Hypertensive State Research Articles

Analysis of factors related to the incidence of hypertension in the elderly

Introduction: Hypertension or high blood pressure is one of the main health problems in the elderly population in various parts of the world. The elderly are more susceptible to hypertension due to the ageing process that affects the elasticity of blood vessels, as well as increased peripheral resistance. In addition, various risk factors, such as an unhealthy lifestyle, poor diet, and certain medical conditions, can worsen the condition of hypertension in the elderly. Objective: This study aims to analyze factors related to the incidence of hypertension in the elderly. Methods: This research uses a cross-sectional design, an analytical study that studies the causes of incidents or incidents. Data collection uses a questionnaire. The sample in this study was 64 elderly hypertensive patients in the working—data analysis using the chi-square test. Result: The results of this study indicate that there is a relationship between physical activity (p=0.000), obesity (p=0.000), diet (p= 0.029), smoking habits (p=0.000) and work (p=0.020) with the incidence of hypertension in the elderly in working. Conclusion: The incidence of hypertension in the elderly with the variables studied shows that there is a relationship, and the most related variable is obesity. So, it is hoped that the elderly, especially those who are obese, should be given intervention to maintain their diet so that complications do not occur and can reduce the risk of hypertension.

Remote Collaborative Specialist Panel Deployment to Address Health Disparities in the RICH LIFE Project.

Individuals with low income or from minoritized racial or ethnic groups experience a high burden of hypertension and other chronic conditions (eg, diabetes, chronic kidney disease, and mental health conditions) and often lack access to specialist care when compared to their more socially advantaged counterparts. We used a mixed-methods approach to describe the deployment of a Remote Collaborative Specialist Panel intervention aimed at the comprehensive and coordinated management of patients with hypertension and comorbid conditions to address health disparities. Participants of the collaborative care/stepped care arm of the Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone (RICH LIFE) Project, a cluster-randomized trial comparing the effectiveness of enhanced standard of care to a multilevel intervention (collaborative care/stepped care) for improving blood pressure control and reducing disparities, were included. Participants were eligible for referral by their care manager to the Specialist Panel if they continued to have poorly controlled hypertension or had uncontrolled comorbid conditions (eg, diabetes, hyperlipidemia, depression) after 3months in the RICH LIFE trial. Referred participant cases were discussed remotely with a panel of specialists in internal medicine, cardiology, nephrology, endocrinology, and psychiatry. Qualitative data on the Specialist Panel recommendations and interviews with care managers to understand barriers and facilitators to the intervention were collected. We used available components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to examine the impact of the intervention. Of 302 participants in the relevant RICH LIFE arm who were potentially eligible for the Specialist Panel, 19 (6.3%) were referred. The majority were women (53%) and of Black race (84%). Referral reasons included uncontrolled blood pressure, diabetes, and other concerns (eg, chronic kidney disease, life-stressors, medication side effects, and medication nonadherence). Panel recommendations centered on guideline-recommended diagnostic and management algorithms, minimizing intolerable medication side effects and costs, and recommendations for additional referrals. Panel utilization was limited. Barriers reported by care managers were lack of perceived need by clinicians due to redundant specialists, a cumbersome referral process, the remote nature of the panel, and the sensitivity of relaying recommendations back to the primary care physician. Care managers who made panel referrals reported it was overwhelmingly valuable. The use of a Remote Collaborative Specialist Panel was limited but well-received by referring clinicians. With modifications to enhance uptake, the Remote Collaborative Specialist Panel may be a practical care model for addressing some disparities in hypertension and multi-morbidity care.

THE CRITICAL CONNECTION BETWEEN ORAL HEALTH AND CARDIOVASCULAR WELL-BEING

The relationship between oral health and cardiovascular health has gained significant attention, particularly regarding the prevention of periodontal diseases to mitigate cardiovascular complications, especially in hypertensive patients. Periodontal diseases, including gingivitis and periodontitis, are chronic infections affecting the gums and supporting structures of teeth, potentially leading to systemic inflammation and the release of inflammatory mediators into the bloodstream. This chronic inflammation is associated with cardiovascular diseases, as it can contribute to plaque formation in arteries, increasing the risk of adverse cardiac events. Hypertension is a notable risk factor for cardiovascular diseases, and studies suggest that individuals with periodontal diseases are more likely to develop hypertension and related conditions. Therefore, proper prevention and treatment of periodontal diseases play a crucial role in the cardiovascular health of hypertensive patients. Early detection and intervention through periodontal screening programs can help reduce systemic inflammation and healthcare costs related to cardiovascular complications. Various studies support the positive effects of periodontal therapy on cardiovascular risk factors, indicating significant reductions in blood pressure and inflammatory markers following periodontal treatment. Furthermore, the alarming prevalence of hypertension, affecting approximately 45% of the global population, necessitates increased awareness of its links to periodontal health. Collaborative approaches between dentists and primary care physicians are essential to improve early detection and management of both periodontal and systemic health issues. Investing in preventive dental care not only enhances oral health but can also lead to substantial savings in healthcare costs by alleviating the financial burden associated with treating cardiovascular diseases. Ultimately, integrating oral health into broader health strategies is vital for promoting overall health and preventing chronic diseases.

The comparative research of aspirin-ethanol induced acute gastric mucosal injury in sprague dawley rats and hypertensive rats

Hypertension is a prevalent chronic health condition that complicates the understanding of gastric injury mechanisms. The aim of this research was to investigate the impact of hypertension on acute gastric mucosal injury induced by aspirin-ethanol in spontaneously hypertensive rats (SHR) and normotensive Sprague Dawley (SD) rats. Both groups were gavaged with 120 mg/ml aspirin and 70 % ethanol, followed by evaluation of gastric injury using gross pathology and histological analysis. SHR rats exhibited significantly less severe gastric mucosal damage compared to SD rats, with lower ulcer index and injury grade scores. Histopathological examination revealed milder edema and hemorrhage in SHR rats. Additionally, gastric tissue from SHR rats showed localized lesions with less epithelial tissue damage compared to SD rats, which exhibited more widespread damage and severe hemorrhagic erosions. These findings suggest that hypertension may reduce the extent of aspirin-ethanol-induced gastric injury, potentially due to thicker vascular walls, enhanced coagulation, and altered vascular responses in hypertensive animals. The study highlights the complex interplay between hypertension and gastric injury, demonstrating that hypertensive conditions may offer some protection against aspirin-induced gastric damage. These insights call for further research to better understand the underlying mechanisms and explore potential therapeutic strategies for gastric injury in hypertensive individuals.

Motivation can improve medication adherence in hypertension patients

Introduction: Motivation is essential in improving medication adherence in hypertensive patients. Non-adherence to medication is often a significant obstacle in the management of high blood pressure, leading to an increased risk of serious complications such as heart disease and stroke. This study analyzes the relationship between patients' motivation levels and adherence to hypertension treatment regimens. Methods: The research design used is descriptive-analytical with a cross-sectional approach to hypertensive patients in a health clinic. Data were collected through questionnaires that measured motivation and adherence to medication. Results: The results of the analysis showed that patients with high motivation had better compliance levels than those with low motivation (p < 0.05). Contributing motivational factors include family support, understanding of the benefits of treatment, and confidence in managing the hypertension condition. Conclusions: Strong motivation plays a significant role in improving medication adherence in hypertensive patients, so health workers need to strengthen the motivational aspect of patient education and counseling programs. This is expected to help reduce the risk of complications and improve the quality of life of hypertensive patients.

Assessment of Plasma Levels of Calcium, Creatinine and Glucose among Hypertensive Patients in Edo State, Nigeria

The present study needs to assess the plasma levels of calcium, creatinine and blood glucose among hypertensive patients in Edo State, Nigeria in order to ascertain whether plasma levels of these parameters are associated with hypertension in this population which will provide improved insight on proper management of hypertensive conditions. Several hereditary and lifestyle factors, including nutrition, influence blood pressure. In this regard, sodium is an important mineral that, in addition to its functions in fluid balance, action potential generation, digestive secretions, and nutrient absorption, also plays a key role in blood pressure regulation, with lower sodium intake linked to lower systolic and diastolic blood pressure. patients compared with their non-hypertensive counterparts. This could be as a result of an overactive parathyroid gland leading to excessive secretion of parathyroid hormone and the attendant increase in plasma calcium level. Regular screening for the plasma level of calcium, creatinine and blood glucose should be considered as routine tests for hypertensive patients. Adequate awareness of the risk of ignoring these parameters in hypertensive patients should be ensured.

Assessment of the Sokolow Lyons Criteria of Left Ventricular Hypertrophy in Comparison with Echocardiography in Hypertensive Patients

Around 65.4% of people over the age of 60 have hypertension, and it's the underlying cause of 6% of all fatalities globally. The left ventricle enlarges, or hypertrophies, in people with hypertension. If the left ventricle of the heart thickens its walls or the chamber of the left ventricle expands, or if both happen at once, the condition is called left ventricular hypertrophy (LVH) [1]. This condition impacts approximately 15 -20% of the general population and has similar rates in men and women. Serious health complications such as cardiovascular diseases, stroke, congestive heart failure, irregular heart rhythms (ventricular arrhythmias), and sudden cardiac death are linked to it.Rationale of the study: In people with slightly hypertensive conditions, the prevalence of LVH is 20%; in those with severe or complex hypertension, it approaches 100%. LVH is also a result of valve disorders, which cause pressure and/or volume overload. Furthermore, "physiological" LVH—which occurs in well-trained athletes in reaction to job overload—can arise. About 0.2% of the general population has hypertrophic cardiomyopathy, a hereditary condition caused by mutations in the sarcomere protein genes. It is characterized by severe cardiac tissue disarray, fibrotic scarring, and aberrant internal coronary arteries.Background and statement of the problem: Hypertension is a leading cause of many cardiovascular problems and cerebrovascular accidents Aim: Assessment of the Sokolowlyon’s Criteria of Left Ventricular Hypertrophy in comparison with Echocardiography Inhypertensives PatientsObjective: To determine whether the ECHO of left ventricular hypertrophy significantly coincides with the Sokolow Lyon criterion of the ECG.Methodology: This cross-sectional study was carried out at the Shree Balaji Medical College and Hospital's general medicine department in Chromepet, Tamil Nadu, India. The study ran from June 2022 to December 2023, a duration of eighteen months.Results: The study focused on assessing the correlation between Sokolow-Lyon criteria on (ECG) and (LVH) as determined by echocardiography (ECHO). The results revealed that among the 125 participants, 88 cases (70.40%) were identified as having LVH based on Sokolow-Lyon criteria, while 37 cases (29.60%) showed no signs of LVH. These findings provide a quantitative breakdown of the prevalence of LVH according to ECG criteria within the study population.Conclusion: Our investigation's findings showed that the ECG LVH Sokolow Lyon criteria had a satisfactory level of specificity and sensitivity in the diagnosis of left ventricular hypertrophy (LVH). The most sensitive diagnostic criteria turned out to be the ECG LVH Sokolow Lyon criteria, especially when it came to patients with co-morbidities. We found that the Sokolow Lyon criteria had a 36% sensitivity in the current investigation. As such, we suggest applying these criteria to assist in verifying the diagnosis of LVH, particularly in low-complexity healthcare environments without image-based diagnostic techniques like MRI and ECHO.

AGE-RAGE Axis and Cardiovascular Diseases: Pathophysiologic Mechanisms and Prospects for Clinical Applications.

Advanced glycation end products (AGE), a diverse array of molecules generated through non-enzymatic glycosylation, in conjunction with the receptor of advanced glycation end products (RAGE), play a crucial role in the pathogenesis of diabetes and its associated complications. Recent studies have revealed that the AGE-RAGE axis potentially accelerated the progression of cardiovascular diseases, including heart failure, atherosclerosis, myocarditis, pulmonary hypertension, hypertension, arrhythmia, and other related conditions. The AGE-RAGE axis is intricately involved in the initiation and progression of cardiovascular diseases, independently of its engagement in diabetes. The mechanisms include oxidative stress, inflammation, alterations in autophagy flux, and mitochondrial dysfunction. Conversely, inhibition of AGE production, disruption of the binding between RAGE and its ligands, or silencing of RAGE expression could effectively impair the function of AGE-RAGE axis, thereby delaying or ameliorating the aforementioned diseases. AGE and the soluble receptor for advanced glycation end products (sRAGE) have the potential to be novel predictors of cardiovascular diseases. In this review, we provide an in-depth overview towards the biosynthetic pathway of AGE and elucidate the pathophysiological implications in various cardiovascular diseases. Furthermore, we delve into the profound role of RAGE in cardiovascular diseases, offering novel insights for further exploration of the AGE-RAGE axis and potential strategies for the prevention and management of cardiovascular disorders.

Fetal growth ultrasound in obese patients for the detection of growth abnormalities.

To examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses. Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. Ultrasound assessments were performed at 16 - 21 and 22 - 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference < 10th percentile) or LGA (EFW > 90 th percentile) among obese compared to non-obese women. A secondary analysis was performed after limiting ultrasound performed from 28-29 weeks. To estimate adjusted relative risks (aRR) with 95% confidence intervals (95%CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates. Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16-21 weeks (16.0% vs. 13.2%; aRR 1.23; 95%CI 1.06-1.42) and 22-29 weeks (16.0% vs. 12.1%; aRR 1.33; 95%CI 1.14-1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16-21 weeks (12.5% vs. 10.3%; aRR 1.24; 95%CI 1.05-1.47) and 22-29 weeks (10.6% vs. 6.9%; aRR 1.66; 95%CI 1.38-2.01). In a secondary analysis limited to the ultrasound 28-29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared to normal weight. Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.

Adaptive integration of history variables in constrained mixture models for organ-scale growth and remodeling.

In the last decades, many computational models have been developed to predict soft tissue growth and remodeling (G&R). The constrained mixture theory describes fundamental mechanobiological processes in soft tissue G&R and has been widely adopted in cardiovascular models of G&R. However, even after two decades of work, large organ-scale models are rare, mainly due to high computational costs (model evaluation and memory consumption), especially in long-range simulations. We propose two strategies to adaptively integrate history variables in constrained mixture models to enable large organ-scale simulations of G&R. Both strategies exploit that the influence of deposited tissue on the current mixture decreases over time through degradation. One strategy is independent of external loading, allowing the estimation of the computational resources ahead of the simulation. The other adapts the history snapshots based on the local mechanobiological environment so that the additional integration errors can be controlled and kept negligibly small, even in G&R scenarios with severe perturbations. We analyze the adaptively integrated constrained mixture model on a tissue patch for a parameter study and show the performance under different G&R scenarios. To confirm that adaptive strategies enable large organ-scale examples, we show simulations of different hypertension conditions with a real-world example of a biventricular heart discretized with a finite element mesh. In our example, adaptive integrations sped up simulations by a factor of three and reduced memory requirements to one-sixth. The reduction of the computational costs gets even more pronounced for simulations over longer periods. Adaptive integration of the history variables allows studying more finely resolved models and longer G&R periods while computational costs are drastically reduced and largely constant in time.

Impact of Medication Nonadherence Across Medical Specialties: Effects on Clinical Outcomes, Physician Satisfaction, and Socioeconomic Factors with Tools for Mitigation

Nonadherence to prescribed medications is a significant issue across many medical specialties and human conditions. Nonadherence affects individuals with chronic diseases like cardiovascular disease, diabetes, hypertension, psychiatric disorders, and respiratory conditions, as well as in more acute conditions. Nonadherence can lead to treatment delays or discontinuation, potentially impacting outcomes, but the challenge of medication adherence spans a wide variety of diseases and treatment settings. Factors influencing nonadherence are complex, including psychological, social, financial, and system-level barriers, which apply to numerous medical specialties. Historically, physicians often had to rely on suspicion and guesswork to identify nonadherence or factors contributing to reduced treatment efficacy and delayed or failed outcomes. This uncertainty often left physicians feeling limited in their ability to provide optimal care and effectively apply diagnostic strategies. Fortunately, today, there are various tools available across medical specialties that significantly reduce the uncertainty surrounding nonadherence and its contributing factors. These tools, while widely available, are sometimes underutilized or less well-known. The purpose of this paper is to serve as both a reminder and an introduction to these tools, encouraging healthcare providers to actively and practically employ them for more accurate patient and treatment assessment. This strategy ultimately supports physicians in their commitment to providing each patient with the best possible care and personalized support, as well as improving physician job satisfaction and reducing overall healthcare costs.

Renal microRNA-144-3p is associated with transforming growth factor-β1-induced oxidative stress and fibrosis by suppressing the NRF2 pathway in hypertensive diabetic kidney disease

Chronic kidney disease (CKD) is a global health problem characterized by progressive renal fibrosis and excessive extracellular matrix deposition. Oxidative stress and epigenetic regulation, particularly through microRNAs (miRNAs), play crucial roles in the pathogenesis of CKD. In this study, we investigated the role of urinary miR-144-3p, which is upregulated in rats with CKD induced by diabetes and hypertension, in renal fibrosis progression, particularly its regulation of the nuclear factor erythroid-2-related factor 2 (NRF2) pathway. Our findings revealed elevated miR-144-3p levels and reduced NRF2 and target gene levels in kidney tissues of streptozotocin-treated spontaneously hypertensive rats. In vitro experiments demonstrated that miR-144-3p directly binds to the 3'-untranslated region of nrf2, suppressing the NRF2 pathway in renal tubular epithelial cells. Additionally, the profibrogenic factor transforming growth factor (TGF)-β1 increased miR-144-3p expression. TGF-β1-induced NRF2 suppression and reactive oxygen species elevation were found to be mediated through miR-144-3p upregulation. In vivo, cilostazol, an antiplatelet drug with an NRF2-activating effect, ameliorated renal injury in diabetic hypertensive rats by decreasing TGF-β1 and miR-144-3p levels while increasing NRF2 and its target gene levels in the kidneys. These findings highlight the potential therapeutic value of targeting the miR-144-3p/NRF2 pathway to attenuate CKD progression in hypertensive diabetic conditions.

Population Health Management effectiveness in the primary healthcare setting: a systematic review

Abstract Background Population Health Management (PHM) has shown promise as a tool in the improvement of health at scale. It works by; harnessing health-related datasets, allowing for population segmentation and risk stratification, and targeting interventions to yield positive health impact. Prior reviews on PHM, have sought to define PHM and assess feasibility. To date, there have been no systematic reviews that assess the effectiveness of PHM in achieving some or all of the quintuple aims of PHM (WHO 2023). The aim of this study is to determine the value and impact of a PHM approach in managing ambulatory care sensitive conditions (ACSCs) in the primary healthcare setting. Methods This systematic review is underpinned by a Population-Intervention-Comparator-Outcome (PICO) framework. The PROSPERO-registered study commenced in February 2024 for papers published since January 2000. Pubmed, Cinahl and Web of Science databases were used. Titles and abstracts of studies were reviewed using agreed eligibility criteria to select studies for inclusion and risk of bias assessment. Data abstraction and synthesis determined the effectiveness of PHM against agreed outcome measures. Results The search yielded 427 articles of which 19 were included. Studies addressed diabetes, hypertension, atrial fibrillation, asthma and comorbid conditions. Nearly all studies were based in the U.S.A. Almost 50% of studies showed a significant improvement in health outcomes following PHM. Study features that corresponded with positive health outcomes included; the use of population management tools, the employment of disease/population health managers and the mobilisation of medication reviews/education. Conclusions The challenges facing communities and health services require an alternative innovative approach to health such as a PHM approach. The results of this study will inform a larger body of work which seeks to establish a PHM approach to the delivery of services in the Mid-West region of Ireland. Key messages • Population health management (PHM) could be a viable mechanism for health services to serve increasing need and multi-morbid populations. • This is the first systematic review of PHM against the quintuple aims of PHM, specifically in the management of ambulatory care sensitive conditions in primary healthcare.

Effect of Short-Term Restraint Stress on the Expression of Genes Associated with the Response to Oxidative Stress in the Hypothalamus of Hypertensive ISIAH and Normotensive WAG Rats.

Normotensive and hypertensive organisms respond differently to stress factors; however, the features of the central molecular genetic mechanisms underlying the reaction of the hypertensive organism to stress have not been fully established. In this study, we examined the transcriptome profiles of the hypothalamus of hypertensive ISIAH rats, modeling a stress-sensitive form of arterial hypertension, and normotensive WAG rats at rest and after exposure to a single short-term restraint stress. It was shown that oxidative phosphorylation is the most significantly enriched process among metabolic changes in the hypothalamus of rats of both strains when exposed to a single short-term restraint stress. The analysis revealed DEGs representing both a common response to oxidative stress for both rat strains and a strain-specific response to oxidative stress for hypertensive ISIAH rats. Among the genes of the common response to oxidative stress, the most significant changes in the transcription level were observed in Nos1, Ppargc1a, Abcc1, Srxn1, Cryab, Hspb1, and Fosl1, among which Abcc1 and Nos1 are associated with hypertension, and Fosl1 and Ppargc1a encode transcription factors. The response to oxidative stress specific to hypertensive rats is associated with the activation of the Fos gene. The DEG's promoter region enrichment analysis allowed us to hypothesize that the response to oxidative stress may be mediated by the participation of the transcription factor CREB1 (Cyclic AMP-responsive element-binding protein 1) and the glucocorticoid receptor (NR3C1) under restraint stress in the hypothalamus of both rat strains. The results of the study revealed common and strain-specific features in the molecular mechanisms associated with oxidative phosphorylation and oxidative stress response in the hypothalamus of hypertensive ISIAH and normotensive WAG rats following a single short-term restraint stress. The obtained results expand the understanding of the most significant molecular targets for further research aimed at developing new therapeutic strategies for the prevention of the consequences of acute emotional stress, taking into account the hypertensive state of the patient.

Aminopeptidase A: A Novel Therapeutic Target for Hypertension Management.

The renin-angiotensin system (RAS) is crucial for regulating and understanding the pathophysiology of hypertension. However, there has been little focus on the breakdown of the active peptide, angiotensin II (AngII). Given that animals lacking aminopeptidase A (APA) exhibit hypertension, it may be concluded that APA is a crucial enzyme in regulating blood pressure by breaking down AngII. It has been also seen that the elevated blood pressure in the spontaneously hypertensive rat (SHR) is caused by the activation of the RAS and a concurrent reduction in renal angiotensin-converting enzyme (ACE) activity. The activity of APA is elevated at the beginning of pre-eclampsia and decreases below the levels seen during a normal pregnancy as pre-eclampsia progresses (particularly, in severe cases). The activity of Serum APA is also heightened after hormone replacement treatment (HRT), perhaps as a response to increasing levels of AngII. Therefore, it is crucial to examine the connection between the activation of the RAS, the levels of AngII in the bloodstream, and the presence of APA in hypertension conditions.

Impairment of neuronal tyrosine phosphatase STEP worsens post-ischemic inflammation and brain injury under hypertensive condition

Hypertension is associated with poor outcome and higher mortality in patients with ischemic stroke. The impairment of adaptive vascular mechanisms under hypertensive condition compromises collateral blood flow after arterial occlusion in patients with acute ischemic stroke resulting in hypoperfusion. The increased oxidative stress caused by hypoperfusion is thought to be a trigger for the rapid evolution of ischemic infarct volume under hypertensive condition. However, the cellular factors and pathways that contribute to the exacerbation of ischemic brain injury under hypertensive condition is not yet understood. The current study reveals that predisposition to hypertension leads to basal loss of function of the neuron-specific tyrosine phosphatase STEP, which plays a crucial role in neuroprotection against excitotoxic insult. The findings further show that a mild ischemic insult in hypertensive rats triggers an early onset and sustained activation of the neuronal extracellular signal regulated kinase (ERK MAPK), a member of the mitogen activated protein kinase family and a substrate of STEP. This leads to rapid increase in the activation of neuronal NF-κB, expression of neuronal cyclooxygenase-2 and subsequent biosynthesis of the pro-inflammatory mediator prostaglandin E2, resulting in rapid morphological transformation of microglia to the pro-inflammatory state and subsequent exacerbation of ischemic brain injury. Restoration of STEP signaling with intravenous administration of a STEP-derived peptide mimetic reduces the pro-inflammatory response in neurons, activation of microglia, and ischemic brain injury. The findings suggest that the basal loss of STEP function under hypertensive condition contributes to the exacerbation of ischemic brain injury by enhancing post-ischemic inflammatory response. The study not only presents a novel role of STEP in regulating neuroimmune communication but also highlights the therapeutic potential of a STEP-mimetic in mitigating ischemic brain damage under hypertensive condition.

Tetralogy of Fallot with Sepsis Induced Coagulopathy in Case of Spontaneous Intracerebral Haemorrhage &amp; Subarachnoid Haemorrhage

Congenital heart disease is the most common cause of stroke in some children. A child aged 5 years 9 months came with complaints of decreased consciousness and shortness of breath, weight 23 kg and height 140 cm, blood pressure 140/95 mmHg, pulse 52x/minute, axillary temperature 36.7oC, respiratory rate 44x/minute and obtained SpO2 62%–78% using a nasal cannula. The patient was diagnosed with Tetralogy of Fallot through echocardiography but it was not corrected, Intracerebral Haemorrhage &amp; Subarachnoid Haemorrhage were discovered on a CT scan, and sepsis induced coagulopathy through other supporting examinations. Children with congenital heart disease (CHD) are more susceptible to infection, this occurs because there is an increased risk for children with congenital heart disease to experience severe complications due to common infections such as sepsis. Sepsis itself will cause a coagulopathy disorder called sepsis induced coagulopathy (SIC) whose mechanism is also based on sepsis. Each of tetralogy of Fallot and Sepsis induced coagulopathy have mutually supporting roles in the mechanism of intracerebral haemorrhage. Most ICHs are caused by hypertension, arteriovenous malformation (AVM), and aneurysm. The patient experiences left ventricular dilatation, this can cause a long-term condition of hypertension. Through the SIC mechanism it can cause systemic inflammation and vascular injury caused by mass production of inflammatory cytokines and their release into the circulation causing excessive activation of the clotting process, impaired fibrinolysis, and suppression of anticoagulant mechanisms which can cause endothelial dysfunction and thrombus formation

Impact of Hypertension and Physical Exercise on Hemolysis Risk in the Left Coronary Artery: A Computational Fluid Dynamics Analysis.

Background and Objectives: Hypertension increases the risk of developing atherosclerosis and arterial stiffness, with secondarily enhanced wall stress pressure that damages the artery wall. The coexistence of atherosclerosis and hypertension leads to artery stenosis and microvascular angiopathies, during which the intravascular mechanical hemolysis of red blood cells (RBCs) occurs, leading to increased platelet activation, dysfunction of the endothelium and smooth muscle cells due to a decrease in nitric oxide, and the direct harmful effects of hemoglobin and iron released from the red blood cells. This study analyzed the impact of hypertension and physical exercise on the risk of hemolysis in the left coronary artery. Methods: To analyze many different cases and consider the decrease in flow through narrowed arteries, a flow model was adopted that considered hydraulic resistance in the distal section, which depended on the conditions of hypertension and exercise. The commercial ANSYS Fluent 2023R2 software supplemented with user-defined functions was used for the simulation. CFD simulations were performed and compared with the FSI simulation results. Results: The differences obtained between the FSI and CFD simulations were negligible, which allowed the continuation of analyses based only on CFD simulations. The drops in pressure and the risk of hemolysis increased dramatically with increased flow associated with increased exercise. A relationship was observed between the increase in blood pressure and hypertension, but in this case, the increase in blood pressure dropped, and the risk of hemolysis was not so substantial. However, by far, the case of increased physical activity with hypertension had the highest risk of hemolysis, which is associated with an increased risk of clot formation that can block distal arteries and lead to myocardial hypoxia. Conclusions: The influence of hypertension and increased physical exercise on the increased risk of hemolysis has been demonstrated.

Multifactorial analysis of risk factors for foot ulcers in patients with neurovascular complications of diabetes.

Diabetic foot ulcers (DFU) are a major complication associated with significant morbidity and mortality. While numerous studies have investigated risk factors for these ulcers in general, few have focused specifically on patients with Neurovascular Complications of Diabetes. This study aimed to evaluate the prevalence and risk factors for DFU in this specific population. We analyzed data from the National Institutes of Health (NIS) database for the years 2017-2019, involving a cohort of 161,834 patients aged over 18 who were diagnosed with neurovascular complications of diabetes. Demographic characteristics (age, gender, ethnicity), hospital characteristics, comorbidities, and other relevant data were included for analysis. A binary logistic regression model was generated to identify independent risk factors for DFU. The prevalence of DFU among patients with neurovascular complications of diabetes was 29.4% during the period from 2017 to 2019. Compared to patients without DFU, those with DFU had longer hospitalization times and higher costs. The multiple regression analysis revealed that Iron-deficiency anemia (OR, 1.10; 95% CI, 1.01-1.11; P=0.019), Hypertension (OR, 1.07; 95% CI, 1.03-1.11; P=0.001), Obesity (OR, 1.08; 95% CI, 1.06-1.11; P<0.001), Peripheral vascular disorders (PVD) (OR, 1.69; 95% CI, 1.65-1.74; P<0.001), Osteomyelitis (OR, 7.10; 95% CI, 6.89-7.31; P<0.001), Tinea pedis (OR, 1.89; 95% CI, 1.59-2.26; P<0.001), Sepsis (OR, 1.24; 95% CI, 1.20-1.28; P<0.001), and onychomycosis (OR, 1.26; 95% CI, 1.13-1.42; P<0.001) were independent predictors for DFU in this population. The study found a high prevalence of DFU in patients with neurovascular complications of diabetes. Identifying and addressing risk factors such as deficiency anemia, hypertension, obesity, PVD, infections, and foot conditions may contribute to reducing the prevalence of DFU in this vulnerable population.

Hypertension-Induced Biomechanical Modifications in the Aortic Wall and Their Role in Stanford Type B Aortic Dissection.

Hypertension is a major risk factor for the type B aortic dissection (TBAD), while many patients do not manage or regulate their hypertension consistently, leading to stable or unstable hypertension. Currently, the effects of stable and unstable hypertension on the biomechanical properties of the aorta remain unclear. The objective was to identify a blood pressure state that represents a greater risk for TBAD development. A total of 183 samples (108 axial and 75 circumferential) were divided into three groups. Fatigue tensile tests were carried out to simulate normotension, stable hypertension, and unstable hypertension conditions, respectively. Uniaxial tensile tests were performed; thus, the elastic modulus, energy loss, and the peeling force were assessed to evaluate the biomechanical properties. Compared with normal blood pressure, the modulus of elastic fibers decreased under stable hypertension (0.05 ± 0.02 MPa vs. 0.11 ± 0.03 MPa, p < 0.001) and unstable hypertension (0.08 ± 0.02 MPa, p = 0.008), while collagen fibers increased under stable hypertension (2.14 ± 0.51 MPa vs. 1.10 ± 0.24 MPa, p < 0.001) but decreased under unstable hypertension (0.52 ± 0.14 MPa, p < 0.001) in the axial direction. Similar trends were observed circumferentially. Energy loss was highest under unstable hypertension (0.16 ± 0.03 vs. 0.08 ± 0.03, p < 0.001). Peeling force was significantly reduced under stable hypertension (81.69 ± 12.72 N/m vs. 111.10 ± 27.65 N/m, p < 0.001) and further under unstable hypertension (71.37 ± 16.13 N/m, p < 0.001). Stable and unstable hypertension significantly impair the biomechanical properties of the aortic wall, with unstable hypertension leading to greater damage. Hypertensive patients are recommended to strictly follow medical advice to control blood pressure to avoid a higher risk of TBAD due to improper blood pressure management.