Mean Sitting Research Articles

Activité physique et qualité de vie chez les survivantes du cancer du sein

To assess physical activity (PA) and its determinants in breast cancer survivors (BCS), attending a Tunisian hospital, as well as to assess their quality of life (QOL) and examine the relationship between PA and BCS'QOL. We conducted a cross-sectional study among BCS attending the outpatient oncology, gynecology and radiotherapy clinics at a Tunisian hospital in April 2022 using a self-administered questionnaire. The valid Arabic version of the International Physical Activity. Questionnaire short version was used to assess PA and sitting time. QOL was assessed using the valid Arabic version of the 12-item Short-Form health survey. A total of 95 BCS were recruited. BCS reported overall moderate PA levels with a median MET of 1440 (IQR 680- 2400) minutes/week and a mean total sitting time of 281.79±134.36 minutes/day. Overall, patients aged 50 years and above had significantly lower levels of sitting time (231.43±129.32vs 332.14±121.63, p= 0.04). Similarly, subjects aged 50 years and above, and of rural origin had higher levels of PA (1908.5 (IQR 939.7-3268.5) vs. 1266 (IQR 471-2946), p= 0.114 and 1788.5 (IQR 1072.5-3252) vs. 1440 (IQR 537-3057), p= 0.259 respectively). Regarding BCS'QOL, they showed moderate disability in the physical component (39.3 ±7.08) , and mild disability in the mental component (43.94 ±9.23). BCS' QOL was significantly correlated to PA (r=0,258, p=0,012). Adherence to regular PA is effective in improving BC patients' survival rate. Therefore, to enhance survivors' QOL, a healthy lifestyle including regular PA is well recommended.

#5705 EFFICACY AND SAFETY OF SACUBITRIL/VALSARTAN IN PATIENTS WITH STAGE 3B-5 CKD AND HYPERTENSION

Abstract Background and Aims Sacubitril/valsartan (SV) plays a key role in improving left ventricular remodeling and prognosis in patients with heart failure. However its effects on kidney function in people with moderate to severe chronic kidney disease (CKD3b-5) are unknown. The present study was designed to assess the efficacy and safety of sacubitril-valsartan in patients with stage 3b-5 CKD and hypertension. Method In this randomized, double-blind, 3-month trial, patients with stage 3b-5 CKD and hypertension were randomly assigned to sacubitril/valsartan treatment group (n = 44, the doses of SV were up-titrated to sacubitril/valsartan 400 mg), and conventional antihyperensive treatment group (n = 40). The primary outcome was reduction in GFR from baseline at week 12. Results In total, 44 participants were assigned to sacubitril/valsartan group and 40 to crontol group (conventional antihyperensive group). Baseline measured GFR was 29.94±11.83, 27.86±10.14 mL/min/1.73 m2, respectively. There was no difference in measured GFR (P = 0.064). At week 12, there was a reduction in measured GFR in control group: 27.86±9.15 versus 22.03±11.41, but there was no significant difference (P = 0.155). Sacubitril/ valsartan could improve eGFR: 29.94±11.83 versus 32.05±14.57 (P = 0.018). We also observed that, compared with control group, sacubitril/valsartan decreased albuminuria: reductions in urinary albumin:creatinine ratio (ACR) in sacubitril/valsartan group was 89.5mg/g and reductions in urinary ACR in control group was -44.55mg/g. At week 12, Sacubitril/valsartan provided a significantly greater reduction in office mean sitting (ms) systolic BP (msSBP) than control group (20.75mmHg vs 12.88mmHg, P = 0.046). There was no serious adverse events in both groups. The incidence of hyperkalemia (potassium≥5.5 mmol/L) was 4.5% in SV group and 7.5% in control group. Conclusion The present data suggested that, in patients with stage 3b-5 CKD and hypertension, Sacubitril-valsartan could improve kidney function and decrease albuminuria, and was generally safe and well tolerated.

Determinants of instrumented sedentary and physical activity behavior in geriatric rehabilitation inpatients: RESORT

BackgroundPhysical inactivity in hospitalized older adults is highly prevalent and associated with detrimental health outcomes. Understanding its determinants is important for prognosis and tailoring interventions in geriatric rehabilitation inpatients. MethodsWithin the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort, geriatric rehabilitation inpatients wore an inertial sensor (ActivPAL4) for one week to objectively assess instrumented sedentary behavior (i-SB) and physical activity (i-PA). Determinants were grouped in five geriatric domains: morbidity, cognition/psychology, physical performance, functional performance, and nutritional status. Their association with i-SB (mean sitting, lying, non-upright time) and i-PA (mean number of steps, sit-to-stand transitions and upright time) quintiles were examined using multivariate ordinal logistic regression analyses with Bonferroni correction (p < 0.006). ResultsA total of 145 inpatients were included (mean age 83.0, SD 7.7 years; 55.9% females). More comorbidities were associated with a lower daily number of steps (OR:0.91, 95%CI: 0.86–0.96) and lower upright time (OR:0.93, 95%CI: 0.88–0.98). Depressive symptoms (higher Hospital Anxiety and Depression Scale score) were associated with higher non-upright time (OR: 1.12, 95%CI: 1.03–1.21) and lower upright time (OR: 0.89, 95%CI: 0.83–0.96). Better physical performance (higher Functional Ambulation Classification, gait speed, and Short Physical Performance Battery score) was associated with lower i-SB measures (OR range: 0.07–0.78, p < 0.0005) and higher i-PA measures (OR range: 1.35–19.50, p < 0.0005). Higher functional performance (Katz index of Activities of Daily Living score) was associated with lower i-SB measures (OR range: 0.61–0.69, p ≤ 0.003) and higher i-PA measures (OR range: 1.60–3.64, p < 0.0005). Being malnourished was associated with lower i-PA measures (OR range: 0.29–0.32, p ≤ 0.004). ConclusionsWorse morbidity, depressive symptoms, worse physical and functional performance, and worse nutritional status were associated with higher i-SB and lower i-PA. These determinants should be taken into account while designing and promoting multidisciplinary physical activity interventions.

Chair dimension compatibility with elementary school students anthropometric data in North Jakarta

BACKGROUND In Indonesia, primary school begins at 6 years old and continues until 12, where most of their growth is experienced at that age. Non-ergonomic school furniture can harm the musculoskeletal system. This study evaluates the suitability of chair dimensions to elementary school student’s anthropometry in North Jakarta. METHODSA cross-sectional study of 98 students in North Jakarta. Chair dimension data and student anthropometry were measured using a tape measure, which was then analyzed using the Chi-Square Goodness of Fit Test to evaluate their suitability. RESULTSThe ages of the students ranged from 5 to 11 years. Anthropometric measurements of students show that the mean Sitting Shoulder Height is 41.81±4.36 cm, Popliteal Height 36.83±3.77 cm, Hip Breadth 25.88±3.47 cm, and Buttock-Popliteal Length 36.56±4.33 cm. While the average size assessed from the seat dimensions is Seat Height 41.71±0.22 cm, Seat Width 37.2±1.26 cm, Seat Depth 37.2±1.42 cm, and Backrest Height Above Seat 35.54±3.19 cm. The results of Goodness of Fit with Kendall's Tau-b critical value for the suitability of chair dimensions to student anthropometry were 0.37, and vice versa 0.672, which stated a discrepancy. CONCLUSIONThere is a mismatch between chair dimension and anthropometry of elementary school students in North Jakarta. Adjustment of chair dimensions needs to be done using a student's average size approach to prevent musculoskeletal disorders.

The impact of digital technology development on sitting time across Europe

Digital technology development has been proposed to explain higher levels of sedentary behaviour; but this has not yet been confirmed. Thus, here we evaluated the impact of digital development on sedentary behaviour using two metrics: digital country development and e-devices ownership from the Digital Economy and Society Index (DESI) and the Eurobarometer 88.4 cross-sectional survey with 28,031 participants ≥ 15 years old. From an environmental macro perspective, at the national level, a simple linear regression has been performed between the DESI and mean sitting time per country. To develop a micro approach to this phenomenon, binomial logistic regression models have been run among individual e-devices ownership and the daily amount of time spent sitting (≤3.5 h/day, > 4.5 h/day). Digital country development is positively related to sitting time, whereas the ownership of e-device (either DVD player, CD player, desk computer, laptop, and Internet connection) was associated with a higher sitting time (>4.5 h/day) in the overall population, with slight differences by gender. While further research is needed to understand the effect of digitalization on sedentary behaviour throughout time, here we document how it is associated with higher sitting time, as assessed through both macro and micro approaches.

Postural Changes and the Trans–Lamina Cribrosa Pressure Difference: A Pilot Study in Neurosurgical Patients without Glaucoma

To evaluate the effect of changes in position in the trans-lamina cribrosa pressure difference (TLCPD) by simultaneously measuring and comparing intracranial pressure (ICP) with intraocular pressure (IOP) in seated and supine positions. Prospective cohort study. Patients admitted to the neurosurgery unit at Toronto Western Hospital with an external ventricular drain placed for ICP monitoring. Exclusion criteria were any ophthalmic surgical procedures within the preceding 6 months, history of glaucoma, and corneal abnormalities affecting IOP measurement. Intraocular pressure and ICP were recorded simultaneously in both the supine and seated positions with the order of positions randomized. Measurements were made 10 minutes after assuming each position. The TLCPD (IOP minus ICP) was calculated for the sitting and supine positions. The paired t test was used to assess significance of differences. The TLCPD. Twenty patients were included in the study. The average age was 54±17 years. Results were similar for left and right eyes. Data are shown for right eyes only. Mean sitting and supine IOPs were 15.3±3.5 mmHg and 15.9±3.7 mmHg, respectively (P= 0.32). Mean sitting and supine ICPs were 12.5±6.8 mmHg and 12.8±5.1 mmHg, respectively (P= 0.66). Mean TLCPD was 3.1±6.0 mmHg in the sitting position and 3.1±7.0 mmHg in the supine position (P= 1.00). Supine TLCPD increased in 10 patients (50%), decreased in 8 patients (40%), and was unchanged in 2 patients (10%). In this pilot study of 20 neurosurgical patients without glaucoma, posture-induced TLCPD changes were variable.

Efficacy and Safety of Sacubitril/Valsartan (LCZ696) Compared With Olmesartan in Elderly Asian Patients (≥65 Years) With Systolic Hypertension.

Systolic hypertension is common in elderly patients and remains a challenge to treat effectively. The efficacy and safety of sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, vs. olmesartan was evaluated in elderly Asian patients (≥65 years) with systolic hypertension. In this randomized, double-blind, 14-week study, patients initially received once-daily sacubitril/valsartan 100 mg or olmesartan 10 mg, increased to sacubitril/valsartan 200 mg or olmesartan 20 mg at week 4. At week 10, for patients with blood pressure (BP) >140/90 mm Hg, the doses were up-titrated to sacubitril/valsartan 400 mg or olmesartan 40 mg. The primary assessment was superiority of sacubitril/valsartan vs. olmesartan in reducing office mean sitting (ms) systolic BP (msSBP) from baseline at week 10. Secondary efficacy assessments included changes from baseline in ms diastolic BP (msDBP), ms pulse pressure (msPP), 24-hour mean ambulatory (ma) BP (maBP), and maPP at week 10; msBP and msPP at weeks 4 and 14. Overall, 588 patients were randomized (mean age, 70.7 years; baseline msBP, 160.3/84.9 mm Hg; msPP, 75.4 mm Hg). At week 10, sacubitril/valsartan provided superior msSBP reductions vs. olmesartan (22.71 vs. 16.11 mm Hg, respectively; P < 0.001); similarly, reductions from baseline in other BP and PP assessments were significantly greater with sacubitril/valsartan. At week 14, despite more patients requiring up-titration in the olmesartan group, msBP and msPP reductions from baseline were significantly greater with sacubitril/valsartan. Both treatments were generally well-tolerated. Sacubitril/valsartan is more effective than olmesartan in reducing BP in elderly Asian patients with systolic hypertension.

The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.

The aim of this study was to determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease, heart failure and stroke risks. Black and White participants, N = 11,129, enrolled in the Atherosclerosis Risk in Communities study (mean age 53.9 ± 5.7 (SD) years) were included. Each participant had three sitting, five supine, and six standing blood pressure measures during one day. Main outcome measures were changes in estimated coronary heart disease, heart failure and stroke risk when using the different blood pressure measures. Mean sitting, standing and supine systolic blood pressure values of the study population were 120.8 ± 18.6, 124.9 ± 20 and 124.7 ± 19.6 mmHg, respectively. The substitution of the second sitting systolic blood pressure with the third sitting systolic blood pressure (taken ∼5 min later) in two separate coronary heart disease risk models reclassified 3.3% to 5.1% of study participants. Similar substitutions for heart failure and stroke risk prediction models led to reclassification of 1.9% and 2.7% of participants respectively. When mean sitting systolic blood pressure was replaced with mean standing systolic blood pressure 5.4% to 11.6% of the participants were reclassified. Maximum upward and downward change in an individual's estimated risk was 31% and 26% respectively. Estimated risks of coronary heart disease, heart failure, and stroke for an individual can change significantly within a day due to changes in systolic blood pressure. Given recommendations to use estimated risk for therapeutic decisions, our study has implications for the use of a single systolic blood pressure in cardiovascular risk estimation.

Associations between obesity, physical fitness, and urinary incontinence in non-institutionalized postmenopausal women: The elderly EXERNET multi-center study

ObjectivesTo investigate the associations between body composition, fitness level, and urinary incontinence (UI) in 471 non-institutionalized women ≥ 65 years of age. Study designCross-sectional study. MethodUI was assessed using the International Consultation on Incontinence Questionnaire Short-Form and a specific severity UI item. Anthropometric measurements were obtained using standardized techniques and equipment. Body fat percentage (BF%) was measured by bioelectrical impedance. Physical fitness (PF) was evaluated by a set of 8 tests and a fitness index (FI) was calculated. Active and sedentary behaviors were recorded by standardized questionnaires. ResultsUI was reported in 28.5% of the participants. Women with UI showed higher values of body mass index (BMI), BF% and waist circumference (WC) (all p<0.05) compared to urinary continent women, whereas there was a lower fitness index (FI) level in women with UI (p=0.08). Among all fitness capacities, upper body flexibility showed the closest relationship with UI. UI risk increased by 87.0% [95% confidence intervals (1.01–3.17)] in obese women compared to the normal group, according to the BF% while no significant results were found when PF, WC and BMI were included in the model. Mean sitting and walking time per day were 4.3±1.4 and 1.8±0.9h/d, respectively. ConclusionUI was associated with an excess of fat mass and poor PF, especially upper-body flexibility.

Abstract 474: Efficacy and Safety of LCZ696 Compared with Olmesartan in Japanese Patients with Systolic Hypertension

Objective: To evaluate the efficacy and safety of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI) vs olmesartan in Japanese patients with systolic hypertension (SH). Methods: Patients aged ≥20 yrs with mean sitting (ms) SBP ≥150-&lt;180 mmHg were randomized to once-daily LCZ696 200 mg or 400 mg (forced-titrated from 1-week LCZ696 200 mg), or olmesartan 20 mg for 8 weeks. The primary objective of this study was to test if LCZ696 200 mg is superior over olmesartan in msSBP reductions from baseline at week 8. Secondary endpoints were reductions in msSBP with LCZ696 400 mg, reductions in msDBP and ms pulse pressure (PP), BP control rate, and safety for all treatment groups at week 8. Efficacy and safety was also assessed by age (&lt;65 and ≥65 years). Results: A total of 1161 patients (LCZ696 200 mg, n=387; LCZ696 400 mg, n=385; olmesartan, n=389) were randomized. Demographic and baseline characteristics were generally comparable across the treatment groups with mean age of 58.7 yrs (&lt;65 yrs, 771 [67.1%]; ≥65 yrs, 382[32.9%]). The msSBP reductions at week 8 with LCZ696 200 mg were statistically significantly superior to olmesartan and significantly greater with LCZ696 400 mg than olmesartan (Table). Reductions in msDBP and msPP were significantly greater and BP control rates were significantly higher with LCZ696 vs olmesartan. Greater BP and PP lowering with LCZ696 vs olmesartan was independent of age. The incidence of AEs was similar across the treatment and age groups. Conclusion: Treatment with LCZ696 is effective and generally well-tolerated in Japanese patients with SH regardless of age and LCZ696 200 mg showed superior BP lowering effect than olmesartan 20 mg.

Comparative effectiveness of chlorthalidone with hydrochlorothiazide using two ratios of potency in a real world managed care population

Patients with hypertension whose blood pressure (BP) does not reduce during the nighttime period (non-dippers) are at increased risk of cardiovascular events. Antihypertensive therapies that improve the dip in BP from daytime to nighttime could improve outcomes beyond overall BPlowering. We investigated the efficacy of LCZ696 (Japanese Adopted Name: Sucabitril Valsartan Sodium Hydrate), a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), in sub-populations of patients with hypertension classified as dippers ( 10% decrease in mean ambulatory [ma] systolic blood pressure [SBP] at nighttime vs. daytime) and non-dippers (<10% decrease in maSBP at nighttime vs. daytime) at baseline. This double-blind, placebo-controlled study was conducted in 389Asian patients with mild to moderate hypertension (mean sitting [ms] diastolic blood pressure [DBP] 95 and<110 mmHg and msSBP 140 and<180 mmHg) randomized to 8 weeks’ treatment with LCZ696 100, 200 or 400 mg, or placebo.Changes frombaseline in 24-h and nighttime (10 pm-6 am)maSBPand maDBP were assessed at Week 8 in dippers and non-dippers. Of 362 patients who completed the study, baseline characteristics (mean age 51.5 yrs [11% 65 yrs]; 72% male; BMI 25.9 kg/m) and baseline maBP (maSBP/maDBP) were similar between dippers (143.6/93.8 mmHg) and non-dippers (147.4/96.4 mmHg). 319 dippers or non-dippers had evaluable maBP measurements at baseline and post-baseline. All doses of LCZ696 provided significantly greater reductions in mean 24-h and nighttime maSBP and maDBP vs. placebo, with a trend (NS) for the greatest benefit observed with the two higher doses of LCZ696 in non-dippers (Table). Overall incidence of adverse events was similar between each treatment group (37.5-38.0%) and placebo (32.6%). These results suggest that the ARNI LCZ696 is an effective treatment for Asian patients with hypertension, reducing BP throughout the 24-h period and restoring nighttime BP reduction in non-dippers.

Comparison of new-onset gout incidence in adults prescribed hydrochlorothiazide versus chlorthalidone

Patients with hypertension whose blood pressure (BP) does not reduce during the nighttime period (non-dippers) are at increased risk of cardiovascular events. Antihypertensive therapies that improve the dip in BP from daytime to nighttime could improve outcomes beyond overall BPlowering. We investigated the efficacy of LCZ696 (Japanese Adopted Name: Sucabitril Valsartan Sodium Hydrate), a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), in sub-populations of patients with hypertension classified as dippers ( 10% decrease in mean ambulatory [ma] systolic blood pressure [SBP] at nighttime vs. daytime) and non-dippers (<10% decrease in maSBP at nighttime vs. daytime) at baseline. This double-blind, placebo-controlled study was conducted in 389Asian patients with mild to moderate hypertension (mean sitting [ms] diastolic blood pressure [DBP] 95 and<110 mmHg and msSBP 140 and<180 mmHg) randomized to 8 weeks’ treatment with LCZ696 100, 200 or 400 mg, or placebo.Changes frombaseline in 24-h and nighttime (10 pm-6 am)maSBPand maDBP were assessed at Week 8 in dippers and non-dippers. Of 362 patients who completed the study, baseline characteristics (mean age 51.5 yrs [11% 65 yrs]; 72% male; BMI 25.9 kg/m) and baseline maBP (maSBP/maDBP) were similar between dippers (143.6/93.8 mmHg) and non-dippers (147.4/96.4 mmHg). 319 dippers or non-dippers had evaluable maBP measurements at baseline and post-baseline. All doses of LCZ696 provided significantly greater reductions in mean 24-h and nighttime maSBP and maDBP vs. placebo, with a trend (NS) for the greatest benefit observed with the two higher doses of LCZ696 in non-dippers (Table). Overall incidence of adverse events was similar between each treatment group (37.5-38.0%) and placebo (32.6%). These results suggest that the ARNI LCZ696 is an effective treatment for Asian patients with hypertension, reducing BP throughout the 24-h period and restoring nighttime BP reduction in non-dippers.

Blood pressure-lowering efficacy of LCZ696 in non-dipper patients with hypertension

Patients with hypertension whose blood pressure (BP) does not reduce during the nighttime period (non-dippers) are at increased risk of cardiovascular events. Antihypertensive therapies that improve the dip in BP from daytime to nighttime could improve outcomes beyond overall BPlowering. We investigated the efficacy of LCZ696 (Japanese Adopted Name: Sucabitril Valsartan Sodium Hydrate), a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), in sub-populations of patients with hypertension classified as dippers ( 10% decrease in mean ambulatory [ma] systolic blood pressure [SBP] at nighttime vs. daytime) and non-dippers (<10% decrease in maSBP at nighttime vs. daytime) at baseline. This double-blind, placebo-controlled study was conducted in 389Asian patients with mild to moderate hypertension (mean sitting [ms] diastolic blood pressure [DBP] 95 and<110 mmHg and msSBP 140 and<180 mmHg) randomized to 8 weeks’ treatment with LCZ696 100, 200 or 400 mg, or placebo.Changes frombaseline in 24-h and nighttime (10 pm-6 am)maSBPand maDBP were assessed at Week 8 in dippers and non-dippers. Of 362 patients who completed the study, baseline characteristics (mean age 51.5 yrs [11% 65 yrs]; 72% male; BMI 25.9 kg/m) and baseline maBP (maSBP/maDBP) were similar between dippers (143.6/93.8 mmHg) and non-dippers (147.4/96.4 mmHg). 319 dippers or non-dippers had evaluable maBP measurements at baseline and post-baseline. All doses of LCZ696 provided significantly greater reductions in mean 24-h and nighttime maSBP and maDBP vs. placebo, with a trend (NS) for the greatest benefit observed with the two higher doses of LCZ696 in non-dippers (Table). Overall incidence of adverse events was similar between each treatment group (37.5-38.0%) and placebo (32.6%). These results suggest that the ARNI LCZ696 is an effective treatment for Asian patients with hypertension, reducing BP throughout the 24-h period and restoring nighttime BP reduction in non-dippers.

Rationale and study design of the Prospective comparison of Angiotensin Receptor neprilysin inhibitor with Angiotensin receptor blocker MEasuring arterial sTiffness in the eldERly (PARAMETER) study

IntroductionHypertension in elderly people is characterised by elevated systolic blood pressure (SBP) and increased pulse pressure (PP), which indicate large artery ageing and stiffness. LCZ696, a first-in-class angiotensin receptor neprilysin...

A study of sedentary behaviour in the older Finnish twin cohort: a cross sectional analysis.

The aim of the study was to investigate the effects of age, sex, and body mass index (BMI) on total sitting time among the Finnish twin cohort. Also, heritability and environmental factors were analysed. The final sample included 6713 twin individuals 53–67 years of age (46% men). Among them there were 1940 complete twin pairs (732 monozygotic [MZ] and 1208 dizygotic [DZ] twin pairs). Sedentary behaviour was queried with a self-reported questionnaire with multiple-choice questions about sitting time at different domains. The mean total sitting time per day was 6 hours 41 minutes (standard deviation: 2 hours 41 minutes). The total sitting time was less in women than in men (P = 0.002). Older age was associated with less total sitting time (P < 0.001). Those with higher body mass index had higher total sitting time in age and sex adjusted analysis (P < 0.001). MZ pairs were more similar for sitting time than DZ pairs, with initial estimates of heritability for the total sitting time of 35%.The influence of shared environmental factors was negligible (1%), while most (64%) of the variation could be ascribed to unique environmental factors, the latter including measurement error.

Sedentary Behaviour and Physical Activity in South Asian Women: Time to Review Current Recommendations?

ObjectiveOur aims were to describe activity and sedentary behaviours in urban Asian women, with dysglycaemia (diagnosed at recruitment), and without dysglycaemia and examine the relative contribution of these parameters to their glycaemic status.Methods2800 urban women (30–45 years) were selected by random cluster sampling and screened for dysglycaemia for a final sample of 272 newly diagnosed, drug naive dysglycaemic and 345 normoglycaemic women. Physical activity and sedentary behaviours were assessed by the International Physical Activity Questionnaire (IPAQ). Demographic data, diet and anthropometry were recorded. Logistic regression analysis assessed contribution of all parameters to dysglycaemia and exposure attributable fractions were calculated.ResultsThe mean energy expenditure on walking (2648.5±1023.7 MET-min/week) and on moderate and vigorous physical activity (4342.3±1768.1 MET-min/week) for normoglycemic women and dysglycaemic women (walking;1046.4±728.4 MET-min/week, moderate and vigorous physical activity; 1086.7±1184.4 MET-min/week) was above the recommended amount of physical activity per week. 94.3% of women spent >1000 MET-minutes/week on activity. Mean sitting and TV time for normoglycaemic and dysglycaemic women were 154.3±62.8, 38.4±31.9, 312.6±116.7 and 140.2±56.5 minutes per day respectively. Physical activity and sedentary behaviour contributed to dysglycaemia after adjustment for family history, diet, systolic blood pressure and Body Mass Index. Exposure attributable fractions for dysglycaemia were; lower physical activity: 78%, higher waist circumference: 94%, and TV viewing time: 85%.ConclusionsUrban South Asian women are at risk of dysglycaemia at lower levels of sedentary behaviour and greater physical activity than western populations, indicating the need for re-visiting current physical activity guidelines for South Asians.

Triple Fixed-Dose Combination Therapy

In this issue of Hypertension , Calhoun et al1 report on a large (n=2271), short (9 weeks of treatment after 4 weeks of washout and placebo), well-designed, properly controlled, international randomized trial of a triple combination of a diuretic (D; hydrochlorothiazide [HCTZ]), a dihydropyridine calcium channel blocker (DHPCCB; amlodipine [A]), and an angiotensin reception blocker (ARB; valsartan [V]) in volunteers who had a mean sitting (MS) diastolic blood pressure (BP; MSDBP) of ≥100 mm Hg. The results support what all would have anticipated: the use of 3 antihypertensive medications with different mechanisms of action would lead to a greater drop in BP than would combinations of any 2 of the 3 drugs given as 2-drug combinations. In fact, any other result would have been news, because combination therapy has many obvious advantages and some disadvantages compared with single-drug therapy (Tables 1 to 3⇓⇓). View this table: Table 1. Advantages of Multidrug Therapy in Hypertension View this table: Table 2. Advantages of a Fixed-Dose Combination as Antihypertensive Therapy View this table: Table 3. Disadvantages of a Fixed-Dose Combination as Antihypertensive Therapy The main result was that the triple combination reduced MS BP by 40/25 mm Hg, whereas the 2-drug combination of the ARB/D achieved a 32/20-mm Hg reduction, and the ARB/DHPCCB combination lowered MSBP by 34/22 mm Hg, whereas the DHPCCB/D combination dropped MSBP by 31/19 mm Hg. All of these differences were highly statistically significant, thanks in part to the large sample size. More important, the differences between these regimens, a minimum of 8/5 mm Hg for ARB/D versus the triple therapy, 6/3 mm Hg for ARB/DHPCCB versus the triple therapy, and 8/5 mm Hg for D/DHPCCB versus the triple therapy, are also clinically relevant. The study was large enough for a reliable comparison of prespecified subgroups: age (≥65 years versus <65 years); ethnicity (whites versus …

Systolic blood pressure reduction with olmesartan medoxomil versus nitrendipine in elderly patients with isolated systolic hypertension

The prevalence of isolated systolic hypertension (ISH) is high in the elderly, and the objective of this study was to compare the antihypertensive efficacy of olmesartan medoxomil with that of nitrendipine in elderly (65-74 years) and very elderly (>/= 75 years) male and female patients with ISH. Patients were randomized to 24 weeks of treatment with either olmesartan medoxomil 20 mg daily (n = 256) or nitrendipine 20 mg (n = 126) twice daily, with possible dose increase (to 40 mg daily) and addition of hydrochlorothiazide (HCTZ) 12.5 or 25 mg daily if required. On the primary endpoint [reduction in mean sitting systolic blood pressure (SBP) after 12 weeks of treatment], the two treatments were similar (olmesartan medoxomil, -30.0 mmHg; nitrendipine, -31.4 mmHg). No significant difference between the treatment groups was observed, and non-inferiority of olmesartan medoxomil to nitrendipine was demonstrated using an analysis of covariance (ANCOVA) model. Reductions in mean sitting and standing SBP and diastolic blood pressure (DBP) up to week 24 were also similar with both treatments. Blood pressure (BP) goal attainment rates (sitting SBP </= 135 mmHg) increased consecutively, and were higher with olmesartan medoxomil (62.5%) than with nitrendipine (56.0%) at week 24 (not significant). Both treatments were well tolerated. In elderly patients with ISH, the mean reduction in SBP produced by olmesartan is similar to that produced by nitrendipine.

Olmesartan compared with other angiotensin II receptor antagonists: Head-to-head trials

Background: Drugs that block the renin-angiotensin system represent one of the most significant therapeutic interventions available for the treatment of hypertension. The angiotensin II receptor antagonists (AIIRAs), also known as sartans, are one such class of drugs that block the effects of angiotensin II by antagonizing the angiotensin II type 1 receptor. Olmesartan is the newest member of this class. Objective: The present article reviews 3 head-to-head trials directly comparing the antihypertensive efficacy of olmesartan with that of 4 other AURAS, at recommended maintenance doses, already in clinical use for the treatment of hypertension. Results: In the first study, olmesartan 10 mg/d was compared with losartan 50 mg/d in 316 patients with mild to moderate hypertension (mean baseline diastolic blood pressure [DBP], 95–114 mm Hg). Dosage was doubled at week 4 and hydrochlorothiazide was added at week 12 if blood pressure response was inadequate. Olmesartan was significantly more effective than losartan with respect to the reduction in blood pressure at weeks 2, 4, and 12, and to the responder rate at weeks 2 and 4 (with the starting dose of the respective drug). In a second study, olmesartan 20 mg/d was shown to be significantly more effective than losartan 50 mg/d, valsartan 80 mg/d, and irbesartan 150 mg/d in 588 patients with mild to moderate hypertension (mean sitting baseline DBP, 100–115 mm Hg) ( P ⩽ 0.05). At week 2, the reduction in blood pressure observed with olmesartan was significantly greater than that of the comparator treatments ( P ⩽ 0.05). The superiority of olmesartan was maintained at week 8. The third study involved 643 evaluable patients with moderate to severe hypertension (mean DBP, 100–120 mm Hg; mean systolic blood pressure, >150 mm Hg). Olmesartan 20 mg/d was more effective than candesartan 8 mg/d in lowering 24-hour blood pressure at week 8 ( P ⩽ 0.05). Most of this treatment effect was evident after only 1 or 2 weeks, with greater reductions in blood pressure compared with candesartan. Conclusions: These data indicate that, at the doses studied, olmesartan is more effective than other AIIRAs tested at their recommended doses, in terms of reduction of cuff or 24-hour ambulatory blood pressure, in patients with essential hypertension. These differences in blood pressure reduction between these agents may be clinically relevant and have important long-term implications. Additional studies will further define the role of olmesartan in the management of cardiovascular diseases, such as atherosclerosis.

A single-masked study comparing doxazosin and enalapril in patients with non—insulin-dependent diabetes mellitus and hypertension

Angiotensin-converting enzyme (ACE) inhibitors are recognized as eminently suitable drugs for the treatment of hypertensive patients with non—insulin-dependent diabetes mellitus (NIDDM). They are metabolically neutral, may reduce insulin resistance, and are reno-protective. Long-acting alpha 1-blockers such as doxazosin are also metabolically neutral, effective antihypertensive agents. The objective of this study was to compare the efficacy and acceptability of doxazosin and the ACE inhibitor enalapril. We investigated the effects of these drugs on blood pressure, diabetic control, lipid levels, renal function, and safety in patients with NIDDM (type II diabetes) and mild-to-moderate hypertension. Fifty-two patients with NIDDM and stable essential hypertension were randomized to two parallel groups. The study comprised three phases: placebo washout (4 weeks), dose adjustment monotherapy of doxazosin 1 to 4 mg/d or enalapril 5 to 20 mg/d (8 weeks), and maintenance (4 weeks). Patients not controlled on monotherapy entered a 4-week, open-label, dual-therapy phase before maintenance. Black patients were excluded, as were those with macroalbuminuria (urinary albumin >3.5 g/24 h) and renal failure (serum creatinine ⩾150 μmol/L). Variables being compared included critical blood pressure (CBP) (ie, the lesser of mean sitting and standing diastolic blood pressure [DBP]), sitting and standing systolic blood pressure (SBP) and DBP, blood glucose (fasting and postprandial), serum cholesterol levels, serum triglyceride levels, body mass index (BMI), and electrocardiographic (ECG) evidence of left ventricular hypertrophy. Patients in the doxazosin group exhibited a larger decrease in CBP (−11.3 vs −6.2 mm Hg), sitting (−9.9 vs −1.1) and standing SBP (−10.3 vs 0.0), and sitting (−12.2 vs −8.4) and standing DBP (−7.9 vs −0.8) compared with the enalapril group. The difference in the reduction in standing DBP was statistically significant, whereas the other differences did not reach statistical significance. No statistically significant differences were found between the groups in metabolic variables, BMI, or ECG findings. The metabolic profiles of enalapril and doxazosin were similar, except for a mild increase in serum triglyceride levels in the doxazosin group. However, the confidence index for the doxazosin-enalapril difference was wide, meaning that no conclusive statement can be made about the difference. Adverse events were common (26.9% doxazosin vs 42.3% enalapril), but none were serious. The doxazosin-treated patients showed a larger decrease in blood pressure on average than patients receiving enalapril; apart from standing DBP, the differences were not statistically significant. This study has demonstrated that doxazosin is at least as affective as enalapril in decreasing blood pressure in patients with NIDDM and mild-to-moderate hypertension.