Diastolic Blood Pressure Research Articles

Derivation and Validation of Prediction of Preterm preeclampsia using machine learning algorithms.

To develop machine learning models for predicting preterm preeclampsia using the information available before 23 weeks' gestation. This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort. We considered 131 features available before 23 weeks including maternal demographics, obstetrics and family history, social determinants of health, physical activity, nutrition, and early second-trimester ultrasound. Our primary outcome was preterm preeclampsia before 37 weeks. The dataset was randomly split into a training set (70%) and a validation set (30%). Machine learning models using glmnet, multilayer perceptron, random forest, XGBoost, and LightGBM models were developed. Using the machine learning approach that achieved the best area under the curves (AUC), we developed the final model. Further feature selection was conducted from the top 25 important features based on SHapley Additive exPlanations values. The performance of the final model was assessed using the validation dataset. Of 9,467 individuals, 219 (2.3%) had preterm preeclampsia. The AUC of the XGBoost model was the highest (AUC 0.749 [95% confidence interval 0.736-0.762]) compared with other models. Therefore, XGBoost was used to develop models using fewer variables. The XGBoost model with the 8 features (in order of importance: mean uterine artery pulsatility index in the early second trimester, chronic hypertension, pregestational diabetes, uterine artery notch, systolic and diastolic blood pressure in the first trimester, body mass index, and maternal age) was chosen as the final model as it had an AUC of 0.741 (95% confidence interval 0.730-0.752) which was not inferior to the original model (P=0.58). The final model in the validation dataset had an AUC of 0.779 (95% confidence interval 0.722-0.831). An online application of the final model was developed (https://kawakita.shinyapps.io/Preterm_preeclampsia/). Machine learning algorithms using information available before 23 weeks can accurately predict preterm preeclampsia before 37 weeks.

The Effect of Immersive Virtual Reality on Dental Anxiety and Intraoperative Pain in Adults Undergoing Local Anesthesia: A Randomized Clinical Trial

Aims: This study assessed the effect of immersive virtual reality (IVR) on anxiety and intraoperative pain in adult patients undergoing dental extractions with local anesthesia. Methods: In a single-blind, randomized clinical trial from September 2022 to December 2023 at a private dental clinic, 190 patients with dental anxiety were randomly assigned to either an IVR or a control group. Primary outcomes—dental anxiety and perioperative pain—were measured using the State-Trait Anxiety Inventory (STAI), Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS) before and after the procedure. Secondary outcomes included heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP), recorded at various stages. Results: The IVR group showed significant reductions in total anxiety, state anxiety, and MDAS scores compared to the control group (p < 0.001). Pain intensity was also lower in the IVR group (p = 0.03). Additionally, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were consistently lower in the IVR group across different stages. Post anesthesia, the IVR group showed notably lower mean SBP and DBP values (p < 0.001). After surgery, the IVR group also showed lower HR (p = 0.01), SBP (p < 0.001), and DBP (p < 0.001) compared to the control group. Conclusions: IVR significantly reduced STAI, STAI-S, and MDAS scores and decreased intraoperative pain compared to the control group.

Development and Preliminary Testing of the Withdrawal Assessment Tool-Alpha 2 Agonist: An Assessment Instrument for Monitoring Iatrogenic Withdrawal Symptoms in Children Receiving an Alpha-2 Agonist

Objectives: To develop and conduct preliminary testing of the Withdrawal Assessment Tool-Alpha 2 Agonist (WAT-A2A) to monitor dexmedetomidine and clonidine withdrawal symptoms in acutely ill children. Design: Three-phase instrument development study. Phase 1: retrospective chart review of symptoms exhibited by children with documented dexmedetomidine withdrawal; phase 2: WAT-A2A instrument construction based on phase 1 data; and phase 3: prospective testing of the WAT-A2A in children weaning from alpha 2 agonists (A2As). Setting: Academic free-standing children’s hospital. Patients: Acutely ill children weaning from at least 5 days of dexmedetomidine. Excluded were children concurrently weaning other sedatives. Interventions: None. Measurements and Main Results: Phase 1: In 83 of 303 children weaning from at least 5 days of dexmedetomidine who had clinician documentation and were managed for A2A withdrawal, 88% (n = 72) exhibited at least a 20% increase in heart rate (HR), 83% (n = 69) exhibited agitation or change in usual state behavior, 46% (n = 38) exhibited at least a 20% increase in diastolic blood pressure (DBP), and when documented, 56% (27/48) exhibited tremors during their A2A withdrawal episode. Phase 2: The WAT-A2A was constructed, based on phase 1 data, and includes four items: HR, state behavior, DBP, and tremors. Phase 3: The WAT-A2A was tested and performed well in 82 children weaning from A2A. The total WAT-A2A score correlated with clinician subjective assessment of A2A withdrawal (Spearman correlation = 0.5; p < 0.001). Inter-rater agreement, comparing paired ratings of prospectively collected WAT-A2A data, indicated moderate inter-rater reliability. Conclusions: Acutely ill children receiving sedation with an A2A for more than 5 days may develop physiologic dependence, requiring gradual dosing reductions. While further psychometric testing is advised, the WAT-A2A provides an objective instrument to help clinicians quantify dexmedetomidine withdrawal symptoms in acutely ill children may facilitate A2A weaning and limit unnecessary variation in practice.

Identification of Circulating Proteins Associated With Blood Pressure.

Circulating proteins in blood are involved in various physiological processes, but their contributions to blood pressure regulation remain partially understood. In traditional observational studies, identifying circulating proteins causally associated with blood pressure is challenging because of potentially unmeasured confounding and possible reverse causality. Two-sample Mendelian randomization analyses were conducted to estimate the causal effects of 2270 circulating proteins (data sourced from 8 genome-wide association studies) on diastolic blood pressure, systolic blood pressure, and pulse pressure. Colocalization analyses were then used to investigate whether the circulating proteins and blood pressure traits shared causal genetic variants. To further verify the findings, we subsequently performed Steiger filtering analyses, annotation of protein-altering variants, assessment of overlap between protein quantitative trait loci and expression quantitative trait loci, protein-protein interaction and functional enrichment analyses, and drug target evaluation. To provide more potential biomarkers, we further evaluated the epidemiological associations of 2923 circulating proteins with blood pressure and hypertension by cross-sectional and longitudinal analyses using individual data in the UK Biobank. Mendelian randomization and colocalization analyses identified 121 circulating proteins with putative causal effects on at least 1 blood pressure trait. Many of the identified proteins are enriched in the pathways relevant to blood pressure regulation, and a majority of these proteins are either known drug targets or druggable candidates. This study has uncovered numerous circulating proteins potentially causally associated with blood pressure, providing insights into the regulatory mechanisms of blood pressure and potential therapeutic targets to facilitate blood pressure management.

Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study.

The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Of the 389 participants who enrolled in and completed the study, 380 (98%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1%) of the 239 participants entered full BP routines into the digital app 80% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as "excellent" for domains of perspicuity, efficiency, and dependability and "above average" for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension.

Association of diastolic blood pressure and coronary artery calcium in South Asian American adults.

DBP is associated with atherosclerosis and cardiovascular disease, independent of SBP. However, prior evaluation of the association of DBP with coronary artery calcium (CAC) has not included South Asian adults, a population that is at excess risk of atherosclerotic cardiovascular disease. In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we evaluated the association of sex-specific DBP tertiles and CAC score at least 100 with robust Poisson regression adjusted for age, sex, SBP, BP medication use, and other cardiovascular risk factors. We examined these associations stratified by antihypertensive medication use, and secondarily the association of baseline DBP tertile with incident CAC at least 100 over median 4.7 years of follow-up. Among 1155 participants (48% women, mean age 57 years), mean (standard deviation) DBP was 74 (10) mmHg, 33% were on antihypertensive medications, and 22% had CAC at least 100. Relative to DBP in tertile 1, DBP in tertiles 2 and 3 was associated with a significantly higher prevalence of CAC at least 100 [adjusted prevalence ratio 1.30 [95% confidence interval (CI) 1.03-1.65] and 1.47 (1.12-1.93), respectively]. These significant associations were primarily observed in participants who were not on antihypertensive medications. Baseline DBP tertile was not associated with incident CAC at least 100. Among South Asian adults in MASALA, DBP in the second or third tertiles vs. tertile 1 were associated with a higher prevalence of CAC at least 100 after adjustment for covariates including SBP. DBP may be an important clinical ASCVD risk factor among South Asian adults.

Effects of L-carnitine supplementation on lipid profile in adult patients under hemodialysis: a systematic review and meta-analysis of RCTs

BackgroundChronic kidney disease (CKD) affects 10% of the global population and leads to end-stage renal disease (ESRD). Hemodialysis is a common treatment for ESRD, but patients often have low carnitine levels, leading to dyslipidemia, a risk factor for cardiovascular disease and the leading cause of mortality. This study aimed to assess the effects of L-carnitine on lipid profiles in adult hemodialysis patients.MethodsA comprehensive search was conducted across the online databases from inception to June 2024 to identify randomized clinical trials (RCTs) evaluating the effects of L-carnitine on lipid profiles in hemodialysis patients. Data extraction and quality assessment were performed, focusing on primary outcomes, including changes in triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL), and secondary outcomes including blood pressure (BP) and body mass index (BMI).ResultsA total of 28 RCTs were eligible for the current systematic review, including 1,340 hemodialysis patients (671 intervention, 669 control). There were no significant differences in the mean change of TG (SMD: −0.006; 95% CI, −0.272 to 0.259; P = 0.95), TC (SMD: −0.086; 95% CI, −0.253 to −0.079; P = 0.29), HDL (SMD: 0.060; 95% CI, −0.057 to 0.177; P = 0.29), LDL (SMD: −0.075; 95% CI, −0.274 to 0.123; P = 0.43), VLDL (SMD: −0.064; 95% CI, −0.272 to 0.142; P = 0.51), BMI (SMD: −0.025; 95% CI, −0.139 to 0.088; P = 0.56), systolic BP (SMD: 0.055; 95% CI, −0.110 to 0.220; P = 0.43), and diastolic BP (SMD: −0.028; 95% CI, 0.156 to 0.099; P = 0.56). The same insignificant findings were observed after conducting a subgroup analysis based on the route of administration (intravenous vs. Oral).ConclusionL-carnitine supplementation does not significantly change and improve the serum lipid profile, including TG, TC, HDL, LDL, and VLDL levels. Additionally, it has no notable effects on BMI, systolic, or diastolic BP.

Association between cardiovascular risk and diastolic blood pressure in older adults with systolic blood pressure less than 130mmHg: a prospective cohort study from 2014 to 2022

BackgroundThe 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline lowered the diagnostic threshold for hypertension to a systolic/diastolic blood pressure (SBP/DBP) of 130/80 mmHg. However, the predictive value of DBP for cardiovascular (CV) risk assessment diminishes with aging. The study aimed to explore whether the new diagnostic threshold for diastolic hypertension is associated with increased risk of CV organ damage and major adverse cardiovascular events (MACEs) in older adults.Methods1181 individuals aged 65 years or older with SBP < 130 mmHg were enrolled a prospective cohort study. They were classified into Low (< 70 mmHg), Optimal (70 to < 80 mmHg), and High (80 to < 90 mmHg) DBP groups. Cardiac, vascular, and renal organ damage were measured at baseline. The endpoint of the study was MACEs.ResultsAmong 1181 participants (average age 71.9 years, 44.8% men), 172 MACEs were observed during an average follow-up of 6.4 years. We found no significant differences in CV organ damage or MACEs rates (Log-rank P = 0.73) among three groups. In multivariable Cox regression, compared to the Optimal DBP group, no significant increase in CV risk was observed in the Low DBP group (hazard ratio [HR] 1.02, [95% CI 0.68–1.52], P = 0.93) or the High DBP group (HR 1.04, [95% CI 0.72–1.49], P = 0.85). Propensity score matching showed consistent results.ConclusionIn older adults with SBP < 130 mmHg, DBP values 80–89 mmHg were not associated with higher risk of CV organ damage, events or mortality.

Analysis of influencing factors of exercise systolic blood pressure response in nonalcoholic fatty liver disease aged 40–60 years

ABSTRACT Objectives This study investigated the influencing factors of exercise systolic blood pressure response (ESBPR) by cardiopulmonary exercise test (CPX) in nonalcoholic fatty liver disease (NAFLD) in people aged 40–60 years. Methods A total of 603 adults were enrolled in this study. The inclusion criteria of this cross-sectional study were adults who underwent health checks and CPX. Results There were significant differences in body mass Index (BMI) (26.80 ± 2.64 VS 23.31 ± 2.41, p < 0.001) kg/m2, fasting blood glucose (FPG) (5.56 ± 0.94 VS 5.13 ± 0.55, p < 0.001) mmol/L, alanine aminotransferase (ALT), aspartate transaminase (AST), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C) (1.13 ± 0.22 VS 1.43 ± 0.33, p < 0.001) mmol/L, low-density lipoprotein-cholesterol (LDL-C) (3.21 ± 0.79 VS 2.99 ± 0.68, p = 0.001) mmol/L, resting systolic blood pressure (SBP) (123.53 ± 14.73 VS 118.79 ± 14.79, p < 0.001) mmHg, resting diastolic blood pressure (DBP) (80.29 ± 9.62 VS 75.27 ± 10.41, p < 0.001) mmHg, peak SBP (184.01 ± 23.50 VS 172.81 ± 24.95, p < 0.001) mmHg, peak DBP (87.47 ± 10.50 VS 84.01 ± 11.46, p = 0.001) mmHg, oxygen pulse (VO2/HR) (0.88 ± 0.15 VS 0.92 ± 0.16, p = 0.004) ml/beat, exercise maximum heart rate, carbon dioxide Ventilation equivalent (VE/VCO2) (25.84 ± 4.43 VS 25.12 ± 3.58, p = 0.038), peak oxygen uptake (VO2 peak) (1.78 ± 0.45 VS 1.56 ± 0.46, p < 0.001) mL/min between the NAFLD and control groups. VE/VCO2 (OR = 0.822, p = 0.036) and oxygen uptake/work rate (VO2/WR) (OR = 0.517, p = 0.021) mL/min/watt were associated with a lower risk of ESBPR in NAFLD subjects. Resting SBP was associated with a higher risk of ESBPR in NAFLD patients (OR = 1.059, p = 0.003) and overweight NAFLD subjects (OR = 1.075, p = 0.002). ESBPR (OR = 1.268, p = 0.045), skeletal-muscle mass (OR = 1.305, p < 0.001), and SMI (OR = 1.315, p < 0.001) were linked to an elevated risk of NAFLD in individuals. Conclusion Our findings indicate that ESBPR is associated with an increased risk of NAFLD in individuals aged 40–60 years. Furthermore, in NAFLD subjects, VE/VCO2 and VO2/WR were found to be correlated with a decreased risk of ESBPR, whereas resting SBP was linked to an elevated risk of ESBPR. This will provide a research basis for the NAFLD subjects who have ESBPR at risk of adverse events during exercise.

Decoction of bay leaf (syzygium polyanthum) against the reduction of high blood pressure in 3-month injectable birth control receptors

Introduction: Hypertension or high blood pressure is a serious health problem and has the potential to trigger various complications, such as heart disease and stroke. Bay leaf (Syzygium polyanthum), which is traditionally used as an herbal medicine, is known to contain bioactive compounds such as flavonoids, tannins, and saponins, which have the potential to lower blood pressure. However, research on the effectiveness of bay leaf decoction in 3-month injectable birth control receptors is still limited. Objective: This study aims to evaluate the effect of bay leaf decoction (Syzygium polyanthum) on the reduction of high blood pressure in 3-month injectable birth control receptors. Methods: This study uses a quasi-experimental method with a pre-test and post-test design in one group. A total of 60 respondents who were long-term acceptors of 3-month injectable birth control with high blood pressure were selected purposively. The respondents were given a decoction of bay leaves every day. Blood pressure was measured before and after the intervention using a digital sphygmomanometer. Data were analyzed using a paired t-test to determine the significant difference between blood pressure before and after the intervention. Result: The study showed a significant decrease in systolic and diastolic blood pressure after administering bay leaf decoction. The average decrease in systolic blood pressure was 12 mmHg, and diastolic blood pressure was eight mmHg after 14 days of consumption. The paired t-test showed a p&lt; value of 0.05, indicating a significant difference between blood pressure before and after the intervention. Conclusion: Bay leaf decoction (Syzygium polyanthum) significantly lowers high blood pressure in 3-month injectable birth control receptors. These results suggest that bay leaf can be a potential complementary therapy in the management of hypertension, especially for those who use long-term hormonal contraceptives. Although the results of this study are promising, more research with larger sample sizes and extended intervention periods is needed to confirm these findings and assess the long-term safety of using bay leaf decoction

Effects of anodal transcranial direct current stimulation on intracranial compliance in the subacute phase of stroke

ObjectivesTranscranial direct current stimulation (tDCS) increases cerebral blood flow. This study evaluated the effects of anodal tDCS (A-tDCS) on intracranial compliance (ICC) in patients with subacute stroke using a non-invasive method. MethodsThis was a randomized, proof-of-concept, double-blind, pilot study. Patients with ischemic stroke of the middle cerebral artery (MCA) were divided into the following two groups: 1) A-tDCS in the motor cortex on the affected side for 30min at 2mA, and 2) sham tDCS in the motor cortex on the affected side. The primary outcomes were intracranial compliance (P2/P1 ratio and time-to-peak [TTP]) and ICC normalization after the intervention (P2/P1 ratio <1). Secondary outcomes were systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation. ResultsNo significant differences were observed in the P2/P1 ratio (P = 0.509) and TTP (P = 0.480) between the groups. However, the A-tDCS group was significantly associated with a normal P2/P1 ratio after intervention (B = 2.583; standard error [SE]: 1.277; P = 0.043; corrected for age and stroke severity). No significant associations were observed between the groups and systolic blood pressure (F = 0.16; P = 0.902), diastolic blood pressure (F = 0.18; P = 0.892), heart rate (F = 0.11; P = 0.950), or peripheral oxygen saturation (F = 0.21; P = 0.750). ConclusionICC morphology normalization was observed in the A-tDCS group. However, no differences were observed in the P2/P1 ratio, TTP, or hemodynamic variables between the groups. A sample size of 66 patients with ischemic stroke of the MCA can be estimated using the observed effect size and standard α = 5% and β = 20% for future trials. Furthermore, this will aid in conducting the necessary randomized trials targeting these populations.

Effect of vitamin C and hawthorn beverage formula on blood pressure and oxidative stress in heat-exposed workers: a cluster-randomized controlled trial.

There is no evidence on antioxidant-rich diets in preventing hypertension in heat-exposed workers. We aimed to evaluate the effects of formula supplemented with vitamin C (Vit C) and hawthorn beverage on reducing blood pressure (BP) and oxidative stress levels in heat-exposed workers. In the 40-day cluster-randomized controlled trial, four heat-exposed shift-teams were enrolled and randomly assigned to the intervention and control groups. The intervention group was given one Vit C tablet (130 mg) and a 500 mL hawthorn beverage containing 278.7 mg flavonoids daily whereas the control group was given 500 mL of slightly salted water daily; both groups were provided education on a healthy diet. BP and creatinine-corrected urinary 8-isoprostane-prostaglandin F2α (8-iso-PGF2α/Cr) concentrations were assessed at baseline, Day 17 (only BP) and Day 41, respectively. Compared with the control group, the systolic BP (SBP), diastolic BP (DBP), and log10-transformed 8-iso-PGF2α/Cr in the inter-vention group decreased by 7.41 mmHg, 7.93 mmHg and 0.232, respectively, from baseline to day 41 (all p<0.05). When comparing BP levels at baseline, DBP in the intervention group was reduced by 5.46 mmHg when compared to control (p<0.05) among participants with lower baseline BP; SBP and DBP experienced reductions of 9.74 and 9.22 mmHg among participants with higher baseline BP (both p<0.05). Supplementation of Vit C and flavonoids rich hawthorn beverage to heat-exposed workers prevented elevated BP caused by heat exposure which may be attributed to its oxidative stress inhibition effects.

Impact of Physical Exercise to Reduce the Risk of Gestational Hypertension, A Role of Leptin and Adiponectin

Objective: To investigate the effect of exercise on the blood pressure of new-onset hypertension and non-hypertensive pregnant women and to determine the serum leptin and adiponectin levels and their response to exercise. Methodology: This quasi-experimental cross-over study was conducted at the Department of Gynaecology and Obstetrics, Hayatabad Medical Complex Peshawar. Samples were processed and analyzed at Khyber Girls Medical College Peshawar from January 2022 to April 2022. A total of 140 pregnant females were recruited for this study through convenience sampling. Out of this total, 70 were normotensive for the control group and 70 were hypertensive (gestational hypertensive). All participants were included after taking an informed consent. Results: In normotensive pregnant women, mean systolic and diastolic blood pressure remained normal, and no hypertension developed. In gestational hypertensive women, 70% responded significantly to physical exercise. Post-exercise, Group A saw decreases in systolic BP , diastolic BP , and leptin levels, with an increase in adiponectin. Group B exhibited more pronounced changes by decreased systolic BP, diastolic BP, leptin, and increased adiponectin. Conclusions: We observed that recommended physical exercise during pregnancy is safe and beneficial for maternal health in pregnancy. Physical exercise significantly reduced the progression of GH and brought the serum leptin and adiponectin levels toward normal range. Therefore, physical activity should be encouraged in every healthy woman after addressing potential barriers to exercise during pregnancy. Keywords: Gestational hypertension, Exercise, Leptin, Adiponectin

Cardiopulmonary coupling predictors of blood pressure response to positive airway pressure therapy

The effect of continuous positive airway pressure (CPAP) treatment on reducing cardiovascular disease risk in sleep apnea subjects remains inconclusive. It is plausible that pathological respiratory chemoreflex activation (high loop gain) is a predictive signal biomarker. To determine whether narrow band (e-LFCNB%) metric derived from cardiopulmonary coupling analysis is related with blood pressure reduction after CPAP. A secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES). The elevated low frequency coupling - narrow band (e-LFCNB %) metric derived from cardiopulmonary coupling analysis detects periodic breathing (as a surrogate for high loop gain), and was estimated in baseline polysomnogram. Linear regression analysis was performed to identify the potential association between e-LFCNB% of total sleep time and the observed reduction in blood pressure following the specified treatment. A total of 388 subjects received CPAP and had e-LFCNB % measurements. At 2 months, 90/322 subjects had e-LFCNB ≥ 4% at baseline. At 6 months 137/313 subjects had e-LFCNB higher than 2% at baseline. For morning systolic blood pressure, e-LFCNB ≥ 4% [β: 2.534, standard error (SE): 1.198, p: 0.035] was positively related with the extent of systolic blood pressure reductions after 2 months CPAP treatment and e-LFCNB ≥ 2% was marginally related with systolic blood pressure decrement after 6 months (β: 2.162, SE: 1.173, p: 0.066). For the morning diastolic blood pressure, e-LFCNB ≥ 2% predicted reductions at 6 months of treatment (β: 1.883, SE: 0.888, p: 0.035). e-LFCNB % (probable high loop gain) was positively related to systolic blood pressure reduction (short-term) and diastolic blood pressure reduction (longer-term), following CPAP.

Employee well-being in the digital age: Assessing the impacts of a smartphone application in the workplace

Recently, providing smartphone-based health-improving applications to employees has emerged as a promising strategy for sustaining their well-being. This study estimates the impact of the routine use of an application, introduced in 2020 by a Japanese manufacturing company, on various health-related behaviours and outcomes among employees by exploiting a distinctive large-scale longitudinal dataset and personnel records. The analysis addresses potential selection biases arising from the non-random nature of application usage by employing the instrumental variable approach. Regular application use generates significant positive impacts on health-related habits, including moderate alcohol consumption, regular breakfast intake and refraining from eating two hours before bedtime. Furthermore, regarding physical and psychological stress, noteworthy reductions in physical burden and less frequent experiences of annoyance are observed. Employees also report a lower frequency of dizziness, headaches and palpitations, albeit an increase in the frequency of strained eyes is noted. Additionally, application use is associated with lower systolic and diastolic blood pressure, as well as decreased levels of triglycerides and gamma-GTP.

Prediction of metabolic syndrome and its associated risk factors in patients with chronic kidney disease using machine learning techniques.

Chronic kidney disease (CKD) and metabolic syndrome (MS) are recognized as public health problems which are related to overweight and cardiometabolic factors. The aim of this study was to develop a model to predict MS in people with CKD. This was a prospective cross-sectional study of patients from a reference center in São Luís, MA, Brazil. The sample included adult volunteers classified according to the presence of mild or severe CKD. For MS tracking, the k-nearest neighbors (KNN) classifier algorithm was used with the following inputs: gender, smoking, neck circumference, and waist-to-hip ratio. Results were considered significant at p < 0.05. A total of 196 adult patients were evaluated with a mean age of 44.73 years, 71.9% female, 69.4% overweight, and 12.24% with CKD. Of the latter, 45.8% had MS, the majority had up to 3 altered metabolic components, and the group with CKD showed statistical significance in: waist circumference, systolic blood pressure, diastolic blood pressure, and fasting blood glucose. The KNN algorithm proved to be a good predictor for MS screening with 79% accuracy and sensitivity and 80% specificity (area under the ROC curve - AUC = 0.79). The KNN algorithm can be used as a low-cost screening method to evaluate the presence of MS in people with CKD.

Potential blood pressure regulatory effect of low molecular weight α-chymotrypsin extract and its peptides from Stichopus japonicus: Peptide-ACE interaction study via in silico molecular docking

Hypertension is a significant risk factor for cardiovascular disease and heart damage. Stichopus japonicus (S. japonicus) is a red sea cucumber with antioxidant and anti-hypertensive activities. However, its anti-hypertensive mechanism remains unclear. In this study, we evaluated the inhibitory effects of angiotensin-converting enzyme (ACE) of α-chymotrypsin-assisted hydrolysate of S. japonicus (α-chy) and its ultrafiltrate fractions (>10 kDa [α-chy-I], 5–10 kDa [α-chy-II], and <5 kDa [α-chy-III]). Low molecular α-chy-III exerted excellent ACE inhibitory and anti-hypertensive activities in spontaneously hypertensive rats (SHR). Moreover, α-chy-III significantly reduced the systolic and diastolic blood pressure by modulating the serum angiotensin and ACE levels. Histological analysis revealed that α-chy-III markedly protected the aorta, heart, and kidney tissues of SHR from hypertension-induced tissue damage.Taken together, our findings highlight the potential of α-chy-III as a functional food ingredient for the treatment of hypertension and its comorbidities.

Novel maternal risk factors for preeclampsia prediction using machine learning algorithms

&lt;div align="center"&gt;&lt;table width="590" border="1" cellspacing="0" cellpadding="0"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td valign="top" width="387"&gt;&lt;p&gt;Preeclampsia and eclampsia are the most common obstetric disorders associated with poor outcomes for women, fetuses, and newborns throughout the perinatal period. The study’s primary objective was to assess the accuracy of novel high-risk factors using MLA in predicting preeclampsia. The study included 400 pregnant women and used 27 novel high-risk factors to predict preeclampsia. The target variables for predicting preeclampsia are systolic and diastolic blood pressures. Various algorithms, including DT, RF, Gradient Boosting, SVM, K-Neighbors, LGBM, MLP, Ada Boost Classifier, and Extra Trees Classifier are used in the analysis. The accuracy and precision of the LGBM Classifier (0.85 and 0.9583 with F1 0.7188), Support Vector Classifier (0.8417 and 0.92 with F1 0.7077), Decision Tree (0.825 and 0.913 with F1 0.6667), and Extra Trees (0.8167 and 0.9091 with F1 0.6452) are found to be better algorithms for prediction of preeclampsia than those of the other models used in the study. According to the novel high-risk factors score, 17.5% of pregnant women were identified as being at high risk for preeclampsia during the first trimester, which increased to 18.7% in 3rd trimester; in addition, 16% of pregnant women had a BP of 140/90 mmHg and the above. Novel, high-risk scores and MLA can effectively predict preeclampsia at an early period.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;

Acute Effects of Cadence-Controlled Walking on Cognition and Vascular Function in Physically Inactive Older Adults: A Randomized Crossover Study.

Cadence-controlled walking may be a desirable approach for older adults to self-monitor exercise intensity and achieve physical activity guidelines. We examined the acute effects of cadence-controlled walking on cognition and vascular function in physically inactive older adults. In a randomized crossover design, 26 participants (65% females, 67.8 ± 11.3years) underwent 30-min acute exercise (walking at 100steps/min) and control (sitting) conditions. We measured cognition, central blood pressure (BP), and arterial stiffness before, and immediately, after each condition. We observed significant Time × Condition interactions in the Flanker Inhibitory Control and Attention (Flanker) test and Dimensional Change Card Sort (DCCS) test scores, and in central systolic BP, central pulse pressure, and carotid to femoral pulse wave velocity (p < .05). The Flanker and DCCS scores significantly increased after walking (d = 0.4 and 0.5, respectively), but not after sitting. Central systolic BP, central pulse pressure, and carotid to femoral pulse wave velocity significantly increased after sitting but remained unchanged after acute walking (d = 0.4-0.2), with p-values < .05. After walking, significant correlations were observed between DCCS and diastolic BP and central pulse pressure change scores and change scores in central pulse wave velocity,Flanker, and DCCS (rs = -0.45 to -0.52). These findings suggest that a single bout of cadence-controlled walking elicited an immediate improvement in cognition and might have mitigated increases in arterial stiffness and central BP observed in the seated control condition. Further research is needed to examine the association between cognition and vascular function following acute exercise compared to control conditions. Our findings may have practical implications for developing daily physical activity recommendations for improving the cognitive health for successful aging.

Immediate effects of structured and natural deep breathing on heart rate variability and blood pressure in community-dwelling older adults

BackgroundThis study investigated the immediate effects of structured deep breathing (SDB) and natural deep breathing (NDB) on heart rate variability (HRV) and blood pressure (BP) in community-dwelling older adults. MethodsTwenty-six participants were randomly assigned to SDB (n = 14) or NDB (n = 12) groups. HRV parameters (time domain: standard deviation of normal-to-normal intervals [SDNN], root mean square of successive differences [RMSSD]; frequency domain: low frequency [LF], high frequency [HF], LF/HF ratio, total power [TP], normalized low frequency [LFnu], normalized high frequency [HFnu]) and BP were assessed during spontaneous breathing, DB, and post DB. ResultsBoth groups showed significant increases during DB in SDNN (p < 0.001), RMSSD (p = 0.021), LF power (p < 0.001), LFnu (p < 0.001), TP (p < 0.001), and LF/HF ratio (p < 0.001). HFnu decreased significantly during DB (p < 0.001) with no group differences. HF power showed no significant effect in group and time. BP remained stable throughout the protocol, with no significant changes in either systolic or diastolic BP across time points or between groups. ConclusionsThis first direct comparison of structured versus natural DB in healthy older adults demonstrates that both approaches effectively enhance parasympathetic activity. These findings support DB as a cost-effective, accessible intervention for promoting autonomic balance in healthy aging, without requiring specialized equipment or instruction.