Higher Rates Of Hypertension Research Articles

Self-employment, educational attainment, and hypertension among Black women and men.

Self-employment is generally associated with better health outcomes and educational attainment can shape self-employment. Yet, Black Americans are less likely to be self-employed and analyses of self-employment and health among Black Americans are few. The aim of this study was to determine how educational attainment moderates the associations between self-employment and hypertension among Black adults. Using data from the 2007-2018 National Health and Nutrition Examination Survey, participants who self-identified as non-Hispanic Black (n = 2,855) were categorized as (1) employees with no self-employment income, (2) employees with self-employment income, or (3) having full-time self-employment. Modified Poisson regressions and multiplicative interaction terms were used to determine whether educational attainment moderated the associations between self-employment and measured hypertension (i.e., 140/90 mm Hg or anti-hypertensive medication). Most participants were employees with no self-employment income (81.9%), but 11.8% were employees reporting some self-employment income and 6.3% were self-employed full-time. About two in five (40.9%) had hypertension. Having full-time self-employment was associated with lower risk of hypertension compared to those who were employees (risk ratio = 0.82, 95% confidence interval = 0.67-0.98), and educational attainment moderated the associations among Black men such that part-time self-employment was associated with high rates of hypertension among Black men who had not completed high school. These results suggest that full-time self-employment is associated with lower risk of hypertension among Black adults, but that being an employee with some self-employment income may elevate rates of hypertension among Black men depending on educational attainment. Future studies should assess pathways between self-employment and hypertension by educational attainment among Black women and men.

Lupus low disease activity state as a treatment target for pediatric patients with lupus nephritis.

Lupus low disease activity state (LLDAS) is a treatment target for patients with SLE and is associated with decreased risk for severe flare and new damage. We investigated the utility of the achievement of LLDAS in children with lupus nephritis and whether attainment of LLDAS is associated with more favorable outcomes. Data of children, diagnosed with biopsy-proven lupus nephritis between January 2012 and December 2020, were retrospectively analyzed. For patients who did not achieve LLDAS after initial treatment (first 6months), presence of autoimmune hemolytic anemia (62% vs. 18%, p = 0.047), anti-Sm (85% vs. 18%, p = 0.003) and anti-dsDNA (77% vs. 27%, p = 0.038) antibodies, proliferative lupus nephritis (77% vs. 27%, p = 0.038), and hypertension (69% vs. 9%, p = 0.005) at onset were more frequently encountered. Also, a lower rate of complete kidney response (43% vs. 100%, p = 0.005) and a higher rate of hypertension (86% vs. 13%, p = 0.002) were observed in patients who did not achieve LLDAS-50, defined as being in LLDAS at least 50% of the observation time. Attainment of both LLDAS after initial treatment and LLDAS-50 were associated with lower rates of kidney flare (p = 0.001 and p = 0.002, respectively) and damage accrual (p = 0.007 and p = 0.02, respectively) through the observation period. LLDAS is an attainable treatment target for children with lupus nephritis and associated with lower rates of kidney flare and damage. Presence of hematologic involvement, hypertension, and proliferative lupus nephritis at onset adversely influenced the early achievement of LLDAS. A higher resolution version of the Graphical abstract is available as Supplementary information.

Abstract P211: Use Of Coaching And Technology To Improve Blood Pressure Control In Black Women With Hypertension

Introduction: Hypertension (HTN) is the main cause of cardiovascular disease, especially in women. Black females (58%) are disproportionately affected by higher rates of HTN than White (41%), Hispanic (41%), and Asian (42%) females, contributing to higher death rates from myocardial infarction, heart failure, stroke, and renal failure. Active involvement in self-care is key to preventing and controlling HTN. Aim: To test the effects of Interactive Technology Enhanced Coaching (ITEC) on achieving blood pressure (BP) control, adherence to antihypertensive medication, and adherence to lifestyle modifications (physical activity, healthy diet, and weight management) at 3-, 6-, and 9-months post Chronic Disease Self-Management Program (CDSMP) compared with Interactive Technology (IT) alone. Methods: Black women in this RCT pilot study were prescribed antihypertensive medication and had BPs ≥ 130/80. All participants completed a 6-week CDSMP and afterwards were randomly assigned to the ITEC or IT group. Participants were trained to use equipment and apps that were synced to smartphones to daily monitor (over a 9-month period) BP, weight, physical activity (steps), diet (caloric intake), and medication adherence in real-time, though the Fitbit Plus Platform. Results: A total of 90 women were recruited. Data were analyzed from 77 participants aged 24 to 70 years. A hierarchical, mixed-effects repeated measures design was used to measure changes over time. The main effect of group means indicated no significant difference between the treatment and control groups on all study variables. The main effect of time indicated significant differences between repeated measures for SBP ( p < .0001 and steps ( p = .012). An interaction effect was significant for all measures except DBP and calories. SBP decreased to <130 following CDSMP and remained stable thereafter for both groups. Conclusions: Participant engagement declined as coaching decreased in the treatment group. Enhancing motivation and making self-care a priority in this population warrants further exploration.

High Rates of Multimorbidity Reported Among People of Color Despite Healthy Weight.

Purpose:Weight management is one of the most cited levers for preventing and managing many chronic conditions, particularly those considered to be “lifestyle modifiable.” However, it is unclear how much weight is a driver of illness burden among people of color. This article sought to examine whether people of color are more likely to develop “lifestyle-modifiable” conditions, including diabetes, kidney disease, heart disease, lung disease, and hypertension, both individually and in combination (multimorbidity), in the absence of being obese.Methods:Using data from the 2019 Behavioral Risk Factors Surveillance System survey, we examined the risk of having these conditions among Black, Asian, Native American, Latino/a, and White respondents who reported being “normal weight” (n=86,682), while also controlling for age, gender, smoking history, physical activity, and diet.Results:For each individual condition, White respondents almost always had the lowest risk. On the other hand, Latino/a respondents had the highest rates of diabetes and kidney disease. Native American respondents had the highest rates of heart and lung disease. Black respondents had the highest rates of hypertension. Despite an otherwise healthy weight, Native American, Black, and Latino/a people were 2.5, 2.3, and 1.8 times, respectively, more likely to develop multiple chronic conditions that are typically considered “lifestyle modifiable,” compared to White people.Conclusion:Disease prevention and management guidelines driven by the clinical experience of White people are insufficient for addressing the considerable illness burden that people of color continue to experience.

Abstract P213: Bridging The Gap In Hypertension Outcomes In Rural United States: A 6-month Report From A Pharmacist-run Hypertension Clinic In An Appalachian University Teaching Hospital

Background: Hypertension (HTN) constitutes a significant risk factor for cardiovascular diseases, including stroke and myocardial infarction. According to CDC, HTN rate is 10% higher in rural areas than in most urban areas. Rural Appalachia has even higher HTN rates (>10% above the national rate). Optimization of rural health care is critical in improving overall outcomes of HTN. We, thus, compared a 6-month trend in BP control pre and post-referral of patients to a pharmacist-led BP clinic. Methods: This was a prospective study carried out in the HTN clinic of an Appalachian teaching hospital. The analysis was restricted to hypertensive patients aged ≥18 years. Interventions included medication management and health promotion. Average and upper limits of BP and the number of office visits in both periods were collected. Paired T-test was used for analysis. A p-value <0.05 is considered to be statistically significant. Results: Of the 51 persons analyzed, 38 were eligible for inclusion. The average systolic BP demonstrated a significant decline from 160s to 140s mm Hg (p-value <0.0001; 95% confidence interval -27.83 to -14.75; SEM 3.228). DBP showed a drop from around 85 to 80 mm Hg (p-value 0.0039; 95% CI -9.683 to -2.002; SEM of 1.895). The upper limits of SBP before and after referral also reached statistical significance (p-value 0.0008; CI -24.43 to -6.976; SEM 4.303). The BMI did not reach statistical significance. Patients visited the clinic almost twice as much after referral within the 6-month period that was studied (1.27 vs 2.29). Conclusions: Overall, pharmacist-led BP control may potentially play a huge role in improving the outcomes of HTN in resource-limited, rural areas.

Endovascular thrombectomy is beneficial for functional nonagenarians – a multicenter cohort analysis

IntroductionThe use of endovascular thrombectomy (EVT) has dramatically increased in recent years. However, most existing studies used an upper age limit of 80 and data regarding the safety and efficacy of EVT among nonagenarians is still lacking. Methods767 consecutive patients undergoing EVT for large vessel occlusion (LVO) in three participating centers were recruited into a prospective ongoing database. Demographic, clinical and imaging characteristics were documented. Statistical analysis was done to evaluate EVT outcome among nonagenarians compared to younger patients. ResultsThe current analysis included 41 (5.4%) patients older than 90 years. Compared to younger patients, nonagenarians were more often female (78% versus 50.3%, p ≤ 0.001), had worse baseline mRS scores (2 [0–3] versus 0 [0–2], p < 0.001), higher rates of hypertension and hyperlipidemia and a higher admission NIHSS (20 [14–23] versus 16 [11–20], p < 0.001). No differences were found between groups regarding the involved vessel, stroke etiology, time from symptoms to door or symptoms to EVT, successful recanalization rates and hemorrhagic transformation rates. Nonagenarians had worse mRS at 90 days (5 [3–6] versus 3 [2–5], p = 0.001), similar discharge NIHSS (5 [1–11] versus 4 [1–11], p = 0.78) and higher mortality rates (36.6% versus 15.8%, p < 0.001). All nonagenarians with baseline mRS 4 have died within 90 days. 36.4% of nonagenarian patients with baseline MRS of 3 or less had favorable outcome. DiscussionThis study demonstrates that nonagenarian stroke patients with baseline mRS of 3 or less benefit from EVT with no significant difference in the rate of favorable outcome compared to octogenarians.

The Relationship between Family Functions and the Quality of Life of the Elderly with Hypertension in the working area Public Health Center of Babadan

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hypertension is still a major problem in the elderly at the Babadan Health Center, based on data in 2021 the incidence of hypertension at the Babadan Health Center is 539 cases. Due to the high rate of hypertension in the elderly, it has a negative impact on the quality of life. Elderly who suffer from hypertension need the role of a good family function in order to create a good quality of life as well. The general purpose of this study was to explain the relationship between family functions and the quality of life of elderly patients with hypertension in the working area of Babadan Health Center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Analytical observational research with cross sectional approach and using simple random sampling technique. This research was conducted from October to December 2021 in the working area of the Babadan Health Center, Ponorogo Regency. The number of samples for this study was 67 samples with inclusion criteria and exclusion criteria. Data collection was obtained from the results of filling out the APGAR Family questionnaire and the WHOQOL-BREF questionnaire which had been tested for validity and reliability. The data obtained were analyzed with bivariat analysis used Chi-Square test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The majority of elderly people with hypertension at the Babadan Health Center have healthy family functions and a good quality of life, especially in the domain of social relations. Based on statistical analysis using the Chi-Square test, it was found that there was a significant relationship between family function and the quality of life of the elderly with hypertension (p = 0.000; PR = 8.9; CI = 95% 2.954 to 26.830).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Elderly people with hypertension who come from healthy families are 9 times more likely to have a good quality of life than the elderly who come from unhealthy families. The role of a good family function will affect the quality of life of elderly people with hypertension, especially in terms of social relationships.&lt;/p&gt;

Comparison of pneumonia and nonpneumonia-related Acinetobacter baumannii complex bacteremia: A single-center retrospective study

Acinetobacter baumannii complex (ABC) is a group of increasingly prevalent opportunistic pathogens that cause a variety of life-threatening nosocomial infections, especially in the intensive care unit (ICU). This study assessed the differences between pneumonia- and non-pneumonia-related ABC bacteremia and possible independent risk factors for 30-day mortality. The clinical data of ICU patients diagnosed with ABC bacteremia at a tertiary care hospital from January 2009 to December 2020 were collected, and sorted into groups of ABC bacteremia with and without pneumonia. Significant changes in the incidence of ABC bacteremia and antibiotic resistance were observed over the 12-year study. Compared with nonpneumonia-related ABC bacteremia, pneumonia-related ABC bacteremia was associated with a higher rate of hypertension, less prior tigecycline use, more carbapenem-resistant (CR) strains, and a higher 30-day mortality rate. In multivariate analysis, immunosuppression, higher APACHE II score, and SOFA score were independent risk factors for 30-day mortality. Moreover, the risk of death was 1.919 times higher in the pneumonia-related group. Although pneumonia-related ABC bacteremia had worse outcomes, it was not an independent risk factor for death statistically. Immunosuppression and disease severity levels increased the risks of death in ICU patients with ABC bacteremia.

Use of health care utilization as a metric of intervention success may perpetuate racial disparities: An outcome evaluation of a homeless transitional care program.

This study explored race-based differences in disease burden, health care utilization, and mortality for Black and White persons experiencing homelessness (PEH) who were referred to a transitional care program, and health care utilization and program outcomes for program participants. This was a quantitative program evaluation. Black and White PEH referred to a transitional care program (n=450). We also analyzed data from the subgroup of program participants (N=122). Of the 450 referrals, 122 participants enrolled in the program. We included chronic disease burden, mental illness, substance use, health care utilization, and mortality rates for all PEH referred. For program participants, we added 6-month pre/post health care utilization and program outcomes. All results were dichotomized by race. Black PEH who were referred to the program had higher rates of hypertension, diabetes, renal failure, and HIV and similar post-referral mortality rates compared to White PEH. Black and White PEH exhibited similar program outcomes; however, Black PEH revisited the emergency department (ED) less frequently than White PEH at 30 and 90 days after participating in the program. Health care utilization may be a misleading indicator of medical complexity and morbidity among Black PEH. Interventions that rely on health care utilization as an outcome measure may unintentionally contribute to racial disparities.

Direct Comparison of Outcomes After Transcatheter Aortic Valve Replacement in Veterans and Non-Veterans Using the Transcatheter Valve Therapy Registry.

This study aims to compare veterans and non-veterans undergoing transcatheter aortic valve replacement (TAVR) using data from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) registry. Patients undergoing TAVR at George Washington University (GWU) and veterans treated at Washington DC Veterans Affairs Medical Center (VAMC) who underwent TAVR at GWU from 2014-2020 were included. All patients were reported in the TVT registry. Emergency and valve-in-valve TAVR were excluded. Cohorts were divided based on veteran status. Operators were the same for both groups. Outcomes were compared at 30 days and 1 year. The primary outcome was mortality and secondary outcomes were morbidity metrics. A total of 299 patients (91 veterans, 208 non-veterans) were included. Veterans had higher rates of hypertension (87.9% vs 77.9%; P=.04), diabetes (46.7% vs 28.9%; P<.01), and lung disease (2.4% vs 11.0%; P<.001). Outcomes were not significantly different between veterans and non-veterans, including 30-day mortality (0% vs 2.9%, respectively; P=.18), 1-year mortality (9.8% vs 10.7%, respectively; P=.61), stroke incidence (0% vs 2.5%, respectively; P=.73), median intensive care unit stay (24 hours in both groups), and overall hospital stay (2 days in both groups). The affiliation between a VAMC and an academic medical center allowed for direct comparison between veterans and non-veterans undergoing TAVR by the same operators using the TVT registry. Despite significantly higher rates of comorbidities, veterans had equivalent outcomes compared with non-veterans. This may be in part due to the comprehensive care that veterans receive in the VAMC and this institution's integrated heart center team.

Hypertension in stroke survivors and associations with national premature stroke mortality: data for 2·5 million participants from multinational screening campaigns

Blood pressure control has a pivotal role in reducing the incidence and recurrence of stroke. May Measurement Month (MMM), which was initiated in 2017 by the International Society of Hypertension, is the largest global blood pressure screening campaign. We aim to compare MMM participants with and without a previous history of stroke and to investigate associations between national-level estimates of blood pressure management from MMM and premature stroke mortality. In this annual, global, cross-sectional survey, more than 2·5 million volunteers (≥18 years) from 92 countries were screened in May, 2017, and May, 2018. Three seated blood pressure readings and demographic, lifestyle, and cardiovascular disease data were collected. Associations between risk factors and stroke history were analysed with mixed-effects logistic regression, and associations between national-level estimates of blood pressure management and premature stroke mortality based on Global Burden of Disease data were investigated with linear regression. 2 222 399 (88·4%) of 2 515 365 participants had recorded data on a history of stroke, of whom 62 639 (2·8%) reported a previous stroke. Participants with a history of stroke had higher rates of hypertension (77·0% vs 32·9%, p<0·0001) and of treated (90·2% vs 57·0%, p<0·0001) and controlled (55·9% vs 32·4%, p<0·0001) hypertension than those without a history of stroke. A third of participants with a history of stroke had either untreated hypertension or treated but uncontrolled hypertension (blood pressure ≥140/90 mm Hg). Strong positive associations were found between national premature stroke mortality and mean systolic blood pressure (84·3 [95% CI 38·8 to 129·9] years of life lost [YLL] per 100 000 people per mm Hg increase) and the percentage of participants with raised blood pressure (49·1 [22·6 to 75·6] YLL per 100 000 people per 1% increase). Strong negative associations were found between national premature stroke mortality and the percentage of participants with hypertension on treatment (-21·0 [-33·0 to -8·9] YLL per 100 000 people per 1% increase) and with controlled blood pressure (-31·6 [-43·8 to -19·4] YLL per 100 000 people per 1% increase). Blood pressure control remains suboptimal worldwide among people with a history of stroke. National estimates of blood pressure management reflect national premature stroke mortality sufficiently to prompt policy makers to promote blood pressure screening and management. International Society of Hypertension and Servier Pharmaceuticals.

Racial-ethnic diversity in ambulatory blood pressure monitoring in children with chronic kidney disease

BackgroundBlack adults with chronic kidney disease (CKD) have higher rates of hypertension as compared to White adults with CKD. Little is known of how race and ethnicity associate with the prevalence of hypertension in pediatric CKD patients. The aim was to compare ambulatory blood pressure monitoring (ABPM) results for patients with CKD enrolled in the Chronic Kidney Disease in Children (CKiD) study across racial-ethnic groups.MethodsPatients from the CKiD study who identified as non-Hispanic White, non-Hispanic Black, or Hispanic were included to analyze differences in ABPM results across these racial-ethnic groups. The outcomes were fitted using 3 progressively adjusted models.ResultsThis study included 501 CKiD participants with at least one successful ABPM study. Compared to White participants, Black participants had 4.2 mmHg higher mean sleep systolic blood pressure and 2.7 mmHg higher mean sleep diastolic blood pressure (p = 0.001 and p = 0.004, respectively). Additionally, Black participants had higher odds of abnormal wake systolic load (OR 1.88, 1.21–2.91, p = 0.005), wake diastolic load (OR 1.68, 1.03–2.73, p = 0.04), sleep systolic load (OR 2.19, 1.36–3.5, p = 0.001), sleep diastolic load (OR 2.01, 1.28–3.15, p = 0.002), systolic non-dipping (OR 2.02, 1.31–3.10, p = 0.001), and diastolic non-dipping (OR 2.69, 1.60–4.51, p < 0.001). Compared to White participants, Hispanic participants demonstrated only a lower sleep diastolic load (OR 0.54, 0.31–0.95, p = 0.03).ConclusionsBlack children with CKD have higher absolute nocturnal blood pressures and higher rates of abnormal dipping. Further studies are needed to determine the etiology of these differences and the clinical implications of racial-ethnic differences in ABPM outcomes within the pediatric CKD population.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Chlorthalidone and Advanced Chronic Kidney Disease.

Chlorthalidone and Advanced Chronic Kidney Disease.

Developmental Programming in Animal Models: Critical Evidence of Current Environmental Negative Changes.

The Developmental Origins of Health and Disease (DOHaD) approach answers questions surrounding the early events suffered by the mother during reproductive stages that can either partially or permanently influence the developmental programming of children, predisposing them to be either healthy or exhibit negative health outcomes in adulthood. Globally, vulnerable populations tend to present high obesity rates, including among school-age children and women of reproductive age. In addition, adults suffer from high rates of diabetes, hypertension, cardiovascular, and other metabolic diseases. The increase in metabolic outcomes has been associated with the combination of maternal womb conditions and adult lifestyle–related factors such as malnutrition and obesity, smoking habits, and alcoholism. However, to date, “new environmental changes” have recently been considered negative factors of development, such as maternal sedentary lifestyle, lack of maternal attachment during lactation, overcrowding, smog, overurbanization, industrialization, noise pollution, and psychosocial stress experienced during the current SARS-CoV-2 pandemic. Therefore, it is important to recognize how all these factors impact offspring development during pregnancy and lactation, a period in which the subject cannot protect itself from these mechanisms. This review aims to introduce the importance of studying DOHaD, discuss classical programming studies, and address the importance of studying new emerging programming mechanisms, known as actual lifestyle factors, during pregnancy and lactation.

Health status of young adults with serious mental illness enrolled in integrated care.

People with serious mental illness (SMI) are more likely to develop chronic health conditions and die prematurely. Timely identification of modifiable health risk factors may enable early intervention. We aimed to describe the physical health characteristics and service utilization of young people with SMI. Young people with SMI enrolled in an integrated community mental health clinic (CMHC) and primary care program were assessed for physical and mental health history and past year service utilization. A total of 122 participants, ages 16-35 (m=27.0 ± 5.0 years), half male, 78.3% White were assessed. Half smoked cigarettes, half had obesity, almost half (47.5%, n=56) had hypertension, and about a third had laboratory metabolic abnormalities. The group averaged 10.7 ± 5.1 h of sedentary behavior per day. Obesity was associated with high blood pressure, prediabetes, poor self-rated health abilities, sedentary behavior and low health satisfaction. Over half had been to the emergency department (ED) for a medical reason (55.0%, n=66) and 24.6% had been hospitalized for a health condition in the past year. Over half had a lifetime cardiovascular risk score indicating a 50-67% chance of having a cardiovascular event; simply quitting smoking would reduce the number with this risk by almost half. Most physical health diagnoses were not recorded in the CMHC record. Young people with SMI newly enrolled in integrated care had high rates of smoking, obesity, hypertension, and other cardio-metabolic abnormalities contributing to high risk for future disease. Research is needed to examine appealing, scalable interventions to improve health, reduce unnecessary medical care, and prevent disparate chronic disease in this group.

Determining the incidence of postpartum haemorrhage among Ontario women with and without inherited bleeding disorders: A population-based cohort study.

At a population level, there is a poor understanding of the incidence and pre-disposing risk factors of postpartum haemorrhage (PPH) among women with inherited bleeding disorders (IBD). To determine the incidence of PPH, and identify maternal factors associated with risk of PPH among women with IBD. We conducted a retrospective cohort study using data housed within ICES (formerly known as the Institute for Clinical Evaluative Sciences). The cohort included women with an in-hospital, live or stillborn delivery, between January 2014 and December 2019. The primary outcome was PPH (identified by ICD-10 code O72). PPH incidence and risk factors were compared between women with and without IBD. Temporal trends were assessed using the Cochrane-Armitage test. Between group differences were assessed using standardised differences (std. difference). Total 601,773 women were included; 2002 (.33%) had an IBD diagnosis. PPH incidence was 1.5 times higher (7.3 vs. 4.9 cases/100 deliveries, std. difference .1) among women with IBD compared to women without. Women with IBD were slightly older (31.7 vs. 30.7 years), had higher rates of hypertension, previous PPH, and induction of labour. Women with IBD were more frequently diagnosed with anaemia (4.8% vs. 1.8%; std difference .17) and had lower haemoglobin levels at admission for delivery compared to women without IBD. This study contributes to the literature regarding obstetric bleeding among women with IBD, showing that anaemia at delivery may be an important risk factor for PPH. Given their predisposition to anaemia, clarifying this relationship will optimise management and outcomes.

UNATTENDED AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT VERSUS CLASSIC OFFICE AUTOMATED BLOOD PRESSURE MEASUREMENT IN A HYPERTENSION OUTPATIENT CLINIC

Objective: Accurate measurement of blood pressure is a fundamental pre-requisite requirement for an appropriate management of arterial hypertension. In order to eliminate the well-known limitations of classic office blood pressure measurements, the so-called unattended automatic office blood pressure measurement method can be a solution. Design and method: In 52 patients arriving for regular follow-up into one of the Hypertension Outpatinet Clinic of the Nephrology-Hypertension Center of the University of Szeged 3–3 blood pressure measurements were made at 1–1 minute intervals first by a doctor with an MIT5 automatic device and then in a separate room unattended, starting alone by the patient with a Hem-907 device. We also included the patients’ home blood pressure in the comparison, which was recorded on the basis of the home diaries they kept. Results: Based on our results, the MIT5 device had the highest blood pressure values of the three modalities, both in terms of systolic and diastolic values. The mean systolic blood pressure values measured with MIT5 device were signifincantly higher but not with Hem-907 device compared to home blood pressure values (p = 0.004). Diastolic values measured with MIT5 were significantly higher compared to Hem-907 (p &lt; 0.001) and compared to home measurements (p = 0.001). Forty-nine percent of the patients had blood pressure in the goal range both with MIT5 and Hem-907 device, and 29% with both methods above the goal range. If only one measurement had been taken in each patient during the study, a much higher rate of hypertension would be included in the data. Conclusions: Our results support the use of unattended automated office blood pressure measurements in the everyday practice. Whether Hem-907 or other devices should be used is another matter.

Chronic Thromboembolic Pulmonary Hypertension Presented with Dyspnea on Exertion: A Case Report

&lt;p&gt;慢性血栓栓塞性肺高壓是一種罕見、嚴重且持續惡化的肺部血管性疾病，隨病程進展，致死率極高，儘早鑑別診斷，方能提供準確治療計劃。本文是一位67歲女性案例，因活動呼吸喘就醫， 初步臆斷為心臟衰竭合併急性惡化，入院後藉由病史詢問、檢驗及理學檢查結果顯示BNP持續上升且心電圖呈現S1Q3T3，初步懷疑可能有肺栓塞併心衰竭，故安排心臟超音波檢查，結果發現有肺動脈高壓（肺動脈壓：62.3 mmHg）與右心衰竭，安排胸部電腦斷層攝影，顯示肺動脈栓塞，隨即召開家庭會議解釋病情後，接受右心導管合併肺動脈血管攝影檢查，最終確診為遠端型慢性血栓栓塞性肺高壓併右心衰竭。經由醫療團隊評估後，治療計劃即以藥物為主，故協助申請標靶藥物Riociguat。針對此類病人，即便臨床表徵不具特異性，仍可依病史詢問、檢驗及理學檢查預測肺栓塞的可能性，之後進入影像學鑑別診斷。換言之，雖然慢性血栓栓塞性肺高壓有其高致命的危險性，倘若能及早做出診斷與治療，便能降低死亡風險。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Chronic thromboembolic pulmonary hypertension is a rare, severe and continuous deterioration of pulmonary vascular disease which has high mortality rate along with disease progression. Earlier di&amp;shy;agnosis could contribute to a more accurate treatment plan. A case of 67-year-old female was admitted to hospital because of exertional dyspnea. She was initially suffering from heart failure with acute deterioration. After admission, the results of medical history inquiry, laboratory data and physical ex&amp;shy;amination revealed that BNP level kept raising and the electrocardiogram showed S1Q3T3, which pul&amp;shy;monary embolism with heart failure was suspected. Therefore, echocardiography revealed pulmonary hypertension (pulmonary artery pressure: 62.3 mmHg) and right heart failure. Pulmonary embolism was noticed on chest computed tomography. Soon after the family meeting of medical condition dis&amp;shy;cussion, the patient received right heart catheterization combined with pulmonary artery angiography, and the final diagnosed is distal chronic thromboembolic pulmonary hypertension with right heart failure. After medical team&amp;rsquo;s assessment, the treatment plan was based on armaceutical control. Thus, the target therapy of Riociguat was performed. For such type of patients, even with non-specific symptoms, the possibility of pulmonary embolism can still be predicted based on medical history, lab&amp;shy;oratory data, physical examination, and the imaging differential diagnosis. If diagnosis and treatment can be conducted as early as possible, the high mortality rate of chronic hromboembolic pulmonary hypertension can be reduced.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Paroxysmal and Non-Paroxysmal Atrial Fibrillation in Middle Eastern Patients: Clinical Features and the Use of Medications. Analysis of the Jordan Atrial Fibrillation (JoFib) Study.

(1) Background: Atrial fibrillation (AF) is the most common arrhythmia causing an increased risk of mortality and morbidity. It is classified into paroxysmal and non-paroxysmal AF depending on the duration and frequency of the episodes. (2) Aims: Our goal was to investigate and compare the clinical profiles, risk of co-morbidities, the use of oral anticoagulation, and outcomes of patients with paroxysmal and non-paroxysmal AF in inpatient and outpatient settings. (3) Methods: Data were extracted from 28 different hospitals and centers in Jordan with a total of 2160 patients enrolled in the study using an observational non-interventional study model. The clinical features and the use of oral anticoagulants were compared in patients with paroxysmal and non-paroxysmal AF. (4) Results: Paroxysmal AF was documented in 35.6% (769) of the patients and non-paroxysmal types in 63.9% (1380); in addition, the type of AF was unknown in 11 (0.5%) patients. Our results showed that non-paroxysmal AF patients tend to be older with more co-morbidities and higher CHA2DS2-VASC and HAS-BLED scores. They also have higher rates of hypertension and diabetes. Anticoagulant, antiarrhythmic, and diuretic agents, overall, were used more in non-paroxysmal AF than paroxysmal AF. Hospital admissions were also more frequent in non-paroxysmal AF due to various factors, some of which are heart failure, bleeding risk, and COPD. (5) Conclusions: Non-paroxysmal AF is more common among Jordanian AF patients. The prevalence of comorbidities and the use of different types of therapies, especially anticoagulants, were higher in these patients.

Long‐term Gut Microbiota Depletion Exacerbates Hypertension and Renal Injury in an Experimental Model of Autoimmune Disease

The gut microbiota plays an indispensable role in the development and maintenance of both the innate and adaptive immune systems. Alterations in the gut microbiota, or gut dysbiosis, is associated with many autoimmune disorders, including those without gastrointestinal manifestations, such as rheumatoid arthritis and systemic lupus erythematosus (SLE). SLE is a multisystem autoimmune disorder that primarily affects women and is characterized by high rates of hypertension, renal injury, and cardiovascular disease. Recent studies in several animal models have also posited a possible causative role of the gut dysbiosis in the development of hypertension. In the present study, we hypothesized that the gut dysbiosis in SLE may play a role in the development of immune system dysfunction and hypertension in an experimental model of SLE, the NZBWF1 mouse. To test this hypothesis, we treated 18‐week‐old female control (NZW, n=14) and SLE (NZBWF1, n=14) mice with broad spectrum antibiotics (Abx: 0.4 g/L ampicillin, 0.4 g/L neomycin sulfate, 0.4 g/L metronidazole, and 0.2 g/L vancomycin) in drinking water for 16 weeks. Additional groups of control and SLE mice received normal drinking water (control, n=14; SLE, n=14) over the course of the study. At the conclusion of the treatment, we confirmed successful gut microbiome depletion in the feces of control and SLE mice by qPCR of 16S rRNA. Mean arterial pressure (MAP; mmHg), measured in conscious mice by carotid artery catheter, was higher in SLE mice than in control mice (110±4 mmHg control vs. 131±6 mmHg SLE, p&lt;0.01). Unexpectedly, treatment with antibiotics further increased blood pressure in SLE mice (SLE‐Abx: 151±4 mmHg, p&lt;0.01 vs. SLE), but had no impact on blood pressure in control animals (110±4 mmHg control vs. 106±4 mmHg control‐Abx, p=0.91). Urinary albumin excretion, a marker of renal injury, was assessed by ELISA at the conclusion of the study. Albumin excretion was increased in SLE mice (0.22±0.08 mg/day control vs. 25.1±15.7 mg/day SLE, p=0.08), and urinary albumin remained elevated in SLE mice administered antibiotics (43.6±17.3 mg/day, p=0.68 vs. SLE‐Abx). Additionally, renal immune cell infiltration was assessed using flow cytometry. SLE mice had significantly higher levels of renal CD4+ T cells as compared to control mice (0.46±0.04% control vs. 0.84±0.1% SLE, p&lt;0.05), but treatment with antibiotics elevated renal CD4+ T cells further (2.9±0.5%, p&lt;0.001 vs. SLE). An additional pilot study (n=7‐9 mice/group) of short‐term antibiotic treatment from 26‐32 weeks of age had no impact on blood pressure in SLE mice (120±4 mmHg SLE vs. 122±3 mmHg SLE‐Abx, p=0.97). These data suggest that a long‐term loss of the microbiome in SLE actually further exacerbate disease progression and the development of hypertension.