Hypertension Research Articles

Absence of coronary artery disease in high-risk sickle cell anemia patients: a new illustration supporting the protective effect of Bilirubin against atherosclerosis?

Abstract Background Sickle cell anemia (SCA) is associated with both cardiac and systemic vascular disorders, which are the leading cause of morbi-mortality. Although these patients cumulate multiple cardiovascular (CV) risk factors, along with chronic inflammation and endothelial activation, some pre-clinical studies underlined a paradoxical protection against atherosclerosis. Purpose The aim of this study was to evaluate the prevalence of coronary artery disease in a high-risk SCA population. Methods From January 2019 to December 2023, consecutive adult patients with SCA were prospectively included in the DREPACOEUR registry to specifically analyze cardiac structure and function. They all had a comprehensive CV evaluation at steady-state in day-hospital including clinical exam, cardiac imaging, rhythm monitoring along with biology analysis. Only patients that underwent coronary imaging (CT coronary angiogram) were included in this study. Results Ninety patients were included. Mean age was 44±12, 50% were male with a high prevalence of systemic hypertension (57%), obstructive sleep apnea (21%) and 10% smokers. Only one patient had history of diabetes while no dyslipidemia (or lipid lowering therapy) was reported. Heart function was mainly preserved with a mean left ventricular ejection fraction (LVEF) of 58±5%. Expectedly, patients showed low hemoglobin level 8,7±1.4g/dL with high hemolysis markers. Glomerular filtration rate was 109 [62; 122] mL/min/m² with 21% having chronic kidney disease. Plasmatic LDLc level was low (0.7±0.3g/L, with 20% <0.5g/l) while triglycerides (TG) were highly variable (1.1±0.7mg/dL). Strikingly, no patient showed signs of significant coronary artery disease, with 87% presenting a calcium score of 0, 77% had a CAD-RADS of 0 while no patient was higher than 2. Correlation and linear regression analysis were performed to find independent parameters associated with LDLc and TG. Total bilirubin was the only variable that correlated with both LDLc and TG (R= -0.37, p<0.001 and R= -0.33, p=0.001 respectively). Conclusion Despite systemic vasculopathy and chronic inflammation, ageing SCA patients showed no significant coronary artery disease. These data are in line with pre-clinical studies suggesting a lipid-lowering role of bilirubin and its protective effect against atherosclerosis.

Chronopharmacotherapy and correction of central pressure in the aorta, structural and functional state of the left ventricular in patients with arterial hypertension and ischemic stroke

Objective. To evaluate the dynamics of central aortic pressure and the cardioprotective effect of antihypertensive chronopharmacotherapy in patients with arterial hypertension (AH) and ischemic stroke. Materials and methods. The study included 119 patients with AH who has suffered an ischemic stroke; patients were randomized in 2 groups depending on the chronopharmacotherapy option: group 1 (n = 60) – patients who received indapamide retard 1.5 mg and valsartan 160 mg in the morning; group 2 (n = 59) – indapamide retard 1.5 mg in the morning and valsartan 80 mg each in the morning and before bedtime. After 2 months of pharmacotherapy, the achievement of the target level of blood pressure was assessed. In group 1, blood pressure was recorded in 47 (78.3 %), in group 2 – in 56 (94.9 %) patients (p < 0.05). The rest of the respondents, who did not reach the blood pressure target, underwent correction of antihypertensive therapy and were excluded from further follow-up. Accordingly, further follow-up was carried out in 47 patients of group 1 (group 1a) and 56 patients of group 2 (group 2a). Initially and after 12 months of therapy, echocardiography parameters ("ALOKA SSD 2500", Japan), as well as daily blood pressure monitoring with determination of central aortic pressure (Peter Telegin LLC BPLabVasotens, Russia) were performed. The results of the study were processed using the Statistica 12.0 program (StatSoftInc, USA). Results. At the time of inclusion in the study, the main parameters of the central aortic pressure and echocardiography parameters in both groups of patients were equivalent. After 12 months a statistically more significant decrease in the main parameters of the central aortic pressure (average daily systolic and diastolic pressure in the aorta, pulse pressure in the aorta, augmentation index in the aorta, amplification of pulse pressure, duration of the expulsion period, subendocardial blood flow efficiency index), as well as echocardiography indicators was recorded in group 2a (end-systolic and end-diastolic dimensions, thickness of the interventricular septum, thickness of the posterior wall of the left ventricular myocardium, left ventricular myocardial mass, left ventricular myocardial mass index and ejection fraction) (p < 0.05). The left ventricular myocardial geometry normalized during therapy was recorded significantly more often in group 2a than in group 1a (p < 0.05). Conclusion. Two times a day intake of valsartan with thiazidelike diuretic in the morning facilitated more significant improvement of central aortic pressure, echocardiography parameters and as well as an improvement in the geometry of the left ventricular myocardium comparing to just morning intake.

Health Benefits of Yerba Mate Consumption on Cardiovascular Health

Background: Yerba mate is a Paraguayan kind of herbal tea prepared from the dried and roasted leaves of trees called Ilex paraguariensis St. Hill. It is known for high content of polyphenols, methylxanthines and saponins. According to the studies products rich in those nutrients may have a positive influence on the humans cardiovascular health. Materials and methods: We reviewed publications obtained from PubMed and Google Scholar. Articles were selected based on keywords such “yerba mate’’, “Ilex paraguariensis’’, “cardiovascular diseases’’. For the final analysis, qualified articles were published from 2005 to 2024. Results: Confirming positive impact on serum lipid levels individuals using mate tea. Long – term positive influence on blood pressure. Moreover subjects with obesity took advantages of Yerba beverage by decreasing waist-to-hip ratio. Patients with diabetes were observed to have a significant reduction in fasting plasma glucose level and HbA1c concentration. Conclusions: Most of the cited researches support the hypothesis of benefits coming from drinking mate infusions for patients with elevated lipid serum levels, obesity, high blood pressure and type 2 diabetes mellitus. All of mentioned health issues can lead to the cardiovascular problems therefore using mate infusions can prevent CVDs. Taking everything into consideration, medical professionals might recommend Yerba mate tea for their patients especially as a replacement of a coffee.

Cardio-metabolic disorders in a patient with non-alcoholic fatty liver disease and normal body weight

The relationship between the formation of non-alcoholic fatty liver disease (NAFLD) in obese individuals has been proven, which increases the patient’s cardio-metabolic risk. A number of studies have demonstrated that patients with normal body weight (NBW) have comparable risks of developing cardiovascular disease and progression to NAFLD compared to obese patients. Purpose of the study: To assess the incidence of cardio-metabolic disorders in patients with NAFLD and NBW. Materials and methods: 225 patients of both sexes (18–65 years old) with confirmed NAFLD were included. Patients were divided into 3 groups according to body mass index (BMI) values. Results: In patients of group 1, an increased risk of developing coronary heart disease (CHD), arterial hypertension (AH), type 2 diabetes mellitus and progression of liver fibrosis was revealed with an increase in the level of the triglyceride index. Conclusions: The study demonstrated the need for early identification of NAFLD in NBW individuals and assessment of existing cardiometabolic risk factors.

Pattern of Birth Defects, Association And Their Outcomes Among Neonates In A Tertiary Care Hospital In Bangladesh

Introduction: Birth defects are one of the major cause of stillbirths and neonatal mortality in developed and developing countries. The prevalence of birth defects varies in different parts of the world. In many cases, the causes are unknown; however, several factors known to be associated are genetic factors, maternal age, health, dietary factors, maternal infections, geographical factors, drugs, smoking and irradiation. Objectives: To identify the pattern of birth defects, association and their outcomes among neonates Methodology: This observational cross-sectional study was conducted in the department of neonatology, Dhaka Medical College Hospital, Dhaka from 1st July 2019 to 30th June 2021. Sample was collected by purposive sampling technique. Total 407 babies were enrolled. Out of them 207 babies were with birth defects in group-A and 200 babies had no birth defects in group-B. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data. Results: In this study the two study groups were almost similar with respect to their demographic characteristics like sex, residence, place of delivery, mode of delivery, gestational age, parity and maternal age. The total number of admission during this period was 3050 and total number of birth defects was 207 (6.78%0). In this study on evaluation of maternal risk factors, group-A maternal high blood pressure were in 25.12% cases( OR=1.62;p=.002), maternal diabetes were in 15.46% cases( OR=1.12;p=.001), poor maternal nutritional status was 14.50%( p=.001), history of taking folic acid was 9.66%(OR=0.10;p=.001), 5.80% of the patient had history of exposure to antenatal radiation(OR=.06;p=.001), 4.43% had history of consanguinity(OR=.05;p=.001), 2.420% of women noticed that exposure to pesticides(OR=.025;p=.001), H/O of taking anticonvulsant was 2.420%(OR=.025;p=.001). Group-B was maternal high blood pressure in 7.25% cases(OR=.078;p=.001), maternal diabetes were in 6.28% cases(OR=.067;p=.001), poor maternal nutritional status was 5.80%(p=.001), history of taking folic acid was 4.83% (OR=.051;p=.001), 1.45% of the patient had history of exposure to antenatal radiation(OR=.015;p=.001) and 0.97% had history of consanguinity(OR=.01;p=.001). In this study pattern of birth defects summarized as the cardiovascular system defects was the most commonly affected(26.57%), followed by defects in the head, neck ear,- and eye(19.32%), Syndromes(14.50%), gastrointestinal defects(12.56%), musculoskeletal system defects(10.14%), central nervous system defects (8.70%) and genitourinary system(4.83%) of total defects. In group-A 78.26% of the patients recovered and 23 patients expired during hospital stay (p=.001). In group-B 85.99% of the patients recovered and 17 patients expired. Conclusion: Congenital cardiac defects were the most prevalent anomaly detected. Maternal high blood pressure and diabetes are the risk factors of birth defects in neonates. Antenatal diagnosis and proper management can improve the outcome of these neonates. J Dhaka Med Coll. 2023; 32(1) : 43-50

Quality of life аssessment in patients with pulmonary arterial hypertension

Quality of life аssessment in patients with pulmonary arterial hypertension

Stress-induced arterial hypertension: search for predictors

Background. Despite the existence of a clear cause-and-effect relationship between job strain and hypertension, there are still no clear criteria for defining stress-induced arterial hypertension (SIAH). Objective. Search for SIAH criteria, in particular predictors of hypertension in the workplace. Materials and methods. The study included volunteers experiencing stress in the workplace and not having hypertension. Before the start of the working day and at the end of the working day, the subject was surveyed, given questionnaires (Ch. D. Spielberg scale, Montgomery-Asberg MADRS scale, A. M. Vein scale, hospital anxiety and depression scale HADS), blood pressure and resting heart rate were measured, fasting blood was taken to determine the values of ACTH, TSH, T4, insulin, cortisol. All patients underwent ABPM on a working day and a day off. Results. According to ABPM (n=52), no signs of masked hypertension were detected, however, significant differences between workdays and weekends in the levels of maximum SBP and DBP during the daytime were noteworthy. In the group with maximum SBP>140 mm Hg during the daytime (SIAH, n = 34), on a workday there was an increase in the time index for SBP>30% (24 hours and day), characteristic of hypertension, and for DBP (24 hours and day), characteristic of borderline (possible) hypertension, the average DBP values during the day and at night were at the upper limit of the norm, which was significantly different from the Normotonic group (n = 19). On a weekday, the SIAH group also had significantly increased SBP (24 hours, day) and DBP (24 hours, day and night) indexes versus Normotonic. For all other indicators except ABPM, the groups were comparable. Conclusions. Taking into account the increase in the time index for SBP and DBP, it can be assumed that, against the background of stressful situations at the workplace, the subjects had short frequent increases in blood pressure, which have not yet led to a significant violation of self-regulation of blood pressure and the development of hypertension. An increase in the maximum values of systolic and/or diastolic blood pressure against the background of an increased time index on a working day are possible predictors of SIAH, in particular hypertension at the workplace.

Clinical course and prognosis of patients with idiopathic pulmonary arterial hypertension after COVID-19

The coronavirus disease of 2019 (COVID-19) is an infectious disease caused by severe acute respiratory coronavirus (SARS-CoV-2). This virus has many factors in its pathogenesis that affect the function of the right ventricle and pulmonary hemodynamics, which can negatively influence the clinical course of IPAH. According to the results of our study, the fact of getting over COVID-19 in patients with IPAH leads to some changes in laboratory and instrumental parameters. But no significant effect of COVID-19 on risk modification during the year was detected. This result can be explained by a combination of pathophysiological features of the pulmonary hypertension and the protective effect of constantly taken PAH-specific and anticoagulant therapy.

In Case You Haven't Heard…

Keeping your brain sharp as you age has a lot to do with your heart — and the younger you start taking better care of it, the better — according to a new scientific statement published by the American Heart Association (AHA), CNN Health reported Oct. 10. “Dementia is commonly seen as an incurable and relentless disease that cannot be prevented,” said Fernando Testai, M.D., Ph.D., a professor of neurology and rehabilitation at the University of Illinois College of Medicine in Chicago, in a statement. “Evidence shows, however, that adopting a healthy lifestyle and identifying and treating vascular risk factors early may help preserve normal brain function and reduce the burden of Alzheimer's disease and other related dementias,” said Testai, who chaired the statement writing group. Nearly 130 million adults in the United States have some form of heart disease, according to the AHA. The disease also takes a toll on the brain. The narrowing of arteries that occurs with coronary heart disease and high blood pressure can reduce blood flow and cause damage to the small blood vessels in the brain, resulting in cognitive impairment, the AHA said. High blood pressure and Type 2 diabetes can also reduce blood flow to the brain and increase inflammation, leading to cognitive decline and dementia. Having coronary heart disease raises the risk of future dementia by 27% compared with people without heart disease, the AHA statement said.

Cardiovascular risk factors in diabetic patients

Introduction: the term Diabetes Mellitus describes a syndrome in which there is a metabolic disorder characterized by chronic hyperglycemia with alterations in the metabolism of carbohydrates, fats and proteins as a result of defects in the secretion or action of insulin or both. Objective: to determine cardiovascular risk factors in diabetic patients belonging to the Family Medical Clinic # 130 of the Hermanos Cruz Teaching Polyclinic in Pinar del Río, during the period from September 2021 to September 2023. Methods: an observational, descriptive and transversal research was carried out. The universe was constituted by 64 patients. For this purpose, the following fundamental research methods and techniques were used: documentary analysis, observation, interview, measurement and hypothetical-deductive; computer tools were also used for the statistical processing of information, such as SPSS. Results: patients between 70-79 years of age predominated with 28% of the patients. According to the time of evolution of the disease, patients who had suffered from it for more than 10 years prevailed. The most representative cardiovascular risk factors were: arterial hypertension, smoking and sedentary lifestyle. Conclusions: it was determined that arterial hypertension, smoking and sedentary lifestyle are the risk factors with the highest incidence and prevalence in the overall cardiovascular risk in diabetic patients

High Blood Pressure Associated with Depression, Not Anxiety: Results from the Tabriz Older People Survey (TOPS)

Objectives: To investigate the relationship between depression/anxiety and hypertension (HTN) in a large population-based sample in Iran. Design: A cross-sectional study. Setting: Tabriz, the capital of East Azerbaijan province in northwest Iran. Participants: A total of 1362 individuals were chosen from a representative sample of community-dwelling older adults aged 60 and above, residing in Tabriz. Participants were selected using the probability proportional to size sampling method. Outcome measures: A structured survey was used to measure socio-demographic variables, along with the hospital anxiety and depression scale. Blood pressure (BP) was measured using a standard mercury sphygmomanometer. Results: The results of a multiple logistic regression revealed that age (70-79 years old; P=0.01), employment status (housewives; P=0.02), level of education (illiterate; P<0.01), smoking status (having quit smoking; P<0.01), and depression (P=0.02) were related to HTN among these older adults. Conclusions: These findings highlight the critical importance of integrating mental health assessments and interventions in HTN management and prevention strategies, particularly for older populations.

Interaction and combined effect of triglyceride-glucose index and hypertension ontype 2 diabetesindividuals'peripheral arterial disease risk.

The interaction and combined effect of the triglyceride-glucose (TyG) index, an alternative parameter of insulin resistance, along with hypertension (HT), on the risk of peripheral arterial disease (PAD), a specific type of atherosclerotic cardiovascular disease, in individuals with type 2 diabetes (T2D) seems straightforward. However, specific research on this topic remains scarce. In this cross-sectional study, 2027 adult participants with T2D were devided into four groups based on the mean values of TyG index and various blood pressure parameters along with its category. Binary logistic regression, interaction analysis, combined effect size, and goodness-of-fit of the constructed models were performed. The TyG index's individual effect and it's combined effect with HT, or higher systolic blood pressure (SBP) or higher mean arterial pressure in patients with T2D correlated with a higher PAD risk respectively (odds ratio [OR], 0.50, [95% confidence interval {CI} 0.28-0.89]; OR, 0.32, [95% CI 0.12-0.90]; OR, 0.35, [95% CI 0.13-0.94]; OR, 0.35, [95% CI 0.12-0.98], respectively). Only an interaction effect exists between the TyG index and SBP (multiplicative interaction{INTM}: 1.02 [1.002, 1.038]). Combining them can significantly improve the accuracy of predicting PAD (area under the receiver operating characteristic curve {AUC}MAX = 0.7, AUCModel3 + TyG index + SBP-AUCModel3 = 0.027). All P values were < 0.05. This study suggested that TyG index and hypertension, as well as their combined and interaction effect were significantly correlated with the risk of PAD in T2D individuals.

Complications of acute myocardial infarction in women over 50 years of age in a coronary unit

Background: Cardiovascular diseases are the main cause of mortality in women around the world. Erroneously for many years it was considered a disease of men and therefore they were the most studied in terms of risk factors, symptoms, treatments and complications. Ischemic heart disease mainly affects postmenopausal women because by decreasing the estrogen load, cardiovascular risk increases. Therefore, we will study the characteristics of acute myocardial infarction in women over 50 years of age to learn about this highly prevalent disease from another gender. Material and methods: For this study we will carry out an observational, retrospective, cross-sectional and analytical investigation. At the Instituto Cardiovascular de Buenos Aires, collecting information from the medical records of female patients over 50 years of age with acute myocardial infarction in the period May-July 2022.Results: Of 22 patients analyzed in this study, 19 of them successfully survived the cardiovascular event and only 3 had fatal consequences. These patients, who were between the ages of 53 and 94 (with almost 50% of them between the ages of 70 and 80) had comorbidities at the time of the coronary event. 72% had high blood pressure, while only 18% had diabetes. In the interview we found that 77% of them led a sedentary life, 36% were smokers, and 22% had suffered a previous myocardial infarction. When performing the admission electrocardiogram, 36% revealed ST-segment elevation while 63% presented ST-segment depression. The treatment of choice in 36% of the patients was transluminal coronary angioplasty within the first hour of admission, while 63% received the same treatment on a scheduled basis in the following days. Conclusion: Based on what was analyzed in this study, transluminal coronary angioplasty is the treatment with the highest success rate for acute-stage infarction, because it is a minimally invasive procedure and has a low mortality rate. Sometimes when performed together with the placement of a stent, the percentage of recurrence decreases since the artery is kept patent. Its main objective is to restore blood flow to the heart tissue with the intention of preventing a more complex procedure

Associated Factors of Low Birth Weight among Newborns at Hospitals in Kisangani, Democratic Republic of Congo

Background: Low birth weight remains a major public health problem in every country in the world. It is a predictor of early neonatal mortality, morbidity and long-term health. The aim of this study was to determine the prevalence of low birth weight and to identify the associated factors in a hospital setting in Kisangani. Material and Methods: An unmatched case-control study was used including all live and full-term births was conducted from 1 December 2023 to 31 May 2024 in the maternity wards of Makiso-Kisangani General Referral Hospital, Mangobo General Referral Hospital, Tshopo General Referral Hospital and Alwaleed Health Centre. A sample of 646 newborns was selected: 86 cases (newborns weighing less than 2500 grams) and 560 controls (newborns weighing 2500 grams or more). Factors associated with prehypertension were identified using logistic regression. Results: The prevalence of low birth weight was 13.4%. Factors associated with low birth weight were maternal age less than 18 years, intergenital interval less than 2 years, maternal infection during pregnancy, high blood pressure, level of primary education and urban residential environment. Conclusion: This study shows that low birth weight remains a public health problem in Kisangani. In addition to shedding light on the other contributing variables and the connections between them, prospective national research would enable the development of preventative measures.

Monitoring of urinary nickel and chromium in metal industries workers in Alborz, Iran

Heavy metal contamination from occupational sources is a cause for concern due to its potential accumulation in the environment and the body of living organisms, which leads to long-term toxic effects. There is limited evidence on the concentration of heavy metals in the body fluids of welding workers. This study aimed to measure the concentration of nickel (Ni) and chromium (Cr) as two main toxic heavy metals in the urine samples of welders and determine the potential relationship of various environmental factors on their concentration levels. This study was conducted in Iran in 2022–2023. Eighty-five urine samples were collected from the studied welding workers. Inductively coupled plasma optical emission spectrometry (ICP-OES) was used to measure the concentration of Ni and Cr. Data related to socio-demographic characteristics (education level, income, work experience, age, and body mass index (BMI)), lifestyle profile (consumption of seafood and canned food, smoking, physical activity), type of ventilation and preventive devices at work, and suffering from underlying diseases (cardiovascular and high blood pressure) were collected using valid questionnaires. Ni and Cr were present in 100% of urine samples with mean concentrations of (1.09 ± 0.294) and (11.45 ± 16.751) µg/g creatinine, respectively. A significant correlation was observed between the mean concentration of Ni and Cr with the level of education, income, work experience, age, consumption of seafood and canned food, smoking, type of ventilation and preventive devices, and underlying diseases (p-value < 0.05). Also, there was no significant difference between Ni concentration and physical activity and Cr concentration with BMI. Lifestyle determinants and not using preventive devices are important predictors of urinary heavy metals in welding workers. Therefore, more research is required to determine the adverse effects of long-term exposure to these heavy metals.

Bio-Guided Extraction of a Phenolic-Rich Extract from Industrial Peanut Skin with Antioxidant and Hypotensive Potential

Peanut composition includes phenolic compounds, especially in the skins, which are often not consumed. High blood pressure affects more than one billion people worldwide and is considered a high-risk factor for cardiovascular diseases. Several studies have correlated antihypertensive activity with the total phenolic content present in the plants. This study evaluated the hydroethanolic extraction of phenolic compounds from the industrial residue of peanut skin and evaluated the antioxidant and antihypertensive capacity of these extracts using in vitro models. A rotational central composite design (DCCR) was proposed to study the influence of the variables: (1) the ethanol concentration on the hydroalcoholic extractor solution, and (2) the proportion of solid sample (waste) per liquid in the extraction (mass/volume) in a simple solid—a liquid extraction process. The optimal extraction conditions within this model were 50% ethanol in water, and the proportion of sample to extraction solution (m/v) equaled to 0.2. The extract obtained had significant antioxidant capacity, both in chemical (ORAC) and in cellular models, with potential for free radical scavenging. Significant levels of ACE inhibition were also found, indicating antihypertensive activity.

Assessing personalized molecular portraits underlying endothelial-to-mesenchymal transition within pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a progressive and rapidly fatal disease with an intricate etiology. Identifying biomarkers for early PAH lesions based on the exploration of subtle biological processes is significant for timely diagnosis and treatment. In the present study, nine distinct cell populations identified based on gene expression profiles revealed high heterogeneity in cell composition ratio, biological function, distribution preference, and communication patterns in PAH. Notably, compared to other cells, endothelial cells (ECs) showed prominent variation in multiple perspectives. Further analysis demonstrated the endothelial-to-mesenchymal transition (EndMT) in ECs and identified a subgroup exhibiting a contrasting phenotype. Based on these findings, a machine-learning integrated program consisting of nine learners was developed to create a PAH Endothelial-to-mesenchymal transition Signature (PETS). This study identified cell populations underlying EndMT and furnished a potential tool that might be valuable for PAH diagnosis and new precise therapies.

Impenetrable Abdomen: A Case Report of Endoscopic Sleeve Gastroplasty Performed in Patient with Huge Paramedian Laparocele.

Bariatric surgical techniques have demonstrated scientific efficacy and interventional safety; however, these approaches are not universally appropriate for all patients. The term "impenetrable abdomen" refers to the inability to achieve surgical access to the abdominal cavity, a condition that may arise from several underlying factors. Endoscopic sleeve gastroplasty (ESG) is proposed as a safe and effective technique in this subgroup of patients with obesity. A 56-year-old Caucasian woman with an impenetrable abdomen due to the presence of a large left paramedian laparocele underwent ESG (Fig. 1) to our unit. An abdominal computed tomography (CT) scan revealed a substantial laparocele in the left paramedian region, involving the tenuous loops, mesentery, and part of the transverse colon. The patient body mass index (BMI) at presentation was 47.15 kg/m2 (116 kg per 1.57 m). Comorbidities included obstructive sleep apnea syndrome (OSAS), requiring nocturnal continuous positive airway pressure (CPAP) therapy, hepatic steatosis, hypertension, hypertriglyceridemia, and hypovitaminosis D. The case was discussed with our multidisciplinary board team (MDT), who agreed to proceed with the ESG. The endoscopic procedure was performed in the supine position, using the Overstitch device and lasted 58 min. No intraprocedural or post-procedural complications/adverse events have been observed. The patient resumed a liquid diet on the first postoperative day and was discharged from the hospital 24 h after the procedure in good clinical condition. Regular outpatient follow-up visits showed significant reduction of the BMI at 6 months post-procedure with a value of 34.9 kg/m2 compared with the initial value of 47.1 kg/m2. Additionally, the patient's use of nocturnal CPAP for OSAS was successfully discontinued suggesting an improvement in her respiratory condition as a result of weight loss. Moreover, there was a notable reduction in the pharmacological management required for arterial hypertension. These outcomes underscore the positive impact of selecting the most appropriate therapeutic strategy for each patient with obesity through a multidisciplinary team approach. In our experience, we confirm that endoscopic sleeve gastroplasty is both feasible and safe in patients presenting with an impenetrable abdomen. Despite the minimally invasive approach, this technique has proven effective in terms of body weight loss and reduction of obesity related compared with bariatric surgery.

Effect of Short-Term Restraint Stress on the Expression of Genes Associated with the Response to Oxidative Stress in the Hypothalamus of Hypertensive ISIAH and Normotensive WAG Rats

Normotensive and hypertensive organisms respond differently to stress factors; however, the features of the central molecular genetic mechanisms underlying the reaction of the hypertensive organism to stress have not been fully established. In this study, we examined the transcriptome profiles of the hypothalamus of hypertensive ISIAH rats, modeling a stress-sensitive form of arterial hypertension, and normotensive WAG rats at rest and after exposure to a single short-term restraint stress. It was shown that oxidative phosphorylation is the most significantly enriched process among metabolic changes in the hypothalamus of rats of both strains when exposed to a single short-term restraint stress. The analysis revealed DEGs representing both a common response to oxidative stress for both rat strains and a strain-specific response to oxidative stress for hypertensive ISIAH rats. Among the genes of the common response to oxidative stress, the most significant changes in the transcription level were observed in Nos1, Ppargc1a, Abcc1, Srxn1, Cryab, Hspb1, and Fosl1, among which Abcc1 and Nos1 are associated with hypertension, and Fosl1 and Ppargc1a encode transcription factors. The response to oxidative stress specific to hypertensive rats is associated with the activation of the Fos gene. The DEG’s promoter region enrichment analysis allowed us to hypothesize that the response to oxidative stress may be mediated by the participation of the transcription factor CREB1 (Cyclic AMP-responsive element-binding protein 1) and the glucocorticoid receptor (NR3C1) under restraint stress in the hypothalamus of both rat strains. The results of the study revealed common and strain-specific features in the molecular mechanisms associated with oxidative phosphorylation and oxidative stress response in the hypothalamus of hypertensive ISIAH and normotensive WAG rats following a single short-term restraint stress. The obtained results expand the understanding of the most significant molecular targets for further research aimed at developing new therapeutic strategies for the prevention of the consequences of acute emotional stress, taking into account the hypertensive state of the patient.

Self-Guided Blood Pressure Screening in the Community, Opportunities, and Challenges.

Community-based health check kiosks provide opportunities to improve the detection and long-term monitoring of hypertension. We describe the sociodemographic and cardiovascular characteristics of first-time and repeat users of these kiosks. This was an observational study. Deidentified data collected from 430 SiSU Health consumer-facing health check stations in pharmacies across Australia between January 2018 and November 2020 were analyzed. Using a logistic regression, we identified factors associated with repeat checks in the overall cohort and in those with possible hypertension presented as adjusted odds ratios (aOR) and 95% CIs. A total of 982 122 unique checks were conducted; 54% (n=530 139) of the health check users were female, and the average age of all users was 38.2 (SD, 16.0) years. Notably, 13% used the kiosks more than once. Overall, 22% met the definition of possible hypertension, 16% (n=136 345) had blood pressure (BP) ≥140/90 mm Hg, 4% (n=34 349) had BP >160/100 mm Hg, and 13% (121 282) reported taking BP medicines. In the adjusted analysis, first-time users who were aged 50 to 69 years (aOR, 0.91 [95% CI, 0.87-0.96]) or ≥70 years (aOR, 0.68 [95% CI, 0.62-0.74]) were less likely than young users (18-29 years) to return for a second health check. Those in very remote areas were 61% (aOR, 0.39 [95% CI, 0.19-0.72]), and smokers were 13% less likely to return (aOR, 0.87 [95% CI, 0.83-0.91]). People taking BP medications were more likely to return (aOR, 1.16 [95% CI, 1.09-1.22]). Community-based health checks may identify people with high BP and could provide an option for self-monitoring. Broader implementation is needed to increase the reach in rural areas and among the elderly population.