Normal Blood Pressure Levels Research Articles

A prospective cohort study investigating the association between type 2 diabetes and subsequent cardiovascular events in patients with different blood pressure, HbA1c, and lipid levels.

Globally, there has been a steady increase in the prevalence of type 2 diabetes, and the risk of cardiovascular disease has increased. The relationship between diabetes and the incidence of cardiovascular disease (CVD) at different blood pressure, glycated haemoglobin A1c (HbA1c), and lipid levels remains uncertain. This study aimed to investigate these associations within a population-based cohort. We analysed data from the Guiyang subcentre of the China Cardiometabolic Disease and Cancer Cohort Study, which enrolled participants aged 40 years and older between 2011 and 2012. Subsequently, a follow-up visit was conducted during 2014-2016 to assess incident CVD events. The analysis included a cohort of 7197 adults, of whom 590 were diagnosed with diabetes. Among all the participants, the CVD events linked to diabetes had a multivariable adjusted hazard ratio of 2.37 [95% confidence intervals (CI): 1.38-4.08]. Patients with diabetes had a greater risk of experiencing CVD events if they had high blood pressure [hazard ratios (HR): 1.24, 95% CI: 1.39-4.21] and high lipid levels (HR: 2.19, 95% CI: 1.29-3.70) compared to people with normal blood pressure (HR: 1.23, 95% CI: 0.54-2.82) and lipid levels (HR: 1.26, 95% CI: 0.47-3.41). Our analysis revealed a significant association between diabetes and an increased risk of subsequent CVD events, which can be mitigated through optimal management of the metabolic profile of cardiovascular risk factors.

Relationship Between Age and Blood Pressure in Patients Postoperative Sectio Caesarea

Background: Cesarean section (C-section) is a surgical procedure for childbirth, involving an incision in the uterine wall through the abdomen, typically indicated for various medical reasons. Spinal anesthesia is commonly employed during C-sections, although it is associated with side effects such as fluctuations in blood pressure. The majority of C-section patients under spinal anesthesia are between 20 and 35 years of age, considered the optimal reproductive years for pregnancy and childbirth. Purpose: This study aims to evaluate the correlation between age and blood pressure in postoperative C-section patients under spinal anesthesia. Methods: A cross-sectional, observational-analytical study design was used, involving 81 purposively sampled respondents. Data were analyzed using Spearman's rank correlation to assess the relationship between age and blood pressure postoperatively. Findings: The majority of respondents (67.9%) were aged between 20 and 35 years. Postoperative blood pressure in the recovery room was predominantly within the normal range, with 71.6% of patients displaying normal blood pressure levels. A statistically significant correlation was found between age and blood pressure, with a p-value ≤ 0.05. Conclusion: Age is significantly associated with postoperative blood pressure in patients undergoing C-sections under spinal anesthesia. This finding highlights the importance of monitoring blood pressure in this population to ensure optimal recovery outcomes.

Prevalence and Characteristics of Isolated Nighttime Masked Uncontrolled Hypertension in Treated Patients.

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH.

Effect of a multidisciplinary program with seven color balls on non-communicable diseases prevention in a Muslim community: A real-world study

Prevalence of diabetes and hypertension are increasing. Health promotion is needed for the diseases prevention. The objective of this study was to determine the impact of a multidisciplinary program and a seven-color balls on fasting blood glucose and blood pressure in a Muslim community. A one-group pre-post test of participatory action research was employed. The screening test was administered and assigned a color to each of seven health statuses. All participants made a commitment to improve their weekly performance. They were instructed and practiced for three weeks on six health information topics. Then, each village health volunteer reminded the participants of health information, and a religious leader declared (Kutbah) during Friday prayer that tobacco and alcohol are contrary to Islam. Utilizing frequency and percentage, the study outcome at the end of the program was compared to that at baseline. The results revealed that the mean age of the participants was 33.92 years, with a range of 15 to 82 years. Six months after program finish, 87.5% of those at risk and 93.3% of high risk for hypertension returned to normal blood pressure levels. For FBS level, risk for diabetes participants improved to a normal level by 57.6%, participants who were possibly for diabetes improved to better level by 50%, and third level illness decreased to a lower level by 50%. The program could improve participants’ health status and encourage their self-esteem for health prevention. Prevention of hypertension, and diabetes is essential for promoting individual and community health.

Counseling and examination related to the prevention of hypertension and diabetes in the elderly

Aging brings various health challenges, including hypertension and diabetes mellitus, which can affect the quality of life of the elderly. This study aims to identify the prevalence of these two diseases in Kepatihan Village, Kaliwates District, Jember Regency, and evaluate the effectiveness of health education in managing them. Community service activities include initial examinations that show a high prevalence of hypertension and prediabetes among the elderly, with only a few having normal blood pressure and blood sugar levels. The program involves health examinations, disease prevention and control education, and re-examination two weeks after the education. The results showed that older adults with normal blood pressure increased from 3 to 8 people, and regular blood sugar levels increased from 5 to 21 people. A significant decrease in cases of prehypertension and diabetes indicates the success of the education in increasing participants' awareness and knowledge about managing their health. However, high initial health conditions and limited resources remain barriers. This program shows the effectiveness of education in reducing the prevalence of non-communicable diseases among the elderly but requires continued efforts to support more sustainable health improvements

Tracking of blood pressure levels from childhood.

The overall goal of this review is to summarize what is currently known regarding the tracking of blood pressure levels from early childhood into later adulthood and to describe the factors contributing to increased hypertension prevalence across the lifespan. This review describes 4 theoretical constructs of blood pressure trajectory across the lifespan: forward development, forward tracking, forward reversal, and maintenance of normal blood pressure levels.

Cumulative Blood Pressure Load and Incident CKD

The association of long-term cumulative blood pressure (BP) loads with the risk of incident chronic kidney disease (CKD) remains a matter of debate. This study investigated this association among healthy Korean adults with normal kidney function. Prospective cohort study. We analyzed 5,221 participants without CKD in the Korean Genome and Epidemiology Study. Cumulative systolic and diastolic BP (SBP and DBP) loads were calculated as the ratios of the areas under the curve (AUC) for SBP≥120mm Hg or≥80mm Hg for DBP divided by the AUC for all SBP or DBP measurements during the exposure period. These AUCs were categorized into 4 groups: group 0 (reference), cumulative BP load of 0 and groups 1-3, tertiles of cumulative BP loads. Primary end point was incident CKD defined as a composite of an estimated glomerular filtration rate (eGFR) below 60mL/min/1.73m2 or proteinuria greater than 1+on dipstick examination for at least 2 consecutive measurements≥90 days apart. Multivariable Cox proportional hazards regression to estimate the independent association of cumulative BP loads with incident CKD. Higher cumulative SBP and DBP loads were associated with an increased risk of incident CKD (HR, 1.23 [95% CI, 1.12-1.35] for SBP; and HR, 1.14 [95% CI, 1.04-1.26] for DBP loads for each 1.0-unit greater load). Compared with SBP group 0, groups 2 and 3 were associated with 1.94- and 1.89-fold greater risk of incident CKD. Compared with DBP group 0, groups 2 and 3 were associated with 1.42- and 1.54-fold greater risks. These associations of high cumulative BP loads with an increased risk of incident CKD remained consistent even in the subgroups not taking antihypertensive agents or without prior hypertension diagnosis. The assessment of CKD outcomes relied on eGFR and spot urine tests. These findings highlight the association between high cumulative SBP and DBP loads and the occurrence of CKD, even in individuals with normal BP levels. Although hypertension is a major risk factor for chronic kidney disease (CKD), most studies have focused on single-point blood pressure (BP) measurements. To explore the association between long-term cumulative BP load and the development of CKD, 5,221 Korean adults with normal kidney function were included in this study. Cumulative systolic BP and diastolic BP load both exhibited a significant association with an increased risk of incident CKD. Notably, the association of cumulative BP loads with elevated risk of incident CKD was evident also in individuals who were not taking antihypertensive agents or who had no previous history of hypertension. These findings underscore the importance of managing long-term exposure to high BP, even in individuals with normal BP levels.

Metabolic syndrome and pharmacotherapy outcomes in patients with type 2 diabetes mellitus

BackgroundMetabolic syndrome is a group of metabolic abnormalities that increase predisposition to several diseases including ischemic heart disease and diabetes mellitus. The study aimed to investigate metabolic syndrome among patients with type-2 diabetes mellitus (DM), and its impact on pharmacotherapy outcomes.MethodsAn observational cross-sectional study was performed on 910 patients with type-2 DM between June and December 2023. Fasting blood sugar, triglycerides, high-density lipoproteins (HDL), blood pressure, and abdominal obesity were measured. Metabolic syndrome was identified according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Pharmacotherapy outcomes were assessed according to American Association of Clinical Endocrinologists and American Diabetes Association guidelines using the ability to achieve adequate glycemic control and normal levels of blood pressure and fasting plasma lipoproteins.ResultsIn total, 87.5% of type-2 DM patients had metabolic syndrome; the prevalence increased with age and was higher among females. Metabolic syndrome showed the following distribution of risk factors: insulin resistance (100%), low HDL (95.3%), elevated blood pressure (83%), triglycerides dyslipidemia (80.1%), and abdominal obesity (62.5%). Majority of the patients had either 5 or 4 risk factors of metabolic syndrome. The most common comorbidities were dyslipidemia (97.7%) and hypertension (83%). Treatment outcomes were insufficient where adequate glycemic control was only achieved in 12% of type-2 DM patients, and proper management of comorbid dyslipidemia and hypertension was achieved in 29% and 40.9% of patients, respectively. Adequate blood pressure control was less achieved in patients with metabolic syndrome (34.4%) than those without metabolic syndrome (77.2%). Similarly, dyslipidemia was less controlled in patients with metabolic syndrome (26.9%) than in those without metabolic syndrome (47.3%).ConclusionPharmacotherapy outcomes were inadequate for most patients with type-2 diabetes mellitus. Adopting early preventive and therapeutic interventions for metabolic syndrome is advised to improve treatment outcomes of the comorbid dyslipidemia and hypertension.

CENTRAL BLOOD PRESSURE AND VASCULAR RESPONSES TO DIFFERENT PHYSICAL EXERCISE INTENSITIES IN NORMAL AND HIGH-NORMAL BLOOD PRESSURE AS A TOOL TO IDENTIFY EARLY VASCULAR DAMAGE

Objective: To evaluate acute changes in arterial distensibility and central pressure by high-intensity interval physical exercise (HIIPE) compared to moderate intensity continuous physical exercise (MICPE) sessions in subjects with normal and high-normal blood pressure (BP). Design and method: A randomized two-period crossover trial with 29 subjects (48±7years, 76%female, BMI=28.3±4.3kg/m2) divided into two groups according to Normal BP (120-129 and/or 80-84 mmHg) or HighNormal BP (130-139 and 85-89 mmHg) levels. They underwent either MICPE-HIIPE or HIIPE-MICPE sequences. Exercise intensity was defined according to the cardiopulmonary exercise test. The measures included aortic pulse wave velocity (PWV) and applanation tonometry (Sphygmocor®) changes at baseline, immediately, and 24 hours after each physical exercise session. Results: In HighNormal BP group, PWV was significantly lower 24h after MICPE compared to baseline (7.49 ±0.95 vs 8.20± 0.64 m/s; p=0.022). Aortic SBP was significantly lower immediately after HIIPE than baseline and 24h after MICPE (113 ± 8; 124±9 and 121±9; p &lt; 0.05). Comparison between groups, aortic SBP was higher in HighNormal BP at baseline and immediately after MICPE compared to Normal BP (124 ±9 and 122 ±17 vs 114± 9 and 110 ±8; respectively p=0.012). Conclusions: In subjects with normal and high-normal BP, vascular distensibility response to exercise is more dependent on basal levels of stiffness and more sensitive to the stimulus of MICPE; however, changes in aortic BP are more dependent on basal BP levels and more sensitive to high-intensity stimuli.

Association of ideal cardiovascular health metrics with incident low estimated glomerular filtration rate: More than a decade follow-up in the Tehran Lipid and Glucose Study (TLGS).

To evaluate the association between ideal cardiovascular health metrics (ICVHM) and incident low estimated glomerular filtration rate (eGFR) among the Iranian population. The study population included 6927 Iranian adults aged 20-65 years (2942 male) without prevalent low eGFR [i.e., eGFR < 60 ml/min/1.73 m2] and free of cardiovascular disease. The ICVHM was defined according to the 2010 American Heart Association. The multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratios (HRs) of ICVHM both as continuous and categorical variables. Over the median of 12.1 years of follow-up, we found 1259 incident cases of low eGFR among the study population. In this population, ideal and intermediate categories of body mass index (BMI) and blood pressure (BP) and only the ideal category of fasting plasma glucose (FPG) significantly decreased the risk of developing low eGFR; the corresponding HRs and (95% confidence intervals) were (0.87, 0.77-0.99), (0.84, 0.76-0.99), (0.79, 0.68-0.93), (0.70, 0.60-0.83) and (0.76, 0.64-0.91). Also, one additional ICVHM was associated with a reduced risk of low eGFR for the global (0.92, 0.88-0.97) and biological cardiovascular health (0.88, 0.82-0.93) in these participants. A sensitivity analysis using the interval-censoring approach demonstrated that our method is robust, and results remained essentially unchanged. In a subgroup population with dietary data (n = 2285), we did not find the beneficial impact of having intermediate/ideal categories of nutrition status compared to its poor one on incident low eGFR. We found a strong inverse association between having higher global ICVHM with incident low eGFR among the non-elderly Iranian population; the issue is mainly attributable to normal BP, BMI, and FPG levels.

Assessment of clinical profile among hypertensive patients, Meru, Kenya

Background: Non-communicable diseases (NCDs) are the leading cause of global morbidity and mortality. Globally, more than 1.28 billion adults are hypertensive and in Kenya, 24% of adult population has elevated blood pressure and 56% of these have never been screened for hypertension. Assessment of clinical profile helps guide the management of hypertensive patients towards obtaining normal blood pressure levels. The aim of this study was to investigate the clinical profile of hypertensive patients at the Meru Teaching and Referral Hospital in Kenya. Methods: A cross sectional survey was conducted and systematic random sampling was used to sample 75 hypertensive patients who participated in the study. The collected data were summarized using frequencies and percentages. Chi square was used to assess the relationship between the participants’ demographic characteristics, clinical profile and hypertension. Statistical significance was set at p≤0.05. Results: The average mean age of the participants was 58.53 years and majority were female (52%). Thirty-three (33.3%) were overweight and 24% were obese. The mean body mass index (BMI) for both genders was 26.48±5.24, the mean waist-to-hip ratio (WHR) and waist circumference (WC) was 0.94 and 102.09 respectively with 85.3% of the participants having a substantially increased WHR. Diabetes was the most common comorbidity (70.73%). Of the five clinical profiles assessed (BMI, RBS, WHR, presence of comorbidities and drug used) only the presence of comorbidity was associated with BP levels χ2 (10.01,3), p=0.018. Conclusions: Participants had high blood pressure, BMI, WHR and WC readings as well as several comorbidities.

STUDY OF RISK FACTORS FOR CARDIOVASCULAR DISEASES AND CENTRAL HEMODYNAMICS IN SENIOR STUDENTS

HighlightsThe article examines the prevalence of risk factors for cardiovascular diseases (CVD) and the state of central hemodynamics (CHD) in senior students. Aim. To study the risk factors for CHD and CVD in senior students with the aim of early detection of arterial hypertension (AH) and the implementation of therapeutic and prophylactic measures.Methods. The study involved 223 senior students of medical universities in Moscow aged 20-27 years (the mean age was 22.8±0.17 years). The following cardiovascular risk factors were assessed for each student: age, gender, smoking, physical activity, genetic predispositions; body mass index. The indicators of CHD were studied by volumetric compression oscillometry using a portable automated software-hardware complex for non-invasive research of central hemodynamics (“SHCNIR CHD vco-“Globus” device).Results. The presence of CVD risk factors in senior students was revealed in 52.5% of cases; more than two risk factors were found in 19.3% of cases; 1st degree arterial hypertension (AH) in 11.2% of cases; “white coat hypertension” in 10.8% of cases; genetic predisposition to CVD in 30.0% of cases; overweight in 17.0% of cases; obesity in 5.4% of cases; low physical activity in 23.8% of cases; smoking in 16.1% of cases. An altered CHD profile was found in 62.1% of students. An increase in total peripheral vascular resistance at normal blood pressure levels was noted in 31.8% of cases. Indicators of total peripheral vascular resistance, mean blood pressure, systolic and diastolic blood pressure were significantly higher in the group of students with CHD risk factors.Conclusion. Outpatient follow-up groups should include students with established risk factors for cardiovascular diseases, diagnosed AH, and with altered indicators of CHD. Preventive examinations should include a simple method for studying hemodynamics – compression oscillometry.

Blood Pressure at Different Life Stages Over the Early Life Course and Intima-Media Thickness

Although cardiovascular disease (CVD) begins in early life, the extent to which blood pressure (BP) at different life stages contributes to CVD is unclear. To determine the relative contribution of BP at different life stages across the early-life course from infancy to young adulthood with carotid intima-media thickness (IMT). The analyses were performed in 2022 using data gathered from July 1989 through January 2018 within the Special Turku Coronary Risk Factor Intervention Project, a randomized, infancy-onset cohort of 534 participants coupled with annual BP (from age 7 months to 20 years), biennial IMT measurements (from ages 13 to 19 years), who were followed up with again at age 26 years. BP measured from infancy (aged 7 to 13 months), preschool (2 to 5 years), childhood (6 to 12 years), adolescence (13 to 17 years), and young adulthood (18 to 26 years). Primary outcomes were carotid IMT measured in young adulthood at age 26 years. Bayesian relevant life-course exposure models assessed the relative contribution of BP at each life stage. Systolic BP at each life stage contributed to the association with young adulthood carotid IMT (infancy: relative weight, 25.3%; 95% credible interval [CrI], 3.6-45.8; preschool childhood: relative weight, 27.0%; 95% CrI, 3.3-57.1; childhood: relative weight, 18.0%; 95% CrI, 0.5-40.0; adolescence: relative weight, 13.5%; 95% CrI, 0.4-37.1; and young adulthood: relative weight, 16.2%; 95% CrI, 1.6-46.1). A 1-SD (at single life-stage) higher systolic BP accumulated across the life course was associated with a higher carotid IMT (0.02 mm; 95% CrI, 0.01-0.03). The findings for carotid IMT were replicated in the Cardiovascular Risk in Young Finns Study that assessed systolic BP from childhood and carotid IMT in adulthood (33 to 45 years). In this cohort study, a life-course approach indicated that accumulation of risk exposure to BP levels at all life stages contributed to adulthood carotid IMT. Of those, the contribution attributed to each observed life stage was approximately equal. These results support prevention efforts that achieve and maintain normal BP levels across the life course, starting in infancy.

Abstract 15280: Does Weight Reduction Drive the Reduction in Blood Pressure in People Living With Obesity Treated With Tirzepatide?: Insights From SURMOUNT-1 Study

Background: Tirzepatide (TZP) is a GIP/GLP-1 receptor agonist indicated for the treatment of type 2 diabetes and in development for chronic weight management. In SURMOUNT-1, in participants with obesity or overweight, TZP 5, 10 and 15 mg reduced body weight (-15 to -20.9%), SBP (-7 to -8.2 mmHg) and DBP (-4.6 to -5.5 mmHg) after 72 weeks of intervention. Aim: To assess the effects of TZP on SBP and DBP by baseline (BL) blood pressure (BP) levels and to evaluate the contribution of weight loss to the effect. Methods: Adults with a BMI ≥30 kg/m2, or ≥27 kg/m2 and ≥ 1 diagnosed weight-related complication, excluding diabetes, received TZP (5, 10, or 15 mg) or placebo (PBO) for 72 weeks. Participants with a valid BL BP value and ≥1 post-BL value were included in the analysis using the efficacy analysis set (excluding off-treatment data). Changes from BL through 72 weeks in SBP and DBP were compared between pooled TZP doses and PBO with mixed models for repeated measures (MMRM) by BL BP levels. The proportion of participants reaching recommended BP thresholds was also evaluated. Post-hoc mediation analyses evaluated the weight-loss dependent, and independent, effects of TZP in SBP and DBP reduction. Results: Regardless of BL BP values, pooled TZP showed consistent SBP and DBP reduction at 72 weeks from BL, relative to PBO (Figure 1a). At 72 weeks, a greater proportion of TZP treated participants achieved recommended SBP and DBP levels than participants treated with PBO (Figure 1b), nearly doubling the proportion of patients with normal BP values. Changes in body weight with SBP (r=0.24) and DBP (r=0.24) were moderately correlated. Mediation analysis indicated that SBP and DBP reductions were primarily mediated through weight loss (77% and 99% respectively). Conclusions: Effects of TZP on blood pressure were consistent regardless of SBP or DBP values at BL, increasing the proportion of patients reaching normal BP levels. Reductions in SBP and DBP were substantially mediated by weight reduction.

Effect of Aerobic Exercise in Chinese Adult Individuals at Risk for Type 2 Diabetes Mellitus (T2DM) with Low Salivary Amylase Gene (AMY1) Copy Number Variation.

Type 2 Diabetes mellitus (T2DM) has become a life-threatening health problem around the world. Studies have confirmed that aerobic exercise can prevent the risk of T2DM. Furthermore, recent research showed that salivary amylase gene (AMY1) copy number variation (CNV) could be one of the genetic factors that increased the risk of T2DM. To provide more evidence on how AMY1 CNV and exercise is correlated with the risk of T2DM, we designed this study to show the differences in postprandial carbohydrate metabolism between people with different AMY1 copy numbers, and how aerobic exercise can influence this process. Sixteen participants without cardiovascular disease were chosen, 8 with AMY1 CNV≥6 (High CNV group, HCNV), and 8 with AMY1 CNV ≤ 2 (Low CNV group, LCNV). All participants were Chinese, Han nationality, 18 to 40 years old, with fasting blood glucose lower than 6.1 mmol/L and normal blood pressure levels. They were asked to visit the laboratory in fasting state and drink a cup of solution with 75 grams of edible carbohydrate (glucose or starch). After carbohydrate intake, blood samples were taken at certain times at rest or after aerobic exercise. Blood glucose levels were tested with a portable blood glucose monitor, and insulin levels were tested with the enzyme-linked immunosorbent assay (ELISA). The LCNV group had significantly higher resting insulin levels and homeostatic model assessment of insulin resistance (HOMA-IR) than the HCNV group. Compared to the HCNV group, postprandial blood glucose levels and insulin levels were insensitive to starch intake in the LCNV group. However, this difference disappeared after aerobic exercise was added as an intervention. Lower AMY1 CNV could be associated with higher risk of T2DM and complex carbohydrate metabolism disorder, while aerobic exercise can reduce the risk by increasing the carbohydrate utilization rate.

Associations among Food Systems, Food Environments, Food Choices, Food Security, and Nutrition Transition in Limpopo Province, South Africa: A Cross-Sectional Study.

A cross-sectional study was applied to investigate the influence of food systems and food environments on food choices and nutrition transition of households in Limpopo province, South Africa. A sample of 429 households was systematically selected using a paper selection draw from three districts. This paper determines the association among food systems, food environments, food choices, and nutritional measurements of the respondents. A validated questionnaire was used. Most of the respondents responsible for food procurement were females (80.4%). There was a significant association (p < 0.001) between proximity to food stores and dietary diversity of the households. Staple foods such as bread, maize, rice, samp, and mealie rice were available in almost all surveyed households (95.6%). More than half of the households (59.8%) had home gardens in their yards. Almost half of the households (48.4%) had a low Dietary Diversity Score. The study further revealed that 46.0% of households were food secure. Over a third (36.2%) of the respondents were obese, and 32.5% were diabetic. The mean total blood cholesterol was 3.69 ± 0.74 mmol/L. A high percentage of both females (89.6%) and males (91.5%) had normal hemoglobin levels. Almost half of the respondents had normal systolic blood pressure levels (45.6%), and nearly a quarter had high diastolic levels (21.4%). The 25 coping strategies were applied during food shortage periods. Even though the food environments provided both obesogenic and protective foods, the consumption of unhealthy foods was high.

Knowledge of non-communicable diseases among adolescents in Uasin Gishu County, Kenya.

Exposure to risk factors of non-communicable diseases (NCDs) begins early especially during adolescence while morbidity and mortality occurs mainly in adulthood. To assess the level of knowledge of major NCDs (cardiovascular disease, cancer, and diabetes) and risk factors among adolescents in a semi-urban setting. A descriptive cross-sectional survey was used to collect data. The study targeted students attending mixed secondary schools in Uasin Gishu County in Kenya. An adapted knowledge assessment questionnaire relating to chronic diseases of lifestyle was used for data collection. Data was analysed using SPSS version 25. A total of 1,281 students participated in the study. The results revealed that most of the participants (62.1%) had low levels of knowledge about NCD risk factors. Very few students in the present study recognized the role of family history and genetic predisposition as potential risk factors of hypertension (18%) and diabetes (24.7%) as well as the normal blood pressure (35.9%) and blood glucose levels (20.5%). Although most of the students identified alcohol and smoking as risk factors for cancer, half (51.6%) of them did not have the knowledge that regular physical activity reduces the risk of getting cancer. Many of the adolescents in Uasin Gishu County, Kenya had low level of knowledge regarding NCDs and their risk factors. The findings of this study highlight the need for a school-based intervention programme to raise awareness of non-communicable disease risk factors among adolescents.

Paradigm shift on the role of mineralocorticoid receptor antagonists in hypertension therapy

The literature review is devoted to modern ideas about the role of hyperaldosteronism as one of the important pathophysiological links in hypertension (HTN) development. Data are presented on aldosterone synthesis mechanisms both in healthy and sick people, in particular in primary aldosteronism (PA), as well as in some cases of secondary aldosteronism. The results of modern studies are discussed, which established autonomous formation of aldosterone in elderly and senile people even without formal criteria for PA. The most important stages of studying and solving the hyperaldosteronism problem using surgical or conservative methods areconsidered. Data are presented on target organ damage caused by an increased blood concentration of aldosterone. The influence of the interaction between increased dietary sodium intake and the severity of cardiovascular damage is discussed. Separately, the role of subclinical hyperaldosteronism in the development of hypertension is considered, as well as the possibility of target organ damage in such cases, despite the normal blood pressure level. Modern data on the role of mineralocorticoid receptor antagonists (MRAs), in particular spironolactone, in the treatment of hyperaldosteronism and resistant hypertension are presented. The limitations of MRA use, which are mainly due to reduced kidney function, are considered. In particular, the results of the most important clinical studies are discussed, which became the basis for higher prescription rate of MRAs in the treatment of hypertensive patients.

Ideal cardiovascular health metrics and risk of type 2 diabetes: A systematic review and dose-response meta-analysis of prospective cohort studies

Background and aimsStudies suggest a potential link between ideal cardiovascular health (CVH) and the risk of type 2 diabetes (T2D). However, systematic reviews are lacking to pool these data and present a balanced review about this association. Methods and resultsWe performed a systematic search of PubMed/Medline, Web of Sciences, and Scopus from inception until November 2022 to search for prospective observational studies assessing the link between ideal CVH metrics, as introduced by the American Heart Association, and the risk of T2D in adults. Nine cohort studies with 78,912 participants and 6242 cases of T2D were included. The pooled relative risk of T2D for the highest versus the lowest category of ideal CVH metrics was 0.36 (95% confidence interval [CI]: 0.25, 0.47; risk difference: 5 fewer per 100 patients, 95% CI: 6 fewer, 4 fewer; Grading of Recommendations Assessment, Development and Evaluation certainty = high). Each unit increase in the components of the ideal CVH metrics was associated with a 20% lower risk of T2D. Dose-response meta-analysis indicated a monotonic inverse association between ideal CVH metrics and the risk of T2D. Results from analysis of individual components showed that having a normal weight, adopting a healthy diet, and having normal blood pressure levels were associated with a reduced risk of T2D. ConclusionsHaving an ideal CVH profile and a unit increase in any CVH metric are inversely associated with the risk of T2D. Systematic review registrationPROSPERO CRD42022376934.

EARLY DIAGNOSIS OF HYPERTENSIVE DISEASE IN YOUTH WITH NORMAL SYSTOLIC AND DIASTOLIC BLOOD PRESSURE LEVELS

Objective: Hypertensive cardiovascular disease can develop functional and/or structural organ damage by the increase of the volume/pressure and arterial stiffness, even before the current cut-off level of the systolic/diastolic blood pressure. The aim of this study was to evaluate in a young population with normal blood pressure levels if they presented any cardiovascular risk factors, arterial stiffness, signs, and symptoms of hypertensive disease. Design and method: This is a retrospective cross-sectional study developed between the years 2007/2022 from 9,600 non-invasive applanation tonometry, females-males 200-103 were entered, with an age range of 18 and 30 years old, and an average age of 24 years. Patients made their first cardiology visit without a previous diagnosis of arterial hypertension or decompensated associated diseases with a blood pressure not higher than 130/80 mmHg. Anthropological data, systolic/diastolic blood pressure, and heart rate were registered. Central Haemodynamics Parameters were measured with a SphygmoCor-PVX device (AtCor, Australia), a validated system employing the high-fidelity technique of applanation tonometry according to established protocols. Results: The average systolic/diastolic blood pressure among female-male was 112.9/72.4 mmHg-119.8/73.9 mmHg, respectively. Also, the Central Aortic Pressure in the female-male groups was 100.0 mmHg/103.7 mmHg, while the maximum values are 101.5 mmHg/106.0 mmHg, but the differences between the observed values and the normal levels of the Augmentation Index (a surrogate measure of arterial stiffness) were higher than normal in female-male 3.6%-4.6% indicating an incipient arterial stiffness. Into the female-male groups, were observed hyperlipidemia 10%-10%, smoking 26%-20%, minimal-mitral regurgitation 5%-8%, headache 46%-26%, palpitations 33%-25%, asthenia 22%-14%, sweating 9%-14%, and chest-pain 16%-27%, respectively. The percentage of women who had a history the polycystic ovarian syndrome was 19%, and the women in current or former estrogen-progesterone therapy were 17%-12%, respectively. Among the female-male groups that do not register any risk factor, symptoms, signs, or arterial stiffness were 8.5%-10%. Conclusions: In young people with normal blood pressure values, it is important to know the risk factors, symptoms, signs, and arterial stiffness of hypertensive disease for early diagnosis and to be able to optimize the time to start therapy.