Lower Systolic Pressure Research Articles

Central α2-adrenergic mechanisms differentially affect baroreflex control of sympathetic and cardiovagal outflow

This study aimed to investigate the impact of central α2-adrenergic mechanisms on arterial baroreflex control of sympathetic and cardiovagal outflow in healthy humans. R-R interval (ECG), blood pressure (brachial arterial catheter), and muscle sympathetic nerve activity (MSNA; peroneal microneurography) were measured in eight healthy participants (5 females; 28±7 years). Sympathetic action potentials (AP) were extracted from the filtered MSNA neurogram (continuous wavelet transform) during a 5-minute baseline (BSL) and an intravenous dexmedetomidine infusion consisting of a loading dose (LD; 10 minutes at 0.225 μg/kg/hr) and a maintenance dose (MD; ~0.15 μg/kg/hr). Sympathetic AP baroreflex threshold gain was measured as the slope of the linear relationship between AP discharge probability and diastolic blood pressure. The linear relationship between R-R interval and systolic blood pressure (sequence technique) quantified cardiovagal baroreflex gain. Mixed-effects analyses and post-hoc t-tests were performed. Data are reported as mean ± SD. Dexmedetomidine reset the baroreflex threshold operating points for all sympathetic AP clusters downwards to lower firing probabilities (cluster 4; BSL: 20±6, LD: 13±8, MD: 6±5%, both p<0.01 vs. BSL) and leftwards to lower diastolic pressures (BSL: 72±9, LD: 69±8, MD: 65±10 mmHg, both p<0.01 vs. BSL). Dexmedetomidine reduced baroreflex threshold gain for the subpopulation of medium-sized sympathetic APs (cluster 4; BSL: -6.5±2.0, LD: -2.6±1.6, MD: -2.0±0.7 %/mmHg, both p<0.01 vs. BSL). Dexmedetomidine did not affect baroreflex threshold gain of small (cluster 1; BSL: -1.9±1.1, LD: -1.3±1.6, MD: -1.1±0.8 %/mmHg, both P>0.88 vs. BSL) or large AP clusters (cluster 9; BSL: -0.8±0.4, LD: -0.8±1.0, MD: -0.2±0.7 %/mmHg, both P>0.98 vs. BSL). Dexmedetomidine reset the cardiovagal baroreflex to lower systolic pressures but did not affect R-R interval (BSL: 1035±261, LD: 1025±308, MD: 1005±292ms, Main effect P=0.45) or gain (BSL: 24±11, LD: 30±20, MD: 26±25 ms/mmHg, Main effect P=0.63). These findings suggest that central α2-adrenergic mechanisms differentially affect arterial baroreflex control of sympathetic and cardiovagal outflow in humans by minimally affecting cardiovagal baroreflex gain but strongly affecting the baroreflex gain for the subpopulation of medium-sized sympathetic APs. This work was supported by the Natural Sciences and Engineering Research Council of Canada (NSERC) and the National Institutes of Health (NIH). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Long-Term Mortality after Transcatheter Edge-to-Edge Mitral Valve Repair Significantly Decreased over the Last Decade: Comparison between Initial and Current Experience from the MiTra Ulm Registry.

(1) Objective: We aimed to assess whether the candidate profile, the long-term outcomes and the predictors for long-term mortality after transcatheter edge-to-edge mitral valve repair (M-TEER) have changed over the last decade; (2) Methods: Long-term follow-up data (median time of 1202 days) including mortality, MACCE and functional status were available for 677 consecutive patients enrolled in the prospective MiTra Ulm registry from January 2010 to April 2019. The initial 340 patients treated in our institution before January 2016 were compared with the following 337 patients; (3) Results: Patients treated after 2016 showed significantly less ventricular dilatation (left ventricular end-systolic diameter of 43 ± 13 mm vs. 49 ± 16 mm, p < 0.007), lower systolic pulmonary pressures (50 ± 15 mmHg vs. 57 ± 21 mmHg, p = 0.01) and a lower prevalence of severe tricuspid regurgitation (27.2% vs. 47.3%, p < 0.001) at baseline than patients treated before 2016. Compared to the cohort treated before 2016, patients treated afterwards showed a significantly lower all-cause 3-year mortality (29.4% vs. 43.8%, p < 0.001) and lower MACCE (38.6% vs. 54.1%, p < 0.001), without differences for MR etiology. While severe tricuspid regurgitation and NYHA class IV remained independently associated with an increased long-term mortality over the last decade, severe left ventricular dilatation (hazard ratio, HR 2.12, p = 0.047) and severe pulmonary hypertension (HR 2.18, p = 0.047) were predictors of long-term mortality only in patients treated before 2016. (4) Conclusions: The M-TEER candidates are currently treated earlier in the course of disease and benefit significantly in terms of a better long-term survival than patients treated at the beginning of the M-TEER era.

Association between preoperative hemoglobin with length of hospital stay among non-cardiac and non-obstetric surgery patients: a secondary analysis of a retrospective cohort study

BackgroundPrevious studies concerning the association between preoperative Hemoglobin (HB) level and the Length Of hospital Stay (LOS) in patients with non-cardiac surgery and non-obstetric surgery remain inconclusive. Herein, the objective of this study was to analyze whether and to what extent the preoperative HB level was connected with the LOS in non-cardiac and non-obstetric surgery patients.MethodsThis retrospective cohort study was performed at a single institution, involving patients who underwent elective non-cardiac, non-obstetric surgery from April 2007 to September 2013. Clinical characteristics of patients such as demographics, comorbidities, preoperative HB level, LOS, mortality, procedure length, and pulmonary hypertension (PHTN) Severity Class data were collected. A univariate analysis was used to determine the association between clinical characteristics and LOS. Multivariate regression analysis was conducted to investigate the relationship between preoperative HB level and LOS.Results and discussionIn this study, 311 patients were included. We observed that compared with the LOS > 7 days group, the average HB level of patients in the LOS ≤ 7 days group was higher (12.04 ± 2.20 g/dl vs. 10.92 ± 2.22 g/dl, p < 0.001). In addition, there were fewer patients with moderate-to-severe anemia in LOS ≤ 7 days group than the LOS > 7 days group (32.74% vs 58.82%, p < 0.001). In addition, we found that patients with LOS ≤ 7 days were accompanied with lower mortality (0.44% vs. 7.06%, p < 0.001) and lower mean combined pulmonary artery systolic pressure (PASP) and right ventricular systolic pressure (RVSP) than that in patients with LOS > 7 days (42.56 ± 11.97 vs. 46.00 ± 12.37, p < 0.05). After controlling for relevant confounders, we discovered a nonlinear association between preoperative HB level and LOS as well as a threshold effect based on LOS. Specifically, when preoperative HB level was less than 11.9 g/dL, LOS decreased by 2 days for each 1 g/dL increase in HB level. However, LOS did not alter substantially with the rise of preoperative HB level when it was higher than 11.9 g/dL.ConclusionOur study showed a close non-linear association between preoperative HB level and LOS in patients with non-cardiac surgery and non-obstetric surgery. In particular, for patients with preoperative HB less than 11.9 g/dL, increasing the preoperative HB level can help shorten the LOS after operation.

The role of resonance frequency in slow-paced breathing: Systematic review

Introduction&#x0D; A healthy heart does not beat like a metronome because it shows characteristics of complex non-linear oscillations and mathematical chaos, together with the existence of resonance in the cardiorespiratory system (Shaffer et al., 2014). On one swing, the inhalation causes an increase of the heart rate, while the opposite effect is during exhaling, thus having variability properties in the inter-beat intervals. By utilizing this effect of respiratory sinus arrhythmia, resonance frequency (RF) gives insight into the respiratory rate at which this resonance is amplified in the heart rate, blood pressure, and respiration systems (Shaffer &amp; Meehan, 2020). The aim of this systematic review was to examine the effects of resonance frequency in Slow-Paced Breathing (SPB) studies, as well as the relation between RF and anthropological measures of gender, height, and age.&#x0D; Methods&#x0D; We systematically reviewed the literature regarding the role of resonance frequency in the SPB research using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) evidence-based reporting checklist and a Participants, Index Test, Comparison, Outcomes, and Study Design (PICOS) framework (PROSPERO Registration Number CRD42021253009). We included SPB studies with experimental and quasi-experimental designs, conducted on healthy populations that determined individual RF in the breathing protocols, with no specific criteria on gender, age restrictions, or publication year. Additionally, interventions combining RF SPB with biofeedback monitoring were included. Outcomes of the included studies included any psychological or physiological findings. Altogether, 17 studies (n = 810 participants) were assessed for risk of bias with The Joanna Briggs Institute Critical Appraisal Checklist (Moola et al., 2015).&#x0D; Results&#x0D; Overall, positive effects on psychological constructs like attention control, executive functioning, sleep quality, psychological relaxation, mindful awareness, self-compassion, vigor, self-efficacy, mood, depression, anxiety, and stress have been reported. Physiologically, RF breathing caused a more coherent heart rhythm pattern with high amplitude oscillation, while lowering systolic pressure, decreasing HF power, HR beats per minute, a-amylase and cortisol stress biomarkers, and increasing the average baroreflex gain, SpO2, and LF power. The scarcity of reported data and analysis concerning the effects of anthropological data do not give a strong claim to the existence of height, gender, and age influences, but there is a notion that height and RF are negatively correlated, while men have lower RF than women.&#x0D; Discussion/Conclusion&#x0D; We conclude the overall beneficial effects of RF breathing on psychological and physiological systems. Namely, improved attention control, executive functioning, sleep quality with fewer disturbances, and psychological relaxation, increased mindful awareness, self-compassion, vigor, and self-efficacy; less worrying and a decrease in total mood disturbance, depression, anxiety, and stress were observed. On a physiological level, RF breathing caused a lowering of systolic pressure, a decrease of HF power, HR beats per minute, a-amylase, and cortisol stress biomarkers, while increasing the average baroreflex gain, SpO2, and LF power through a more coherent heart rhythm pattern with high amplitude oscillation. In regard to the anthropological measures, scarcely reported data suggests the RF is related to the blood volume and the perfusion of the arterial tree, hence men are supposedly having a lower resonance frequency than women, and RF being negatively correlated with height. While these findings are in overall support for RF breathing, they are not ubiquitous, and thus warrants more experimental evidence to test the aforementioned effects. Besides limitations on technical levels and methodological inconsistencies among reviewed studies (e.g., differences in RF determination protocols, operationalization variables and inhale/exhale ratio), one of the major obstacles in the review process was the insufficient gathering and reporting data on some important RF aspects (i.e. no report on detected RF distribution among participants and their anthropological data, control of transient characteristics and lifestyle choices that influence HRV). Finally, future studies should empirically replicate reviewed studies and test the RF biofeedback model in a laboratory and natural setting.&#x0D; References&#x0D; Shaffer, F., McCraty, R., &amp; Zerr, C. L. (2014). A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology, 5, Article 1040. https://doi.org/10.3389/fpsyg.2014.01040&#x0D; Shaffer, F., &amp; Meehan, Z. M. (2020). A practical guide to resonance frequency assessment for heart rate variability niofeedback. Frontiers in Neuroscience, 14, Article 570400. https://doi.org/10.3389/fnins.2020.570400&#x0D; Moola, S., Munn, Z., Sears, K., Sfetcu, R., Currie, M., Lisy, K., Tufanaru, C., Qureshi, R., Mattis, P., &amp; Mu, P. (2015). Conducting systematic reviews of association (etiology): The Joanna Briggs Institute’s approach. International Journal of Evidence-Based Healthcare, 13(3), 163–169. https://doi.org/10.1097/XEB.0000000000000064

Association of Christian Orthodox Fasting with Sociodemographic, Anthropometric and Lifestyle Factors and Serum Biochemical Indices: A Cross-Sectional Study on Patients with Metabolic Diseases.

Christian Orthodox fasting, a type of time-restricted diet, which presents some similarities to the Mediterranean Diet, also including certain similarities with periodic vegetarianism or other time-restricted diets (e.g., intermittent diet and Ramadan fasting), may cumulatively be related to the same or even better beneficial healthy effects as these well-recognized dietary patterns. The present study aimed to explore the potential beneficial impact of Christian Orthodox fasting in patients with metabolic disorders, such as diabetes mellitus type 2, excessive obesity, hypothyroidism and osteoporosis. This was a cross-sectional study, including 135 patients with metabolic disorders (67 fasters and 68 non-fasters). The enrolled fasters had adapted Christian Orthodox fasting recommendations for at least twelve consecutive years or even from childhood. Relevant questionnaires were used to record sociodemographic, anthropometric and lifestyle data of the study population through face-to-face interviews between the enrolled individuals and qualified personnel during a non-fasting period. Christian Orthodox fasting patients showed a significantly and independently lower prevalence of overweight/obesity and abdominal obesity, which is highly associated with cardiometabolic disease risks, as well as a significantly and independently lower incidence of hypertension, including separately lower systolic and diastolic pressure, than non-fasting patients. Fasters also had a significantly and independently increased prevalence of an advanced educational level and no smoking history, as well as a lower incidence of sedentary behavior, and a trend of a correlation with reduced c-reactive protein (CRP), an indicator of inflammation, compared to non-fasters. Fasters also exhibited higher serum albumin and high-density lipoprotein (HDL) levels, as well as lower glucose levels, than non-fasters. This is one of the few cross-sectional studies demonstrating that Christian Orthodox fasting may promote metabolic health by improving several aspects of metabolic disorders, being associated with specific sociodemographic, anthropometric and lifestyle factors. Further studies conducted on larger sample sizes from different countries and different ethnicities that include Christian Orthodox fasters are recommended to evaluate the impact of long-term religious fasting effects on human health, either as a preventative factor reducing the risk of chronic diseases and especially cardiometabolic disorders or as a nutritional intervention to ameliorate symptom severity.

Empagliflozin improves vascular insulin sensitivity and muscle perfusion in persons with type 2 diabetes.

Sodium glucose cotransporter 2 inhibitors (SGLT2is) improved major adverse cardiovascular events (MACE), heart failure, and renal outcomes in large trials; however, a thorough understanding of the vascular physiological changes contributing to these responses is lacking. We hypothesized that SGLT2i therapy would diminish vascular insulin resistance and improve hemodynamic function, which could improve clinical outcomes. To test this, we treated 11 persons with type 2 diabetes for 12 wk with 10 mg/day empagliflozin and measured vascular stiffness, endothelial function, peripheral and central arterial pressures, skeletal and cardiac muscle perfusion, and vascular biomarkers before and at 120 min of a euglycemic hyperinsulinemic clamp at weeks 0 and 12. We found that before empagliflozin treatment, insulin infusion lowered peripheral and central aortic systolic pressure (P < 0.05) and muscle microvascular blood flow (P < 0.01), but showed no effect on other vascular measures. Following empagliflozin, insulin infusion improved endothelial function (P = 0.02), lowered peripheral and aortic systolic (each P < 0.01), diastolic (each P < 0.05), mean arterial (each P < 0.01), and pulse pressures (each P < 0.02), altered endothelial biomarker expression, and decreased radial artery forward and backward pressure amplitude (each P = 0.02). Empagliflozin also improved insulin-mediated skeletal and cardiac muscle microvascular perfusion (each P < 0.05). We conclude that empagliflozin enhances insulin's vascular actions, which could contribute to the improved cardiorenal outcomes seen with SGLT2i therapy.NEW & NOTEWORTHY The physiological underpinnings of the cardiovascular benefits of SGLT2 inhibitors remain uncertain. We tested whether empagliflozin mitigates vascular insulin resistance in patients with type 2 diabetes. Aortic and peripheral systolic, diastolic, mean and pulse pressures, endothelial function, vascular stiffness, and heart and muscle microvascular perfusion were measured before and during an insulin infusion at baseline and after 12 wk of empagliflozin. After empagliflozin, vascular responses to insulin improved dramatically.

Relationship between Noise Exposure and Prognosis of Patients with Heart Failure: A Retrospective Analysis.

Environmental noise damages the cardiovascular system and endangers human health. This study was conducted to analyze the relationship between noise exposure and prognosis of patients with heart failure and to provide a good strategy for disease treatment. This study was a retrospective analysis. A total of 487 patients with heart failure admitted to Ganzhou People's Hospital from September 2021 to September 2023 were selected as research subjects, and they were divided into the low noise exposure group (<55 dB; group A) and the high noise exposure group (≥55 dB; group B) according to the noise exposure conditions. The baseline data and physiological indicators of the two groups were analyzed. In this study, 84 patients were included in group B, and the remaining 403 patients were included in group A. Group A had lower systolic pressure, diastolic pressure, heart rate, and respiratory rate compared to group B (P < 0.05). The serum B-type natriuretic peptide (BNP) level in group A was lower than that in group B (P < 0.001). Group B had significantly higher scores on the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) compared to group A (P < 0.001). The noise level was correlated with SAS score, SDS score, and serum BNP level (all P < 0.001). The noise exposure is correlated with the prognosis of patients with heart failure, suggesting that active strategies should be adopted to reduce the impact of noise on their disease.

Maternal Hyperglycemia Induces Autonomic Dysfunction and Heart Failure in Older Adult Offspring.

Offspring exposed to an adverse fetal environment, such as gestational diabetes, may manifest increased susceptibility to several chronic diseases later in life. In the present study, the cardiovascular function of three different ages of offspring from diabetic rats was evaluated. Diabetes mellitus was induced in pregnant rats by a single dose of streptozotocin (50 mg/kg). The offspring from diabetic (OD) and control rats (OC) were evaluated at three different ages: 6, 12 or 18 months. In the corresponding OC groups, fasting glycemia, baseline mean arterial pressure, and sympathetic tonus increased in the OD rats at 12 (OD12) and 18 (OD18) months of age, while cardiac hypertrophy was observed in all OD groups. Cardiac function evaluation in vivo showed low left ventricular systolic pressure and+dP/dt in the OD18 rats, suggesting a systolic dysfunction. OD12 and OD18 groups showed high left ventricle end-diastolic pressure, suggesting a diastolic dysfunction. OD groups showed an age-related impairment of both baroreflex-mediated tachycardia and baroreflex-mediated bradycardia in OD12 and OD18 rats. In isolated hearts from OD18 rats, both inotropic and tachycardiac responses to increasing isoproterenol were significantly reduced compared to the corresponding OC group. These results suggest that gestational diabetes triggers the onset of hyperglycemia hypertension with impaired baroreflex sensitivity and heart failure in older age of offspring, representing important risk factors for death. Therefore, ensuring optimal glycemic control in diabetic pregnancy is important and serves as a key to preventing cardiovascular disease in the offspring in their older age.

Abstract P319: Eliminating Cardiotoxicity In Alpha1-adrenergic Receptor Antagonists

Introduction: Alpha-1 adrenergic receptor (α1-AR) antagonists (α1-blockers) are efficacious antihypertensives, but ALLHAT found that doxazosin (Dzn) doubled the risk of heart failure (HF). We previously demonstrated that α1-ARs, specifically the α1A-AR, protect the heart, explaining the worse outcomes with Dzn in ALLHAT. Interestingly, α1-ARs localize to and signal at the nucleus in cardiac myocytes (CM), whereas α1-ARs localize to the sarcolemma in smooth muscle (SM). Hypothesis: We hypothesize that a membrane impermeant α1-blocker would inhibit α1-ARs in SM, reducing blood pressure, but preserve protective α1-signaling in CMs, preventing HF. Methods: We developed an α1A-AR homology model to define the structural basis of α1-blocker binding and modified existing α1-blocker structure to reduce cardiotoxicity. Using this model, we designed 30 compounds, synthesized 9 in gram quantities, and tested 2 compounds. Results and Conclusions: Binding assays identified 2 novel high affinity α1-ligands; α1705 (IC50 = 5.2 [CI:3.5,7.6] nM, n=3) and α1707 (5.8 [CI:4.2,8.1] nM, n=3) (Dzn: 7.7 [CI:6.3,9.2] nM, n=6). Uptake assays in cultured CM indicated uptake of Prazosin (10 μM Prz: 230 nM in CMs detected by mass spectrometry), whereas α1705 and α1707 were not detected. In HEK cells expressing α1A-AR at the cell surface, Prz, α1705, and α1707 (all 2 μM) inhibited Ca2+ transients (90%, 76%, 88%) induced by the α1A agonist A61603 (20 μM). In CM, A61603 increased ERK phosphorylation (1.55±0.04 fold, n=7, P&lt;0.0001), a survival signal, which was blocked by Prz (1.21±0.06 fold, n=7, P=NS), but not α1705 (1.72±0.13 fold, n=7, P&lt;0.001). Further, A61603 (20 μM) inhibited H202-induced CM death (-17.4±7.6%, n=5), which was reversed by Prz (30.9±15.4%, n=5, P=0.035), but not α1705 (-0.94±11.6%, n=5, P=NS). In DOCA-salt hypertensive mice, infusion of Prz or α1705 (2 mg/kg/d, 3 d) lowered systolic pressure (Cont: +18.9 mmHg, n=1; Prz: 6.4±3.2 mmHg, n=3, α1705: -6.1±5.6 mmHg, n=3), and while Prz was detected in CMs following 4 d, α1705 was not. In conclusion, we have developed a novel membrane impermeant α1-blocker with reduced cardiotoxicity that could improve hypertension outcomes, especially in patients suffering from chronic kidney disease or benign prostatic hyperplasia.

Combined Exercise Training Promotes More Benefits on Cardiovascular Autonomic Modulation in Ovariectomized Rats Than Isolated Aerobic or Resistance Training.

Cardiovascular risk increase after ovarian deprivation has been extensively demonstrated by our research group through cardiovascular autonomic analysis. Interventions involving different types of exercises, such as resistance exercises or combined exercises (aerobic and resistance) have been widely recommended to prevent or minimize neuromuscular decline in postmenopausal women, which is aggravated by a sedentary lifestyle. Experimentally, the cardiovascular effects of resistance or combined training, as well as comparison between aerobic, resistance, and combined training, in ovariectomized animals are scarce. In this study, we hypothesized that the combination of aerobic and resistance training may be more effective in preventing muscle mass loss, as well as improving cardiovascular autonomic modulation and baroreflex sensitivity, than aerobic or resistance training individually in ovariectomized rats. Female rats were divided into 5 groups: sedentary (C); ovariectomized (Ovx); trained ovariectomized submitted to aerobic training (OvxAT); resistance training (OvxRT); combined training (OvxCT). Exercise training lasted 8 weeks, with the combined group alternating between aerobic training and resistance training every other day. At the end of the study, glycemia and insulin tolerance were evaluated. Arterial pressure (AP) was directly recorded. Baroreflex sensitivity was assessed by heart rate response to changes in arterial pressure. Cardiovascular autonomic modulation was evaluated by spectral analysis. Combined training was the only training regime that increased baroreflex sensitivity for tachycardic response and reduced all systolic blood pressure variability parameters. Furthermore, all animals submitted to exercise training on a treadmill (OvxAT and OvxCT) presented lower systolic, diastolic, and mean pressure, as well as improvements in the autonomic modulation for the heart. Combined training showed to be more effective than isolated aerobic and resistance training, mixing the isolated benefits of each modality. It was the only modality able to increase baroreflex sensitivity to tachycardic responses, reduce arterial pressure and all parameters of vascular sympathetic modulation.

Effects of Moringa oleifera leaves on the blood glucose, blood pressure, and lipid profile of type 2 diabetic subjects: A parallel group randomized clinical trial of efficacy.

There is a paucity of information on the antidiabetic potential of graded amounts of Moringa leaves on diabetes human subjects. To ascertain the effeccts of Moringa leaves on type 2 diabetic subjects' blood glucose, blood pressure, and lipid profile levels in a rural Nigerian community. This study adopted a parallel group randomized control design. Participants included 40 adult male and female diabetic subjects who met the inclusion criteria and consented to participate in the study. The participants were randomly assigned to four groups. The control group was fed diets without Moringa oleifera leaves while the experimental groups received 20, 40, and 60 g of Moringa leaves respectively daily for 14 days in addition to the diets. The subjects' baseline data and post-intervention data were collected before and after the intervention, respectively. Data were analyzed using paired-sample t-test and analysis of covariance. Significance was accepted at p < 0.05. The mean fasting blood glucose levels in all the groups did not differ significantly from one another. Group 3 had significantly (p = 0.01) lower mean systolic pressure (from 136.40 ± 7.66 to 123.90 ± 13.82) after the intervention. Group 3 subjects had a significant (p = 0.04) increase in their triglyceride values (from 123.80 ± 53.69 before intervention to 151.20 ± 41.47) after intervention. After adjusting for the pre-intervention values, there was no significant (p > 0.05) difference in all the parameters at the end of the intervention. There were marginal improvements in the parameters assessed which were not dose-dependent.

Age-specific differences in hypertension combination management and associated factors influencing treatment choice.

The current hypertension guideline emphasizes combination therapy, especially single-pill combination therapy (SPC). However, few studies compared the prevalence and factors associated with initial therapy choice across heterogeneous age groups in a current population. First, the authors consecutively identified 964 treatment naïve hypertensive patients in a large academic hospital from 01/31/2019 to 01/31/2020. All patients were grouped into (1) young aged, age<55; (2) middle-aged, 55≤age<65; and (3) older aged, age ≥65. The multivariable regression model examined the factors associated with the combination therapy by age group. Overall, 80 (8.3%) were young, 191 (19.8%) were middle, and 693 (71.9%) were older aged. Compared with older age, younger patients were more likely to be male, highly educated, regularly exercised, have metabolic syndrome, and less likely to have cardiovascular-related comorbidities, with a lower systolic but higher diastolic pressure. Only one in five patients used SPC, and the prevalence decreased with age. Besides hypertension grade, young patients without catheterization or echo test were less likely to receive multiple therapies, while older patients who were male with lower weight and lower risk levels were less likely to receive multiple therapies. In conclusion, combination therapy, especially SPC, was underused in the targeted hypertensive population. Our contemporary population study showed that young patients (<55) without a history of catheterization or echo examination and male older-aged (≥65) patients with low-risk classification were the population most likely to be neglected. Such information can help triage medical care resources in improving SPC use.

Children with inflammatory bowel disease already have an altered arterial pulse wave.

Adults with inflammatory bowel disease (IBD) have an increased risk for vascular events. This study aims to evaluate arterial parameters in paediatric IBD. Carotid intima-media thickness (CIMT) was measured by ultrasound, and Arteriograph was used to assess aortic pulse wave velocity (PWVao), brachial and aortic augmentation indexes (AixBrach, AixAo), central systolic blood pressure (SBPao), and heart rate (HR). A total of 161 children were included; 55 (34%) children with newly diagnosed IBD (median age 14.35 (11.88-16.31) years, 53% males), 53(33%) in remission (median age 15.62 (13.46-16.70) years, 66% males), and 53 (33%) controls (median age 14.09 (11.18-14.09) years, 55% males) were recruited into a case-control study. Compared to controls, patients with active disease and those in clinical remission had significantly lower AixBrach and AixAo (P < 0.001, P = 0.009; P < 0.001, P = 0.003). PWVao and CIMT were still normal. HR was higher in both IBD groups than in controls (P < 0.001; P = 0.006). HR positively correlated with disease duration (P = 0.001). In the ordinary least squares regression models, anti-tumour necrosis factor (TNF) α treatment predicted lower peripheral and central systolic blood pressures, in contrast to aminosalicylates and methotrexate. Aminosalicylate treatment predicted increased HR. Conclusion: Children with IBD have an increased heart rate, a lower augmentation index and, therefore, an altered pulse waveform. In paediatric IBD, arterial stiffness and CIMT are still normal, indicating the potential for adequate IBD treatment to preserve arterial health. What is Known: • Adult patients with inflammatory bowel disease (IBD) have increased carotid intima-media thickness and arterial stiffness, which positively correlates with cardiovascular risk and predicts mortality. Adequate treatment, especially anti-tumour necrosis factor (TNF) α medications, lower these risks. • Children with IBD have impaired endothelial function and reduced heart rate (HR) variability. What is New: • Children with IBD have impaired endothelial function and reduced heart rate (HR) variability. • Anti-TNFα treatment in children and adolescents with IBD lowers systolic pressure, whereas methotrexate and aminosalicylates have the opposite effect. Amiynosalyiciylate treatment also increases HR.

Relationship Between Ascending Thoracic Aortic Diameter and Blood Pressure: A Mendelian Randomization Study.

Observational studies identified elevated blood pressure (BP) as a strong risk factor for thoracic aortic dilation, and BP reduction is the primary medical intervention recommended to prevent progression of aortic aneurysms. However, although BP may impact aortic dilation, aortic size may also impact BP. The causal relationship between BP and thoracic aortic size has not been reliably established. Genome-wide association studies summary statistics were obtained for BP and ascending thoracic aortic diameter (AscAoD). Causal effects of BP on AscAoD were estimated using 2-sample Mendelian randomization using a range of pleiotropy-robust methods. Genetically predicted increased systolic BP, diastolic BP, and mean arterial pressure all significantly associate with higher AscAoD (systolic BP: β estimate, 0.0041 mm/mm Hg [95% CI, 0.0008-0.0074]; P=0.02, diastolic BP: β estimate, 0.0272 mm/mm Hg [95% CI, 0.0224-0.0320]; P<0.001, and mean arterial pressure: β estimate, 0.0168 mm/mm Hg [95% CI, 0.0130-0.0206]; P<0.001). Genetically predicted pulse pressure, meanwhile, had an inverse association with AscAoD (β estimate, -0.0155 mm/mm Hg [95% CI, -0.0213 to -0.0096]; P<0.001). Multivariable Mendelian randomization analyses showed that genetically predicted increased mean arterial pressure and reduced pulse pressure were independently associated with AscAoD. Bidirectional Mendelian randomization demonstrated that genetically predicted AscAoD was inversely associated with pulse pressure (β estimate, -2.0721 mm Hg/mm [95% CI, -3.1137 to -1.0306]; P<0.001) and systolic BP (β estimate, -1.2878 mm Hg/mm [95% CI, -2.3533 to -0.2224]; P=0.02), while directly associated with diastolic BP (0.8203 mm Hg/mm [95% CI, 0.2735-1.3672]; P=0.004). BP likely contributes causally to ascending thoracic aortic dilation. Increased AscAoD likely contributes to lower systolic BP and pulse pressure, but not diastolic BP, consistent with the hemodynamic consequences of a reduced aortic diameter.

QUALITY ASPECTS TO CONSIDER IN FLAXSEED AS A VALID OMEGA-3 DIETARY SUPPLEMENT: A RANDOMIZED CONTROLLED TRIAL

Dietary supplements, based on essential polyunsaturated fatty acids, help in normalizing the circulating lipids in overweight people. These fatty acids are abundant in fish oils and certain vegetable seed oils. In this context, the fatty acid profile of 9 commercial flaxseed trademarks was analyzed. Regarding fatty acid composition, α-linolenic acid represented more than 60% of the total fatty acids. In addition, sample 3 displayed the highest oxidative stability; thus, it was selected to be used in a pilot nutritional intervention study. The objective was to assess the hypolipidemic effects of flaxseed together with an isocaloric fish-rich diet. Two groups of women aged 25-70 years presenting high levels of circulating cholesterol (&gt; 200 mg dL-1) and triglycerides (&gt;150 mg dL-1) participated. Group F consumed flaxseed, while group D did not. At the end of intervention, participants from group F presented significantly reduced total cholesterol and lower systolic and diastolic pressure as compared to group D. Triacylglycerols decreased in both groups with respect to initial values, suggesting a role of diet. The flaxseed trademark is an influencing variable in its fatty acid composition and flaxseed supplementation combined with a fish-rich diet can help to reduce blood lipid parameters.

Establishment of a Risk Scoring Model for Perioperative Unex-Plained Shock during Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion.

Several complications can contribute to the risk of shock during the chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedure. However, some patients that develop shock do not exhibit any apparent complications, and few studies to date have discussed the risk of unexplained perioperative shock in patients undergoing CTO PCI. Accordingly, this study was designed with the goal of defining perioperative risk factors linked to the odds of unexplained shock during CTO PCI. In total, this study analyzed data from 924 patients that underwent CTO PCI without any in-hospital complications from January 2016-August 2021. Cardiologists collected data pertaining to patient clinical characteristics, laboratory findings, angiographic findings, and procedural characteristics. Patients were separated into two groups based upon whether or not they experienced perioperative shock. The relationship between specific variables and perioperative shock incidence was assessed via a multivariable stepwise logistic regression approach. A risk-scoring nomogram was then designed for use as a tool to guide patient risk assessment efforts during PCI procedural planning. Overall, 4.8% of these patients (44/924) experienced unexplained perioperative shock. Independent predictors associated with unexplained shock during CTO PCI included baseline systolic pressure (odds ratio (OR) 0.968, 95% confidence interval (CI): 0.945-0.991), baseline heart rate (OR 1.055, 95% CI: 1.020-1.091), baseline hemoglobin (OR 0.970, 95% CI: 0.947-0.994), procedure duration (OR 1.008, 95% CI: 1.002-1.015), J-CTO score (OR 1.521, 95% CI: 1.021-2.267), and use of a retrograde approach (OR 3.252, 95% CI: 1.426-7.415). The unbiased C-index estimate was 0.859, and this model exhibited excellent calibration. The risk of unexplained shock is an important consideration for clinicians performing the CTO PCI procedure. These analyses revealed unexplained shock risk to be independently related to lower baseline systolic pressure, higher baseline heart rate, lower baseline hemoglobin, more procedure time, higher J-CTO score, and more use of a retrograde approach.

Reduction of Atrial Septal Defect Size After Catheter Ablation for Atrial Tachyarrhythmia and Its Predictive Factors

<h2>Abstract</h2> The prevalence of atrial tachyarrhythmia is high in patients with atrial septal defect (ASD), and catheter ablation (CA) is often performed before percutaneous ASD closure. We aimed to clarify the effect of CA on the ASD size. We analysed 16 patients with secundum ASD who had a history of CA for atrial tachyarrhythmia and underwent ASD size evaluation before and after CA. The size of ASD significantly decreased after CA. Younger age and lower tricuspid regurgitation pressure gradients and pulmonary arterial systolic pressures were associated with size reduction. These factors are crucial for making strategies of percutaneous ASD closure.

The Preventive Role of Physical Activity in Systemic Sclerosis: A Cross-Sectional Study on the Correlation with Clinical Parameters and Disease Progression.

Although exercise is associated with improved health in many medical conditions, little is known about the possible influences of physical activity (PA) habits pre- and post- a diagnosis of systemic sclerosis (SSc) on disease activity and progression. This cross-sectional study assessed, for the first time, self-reported pre- and post-diagnostic PA levels with the aim to verify if changes in these levels were correlated with demographic/anthropometric data (e.g., weight, height, gender, age, BMI), disease duration, diagnostic/clinical parameters (e.g., skin involvement, pulmonary hemodynamic/echocardiographic data, disease activity) related to disease activity and progression, and quality of life in a population-based sample of patients with SSc. Adult participants (n = 34, age 56.6 ± 13.3 years) with SSc (limited cutaneous SSc, lcSSc, n = 20; diffuse cutaneous SSc, dcSSc, n = 9; sine scleroderma SSc, n = 5) were enrolled at the Division of Rheumatology and Clinical Immunology of the Humanitas Research Hospital. All medical data were recorded during periodic clinical visits by a rheumatologist. Moreover, all subjects included in this study completed extensive questionnaires to evaluate their health-related quality of life (HRQOL), and others related to health-related physical activity performed before (PRE) and after (POST) the diagnosis of disease. The linear regression analysis has shown that either a high Sport_index or Leisure_index in the PRE-diagnostic period was correlated with lower disease duration in dcSSc patients. Physical load during sport activity and leisure time accounted for ~61.1% and ~52.6% of the individual variation in disease duration, respectively. In lcSSc patients, a high PRE value related to physical load during sporting activities was correlated with a low pulmonary artery systolic pressure (sPAP) and the POST value of the Work_index was positively correlated with the left ventricular ejection fraction (LVEF), and negatively with creatine kinase levels (CK). Interestingly, the univariate analysis showed that Work_index accounts for ~29.4% of the variance in LVEF. Our analysis clearly reinforces the concept that high levels of physical load may play a role in primary prevention—delaying the onset of the disease in those subjects with a family history of SSc—as well as in secondary prevention, improving SSc management through a positive impact on different clinical parameters of the disease. However, it remains a priority to identify a customized physical load in order to minimize the possible negative effects of PA.

If We Cannot Use Nitric Oxide for Newborn Persistent Pulmonary Hypertension, is Oral Sildenafil Therapeutic? A Single-center Experience

Background: Persistent pulmonary hypertension is still an issue in newborn period with different treatment strategies. In this study, we aimed to evaluate the three-year experience of a neonatal intensive care unit on use of sildenafil citrate for treating newborns with persistent pulmonary hypertension. Methods: Twenty-nine newborn patients with the diagnosis of persistent pulmonary hypertension solely treated by sildenafil citrate (2 mg/kg per dose, orally, three times a day) in intensive care unit of a private hospital between 2018 and 2021 were retrospectively analyzed. Results: The newborns that underwent sildenafil treatment and the newborns that received no treatment had statistically similar length of hospital stay (p = 0.188). The premature newborns had significantly lower systolic and diastolic blood pressure than the term newborns on their first day of sildenafil treatment (p = 0.001 for both). The premature newborns had significantly lower systolic, diastolic, and right ventricular systolic pressure than the term newborns on their day of hospital discharge (p = 0.003, p = 0.013 and p = 0.001 respectively). The premature newborns had significantly lower systolic, diastolic, and right ventricular systolic pressure on their day of hospital discharge than their first day of sildenafil treatment (p = 0.039, p = 0.041 and p = 0.043 respectively). The term newborns had also significantly lower systolic, diastolic, and right ventricular systolic pressure on their day of hospital discharge than their first day of sildenafil treatment (p = 0.001 for each). Conclusions: Sildenafil citrate can be considered as an efficient and safe alternative for the treatment of persistent pulmonary hypertension in newborn at the in tertiary neonatal intensive care units without nitric oxide and devices.

Microencapsulated bioactive peptides from brewer's spent grain promotes antihypertensive and antidiabetogenic effects on a hypertensive and insulin-resistant rat model.

The effects of microcapsules containing brewer's spent grain (BSG) peptides were evaluated on a hypertensive/insulin-resistant rat model induced by a sucrose-rich diet (SRD) administration. Animals received for 100 days the control diet (CD), SRD, and CD and SRD diets supplemented with microencapsulated peptides (CD-P and SRD-P). During the experimental period, blood pressure was monitored. Glycemia, tissue glycogen content, nitric oxide, and the activity of enzymes related to hypertensive and diabetogenic mechanisms were determined. The consumption of SRD caused hypertensive and hyperglycemic effects compared to CD. However, the SRD-P group presented lower systolic pressure at the middle of ingestion, achieving similar values than the CD. The SRD-P rats decreased all enzymes' activities compared to the SRD reaching the values of CD, except for those of α-amylase in cecal content and DPP-IV in serum. It was possible to corroborate potential antihypertensive and antidiabetogenic in vivo effects of the microencapsulated BSG peptides. PRACTICAL APPLICATIONS: Brewer's spent grain (BSG) is the main waste obtained from brewing industry. Bioactive peptides obtained after an enzymatic hydrolysis of proteins with in vitro antihypertensive and antidiabetogenic activity have been described. However, to corroborate the action of these bioactive peptides, in vivo studies are necessary. In the present work, microcapsules containing bioactive peptides from BSG were administered on the rat model with induced hypertension and insulin-resistance, corroborating an in vivo antihypertensive and antidiabetogenic effects by inhibition of enzymes related with blood pressure regulation and glucose metabolism. This work demonstrated that microcapsules of BSG peptides could be included into functional foods formulations, or used as dietary supplement for improving health and the prevention of non-communicable diseases, adding value to the brewing process by-product.