Elevated Diastolic Blood Pressure Research Articles

Risk Factors for Postoperative Bleeding after Adenoidectomy.

IMPORTANCE: Postoperative bleeding is a common and potentially life-threatening complication. Precise identification of risk factors in addition to the basic ones, such as coagulation parameters, is certainly very desirable. OBJECTIVE: The aim of this study was to identify other possible risk factors for bleeding after adenoidectomy in children. DESIGN: This observational prospective study enrolled children undergoing adenoidectomy from October 2019 to February 2020, then evaluated the influence of possible risk factors for bleeding. SETTING: Tertiary pediatric otorhinolaryngology center. PARTICIPANTS: A total of 288 children aged 0–18 years undergoing adenoidectomy for recurrent upper respiratory tract infections, recurrent acute otitis media, secretory otitis media, and obstructive sleep apnea syndrome. MAIN OUTCOMES AND MEASURES: Increased blood pressure and time of surgery were identified as risk factors for bleeding after adenoidectomy. RESULTS: Elevated systolic (p = 0.046), diastolic (p = 0.012), and mean arterial blood pressure (p = 0.007) (Mann–Whitney U test) as adjusted for age-specific distributions and with corrections for height and weight, as well as time length of surgery (p < 0.001) (Fisher’s exact test) were revealed as statistically significant risk factors for postoperative bleeding. Atmospheric pressure, surgeon’s level of experiences, chronic inflammatory content in adenoid vegetation (AV), size of AV, recidivism of AV, recurrent infections of the upper respiratory tract, type of anesthesia, long-term using of drugs, and positive coagulation questionnaire or pathology in standard coagulation tests were not found to be risk factors for bleeding after adenoidectomy. CONCLUSIONS AND RELEVANCE: In this prospective study within a well-defined population of children, we evaluated increased blood pressure and time of surgery as risk factors for bleeding after adenoidectomy. These data bring new information that complements current knowledge in this field.

Blood pressure and left ventricular function changes in different ambulatory blood pressure patterns at high altitude.

Acute high‐altitude (HA) exposure induces physiological responses of the heart and blood pressure (BP). However, few studies have investigated the responses associated with dipper and non‐dipper BP patterns. In this prospective study, 72 patients underwent echocardiography and 24‐h ambulatory BP testing at sea level and HA. Patients were divided into dipper and non‐dipper groups according to BP at sea level. Acute HA exposure elevated 24‐h systolic and diastolic BP and increased BP variability, particularly in the morning. Moreover, acute exposure increased left ventricular torsion, end‐systolic elastance, effective arterial elastance, and untwisting rate, but reduced peak early diastolic velocity/late diastolic velocity and peak early diastolic velocity/early diastolic velocity, implying enhanced left ventricular systolic function but impaired filling. Dippers showed pronounced increases in night‐time BP, while non‐dippers showed significant elevation in day‐time BP, which blunted differences in nocturnal BP fall, and lowest night‐time and evening BP. Dippers had higher global longitudinal strain, torsion, and untwisting rates after acute HA exposure. Variations in night‐time systolic BP correlated with variations in torsion and global longitudinal strain. Our study firstly demonstrates BP and cardiac function variations during acute HA exposure in different BP patterns and BP increases in dippers at night, while non‐dippers showed day‐time increases. Furthermore, enhanced left ventricular torsion and global longitudinal strain are associated with BP changes. Non‐dippers showed poor cardiac compensatory and maladaptive to acute HA exposure. However, the exact mechanisms involved need further illumination.

The risk of micro and macrovascular disease in Egyptian patients with diabetes and peripheral arterial disease

ABSTRACT Aim: The aim of this study was to assess the prevalence of micro- and macrovascular disease in Egyptian patients with diabetes mellitus (DM) and peripheral arterial disease (PAD). Methods: The study included 161 Egyptian patients with DM and PAD (91.3% had type 2 DM and 67.1% were females). Mean diabetes duration was 14.2 ± 5.2 years. Full history, clinical and fundus examination as well as laboratory investigations were done. PAD was diagnosed through assessment of ankle/brachial index (ABI) by Doppler ultrasonography. Results: ABI was <0.9 in 33.5% and >1.3 in 66.5% of patients. A significant positive correlation was found between abnormal ABI and diabetes duration, ischemic heart disease (IHD), diabetic retinopathy and neuropathy, foot ulcers, elevated blood pressure (BP), creatinine, urine albumin/creatinine ratio (ACR) and triglycerides and a significant negative correlation with HDL. Multivariate regression analysis revealed that the independent predictors for PAD in patients with ABI< 0.9 were neuropathy, creatinine, triglyceride, LDL, urine ACR and low HDL, and in patients with ABI >1.3 were IHD, neuropathy, elevated diastolic BP and triglyceride. Conclusion: The risk of micro- and macrovascular disease is high in Egyptian patients with diabetes and PAD. Early diagnosis and good control of risk factors could reduce PAD progression.

Does psychosocial stress modify the association of fine particulate matter and ozone with cardiovascular health indicators?

Fine particulate matter (PM2.5) and ozone (O3) air pollution can cause abnormal changes in blood pressure (BP), blood glucose and lipids, which are important indicators for cardiovascular health. Psychosocial stress could be a potential effect modifier for adverse health effects of air pollution, but research evidence is scarce. A cross-sectional study with 373 elderly subjects was conducted in Beijing during 2018-2019. We collected psychosocial stress information on anxiety, perceived stress and depression, obtained daily environmental data, measured resting BP, blood glucose and lipids in study participants, and analyzed the associations of PM2.5 or O3 with cardiovascular health indicators and the modification effect by psychosocial stress. Results showed that PM2.5 was significantly associated with increased systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) ; and O3 was significantly associated with elevated DBP, glycated hemoglobin (HbA1c) and total triglyceride (TG). In addition, the associations of PM2.5 with TG, and O3 with SBP and TG were higher in participants with high psychosocial stress, whereas the associations of O3 with high-density lipoprotein cholesterol (HDL-C)were higher in participants with low psychosocial stress. For an interquartile range (IQR) (56.8μg/m³) increase in PM2.5 at 4-d moving average, TG increased by 21.43% (95% CI: 2.90, 43.29) in high perceived-stress group, and decreased by 20.05% (95% CI:-30.31,-8.28) in low perceived-stress group (p for interaction= 0.04). For an IQR (63.0μg/m³) increase in O3at 2-d moving average, TG increased by 32.01% (95% CI: 7.65, 61.89) in high perceived-stress group, and increased by 7.95% (95% CI:-9.80, 29.20) only in low perceived-stress group (p for interaction= 0.04). For an IQR (64.0μg/m³) increase in O3 at 3-d moving average, HDL-C decreased by 4.55% (95% CI:-12.15, 3.72) in high perceived-stress group, and increased by 0.57% (95% CI:-6.99, 8.75) in low perceived-stress group (p for interaction=0.002). In conclusion, our results indicated that short-term exposures to PM2.5 and O3 were associated with significant changes in BP, blood glucose and lipids, and psychosocial stress may increase the susceptibility of the participants to the adverse cardiovascular effects of PM2.5 and O3.

525 Maternal morbidity and pregnancy outcomes in teens vs. adults with hypertensive disorders of pregnancy

Teens <20 years old carry a 2.6x increased risk of preeclampsia (PREE) compared to older gravidas, but whether they have more severe disease is unclear. We sought to compare rates of hypertensive-related morbidity, abnormal labs, intrapartum BP, and delivery gestational age between teen and older gravidas with hypertensive disorders of pregnancy. This was a retrospective cohort study of women with a diagnosis of gestational HTN, PREE, or eclampsia carrying a singleton non-anomalous pregnancy in a University-based healthcare system, 2014-2020. The primary outcome was major maternal HTN-related morbidity (defined as ≥ 1 of the following: lab criteria for HELLP, Cr ≥1.0, seizure, stroke, MI, heart failure, and pulmonary edema), regardless of BP. Secondary outcomes were delivery GA, SGA < 10%, SGA < 3%, individual lab parameters, and intrapartum BP parameters. Data were analyzed with chi-square, t-test, and logistic regression. 8,659 women met inclusion criteria; 395 (4.6%) were teens < 20yo at EDC. HTN morbidity occurred in 9.6% of all women. Teens were “healthier” at baseline with lower pre-pregnancy BMI, lower rates of diabetes, CHTN, and smoking during pregnancy (Table 1). Teens also delivered later and were less likely to deliver preterm. However, SGA neonates < 10% and < 3% were more commonly delivered to teens. In addition, teens were less likely to have elevated systolic ( >140 and > 160) and diastolic ( > 90) initial BP readings intrapartum. Despite this, rates of HTN-related morbidity were similar in teens and adults (8.4% vs. 9.6%, p=0.40). In multivariable models, after controlling for Black race, chronic hypertension, diabetes mellitus, and smoking during pregnancy, teen gravidas did not have a higher risk of HTN-related morbidity (aOR 0.92, 95% CI 0.64-1.33). Though teens with hypertensive disorders of pregnancy are “healthier” at the onset of pregnancy than older gravidas, serious HTN-related morbidity is common and occurs at similar rates among teens compared to adults.

The Impact of Erythropoietin on Short- and Long-Term Kidney-Related Outcomes in Neonates of Extremely Low Gestational Age. Results of a Multicenter, Double-Blind, Placebo-Controlled Randomized Clinical Trial

To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22-26months of corrected gestational age (cGA) compared with those randomized to placebo. We performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. The prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine/cystatin C values at days 0, 7, 9, and 14). At 22-26months of cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) <90mL/min/1.73 m2, 35.8% had urine albumin/creatinine ratio >30mg/g, 23% had a systolic blood pressure (SBP) >95th percentile for age, and 40% had a diastolic blood pressure (DBP) >95th percentile for age. SBP >90th percentile occurred less often among recipients of erythropoietin (P<.04). This association remained even after controlling for gestational age, site, and sibship (aOR 0.6; 95% CI 0.39-0.92). We did not find statistically significant differences between treatment groups in eGFR, albumin/creatinine ratio, rates of SBP >95th percentile, or DBP >90th or >95th percentiles at the 2 year follow-up visit. ELGANs have high rates of in-hospital AKI and kidney-related problems at 22-26months of cGA. Recombinant erythropoietin may protect ELGANs against long-term elevated SBP but does not appear to protect from AKI, low eGFR, albuminuria, or elevated DBP at 22-26months of cGA.

Association between birthweight, cardiovascular risk factors, and depression in young Mexican adults.

Background: the aim of this study was to investigate the association between birthweight, cardiovascular disease (CVD) risk factors, and depression in young Mexican adults. Methods: birthweight reports, family history of CVD and diabetes-related diseases, anthropometrics, serum lipid profile (total cholesterol [TC], triglycerides [TG], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], and very-low density lipoprotein-cholesterol [VLDL-C]), and depressive symptoms were measured in 778 subjects of the UP-AMIGOS cohort study. To investigate the association between birthweight categories and CVD risk factors and depression, a one-way analysis of variance with post-hoc test was performed of quantitative variables, and 2 test for qualitative variables. Results: mean age was 17.8 years and 469 (60.3 %) of patients were female (n = 469, 60.3 %). The percentage of patients with low birthweight (LBW) was 8.1 % (n = 63), and 3.3 % (n = 26) reported high birthweight (HBW). Young adults with HBW were associated with elevated diastolic blood pressure (DBP), and high weight and body mass index (BMI) when compared to LBW subjects, the difference being statically significant (p < 0.05). Birthweight had no significant association with depression (p > 0.67). Conclusion: the findings from this population-based study revealed a positive relation between birthweight categories and some CVD risk factors. Depression was not related to birthweight.

Linkage of blood pressure, obesity and diabetes mellitus with angiotensinogen gene (AGT 704T>C/rs699) polymorphism in hypertensive patients.

The study aim was to analyse the frequency of polymorphic variants of angiotensinogen gene polymorphism (AGT 704T>C, rs699) in essential arterial hypertension (EAH) patients. Seventy-two individuals with EAH and hypertension‑mediated organ damage (stage 2), moderate, high or very high cardiovascular risks were involved in the case-control study. Among them, 70.84 % (51) were females and 29.16 % (21) were males; mean age was 59.87±7.98 y. The control group consisted of fifty practically healthy individuals at relevant age (49.13±6.28 y) and with relevant sex distribution (62 % were females, 38 % were males). AGT (704T>C) gene polymorphism was examined by RT-PCR. The distribution of genotypes in the study group was as follows: TT - 14 %, TC - 60 %, CC - 26 %, which corresponded to the distribution in the control group - 16 %, 54 % and 30 %, respectively, and did not deviate from the Hardy-Weinberg equilibrium. Smoking, type 2 diabetes mellitus (DM2) and obesity increased the relative risk of EAH in the examined population 2.5 times [OR=2.81; p=0.049], 3.75 times [OR=4.68; p=0.005] and almost twofold [OR=2.90; p=0.004], respectively. The probability of EAH increases fourfold with the angiotensin II elevation in the serum. Genotypes and alleles of the AGT (704T>C) gene were not significant risk factors for EAH and DM2 in the studied population. However, the TC-genotype (lesser T-allele) increases the risk of obesity in EAH patients more than 1.5 times [OR=2.93; p=0.03]. In addition, the T-allele increases the risk for blood pressure (BP) to elevate up to grade 2-3 [OR=3.64; p < 0.001]. One-way ANOVA analysis confirmed the AGT (704T>C) gene polymorphism to be associated with systolic and diastolic BP elevation (F=7.80; p < 0.001 and F=4.90; p=0.01, respectively), especially in TT-genotype carriers (p < 0.05), and with body mass index increase, albeit only in women (F=13.94; p < 0.001) (Tab. 4, Fig. 3, Ref. 26). Text in PDF www.elis.sk Keywords: angiotensinogen gene (AGT 704T>C), diabetes mellitus type 2, arterial hypertension, obesity, risk.

Masked Hypertension in Adolescents with Type 1 Diabetes Mellitus: An Exploratory Study

Introduction: Masked hypertension (MHTN) is the finding of elevated out-of-office blood pressure (BP) measurement. This is a pilot study to evaluate the prevalence of MHTN in adolescents with type 1 diabetes mellitus (T1DM). Patients and Methods: Normotensive, adolescents with T1DM were recruited from Tawam Adolescents Diabetes Clinic at Tawam hospital, Al Ain, UAE. They consented to wear the ambulatory BP monitoring (ABPM) device. The heart rate and ambulatory BP were recorded at 15-min intervals for 24 h. Abnormal systolic BP (SBP) and diastolic BP (DBP) were defined as readings above 135 and 85 mm Hg; respectively. Results: Thirteen patients (10 females) were recruited from “Tawam Adolescents Diabetes Clinic.” The median age was 17 (15–19) years, median BMI 21.4 (14.8–29), and median diabetes duration 9 (3–12) years. All patients had normal retinal examination within the past 12 months. Family history of hypertension (HTN) was present in 6/13 (46%) patients. Office BP measurements revealed a mean DBP ± SD of 72 ± 6.9 mm Hg and mean SBP ± SD116 ± 5.5 mm Hg. The median HbA1c was 8.4% (5.6–13.7) and median GFR 125 mL/min/m² (87–134). Two patients had microalbuminuria. Twenty-four hour ABPM revealed elevated SBP and DBP in 12.2 and 5.8% of the values; respectively. Further analysis confirmed MHTN in 4 (30%) patients, nondipping pattern of BP in 5 (38%) patients, and elevated pulse pressure in 8 (61.5%) patients. Only 4 (30%) patients had normal studies. Conclusions: ABPM uncovered a very high prevalence of MHTN in our patients. Whenever available, ABPM provides an excellent tool for diagnosis and hence early evaluation and management of HTN in adolescents with T1DM. Well-designed large-scale studies are needed to examine the magnitude of MHTN among adolescents with T1DM.

Značaj/uloga ambulante porodične medicine u ranom otkrivanju sekundarne hipertenzije

SUMMARY - Introduction: Secondary arterial hypertension has an identifiable underlying cause. Routine screening is not indicated given the low prevalence of the disease (5-10% arterial hypertension), longterm and costly diagnostic evaluation. Case report: An outpatient family medication presents a 34-year-old patient due to worsening, by then stable, arterial hypertension. She was found 12 months ago when reported to a private healthcare facility where she was allowed perindopril / amlodipine 4/5 mg, 1x1 tablet. So far healthy, it negates diseases of relevance to inheritance. Smoker. 24hour outpatient blood pressure monitoring checks for elevated diastolic blood pressure levels in 59,3% of measurements during the day and 59,2% of measurements during the night. Thyroid ultrasound checks for inhomogeneous structure, right flap 40x15x16 mm, left flap 42x15x16 mm. Abdominal ultrasound reduces left kidney, bilateral thinning cortex, left ventricular moderate hydronephrosis. The laboratory contains large amounts of tyrosimulating hormone as well as antibodies to thyroid peroxidase, decreased levels of free thyroxine and a slight increase in albumin in 24 hours of urine. The patient is referred for a consultative examination by a nephrologist and a nuclear medicine specialist. Same indicative hygiene dietary regimen and introduction of levothyroxine sodium tablets 100 mcg 1x 1 ¼ tablets (125 mcg). Antihypertensive therapy was discontinued at most months later, while levothyroxine sodium replacement therapy was reduced to 1 x 100 mcg. Conclusion: The work of a selected family physician in accordance with good clinical practice guidelines allows for the early detection, normalization or increase in the number of secondary hypertension, the reduction of the possibility of accommodation of irreversible changes in blood vessels, and coexisting essential hypertension.

BLOOD PRESSURE INCREASES INDUCED BY IATROGENESIS, OVER THE COUNTER SUBSTANCES, AND HERBALS PRODUCTS

A number of both prescription and over the counter drugs, herbal supplements, and miscellaneous substances can increase blood pressure in subjects by degrees that vary substantially within drug classes and individual patients; such increases often remain within the normal range but may cause overt hypertension (BP&gt;140/90) mmHg and even precipitate hypertensive crises. Blood pressure increases are often potentiated by co-existing cardiovascular conditions, age, renal disease, diabetes, obesity, and interactions with other concomitant medications. The need to scrutinize for drugs or other substances that may be contributing to elevated blood pressures or impairing responses to anti-hypertensive medications is critically important, particularly in the evaluation of resistant and refractory hypertension. Anti-hypertensive effects of diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers may be blunted. The drugs most commonly associated with blood pressure elevations are non-steroidal anti-inflammatory agents, sympathomimetic amines, estrogen-containing oral contraceptives, certain antidepressants, angiogenesis inhibitors, and ephedra. Although most drug-induced blood pressure increases do not, in fact, lead to overt hypertension, systolic and diastolic blood pressure elevations of as little as 2 mmHg lead to significant increases in the risk of cardiovascular events. When a medication with the potential to increase blood pressure is added to a patient’s therapeutic regimen, it is most important to monitor for possible changes in blood pressure even within the normal range. An initial diagnosis of hypertension should not be made until a thorough examination of all over the counter products and herbal substances that a patient may be consuming.

Statin eligibility based on the ACC/AHA guidelines among Middle Eastern patients with diabetes mellitus presenting with acute myocardial infarction

BackgroundStatin eligibility based on the American College of Cardiology/American Heart Association cholesterol guidelines among patients with diabetes admitted with first time acute myocardial infarction has not been evaluated in the Middle East. PurposeTo assess statin eligibility for diabetic patients admitted with first time myocardial infarction in Jordan according to ACC/AHA guidelines. MethodsConsecutive patients admitted with a first acute myocardial infarction who were not taking statins, and had their serum lipoproteins measured upon hospital admission were enrolled in the study. Statin eligibility among patients with diabetes admitted with first time myocardial infarction was determined based on the ACC/AHA guidelines. ResultsOf 774 patients enrolled, 292 (37.30%) had diabetes. Compared with non-diabetic patients, those with diabetes were females, older, more hypertension, more hypercholesterolemia, more triglycerides, more diastolic blood pressure, less smokers and less low density lipoprotein. Among patients with diabetes, 242 diabetic patients (82.9%) were statin eligible, including 20 (6.90%) for having high serum levels of low density lipoprotein cholesterol (LDL-C) >190 mg/dL, and 222 (76%) for being aged 40–75 years with LDL-C 70–189 mg/dL. No patient had a calculated atherosclerotic cardiovascular risk score ≥7.5%. On the other hand, 393 non-diabetic patients (81.3%) were statin eligible, including 41 (8.50%) for having high serum levels of low density lipoprotein cholesterol (LDL-C) >190 mg/dL, and 351 (72.80%) for being aged 40–75 years with LDL-C 70–189 mg/dL. ConclusionsBased on the ACC/AHA guidelines, the majority of patients with diabetes admitted with first acute myocardial infarction would have been eligible for statin treatment if they have LDL-c >190 mg/dl or aged 40–75 years old and they have their LDL 70–189 mg/gl. More efforts should be taken for patients who are female, older than 50 years, hypertensive, elevated diastolic blood pressure have hypercholesterolemia, and elevated triglycerides because of their significant association with diabetes.

Clinical correlation of glaucoma with systemic hypertension and its effect on visual morbidity

Glaucoma and hypertension share a common pathophysiology of altered sodium transport in the renal and ciliary epithelium and can co exist. High blood pressure is a significant risk factor for glaucoma progression due to intraocular pressure spikes.This study was performed to evaluate the association of hypertension with glaucoma and to assess the extent of optic disc damage, the role of anti hypertensive medications and visual morbidity.This is a prospective, multidisciplinary study performed on a cohort of118 hypertensive patients over 1 year. Ophthalmic examination, ancillary ocular investigations, systemic tests and multi speciality referrals were obtained for all patients.Among 118 hypertensive patients, 64 (54.8%) had glaucoma. 65 patients (55.1%) were female and 53 patients (44.1%) male. Age group most frequently affected was between 60 and 70 years. There was increased incidence of ocular hypertension which was statistically significant (p value of 0.02). The range of IOP in those on anti hypertensive medications was 10-16 mmHg which was statistically significant (p value = 0. 03).Risk of glaucoma in hypertension was higher in women. An elevation of diastolic blood pressure is more significant than systolic BP in raising IOP. Decreased IOP was highest among patients taking calcium channel blockers.: Hypertension can cause both reduction and elevation in IOP. Treatment of hypertension does lower the IOP and prevent further progression of glaucoma and prevent any visual loss.

Underdiagnosis of Isolated Systolic and Isolated Diastolic Hypertension

Systolic and diastolic hypertension independently predict the risk of adverse cardiovascular events. It remains unclear how systolic pressure, diastolic pressure, and other patient characteristics influence the initial diagnosis of hypertension. Here, we use a cohort of 146,816 adults in a large healthcare system to examine how elevated systolic and/or diastolic blood pressure measurements influence initial diagnosis of hypertension and how other patient characteristics influence the diagnosis. Thirty-four percent of the cohort were diagnosed with hypertension within 1 year. In multivariable logistic regression of the diagnosis of hypertension, controlling for covariates, isolated systolic hypertensive measures (odds ratio [OR] 0.42 [95% confidence interval {CI} 0.41 to 0.43]) and isolated diastolic hypertensive measures (OR 0.32 [95% CI 0.31 to 0.33]) were less likely to lead to hypertension diagnosis when compared with combined hypertensive measures. Higher levels of systolic blood pressure had a greater impact on hypertension diagnosis (OR 1.77 [95% CI 1.75 to 1.79] per Z-score) than did higher levels of diastolic blood pressure (OR 1.34 [95% CI 1.32 to 1.36] per Z-score). Older age, non-white race/ethnicity, and medical comorbidities all predicted the establishment of a diagnosis of hypertension. Isolated systolic and isolated diastolic hypertension are underdiagnosed in clinical practice, and several patient-centered factors also strongly influence whether a diagnosis is made. In conclusion, our findings uncover a care gap that can be closed with increased attention to the independent influence of systolic and diastolic hypertension and the various patient-centered factors that may impact hypertension diagnosis.

&lt;p&gt;Assessment of Cardiovascular Risk Factors in Patients with Type 2 Diabetes in Upper Egypt Villages&lt;/p&gt;

BackgroundA large percentage of diabetic patients also have other components of metabolic syndrome, which is a group of cardiovascular (CV) hazard factors related to both diabetes mellitus (DM) and cardiovascular diseases (CVD). We do not know about the prevalence of CV risk factors in diabetic patients in Upper Egypt. We aimed to assess the CV risk factors in type 2 diabetic patients in Upper Egypt villages.MethodsWe conducted a cross-sectional study that included 800 patients with type 2 DM. We classified the participants into three groups according to the hemoglobin A1c (HbA1c) levels. We assessed the prevalence of other cardiovascular risk factors and their association with HbA1c levels through a detailed history, full clinical examination, and laboratory tests.ResultsWe found that 75% of the participants were males, 25.5% elderly, 60.25% had hypertension, 60.75% had dyslipidemia, 33.25% were overweight or obese, 19.75% had a family history of coronary artery disease (CAD), 55.75% had established CVD, 42.5% were smokers, and only 12.25% were physically inactive. We found that 84% of the participants had ≥ two cardiovascular risk factors other than DM. HbA1c level was ≥ 7% in 77% of patients. After multivariate regression analysis, we found a significant association of higher systolic blood pressure (BP), more elevated diastolic BP, higher body mass index (BMI), increased waist circumference, old age, long duration of DM, and an increase in the number of clustered CV risk factors with a higher HbA1c level. At the same time, insulin therapy was significantly associated with a lower HbA1c level.ConclusionAll type 2 diabetic patients in Upper Egypt villages have other associated CV risk factors. The clustering of cardiovascular risk factors showed a significant association with higher HbA1c levels. These findings require the thought of associated CV risk factors in choosing medical treatments to optimize glycemic control and multifactorial intervention to improve CV risk.

Midlife blood pressure is associated with the severity of white matter hyperintensities: analysis of the UK Biobank cohort study.

AimsWhite matter hyperintensities (WMH) progress with age and hypertension, but the key period of exposure to elevated blood pressure (BP), and the relative role of systolic BP (SBP) vs. diastolic BP (DBP), remains unclear. This study aims to determine the relationship between WMH and concurrent vs. past BP. Methods and results UK Biobank is a prospective community-based cohort of 40–69-year olds from 22 centres, with magnetic resonance imaging in a subgroup of over 40 000 people at 4–12 years after baseline assessment. Standardized associations between WMH load (WMH volume normalized by total white matter volume and logit-transformed) and concurrent vs. past BP were determined using linear models, adjusted for age, sex, cardiovascular risk factors, BP source, assessment centre, and time since baseline. Associations adjusted for regression dilution bias were determined between median WMH and usual SBP or DBP, stratified by age and baseline BP.In 37 041 eligible participants with WMH data and BP measures, WMH were more strongly associated with concurrent SBP [DBP: β = 0.064, 95% confidence interval (CI) 0.050–0.078; SBP: β = 0.076, 95% CI 0.062–0.090], but the strongest association was for past DBP (DBP: β = 0.087, 95% CI 0.064–0.109; SBP: β = 0.045, 95% CI 0.022–0.069), particularly under the age of 50 (DBP: β = 0.103, 95% CI 0.055–0.152; SBP: β = 0.012, 95% CI −0.044 to 0.069). Due to the higher prevalence of elevated SBP, median WMH increased 1.126 (95% CI 1.107–1.146) per 10 mmHg usual SBP and 1.106 (95% CI 1.090–1.122) per 5 mmHg usual DBP, whilst the population attributable fraction of WMH in the top decile was greater for elevated SBP (19.1% for concurrent SBP; 24.4% for past SBP). Any increase in BP, even below 140 for SBP and below 90 mmHg for DBP, and especially if requiring antihypertensive medication, was associated with increased WMH.ConclusionsWMH were strongly associated with concurrent and past elevated BP with the population burden of severe WMH greatest for SBP. However, before the age of 50, DBP was more strongly associated with WMH. Long-term prevention of WMH may require control of even mildly elevated midlife DBP.

Discovery of rare variants associated with blood pressure regulation through meta-analysis of 1.3 million individuals.

Genetic studies of blood pressure (BP) to date have mainly analyzed common variants (minor allele frequency, MAF > 0.05). In a meta-analysis of up to >1.3 million participants, we discovered 106 new BP-associated genomic regions and 87 rare (MAF ≤ 0.01) variant BP associations (P < 5 × 10-8), of which 32 were in new BP-associated loci and 55 were independent BP-associated SNVs within known BP-associated regions. Average effects of rare variants (44% coding) were ~8 times larger than common variant effects and indicate potential candidate causal genes at new and known loci (e.g. GATA5, PLCB3). BP-associated variants (including rare and common) were enriched in regions of active chromatin in fetal tissues, potentially linking fetal development with BP regulation in later life. Multivariable Mendelian randomization suggested possible inverse effects of elevated systolic and diastolic BP on large artery stroke. Our study demonstrates the utility of rare variant analyses for identifying candidate genes and the results highlight potential therapeutic targets.

Probable PTSD, depression and anxiety in 40,299 UK police officers and staff: Prevalence, risk factors and associations with blood pressure.

IntroductionPolice employees undertake challenging duties which may adversely impact their health. This study explored the prevalence of and risk factors for probable mental disorders amongst a representative sample of UK police employees. The association between mental illness and alterations in blood pressure was also explored.MethodsData were used from the Airwave Health Monitoring Study which was established to monitor the possible physical health impacts of a new communication system on police employees. Data included sociodemographic characteristics, lifestyle habits, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms and blood pressure. Descriptive statistics were used to explore the prevalence of probable mental disorders and associated factors. Stepwise linear regression was conducted, controlling for confounding variables, to examine associations between mental disorders and blood pressure.ResultsThe sample included 40,299 police staff, police constable/sergeants and inspectors or above. Probable depression was most frequently reported (9.8%), followed by anxiety (8.5%) and PTSD (3.9%). Groups at risk for probable mental disorders included police staff, and police employees who reported drinking heavily. Police employees exposed to traumatic incidents in the past six months had a doubling in rates of anxiety or depression and a six-fold increase in PTSD compared to those with no recent trauma exposure. Adjusted logistic regression models did not reveal any significant association between probable mental disorders and systolic blood pressure but significantly elevated diastolic blood pressure (≈1mmHg) was found across mental disorders.ConclusionsThese results show lower rates of probable mental disorders, especially PTSD, than reported in other studies focusing on police employees. Although mental ill health was associated with increased diastolic blood pressure, this was unlikely to be clinically significant. These findings highlight the importance of continued health monitoring of members of the UK police forces, focusing on employees recently exposed to traumatic incidents, heavy drinkers and police staff.

Impact of diastolic blood pressure on speckle tracking derived myocardial work components in a population of normotensive and untreated hypertensive patients

Abstract Background Arterial hypertension deeply influences left ventricular (LV) mechanics and global longitudinal strain (GLS). The effect of blood pressure (BP), in particular systolic BP burden, on speckle tracking derived myocardial work (MW) was demonstrated in both hypertensive and healthy subjects. Purpose Aim of our study was to evaluate the impact of diastolic BP (DBP) on MW components in a population of newly-diagnosed, never treated hypertensive patients and healthy subjects. Methods The study population included 105 newly-diagnosed, never treated hypertensive patients (M/F= 62/43; age=46.1±13.0 years, BP=145.1±10/89.8±7.4 mmHg), and 105 healthy normotensive subjects (BP=121.6±9.8/73.7±7.4mmHg), matched for age and sex. All participants underwent standard echo exam, including GLS evaluation (in absolute value). Cuff BP was employed as a surrogate of LV peak pressure for the assessment of global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. The study population was divided into two groups according to DBP threshold of normalcy defined by 2018 ESH/ESC guidelines: the first group including individuals with normal DBP (n=135, DBP&amp;lt;90mmHg) and the second group including patients with abnormal DBP (n=75, DBP ≥90 mmHg). Results The two groups were comparable for sex prevalence, age and heart rate. Body mass index (BMI), systolic and mean BP were higher in the group with abnormal DBP (all p&amp;lt;0.0001). Among echo data, no significant intergroup difference was found in LV mass index, relative wall thickness, ejection fraction and diastolic parameters. GLS was lower in patients with abnormal DBP (20.4±1.9 vs. 22.1±2.1%, p&amp;lt;0.0001). GWI (2443.0±403.1 vs. 2277.3±359.6 mmHg%, p&amp;lt;0.002), GCW (2733.5±406.0 vs. 2556.9±405.6 mmHg%, p=0.003) and GWW (112.8±84.4 vs. 76.8±45.1 mmHg%, p&amp;lt;0.0001) were significantly higher in patients with abnormal DBP, whereas GWE (95.3±2.8 vs. 96.2±1.7%, p&amp;lt;0.002) was lower in this group. In the pooled population, DBP was positively related to GWI, GCW (both r=0.30, p&amp;lt;0.0001) and GWW (r=0.26, p&amp;lt;0.0001), while negatively correlated with GLS (r=−0.37, p&amp;lt;0.0001) and GWE (r=−0.21, p&amp;lt;0.002). By separate multiple linear regression analyses, GWI (β=0.45, p&amp;lt;0.0001), GCW (β=0.47, p&amp;lt;0.0001), GWW (β=0.20, p=0.007) and GWE (β=−0.15, p&amp;lt;0.05) were all independently associated with DBP, after adjusting for male sex, age, BMI, heart rate, GLS and E/e' ratio. Conclusions In a population of untreated hypertensive patients and healthy subjects, increased DBP affects longitudinal function and MW. In particular, elevated diastolic BP induces an increase of wasted work which is only partially balanced by the increased constructive work, thus provoking a clear reduced efficiency of myocardial mechanics. Figure 1 Funding Acknowledgement Type of funding source: None

Increased Stroke Risk in Metabolically Abnormal Normal Weight: a 10-Year Follow-up of 102,037 Participants in China.

The purpose of this study was to investigate the risks of stroke in subjects with metabolically abnormal normal weight (MANW) in China. We recruited 102,037 participants from the Zhejiang Metabolic Syndrome Cohort and the Kailuan cohort. The mean years of follow-up were 9.9years. General obesity was defined by body mass index (BMI) ≥ 28, overweight by BMI < 28 and ≥ 24, and normal weight by BMI < 24 and ≥ 18.5. Metabolic abnormality was defined as two or more abnormal components (elevated triglycerides, low high-density lipoprotein cholesterol, elevated systolic blood pressure or diastolic blood pressure, or use of antihypertensive drug therapy, elevated fasting plasma glucose, or antidiabetic treatment). A multiple Cox regression model was used to calculate hazard ratio (HR) and its 95% confidence interval (CI), adjusted by potential confounding factors. Overall HR of the risks in two cohorts was calculated by a meta-analysis. Compared with the subjects who were metabolically normal with normal weight (MNNW), the pooled HR for stroke in MANW subjects was 1.82 (95% CI, 1.59-2.07). The risks of stroke in MANW subjects were significantly lower than that in subjects with metabolically abnormal obesity (MAO), but higher than that in those with metabolically normal obesity (MNO) (P < 0.05). These associations remained in the subtypes of cerebral infarction and cerebral hemorrhage. In normal-weight subjects, the HR for stroke was significantly positively correlated with the number of abnormal metabolic components (Ptrend < 0.001). In brief, metabolic abnormality increased the risk of stroke irrespective of obesity status. MANW individuals showed a greater risk of stroke, and this risk was positively correlated with the number of abnormal metabolic components.