Blood Pressure Control Research Articles

High plasticity of temperament as a marker of flexible autonomic regulation of the cardiovascular system in urgent adaptive response to cold in young people

The properties of temperament are due to differences in the excitability of brain systems that integrate the behavior of an individual, his emotions and autonomic functions and play an important role in the adaptation of the body to the environment. The mechanisms of mutual influences of individual characteristics of temperament properties and regulation of the cardiovascular system have not been fully elucidated. The aim of this study to assess the relationship between expression of temperament traits and the autonomic regulation of the cardiovascular system in the baseline condition and in response to exposure to cold. The study involved 25 healthy male volunteers aged between 18 and 21 years. Temperament traits were measured using the Structure of Temperament Questionnaire. During the study, heart rate variability (HRV) parameters (5 min), systolic and diastolic blood pressure (SBP and DBP) were recorded at room temperature. In the period from 5 to 10 min of exposure in an UShZ-25N cold chamber (–20°C), HRV were assessed. Immediately after the subjects came out from the cold chamber, blood pressure was measured. Then, 5 min after they left the cold chamber, SBP, DBP, HRV were recorded. The results showed that in young people with different expressions of temperamental properties, no differences were found in the regulation of heart rhythm by the autonomic nervous system in the baseline condition. The high object-related plasticity, i.e. the ease of switching from one type of activity to another, linked with autonomic flexibility and blood pressure control, which restrains a significant increase in blood pressure when exposed to short-term cold, and contributes to the preservation of health.

Sex‐Dependent Manifestations of Intracranial Aneurysms

Background Intracranial aneurysms (IAs) are more common in women than in men; however, there is still limited knowledge on sex‐dependent differences regarding aneurysm location, multiplicity, rupture risk, risk factors, and histopathology. Methods This cross‐sectional, consecutive cohort study examined whether IAs differ in multiplicity, location, geometry, rupture risk, risk factors, and histology between sexes. Results We included 982 patients (714 women, 268 men) totaling 1484 IAs (1056 unruptured, 397 ruptured). A total of 363 patients (36.97%) had multiple IAs, the proportion of which was significantly higher in women. In women, the internal carotid artery (40.79%) was the most frequent location for IAs, whereas in men most were found along the anterior carotid artery territory (32.86%). Men were significantly more often diagnosed with ruptured aneurysms. Aneurysm geometry did not differ between sexes; however, ruptured aneurysms in men presented with a significantly larger neck diameter than unruptured ones. Regarding risk factors for aneurysm rupture, blood pressure control was more effective in women, whereas the effect of smoking status did not show clear sex‐dependent differences. Histologically, wall‐type classification analysis showed significantly more severe aneurysm wall types in men. Conclusion IA prevalence in women is significantly higher than in men. Women more often present with multiple IAs, whereas men were more often diagnosed with ruptured IAs. Sex‐specific differences in IA location were identified, whereas geometry of IAs did not differ between sexes. IAs in men showed a more severe histological wall type. Further research is needed to unravel the molecular mechanisms underlying these important sex‐dependent manifestations in IAs.

Long-term effectiveness and safety of tolvaptan in autosomal dominant polycystic kidney disease

Background and objectivesEvidence on the long-term use of tolvaptan in autosomal dominant polycystic kidney disease (ADPKD) is limited. The aim was to evaluate the tolvaptan effectiveness and safety in real clinical setting. Material and methodsA single-center observational study (2016–2022) involving ADPKD patients treated with tolvaptan was conducted. Annual change in serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) before and after treatment initiation were evaluated. Change in total kidney volume (TKV), blood pressure (BP) and urinary albuminuria at 12, 24 and 36 months after initiation were also determined. Adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 were analyzed. ResultsA total of 22 patients were included. No significant differences pre- vs post tolvaptan treatment in annual rate of change in eGFR (−3.52ml/min/1.73m2 [−4.98%] vs −3.98ml/min/1.73m2 [−8.48%], p=0.121) and sCr (+0.06mg/dL [4.22%] vs +0.15mg/dL [7.77%], p=0.429) were observed. Tolvaptan improved urinary osmolality at 12 (p=0.019) and 24 months (p=0.008), but not at 36 months (p=0.11). There were no changes in TKV, BP control and urinary albuminuria at 12, 24 or 36 months. A worse response was shown in patients with rapid kidney function decline (p=0.042). A 36.4% of the patients developed grade III/IV AEs. A 22.7% discontinued treatment due to unacceptable toxicity. ConclusionsThis study shows a modest benefit of tolvaptan in ADPKD patients, as well as safety concerns.

Review on Nutritional Potential of Underutilized Millets as a Miracle Grain.

The current situation, which includes changes in eating habits, an increasing population, and the unrestricted use of natural resources, has resulted in a lack of resources that could be used to provide nourishing food to everyone. Natural plant resources are quickly being depleted, so it is necessary to consider new alternatives. In addition to the staple grains of rice and wheat, many other crops are being consumed that need to be utilized to their full potential and have the potential to replace the staple crops. Millets are one of the most important underutilized crops that have the potential to be used as a nutricereal. Millets have a high nutritional value, do not produce acids, do not contain gluten, and can contribute to a healthy diet. Due to a lack of awareness regarding the nutritional value of millets, their consumption is still restricted to the population that adheres to conventional diets and is economically disadvantaged even though millets contain a significant amount of nutrients. Millets are becoming increasingly unpopular due to a lack of processing technologies, food subsidies, and the inconvenience of preparing food with millets. Millets are a Nutricereal rich in carbohydrates, dietary fibers, energy, essential fatty acids, proteins, vitamin B, and minerals such as calcium, iron, magnesium, potassium, and zinc. These nutrients help to protect against post-translational diseases such as diabetes, cancer, cardiovascular disease, and celiac disease, among others. Millets are beneficial for controlling blood pressure, blood sugar level, and thyroid function; however, despite these functional properties, millets consumption has declined. Utilizing millets and other staple food crops to develop alternative food sources has become a new area of focus for businesses in the food industry. In addition, millet consumption can help foster immunity and health, which is essential in strengthening our fight against malnutrition in children and adolescents. In this article, the authors examine the potential of millets in terms of their nutricereal qualities.

Couvelaire Syndrome: A Case Report and Literature Review

Introduction. Couvelaire syndrome is a rare complication of pregnancy involving the placenta and the uterine wall. It is caused by placental abruption, preeclampsia, or other disorders that compromise the blood supply to the placenta. Diagnosis is typically made through history, clinical evaluation, and ultrasound. This study aims to report a grave case of Couvelaire syndrome complemented by presenting a review of the relevant literature, to aid the meaning of a clinical path, as well as early and adequate diagnosis and treatment of Couvelaire syndrome, to prevent feto-maternal consequences. The treatment of Couvelaire syndrome depends on the severity of the condition and the well-being of both the mother and the fetus. If the condition is severe and poses a risk to the mother or fetus, immediate delivery may be recommended, mainly with urgent Cesarean section in general endotracheal anesthesia. If there is significant blood loss leading to a decrease in hemoglobin levels, blood transfusions may be necessary to restore normal blood volume and oxygen-carrying capacity. Part of the general treatment plan should also be the management of the underlying cause of placental abruption, for example, in cases of preeclampsia, medications are prescribed to control blood pressure and prevent seizures.

Infected Kidney Stone in a Patient with Undiagnosed ADPKD: An Unusual Source of Postpartum Sepsis

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic diseases and has an incidence rate of 1 in 1,000-2,500. It is characterized by the development of cysts throughout the renal parenchyma and causes a progressive decline in renal function and eventually renal failure. In non-pregnant patients, common complications include hypertension, chronic pain from cysts, hematuria, urinary tract infection (UTI), and nephrolithiasis. Women who have chronic kidney disease (CKD) during pregnancy are at higher risk for both maternal and neonatal adverse outcomes including preeclampsia, worsening of renal function, preterm birth, and fetal growth restriction. Specific to ADPKD, some studies reported poor fetal outcomes and decline in maternal renal function with an increased risk of developing gestational hypertension, preeclampsia, and UTI. However, this research is not consistent and other studies suggest that there is only an increase in maternal complications if they have preexisting hypertension or elevated creatinine prior to pregnancy. This case presents a patient who was diagnosed with ADPKD as part of her workup for postpartum fever of unknown origin, and ultimately sepsis, from an infected kidney stone. Case Report: A 29-year-old G2P0010 at 37 0/7 weeks was admitted for induction of labor for fetal growth restriction. She ruled in for preeclampsia with severe features during her intrapartum course. After her vaginal delivery, she remained in the hospital for blood pressure control. On PPD4, she ruled in for sepsis based on a fever of 102.2 F, hypotension, and tachycardia. Despite the absence of fundal tenderness or purulent lochia, patient was started on IV Gentamicin and Clindamycin empirically for endometritis. CT of the abdomen and pelvis showed severe polycystic kidney disease worse on the left and enlarged uterus with thickened endometrial echoes. Her urinalysis was positive for leukocyte esterase and white blood cells and blood cultures returned positive for gram negative rods; but still no source had been confirmed. Due to worsening sepsis, Internal Medicine (IM) was consulted, and antibiotics were changed to Cefepime and Flagyl. Nephrology was also consulted due to incidental finding of ADPKD and AKI. On PPD5, her leukocytosis worsened, and she continued to be febrile, so infectious disease (ID) was consulted. ID escalated the antibiotics to IV meropenem and suspected a gynecologic source of her sepsis. By PPD6, the blood cultures grew E. coli and by PPD7 her leukocytosis reached a peak of 30.5 103uL. She was transitioned to Cefazolin 1g IV q8hrs. On PPD 9, she was discharged home with 12 days of Ceftriaxone 2 g IV daily. On PPD 16, however, the patient was sent into the ED for evaluation after experiencing a fever of 101.3F in her obstetrician’s office and concern over retained products of conception due to a thickened endometrium noted on ultrasound. Despite undergoing dilation and curettage and continuing IV antibiotics, the fevers persisted. She began to report left sided flank pain. An MRI of the abdomen and pelvis was ordered and revealed moderate to severe left hydronephrosis due to an obstructing 6 mm stone at the left ureteropelvic junction. Urology was consulted and the patient had a cystoscopy, left retrograde pyelogram, ureteroscopy, and ureteral stent placement. During the procedure, purulence and sediment was noted in the left kidney, consistent with infected kidney stone. Urology suspected this was the source of her infection. She remained afebrile after the procedure and completed an additional week of Cefdinir. Upon discharge home, she followed up with urology and underwent an additional laser lithotripsy and basket extraction of stones. Discussion: While UTI and nephrolithiasis are known complications of ADPKD during pregnancy, it is important to recognize early symptoms. It is estimated that women with ADPKD have a 14% increased risk of UTI. Untreated UTIs can lead to pyelonephritis, which is associated with preterm birth, low birth weight, and pregnancy loss. A less thought about complication of ADPKD, both in the pregnant and non-pregnant population, is nephrolithiasis. It is estimated that the incidence of nephrolithiasis ranges from 10 to 36% in patients with ADPKD. Nephrolithiasis can cause obstructions, worsen UTIs, and become infected, which is what occurred with the patient described above. It is thought that having large cysts, like our patient, places them at even higher risk for nephrolithiasis due to urinary statis. Our patient had multiple risk factors for nephrolithiasis. Ultimately, we had a favorable outcome, but if her infected kidney stone was diagnosed in a timelier fashion, she could have avoided worsening sepsis and a hospital readmission. Conclusion: In patients with ADPKD and sepsis of unknown etiology, there needs to be a high suspicion for UTI, pyelonephritis, infected nephrolithiasis, and infected cysts, as all of these are associated with increased morbidity and mortality, especially during pregnancy and the post-partum period.

Infected Kidney Stone in a Patient with Undiagnosed ADPKD: An Unusual Source of Postpartum Sepsis

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic diseases and has an incidence rate of 1 in 1,000-2,500. It is characterized by the development of cysts throughout the renal parenchyma and causes a progressive decline in renal function and eventually renal failure. In non-pregnant patients, common complications include hypertension, chronic pain from cysts, hematuria, urinary tract infection (UTI), and nephrolithiasis. Women who have chronic kidney disease (CKD) during pregnancy are at higher risk for both maternal and neonatal adverse outcomes including preeclampsia, worsening of renal function, preterm birth, and fetal growth restriction. Specific to ADPKD, some studies reported poor fetal outcomes and decline in maternal renal function with an increased risk of developing gestational hypertension, preeclampsia, and UTI. However, this research is not consistent and other studies suggest that there is only an increase in maternal complications if they have preexisting hypertension or elevated creatinine prior to pregnancy. This case presents a patient who was diagnosed with ADPKD as part of her workup for postpartum fever of unknown origin, and ultimately sepsis, from an infected kidney stone. Case Report: A 29-year-old G2P0010 at 37 0/7 weeks was admitted for induction of labor for fetal growth restriction. She ruled in for preeclampsia with severe features during her intrapartum course. After her vaginal delivery, she remained in the hospital for blood pressure control. On PPD4, she ruled in for sepsis based on a fever of 102.2 F, hypotension, and tachycardia. Despite the absence of fundal tenderness or purulent lochia, patient was started on IV Gentamicin and Clindamycin empirically for endometritis. CT of the abdomen and pelvis showed severe polycystic kidney disease worse on the left and enlarged uterus with thickened endometrial echoes. Her urinalysis was positive for leukocyte esterase and white blood cells and blood cultures returned positive for gram negative rods; but still no source had been confirmed. Due to worsening sepsis, Internal Medicine (IM) was consulted, and antibiotics were changed to Cefepime and Flagyl. Nephrology was also consulted due to incidental finding of ADPKD and AKI. On PPD5, her leukocytosis worsened, and she continued to be febrile, so infectious disease (ID) was consulted. ID escalated the antibiotics to IV meropenem and suspected a gynecologic source of her sepsis. By PPD6, the blood cultures grew E. coli and by PPD7 her leukocytosis reached a peak of 30.5 103uL. She was transitioned to Cefazolin 1g IV q8hrs. On PPD 9, she was discharged home with 12 days of Ceftriaxone 2 g IV daily. On PPD 16, however, the patient was sent into the ED for evaluation after experiencing a fever of 101.3F in her obstetrician’s office and concern over retained products of conception due to a thickened endometrium noted on ultrasound. Despite undergoing dilation and curettage and continuing IV antibiotics, the fevers persisted. She began to report left sided flank pain. An MRI of the abdomen and pelvis was ordered and revealed moderate to severe left hydronephrosis due to an obstructing 6 mm stone at the left ureteropelvic junction. Urology was consulted and the patient had a cystoscopy, left retrograde pyelogram, ureteroscopy, and ureteral stent placement. During the procedure, purulence and sediment was noted in the left kidney, consistent with infected kidney stone. Urology suspected this was the source of her infection. She remained afebrile after the procedure and completed an additional week of Cefdinir. Upon discharge home, she followed up with urology and underwent an additional laser lithotripsy and basket extraction of stones. Discussion: While UTI and nephrolithiasis are known complications of ADPKD during pregnancy, it is important to recognize early symptoms. It is estimated that women with ADPKD have a 14% increased risk of UTI. Untreated UTIs can lead to pyelonephritis, which is associated with preterm birth, low birth weight, and pregnancy loss. A less thought about complication of ADPKD, both in the pregnant and non-pregnant population, is nephrolithiasis. It is estimated that the incidence of nephrolithiasis ranges from 10 to 36% in patients with ADPKD. Nephrolithiasis can cause obstructions, worsen UTIs, and become infected, which is what occurred with the patient described above. It is thought that having large cysts, like our patient, places them at even higher risk for nephrolithiasis due to urinary statis. Our patient had multiple risk factors for nephrolithiasis. Ultimately, we had a favorable outcome, but if her infected kidney stone was diagnosed in a timelier fashion, she could have avoided worsening sepsis and a hospital readmission. Conclusion: In patients with ADPKD and sepsis of unknown etiology, there needs to be a high suspicion for UTI, pyelonephritis, infected nephrolithiasis, and infected cysts, as all of these are associated with increased morbidity and mortality, especially during pregnancy and the post-partum period.

A Case of Partial Molar Pregnancy Complicated by HELLP and PRES

Introduction: The term gestational trophoblastic disease encompasses premalignant and malignant conditions arising from trophoblastic cells. Premalignant disorders include complete or partial hydatidiform mole, whereas malignant disorders include invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. Partial hydatidiform moles are triploid in nature and occur when 2 sperm fertilize a single ovum. Preeclampsia is a syndrome complicating 2-8% of pregnancies which presents as new-onset hypertension plus proteinuria. The occurrence of hemolysis, elevated liver enzymes and low platelet count, referred to as HELLP syndrome, is a severe form of preeclampsia. A related severe manifestation is posterior reversible encephalopathy syndrome (PRES) - a clinicoradiological syndrome characterized by symptoms including headache, seizures, altered consciousness and visual disturbances. PRES is commonly associated with acute hypertension. The symptoms of PRES vary widely: i.e., the visual disturbance can vary from blurred vision and homonymous hemianopsia to cortical blindness. Seizures and status epilepticus are common. Although preeclampsia and HELLP syndrome rarely occur before 20-weeks of gestation, reports have suggested early occurrences of these hypertensive disorders specifically in the setting of a molar pregnancy. Case Report: The patient is a 23-year-old, female gravida 1 at 16 week 5 days who presented to an outside emergency department with a 3-day history of progressive abdominal pain which radiated to her back, arms, and shoulders. At the outside facility, the patient had multiple systolic blood pressures greater than 160 mmHg and had a witnessed 30-second seizure which resolved with an intravenous (IV) injection of 2-mg of Lorazepam and 4-gram magnesium sulfate loading dose. She was initiated on magnesium sulfate maintenance pending transfer to our institution. On admission, the patient met criteria for eclampsia and HELLP (platelets 79,000 K/uL, AST 144 U/L, ALT 96 U/L, LDH 482 U/L, Hemoglobin 8.7 g/dL). The beta human chorionic gonadotropin level (HCG) was greater than 200,000 mIU/mL. Bedside ultrasound suggested the presence of an enlarged cystic placenta and a growth restricted fetus (estimated fetal weight 124g, 2%). The patient and her family were counseled and the decision was made to proceed with misoprostol induction and termination of the pregnancy due to maternal indications. During the induction, the patient developed significant vaginal bleeding and was taken to the operating room for an uncomplicated dilation and evacuation. After the procedure, the patient developed progressive visual blurring with 4+ hyperreflexia. Magnetic resonance imaging (MRI) of the brain with and without contrast was obtained with findings significant for PRES. The MRI revealed T2 high-signal lesions within the cortex of the bilateral occipital lobes. Neurology was consulted and recommended blood pressure control and initiation of levetiracetam for seizure prophylaxis. She was initiated on long-acting nifedipine with subsequent blood pressure control. Patient’s visual symptoms and hyperreflexia resolved. Her liver function tests, platelets, and LDH also returned to normal. The patient received contraceptive counseling to prevent pregnancy during gestational neoplastic disease surveillance period. She underwent weekly beta-hCG until negative, followed by three weekly consecutive negative levels before spacing measurements to every 3 months for a period of six months per National Comprehensive Cancer Network (NCCN) guidelines. The pathology results indicated the presence of chorionic villi composed of both large hydropic and smaller normal-appearing villi, a 69.3-gram female fetus compatible with caudal neurocutaneous defect with abnormal localization of brain tissue. The genetic profile of the villous tissue consisted of two sets of dispermic paternal alleles in addition to one set of maternal alleles consistent with a partial mole diagnosis. Discussion: There is an association between preeclampsia and molar pregnancy. Of partial hydatidiform molar pregnancies, 41.9% will develop the symptoms of preeclampsia if left untreated. Although the pathophysiology of eclampsia spectrum disorders is incompletely understood, some evidence points to the role of increased death of trophoblasts and the maternal inflammatory response to trophoblast deportation. Additional evidence points to angiogenic factor imbalance and interestingly, molar placentas produce high levels of antiangiogenic factors. Other causative agents include placental factors that trigger maternal endothelial activation. It is known that trophoblastic debris shed from the placenta into the maternal blood is associated with this condition. It has been demonstrated that trophoblastic debris from molar pregnancies also induces endothelial cell activation through heat-shock protein 70 (HSP70) expressed on a hydatidiform molar placenta, which may be a pathogenic signal to endothelial cells. This case reiterates the association between hydatidiform moles and the hypertensive disorders of pregnancy possibly supporting the theories that such disorders may share an etiologic linkage through trophoblast debris and angiogenic factor imbalance. This case also supports screening molar pregnancies for severe preeclampsia syndrome.

Clinical outcome in hypertensive patients treated with amlodipine plus bisoprolol or plus valsartan

Clinical outcome in hypertensive patients treated with amlodipine plus bisoprolol or plus valsartan

Heterogeneous Effects of Intensive Glycemic and Blood Pressure on Cardiovascular Events Among Diabetes by Living Arrangements.

Although living alone versus with others is a key social element for cardiovascular prevention in diabetes, evidence is lacking about whether the benefit of intensive glycemic and blood pressure (BP) control differs by living arrangements. We thus aim to investigate heterogeneity in the joint effect of intensive glycemic and BP control on cardiovascular events by living arrangements among participants with diabetes. This study included 4731 participants with diabetes in the ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) trial. They were randomized into 4 study arms, each with glycated hemoglobin target (intensive, <6.0% versus standard, 7.0-7.9%) and systolic BP target (intensive, <120 mm Hg versus standard <140 mm Hg). Cox proportional hazard models were used to estimate the joint effect of intensive glycemic and BP control on the composite cardiovascular outcome according to living arrangements. At a mean follow-up of 4.7 years, the cardiovascular outcome was observed in 445 (9.4%) participants. Among participants living with others, intensive treatment for both glycemia and BP showed decreased risk of cardiovascular events compared with standard treatment (hazard ratio [HR], 0.68 [95% CI, 0.51-0.92]). However, this association was not found among participants living alone (HR, 0.96 [95% CI, 0.58-1.59]). P for interaction between intensive glycemic and BP control was 0.53 among participants living with others and 0.009 among those living alone (P value for 3-way interaction including living arrangements was 0.049). We found benefits of combining intensive glycemic and BP control for cardiovascular outcomes among participants living with others but not among those living alone. Our study highlights the critical role of living arrangements in intensive care among patients with diabetes.

Management of Type A Aortic Dissection in the Emergency Department: A Comprehensive Case Report

This case report elucidates the presentation and management of a 54-year-old man with type A aortic dissection (TAAD) in the emergency department. The patient, a known diabetic with uncontrolled hypertension and a history of heavy smoking, presented with severe central chest pain radiating to the back, accompanied by diaphoresis. Clinical evaluation revealed tachycardia and normotension. An immediate computed tomography angiogram confirmed the diagnosis of TAAD. The patient received timely medical intervention with intravenous beta-blockers and was prepared for a surgical consultation. This report underscores the critical importance of rapid diagnosis, effective blood pressure control, and multidisciplinary collaboration in the management of TAAD in the emergency setting, emphasizing contemporary evidence-based practices. While the article omits details on operative procedures, it notes that the patient was discharged in stable condition postsurgery, and at the 3-month follow-up, he is progressing well.

Systematic review and meta-analysis on the prevalence and associated factors of depression among hypertensive patients in Ethiopia.

Identifying individuals at increased risk for depression allows for earlier intervention and treatment, ultimately leading to better outcomes and potentially preventing severe symptoms. However, to date, no systematic reviews or meta-analyses have estimated the prevalence of depression among hypertensive patients. Thus, this review was initiated to determine the prevalence and factors associated with depression among patients with hypertension in Ethiopia. Multiple databases, such as PubMed, African Journals Online, the Cochrane Library, and Google Scholar, were used to ensure wider coverage of relevant studies. The data extracted from Microsoft Excel were imported into STATA version 11 (Stata Corp LLC, TX, USA) for further analysis. The pooled prevalence of depression was estimated using a random effects model. To evaluate statistical heterogeneity, the Cochrane Q test and I2 statistic were used. The random effect model indicated that the pooled prevalence of depression in 12 studies conducted in Ethiopia was 32.43% (95% CI: 25.18, 39.67%). Being female (POR = 2.41; 95% CI: 1.89, 3.07, I2 = 17.7%, P = 0.302), having comorbid illnesses (POR = 3.80; 95% CI: 2.09, 6.90, I2 = 81%, P = 0.005), having poor blood pressure control (POR = 3.58; 95% CI: 2.51, 5.12, I2 = 0.0%, P = 0.716), having a family history of depression (POR = 3.43; 95% CI: 1.98, 5.96, I2 = 62.6%, P = 0.069), being single (POR = 2.30; 95% CI: 1.35, 3.99, I2 = 48.0%, P = 0.146) and having poor social support (POR = 4.24; 95% CI: 1.29, 13.98, I2 = 95.8%, P<0.001) were positively associated with depression among hypertensive patients. Overall, the results of our review showed that depression affects a significant number of Ethiopians who have hypertension. Being female, being single, having comorbidities, having poor blood pressure control, having a family history of depression, and having poor social support were factors associated with depression among patients with hypertension. For those who are depressed, improving the psycho-behavioral treatment linkage with the psychiatric unit can result in improved clinical outcomes. Prospero Registration number: CRD42024498447. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024498447.

Effectiveness of digital health interventions on adherence and control of hypertension: a systematic review and meta-analysis.

Hypertension, a risk factor for developing cardiovascular disease, is becoming increasingly prevalent worldwide. Digital health is now widely utilized for hypertension management, and numerous studies have assessed its effectiveness. The review aims to analyse the effectiveness of digital health (i.e., mobile health (mHealth), telehealth, and the combination of mHealth & telehealth) on hypertensive patients, concerning three key areas: clinical outcomes, medication adherence, and adherence to lifestyle changes, as compared to standard care. The review followed the PRISMA framework. Eight electronic databases were scanned for randomized control trials focusing on the effects of mHealth or telehealth on hypertensive patients, published between 2010 and 2023. All processes were conducted by the first two authors independently. A meta-analysis was conducted for quantitative data, while a narrative synthesis was conducted for qualitative data. In total, 74 studies involving 92 686 participants were identified. The meta-analysis favoured the interventions, revealing a significant decrease in systolic blood pressure and diastolic blood pressure for mHealth, telehealth and mHealth & telehealth groups. Nevertheless, medication adherence showed improvement only in the mHealth group, while blood pressure control showed improvement in both mHealth and mHealth & telehealth groups, and BMI showed improvement only in the mHealth group. Evidence for adherence to physical activity and DASH diet/salt intake remained inconclusive. In general, mHealth and telehealth have demonstrated their merits in improving the clinical outcomes of hypertensive patients.

Is There a Role for SGLT2 Inhibitors in Patients with End-Stage Kidney Disease?

Chronic kidney disease and end-stage kidney disease (ESKD) are well-established risk factors for cardiovascular disease (CVD), the leading cause of mortality in the dialysis population. Conventional therapies, such as statins, blood pressure control, and renin-angiotensin-aldosterone system blockade, have inadequately addressed this cardiovascular risk, highlighting the unmet need for effective treatment strategies. Sodium-glucose transporter 2 (SGLT2) inhibitors have demonstrated significant renal and cardiovascular benefits among patients with type 2 diabetes, heart failure, or CKD at risk of progression. Unfortunately, efficacy data in dialysis patients is lacking as ESKD was an exclusion criterion for all major clinical trials of SGLT2 inhibitors. This review explores the potential of SGLT2 inhibitors in improving cardiovascular outcomes among patients with ESKD, focusing on their direct cardiac effects. Recent clinical and preclinical studies have shown promising data for the application of SGLT2 inhibitors to the dialysis population. SGLT2 inhibitors may provide cardiovascular benefits to dialysis patients, not only indirectly by preserving the remaining kidney function and improving anemia but also directly by lowering intracellular sodium and calcium levels, reducing inflammation, regulating autophagy, and alleviating oxidative stress and endoplasmic reticulum stress within cardiomyocytes and endothelial cells. This review examines the current clinical evidence and experimental data supporting the use of SGLT2 inhibitors, discusses its potential safety concerns, and outlines ongoing clinical trials in the dialysis population. Further research is needed to evaluate the safety and effectiveness of SGLT2 inhibitor use among patients with ESKD.

A mixed methods approach identifying facilitators and barriers to guide adaptations to InterCARE strategies: an integrated HIV and hypertension care model in Botswana

BackgroundBotswana serves as a model of success for HIV with 95% of people living with HIV (PLWH) virally suppressed. Yet, only 19% of PLWH and hypertension have controlled blood pressure. To address this gap, InterCARE, a care model that integrates HIV and hypertension care through a) provider training; b) adapted electronic health record; and c) treatment partners (peer support), was designed. This study presents results from our baseline assessment of the determinants and factors used to guide adaptations to InterCARE implementation strategies prior to a hybrid type 2 effectiveness-implementation study.MethodsThis study employed a convergent mixed methods design across two clinics (one rural, one urban) to collect quantitative and qualitative data through facility assessments, 100 stakeholder surveys (20 each PLWH and hypertension, existing HIV treatment partners, clinical healthcare providers (HCPs), and 40 community leaders) and ten stakeholder key informative interviews (KIIs). Data were analyzed using descriptive statistics and deductive qualitative analysis organized by the Consolidated Framework for Implementation Research (CFIR) and compared to identify areas of convergence and divergence.ResultsAlthough 90.3% of 290 PLWH and hypertension at the clinics were taking antihypertensive medications, 52.8% had uncontrolled blood pressure. Results from facility assessments, surveys, and KIIs identified key determinants in the CFIR innovation and inner setting domains. Most stakeholders (> 85%) agreed that InterCARE was adaptable, compatible and would be successful at improving blood pressure control in PLWH and hypertension. HCPs agreed that there were insufficient resources (40%), consistent with facility assessments and KIIs which identified limited staffing, inconsistent electricity, and a lack of supplies as key barriers. Adaptations to InterCARE included a task-sharing strategy and expanded treatment partner training and support.ConclusionsIntegrating hypertension services into HIV clinics was perceived as more advantageous for PLWH than the current model of hypertension care delivered outside of HIV clinics. Identified barriers were used to adapt InterCARE implementation strategies for more effective intervention delivery.Trial registrationClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT05414526. Registered 18 May 2022 – Retrospectively registered.

The Global Burden of Resistant Hypertension and Potential Treatment Options.

Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains .140 mmHg or .90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.

Clustering of 24H movement behaviors associated with clinic blood pressure in older adults: a cross-sectional study.

Physical activity (PA), sedentary behavior (SB), and sleep duration are known to have an individual effect on clinic blood pressure (BP) of older adults. However, whether different patterns of these so-called movement behaviors over the 24h-cycle on BP remains poorly investigated. The study aimed to identify movement behavior patterns associated with clinic BP among older adults with chronic diseases. Cross-sectional study with 238 older adults (80.3% female; mean age 68.8 ± 6.6) with at least one chronic disease. PA, SB, and sleep duration were measured by a triaxial accelerometer. Clinic systolic BP (SBP) and diastolic BP (DBP) were obtained through an automated method following standard procedures. Non-hierarchical K-means cluster and linear regression modeling were employed to identify the clusters of movement behaviors and to examine the associations. Two clusters were identified [active and non-sedentary, n = 103 (i.e., sufficient sleep duration, higher LPA and MVPA, and lower SB) and sedentary and inactive, n = 135 (i.e., sufficient sleep duration, lower LPA and MVPA, and higher SB). Active and non-sedentary older adults presented lower systolic BP compared to sedentary and inactive ones, even after adjustments for sociodemographic and clinical characteristics (β = 6.356; CI 95% from 0.932 to 11.779; P = 0.022). No associations were found for diastolic BP. In conclusion, higher PA and lower SB were associated with lower systolic BP in older adults with chronic diseases. However, sleep duration did not modify this association. Therefore, interventions focusing on concomitantly increasing PA levels and reducing SB should be the priority for controlling blood pressure.

The Role Of Swimming Training In Preventing Preeclampsia During Pregnancy

Introduction: Preeclampsia is a serious complication that affects pregnant women and poses risks to both maternal and fetal health. Understanding the relationship between swimming training and the risk of preeclampsia is crucial in developing comprehensive guidelines and exercise programs. This knowledge can empower pregnant women and healthcare professionals to utilize swimming as part of a strategy for preventing and managing preeclampsia. Materials &amp; Methods: The research method involved a thorough literature search in various sources such as electronic databases, journals, and other related articles. Inclusion criteria were set to select studies relevant to the research topic. The results of the literature search were systematically analyzed and synthesized. Results: According to the findings of this study, swimming training has a significant role in preventing preeclampsia during pregnancy. Engaging in regular swimming exercises during pregnancy can effectively reduce the risk of developing preeclampsia. The underlying mechanisms that contribute to this preventive effect include improved blood circulation, better control of blood pressure, and a reduction in inflammation within the body. These research findings hold important implications for the development of comprehensive guidelines and exercise programs specifically designed for pregnant women. By incorporating swimming as a part of the prevention and management strategy for preeclampsia, pregnant women and healthcare professionals can benefit greatly Conclusions: The effectiveness of swimming training in preventing preeclampsia during pregnancy by improving blood circulation, blood pressure control, and reducing inflammation

Trends in cardiovascular risk factor prevalence, treatment, and control among US adolescents aged 12 to 19 years, 2001 to March 2020

BackgroundEarly-life cardiovascular risk factors (CVRFs) are known to be associated with target organ damage during adolescence and premature cardiovascular morbidity and mortality during adulthood. However, contemporary data describing whether the prevalence of CVRFs and treatment and control rates have changed are limited. This study aimed to examine the temporal trends in the prevalence, treatment, and control of CVRFs among US adolescents over the past 2 decades.MethodsThis is a serial cross-sectional study using data from nine National Health and Nutrition Examination Survey cycles (January 2001—March 2020). US adolescents (aged 12 to 19 years) with information regarding CVRFs (including hypertension, elevated blood pressure [BP], diabetes, prediabetes, hyperlipidemia, obesity, overweight, cigarette use, inactive physical activity, and poor diet quality) were included. Age-adjusted trends in CVRF prevalence, treatment, and control were examined. Joinpoint regression analysis was performed to estimate changes in the prevalence, treatment, and control over time. The variation by sociodemographic characteristics were also described.ResultsA total of 15,155 US adolescents aged 12 to 19 years (representing ≈ 32.4 million people) were included. From 2001 to March 2020, there was an increase in the prevalence of prediabetes (from 12.5% [95% confidence interval (CI), 10.2%-14.9%] to 37.6% [95% CI, 29.1%-46.2%]) and overweight/obesity (from 21.1% [95% CI, 19.3%-22.8%] to 24.8% [95% CI, 21.4%-28.2%]; from 16.0% [95% CI, 14.1%-17.9%] to 20.3% [95% CI, 17.9%-22.7%]; respectively), no improvement in the prevalence of elevated BP (from 10.4% [95% CI, 8.9%-11.8%] to 11.0% [95% CI, 8.7%-13.4%]), diabetes (from 0.7% [95% CI, 0.2%-1.2%] to 1.2% [95% CI, 0.3%-2.2%]), and poor diet quality (from 76.1% [95% CI, 74.0%-78.2%] to 71.7% [95% CI, 68.5%-74.9%]), and a decrease in the prevalence of hypertension (from 8.1% [95% CI, 6.9%-9.4%] to 5.5% [95% CI, 3.7%-7.3%]), hyperlipidemia (from 34.2% [95% CI, 30.9%-37.5%] to 22.8% [95% CI, 18.7%-26.8%]), cigarette use (from 18.0% [95% CI, 15.7%-20.3%] to 3.5% [95% CI, 2.0%-5.0%]), and inactive physical activity (from 83.0% [95% CI, 80.7%-85.3%] to 9.5% [95% CI, 4.2%-14.8%]). Sex and race/ethnicity affected the evolution of CVRF prevalence differently. Whilst treatment rates for hypertension and diabetes did not improve significantly (from 9.6% [95% CI, 3.5%-15.8%] to 6.0% [95% CI, 1.4%-10.6%]; from 51.0% [95% CI, 23.3%-78.7%] to 26.5% [95% CI, 0.0%-54.7%]; respectively), BP control was relatively stable (from 75.7% [95% CI, 56.8%-94.7%] to 73.5% [95% CI, 40.3%-100.0%]), while glycemic control improved to a certain extent, although it remained suboptimal (from 11.8% [95% CI, 0.0%-31.5%] to 62.7% [95% CI, 62.7%-62.7%]).ConclusionsFrom 2001 to March 2020, although prediabetes and overweight/obesity increased, hypertension, hyperlipidemia, cigarette use, and inactive physical activity decreased among US adolescents aged 12 to 19 years, whereas elevated BP, diabetes, and poor diet quality remained unchanged. There were disparities in CVRF prevalence and trends across sociodemographic subpopulations. While treatment and control rates for hypertension and diabetes plateaued, BP control were stable, and improved glycemic control was observed.

Extemporaneous combination therapy with nebivolol/ramipril for the treatment of hypertension: a real-world evidence study in Europe

Objectives To describe the clinical characteristics and treatment adherence in European adult hypertensive patients starting treatment with the extemporaneous combination of nebivolol and ramipril (NR-EXC). Methods Retrospective database analysis of patients receiving NR-EXC treatment across five European countries (Italy, Germany, France, Poland, Hungary) over a period ranging from 3 to 9 years (until 30 June 2020) according to data availability for the different data sources. Patient demographics, comorbidities, and treatment adherence were evaluated. Results We identified 592,472 patients starting NR-EXC. Most of them were over 60 years of age, with ramipril most commonly prescribed at 5 mg (from 30.0 to 57.2% of patients across the databases). Notable comorbidities included diabetes (19.2%) and dyslipidemia (18.2%). The study population was also highly subjected to polytherapy with antithrombotics, lipid-lowering agents, and other lowering blood pressure agents as the most co-prescribed medications, as resulted from Italian database. Up to 59% of the patients did not request a cardiologic visit during the study period. Adherence to therapy was low in 56.3% of the patients, and it was high only in 11.1% of them. Conclusions The combination of nebivolol and ramipril is frequently prescribed in Europe, but adherence to treatment is suboptimal. The transition to a single pill combination could enhance treatment adherence and streamline regimens, potentially leading to significant benefits. Improved adherence not only correlates with better blood pressure control but also reduces the risk of cardiovascular events, underscoring the importance of this development.