Systolic Blood Pressure Measurements Research Articles

Year-by-Year Blood Pressure Variability From Midlife to Death and Lifetime Dementia Risk

High visit-to-visit blood pressure variability (BPV) in late life may reflect increased dementia risk better than mean systolic blood pressure (SBP). Evidence from midlife to late life could be crucial to understanding this association. To determine whether visit-to-visit BPV at different ages was differentially associated with lifetime incident dementia risk in community-dwelling individuals. This cohort study analyzed data from the Adult Changes in Thought (ACT) study, an ongoing population-based prospective cohort study in the US. Participants were 65 years or older at enrollment, community-dwelling, and without dementia. The study focused on a subset of deceased participants with brain autopsy data and whose midlife to late-life blood pressure data were obtained from Kaiser Permanente Washington medical archives and collected as part of the postmortem brain donation program. In the ACT study, participants underwent biennial medical assessments, including cognitive screening. Data were collected from 1994 (ACT study enrollment) through November 2019 (data set freeze). Data analysis was performed between March 2020 and September 2023. Visit-by-visit BPV at ages 60, 70, 80, and 90 years, calculated using the coefficient of variation of year-by-year SBP measurements over the preceding 10 years. All-cause dementia, which was adjudicated by a multidisciplinary outcome adjudication committee. A total of 820 participants (mean [SD] age at enrollment, 77.0 [6.7] years) were analyzed and included 476 females (58.0%). A mean (SD) of 28.4 (8.4) yearly SBP measurements were available over 31.5 (9.0) years. The mean (SD) follow-up time was 32.2 (9.1) years in 27 885 person-years from midlife to death. Of the participants, 372 (45.4%) developed dementia. The number of participants who were alive without dementia and had available data for analysis ranged from 280 of those aged 90 years to 702 of those aged 70 years. Higher BPV was not associated with higher lifetime dementia risk at age 60, 70, or 80 years. At age 90 years, BPV was associated with 35% higher dementia risk (hazard ratio [HR], 1.35; 95% CI, 1.02-1.79). Meta-regression of HRs calculated separately for each age (60-90 years) indicated that associations of high BPV with higher dementia risk were present only at older ages, whereas the association of SBP with dementia gradually shifted direction linearly from being incrementally to inversely associated with older ages. In this cohort study, high BPV indicated increased lifetime dementia risk in late life but not in midlife. This result suggests that high BPV may indicate increased dementia risk in older age but might be less viable as a midlife dementia prevention target.

Impact of implementing Dutch versus European guideline risk factor targets in older patients with ischaemic heart disease.

In patients with ischaemic heart disease (IHD) aged > 70years, Dutch and European guidelines recommend different treatment targets: low-density lipoprotein cholesterol (LDL-c) < 2.6versus < 1.4 mmol/l and systolic blood pressure (SBP) < 140 versus < 130 mm Hg, respectively. How this impacts cardiovascular event-free life expectancy has not been investigated. The study objective was to compare estimated lifelong treatment benefits of implementing Dutch and European LDL‑c and SBP targets. Data from patients aged 71-80years hospitalised for IHD in 2017-2019 were extracted from the PHARMO Database Network, which links primary and secondary healthcare settings, with follow-up until 31December 2020. Potential benefit according to treatment strategy (in gain in event-free years) was estimated using the SMART-REACH model. Of the 3003 eligible patients, 1186 (39%) had missing LDL‑c and/or SBP measurements. Of the 1817 included patients (36% women, median age at event: 74years (interquartile range (IQR): 72-77), 84% achieved the Dutch targets for both LDL‑c and SBP; for European targets, this was 23% and 61%, respectively. If Dutch targets were met for LDL‑c and SBP (n = 1281), the additional effect of reaching European targets was amedian gain of 0.6event-free life years (IQR: 0.3-1.0). The greatest effect could be reached in patients not reaching Dutch targets (n = 501), with amedian gain of 0.6(IQR: 0.2-1.2) and 1.7(IQR: 1.2-2.5) event-free years with Dutch versus European targets. In patients aged > 70years with IHD, implementation of European targets resulted in agreater gain of event-free years compared with Dutch targets, especially in patients with poorer risk factor control. The considerable number of patients with missing risk factor documentation suggested additional opportunities for risk reduction.

Non-Invasive Blood Pressure Sensing via Machine Learning.

In this paper, a machine learning (ML) approach to estimate blood pressure (BP) using photoplethysmography (PPG) is presented. The final aim of this paper was to develop ML methods for estimating blood pressure (BP) in a non-invasive way that is suitable in a telemedicine health-care monitoring context. The training of regression models useful for estimating systolic blood pressure (SBP) and diastolic blood pressure (DBP) was conducted using new extracted features from PPG signals processed using the Maximal Overlap Discrete Wavelet Transform (MODWT). As a matter of fact, the interest was on the use of the most significant features obtained by the Minimum Redundancy Maximum Relevance (MRMR) selection algorithm to train eXtreme Gradient Boost (XGBoost) and Neural Network (NN) models. This aim was satisfactorily achieved by also comparing it with works in the literature; in fact, it was found that XGBoost models are more accurate than NN models in both systolic and diastolic blood pressure measurements, obtaining a Root Mean Square Error (RMSE) for SBP and DBP, respectively, of 5.67 mmHg and 3.95 mmHg. For SBP measurement, this result is an improvement compared to that reported in the literature. Furthermore, the trained XGBoost regression model fulfills the requirements of the Association for the Advancement of Medical Instrumentation (AAMI) as well as grade A of the British Hypertension Society (BHS) standard.

Effect of cardamom consumption on inflammation and blood pressure in adults: A systematic review and meta-analysis of randomized clinical trials.

Cardamom has the potential to offer anti-inflammatory and antihypertensive advantages, but the findings from clinical trials have been inconsistent. To address this knowledge gap, the present systematic review and meta-analysis were conducted to evaluate the anti-inflammatory and antihypertensive effects of cardamom in adults. We systematically searched databases including PubMed, Scopus, and ISI Web of Sciences, for papers published up to October 2022 to identify clinical studies. Eight eligible studies were included in the meta-analysis. A fixed model was used to estimate weighted mean difference (WMD), standardized mean difference (SMD), and 95% confidence interval (95% CI). The results showed that cardamom significantly reduced the levels of inflammatory factors, including hs-CRP (SMD: -0.60 mg/dL; 95% CI: -0.78 to 0.42), IL-6 (WMD: -1.25 mg/dL; 95% CI: -1.48 to -1.03), TNF-α (WMD: -2.10 kg; 95% CI: -2.36 to -1.84, p < .001), and measures of systolic (WMD: -0.54 mmHg, 95% CI: -0.88, -0.19, p = .002) and diastolic (WMD: -0.90 mmHg; 95% CI: -1.07 to -0.73) blood pressure. The current meta-analysis showed that cardamom can help reduce inflammation and improve blood pressure. However, due to the limited number of studies, caution must be exercised when interpreting the current results.

Pharmacist-Led Diabetes Control Intervention and Health Outcomes in Hispanic Patients With Diabetes

Among patients with type 2 diabetes (T2D), Hispanic individuals are more likely than non-Hispanic White individuals to develop diabetes-related complications. To examine the association of a pharmacist-led intervention (UCMyRx) with hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) among Hispanic patients with T2D. This quality improvement study used electronic health record data and a difference-in-differences study design to evaluate the association of UCMyRx exposure with changes in HbA1c concentration and SBP among Hispanic patients with T2D, relative to usual care, at University of California, Los Angeles primary care clinics between February and April of 2023. The study population included patients with an International Classification of Diseases, Ninth Revision/International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis of T2D, self-reporting Hispanic ethnicity, age 18 years or older, with 1 or more visits with a UCMyRx pharmacist (treatment) or 2 or more visits, 2 or more years apart, during the study window (comparison). Additionally, patients had to have the following observations during the study window (March 2, 2013-December 31, 2018): (1) a HbA1c 8% or higher, anywhere between 365 days before and 14 days after the index date (date of the first UCMyRx visit or a randomly generated index date) and a follow-up HbA1c measure within 120 to 365 days after the index date (n = 396) and/or (2) a SBP 140 mm Hg or higher between 365 days before and 14 days after the index date, and a follow-up SBP measure within 120 to 450 days after the index date (n = 795). Pharmacists review laboratory results/vital signs, perform medication reconciliation, and develop personally tailored interventions to address adherence barriers and increase guideline-concordant care. Pre- to post-index date changes in HbA1c and SBP. Of the 931 unique patients with T2D analyzed, the mean (SD) age was 64 (14.1) years, and 552 (59.3%) were female. In adjusted analyses, having 1 or more UCMyRx visits was associated with a reduction in HbA1c concentration (β = -0.46%; 95% CI, -0.84% to -0.07%) but no change in SBP (β = -1.71 mm Hg; 95% CI, -4.00 to 0.58 mm Hg). In this quality improvement study of UCMyRx among Hispanic patients with T2D, a negative association was observed between UCMyRx exposure and HbA1c concentration but not SBP. Pharmacist-led intervention may be a strategy for improving outcomes among Hispanic patients with T2D.

Effectiveness of an algorithm-driven home telemonitoring system on the metabolic control and self-care behaviour of Asian adults with type-2 diabetes mellitus: A randomised controlled trial.

Healthcare professionals are leveraging on telehealth to manage patients with type-2 diabetes mellitus (T2DM). This study aimed to determine the clinical outcomes of patients using a novel tele-monitoring system (OPTIMUM) as compared to the standard of care. An open-labelled randomised controlled trial involving 330 Asian patients with T2DM, aged 26-65 years, and suboptimal glycaemic control (HbA1c = 7.5-10%) was conducted in a Singapore public primary care clinic. The patients were assigned in a 1:1 ratio by block randomization to the intervention group to receive: in-app video-based tele-education, tele-monitoring of the blood pressure (BP), capillary glucose and weight via Bluetooth devices and mobile application, followed by algorithm-based tele-management by the OPTIMUM telehealth care team for abnormal parameters. Patients received usual care in the control group. Clinical assessments and self-care-related questionnaires were administered for both groups at baseline and 6 months. Complete data of 159 (intervention) and 160 (control) patients with comparable demographic profiles were analysed. Those in the intervention group showed significantly lower HbA1c by 0.34% (95%CI = -0.57 to -0.11; p = 0.004); first measurement of systolic BP decreased by 2.98 mmHg (95%CI:-5.8 to -0.08; p = 0.044) and diastolic BP by 4.24 mmHg (95%CI = -6.0 to -2.47; p = 0.001); and total cholesterol by 0.18 mmol/L (95%CI: -0.34 to -0.01; p = 0.040) compared to the control group, after adjusting for baseline variables. Questionnaire scores showed significant improvements in medication adherence and self-care behaviour in the intervention group. No significant weight change was noted between groups. The OPTIMUM tele-monitoring system improved the glycaemic, BP and total cholesterol control in patients with suboptimal T2DM control by enhancing their medication adherence and self-care over 6 months.

What is the prevalence of orthostatic hypotension in an Australasian emergency department population?

Orthostatic hypotension (OH) is associated with increased morbidity and there is limited research on the prevalence in the Australian ED population. The aim was to determine the prevalence of OH in an Australian ED population. Secondary outcomes included any associations of OH with symptoms, presenting complaints, patient demographics, or hospital admission, and the timing of OH findings. Patients presenting to a regional Australasian ED underwent orthostatic measurements at 1, 3 and 5 min of standing following 5 min of supine bed rest. OH was defined as a drop in systolic and/or diastolic blood pressure by ≥20 and ≥10 mmHg, respectively. Of the 312 patients who were enrolled in the study, 69 (22.1%, 95% confidence interval 17.7-27.2%) had OH and 76.8% of cases were detected after 3 min of standing. There was evidence of difference in the prevalence of OH with age (P < 0.001). Similarly, there was evidence of a difference in supine systolic and diastolic blood pressure measurements (P = 0.012 and P < 0.001, respectively) between orthostatic and normotensive subjects. No association was found with OH and hospital admission, presenting complaints or comorbid medical illnesses. In this single Australian ED population, there was a high prevalence of OH (22.1%) with most cases detected within 3 min of standing. A higher-powered study across multiple sites would better substantiate these findings.

Blood Pressure Measurement Based on the Camera and Inertial Measurement Unit of a Smartphone: Instrument Validation Study.

Even though several mobile apps that can measure blood pressure have been developed, the data about the accuracy of these apps are limited. We assessed the accuracy of AlwaysBP (test) in blood pressure measurement compared with the standard, cuff-based, manual method of brachial blood pressure measurement (reference). AlwaysBP is a smartphone software that estimates systolic blood pressure (SBP) and diastolic blood pressure (DBP) based on pulse transit time (PTT). PTT was calculated with a finger photoplethysmogram and seismocardiogram using, respectively, the camera and inertial measurement unit sensor of a commercially available smartphone. After calculating PTT, SBP and DBP were estimated via the Bramwell-Hill and Moens-Korteweg equations. A calibration process was carried out 3 times for each participant to determine the input parameters of the equations. This study was conducted from March to August 2021 at Chungnam National University Sejong Hospital with 87 participants aged between 19 and 70 years who met specific conditions. The primary analysis aimed to evaluate the accuracy of the test method compared with the reference method for the entire study population. The secondary analysis was performed to confirm the stability of the test method for up to 4 weeks in 15 participants. At enrollment, gender, arm circumference, and blood pressure distribution were considered according to current guidelines. Among the 87 study participants, 45 (52%) individuals were male, and the average age was 35.6 (SD 10.4) years. Hypertension was diagnosed in 14 (16%) participants before this study. The mean test and reference SBPs were 120.0 (SD 18.8) and 118.7 (SD 20.2) mm Hg, respectively (difference: mean 1.2, SD 7.1 mm Hg). The absolute differences between the test and reference SBPs were <5, <10, and <15 mm Hg in 57.5% (150/261), 84.3% (220/261 ), and 94.6% (247/261) of measurements. The mean test and reference DBPs were 80.1 (SD 12.6) and 81.1 (SD 14.4) mm Hg, respectively (difference: mean -1.0, SD 6.0 mm Hg). The absolute differences between the test and reference DBPs were <5, <10, and <15 mm Hg in 75.5% (197/261), 93.9% (245/261), and 97.3% (254/261) of measurements, respectively. The secondary analysis showed that after 4 weeks, the differences between SBP and DBP were 0.1 (SD 8.8) and -2.4 (SD 7.6) mm Hg, respectively. AlwaysBP exhibited acceptable accuracy in SBP and DBP measurement compared with the standard measurement method, according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization protocol criteria. However, further validation studies with a specific validation protocol designed for cuffless blood pressure measuring devices are required to assess clinical accuracy. This technology can be easily applied in everyday life and may improve the general population's awareness of hypertension, thus helping to control it.

Abstract P428: Angiotensin II Type 1 Receptor-associated Protein Deletion Combined With Angiotensin II Stimulation Exacerbates Diabetic Kidney Disease In C57BL/6 Mice

The progress in the research field of diabetic kidney disease (DKD) has been disturbed by the lack of reliable animal models. Angiotensin II (Ang II) type 1 receptor (AT1R)-associated protein (ATRAP) promotes internalization of AT1R and selectively inhibits pathological AT1R signaling. In this study, we investigated whether overactivation of the renin-angiotensin system (RAS) through a combination of ATRAP deletion with Ang II stimulation developed a progressive DKD model in C57BL/6 mice, which are resistant to the development of kidney injury. Eight-week-old male systemic ATRAP-knockout mice on the C57BL/6 strain (KO) and their littermate wild-type mice (Ctrl) were divided into five groups: 1) Ctrl, 2) Ctrl-streptozotocin (STZ), 3) KO-STZ, 4) Ctrl-STZ-Ang II, and 5) KO-STZ-Ang II. Ang II was administered for 6 weeks from 4 weeks after STZ administration. At 10 weeks after STZ administration, mice were euthanized to evaluate kidney injuries after measurements of systolic blood pressure (SBP) and urinary albumin excretion (UAE). Neither ATRAP deletion alone nor Ang II stimulation alone developed a progressive DKD model in STZ-induced diabetic C57BL/6 mice (UAE, Ctrl vs Ctrl-STZ vs KO-STZ vs Ctrl-STZ-Ang II: 10.6±2.0 vs 89.0±11.9 vs 69.1±15.0 vs 151.3±55.4 μg/day). However, a combination of ATRAP deletion with Ang II stimulation accelerated the development of DKD as manifested by overt albuminuria (UAE, KO-STZ-Ang II: 852.0±195.6 μg/day, p &lt;0.001 vs Ctrl-STZ-Ang II), glomerular hypertrophy, podocyte loss, mesangial expansion, kidney interstitial fibrosis, and functional insufficiency, concomitant with increased angiotensinogen and AT1R expression in the kidneys. SBP levels were comparable between the Ctrl-STZ-Ang II and KO-STZ-Ang II groups (SBP, Ctrl-STZ-Ang II vs KO-STZ-Ang II: 144±4 vs 154±5 mmHg, p =0.363). In STZ-induced diabetic C57BL/6 mice, the combination of ATRAP deletion and Ang II stimulation accelerates the development of DKD by converting the C57BL/6 strain from being nephropathy-resistant to -susceptible, which may be associated with intrarenal RAS overactivation.

Abstract P398: Reduced Expression Of Nfatc1 Protects Against Salt-sensitive Hypertension In Mice

Background: While nuclear factor of activated T cells-cytoplasmic 1 (NFATc1) is a transcription factor that canonically plays a role in the immune response, it is also widely expressed in non-immune cells. A recent trans-ethnic meta-analysis of genome-wide association studies (GWAS) found that the NFATC1 gene in humans was associated with chronic kidney disease. Additionally, renal Nfact1 mRNA expression was decreased during high-salt exposure in a salt-sensitive murine model, suggesting a link between NFATc1 and salt-sensitive hypertension. Methods: Here, young adult heterozygous Nfatc1 knockout mice (Het) and wild-type (WT) male mice on a salt-sensitive 129S6 background were studied. Systolic blood pressure (SBP) measurements were obtained by either tail cuff manometry with at least 2 weeks of training or implanted radiotelemetry with at least 2 weeks of recovery following surgery. SBP was recorded on standard chow (NSD), on a matched high-salt diet (HSD, 6% total NaCl), or on standard chow with 1000 ng/kg/min angiotensin II (AngII) delivered by osmotic minipump. Pressure natriuresis was examined by correlating 24 h SBP from telemetry with 24 h urine sodium collected in metabolic cages before and for 3 days after switching from NSD to HSD. Results: On NSD, there was no difference in SBP between WT and Het mice (127.8±9.9 vs 125.8±8.7 mmHg, n = 9/group). However, while WT mice displayed an expected elevation in SBP after 3 weeks on HSD, Het mice showed no change in SBP, resulting in a statistically significant difference between genotypes (143.4±8.9 vs 125.7±10.6 mmHg, p = 0.0024, n = 9/group). Pressure natriuresis curves were not significantly different between genotypes. SBP was not significantly different on AngII (167.6±22.2 vs 161.8±10.9 mmHg, n = 2/3). Conclusion: Our preliminary data shows that decreased Nfatc1 expression protects against salt-sensitive hypertension. However, this effect is not mediated through a change in pressure natriuresis, suggesting possible involvement of a vascular mechanism. NFATc1 is a potential therapeutic target in salt-sensitive hypertension.

Abstract P331: Cumulative Hypertensive Peaks In 24h Blood Pressure And Cardiovascular Risk

Background: Blood pressure (BP) variability relates to cardiovascular (CV) diseases and one unexplored mechanism may involve hypertensive peaks caused by high BP variability. To test this hypothesis, we studied the association of cumulative hypertensive peaks (CHP) in 24-h systolic BP with CV risk. Methods: A total of 1212 participants from the Maracaibo Aging Study (mean age, 66; women, 67.2%) underwent 24-h ambulatory BP monitoring and were followed between 1998 and 2010. BP variability was the 24-h average real variability (ARV). CHP in systolic BP (expressed as %) was the number of systolic BP measures ≥125 mmHg (based on the ACC/AHA threshold) each participant experienced over 24-h divided by the number of recordings. The primary endpoint was a composite of fatal and nonfatal coronary, heart failure, and stroke events, while secondary endpoints were total and CV mortality, and fatal and nonfatal coronary and stroke endpoints. Statistics included adjusted Cox proportional models adjusted. Results: During a median follow-up of 8 years, 242 participants developed a composite of any CV endpoint, and 353 died (210 cardiovascular deaths), 129 had coronary and 57 stroke endpoints. An increment of +2 mmHg in 24-h ARV (HR [hazard ratio], 1.18; 95% confidence interval [CI], 1.05-1.33) or +5% in CHP (HR, 1.05; 95% CI, 1.02-1.07) increased CV risk. The inclusion of both indexes in the same Cox proportional models resulted in CHP, but not ARV ( P =0.075), associated with the primary endpoints ( P =0.004). For secondary endpoints, the association of ARV attenuated while CHP was similar. Conclusions: In this population-based cohort study, CHP in 24-h systolic BP explains the association of high 24-h BP variability and CV risk. Clinical management of high 24-h BP variability is challenging but recognizing that an increased variability results in CHP seems a feasible alternative to address in CV prevention.

The Effect Of Dıfferent Body Posıtıons On Calf Blood Pressure: A Cross-Sectional Study

The calf area is an alternative measurement site when blood pressure cannot be measured at the arm. To determine the effects of different body positions on calf blood pressure readings in healthy young students. A total of 100 healthy young students who agreed to participate in the study were randomly selected. The study was carried out in Aydın Adnan Menderes University Nursing Faculty. In all participants, blood pressure was measured in four positions: supine, prone, right lateral, and left lateral recumbent. All measurements were performed three times at 1-min intervals, and the results were compared. There was no statistically significant difference between the systolic and diastolic blood pressure measurements in the supine and prone positions (p&gt;0.05). The systolic blood pressure value was significantly lower in the left lateral recumbent position than in the other positions (p

RV size may predict death in unstable patients with PE.

Pulmonary emboli (PE) is a life threatening condition that discovered in many patients only "post mortem". Sub massive and massive PE that led to hemodynamic collapse characterized by right ventricular (RV) dysfunction, leading to a higher risk of death. To assess the ability to predict in hospital death of patients with acute PE, using a non-gated computed tomography pulmonary angiography (CTPA), based on the dimensions of the right ventricle. A retrospective study that analyzed CTPA images of patients admitted with acute PE during the years 2012-2017. The cohort study included 300 patients with documented acute PE, among them 255 hospitalized in medical (non-intensive care unit) wards, 45 were hospitalized in an intensive care unit (ICU). Among the 45 patients admitted to the ICU 8% died. Larger RV diameters predicted mortality (OR = 10.14, 95% CI [1.09-93.86]) as well as lower systolic and diastolic blood pressure measurements (p = 0.001 and 0.01). Among the 255 patients admitted to the Internal Medicine Ward 7% died. Older age (p = 0.028), sepsis and cancer (both p < 0.001), high WBCs count (p < 0.001), and renal failure (p < 0.001) predicted death. Lower blood pressure (systolic and diastolic) (p < 0.001, 0.008), older age (p < 0.007), sepsis (p < 0.001), cancer (p = 0.006), higher WBCs count (p < 0.001), and impaired renal function (p < 0.001) predicted death in patients admitted with acute PE. Clinical parameters and hematological parameters could predict death of patients admitted with acute PE. RV diameter, measured by the non-ECG gated CTPA, had an additive predictive value for patients who admitted to the ICU.

Impact of Successive Office Blood Pressure Measurements During a Single Visit on Cardiovascular Risk Prediction: Analysis of CARTaGENE.

Multiple office blood pressure (BP) readings correlate more closely with ambulatory BP than single readings. Whether they are associated with long-term outcomes and improve cardiovascular risk prediction is unknown. Our objective was to assess the long-term impact of multiple office BP readings. We used data from CARTaGENE, a population-based survey comprising individuals aged 40 to 70 years. Three BP readings (BP1, BP2, and BP3) at 2-minute intervals were obtained using a semiautomated device. They were averaged to generate BP1-2, BP2-3, and BP1-2-3 for systolic BP (SBP) and diastolic BP. Cardiovascular events (major adverse cardiovascular event [MACE]: cardiovascular death, stroke, and myocardial infarction) during a 10-year follow-up were recorded. Associations with MACE were obtained using adjusted Cox models. Predictive performance was assessed with 10-year atherosclerotic cardiovascular disease scores and their associated C statistics. In the 17 966 eligible individuals, 2378 experienced a MACE during follow-up. Crude SBP values ranged from 122.5 to 126.5 mm Hg. SBP3 had the strongest association with MACE incidence (hazard ratio, 1.10 [1.05-1.15] per SD) and SBP1 the weakest (hazard ratio, 1.06 [1.01-1.10]). All models including SBP1 (SBP1, SBP1-2, and SBP1-2-3) were underperformed. At a given SBP value, the excess MACE risk conferred by SBP3 was 2× greater than SBP1. In atherosclerotic cardiovascular disease scores, SBP3 yielded the highest C statistic, significantly higher than most other SBP measures. In contrast to SBP, all diastolic BP readings yielded similar results. Cardiovascular risk prediction is improved by successive office SBP values, especially when the first reading is discarded. These findings reinforce the necessity of using multiple office BP readings.

Overweight and dysregulation of the autonomic nervous system in young persons

Background. More than 1 billion people worldwide are obese, and this number is growing. Obesity at an early age is accompanied by impaired carbohydrate tolerance and the development of type 2 diabetes, lipid metabolism pathology, obstructive apnea, hypercoagulability, chronic inflammation and the development of insulin resistance in the future. In modern literature, there is no single point of view regarding the role of the autonomic nervous system in the coordination of hormonal, nervous and metabolic factors in the body.Aim. The article presents the results of studying the functional state of the sympathetic and parasympathetic parts of the autonomic nervous system in overweight persons and presents an assessment of the central hemodynamic parameter depending on the type of autonomic reactivity of the cardiovascular system.Methods. The study involved measuring systolic and diastolic blood pressure, heart rate, and anthropometric measurements for calculating the corresponding indices. An active orthostatic test to determine the functional state of reflex mechanisms for regulating hemodynamics. Statistical methods were used for data analysis.Results. Based on anthropometric indicators and calculated indices, boys and girls with overweight differed from the control group in abdominal and total distribution of fat. However, there were no differences in terms of vegetative tone (sympathicotonic, vagotonic, eutonic). The distribution of eutonic and vagotonic types of the autonomic nervous system and sympathicotonia was similar in both groups. Most overweight individuals had insufficient reactivity of the parasympathetic autonomic nervous system. Paradoxical reactivity in both groups was observed with the same frequency. In the group of people with paradoxical autonomic reactivity among overweight people, a significantly lower increase in heart rate was found than in the control group. In persons with overweight and increased autonomic reactivity, minute blood volume and pulse pressure increased 1.5-fold, there was a tendency to increase stroke volume and inotropic function of the heart. The increase in this characteristic indicated a hyperkinetic type of hemodynamics in overweight persons in the group with normal autonomic reactivity. In groups with paradoxical and increased autonomic reactivity of the cardiovascular system, a normokinetic type of hemodynamics was observed.Conclusions. Signs of altered autonomic reactivity found in most overweight individuals indicate dysfunction of the parasympathetic autonomic nervous system and possible dysfunction of nonspecific regulatory (limbic-reticular) parts of the brain.

Cardiological Reference Intervals in Adult American Staffordshire Terrier Dogs.

The aim of this study was to determine reference intervals (RI) for echocardiography, electrocardiography (ECG), vertebral heart score (VHS) measurement, and arterial systolic blood pressure (SBP) in American Staffordshire Terrier dogs. The study population included 29 clinically healthy AST dogs of different ages, genders, and body weights. SBP measurement, ECG, thoracic radiography, and echocardiography were performed on each dog. Compared to RIs available for the general population of dogs, the duration of the P wave and QRS complex was longer and VHS was higher. Moreover, the left ventricular dimension in diastole and systole, left atrial dimension, and end point to septal separation values were higher, while the interventricular septum in diastole and systole and aortic root diameter were lower compared to general similar average body weight. The AST breed has a different heart shape, which in this breed is more rounded compared to other dog breeds, especially the deep chest. The specific body structure and the shape of the heart had an impact on the results of the cardiological examination.

Admission blood eosinophil count, inpatient death and death at 1 year in exacerbating patients with COPD

BackgroundBlood eosinophil counts have been studied in patients with stable chronic obstructive pulmonary disease (COPD) and are a useful biomarker to guide inhaled corticosteroid use. Less is known about eosinophil...

T helper cell polarity determines salt sensitivity and hypertension development.

High-salt intake is known to induce pathogenic T helper (Th) 17 cells and hypertension, but contrary to what is known, causes hypertension only in salt-sensitive (SS) individuals. Thus, we hypothesized that Th cell polarity determines salt sensitivity and hypertension development. Cultured splenic T cells from Dahl SS and salt-resistant (SR) rats subjected to hypertonic salt solutions were evaluated via ELISA, flow cytometry, immunocytochemistry and RT-qPCR. Seven-week-old SS and SR rats were fed a chow (CD) or high-salt diet (HSD) for 4 weeks, with weekly measurements of systolic blood pressure. The relaxation response of the aorta rings to the cumulative addition of acetylcholine was measured ex vivo. In these experimental animals, the Th cell polarity (Th17 and T regulatory [Treg]), the expression of Th17- or Treg-related genes, and the enrichment of the transcription factors RORγt and FOXP3 on the target gene promoter regions were determined via flow cytometry, RT-qPCR, and chromatin immunoprecipitation. Hypertonic salt solution induced Th17 and Treg cell differentiation in cultured splenic T cells isolated from SS and SR rats, respectively. HSD induced hypertension, endothelial dysfunction and proinflammatory Th17 cell differentiation only in SS rats. The enrichment of RORγt on the promoter regions of Il17a and Il23r increased their expression only in SS rats. Regardless of HSD, SR rats remained normotensive with Treg polarity, causing high Treg-related gene expressions (Il10, Cd25 and Foxp3). This study demonstrated that Th cell polarity determines salt sensitivity and drives hypertension development. SR rats were protected from HSD-associated hypertension via anti-inflammatory Treg polarity.

Non-esterified erythrocyte linoleic acid, arachidonic acid, and subjective sleep outcomes

ObjectiveThis study investigated whether non-esterified erythrocyte omega-6 PUFAs were associated with subjective assessment of sleep quality and duration, and risk for obstructive sleep apnea. MethodsIn this secondary analysis of the cross-sectional OPPERA-II study, 538 adults completed the Pittsburgh Sleep Quality Index (PSQI), reported their usual hours of sleep, and answered STOP screening questions for obstructive sleep apnea. Circulating non-esterified erythrocyte concentrations of omega-6 PUFA linoleic acid and arachidonic acid were quantified by liquid chromatography tandem mass spectroscopy. Sleep outcomes were dichotomized as poor (PSQI ≤5) vs good (PSQI ≥6) sleep quality, insufficient or excessive (≤6 or >9 h) vs good (7-9 h) sleep duration, and high (≥2 affirmative responses) vs low (<2 affirmative responses) risk for obstructive sleep apnea. Non-esterified omega-6 PUFAs and the continuous covariates of body mass index, Short Form (SF) 12 Health Survey Physical and Mental Component scores and resting measures of systolic and diastolic blood pressure were standardized for multivariable analysis. Categorical covariates were study site, age, sex, and race/ethnicity. Multivariable-adjusted logistic regression first estimated odds ratios (OR) and 95% confidence limits (CL) for sleep outcomes using linoleic acid as the main exposure. Analysis was then repeated using arachidonic acid as the main exposure. ResultsIn the multivariable-adjusted model, each standard deviation increase in non-esterified erythrocyte linoleic acid was associated with higher odds of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), insufficient or excessive sleep (OR= 1.3, 95% CL: 1.1, 1.6) and high-risk for obstructive sleep apnea (OR=1.3, 95% CL: 1.1, 1.6). Likewise, for each standard deviation increase in non-esterified erythrocyte arachidonic acid, odds increased of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), and insufficient or excessive sleep (OR=1.2, 95% CL: 1.1, 1.5). Odds of being high risk for obstructive sleep apnea increased with greater circulating arachidonic acid, but the association did not reach statistical significance (OR=1.1, 95% CL: 0.9, 1.4). ConclusionNon-esterified erythrocyte linoleic acid and arachidonic acid were associated with poor sleep quality and insufficient or excessive sleep duration. Linoleic acid, but not arachidonic acid, was also associated with high risk for obstructive sleep apnea.

Antihypertensive, antioxidant, and renal protective impact of integrated GJD with captopril in spontaneously hypertensive rats

Hypertension is the most prevalent chronic disease World-wide, and the leading preventable risk factor for cardiovascular disease (CVD). Few patients accomplish the objective of decreasing blood pressure and avoiding hypertensive target organ damage after treatments with antihypertensive agents which opens the door for other treatments, such as herbal-and antihypertensive combination therapy. Captopril (CAP), as a-pril which inhibits angiotensin converting enzyme has long been used in the management of hypertension and CVD. Gedan Jiangya Decoction (GJD) is known for antihypertensive effects in prior studies. The research is aimed to determine whether GJD in combination with captopril has antihypertensive, kidney protective, antioxidant, and vasoactive effects in spontaneously hypertensive rats (SHR). Regular measurements of systolic and diastolic blood pressure (SBP and DBP), and body weight were monitored weekly. H&E staining was utilized to examine histopathology. The combined effects were studied using ELISA, immunohistochemistry, and qRT-PCR. Significant reductions in SBP, DBP, aortic wall thickness, and improvement in renal tissue were observed following GJD + CAP treatment, with increased serum levels of NO, SOD, GSH-Px, and CAT and decreases in Ang II, ET-1, and MDA. Similarly, GJD + CAP treatment of SHR's significantly decreased ET-1 and AGTR1 mRNA and protein expression while increasing eNOS mRNA and protein expression in thoracic aorta and kidney tissue. In conclusion, the present investigation found that GJD + CAP treatment decreases SHR blood pressure, improves aorta remodeling and renal protection, and that this effect could be attributable, in part, due to antioxidant and vascular tone improvement.