BP Variables Research Articles

Eight weeks of high-intensity interval vs. sprint interval training effects on overweight and obese adolescents carried out during the cool-down period of physical education classes: randomized controlled trial.

The aim of this study was to evaluate the effect of sprint interval training (SIT) and [high intensive interval training (HIIT)] carried out during the cool-down period of the physical education classes on body composition, blood pressure variables (BP) and pulse rate (PR), and cardiorespiratory fitness of adolescents who are overweight and obese, and to compare the differences in enjoyment in response to SIT vs. HIIT. For this randomized controlled trial, forty-five adolescents were recruited from a high school and were randomly placed into three groups. SIT and HIIT trained for 8 weeks, twice a week, for 12 min/session. Experimental group (EG) 3 was the control, and they maintained their regular physical education class schedule. The SIT group performed 6 sets of 60 s of work (90-95%HRmax) / 60 s of rest (50-55%HRmax), and the HIIT group performed 3 sets of 2 min of work (80-85%HRmax) / 2 min of rest (50-55%HRmax). Both experimental groups showed a significant improvement in fat mass (FM) (%) and trunk FM (kg). In addition, EG2 reported a significance improvement in lean mass (kg), blood pressure BP (mmHG), systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), PR (bpm), and VO2max (ml/kg/min). The present study found that a HIIT protocol performed during the cool-down period of the physical education classes generated adaptations such as improvement in body composition, BP variables and PR, and cardiorespiratory fitness, in overweight and obese adolescents. In contrast, the group of overweight and obese adolescents who performed SIT showed limited benefits, with changes in fat mass only.

PS-C02-3: GREATER BLOOD PRESSURE VARIABILITY MEASURED BY 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING PREDICTS THE RECURRENCE AFTER ATRIAL FIBRILLATION CATHETER ABLATION

Objective: Atrial fibrillation (AF) is an important prognostic factor even in the general population, and its clinical importance is increasing with the aging of the population. In recent years, catheter ablation (CA) of AF has become a common treatment modality, but recurrence of AF is observed in some patients. Especially, hypertension is an important risk factor for recurrence of AF after CA. Regarding blood pressure measurement, ambulatory blood pressure monitoring (ABPM) is known to provide a better prediction of cardiovascular events compared to conventional clinical BP measurement. However, the association between ambulatory BP variables (BPV) and AF recurrence after CA remains unclear. The purpose pf this study is to identify the association between BPV measured by 24-Hour ABPM device and recurrence after CA for AF. Design and method: All patients were admitted in Osaka metropolitan university hospital to undergo CA of AF, and were measured 24-hour BP monitoring using an ambulatory BP device (Mobil-O-Graph) after CA between August 2017 and April 2021. Twenty four-hour mean peripheral and central systolic/diastolic BP were separately calculated. BPV was calculated as coefficient of variation (standard deviation/mean BP). Results: A total of 107 patients were included in this study. After a median follow-up period of 563 days, AF recurrence was documented in 23 of 107 patients (21.5%). In univariate analysis, patients with AF recurrence tended to have higher age (OR = 1.08, 95%CI = 1.02–1.14, p < 0.01), serum BNP (OR = 1.00, 95%CI = 1.00–1.01, p = 0.01), CHADs2 VASc score (OR = 1.67, 95%CI = 1.22–2.29, p < 0.01), left atrial volume index (OR = 1.07, 95%CI = 1.04–1.10, p < 0.01), E/e’ (OR = 1.11, 95%CI = 1.02–1.21, p = 0.02) than those of non-AF recurrence. In ABPM variables, greater 24-hour mean peripheral and central systolic/diastolic BPV were associated with AF recurrence after CA, whereas any indices of 24-hour mean BP variables were not (Table 1.). Multivariate cox regression analysis after adjustment for relevant variables, 24-hour mean peripheral and central systolic/diastolic BPV were independently associated with AF recurrence after CA (Table 1.). Conclusions: Greater BPV measured by ABPM, either in peripheral or central, were indicated to be predictors of AF recurrence after CA. Our data suggest that BP control to aim at minimizing BPV attenuates the risk of AF recurrence after CA.

Avaliação da espectroscopia no infravermelho próximo para previsão da composição químico-bromatológica da silagem de sorgo

The objective was to evaluate the adequacy of near-infrared spectroscopy for predicting the chemical-bromatological composition of sorghum BRS 658 and BRS Ponta Negra silage, in PVC mini-silos, ensiled at grain maturation stages E7 or milky, E8 or pasty and hard mealy. The model using the Savitzky-Golay 1st Derivative for DIVMS showed lower RMSEC, RMSECV and RMSEP (5.96, 7.42, 6.96) respectively. For DIVMO, the Multiplicative Signal Correction (MSC) + Savitzky-Golay 1st Derivative model with two windows showed better performance, with higher R2 in calibration, validation and prediction (0.82, 0.72, 0.56) respectively. In the independent validation of the models, no significant difference was observed between the predicted and reference values for the BP, IVMSD and IVMOD variables. The NIRS methodology is capable of accurately predicting the protein content, in vitro digestibility of dry matter and in vitro digestibility of organic matter in sorghum silage.

Moth-Flame Optimization for Early Prediction of Heart Diseases.

Heart disease is among the leading causes of mortality globally. Predicting cardiovascular disease is a major difficulty in clinical data analysis. AI has been demonstrated to be powerful in deciding and anticipating an enormous measure of information created by the health domain. We provide a unique method for finding essential traits employing machine learning approaches in this paper, which enhances the effectiveness of identifying heart diseases. Decision tree (DT), support vector machine (SVM), artificial neural network (ANN), and K-nearest neighbor (KNN) are the classification techniques used to create the proposed system. Ensemble stacking integrates the four classification models to create a single best-fit predictive model using logistic regression. Many explorations have been directed at the identification of cardiac infection; however, the exactness of the outcomes is poor. Accordingly, to further enhance the efficiency, Moth-Flame Optimization (MFO) algorithm is proposed. The feature selection strategies are used to improve the classification accuracy while shortening the execution time of the classification system. Medical data are used to assess the probability of heart disease based on BP, age, gender, chest ache, cholesterol, blood sugar, and other variables. Results revealed that the proposed system excelled other existing models, obtaining 99% accuracy in the Cleveland dataset.

COVID-19 IMPACT ON THE PREVALENCE OF SUBCLINICAL HYPERTENSION AMONG PRACTICALLY HEALTHY MEDICAL STUDENTS

Objective: Silent arterial hypertension is not rare among young adults suffering chronic distress like medical students. COVID-19 pandemic with increased fears and anxiety, social isolation, distant learning, and decreased ACE2 receptor activity could boost hypertension and other cardiovascular risk factors. The study was aimed to compare the frequency of subclinical hypertension in cohorts of ‘apparently healthy’ young adults revealed before the COVID-19 pandemic and two years after its onset. Design and method: Medical students without any known diseases or apparent signs of ‘health problems’ enrolled. 24-hour BP monitoring and test questioning with “International Physical Activity Questionnaire” and “The Perceived Stress Scale-10” were performed in ‘pre-COVID’ November and December of 2019 (Group 1) and the same months of ‘peak-COVID’ of 2021 (Group 2). Results: A total of 160 students aged 19 to 26 years were enrolled (group 1, n = 74; group 2, n = 86). The groups did not differ with respect to gender, age, body mass index (BMI) or physical activity (table). The proportion of participants with high perceived stress level (24 and more points) was higher in group 2 vs group 1 (58.1% vs 11.2%, p < 0.001). Masked hypertension prevalence and average values of systolic and diastolic blood pressure (SBP and DBP) did not differ between groups, however daytime and nighttime BP load index was significantly higher in group 2 vs group 1 for both SBP and DBP. Conclusions: Despite the absence of significant differences in the mean BP variables, when compared with similar group from ‘pre-COVID’ period, ‘apparently healthy’ students examined after two years of the COVID-19 pandemic had significantly worsened day and night BP load indexes. These changes correlated with the increase of perceived stress levels.

The role of the multi-inflammatory index as a novel inflammation-related index in the differential diagnosis of massive and non-massive pulmonary embolism.

Systemic inflammatory response and pro-coagulator factors are critical in acute pulmonary embolism. Recently, there is increasing evidence that the multi-inflammatory index (MII) may be prognostic in many clinical situations. The study investigated whether MII-1 and MII-2 can distinguish massive (MPE) and non-massive pulmonary embolism (NMPE). A total of 146 patients (73 MPE and 73 NMPE) were included in the study that was designed as a retrospective cross-sectional analysis. Following haemogram analysis, MII-1 (platelet-to-lymphocyte x CRP) and MII-2 (neutrophil-to-lymphocyte x CRP) were calculated manually. MII-1 and 2 showed a positive significant correlation with PLR and NLR, moderate positive correlation with CPR, and weak positive correlation with PAP (P<.001). CRP, MII-1, MII-2, PAP and systolic BP variables showed strong diagnostic value in distinguishing MPE and NMPE [AUC (SE): 0.816 (0.037), 0.811 (0.038), 0.810 (0.037), 0.870 (0.032) and 0.864 (0.032); respectively] (P<.001). MPR, MPV, RDW, and PLR in distinguishing MPE and NMPE groups did not show significance (P>.05). Although MII-1 and MII-2 are simple, cheap, and easy indexes to calculate, they showed a strong ability to distinguish MPE and NMPE compared with the previously studied classical inflammatory indexes.

Abstract P188: Anxiety Is Associated With Six-year Blood Pressure Change And Incident Hypertension: Findings From The Hispanic Community Health Study/ Study Of Latinos

Introduction: Prior research on the association of anxiety with hypertension has yielded mixed results. Despite the high burden of both conditions in Hispanics/Latinos, little is known about their association in this population. This study examined the longitudinal relationship of trait anxiety with changes in BP and incidence of hypertension. Hypothesis: Higher trait anxiety at Visit 1 (V1) will be associated with greater increases in BP and incident hypertension over 6 years. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-center prospective community-based study of 16,415 diverse Hispanics/Latinos ages 18-74 at V1 (2008-11). Data included 11,048 participants with complete information on BP, trait anxiety, and other variables at V1 and V2 (2014-17). Trait anxiety was measured at V1 using the 10-item Spielberger Trait Anxiety Scale, which was dichotomized into low and high using a cut-point of 20 points, the top quartile in the HCHS/SOL cohort. BP was measured using a standardized protocol and validated automated device. Hypertension was defined as systolic BP ≥ 140 or diastolic BP ≥ 90 mm Hg or self-reported antihypertensive medication use. Linear regressions were used to examine the association of anxiety with BP change; to account for medication use, 9 mmHg and 6 mmHg were added to systolic and diastolic BP of treated participants, respectively. The association of anxiety with incident hypertension at V2 was examined using Poisson regression among those without hypertension at V1 ( N = 7,878). Estimates were adjusted for complex survey design, sociodemographic factors, baseline BP, antidepressant/anxiolytic medication use, and health conditions. Results: Mean baseline age was 45.8 years and 60% were women. Mean change was 3.13 ( SE = 15.67) in systolic and 0.21 ( SE = 9.73) in diastolic BP. Individuals with high, compared to those with low, trait anxiety had greater increases in systolic ( B = 1.10, 95% CI = 0.28-1.93, p = 0.009) and diastolic BP ( B = 0.69, 95% CI = 0.11-1.27, p = 0.02) over 6 years, after adjusting for covariates. Individuals with high, relative to those with low, trait anxiety had an 18% higher risk of hypertension (RR = 1.18, 95% CI = 1.03-1.34, p = 0.012). Conclusions: Elevated trait anxiety is associated with small increases in BP over 6 years and an 18% higher risk of hypertension among diverse Hispanics/Latino adults. Research on the mechanisms underlying these relationships among Hispanics/Latinos is warranted to develop effective interventions to prevent and treat hypertension in this population.

An exploratory, randomised, placebo-controlled, 14\xa0day trial of the soluble guanylate cyclase stimulator praliciguat in participants with type 2 diabetes and hypertension

Aims/hypothesisPraliciguat (IW-1973), a soluble guanylate cyclase stimulator, amplifies nitric oxide signalling. This exploratory trial investigated the safety, tolerability, pharmacokinetic profile and pharmacodynamic effects of praliciguat in individuals with type 2 diabetes and hypertension.MethodsThis Phase IIA, double-blind, placebo-controlled trial investigated praliciguat in 26 participants with type 2 diabetes and hypertension on stable glucose- and BP-lowering therapies. Participants were randomly allocated in a 3:5:5 ratio to three groups: placebo (n = 6), praliciguat 40 mg once daily for days 1–14 (n = 10), or praliciguat 20 mg twice daily for days 1–7 then 40 mg once daily for days 8–14 (n = 10). Assessments were made in clinic and included treatment-emergent adverse events, pharmacokinetics, metabolic variables, 24 h BP and heart rate, platelet function, reactive hyperaemia index (RHI) and plasma biomarkers. Participants, the sponsor, the investigator and clinic study staff (except designated pharmacy personnel) were blinded to group assignment.ResultsParticipants treated for 14 days with praliciguat had least-square mean change-from-baseline differences vs placebo (95% CI) of −0.7 (−1.8, 0.4) mmol/l for fasting plasma glucose, −0.7 (−1.1, −0.2) mmol/l for total cholesterol, −0.5 (−1.0, −0.1) mmol/l for LDL-cholesterol, −23 (−56, 9) for HOMA-IR in those not being treated with insulin, and −5 (−10, 1) mmHg and 3 (−1, 6) beats/min for average 24 h mean arterial pressure and heart rate, respectively. Apart from one serious adverse event (SAE; upper gastrointestinal haemorrhage), praliciguat was well tolerated. Praliciguat did not affect platelet function or RHI. Among exploratory biomarkers, plasma levels of asymmetric dimethylarginine decreased in praliciguat vs placebo recipients.Conclusions/interpretationIn participants with type 2 diabetes and hypertension on standard therapies, over 14 days praliciguat was well tolerated, except for a single SAE, and showed positive trends in metabolic and BP variables. These results support further clinical investigation of praliciguat.Trial registrationClinicalTrials.gov NCT03091920.FundingThis trial was funded by Cyclerion Therapeutics.

DIFFERENCES IN AORTIC AUGMENTATION PRESSURE BETWEEN NORMOTENSIVE AND HYPERTENSIVE SUBJECTS MEASURED IN COMMUNITY PHARMACIES IN SPAIN

Objective: Augmentation pressure (AP) and Augmentation Index (AIx) are markers of arterial stiffness that could also improve cardiovascular stratification beyond pulse wave velocity (PWV). Our objective was to study the determinants of AP and AIx in a sample of subjects attending Community Farmacies in Spain. Design and method: Cross-sectional, observational, descriptive, non-interventional study in 32 community pharmacies of the Valencia Community, belonging to SEFAC (Spanish Society of Community Pharmacies). Office BP and stiffness-related variables were measured with a validated device (MOBIL-O-GRAPH, IEM®), according to ESH-recommendations, followed by a 10 items-containing questionnaire and measurement of the waist circumference. Results: : Mean age of the 1,427 consecutive recruited patients was 56.6 years with 848 (59,4%) women and 579 (40,6%) men. Mean office braquial BP was 125/78 mmHg, central BP was 114/79 mmHg. 827 (57.9%) not treated subjects with normal BP < 140/90 mmHg were considered normotensives (NT), 600 (42.1%) patients under antihypertensive treatment were hypertensives (HT), not treated subjects with BP > 140/90 mmHg were excluded. AP and AIx were significantly higher in women compared to men (10.8 vs. 7.0 mmHg, p < 0.001 and 25.9 vs. 15.9%, p < 0.001, respectively) and in HT compared to NT (11.0 vs. 7.9 mmHg, p < 0.001 and 23.9 vs. 20.4 mmHg, p < 0.001, respectively). Dividing the sample by ten years in 7 age groups, we observed increasing AP with age, except in the group of male NT, and an increasing pattern of AIx until the age of 60 years with a plateau in the three last age groups. Multivariate logistic regression showed independent association of AP with central pulse pressure (ß = 0.48, p < 0.001), pulse wave velocity (ß = 0.16, p < 0.001), heart rate (ß = −0.23, p < 0.001), gender (ß = −0.19, p < 0.001) and height (ß = −0.07, p = 0.004), with very similar values for the same variables with AIx. Conclusions: Our study confirms the dependence of AP and AIx on gender and BP and the ability of community pharmacies to perform CV on a large scale. Further studies will show if these parameters have predictive CV value beyond arterial stiffness.

Influence of Acute Aerobic Exercise on 24-hour Ambulatory Central Blood Pressure

Ambulatory central blood pressure (cABP) assessed for 24-hours is a relatively new measurement that may be predictor of cardiovascular disease (CVD). Acute bouts of exercise lower peripheral blood pressure; however, it is currently unknown if an acute bout of vigorous exercise reduces 24-hour cABP. PURPOSE: To examine the response of cABP over 24 hours after an acute bout of aerobic exercise. METHODS: Apparently healthy adults (N=10; 6 males; age 25.9±1.8 years; body mass index 25.4±0.6 kg/m2; VO2max 46.1±2.7 ml/kg/min) completed two trials in a randomized order. Trials consisted of a progressive maximal treadmill exercise test to assess VO2max or a non-exercise control. During each trial, participants wore an ambulatory BP (ABP) monitor to record brachial and central BP variables over 24 hours. Hemodynamic variables between trials were analyzed as mean for 24 hours and by time of day; Daytime (0800-2200 hours), and Nighttime (2200- 0800 hours). Dependent t-test were used to compare 24-hour averages between control and exercise. A 2-way ANOVA with repeated measures was performed to examine time of day differences between trials. RESULTS: Over the course of 24 hours, average brachial systolic BP (bSBP) (119.6 ±2.2 vs. 122.0 ±2.5 mmHg) central systolic BP (cSBP) (108.1 ± 2.2 vs. 111.2 ± 2.4 mmHg), and mean arterial pressure (MAP) (86.9 ± 1.5 vs. 89.4 ± 1.9 mmHg) were lower (p<0.05) after exercise compared to control. A main effect for time (p<0.05) indicated that bSBP, bDBP, brachial pulse pressure, MAP, cSBP, and cDBP, were lower during nighttime compared to day time, independent of exercise. CONCLUSION: A single, vigorous bout of aerobic exercise lowers ambulatory central hemodynamics for at least 24 hours. These novel findings provide insight into the regulatory effects of exercise on blood pressure.

Blood Pressure and Haematological Indices in Twelve Communities in Ashanti, Ghana.

Hypertension is the most important risk factor for cardiovascular mortality and morbidity in Sub-Saharan Africa. In western populations, high haemoglobin levels are associated with raised BP unlike in Sub-Saharan Africa where there is a paucity of data. Our study examines the association between haematological indices with BP variables. Weight, height, BP, and whole blood indices of viscosity (Hb, haematocrit, RBC count, and MCV) were measured in 921 adults (340 men, 581 women; aged 40–75) in 12 communities in Ghana. Mean values for Hb (12.3 g/dl ± 1.7 SD), haematocrit (36.7% ± 5.2), RBC (4.10 million/μL ± 0.64), and MCV were lower than reference values used in Sub-Saharan Africa. Mean BMI was 21.1 ± 4.1 indicating a lean population. Systolic BP increased by 1.0 mmHg (95% CI 0.5–1.5), p < 0.001, for women and 0.5 (0.1–1.0), p = 0.027, for men per unit increase in haematocrit. Similar relationships were found for Hb and RBC but not for MCV or platelets. The relationships were weaker when adjusted for BMI, 0.7 mmHg (0.2–1.2) in women and 0.5 (0.0–1.0) in men. Findings for diastolic BP were similar. Overall haematological indices were low. We have found a significant, positive relationship between BP, Hb, Haematocrit, and RBC count in our population.

Nitrate-rich beetroot juice selectively lowers ambulatory pressures and LDL cholesterol in uncontrolled but not controlled hypertension: a pilot study

Dietary nitrate has been shown to increase nitrate/nitrite levels in multiple populations, with potential blood pressure lowering effects. However, there are few reports among hypertensives. We aimed to assess the effect of daily nitrate in subjects with controlled hypertension vs. uncontrolled hypertension. On day 0, hypertensives wore an ambulatory BP monitor (ABPM) for 24h and fasting blood was taken. Subjects then consumed concentrated beetroot juice (12.9mmol nitrate) for 14 consecutive days. On day 14 subjects consumed their last nitrate dose after fasting blood was drawn and again had an ABPM for 24h. According to baseline ABPM, 11 subjects had controlled BP while 8 had uncontrolled BP. There were similar, significant increases in serum nitrate/nitrite in both groups. We observed little change in BP variables among controlled hypertensives. However, there were reductions in BP variables in uncontrolled hypertensives where decreases in nighttime DBP (-6±4.8mmHg), arterial stiffness (-0.08±0.03 ambulatory arterial stiffness index) and LDL (-0.36±0.42mmol/L) reached significance (p=003, 0.05 and 0.046, respectively). Our results support the existing data suggesting an anti-hypertensive effect of nitrate-containing beetroot juice, but only among those with uncontrolled hypertension.

PP.27.15] PREVALENCE OF HYPERTENSION DETERMINED IN COMMUNAL PHARMACIES OF THE VALENCIAN COMMUNITY (RIVALFAR-STUDY)

Objective: Hypertension represents an underdiagnosed disease, its real prevalence is difficult to determine in population-based inquiries but also in observational studies. This study aims to measure the prevalence of HTN, associated risk factors and associated clinical diseases in a sanitary environment like communal pharmacies. Design and method: Cross-sectional, observational, descriptive, non-interventional study in 32 communal pharmacies of the Valencian Community, belonging to SEFAC (Spanish Society of Communal Pharmacies), between November 2015 and April 2016. BP variables were measured with a validated device (MOBIL-O-GRAPH, IEM®), according to ESH-recommendations, followed by a 10 items-containing questionnaire and measurement of the waist circumference. Results: During the first month, 638 consecutive patients were recruited. Mean age was 56,5 ± 14,1 years, the percentage of men was 38,6 %, with a global BMI of 28,5 kg/m2. We found significant differences between women and men in systolic BP (126 vs. 129, p = 0.019), diastolic BP (78 vs. 83, p < 0.001) and waist circumference (88 vs.100, p < 0.001). Prevalence of HTN (35,5 vs. 47, 0 %; OR = 1, 6; IC: 1, 12–2, 30, p < 0.009) was lower in women, but not obesity (41, 9 vs. 49, 1 %; OR = 0, 75; IC: 0, 54–1, 04, p = 0, 08) or smoking (14, 8 % vs. 19, 9 %; OR = 1, 4; IC: 0, 94–2, 18, p = 0, 09). Visits directly related to BP made up to 35, 4 % of the total count. 28, 7 % of the participants stood under antihypertensive and 26, 8 % under lipid-lowering treatment, 7, 7 % of patients were known diabetics. The prevalence of diagnosed ischemic heart disease was 6, 0 %, that of stroke 4, 2 %. Only 45, 7 % of participants considered their BP was adequately controlled. Noteworthy, under participants without known HTN, prevalence of elevated BP was 25, 3 %, whereas among already treated patients we found increased values in 29, 2 %. Conclusions: This pioneering large scale study involving communal pharmacies shows their capability to determine adequately BP, risk factors and associated clinical diseases, identifying a significant percentage of uncontrolled, already treated patients, as well as a group of de novo, naïve participants with elevated BP. Future studies shall clear if a pharmacy-based strategy is able to improve adherence and control of HTN on the long run.

PP.31.13

Objective: Blood nitrate/nitrite indicate nitric oxide (NO) bioavailability and levels are typically lower in hypertensives compared to matched controls. Dietary nitrate has recently been shown to increase plasma nitrate/nitrite and decrease BP in multiple populations, including normotensives, subjects with peripheral vascular disease or COPD and recently in both treated and untreated hypertensives. The antihypertensive effect of dietary nitrate appears attributable to its in vivo reduction to nitrite and eventually NO. In this pilot study we wanted to assess the chronic effect of daily dietary nitrate supplementation among a group of hypertensives established on diverse antihypertensive regimens.Design and method: On day 0, eligible subjects wore an ambulatory BP monitor for 24 hours and fasting blood was taken. Subjects then consumed concentrated beetroot juice (140 ml), containing 12.9mmol nitrate for 14 consecutive days. On day 14 subjects consumed their last nitrate dose and again wore an ambulatory BP monitor for ∼24 hours and fasting blood was taken. Instructions not to alter activities which may affect NO kinetics was provided. Results: We recruited 21 subjects on anti-hypertensive treatment. Table 1 displays baseline demographics and changes in BP variables following nitrate supplementation. Despite significant increases in both serum nitrate and nitrite with nitrate supplementation, there was no overall effect on BP variables and a trend towards increase heart rate. In addition, we have commenced a double-blind, randomized, placebo-controlled, crossover trial to further examine the effect of dietary nitrate supplementation among treated hypertensives. Although we are still blinded to the treatment arms, interim analysis reveal conflicting responses in both arms. This trial will be completed in May 2015. Conclusions: Our results do not support the existing data suggesting an anti-hypertensive effect of dietary nitrate. Possible explanations may include co-existing morbidities, long standing hypertension with use of multiple anti-hypertensive agents and differing nitrate dosing. Further work is required to evaluate this therapeutic concept.

Environmental social governance management: a theoretical perspective for the role of disclosure in the supply chain

This study proposes to examine the empirical association and relationship between voluntary disclosure of environmental, social, and governance management activity/practices and business performance, by investigating their causal effects. More specifically, employing data for the largest and most valued US stock-listed corporations, this study proposes to examine both the impact of voluntary disclosure of environmental, social, and governance management activity/practices on business performance, and the impact of business performance on voluntary disclosure of environmental, social, and governance management activity/practices, using a lag of E, S, G, ESG and BP variables. Stakeholder theory, institutional theory, and resource-based view RBV theory of the firm suggest that differentiation in capabilities and in resources, developed through inter-organisational workings among supply chain members, is a primary source of improved performance and sustained competitive advantage. This working together, or collaboration among supply chain members, can equally benefit other domains, including environmental, social, and governance areas, and their voluntary disclosures.

A randomized controlled trial of acupuncture in stable ischemic heart disease patients

BackgroundHeart rate variability (HRV) is reduced in stable ischemic heart disease (SIHD) patients and is associated with sudden cardiac death (SCD). We evaluated the impact of traditional acupuncture (TA) on cardiac autonomic function measured by HRV in SIHD patients. MethodsWe conducted a randomized controlled study of TA, sham acupuncture (SA), and waiting control (WC) in 151 SIHD subjects. The TA group received needle insertion at acupuncture sites, the SA group received a sham at non-acupuncture sites, while the WC group received nothing. The TA and SA groups received 3 treatments/week for 12weeks. 24-Hour, mental arithmetic stress, and cold pressor (COP) HRV was collected at entry and exit, along with BP, lipids, insulin resistance, hs-CRP, salivary cortisol, peripheral endothelial function by tonometry (PAT), and psychosocial variables. ResultsMean age was 63±10; 50% had prior myocardial infarction. Comparison of WC and SA groups demonstrated differences consistent with the unblinded WC status; therefore by design, the control groups were not merged. Exit mental stress HRV was higher in TA vs. SA for markers of parasympathetic tone (p≤0.025), including a 17% higher vagal activity (p=0.008). There were no differences in exit 24-hour or COP HRV, BP, lipids, insulin resistance, hs-CRP, salivary cortisol, PAT, or psychosocial variables. ConclusionsTA results in intermediate effects on autonomic function in SIHD patients. TA effect on HRV may be clinically relevant and should be explored further. These data document feasibility and provide sample size estimation for a clinical trial of TA in SIHD patients for the prevention of SCD. Condensed abstractWe conducted a randomized, single-blind trial of traditional acupuncture (TA) vs. sham acupuncture (SA) vs waiting control (WC) in stable ischemic heart disease (SIHD) patients to evaluate cardiac autonomic function measured by heart rate variability (HRV). Exit mental stress HRV was higher in the TA compared to SA group for time and frequency domain markers of parasympathetic tone (all p≤0.025), including a 17% higher vagal activity (p=0.008). These data document feasibility and provide sample size estimation for an outcome-based clinical trial of TA in SIHD patients for the prevention of sudden cardiac death.

Clustering of the Metabolic Syndrome Components in Adolescence: Role of Visceral Fat

Visceral fat (VF) promotes the development of metabolic syndrome (MetS), which emerges as early as in adolescence. The clustering of MetS components suggests shared etiologies, but these are largely unknown and may vary between males and females. Here, we investigated the latent structure of pre-clinical MetS in a community-based sample of 286 male and 312 female adolescents, assessing their abdominal adiposity (VF) directly with magnetic resonance imaging. Principal component analysis of the five MetS-defining variables (VF, blood pressure [BP], fasting serum triglycerides, HDL-cholesterol and glucose) identified two independent components in both males and females. The first component was sex-similar; it explained >30% of variance and was loaded by all but BP variables. The second component explained >20% of variance; it was loaded by BP similarly in both sexes but additional loading by metabolic variables was sex-specific. This sex-specificity was not detected in analyses that used waist circumference instead of VF. In adolescence, MetS-defining variables cluster into at least two sub-syndromes: (1) sex-similar metabolic abnormalities of obesity-induced insulin resistance and (2) sex-specific metabolic abnormalities associated with BP elevation. These results suggest that the etiology of MetS may involve more than one pathway and that some of the pathways may differ between males and females. Further, the sex-specific metabolic abnormalities associated with BP elevation suggest the need for sex-specific prevention and treatment strategies of MetS.

Ambulatory Blood Pressure Monitoring in Prehypertensive Subjects

Although treatment of prehypertensives is feasible and effective, it is unclear how to define those who may benefit. We hypothesized that ambulatory blood pressure monitoring (ABPM) might be a tool for selecting prehypertensive subjects, classified according to the JNC 7, who later develop drug-treated hypertension. Prehypertensives (n=107; 62 M, 45 F; age 50 ± 14 years) with or without cardiovascular risk factors were assessed for drug-treated hypertension development. They underwent ABPM at entry examination and were clinically followed-up for an average of 99 ± 42 months. Thereafter, subjects were divided into 2 groups according to the development of drug-treated hypertension. Stepwise logistic regression (LR) analysis was performed to assess the role of factors contributing independent prediction of outcome (i.e. drug-treated hypertension onset). In LR analysis body mass index [odds ratio (OR)=1.29, confidence intervals (CI)95% 1.03-1.62], female gender (OR=11.10, CI95% 2.66-46.30), total cholesterol (OR=1.03, CI95% 1.01-1.05), smoking (OR=3.90, CI95% 0.94-16.20), daytime SBP (OR=1.10, CI95% 1.01-1.19) and 24h DBP (OR=1.23, CI95% 1.08-1.41) predicted the development of hypertension. The criteria combining BP and clinical variables were superior to BP or clinical criteria alone in the correct classification of true positives and true negatives. Altogether there was an improvement of 14.02% (p < 0.01) in comparison to only clinical criteria. In the setting of global cardiovascular risk assessment, ABPM, in the early diagnosis of hypertension in prehypertensive individuals, appears as a useful tool, both diagnostically and prognostically, to index subjects who are suspected to be masked hypertensives.

The relationship of oxidative stress and cholesterol with dipping status before and after aerobic exercise training

Objective. The purpose of this study was to examine the effects of aerobic exercise training (AEXT) on dipping status in pre-hypertensive and stage-1 hypertensive individuals. A secondary purpose was to evaluate whether AEXT alters oxidative stress and endothelial biomarkers correlated to dipping status. Methods. Twenty-three subjects underwent 24-h ambulatory blood pressure monitoring at baseline and after 6 months of AEXT. AEXT consisted of training at 70% VO2max 3 days/week for 6 months. Total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein (LDL)-cholesterol, oxidized LDL (ox-LDL), triglycerides, urinary and plasma nitric oxide end-products, superoxide dismutase and 8-iso-PGF2α were measured before and after AEXT. Statistically, ANOVA and linear regression were used. Results. Before and after AEXT, there were no significant differences between dippers and non-dippers in any of the biomarkers except for total cholesterol following AEXT. In a sub-analysis following AEXT, 14 subjects retained their original dipping status, five subjects changed from dippers to non-dippers and four subjects changed from non-dippers to dippers. Significant differences existed between these groups in changes in total and LDL-cholesterol, ox-LDL, 8-iso-PGF2α and % Dip. Conclusions. Changes in cholesterol levels but not oxidative stress or endothelial biomarkers were related to changes in BP variables following AEXT in dippers and non-dippers.

Distribution of blood pressure in school going children in rural area of Wardha district, Maharashatra, India

Objectives:To study the blood pressure of school going children in a rural area and its relationship with the anthropometric indices.Methods:A prospective, cross-sectional study was carried out from November 2006 to December 2007 in the school going children between the ages of 6–17 years from eight different schools in the rural areas of Wardha district. The height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in both sexes followed by complete clinical examination with special emphasis on cardiovascular system. Hypertension (HT) was defined as SBP or DBP exceeding the 95th percentile for age, gender, and height on at least three separate occasions, 1–3 weeks apart. SPSS software was used to analyze the data. Coefficient correlation tests were employed to assess the relation between BP and anthropometric variables.Results:Of 2643 school children, 1227 were boys and 1416 girls with a male to female ratio of 1:1.16. In boys, SBP and DBP increased with age except a marginal decline in SBP at the age of 17 years (−0.09) and decrease in the DBP (−1.29) at 16 years of age. In girls, SBP and DBP also increased with age except at 11 years, wherein there was a mild decrease in SBP (−0.09) as well as the DBP (−0.24). Correlation coefficient analysis showed highly significant positive correlation of height with SBP and DBP. There was a significant correlation of SBP and DBP with the weight, and body mass index (BMI). The prevalence of HT was 5.75% (i.e., 3.25% for systolic HT and 2.49% for diastolic HT).Conclusion:We recommend that there is a need for checking BP to detect HT in children, so that remedial measures can be initiated as early as possible.