Middle-aged Hypertensive Patients Research Articles

Health literacy and self-management among middle-aged and young hypertensive patients: a parallel mediation effect of illness perception and self-efficacy.

Hypertension is increasingly prevalent among young and middle-aged populations in rural China, accompanied by suboptimal self-management. Given that this population forms the backbone of the labor force, enhancing their self-management capabilities is crucial for improving overall population health. Studies indicate that individuals with good health literacy are more likely to effectively manage their health. Grounded in the health literacy skills framework, a model was constructed in this study to examine the impact of health literacy on self-management among young and middle-aged hypertensive patients in rural China. Meanwhile, the mediating roles of illness perception and self-efficacy were also verified. Using a multi-stage stratified random sampling method, 338 patients were recruited to participate in the study. Structural equation modeling was utilized to establish the relationship model, and bootstrap tests were carried out to examine the mediating effects. The average self-management score was 70.45 ± 11.36. Health literacy exhibited a positive correlation with self-management (standardized β = 0.372, p < 0.001). The mediating effects through illness perception and self-efficacy were 0.040 and 0.236, constituting 6.68 and 39.31% of the total effect, respectively. Illness perception and self-efficacy serve as parallel mediators amid the association between health literacy and self-management. Implementing psychological counseling and health education is imperative for augmenting self-management competence and cultivating an adaptive coping mentality.

Disparity of serum uric acid threshold for CKD among hypertensive and non-hypertensive individuals

Introduction Hypertension and rising serum uric acid (sUA) played a pivotal role in the development of Chronic Kidney Disease (CKD). This study investigates the interactive effect of sUA and hypertension on CKD and identifies the optimal threshold of sUA among individuals with and without hypertension in the Chinese community population. Materials and methods The study included 4180 individuals aged 45–85 years, derived from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015. Additionally, a hospital-based study enrolled subjects in the Department of Nephrology at Zhongshan Hospital, China from January 1, 2019, to December 31, 2021. The interaction effect analysis were used to assess the impact of sUA and hypertension on CKD. We also compared the distribution of sUA and the CKD risk in community populations, distinguishing between those with and without hypertension. For the hospital-based population, kidney injury was marked by a KIM-1 positive area. Results Our results indicate a higher prevalence of CKD in the community population with hypertension (10.2% vs. 3.9%, p < .001). A significant additive synergistic effects of the sUA and hypertension on the CKD risk were found. When the sUA level was < 4.55 mg/dL in the hypertensive population and < 5.58 mg/dL in the non-hypertensive population, the risk of CKD was comparable (p = .809). In the propensity score matched (PSM) population, the result remained roughly constant. Conclusion Therefore, even moderate levels of sUA was associated with a higher risk of CKD in middle-aged hypertensive patients, who warrant stricter sUA control.

Effect of quality control circle activities on the blood pressure control rate in young and middle-aged hypertensive patients

Effect of quality control circle activities on the blood pressure control rate in young and middle-aged hypertensive patients

Treatment burden mediates the association between the number of comorbidities and health-related quality of life in young and middle-aged patients with hypertension and comorbidities

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation of Korea grants funded by the Korea government (2021R1C1C100849812). Background The patient-reported outcome such as health-related quality of life (HRQoL) is important in providing patient-centered care to patients with hypertension. Previous studies have shown that comorbidities are negatively associated with HRQoL in patients with hypertension. To effectively improve their HRQoL, it is crucial to comprehend the mechanism of how comorbid diseases affect the HRQoL. Patients with multimorbidity experience an increased burden of treatment associated with simultaneously managing multiple chronic conditions. The treatment burden can contribute to poor HRQoL. Therefore, we hypothesize that treatment burden mediates the association between the number of comorbidities and HRQoL among patients with hypertension. Because most studies on the HRQoL of patients with hypertension have been conducted in older people, levels of treatment burden are different between older and younger patients, this study was conducted in young and middle-aged hypertensive patients with comorbidities. Purpose To examine the mediating effect of treatment burden on the association between the number of comorbidities and HRQoL in young and middle-aged hypertensive patients with comorbidities. Methods Hypertensive patients (age 19-54 years) with additional diseases completed the cross-sectional questionnaire survey. The number of comorbidities was measured based on self-report using the list of 20 or more chronic conditions. The treatment burden was measured with the 13-item Multimorbidity Treatment Burden Questionnaire, and high scores indicate a higher level of treatment burden. HRQoL was measured with the Patient-Reported Outcomes Measurement Information System-29 profile v2.1 (PROMIS-29 v2.1). The scores from the PROMIS-29 v2.1 were used to compute the PROMIS-Preference scores, which is a summary score of the HRQoL. The PROMIS-Preference scores ranged from 0 (bad health) to 1 (ideal health). To examine the mediating role of treatment burden on the relationship between the number of comorbidities and HRQoL, the mediation analysis was performed after adjusting for sex. This analysis was conducted using Mplus 8.8 with 5000 bootstrap samples. Results A total of 186 hypertensive patients with comorbidities (mean age 44.9 years; 72% male) were included in this study. Patients had an average of 2.6 additional chronic conditions along with hypertension. (SD: 1.7). The mean HRQoL score was 0.35 (SD: 0.21). The direct effect of the number of comorbidities on HRQoL was significant, and the indirect effect mediated by treatment burden was also significant (Figure). Conclusion We found that the treatment burden mediated the association between the number of comorbidities and HRQoL in young and middle-aged patients with hypertension and comorbidities. These findings suggest that strategies to lower the treatment burden are important to improve the HRQoL in this population.

FEATURES OF AMBULATORY BLOOD PRESSURE MONITORING WITH DIFFERENT BLOOD PRESSURE PROFILES IN PATIENTS WITH HYPERTENSION DISEASE OF MIDDLE AND ELDERLY AGE

Background. Insufficient night-time reduction of blood pressure (BP) and night hypertension are associated with an increased risk of death regardless of the average daily BP. The study of daily BP profiles is very relevant in patients with hypertension of different age categories due to the high risk of thrombotic complications.&#x0D; Aim: of the study was to determine the peculiarities of ambulatory blood pressure monitoring (ABPM) indices in middle-aged and elderly hypertensive patients depending on the daily BP profile.&#x0D; Materials and methods. ABPM indicators were determined in 125 patients who were divided into 2 groups. 1st group (n=82) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old). In the groups of middle-aged and elderly subjects 2 groups of daily BP profiles were distinguished: "dipper" and "non-dipper".&#x0D; Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily systolic BP (SBP) (mm Hg), the average daly diastolic BP (DBP) (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP.&#x0D; Results. The baseline BP level in the average daily SBP and DBP in middle-aged patients of dipper group was significantly higher by 49,6% and corresponded to 155,9±12,0 mm Hg (p&lt;0,001) and 50,4% and was 97,3±6,1 mm Hg (p&lt;0,01). Similar results are observed in the average BP and the maximal daily SBP and the maximal daily DBP values which were significantly higher than the control group by 21,5% (p&lt;0,05) and equaled 110,0±3,6 mm Hg and 21,3% and amounted to 176,3±23,5 mm Hg (p&lt;0,05) and 23,6% and amounted to 117,0±19,2 mm Hg (p&lt;0,05). The baseline BP level in the average daily and maximal SBP, the average daily DBP and the average BP in patients of non-dipper group was significantly higher by 50,8% (p&lt;0,01) and corresponded to 157,1±12,9 mm Hg and 27,4% and equal to 176,9±24,0 mm Hg (p&lt;0,05), 63,8% and amounted to 106,0±1,0 mm Hg (p&lt;0,05) and 44% and was 124,3±6,8 mm Hg (p&lt;0,05) too. In the surveyed elderly patients only the average daily DBP was significantly different from the corresponding control indicator and was lower by 21,4% (p&lt;0,05) and amounted to 91,5±0,7 mm Hg in dipper and 23,1% (p&lt;0,01) and was 93,5±0,7 mm Hg in non-dipper group.&#x0D; Conclusion. Non-dipper group predominates in the structure of daily BP rhythm in elderly hypertensive patients (62,8% versus 37,2%). The average BP decreases in elderly patients of non-dipper group by 11,1% (p&lt;0,05) reliably to patients of middle age.

Structural equation modeling for associated factors with self-care behavior among young and middle-aged hypertensive patients: a cross-sectional study

Background Self-determination theory (SDT) states that the self-care behaviors of patients with chronic illnesses are affected by an autonomy-supportive healthcare climate, satisfaction of autonomy, competence, and relatedness. Autonomy-supportive healthcare climate means to provide interpersonal conditions that support the person's volition, initiative, and integrity. Objective The aim of this study was to explore the structural relationships of an autonomy-supportive healthcare climate, as well as the perception of illness consequences, autonomy, competence, and relatedness with self-care behaviors among adult outpatients with hypertension. Design A cross-sectional survey was conducted in 2020 across three hospitals outpatient clinics in South Korea. Methods A questionnaire package containing instruments measuring the perception of autonomy-supportive healthcare climate, autonomy, competence, relatedness, perception of illness consequence, self-care behaviors, sociodemographic data, and disease-related characteristics among the patients. The hypothetical model was derived from the SDT. Data were analyzed to test the hypothetical model and propose the final model. Results Complete survey data was provided by 228 participants. Overall, the findings supported the hypothesized model (Goodness-of-Fit Index = 0.90 and Comparative Fit Index = 0.99). An autonomy-supportive healthcare climate and autonomy, competence, and relatedness directly influenced the self-care behaviors of adult hypertensive patients. However, the perception of illness consequences did not have a significant direct effect on self-care behavior. Conclusion Improving the autonomy-supportive healthcare climate, as well as positive perception of illness consequences, autonomy, competence, and relatedness among patients positively affects self-care behavior. Thus, an authentic partnership between healthcare providers and hypertensive patients is required to enhance trust, cooperation, and adaptation, consequently improving self-care behaviors among patients. Impact Statement Autonomy-supportive healthcare climate was both directly and indirectly associated with self-care behavior that mediates autonomy, competence, and relatedness among young and middle-aged hypertensive patients.

Football Training: Prophylaxis of Hypertension and Prediabetes in Malaysia

According to the 2019 National Health and Morbidity Survey (NHMS), 3.4 million Malaysians are affected by at least two of the three major noncommunicable diseases (NCDs), i.e., diabetes, hypertension, and high cholesterol. The fundamental issue in Malaysia is that individuals are unwilling to attend the hospital for periodic examinations and to seek preventative medical care. It is necessary to adapt football training as a hobby and concurrently as a preventative measure against the NCDs as it appears to be the optimal strategy. In Germany, a prospective interventional study was conducted. Statistical analysis using IBM SPSS Statistics version 26 revealed that providing middle-aged hypertensive patients with football training can improve blood pressure control and minimize the need for antihypertensive medication. Using SPSS version 22, it has been demonstrated in a randomized control trial in the Faroe Islands that football training combined with professional nutrition counseling had a greater effect on metabolic and cardiovascular health prediabetes individuals aged 55 to 70 than expert dietary advice alone. At the state level, Selangor has greatly progressed in health sector reform. Initiatives to minimize noncommunicable diseases have received special attention. This study implies that the mission and vision of the Selangor Health and Sports Council align. After a comprehensive assessment, a viable policy for integrating football training as a preventative intervention should be considered.

PS-P16-1: INFLUENCE OF AGE AND SEX ON THE RELATIONSHIP BETWEEN MAP AND CENTRAL PULSE PRESSURE DURING YOUNG ADULTHOOD

The present study evaluates the interplay between age and sex on the relationship between MAP and brachial and central PP in young to middle-aged hypertensive patients. This is a cross-sectional study of hypertensive patients referred for radial pulse wave evaluation (Sphygmocor device). A total of 312 patients (69% under antihypertensive treatment), mean age 35 ± 9 years (16–49 years) and 134 ± 14 /82 ± 10 mmHg, with operator index &gt; 70% were included. As shown in the figure, increasing age was associated with a progressive dissociation of central PP between subgroups of MAP below and above the mean (100 mmHg), reaching statistical significance in women only (P = 0.01 for the interaction between age and MAP). Higher MAP significantly boosted the age-related increase in AP (p = 0.01 in men and 0.049 in women for the interaction between age and MAP). The strength of the correlation between MAP and central PP increased with age more steeply in women than in men (see the table). Multiple regression analyses including the agexMAP interaction term confirmed the interaction between age and MAP on central PP in both sexes. In conclusion, the association between distending pressure and PP increases in strength from early adulthood to midlife. Women are more vulnerable to the effect of MAP on central pulsatility. JOURNAL/jhype/04.03/00004872-202301001-01311/figure1/v/2023-10-24T163949Z/r/image-jpeg

PECULIARITIES OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING INDICES IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS

Relevance. Until now, there is an ongoing debate about the value of different indicators of blood pressure (BP) − systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse blood pressure (PBP) as predictors of essential hypertension (EH). In this regard the issue of target BP levels in patients of different ages remains studied incompletely.&#x0D; Objective is to determine peculiarities of 24 hour ambulatory blood pressure monitoring indices in patients with essential hypertension, stage II of different age groups.&#x0D; Materials and methods. ABPM indicators were determined in 130 patients who were divided into 4 groups. 1st group (n=57) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old); 3rd group (n=15) – middle-aged patients without EH – control for the 1st group; 4th group (n=15) − elderly patients without EH − control for the 2nd group. Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily SBP (mm Hg), the average daly DBP (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP.&#x0D; Results. In group 1 the average and maximal DBP were lower than in group 2 by 7,4% (p&lt;0,001) and 13,1% (p&lt;0,05), respectively. In group 1, the average daily and maximal SBP decreased by 3,8% and 4,1%, respectively; average heart rate by 3,8%; DI of SBP by 7,8% and DI of average BP by 5,8% but the data were unreliably smaller compared to the data of middle-aged patients. In group 1, the maximal DBP, DI SBP and DBP were not significantly different from the corresponding indicators in the control group. The maximal DBP was higher by 29,3% and amounted to 115,6±21,0 mm Hg and DI SBP and DI DBP are lower by 11,1% and 17,9%, respectively; and were equal to 9,6±7,4 and 13,8±8,1, respectively. In the 2nd group the following parameters decreased unreliably (p&gt;0,05): heart rate by 8,6% and was 63,0±9,1/min., DI SBP by 17,6% and was 8,9±5,5%; DI DBP by 16,1% and was 14,1±7,1%; DI of average BP– by 20,4% and was equal to 11,3±6,1%.&#x0D; Conclusions. It is found that with the age DBP decreases with steadily increased SBP in hypertensive patients. The average daily and the maximal daily DBP are significantly less by 7,4% (p&lt;0,001) and 13,1% (p&lt;0,05) accordingly in elderly patients compared with the middle-aged.

FEATURES OF HAEMOSTASIS IN DIFFERENT TYPES OF 24 HOURS DAY'S PROFILE OF BLOOD PRESSURE IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS

Relevance. The phenomenon of non-dipper (insufficient nocturnal decrease in blood pressure) has prognostic significance for increasing the risk of complications of arterial hypertension - myocardial infarction, stroke. To date, there are only isolated reports of platelet hemostasis in this category of individuals. Therefore, it is important to find out the peculiarities of state of platelet aggregation depending on circadian rhythm of blood pressure (BP).&#x0D; Objective is to identify the baseline level of platelet and plasma hemostasis at different 24 hours day's blood pressure profiles in middle-aged and elderly hypertensive patients.&#x0D; Materials and methods. Subjects (n=90) are divided into 3 groups. Group 1 (n=30) included middle-aged hypertensive patients (45-59 years), group 2 (n=30) − elderly hypertensive (60-74 years) patients. Patients are divided into two subgroups in each of these groups, 15 people in each: subgroup dipper (D) − with adequate nocturnal blood pressure reduction (10-20 %) and subgroup non-dipper (ND) − with insufficient nocturnal blood pressure reduction (&lt;10 %). The control group (n = 30) consisted of 15 patients without arterial hypertension for each of the examined groups. &#x0D; The state of spontaneous and induced platelet aggregation was determined. Adenosine diphosphate (1´10-5 mM/L) and adrenaline (1 µg/mL) were used as aggregation inducers on SOLAR AP-2110 optical aggregometer. The following parameters of aggregatograms were calculated: amplitude of spontaneous and induced aggregation (AA, %); time of maximal aggregation (TMA, min.); slope of aggregation (SA, %/min.). The state of plasma hemostasis was determined on hemocoagulometer Amelung KC 1A. The following parameters were determined to assess state of plasma hemostasis: fibrinogen (FG, g/L), antithrombin III (AT-III, %), fibrinolysis (min.).&#x0D; Results. The increase in induced platelet aggregation activity was found in middle-aged hypertensive patients. In subgroup D AA was 1,9 times and in subgroup ND – 2,3 times higher than the norm; the rate of SA increased by 105,5 % and 112 %, respectively. In subgroup ND compared with subgroup D AA was higher by 21 % and SA − by 3,2 %.&#x0D; In elderly hypertensive patients, the rate of spontaneous aggregation AA is 1,7 times higher in subgroup ND compared with subgroup D (4,2±1,6 % vs. 2,5±0,2 %). In the ND subgroup AA rate is 68 % higher than in the control. Indicators of induced platelet aggregation were also higher in subgroup ND compared with subgroup D: AA with induction of ADP – 74,7±25,1 % vs. 51,4±22,2 %; TMA with adrenaline induction – 8,2±2,6 minutes against 5,7±2,5 minutes, respectively. There was the significant reduction in TMA with adrenaline-induced aggregation by 30,5 % in subgroup D compared with the control also.&#x0D; Fibrinolysis activity in middle-aged hypertensive patients in subgroup D was slowed down by 36,1% compared with the control group: fibrinolysis was 215,0±49,7 minutes while 158,0±5,7 minutes in the control group.&#x0D; Conclusions. Platelet hemostasis changes with age in the direction of increasing the aggregation properties of platelets in hypertensive patients. More pronounced changes were found in patients with insufficient reduction of blood pressure at night. In elderly patients, the most significant changes are determined by adrenaline-induced aggregation compared with middle-aged patients.

Interaction between self-perceived disease control and self-management behaviours among Chinese middle-aged and older hypertensive patients: the role of subjective life expectancy

BackgroundOne of the effective ways to control hypertension is long-term self-management, which is difficult to maintain. Therefore, understanding how people engage in the process of self-management behaviour change is necessary. In this study, we aimed to examine the dynamic relationship between self-perceived disease control and self-management behaviours in Chinese middle-aged and older hypertensive patients, namely, medication use, self-monitoring, physical activity, tobacco and alcohol avoidance, and to explore the mediating role of subjective life expectancy (SLE) on this relationship.MethodsData were obtained from a nationally representative sample of 508 middle-aged and older hypertensive patients (aged 45+) from the 2013, 2015, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. A cross-lagged panel model combined with mediation analysis was used to determine the dynamic relationship between self-perceived disease control and self-management behaviours and to clarify the mediating effect of SLE on this ascertained relationship.ResultsGood self-perceived disease control subsequently predicted good medication use, self-monitoring and physical activity, and vice versa. Subjective life expectancy (SLE) partially mediated the prospective reciprocal relationships between self-perceived disease control and these self-management behaviours, which accounted for 37.11, 25.88, and 19.39% of the total effect of self-perceived disease control on medication use, self-monitoring and physical activity, respectively. These self-management behaviours had a significant and positive feedback effect on self-perceived disease control. However, neither the direct and indirect effects (via SLE) of self-perceived disease control on tobacco and alcohol avoidance were revealed.ConclusionsPositive feedback loops of present self-perceived disease control, future SLE and self-management behaviours (medication use, self-monitoring, and physical activity) help middle-aged and older hypertensive patients adhere to these behaviours but are useless for the avoidance of addictive behaviours. Interventions aimed at enhancing the effect perception of general self-management behaviours (e.g., medication use, self-monitoring and physical activity) on the present disease control perspective, and future lifespan perspective would be beneficial for the consistent self-management behaviours of middle-aged and older hypertensive patients. The utility of present disease control perception to these self-management behaviours was much higher than the utility of future expectations. Alternative stress relief strategies may be conducive to long-term changes in addictive behaviours.

Nonalcoholic fatty liver disease and its prognosis associates with shorter leucocyte telomeres in a 21-year follow-up study

Leucocyte telomere length (LTL) has been associated with nonalcoholic fatty liver disease (NAFLD), but the evidence is imperfect. Furthermore, liver fibrosis has been shown to correlate with mortality and recent studies have also found associations with LTL and fibrosis suggesting that LTL may have additional prognostic value in liver diseases. Our objective was to study the association of LTL and NAFLD and evaluate the association of LTL in prognosis of NAFLD subjects. Study subjects (n = 847) were middle-aged hypertensive patients. All participants were evaluated for NAFLD and their LTL was measured at baseline. Outcomes were obtained from Finnish Causes-of-Death Register and the Care Register for Health Care in Statistics Finland to the end of 2014. An inverse association with NAFLD prevalence and LTL length was observed (p < .001 for trend). Shortest telomere tertile possessed statistically significantly more NAFLD subjects even with multivariate analysis (shortest vs. middle tertile HR 1.98 p = .006 and shortest vs. longest tertile HR 2.03 p = .007). For the study period, mortality of the study group showed statistically significant relation with telomere length in univariate but not for multivariate analysis. In subgroup analysis, LTL did not associate with prognosis of non-NAFLD subjects. However, LTL was inversely associated with overall mortality in the subjects with NAFLD in both univariate (HR 0.16 p = .007) and multivariate analysis (HR 0.20 p = .045). In middle-aged Caucasian cohort, shorter leucocyte telomeres associated independently with increased prevalence of NAFLD. Shorter LTL was not associated with mortality in non-NAFLD patients whereas it predicted mortality of NAFLD patients independently.

Social Engagement and Urban-Rural Disparity in Self-Management Behaviors: Study of Middle-Aged and Older Chinese Hypertension Patients.

BackgroundThis study examines the effect of social engagement on urban–rural disparities in self-management behaviors (medication use, self-monitoring, physical activity, and tobacco and alcohol avoidance) among middle-aged and older Chinese patients with hypertension.MethodsData from 2011 to 2018 were extracted from the four latest waves of the China Health and Retirement Longitudinal Study. Chi-square tests and t-tests were performed to examine urban–rural gaps in self-management behaviors. Random-effects panel logit regression models were adopted to confirm the effect of social engagement on urban–rural disparity in self-management behaviors and to explore whether this effect has narrowed or widened with “bilateral flow” between urban and rural residents. A Fairlie decomposition technique was also used to calculate the extent to which social engagement reflects urban–rural disparities.ResultsThere was significant urban–rural disparity in medication use and tobacco avoidance behaviors among the sampled patients. Medication use behavior (p < 0.001) among urban middle-aged and older patients was significantly better, whereas tobacco avoidance behavior (p < 0.05) was significantly lower compared with the rural population. Social engagement significantly enlarged the urban–rural gap in tobacco avoidance behavior (p < 0.01), but significantly narrowed the urban–rural gap in medication use behavior (p < 0.001). The Fairlie decomposition revealed that ~75.000% and 29.412% of the explained urban–rural gap in tobacco avoidance and medication use, respectively, could be attributed to social engagement. The negative effect of social engagement on urban–rural disparity in medication use increased when urban residents moved to rural areas (p < 0.05).ConclusionsThe urban–rural disparities in self-management behaviors of middle-aged and older Chinese hypertensive patients were mainly manifested in medication use and tobacco avoidance behaviors. The gaps in these two behaviors partly changed with social engagement, while the migration of urban population to rural areas weakens the positive role of social engagement in narrowing the urban–rural gap in medication use behavior. The insights of this paper on social engagement and urban–rural disparity in self-management behaviors, and the effect of urban–rural migration thereof, deserve the attention of health policymakers and researchers.

Effects of 12-week Tai Chi exercise on the microvascular reactivity of the middle-aged and elderly patients with mild hypertension and its mechanism

Objective: To study the effects of 12-week Taijiquan exercise on the microvascular reactivity of middle-aged and elderly patients with mild hypertension and to explore the mechanisms of microvascular reactivity. Methods: Thirty patients with mild hypertension were divided into exercise group (53.8±6.3 years old) and control group (52.6±7.5 years old). The number and gender ratio of the two groups were the same. The exercise group performed Tai Chi exercise for 12 weeks, and the control group maintained the original lifestyle and did not do other regular sports. The two groups of subjects were tested for microvascular reactivity, blood pressure, serum nitric oxide content, and nitric oxide synthase activity before exercise intervention, 6th week and 12th week, respectively. Results: There was no significant difference in the basic values of each index between the two groups of subjects before the test (P＞ 0.05). In the 6th week, the microvascular reactivity (blood flow increase rate), systolic blood pressure, diastolic blood pressure, nitric oxide content, nitric oxide synthase activity of the exercise group did not significantly change from the basic value (P＞0.05). At the 12th week, the microvascular reactivity, nitric oxide content, c nitric oxide synthase activity were significantly higher than those of the base values and the control group (P＜0.05), but the systolic blood pressure and diastolic blood pressure were significantly lower than those of the base values and control group (P＜0.05). In the control group, there were no significant changes in the 6th and 12th week values of each index from the basic value (P＞0.05). Conclusion: Twelve weeks of Taijiquan exercise can improve the microvascular reactivity of middle-aged hypertensive patients, reduce blood pressure, and increase the nitric oxide content and c nitric oxide synthase of patients. The increase of endogenous nitric oxide production is one of the biological mechanisms of Tai Chi exercise to improve the microvascular responsiveness of hypertension patients.

Football beats hypertension: results of the 3F (Fit&Fun with Football) study.

Football as the most popular sport could improve insufficient physical activity in patients with cardiovascular risk factors. A modified 'healthy' football training format could motivate hypertensive patients to return to sport and improve risk factors. The 3F study: 'Fit and Fun with Football' a prospective interventional study with 1 year follow-up. Football group: n = 103, structured 'health'-football training (1×/week, 90 min) led by Deutscher Fußball Bund-licensed football coaches. Hypertensive patients at least 45 years who have not exercised for several years were compared with a control group (n = 105). Reduction of office (OBP) and/or 24-h ambulatory blood pressure (BP) monitoring (ABPM) and/or reduction of number or dosage of antihypertensive medication. OBP values decreased significantly in the football group from 142.6/87.9 to 130.8/81.8 mmHg (P < 0.001), in the control group the values increased slightly (NS). ABPM values decreased significantly in the football group, while a slight increase was found in the control group. At the end of the study, the mean values in the football group of both OPB (P < 0.001) and ABPM (systolic P < 0.001, diastolic P = 0.017) were significantly lower than in the control group. Significantly more people in the football group were able to reduce antihypertensive patients than in the control group (football group:16, control group:6), while more participants in the control group intensified antihypertensive therapy (football group:3, control group:14) (P < 0.001). Among the secondary endpoints, there was a weight loss of 3 kg in the football group and an increase of 1.7 kg in the control group (P < 0.001). Offering modified 'healthy' football-training to middle-aged hypertensive patients can lead to better BP control and a reduction of antihypertensive medication. Therefore, the offer of 'health football' should be established and supported by clubs, insurances and authorities.

HDL CHOLESTEROL LEVELS AND ENDOTHELIAL GLYCOCALYX INTEGRITY IN TREATED HYPERTENSIVE PATIENTS OVER 40 YEARS OLD

Abstract Objective: Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity and finally to cardiovascular disease. We aimed to investigate the role of increased HDL cholesterol levels (HDL-C), which usually are considered protective against cardiovascular disease, in EG integrity in middle aged hypertensive patients. Design and method: We studied 186 treated hypertensive patients, apparently healthy and older than 40 years. They were divided regarding sex distribution in two groups. In males’ group, HDL-C was 48 + 19 mg/dl (n = 77, mean age 51 + 11 years) while in females’ group, HDL-C was 67 + 16 mg/dl (n = 109, mean age 63 + 12 years). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–9 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. Results: Females were older (p = 0.04) with fewer smokers (p = 0.04), higher levels of office SBP (148 + 19 mmHg vs. 139 + 15 mmHg, p &lt; 0.001) as well as higher HDL levels (p &lt; 0.001). No differences were found within groups regarding BMI, DBP, total Cholestelol and PBR 5–9. In males, HDL-C was inversely related with PBR 5–9 (r = -0.29, p = 0.01). In a multiple linear regression analysis model, using smoking habit and office SBP levels, as independent variables, we found that HDL-C independently predicted PBR 5–9 (Beta = 0.25, p = 0.006) in male hypertensives. Conclusions: In middle-aged, apparently healthy, hypertensive patients, higher HDL-C levels protect EG and subsequently endothelial function. However, the role of EG as a novel index regarding cardiovascular risk in essential hypertension needs to be extensively investigated in future studies.

Initiating and Secondary Mechanisms of Hypertension along the Time Course

Due to the difference in drug treatment strategies between the “2020 International Society of Hypertension Global Hypertension Practice Guidelines” and the “Expert consensus on the management of hypertension in the young and middle-aged Chinese population” consensus, I made a hypothesis on hypertension mechanisms. The mechanisms behind hypertension differ between age groups. For instance, the sympathetic nervous system might play more important role young and middle-aged hypertensive patients. In this commentary, hypertension mechanisms were classified into initiation and secondary mechanisms. Thereafter, their quantity-effect relationship was speculated. These helped deepen the understanding of the time association and the crosstalk mechanisms.

Effect of aerobic and resistance exercise training on inflammation, endothelial function and ambulatory blood pressure in middle-aged hypertensive patients.

The current randomized controlled trial tested the hypothesis that both aerobic training and dynamic resistance training will improve inflammation, endothelial function and 24-h ambulatory blood pressure (ABP) in middle-aged adults with hypertension, but aerobic training would be more effective. Forty-two hypertensive patients on at least one antihypertensive medication (19 men/23 women; 30-59 years of age) were randomly assigned to 12 weeks of supervised aerobic training (n = 15), resistance training (n = 15) or a nonexercise control (n = 12) group. Inflammation, endothelial function, 24-h ABP and related measures were evaluated at pre and postintervention. We found that aerobic training and resistance training were well tolerated. Both aerobic training and resistance training reduced daytime systolic ABP (-7.2 ± 7.9 and -4.4 ± 5.8 mmHg; P < 0.05) and 24-h systolic ABP (-5.6 ± 6.2 and -3.2 ± 6.4 mmHg; P < 0.05). aerobic training and resistance training both improved brachial artery flow-mediated dilation by 1.7 ± 2.8 and 1.4 ± 2.6%, respectively (7.59 ± 3.36 vs. 9.26 ± 2.93 and 7.24 ± 3.18 vs. 8.58 ± 2.37; pre vs. post P < 0.05). However, only aerobic training decreased markers of inflammation (C-reactive protein, monocyte chemoattractant protein-1, vascular cell adhesion molecule-1 and lectin-like oxidized LDL receptor-1) and endothelin-1 and increased nitrite and nitrate levels (P < 0.05). Healthcare providers should continue to emphasize aerobic training for hypertension management given the established role of nitric oxide, endothelin-1 and chronic low-level inflammation in the pathogenesis of cardiovascular disease. However, our study demonstrates that resistance training should also be encouraged for middle-aged hypertensive patients. Our results also suggest that even if patients are on antihypertensive medications, regular aerobic training and resistance training are beneficial for blood pressure control and cardiovascular disease risk reduction.

Associations between Intrinsic Heart Rate, P Wave and QT Interval Durations and Pulse Wave Analysis in Patients with Hypertension and High Normal Blood Pressure.

The present study aimed to explore the relationship between electrocardiographic (ECG) and pulse wave analysis variables in patients with hypertension (HT) and high normal blood pressure (HNBP). A total of 56 consecutive, middle-aged hypertensive and HNBP patients underwent pulse wave analysis and standard 12-lead ECG. Pulse wave velocity (PWV), heart rate, intrinsic heart rate (IHR), P wave and QT interval durations were as follows: 7.26 ± 0.69 m/s, 69 ± 11 beats/minute, 91 ± 3 beats/minute, 105 ± 22 mm and 409 ± 64 mm, respectively. Significant correlations were obtained between PWV and IHR and P wave duration, respectively, between early vascular aging (EVA) and P wave and QT interval durations, respectively. Linear regression analysis revealed significant associations between ECG and pulse wave analysis variables but multiple regression analysis revealed only IHR as an independent predictor of PWV, even after adjusting for blood pressure variables and therapy. Receiver-operating characteristic (ROC) curve analysis revealed P wave duration (area under curve (AUC) = 0.731; 95% CI: 0.569–0.893) as a predictor of pathological PWV, and P wave and QT interval durations were found as sensitive and specific predictors of EVA. ECG provides information about PWV and EVA in patients with HT and HNBP. IHR and P wave durations are independent predictors of PWV, and P wave and QT interval may predict EVA.

QTc Interval Predicts Disturbed Circadian Blood Pressure Variation.

BackgroundThe relationship between electrocardiographic evaluation and circadian blood pressure (BP) variation in young and middle-aged hypertensive patients remains unknown.MethodsA total of 171 hypertensive patients were included in the study. First, patients were divided into a young and middle-aged group and an elderly group. The two groups were then separately classified into three subgroups on the basis of circadian variation of BP as dippers, non-dippers and reverse-dippers. The electrocardiographic evaluation was calculated from 12-lead electrocardiography (ECG).ResultsQTc intervals were shortest in the dippers and longest in the reverse-dippers in the young and middle-aged group (QTc dipper: 416.53±18.37ms; non-dipper: 438.30±29.71ms; reverse-dipper: 444.93±25.47ms; for dipper vs non-dipper, and dipper vs reverse-dipper P<0.05). QTc interval was found to be an independent risk factor for the non-dipper BP pattern (Odds ratio 1.049; 95% CI 1.01-1.089; P=0.012) and reverse-dipper BP pattern (Odds ratio 1.051; 95% CI 1.007-1.098; P=0.023) in young and middle-aged hypertensive patients. No significant differences in other ECG parameters were found among the three subgroups in the young and middle-aged group.ConclusionOur study suggested that QTc interval might serve as a risk factor for non-dipper BP pattern and reverse-dipper BP pattern in young and middle-aged hypertensive patients.