Improve Blood Pressure Research Articles

Osilodrostat improves blood pressure and glycemic control in patients with Cushing’s disease: a pooled analysis of LINC 3 and LINC 4 studies

PurposeTo evaluate the effect of osilodrostat and hypercortisolism control on blood pressure (BP) and glycemic control in patients with Cushing’s disease.MethodsPooled analysis of two Phase III osilodrostat studies (LINC 3 and LINC 4), both comprising a 48-week core phase and an optional open-label extension. Changes from baseline in systolic and diastolic BP (SBP and DBP), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were evaluated during osilodrostat treatment in patients with/without hypertension or diabetes at baseline.ResultsOf 210 patients, 82.9% met criteria for hypertension and 40.0% for diabetes at baseline. In patients with hypertension, reductions in mean SBP/DBP were observed from week (W)12 to W72, and 49.1%/58.5% of patients with high SBP/DBP (> 130/>90 mmHg) at baseline had normotensive levels at W72. Antihypertensive medication dose was reduced/stopped in 26.8% of patients, and the proportion taking antihypertensive medication decreased from 54.3% at baseline to 47.3% at W72. In patients with diabetes, mean FPG and HbA1c decreased from W12 to W72, and 33.3%/61.5% with high FPG/HbA1c (≥ 100 mg/dL/≥6.5%) at baseline had normal levels at W72. Antihyperglycemic medication dose was reduced/stopped in 35.7% of patients, and the proportion taking antihyperglycemic medication decreased from 21.9% at baseline to 17.1% at W72; improvements in SBP/DBP and FPG/HbA1c were correlated with improvement in mean urinary free cortisol but not weight change. BP/glycemic parameters generally remained normal in patients without hypertension/diabetes at baseline.ConclusionsPatients with Cushing’s disease and comorbid hypertension/diabetes receiving osilodrostat had rapid and sustained improvements in SBP/DBP and glycemic control, respectively.

Patient Perceptions of Provider Race Concordance and Quality of Chronic Illness Care.

Black people are more likely to have hypertension and report lower quality of care than White people. Patient-provider race concordance could improve perceived quality of care, potentially lessening disparities. Investigate the association between patient-provider race concordance and patient-perceived quality of chronic disease care, as measured by the Patient Assessment of Chronic Illness Care (PACIC) scale. Cross-sectional analysis of baseline data from a randomized trial with Black patients with persistently uncontrolled hypertension. Participants received care at one of 69 rural primary care practices in Alabama and North Carolina. Three hundred and ninety-one Black patients with persistently uncontrolled hypertension enrolled in the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial. PACIC overall scores and subscale scores (patient activation, delivery system, goal setting, problem solving, follow-up). Of 1592 patients enrolled in the SEC trial, 391 participants self-reported race concordance data and completed the PACIC. Most participants were age < 60 (52.4%), 65.2% identified as women, and 50.1% were beneficiaries of either Medicare or Medicaid. Those with patient-provider race concordance reported higher overall PACIC scores (58.8% vs 46.1%, p < 0.05), with higher sub-scores of goal setting (60.9% vs 46.8%, p < 0.05) and problem-solving (62.7% vs 48.0%, p < 0.05) compared to those without race concordance. Poisson regression models of participants age ≥ 60years demonstrated that those with race concordance were more likely to have higher overall PACIC scores (RR 1.53, 95% CI 1.17-2.0, p = 0.002), goal-setting subscale scores (RR 1.63, 95% CI 1.24-2.15, p = 0.0005), and problem-solving subscale scores (RR 1.66, 95% CI 1.29-2.14, p < 0.0001). Those < 60years of age had no significant findings comparing those with and without race concordance. OlderBlack patients perceived greater quality of care if their providers were also Black.

Adapting self-measured blood pressure monitoring to reduce health disparities (ASPIRE): a pilot hybrid effectiveness‑implementation study protocol

BackgroundHypertension is the leading risk factor for cardiovascular disease (CVD). Despite advances in blood pressure management, significant racial and ethnic disparities persist, resulting in higher risks of stroke, heart disease, and mortality among non-White populations. Self-measured blood pressure (SMBP) monitoring, also known as home blood pressure monitoring, has shown promise in improving blood pressure control, especially when combined with feedback from healthcare providers. However, the adoption of SMBP remains low, particularly among racial and ethnic minorities, due to various patient, provider, and system-level barriers.ObjectivesThis study aims to evaluate the feasibility of study methods implementing the ASPIRE (adapting self-measured blood pressure to reduce health disparities) toolkit in a primary care setting. The toolkit is designed to address barriers to SMBP adoption and improve hypertension management among underserved populations to increase SMBP adoption.MethodsThis pilot hybrid effectiveness-implementation randomized controlled trial (RCT) will be conducted at a primary care clinic in South Side Chicago, serving a diverse patient population. Eligible patients with uncontrolled hypertension will be randomized to either the intervention group, receiving the ASPIRE toolkit and support, or the control group, receiving usual care. The primary outcomes include feasibility measures including recruitment rates, attrition, and availability of data in the electronic health records.ResultsThe feasibility of the study methods will be analyzed to inform a larger multi-site RCT informed by progression criteria developed in this protocol. Qualitative interviews with patients and providers will explore the appropriateness and implementation success of the toolkit using the Consolidated Framework for Implementation Research (CFIR).ConclusionsThis pilot RCT will provide critical insights into the feasibility of study methods to evaluate the implementation success of the ASPIRE toolkit in a real-world primary care setting. By addressing barriers to SMBP adoption, this intervention has the potential to improve hypertension management and reduce health disparities in underserved populations.Trial registrationNCT: NCT06175793. Registered 19 December 2023, https://clinicaltrials.gov/study/NCT06175793.

The impact of oleuropein, hydroxytyrosol, and tyrosol on cardiometabolic risk factors: a meta-analysis of randomized controlled trials

The so-called Mediterranean diet, with olive oil as a key component, is effective in reducing cardiometabolic disease risk. Olive oil consumption improves blood pressure, insulin levels and resistance, supporting heart health and glycemic control. Its phenolic compounds, including oleuropein (OLE), hydroxytyrosol (HT), and tyrosol (TYR) are hypothesized to likely contribute to these benefits. Thus, this meta-analysis evaluated the clinical effects of dietary supplementation with OLE, HT, and TYR on cardiometabolic outcomes. Fourteen human intervention studies with 594 participants were included. The analysis using a random-effects model showed that OLE, HT, and TYR significantly reduced total cholesterol (SMD = −0.19, CI: −0.37 to −0.01, p = 0.04, I 2 = 35%), triacylglycerol (SMD = −0.32, CI: −0.60 to −0.03, p = 0.03, I 2 = 73%), and insulin (SMD = −0.42, CI: −0.82 to −0.01, p = 0.04, I 2 = 78%). Subgroup analysis showed that, in certain contexts, interventions may be more beneficial for BMI <30, non-Mediterranean, and cardiometabolic disease individuals, while intervention compound, type of intervention, and duration might have differential effects regarding considered outcomes. Overall, the meta-analysis suggests that supplementation with OLE, HT, and TYR may beneficially impact some cardiometabolic parameters, though further studies are needed to confirm these findings.

National Telehealth Contingency Staffing Program and Primary Care Quality in the VHA

The Veterans Health Administration (VHA) launched the Clinical Resource Hub (CRH), a national telehealth contingency staffing program, to address primary care staffing shortages and improve veteran access to primary care. How this large-scale telehealth intervention affects quality of care is unknown. To assess the quality of care for chronic disease management among US veterans receiving high vs low levels of CRH-delivered primary care services and whether racial and ethnic minority veterans experience outcomes similar to those of White veterans when receiving CRH-delivered care. This retrospective quality improvement study was conducted using VHA administrative data. Veterans receiving primary care services from CRH clinicians between October 1, 2022, to September 30, 2023, were included. Low, medium, and high tertiles of CRH intensity, defined as the proportion of a veteran's CRH primary care visits to their total primary care visits within the study period. The main outcomes were chronic disease quality measures for 2 common conditions in ambulatory care: diabetes and hypertension. Logistic regression models were used to estimate the association between individual-level receipt of care from a CRH clinician and the study outcomes. This study included 71 508 veterans (mean [SD] age, 66 [15] years; 91.4% were male). Veterans who received a higher proportion of care from CRH clinicians were more likely to have improved blood pressure control compared with those who received a lower proportion of care. Higher vs lower CRH intensity was associated with improved blood pressure control among veterans with diabetes (79.5% [95% CI, 78.5%-80.4%] vs 76.6% [95% CI, 75.7%-77.5%]) and veterans with hypertension (76.8% [95% CI, 76.0%-77.5%] vs 73.9% [95% CI, 73.2%-74.7%]). Among racial and ethnic minority veterans, no association between CRH intensity and clinical quality was observed. In this large retrospective cohort study among veterans receiving primary care services through a national telehealth contingency staffing program, veterans with a higher proportion of care from CRH clinicians had improvement in blood pressure outcomes. These findings suggest that the CRH program may be helpful in addressing veteran primary care needs without introducing or worsening disparities in ambulatory quality measures among racial and ethnic minority veterans. As health systems face staffing shortages in primary care, these findings can inform strategies for equitable implementation of large-scale telehealth initiatives to fill these gaps and maintain timely access to primary care.

Aqua training and its effect on physical and physiological parameters in middle-aged women

Problem statement. As individuals transition from middle age to old age, it is important for those in their middle age to adapt to and sustain a consistent level of physical activity. Aqua training can serve as a beneficial form of exercise for middle-aged women. Approach. This study investigates the effects of aqua aerobics on the physical and physiological parameters of women in their middle age. The study included 40 women (aged 35 to 45 years) from Kakching in Manipur, who were randomly assigned to either the experimental or control group. Methods. Over a 12-week period, the experimental group participated in organised aquatic activities, while the control group maintained their regular routines. The exercise programme was carefully designed, incorporating varying levels of intensity and specific factors to optimise physical and physiological benefits. The pre- and post-test data were compared using a t-test for matched samples and ANOVA. Results. The results demonstrated significant improvements in the experimental group’s physical measures, including flexibility (FX) (t = 9.06), back strength (BS) (t = 2.093), leg strength (LS) (t = 8.07), cardiovascular endurance (CE) (t = 2.208), muscular endurance (ME) (t = 18.262), and body fat percentage (BFP) (t = 8.17). The physiological benefits included increased vital capacity (VT) (t = 6.22), peak flow rate (PFR) (t = 3.26), and improved blood pressure (systolic t = 3.26, diastolic t = 2.29). Conclusion. The results highlight the effectiveness of aqua aerobics in improving the general health and fitness of middle-aged women, demonstrating its potential as a safe and beneficial form of exercise for this group.

Effectiveness and compliance of telemedicine on blood pressure management in poststroke patients: a systematic review and meta-analysis of randomised controlled trials.

To examine the effectiveness of telemedicine on blood pressure control and compliance. Systematic review and meta-analysis. A search of PubMed, Web of Science, Embase and Cochrane Library for studies of randomised controlled trials (RCTs) of telemedicine on blood pressure control in poststroke survivors from the time of their construction until November 2023. Inclusion criteria were as follows: (1) studies that were RCTs; (2) enrolment of patients who were stroke survivors; (3) studies that compared subjects who received telemedicine with usual care treatment. Exclusion criteria were as follows: (1) studies in which telemedicine was used for other diseases; (2) study protocols with no data; (3) non-English language articles and (4) case reports, conference papers, letters or articles with incomplete data. Quality assessment of included studies was performed using the Cochrane Risk of Bias Tool. The primary outcomes was the systolic blood pressure (SBP) (mm Hg), diastolic blood pressure (DBP) (mm Hg), patient compliance and the proportion of patients achieving target blood pressure. A total of 11 studies with 2903 patients were included in this paper. There were 1453 cases in the telemedicine group and 1450 cases in the usual care group. Meta-analysis showed a statistically significant decrease in SBP (mm Hg) in the telemedicine group compared with the usual care group at weeks 3, 6 and 12 of follow-up (week 3: mean difference (MD), -8.8; 95% CI, -12.05 to -5.56; p<0.00001; week 6: MD, -5.13; 95% CI, -8.07 to -2.18; p=0.0007; week 12: MD, -2.78; 95% CI, -4.68 to -0.89; p=0.004). At week 12 of follow-up, there was a statistically significant decrease in DBP (mm Hg) in the telemedicine group compared with the usual care group (MD, -1.57; 95% CI, -2.59 to -0.55; p=0.003). In addition, patient compliance was better in the telemedicine group than in the usual care group (OR, 1.61; 95% CI, 1.29 to 2.01; p<0.0001), and the proportion of patients achieving target blood pressure was higher than in the usual care group (OR, 3.49; 95% CI, 2.64 to 4.63; p<0.00001). Compared with usual care, telemedicine interventions can better improve blood pressure control in poststroke survivors and increase patient compliance. CRD42022382001.

Improving Blood Pressure Control and Tobacco Use Cessation Intervention In Primary Care: Protocol for the Alabama Cardiovascular Cooperative Heart Health Improvement Project.

Alabama has the second highest rate of cardiovascular disease (CVD) mortality of any US state and a high prevalence of CVD risk factors such as hypertension, diabetes, obesity, and smoking. Within the state, there are disparities in CVD outcomes and risk factors by race or ethnicity and geography. Many primary care practices do not have the capacity for full-scale quality improvement (QI) initiatives. The Alabama Cardiovascular Cooperative (ALCC), which includes academic and community stakeholders, was formed to support primary care practices to implement QI initiatives to improve cardiovascular health. The ALCC is implementing a Heart Health Improvement Project (HHIP) in primary care practices with suboptimal rates of blood pressure (BP) control and tobacco use screening. The study aimed to support primary care practices to increase BP control among adults with hypertension and increase rates of tobacco use screening and cessation intervention. We are using a type 1 hybrid design to test the effects of the HHIP on BP control among adults with hypertension and tobacco use screening and cessation intervention, while collecting information on implementation. Primary care practices were recruited through existing practice networks and additional electronic and in-person outreach. To ensure participation from a broad range of clinics, we required at least 50% of practices to be Federally Qualified Health Centers or look-alikes and to include representation from practices in rural areas. At baseline, we collected information about practice characteristics and preintervention rates of BP control and tobacco use screening and cessation intervention. The QI intervention includes quarterly activities conducted over a 12-month period. The HHIP uses a multipronged approach to QI, including practice facilitation and technical assistance, on-site and e-learning, and improvement through data transparency. We will conduct a pre-post analysis to estimate the effects of the HHIP and whether there is an enduring change in outcomes after the 12 months of HHIP activities beyond what would be expected due to secular trends. Practice recruitment took place between April 2021 and October 2022. After contacting 417 primary care practices, 51 were enrolled, including 28 Federally Qualified Health Centers or look-alikes; 47 practices implemented the HHIP. Among 45 practices that completed the baseline survey, 11 (24%) were solo practices, while 28 (62%) had 1-5 clinicians, and 6 (13%) had 6 or more clinicians. The median number of patient visits per year was 5819 (IQR 3707.3-8630.5). Practices had been in operation for a mean of 19.2 (SD 13.0) years. At baseline, the mean BP control rate was 49.6% and the rate of tobacco use screening and cessation intervention was 67.4%. If successful, the ALCC and HHIP may improve the implementation of evidence-based guidelines in primary care and, subsequently, cardiovascular health and health equity in the state of Alabama. DERR1-10.2196/63685.

Neurofibromatosi e ipertensione arteriosa: alla ricerca della causa

The paper describes the case of a 6-year-old girl with neurofibromatosis type 1 (NF1) who was diagnosed with significant arterial hypertension during a routine check-up. After initial ineffective therapy and inconclusive investigations, an angio-CT revealed renal artery stenosis. Ballooning treatment improved blood pressure control. The case highlights the importance of monitoring blood pressure in NF1 patients and investigating suspected renovascular hypertension.

The Acquisition of Cardiovascular Adaptation to Aerobic Exercise: When Does It Begin and How Does It Evolve Depending on Intrinsic and Extrinsic Factors?

The acquisition and evolution of cardiovascular (CV) adaptation to physical activity or exercise training are critical in enhancing cardiorespiratory fitness (CRF) and reducing CV disease (CVD) risk. CV adaptations to exercise occur through structural, functional, and molecular changes that enhance cardiac efficiency. These adaptations, such as increased stroke volume, improved blood pressure regulation, and enhanced endothelial function, collectively reduce CVD morbidity and mortality. This review explores how cardiovascular adaptations vary across different demographics, highlighting the importance of exercise timing, intensity, and recovery periods. It delves into the immediate physiological responses to physical activity, such as increased heart rate and cardiac output, and the longer-term adaptations, including cardiac hypertrophy and improved vascular function. The influence of age, sex, and pre-existing health conditions on cardiovascular responses to exercise is also discussed, emphasizing the need for tailored exercise interventions. Finally, the review highlights the significance of recovery periods in optimizing cardiovascular adaptations and how insufficient recovery may lead to adverse outcomes. Overall, understanding the timing and evolution of cardiovascular adaptations can inform exercise prescriptions to improve cardiovascular health across populations for the primary and secondary prevention of CVD.

7 days of L-citrulline supplementation does not improve running performance in the heat whilst in a hypohydrated state.

7days L-citrulline supplementation has been reported to improve blood pressure, O2 kinetics, gastrointestinal (GI) perfusion and endurance cycling performance through increasing arterial blood flow. In situations where blood volume is compromised (e.g., hyperthermia/hypohydration), L-citrulline may improve thermoregulation and exercise performance by redistributing blood flow to aid heat loss and/or muscle function. This study assessed 7days L-citrulline supplementation on running performance in the heat, whilst mildly hypohydrated. 13 endurance runners (2 female, 31 ± 8y, O2peak 60 ± 6mL/kg/min) participated in a randomised crossover study with 7days L-citrulline (CIT; 6g/d) or placebo (maltodextrin powder; PLA) supplementation. Participants completed a 50min running 'preload' at 65% O2peak (32°C, 50% relative humidity) to induce hyperthermia and hypohydration before a 3km running time trial (TT). Body mass and blood samples were collected at baseline, pre-preload, post-preload and post-TT, whilst core and skin temperature, heart rate and perceptual responses were collected periodically throughout. TT performance was not different between trials (CIT 865 ± 142s; PLA 892 ± 154s; P = 0.437). Core and skin temperature and heart rate (P ≥ 0.270), hydration (sweat rate, plasma volume, osmolality) indices (P ≥ 0.216), GI damage (P ≥ 0.260) and perceptual responses (P ≥ 0.610) were not different between trials during the preload and TT. 7days of L-citrulline supplementation had no effect on 3km running performance in the heat or any effects on thermoregulation or GI damage in trained runners in a hypohydrated state.

Renal Denervation: A Promising Alternative for Medications to Ameliorate the Physical and Mental Burden of Hypertension, A Narrative Review

: Hypertension is the most significant modifiable risk factor for cardiovascular disease (CVD) and is associated with substantial negative effects on both individual and societal levels. Renal denervation (RDN) has been established as a safe and effective medical intervention for treating resistant hypertension, with approval from the Food and Drug Administration and endorsement by guidelines such as those of the European Society of Cardiology (2023) and the American Heart Association. However, with the advent of various types of RDN methods, including radiofrequency-, ultrasound-, and alcohol-based techniques, debates have intensified regarding their comparative efficacy and safety. Additionally, researchers have expanded their focus to consider outcomes beyond hypertension management. Most studies have demonstrated that this non-pharmacologic treatment significantly improves systolic and diastolic 24-hour ambulatory and office blood pressure in both the short- and long-term. Despite these findings, the social and psychological impacts of RDN on a broader scale have been less frequently discussed. Given the high burden of hypertension and its complications, such as cardiovascular and cerebrovascular events, this intervention could substantially enhance the quality of life and mental health of affected populations. Non-adherence to antihypertensive medications remains a critical challenge, driven by factors such as side effects, pregnancy, financial constraints, psychiatric disorders, and polypharmacy with its associated consequences. Renal denervation, by improving blood pressure control, offers the potential to enhance quality of life and reduce the incidence of severe physical and mental health conditions. This study provides a comprehensive perspective on this advanced treatment, emphasizing its impact on individual and societal well-being, physical health, and mental health.

Efficacy and Safety of Sacubitril/Valsartan Versus Amlodipine in Japanese Patients With Essential Hypertension: A Randomized, Multicenter, Open-Label, Noninferiority Study (PARASOL Study).

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has demonstrated a superior blood pressure-lowering effect compared with renin-angiotensin system inhibitors in several clinical trials. However, there has been no available evidence on the comparison between sacubitril/valsartan and calcium channel blockers (CCBs), a well-established class of antihypertensive drugs. In this open-label, multicenter study, we aimed to demonstrate the efficacy and safety of sacubitril/valsartan versus amlodipine, one of the most widely used CCBs, after 8 weeks of treatment. A total of 359 Japanese patients with essential hypertension (office systolic blood pressure [SBP] ≥150 to <180mmHg), aged 18-79, were randomly assigned to receive either once-daily sacubitril/valsartan 200mg or once-daily amlodipine 5mg in a 1:1 allocation ratio. The primary endpoint was the noninferiority of sacubitril/valsartan compared with amlodipine in mean change in 24-h SBP from baseline to Week 8, followed by a significance test as a secondary endpoint analysis. The mean change in 24-h SBP in sacubitril/valsartan was noninferior to that in amlodipine (between-treatment difference -0.62mmHg [95% confidential interval: -3.23 to 1.98; p = 0.003 for noninferiority; independent t-test with noninferiority margin 3.0mmHg]), with no significant difference observed (p=0.637). There was no significant difference in the incidence of adverse events (AEs). These results suggested that the blood pressure-lowering effect of sacubitril/valsartan is comparable to that of amlodipine, with no marked differences in tolerability between the two groups. Sacubitril/valsartan, a potent antihypertensive drug comparable to amlodipine, is expected to improve blood pressure control in clinical practice.

Targeting acetylated high mobility group box 1 protein (HMGB1) and toll-like receptor (TLR4) interaction to alleviate hypertension and neuroinflammation in fructose-fed rats.

Our previous study reported that fructose intake increased systemic blood pressure and reduced nitric oxide (NO) in the nucleus tractus solitarius (NTS) due to oxidative stress and neuroinflammation. However, it remains unclear how reactive oxygen species (ROS) reduce NO and how this process impacts neuroinflammation in the NTS. This study aimed at investigating the effect of ROS on acetylation of high mobility group box 1 protein (HMGB1) in the NTS of fructose-induced hypertensive rats. Male Wistar-Kyoto (WKY) rats were fed with 10% fructose water to elevate blood pressure. Thereafter, CLI-095 and glycyrrhizic acid (GA) treatments were delivered for up to 2weeks (1mg·12 μL-1·day-1, by intracerebroventricular injection) to reduce the negative effects of toll-like receptor 4 (TLR4) and HMGB1 activation. Two weeks of CLI-095 and GA treatment reduced systemic blood pressure and significantly preserved neuronal and endothelial nitric oxide synthase (nNOS and eNOS) availability against the inflammatory insults of fructose consumption. Both CLI-095 and GA halted the interaction of acetylated HMGB1 and TLR4. Two weeks of CLI-095 and GA treatment markedly reduced NTS inflammation (pro-inflammatory cytokines and microglial activation) and lowered serum norepinephrine levels. Our data reveal novel pharmacological properties for CLI-095 and GA, which improved blood pressure and inflammatory conditions by decreasing the interaction of acetylated HMGB1 with TLR4. These findings challenge the commonly accepted dogma that essential hypertension is specifically mediated by neuroinflammation due to acetylated HMGB1 coupling to TLR4.

Impact of eating duration on weight management, sleeping quality, and psychological stress: A pilot study.

The daily eating window significantly impacts weight and metabolic health, yet its ideal duration remains uncertain. Thirty-four healthy middle-aged women were randomly assigned to two intervention groups: 8-h time-restricted eating (TRE) and 14-h time-extended eating (EXE). Each intervention lasted 4 wk, with a 16-d washout period before switching to the other intervention. Clinical biomarkers were collected before and after each intervention, and sleep quality was assessed using the Korean Version of the Pittsburgh Sleep Quality Index (PSQI-K). Additionally, a daily visual analogue scale (VAS) was used to evaluate psychological changes. The TRE group experienced significant weight reduction, lower fasting plasma glucose and total serum cholesterol levels compared to the EXE group, but with an increase in systolic blood pressure. The EXE group showed improved blood pressure. The TRE group reported higher stress levels on the VAS, but the PSQI-K indicated improved sleep quality during the second intervention. An 8-h TRE, without calorie restriction or diet composition changes, proves more beneficial for weight management and plasma glucose control compared to the 14-h EXE among Korean women. Implementation of this approach is recommended to be gradual to mitigate psychological fluctuations and adverse blood pressure changes. The trial was registered with ClinicalTrials.gov (ID: NCT05964179) and Clinical Research Information Service (CRIS, Korea) (ID: KCT0008640).

Exercise Intervention to Mitigate the Cardiovascular Sequence of Pregnancy Complications.

Pregnancy issues such as gestational hypertension, preeclampsia, and gestational diabetes mellitus (GDM) are significant contributors to long-term cardiovascular diseases (CVDs) in women. Recent research has proved the impact of exercise on improving cardiovascular outcomes, particularly in women with pregnancy-related disorders. This review explores the outcomes of various exercise interventions on cardiovascular health in pregnant women. Among these, aerobic exercise has been widely studied, with results from observational studies and randomized controlled trials (RCTs) showing its positive outcomes on cardiovascular health in pregnant women, especially with complications. It has been found that regular aerobic exercise has been associated with reduced hypertension and improved endothelial function, particularly in women with a history of preeclampsia. Evidently, aerobic exercise results in better blood pressure regulation and enhanced vascular health that directly attends to the risk of cardiovascular diseases associated with pregnancy complications. Another form of exercise is resistance training, which despite being studied less, has shown potential benefits as well. Some advantages of resistance exercise have been found to improve muscle strength and overall enhancement in metabolic control. This is important, especially in women with GDM whereby improvement in insulin sensitivity reduces the overall risk of type 2 diabetes and future CVDs. Combined exercise that incorporates both aerobic and resistance elementshas been known to offer the most comprehensive benefits. Various studies suggest that a combinatory approach maximizes the positive cardiovascular effects. Practicing women have experienced better overall heart health, with improved blood pressure regulation, enhanced endothelial function, and reduced metabolic risks. However, despite these findings, there are challenges such as small sample sizes and limited follow-up durations that hinder the generalizability of current research. Importantly, previous studies targeting exercise interventions for women experiencing complications during pregnancy have been limited in evidence by small sample sizes, short follow-ups, and lack of diversity. Such broader, more diverse populations were needed to reflect the various health risks and responses to exercise. Future research must include multi-center RCTs, diverse exercise regimens, and digital health tools for monitoring exercise adherence. This warrants future large-scale, multicenter trials that are necessary to establish more definitive evidence. Additionally, clinicians should consider including tailored exercise programs in care plans for women with pregnancy complications to mitigate long-term cardiovascular risks.

Remote Collaborative Specialist Panel Deployment to Address Health Disparities in the RICH LIFE Project.

Individuals with low income or from minoritized racial or ethnic groups experience a high burden of hypertension and other chronic conditions (eg, diabetes, chronic kidney disease, and mental health conditions) and often lack access to specialist care when compared to their more socially advantaged counterparts. We used a mixed-methods approach to describe the deployment of a Remote Collaborative Specialist Panel intervention aimed at the comprehensive and coordinated management of patients with hypertension and comorbid conditions to address health disparities. Participants of the collaborative care/stepped care arm of the Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone (RICH LIFE) Project, a cluster-randomized trial comparing the effectiveness of enhanced standard of care to a multilevel intervention (collaborative care/stepped care) for improving blood pressure control and reducing disparities, were included. Participants were eligible for referral by their care manager to the Specialist Panel if they continued to have poorly controlled hypertension or had uncontrolled comorbid conditions (eg, diabetes, hyperlipidemia, depression) after 3months in the RICH LIFE trial. Referred participant cases were discussed remotely with a panel of specialists in internal medicine, cardiology, nephrology, endocrinology, and psychiatry. Qualitative data on the Specialist Panel recommendations and interviews with care managers to understand barriers and facilitators to the intervention were collected. We used available components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to examine the impact of the intervention. Of 302 participants in the relevant RICH LIFE arm who were potentially eligible for the Specialist Panel, 19 (6.3%) were referred. The majority were women (53%) and of Black race (84%). Referral reasons included uncontrolled blood pressure, diabetes, and other concerns (eg, chronic kidney disease, life-stressors, medication side effects, and medication nonadherence). Panel recommendations centered on guideline-recommended diagnostic and management algorithms, minimizing intolerable medication side effects and costs, and recommendations for additional referrals. Panel utilization was limited. Barriers reported by care managers were lack of perceived need by clinicians due to redundant specialists, a cumbersome referral process, the remote nature of the panel, and the sensitivity of relaying recommendations back to the primary care physician. Care managers who made panel referrals reported it was overwhelmingly valuable. The use of a Remote Collaborative Specialist Panel was limited but well-received by referring clinicians. With modifications to enhance uptake, the Remote Collaborative Specialist Panel may be a practical care model for addressing some disparities in hypertension and multi-morbidity care.

The Impact of the Fruit and Seed of Date on Childbirth Stages and Pregnancy Complications.

This review aimed to investigate the effects of date fruit products on childbirth and pregnancy-related complications. MeSH keywords were systematically searched in scientific databases, and 16 articles were reviewed. It was found that consuming 7 date fruits (average of 80 g) per day for 2-4 weeks before the estimated date of delivery leads to a better cervical dilatation at admission or improvement of Bishop score, a decrease in the need for induction or stimulation of labour and an increase in effective uterine contractions, which, in turn, decreases the duration of pregnancy and the different stages of labour. Additionally, date fruit products can improve blood pressure parameters in pregnant women at risk of preeclampsia and accelerate episiotomy healing.

Integrating the health belief model into health education programs in a clinical setting.

The article demonstrates that health belief model (HBM)-based health education in hypertensive patients effectively improves blood pressure control and medication adherence at 3 months and 6 months. The HBM addresses perceived barriers, benefits, susceptibility, severity, and self-efficacy, leading to better health behaviors. HBM-based education has been effective in various contexts, including managing chronic diseases, promoting cancer screenings, and preventing infectious diseases. However, the model has limitations, such as cultural applicability and addressing complex health behaviors influenced by environmental factors. Future research should integrate HBM with other theories and conduct longitudinal studies to assess long-term impacts. Despite these limitations, HBM-based education significantly improves patient outcomes, highlighting its potential in health education and promotion when appropriately adapted and implemented. This reinforces the model's value in designing effective health interventions and advancing public health.

PENERAPAN SENAM HIPERTENSI SEBAGAI INTERVENSI NON-FARMAKOLOGIS PADA LANSIA DI PUSKESMAS ARJUNO KOTA MALANG

Hypertension in the elderly poses significant health challenges, so effective non-pharmacological interventions are needed. This study aims to evaluate the effectiveness of hypertension gymnastics as a non-pharmacological intervention for elderly patients at the Arjuno Health Center, Malang City. The research method used was a qualitative case study, which involved two elderly subjects with hypertension over a period of two weeks. Data collection was carried out through in-depth interviews, direct observation, and blood pressure measurements before and after the gymnastics intervention. This hypertension gymnastics program includes light to moderate aerobic exercise and flexibility training. The results showed a consistent decrease in blood pressure in both participants, with an average decrease in systolic pressure of 10-15 mmHg and diastolic pressure of 5-10 mmHg over the study period. In addition, participants showed increased knowledge about hypertension management and motivation to engage in physical activity. Subjective symptoms such as headaches and sleep disturbances also improved. The effectiveness of hypertension exercises in this study was achieved through a dose of exercise in the form of a frequency of 4 times per week with a duration of 30 minutes per session, which was proven to provide a significant reduction in blood pressure. This gymnastics program emphasizes light to moderate intensity aerobic exercise, which has been shown to help improve cardiovascular function and lower vascular resistance. This research contributes to the development of scientific evidence regarding the effectiveness of structured gymnastics programs in the management of hypertension in the elderly. These results confirm the importance of hypertension gymnastics as an integral part of primary care strategies for hypertensive elderly patients, emphasizing the importance of a tailored non-pharmacological approach to improve blood pressure control and overall quality of life.