Normal Blood Pressure Research Articles

Does ongoing inflammation in recovered COVID-19 pneumonia cases aggravate underlying hypertension or unmasks new onset hypertension? A single center experience of 800 cases

<b>Introduction:</b> New onset hypertension and aggravation of hypertension during the post-COVID-19 period are issues of concern having very limited data published on them. Hence, the current study was conducted with the aim of studying the blood pressure profiles as new onset hypertension, pre-existent hypertension and an aggravation of pre-existent hypertension in post-COVID-19 patients.<br /> <b>Methods:</b> Retrospective cohort study conducted between October 2021 to March 2022, included 800 post-COVID-19 patients above 18 years of age treated at the dedicated COVID-19 care center irrespective of their disease severity and comorbidity after a valid written consent. All the study cases were followed after six months of discharge from hospital. Protocolled recording of covariates such as blood pressure, anthropometric indices, ECG, blood sugar, lipid profile and uric acid were done at entry point. Retrospective data collection of indoor records was done such CT severity assessment as mild (score < 8), moderate (score 9-15) and severe (score > 15); inflammatory markers IL-6, Ferritin, CRP, LDH and D-dimer, interventions used during hospitalization such as oxygen supplementation and oxygen plus BIPAP/NIV. Statistical analysis was done by using a Chi-square test.<br /> <b>Results:</b> In study of 800 post-COVID-19 cases, pre-existent hypertension in 10% (80/800), new onset hypertension in 8.5% (68/800), aggravation of pre-existent hypertension in 47.5% (38/80) cases. Significant association was observed between interventions used as hypertension profile such as cases with oxygen requirement new onset HTN 32/68 (47.05%), pre-existent hypertension in 10/42 (23.80%), aggravation of pre-existent hypertension in 16/38 (42.10%) and oxygen plus BIPAP/NIV requirement in new onset HTN 27/68 (39.70%), pre-existent hypertension in 10/42 (23.80%), aggravation of pre-existent hypertension in 16/38 (42.10%) cases (p < 0.0001). Significant association was observed in blood pressure switch during pre-COVID-19 to post-COVID-19 state during follow up from normotensive to hypertensive range (p < 0.00001). Comorbidities such as DM, hyperlipidemia and IHD showed significant association with blood pressure profile in study cases in post-COVID-19 setting (p < 0.00001). Inflammatory markers during hospitalization (IL-6, CRP, LDH, ferritin, and D-dimer) and uric acid analysis during follow-up documented significant association with new onset HTN, pre-existent hypertension, aggravation of pre-existent hypertension and no hypertension or normal blood pressure cases during post-COVID-19 follow-up (p < 0.00001).<br /> <b>Conclusions:</b> COVID-19 infection is probably a risk factor for new onset hypertension and increased prevalence of hypertension was observed in the post-COVID-19 period and considered as unmasking effect on hypertension. Additionally, disease related inflammatory burden, stress and anxiety are associated with aggravation of hypertension in pre-existent cases.

Decoding Monogenic Hypertension: A Review of Rare Hypertension Disorders.

Hypertension is a growing concern worldwide, with increasing prevalence rates in both children and adults. Most cases of hypertension are multifactorial, with various genetic, environmental, socioeconomic, and lifestyle influences. However, monogenic hypertension, a blanket term for a group of rare of hypertensive disorders, is caused by single-gene mutations that are typically inherited in an autosomal dominant fashion, and ultimately disrupt normal blood pressure regulation in the kidney or adrenal gland. Being able to recognize and understand the pathophysiology of these rare disorders is critical for properly diagnosing hypertension, particularly in children and young adults, as treating each form of monogenic hypertension requires specific and targeted treatment approaches. A scoping literature review was conducted on the available knowledge regarding each of the disorders currently categorized as forms of monogenic hypertension. This narrative review serves to highlight the epidemiology, pathophysiology, clinical presentation, recent case reports, and most current methods of evaluation and treatment for familial hyperaldosteronism types I-IV, Gordon Syndrome. Liddle Syndrome, syndrome of apparent mineralocorticoid excess, congenital adrenal hyperplasia, Geller syndrome, and brachydactyly type E. Recent and future advances in genetic analysis techniques will further enhance the diagnosis and early management of these disorders, preventing the consequences of uncontrolled hypertension.

HIF-1α mediates hypertension and vascular remodeling in sleep apnea via hippo–YAP pathway activation

BackgroundSleep apnea syndrome (SAS) is associated with hypertension and vascular remodeling. Hypoxia-inducible factor-1α (HIF-1α) and the Hippo–YAP pathway are implicated in these processes, but their specific roles remain unclear. This study investigated the HIF-1α/Hippo-YAP pathway in SAS-related hypertension.MethodsWe established a rat model of SAS-induced hypertension via chronic intermittent hypoxia (CIH). Rats were treated with siRNA targeting HIF-1α. Blood pressure, inflammation, oxidative stress, vascular remodeling, and VSMC function were assessed. In vitro experiments with A7r5 cells and human aortic smooth muscle cells (HAoSMCs) explored the effects of HIF-1α silencing and YAP1 overexpression.ResultsCompared with the control group, the CIH group presented significant increases in both HIF-1α and YAP1 expression, which correlated with increased blood pressure and vascular changes. HIF-1α silencing reduced hypertension, oxidative stress, inflammation, and the severity of vascular remodeling. Specifically, siRNA treatment for HIF-1α normalized blood pressure, decreased the levels of oxidative damage markers (increased SOD and decreased MDA), and reversed the changes in the levels of inflammatory markers (decreased high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and soluble E-selectin (sE-s)). Structural analyses revealed reduced vascular smooth muscle cell proliferation and collagen deposition, along with normalization of cellular markers, such as α-SMA and TGF-β1. Furthermore, the Hippo–YAP pathway appeared to mediate these effects, as evidenced by altered YAP1 expression and activity upon HIF-1α modulation.ConclusionsOur findings demonstrate the significance of the HIF-1α/Hippo-YAP pathway in CIH-induced hypertension and vascular remodeling. HIF-1α contributes to these pathophysiological processes by promoting oxidative stress, inflammation, and aberrant VSMC behavior. Targeting this pathway could offer new therapeutic strategies for CIH-related cardiovascular complications in SAS patients.

Evaluation of the Effects of Mulberry Leaf Extracts Morus alba L. on Cardiovascular, Renal, and Platelet Function in Experimental Arterial Hypertension.

Numerous epidemiological studies have demonstrated that consuming foods rich in polyphenols and flavonoids can have beneficial effects on various diseases, including arterial hypertension (HTN). Recent research from our laboratory has shown that certain flavonoids exhibit antihypertensive properties in several animal models of HTN. Our objective was to evaluate the effect of Morus alba L. (white mulberry) extracts in an experimental HTN model characterized by nitric oxide (NO) deficiency. Male Sprague-Dawley rats were divided into four groups: a control group, hypertensive rats treated with an NO synthesis inhibitor (L-NAME) in drinking water for six weeks, L-NAME rats treated with Morus alba L. extract, and L-NAME rats treated simultaneously with captopril. After six weeks of treatment, we measured blood pressure, endothelial vascular function in the aorta, and platelet aggregation function. Morus alba L. extract partially prevented the development of arterial hypertension due to NO deficiency, although it did not completely normalize blood pressure as captopril did. The extract reduced the excessive vasoconstrictor response to phenylephrine in aortic rings and improved vasodilation in response to acetylcholine, with both effects dependent on increased NO production. Morus alba L. extract also reduced the increased platelet aggregation in response to ADP and collagen in hypertensive animals, although it did not fully normalize this function. Morus alba L. extract demonstrates antihypertensive effects, improves vascular reactivity, and reduces platelet aggregation in a model of arterial hypertension. These effects are primarily related to an increase in nitric oxide activity.

Acute Anterior Wall Myocardial Infarction in a Gallbladder Cancer Patient: A Case of Sudden Coronary Thrombosis Post-normal Angiogram

Cancer patients face a heightened risk for thromboembolic events, including arterial thromboembolism such as myocardial infarction (MI). Thrombosis is a major cause of mortality in these patients due to the hypercoagulable state induced by malignancy and its treatments. Pro-inflammatory cytokines and pro-coagulants secreted by tumor cells lead to endothelial damage and an increased risk of thrombus formation. Despite extensive research on venous thromboembolism in cancer, arterial thromboembolism remains less studied. This case report highlights an acute anterior wall MI in a patient with metastatic gallbladder cancer, who developed a sudden thrombotic event despite having a normal coronary angiogram shortly before. A 52-year-old female with metastatic gallbladder cancer presented to the emergency department with acute chest pain. Her cancer, diagnosed 6 months earlier, had been managed with cholecystectomy and subsequent chemotherapy. Fifteen days before her current admission, she had undergone a coronary angiogram due to atypical chest pain, which showed no significant coronary artery disease. At presentation, the patient reported, sudden chest pain radiating to the left arm. She was hemodynamically stable with normal blood pressure and heart rate. The physical examination was unremarkable. Electrocardiogram segment elevation (ST)-segment elevation in anterior leads (V2-V6) and limb leads (II, II, and augmented vector foot [aVF]), indicative of an acute anterior wall MI. Elevated cardiac biomarkers confirmed myocardial injury. A two-dimensional echocardiogram showed mild hypokinesia of the distal interventricular septum and the apex. A repeat coronary angiogram identified a thrombus in the left anterior descending artery, which was not present in the previous angiogram. The rapid appearance of the thrombus pointed to an acute thrombotic event. This case illustrates the aggressive nature of thrombotic events in cancer patients. Despite a normal angiogram 2 weeks prior, the patient developed a sudden coronary thrombus, reflecting the hypercoagulable state associated with malignancy. The management involved thrombus aspiration and tirofiban, which effectively resolved the acute event. This aligns with existing literature, emphasizing the need for vigilant monitoring and proactive management in cancer patients to address the risk of rapid-onset thrombotic events. Cancer patients can experience sudden and severe thrombotic events, even with recent normal coronary evaluations. This case highlights the importance of ongoing cardiovascular assessment and tailored therapeutic strategies in managing cancer-associated thrombosis, underscoring the need for a collaborative approach between oncologists and cardiologists.

The Cardiac Output-Cerebral Blood Flow Relationship Is Abnormal in Most Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients with a Normal Heart Rate and Blood Pressure Response During a Tilt Test.

Orthostatic intolerance is highly prevalent in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is caused by an abnormal reduction in cerebral blood flow (CBF). In healthy controls (HCs), the regulation of CBF is complex and cardiac output (CO) is an important determinant of CBF: a review showed that a 30% reduction in CO results in a 10% reduction in CBF. In previous and separate ME/CFS studies, we showed that CO and CBF decreased to a similar extent during tilt testing. to test the relationship between CBF and CO, which seems to be abnormal in ME/CFS patients and is different from that in HCs. In this retrospective study we analyzed this relationship in a large group of patients. To compare the patient data with those of HCs, we focused on patients with a normal heart rate (HR) and blood pressure (BP) response to upright tilt. Also, the influence of clinical data was analyzed. A total of 534 ME/CFS patients and 49 HCs underwent tilt testing with measurements of HR, BP, CBF, CO, and end-tidal PCO2. To measure CBF, extracranial Doppler flow velocity and vessel diameters were obtained using a GE echo system. The same device was used to measure suprasternal aortic flow velocities. End-tidal PCO2 was recorded using a Nonin Lifesense device. In 46 (9%) patients, CO and CBF changes were in the normal range for HCs, and in 488 (91%) an abnormal CO and CBF reduction was found. In patients with abnormal CO and CBF reductions, the slope of the regression line of CO versus CBF reduction was almost 1. The multiple regression analysis of the latter group showed that the CO reduction for the most part predicted the CBF reduction, with a limited role for the PETCO2 reduction. Two different patient groups with a normal HR and BP response during the tilt were identified: those with a CO and CBF in the normal range for HCs and those with an abnormal CO and CBF reduction during the tilt (91% of patients). In the latter group of patients, an almost 1:1 relationship between the CO and CBF reduction suggests the absence of compensatory vasodilation in the cerebral vasculature. This might indicate endothelial dysfunction in most ME/CFS patients and may have clinical and therapeutic implications.

Unveiling relationships of human instinctive behaviors and blood pressure in Chinese adults: A network analysis.

Human behaviors and blood pressure (BP) are closely intertwined, affecting health. However, few studies have demonstrated their complex relationships. Using network analysis, we aimed to untangle the intricate and potential causal relationships between BP and human instinctive behaviors, identifying potential action points for hypertension prevention and control. Cohort study. This study is based on two-wave data from 11,277 Chinese adults in the China Multi-Ethnic Cohort (CMEC) and an independent validation cohort of 21,947 adults from the Chinese Cohort of Working Adults (CCWA). We conducted a cross-sectional network analysis to estimate the interrelationships between measured BP and self-reported physical activity (PA), diet, and sleep. The centrality of each variable within the network was estimated using strength centrality index. Additionally, we performed a longitudinal network analysis to infer the potential causal relationships between BP and human instinctive behaviors in participants with normal or above-normal BP. The network models suggested that BP exhibited negative associations with the dietary score (edge weight: -0.09) and sleep duration (-0.05). Non-sedentary behavior and dietary score were the most central variables, strongly connecting BP and other lifestyles. Higher BP predicted a poorer dietary score (β=-0.21) in participants with above-normal BP. The effect of BP on dietary score was replicated in the validation cohort and validated by linear regression analysis. Non-sedentary behaviors and dietary behaviors may be the potential action points in promoting healthy behaviors and contributing to BP management. It is essential to manage individuals' BP status, non-sedentary behaviors, and dietary behaviors to disrupt malignant cycles.

Effects of pre-pregnancy body mass index on cardiometabolic biomarkers in pregnant emirati women

BackgroundTo study effect of pregnancy on obese women’s maternal cardiometabolic biomarkers as a signature for maternal morbidity and complications.MethodsThis cross-sectional cohort study involved pregnant Emirati women who had regular menstrual cycles and had normal blood pressure. Pre-pregnancy body mass index was calculated using height and weight measurements recorded within three months before current pregnancy. Average systolic and diastolic blood pressure measurements were calculated from each visit. Blood samples were collected randomly once and following cardiometabolic biomarkers were measured.ResultsWe enrolled 178 pregnant women, with a mean age ± standard deviation of cohort was 29.9 ± 4.97 years and Pre-pregnancy body mass index 28.11 ± 6.58 kg/m2. None of blood pressure measurements or biomarkers serum concentrations were statistically different across Pre-pregnancy body mass index groups except for soluble intercellular cytoadhesive molecule-1levels which were the highest in underweight women. Pregnant women with pre-gestational obesity had higher systolic and diastolic blood pressure levels compared to women with normal or overweight. All variables were statistically significantly different by trimesters except systolic blood pressure, random blood glucose, lipoprotein-A, and high-sensitivity C-Reactive Protein. After adjusting, in a multivariate linear regression model, for maternal age, trimester of pregnancy, education level, parity and smoking, none of biomarkers or blood pressure were found to be significantly associated with Pre-pregnancy body mass index. In a multivariate linear regression model adjusting for maternal age, Pre-pregnancy body mass index, education level, parity and smoking, gamma-glutamyl transferase, total cholesterol, high density lipoprotein, low-density lipoprotein, triglycerides, apolipoprotein A & B, interleukin-6, tumor necrosis factor-alpha and insulin-like growth factor-1 concentrations remained significantly associated with advancing trimester of pregnancy. There was a significant interaction between Pre-pregnancy body mass index and trimester of pregnancy for serum gamma-glutamyl transferase and soluble intercellular cytoadhesive molecule-1concentration.ConclusionThis study emphasizes how pregnancy has a significant impact on cardiometabolic markers in obese women, indicating both hyperlipidemic status of pregnancy and diabetogenic tendency in obese patients who are not diabetics. These findings may suggest that pregnancy in obese patients increases risk of developing metabolic syndrome in future, therefore more attention is recommended of pregnant obese women and further study of establishing specific cardiometabolic biomarkers screening program.

Impact of hypertension, diabetes, and obesity on quality of life in rural Punjab, India

BackgroundAdverse health conditions are believed to reduce one’s quality of life (QoL). However, the impact of common lifestyle-related conditions like hypertension, obesity, and diabetes on the QoL in rural communities in India remains largely unexplored. This study aims to understand the impact of hypertension, diabetes, and obesity on the QoL in rural Punjab, India.MethodsThis cross-sectional study was conducted among 931 individuals of both sexes, aged 20–75 years, in the Mansa district of Punjab, India. Sociodemographic data were collected by using a pre-tested interview schedule. Somatometric measurements, blood pressure (BP), and fasting glucose were measured using standard protocols. QoL was evaluated using WHOQOL-BREF.ResultsIndividuals with already-diagnosed hypertension were at a significantly higher risk of poor QoL, both overall and specifically in the psychological and social relationships domains than those with normal BP. Underweight individuals exhibited a greater risk of poor QoL in the physical health domain compared to those with normal weight. Additionally, individuals with diagnosed diabetes were at an elevated risk of poor QoL in the psychological health domain compared to non-diabetics. However, neither general nor central obesity, nor newly screened cases of hypertension and diabetes (individuals who were previously unaware of their conditions), showed a significant impact on QoL.ConclusionsThe study suggests that the diagnosis of hypertension and diabetes, rather than the mere presence of these conditions, may be associated with poor QoL. Counseling and awareness post-diagnosis may help reduce the effects of diagnostic labeling and counter misinformation.Graphical

Two Different Hemodynamic Responses in ME/CFS Patients with Postural Orthostatic Tachycardia Syndrome During Head-Up Tilt Testing.

Introduction: While the diagnosis of postural orthostatic tachycardia syndrome (POTS) is based on heart rate (HR) and blood pressure (BP) criteria, the pathophysiology of POTS is not fully understood as multiple pathophysiological mechanisms have been recognized. Also, cardiac function, being dependent on preload, afterload, contractility, and HR, has not been properly studied. Preload and contractility changes can be inferred from stroke volume index (SVI) changes during a tilt test. Afterload plays a minor role in POTS as a normal BP response is a prerequisite for POTS. Therefore, we analyzed the HR-SVI relation during a tilt test in myalgic encephalomyelitis (ME/CFS) patients with POTS and compared the data with ME/CFS patients with a normal HR-BP response and with that of healthy controls (HC). Material and Methods: In ME/CFS patients with either POTS (n = 233) or a normal HR-BP response (n = 507) and healthy controls (n = 48), we measured SVI (by suprasternal echo), HR, and BP during the tilt. Results: In all ME/CFS patients, the decrease in SVI was larger compared to HC. In patients with a normal HR-BP response and in POTS patients with a HR increase between 30-39 bpm, there was an inverse relationship between the HR increase and SVI decrease during the tilt, compatible with increased venous pooling. In POTS patients with a HR increase ≥40 bpm, this inverse relation was lost, and SVI changes were significantly less compared to POTS patients with a HR increase between 30-39 bpm, suggestive of a hyperadrenergic response. Conclusions: In ME/CFS patients with POTS, two different hemodynamic profiles can be observed: in patients with a limited HR increase, mainly increased venous pooling is observed, while in patients with a large (≥ 40 bpm) HR increase the data are suggestive of a hyperadrenergic response. These two different profiles may have different therapeutic implications.

Mortality risks in different subtypes of masked hypertension in the Spanish ambulatory blood pressure monitoring registry.

We aimed to evaluate the risks of death and cardiovascular death of different subtypes of masked hypertension, defined by either isolated daytime or nighttime blood pressure (BP) elevation, or both, compared with patients with normal both office and 24-h BP. We selected 4999 patients with masked hypertension (normal office BP and elevated 24-h BP). They were divided in three different categories: isolated daytime masked hypertension (elevated daytime BP and normal nighttime BP, 800 patients), isolated nighttime masked hypertension (elevated nighttime BP and normal daytime BP, 1069 patients) and daytime and nighttime masked hypertension (elevation of both daytime and nighttime BP, 2989). All-cause and cardiovascular death (median follow-up 9.7 years) were assessed in each of these subtypes in comparison to 10 006 patients with normal both office and 24-h BP. Hazard ratios from Cox models after adjustment for clinical confounders were used for such comparisons. Compared with patients with normal both office and 24-h BP, isolated daytime masked hypertension was not associated with an increased risk of death in models adjusted for clinical confounders [hazard ratio 1.07; 95% confidence interval (CI): 0.80-1.43]. In contrast, isolated nighttime masked hypertension (hazard ratio: 1.39; 95% CI 1.19-1.63) and daytime and nighttime masked hypertension (hazard ratio: 1.22; 95% CI 1.08-1.37) had an increased risk of death in comparison to patients with BP in the normal range. Similar results were observed for cardiovascular death. The risk of death in masked hypertension is not homogeneous and requires nocturnal BP elevation, either isolated or with daytime elevation. Isolated daytime masked hypertension is not associated with an increased risk of death.

Left ventricular Dysfunction in Normotensive Diabetic Patients

Background: Diabetes is a major risk factor for impaired left ventricular function independent of coronary artery disease and hypertension. Left ventricular diastolic dysfunction is demonstrated in diabetic patients who are normotensive and have no symptoms of cardiac disease. Increased mortality is evident among type II diabetic patients with left ventricular failure with preserved ejection fraction also suggests its causative role diastolic dysfunction. Objective: To describe Left ventricular dysfunction in normotensive diabetic patients. Method: A Cross Sectional Study was undertaken in Comilla Medical College Hospital in 51 patients .29 diabetic patients with normal blood pressure (blood pressure ≤140/90 mmHg) who are not on anti-hypertensive medications and 22 healthy controls enrolled into the study. All patients and control subjects underwent transthoracic echocardiographic evaluation using GE LOGIQ V2 machine. The categorical variables described as frequencies and percentages, while continuous variables presented as medians and interquartile range (IQR) values and means and standard deviations. Continuous variables were compared using the Student’s t- test, while categorical parameters were analyzed with the Chi-square test or two tailed Fischer’s exact test as appropriate. A P-value of 0.05 or less was considered statistically significant. Result: Among 51 patients, 29 were cases and 22 were control. Male to female ratio was 1:1.7. The mean ages were 50.03±12.75 and 41.59±11.25 in case and control group respectively. The body mass index in two groups did not showed any significant difference (21.12±4.1 versus 20.91±3.60: P=0.374). The cases had a normal but significantly lower mean ejection fraction than controls (56.98±13.06 versus 62.48±7.73, respectively: P=0.033). Left ventricular diastolic filling pattern was abnormal in 17 (59%) cases and 6 (28%) in control group. The mean relative wall thickness (RWT) was higher in cases than controls. (0.47±0.11 versus .42±0.08; P= 0.014). Also the same difference observed in case of left ventricular mass index. (101.55±35.45 versus 86.98±28.01; P=0.053). The respondents were normotensive but abnormal filling pattern was observed in 17 (59%) and 6 (28%) in cases and control groups respectively which was significant. (P= 0.00018). Conclusion: Normotensive diabetic patients have asymptomatic diastolic dysfunction. J Com Med Col Teachers Asso July 2024; 28(2): 53-57

Comparative analysis of adolescent hypertension definitions for predicting early adulthood carotid artery intima-media thickness: Tehran lipid and glucose study.

Definitions of childhood and adolescent hypertension (HTN) do not precisely elucidate the relationship between HTN and cardiovascular outcomes. Carotid intima-media thickness (CIMT), as a substitute for cardiovascular outcomes, enables the early identification of cardiovascular events throughout early adulthood. This study aimed to compare the ability of childhood HTN definitions to predict a high CIMT in early adulthood. This prospective cohort study included 921 individuals aged 10-17 years from the Tehran Lipid and Glucose Study. The CIMT was measured after 18 years of follow-up. Participants were categorized into normal blood pressure (BP), high-normal BP, HTN stage 1, and HTN stage 2 groups based on the childhood HTN definitions of the 4th report, European Society of Hypertension (ESH), and American Academy of Pediatrics Clinical Practice Guidelines (AAP-CPG). Akaike information criterion (AIC) and relative efficiencies (RE) were calculated to compare the ability of each to predict a high CIMT (≥95th percentile) during early adulthood. The highest and lowest prevalence of stage 1 HTN was observed with the AAP-CPG (17.7%) and ESH (8.8%), respectively. Similarly, the highest and lowest prevalence of stage 2 HTN was noted with the AAP-CPG (1.5%) and ESH (0.8%), respectively. According to the RE values, the highest to lowest predictive abilities belonged to the 4th report, ESH, and AAP-CPG, respectively. In all models, the 4th report's pediatric HTN definition had the lowest AIC value and offered the best predictive ability. Among the various definitions of pediatric HTN, the 4th report offered the best ability to predict a high CIMT during early adulthood, followed by the ESH and AAP-CPG. Because the reference population of the 4th report includes overweight, obese, and normal- weight individuals, our findings suggest that excessive adiposity is among the main predictors of early adulthood atherosclerosis risk.

Evaluation of a Semi-Automated Ultrasound Guidance System for Central Vascular Access.

Hemorrhage remains a leading cause of death in both military and civilian trauma settings. Oftentimes, the control and treatment of hemorrhage requires central vascular access and well-trained medical personnel. Automated technology is being developed that can lower the skill threshold for life-saving interventions. Here, we conduct independent evaluation testing of one such device, the Vu-Path™ Ultrasound Guidance system, or Vu-Path™. The device was designed to simplify needle insertion using a needle holder that ensures the needle is within the ultrasound field of view during its insertion into tissue, along with guidance lines shown on the user interface. We evaluated the performance of this device in a range of laboratory, animal, and human testing platforms. Overall, the device had a high success rate, achieving an 83% insertion accuracy in live animal testing across both normal and hypotensive blood pressures. Vu-Path™ was faster than manual, ultrasound-guided needle insertion and was nearly 1.5 times quicker for arterial and 2.3 times quicker for venous access. Human usability feedback highlighted that 80% of the participants would use this device for central line placement. Study users noted that the guidance lines and small form factor were useful design features. However, issues were raised regarding the needle insertion angle being too steep, with potential positioning challenges as the needle remains fixed to the ultrasound probe. Regardless, 75% of the participants believed that personnel with any level of clinical background could use the device for central vascular access. Overall, Vu-Path™ performed well across a range of testing situations, and potential design improvements were noted. With adjustments to the device, central vascular access can be made more accessible on battlefields in the future.

Apocynin and Hyperbaric Oxygen Therapy Improve Renal Function and Structure in an Animal Model of CKD.

Chronic kidney disease (CKD) is a progressive pathological condition which results in the severe fibrosis of the kidneys. However, the mechanisms of CKD progression and fibrogenesis remain unclear. We wanted to examine the effects that apocynin and hyperbaric oxygen therapy (HBOT) have on renal function and structure in animals with CKD induced through 5/6 nephrectomy (5/6 Nx-L). Male Wistar rats were divided in 5 groups (n = 8/group) as follows: control-sham-operated rats; Nx-L-rats with 5/6 Nx-L; APO-5/6 Nx-L + apocynin treatment; HBOT-5/6 Nx-L + hyperbaric oxygen treatment, and APO+HBOT-5/6 Nx-L, treated with both treatments. All treatments started 4 weeks after the final step of CKD induction and lasted for 4 weeks. At the end of the experiment, urine samples were collected for the proteinuria assessment and the mean arterial pressure (MAP) was measured. Kidneys were collected for histopathological, Western blot, and immunohistochemical analyses. All treatments significantly decreased MAP compared to the Nx-L group (p < 0.001). In the APO and APO+HBOT groups, the level of proteinuria was decreased compared to the Nx-L group (p < 0.05 and p < 0.01, respectively). All examined treatments significantly decreased the intensity of lesions in the kidney compared to those observed in the Nx-L group (p < 0.001). Isolated treatments with apocynin and HBOT induced a significant decrease in desmin expression compared to the Nx-L group (p < 0.05); meanwhile, they did not affect the levels of fibronectin (FN) and hypoxia-inducible factor-1α (HIF-1α). Combined treatment did not affect desmin expression levels; however, it induced a significant increase in fibronectin expression compared to Nx-L (p < 0.001). Apocynin treatment decreased BP and protein loss, and it improved renal morphology at least partly through the downregulation of desmin expression without changing FN and HIF-1α. Hyperbaric oxygen therapy improved hypertension but failed to significantly affect the level of proteinuria. Combined treatment (apocynin and HBOT) normalized blood pressure (BP) values, renal function, and improved kidney structure by modulating FN and HIF-1α, without affecting desmin protein expression. Further studies are needed to elucidate the mechanisms of slowing down the progression of CKD in this experimental model.

Knowledge, attitudes, and practices on hypertension among the health science faculty and students at the University of Namibia: A cross-sectional study.

Hypertension is a serious health concern, especially in developing countries, and assessing people's knowledge, attitudes, and practices (KAP) is important for its awareness and management. This cross-sectional study aimed to assess the KAP on hypertension among students and staff from the Health Sciences and Veterinary Medicine Faculty of the University of Namibia. A cross-sectional study design was conducted on adult participants who completed the KAP questionnaire while resting, and thereafter their blood pressure (BP) was measured. This study was conducted in September 2023. The sample comprised 99 participants (77 females and 22 males) aged 18 to 64 years. The majority (94%) of the participants had normal BP (≥140/90 mm Hg). The systolic BP of females (113.13 ± 13.70 mm Hg) was significantly lower (P = .011) than that of males (121.64 ± 13 mm Hg); however, there was no significant difference in diastolic BP between the 2 genders (73.58 ± 9.37 for females and 75.95 ± 10.55 for males; P = .311). Approximately 85% of the participants demonstrated a good understanding of the risk factors associated with hypertension. About 91% of the participants believed that hypertension is a serious health problem and were willing to change their daily routine to better manage their hypertension. Only approximately 39% of the participants regularly monitored their BP. Just above 50% of the participants regularly engaged in physical activities and made dietary modifications to maintain a healthy heart. It is important to host regular hypertension campaigns among health science personnel, as this would help refresh and improve their KAP in prevention and management.

Social Determinants of Health, Blood Pressure Classification, and Incident Stroke Among Chinese Adults

Although cumulative evidence suggests that higher blood pressure (BP) and a greater burden of social determinants of health (SDOH) are associated with an increased risk of stroke, few studies have examined whether SDOH burden modifies the association between BP and stroke risk. To evaluate whether the association between BP classification and stroke risk differs by SDOH burden among Chinese adults. In this cohort study, analyses were conducted among 90 850 participants in the prospective subcohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, with recruitment from January 1, 2016, to December 31, 2020. Participants without cardiovascular diseases and with complete data were included and followed up for stroke events until June 30, 2023. Social determinants of health burden was defined using 5 components: educational attainment, economic stability, health care access, social support, and urban vs rural residence. Blood pressure was categorized according to the 2017 American College of Cardiology/American Heart Association BP guideline. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of BP classification with incident stroke stratified by SDOH burden groups. The study included 90 850 participants (median age, 54.0 years [IQR, 46.0-62.0 years]; 55 390 women [61.0%]). During a median follow-up of 5.0 years (IQR, 4.1-5.8 years), 4408 incident stroke events were recorded. Compared with normal BP, elevated BP (HR, 1.33 [95% CI, 1.17-1.52]), stage 1 hypertension (HR, 1.60 [95% CI, 1.43-1.78]), and stage 2 hypertension (HR, 1.79 [95% CI, 1.61-2.00]) were associated with stroke among participants with high SDOH burden, while only stage 2 hypertension (HR, 1.52 [95% CI, 1.20-1.93]) was associated with stroke among those with low SDOH burden, with a significant multiplicative interaction of SDOH burden and BP classification (P = .03). Participants with high SDOH burden and stage 2 hypertension had the highest risk of stroke compared with participants with low SDOH burden and normal BP (HR, 2.13 [95% CI, 1.75-2.60]). This study suggests that higher BP levels, even at lower stages of hypertension, pose a greater stroke risk for individuals with high SDOH burden. Early surveillance and intervention for high BP should be emphasized in socioeconomically disadvantaged populations.

Beyond Intention: Barriers to Undergoing a Blood Pressure Check in the South-West Shewa Zone, Ethiopia.

Hypertension is often asymptomatic, progresses slowly, and leads to multiple secondary diseases. Thus, a regular blood pressure check is recommended. The objective of this study is to assess the intention to undergo a blood pressure check and its associated factors among adults in Southwest Shewa Zone, Ethiopia. A healthcare-facility-based cross-sectional design was utilized. A standardized questionnaire, adapted from previous research, was administered by trained interviewers. Binary logistic regression analysis was used to determine the factors the intention to undergo blood pressure checks is associated with, utilizing SPSS version 27. Four hundred twenty-one participants provided a complete response, yielding a 99.7% response rate. Of these participants, 153 (36%) had had their blood pressure checked at some point. The vast majority of the study participants (387, 91.9%) did not know the normal blood pressure range. The median score for intention to undergo blood pressure check was 11 (interquartile range 10-13). Female participants were 59% less likely (adjusted odds ratio [AOR] 0.408, 95% confidence interval 0.208-0.801) to intend to undergo a blood pressure check than male participants. Participants in the poorest wealth quintile were 82% less likely (AOR 0.183, 95% CI = 0.063-0.533) to intend to undergo a blood pressure check than those in the richest quintile. Participants who intended to undergo a blood pressure check had a significantly favorable attitude (t = 10.801, p < 0.001) and lower perceived behavioral control (t = -2.865, p < 0.001) compared with those who had no intention of checking. A high intent to undergo a blood pressure check should prompt healthcare facilities to offer regular blood pressure check-up services. Behavioral change communication interventions should address the attitude and perceived behavioral controls of individuals associated with the intention to undergo a blood pressure check. In doing so, special attention should be given to female and economically disadvantaged populations.

Rationale and Design of the PE-TRACT Trial - A Multicenter Randomized Trial to Evaluate Catheter-Directed Therapy for the Treatment of Intermediate-Risk Pulmonary Embolism

The optimal management of patients with intermediate-risk pulmonary embolism (PE), who have right heart dysfunction (determined by a combination of imaging and cardiac biomarkers) but a normal blood pressure, is uncertain. These patients suffer from reduced functional capacity and a lower quality of life over the long-term, despite use of anticoagulant therapy. Catheter-directed therapy (CDT) is a promising treatment for acute PE that rapidly removes thrombus and potentially improves cardiac dysfunction. However, CDT has risk and is costly, and it is not known whether it improves long-term cardiorespiratory fitness and/or quality of life compared with anticoagulation alone. We are therefore conducting an open-label, assessor-blinded, multicenter randomized trial, the Pulmonary Embolism: Thrombus Removal with Catheter-Directed Therapy (PE-TRACT) Study, to compare CDT plus anticoagulation (CDT group) with anticoagulation alone (No-CDT group) in 500 patients with intermediate-risk PE. The primary study hypothesis is that CDT will increase the peak oxygen uptake (peak VO2) with cardiopulmonary exercise testing at 3 months and reduce New York Heart Association (NYHA) Class at 12 months compared with No-CDT. These two primary efficacy outcomes will be analyzed sequentially using a "gatekeeping" procedure; for NYHA class to be compared, peak oxygen consumption must first be shown to be significantly increased by CDT. Safety and cost-effectiveness will also be assessed. When completed, PE-TRACT will provide important evidence regarding the benefits and risks of CDT to treat intermediate-risk PE compared with anticoagulation alone.

Feasibility Testing of a Health Literacy Intervention With Adolescents and Young Adults in South Africa: The LifeLab Soweto Programme.

Low health literacy levels during adolescence and young adulthood (AYA) may impact acute healthcare access and longer-term health outcomes. Previous research in South African AYA suggests that health literacy levels are typically suboptimal but few interventions exist. This study aimed to test the acceptability and feasibility of a co-created, interactive health literacy intervention (LifeLab-Soweto) with AYA in Soweto, South Africa. Participants (18-24 years, n = 107) were recruited (September-October 2022) from a youth development centre database by telephone and through snowball sampling. AYA involved in the co-creation process were excluded. Pre-intervention data on participant age, gender identity and ability to correctly identify a normal blood pressure (BP) reading were captured via survey. Post-intervention, participants repeated the BP question and completed a satisfaction survey. Additionally, n = 31 AYA agreed to an in-depth interview about their LifeLab-Soweto experience. Interview transcripts were analysed using inductive thematic analysis. Participants (mean age 21 ± 2.4 years; 59% female, 39% male, 2% nonbinary) generally viewed LifeLab-Soweto as well-designed, relevant, simple to follow, fun, useful, and interesting, with most reporting an increased understanding of health and that they would use this new knowledge. Comparing pre- and post-intervention BP question accuracy, males showed the greatest improvement in scores. Interviews showed that, while LifeLab-Soweto was not what AYA were expecting, gains in health knowledge led AYA to consider changes in health behaviours including accessing health services. Life-Soweto presents an acceptable, feasible and relevant health literacy intervention for South African youth with potential to improve health literacy and health behaviours. To ensure the health literacy intervention was contextually relevant, age appropriate, and gender inclusive, a group of 40 adolescents (aged 18-24 years, male, female and non-binary) were recruited from Soweto to firstly identify the health topics that were most pressing in their daily lives. This youth advisory group identified stress as a major challenge impacting physical and mental health, health behaviour and daily functioning. Together with the youth group, researchers from South Africa and the UK worked to co-develop the health literacy intervention that delivers self-directed exploration and learning of how stress impacts health, behaviour and well-being. This manuscript describes how this cocreated intervention was received by a broader range of South African youth who were not involved in the cocreation process.