Lower Systolic Blood Pressure Research Articles

Sequential Treatment of Acute Heart Failure in the Elderly: Efficacy of Recombinant Human Brain Natriuretic Peptide and Sacubitril-Valsartan

Objective: To explore the clinical efficacy of recombinant human brain natriuretic peptide (rhBNP) and sacubitril-valsartan in the sequential treatment of acute heart failure (AHF) in older individuals. Methods: Clinical data from 64 older patients with AHF were collected for this study. The patients were divided into two groups: a control group (Group A, n = 34) and an observation group (Group B, n = 30) based on different treatment regimens. Group A received rhBNP treatment, while Group B received sequential treatment with rhBNP and Sacubitril-Valsartan. The evaluation of the sequential treatment’s effect on older patients with AHF was conducted using various indicators. Results: The clinical efficacy rate in Group A (93.33%) was significantly higher than that in Group A (73.53%), with a significant difference observed (P < 0.05). Furthermore, after treatment, the clinical efficacy remained significantly higher in Group B than in Group A. Group B exhibited a significantly higher left ventricular ejection fraction (LVEF) and significantly lower systolic blood pressure, diastolic blood pressure, and heart rate compared to Group A (P < 0.05). Although the left ventricular end-diastolic diameter (LVEDD) was lower in Group B after treatment, the difference was not statistically significant (P = 0.127). Moreover, post-treatment levels of NT-proBNP were significantly lower in Group B compared to Group A (P = 0.01). Additionally, Group B had shorter hospitalization times, faster improvement in clinical symptoms, and further 6-minute walking distances after the treatment compared to Group A (P < 0.01). Conclusion: Sequential treatment with rhBNP and Sacubitril-Valsartan demonstrates promising therapeutic effects in older patients with AHF, suggesting its potential for broader adoption and promotion in clinical practice.

Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre-frailty or frailty status.

In patients with hypertension and pre-frailty or frailty, the influence of systolic (SBP) and diastolic blood pressure (DBP) time in target range (TTR) on clinical outcomes is unclear. Thus, we conducted a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Classifying 4208 participants into frail and non-frail groups using a frailty index, the study calculated blood pressure time in target range (BP-TTR) for the first three months using the Rosendaal method. The primary endpoint included a composite of nonfatal myocardial infarction (MI), acute coronary syndromes, stroke, acute decompensated heart failure (ADHF), and cardiovascular death. Relationships between BP-TTR and outcomes were analyzed using Kaplan-Meier curves, Cox models, and restricted cubic spline curves, with subgroup analysis for further insights. In a median follow-up of 3.17 years, primary outcomes occurred in 6.7% of participants. Kaplan-Meier analysis showed that a lower systolic blood pressure time in target range (SBP-TTR) (0%-25%) correlated with an increased cumulative incidence of the primary outcome (p<.001), nonfatal MI (P=.021), stroke (P=.004), and cardiovascular death (P=.002). A higher SBP-TTR (75%-<100%) was linked to a reduced risk of these outcomes. The restricted cubic spline (RCS) curve revealed a linear association between SBP-TTR and the primary outcome (non-linear P=.704). Similar patterns were observed for diastolic blood pressure time in target range (DBP-TTR). Subgroup analysis showed that the protective effect of higher SBP-TTR was less pronounced at low DBP-TTR levels (P for interaction=.023). In conclusion, this study highlights the importance of maintaining BP within the target range to mitigate cardiovascular risks in this population.

Comparison of Low-Frequency or High-Frequency Electrical Acupoint Stimulation on Hypotension After Spinal Anesthesia in Parturients: A Prospective Randomized Controlled Clinical Trial.

Objective: To investigate whether transcutaneous electrical acupoint stimulation (TEAS) at PC6 could reduce hypotension after spinal anesthesia (SA) in parturients and to compare the effect of TEAS at different frequencies. Methods: From February 20, 2023, to August 29, 2023, 90 parturients scheduled for c-section under SA were randomly assigned to receive no treatment (Control), TEAS at high frequency (TEAS-HF), or TEAS at low frequency (TEAS-LF). Treatments started immediately after SA and lasted for 30 min. The primary endpoint was incidence of hypotension by 30 min after SA. Secondary endpoints included lowest systolic blood pressure (SBP) during 30 min after SA, dose of ephedrine, dose of atropine, Apgar score at 1 min, and adverse events, including nausea, vomiting, dizziness, dyspnea, and chest congestion. Results: In the TEAS-HF group, the incidence of hypotension by 30 min after SA was lower (13.3%) than in the Control (53.3%, p = 0.001; OR 1.9, 95% confidence interval [CI]: 1.2-2.8) and TEAS-LF group (40.0%, p = 0.02, OR 1.4, 95% CI: 1.0-2.0). The lowest SBP during 30 min after SA was higher in the TEAS-HF group (100.0 ± 9.4 mm Hg) than in the Control group (91.5 ± 16.5 mm Hg) and TEAS-LF group (93.9 ± 16.6 mm Hg). Patients who received TEAS showed a lower score of nausea and vomiting (both p = 0.02). Patients in the group TEAS-HF showed a lower incidence of dizziness, dyspnea, and of chest congestion than those in the other two groups. There was no difference with respect to atropine consumption and neonatal Apgar score. Conclusions: TEAS-HF at PC6 reduced hypotension after SA in parturients, while TEAS-LF did not. Trial registration: ClinicalTrials.gov (NCT05724095).

Lower autonomic arousal as a risk factor for criminal offending and unintentional injuries among female conscripts.

Lower autonomic arousal is a well-known correlate of criminal offending and other risk-taking behaviors in men, but few studies have investigated this association in women. To test associations between autonomic arousal and criminal offending as well as unintentional injuries among female conscripts. All women born 1958-1994 in Sweden who participated in voluntary military conscription (n = 12,499) were identified by linking Swedish population-based registers. Predictors were resting heart rate (RHR) and systolic blood pressure (SBP). Covariates were height, weight, and physical energy capacity. Main outcomes were criminal convictions (any, violent, and non-violent) from the National Crime Register. Secondary outcome was unintentional injuries requiring medical treatment or causing death. We used survival analyses to test for associations between predictors and outcomes. Low RHR, relative to high RHR, was associated with an increased risk of any criminal conviction, non-violent criminal convictions, and unintentional injuries. Low SBP, relative to high SBP, was associated with an increased risk of violent criminal convictions. Results support lower autonomic arousal, particularly lower RHR, as a correlate of criminal offending among women that warrants further examination, as the reported findings have potential implications for the prediction of future female crime.

Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular disease.

Fixed-dose combination (FDC) therapy, also known as polypill therapy, targets risk factors for atherosclerotic cardiovascular disease (ASCVD) and has been proposed as a strategy to reduce global ASCVD burden. Here we conducted a systematic search for relevant studies from 2016-2022 to assess the effects of FDC therapy for prevention of ASCVD. The studies selected include randomized trials evaluating FDC therapy with at least one blood pressure-lowering drug and one lipid-lowering drug. The study data were independently extracted, the quality of evidence was appraised by multiple reviewers and effect estimates were pooled using a fixed-effect meta-analysis when statistical heterogeneity was low to moderate. The main outcomes of the analysis were all-cause mortality, fatal and nonfatal ASCVD events, adverse events, systolic blood pressure, low-density lipoprotein cholesterol and adherence. Among 26 trials (n = 27,317 participants, 43.2% female and mean age range 52.9-76.0), FDC therapy was associated with lower low-density lipoprotein cholesterol and systolic blood pressure, with higher rates of adherence and adverse events in both primary and mixed secondary prevention populations. For studies with a mostly primary prevention population, FDC therapy was associated with lower risk of all-cause mortality by 11% (5.6% versus 6.3%; relative risk (risk ratio) of 0.89; 95% confidence interval 0.78 to 1.00; I2 = 0%; four trials and 16,278 participants) and risk of fatal and nonfatal ASCVD events by 29% (6.1% versus 8.4%; relative risk (risk ratio) of 0.71; 95% confidence interval 0.63 to 0.79; I2 = 0%; five trials and 15,503 participants). One adequately powered trial in an exclusively secondary prevention population showed that FDC therapy reduced the risk of major adverse cardiovascular events by 24%. These findings support adoption and implementation of polypills to lower risk for all-cause mortality and ASCVD.

Blood pressure difference between pre and post-menopausal women and age-matched men: A cross-sectional study at a tertiary center.

Hypertension is a prominent risk factor for cardiovascular and cerebrovascular diseases. Gender differences and menopausal status contribute to blood pressure changes across the lifespan which have not been completely characterized. Our study aims to explore the impact of multiple factors on blood pressure levels in previously healthy women and men. Factors of interest included gender, menopausal status, age, and body mass index. Healthy women and men were recruited through healthcare facility announcements. Detailed menopausal history was obtained from females. The authors measured each participant's systolic and diastolic blood pressure at our outpatient clinics twice on the same day, and two different days, one week apart, and the authors included the mean of the averaged two readings for each participant. The study sample consisted of 313 participants. Female gender was a significant predictor of lower systolic and diastolic blood pressure (p<.001), while age significantly correlated with higher systolic blood pressure readings (p=.004). Although systolic blood pressure levels were significantly higher in postmenopausal females (124mmHg) compared to premenopausal females (116mmHg), our multiple linear regression analysis revealed that postmenopausal status did not significantly predict changes in either systolic or diastolic blood pressure. Our study demonstrates significant associations between blood pressure levels and various factors such as gender and age. This could emphasize the intricate interplay of demographic and clinical factors in blood pressure variations among individuals, highlighting the importance of a holistic approach to diagnosing hypertension, which considers various individual factors, including gender and age.

Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study

Objective To explore in a primary care setting the associations between patients’ daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.

Serum lactate normalization time associated with prolonged postoperative ileus after surgical management of the small bowel and/or mesenteric injuries

Back ground: Determining the optimal timing of postoperative oral feeding in trauma patients who have undergone abdominal surgery with small bowel and/or mesenteric injuries is challenging. The aim of this study is to investigate serum lactate as a factor that can predict oral feeding tolerance and prolonged postoperative ileus (PPOI) in patients who underwent surgery for small bowel and/or mesenteric injury due to trauma.Methods: The single center retrospective observational study was conducted on 367 patients who underwent surgery for small bowel and/or mesenteric injury between January 2013 and July 2021. The patient group was divided into two groups based on whether the peak serum lactate was over 2mmol/L (18 mg/dL). In the group of lactate > 2mmol/L, it was divided into prolonged postoperative ileus (PPOI) groups and groups rather than PPOI.Results: Patients in the peak serum lactate > 2 group had tendency to use vasopressors, lower initial systolic blood pressure, larger number of packed red blood cells for 24 h, higher injury severity score, higher PPOI incidence, and a tendency for delayed oral intake tolerance. In peak serum lactate greater than 2 mmol/L group, the lactate normalization time (OR 1.699, p = 0.04), quantity of FFP transfusion for 24 h (OR 1.145, p = 0.012), and creatine kinase (OR 1.001, p = 0.023) were related to PPOI. The lactate normalization time had the highest correlation.Conclusion: In patients undergoing surgical management for small bowel and/or mesenteric injury after trauma, serum lactate normalization time affects oral intake tolerance and prolongs postoperative ileus.

Vasorelaxant and hypotensive effects of an ethanolic extract of Nymphaea pubescens and its main compound quercetin 3-methyl ether 3'-O-β-xylopyranoside.

Aim: Nymphaea plants were traditionally used to treat diseases associated with endothelial dysfunction. The present study investigated the effects of an ethanolic extract of Nymphaea pubescens Willd. (commonly named water lily, WL) and its main compound 1 (quercetin 3-methyl ether 3'-O-β-xylopyranoside) on vascular function in rats. Materials and methods: The vasorelaxant effects of the WL extract and its main compound 1 and their underlying mechanisms of action were evaluated on isolated mesenteric arteries from Wistar rats. Blood pressure and heart rate were measured in anesthetized rats after infusion (i.v) of vehicle, WL extract, and compound 1 (at 0.01, 0.025, 0.05, 0.1, 0.5, and 1mg/kg). Nifedipine was used as a positive control. Results: Both WL extract and compound 1 induced vasorelaxant effects (with EC50 of 0.08 ± 0.01mg/mL and 42.8 ± 6.3 µM, respectively) that were reduced by endothelium removal. A significant decrease in these relaxations was observed with L-NAME but not with apamin-charybdotoxin or indomethacin. In the endothelium-denuded condition, WL extract-induced relaxation was enhanced by 4-aminopyridine and glibenclamide, while iberiotoxin and ODQ (1H-[1,2,4]oxadiazolo[4,3-a]quinoxaline-1-one) had no effect. In contrast, compound 1-induced relaxation was not changed by any of these inhibitors. Both WL extract and compound 1 enhanced sodium nitroprusside-induced relaxation and inhibited receptor-operated Ca2+ channels. Only the WL extract was able to reduce PE-induced contraction (p < 0.001). As compared to the vehicle, the infusion of WL extract and compound 1 lowered systolic and diastolic blood pressure. Interestingly, the hypotensive effect of the compound was similar to that of nifedipine. The rebound tachycardia found at the highest dose of nifedipine was not observed with the WL extract or compound 1 (p < 0.05). Conclusion and discussion: Our study demonstrated a vasorelaxant effect of the WL extract and its main compound quercetin 3-methyl ether 3'-O-β-xylopyranoside, relying on the potentiation of the NO-cGMP pathway and calcium inhibitory effects. These vasorelaxant effects were associated with a potent hypotensive effect, providing pharmacological evidence for the traditional use of this plant.

Glucagon-like peptide-1 receptor agonists modestly reduced blood pressure among patients with and without diabetes mellitus: A meta-analysis and meta-regression.

The cardiovascular benefits provided by glucagon-like peptide-1 receptor agonists (GLP-1RAs) extend beyond weight reduction and glycaemic control. One possible mechanism may relate to blood pressure (BP) reduction. We aim to quantify the BP-lowering effects of GLP1-RAs. A comprehensive database search for placebo-controlled randomized controlled trials on GLP-1RA treatment was conducted until December 2023. Data extraction and quality assessment were carried out, employing a robust statistical analysis using a random effects model to determine outcomes with a mean difference (MD) in mmHg and 95% confidence intervals (CIs). The primary endpoint was the mean difference in systolic BP (SBP) and diastolic BP. Subgroup analyses and meta-regressions were done to account for covariates. Compared with placebo, GLP-1RAs modestly reduced SBP [semaglutide: MD -3.40 (95% CI -4.22 to -2.59, p < .001); liraglutide: MD -2.61 (95% CI -3.48 to -1.74, p < .001); dulaglutide: MD -1.46 (95% CI -2.20 to -0.72, p < .001); and exenatide: MD -3.36 (95% CI -3.63 to -3.10, p < .001)]. This benefit consistently increased with longer treatment durations. Diastolic BP reduction was only significant in the exenatide group [MD -0.94 (95% CI -1.78 to -0.1), p = .03]. Among semaglutide cohorts, mean changes in glycated haemoglobin and mean changes in body mass index were directly associated with SBP reduction. Patients on GLP-1RA experienced modest SBP lowering compared with placebo. This observed effect was associated with weight/body mass index reduction and better glycaemic control, which suggests that BP-lowering is an indirect effect of GLP-1RA and unlikely to be responsible for the benefits.

Abstract P467: Patterns of Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease: Preliminary Analysis of the RESILIENT Trial

Background: Hypertension (HTN) is highly prevalent among older adults. Despite evidence that home blood pressure monitoring (HBPM) improves HTN awareness, treatment, and control, engagement with HBPM remains understudied in older adults with ischemic heart disease. This study sought to explain trends associated with HBPM engagement. Methods: We performed an interim analysis of the ongoing RESILIENT randomized mobile health cardiac rehabilitation (mHealth-CR) trial of patients age ≥65 years with ischemic heart disease. Participants in the RESILIENT mHealth-CR group were instructed to perform at least weekly home BP measurements over 12 weeks as part of the study intervention. Three engagement groups (high engagement, gradual decline, baseline engagement) were determined by latent class analysis. ANOVA or Chi-Squared tests were used to determine trends in HBPM engagement and changes in blood pressure (BP) overall and between engagement groups over the 12-week study. Results: Of the 111 participants, the mean (SD) HBPM engagement was 2.3 (2.3) days of HBPM/week and 31.6 (33.1) measures over 12 weeks ( Table ). Weekly HBPM declined from 74.8% to 50.5% from week 1 to week 12. Frequency of HBPM declined over time in both the gradual decline and baseline engagement groups, though remained consistent in the high engagement group. There were no significant differences in mean BP levels at week 1 and week 12 overall or between groups. However, there was a non-significant trend toward a lower systolic BP in the gradual decline group (106 (SD 20.5) mmHg) compared to the high engagement and baseline engagement groups (130 (SD 11.5) and 126 (SD 15.5) mmHg, respectively, p = 0.14). Conclusion: The majority of RESILIENT trial participants measured BP weekly as instructed. There was an overall downward trend in HBPM engagement over time. Once enrollment of the full RESILIENT sample is complete (target N=300 intervention participants), our next steps will be to investigate patient-level factors associated with differential HBPM engagement.

Abstract MP12: Educational Attainment and the Effect of Intensive Blood Pressure Reduction: A Post-Hoc Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)

Introduction: Hypertension is a major risk factor for cardiovascular disease (CVD). The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that systolic blood pressure (SBP) &lt;120 mm Hg reduced CVD risk and all-cause mortality among those with elevated SBP and high CVD risk. Educational attainment (EA) is associated with CV health, but whether EA modifies the effect of intensive SBP reduction remains unclear. Hypothesis: We predicted that SPRINT participants with lower EA would have greater CVD risk reduction with intensive SBP lowering than those with higher EA. Methods: We included 9,361 individuals recruited as part of the SPRINT study and categorized them by EA (&lt;college, some college through college graduate, and &gt;college degree). We examined the effect of intensive SBP lowering across EA strata in relation to the composite endpoint defined by SPRINT (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or CV death) in multivariable proportional hazards models. Results: The cohort was age 67.9±9.4 years, 35.6% female, and 57.8% White race. Those with high EA were more likely to be older, male, and White race. Higher EA was associated in a dose-response manner with a larger reduction in the risk of developing the composite endpoint after intensive SBP lowering [highest to lowest EA: adjusted HR 0.48 (95% CI: 0.34, 0.70); 0.81 (0.63, 1.03); 0.90 (0.70, 1.15); P , interaction=0.01] ( Table ). The interaction between intensive SBP lowering and EA was limited to non-Black individuals; among Black participants, the association of SBP lowering with the endpoint did not differ significantly by EA. Conclusion: In the SPRINT cohort, higher EA was associated with a larger improvement in CV outcomes after intensive SBP reduction, with differences by race or ethnicity. This post-hoc SPRINT analysis suggests that the benefit of intensive SBP lowering varies by EA, and highlights a need for tailored approaches to optimize hypertension management for individuals with different social backgrounds.

Abstract P475: Adherence to the EAT-Lancet Planetary Health Diet and Cardiometabolic Risk Markers in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Introduction: Poor diet is among the top risk factors for cardiometabolic disease, which disproportionately burdens South Asians. In 2019, the EAT-Lancet Commission proposed a Planetary Health Diet (PHD) designed to optimize human and global environmental health. Objective: We examined associations between a novel Planetary Health Diet Index (PHDI), that reflects adherence to the EAT-Lancet recommendations, and cardiometabolic risk in a prospective cohort of South Asians in the US. Methods: We included participants from the MASALA study with complete baseline (n=891) and 5-year follow-up (n=735) examinations. The PHDI was comprised of 15 food components with scoring based on the ranges prescribed by the EAT-Lancet commission for a total score range of 0–140. Higher scores indicate greater adherence to the PHDI. We used multivariable linear and logistic regression models to examine cross-sectional and prospective (5-years) associations between baseline PHDI and measures of glycemia, blood lipids, inflammation, and adiposity, adjusting for demographic, health, lifestyle, and baseline value of biomarker (for prospective models). Logistic regression was used to examine association between baseline PHDI and incident type 2 diabetes (among n=661 participants free from diabetes at baseline) Results: Among MASALA study participants (49% female, mean age 57 y), the mean PHDI score was 88.8 (SD 9.47). At baseline, each 10 unit increase in PHDI scores were associated with (β ± SE) lower fasting glucose (-0.5±0.24 mmol/L), HbA1c (-0.49±0.22%), LDL cholesterol (-0.015±0.007 mmol/L), CRP (-5.87±2.35 mg/L), higher adiponectin (4.71 ±2.01 mg/dL), lower body weight (-0.59 ±0.26 kg), BMI (-0.27±0.11 kg/m 2 ), waist circumference (-0.82±0.29 cm), visceral fat (-3.22±1.32 cm 2 ), and pericardial fat (-0.92±0.43 cm 3 ) ( p &lt;0.05 for all). Higher PHDI scores were associated lower odds of obesity [OR (95% CI): 0.80 (0.71-0.92] and overweight [0.77 (0.74-0.85)]. Prospectively, higher PHDI scores were associated with lower fasting glucose (-0.28 ± 0.14 mmol/L), lower HbA1c (-0.08±0.03%), higher HDL (0.38±0.17 mmol/L), lower body weight (-0.37±0.12 kg), BMI (-0.08±0.03 kg/m 2 ), waist circumference (-0.49±0.17 cm), and systolic blood pressure (-0.65 ± 0.30 mmHg) ( p &lt;0.05 for all). Each 10-unit higher PHDI was associated with a 20% lower risk of incident diabetes [OR (95%CI): 0.80 (0.54-0.86)]. Conclusions: In the MASALA study, we found that greater adherence to the PHDI was associated with better cardiometabolic risk factors and lower risk of incident type 2 diabetes. These observations support the planetary health diet as a feasible strategy to address planetary health while optimizing human health outcomes.

Abstract P125: Association of Cardiology Encounters for Underrepresented Racial and Ethnic Groups With Human Immunodeficiency Virus With Subsequent Lipid and Blood Pressure Control

Background: People with HIV (PWH) are at elevated atherosclerotic cardiovascular disease (ASCVD) risk. Underrepresented racial and ethnic groups (UREGs) with HIV in the Southern U.S. are disproportionately affected, yet whether cardiology specialist care for this at-risk group improves blood pressure and lipid control is unknown. Methods: We evaluated a cohort of UREGs with HIV at elevated ASCVD risk without known cardiovascular disease. Participants received HIV-related care from 2015-2018 at four academic medical centers in the Southern United States with follow up through 2020. To create the cardiology and non-cardiology comparator groups, we divided the study into 6-month intervals, creating 8 cohorts and identified eligible patients with a new cardiology encounter during the interval. We included those without a cardiology encounter in that interval or any prior as controls. Primary outcomes were blood pressure control (&lt;140/90 mmHg) and lipid control (LDL-C ≤ 100 mg/dl) assessed during 2 years of follow-up. Statistical analyses were adjusted for cohort, patient factors, HIV measures, and comorbidities, and used random effects to account for repeated use of patients across cohorts. Results: Among 4096 included individuals, 411 (10%) had a cardiology encounter (Table 1). Cardiology encounters were associated with subsequent lipid control (OR 2.55, 95% CI 1.17-5.55, p=0.02), but not blood pressure control (OR 0.94, 95% CI 0.46-1.92, p=0.86). Compared to those without a cardiology encounter, those with a cardiology encounter did not subsequently have lower LDL-C (0.46 mg/dl higher per month, p=0.03) or systolic blood pressure (0.05 mm Hg higher per month, p=0.07). Conclusions: Cardiology encounters are associated with lipid control for UREGs with HIV. The lack of a decrease in LDL or systolic blood pressure suggests cardiology encounters may not be adequate to improve blood pressure and lipid control, two major modifiable risk factors for atherosclerotic cardiovascular disease among PWH.

Exercise as an anti-inflammatory Therapy in Axial Spondyloarthritis Therapeutic Intervention (EXTASI) study: a randomized controlled trial

Abstract Objectives Axial SpA (axSpA) is a chronic inflammatory disease, yet despite known anti-inflammatory effects of exercise, the effect of exercise on inflammatory immune cell populations and associated inflammatory profiles in axSpA is unknown. This randomized controlled trial investigated the effect of 12 weeks of walking on symptom severity, cardiometabolic health, inflammatory biomarkers and immune cell populations. Methods Twenty people (60% male) living with axSpA who were on a stable dose of NSAIDs participated. Participants were randomly assigned to control or exercise (30 min of walking five times per week). Participants were invited back every 4 weeks for assessment. Results There was a 0% dropout rate and no adverse events in the exercise group, showing walking exercise was well tolerated. Home-based walking for 12 weeks lowered the proportion of pro-inflammatory monocytes, whereas they increased in the control group. Changes were associated with lower IL-6 and CRP concentrations, lower spinal pain and lower systolic blood pressure in the exercise group, whereas these markers increased in the control group. Reductions in IL-6 and pro-inflammatory monocytes with exercise were independent of lower body fat percentage. Conclusions Supplementing NSAID therapy with walking exercise can improve inflammatory immune profiles in people with axSpA, coinciding with reductions in spinal pain. Importantly, the exercise was well tolerated, suggesting walking exercise can be used as an adjuvant anti-inflammatory therapy for NSAID treatments. This should now be explored in people living with axSpA who have had high enough disease activity to necessitate the prescription of biologic or synthetic DMARD treatments. Trial registration ClinicalTrials.gov (http://clinicaltrials.gov), NCT04368494.

Myocarditis-A Helpful Algorithm to Overcome Diagnostic Challenges in the Pediatric Population.

This study was designed to investigate clinical differences between pediatric patients who presented with chest pain, tachycardia, and/or tachypnea who subsequently were or were not diagnosed with myocarditis. The results were used to develop a decision tree to aid in rapid diagnosis of pediatric myocarditis. A retrospective case-control study was performed using the electronic medical records of children aged 0 to 18 years between the years 2003 and 2020 with a complaint of chest pain, tachycardia, and/or tachypnea. Patients included in the study were those diagnosed with myocarditis and those with suspected myocarditis, which was ultimately ruled out. Demographic and clinical differences between the research groups were analyzed. A decision tree was rendered using the rpart (Recursive Partitioning and Regression Trees) package. Four thousand one hundred twenty-five patients were screened for eligibility. Seventy-three myocarditis patients and 292 nonmyocarditis patients were included. Compared with the control group, the study group was found to have a higher mean respiratory rate (37 ± 23 vs 23 ± 7 breaths per minute) and mean heart rate (121 ± 44 vs 97 ± 25 beats per minute) and lower mean systolic and diastolic blood pressure (102 ± 27/56 ± 17 mm Hg vs 114 ± 14/67 ± 10 mm Hg). The mean white blood cell count was greater in the case group (13 ± 6 vs 10 ± 5 × 10 3 /μL). A decision tree was rendered using simple demographic and clinical variables. The accuracy of the algorithm was 85.2%, with 100% accuracy in patients aged 0 to 2.5 years and 69% in patients aged 2.5 to 18 years. The clinical and laboratory characteristics described in this study were similar to what is described in the literature. The decision tree may aid in the diagnosis of myocarditis in patients 2.5 years and younger. In the population aged 2.5 to 18 years, the decision tree did not constitute an adequate tool for detecting myocarditis.

Intermittent fasting and health outcomes: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials

Benefits of Intermittent fasting (IF) on health-related outcomes have been found in a range of randomised controlled trials (RCTs). Our umbrella review aimed to systematically analyze and synthesize the available causal evidence on IF and its impact on specific health-related outcomes while evaluating its evidence quality. We comprehensively searched the PubMed, Embase, Web of Science, and Cochrane databases (from inception up to 8 January 2024) to identify related systematic reviews and meta-analyses of RCTs investigating the association between IF and human health outcomes. We recalculated the effect sizes for each meta-analysis as mean difference (MD) or standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs). Subgroup analyses were performed for populations based on three specific status: diabetes, overweight or obesity, and metabolic syndrome. The quality of systematic reviews was evaluated using A Measurement Tool to Assess Systematic Reviews (AMSTAR), and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. This study is registered with PROSPERO (CRD42023382004). A total of 351 associations from 23 meta-analyses with 34 health outcomes were included in the study. A wide range of outcomes were investigated, including anthropometric measures (n=155), lipid profiles (n=83), glycemic profiles (n=57), circulatory system index (n=41), appetite (n=9), and others (n=6). Twenty-one (91%) meta-analyses with 346 associations were rated as high confidence according to the AMSTAR criteria. The summary effects estimates were significant at p<0.05 in 103 associations, of which 10 (10%) were supported by high certainty of evidence according to GRADE. Specifically, compared with non-intervention diet in adults with overweight or obesity, IF reduced waist circumference (WC) (MD=-1.02cm; 95% CI:-1.99 to-0.06; p=0.038), fat mass (MD=-0.72kg; 95% CI:-1.32 to-0.12; p=0.019), fasting insulin (SMD=-0.21; 95% CI:-0.40 to-0.02; p=0.030), low-density lipoprotein cholesterol (LDL-C) (SMD=-0.20; 95% CI:-0.38 to-0.02; p=0.027), total cholesterol (TC) (SMD=-0.29; 95% CI:-0.48 to-0.10; p=0.003), and triacylglycerols (TG) (SMD=-0.23; 95% CI:-0.39 to-0.06; p=0.007), but increased fat free mass (FFM) (MD=0.98kg; 95% CI: 0.18-1.78; p=0.016). Of note, compared with the non-intervention diet, modified alternate-day fasting (MADF) reduced fat mass (MD=-0.70kg; 95% CI:-1.38 to-0.02; p=0.044). In people with overweight or obesity, and type 2 diabetes, IF increases high-density lipoprotein cholesterol (HDL-C) levels compared to continuous energy restriction (CER) (MD=0.03mmol/L; 95% CI: 0.01-0.05; p=0.010). However, IF was less effective at reducing systolic blood pressure (SBP) than a CER diet in adults with overweight or obesity (SMD=0.21; 95% CI: 0.05-0.36; p=0.008). Our findings suggest that IF may have beneficial effects on a range of health outcomes for adults with overweight or obesity, compared to CER or non-intervention diet. Specifically, IF may decreased WC, fat mass, LDL-C, TG, TC, fasting insulin, and SBP, while increasing HDL-C and FFM. Notably, it is worth noting that the SBP lowering effect of IF appears to be weaker than that of CER. This work was supported by the National Key Research and Development Program of China (Q-JW), the Natural Science Foundation of China (Q-JW and T-TG), Outstanding Scientific Fund of Shengjing Hospital of China Medical University (Q-JW), and 345 Talent Project of Shengjing Hospital of China Medical University (T-TG).

Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV

Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of HIV primary care. To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non-high-density lipoprotein (HDL) cholesterol level in a diverse population of PWH receiving antiretroviral therapy (ART). This randomized clinical trial enrolled PWH at 3 academic HIV clinics in the US from September 2019 to January 2022 and conducted follow-up for 12 months until January 2023. Included patients were 18 years or older and had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. Participants were stratified by trial site and randomized 1:1 to either the multicomponent EXTRA-CVD (A Nurse-Led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention) intervention group or the control group. Primary analyses were conducted according to the intention-to-treat principle. The EXTRA-CVD group received home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse at 4 in-person visits (baseline and 4, 8, and 12 months) and frequent telephone check-ins up to every 2 weeks as needed. The control group received general prevention education sessions from the prevention nurse at each of the 4 in-person visits. Study-measured SBP was the primary outcome, and non-HDL cholesterol level was the secondary outcome. Measurements were taken over 12 months and assessed by linear mixed models. Prespecified moderators tested were sex at birth, baseline ASCVD risk, and trial site. A total of 297 PWH were randomized to the EXTRA-CVD arm (n = 149) or control arm (n = 148). Participants had a median (IQR) age of 59.0 (53.0-65.0) years and included 234 males (78.8%). Baseline mean (SD) SBP was 135.0 (18.8) mm Hg and non-HDL cholesterol level was 139.9 (44.6) mg/dL. At 12 months, participants in the EXTRA-CVD arm had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P < .001) lower non-HDL cholesterol level compared with participants in the control arm. There was a clinically meaningful but not statistically significant difference in SBP effect in females compared with males (11.8-mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06). Results of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for PWH. ClinicalTrials.gov Identifier: NCT03643705.

Harmonizing Hearts: Exploring the Impact of Music Therapy on Cardiovascular Health.

Music therapy (MT) is a music intervention involving a credentialed professional and a client, which has gained increasing recognition in current practices as an adjunct therapy for various conditions, including cardiovascular diseases (CVDs). MT demonstrates notable physiological as well as psychological effects leading to lowered anxiety, depression, and systolic blood pressure in patients with CVDs as well as having effects on heart rate and heart rate variability in healthy subjects. MT emerges as a promising adjunct in the prevention and rehabilitation of CVDs and its holistic impact on physiological and psychological parameters underscores its potential as a noninvasive, cost-effective intervention. Existing literature shows heterogeneity in methods in the studies such as the genre and quality of music utilized as well outcomes. While further research is warranted to optimize protocols and assess long-term effects, the current evidence highlights MT's substantial benefits in cardiovascular health care, making it a promising asset in modern therapeutic approaches. This comprehensive review explores the multifaceted role of MT in CVDs, discussing its mechanisms and clinical applications.

Prognostic value of geriatric and cardiac parameters for one-year mortality in older heart failure patients. A multicentre, observational, prospective study

ABSTRACT Purpose Heart failure is prevalent among older people and has a poor prognosis. The aim of this study is to identify potential prognostic, geriatric, and cardiac parameters which could help clinicians identify older heart failure patients at high risk for one-year mortality. Methods The multicentre, observational cohort study which included 147 heart failure patients aged ≥75 years, hospitalized in the cardiac or geriatric department in two hospitals. One-year survival was the outcome measure. For univariate analysis Chi-square test and independent sample T-test were used; for multivariate analysis Logistic regression and Cox regression for time-dependent analysis. Results One-year mortality was 28% (41/147). One-year survivors and non-survivors did not differ in the following characteristics: age, gender, sodium level at hospital discharge, ejection fraction, NYHA Class, basic and instrumental activities of daily living, and the presence of a geriatric risk profile. There was a significant lower systolic blood pressure at discharge in non-survivors compared to one-year-survivors (mean 125.26 mmHg vs. 137.59 mmHg). Non-survivors had more severe underlying comorbidities according to the age adjusted Charlson Comorbidity index (CCI) (mean 8.80 vs. 7.40). Both logistic and Cox regression showed a higher risk and rate of mortality with decreasing systolic blood pressure at discharge (OR 0.963, p=0.001 and HR 0.970, p<0.001) and with increasing CCI (OR 1.344, p=0.002 and HR 1.269, p=0.001); the other variables were not significantly related. Conclusion Lower blood pressure and more severe comorbidities, but not functionality nor the presence of a geriatric risk profile, are related to one-year mortality in older, in-hospital heart failure patients.