patients developing acute coronary syndrome

Abstract Background Imbalanced gut microbiota or gut dysbiosis leads to systemic inflammation, one of key contributors to the development and progression of atherosclerosis. A recent study revealed the association of the gut microbiota and the severity of coronary artery lesions in patients with acute coronary syndrome (ACS). However, the gut microbiota profile in ACS patients in comparison with patients with high-risk cardiovascular disease (CVD) has not been thoroughly investigated. Purpose We aimed to compare the profiles of gut microbiome between patients with ACS and patients with high-risk CVD, as well as to determine the association between gut microbiota and CVD risk factors. Methods This cross-sectional study enrolled 24 stabilized ACS patients within 24 hrs of hospitalization and 59 outpatients in CVD clinics, as a control group. Echocardiography was done in those patients. Blood was collected for biochemical analysis, and fecal samples were collected for gut microbiome analysis via 16S RNA sequencing. Results The demographic data showed no significant differences between groups in CVD risk factors (age, levels of systolic and diastolic blood pressure, fasting glucose, high- and low-density cholesterol, and triglycerides). However, patients with ACS had greater cigarette use and alcohol consumption than the control group. For gut microbiome, both alpha and beta diversity levels of ACS group were significantly higher than those in a control group (Figure 1A-B). Differential abundance analysis by ANCOM-BC revealed significantly increased level of bacteria in the Atopobiaceae family in ACS patients, compared to controls (Figure 1C). Since Atopobiaceae was reported to be positively associated with percent atheroma volume (PAV), a marker of plaque deposit in the arteries, we found an increased number of Atopobiaceae which was positively associated with serum Troponin T level (Figure 1D), systemic inflammation (Figure 1E), and a trend to negatively correlated with LV ejection fraction. Conclusion Our findings suggested that alterations of gut microbiota occurred in ACS patients, and an increase in gut Atopobiaceae level could potentially be the predictive marker of the development of ACS in CVD patients.Figure 1

The influence of the daily salt-intake on the antihypertensive action and atrial natriuretic peptide level in patietns with angiotensin receptor neprilysin inhibition

Abstract Background The angiotensin receptor–neprilysin inhibitor (ARNI) is a drug which acts through angiotensin receptor blocking effect and the increase in atrail natriuretic peptide (ANP) through neprilysin inhibitor in hypertension (HT). These combined effects result in a reduced risk of hospitalization for heart failure or death from cardiovascular causes. ANP is also known for its various cardioprotective effects including vasodilator and natriuretic action. Acording to Guyton's pressure-natriuresis curve, the efficacy of angiotensin receptor blocker drugs is diminished in HT cases with high daily salt inatke. However, whether the effect of ARNI on HT is attenuated in patients with high daily salt intake remains unclear. Purpose The present study investigated the influence of a daily salt intake on the antihypertensive action and ANP level in patients with ARNI. Methods Fourty-four consecutive essential HT patients on ARNI were enrolled. Blood pressure and ANP level were measured at baseline (before taking ARNI) and 3 weeks later. ARNI (200mg) was prescribed and maintained during the study. In addtion, the daily salt intake was calculated using creatinine and natrium levels in urine, age, and body weight according to Japanese hypertensive guideline at baseline and 3 weeks later. Results The average age was 70±8 years old. About 50% (N=23) was male. The mean sytolic and diastolic blood pressure was 148±14mmHg and 89±10mmHg, respectively. The mean daily salt intake was 9.5±2.2 g/day at baseline. The mean ANP level was 529±300pg/ml. At follow up (3 weeks later), the mean systolic and diastolic blood pressure significanly went down to 132± 18 mmHg and 70± 9 mmHg, respectively (p=0.03). ANP level also increased from 529±300pg/ml to 793±580pg/ml. However, the mean daily salt intake was almost same as the baseline at 9.4±3.2 g/day. The patients were divided into 2 groups; high daily salt intake (N=20 with mean daily salt intake 10.5±1.7g/day)) and low daily salt intake (N=24 with 8.4±3.1g/day) groups compared to the baseline. The absolute and percentage changes in systolic blood pressure were almost same in the high and low daily salt intake groups (-12.7±15.8mmHg vs -13.7±14.2mmHg, p=0.75; -5.8±6.5% vs.-7.0±9.6%, p=0.58, respectively). However, the change rate in ANP level was significantly higer in the high daily salt intake group than in the low daily salt intake group (155±63 vs. 12±16%, p=0.01). Conclusion ARNI demonstrates effectiveness in lowering the blood pressure even in patients with higher salt intake, unlike angiotensin receptor blocker. In cases with high salt intake, the notable increase in ANP levels may contribute to decreasing blood pressure through vasodilator and natriuretic action.

Serum Irisin, Myostatin, and Myonectin Correlate with Metabolic Health Markers, Liver Disease Progression, and Blood Pressure in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease and Hypertension

Background/Objectives: Recent data indicate the involvement of skeletal muscles in the regulation of metabolism and in the pathogenesis of chronic noncommunicable diseases. The goal of our study was to describe the serum concentrations of myokines in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension (HTN) and their correlation with laboratory parameters, blood pressure (BP), and MASLD severity. Methods: A total of 67 patients with MASLD and HTN underwent anthropometric measurements, laboratory tests, and point shear-wave elastography. The serum concentrations of myokines were measured using enzyme-linked immunosorbent assay (ELISA). Results: Patients with detectable serum myonectin concentrations had significantly higher maximum systolic blood pressure (p = 0.022) and higher blood levels of uric acid (p = 0.029). Serum irisin concentration ≥ 6.1 μg/mL was associated with higher FLI values (p = 0.042) and liver stiffness (p = 0.034), as well as with slightly higher waist circumference (p = 0.082) and triglyceride level (p = 0.062). Patients with serum myostatin concentration ≥ 4.98 ng/mL were significantly older (p = 0.033) and had a lower blood albumin level (p = 0.043). Conclusions: In conclusion, the myokine profile in patients with MASLD and HTN correlates both with the severity of MASLD and the parameters characteristic of metabolic health, suggesting the possible contribution of altered irisin, myonectin, and myostatin concentrations to the occurrence of cardiometabolic risks in patients with MASLD.

Long-term administration of atorvastatin had no effect on the occurrence and progression of spontaneous hypertensive intracerebral hemorrhage in mice

Abstract Background Intracerebral hemorrhage (ICH) is a catastrophic disease with limited treatment options. Statins and low low-density lipoprotein cholesterol (LDL-C) levels have been reported to be associated with increased risk of ICH. Safety concerns of statins were raised as statins become the cornerstone of anti-atherosclerosis therapy. To date, the effect of statins on the incidence of ICH still remains a controversial topic. Purpose The aim of this study was to investigate the effect of atorvastatin on the occurrence and progression of hypertensive ICH in mice. Methods Male wild-type C57BL/6J mice, 13 months old, were randomly divided into atorvastatin (Ato, n=20) group and vehicle (Veh, n=20) group. The atorvastatin group and vehicle group were given atorvastatin (20 mg/kg) and same volume of 0.5% sodium carboxymethylcellulose by oral gavage for 8 weeks, separately. Angiotensin II (Ang II) and L-NAME were then used to induce hypertensive ICH. The time of stroke symptom onset was documented. Hemorrhage volumes were measured by spectrophotometric hemoglobin assay. Results After 8 weeks of atorvastatin or vehicle administration, serum LDL-C levels were significantly lower in the mice treated with atorvastatin than vehicle controls (0.705 vs. 1.008 mmol/L, P&amp;lt;0.001). The administration of atorvastatin did not show significant effects on the systolic blood pressure (SBP) levels when compared with the vehicle group (164 vs. 166 mmHg, P=0.497) after the induction of Ang II and L-NAME. Hemorrhage was observed in brain morphology, and was further verified by hematoxylin and eosin staining or MRI scans in mice that showed signs of stroke. During the 28-day experimental period, 75% (15/20) of mice in the atorvastatin group developed signs of ICH, and 70% (14/20) of mice in the vehicle group developed in the similar time window. The incidence of hypertensive ICH had no significant difference between atorvastatin and vehicle groups (Log-rank P=0.761). Hemorrhage volumes were also comparable between the two groups (1.462 vs. 1.392 uL, P=0.788). Conclusion Reducing serum LDL-C levels by long-term administration of atorvastatin had no effect on the occurrence and progression of spontaneous hypertensive ICH in middle-aged mice.

Plasma cytokines are associated with major adverse cardiovascular events in follow-up of patients undergoing carotid endarterectomy

Abstract Background Patients with carotid artery disease undergoing carotid endarterectomy (CEA) have a high risk of experiencing Major Adverse Cardiovascular Events (MACE) after surgery. The occurrence of MACE in CEA-treated patients is not predicted by common cardiovascular (CV) risk factors. Purpose We aimed to identify the association between plasma and plaque inflammatory cytokines and the incidence of MACE in the follow-up after CEA. We hypothesized that MACE is related to a higher level of circulating inflammatory cytokines at the time of surgery. Methods We prospectively enrolled patients with carotid artery disease undergoing CEA. Plasma and carotid plaques were collected during the surgery. Inflammatory cytokines (MCP-1/CCL2, IL-8/CXCL8, IFN-gamma, IL-10, IL-1beta/IL-1F2, IL-6, PDGF-AA, PDGF-AB/BB, TNF-alpha, VEGF) were measured in plasma and tissue homogenates using a customized 10-plex Luminex assay. Baseline demographics and clinical data for all the patients were extracted from electronic health records. MACE after CEA was defined as a composite measure of nonfatal cardiac events such as myocardial infarction with or without revascularization, cerebrovascular events (ischemic stroke, TIA, and amaurosis fugax), and all-cause mortality. Results Of 107 patients who underwent CEA with a median age of 73 (67-78) years, 57 (53.2%) experienced MACE during a median follow-up of 5.2 [2.2-9.3] years: 23 (40.3%) cardiac events, 9 (15.7%) CVA, and 25 (43.8%) all-cause mortality. Plaque cytokines levels did not differ between the groups with and without MACE in the follow-up after CEA. Instead, plasma cytokines were associated with MACE in the follow-up after CEA, as summarized in Figure 1. In the logistic regression analysis, plasma levels of MCP-1/CCL2, IFN-gamma, and TNF-alpha were independent predictors of MACE in follow-up post-CEA in univariate and multivariable models adjusted for CV risk factors such as age, BMI, systolic and diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, and glucose level: MCP1/CCL2 (HR 1.009 [1.002-1.015]; p=0.007), IFN-gamma (HR 1.368 [1.014-1.845]; p=0.040), and TNF-alpha (HR 1.121 [1.022-1.228]; p=0.015) (Table 1). Conclusions Plasma levels of CCL2, IFN-gamma, and TNF-alpha are associated with the high incidence of MACE in the follow-up after CEA, indicating that these are potential biomarkers of MACE in this patient population and potential therapeutic targets in patients' progression of systemic atherosclerosis.Plasma cytokines and MACE after CEACytokines logistic regression analysis

The effect of spironolactone versus eplerenone on blood pressure targets in resistant hypertension patients

Abstract Objective to evaluate different effects on blood pressure (BP) control in two treatment options spironolactone (SPIR) versus eplerenone (EPL) as an add-on therapy in resistant hypertensive (RAH) patients. Design and methods: We studied 208 patients with true RAH confirmed by the office and ambulatory BP monitoring (ABPM) despite the use of 3 antihypertensive medications including a calcium channel blocker, a blocker of the renin-angiotensin system, and a thiazide diuretic with maximally tolerated doses for at least 3 months. Patients were randomized into 2 groups throughout 12 weeks of once-daily treatment with SPIR (25–50 mg) or EPL (25-50 mg) in addition to their baseline triple-combination and then rotated with drugs. BP was measured in the office and by ABPM. Changes in laboratory tests were also studied. The predictive values of plasma aldosterone, active renin concentration (ARC), aldosterone-renin ratio (ARR), and serum potassium were analyzed to determine the antihypertensive response. Results There were no significant differences in the reduction of average office BP, average systolic 24-h, daytime, and nighttime BP by SPIR and EPL. SPIR reduced average diastolic 24-h BP by 7.3 mm Hg, diastolic daytime BP by 7.2 mm Hg, and diastolic nighttime BP by 7.5 mm Hg compared with a reduction of 5.6 mm Hg (P = 0.01), 5.6 mm Hg (P = 0.03) and 4.2 mm Hg (P = 0.0001) with EPL, respectively. Overall, 40.7 % RAH patients achieved targets of clinical BP and 24-h ABPM levels on SPIR and 33.3 % on EPL (Р = 0.002). After 12 weeks of treatment mean plasma potassium concentrations increased by 7.1 (P = 0.0001) on SPIR and by 5.0 % (Р = 0.0001) on EPL, but eGFR did not significantly change on the two drugs. Plasma aldosterone (β = 0.498, Р = 0.02) and ARC (β= -0.374, Р = 0.04) were predictors of the BP-lowering effect of SPIR and plasma aldosterone (β = 0.453, Р = 0.04) was a predictor of reduction BP for EPL in multivariate modeling. Breast pain or tenderness, changes in sex drive, and irregular menstrual cycles or spotting were more often by SPIR than by EPL (5.2 % vs 1.9 %, respectively, P = 0.04). Conclusions The greater antihypertensive effect of SPIR is related to aldosterone status, ARS level in resistant hypertension. EPL may be recommended for RAH patients who have high serum potassium levels that cannot tolerate spironolactone and for people with systolic resistant hypertension.