Higher Risk Of Hypertension Research Articles

Hypertension Induced by Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors in Treating Anemia in Patients With Chronic Kidney Disease: A Mini-Review.

Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors are a new class of agents for the treatment of anemia in chronic kidney disease (CKD). Unlike traditional treatments such as erythropoiesis-stimulating agents (ESAs), HIF-PH inhibitors are orally administered drugs and may increase endogenous erythropoietin and improve iron homeostasis. However, a significant concern is their possible side effect on blood pressure. The current mini-review summarizes the data of 26 randomized controlled (placebo or ESAs) trials on six different HIF-PH inhibitors with regard to their potential influence on blood pressure and hypertension in the management of anemia in CKD. Overall, the use of HIF-PH inhibitors was associated with a higher risk of hypertension than placebo (pooled risk ratio 1.36, 95% confidence interval [CI] 1.16-1.59), but a lower risk of hypertension than ESA treatment (pooled risk ratio 0.92, 95% CI 0.86-0.98), especially in CKD patients not undergoing dialysis (pooled risk ratio 0.85, 95% CI 0.73-0.98). This review highlights the importance of blood pressure monitoring during the treatment of HIF-PH inhibitors, especially out-of-office blood pressure measurement.

Association between slow wave sleep and blood pressure in insomnia.

The majority of patients with insomnia exhibit abnormal sleep in objective testing (e.g., decreased sleep duration, decreased slow wave sleep (SWS). Previous studies have suggested that some of these objective measures of poor sleep, such as decreased sleep duration, are associated with a higher risk of hypertension in insomnia. We examined the relationship between SWS and morning and evening blood pressure (BP) levels in patients with clinically diagnosed insomnia. A total of 229 normal sleepers and 1378 insomnia patients were included in this study. Insomnia was defined based on standard diagnostic criteria with symptoms lasting ≥6 months. All subjects underwent in-laboratory polysomnography. Patients were classified into quartiles of percent SWS. Evening and morning hypertension were defined using BP measurements taken in the evening before and in the morning after polysomnography, respectively. Multivariable logistic regression models were used to assess the relationship between insomnia, SWS and hypertension. Insomniacs with <3.5% SWS (OR 3.27, 95% CI 1.31-7.66) and those with 3.5-10.2% SWS (OR 2.38, 95% CI 1.28-5.91) had significantly greater odds of morning hypertension compared to normal sleepers. No associations were seen in insomnia with 10.2-15.8% SWS and with >15.8% SWS. Significant effect modifications by sex (p=0.043) were found, as decreased SWS was associated with morning hypertension only in men. Odds of evening hypertension were not significantly associated with SWS. Decreased SWS is associated with morning hypertension in a dose-dependent manner in insomnia, especially in men.

Systemic inflammation and risk of death in patients with atherosclerotic cardiovascular disease and chronic kidney disease

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease stage 3 - 4 (CKD) affects 7% and 10% of the Danish population, respectively. Systemic inflammation (SI) contributes to destabilisation of atherosclerotic plaques and is characterized by elevated levels of C-reactive protein (CRP) in the blood. CKD is associated with SI and is independently associated with an increased risk of ASCVD. CRP levels ≥2 mg/L have been identified as a risk factor for mortality and major adverse cardiovascular events (MACE). Purpose To provide real-world evidence on the clinical burden of SI in patients diagnosed with ASCVD and CKD, using national health registers. Method Data from the Danish National Patient Registry from 1994-2022 was used to identify ASCVD patients by ICD-10 codes. CKD was identified by eGFR test results in the range [15 -59mL/min/1.73m2], in the Register of Laboratory Results for Research (RLRR). The latter diagnosis of ASCVD and CKD was set as index date. CRP-test results were extracted from RLRR and only individuals with at least two CRP tests were included. If two CRP-test results ≥2mg/L to &amp;lt; 20mg/L were observed less than six month apart, and within two years of index date, the individual was classified to have SI. The eGFR data from RLRR was available from 2011 onwards, with some regional differences in reporting. Individuals observed with CKD or ASCVD in the first year of eGFR availability were excluded to ensure a study of incident individuals. Individuals using select medications or diagnosed with selected chronic conditions thought to influence CRP levels were excluded. Additional population characteristics were extracted from corresponding national health and administrative registers. Hazard of all-cause mortality and MACE was analysed in a Cox proportional risk regression. Results From 2012 to 2022, a total of 19,162 individuals were eligible for the study population (SI: 13,039, No SI: 6,123). Median follow-up time was 4.1 and 8.2 years for individuals with or without SI, respectively. Median CRP two years before and after index date in the two groups was 7mg/L and 1mg/L. No clinically significant differences were found for demographic or socioeconomic characteristics. Patients with SI had more frequent history of hypertension, atrial fibrillation, COPD, heart failure and Type 2 diabetes before index, and higher risk of hypertension, atrial fibrillation, stroke, heart failure and type 2 diabetes after index. SI population had significantly increased hazard of mortality in a crude model (HR: 2.35, 95% CI: [2.22 – 2.50]), and in adjusted analysis HR: 2.06 ([1.92 - 2.21]). The corresponding hazard ratios for MACE were 1.9 ([1.81 – 2.01]) and 1.66 ([1.57 – 1.77]). The results were consistent across different model specifications and subgroups. Conclusion SI is associated with a significantly higher clinical burden of disease and a higher risk of all-cause mortality.Flowchart of inclusion/exclusionHazard ratio, overall and by subgroup

Predicting Portal Pressure Gradient in Patients with Decompensated Cirrhosis: A Non-invasive Deep Learning Model.

A high portal pressure gradient (PPG) is associated with an increased risk of failure to control esophagogastric variceal hemorrhage and refractory ascites in patients with decompensated cirrhosis. However, direct measurement of PPG is invasive, limiting its routine use in clinical practice. Consequently, there is an urgent need for non-invasive techniques to assess PPG. To develop and validate a deep learning model that predicts PPG values for patients with decompensated cirrhosis and identifies those with high-risk portal hypertension (HRPH), who may benefit from early transjugular intrahepatic portosystemic shunt (TIPS) intervention. Data of 520 decompensated cirrhosis patients who underwent TIPS between June 2014 and December 2022 were retrospectively analyzed. Laboratory and imaging parameters were used to develop an artificial neural network model for predicting PPG, with feature selection via recursive feature elimination for comparison experiments. The best performing model was tested by external validation. After excluding 92 patients, 428 were included in the final analysis. A series of comparison experiments demonstrated that a three-parameter (3P) model, which includes the international normalized ratio, portal vein diameter, and white blood cell count, achieved the highest accuracy of 87.5%. In two distinct external datasets, the model attained accuracy rates of 85.40% and 90.80%, respectively. It also showed notable ability to distinguish HRPH with an AUROC of 0.842 in external validation. The developed 3P model could predict PPG values for decompensated cirrhosis patients and could effectively distinguish HRPH.

Left atrial enlargement: a crucial indicator for identifying atrial fibrillation in patients with hypertension

Abstract Background Left atrial enlargement resulting from hypertension is closely linked to the development and persistence of atrial fibrillation (AF). The newly proposed staging recognizes AF as disease continuum, which makes us aware that AF prevention should focus on the Pre-AF stage, and atrial enlargement is one of the important manifestations in this stage. Previous scoring systems, such as CHA2DS2-VASc and C2HEST, along with the recently highlighted left atrial diameter (LAD), have been significant tools for predicting AF occurrence. However, a comprehensive assessment of their utility is currently lacking. Purpose This study aims to explore the role of left atrial size in identifying atrial fibrillation (AF) among hospitalized hypertensives, and to compare its recognition effectiveness with previous scoring systems. Methods We conducted a cross-sectional analysis within hospitalized hypertensives. The discovery, internal and external validation datasets were established. The XGBoost was employed to identify key variables related to AF occurrence, which were ranked based on their importance scores. To gauge the predictive prowess of LAD regarding AF occurrence, we plotted the receiver operating characteristic curve (ROC) and calculated the area under the curve (AUC). This enabled us to pinpoint the LAD cutoff value corresponding to the maximum Youden index, indicative of susceptibility to AF. Subsequently, Youden index determined the optimal cutoff value from the ROC curve. Delong’s test compared the identification abilities of different tools within the same dataset. Logistic regression analysis assessed the correlation between clinical variables and left atrial size. Results The XGBoost revealed 17 variables affecting AF occurrence in hypertensives, with LAD, age, and HF ranking among the top 3 (Figure 2a). LAD had a more pronounced impact on AF occurrence than other variables. LAD-based identification of AF in hypertensives had AUC of 0.827 (95%CI: 0.816-0.837), with an optimal cutoff of 38mm. Subgrouping the study population by LAD≥38mm, ROC curves showed AUCs of 0.757 (95%CI: 0.745-0.768) for the discovery set, 0.750 (95%CI: 0.731-0.768) for internal validation, and 0.759 (95%CI: 0.743-0.776) for external validation. LAD≥38mm had a more higher and stable AUC value for judging the AF occurrence than CHA2DS2-VASc and C2HEST scores (Figure 2b). Hypertensives with LAD≥38mm had a 9.72-fold higher AF risk than those with LAD&amp;lt;38mm. Conclusion LAD is a pivot determinant for AF occurrence. LAD≥38mm is a valuable identifier for high-risk hypertensives prone to AF.Figure 1.Center illustrationFigure 2.XGboost and Delong’s test of ROC

A Bioequivalence Study of Azilsartan in Healthy Chinese Subjects.

Azilsartan is an angiotensin II receptor blocker used for treating adult hypertension. It significantly improves cardiovascular outcomes in patients with high-risk hypertension, heart failure, and diabetic nephropathy. A single-center, randomized, open-label, single-dose, dual-cycle, dual-crossover clinical trial was conducted to evaluate the bioequivalence of azilsartan under fasting and postprandial conditions in 60 Chinese healthy volunteers. Thirty healthy subjects were enrolled in each test group, with random cross-administration for fasting and postprandial tests. The concentration of azilsartan in human plasma was evaluated using liquid chromatography-tandem mass spectrometry after a single oral administration of test and reference preparations, each at a dose of 20mg (1 tablet). Pharmacokinetic parameters were determined using WinNonlin8.2 software, and bioequivalence was evaluated using SAS 9.4 software. The geometric mean ratios and 90% confidence intervals for maximum concentration, area under the plasma concentration-time curve from time 0 to the time of last measurable concentration, and area under the plasma concentration-time curve from time 0 to infinity of the test and reference preparations in the fasting and postprandial test groups were in the range of 80%-125%. The incidence of adverse events in the fasting and postprandial test groups was 30% (9/30) and 33.3% (10/30), respectively. No serious adverse events or unexpected adverse drug reactions were observed. In conclusion, the test and reference preparations of azilsartan tablets demonstrate bioequivalence and good safety in healthy Chinese subjects under fasting and postprandial conditions.

Predictors of Pre-Hypertension and Hypertension in Rural Adults: Insights Into the Impact of Yoga, Lifestyle, and Demographic Factors

Background: Hypertension is a leading risk factor for cardiovascular diseases, particularly in rural areas where healthcare access is limited. This study investigates predictors of pre-hypertension and hypertension, with a focus on yoga and lifestyle factors such as physical activity, smoking, and alcohol consumption. Methods: A cross-sectional study was conducted among rural adults to collect data on demographic factors (age, gender, education level), lifestyle habits (smoking, alcohol, physical activity), and yoga participation. Blood pressure was measured and classified into normal, pre-hypertension, and hypertension categories. Logistic regression was used to identify significant predictors of hypertension and pre-hypertension. Results: Key predictors of hypertension include age (OR = 0.998), gender (OR = 0.648 for males), and BMI (OR = 1.012). Alcohol consumption was significantly associated with higher hypertension risk (OR = 1.293). Yoga participation, particularly improvements in flexibility, showed a modest reduction in hypertension odds (OR = 0.945). Non-yoga physical activity also demonstrated a protective effect (OR = 0.958). Conclusion: Lifestyle factors such as alcohol consumption and physical activity play important roles in hypertension risk. While yoga showed some benefits, particularly in flexibility improvements, further research is needed to explore its longterm effects. Public health interventions targeting modifiable risk factors, including yoga, may help reduce the prevalence of hypertension in rural communities.

Effect of a multidisciplinary program with seven color balls on non-communicable diseases prevention in a Muslim community: A real-world study

Prevalence of diabetes and hypertension are increasing. Health promotion is needed for the diseases prevention. The objective of this study was to determine the impact of a multidisciplinary program and a seven-color balls on fasting blood glucose and blood pressure in a Muslim community. A one-group pre-post test of participatory action research was employed. The screening test was administered and assigned a color to each of seven health statuses. All participants made a commitment to improve their weekly performance. They were instructed and practiced for three weeks on six health information topics. Then, each village health volunteer reminded the participants of health information, and a religious leader declared (Kutbah) during Friday prayer that tobacco and alcohol are contrary to Islam. Utilizing frequency and percentage, the study outcome at the end of the program was compared to that at baseline. The results revealed that the mean age of the participants was 33.92 years, with a range of 15 to 82 years. Six months after program finish, 87.5% of those at risk and 93.3% of high risk for hypertension returned to normal blood pressure levels. For FBS level, risk for diabetes participants improved to a normal level by 57.6%, participants who were possibly for diabetes improved to better level by 50%, and third level illness decreased to a lower level by 50%. The program could improve participants’ health status and encourage their self-esteem for health prevention. Prevention of hypertension, and diabetes is essential for promoting individual and community health.

The Effectiveness of a Self-Management and Multifactorial Program for Blood Pressure Control Among Older Home-Based Workers in Urban Bangkok, Thailand

Older adults aged between 50-65 years old have a high risk of hypertension. With the growing numbers of home-based workers among adults and older adults in Thailand, this study aimed to evaluate the effectiveness of self-management with a multifactorial program to control blood pressure among older adults. A randomized controlled trial was conducted. Participants who worked as home-based workers aged between 50-65 years old were recruited from a community in the western area of Bangkok. Approximately 70 participants were randomly and equally assigned to the intervention and control groups (35 participants in each group). Participants in the intervention group received the program that consisted of education regarding food selection, work time management and arm swinging; a practical protocol, an exercise program, a heart rate monitor, a recorded book for facilitating participants’ progress to ensure their safety and efficiency in a health professional manner for a week/month. While those in the control group received usual care. A Knowledge Attitude Practice questionnaire was utilized to assess their knowledge, attitude, and practice, which demonstrated a content validity index and Cronbach alpha of 0.80, respectively. The Citizen CH-403C was utilized to measure blood pressure and heart rate. Two-way Repeated Measures ANOVA was employed to analyze the differences in outcome scores at baseline, 3-month after program, and 6-month follow up. The results showed a significant increase in participant’s knowledge, attitudes, and behaviors toward hypertension and a decrease in blood pressure to nearly normal after 3months following the completion of the program and 6-month follow-up. Therefore, the self-management and multifactorial program could be an effective preventive intervention for older adults with pre-hypertension conditions to offer them valuable knowledge on work-life balance as well as to help prevent hypertension, and related stroke complications.

Assessing the Hypertension Risk: A Deep Dive into Cereal Consumption and Cooking Methods-Insights from China.

Cereal grains are rich in carbohydrates and could trigger a hyperglycemic response which is closely linked to blood pressure status. We aim to examine the associations between the consumption of cereals with different cooking methods and hypertension risk. We conducted a prospective analysis utilizing the nationwide data of 11,080 adult participants who were free of hypertension at baseline. Cereal intake was assessed using 3-day 24 h dietary recalls with a weighing technique. Hypertension incidence was identified in adherence with the Seventh Joint National Commission guidelines during the follow-up. Cox proportional hazards regression models were used to extrapolate hazard ratios associated with hypertension risk. Over an average follow-up span of 7 years (77,560 person-years), we identified 3643 new hypertension cases. The intake of total, fried, and baked cereals was associated with 15%, 20%, and 20% higher risk of hypertension, respectively. Whole grain consumers had an 8% lower risk of hypertension compared with non-consumers, while total refined grain consumers showed no significant association. Replacing one daily serving of fried or baked cereals with an equivalent serving of boiled cereals was related to a 28% or 14% lower risk, respectively. Total, fried, and baked cereal consumption was positively associated with hypertension risk, while consuming whole grains was related to a lower risk. Modifying cooking methods from frying or baking to boiling for cereals may be beneficial to lower risk. The current study underscores the significance of considering both the degree of processing and cooking methods applied to cereals in addressing hypertension prevention and management.

P192 PREVALENCE OF HYPERTENSION AND ITS ASSOCIATED FACTORS AMONG PUBLIC VEHICLE DRIVERS IN POKHARA, NEPAL

Introduction: Hypertension, defined as &gt;=140/90 mm Hg or currently taking antihypertensive medicine, is a major public health concern globally, affecting individuals of all ages, backgrounds, and lifestyles. Occupational risk factors associated with hypertension are poorly studied in the context of Nepal, drivers could be at a higher risk of hypertension because of multiple shift work, stress, inactivity, and poor diet. Methodology This cross-sectional study recruited 358 public vehicle drivers from Pokhara Metropolitan City of Nepal. The WHO STEPS questionnaire was used to assess the prevalence of hypertension. Data were entered into REDCap software and analyzed by using SPSS. The chi-square test and binary logistic regression were applied to identify hypertension-related factors. Results: The mean age of the participants was 37.3 ±8.5 years, and all of them were male. The prevalence of hypertension was found to be 41.9%. Using the chi-square test, hypertension was found to be associated with age, lower education, being married, tobacco consumption, age of smoking initiation, alcohol consumption, binge alcohol intake, lower physical activity, obesity, duration of driving, and service. However, when using binary logistic regression, the association was found only with age (OR=0.353; 95% CI: 0.183 to 0.680) and obesity (OR=0.429; 95% CI: 0.234 to 0.783). Conclusion: This study concludes that nearly two-fifths of drivers had hypertension, which is higher than the prevalence in the general population. The research highlights the need to focus on risk factors associated with hypertension among public vehicle drivers in Pokhara, Nepal.

Efficacy and safety of androgen receptor inhibitors for treatment of advanced prostate cancer: A systematic review and network meta-analysis.

Androgen receptor inhibitors (ARIs) have become an effective treatment for advanced prostate cancer (PC). However, it is unknown which ARI is the most helpful and safe for men with advanced PC. Our aim is to help physicians make clinical decisions and provide medication guidelines for patients with advanced PC to avoid potential risks when using ARIs for treatment. We systematically searched the following databases: PubMed, Embase and Cochrane Library, with a literature publication deadline of February 2023. The primary efficacy outcomes were 18-month overall survival (OS), treatment-emergent adverse events (TEAEs), hypertension and fatigue. The network meta-analysis (NMA) was performed by Stata 15.1, and Revman 5.3 was used to assess the included studies' risk of bias. The analysis included 26 trials with 26 263 people. The surface under the cumulative ranking curve (SUCRA) concluded that enzalutamide (86.8%) showed the best effect in prolonging the OS of patients. Flutamide led to the highest risk of TEAEs (29.9%) and AEs leading to discontinuation (12.8%). Apalutamide (13.4%) led to the highest risk of grade ≥3 TEAEs. Enzalutamide had the highest risk of hypertension (0.2%), grade ≥3 hypertension (4.5%) and fatigue (5.2%). This NMA indicates there is no one ARI to reach both the most effective and safe therapy aims for treating advanced PC and that there is a compromise between the efficacy and safety of ARIs in the treatment of advanced PC. Physicians should weigh the risks to safety against the anticipated benefits when prescribing these drugs to patients with PC.

P118 EFFECT OF A FIXED COMBINATION THERAPY WITH PERINDOPRIL/AMLODIPINE AND ROSUVASTATIN TO PATIENTS WITH HIGH AND VERY HIGH RISK HYPERTENSION AND DYSLIPEDEMIA

Purpose: Assess achievement target level blood pressure, LDL cholesterol, non-HDL cholesterol, Triglyceride, patients with high, very high risk AH during 6-month therapy with fixed combination perindopril/amlodipine addition rosuvastatin. Material, methods: Study included 43 patients hypertension I-II degrees (ESC/ESH, 2018), All patients assessed for cardiovascular risk using the SCORE2scale, high risk identified n=34 (80%) patients, very high n=9 (20%) patients. Average age patients 58.23±9.82 years, the average duration hypertension 13.07±8.53 years. SBP 159.46±10.52 mmHg, DBP 91.69±8.60 mmHg. All patients underwent: determination level blood lipids, glucose, ALT, AST, CPK, creatinine, uric acid in the blood and microalbuminuria. All patients with AHT and hypolipidemic purposes prescribed fixed combination drug perindopril/amlodipine and rosuvastatin. Drug dose titrated every 2 weeks until target values of BP and LDL cholesterol (&lt;100-70 mg/dl), non-HDL cholesterol (&lt;100-85 mg/dl), TG (&lt;150 mg/dl) achieved. Average drug doses were perindopril at dose 4 to 8 mg/day, amlodipine dose 5 to 10 mg/day, initial dose orosuvastatin10 mg/day. All types analysis, p values &lt;0.05 were considered statistically significant (Wilcoxontest). Results: In general, 6-month combination therapy with perindopril/amlodipine, rosuvastatin showed high lipotensive effectiveness. There was significant decrease in scores SCORE2scale, LDL cholesterol, non-HDL cholesterol, TG, SBP, DBP, blood pressure. The degree of scores SCORE2scale: initially 20.92±8.05 dynamics 14.92±9.66 points (p&lt;0.001); LDL cholesterol 146.53±35.90,dynamics 114.86±36.43 mg/dl (p&lt;0.003); Non-HDL cholesterol 185.61±35.90 mg/dl, dynamics 143.25±37.01 mg/dl (p&lt;0.079); TG 181.23±108.47 dynamics 143.90±64.47 mg/dl (p&lt;0.006); SBP 159.84±9 mmHg, dynamics 131.65±5.93 mmHg (p&lt;0.000); DBP 91.69±8.60 mmHg, dynamics 82.55±4.17 mmHg(p&lt;0.000); BPmean 115.48±7.22 mmHg, dynamics 99.96±3.75 mmHg. (p&lt;0.000). In addition SBP decreased by -16.86±4.70%, DBP by -8.16±6.99%. The target level LDL cholesterol reached by39% patients, non-HDL cholesterol by 18%, Triglycerides by 55%, the target level SBP reached 88%, DBP 81% patients, SBP and DBP simultaneously 81% patients. Conclusion: Analysis effectiveness of combination therapy with drug perindopril/amlodipine, rosuvastatin showed significant decrease in level of indicators SCORE2 scores, LDL cholesterol, non-HDL cholesterol, TG, SBP, DBP, blood pressure. In patients with high, very high risk hypertension.

P220 APOL 1 RISK GENOTYPE IS ASSOCIATED WITH ALBUMINURIA IN SUB-SAHARAN AFRICAN WITHOUT HYPERTENSION: A CASE STUDY OF TRYPANOSOMA BRUCEI GAMBIENSE ENDEMIC AREA

Background and Objective. An association between APOL1 risk genotypes and hypertension has been reported in African Americans with chronic kidney diseases (CKD). However, such data from African populations living in a Human African Trypanosomiasis (HAT) area remain limited. This study assessed the association between APOL1 high-risk genotypes (HRG) and hypertension among sub-Saharan African in T.b. gambiense endemic area. Methods. This cross-sectional study enrolled 94 HAT-infected and 144 non–infected participants in Masimanimba, the Democratic Republic of the Congo, from April 2019 to April 2021. APOL1 HRG was defined as the presence of two risk variants (G1/G1, G2/G2, or G1/G2), and a low-risk genotype (LRG) with the presence of 0 or 1 single variant. The elevated albuminuria was defined as urinary albumin/creatinine ratio ≥ 30 mg/g. Student's and Pearson's Chi2 tests or Fisher's exact test were used to compare means and proportions. Statistical significance was set at p &lt; 0.05, based on 2-tailed test. Results. APOL1 sequence analysis revealed that 3 of 21 (14.3%) hypertensive participants carried HRG (G1G1) and 7 of 103 (6.8%) non-hypertensive carried HRG (G1G1, G2G2, and G1G2) (p=0.371). Ten of 21 (47.6%) hypertensive individuals with elevated albuminuria had a higher incidence of CKD (100% vs. 0%; p &lt; 0.001) and HRG (30% vs. 0%; p = 0.09) than 11 (52.3%) without albuminuria who carried LRG. Of 103 non-hypertensive subjects, 43 (41.7%) with elevated albuminuria had a higher frequency of HRG (16.3% vs. 0%; p = 0.002) and CKD (100% vs. 1.7%; p&lt;0.001) compared with 60 of 103 (58.3%) without albuminuria who carried LRG. Conclusion. APOL1 HRG was associated with albuminuria and CKD, regardless of the hypertension status in T.b. gambiense HAT endemic area.

Socioeconomic Gender Variables Impact the Association between Hypertension and Chronic Health Issues: Cross-Sectional Study.

Our aim is to investigate if sex and gender influence the association of hypertension and their comorbidities. We investigated how gender differences in five socioeconomic factors impact the relation between hypertension and ten comorbidities including diabetes mellitus, renal disease, and chronic pulmonary disease in European countries grouped by their gender inequality index using representative survey data from the European Health Interview Survey. Using logistic regressions, we compute the ratio of odds ratios in females versus males. Therefore, an ORR > 1 is associated with a higher odds ratio for females than for males while an ORR < 1 means the opposite. To account for multiple hypothesis testing, we applied the Bonferroni correction. Hypertension in both sexes was associated with lower educational level, being unemployed, and lower income. In males, being divorced/widowed (OR1.12, p < 0.001) had an association to hypertension, whereas in females, being common-law/married (OR1.30, p < 0.001) and being divorced/widowed (OR1.17, p < 0.001) was associated with a higher risk for hypertension. Moreover, in hypertension, females who worked had an association with myocardial infarction (OR1.39, p < 0.001) and having post-secondary education had an association with arthrosis (OR 1.35, p < 0.001) compared to males. Our findings show that gender variables influence the association of hypertension and comorbidities, especially in females. These results can be used to inform targeted prevention measures taking gender-specific contextual factors into account.

The association of birth weight and current BMI on the risk of hypertension: the Tohoku medical megabank community-based cohort study

This study aimed to investigate the association of combination of birth weight and current body mass index (BMI) with the risk of hypertension in adulthood. This cross-sectional study used data from the Tohoku Medical Megabank Community-based Cohort Study conducted in Japan. A total of 10,688 subjects aged ≥20 years were eligible. We calculated the least square (LS) means of systolic blood pressure (SBP) and trend tests were performed to evaluate the linear relationships between birth weight categories and SBP. We also used a multivariate logistic regression analysis to assess the risk of hypertension associated with the combination of birth weight and current BMI. There was a statistically inverse association between birth weight and SBP in the 20–64 age group, but no significant association in the ≥65 age group. Low birth weight (LBW) with normal BMI group had a higher risk of hypertension than the normal or high birth weight groups with normal BMI. Furthermore, the group with LBW and BMI ≥25.0 kg/m2 was the highest risk for hypertension (adjusted odds ratio: 2.73; 95% CI, 2.04–3.65) compared to the reference group (birth weight 2500–3499 g and BMI 18.5–24.9 kg/m2). There was a significant association between LBW and subsequent risk of hypertension. In addition, participants with lower birth weights had a higher risk of hypertension than those with higher birth weights. However, even in participants with a lower birth weight, the risk of hypertension could be reduced when they maintained an optimal BMI.

Cardiovascular risks of Asian patients on androgen-receptor-targeted agents for prostate cancer: a systematic review and meta-analysis

BackgroundProstate cancer is now one of the most prevalent cancers in men in Asia. As the average life expectancy of Asian males with prostate cancer increases with the availability of treatment options, the possible risk of cardiac-related adverse effects arising from androgen-receptor-targeted agents (ARTAs) may be increased due to the greater exposure. We aim to perform a meta-analysis on the incidence of cardiac-related adverse events in Asian patients with prostate cancer treated with ARTAs. Materials and methodsDatabases were thoroughly searched for relevant articles. The Patient Intervention Comparison Outcome Study type model was used to frame our clinical question, and 2 independent authors went through several rounds of screening to select the final included studies. A meta-analysis was conducted using the Cochran–Mantel–Haenszel method. Quality assessment was carried out with the Cochrane risk-of-bias tool RoB 2. ResultsSeven randomized controlled trials were included for the final meta-analysis. Use of ARTA in Asian men did not show any significant increase in the total number of cardiac-related adverse events (risk ratio [RR]: 1.66 [0.84–3.26], p = 0.14). However, there was increase in incidence of hypertension (RR: 2.30 [1.41–3.73], p = 0.0008) and hypertension crises (RR: 16.87 [2.13–133.34], p = 0.007). A subgroup analysis of the type of ARTA used showed enzalutamide having the highest risk of hypertension (RR: 5.86 [2.10–16.38], p = 0.0008). Conclusion:Although ARTAs did not show any significant increase in incidence of cardiac-related adverse events, there is an increased risk of hypertension especially with the use of enzalutamide. With this knowledge, closer blood pressure monitoring is needed for patients started on ARTA, especially enzalutamide.

Cluster analysis of adult individuals with type 1 diabetes: Treatment pathways and complications over a five-year follow-up period

AimsTo identify subgroups of adults with type 1 diabetes and analyse their treatment pathways and risk of diabetes-related complications over a 5-year follow-up. MethodsWe performed a k-means cluster analysis using the T1DExchange Registry (n = 6,302) to identify subgroups based on demographic and clinical characteristics. Annual reassessments linked treatment trajectories with these clusters, considering drug and technology use. Complication risks were analysed using Cox regression. ResultsFive clusters were identified: 1) A favourable combination of all variables (31.67 %); 2) Longer diabetes duration (22.63 %); 3) Higher HbA1c levels (13.28 %); 4) Higher BMI (15.25 %); 5) Older age at diagnosis (17.17 %). Two-thirds of patients remained in their initial cluster annually. Technology adoption showed improved glycaemic control over time. Cox proportional hazards showed different risk patterns: Cluster 1 had low complication risk; Cluster 2 had the highest risk for retinopathy, coronary artery disease and autonomic neuropathy; Cluster 3 had the highest risk for albuminuria, depression and diabetic ketoacidosis; Cluster 4 had increased risk for multiple complications; Cluster 5 had the highest risk for hypertension and severe hypoglycaemia, with elevated coronary artery disease risk. ConclusionsClinical characteristics can identify subgroups of patients with T1DM showing differences in treatment and complications during follow-up.

Predicting high-risk pre-capillary pulmonary hypertension: an echocardiographic multiparameter scoring index

BackgroundThe risk stratification of pulmonary arterial hypertension proposed by the European Society of Cardiology /European Respiratory Society guidelines in 2015 and 2022 included two to three echocardiographic indicators. However, the specific value of echocardiography in risk stratification of pre-capillary pulmonary hypertension (pcPH) has not been efficiently demonstrated. Given the complex geometry of the right ventricular (RV) and influencing factors of echocardiographic parameter, there is no single echocardiographic parameter that reliably informs about PH status. We hypothesize that a multi-parameter comprehensive index can more accurately evaluate the severity of the pcPH. The purpose of this study was to develop and validate an echocardiographic risk score model to better assist clinical identifying high risk of pcPH during initial diagnosis and follow-up.MethodsWe studied 197 consecutive patients with pcPH. A multivariable echocardiographic model was constructed to predict the high risk of pcPH in the training set. Points were assigned to significant risk factors in the final model based on β-coefficients. We validated the model internally and externally.ResultsThe echocardiographic score was constructed by multivariable logistic regression, which showed that pericardial effusion, right atrial (RA) area, RV outflow tract proximal diameter (RVOT-Prox), the velocity time integral of the right ventricular outflow tract (TVIRVOT) and S’ were predictors of high risk of pcPH. The area under curve (AUC) of the training set of the scoring model was 0.882 (95%CI: 0.809–0.956, p < 0.0001). External validation was tested in a test dataset of 77 patients. The AUC of the external validation set was 0.852. A 10-point score risk score was generated, with scores ranging from 0 to 10 in the training cohort. The estimate risk of high risk of pcPH ranged from 25.1 to 94.6%.ConclusionsThe echocardiographic risk score using five echocardiographic parameters could be comprehensive and useful to predict the high risk of pcPH for initial assessment and follow-up.

Prevalence of Hypertension and Its Associated Factors among Adolescents in Eastern Sudan: A Community-Based Study.

Elevated blood pressure, or hypertension, is one of the main health problems among adolescents globally. However, there are limited data on hypertension among adolescents in Sudan. This survey aimed to investigate the prevalence of elevated blood pressure/hypertension and associated factors among adolescents in Gadarif City, Sudan. A community-based cross-sectional survey was conducted during a three-month period (August to October 2023) in Gadarif City, Eastern Sudan. A face-to-face interview questionnaire was used to collect sociodemographic information. Adolescents' anthropometric (weight and height) measurements were taken, and blood pressure was measured. Multivariate binary and linear regression analyses were performed to analyze the data. A total of 384 adolescents (178 [46.4%] boys and 206 [53.6%] girls) were included in the study. The median (interquartile range, IQR) of the age was 14.0 (12.1-16.1) years, and that of the body mass index (BMI) was 16.9 (15.2-20.0) kg/m2. Thirty-four (8.9%) adolescents had hypertension/elevated blood pressure (≥95th percentile). After adjusting for confounders, multivariable binary regression analysis showed that age (adjusted odds ratio [AOR], 1.20; 95% confidence interval [CI], 1.03-1.42) and BMI (AOR, 1.12; 95% CI, 1.04-1.20) were associated with hypertension. Approximately one in ten adolescents in Eastern Sudan was hypertensive. Adolescents with higher age and BMI were at higher risk for hypertension. Maintaining a healthy BMI during adolescence is recommended to promote adolescents' health.