Reduction In Diastolic Blood Pressure Research Articles

Dapagliflozin and Blood Pressure in Patients with Chronic Kidney Disease and Albuminuria

Background and AimsSodium–glucose cotransporter 2 inhibitors decrease blood pressure in patients with type 2 diabetes, but the consistency and magnitude of blood pressure lowering with dapagliflozin in patients with chronic kidney disease (CKD) is unknown. We conducted a prespecified analysis of the DAPA-CKD trial to investigate the effect of dapagliflozin on systolic blood pressure (SBP) in patients with CKD, with and without type 2 diabetes. MethodsA total of 4304 adults with baseline estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73m2 and urinary albumin-to-creatinine ratio (UACR) 200-5000 mg/g were randomized to either dapagliflozin 10 mg or placebo once daily; median follow-up was 2.4 years. The primary endpoint was a composite of sustained ≥50% eGFR decline, end-stage kidney disease, or death from a kidney or cardiovascular cause. Change in SBP was a prespecified outcome. ResultsBaseline mean (SD) SBP was 137.1 mmHg (17.4). By Week 2, dapagliflozin compared to placebo reduced SBP by 3.6 mmHg (95% CI 2.8-4.4 mmHg), an effect maintained over the duration of the trial (2.9 mmHg, 2.3-3.6 mmHg). Time-averaged reductions in SBP were 3.2 mmHg (2.5-4.0 mmHg) in patients with diabetes and 2.3 mmHg (1.2-3.4 mmHg) in patients without diabetes. The time-averaged effect of dapagliflozin on diastolic blood pressure (DBP) was 1.0 mmHg (0.6-1.4 mmHg); 0.8 mmHg (0.4-1.3 mmHg) in patients with diabetes and 1.4 mmHg (0.7-2.1 mmHg) in patients without diabetes. Benefits of dapagliflozin on the primary composite and secondary endpoints were evident across the spectrum of baseline SBP and DBP. ConclusionIn patients with CKD and albuminuria, randomization to dapagliflozin was associated with modest reductions in systolic and diastolic BP.

Retinal microvascular alterations in patients with active rheumatoid arthritis without cardiovascular risk factors: the potential effects of T cell co-stimulation blockade.

The evaluation of microvascular alterations might provide clinically useful information for patients with an increased cardiovascular (CV) risk, such as those with rheumatoid arthritis (RA), being the small artery remodeling the earliest form of target organ damage in primary CV diseases, such as arterial hypertension. The evaluation of retinal arterioles is a non-invasive technique aimed to identify an early microvascular damage, represented by the increase of the wall-to-lumen ratio (WLR) index. Abatacept (ABA), a T-cell co-stimulator blocker, is used to treat RA. A CV protective action was hypothesized for its peculiar mechanism of action in the modulation of T-cells, potentially involved in the pathogenesis of CV comorbidity. The study aimed to non-invasively investigate morphological characteristics of retinal arterioles in a cohort of RA patients treated with ABA. Seventeen RA patients [median (25th-75thpercentile) age = 58 (48-64) years, baseline 28-joint Disease Activity Score DAS28-C-reactive protein (DAS28-CRP) = 4.4 (3.9-4.6), body mass index (BMI) = 24.2 (23.4-26) kg/m2, rheumatoid factor positive:52.9%, anti-citrullinated peptide autoantibodies positive:76.5%] without known CV risk factors (arterial hypertension, diabetes, hypercholesterolemia, previous CV events, smoking) were evaluated by the adaptive optics imaging system of retinal arterioles before and every 6 months of therapy with ABA (T0, T6 and T12). Office blood pressure evaluation, 24-h ambulatory blood pressure monitoring and tissue-doppler echocardiography were also performed. A progressive significant reduction of the WLR of retinal arterioles was observed [T0 = 0.28 (0.25-0.30), T6 = 0.27 (0.24-0.31), T12 = 0.23 (0.23-0.26); p T0 vs. T6 = 0.414; p T6 vs. T12 = 0.02; p T0 vs. T12 = 0.009], without significant variations in other parameters. The T0-T12 reduction of WLR was correlated with that of DAS28-CRP (r:0.789; p = 0.005). Moreover, a significant reduction of diastolic office blood pressure and a trend for reduction of daily pressure measured by ambulatory monitoring were observed. In a cohort of RA patients without known CV risk factors, a reduction of retinal microvascular alterations was demonstrated after treatment for 12 months with ABA, in parallel with the reduction of disease activity. These results might suggest the possibility of microvascular abnormalities regression induced by the immune system modulation.

Nature’s therapeutic power: a study on the psychophysiological effects of touching ornamental grass in Chinese women

The health of city residents is at risk due to the high rate of urbanization and the extensive use of electronics. In the context of urbanization, individuals have become increasingly disconnected from nature, resulting in elevated stress levels among adults. The goal of this study was to investigate the physical and psychological benefits of spending time in nature. The benefits of touching real grass and artificial turf (the control activity) outdoors with the palm of the hand for five minutes were measured. Blood pressure and electroencephalography (EEG) as well as State-trait Anxiety Inventory (STAI) scores, and the semantic differential scale (SDM) were used to investigate psychophysiological responses. Touching real grass was associated with significant changes in brainwave rhythms and a reduction in both systolic and diastolic blood pressure compared to touching artificial turf. In addition, SDM scores revealed that touching real grass increased relaxation, comfort, and a sense of naturalness while decreasing anxiety levels. Compared to the control group, the experimental group had higher mean scores in both meditation and attentiveness. Our findings indicate that contact with real grass may reduce physiological and psychological stress in adults.

Sakuranetin as a Potential Regulator of Blood Pressure in Spontaneously Hypertensive Rats by Promoting Vasorelaxation through Calcium Channel Blockade.

Natural compounds, known for diverse pharmacological properties, have attracted attention as potential sources for hypertension treatment. Previous studies have revealed the hypotensive effect and vascular relaxation of prunetin, a natural compound derived from Prunus yedoensis. However, the potential blood pressure-lowering and vasorelaxant effects of sakuranetin, another representative compound found in plants belonging to the genus Prunus, have remained unexplored. We aimed to fill this gap by investigating the hypotensive and vasorelaxant effects of sakuranetin in rats. Results indicated that sakuranetin, particularly in the sakuranetin 20 mg/kg group, led to significant reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) by -14.53 ± 5.64% and -19.83 ± 6.56% at 4 h after administration. In the sakuranetin 50 mg/kg group, the SBP and DBP decreased by -13.27 ± 6.86% and -16.62 ± 10.01% at 2 h and by -21.61 ± 4.49% and -30.45 ± 5.21% at 4 h after administration. In addition, we identified the vasorelaxant effects of sakuranetin, attributing its mechanisms to the inhibition of calcium influx and the modulation of angiotensin II. Considering its hypotensive and vasorelaxant effects, sakuranetin could potentially serve as an antihypertensive agent. However, further research is required to evaluate the safety and long-term efficacy.

Feasibility of Self-Management of Hypertension and Diabetes Using Patient-Generated Health Data Through M-health in Central India.

Digital health innovations are modern solutions for the management and treatment of diseases, particularly non-communicable diseases. This study was conducted to assess the feasibility of the management of diabetes and hypertension through patient-generated health data (PGHD). A mobile application (One Health) was used for the entry of data on blood pressure, blood glucose, physical activity, and dietary intake for six months by the patients. Frequency of application download, monthly data entry, and change in control of blood pressure and glycemic markers during six months of application use were used to assess the feasibility and impact of the application for the management of hypertension and type 2 diabetes mellitus (T2DM). A higher proportion of patients entered data generated non-invasively (blood pressure) as compared to data generated via invasive techniques (glycemic control measures). The frequency of monthly data entry remained unchanged during One Health use. At the end of six months, control of hypertension and glycemic control was achieved in 53.3% and 33.9% of patients, respectively. Furthermore, there was a significant reduction of mean diastolic blood pressure (0.60 (±2.31); p=0.03) and glycosylated hemoglobin (0.657 (±1.808); p=0.04). The acceptability of One Health appears to be associated with the frequency of data entry. The entry of health data by patients was sufficient to effect positive change in health indicators.Although mobile applications enable the monitoring and management of chronic health conditions, additional research shall help in optimizing interventions to be adopted as acceptable tools of patient management.

Effects of long-term indoor air purification intervention on cardiovascular health in elderly: a parallel, double-blinded randomized controlled trial in Hong Kong

Ambient fine particulate matter (PM2.5) is a leading environmental risk factor globally, and over half of the associated disease burden are caused by cardiovascular disease. Numerous randomized controlled trials (RCT) have investigated the short-term cardiovascular benefits of indoor air purifiers (IAPs), but major knowledge gaps remain on their longer-term benefits. In this 1-year, randomized, double-blinded, parallel controlled trial of 47 elderly (ntrue-purification = 24; nsham-purification = 23) aged ≥70 years, true-purification reduced household PM2.5 levels by 28% and maintained lower exposure throughout the year compared to the sham-purification group. After 12 months of intervention, a significant reduction of diastolic blood pressure was found in the true-purification versus sham-purification group (-4.62 [95% CI: -7.28, -1.96] mmHg) compared to baseline measurement prior to the intervention, whereas systolic blood pressure showed directionally consistent but statistically non-significant effect (-2.49 [95% CI: -9.25, 4.28] mmHg). Qualitatively similar patterns of associations were observed for pulse pressure (-2.30 [95% CI: -6.57, 1.96] mmHg) and carotid intima-media thickness (-10.0% [95% CI: -24.8%, 4.7%]), but these were not statistically significant. Overall, we found suggestive evidence of cardiovascular benefits of long-term IAPs use, particularly on diastolic blood pressure. Evidence on other longer-term cardiovascular traits is less clear. Further trials with larger sample sizes and long-term follow-up are needed across diverse populations to evaluate the cardiovascular benefits of IAPs.

14-Week exercise training modifies the DNA methylation levels at gene sites in non-Alzheimer's disease women aged 50 to 70 years

Exercise training emerges as a key strategy in lifestyle modification, capable of reducing the risk of developing Alzheimer's disease (AD) due to risk factors such as age, family history, genetics and low level of education associated with AD. We aim to analyze the effect of a 14-week combined exercise training (CT) on the methylation of genes associated with AD in non-alzheimer's disease women. CT sessions lasted 60 min, occurring three times a week for 14 weeks. Forty non-Alzheimer's disease women aged 50 to 70 years (60.7 ± 4.1 years) with a mean height of 1.6 ± 0.1 m, mean weight of 73.12 ± 9.0 kg and a mean body mass index of 29.69 ± 3.5 kg/m2, underwent two physical assessments: pre and post the 14 weeks. DNA methylation assays utilized the EPIC Infinium Methylation BeadChip from Illumina. We observed that 14 weeks of CT led to reductions in systolic (p = 0.001) and diastolic (p = 0.017) blood pressure and improved motor skills post-intervention. Among 25 genes linked to AD, CT induced differentially methylated sites in 12 genes, predominantly showing hypomethylated sites (negative β values). Interestingly, despite hypomethylated sites, some genes exhibited hypermethylated sites (positive β values), such as ABCA7, BDNF, and WWOX. A 14-week CT regimen was adequate to induce differential methylation in 12 CE-related genes in healthy older women, alongside improvements in motor skills and blood pressure. In conclusion, this study suggest that combined training can be a strategy to improve physical fitness in older individuals, especially able to induce methylation alterations in genes sites related to development of AD. It is important to highlight that training should act as protective factor in older adults.

Assessment of the significance of dilated perivascular spaces and nocture arterial hypertension in the development of Alzheimer's disease

To study the severity and localization of dilated perivascular spaces (DPVS), the levels of protein markers of amyloidosis and neurodegeneration in the cerebrospinal fluid (CSF) at different daily blood pressure (BP) profiles in patients with Alzheimer's disease (AD) and other types of cognitive impairment. A total of 119 people, aged 53 to 92 years, including 55 patients with AD, 27 patients with vascular cognitive disorders (VCD), 19 patients with frontotemporal degeneration (FTD). All patients underwent BP monitoring for 24 hours using a standard oscillometric measurement method, lumbar puncture to assess Aβ-42 and Aβ-40 amyloid protein, total and phosphorylated tau protein in the CSF, magnetic resonance imaging tomography of the brain with subsequent assessment of the severity of expansion and localization of DPVS according to the G.M. Potter scale. In 58.3% of patients with AD, there is no adequate reduction in BP at night in comparison with patients with VCD (p<0.05). A significant degree of expansion of the DPVS turned out to be most typical for patients with AD: grade 3 was detected in 45.7% of patients, and the maximum, grade 4, was detected in 13.4%. At the same time, DPVSs were significantly more often detected in the group of subjects with insufficient reduction in diastolic BP (DBP) at night. A strong inverse correlation was established between the level of Aβ-42 in the CSF and the variability of DBP at night (r= -0.92; p<0.05). The decrease in the level of Aβ-42 in AD, especially at the prodromal stage, is directly related to the low variability of DBP at night, which is more characteristic of an insufficient decrease or increase in BP during night sleep. Patients with AD were characterized by an insufficient decrease in BP at night, which is associated with the severity and degree of maximum expansion of the DPVS. A decrease in the level of Aβ-42 amyloid protein in the CSF strongly correlates with the variability of DBP at night.

Effect of a Low Salt Diet on the Progression of Chronic Kidney Disease: A Prospective, Open-Label, Randomized Controlled Trial.

A causal relationship exists between salt intake and hypertension, stroke, and kidney disease. However, whether or not reduced salt intake slows progression of renal diseases has been intensely debated. In this prospective, open-label, randomized controlled trial, we examined the impact of a low salt diet on renal function, blood pressure, and other metabolic parameters. Herein, 194 patients with chronic kidney disease (CKD) stages 1 to 3 were randomized in low salt (intervention) and control groups. The intervention group was provided a low salt diet (1.5 g/day) for 3 months. The control group consumed their usual diet, and daily food intake was recorded in the control group. Renal function tests, 24-h urinary sodium excretion, urinary protein, serum calcium, phosphorus, and electrolyte levels were recorded monthly. After 3 months, the mean reduction in estimated glomerular filtration rate was significantly higher in the control group (mean reduction in eGFR, -3.011 mL/min/1.73 m2; 95% confidence interval (CI) = -5.367, -0.656, P = .013). Blood pressure (BP) decreased significantly in both groups; systolic and diastolic BP reduction at 3 months was significantly greater in the intervention group (systolic BP mean reduction -6.57/-4.29 mmHg; 95% CI = -10.24, -2.89) and diastolic BP mean reduction -6.95, -1.64 mmHg) compared with the control group (systolic BP mean reduction -0.58/-2.63 mmHg; 95%, CI = -4.33, 3.17 and diastolic BP mean reduction -5.34, -0.08 mmHg). The mean reduction in 24-h urine sodium excretion was greater in the intervention group, reaching a significant level at month 2 (-14.45 mmol/day; 95% CI = -27.63, -1.22). Overall, salt restriction can help slow the progression of renal insufficiency and results in statistically significant and clinically important reductions in BP among patients with CKD. NCT05716386 on 28/01/2023.

The effect of water-soluble tomato concentrate on elevated serum cholesterol in the middle-aged and elderly Chinese individuals.

Water-soluble tomato concentrate (WSTC) has demonstrated beneficial effect on blood flow in healthy populations. The prospective, randomized, double-blind, and placebo-controlled clinical trial was conducted to explore the impact of WSTC on individuals with elevated cholesterol levels. Sixty participants aged 35-65 with high cholesterol were enrolled and evenly divided into a treatment group (FFG) and a placebo group (PCG). Over a 60-day period comprising a 45-day treatment phase followed by a 15-day observational follow-up. Participants in the FFG received 300 mg daily of Fruitflow tablets, while the PCG were received placebos. The study showed that there were no significant differences in baseline parameters between the FFG and PCG (p > 0.05). Post-intervention, the FFG exhibited significant reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 4.2% (SBP, p < 0.001) and 3.8% (DBP, p = 0.015), respectively, compared to the PCG (p = 0.041). These reductions were sustained during the follow-up period. In contrast, the PCG showed no significant changes in SBP and DBP (p > 0.05). Stratified analysis by hypertension status revealed a significant SBP reductions both hypertensive and non-hypertensive FFG subjects (p < 0.05), with a trend towards DBP reduction. No significant changes in SBP and DBP were observed in the PCG. Moreover, the FFG group showed a significant increase in high-density lipoprotein (HDL) cholesterol (p < 0.05), along with a marked reduction in both weight and body mass index (BMI) (p < 0.05). The FFG also showed decreased levels of homocysteine, high-sensitivity C-reactive protein, and fasting blood glucose compared to the PCG (p < 0.05). In conclusion, WSTC has the potential to lower blood pressure and cardiovascular risk profiles in hypercholesterolemic individuals, presenting a viable non-harmacological option for enhancing cardiovascular health. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=27052, identifier ChiCTR1800015904.

Testosterone Replacement Therapy: Effects on Blood Pressure in Hypogonadal Men.

While testosterone therapy can improve the various pathologies associated with adult-onset testosterone deficiency (TD), Summary of Product Characteristics (SPC) of five testosterone preparations caution that treatment may be associated with hypertension. This paper evaluates the impact of testosterone undecanoate (TU) on blood pressure (BP) in men with adult-onset TD. Of 737 men with adult-onset TD in an on-going, observational, prospective, cumulative registry, we studied changes in BP using non-parametric sign-rank tests at final assessment and fixed time points. We used multiple regression analysis to establish factors (baseline BP, age, change/baseline waist circumference [WC] and hematocrit [HCT] and follow-up) potentially associated with BP change in men on TU. TU was associated with significant reductions in systolic, diastolic BP and pulse pressure, regardless of antihypertensive therapy (at baseline or during follow-up), larger reductions were seen with concurrent antihypertensive therapy. In men never on antihypertensive agents, median changes (interquartile range [IQR]) in systolic BP, diastolic BP and pulse pressure were -12.5 (-19.0, -8.0), -8.0 (-14.0, -3.0), and -6.0 (-10.0, -1.0) mmHg, respectively at final assessment, with only baseline BP values inversely associated with these changes (HCT and WC were not significantly associated). In men not on TU, systolic BP, diastolic BP, and pulse pressure significantly increased. In the TU treated men only 1 of the 152 men (not on antihypertensive agents at baseline) were started on antihypertensives during follow-up. In contrast 33 of the 202 men on antihypertensives (at baseline or follow-up) had the antihypertensive agent discontinued by the end of the follow-up. TU was associated with lowering of BP during follow-up irrespective of antihypertensive therapy, with greater reductions in men with higher baseline BP. In the context of SPC warnings, our long-term data provide reassurance on the effect of TU on BP.

Orienteering and hiking programs for older adults as a model of healthy aging: a randomized clinical trial

Objectives: To compare the effects of orienteering vs hiking on the physical fitness and quality of life of older adults. Methods: A 24-week randomized controlled trial was conducted with 96 participants who were assigned to orienteering (OG), hiking (HG), or a control group (CG) with no intervention. Physical fitness was assessed with the handgrip strength, chair stand, 6-minute walk, sitand-reach, and balance tests, with monitoring of blood pressure (BP) and resting heart rate. Generalized Estimating Equations were used for within- and between-group comparisons, with effect sizes (ES) calculated. Baseline and post-intervention differences were assessed using unpaired and paired tests. Results: Significant improvement in balance were observed, with OG reducing their time by -6.23 seconds (29.1%; ES = 0.83) and HG by -2.12 seconds (9.9%; ES = 0.49), p = 0.017. For paired effects, hemodynamic parameters showed a reduction in systolic (p = 0.014) and diastolic (p &lt; 0.001) BP in the OG and in diastolic BP (p &lt; 0.004) in the HG. Interaction effects were significant for all physical fitness and hemodynamic parameters compared with the CG (p &lt; 0.001) compared with the CG (p = 0.571). Conclusion: Older adults participating in orienteering and hiking experienced improvement in their physical fitness and quality of life, with orienteering showing a greater effect on balance. These activities are valuable for healthy aging programs, as sedentary behavior should be prevented. This trial was registered at the Brazilian Clinical Trials Registry (REBEC): RBR-99jmmpf.

Effects of Galvanic Skin Resistance Biofeedback on Perceived Stress in Individuals with High Blood Pressure: A Quasi-experimental Study

Introduction: According to the World Health Organisation (WHO), hypertension is one of the leading causes of premature morbidity and mortality, both in industrialised and developing countries. Patients with arterial hypertension are advised to make lifestyle adjustments, such as increasing physical activity and reducing stress. Nowadays, a variety of relaxation techniques are used to reduce stress and tension. The practise of Biofeedback (BF) is regarded as a successful treatment for this purpose. Aim: To investigate the effect of Galvanic Skin Resistance Biofeedback (GSRBF) on perceived stress. Materials and Methods: In present quasi-experimental study, 53 individuals with high blood pressure, including prehypertensive and hypertensive individuals {Blood Pressure (BP)&gt; 120/80 mmHg}, were included. Participants were recruited from various Medical and Physiotherapy Outpatient Departments (OPD) of private and Government hospitals and clinics in Veraval, Gujarat, India, from March 2022 to September 2022. Basic demographic data was collected, Blood Pressure (BP) was measured, and the Perceived Stress Scale (PSS) was administered. Participants were then connected to the GSRBF instrument and instructed to relax using a relaxation response technique. After 12 sessions, BP was measured again, and the PSS was administered. As the data were not normally distributed, a t-test was performed at a significance level of 95% (p&lt;0.05). Results: The analysis revealed a significant decrease in PSS scores following GSRBF sessions, with a p-value of &lt;0.05. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) also showed a significant reduction, with a p-value of &lt;0.05. Conclusion: The GSRBF demonstrated a significant reduction in perceived stress among individuals with high blood pressure, and it also showed a significant reduction in SBP and DBP. The present study provides valuable insights into the potential of GSRBF as an adjunct therapy for managing hypertension and promoting overall well-being.

Preliminary efficacy of a community health worker homebased intervention for the control and management of hypertension in Kiambu County, Kenya- a randomized control trial.

In Sub Saharan Africa, there is a growing burden of non-communicable diseases, which poses a big challenge to the resource-limited health system in these settings. The aim of this study was to determine the feasibility and preliminary efficacy of a community health workers (CHWs) home-based lifestyle interventions to improve blood pressure (BP) control and body composition among hypertensive patients in low-income populations of Kiambu County, Kenya. This was a randomized controlled trial (RCT) involving 80 patients with uncontrolled high BP (systolic BP (SBP) ≥140mmHg and/or diastolic BP (DBP) ≥90) randomized to either a CHW homebased intervention or a usual care (control) arm and followed up for 6 months. The intervention involved monthly CHW home-visits for health education and audits on behavioral risk factors that affect BP. An adapted WHO stepwise questionnaire and international physical activity questionnaire was used to collect data on behavioral cardiovascular risk factors. To assess the main outcomes of BP, body mass index (BMI) and waist-height-ratio (WHtR), a survey was conducted at baseline, 3 months, and 6 months. Data regarding univariate, bivariate and multivariate (repeated measurements between and within groups) analysis at 5% level of significance were analyzed using STATA 18. Generalized estimating equations (GEE) for repeated measures were used to estimate changes in BP, BMI and WHtR, and to examine the association between the CHW intervention and BP control. The study revealed that 77.5% and 92.5% of the participants in usual care and intervention groups completed the follow-up, respectively. After 6 months of follow-up, there was a reduction in the mean SBP and DBP for both arms, and reductions in BMI and WHtR only in the intervention arm. The adjusted mean reduction in SBP (-8.4 mm Hg; 95% CI, -13.4 to -3.3; P = 0.001) and DBP (-5.2 mm Hg 95% CI, -8.3 to -2.0; P<0.001) were significantly higher in the intervention group compared to the control group. The proportion of participants who achieved the controlled BP target of <140/90 mm Hg was 62.2% and 25.8% for the intervention and usual care arm, respectively. The proportion with controlled BP was significantly higher in the intervention arm compared to the usual care arm after adjusting for baseline covariates (AOR 2.8, 95% CI 1.3-6.0, p = 0.008). There was no significant effect of the intervention on BMI and WHtR. A home-based CHW intervention was significantly associated with reduction in BP among hypertensive patients compared to usual care. Future fully powered RCTs to test the effectiveness of such interventions among low-income populations are recommended. Trial registration number: PACTR202309530525257.

Impact of Hyperuricemia and Urate-Lowering Agents on Cardiovascular Diseases.

The association between hyperuricemia and cardiovascular diseases has been studied for many years. Research has shown a link between high uric acid levels and increased risk of including coronary artery disease hypertension and other cardiovascular conditions. Urate-lowering therapy, particularly with xanthine oxidase inhibitors like allopurinol, has shown promising results in reducing blood pressure in individuals with hyperuricemia and hypertension. Clinical trials and studies have demonstrated significant reductions in both systolic and diastolic blood pressure with urate-lowering treatment. Urate-lowering treatment has shown a favorable effect on reducing systolic blood pressure and major adverse cardiovascular events in patients with previous cardiovascular disease. In terms of cardiovascular safety, clinical trials have indicated that xanthine oxidase inhibitors such as febuxostat are non-inferior to allopurinol and do not increase the risk of death or serious adverse events. Overall, these findings highlight the importance of managing hyperuricemia and utilizing urate-lowering therapy to mitigate the adverse cardiovascular effects associated with elevated uric acid levels.

Efficacy of atorvastatin calcium on clinical manifestations and serum inflammatory markers in elderly patients with hypertension.

To evaluate the effects of atorvastatin calcium on clinical manifestations and serum inflammatory markers in elderly patients with hypertension. This retrospective cohort study included 68 elderly patients with hypertension admitted to the Chongming Branch of Shanghai Tenth People's Hospital between March 2022 and June 2023. Patients were matched into two groups, each comprising 34 participants: a control group receiving amlodipine besylate and an experimental group receiving additional atorvastatin calcium. The study compared blood pressure, lipid profiles, and serum inflammatory markers before and after treatment between the groups. Biomarkers measured included tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6). Indices of target organ function measured were urinary microalbumin (mAlb), endogenous creatinine clearance (Ccr), and various cardiac structural indices, including left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular posterior wall thickness (LVPW). Adverse reactions post-treatment were also recorded. Post-treatment assessments indicated significant reductions in both diastolic and systolic blood pressure (DBP and SBP), as well as improvements in lipid profiles (total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol) in both groups. The experimental group exhibited greater improvements in 24-hour mean diastolic and systolic blood pressures after 4, 8, and 12 weeks of treatment compared to the control group (all P < 0.05). Additionally, serum inflammatory markers, including TNF-α, hs-CRP, and IL-6, were significantly lower in the experimental group than in the control group (all P < 0.05). The experimental group also showed superior improvements in mAlb and Ccr levels (both P < 0.05). Cardiac function indicators improved, with the experimental group showing greater increases in LVEF and more pronounced reductions in LVEDD and LVPW (both P < 0.05) compared to the control group. The incidence of adverse reactions was slightly lower in the experimental group (11.76%) than that in the control group (14.71%), although this difference was not statistically significant (P > 0.05). Adding atorvastatin calcium to amlodipine therapy significantly improves clinical outcomes and reduces serum inflammatory marker levels in elderly patients with hypertension. This combination therapy is considered safe and may be recommended for broader clinical application.

Characterization, mechanisms, structure-activity relationships, and antihypertensive effects of ACE inhibitory peptides: rapid screening from sufu hydrolysate.

This study investigates the characterization, mechanisms of action, structure-activity relationships, and in vivo antihypertensive effects of ACE inhibitory peptides derived from sufu hydrolysate following simulated gastrointestinal digestion. Sufu was enzymatically digested using pepsin, trypsin, and chymotrypsin to mimic gastrointestinal conditions, followed by ultrafiltration to fractionate the peptides based on molecular weight. The fraction under 1 kDa exhibited the highest ACE inhibitory activity. LC-MS/MS analysis identified 119 peptide fragments, with bioinformatics screening highlighting 41 peptides with potential ACE inhibitory properties. Among these, two peptides, AWR and LLR, were selected and synthesized for in vitro validation, displaying IC50 values of 98.04 ± 2.56 μM and 94.01 ± 5.07 μM, respectively. Stability tests showed that both peptides maintained their ACE inhibitory activity across various temperatures and pH levels. Molecular docking and Highest Occupied Molecular Orbital analysis indicated strong binding interactions between these peptides and ACE, with the second-position tryptophan in AWR and the N-terminal leucine in LLR identified as key bioactive sites. These findings were further supported by molecular dynamics simulations, which confirmed the stability of the peptide-ACE complexes. In vivo studies using spontaneously hypertensive rats demonstrated significant reductions in both systolic and diastolic blood pressure, indicating that AWR and LLR have strong antihypertensive potential. This study illustrates that ultrafiltration, combined with LC-MS/MS and bioinformatics analysis, is an effective approach for the rapid screening of ACE inhibitory peptides. These results not only enhance our understanding of sufu-derived peptides but also offer promising implications for hypertension management.

The long term effect of renal denervation on ambulatory blood pressure in obese patients with resistant hypertension: A systematic review and meta-analysis of randomized control trials

The global surge in obesity is emerging as a significant contemporary public health challenge, linked with an elevated occurrence of cardiovascular risks like hypertension. Obesity exacerbates the complexity of managing resistant hypertension, as it not only increases the prevalence of hypertension but also contributes to medication resistance. Renal denervation (RDN) stands as a potential approach to address resistant hypertension (RH). A systematic search was conducted through PubMed, Science Direct, and Cochrane Library selecting RCT studies until August 2023. The RCTs showed the long term effect of renal denervation on ambulatory blood pressure in individuals with both obesity and resistant hypertension. Meta-analysis was conducted using Review Manager 5.4 software. There were 9 included RCTs with total 1056 resistant hypertensive patients. Meta-analysis of the difference in changes in ambulatory systolic blood pressure was performed in nine available studies. Renal denervation showed significant ambulatory systolic blood pressure reduction (Mean Difference [MD]: -2.30; 95% CI: -4.34, -0.27; p = 0.03) and non-significant ambulatory diastolic blood pressure reduction (Mean Difference [MD]: -1.07; 95% CI: -2.94, 0.8; p = 0.26). RDN could be an additional treatment for resistant hypertension patients. RDN is not recommended to be performed routinely and not recommended for patients with secondary hypertension or eGFR less than 30 mL/min/1.73 m2.

Applying the transtheoretical model of health behavior change: using calendars for hypertension management in elderly individuals during the COVID-19 pandemic in Phrae Province, Thailand

Hypertension is a persistent global public health concern, particularly affecting elderly individuals and is further compounded by the challenges posed by the COVID-19 pandemic. Innovative interventions are essential to effectively manage blood pressure in this vulnerable demographic group. This quasi-experimental study implemented a calendar-based intervention among 84 elderly individuals in Phrae Province, Thailand. The intervention integrated dietary recommendations, physical activity guidelines, and hypertension education. Over eight weeks, the intervention group exhibited a significant reduction in systolic blood pressure (6.59 mmHg) and diastolic blood pressure (2.52 mmHg) levels (p-value&lt;0.05), contrasting with the comparison group's increase. The calendar-based program effectively enhanced hypertension knowledge, empowering participants to make informed health decisions. The study's holistic approach, grounded in health behavior change models, effectively promoted hypertension awareness and facilitated healthier lifestyles. Results suggest the calendar-based program's suitability for elderly individuals at high risk of hypertension, especially during the COVID-19 pandemic, due to its cost-effectiveness and accessibility. This research underscores the potential of calendar-based interventions in supporting blood pressure management among elderly populations, with broader implications for public health strategies, especially during challenging circumstances such as pandemics.

Foot Massage terhadap Tekanan Darah Penderita Hipertensi

This study aims to identify differences in the mean value of systolic and diastolic blood pressure reduction in hypertension sufferers in the intervention and control groups. The method used is Quasi Experiment pre-test and post-test with a control group design. This study showed a significant difference in the mean values of systolic and diastolic pressure before and after foot massage for 30 minutes, carried out three times within six days in the intervention group. Hypothesis testing was carried out using the Independent Samples Test statistical test, obtaining a p-value of 0.000. In conclusion, there is a significant difference in systolic and diastolic blood pressure between the intervention group and the control group&#x0D; Keywords: Diastolic, Foot massage, Hypertension, Systolic