Changes In Systolic Blood Pressure Research Articles

Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial

BackgroundHypertension (HT) is an orchestrator of atherosclerotic cardiovascular disease (ASCVD) in people living with type 2 diabetes (T2D). Control of systolic blood pressure (SBP) and HT as a whole is suboptimal in diabetes, partly due to the scarcity of doctors. While nurse-led interventions are pragmatic and cost-effective in the control of HT in primary health care, their effectiveness on SBP control among patients with T2D in Uganda is scantly known.AimWe evaluated the effectiveness of a nurse-led management intervention on SBP among T2D patients with a high ASCVD risk in Uganda.MethodsA two-armed cluster randomized controlled trial compared the nurse-led management intervention with usual doctor-led care. The intervention involved training nurses to provide structured health education, protocol-based HT/CVD management, 24-h phone calls, and 2-monthly text messages for 6 months. The primary outcome was the mean difference in SBP change among patients with T2D with a high ASCVD risk in the intervention and control groups after 6 months. The secondary outcome was the absolute difference in the number of patients at target for SBP, total cholesterol (TC), fasting blood glucose (FBG), glycated hemoglobin (HbA1C), low-density lipoprotein (LDL), triglycerides (TG), and body mass index (BMI) after the intervention. The study was analyzed according to the intention-to-treat principle. Generalized estimating equations were used to assess intra-cluster effect modifiers. Statistical significance was set at 0.05 for all analyses.ResultsEight clinics (n = 388 patients) were included (intervention 4 clinics; n = 192; control 4 clinics; n = 196). A nurse-led intervention reduced SBP by -11.21 ± 16.02 mmHg with a mean difference between the groups of -13.75 mmHg (95% CI -16.48 to -11.02, p < 0.001). An increase in SBP of 2.54 ± 10.95 mmHg was observed in the control group. Diastolic blood pressure was reduced by -6.80 ± 9.48 mmHg with a mean difference between groups of -7.20 mmHg (95% C1 -8.87 to -5.48, p < 0.001). The mean differences in the change in ASCVD score and glycated hemoglobin were -4.73% (95% CI -5.95 to -3.51, p = 0.006) and -0.82% (95% CI -1.30 to -0.35, p = 0.001), respectively. There were significant absolute differences in the number of patients at target in SBP (p = 0.001), DBP (p = 0.003), and TC (p = 0.008).ConclusionA nurse-led management intervention reduces SBP and ASCVD risk among patients with T2D. Such an intervention may be pragmatic in the screening and management of HT/ASCVD in Uganda.Trial registrationPan African Clinical Trial Registry, PACTR202001916873358, registered on 6th October 2019.

The Analysis of The Functional Status of Female Soldiers In The Conditions of The Legal Regime of The Martial State

This article presents the results of a study on the cardiorespiratory system of 30 female soldiers during a period of legal regime of martial state. It is important to note that all investigated cardiovascular parameters, determined by median, were within age norms. Our findings from hypoxic tests demonstrated that the functional capacity of the respiratory system of female military personnel was within age norms as well. The results also confirm that this category has the ability to effectively operate in hypoxic conditions, which is a crucial aspect for professional performance. Analysis of orthostatic test results indicates a significant variability in the body’s reactions to body position changes, with a median value of 5.0 bpm, a minimum of 0.0 bpm, and a maximum of 56.0 bpm. This means that female soldiers have different levels of adaptation. However, it is worth noting the stability of the cardiovascular system’s response to orthostatic stress, with minimal changes in systolic and diastolic blood pressure at 5 mmHg, indicating cardiovascular stability during orthostatic activity. In the vast majority of female military personnel (60.0%), hemodynamic reactions to changes in body position indicate a high level of adaptive capacity of the cardiovascular system. The results of the study of the functional state of the cardiovascular and respiratory systems in female military personnel indicate compliance with the majority of physiological norms; however, isolated cases are observed where the detected values may indicate certain abnormalities, particularly arterial hypertension. The results of respiratory tests indicate a normal response of the female military personnel's bodies to hypoxia conditions, which is important for fulfilling their service duties.

Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis

Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis

Effects of acute carotid baroreceptor stimulation on sympathetic nerve traffic in resistant and uncontrolled hypertension: a systematic review and meta-analysis.

In resistant hypertensive patients acute carotid baroreflex stimulation is associated with a blood pressure (BP) reduction, believed to be mediated by a central sympathoinhbition.The evidence for this sympathomodulatory effect is limited, however. This meta-analysis is the first to examine the sympathomodulatory effects of acute carotid baroreflex stimulation in drug-resistant and uncontrolled hypertension, based on the results of microneurographic studies. The analysis included 3 studies assessing muscle sympathetic nerve activity (MSNA) and examining 41 resistant uncontrolled hypertensives. The evaluation included assessment of the relationships between MSNA and clinic heart rate and BP changes associated with the procedure. Carotid baroreflex stimulation induced an acute reduction in clinic systolic and diastolic BP which achieved statistical significance for the former variable only [systolic BP: -19.98 mmHg (90% CI, -30.52, -9.43), P < 0.002], [diastolic BP: -5.49 mmHg (90% CI, -11.38, 0.39), P = NS]. These BP changes were accompanied by a significant MSNA reduction [-4.28 bursts/min (90% CI, -8.62, 0.06), P < 0.07], and by a significant heart rate decrease [-3.65 beats/min (90% CI, -5.49, -1.81), P < 0.001]. No significant relationship was detected beween the MSNA, systolic and diastolic BP changes induced by the procedure, this being the case also for heart rate. Our data show that the acute BP lowering responses to carotid baroreflex stimulation, although associated with a significant MSNA reduction, are not quantitatively related to the sympathomoderating effects of the procedure. This may suggest that these BP effects depend only in part on central sympathoinhibition, at least in the acute phase following the intervention.

The effect of aromatherapy during urodynamic testing on patients anxiety and cortisol levels: A randomized controlled trial.

During urodynamic testing (UT), patients may experience emotions such as embarrassment, discomfort, irritability, and tension, which can cause anxiety. Aromatherapy is a complementary and alternative treatment that may be employed in clinical settings to alleviate patients' anxiety before invasive procedures. The aim of this study was to determine the effect of aromatherapy on patients' anxiety and cortisol levels during UT. The sample of this single-center, prospective, two-armed, randomized controlled clinical study consisted of 98 patients undergoing UT. Patients were randomly assigned to the intervention group (n = 49) and the control group (n = 49). The anxiety level was assessed using the state-trait anxiety inventory (STAI), and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and cortisol levels, pre and post-UT. Aromatherapy was applied to the intervention group starting 5 min before UT and continuing throughout the testing. The control group received routine treatment and care. Data were analyzed using Pearson's χ2, dependent samples t-tests, and independent samples t-tests. In the study, post-UT anxiety in the intervention group was significantly lower than in the control group (p < 0.001), while SpO2 was higher (p = 0.021). In the study group, post-UT anxiety (p < 0.001), HR (p = 0.000), and cortisol levels (p = 0.005) decreased compared to pre-UT, whereas in the control group, anxiety (p < 0.001) and HR (p = 0.000) decreased, and SBP (p = 0.010) and RR (p = 0.004) increased. Aromatherapy during UT positively influenced both the psychological and physiological responses to anxiety.

The effect of increased fruit and vegetable consumption on blood pressure and lipids: a pooled analysis of six randomised controlled fruit and vegetable intervention trials.

Increasing fruit and vegetable (FV) consumption is associated with reduced cardiovascular disease risk in observational studies but with little evidence from randomised controlled trials (RCTs). The impact of concurrent pharmacological therapy is unknown. To pool data from six RCTs to examine the effect of increasing FV intake on blood pressure (BP) and lipid profile, also exploring whether effects differed by medication use. Across trials, dietary intake was assessed by diet diaries or histories, lipids by routine biochemical methods and BP by automated monitors. Linear regression provided an estimate of the change in lipid profile or BP associated with a one portion increase in self-reported daily FV intake, with interaction terms fitted for medication use. The pooled sample included a total of 554 participants (308 males and 246 females). Meta-analysis of regression coefficients revealed no significant change in either systolic or diastolic BP per portion FV increase, although there was significant heterogeneity across trials for systolic BP (I2= 73%). Neither adjusting for change in body mass index, nor analysis according to use of anti-hypertensive medication altered the relationship. There was no significant change in lipid profile per portion FV increase, although there was a significant reduction in total cholesterol among those not on lipid-lowering therapy (P < 0.05 after Bonferroni correction). Pooled analysis of six individual FV trials showed no impact of increasing intake on BP or lipids, but there was a total cholesterol-lowering effect in those not on lipid-lowering therapy.

Effect of pharmacist‐led interventions on hypertension‐related knowledge, medication adherence, and blood pressure control: A multi‐center, randomized, controlled trial in Vietnam

AbstractIntroductionHypertension is the single most important leading cause of morbidity and mortality in the Vietnamese population and remains poorly controlled by the current conventional care model.ObjectivesTo evaluate whether pharmacist‐led interventions can improve hypertension knowledge, medication adherence, and blood pressure (BP) control in Vietnamese patients with hypertension.MethodsA multi‐center, randomized, controlled trial was conducted in three hospitals in Vietnam from October 2021 to May 2022. The educational interventions included direct counseling, printed material, and educational videos for smartphones. The primary outcome was hypertension knowledge assessed by the Hypertension Knowledge‐Level Scale (HK–LS). Secondary outcomes were medication adherence as assessed by the Morisky Green Levine Adherence Scale (MGL) and changes in systolic (SBP) and diastolic BP (DBP) at week 12.ResultsA total of 381 patients were included in the study, with 190 and 191 patients in the intervention and control groups, respectively. At week 12, patients in the intervention group had a significantly higher mean HK–LS than the control group (18.97 ± standard deviation [SD] 2.10 vs. 14.98 ± SD 3.55, respectively; p &lt; 0.001). Significantly higher medication adherence was observed in the intervention group than in the control group (MGL score of 3.76 ± 0.52 vs. 3.20 ± 0.87, respectively; p &lt; 0.001). Patients in the intervention group had a significant reduction in mean SBP/DBP (−6.15/−2.58 mmHg) compared with the control group (−0.98/−0.92 mmHg; p &lt; 0.001).ConclusionPharmacist‐led interventions resulted in a significant improvement in disease knowledge, medication adherence, and BP control in the Vietnamese context of practice and health system.

Evaluation of the correlation between cerebral hemodynamics and blood pressure by comparative analysis of variation in cerebral blood flow in hypertensive versus normotensive individuals: A systematic review and meta-analysis.

Current understanding of the cerebral vascular response to variations in blood pressure (BP) among individuals with hypertension is limited. The aim of this meta-analysis was to determine the correlation between hypertension, risk of stroke, and cerebral blood flow (CBF). We reviewed studies published between 2000 and 2023 from PubMed, Google Scholar, and Science Direct that compared mean CBF in normotensive and hypertensive patients. A random effects model was used to construct the risk ratio (RR), 95% confidence interval (CI), forest plot, and inverse variance weighting. Additionally, a mixed-effects meta-regression was employed to examine the impact of study-specific patient variables. This meta-analysis included eight prospective cross-sectional studies published from 2002 to 2023. It revealed a significant average difference in the standard mean CBF of -0.45 (95% CI -0.60 to -0.30, I2 = 69%, P < 0.00001), distinguishing normotensive from hypertensive subjects. A RR of 0.90 (95% CI 0.63 to 1.30, I2 = 89%, P = 0.04) indicated a significant decrease in CBF among individuals with hypertension. We found a statistically significant relationship between changes in diastolic and systolic BPs and the mean CBF (R = -0.81, P = 0.001 and R = -0.90, P = 0.005, respectively). Our research demonstrates a strong relationship between elevated BP and reduced CBF, with hypertension reducing CBF compared to normotensive individuals, by increasing cerebrovascular resistance.

Blood pressure responses to handgrip exercise but not apnea or mental stress are enhanced in women with a recent history of preeclampsia.

Preeclampsia is a risk factor for future cardiovascular diseases. However, the mechanisms underlying this association remain unclear, limiting effective prevention strategies. Blood pressure responses to acute stimuli may reveal cardiovascular dysfunction not apparent at rest, identifying individuals at elevated cardiovascular risk. Therefore, we compared blood pressure responsiveness to acute stimuli between previously preeclamptic (PPE) women (34±5yr, 13±6 months postpartum) and women following healthy pregnancies (CTRL; 29±3yr, 15±4 months postpartum). Blood pressure (finger photoplethysmography calibrated to manual sphygmomanometry-derived values; PPE: n=12, CTRL: n=12) was assessed during end-expiratory apnea, mental stress, and isometric handgrip exercise protocols. Integrated muscle sympathetic nerve activity (MSNA) was assessed in a subset of participants (peroneal nerve microneurography; PPE: n=6, CTRL: n=8). Across all protocols, systolic blood pressure (SBP) was higher in PPE than CTRL (main effects of group all P<0.05). Peak changes in SBP were stressor-specific: peak increases in SBP were not different between PPE and CTRL during apnea (+8±6 vs. +6±5mmHg, P=0.32) or mental stress (+9±5 vs. +4±7mmHg, P=0.06). However, peak exercise-induced increases in SBP were greater in PPE than CTRL (+11±5 vs. +7±7mmHg, P=0.04). MSNA was higher in PPE than CTRL across all protocols (main effects of group all P<0.05), and increases in peak MSNA were greater in PPE than CTRL during apnea (+44±6 vs. +27±14burst/100hb, P=0.04) and exercise (+25±8 vs. +13±11burst/100hb, P=0.01) but not different between groups during mental stress (+2±3 vs. 0±5burst/100hb, P=0.41). Exaggerated pressor and sympathetic responses to certain stimuli may contribute to the elevated long-term risk for cardiovascular disease in PPE.

Effect of series of periodic limb movements in sleep on blood pressure, heart rate and high frequency heart rate variability.

The phenomenon known as periodic limb movements in sleep (PLMS) has been linked to a change in autonomic nervous system (ANS) activity and its effect on circulatory regulation. Autonomic dysfunction or dysregulation in patients with PLMS has been described in some domains; however, any relationship between heart rate variability (HRV) and PLMS has not been clearly established. HRV analysis is a recognised, non-invasive research method that describes the influence of the ANS on heart rate (HR). The aim of our study was to further investigate the dysregulation of autonomic HR control in patients with PLMS. We undertook a retrospective analysis of the polysomnographic (PSG), demographic and medical data of five patients with a total number of 1,348 PLMS. We analysed HR, HRV HF, systolic blood pressure (SBP), and diastolic blood pressure (DBP) for 10 heartbeats before the series of PLMS and 10 consecutive heartbeats as beat-to-beat measurements. The presented method of using successive, short, 10 RR interval segments refers to the time-frequency measurement, which is very clear and useful for presenting changes in the calculated parameters over time and thereby illustrating their dynamics. This method allowed us to assess dynamic changes in HRV HF during successive PLMS series. Statistical analysis was performed using IBM SPSS Statistics (v. 28.0.0.0). The Kruskal-Wallis test was performed to find statistically significant changes from baseline. No statistically significant changes in HR, SBP, or DBP were found in our group, although an increase in the value of the HRV HF was noted, suggesting an increase in intracardiac parasympathetic activity during the subsequent series of PLMS. Our study indicates an increase in parasympathetic activity during the appearance of successive PLMS, which, with the simultaneous lack of changes in HR, may suggest an increase in sympathetic activity, and therefore the appearance of so-called 'autonomic co-activation' resulting in the possibility of life-threatening cardiac events. Our findings add to the literature information regarding HRV in PLMS, and highlight the need for further studies to elucidate the effects of these conditions on the ANS, and on cardiovascular health.

Comparative Efficacy of Monotherapy of Angiotensin-converting Enzyme Inhibitors Versus Angiotensin Receptor Blockers in Treating Essential Hypertension – A Meta-analysis

Background: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are widely used medications for treating essential hypertension, but there is limited research comparing their effectiveness. To address this gap, a recent meta-analysis was conducted to evaluate and compare the efficacy of these two drug classes in decreasing blood pressure (BP) among patients with essential hypertension. Objective: Evaluating of comparative efficacy of ACEIs versus ARBs in reducing BP in essential hypertension. Methods: An extensive literature search for randomized controlled trials (RCTs) following PRISMA guidelines (2020), with inclusion criteria of age ≥18 years, with either gender and diagnosed of essential hypertension and receiving ACEIs or ARBs for at least 4 weeks. Patients with secondary hypertension, malignancy, symptomatic cardiovascular system (CVS) disease, hepatic involvement, and studies with Fimasartan and Allisartan were excluded. For this study, all RCTs that reported changes in mean systolic BP (SBP) and diastolic BP (DBP) before and after administration of the drugs were gathered. Standardized mean difference (SMD) was calculated using RevMan 5.4.1 software. The significance level was set at a P &lt; 0.05. Results: A total of 28 RCTs ( n = 9778) were included in our study. Both groups reduce SBP and DBP from the baseline values. Pooled analyses of studies showed that ARBs were superior to ACEIs with SMD = 0.179 in the random-effect model, 95% confidence interval (CI) (0.0975–0.260), P &lt; 0.001, and in the fixed-effect model, SMD = 0.207, 95% CI (0.167–0.248), P &lt; 0.001 in the mean reduction of SBP. Furthermore, for a mean reduction in DBP, ARBs were superior to ACEIs with SMD = 0.329 in the random-effect model, 95% CI (0.161–0.496), P &lt; 0.001, and in the fixed-effect model, SMD = 0.317, 95% CI (0.276–0.357), P &lt; 0.001. Our study included 28 RCTs with a combined sample size of 9778 participants. Both ACEIs and ARBs were found to effectively reduce SBP and DBP from their baseline values. However, our pooled analysis of the studies revealed that ARBs were more effective than ACEIs in reducing mean SBP, with an SMD of 0.179 in the random-effect model and 0.207 in the fixed-effect model. The 95% CIs for these estimates were (0.0975–0.260) and (0.167–0.248), respectively, with P &lt; 0.001. Similarly, for a mean reduction in DBP, ARBs were found to be superior to ACEIs with a SMD of 0.329 in the random-effect model and 0.317 in the fixed-effect model, with 95% CIs of (0.161–0.496) and (0.276–0.357), respectively, and a P &lt; 0.001. Conclusion: ARBs are more efficacious as compared to ACEIs in essential hypertension.

Clemastine as a Main Sedative Drug in Colonoscopy

Background: Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber-optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis. Methods: In this study, clemastine plus fentanyl was compared with fentanyl plus midazolam in analgesia during colonoscopy. Patients were monitored for pain and hemodynamic changes. The mean age in the group treated with clemastine was 52 years and in the group treated with midazolam was 54 years. There were 56 males and 35 females in the study. There was no significant difference in gender in the two groups. Systolic blood pressure was 109.9 mmHg before and 109.35 mmHg after clemastine administration, which showed no significant difference. Results: Diastolic blood pressure was 72.2 mmHg before and 73.7 mmHg after clemastine administration, which showed no significant difference. No change in mean pulse rate (PR) was seen (84/min before and after clemastine administration). In the group receiving midazolam, systolic and diastolic blood pressure changes were not significant, but changes in PR and arterial oxygen saturation were significantly different. Meanwhile, the two groups had a significant lower pain level after colonoscopy in the group receiving clemastine compared to midazolam. Conclusion: Based on the results of the present study, clemastine can be used as a main drug for sedation during colonoscopy.

The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis

BackgroundPrevious systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions.MethodsWe conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality.ResultsWe included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible.ConclusionsNurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.

Comparison of Acute Effects of E-cigarettes With and Without Nicotine and Tobacco Cigarettes on Hemodynamic and Endothelial Parameters: A Systematic Review and Meta-analysis.

Smoke from traditional cigarettes and e-cigarette aerosols have distinct chemical compositions that may impact blood pressure (BP) and heart rate (HR) differently. This study compared the impact of nicotine-containing e-cigarettes (EC+) versus nicotine-free (EC-) on BP, HR and endothelial markers, and assessed if EC+ posed fewer risks than tobacco cigarettes (TC). Electronic databases were searched from inception until November 2023 for studies reporting changes in systolic and diastolic BP (SBP, DBP) and HR and endothelial parameters before and after the use of EC+, EC- and TC. Data were analyzed using weighted mean differences (WMDs) and 95% confidence intervals (CIs). Fifteen studies (n=752) were included in our meta-analysis. We demonstrate that EC+ significantly increased systolic BP (WMD=3.41, 95% CI [0.1,6.73], p=0.04], diastolic BP (WMD=3.42, 95% CI [1.75, 5.09]; p<0.01], and HR (WMD=5.36 BPM, 95% CI [1.87, 8.85]; p<0.01) compared to EC-. However, EC+ was observed to cause less detrimental effect on SBP (WMD=-4.72 mmHg, 95% CI [-6.58, -2.86], p<0.01), and HR (WMD=-3.11 BPM, 95% CI [-4.54, -1.68]; p<0.01) as compared to TC with no difference on DBP (WMD=-1.14mmHg, 95% CI [-2.38, 0.1]; p=0.07). EC+ also led to greater deterioration of endothelial parameters as compared to EC- but to a lesser degree as compared to TC. EC+ shows greater impairment in hemodynamic and endothelial parameters than EC- but less than TC. Additional studies are needed to evaluate prolonged effectsofECuse.

Sympathetic dysfunction as an early indicator of autonomic involvement in Parkinson's disease.

The specific characteristics of autonomic involvement in patients with early Parkinson's disease (PD) are unclear. This study aimed to evaluate the characteristics of autonomic dysfunction in drug-naïve patients with early-stage PD without orthostatic hypotension (OH) by analyzing Valsalva maneuver (VM) parameters. We retrospectively analyzed drug-naïve patients without orthostatic hypotension (n = 61) and controls (n = 20). The patients were subcategorized into early PD (n = 35) and mid-PD (n = 26) groups on the basis of the Hoehn and Yahr staging. VM parameters, including changes in systolic blood pressure at late phase 2 (∆SBPVM2), ∆HRVM3, Valsalva ratio (VR), pressure recovery time, adrenergic baroreflex sensitivity, and vagal baroreflex sensitivity, were assessed. In the early PD group, ∆SBPVM2, a marker of sympathetic function, was significantly lower compared with that in controls (risk ratio = 0.95, P = 0.027). Receiver operating characteristic (ROC) curve analysis showed an optimal cut-off value of -10mmHg for ∆SBPVM2 [P = 0.002, area under the curve (AUC): 0.737]. VR exhibited an inverse relationship with Unified Parkinson's Disease Rating Scale Part 3 scores in the multivariable regression analysis (VR: P = 0.038, β = -28.61), whereas age showed a positive relationship (age: P = 0.027, β = 0.35). The ∆BPVM2 parameter of the VM may help detect autonomic nervous system involvement in early-PD without OH. Our results suggest that sympathetic dysfunction is an early manifestation of autonomic dysfunction in patients with PD.

Impact of guideline-directed medical therapy on systolic blood pressure and cardiovascular outcomes in patients with heart failure and low blood pressure: A systematic review and meta-analysis.

Existing research indicates that patients with heart failure (HF) may have restricted access to guideline-directed medical therapy (GDMT) when their blood pressure (BP) is comparatively low. However, recent clinical trials suggest that HF patients with low BP could still benefit from certain HF medications, which have a minimal impact on BP. This systematic review and meta-analysis was conducted to determine whether this applies to all GDMT. A systematic search of MEDLINE and EMBASE was conducted for studies published from inception to 10 January 2024. Randomized controlled trials were selected if they reported on the longitudinal change of systolic BP (SBP) due to GDMT, or the risks of cardiovascular events in HF patients based on SBP categories. Weighted mean difference (WMD), hazard ratio or relative risk, and corresponding 95% confidence intervals (CI) were pooled for meta-analysis where possible. Data from 20 studies, encompassing information on 84 782 individuals, were analysed. Overall, GDMT is associated with lower SBP (WMD, -2.16; 95% CI -2.86 to -1.46), with no significant difference between baseline low and non-low BP subgroups (interaction p = 0.810). However, SBP of the treatment group increased by 5.8 mmHg from baseline in the low SBP subgroup during follow-up, while it decreased by 4.0 mmHg in the baseline non-low SBP subgroup. GDMT demonstrated similar cardiovascular benefits and risk of hypotension between low and non-low SBP subgroups (interaction p = 0.318 and 0.903, respectively). Guideline-directed medical therapy is associated with a negligible decrease in SBP, but can provide similar cardiovascular benefits in both low and non-low SBP HF patients, with no significant interaction with SBP as to hypotension. Therefore, GDMT should be initiated and maintained in HF patients with low BP.

Effect of Alcohol-Mediated Renal Denervation on Blood Pressure in the Presence of Antihypertensive Medications: Primary Results from the TARGET BP I Randomized Clinical Trial.

Renal denervation (RDN) has demonstrated clinically relevant reductions in blood pressure among individuals with uncontrolled hypertension despite lifestyle intervention and medications. The safety and effectiveness of alcohol-mediated RDN has not been formally studied in this indication. TARGET BP I is a prospective, international, sham-controlled, randomized, patient- and assessor-blinded trial investigating the safety and efficacy of alcohol-mediated RDN. Patients with office systolic blood pressure (SBP) ≥150 and ≤180 mmHg, office diastolic BP ≥90 mmHg and mean 24-hour ambulatory SBP ≥135 and ≤170 mmHg, despite prescription of 2-5 antihypertensive medications were enrolled. The primary endpoint was the baseline-adjusted change in mean 24-hour ambulatory systolic BP at 3 months post procedure. Secondary endpoints include mean between-group differences in office and ambulatory BP at additional time points. Among 301 patients randomized 1:1 to RDN or sham control, RDN was associated with a significant reduction in 24-hour ambulatory SBP at 3 months (mean ± standard deviation -10.0 ± 14.2 mmHg versus -6.8 ± 12.1 mmHg, treatment difference -3.2 mmHg, 95% confidence interval [CI] -6.3, 0.0 mmHg; P=0.0487). Subgroup analysis of the primary endpoint revealed no significant interaction across predefined subgroups. At 3 months, the mean change in office SBP was -12.7 ± 18.3 mmHg and -9.7 ± 17.3 mmHg (difference, -3.0, 95% CI -7.0, 1.0; P=0.173), for RDN and sham, respectively. No significant differences in ambulatory or office diastolic BP were observed. Adverse safety events through 6 months were uncommon with 1 instance of accessory renal artery dissection in the RDN group (0.7%). No significant between-group differences in medication changes or patient adherence were identified. Alcohol-mediated RDN was associated with a modest but statistically significant reduction in 24-hour ambulatory systolic BP compared with sham control. No significant differences between groups in office BP or 6-month major adverse events were observed.

Assessment of Registered Clinical Trial Designs: Comparison of L-Arginine and/or L-Citrulline Interventions for Hypertension.

L-Arginine (Arg) is an essential amino acid and a precursor for the synthesis of vascular nitric oxide, while L-Citrulline is a non-essential amino acid substrate for increasing L-arginine. Both L-arginine and L-Citrulline in translational studies may acutely lower the blood pressure. Current meta-analysis for L-arginine or L-Citrulline interventions in blood pressure have identified significant heterogeneity. Clinical trial evidence for L-arginine or L-Citrulline in chronic blood pressure reduction in the general population requires an examination of trial designs, as not all translational studies may have influenced vascular reactivity. Our aims are to explore whether L-arginine and L-citrulline intervention trials in chronic blood pressure consider standardized end points relevant to the general adult populations. A step-wise search on clinicaltrials.gov, the U.S. Library of Medicine registry for clinical trials, was performed including the following keyword search parameters: "completed" "L-Citrulline" "L-arginine" trial", and "adults", involving "blood pressure" reduction as a primary end point in adult humans. Of the forty-four completed trials, only five were included for analysis. Following the careful evaluation of trial design, we observed heterogeneity across participant inclusion criteria (population sample size, age range, sex), interventional design (dosages, duration), and primary outcomes, measured with respect to changes in diastolic or systolic blood pressure. In conclusion, there is a lack of robust trial design evidence to suggest that L-arginine or L-Citrulline, based on current RCTs in the general population, have an overall positive effect on vascular endothelial reactivity and a beneficial chronic blood pressure-lowering effect. Indeed, conclusions drawn from human meta-analysis studies have been heterogenous between studies, which may be attributed to study design heterogeneity, including differences in sample population, age, and blood pressure at the time of entry. Inconsistencies in the study design poses a challenge for systematic reviews and meta-analysis to accurately assess the effect size and impact of L-arginine or L-citrulline on both systolic and diastolic blood pressure.

Determinants of prolonged baseline blood pressure restoration following autonomic dysreflexia for individuals with spinal cord injuries

Objective This study aimed to identify the determinants affecting the time required for blood pressure (BP) restoration after autonomic dysreflexia (AD) and to propose a new method for BP measurement in individuals with cervical spinal cord injury (SCI) who experience AD. Methods In a prospective, single-center observational study, participants’ bladders were filled with body-temperature saline until reaching cystometric capacity, as confirmed by previous urodynamic studies. Restoration time (RT), defined as the time from the onset of voiding until BP returned to baseline, was measured during the morning voiding session. This session involved the use of a 10F hydrophilic transurethral catheter. Data were then compared with various clinical determinants including demographic, urodynamic, and cystographic variables. Results The study included 29 individuals with cervical SCI. Notable variations in RT were observed among individuals with differing levels of detrusor overactivity (DO) and bladder compliance. An inverse correlation was noted between RT and bladder compliance, whereas positive correlations were identified with maximal detrusor pressure, peak systolic BP (SBP), and the magnitude of BP changes. Factors associated with prolonged RT included injury completeness, bladder trabeculation, vesicoureteral reflux (VUR), DO, and changes in SBP. Conclusions A significant association was found between BP elevation and prolonged RT. Determinants such as the severity of the SCI, bladder trabeculation, VUR, and DO were correlated with prolonged RT, considering their importance in the assessment of baseline BP following AD.

Design and rationale of the Comprehensive intelligent Hypertension managEment SyStem (CHESS) evaluation study: A cluster randomized controlled trial for hypertension management in primary care

BackgroundHypertension management in China is suboptimal with high prevalence and low control rate due to various barriers, including lack of self-management awareness of patients and inadequate capacity of physicians. Digital therapeutic interventions including mobile health and computational device algorithms such as clinical decision support systems (CDSS) are scalable with the potential to improve blood pressure (BP) management and strengthen the healthcare system in resource-constrained areas, yet their effectiveness remains to be tested. The aim of this report is to describe the protocol of the Comprehensive intelligent Hypertension managEment SyStem (CHESS) evaluation study assessing the effect of a multi-faceted hypertension management system for supporting patients and physicians on BP lowering in primary care settings. Materials and MethodsThe CHESS evaluation study is a parallel-group, cluster-randomized controlled trial conducted in primary care settings in China. 41 primary care sites from 3 counties of China are randomly assigned to either the usual care or the intervention group with the implementation of the CHESS system, more than 1600 patients aged 35-80 years with uncontrolled hypertension and access to a smartphone by themselves or relatives are recruited into the study and followed up for 12 months. In the intervention group, participants receive patient-tailored reminders and alerts via messages or intelligent voice calls triggered by uploaded home blood pressure monitoring data and participants’ characteristics, while physicians receive guideline-based prescription instructions according to updated individual data from each visit, and administrators receive auto-renewed feedback of hypertension management performance from the data analysis platform. The multiple components of the CHESS system can work synergistically and have undergone rigorous development and pilot evaluation using a theory-informed approach. The primary outcome is the mean change in 24-hour ambulatory systolic BP from baseline to 12-month. DiscussionThe CHESS trial will provide evidence and novel insight into the effectiveness and feasibility of an implementation strategy using a comprehensive digital BP management system for reducing hypertension burden in primary care settings. Trial registrationhttps://www.clinicaltrials.gov, NCT05605418