Female Hypertension Research Articles

Abstract P053: Enhanced Exercise Capacity By Muscadine Grape Extract Treatment Is Only Evident In Older Hypertensive Female Rats And Is Independent Of Blood Pressure

Physical performance and systolic blood pressure (SBP) during aging in normotensive female Sprague-Dawley (SD) and hypertensive (mRen2)27 transgenic rats were assessed following long-term treatment with a Muscadine Grape Extract (MGE, Piedmont Research and Development Corp). MGE was administered at a dose of 0.2 mg/mL in the drinking water starting at 14 weeks (wks) of age with an endpoint at 70 wks of age (total time of treatment of 56 wks). At 20-, 40- and 70-wks of age, physical performance (exercise capacity in seconds and workload in grams - meters) was determined using a treadmill at a velocity of 17 cm/second with a 5% incline. SBP was determined by tail-cuff plethysmography in trained rats. There were no significant differences in physical performance between SD and (mRen2)27 female rats at any age despite the higher SBP in the (mRen2)27 rats at all ages. Long-term treatment with MGE had no significant effect on physical performance or SBP in SD rats at any age. In contrast, MGE treatment markedly increased exercise capacity (40 wks: 1615 ± 166 vs 4943 ± 442 seconds, p<0.01, n = 4-9; 70 wks: 2520 ± 374 vs 4117 ± 245 seconds, p<0.01, n = 4-8) and workload (40 wks: 4579 ± 490 vs 14730 ± 1353 grams - meters, p<0.01, n = 4-9; 70 wks: 8338 ± 1340 vs 13659 ± 933 grams - meters, p<0.01, n = 4-8) at the later ages in female (mRen2)27 rats, while there was no effect on SBP (20 wks: 167 ± 4 vs 173 ± 4 mm Hg, n = 4-6; 40 wks: 177 ± 8 vs 170 ± 7 mm Hg, n = 6-7; 70 wks:154 ± 6 vs 172 ± 6 mm Hg, n = 5) at any age. These data suggest that MGE treatment is effective in improving physical performance only in hypertensive female rats and may be independent of changes in blood pressure. The benefit of MGE in the older hypertensive female may reflect reductions in vascular stiffness and oxidative stress. Support: Chronic Disease Research Fund, Hypertension & Vascular Research Center

The patterns of lifestyle, metabolic status, and obesity among hypertensive Korean patients: a latent class analysis.

OBJECTIVESThis study aimed to identify latent classes in hypertensive patients based on the clustering of factors including lifestyle risk factors, metabolic risk factors, and obesity in each sex.METHODSThis cross-sectional study included 102,780 male and 103,710 female hypertensive patients who underwent health check-ups at 16 centers in Korea, in 2018. A latent class analysis approach was used to identify subgroups of hypertensive patients. Multinomial logistic regression was performed to examine the association between latent classes and comorbidities of hypertension.RESULTSA four-class model provided the best fit for each sex. The following latent classes were identified: Class I (male: 16.9%, female: 1.7%; high risk of lifestyle behaviors [HB] with metabolic disorders and obesity [MO]), Class II (male: 32.4%, female: 47.1%; low risk of lifestyle behaviors [LB] with MO), Class III (male: 15.3%, female: 1.8%; HB with metabolic disorders and normal weight [MNW]), Class IV (male: 35.5%, female: 49.4%; LB with MNW). Lifestyle patterns in the latent classes were classified as high-risk or low-risk according to smoking and high-risk drinking among male, and presented complex patterns including physical inactivity alone or in combination with other factors, among female. Stage 2 hypertensive or diabetic individuals were likely to belong to classes including obesity (HB-MO, LB-MO) in both sexes, and additionally belonged to the HB-MNW class in male.CONCLUSIONSMetabolic disorders were included in all latent classes, with or without lifestyle risk factors and obesity. Hypertensive females need to manage obesity, and hypertensive males need to manage lifestyle risk factors and obesity. Sex-specific lifestyle behaviors are important for controlling hypertension.

A hypertension patient-derived iPSC model demonstrates a role for G protein-coupled estrogen receptor in hypertension risk and development.

Hypertension (HTN) is a polyfactorial disease that can manifest severe cardiovascular pathologies such as heart failure or stroke. Genome-wide association studies (GWAS) of HTN indicate that single-nucleotide polymorphisms (SNPs) contribute to increased risk for HTN and resistance to some HTN drug regimens (Hiltunen TP et al., J Am Heart Assoc 4: e001521, 2015; Le MT et al., PLoS One 8: e52062, 2013; McDonough CW et al., J Hypertens 31: 698-704, 2013; Vandell AG et al., Hypertension 60: 957-964, 2012). However, cellular mechanistic insights of such SNPs remain largely unknown. Using a bank of induced pluripotent stem cells (iPSCs) derived from patients with HTN and CRISPR/Cas9-mediated gene-editing approach, we investigated the effects of a female HTN risk-associated SNP (rs1154431) of the G protein-coupled estrogen receptor (GPER) (Bassuk SS, Manson JE., Clin Chem 60: 68-77, 2014) in vascular endothelial cells. Although GPER1 deletion reduced endothelial nitric oxide synthase (eNOS) activation in iPSC-derived endothelial cells (iECs), the polymorphism itself did not significantly affect eNOS and NO production in a comparison of isogenic hemizygous iECs expressing either normal (P16) or HTN-associated (L16) GPER. Interestingly, we demonstrate for the first time that GPER plays a role in regulation of adhesion molecule expression and monocyte adhesion to iECs. Moreover, the L16 iECs had higher expression of inflammation genes than P16 iECs, implying that the risk variant may affect carrier individuals through increased inflammatory activity. This study further indicates that iPSCs are a useful platform for exploring mechanistic insights underlying hypertension GWAS endeavors.

Spousal alcohol consumption and female hypertension status: evidence from Nepal

ObjectivePsychosocial factors, such as environmental stressors, can increase the risk of hypertension. This study examines the role of the household environment in hypertension outcomes by assessing the link between female hypertension status and spousal alcohol consumption in Nepal. Study designThis is a cross-sectional study. MethodsWe used the 2016 Nepal Demographic and Health Survey to assess differences in hypertension outcomes in women aged 15 to 49 years whose husbands drink alcohol and in those whose husbands do not. We estimated a multinomial logistic model to obtain adjusted differences in the likelihood of being hypertensive between the two groups. We also examined several socio-economic conditions across the two groups to discuss various aspects of the association. ResultsAfter controlling for anthropometric and various sociodemographic attributes, we find that women whose husbands drink alcohol were 2.5 percentage points (95% confidence interval [CI]: −0.31, 5.31) more likely to be hypertensive than women whose husbands do not. They were also more likely to experience food insecurity, to experience spousal violence, and to consume tobacco products. Among women whose husbands became intoxicated (‘got drunk’) very often, the likelihood of being hypertensive was 4.0 percentage points (95% CI: −0.26, 7.67) higher than among women whose husbands do not drink alcohol. ConclusionWomen whose husbands consume alcohol have an elevated risk of being hypertensive, illustrating the association between hypertension and the household environment. The findings document the added hypertension burden in socially vulnerable population groups and can inform initiatives to reduce alcohol consumption in Nepal.

SAT-LB127 Regulation of ENaC by Exosomal Lipids in the Diabetic Kidney

Effective treatment of hypertension (HTN) in patients with diabetes may help to significantly reduce the risk of those patients developing additional complications including vascular disease and diabetic nephropathy. Blockers of the renin-angiotensin system including angiotensin converting enzyme inhibitors and angiotensin receptor blockers are not always effective in treating HTN in diabetic patients. Therefore, the aim of this study was to use an animal model of type 2 diabetes to investigate a novel mechanism of diabetes associated HTN involving exosomal lipids in the upregulation of epithelial sodium channel (ENaC) activity in the kidney. We performed metabolic cages studies using male and female hypertensive (salt-loaded induced) diabetic db/db mice and healthy age-matched wild-type control mice in order to isolate and characterize urinary exosomes from each group by nanoparticle tracking analysis, Western blotting, and transmission electron microscopy. Our mass spectrometry based lipidomic studies identified key lipids that were differentially expressed in the kidney derived exosomes from the hypertensive diabetic mice compared to control mice. Sphingomyelin quantification assays showed total sphingomyelin content was elevated in the exosomes from the hypertensive diabetic mice compared to the control group. Single channel patch clamp studies showed urinary exosomes enriched in sphingomyelins from hypertensive diabetic mice compared to controls increase ENaC activity (at the level of channel density and open probability) in cultured distal tubule renal epithelial cells. Moreover, exogenous application of sphinomyelin-6 to cultured mouse cortical collecting duct (mpkCCD) cells resulted in an increase in amiloride-sensitive transepithelial current. Taken together, our data show various lipids are enriched in exosomes from hypertensive diabetic mice compared to controls and these exosomes positively regulate ENaC activity in distal tubule and collecting duct cells.

Higher blood pressure in elderly hypertensive females, with increased arterial stiffness and blood pressure in females with the Fibrillin-1 2/3 genotype

BackgroundElderly patients have a relatively high cardiovascular risk due to increased arterial stiffness, elevated blood pressure and decreased amounts of elastin in the arteries. The composition of the media layer in the arterial wall, comprising elastin, collagen, smooth muscle cells, proteoglycans, fibronectin and fibrillin-1, influences its mechanical properties. Mutations in the fibrillin-1 gene leads to increased aortic stiffness, elevated pulse pressure and aortic root dilatation. This study investigates whether there is a sex difference among hypertensive elderly patients regarding blood pressure, arterial stiffness and fibrillin-1 genotypes.MethodsA total of 315 hypertensive subjects (systolic blood pressure > 140 mmHg) were included in this study (155 men and 160 women aged 71–88 years). Aortic pulse wave velocity and augmentation index were determined using SphygmoCor, and brachial blood pressure was measured using an oscillometric technique. Fibrillin-1 was genotyped by polymerase chain reaction and with a capillary electrophoresis system.ResultsFemales showed a significantly higher peripheral mean arterial pressure (females; 107.20 mmHg, males 101.6 mmHg, p = 0.008), central mean arterial pressure (females; 107.2 mmHg, males 101.6 mmHg p = 0.008), central systolic blood pressure (females; 148.1 mmHg, males 139.2 mmHg, p < 0.001) and central pulse pressure (females; 68.9 mmHg, males 61.6 mmHg, p = 0.035) than males. Females with the Fibrillin-1 2/3 genotype showed a significantly higher augmentation index (FBN1 2/3; 39.9%, FBN1 2/2 35.0%, FBN1 2/4 35.8, p = 0.029) and systolic blood pressure (FBN1 2/3; 174.6 mmHg, FBN1 2/2168.9 mmHg, FBN1 2/4169.9 mmHg, p = 0.025) than females with the 2/2 and 2/4 genotypes.ConclusionThe findings of this study may indicate that hypertensive elderly females, especially elderly females with Fibrillin-1 2/3, have increased systolic blood pressure and arterial stiffness.

Male, but not female, spontaneously hypertensive rats (SHR) have sustained renal injury following a single ischemic insult progressing to chronic kidney disease (CKD).

Renal ischemia‐reperfusion (IR) injury is a major cause of acute kidney injury (AKI), which is an independent risk factor for the development of CKD and all‐cause mortality. Clinical and pre‐clinical studies further support sex differences in incidence and mortality rates of AKI and a higher tendency to develop AKI to CKD transition than females. Hypertension is a common co‐morbid condition associated with AKI and CKD. Despite the prevalence of hypertension and the importance of blood pressure (BP) control in maintaining renal health, little is known regarding the impact of hypertension on AKI recovery and AKI to CKD progression. The goal of the current study was to test the hypothesis that hypertensive males will have greater IR injury than hypertensive females resulting in more rapid CKD progression. 13 wk old male and female SHR were subjected to sham or 30‐minute warm bilateral ischemia followed by reperfusion (n=5–6). Blood, a 24 hr urine sample and kidneys were collected 1 week post‐IR to assess renal injury. Systolic blood pressure (BP) measured weekly by tail cuff method. Plasma creatinine (Pcr) and urine protein creatinine ratio (UPCR) remained elevated at 1‐week post IR in male SHR compared sham (Pcr PIR=0.03, Psex=0.05; PIR*sex=0.04; ACR PIR=0.005, Psex=0.0005; PIR*sex=0.005); Pcr and UPCR returned to baseline in SHR females. Consistent with this finding, histological examination of SHR kidneys 7 days post‐IR showed increases in vascular congestion (Psex*IR=0.002) and tubular damage (Psex*IR=0.001) compared to sham only in males. However, glomerular filtration rate (GFR) and systolic BP was not altered in both male and female SHR at 1‐week post IR. To determine if this was sustained dysfunction or simply delayed recovery, additional 13 wk old male and female SHR were subjected to sham or 30‐minute warm bilateral ischemia followed by 20 weeks of reperfusion. Plasma and urine were collected weekly (n=3–4). Male SHR showed progressive increases in UPCR (PIR&lt;0.05) and systolic BP up to 20 weeks post‐IR compared to respective shams (PIR=0.001). Whereas in SHR female, UPCR remains at baseline up to 16‐week post IR compared to respective sham. However, at 20 weeks of post IR, both male and female SHR exhibit increase in UPCR compared to respective sham control; although the increase in UPCR was greater in males (PIR=0.0002, Psex=0.01; PIR*sex=0.09). Male SHR also exhibited decreases in glomerular filtration rate (GFR) (PIR=0.007, Psex=0.02; PIR*sex=0.12) and increases in systolic BP (PIR=0.008, Psex=0.0001; PIR*sex=0.27) compared to SHR female at 20 weeks post‐IR. In conclusion, our data demonstrated that impaired renal recovery following IR in SHR males results in exaggerated progression towards CKD compared females.Support or Funding InformationWork was supported by R01 HL127091 and P01 HL134604. Kidney function and systolic BP in male and female SHR at 1 and 20‐week of post‐IR. Male SHR UPCR GFR (mL/min) Systolic BP (mmHg) 1 week post IR Sham 1.14 ± 0.23 2.95±0.33 187±8 IR 3.44±1.37 2.55±0.28 192±6 20 week post IR Sham 1.70±0.26 2.58±0.5 205±10 IR 4.50±0.85 1.10±0.67 225±4 Female SHR 1 week post IR Sham 0.77±0.47 3.24±0.34 164±10 IR 0.79±0.34 3.35±0.68 166±3 20 week post IR Sham 1.10±0.54 2.96±1.09 167±9 IR 2.72±0.46 2.83±0.44 177±9 ACR= Urine Protein Creatinine Ratio; GFR=Glomerular Filtration Rate; BP= Blood Pressure.

RIP‐3 and HMGB‐1 are upregulated in adult hypertensive male spontaneously hypertensive rats (SHR).

BackgroundNecrotic cell death is a hallmark of hypertension. We previously published that male SHR have greater renal necrosis compared to age matched female SHR. Consistent with this, inhibition of necrosis attenuated maturation induced increases in blood pressure (BP) in male, but not female SHR. However, the mechanisms underlying sex differences in renal necrotic cell death in SHR are unknown. The goal of the current study is to test the hypothesis that maturation in male SHR drives increases in necrosis and upregulation of key proteins mediating necrotic cell death, receptor‐interacting protein kinase 3 (RIP‐3) and high mobility group box 1 (HMGB‐1).MethodsMale and female SHR were euthanized at 6 (pre‐hypertensive, sexually immature; n=6) or 15 weeks of age (hypertensive, sexually mature; n=6). The right kidney was isolated and processed for flow cytometric analysis of cell death using 7AAD. The left kidney was isolated for Western blot analysis of total RIP‐3, phosphorylated RIP‐3 and HMGB‐1. Protein expression was normalized to β‐actin. All data are expressed as mean ± standard error.ResultsRenal necrosis was comparable between 6 week old male and female SHR (expressed as % total kidney cells: 2.4±0.2 vs. 1.8±0.1, respectively) and increased with age only in males (5.4±0.2 vs. 1.7±0.3, respectively; Psex&lt;0.0001; Page&lt;0.0001; Pinteraction&lt;0.0001). To gain insight into what mediates sex differences in necrosis in 15 week old SHR, protein expression of RIP‐3 and HMGB‐1 were determined in 6 vs. 15 week old male SHR and in 15 week old male and female SHR. Protein expression of RIP‐3 (1±0.1 vs. 0.7±0.1; P=0.008; n=5–6), p‐RIP‐3 (1±0.1 vs. 0.7±0.03; P=0.008; n=5–6) and HMGB‐1 (1±0.06 vs. 0.7±0.1; P=0.005; n=5–6) were all greater in 15 week old vs 6 week old male SHR. 15 week old male SHR also had greater protein expression of RIP‐3 (1±0.1 vs. 0.4±0.1; P=0.003; n=6), p‐RIP‐3 (1±0.2 vs. 0.4±0.1; P=0.02; n=6) and HMGB‐1 (1±0.2 vs. 0.6±0.1; P=0.02; n=6) compared to age matched females.ConclusionIn contrast to adult, hypertensive SHR, sex differences in renal necrosis were absent in young, sexually immature pre‐hypertensive SHR. Consistent with greater renal necrosis, key proteins of necrotic cell death machinery were also upregulated in hypertensive male SHR compared to either age matched hypertensive females or young, pre‐hypertensive male SHR. Future studies are needed to test the hypothesis that RIP‐3 activation and the subsequent HMGB1 release potentially underlie greater renal necrosis in hypertensive male SHR compared to age matched females.

Epidemiological features of rosacea in Changsha, China: A population-based, cross-sectional study.

Rosacea is a common chronic skin disorder of unknown etiology. While population prevalence rates range 0.2-22% in Europe and North America, prevalence in China is currently undetermined. We conducted a large population-based case-control study to determine the present epidemiological status of rosacea in China, involving 10095 participants aged 0-100years (mean age, 35.5±19.1; 50.5% female). A census of rosacea among 15 communities in Changsha in south central China was conducted with skin examination by board-certified dermatologists. Rosacea was observed in 3.48% (95% confidence interval, 3.13-3.85%) of the study population. Subtype distribution was erythematotelangiectatic in 47.6%, papulopustular in 35.0% and phymatous in 17.4%. Family history was noted in 37.8% and ocular symptoms in 31.3%. Associations with rosacea were observed for melasma, hypertension, hyperthyroidism and breast cancer in females (P<0.05), and also for hyperthyroidism and peptic ulcers in males (P<0.05). Our results provide baseline information about epidemiological aspects of rosacea in China.

The Association of Body Fat Percentage With Hypertension in a Chinese Rural Population: The Henan Rural Cohort Study.

Background: Obesity is an important risk factor for hypertension. Previous studies have explored the association between body fat percentage (BFP) and hypertension, but evidence on the consistency of the association remains uncertain and limited. The aim of this study was to explore the relationship between BFP and hypertension in a Chinese rural population.Methods: The present cross-sectional study including 38,913 eligible individuals was conducted in rural areas of Henan province. BFP was measured by bioelectrical impedance methods using Omron body fat and weight measurement device. Logistic regression models and restricted cubic spline regression models were performed to investigate the relationship between BFP and hypertension. Receiver operating characteristic (ROC) analyses were used to compare the discriminating power of adiposity indices.Results: The age-standard prevalence of hypertension was 23.74 and 17.87% in males and females, respectively. Compared with the first quartile of BFP, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension in the highest BFP quartile were 3.30 (95% CI: 2.85, 3.83) in males and 2.66 (95% CI: 2.36, 2.99) in females, and the adjusted ORs increased along with increasing BFP levels. The areas under ROC and 95% CIs of BFP were 0.673 (0.665, 0.682) in males and 0.696 (0.689, 0.703) in females, respectively.Conclusions: BFP was significantly positively associated with the prevalence of hypertension in both males and females in the Chinese rural population. Controlling of body fat should be emphasized in rural areas of China.Clinical Trial Registration: Registration number: ChiCTR-OOC-15006699. http://www.chictr.org.cn/showproj.aspx?proj=11375

P1419 Sex-related differences in cardiac remodeling in health and hypertension

Abstract Funding Acknowledgements National Medical Research Council OnBehalf National Heart Centre Singapore BACKGROUND Adverse cardiac remodelling is associated with worse cardiovascular outcomes. Development of left ventricular hypertrophy (defined as increased myocardial mass) is a complex process mediated by myocardial wall thickening and/or ventricular dilatation. Sex-related differences in the relationship between myocardial mass and wall thickening/ventricular dilatation have not been well-described. PURPOSE We examine differences in determinants and patterns of cardiac remodeling between males and females. METHODS Comprehensive cardiovascular magnetic resonance imaging was performed in 1006 participants: 316 healthy volunteers (50% males, 46 ± 14 years) and 690 asymptomatic hypertensive patients (60% males, 57 ± 11 years). Myocardial mass, ventricular volumes and maximal myocardial wall thickness (across 16 myocardial segments) were measured using standardized contouring techniques. Clinically relevant variables (age, weight, height, and adiposity) that demonstrated significant univariate association with myocardial mass (P &amp;lt; 0.05) were selected in the multivariable linear regression model using the forward approach. RESULTS Increased body weight, lower body fat composition and higher systolic blood pressures were independently associated with increased myocardial mass in healthy volunteers (males and females) and hypertensive females. In hypertensive males, only increased body weight and elevated systolic blood pressure were independently associated with increased myocardial mass. The association between myocardial mass and ventricular volumes was almost identical between males and females (P = 0.65 for interaction; Figure). Conversely, there was a significant gender-related difference in the association between wall thickness and myocardial mass after adjusting for potential confounders (P &amp;lt; 0.001 for interaction). Concentric remodeling was initially more evident in males; but further with increase, myocardial mass was associated with greater concentric remodeling in females (Figure). Similar results were observed when analyses were performed separately in healthy volunteers and hypertensive patients. CONCLUSION There were sex-related differences in concentric remodeling at progressive stages of myocardial hypertrophy that may explain the higher prevalence of heart failure with preserved ejection fraction reported in females. Abstract P1419 Figure

Epidural steroid and facet joint injection neck in elderly patient: A combined approach

Cervical radicular pain is often due to a combination of factors including intervertebral disc prolapse or herniation, narrowing of the intervertebral foramen, osteoarthritis of facet joints, and spondylolisthesis. Cervical Epidural with local anesthetics along with steroids is used for evaluation and management of radicular pain in patients with pathology that exists at multiple vertebral levels. Medial branch block is given for facet joint arthropathy both for diagnostic and therapeutic purposes. Therefore, the aim of performing this procedure was to provide an interlaminar epidural steroid injection at C7-T1 vertebral level along with a diagnostic right medial branch block under fluoroscopic guidance to 86 years old hypertensive female, with complaints of pain in the neck lower portion, upper part of back and shoulder on the right side, radiating down the arm up to medial two fingers and thumb for 2 years. An interlaminar epidural steroid injection was planned on the right side at the C7-T1 vertebral level under C-arm guidance. A diagnostic right medial branch block was also planned to be given on the same day at 2 levels C5/C6 and C6/C7 facet joint each using 2 mg dexamethasone (0.5 ml) and 1.5 ml of 1% lignocaine. A repeat epidural injection was given using a combination of 1 ml of steroid dexamethasone (4 mg) and 3 ml of 1% lignocaine along with facet medial branch block injection at the same levels using 0.5% bupivacaine 1.5 ml and 2 mg dexamethasone (0.5 ml) on her follow-up visit after 6 weeks. Following the block patient on her first visit, she had considerable pain relief with a visual analog scale (VAS) of 3. She was prescribed gabapentin, methyl-cobalamine and clonazepam. After 6 weeks, the patient had VAS score of 6. She looked comfortable and her paresthesia had grossly improved. At the end of the procedure, patient had good pain relief with no deficit. She was advised to continue gabapentin. On her third follow-up after 3 months, the patient presented with >70% relief in her initial pain with a VAS of <3 and minimal paresthesia along the distribution of the ulnar nerve and hence required no intervention. Cervical epidural steroid injections under fluoroscopy guidance are being used for the conservative management of neck pain or cervical radiculopathy. Facet joint injections and medial branch blocks aim to diagnose and treat the pain arising from facet joints in the spine. It is also important to prescribe drugs to manage the neuropathic component of the pain.

Gender-Specific Differences on the Association of Hypertension with Subclinical Thyroid Dysfunction.

Objective Both hypertension and subclinical thyroid dysfunction (STD) have high prevalence and clinical importance, but their relationship is still a matter of debate. We aimed to explore gender-specific difference on the association between hypertension and STD in Chinese. Methods We recruited 13,380 ostensible healthy participants (8,237 men and 5,143 women). The associations between hypertension and STD were analyzed on a gender-based setting after dividing STD into subclinical hypothyroidism, subclinical hyperthyroidism and further subgrouped euthyroidism. Crude and adjusted odds ratios of STD for hypertension were analyzed by binary logistic regression. Results An increasing trend of hypertension prevalence was found along with aging in both genders. Yet, higher male hypertension prevalence was found until 65 years, and then it intersected with female hypertension prevalence. Women had significantly higher propensity for STD than men. Yet, in elderly participants, this gender-specific difference became less obvious. We displayed detrimental effects for subclinical hypothyroidism in both genders after multiple-covariate adjustments, yet no such effects were shown for subclinical hyperthyroidism. Moreover, females with subclinical hypothyroidism were more likely to be associated with hypertension than males, and the corresponding odds ratios were 1.619 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (Conclusion We demonstrate that hypertension is associated with subclinical hypothyroidism, but not with subclinical hyperthyroidism. Moreover, females with subclinical hypothyroidism are more likely to be associated with hypertension than males.

Current Issues in Chronic Diseases: A Focus on Dementia and Hypertension in Rural West Texans.

Dementia and hypertension are chronic diseases that affect elderly populations worldwide. The prevalence of these diseases increases each year, especially in rural and underserved rural communities like West Texas. The purpose of this study was to find risk factors of dementia and their impact on rural West Texans. Data was provided by the Project FRONTIER for rural West Texas counties. The SPSS software package was used for statistical analysis. Pearson's chi-squared test was also utilized to determine the relationships between the risk factors considering a level of significance (α) = 0.05. The findings have shown that age group had significant associations with hypertension, cerebral, neurologic disease, Romberg test, and muscle strength for both males and females (p≤0.002). Hypertension was significantly associated with cognitive disorder and diabetes in both males and females (p≤0.011). Age group in females was significantly associated with parkinsonism (p = 0.02), neurological stroke (p = 0.002), reflexes (p = 0.003), and sensory intact (hands/feet) (p = 0.004), respectively, whereas age for males was not significantly associated with those variables (p = 0.29, p = 0.05, p = 0.56, and p = 0.76, respectively). Hypertension in females was significantly associated with cardiovascular disease (p = 0.001) and depression (p = 0.001) but was not found to be significant for males (p = 0.30 and p = 0.09, respectively). Both males and females in Hispanic and non-Hispanic groups were found to be significantly associated with Alzheimer's disease (p = 0.0001 and p = 0.045, respectively). Hispanic and non-Hispanic females were found to be significantly associated with hypertension (p = 0.026). Gender-specific differences in dementia risk factors exist and integrating such variables may guide relevant policymaking to reduce dementia incidence in rural West Texas.

ANALISIS FAKTOR RISIKO PENYEBAB HIPERTENSI PADA WANITA DEWASA MUDA DAN KAITANNYA DENGAN PERMASALAHAN KEHAMILAN DI WILAYAH KERJA PUSKEMAS TELADAN TAHUN 2017

Hypertension is a generative disease which becomes a health problem throughout the world. Its prevalence in 18 years-old females is higher than that of males. The data from Riskesdas in 2013 revealed that the prevalence of hypertension in females was 28.8% and in males was 22.8%. it does not attack the aldery; it only attacks young adults. Uncontrolled hypertension can cause various complications in the entire organs and reproductive health in pregnancy and childbirth of young adult females. Goals: The research used observational analytic method with case-control design. It was conducted at Teladan Puskesmas, Medan from March until September, 2017. Method: The population was 96 hypertention young adult females who had been pregnant and visited Teladan Puskesmas. 48 of them were in the case gruop and the other 48 were respondents were in the control group (using total sampling technique). The data were analyzed by using univariate analysis, bivariate analysis with chi square test, and multivariate analysis with logistic regression test. Result: The result of the research showed that there was no influence of history of family on the incidence of hypertension (OR=1.6 95%CI= 0.683-4.1444), while obesity (OR=9 95%CI= 2.876-28.494), physical activity (OR=3.6 95%CI= 1.543- 11.626) had the influence on the incidence of hypertension. Obesity was the most dominant risk factor which influenced the incidence of hypertension in young adult females. Conclusion: It is recommended that young adult females keep their food intake stable with balanced nutrition and regular sport. Hypertension women should use hormonal contraceptive devices and have their blood pressure examined regularly so that complications can be detected early in preparing for pregnancy.

Sex differences in 10-year ischemic cardiovascular disease risk prediction in Chinese patients with prediabetes and type 2 diabetes

BackgroundCardiovascular disease has become a serious public health problem in recent years in China. The aim of the study was to examine sex differences in cardiovascular risk factors and 10-year ischemic cardiovascular disease (ICVD) risk in Chinese patients with prediabetes (PreDM) and type 2 diabetes mellitus (T2DM).MethodsThis was a multi-site retrospective case-control study conducted from April–November 2016 using an electronic medical record database, involving 217 PreDM and 900 T2DM patients admitted to endocrinology units in four hospitals in China. CVD risk was estimated using the Chinese 10-year ICVD risk model. The differences in 10-year absolute ICVD risk according to PreDM, T2DM < 1 year, T2DM 1–5 years or T2DM ≥5 years and sex were analyzed using ANOVA.ResultsWhen compared to PreDM females, males with PreDM had significantly higher 10-year ICVD risk In contrast, the opposite pattern of 10-year ICVD risk was observed in T2DM; males had significantly lower 10-year ICVD risk. Moreover, compared to T2DM females, males with T2DM had a lower proportion s with moderate or greater ICVD risk (p < 0.001). When compared to PreDM males, males with T2DM < 1 year, and with T2DM 1–5 years had no difference in 10-year ICVD risk, but had higher ICVD risk with T2DM ≥5 years (p < 0.05). Compared to PreDM females, females with T2DM in all subgroups had higher ICVD risk (p < 0.05). Among those with T2DM, hypertension rates of awareness, treatment and control were 78.60%, 65.38% and 31.10%, respectively; hyperlipidemia rates of awareness, treatment and control were lower (29.15%, 8.30% and 3.47%, respectively). Females with T2DM had higher prevalence, awareness and treatment of hypertension and hyperlipidemia than males with T2DM (p < 0.001).ConclusionsThere is a greater need for cardiovascular risk reduction programs for females with T2DM at diagnosis. Given the low numbers for awareness, treatment and control of hypertension and hyperlipidemia in both males and females, significant resources focused on them must be expended, specifically improving regular assessment of blood pressure and blood lipids. Strengthening the management of chronic diseases through adherence to evidence-based guidelines to enhance clinical treatment may reduce 10-year ICVD in patients with T2DM in China.

Estradiol-17β inhibits homocysteine mediated damage by promoting H2 S production via upregulating CBS and CSE expression in human umbilical vein endothelial cells.

Associated with reduced hydrogen sulfide (H2 S) production in Hcy metabolic disorders, Plasma Hcy accumulation can bring about vascular dysfunction. Nevertheless, recently proposed therapies for vascular damage by estrogen could contribute to promoting endogenous hydrogen sulfide production. This study explores whether estrogen can come into play in protection in hyperhomocysteinemia and hypertensive patients at a population level, and then analyses the specific mechanism of estrogen protection in homocysteine (Hcy)-treated human umbilical vein endothelial cells (HUVECs) at the foundational level. A case-control study, conducted on 1277 female hypertension and non-hypertensive patients from Hunan Provincial People's Hospital, showed that the Hcy concentration of hypertensive patients emerged higher than that of healthy controls (P < .001), and that of estrogen was the reverse (P < .001). Estrogen had a negative correlation with systolic blood pressure and plasma Hcy concentration. HUVECs were treated with estrogen and Hcy in the basic experimental part, and 17β-estradiol (E2β) stimulated proliferation and inhibited damage in Hcy-treated umbilical vein endothelial cells. Treatment with Hcy dampens the expression of cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) then cuts down H2 S production in cultured HUVECs, however, E2β reverses this process. To sum up, we have demonstrated a significant correlation between estrogen, Hcy concentration and systolic blood pressure reduction, which is bound up with Hcy metabolism and endogenous hydrogen sulfide production. The role of E2β was further strengthened by CBS and the CSE inhibitor through overthrowing the change in hydrogen sulfide of Hcy-treated HUVECs.

Prevalence and pattern of multimorbidity among adults in a primary care rural setting

BackgroundMultimorbidity has substantial impact on the health of the individual in terms of safety, quality of life and functional ability, but little is known about it from rural areas in developing countries. Hence the present study attempted to determine the prevalence and gender difference in multimorbidity from a rural area. MethodsA register based cross sectional study was done by retrieving data from the family health register of the rural health centre. Data on age, gender and all the morbidities, were collected. The most prevalent morbidities were presented as frequency and percentages, prevalence of multimorbidity were presented as dyads and triads. Multiple Logistic regression was done to find the age adjusted risk of gender on multimorbidity. ResultsThe prevalence of multimorbidity was 16.2% (13.05–19.35).The most prevalent morbidities were hypertension, diabetes, dyslipidaemia, visual impairment and thyroid in both males and females and most common dyad was hypertension and diabetes. ConclusionIn the context of lack of studies from this area, the findings of the study may help the health care providers to plan interventions. Further research has to be done to identify the risk factors of multimorbidity.

PREVALENCE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PREOPERATIVE VISIT CLINIC

Objective: To evaluate the prevalence of left ventricular dysfunction and somerelated factors in patients referred to the preoperative visit clinic. Methodology: In this cross-sectional study, patients aged above 20 years whounderwent echocardiography after physical examination at Poorsina Hospitalaffiliated to Guilan University of Medical Sciences Iran from January to July 2016.Patients were evaluated in two groups with left ventricular diastolic dysfunctionand without left ventricular diastolic dysfunction. The research inclusion criteriaincluded a lack of history of systolic heart failure and proven heart valvedysfunction, lack of deformity, infection and ulcers in the echo site. Lack ofpatient's willingness to continue the study and poor echocardiography windowwere our exclusion criteria. Then, the data was analyis in SPSS version 16. Results: Among 399 patients, 175 had no diastolic dysfunction and 224 (56.1%)had diastolic dysfunction, 200 patients (89.3%)had grade 1 diastolic dysfunctionand 24 patients (10.7%) had grade 2 dysfunction. There was a significantdifference in the frequency distribution of sex between the two groups (p=0.001), so that the odd ratio of this dysfunction was two times more in femalecompared to male. There was a significant difference between the two groups inthe mean age and age ranges (p= 0.0001), with increased prevalence ofdiastolic dysfunctions in elderly. The mean BMI in the affected group was higherthan that in non-affected group. (p = 0.034). There was a statistically significantdifference between two groups with and without left ventricular diastolicdysfunction in terms of the history of diabetes (p= 0.0001). Conclusion: Given the high prevalence of diastolic dysfunction in the communityof patients, who were candidate for surgery especially at higher ages as well aspatients with high risk factors (female sex, diabetes, hypertension and medicineusers), echocardiography was recommended to investigate the preoperativeheart diastolic dysfunction.

Spatial analysis of the effects of PM2.5 on hypertension among the middle-aged and elderly people in China

ABSTRACT Hypertension is currently one of the most common chronic diseases with high global prevalence associated with a huge social and economic burden. In recent years, air pollution has become a focus of research, especially the effects of PM2.5 on hypertension. However, few studies have considered the spatial properties of the sample; thus, the results might be unreliable. Based on the China Health and Retirement Longitudinal Study (CHARLS) and the Environmental Status Bulletin for each province in China, we used the extended shared component model (SCM) to fit the spatial variation of hypertension risk and to reveal the impact of PM2.5 on hypertension in males and females. Our results revealed that the crude prevalence of hypertension for the whole population in China was 32.74% in 2015, with the prevalence in men experiencing slightly higher than that in women (32.92% vs. 32.58%). We found that the distribution of hypertension prevalence exhibited obvious spatial aggregation for the whole population in China (Moran’s I = 0.39, P = 0.001), with similar results in both men (Moran’s I = 0.18, P = 0.027) and women (Moran’s I = 0.52, P = 0.001). Furthermore, the smoothed results obtained using the SCM indicated that some eastern and central provinces had relatively higher hypertension risk, while the risk in southeastern provinces was much lower. The risk was also relatively lower in most western provinces, except for some northwestern regions. Notably, our results showed that PM2.5 was a risk factor for hypertension, and the impact of PM2.5 on women was slightly greater than that on men, with odds ratios (OR) of 1.063 (1.041, 1.086) and 1.048 (1.025, 1.071), respectively. Our findings suggest the existence of distinct spatial differences in the prevalence of hypertension and small sex-related differences in the risk of hypertension in China.