Decrease In Systolic Blood Pressure Research Articles

A brief overview of modern approaches to the therapy of resistant arterial hypertension

Resistant hypertension is associated with increased mortality and morbidity. The optimal drug therapy for resistant hypertension has not been fully clarified, there are few studies on this issue in the literature. We compared the efficacy of nebivolol 5 mg, a third-generation beta-blocker, with spironolactone 25 mg in patients with resistant hypertension.
 81 patients with resistant hypertension were included in the study. Resistant hypertension was defined as the presence of official blood pressure ≥ 140/90 mm Hg. when patients received 3 or more antihypertensive drugs, including diuretics. Blood pressure was recorded in office and outpatient settings at baseline and after 8 weeks of treatment.
 Office systolic blood pressure and diastolic blood pressure at 24-hour ambulatory blood pressure monitoring were significantly lower compared to baseline values in the nebivolol and spironolactone groups. The decrease in 24-hour mean systolic and diastolic blood pressure in the nebivolol group was 14.9±19.8 mm Hg. Art. and 9.3±12.7 mm Hg. Art. compared to 19.5±16.4 mm Hg. Art. and 13.7±10.8 mm Hg. Art. in the spironolactone group, respectively. The reduction in 24-hour mean systolic and diastolic blood pressure was not significantly different between the nebivolol and spironolactone groups (P = 0.338 and P = 0.153).
 Therefore, nebivolol is an effective treatment option for resistant hypertension, and the antihypertensive effect of this drug is similar to low doses of spironolactone.

Cardiorespiratory fitness and metabolic risk in Chinese population: evidence from a prospective cohort study

BackgroundStudies on the association between estimated cardiorespiratory fitness (CRF) and changes in metabolic risk in the Chinese population are limited. This study aims to examine the associations between CRF and changes in metabolic risk.Subjects and methodsWe included 4,862 and 2,700 participants recruited from 28 provinces in the China Health and Retirement Longitudinal Study (CHARLS) in the baseline (Wave 1) and follow-up (Wave 4) analyses, respectively. CRF was calculated using sex-specific longitudinal non-exercise equations. Metabolic indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG) levels. The metabolic score was calculated as the number of changes in the above metabolic indicators above the 75th percentile of the distribution of changes (equal to or below the 25th percentile for HDL-C).ResultsIn the baseline analysis, CRF was negatively associated with SBP, DBP, TG, and FPG, and positively correlated with HDL-C after adjusting for age, smoking status, and drinking status (all P < 0.0001) in both males and females. In the follow-up analysis, higher baseline CRF was significantly related to a decrease in SBP, DBP, TG, FPG, and metabolic score (all P < 0.0005), and increased HDL-C (P < 0.0001) after further adjustment for corresponding baseline metabolic indicators. The associations remained significant after stratification by sex, except for the changes in HDL-C levels in females. Furthermore, improved CRF was associated with favorable changes in DBP, TG, HDL-C, FPG, and metabolic scores in all populations and males. Significant associations between changes in CRF and DBP, TG, and FPG levels were found in females.ConclusionHigher baseline CRF and improved CRF were associated with favorable changes in metabolic indicators.

The impact of telehealth education on self-management in patients with coexisting type 2 diabetes mellitus and hypertension: a 26-week randomized controlled trial.

The prevalence of coexisting type 2 diabetes mellitus and hypertension is increasing globally and posing significant health challenges. Effective self-management is crucial for controlling the disease and preventing complications. Telehealth education has emerged as a promising approach to enhancing self-management. This study aimed to investigate the effects of telehealth education on glycolipid metabolism, blood pressure, and self-management in patients with coexisting type 2 diabetes mellitus and hypertension. This study included 174 patients diagnosed with type 2 diabetes and hypertension from October 2022 to March 2023 at the 900th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army. The patients were randomly assigned to the control group or the telehealth education group. The control group received conventional diabetes education including diet and exercise guidance, while the telehealth education group received additional online education through the WeChatapplication. Both groups were followed up for 26weeks and the changes in glycolipid metabolism, blood pressure, and self-management were compared between the groups. After 26weeks of intervention, the telehealth education group showed statistically significant reductions in weight, body mass index, fasting blood glucose, 2h postprandial blood glucose, and hemoglobin A1c compared to the control group (P < 0.05). The telehealth education group also exhibited a significant decrease in systolic blood pressure and low-density lipoprotein-C level (P < 0.05). The Summary of Diabetes Self-Care Activities score, which reflects the level of diabetes self-management, demonstrated that the telehealth education group had a significantly better total score as well as superior scores in all five sub-categories (diet, blood glucose testing, medication use, and foot care) compared to the control group (P < 0.05). Our findings confirmed that telehealth education effectively enhanced the self-management capabilities of patients with coexisting type 2 diabetes and hypertension, leading to better glycolipid and blood pressure control. The use of telehealth education may potentially improve the interaction between medical staff and patients in the management of chronic diseases.

Sex differences in cardiometabolic risk factors and in response to lifestyle intervention in prepubertal and pubertal subjects with obesity.

Childhood obesity is a growing health problem and requires a tailored treatment. This study explored the sex differences in cardiovascular risk factors in children/adolescents with obesity and in response to a weight loss intervention. Five hundred and thirty-three children/adolescents with obesity and their parents underwent to a 3-months lifestyle intervention program. Tanner criteria were used to assess the pubertal stage. Before and after 3 months, anthropometric measurements, blood pressure (BP), and biochemical measurements were assessed. Four hundred and forty five participants completed the treatment (age 12.4 ± 2.7 years, males 45.8%, prepubertal 29.2%, BMI z score 2.3 ± 0.2). In comparison to boys, prepubertal girls had higher values of BMI z score (2.4 ± 02 vs. 2.3 ± 0.2, p < 0.05), waist circumference z score (2.2 ± 0.3 vs. 2.0 ± 0.3, p < 0.05), HOMA-IR [2.9 (2.1-4.9) vs. 2.3(1.5-3.6), p < 0.01], prevalence of hypertransaminasemia (41.3% vs. 17.7%, p < 0.05) and lower levels of HDL cholesterol (46.2 ± 9.8 vs. 51.2 ± 10.5 mg/dl, p < 0.05). In the pubertal stage, boys had worse cardiometabolic risk profile than girls, including unfavourable measure of systolic BP (z score: 0.6 ± 1.0 vs. 0.3 ± 1.0, p < 0.01), fasting glucose (87.2 ± 6.1 vs. 84.8 ± 7.7 mg/dl, p < 0.01), ALT (26.9 ± 21.5 vs. 20.2 ± 10.6 U/L, p < 0.001) and uric acid (6.1 ± 1.9 vs. 5.0 ± 1.0 mg/dl, p < 0.001). After the lifestyle intervention, changes in BMI z score (p < 0.05) were higher in pubertal boys than pubertal girls. The systolic blood pressure decrease was greater in pubertal boys than in their female counterpart (Δ systolic BP: -7.2 mmHg in boys vs. -3.6 mmHg in girls, p < 0.05; Δ systolic BP z score: -0.6 in boys vs. -0.3 in girls, p < 0.05). LDL cholesterol showed an improvement only in boys, and ALT in the whole group. Our study showed that a short-term lifestyle intervention is more effective in reducing BMI z score and cardiovascular risk factors in pubertal boys than in their female counterparts. Further investigation is needed to deepen this gender difference, especially to develop a tailor-made intervention.

Lower-Limb Perfusion and Cardiovascular Physiology Are Significantly Improved in Non-Healthy Aged Adults by Regular Home-Based Physical Activities-An Exploratory Study.

Common daily activities including walking might be used to improve cardiovascular health in the presence of disease. Thus, we designed a specific home-based physical activity program to assess cardiovascular indicators in an older, non-active, non-healthy population. Ten participants, with a mean age of 62.4 ± 5.6 years old, were chosen and evaluated twice-upon inclusion (D0), and on day 30 (D30)-following program application. Perfusion was measured in both feet by laser Doppler flowmetry (LDF) and by polarised spectroscopy (PSp). Measurements were taken at baseline (Phase 1) immediately after performing the selected activities (Phase 2) and during recovery (Phase 3). Comparison outcomes between D0 and D30 revealed relevant differences in Phase 1 recordings, namely a significant increase in LDF perfusion (p = 0.005) and a significant decrease in systolic blood pressure (p = 0.008) and mean arterial pressure (MAP) (p = 0.037). A correlation between the increase in perfusion and the weekly activity time was found (p = 0.043). No differences were found in Phase 2, but, in Phase 3, LDF values were still significantly higher in D30 compared with D0. These simple activities, regularly executed with minimal supervision, significantly improved the lower-limb perfusion while reducing participants' systolic pressure and MAP, taken as an important improvement in their cardiovascular status.

Abstract 137: Post-Stroke Blood Pressure Control and Follow Up Care in Real-World Setting

Introduction: Within 5 years of a stroke, approximately 25% of patients will have a recurrent event. Blood pressure (BP) reduction can reduce this risk; every 10 mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite this benefit, 50% of patients with hypertension remain uncontrolled after a stroke. Reasons for poor control may be related to poor post-stroke follow up care. We aim to quantify post-stroke BP control and follow up in a large health system. Methods: We performed a retrospective analysis of patients with stroke admitted to Yale New Haven Health System (YNHHS) between 2013-2021. YNHHS has 5 hospitals and a large outpatient network. Eligible patients included those who received primary care within YNHHS, were discharged alive, and not on dialysis. We analyzed patient features, time to outpatient encounter, and vital signs. The primary outcome was uncontrolled BP (&gt;140/90) obtained during the office visit closest to and before 6 months from the date of discharge. Results: During the study period 12,561 patients were admitted with stroke to YNHHS. After exclusions, the final cohort was 2,867 patients. Among these patients, 48 % were male, 65% non-Hispanic White, 22% non-Hispanic Black, 9% Hispanic, and 4% other. Mean (standard deviation) age was 68 (12) years. Approximately 25% of patients had uncontrolled BP. When the updated ACC/AHA (2017) BP goal (&lt;130/80) was applied, the amount of patient with uncontrolled BP increased to 52%. After 6 months, 318 (11%) had no visit with a medical provider, 250 (9%) patients had 1 follow up visit, and 2,299 (80%) patients had &gt;2 follow up visits. The median (interquartile range [IQR]) number of days to first visit with a PCP or neurologist was 30 (10-97) days and 45 (27-99) days, respectively. The median (IQR) number of visits with either a PCP or neurologist was 0 (0-2). Conclusion: Among patients with recent stroke, more than half do not achieve BP control per current guidelines. The majority of patients do not engage with a PCP or neurologist within 6 months following a stroke, even though they have an established provider within the system. Gaps in follow up represents a notable opportunity for improving post-stroke care.

Effect of insertion/deletion polymorphism of angiotensin-converting enzyme gene on efficacy of antihypertensive therapy with angiotensin II receptor blockers

The efficacy of the antihypertensive therapy may be related to genetic factors that can influence not only the degree of the blood pressure (BP) elevation but also contribute to the interindividual variability of response to the antihypertensive treatment.The aim of the work was to study pharmacodynamic parameters of the therapy efficacy with angiotensin II receptor blockers in the form of monotherapy and as part of combined drugs in patients with the arterial hypertension depending on the genetic features of patients – polymorphism of the gene encoding angiotensin-converting enzyme, or I/D-polymorphism.Materials and methods. The study included 179 patients of the Moscow region with a first-diagnosed arterial hypertension (AH) of 1–2 degree, including 141 (78.8%) women and 38 (21.2%) men aged from 32 to 69 years. By a simple randomization method, the patients were randomly allocated into groups receiving irbesartan and valsartan as mono- or combination therapy with hydrochlorthiazide. After 3 weeks of this pharmacotherapy, the presence of rs4646994 Alu Ins / Del genetic polymorphism of the angiotensin-converting enzyme (ACE) gene and the minimum equilibrium concentration of angiotensin II receptor blockers (ARBs) were determined.Results. The patients treated with irbesartan, the D/D genotype carriers, were significantly less likely to reach the target BP and more likely to require a pharmacotherapy intensification compared to I/D heterozygotes (p=0.042 and p=0.058, respectively) and I/I homozygotes (p=0.011 and p=0.011, respectively). The patients treated with valsartan, the D/D genotype carriers, significantly more often reached the target BP and significantly less often required a pharmacotherapy intensification than the I/D genotype carriers (p=0.05 and p=0.05, respectively). Herewith, at the end of the study, according to the results of the office BP measurements and daily BP monitoring, the target BP achievement was not significantly correlated with the I/D polymorphism of the ACE gene.Conclusion. When personalizing the AH therapy in patients of the Moscow region, the genotype I/I carriers by I/D polymorphism of the ACE gene, can be recommended irbesartan in the form of mono- or bicomponent therapy as a starting therapy of ARBs; the D/D genotype carriers can be recommended valsartan. A more pronounced decrease in the daytime systolic BP (SBP), the daytime diastolic BP (DBP) and the nighttime SBP variabilities in the valsartan group of patients, the D allele carriers may indicate a more persistent effect of the antihypertensive therapy.

Effects of beetroot-pineapple juice on hypertensive elderly in Depok

The prevalence of hypertension, based on measurement results among the population aged ? 18 in Indonesia, increased by 8.3% from 2013 to 2018. Due to this rise, there is an evident need for treatments to decrease this rate. Introducing non-pharmacological therapies, such as beetroot and pineapple juice, maybe a viable solution. This study aimed to assess the difference in blood pressure before and after the consumption of beetroot and pineapple juice among elderly hypertensive patients in the Abadijaya Public Health Center region of Depok City. The research followed an experimental design, specifically a pretest-posttest one-group format. The study involved 15 elderly individuals aged between 60-80 years with blood pressure readings of ? 140/90 mmHg. They consumed 300 ml of the juice daily for seven consecutive days. Data analysis included the Shapiro-Wilk test for normality, the paired t-test, and the Wilcoxon test for statistical significance. The findings revealed a significant reduction in blood pressure after the consumption of beetroot and pineapple juice, with a p-value for systolic pressure at 0,000 and diastolic pressure at 0,020 (p&lt;0,05). The average decrease in systolic blood pressure was 13,03 mmHg, and for diastolic blood pressure, it was 4,8 mmHg. There was a discernible difference in blood pressure measurements before and after juice consumption among the elderly hypertensive patients.

Evaluation the role of supplementation of oral zinc on systolic and diastolic blood pressure in type 2 diabetic patients

Background: Zinc is an important trace element and a potent antioxidant. Its deficiency causes a common comorbidity with numerous chronic diseases including hypertension and diabetes mellitus, associated with development and progression of various complications. Objective: The present study has been undertaken to evaluate the effects of zinc supplementation on blood pressure in type 2 diabetic patients. Methods: This prospective interventional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka between January 2016 to December 2016. In this study, a total number of 46 diagnosed type 2 diabetic patients of both sexes were selected with age ranging from 40 to 55 years. Among them, 26 type 2 diabetic patients with supplementation of oral zinc (40mg/day) for 12 weeks were considered as study group (Group B). Another 25 age matched type 2 diabetic patients without supplementation of oral zinc were considered as control group (Group A) for comparison. All subjects were selected from Outpatient Department of Endocrinology, Dhaka Medical College Hospital, Dhaka on the basis of inclusion and exclusion criteria. Their blood pressure (BP) was measured and serum zinc level was estimated by Spectrophotometric method accordingly. These parameters were studied 2 times in all subjects of control and study groups i.e. at the beginning of study (base line) and after 12 weeks of study period. Data were collected in pre-designed structured questionnaire form by the researcher herself. For statistical analysis, paired Student’s ‘t’ test and unpaired Student’s ‘t’ test were performed as applicable using SPSS for windows version 22.0. Results: In this study, after zinc supplementation resulted in a significant (p&lt;0.001) decrease in both systolic and diastolic blood pressure in study group but there was no significant change observed in control group. Conclusions: After analyzing the results of the study, it can be concluded that oral zinc supplementation can be useful for improving blood pressure in type 2 diabetic patients. Central Medical College Journal Vol 7 No 1 January 2023 Page: 41-46

Phytochemical and pharmacological evaluation of the anti-hypertensive effect of Theobroma Cacao

Background: This study evaluated the effects of chloroform and ethanol extracts of Theobroma Cacao (T.Cacao) in nitro-L-arginine, methyl esters (L-NAME)-induced hypertensive rats. The acute toxicity and phytochemical analyses of the extracts were carried out using standard methods while hemodynamic parameters of hypertensive rats treated with the extracts were assayed using invasive and non-invasive methods of blood pressure measurements. The percentage yield of the extract was 3.25% (ethanol) and 15.77% (chloroform). The phytochemical analyses revealed the presence of flavonoids, alkaloids, steroids, saponins, anthraquinone, tannins and, cardiac glycosides. Concurrent administration of the extracts with L-NAME showed a significant (p&lt;0.05) decrease in systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure in the treated rats compared with the untreated rats. The mechanism of action showed that ethanol extract led to significant (p&lt;0.05) decreases in systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure also in the presence of muscarinic antagonist (atropine). The isolated rat thoracic aorta showed a slight decrease at each concentration but not statistically significant (p&lt;0.05), it was statistically significant at 50mg/ml while in the presence of high KCl, there were significant (p&lt;0.05) decreases at each of the concentrations compared with the control. The observed results showed that consumption of T. cacao within the experimental dose prevented an increase in hemodynamic status of Wistar rats. Thus, if these results are extrapolated to man, consumption of T. cacao should be encouraged.

Preoperative Renin-Angiotensin System Antagonists Intake and Blood Pressure Responses During Ambulatory Surgical Procedures: A Prospective Cohort Study.

There is limited evidence to inform the association between the intake of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) and intraoperative blood pressure (BP) changes in an ambulatory surgery population. Adult patients who underwent ambulatory surgery and were discharged on the same day or within 24 hours of their procedure were enrolled in this prospective cohort study. The primary outcome of the study was early intraoperative hypotension (first 15 minutes of induction). Secondary outcomes included any hypotension, BP variability, and recovery. Hypotension was defined as a decrease in systolic BP of >30% from baseline for ≥5 minutes or a mean BP of <55 mm Hg. Four exposure groups were compared (no antihypertensives, ACEI/ARB intake <10 hours before surgery, ACEI/ARB intake ≥10 hours before surgery, and other antihypertensives). Of the 537 participants, early hypotension was observed in 25% (n = 134), and any hypotension in 41.5% (n = 223). Early hypotension occurred in 30% (29 of 98) and 41% (17 of 41) with the intake of ACEI/ARBs <10 and ≥10 hours before surgery, respectively, compared to 30% (9 of 30) with other antihypertensives and 21% (79 of 368) with no antihypertensives ( P = .02). Those on antihypertensives also experienced any hypotension more frequently than those who were not on antihypertensives ( P < .001). After adjusting for age and baseline BP in a regression analysis, antihypertensive exposure groups were observed to be associated only with any intraoperative hypotension ( P = .012). In the ACEI/ARB subset, there was no evidence of an association between time since the last ACEI/ARB dose, and hypotension or minimum mean or systolic BP. Compared to normal baseline BP, BP ≥ 140/90 mm Hg increased the odds of early and any hypotension (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.1-7.1 and OR, 7.7; 95% CI, 3.7-14.9, respectively; P < .001). Intraoperative variability in systolic and diastolic BP demonstrated significant differences with age, baseline BP, and antihypertensive exposure group ( P < .001). Early and any hypotension occurred more frequently in those on antihypertensives than those not on antihypertensives. Unadjusted associations between antihypertensive exposure and intraoperative hypotension were largely explained by baseline hypertension rather than the timing of ACEI/ARBs or type of antihypertensive exposure. Patients with hypertension and on treatment experience more intraoperative BP variability and should be monitored appropriately.

The Effectiveness of Extra Virgin Olive Oil on Blood Pressure Reduction in Obese Women

Extra virgin olive oil (EVOO), containing glycerol or subjected to hydrolysis, constitutes approximately 90-99% of the oil, primarily consisting of monounsaturated fatty acids (MUFA), with oleic acid comprising up to 80% of the total oil. This study aims to examine the influence of oleic acid in olive oil on reducing systolic blood pressure (SBP) and diastolic blood pressure (DBP). The intervention spanned 15 days, where the treatment group received EVOO, and the control group received a placebo (water), each administered twice a day at a dosage of 15 ml. Before the intervention, blood pressure was assessed with the Mann-Whitney test, while after intervention, measurements were analyzed using the Independent T-Test. Additional 15 ml Extra Virgin Olive Oil for 15 days results in significant decrease of systolic blood pressure and diastolic blood pressure compared to water only.

Lidocaine, Esmolol, and Beyond: A Comprehensive Analysis of Hemodynamic Stress during Laryngoscopy and Intubation

Aim: To evaluate the haemodynamic stress response in combination of lidocaine and esmolol versus lidocaine or esmolol alone during laryngoscopy and intubation Methods: This research comprised 60 patients who provided written permission and met the inclusion and exclusion criteria. Selected patients were randomly assigned to one of three groups based on a computer-generated random number: lignocaine 1.5 mg/kg (n=40), esmolol 2mg/kg (n=40), or lignocaine 1mg/kg and esmolol 1mg/kg (n=40). This research comprised patients aged 20 to 42 who had elective procedures under general anaesthetic and had ASA I and II. Patients with contraindications to beta blockers, such as bronchial asthma, COPD, a basal heart rate of 60 beats per minute, respiratory impairment, and documented reactions to local anaesthetics. Results: There were no significant variations in age, preoperative heart rate, or blood pressure between the groups. Males and females were approximately equally dispersed throughout all groupings. Following the delivery of the test medicines, all three groups saw a substantial drop in heart rate (Group E 61.23±3.64, Group L 73.25±5.36, Group LE 72.23±5.36) (p&lt;0.001). Four Group E patients developed bradycardia. (HR &lt;60). Although both Group LE and Group L showed near baseline values, Group L showed near baseline values until the third minute, whereas Group LE showed a continuous reduction in heart rate rates. After 30 minutes, all three groups' heart rates were statistically insignificant. Following induction and administration of the test medicines, systolic, diastolic, and hence mean arterial blood pressure lowers gradually in all three groups (p&lt;0.001). (This is for systolic blood pressure.). Group E 97.36±5.69, Group L 125.39±6.36, Group LE 116.78±4.78) Group E 60.034.69, Group L 82.935.36, Group LE 72.034.78) (Group E 72.10±3.69, Group L 96.90±3.85, Group LE 86.44±2.87) Before intubation, patients in Group E experienced substantial decreases in systolic, diastolic, and mean arterial blood pressure (less than 20% of baseline). Following intubation, blood pressure levels in Group LE were near baseline until the 30th minute (p&lt;0.001). Group E had a consistent fall in all three blood pressure readings following intubation until the fifth minute. Group E's blood pressures were likewise around baseline at the 15th and 30th minutes. Until the 15th minute, Group L had a considerable rise in all three blood pressures. Conclusion: As a result, esmolol and lidocaine together are a safe and effective strategy to minimise laryngoscopy responses to intubation and extubation, lowering myocardial oxygen consumption and the risk of myocardial ischemia under general anaesthesia.

Safety and Efficacy of GLP-1 Receptor Agonists in Type 2 Diabetes Mellitus with Advanced and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis.

Background and Objectives: Limited evidence exists regarding the safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients with advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Thus, we conducted a systematic review and meta-analysis to assess the safety and efficacy of GLP-1RAs in T2DM patients with advanced CKD and ESKD. Materials and Methods: We performed a systematic literature search in MEDLINE, EMBASE, and Cochrane database until 25 October 2023. Included were clinical trials and cohort studies reporting outcomes of GLP-1RAs in adult patients with T2DM and advanced CKD. Outcome measures encompassed mortality, cardiovascular parameters, blood glucose, and weight. Safety was assessed for adverse events. The differences in effects were expressed as odds ratios with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference or standardized mean difference (SMD) with 95% confidence intervals for continuous outcomes. The Risk of Bias In Non-randomized Studies-of Interventions (ROBIN-I) tool was used in cohort and non-randomized controlled studies, and the Cochrane Risk of Bias (RoB 2) tool was used in randomized controlled trials (RCTs). The review protocol was registered in the International Prospective Register of Systematic Reviews (CRD 42023398452) and received no external funding. Results: Eight studies (five trials and three cohort studies) consisting of 27,639 patients were included in this meta-analysis. No difference was observed in one-year mortality. However, GLP-1RAs significantly reduced cardiothoracic ratio (SMD of -1.2%; 95% CI -2.0, -0.4) and pro-BNP (SMD -335.9 pmol/L; 95% CI -438.9, -232.8). There was no significant decrease in systolic blood pressure. Moreover, GLP-1RAs significantly reduced mean blood glucose (SMD -1.1 mg/dL; 95% CI -1.8, -0.3) and increased weight loss (SMD -2.2 kg; 95% CI -2.9, -1.5). In terms of safety, GLP-1RAs were associated with a 3.8- and 35.7-time higher risk of nausea and vomiting, respectively, but were not significantly associated with a higher risk of hypoglycemia. Conclusions: Despite the limited number of studies in each analysis, our study provides evidence supporting the safety and efficacy of GLP-1RAs among T2DM patients with advanced CKD and ESKD. While gastrointestinal side effects may occur, GLP-1RAs demonstrate significant improvements in blood glucose control, weight reduction, and potential benefit in cardiovascular outcomes.

Association of heavy metals exposure with lower blood pressure in the population aged 8-17 years: a cross-sectional study based on NHANES.

The existing evidence regarding the joint effect of heavy metals on blood pressure (BP) in children and adolescents is insufficient. Furthermore, the impact of factors such as body weight, fish consumption, and age on their association remains unclear. The study utilized original data from the National Health and Nutrition Examination Survey, encompassing 2,224 children and adolescents with complete information on 12 urinary metals (barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, thallium, tungsten, uranium, mercury and arsenic), BP, and core covariates. Various statistical methods, including weighted multiple logistic regression, linear regression, and Weighted Quantile Sum regression (WQS), were employed to evaluate the impact of mixed metal exposure on BP. Sensitivity analysis was conducted to confirm the primary analytical findings. The findings revealed that children and adolescents with low-level exposure to lead (0.40 μg/L, 95%CI: 0.37, 0.42), mercury (0.38 μg/L, 95%CI: 0.35, 0.42) and molybdenum (73.66 μg/L, 95%CI: 70.65, 76.66) exhibited reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP). Conversely, barium (2.39 μg/L, 95%CI: 2.25, 2.54) showed a positive association with increased SBP. A 25th percentile increase in the WQS index is significantly associated with a decrease in SBP of 0.67 mmHg (95%CI, -1.24, -0.10) and a decrease in DBP of 0.59 mmHg (95% CI, -1.06, -0.12), which remains statistically significant even after adjusting for weight. Furthermore, among individuals who consume fish, heavy metals have a more significant influence on SBP. A 25 percentile increase in the WQS index is significantly associated with a decrease of 3.30 mmHg (95% CI, -4.73, -1.87) in SBP, primarily attributed to mercury (27.61%), cadmium (27.49%), cesium (17.98%), thallium (8.49%). The study also identified a declining trend in SBP among children aged 10-17, whereas children aged 11-18 exhibited lower levels of systolic and diastolic blood pressure, along with a reduced risk of hypertension. Some heavy metals demonstrate an inverse association with the BP of children and adolescents, particularly notable in groups with fish consumption and older children and adolescents. Future studies are warranted to validate these findings and delve deeper into the interplay of heavy metals.

Assessment of the activity of Trauma Centers for Children in Poland in 2021

Aim: Injuries are dominant causes of death and hospitalization among children and adolescents. In some countries, there are designated pediatric trauma centers (PTCs) that offer multiple levels of care for trauma patients. Our aim is to demonstrate that the criteria in Polish PTCs may not identify a large group of patients with life-threatening conditions, and they may be referred to centers with lower capabilities. Material and methods: We analyzed all trauma patients transported by ambulance to the Emergency Department in Pediatric Teaching Hospital of University Clinical Center of the Medical University of Warsaw in 2021. Results: Out of 981 pediatric trauma patients, 27 qualified for PTC. Key factors determining which children are more likely to qualify for PTC include the influence of alcohol, falls from heights, the need for analgesics, and fluid therapy. Physical examination abnormalities more likely found among patients qualified for PTC were: GCS≤13, abnormal pupillary reaction, abnormal pupil width, seizures, a decrease in systolic blood pressure, abnormal heart rate, and a decrease in oxygen saturation. There is a significant group of patients who do not meet PTC criteria but present a risk to life or health. Conclusions: Only a small number of admitted children met the qualification criteria for PTC. It seems that we should not assess a patient solely based on preestablished criteria, but the universality of this problem requires the creation of a segregation system that would allow access to patients more individually.

Effects of recreational team sports on the metabolic health, body composition and physical fitness parameters of overweight and obese populations: A systematic review.

This systematic review aims to provide a summary of the results from individual studies that specifically focused on overweight or obese populations, regardless of age or sex. The goal is to determine the effects of structured recreational team sports interventions (TSG) on metabolic health, body composition and physical fitness parameters when compared to passive or active control groups. This study adhered to the PRISMA guidelines for reporting a systematic review. A thorough examination of relevant literature was conducted on November 06, 2023, using three prominent databases: PubMed, Scopus, and the Web of Science. Inclusion criteria considered overweight (e.g., BMI 25.0-29.9 kg/m2) and obese (e.g., BMI > 30 kg/m2) populations exposed to training interventions using recreational team sports, while the comparator group consisted of the same populations not exposed to exercise (passive controls) or exposed to alternative training methods. The primary outcomes of interest were metabolic health parameters (glucose, waist circumference, blood pressure, cholesterol, triglycerides), body composition (e.g., fat mass, lean mass), as well as physical fitness parameters (e.g., aerobic fitness, muscular fitness). Only studies with two- or multi-arm designs, whether randomized or not, were eligible for inclusion. The PEDro scale was used to assess the methodological bias of the included studies. Out of the initial 275 titles retrieved, we deemed ten eligible for our study. In terms of body composition, TSG demonstrated a significant decrease in body mass index across three studies (-2.3 to -5.1%) and a significant reduction in waist circumference in four studies (-4.6% to -8.4%). Regarding blood pressure, TSG exhibited a significant decrease in systolic blood pressure in two studies (-3.9% to -8.3%), while diastolic blood pressure showed a significant decrease in only one study (-7.3%). Cholesterol levels saw a significant decrease in TSG in three studies (-7.0% to -9.7%), and triglyceride levels showed a significant reduction in four studies (-16.4% to -20.1%). In terms of aerobic fitness, TSG demonstrated within-group improvements in the field-based tests in three studies (8.1% to 79.0%), and within-group improvements in maximal oxygen uptake in four studies (6.5% to 31.0%), with significant favoring of TSG in most studies. Overall, TSG demonstrated significant benefits for overweight and obese populations compared to the control group, particularly in terms of improvements in body mass index, systolic blood pressures, cholesterol and triglyceride levels, and aerobic fitness. Future research ought to concentrate on tailoring responses to varying training volumes on an individualized basis.

Effect of eight-week high-intensity interval training versus moderate-intensity continuous training programme on body composition, cardiometabolic risk factors in sedentary adolescents.

This study aimed to assess and compare the effect of an 8-week high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) programme on body composition and cardiovascular metabolic outcomes of sedentary adolescents in China. Eighteen sedentary normal-weight adolescents (age: 18.5 ± 0.3years, 11 females) were randomized into three groups. HIIT group protocol consisted of three sessions/week for 8-week of "all out" sprints to reach 85%-95% of HRmax, and MICT group protocol undertook three sessions/week for 8-week of continuous running to reach 65%-75% of HRmax. The control group resumed normal daily activities without any intervention. Blood pressure and body composition were measured, and fasting blood samples were obtained at baseline and 48h post-trial. Mixed-design ANOVA analysis was employed followed by post hoc t-tests and Bonferroni alpha-correction was used to evaluate interaction, between-group, and within-group differences, respectively. Results indicated that HIIT and MICT similarly affected body fat mass (p = 0.021, ES = 0.19; p = 0.016, ES = 0.30, respectively), body fat percentage (p = 0.037, ES = 0.17; p = 0.041, ES = 0.28, respectively), visceral fat area (p = 0.001, ES = 0.35; p = 0.003, ES = 0.49, respectively) of body composition. A positive outcome was observed for waist/hip ratio (p = 0.033, ES = 0.43) in HIIT, but not MICT (p = 0.163, ES = 0.33). No significant differences were found between groups for any clinical biomarkers. However, pairwise comparison within the group showed a significant decrease in systolic blood pressure (p = 0.018, ES = 0.84), diastolic blood pressure (p = 0.008, ES = 1.76), and triglyceride (p = 0.004, ES = 1.33) in HIIT, but no significant differences were found in the MICT and Control group. Both 8-week HIIT and MICT programmes have similar positive effects on reducing body fat mass, fat percentage, and visceral fat area. However, sedentary adolescents may have limited scope to decrease insulin resistance after these 8-week interventions. Notably, the 8-week HIIT intervention was highly effective in increasing cardiometabolic health compared to the MICT. The exercise intensity threshold value and metabolic outcomes of high-intensity interval sprints should be explored further to extend the long-term benefit in this cohort.

Effects of residential Yoga therapy on blood pressure and body mass index in women with hypothyroidism and obesity: A retrospective study

Abstract Background: Hypothyroidism is a highly prevalent endocrine disorder among women of reproductive age. Patients with hypothyroidism often develop obesity, which further increases the risk of hypertension and cardiovascular disease. Yoga has positive effects on hypothyroidism indices. Aim: This retrospective study evaluates the effects of a two-week residential Yoga intervention on blood pressure and body mass index (BMI) among women with hypothyroidism and obesity. Materials and methods: Data of 98 females with a clinical diagnosis of hypothyroidism and obesity, aged between 18 and 60 years, who received two weeks of residential Yoga intervention between 2013 and 2020 at Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India, was retrieved retrospectively. The residential Yoga intervention consisted of integrated Yoga sessions, breathing practices, devotional sessions, a simple and wholesome diet, and educational sessions every day. Data on systolic blood pressure, diastolic blood pressure, and body mass index (BMI) were analyzed. Records of patients with cardiac disease, cardiorespiratory compensatory disease, hypertension, or patients on antihypertensive drugs were excluded. Results: There was a significant decrease in systolic blood pressure, diastolic blood pressure, and BMI at two weeks compared to baseline. Conclusion: A two-week residential Yoga intervention has a positive impact on blood pressure and BMI in women with hypothyroidism and obesity. Future randomized controlled trials with larger samples and long-term follow-ups are warranted.

Influence of the Antimycotic Drug Itraconazole on Plasma Cortisol Levels and Blood Pressure in a Patient with Burnout Syndrome

Burnout is a syndrome that is increasingly common nowadays. It is associated with reduced work efficiency and chronic exhaustion. The main cause of burnout is continuous stress at work and not enough rest. The main system involved in the pathogenesis of burnout is the hypothalamic–pituitary–adrenocortical axis with the final substrate of the glucocorticoid hormone cortisol. Therefore, in patients with burnout syndrome, the morning plasma cortisol levels are elevated, but there is no significant change in its evening values. This correlates with an increase in blood pressure, weight gain, muscle weakness, low immunity, etc. The following case report is about the unusual effect of the antifungal drug itraconazole on the circadian rhythm of the plasma cortisol levels, as well as on the blood pressure in patient with burnout syndrome. One month of peroral application of 100 mg itraconazole every day reduces the morning plasma cortisol levels to the greatest extent (by approximately 37%) rather than the evening cortisol levels (by circa 17.5%). The decrease in the mean ambulatory systolic and diastolic blood pressure is also not uniform (it is stronger in diastolic – 27% than in systolic – 17%).