Blood Pressure Profile Research Articles

A novel cuffless blood pressure monitoring device in hypertension care

Background: Hypertension management is challenged by the dynamic nature of blood pressure (BP) fluctuations. These fluctuations are influenced by factors such as physical activity, emotional changes, and sleep patterns. Traditional guidelines focus on static measurements taken in clinical settings. However, these readings may not accurately represent an individual’s typical BP levels. This approach can lead to misdiagnoses, such as white coat or masked hypertension, resulting in either unnecessary treatment or missed diagnoses.Current Concepts: Recent global hypertension guidelines emphasize the importance of home BP monitoring and 24-hour ambulatory BP measurements for more accurate diagnoses and treatment plans. However, several barriers exist, such as the high cost of ambulatory BP devices and practical challenges associated with home BP monitoring, which limit their widespread utilization. Despite these challenges, integrating BP measurements into mobile devices offers a promising approach to monitoring BP outside the clinical setting. Various innovative approaches have been developed, including smartwatches utilizing photoplethysmography sensors and machine learning algorithms. However, their accuracy and the need for periodic calibration are areas of concern.Discussion and Conclusion: Mobile device BP monitoring represents a significant advancement in hypertension management, offering the potential for continuous, convenient, and less intrusive monitoring. Despite these potential benefits, challenges such as device accuracy verification, large-scale data interpretation, and calibration must be addressed. The future of hypertension management will likely rely on these technologies, along with traditional methods, to provide better insight into individual BP profiles. This integration promises to improve hypertension diagnosis, management, and ultimately patient outcomes, although further research and development are necessary to overcome the current limitations.

Changes in body weight and composition, metabolic parameters, and quality of life in patients with type 2 diabetes treated with subcutaneous semaglutide in real-world clinical practice.

Subcutaneous once-weekly (ow) semaglutide is a recent treatment option for type 2 diabetes (T2D) and obesity, but real-world data on weight loss and associated changes in body composition, nutrients intake, and quality of life are still scarce. This observational, prospective clinical study involved all T2D patients starting ow semaglutide according to routine care between December 2021 and February 2022. Clinical information was collected after 6 months (T6) and 12 months (T12) from semaglutide initiation (T0). Bioelectrical Impedance Analysis (BIA) was performed to measure changes in body composition. Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the 36 - items Short Form Health Survey (SF-36) were administered as patient-reported outcomes (PROs). Changes in continuous endpoints (weight, body composition, nutrients intake, other clinical parameters, and PROs) were assessed using mixed models for repeated measurements. Overall, 90 patients (age 63.0 ± 10.0 years; diabetes duration 7.6 ± 5.9 years; 58.9% men; HbA1c 7.7 ± 1.1%; weight 95.4 ± 19.4 Kg, BMI 34.6 ± 6.4 Kg/m2; 36.7% naïve to diabetes treatment, 43.3% on metformin, 10.0% on dual oral therapy, and 10.0% treated with schemes including insulin) were included in the study. After 6 months from semaglutide initiation, body weight significantly decrease by -4.69 Kg (95%CI -6.19;-3.19) (primary endpoint). After 12 months, body weight was further reduced (-5.38 Kg; 95%CI -7.79;-2.97). At BIA, fat mass was significantly reduced by 2.1 Kg after 6 months but only slightly reduced after 12 months vs. baseline; lean mass was also significantly reduced by over 3 Kg both at 6 and 12 months. Intake of all nutrients declined in the first 6 months of therapy, although only lipids reduction reached the statistical significance (-6.73g; p=0.02). Statistically significant improvements in BMI, waist circumference, glycemic control, blood pressure and lipid profile were documented. Satisfaction with treatment (DTSQ questionnaire) and mental health (MCS score of SF-36 questionnaire) significantly increased during the follow-up. The study documented real-world benefits of semaglutide for treating obesity in T2D subjects, with important changes on clinical and patient-reported outcomes. Loss of lean mass associated with weight loss warrants attention; parallel strategies to preserve skeletal muscle and improve physical function, i.e. nutritional education and structured exercise, are of great importance.

Short-Term Variability of Both Brachial and Aortic Blood Pressure is Increased in Patients with Immune-mediated Chronic Inflammation.

Blood pressure (BP) variability (BPV) has emerged as an indicator of subclinical organ damage and an independent predictor of cardiovascular disease (CVD) morbidity and mortality in high-risk populations. We aimed to assess short-term variability of both brachial and aortic BP in psoriasis, a common immune-mediated inflammatory disorder characterized by increased CVD risk. Psoriasis patients and non-psoriasis individuals had their BP assessed throughout a 24h period (Mobil-O-Graph device). Brachial and aortic BPV during the 24h and the respective daytime and nighttime periods was calculated from relevant ambulatory BP profiles. In-house software was applied to automatically calculate average real variability (ARV) of brachial and aortic systolic (bSBP, aSBP) and diastolic BP (bDPB, aDBP), and the weighted standard deviation (wSD) of 24h bSBP/aSBP. 24h pulse wave velocity (PWV) and augmentation index (AIx) were used as widely applied markers of arterial stiffness. Psoriasis patients (n = 74) presented increased ARV of 24h and daytime bSBP/aSBP, and increased ARV of 24h and daytime bDBP/aDBP, compared to controls (n = 40). PWV and AIx correlated with ARV of 24h bSBP/aSBP, daytime bSBP/aSBP, while PWV further correlated with ARV of nighttime aSBP. The observed associations with PWV, yet not AIx, with indices of BPV remained significant after adjusting for CVD risk factors. This is the first study reporting increased 24h variability of both brachial and aortic BP in psoriasis. The association of short-term BPV with arterial stiffness implies a potential role of BPV in terms of CVD risk stratification in patients with chronic immune-mediated inflammation.

EFFECT OF DAPAGLIFLOZIN AND EMPAGLIFLOZIN ON BODY WEIGHT, LIPID PROFILE AND BLOOD PRESSURE IN TYPE 2 DIABETICS

Background: Cardiovascular disease (CVD) is a leading cause of death in type 2 diabetes mellitus (T2DM) patients with risk factors including weight, lipid profile, and blood pressure. Evidence suggests sodium-glucose co-transporter 2 (SGLT-2) inhibitors benefit T2DM patients. This study investigated the effects of SGLT-2 inhibitors on these risk factors in T2DM patients. Methods: This quasi-experimental study at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan randomized T2DM patients with inadequate glycaemic control. First group received dapagliflozin 5?10 mg and second group received empagliflozin 10-25 mg as add-on therapy to conventional antidiabetic drugs for 12 weeks. The dose was adjusted based on serum blood sugar, with primary endpoints assessing changes in glycaemic control (blood sugar and HbA1c) from baseline. Secondary endpoints included recording additional glycaemic effects (body weight, BMI, lipid profile, and blood pressure) from baseline to endpoint. Results: Both drugs showed excellent tolerability and safety profiles with no major adverse effects. Significant reductions in body weight (empagliflozin 86.7±18 to 78±16.5 Kg, p=0.001; dapagliflozin 89.8±12 to 83±10 Kg, p=0.005), and BMI (empagliflozin 28±5.5 to 26.5±4.2 Kg/m², p=0.003; dapagliflozin 29.6±4.2 to 25.7±5.8 Kg/m², p=0.002) were observed. Both drugs significantly improved glycaemic control, fasting blood sugar (empagliflozin 180±32 to 140±44 mg/dL, p=0.003; dapagliflozin 190±48 to 150±33 mg/dL, p=0.005) and HbA1c (empagliflozin 9.7±2.6 to 7.5±1.8%, p=0.004; dapagliflozin 9.0±1.82 to 7.0±2.2%, p=0.001). Neither drug showed significant improvements in blood pressure or serum lipid profile. Conclusion: Empagliflozin and dapagliflozin have a modest effect on CVD risk factors in T2DM patients. Pak J Physiol 2024;20(2):36-40

Aphrodisiaca Activity of Momordica charantia L. and Areca catechu L. Ethanolic Extract Againts Blood Pressure and Body Weight of White Mile Rats

Advances in the discovery of herbal medicine and the increasing popularity of traditional medicines have made accessto traditional medicines in the market increasingly easier. Bitter melon and areca nut are known to have many benefits and potential as natural medicine. Previous studies has shown the aphrodisiac effects of these two natural ingredients. This research aimed to determine the additional effects, particularly on blood pressure and body weight of rats, when bitter melon and areca nut are administered as aphrodisiacs. Test animal retrieval techniques based on complete randomized design (RAL). Blood pressure was measured using the CODA® instrument on 25 white rats divided into 5 treatment groups, namely the control group (CMC Na 0.5 % 0.5 % w/v), the bitter melon extract group at a dose of 280 mg / kg BW, the areca nut extract group at a dose of 50 mg/kg 50 mg / kg BW, the mixed bitter melon and areca nut extracts group (1: 1), and the X-Gra® group. Blood pressure profiles measured included systolic and diastolic blood as well as changes in rat body weight before and after treatment. The results of the study of systole and diastole blood pressure parameters and rat body weight in groups I, II, III, IV, V analyzed using the Tukey HSD method obtained results that were not significantly different (sig 0.05) in all groups. Based on this study, it was concluded that the aphrodisiac activity of bitter melon and areca nut seeds did not significantly influence changes in blood pressure, systole and diastole, and body weight rats.

Efficacy of combined antihypertensive therapy in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease with various polymorphisms of the CYP2C9 gene

Background. The difficulty of achieving target blood pressure (BP) levels in patients with arterial hypertension (AH) is often due to their type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). In turn, taking into account the individual genetic characteristics of the body helps to personalize treatment and make it more effective. Aim. To compare the antihypertensive efficacy of a fixed combination of amlodipine and olmesartan medoxomil (Aml/Ol-M) in patients with hypertension and T2DM, with and without NAFLD, depending on the polymorphism of the CYP2C9 gene. Materials and methods. The study included 139 patients with uncontrolled hypertension and concomitant T2DM; after diagnosis of NAFLD, they were randomized into 2 groups: without NAFLD (group 1, n=70), with NAFLD (group 2, n = 69). After discontinuation of previous ineffective antihypertensive therapy, they were prescribed a combination of Aml/Ol-M in doses of 5-10/20-40 mg/day. At baseline, 4, 8, 12 and 24 weeks, their office BP levels were determined; Also, at the initial visit and after 24 weeks of treatment, the main indicators of 24-hour blood pressure monitoring (ABPM) were measured. Patients who did not reach the blood pressure target within 12 weeks of therapy were excluded from the study. Those who continued to participate in the amplifierThe Rotor Gene-Q allele discrimination method revealed the following distribution of polymorphic variants of the CYP2C9 gene: *1/*1 was found in 52 and 47, *1/*2 – in 6 and 5, *1/*3 – in 5 and 6 subjects, for groups 1 and 2, respectively. Results. The initial levels of office BP values were significantly higher in patients of group 2 and amounted to 153,5 mm Hg for systolic and 93 mm Hg for diastolic blood pressure, compared with 145 mm Hg and 88 mm Hg those included in group 1. After 12 weeks of therapy, the achievement of target blood pressure was registered in 63 (90 %) patients of group 1 and in 58 (84,1 %) of group 2. After 24 weeks of observation, in both groups a beneficial effect of the studied combination of drugs on all indicators of ABPM was noted, but a more pronounced improvement was noted in patients with NAFLD. Along with this, significant improvements in daily blood pressure profiles were registered in both groups 1 and 2: an increase in the number of patients with the “dipper” profile and a decrease in the number of patients with the pathological “non-dipper” profile. The antihypertensive effectiveness of Aml/Ol-M has been demonstrated for all isolated allelic variants of the CYP2C9 gene. Conclusions. A 24-week study with the use of Aml/Ol-M demonstrated a high incidence of achieving office BP target values in patients with hypertension and T2DM, with and without NAFLD. However, a more pronounced decrease in ABPM levels was found in patients with NAFLD. Carriage of any of the identified polymorphic gene variantsCYP2C9 had no effect on the clinical effects of the studied combination.

Epidemiological Relationship of Photoplethysmography Signal Derived from Arterial Stiffness and Blood Pressure to Coronary Artery Disease: A Systematic Review

Current photoplethysmography (PPG) signals and electronic devices had a lot of attention including analysis of coronary heart disease, ageing of blood vessels, metabolic syndrome, endothelial cell damage, predicting the risk of coronary artery disease, and community-acquired pneumonia. This systematic review aims to analyze current technologies used to measure PPG signals. Analysis of PPG signals with patients involved in coronary artery disease and arterial stiffness and other important interests toward the future trends of computational medicine. The hypothesis is that arterial stiffness is epidemiologically related to the risk of coronary heart disease. A systematic search was conducted in different databases to acquire literature examining the use of PPG with coronary artery disease in terms of epidemiological correlations. Search terms included arterial stiffness, epidemiology, PPG, blood pressure, and coronary artery disease. Articles that do not measure PPG signals on real patients/subjects were excluded from the analysis. A total of 17 studies met the inclusion criteria for this systematic review. Nearly half of the studies used PPG with artificial intelligence/machine learning for analytical study patients, while 18% were PPG studies related to endothelial damage and blood pressure profiles, and another 18% were new development of PPG measurement devices. The rest was PPG analyzing coronary artery disease and atherosclerosis. Systematic review findings reveal PPG applications range from the epidemiology of damaged endothelial cell proliferation to advanced digital PPG analysis. Managing cardiovascular risk and exploring new areas including chronic kidney disease and ovarian cancer must be of interest and considered in future studies.

Effect of whole-body vibration on blood pressure in obese postmenopausal women. A randomized controlled study

Background. Menopause constitutes a natural biological process that reflects the end of the reproductive life of women and has been related to elevated risk factors for multiple strokes. Multiple studies have revealed that healthy women during menopause have increased abdominal obesity, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), fasting blood glucose, body mass index (BMI), and blood pressure (BP) besides reduced high-density lipoprotein (HDL). Aim. We aim to determine the impact of whole body vibration (WBV) on BP and blood lipid profile in obese postmenopausal women. Subjects and methods. Our study enrolled 30 postmenopausal women with hypertension (HTN) who were aged 55–65 years old and had a BMI of 30–34.9 Kg/m2. An experienced physician diagnosed the participants with either pre-HTN or stage 1 HTN, with BP measurements of 140/90–159/99 mmHg. The participants were assigned into two equal groups (n = 15) in a random manner. Group A received a dietary regimen, whereas Group B received the dietary regimen along with a two-month whole body vibration (WBV) training program for 30 min, 3 sessions/week. Measurements were obtained for all participants, including their BP and serum TC, TG, HDL, and LDL levels pre- and post-therapy. Results. The results demonstrated that average systolic blood pressure (SBP), diastolic blood pressure (DBP), TC, TG, and LDL values significantly decreased in both groups, with a significant reduction favoring group B. Additionally, the average HDL value exhibited a statistically significant increase in both groups, with a significant increase favoring group B. Conclusion. WBV conjugated with a suitable nutritional intervention is considered a safe, user-friendly, and highly efficient physical therapy strategy for ameliorating blood lipid levels and lowering BP in postmenopausal women with HTN.

Hyperprolactinemia of various genesis in premenopause: effect on cardiovascular risks, a practical aspect

The pathological aspects of hyperprolactinemia have been well studied to date and primarily affect changes in the reproductive system. Regardless of the genesis of hyperprolactinemia, negative changes include, first of all, dysmenorrhea and hyperan drogenism. Changes in the mammary glands include galactorrhea, mastopathy, and the development of breast cancer. The pathological effects of hyperprolactinemia on other organs and systems, including the cardiovascular system, have been studied less. Few existing studies suggest that elevated prolactin levels can potentially affect cardiovas cular risks and provoke myocardial remodeling, arterial hypertension, hyperhomocys teinemia, and disorders of the plasma lipid profile. Menopausal women are particularly vulnerable in this regard, as the cardioprotective role of estrogens is significantly re duced during this period. In this article, we examined the effect of hyperprolactinemia on the formation of cardiovascular disorders in premenopausal women. The purpose of the study was to evaluate the effect of hyperprolactinemia on the genesis of cardiovascular pathology in premenopausal women. Materials and methods: three groups of premenopausal patients were examined. The patients of the first group (n=26) had previously been diagnosed with pituitary adenoma and were treated with cabergoline, maintaining the target prolactin level for at least two years. According to pituitary MRI, prolactinoma and elevated prolactin levels were de tected in the patients of the second group (n=21), but these patients did not take prolac tin-lowering therapy for various reasons. The third group consisted of the patients with idiopathic hyperprolactinemia who did not receive prolactin-lowering therapy (n=19). The patients of all three groups underwent general clinical examination, determination of the daily blood pressure profile, ECG, echocardiography, determination of the level of lipidogram, homocysteine, and other markers of cardiovascular risk. The results of the study showed that regardless of its genesis, pathological hyperprolactinemia influences the development of cardiovascular pathology in premenopausal women.

Metformin Monotherapy With and Without Lifestyle Changes Affects Anthropometric Parameters, Blood Pressure, Blood Glucose, and Lipid Profile in Indian Patients With Newly Diagnosed Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) is a consequence of insulin resistance, insulin deficiency, or both. It is usually seen in adults and is a consequence of genetic (polygenic inheritance), endogenous (obesity and or hormonal factors), and environmental factors (e.g., obesogenic environment, endocrine disrupting chemicals, stress, and medicines). The prevalence of T2DM has increased over the past few decades. South Asians, including Indians, are more prone to central adiposity and develop lifestyle diseases like T2DM at body mass index values lower than those considered normal for the Western population. Generally, the first line of treatment is metformin monotherapy with lifestyle changes in patients with T2DM. Most of the research conducted on this drug is on Western subjects. Since the Indian population has genetic differences in the site of deposition of adipose and is more prone to develop lifestyle diseases, the effect of metformin may be different in Indians. Seventy-one (34 female, non-pregnant, non-lactating) adults with newly diagnosed T2DM were recruited in this short-duration pilot study after obtaining written informed consent. Patients regularly taking any drug were excluded, as were patients with chronic comorbidities. Treatment was initiated with metformin 500 mg OD. Lifestyle changes were recommended according to the age and physical condition of the patients. Anthropometric parameters (age, weight, height, BMI, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)), blood pressure, glycemic status (fasting and 2 h PP glucose and HbA1c), and lipid profile of the subjects were recorded before initiating and six months after initiating metformin monotherapy with lifestyle changes. Small but statistically significant improvements were observed in the WHR,WHtR, blood pressure, blood glucose, and glycated hemoglobin. Although improvement was also observed in weight and lipid profile, these changes were not statistically significant. This study shows that metformin monotherapy with lifestyle changes is suitable for patients of Indian origin and results in improvement in the WHR, WHtR, blood pressure, plasma glucose, and glycated hemoglobin.

The dietary changes during Ramadan and their impact on anthropometry, blood pressure, and metabolic profile.

The effect of Ramadan intermittent fasting (RIF) on the metabolic profile, anthropometry and blood pressure has been investigated in multiple studies. However, it is still unknown to what extent changes in nutrient intakes contribute to these changes. This observational study was conducted in London (UK) in 2019. The study collected diverse data from a community-based sample in London before and during/after Ramadan. Collected data included a 3-day food diary (before and during Ramadan), as well as blood samples, anthropometric measurements and blood pressure (before and after Ramadan). The food diary was translated into nutritional data using nutrition software "Nutritics." The changes in nutrient intakes were investigated using a mixed-effects regression model. The impact of adjusting for nutrient intake change was investigated on the absolute difference of metabolites (Nightingale platform), systolic/diastolic blood pressure and anthropometric measures. The study collected data on food intake before and during Ramadan from 56 participants; the mean age was 44.7 ± 17.3, and 51.8% (n = 29) were females. We found a change in the intake of 11 nutritional factors, glucose, fructose, betaine, sugars, sugars as monosaccharide equivalents, lutein/zeaxanthin, starch, starch as monosaccharide equivalents, proline, glutamic acid and lycopene. No changes in quantities or proportions of macronutrients, carbohydrates, protein and fat. Mainly, the changes in diet during Ramadan are characterized by more consumption of sugars (62%, p < 0.001) and a lower intake of starch (-21%, p = 0.012). The changes in 14 metabolite levels (two glycolysis-related metabolites, one amino acid, two ketone bodies, two triglyceride, six lipoprotein subclasses, and an inflammation marker) after Ramadan were partially associated with some changes in nutrient intakes during Ramadan, especially betaine, fructose, glucose, starches and sugars. The lutein/zeaxanthin intake change explained inversely 14% of systolic blood pressure changes. Moreover, BMI and weight changes were partially explained by changes in intake of fat (7%; 9%), monounsaturated fat (6%; 7%), starch (8%; 9%), and starch as monosaccharide equivalents (8%; 9%) intakes in a direct relationship. Diet changes during Ramadan were associated partially with the observed changes in the metabolic profile, blood pressure and anthropometry. This confirms the changes associated with RIF in the metabolic profile, blood pressure and anthropometry are not an absolute physiological response to the diet transition occurring during Ramadan.

Clinical Effectiveness of the Fixed‐Dose vs Free‐Dose Triple Combinations in Patients with Uncontrolled Arterial Hypertension

Background: The purpose of our study was a comparative assessment of the antihypertensive effectiveness of 2 triple combination antihypertensive therapy (AHT) regimens in a free-dose and fixed-dose combination of perindopril, indapamide, and amlodipine in hypertensive patients with high cardiovascular risk and a poor response to the 2-drug combinations in the clinic practice. Methods and Results: Our study included 143 patients (79 men and 88 women) with arterial hypertension (AH) Grades 1-3 (ESC/ESH, 2018) and high cardiovascular risk who did not achieve the target blood pressure (TBP) on dual combination AHT. The mean age of patients was 55.76±9.35 years; the average duration of AH was 10.69±6.61 years. All patients underwent the examinations according to the 2018 ESC/ESH Guidelines for the management of arterial hypertension. Patients included in the study were divided into 2 groups using the envelope method: Group 1 (n=84) received a fixed-dose, triple combination of perindopril, indapamide, and amlodipine; Group 2 (n=83) received a free-dose combination of these drugs. In both groups, treatment began after discontinuation of previous therapy, with a low dose of a triple combination of antihypertensive drugs (perindopril [5 mg/day], indapamide [1.25 mg/day], amlodipine [5 mg/day]) in the form of a fixed or free combination. The initial doses of perindopril/indapamide/amlodipine in both groups were not statistically different: 6.9±2.4/1.74±0.6/7.1±2.4mg/day in Group 1 and 6.9±2.7/1.95±0.6/7.1±2.5 mg/day in Group 2. After 4 weeks of therapy, if necessary, the doses of drugs were increased, starting with perindopril; the next adjustment of drug doses was carried out after 12 weeks of therapy. The final treatment results were determined after 24 weeks of AHT. Target blood pressure (TBP) of &lt;140/90 mmHg was reached by 94.4% of patients in Group 1 and 83.3% in Group 2 (χ²=7.471, Р=0,006); TBP of &lt;130/80 mmHg was reached by 70% of patients in Group 1 and 42% in Group 2 (χ²=11.61, Р=0,0001). A significant improvement in the diurnal BP profile was also revealed during treatment. According to ABPM data, both groups achieved TBP in terms of the average 24-h and average daytime systolic blood pressure (SBP) and diastolic blood pressure (DBP). Regarding average nighttime SBP and DBP and normalization of average nighttime diastolic blood pressure variability, target values were achieved only in Group 1(P=0.028). In both groups, 24-week triple-combination therapy led to a significant decrease in central SBP, central DBP, and pulse wave velocity (PWV). At the same time, the positive dynamics of central SBP were more pronounced in Group 1 than in Group 2 (Table 4), and PWV in Group 1 reached standard values. Conclusion: The results of our study showed that in the treatment of uncontrolled hypertension on previous therapy in AH patients with high cardiovascular risk, a single-pill triple combination of the ACEI perindopril, the CCB amlodipine, and the thiazide-like diuretic indapamide contributed to the effective daily blood pressure control, the improvement of diurnal blood pressure profile, and a positive effect on central blood pressure and PWV, thereby having a positive impact on the prognosis and quality of life of AH patients with high cardiovascular risk.

Profile of hypertensive Indonesian patients in a cardiovascular hospital using ambulatory blood pressure monitoring focused on resistant hypertension

ObjectiveDespite being the gold standard for diagnosing hypertension, the utilization of ambulatory blood pressure monitoring (ABPM) in clinical practice in Indonesia is still uncommon. This study aims to determine the blood pressure profile of hypertensive patients, with a focus on resistant hypertension (RH), by using ABPM reports and assessing its correlation with CV comorbidities. MethodsThis cross-sectional study analyzed 164 ABPM reports of hypertensive patients who were referred for 24-h ABPM at Hasna Medika Palimanan Cardiovascular Hospital, Cirebon. These patients were on one or more antihypertensive medications. Only ABPM with valid readings (at least 70 % successful recording) were included in the study. The final total of ABPM reports that were included is 149. ResultsThere were 120 (80.5 %) women and 29 (19.5 %) men. The mean age was 57.3 ± 9.3 years. Sixty-four percent of the patients had coronary artery disease (CAD), and 51 % were diagnosed with heart failure (HF). Fifty percent had uncontrolled hypertension, 36 % had a white coat effect, and 13 % of patients had controlled hypertension. A total of 53 (70 %) of uncontrolled hypertensive patients had resistant hypertension. The majority of these patients were women (71.7 %) and under 55 years old (39.6 %). CAD was found to be the most prevalent comorbidity in this group. ConclusionResistant hypertension had a high prevalence in this study, with several possible causes. Therefore, RH should be managed more intensively, as it can increase the risk of major cardiovascular events and mortality.

Indicators of plasma hemostasis in hypertensive patients of different age groups

Background. Scientific works of several authors determine age-related differences in hemocoagulation hemostasis. Thus, in older people, changes in hemovascular hemostasis are noted with impaired vasomotor, anticoagulant and fibrinolytic activity of the endothelium. Anticoagulant system disorders increase with age. There are few studies on plasma hemostasis in arterial hypertension patients, especially in older age groups. Aim: The study aimed at a complex research and comparative assessment of the plasma state hemostasis parameters in older and middle-aged hypertensive patients. Materials and methods. 134 patients who were divided into 2 groups were examined. Group I (n = 65) – the older hypertensive patients (60 - 74 years); group II (n = 69) – the middle-aged hypertensive patients (45 - 59 years) respectively. 15 people were involved in the control for each of the studied groups (group III – the older persons and group IV – the middle-aged persons) comparable to the main in terms of age and sex. They were divided into 2 groups of 24-hour day profile of blood pressure: dippers and non-dippers. Fibrinogen (g/l) was determined on an Amelung KC 1A hemocoagulometer to assess the plasma hemostasis state. The fibrinolytic activity of plasma (min) was according to the Kowalski method, antithrombin III (%) with the help of Humalyzer Junior filter photometer. Results. When comparing the plasma hemostasis indicators in the older and the middle-aged patients the value of antithrombin III in the middle-aged persons exceeded the similar indicator in the older persons. That is, in older patients, on the contrary, suppression of fibrinolytic and anticoagulant activity is noted. A significant slowing of the indicator of fibrinolysis activity was found in the middle-aged patients of the dipper group compared to the control group. A significant decrease in the fibrinogen level was found in the older patients in the dipper group and its increase in the non-dipper group relative to the control. The level of the antithrombin III significantly decreased in the non-dipper group compared to normative indicators. Conclusions. 1. The significant decrease in anticoagulant activity against the background of suppressed fibrinolysis according to indicators of the plasma hemostasis of the older patients was noted. 2. The thrombogenicity of blood plasma revealed by us during the study of plasma hemostasis indicates the high probability of thrombotic complications developing in patients. _________________________________________________________________________________________ Keywords: arterial hypertension; essential hypertension; plasma hemostasis; fibrinogen; fibrinolytic activity of plasma; antithrombin III

Association of a Healthy Lifestyle With Ambulatory 24-Hour Blood Pressure Among Chinese Youths: A Cross-Sectional Study.

This study aims to explore the association between a healthy lifestyle and abnormal ambulatory blood pressure (ABP) in Chinese youths. A school-based sample of 1,296 college students was investigated. A lifestyle score was calculated by synthesizing 5 lifestyle factors, including smoking, alcohol consumption, diet, physical activity, and sleeping. The total score ranged from 0 to 5, with a higher score indicating a healthier lifestyle. This score was then divided into 3 categories representing low adherence to a healthy lifestyle (0-2), medium adherence (3), and high adherence (4-5). Abnormal 24-hour blood pressure (BP) was defined as systolic BP (SBP) ≥ 130 mm Hg and/or diastolic BP (DBP) ≥ 80 mm Hg. Abnormal daytime BP was determined as daytime SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg, while abnormal nighttime BP was characterized as nighttime SBP ≥ 120 mm Hg and/or DBP ≥ 70 mm Hg. We assessed the associations using the binomial regression model. Mean age was 18.81 years, and 74.5% were women. The prevalence of abnormal 24-hour BP, daytime BP, and nighttime BP are 4.2%, 3.7%, and 9.0%, respectively. We found that participants with a high level of adherence to a healthy lifestyle had a significantly lower prevalence of abnormal 24-hour BP [prevalence ratios (PR) = 0.15, 95% CI: 0.05, 0.48] and abnormal daytime BP (PR = 0.16, 95%CI: 0.05, 0.52), when compared to those with a low level of adherence and after adjusting for the potential covariates. A healthier lifestyle is associated with a better ambulatory BP profile among youths.

Effectiveness of herbs taken concurrently with antihypertensive drugs in managing hypertension and lipid outcomes. A systematic review and meta-analysis.

PurposeHypertension is the primary cause of mortality. Hence globally, there is a growing interest in complementing antihypertensive drugs with herbs to alleviate blood pressure among hypertensive patients. Thus, this review aimed to evaluate the effectiveness of complementing drugs with herbs on blood pressure and lipid profile outcomes, the associated factors and the types of complementary herbs alongside their consumption regimes. MethodsThis review is registered in PROSPERO on the National Institute of Health Database with an ID: CRD42021270481. Using the PICOS (population, intervention, comparison, outcome, study type) mnemonic formula and search strategy, we searched (January 2010 to February 2024) five electronic databases including Pubmed, Scopus, Web of Science, CINAHL (Cumulative Index for Nursing and Allied Health Literature) and Psychology & Behavioral Sciences Collection (PBSC). The inclusion criteria of the review were that all included papers had to be randomised control trials in English among hypertensive adults who complemented antihypertensive drugs with herbs. A Cochrane risk of bias assessment as well as a meta-analysis and narrative synthesis were conducted to answer the objectives. ResultsTwenty-five randomised controlled trials involving 1996 participants from 14 countries were included. The risk of bias among included articles was assessed and presented using the Cochrane risk of bias tool and the graphs were generated. The effects of complementing antihypertensive drugs with different herb regimes on blood pressure and lipid profile outcomes were compared to those solely on antihypertensive drugs and placebo via a random model effects meta-analysis using the Revman manager. Systolic blood pressure (SBP) and triglycerides gave a significant reduction in favour of the intervention group which complemented herbs. The overall pooled systolic blood pressure showed a reduction of (SMD=0.81, 95 % CI 0.14–1.47, p < 0.02, p for heterogeneity=0.00001, I2 =97 %) while triglycerides were (SMD=0.73, 95 % CI 0.17–1.28, p < 0.01, p for heterogeneity=0.00001, I2 =85 %). However, diastolic blood pressure, total cholesterol, HDL and LDL did not exert significant outcomes. ConclusionThe complemented herbs with antihypertensive drugs did show improvement in overall blood pressure management in the majority of the studies compared to the placebo group. Blood pressure and lipid profiles are the health outcomes that enable access to complementing herbs in controlling high blood pressure. Some limitations of this review are attributed to performance, detection and attrition bias in a few included articles alongside the presence of a high heterogeneity overall.

The metabolic profiles of patients with autologous hematopoietic stem cell transplantation with graft versus host disease.

e24010 Background: Graft versus host disease (GvHD) is a serious inflammatory complication of hematopoietic stem cell transplant (HSCT) and a leading contributor to morbidity and mortality in HSCT patients. Previous studies have identified increased risk of cardiovascular death in HSCT patients who develop GvHD and characterized echocardiographic changes associated with chronic GvHD. However, details of the metabolic derangements in HSCT patients who develop GvHD remain poorly studied. Methods: This is a retrospective study of patients who underwent HSCT at H. Lee Moffitt Cancer Center and later developed severe chronic GVHD at 1 year. Metabolic data including weight, blood pressure, and lipid profile were recorded at baseline and at 1 year after HSCT. Results: Between January 1, 2010, and December 31, 2020, 1805 patients who received allogeneic HSCT were reviewed. At 1 year, 371 patients (20.5%) had severe GVHD. Compared to baseline, patients had higher total cholesterol (209 vs 183 mg/dL, P &lt; 0.001), high-density lipoprotein (61 vs 47 mg/dL, P &lt; 0.001), and triglycerides (211 vs 163 mg/dL, P &lt; 0.001) at 1 year of follow up. Low-density lipoprotein values were not significantly different (107 vs 102 mg/dL, p = 0.15). Patient weight was significantly less at 1 year (163 vs 183 lbs, p &lt; 0.001). Although blood pressure was not significantly different between baseline and 1 year, more patients were placed on antihypertensive medications at 1 year (50% vs 31%). Conclusions: This study finds that patients who undergo allogeneic HSCT and subsequently develop severe GVHD are at risk for metabolic derangements that may worsen cardiovascular health. We specifically demonstrate an increased need for antihypertensive therapy and elevations in total cholesterol and serum triglycerides. Further research is needed on the impact of these derangements on major adverse cardiac events and the role of cardiovascular risk factor management in these patients.

Effect of Nuts on Anthropometric and Glycemic Indexes and Blood Pressure in Secondary Cardiovascular Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Nut-enriched diets have a positive impact on cardiovascular risk factors, such as body mass, blood pressure, and fasting blood glucose. However, studies in individuals undergoing secondary cardiovascular prevention show controversial results. This systematic review with meta-analysis assessed the effect of nut supplementation on anthropometric, glycemic, and blood pressure indices in patients with atherosclerotic cardiovascular disease, as well as the frequency of adverse events. Six databases were used for the search-PubMed, Cochrane Library, EMBASE, BVS (Biblioteca Virtual da Saude), Web of Science, and ClinicalTrials.gov-until February 2023, with no language restrictions. The Cochrane Handbook for Systematic Reviews of Interventions methodology and the PICOS (Population, Intervention, Comparison, Outcome, Setting/design) strategy were used. Seven independent reviewers were involved in data extraction and resolution of disagreements. Certainty of the evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. From 5187 records identified, 6 publications containing data referring to 5 randomized clinical trials (n = 436) were included in the final analyses. The nuts evaluated were almonds, pecans, Brazil nuts, and mixed nuts, with portions that varied between 5 g and 85 g (median: 30 g/day). The intervention period varied between 6 and 12 weeks. The nuts had no effect on fasting glucose and anthropometric indices, although the certainty of the evidence for most of these outcomes was low or very low. They also had no effect on systolic (mean difference [MD]: -1.16 mmHg [95% CI, -5.68 to 3.35], I2 = 0%-moderate certainty of evidence) or diastolic (MD: 0.10 mmHg [95% CI, -2.30 to 2.51], I2 = 0%-high certainty of evidence) blood pressure. It was not possible to aggregate data on adverse events. Nut supplementation had no effect on blood pressure, fasting glucose, or anthropometric profile in the context of atherosclerotic cardiovascular disease. PROSPERO registration no. CRD42020163456.

#1182 Arterial hypertension and chronic obstructive pulmonary disease—problems of choice of therapy

Abstract Background and Aims The development of hypertension in COPD is based on the early formation of endothelial dysfunction in the small and large circulatory circles, increased sympathetic activity with an imbalance in the synthesis of catecholamines, a violation of the role of the lungs in the metabolism of vasoactive substances, oxidative stress, chronic systemic inflammation, an imbalance in the renin-angiotensin-aldosterone system (RAAS). There are few studies confirming the role of RAAS components in the pathogenesis of cardiovascular changes in patients COPD. The activity of angiotensin converting enzyme (ACE) increases with hypoxia, which may play an important role in increasing the degree of systemic hypertension. An increase in the function of the RAAS is possible both under the direct influence of hypoxia and indirectly through activation of the sympathoadrenal system. To evaluate the efficacy and tolerability of the angiotensin II receptor antagonist valsartan (Nortivan) at a dose 80-160 mg per day in patients with hypertension of 1-2 degrees and COPD of stage II-IV. Method The study design is a local, open, incomparable study on the efficacy and safety of the drug Nortivan in patients with hypertension in combination with COPD. We examined 18 patients with stage II-IV in remission, suffering from grade I and II hypertension, determined in accordance with the generally accepted classification of blood pressure levels (VNOK, 2010). Results The criteria for exclusion from the study were the presence in patients of complications of hypertension, coronary heart disease, decompensated chronic pulmonary heart, endocrine diseases requiring drug correction, kidney pathology, chronic heart failure, oral steroid therapy. 10 days in the last 6 months before inclusion in the study, oncological diseases and any other conditions that could interfere with the interpretation and evaluation of the results of the study. Patients who had not previously received antihypertensive treatment were included in the study immediately, and the rest underwent a washing period for 2 weeks. Patients received Nortivan as antihypertensive therapy for 24 weeks. The effectiveness of therapy was controlled by daily monitoring blood pressure. The choice of quality criteria for the effectiveness of therapy parameters SMAD is associated with literature data and own observations on the prevalence of diurnal blood pressure profiles in patients with hypertension and COPD with no decrease or increase in blood pressure at night, when office blood pressure figures are to a lesser extent reflect the effectiveness of antihypertensive therapy. The initial dosage was 80 mg/day. With insufficient hypotensive effect, the dose of the drug was doubled at the 4th week of treatment. The basic COPD therapy did not change throughout the study period and included anticholinergic drugs (ipratropium bromide, tiotropium bromide), beta2-adrenomimetic (fe-noterol) or a combination thereof. Initially and after 24 weeks of treatment, a complete laboratory examination was performed: a clinical blood test, a biochemical blood test. The thickness of the intima-media complex of the carotid arteries and ECG was also studied. The criterion The safety of the therapy was assessed by the indicators of respiratory function, daily pulse oximetry. Conclusion The use of the drug Nortivan has shown high efficacy and safety in patients Grade I–II hypertension in combination with stage II-IV COPD. A statistically and clinically significant normalization of SMAD indicators with correction of pathological types of daily curves due to a decrease in the number of patients with an increase in or the absence of a decrease in blood pressure during the night period. The safety of using the drug in the clinical group with bronchial obstruction syndrome was confirmed by the dynamics of ventilation indicators according to spirometry and the results of daily pulse oximetry, which showed the absence of exacerbation of hypoxia during therapy.

#2990 Prevalence and risk factors of altered control of BP during the night in a large hemodialysis population investigated by 48 hours ABPM

Abstract Background and Aims Altered BP control during the night (non-dipping, reverse dipping and nocturnal hypertension) is recognized as a powerful risk factor for death and CV events in the hemodialysis (HD) population. However, these alterations have been described in relatively small studies and the epidemiology and risk factors for subtypes non-dipping and nocturnal hypertension are still poorly characterized in the current literature. We investigated the problem in a large Registry (The EURECAm Registry) that is the sole that adopted state of the art 48 h ABPM recording in the HD population. Method We included in this analysis 534 HD patients, enrolled in 7 centers, led by members of the EURECA-m working group, in 3 European countries. 48 h ABPM was measured by using well validated instruments (AAMI/ESH/ISO). As recommended by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes during the night. Hypertension was defined as 48 h blood pressure (BP) &amp;gt;130/80, nocturnal hypertension as a nighttime BP &amp;gt;120/70 mmHg, non-dipping as a night/day systolic BP fall &amp;lt;10% and reverse dipping as a night/day ratio &amp;gt;1. Results Among 534 HD patients, 317 were hypertensive and. 217 normotensive. As many as 274 patients were non-dippers (51%), 32% were reverse dippers, and 381 (71%) had nocturnal hypertension. Of note, forty-one per cent of non-dippers, 37% of reverse dippers and 19% of patients with nocturnal hypertension were normotensives. As expected, the majority of reverse dippers (87%) had frank nocturnal hypertension. In a combined analysis of non-dippers and reverse dippers, as compared to dippers, these patients more frequently exhibited atrial fibrillation and had lower Heart Rate both pre-dialysis (72± 11 vs 77±13 bpm, P = 0.004) and post-dialysis (74± 13 vs 78±14 bpm, P = 0.03) and lower serum albumin (3.9±0.4 vs 4.0±0.3 g/dL, P = 0.02) but did not differ for age and gender. Conclusion In a large cohort of HD patients investigated by the state-of-the-art technique, 48 h ABPM alterations in the nocturnal BP profile were almost universal, and nocturnal hypertension was the more prevalent alteration, followed by non-dipping and reverse dipping. These alterations were independent of age and gender. Long-term, granular follow-up analyses are warranted to identify the prognostic value of these alterations.