DBP Levels Research Articles

Human biomonitoring reference values and characteristics of Phthalate exposure in the general population of Taiwan: Taiwan Environmental Survey for Toxicants 2013-2016.

Since a 2011 incident involving phthalate-tainted food, Taiwanese people have become concerned with food quality, and they are still being exposed to certain levels of phthalates. However, no nationwide human biomonitoring survey had been conducted to gather information on levels or reference values (RVs) of phthalates in the Taiwanese population. We aimed to establish the urinary levels and RVs of phthalate metabolites and identify exposure characteristics among Taiwan's population. We enrolled 1857 participants 7 years of age and older from the Taiwan Environmental Survey for Toxicants (TESTs) conducted during 2013-2016. Levels of 11 phthalate metabolites in each participant's urine samples were determined using liquid chromatography-tandem mass spectrometry. For all phthalate metabolites except for mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), and mono-ethylhexyl phthalate (MEHP), urinary median levels were significantly higher in the 7-17-year old group than in the ≧18-year-old group. For most phthalate metabolites and in the general population, the geometric mean decreased with increasing age. Median levels of MEP (19.55μg/L), mono-benzyl phthalate (MBzP) (2.11μg/L), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) (22.82μg/L), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEOHP) (16.08μg/L), ΣDibutyl phthalate metabolites (ΣDBPm) (0.17nmol/mL), Σdi-(2-ethylhexyl) phthalate metabolites (ΣDEHPm) (0.29nmol/mL) were higher in participants from central Taiwan than those from other areas. The median level of DBP (ΣDBPm: 0.20nmol/mL) was significantly higher in participants from harbor areas than those from other urbanization groups. The RV of the 95 percentile (P95) for phthalate metabolites in the 7-17/≧18-year-old groups were 185.95/208.19μg/L for MMP, 198.46/265.81μg/L for MEP, 119.85/69.99μg/L for mono-isononyl phthalate (MiBP), 165.19/204.32μg/L for Mono-n-butyl phthalate (MnBP), 15.61/11.73μg/L for MBzP, 62.09/59.23μg/L for MEHP, 149.70/69.66μg/L for MEHHP, 112.06/35.07μg/L for MEOHP, 195.20/93.83μg/L for mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), 45.66/27.69μg/L for mono-(2-carboxymethylhexyl) phthalate (MCMHP), and 9.09/12.13μg/L for mono-iso-nonyl phthalate (MiNP). We concluded that phthalate exposure of the general population in Taiwan varies by sex, age, region, and urbanization level. Exposure by the 7-17-year-old group to DMP, DBP, and DEHP in Taiwan remains higher than that of youth from other countries. RV of phthalate metabolites in Taiwan were established in the current study.

Sex differences in the antihypertensive treatment and risk of uncontrolled hypertension in 5308 hypertensive patients in the United Arab Emirates.

Sex differences in the antihypertensive medications used to control blood pressure and risk factor control in hypertensive patients is poorly understood. We conducted a retrospective review of the patients newly diagnosed with hypertension registered for treatment in 52 outpatient settings across Abu Dhabi province between 1 January and 31 December 2017. We explored sex differences in risk factors and treatment management over 6 months of the follow-up period of each patient. Multiple logistic regression models were used to identify factors associated with poor BP control. A total of 5308 patients (2559 men and 2849 women) were identified. We observed an increase in SBP and DBP levels in men (1.72/1.13 mmHg) and only SBP in women (0.87/-0.021 mmHg) with increased incidence of comorbidities overtime. The overall BP control was suboptimal (65%) (<140/90 mmHg) with no significant difference between women (65.3%) and men (64.2%). In men with dyslipidemia, use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with diuretics and in women, only calcium channel blockers showed higher for BP control. Factors significantly associated with poor BP control in men are being overweight and obese, and dyslipidemia in men. After the age of 50, women in contrast to men, with dyslipidemia and heart rate >80 beats per minute are less likely to maintain hypertension control. Sex-specific analysis indicated that BP control among United Arab Emirates men and women was suboptimal (65%). Interventions aiming to achieve better control of BP in hypertensive patients with metabolic syndrome should be emphasized.

A randomized, double-blind, placebo-controlled, clinical trial to evaluate the benefits of Nigella sativa seeds oil in reducing cardiovascular risks in hypertensive patients.

The efficacy, safety, and utility of Nigella sativa seeds oil as a complementary treatment for hypertension, glucose control, and lipid metabolism were evaluated. Hypertensive patients in the intervention (n = 26) and placebo (n = 29) groups received 2.5 ml of N. sativa seeds oil and sunflower oil twice daily for 8 weeks, respectively. The levels of systolic and diastolic blood pressure (SBP, DBP), blood lipid profile, and fasting blood sugar (FBS), at different stages of the treatment period (0, 3, 6, 8 weeks), and malondialdehyde (MDA) and glutathione reductase (GR), at the baseline and end of the study, were assessed. SBP level in the intervention group was significantly reduced, compared with the baseline values (p < .001) and the placebo group (p < .05). A significant decline was observed in the levels of DBP, total cholesterols, and low density lipoprotein (LDL) (p < .000), MDA, and FBS (p < .001); also, a significant increase was observed in the levels of high density lipoprotein (HDL) and GR (p < .001). The use of N. sativa seeds oil as an adjunct to common medications exhibited additional antihypertensive effects as well as beneficial effects on glucose control and lipid metabolism in hypertensive patients with no renal, hepatic, and patient-reported adverse events.

Vitamin D Metabolism Is Significantly Impaired in COVID-19 Inpatients

Objective: to assess the state of vitamin D metabolism in patients hospitalized with COVID-19 infection. Materials and methods: We examined 49 patients, which were hospitalized for inpatient treatment of COVID-19 infection from May to June 2020. Study group included 24 men (49%) and 25 women (51%), median age 58 years [48; 70], BMI 26.4 kg/m2 [24.3; 30.5]. All patients were diagnosed with pneumonia due to SARS-CoV-2 with median percent of lung involvement equal to 29% [14; 37], 22 patients (45%) required oxygen support upon admission. Median SpO2 was equal to 95% (92; 97), median NEWS score was equal to 3 [2; 6]. Participants were tested for vitamin D metabolites (25(OH)D3, 1,25(OH)2D3, 3-epi-25(OH)D3, 24,25(OH)2D3 and D3) by UPLC-MS/MS, free 25(OH)D and vitamin D-binding protein by ELISA, as well as PTH by electrochemiluminescence immunoassay and routine biochemical parameters of blood serum (calcium, phosphorus, albumin) at the time of admission. Results: patients had in general very low 25()D3 levels - median 10.9 ng/mL [6.9; 15.6], corresponding to a pronounced vitamin D deficiency in half of the patients. Levels of 24,25(OH)2D3 were also low – 0.5 ng/mL [0.2; 0.9], and resulting vitamin D metabolite ratios (25(OH)D3/24,25(OH)2D3) were high-normal or elevated in most patients – 24.1 [19.0; 39.2], indicating decreased activity of 24-hydroxylase. Levels of 1,25(OH)2D3, on the contrary, were high-normal or elevated - 57 pg/mL [46; 79], which, in accordance with 25(OH)D3/1,25(OH)2D3 ratio (219 [134; 266]) suggests an increase in 1α-hydroxylase activity. Median level of 3-epi-25(OH)D3 was 0.7 ng/mL [0.4; 1.0] and D3 metabolite was detectable only in 6 patients. Median DBP level was 432 mg/L [382; 498], median free 25(OH)D was 5.6 pg/mL [3.3; 6.7], median calculated free 25(OH)D was 2.0 pg/mL [1.4; 3.3]. Most patients had albumin-adjusted serum calcium level in the lower half of reference range (median 2.24 mmol/L [2.14; 2.34]). Seven patients had secondary hyperparathyroidism and one patient had primary hyperparathyroidism, the rest of the patients had PTH levels within the normal range.25(OH)D3 levels showed significant negative correlation with percent of lung involvement (r = -0.36, p<0.05) and positive correlation with SpO2 (r = 0.4, p<0.05). 1,25(OH)2D3 levels correlated positively with 25(OH)D3 levels (r = 0.38, p<0.05) and did not correlate significantly with PTH levels (p>0.05). Conclusion: Our data suggests that hospitalized patients with COVID-19 infection have significant impairment of vitamin D metabolism, in particular, an increase in 1α-hydroxylase activity, which cannot be fully explained by pre-existing conditions such as vitamin D deficiency and secondary hyperparathyroidism. The observed profound vitamin D deficiency and association of vitamin D levels with markers of disease severity indicate the importance of vitamin D supplementation in these patients.

PREVALENCE OF ARTERIAL HYPERTENSION AND CHARACTERISTICS OF NOCTURNAL BLOOD PRESSURE PROFILE OF ASTHMA PATIENTS ACCORDING TO THERAPY AND SEVERITY OF THE DISEASE: THE BADA STUDY

Objective: Several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects. Available data reports that asthmatics were 36 to 43 % more likely to have high blood pressure than non-asthmatics. None of these studies evaluated the event of an unrecognized hypertension and/or the 24-hours blood pressure profile of asthmatic patients through an Ambulatory Blood Pressure Monitoring (ABPM). Design and method: The BADA (Blood pressure levels, clinical features and markers of subclinical cArdiovascular Damage of Asthma patients) Study is aimed to evaluate the prevalence of the cardiovascular comorbidities of asthma and their impact on the clinical outcome. In this pilot study forty patients affected by asthma were consecutively recruited. Forty consecutive individuals referring for ambulatory examination due to medical reasons different from respiratory diseases served as the control group. Main exclusion criteria were the presence of other respiratory diseases, current smoking, any contraindication to ABPM. Results: The overall percentage of asthmatics having also hypertension was 75 % (30 patients) vs 45 % (18 patients) of the control group (p: 0,012). Reduced level of FEV1 (but neither inhaled steroid therapy or other asthma-related factors) was associated to newly-diagnosed hypertension (p: 0.0002), higher day SBP levels (p: 0.003), higher day DBP levels (p: 0.03), higher 24h-SBP levels (p: 0.005) and higher 24h-DBP levels (p: 0.03). A comparison of nocturnal dipping patterns between asthmatics and controls, do not found any statistically significant differences between the two groups. The regression analysis performed taking into account sex, age, diabetes, fasting glucose, Body Mass Index confirms the independent role played by asthma towards the overall hypertension (both already note adn newly diagnosed): Odds Ratio (OR): 3.66 (CI: 1.29–11.1). Conclusions: Arterial hypertension in asthma is more prevalent than how supposed before, emphasizing the need for a deeper cardiovascular screening for asthma patients. In particular, our data highlights the need for a more extensive use of ABPM.

PREDICTORS OF THE SUPERNOVA (SUPERNORMAL VASCULAR AGING) PHENOMENON IN POPULATION-BASED SAMPLE

Objective: It is known that chronological age can be different from biological age. Supernormal vascular aging (SUPERNOVA) - can be diagnosed in subjects who present an exceptionally low arterial stiffness for their age. The aim of our study was to identify the factors associated with the SUPERNOVA in subjects from population-based Saint Petersburg sample. Design and method: As a part of all-Russian epidemiology survey ESSE-RF random sampling of 1600 Saint-Petersburg inhabitants stratified by age and sex was recruited. Anthropometry, blood pressure measurement and fasting blood-tests: glucose, lipids, C-reactive protein, insulin was performed according to standard protocols. HOMA IR was used as a marker of insulin resistance. Carotid–femoral pulse wave velocity (PWV) was performed by SphygmoCor (AtCor). SUPERNOVA phenomenon was detected in case of equal or less than 10 percentile of PWV for healthy individuals in each age group [European Heart Journal. 2010. Vol. 31. P. 2338–2350]. Results: PWV was performed in 524 individuals, SUPERNOVA was revealed in 55 (10.5%). Cardiovascular (CV) risk predictors were compared in different age groups. In the group of people 25–39 years old, there were no significant differences in CV risk factors between subjects with the SUPERNOVA and other persons. In the group of 40–49 years old, individuals with SUPERNOVA had significantly lower SBP (p = 0.036), BMI (p = 0.042), HDL (p = 0.021) comparing with others. In the 50–59 years old, among SUPERNOVA subjects there were more often females (p = 0.029), significantly lower were: SBP (p = 0.032), BMI (p = 0.009), HDL (p = 0.002), HOMA IR (p = 0.039) and higher adiponectin (p = 0.045). In the oldest age group: 60–69 years old, those with SUPERNOVA also had significantly lower SBP (p = 0.006) and DBP (p = 0.005), total cholesterol (p = 0.009), LDL (p = 0.016), triglycerides (p = 0.025) and significantly higher adiponectin (p = 0.014). Conclusions: It seems that at young age the presence of the SUPERNOVA phenomenon is not determined by the presence of traditional CV risk factors. Starting from middle age (&gt; = 40 years old) such factors as female gender, SBP, BMI, HDL and adiponectin is associated with supernormal vascular aging. In the oldest group the levels of both SBP and DBP, lipids acquire the greatest importance for the presence of SUPERNOVA.

ASSOCIATIONS OF RENALASE WITH BLOOD PRESSURE AND THE RISK OF HYPERTENSION IN CHINESE ADULTS

Objective: Renalase, a novel secretory flavoprotein with amine oxidase activity, is secreted into the blood by the kidneys and is hypothesized to participate in catecholamine metabolism. The aim of the study was to investigate the associations of renalase with blood pressure (BP) and the risk of hypertension from three perspectives of genetic variations, serum and kidney levels in humans. Design and method: 1. A total of 515 Chinese participants from 124 families were eligible for this study. We followed up this cohort in 2009, 2012 and 2018, respectively. 10 SNPs in renalase gene were genotyped to examine the associations with longitudinal BP changes and incident hypertension during 14 years of follow-up. 2. 2342 participants from the Hanzhong Adolescent Hypertension Study cohort who were followed up in 2017 were included. Cross-sectional analysis was used to examine the relationships between serum renalase and the risk of hypertension. 3. 204 patients undergoing renal biopsy were recruited from our hospital. Expression of renalase in renal biopsy specimens were measured by immunohistochemistry (IHC). Results: 1. During 14 years of follow-up, 160 (53.9%) participants developed hypertension. renalase SNPs rs10887800, rs796945, rs1935582, rs2296545 and rs2576178 were significantly associated with 14-year change in DBP while SNP rs7922058 was associated with longitudinal SBP change. In addition, SNPs rs796945, rs1935582 and rs2576178 were significantly associated with hypertension incidence over 14 years. Gene-based analysis found that renalase was significantly associated with hypertension incidence over 14-year follow-up. 2. Hypertensive subjects have higher levels of serum renalase than in the normotensive subjects. Serum renalase showed a linear association with increased BP (24.8, 25.6, 27.1, and 27.7 ug/mL for subjects with normotension, prehypertension, stage 1 and stage 2 hypertension). In addition, serum renalase [1.018 (1.006–1.030)] was significantly associated with the risk of hypertension in 2392 Chinese subjects. 3. The levels of SBP and DBP were positively correlated with the level of renalase in renal tubular epithelial cells (RTEC). The RTEC renalase expression was decreased in hypertensive patients compared to non-hypertensive patients. Conclusions: These findings indicate that renalase may play an important role in BP progression and development of hypertension.

LEVELS OF IMMUNOGLOBULIN G AND MARKERS OF VASCULAR INFLAMMATORY RESPONSE AS PREDICTORS OF POSSIBLE VASCULAR COMPLICATIONS IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER SARS-COV-2

Objective: To investigate the level and relationship of specific immunoglobulin G (IgG) antibodies to SARS-CoV-2 with laboratory parameters of vascular inflammatory response (VIR) during follow-up of patients with arterial hypertension (AH) in 3 months after disease onset. Design and method: Retrospective, single-center observational study included 76 confirmed cases of COVID-19 associated with pneumonia (April-May 2020). Gr.1 consisted of 32 patients without AH; Gr.2 involved 44 AH patients, including 18 patients with metabolic disorders (abdominal obesity and impaired carbohydrate metabolism). Complete blood count, biochemical and hemostatic parameters were determined on the day of admission. Comprehensive analysis of clinical instrumental and laboratory parameters, including blood pressure, heart rate, IgG (positivity rate), cytokines, NT-pro BNP, endothelial dysfunction markers, cystatin C, glucose and others was performed in 3 months after discharge. Results: In Gr.1, IgG was negatively associated with hemoglobin, red blood cell volume, neutrophils, creatine phosphokinase, homocysteine, those were supplemented by NT-pro BNP, interleukin-6, lactate dehydrogenase, creatinine (p &lt; 0.0001–0.034) in Gr.2 and additionally, D-dimer level, transforming growth factor and P-selectin (p &lt; 0.001–0.036) in metabolic disorders subgroup. Therewith, in patients aged over 40 years, positive association of IgG with levels of SBP and DBP (p &lt; 0.011 and 0.034), MDRD (p &lt; 0.01) was registered. Correlation and regression analysis revealed greater association of IgG level &lt; 12.9 with vascular inflammatory markers, and IgG level &gt; 12.9 with thrombogenic parameters. Conclusions: IgG might be a sensitive indicator of VIR and can play a role in predicting possible unwanted vascular complications in AH patients after suffering from SARS-CoV-2.

Different impact factors for accurate oscillometric blood pressure measurement between sinus rhythm and atrial fibrillation.

This study was conducted to evaluate whether the impact factor on the accuracy of oscillometric blood pressure (BP) is different between the patients with atrial affiliation (AF) and sinus rhythm (SR). This study included 124 AF patients and 98 SR patients who underwent coronary arteriography. Upper arm oscillometric and intro-aortic BP were simultaneously measured three times, and the averages were recorded as final values, respectively. The difference between oscillometric and intro-aortic BP was recorded as delta BP. For reducing the influence of baseline BP on delta BP, a percentage difference (PD-BP) was calculated with the formula: PD-BP = delta BP/intro-aortic BP × 100%. The oscillometric SBP and DBP levels slightly underestimated intro-aortic BP (by 2.2/1.6 mmHg) in the SR group, but significantly underestimated (by 5.8/4.8 mmHg) in the AF group. Age was negatively correlated with delta SBP and positively with delta DBP in SR patients, but not correlated in AF patients. Otherwise, ventricular rate (VR) was negatively correlated with delta SBP or delta DBP in AF, which indicated that the accuracy of oscillometric BP declined as the VR increased. With intro-aortic BP as reference, the accuracy of oscillometric BP in AF patients is lower than SR patients. Meanwhile, age may impact the oscillometric BP accuracy in SR patients, but VR may impact that in AF patients.

Вплив засобів фізичної терапії на показники діяльності серцево-судинної системи, метаболізму та психоемоційного статусу осіб похилого віку з метаболічним синдромом та старечою астенією

An increase in the prevalence of insulin resistance in the elderly, associated with physiological changes in carbohydrate metabolism during the aging process, is associated with a high risk of cardiovascular accidents and endocrine diseases. This problem requires a solution by healthcare professionals with medication and non-medication. The purpose of the study was to determine the effectiveness of the program of physical therapy by the dynamics of indicators of the cardiovascular system, carbohydrate and lipid metabolism, psychoemotional status of elderly people with frailty and metabolic syndrome. Material and methods. 96 elderly people were examined. The control group consisted of persons without metabolic syndrome and without frailty. The main group 1 consisted of patients with metabolic syndrome and frailty with a low level of therapeutic alliance who did not want to cooperate with a physical therapist and / or actively improve their health on their own. The main group 2 included patients who agreed to undergo a developed program of physical therapy (a high level of therapeutic alliance) using kinesitherapy, massage, nutritional correction, education of the patient and his family, elements of cognitive training and occupational therapy for 1 year. The effectiveness of the program was assessed by the dynamics of systolic and diastolic blood pressure, heart rate, Kvass endurance coefficient, Baevsky's adaptive potential, Robinson's index, physical performance (based on the results of a 6-minute test), carbohydrate parameters (fasting blood glucose and after glucose load) and lipid (concentration of cholesterol, triglycerides, high density lipoproteins) metabolism, the level of depression according to the GDS-15 questionnaire. Results and discussion. In elderly people with frailty and metabolic syndrome, a statistically significant (p &lt;0.05) deterioration in the parameters of the functioning of the cardiovascular system (according to the levels of DBP, heart rate at rest, Kvass endurance coefficient, Baevsky's adaptive potential, Robinson's index), physical performance (according to the results of a 6-minute test - distance, severity of fatigue, shortness of breath, cardialgia), biochemical parameters (fasting hyperglycemia, impaired glucose tolerance, atherogenic dyslipidemia), psycho-emotional state (depression) from their peers. The use of physical therapy tools led to a statistically significant improvement (p &lt;0.05) of all the studied parameters of the functioning of the cardiovascular system, biochemical parameters in elderly people with metabolic syndrome and frailty, an increase in their physical performance, and an improvement in psycho-emotional status. A low level of therapeutic / rehabilitative alliance led to unsatisfactory fulfillment or non-fulfillment of the recommendations provided by patients and is associated with a lack of improvement in the state of the cardiovascular system, physical performance, age-associated depression. Conclusion. It is advisable to include physical therapy means in the rehabilitation programs for elderly patients with comorbid pathology like frailty and metabolic syndrome for the prevention of cardiovascular accidents

Association between Baseline SBP/DBP and All-Cause Mortality in Residents of Shanxi, China: A Population-based Cohort Study from 2002 to 2015

ObjectiveTo investigate the association between blood pressure and all-cause mortality in Shanxi, China. MethodsThe ‘2002 China Nutrition and Health Survey’ baseline data in Shanxi province was used. A retrospective investigation was performed in 2015. The effects of SBP and DBP on the all-cause mortality were analyzed using the Cox regression model. The hazard ratio (HR) and 95% confidence interval (CI) were estimated by the sex and age groups. ResultsThe follow-up rate was 76.52% over 13 years, while the cumulative mortality rate for all participants was 917.12/100,000 person-years. The mortality rose with an increasing SBP (χ2trend = 270.537, P < 0.001) or DBP level (χ2trend = 57.240, P < 0.001). After adjustment for the confounding factors, a significant association between mortality and high SBP (≥ 160 mmHg) and high DBP (≥ 100 mmHg), with adjusted HR ranging from 1.405- to 2.179-fold for SBP and 1.550- to 2.854-fold for DBP, was noted. Significant HRs for most DBP subgroups were found in > 60-year-old participants. Males with DBP ≥ 100 mmHg had a significantly higher mortality, with an HR (95% CI) of 2.715 (1.377–5.351). ConclusionAdults with SBP > 160 mmHg and DBP > 100 mmHg had a higher mortality risk. Sex and age difference was noted in both DBP and mortality risk.

Insulin Resistance and Non-Alcoholic Fatty Liver Disease in Premenopausal Women with Metabolic Syndrome.

It is suggested that estrogen protects premenopausal women against non-alcoholic fatty liver disease. From another perspective, the relation between metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD) is bidirectional. Role of insulin resistance (IR) in NAFLD continues to be a matter of debate. The present study aimed to assess the relation between IR and NAFLD in premenopausal women with MetS. The study included 51 premenopausal women with MetS. In addition, there were 40 age-matched healthy controls. All participants were subjected to careful history taking and thorough clinical examination. Performed laboratory investigations included fasting blood glucose, fasting insulin, lipid profile, and liver functions. Calculation of IR was achieved by the Homeostasis Model Assessment (HOMA-IR). NAFLD was graded into three grades according to findings of abdominal ultrasound. Patients had significantly higher BMI, SBP, DBP, FBG, fasting insulin, HOMA-IR, total cholesterol, triglycerides, and LDL levels when compared with controls. They also had significantly lower HDL levels in comparison to controls. Moreover, they have more advanced grades of NAFLD in contrast to controls. Comparison between patients with various grades of NAFLD regarding the clinical data revealed significant increase of fasting insulin and HOMA-IR levels with advancing NAFLD grade. Using multivariate regression analysis, HOMA-IR was an independent predictor of advanced NAFLD grade. In conclusion, the present study documented a combined inter-relation between MetS, IR, and NAFLD in premenopausal women with MetS. IR is correlated with NAFLD grade.

The high blood pressure in patients with Parkinson's disease

To evaluate the relationships between blood pressure (BP), duration of the high BP, reaction of the cardiovascular system on the physical load with the duration of Parkinson's disease (PD) and motor disorders in PD patients. Fifty-six women with PD and high BP in the anamnesis and 91 women with arterial hypertension, stage 1 were included in the study. The groups of the patients did not differ by age (67.14±7.75 vs. 67.24±5.70 years; p>0.05). The patients were asked about the duration of high BP, the maximal systolic and diastolic BP (SBP and DBP) and presence of antihypertensive therapy, the patients with PD were additionally asked about the duration of the disease, the medicine for PD treatment, the vegetative dysfunction features. The assessment of the orthostatic reaction was determined by transition of the patient from the supine position to the sitting position. Three types of the reaction were isolated: normal, orthostatic hypotension and hypertension. The assessment of motor function in patients with PD was performed using MDS UPDRS, part III. Before and after the orthostatic test, patients with PD and history of arterial hypertension showed normal SBP and DBP levels, while those with isolated hypertension had elevated mean BP corresponding to the high-normal level: the difference in BP levels between the two groups was significant (134.89±17.19 vs. 124.64±18.19 mm Hg; p<0.05; 130.43±19.88 vs. 122.80±19.08 mm Hg; p<0.05). Patients with isolated hypertension were less likely to receive BP-lowering treatment - 30 (32.61%) vs. 10 (18.87%); p=0.04. There were no differences in the frequency of hypertensive and orthostatic reactions between the groups. The total score of motor disorders in patients with PD was correlated with the duration of high BP (R= -0.26; p=0.04). Among the patients with PD, 37 had hypertension prior to the neurologic disorder, 7 were diagnosed with two diseases simultaneously, while the remaining 12 had PD as the initial diagnosis, developing hypertension later in life. The score of the points of the motor disturbances was greater in patients who had developed two diseases simultaneously with the simultaneous developing of the illnesses (15.88±9.36 vs. 19.84±8.01 vs. 26.14±9.68; p<0.05, χ2=10.47, df=2). The development of arterial hypertension in patients with PD aggravates the disease.

The role of serum monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) in cardiovascular disease risk.

Free fatty acids (FFA) observed as independent risk factors of cardiovascular diseases (CVD). In this study we investigated FFA levels in patients with CVD, and its risk factors. In this case-control study, 214 patients experienced coronary angiography and 222 healthy subjects were enrolled. Participants were categorized into two groups: who had >50% and <30% stenosis were assigned to the angiogram positive (N=90) and negative (N=124) group, respectively. Several risk factors were assessed and the levels of FFAs were determined using gas chromatography. Serum FFA concentrations were compared between healthy and patients with positive and negative angiograms. The association of serum FFA levels with four major risk factors (hypertension, FBG level, high BMI and WHR) were also assessed. Our data showed that median of FFAs was higher in patients than healthy subjects (p<0.0001), such as SFA and n6-FFAs (in patients; 1.59 (1.27) and 1.22 (1.06) and in healthy subjects 0.33 (0.38) and 0.36 (0.35), respectively). According to anthropometric and biochemical data, there were not statistical differences between the groups, except FBG, SBP and hs-CRP that showed significantly higher levels in patients than controls (p<0.0001, p=0.001). Also, lower median levels of total cholesterol, LDL-C, HDL-C and DBP were observed in patients which can due to lipid-lowering medication use like Statins. High serum levels of FFAs are considered as an independent risk factor for CVDs, while various types of FFAs can have different influences on CVD risk factors. Therefore, longitudinal studies are needed to clarify the association between FFAs and CVD risk factors. (www.actabiomedica.it)

Effect of Magnesium Sulfate Nebulization on Stress Response Induced Tracheal Intubation; Prospective, Randomized Study

Background and Aims: Multiple, nonpharmacological and pharmacological measures have been used for attenuating stress response of intubation with variable results. N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inflammation. NMDA receptors are located in peripheral and the central nervous system. Magnesium is also a NMDA receptor blocker. Aim of the Study: To evaluate the effect of nebulized magnesium sulfate on reduce the stress response induced tracheal intubation Material and Methods: Following institutional ethical committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 100 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologists (ASA) status 1 or 2 undergoing elective surgery requiring tracheal intubation. Patients will be recruited in the study divided into two equal groups; Patients in Group A: will receive nebulized magnesium sulfate in 3 ml (240 mg) over 15 min. While group B: will receive nebulized normal saline in 3 ml over 15 min, ending 5 min before the induction of anesthesia. SBP, DBP, HR, and blood glucose level will be measured at the following intervals; Baseline (before induction), after premedication (sedation), after induction, after ETT intubation, 3 min later, 6 min later. Results: Preoperative magnesium sulfate nebulization has a significant effect (p value Conclusion: Magnesium sulfate significantly reduces the stress response of intubation.

Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records

ObjectiveThe objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals...

Associations Between Patient Health Outcomes and Secure Message Content Exchanged Between Patients and Clinicians: Retrospective Cohort Study.

BackgroundThe number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes.ObjectiveTo examine associations between patients’ and clinicians’ message content and changes in patients’ health outcomes.MethodsWe applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff–generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension.ResultsPatients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (β=–.30; 95% CI –0.56 to –0.04), as were staffs’ action responses (β=–30; 95% CI –0.58 to –0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients’ complaints (β=–4.03; 95% CI –7.94 to –0.12). Deferred information sharing by clinic staff was associated with increased SBP (β=1.29; 95% CI 0.4 to 2.19).ConclusionsThis is the first research to find associations between message content and patients’ health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes.

Relationship between blood pressure and kidney diseases in large randomized controlled trials: secondary analyses using SPRINT and ACCORD-BP trials.

Hypertension is a risk factor for acute kidney injury. In this study, we aimed to identify the optimal blood pressure (BP) targets for CKD and non-CKD patients. We analyzed the data of the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) to determine the nonlinear relationship between BP and renal disease development using the Generalized Additive Model (GAM). Optimal systolic BP/diastolic BP (SBP/DBP) with lowest renal risk were estimated using GAM. Logistic regression was employed to find odds ratios (ORs) of adverse renal outcomes by three BP groups (high/medium/low). Both study trials have demonstrated a "U"-shaped relationship between BP and renal outcomes. For non-CKD patients in SPRINT trial, risk of 30% reduction in eGFR among intensive group patients with DBP ≤ 70 mmHg was significantly higher than the group with DBP between 71 and 85 mmHg (OR = 2.31, 95% CI = 1.51-3.53). For non-CKD patients in ACCORD trial, risk of doubling of serum creatinine (SCr) or >20 mL/min decrease in eGFR among intensive group patients with DBP ≤ 70 mmHg was significantly higher than the group with DBP between 71 and 85 mmHg (OR = 1.49, 95% CI = 1.12-1.99). For CKD patients in SPRINT trial, there are no significant differences in renal outcomes by different SBP/DBP levels. Our analysis of both SPRINT and ACCORD datasets demonstrated that lower-than-optimal DBP may lead to poor renal outcomes in non-CKD patients. Healthcare providers should be cautious of too low DBP level in intensive BP management due to poor renal outcomes for non-CKD patients.

Effect of High-Intensity Interval Training on Body Composition, Cardiorespiratory Fitness, Blood Pressure, and Substrate Utilization During Exercise Among Prehypertensive and Hypertensive Patients With Excessive Adiposity.

Regular exercise training is a recognized lifestyle strategy to lower resting blood pressure (BP), but little is known about substrate metabolism in population with high BP. Thus, the purpose of this study was to investigate the effects of 16-weeks of HIIT on body composition, BP, cardiorespiratory fitness by O2max, and substrate utilization during exercise among prehypertensive and hypertensive patients with excessive adiposity. We also aimed to test the potential association between changes in cardiorespiratory fitness, substrate utilization during exercise and BP. Forty-two physically inactive overweight/obese participants participated in 16-weeks of HIIT intervention. The HIIT frequency was three times a week (work ratio 1:2:10, for interval cycling: rest period: repeated times; 80–100% of the maximum heart rate). Groups were distributed based on their baseline BP: HIIT-hypertensive (H-HTN: age 47.7 ± 12.0 years; body mass index [BMI] 30.3 ± 5.5 kg/m2; systolic [SBP]/diastolic BP [DBP] 151.6 ± 10/81.9 ± 4.2 mmHg), HIIT-pre-hypertensive (H-PreHTN: age 37.6 ± 12.0 years; BMI 31.9 ± 5.3 kg/m2; SBP/DBP 134.4 ± 3.2/74.9 ± 7.0 mmHg), and a normotensive control group (H-CG: age 40.7 ± 11.0 years; BMI 29.5 ± 4.2 kg/m2; SBP/DBP 117.0 ± 6.2/72.4 ± 4.1 mmHg). Anthropometry/body composition, BP, and metabolic substrate utilization during exercise (fat [FATox], carbohydrate [CHOox] oxidation, respiratory exchange ratio [RER], and O2max), were measured before and after the 16-week HIIT intervention. Adjusted mixed linear models revealed a significant improved in O2max were + 3.34 in the H-CG, + 3.63 in the H-PreHTN, and + 5.92 mL⋅kg–1⋅min–1, in the H-HTN group, however, the Time × Group interaction were not significant (p = 0.083). All the exercise types induced similar decreases on SBP (−8.70) in the H-HTN, (−7.14) in the H-CG, and (−5.11) mmHg in the H-PreHTN, as well as DBP levels (−5.43) mmHg in H-CG group (p = 0.032 vs. H-HTN group). At 16-week, no significant correlations were noted for the changes of blood pressure, cardiorespiratory fitness or exercise metabolism substrates outcomes. In conclusion, our results suggest that a 16-week HIIT-intervention improved O2max and blood pressure BP, but these changes are independent of substrate utilization during exercise in normotensive and hypertensive participants with excessive adiposity.

Evaluation of the relationship between pseudo-hypertension and the parameters of subclinical atherosclerosis.

Methods using for determining the subclinical atherosclerosis have gained growing interest in the recent years. However, the effects of pseudo-hypertension on the parameters of subclinical atherosclerosis are uncertain. We aimed to evaluate the relationship between pseudo-hypertension and subclinical atherosclerosis in individuals diagnosed with pseudo-hypertension. A total of 122 patients who underwent radial elective coronary angiography were included in the present study. These patients were divided into two groups based on the difference between invasive and noninvasive blood pressure (BP) measurements: pseudo-hypertension group who had a difference ≥15 mmHg in SBP or ≥10 mmHg in DBP levels between invasive and noninvasive measurements (n = 28), and the other group who did not have any difference as described on these levels (n = 94). In order to evaluate the subclinical atherosclerosis; flow-mediated dilatation (FMD), carotid intima-media thickness (IMT), pulse wave velocity (PWV), and augmentation index were recorded in all patients. Two groups were compared with respect to these parameters. The median age of the pseudo-hypertension group was 76 years, while the median age of the other group was 63.5 years (P < 0.0001). The incidence of concomitant hypertension was higher in the pseudo-hypertension group as compared to the other group (P < 0.001). There was a significant difference in augmentation index, cardiac output, PWV, FMD, and IMT values between two groups (P = 0.016, P = 0.023, P <0.001, P < 0.001, P < 0.001, respectively). The present results demonstrated that there was a strong correlation between pseudo-hypertension and the parameters of subclinical atherosclerosis; augmentation index, PWV, FMD, and carotids IMT.