Hypertensive Men Research Articles

Chronic medical conditions based obesity phenotypes: A two-step cluster analysis of a representative sample of obese American adults

Background and objectiveAlthough obesity is a heterogeneous disease, little is known regarding chronic medical conditions (CMCs) that defines variability in obese populations. The characterization of obese populations using CMCs rather than categorization using BMI alone can advance understanding of obesity. The aims of this study are to phenotype obesity in a large representative sample of non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) obese adults using CMCs, and assess relationship between resulting phenotypes and self-rated health (SRH). MethodsSex-specific two-step cluster analysis was used to phenotype obese participants (n = 12,547) to CMC-based clusters. The prevalence of CMCs and lifestyle risk factors in each cluster was assessed. Sex and race/ethnic specific association between cluster membership and SRH was determined using odds ratio (OR) from logistic regression analysis. ResultsDistinct subgroups of obese men and women were observed: moderate dyslipidemic healthy young obese men, hypertensive-dyslipidemic middle-age obese men, hypertensive young obese men, hypertensive-dyslipidemic-asthmatic middle-age obese men, and syndemic elderly obese men, healthy young obese women, hypertensive-dyslipidemic middle-age obese women, dyslipidemic young adult obese women, syndemic middle-age obese women, and syndemic elderly obese women. Participants in the more CMCs symptomatic clusters reported high rates of behavioral risk factors and showed significantly greater odds of poor SRH than participants in the less symptomatic clusters. Compared to obese persons who are asymptomatic for CMCs, syndemic elderly obese and women men had much higher increased ORs for poor SRH with values of 3.88 [95% CI = 2.41–6.26], 3.96 [95% CI = 1.86–8.30] and 7.25 [95% CI = 2.41–9.6] for NHW, NHB and MA men, respectively. The corresponding ORs for women are 4.08 [95% CI = 2.71–6.14], 4.01 [95% CI = 2.40–6.69], and 2.62 [95% CI = 1.32–5.19], respectively. ConclusionObesity treatment and intervention should consider heterogeneity within obese persons and pay greater attention to obesity related co-morbidities and metabolic manifestations.

Systemic arterial hypertension leads to decreased semen quality and alterations in the testicular microcirculation in rats

Arterial hypertension is a cardiovascular disease that leads to important systemic alterations and drastically impairs normal organ function over time. Hypertension affects around 700 million men of reproductive age and hypertensive men present increased risk for reproductive disorders, such as erectile dysfunction. However, the link between arterial hypertension and male reproductive disorders is associative at best. Moreover, many studies have reported associations between decreased male fertility and/or semen quality and alterations to general male health. In this study we aim to investigate the effect of systemic high blood pressure in sperm quality, sperm functional characteristics and testicular physiology in a rat model. Hypertensive rats presented altered testicular morphology – mainly vascular alterations and impaired testicular vasomotion. Hypertensive rats also presented decrease in sperm concentration, DNA integrity and increased percentages of sperm with dysfunctional mitochondria, intracellular superoxide anion activity and abnormal morphology. This study provides mechanistic insights by which arterial hypertension affects the testes, evidencing the testes as another target organ for hypertension as well as its impact on sperm quality.

Dynamics of testosterone and prolactin levels, blood pressure and parameters of cardiovascular remodeling in hypertensive men with androgen deficiency in the course of treatment

Numerous previous and up-to-date guidelines for antihypertensive treatment do not highlight the problem of interrelations between sexual dysfunction and hypertension itself or with the use of frequently prescribed medications. Changes in testosterone and prolactin concentrations in men undergoing antihypertensive treatment are still not well described.The aim of the study was to investigate the impact of combined antihypertensive treatment with the addition of phenibut on testosterone and prolactin concentrations, blood pressure and parameters of cardiovascular remodeling in hypertensive men with androgen deficiency.Materials and methods. A total of 113 men with stage II essential hypertension were recruited to participate in the study. All patients were subjected to routine clinical examination, evaluation of total (TT), free testosterone (FT) and prolactin using ELISA, 24-hour blood pressure monitoring (24-hour BPM), assessment of central aortic pressure and arterial stiffness, transthoracic echocardiography. All study subjects were prescribed the combined antihypertensive treatment with irbesartan and nifedipine. Depending on treatment scheme, all patients were divided into four groups: group 1A consisted of men with low TT who received phenibut in addition to antihypertensive treatment, group 1B – patients with androgen deficiency on antihypertensive treatment only, group 2A – patients with normal TT with the addition of phenibut, group 2B – men with normal TT on antihypertensive medications only.Results. As a result of prescribed treatment, TT and FT levels increased with discordant changes in the concentration of prolactin: a statistically significant increase in TT (29.72 %, P = 0.0002) and FT (28.08 %, P = 0.0003) with a significant decrease in prolactin concentrations (10.68 %, P = 0.008) were in the group 1A. All patients had positive 24-hour BPM dynamics, parameters of central aortic pressure and cardiovascular remodeling. Patients with androgen deficiency with the addition of phenibut had the highest reduction rates in 24-hour BPM values, central SBP, DBP, PBP, mean BP, augmentation index, RWTT, pulse pressure amplification, CAVIa and were characterized by significant improvement of longitudinal LV deformation and diastolic function.Conclusions. The use of combined antihypertensive therapy with irbesartan and nifedipine with the addition of phenibut in men with androgen deficiency contributes to the achievement of target blood pressure levels and improvement of cardiovascular remodeling parameters.

Re: Tighter Blood Pressure Control is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men.

Re: Tighter Blood Pressure Control is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men.

Analysis of factors, associated with the probability of antihypertensive medication in the population of patients with arterial hypertension

Aim . To analyze factors associated with the probability of antihypertensive drugs (AHD) receiving in the population of patients with arterial hypertension (AH). Material and methods . 334 hypertensive men and 436 women of 25-64 years old from the representative sample of general population were examined. The associative analysis included socioeconomic, psychosocial, behavioral and biological variables. Univariable and multivariable (logistic regression) statistics were applied. The error probability <5% was considered statistically significant. Results . Over 60% of the low/moderate cardiovascular risk (CVR) hypertensive women were taking medications. The highest medication rate was found at very high CVR. Men with high CVR have showed lower medication rate than expected. There is a reserve for more complete treatment coverage among those with very high CVR. Factors of nontaking medications in both genders included: being non-informed of elevated blood pressure (BP), lack of knowledge of own BP, AH absence in the relatives, higher education. Younger age, intensive smoking (in those without chronical heart disease), non-attendance of a doctor over the past year correlated with lower odds of medication in men whereas SCORE 10 and above, and occupational physical activity pattern “walking mostly” were associated with lower odds of medications in women. Conclusion . We emphasize several factors, associated with lower odds of taking medication in the hypertensive population. These factors should be considered when developing tools to help motivate obviously healthy people to participate in screening programs and to explain risks and potential benefits of a conscious attitude to hypertension problem.

CARDIORESPIRATORY FITNESS AND HEART FAILURE INCIDENCE IN HYPERTENSIVE PATIENTS

Objective: Hypertension (HTN) is one of the most common risk factors for congestive heart failure (HF). Evidence suggests that increased cardiorespiratory fitness (CRF) may attenuate the risk of CHF in the general population. However, it is not known if the increased HF risk attributed to HTN can be attenuated by increased CRF. The hypothesis was that improved CRF will attenuate the risk of HF in hypertensive patients. Design and method: We studied a total of 9,070 hypertensive men (mean age 59.5 ± 10.5) underwent routine exercise tolerance testing. None of the patients had a diagnosis of HF at baseline. Participants completed a maximal exercise tolerance test (ETT) as a part of clinical evaluation and Metabolic equivalents (METs) were estimated based on the peak exercise time and treadmill grade. We established four fitness categories based on age-stratified quartiles of peak metabolic equivalents (MET) achieved: Least-fit (4.4 ± 1.2 METs; n = 2,108); Low-Fit (6.6 ± 1.2 METs; n = 2,926); Moderately-Fit (7.9 ± 1.3 METs; n = 2,423); and Highly-Fit (10.6 ± 2.2 METs; n = 2,076). Cox proportional hazard models were applied after adjusting for age, BMI, race, family history of CV disease, CV/antihypertensive medications, and risk factors. P-values < 0.05 using two sided tests were considered statistically significant. Results: During a mean follow-up period of 11.9 ± 6.5 (median 11.8), there were 1,216 incidences of CHF (12.7%) or 11.2 events per 1000 person-years of follow-up. The association between new onset CHF risk and fitness was inverse and graded. For every 1-MET increase in exercise capacity, the risk was lowered by 14% (HR = 0.86; CI: 0.84–0. 89; p < 0.001). When compared to the individuals in the Least-Fit category, the risk for developing CHF was progressively lower, ranging from 33% (HR = 0.67; CI: 0.58–0.78; p < 0.001) for the next fitness category (Low-Fit) to 44% (HR = 0.56; CI: 0.48–0.65; p < 0.001) for the Moderately-Fit and 62% those in the highest fitness category (HR = 0.38; CI: 0.32–0.46; p < 0.001). Conclusions: Increased CRF modulates the risk of developing HF in hypertensive patients. The CRF-HF association is independent, inverse and graded. For every 1-MET increase in exercise capacity, the HF risk was lowered by 14%.

CARDIOMETABOLIC RISK FACTORS FOR ATRIAL FIBRILLATION IN TYPE 2 DIABETES MELLITUS

Objective: Atrial fibrillation (AF) in type 2 diabetes mellitus (T2DM) has been little explored so far. However, there are several cardiometabolic risk factors for AF in T2DM patients, such as arterial hypertension, obesity or metabolic syndrome. Our objective was to evaluate cardiometabolic risk factors for AF in T2DM patients. Design and method: We studied the medical records of T2DM patients hospitalized in the Internal Medicine department of an emergency referral hospital in Bucharest, Romania. The study was observational, retrospective and was carried out between January and June 2017. Results: The study group included 221 T2DM patients (mean age 68.65 ± 10.64, range 37–93 years): 116 women (52.49%; mean age 70.53 ± 10.69, range 37–93 years) and 105 men (47.51%; mean age 66.57 ± 10.23, range 38–91 years). 92 patients had AF (41.63%): 40 women (34.48%) and 52 men (49.52%). 180 patients (81.45%) were hypertensive: 103 women (88.79%) and 77 men (73.33%). 113 patients (51.13%) had metabolic syndrome: 58 women (50.00%) and 55 men (52.38%). 77 patients (34.84%) were obese: 45 women (38.79%) and 32 men (30.48%). AF patients associated obesity in 26 cases (28.26%), hypertension in 73 cases (79.35%) and metabolic syndrome in 56 cases (60.87%).Conclusions: The most common cardiometabolic risk factor for AF in T2DM patients was hypertension (79.35%), followed by metabolic syndrome (60.87%) and obesity (28.26%). In T2DM patients, AF was more frequent in men (49.52%) vs. women (34.48%). Regarding cardiometabolic risk factors for AF in T2DM patients, women were more likely to be hypertensive (88.79%) or obese (38.79%) vs. men (73.33% and 30.48%, respectively). Men were more likely affected by metabolic syndrome (52.38%) rather than women (50.00%) in T2DM patients with AF.

Recovery Pattern of Cardiac Autonomic Control Following Aerobic Exercise with Different Volumes in Hypertensive Men

The recovery pattern of cardiac autonomic control to acute aerobic exercise (AE) is a robust index of individual ability to recruit vagal tone and may provide further evidence of the risks and benefits of a typical AE bout to promote health. However, the extent to which postexercise autonomic control, as assessed by heart rate variability (HRV), depends on exercise volume remains unclear in hypertensive individuals. PURPOSE: The present study investigated the effect of cycling bouts with different volumes on HRV markers in hypertensive men. METHODS: Ten unmedicated men [age: 39±7 yr; body mass index: 29.3±1.0 kg/m2 ; maximal oxygen uptake (VO2max): 26.7±0.8 mL∙kg-1∙min-1 ; 24-h ambulatory systolic/diastolic BP (SBP/DBP): 139±8/86±7 mmHg] visited the laboratory four times to undertake the following procedures: a) assessment of resting and maximal VO2 ; b) perform a non-exercise control session (CTL) and two AE expending 150 (AE150) and 300 kcal (AE300) at 50% VO2reserve in a randomized, counter-balanced order. The root mean square of successive R-R differences calculated for consecutive 30-s windows (rMSSD 30s) was calculated to assess the vagal reactivation during the first 5 min of recovery in a supine position via cardiotachometer (RS800cx, Polar TM , Finland). Prolonged HRV analysis [i.e. low-frequency band (LF), high-frequency band (HF), and sympatho-vagal balance (LF:HF ratio)] was performed during the subsequent 21-h under ambulatory conditions using a three-channel Holter (CardioLight, Cardios Ltda, Brazil). Marginal models were used to compare HRV changes between trials. RESULTS: Significant differences for rMSSD 30s were only detected between CTL vs. AE150 [∆ - 38.8 ms (P<0.001)] and CTL vs. AE300 [∆ - 40.0 (P<0.001)]. Within the subsequent 21-h of recovery, no significant differences were observed among CTL, AE150 and AE300 for LF, HF and LF:HF ratio. CONCLUSIONS: These findings suggest that exercise volume is not a major determinant of exercise prescription when considering the recovery pattern of cardiac autonomic control in hypertensive men, at least when AE is performed at moderate-intensity.

Pulse Wave Reflection Responses After Aerobic Exercise with Different Volumes in Normotensive and Hypertensive Men

Pulse Wave Reflection Responses After Aerobic Exercise with Different Volumes in Normotensive and Hypertensive Men

Dietary and Lifestyle Changes Reverses Hypertension Rapidly (P16-020-19)

ObjectivesHypertension increases cardiovascular disease mortality; it is worldwide; and it is the number one cause for medical interventions in the U.S. We tested the effectiveness of reversing systolic blood pressure (SBP) in older adults by an intensive lifestyle of a wholefoods vegan diet together with other health principles of the Adventist Lifestyle that prevents hypertension. MethodsThis is a retrospective 2-week pretest-posttest analysis in 1132 hypertensive men and women (mean ± SD: 64.0 ± 12.3, SBP 143 ± 22 mmHg) enrolled consecutively from 1988 to 1999 in an 18-day medically operated health improvement program, NEWSTART (Nutrition, Exercise, Water, Sunlight, Temperance—moderation and no addictive substances as tobacco or alcohol—fresh Air, Rest, and Trust [spirituality/relationships]). The whole-foods vegan diet had 26% of energy as fat and 1193 mg sodium/1000 calories. Data was analyzed by paired t-test using SPSS Statistics. ResultsSBP dropped significantly (P < 0.001) in the entire population within 18 days from 142 ± 0.8 to 119 ± 1.4–23 (−23 mmHg or −16%). Diastolic blood pressure dropped -14%. SBP pressure decreased in all subgroups (P < 0.001): men −13% or women −15%; not taking (−19%) or taking antihypertensive medications (−11%); and normal (−15%) or excess weight (−14). SBP decreased to <120 mmHg in 68% of the population. Most of the subjects decreased or discontinued the use of antihypertensive medications. ConclusionsThe intervention reversed systolic and diastolic blood pressure rapidly and two thirds of the subjects were no longer hypertensive within 18 days. SBP decreased as rapidly as has been reported for intensive medication therapy that provokes serious side effects. It decreased SBP while antihypertensive medications were being decreased or discontinued by most subjects. The intervention with a whole-foods vegan diet containing moderate levels of fat and salt is effective as a first line treatment of hypertension as recommended by the evidence-based guideline for adults reported by the VIII Joint National Committee (JNC8). Funding SourcesSelf funded.

The Effect of Consuming Mineral Water and Piped Water on Blood Pressure and Lipid Profiles of Hypertensive Men

Background: Hypertension is the third risk factor for the cardiovascular diseases. This study investigated the effects of mineral water from Damavand spring on the blood pressure and serum lipid profiles in men with hypertension. Methods: In this study 41 hypertensive men were randomly assigned to Damavand mineral water (DM) and Tehran water groups (TW). The DM and TW received 1.5-liter bottle of mineral water of Damavand spring and Tehran piped water bottled, respectively. The participants' blood pressure, serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), and high-density lipoprotein cholesterol (HDLc) were measured at the beginning and end of the study. Total hardness of water was measured by titration with EDTA. Results: The results showed that the mean systolic and diastolic blood pressures decreased in both groups at the end of the study compared to the baseline (P &lt; 0.05), but the difference was not significant. Serum TC and LDLc significantly in the case group at the end of week 8 compared to the baseline (P &lt; 0.05) and this reduction was significant (P &lt; 0.05). Moreover, no significant differences were observed between the two groups with regard to the mean changes of TG and HDLc (P &gt; 0.05). Conclusions: The findings showed that the daily consumption of 1.5 liters of premium mineral water of Damavand springs decreased the systolic and diastolic blood pressure, total cholesterol, and LDLc levels.

Association of total testosterone, free testosterone, bioavailable testosterone, sex hormone-binding globulin, and hypertension.

Low testosterone has been inversely associated with hypertension. Our objective was to determine the associations between total testosterone (TT), free testosterone (FT), bioavailable testosterone (BioT), sex hormone–binding globulin (SHBG), and hypertension. Two hundred fifty-three men were enrolled in this study. TT and SHBG were measured by chemiluminescent immunoassay, and FT and BioT were calculated. Hypertension was defined as systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg. Our results showed that hypertensive men had higher SHBG levels, and lower FT and BioT, compared to normotensive men. FT and BioT were inversely associated with SBP and DBP after adjusting for covariates (age, smoking, alcohol consumption, and physical activity). Furthermore, there was a significant decrease in the odds ratios for hypertension in the third and fourth quartiles of BioT and FT, compared to the lowest quartile before and after adjusting for covariates. In contrast, the OR for hypertension in the third quartile of SHBG was lower than the highest quartile. Our data show that FT and BioT are inversely correlated with SBP, DBP, and hypertension in men.

SUN-082 The Impact of Gender on Inpatient Mortality of Hypertensive Latino Patients Across CKD Stage 3 to ESRD in the United States

BACKGROUND: Hypertension and chronic kidney disease are two of the most important risk factors for cardiovascular disease, a major cause of death in the US population. The impact of gender in this equation remains unclear, more so, on how it affects the Hispanic population. Studies comparing the outcomes and difference in inpatient mortality between male and female with hypertension and CKD are sparse. Our aim was to determine if gender in Latino population affect the inpatient survival rate among hypertensive patients across different CKD stages. METHODS: Data was extracted from the 2005 to 2012 Nationwide Inpatient Sample (NIS). Using propensity score matching, female hypertensive with chronic kidney disease (stage 3, 4, 5 or ESRD) patients were matched with hypertensive males at a 1:1 ratio. We compared inpatient mortality, both crude mortality and mortality per CKD stage, length of stay and total hospital charges between male and females. Analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC, USA). RESULTS: Among 227,923 hospitalized hypertensive patients, 118,132 (51.83%) were males and 109,791 (48.17%) females. 18.76%, 10.31%, 3.85% and 67.17% were Females with CKD 3 to ESRD respectively. Males across CKD stages 3 to ESRD were 19.47%, 9.54%, 3.63% and 67.43% respectively. In-hospital crude mortality was significantly higher for males compared to group of females before match, (3.89 vs 3.74 p= 0.05), interestingly, mortality was higher after match for females (3.85 vs 3.79 p= 0.48). Mean length of stay for hypertensive females were significantly higher than males, irrespective of CKD stage (6.74 vs 6.70 days, p= 0.001), however at the male group had an expense of higher hospital charges (63,686 vs 61,667 dollars, p= 0.001). CONCLUSION: Latino hypertensive men with any stage of CKD are more at risk of dying then their counterpart women and have higher hospital charges. Further studies are needed to explore these associated genders in difference outcomes in this population.

The potential role of testosterone in hypertension and target organ damage in hypertensive postmenopausal women.

Objective: The aim of this study was to confirm the potential role of testosterone in hypertension and target organ damage (TOD) in hypertensive postmenopausal women.Methods: A matched group study was conducted. One hundred sixty-one hypertensive postmenopausal women between 45 and 65 years of age were enrolled as group 1. Another 161 age-matched hypertensive men were enrolled as group 2. Ambulatory blood pressure monitoring, echocardiographic imaging, vascular function, sex hormones and clinical characteristics were evaluated. Quantitative data were analyzed using independent Student’s t-test and multiple regression analysis.Results: The mean and load level of blood pressure were lower in women than in men (P<0.05), except for the mean level and load of the nocturnal systolic blood pressure (SBP) (123.77±15.72 mmHg vs 126.35±15.64 mmHg, and 50.43±30.31% vs 55.35±28.51%, P>0.05). However, the carotid-femoral pulse wave velocity (cf-PWV) in women was higher than that in men (9.68±2.23 m/s vs 8.03±2.82 m/s, P<0.05). The ratio of the early diastolic mitral peak flow velocity to early diastolic mitral annular velocity (E/Em) was obviously impaired (13.06±3.53 vs 12.05±3.68, P<0.05) in women. Furthermore, in women, a positive correlation was found between testosterone and cf-PWV (γ=0.157, P=0.046), and Cf-PWV was positively related to the mean level of nighttime SBP (γ=0.210, P=0.008). Moreover, nocturnal SBP was a risk factor for E/Em (γ=0.156, P=0.048, P<0.05).Conclusion: Testosterone may play a role in the correlation between hypertension and TOD in hypertensive postmenopausal women.Clinical Trial number: This research study was registered under the ClinicalTrials.gov PRS Website (NCT03451747).

Morning versus Evening Aerobic Training Effects on Blood Pressure in Treated Hypertension.

The acute blood pressure (BP) decrease is greater after evening than morning exercise, suggesting that evening training (ET) may have a greater hypotensive effect. This study aimed to compare the hypotensive effect of aerobic training performed in the morning versus evening in treated hypertensives. Fifty treated hypertensive men were randomly allocated to three groups: morning training (MT), ET, and control (C). Training groups cycled for 45 min at moderate intensity (progressing from the heart rate of the anaerobic threshold to 10% below the heart rate of the respiratory compensation point), while C stretched for 30 min. Interventions were conducted 3 times per week for 10 wk. Clinic and ambulatory BP and hemodynamic and autonomic mechanisms were evaluated before and after the interventions. Clinic assessments were performed in the morning (7:00-9:00 AM) and evening (6:00-8:00 PM). Between-within ANOVA was used (P ≤ 0.05). Only ET decreased clinic systolic BP differently from C and MT (morning assessment -5 ± 6 mm Hg and evening assessment -8 ± 7 mm Hg, P < 0.05). Only ET reduced 24 h and asleep diastolic BP differently from C and MT (-3 ± 5 and -3 ± 4 mm Hg, respectively, P < 0.05). Systemic vascular resistance decreased from C only in ET (P = 0.03). Vasomotor sympathetic modulation decreased (P = 0.001) and baroreflex sensitivity (P < 0.02) increased from C in both training groups with greater changes in ET than MT. In treated hypertensive men, aerobic training performed in the evening decreased clinic and ambulatory BP due to reductions in systemic vascular resistance and vasomotor sympathetic modulation. Aerobic training conducted at both times of day increases baroreflex sensitivity, but with greater after ET.

Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men

IntroductionTighter blood pressure control is widely thought to be associated with better erectile function, although the preponderance of data is limited to dichotomous representations of hypertension without an attempt to look at degree of blood pressure control. AimTo determine the association between optimal blood pressure control over time and the development of erectile dysfunction (ED) in a cohort of potent men. MethodsWe performed a retrospective cohort study of newly diagnosed hypertensive men without major medical comorbidities in an integrated healthcare system. Patients were stratified by exposure to hypertension, with varying levels of blood pressure control, as measured by ordinal categories of systolic blood pressure and deviation from the mean systolic pressure. Main Outcome MeasuresIncidence of ED was defined by at least 2 primary care or urology diagnoses of ED in our electronic health records within 2 years, at least 2 filled prescriptions for ED medications within 2 years, or 1 diagnosis of ED and 2 filled prescriptions for ED medications. ResultsWe identified 39,320 newly diagnosed hypertensive men. The overall incidence for ED was 13.9%, with a mean follow-up of 55.1 ± 28.7 months. Higher average systolic blood pressure was associated with a higher risk of ED in a dose-dependent manner (trend test, P < .001). Wide variation in blood pressure control was associated with a higher incidence of ED (OR [95% CI]; 1.359 [1.258–1.469]) and a shorter time to the development of ED (log rank, P < .0001). Clinical ImplicationsWe believe these data may serve as a motivator for hypertensive men to better adhere to their hypertension treatment regimen. Strength & LimitationsThe retrospective nature of our study precludes us from drawing more than an association between tighter blood pressure control and ED. Strengths of our study include the large sample size, community cohort, and completeness of follow-up. ConclusionAmong adults diagnosed with hypertension, tighter blood pressure control, as measured by average systolic blood pressure and deviation from the average, is associated with a lower incidence and a longer time to the development of ED.Hsiao W, Bertsch RA, Hung Y-Y, et al. Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019;16:410–417.

Wave reflections in hypertension: role of sex, metabolic, and ethnic factors.

Although the links between pulsatile hemodynamics and age are widely acknowledged in hypertension, the interactions of sex, ethnicity, and metabolic factors with hemodynamic parameters remain largely unknown. We investigated the effects of body weight, glycemia, and cholesterolemia on the carotid augmentation index (CAI) and potential changes over time, with particular focus on the roles of sex and ethnicity. Baseline (V1) and repeat (V2) measurements (at ∼1.7 years) of wave reflections (calculated from CAI), brachial and carotid pulse pressure, and heart rate were assessed in 2530 normotensive and hypertensive men and women living in Paris but born in either France, Africa, or Asia. At V1, and in comparison with French-born individuals, African-born individuals had significantly higher CAI, cardiovascular risk, and body weight, whereas Asian-born individuals had similar CAI but lower body weight, and higher cardiovascular risk, triglyceridemia, and heart rate. Stepwise multiple regression showed similar effects of cholesterolemia on CAI in all populations, whereas only French-born individuals (insulin-resistant men and women) showed associations between hyperglycemia and potential CAI dysfunction. Repeat (V2) measurements highlighted significant interactions (P < 0.008) of sex and ethnicity with changes in CAI over time. In men, CAI changes did not differ as a function of ethnicity, whereas in African-born women, they were lesser than those of Asian-born (P < 0.03) and French-born (P < 0.02) women. In the French-born population, CAI changes are affected by diabetes and possibly insulin-resistance, independently of sex. In African-born and Asian-born populations, CAI is sex-specific. Elevated CAI in African-born women calls for close monitoring of cardiovascular risk.

Hemodynamic responses to different isometric handgrip protocols in hypertensive men

Summary Objectives Several previous studies have shown that regular isometric handgrip (IHG) exercise reduces blood pressure in hypertensive individuals. The aim of this study was to investigate the responses of hemodynamic variables to five IHG protocols of different combinations but similar workloads. Equipment and methods Fifteen sedentary men with pre to stage 1 hypertension (Mean ± SD; age, 46 ± 6 years, systolic blood pressure [SBP], 138 ± 7 mmHg; DBP, 89 ± 6 mmHg) completed five IHG protocols randomly on five separate sessions including 8 × 30 s at 60% of MVC (high intensity high frequency [HIHF]); 4 × 1 min at 60% of MVC (high intensity low frequency [HILF]); 8 × 1 min at 30% of the MVC (low intensity high frequency [LIHF]); 4 × 2 min at 30% of MVC (low intensity low frequency [LILF]) and 8 × 1 min at 3% of MVC (Sham). Blood pressure and heart rate were measured at rest and at 0, 5, 10, 15, 30, 45 and 60 minutes of recovery. Plasma lactate levels were determined at rest and immediately after exercise. Results The highest increase in SBP was found immediately following HILF protocol and it was significantly (P 0.05). Conclusion These findings suggest that different IHG protocols of similar workloads affect hemodynamic variables differently, and that hemodynamic changes during and after IHG are related to the frequency and duration of contractions.

Developing personal sense of risk: a grounded theory in men with hypertension.

For older men with hypertension living in rural areas, non-adherence to treatment is a common phenomenon. The experience on risk perception of individuals with their condition is recognized as playing a critical role in promoting treatment adherence. However, the experience on risk perception in a cohort of older men with hypertension seems unclear. To develop a theory concerning risk perception experience in a cohort of older men with hypertension from a rural area of Thailand. A grounded theory approach was used. Semi-structured, face-to-face interviews with 29 hypertensive older men were conducted in Thailand using purposive and theoretical sampling methods. The grounded theory analytical method that included initial and focused coding, and constant comparison was used to analyse the data. 'Developing a personal sense of risk' emerged as a core category, which incorporated the related four subprocesses: comparing healthcare provider information with stories of people with hypertension, comparing one's own situation with stories of people with hypertension, changing personal sense of risk and changing risk-related behaviour. Older men selected to focus on one particular outcome, using the selected outcome to monitor their risk. This investigation provides a theory for healthcare providers to understand older men's perceptions of personal risk for complications of hypertension. A personal sense of risk influences risk-related behaviour change. The findings can be used in assessing a personal sense of risk and promoting treatment adherence in older men with hypertension. Effective storytelling intervention, a standard tool for assessment personal sense of risk in older men with hypertension, should be developed. Hypertension care policy needs to be developed for individualized approaches.

Erectile dysfunction in patients with arterial hypertension. Cardiovascular risk and impact on their quality of life

ObjectivesEstimate the frequency of erectile dysfunction in patients with essential hypertension and associated variables, degree of control, cardiovascular risk and the impact on quality of life. Material and methodsType of study: Observational study of prevalence in men with essential hypertension. Measurements: Sociodemographic and comorbidity variables were collected from each patient (age, Charlson index, dyslipidaemia and prostatic hyperplasia), degree of control of essential hypertension and treatment, cardiovascular risk and metabolic syndrome. The erectile dysfunction was diagnosed by the International Index of Erectile Function (IIEF-15). Quality of life questionnaires were carried out in essential hypertension (MINICHAL), and the international scale of prostatic symptoms (IPSS). ResultsThe study included 262 hypertensive men with an average age of 65.84 years. Erectile dysfunction was presented in 46.1%, being severe in 54.9%. The bivariate analysis shows an independent association between erectile dysfunction and the variables: age, Charlon index, dyslipidaemia, benign prostatic hypertrophy, diastolic blood pressure, years of diagnosis of hypertension, number of treatments, Regicor and Framingham-Wilson, glycaemia, creatinine and GPT, glomerular filtration through the MDRD formula, irritative symptomatology (IPSS) and somatic manifestations (MINICHAL). The final multivariate model found association with age, presentation of dyslipidaemia, prostatic hyperplasia and metabolic syndrome. ConclusionsErectile dysfunction is significantly associated with age, dyslipidaemia, benign prostatic hypertrophy and metabolic syndrome.