Prehypertensive Stage Research Articles

Do Sleep Time and Duration Affect the Development of Prehypertension in Undergraduate Medical Students? An Experience from a Tertiary Care Hospital in Kolkata

Abstract Introduction and Objective Hypertension is an evolving public health challenge at present, and it is preceded by a prehypertensive stage. Irregular sleep duration and pattern have been found to be linked with cardiovascular diseases. Medical students are highly vulnerable to low quality sleep due to pressure regarding the academic curriculum and poor lifestyle. The present study aimed to estimate the prevalence of prehypertension, describe the risk factors and sleep patterns of undergraduate medical students, and determine the association, if any, involving sleep time and duration and prehypertension. Materials and Methods Data was collected from 254 undergraduate medical students via the Pittsburgh Sleep Quality Index (PSQI) questionnaire and a self-structured questionnaire. The frequency of events was established and the Chi-squared and t-tests were applied to determine the association. Finally, regression analysis was performed to determine the correlation. Results Male sex, high body mass index (BMI), poor sleep quality, and night sleep duration shorter than 5 hours were found to be significant risk factors for the development of prehypertensive condition (prevalence of 42.5%). However, there were no statistically significant associations regarding prehypertension and family history, junk food and salt intake, physical activity and daytime napping, bedtime, and wake-up time. Night sleep duration shorter than 5 hours presented an odds ratio of 4.713 (p = 0.010) for the development of prehypertension after adjusting for other risk factors, such as male sex, sleep quality, and high BMI. Discussion and Conclusion A high prevalence of prehypertension (42.5%) was noted among undergraduate medical students. Night sleep duration shorter than 5 hours was a significant risk factor for the development of prehypertension, whereas sleep time was not significantly associated with prehypertension.

Dynamic dysregulation of transcriptomic networks in brainstem autonomic nuclei during hypertension development in the female spontaneously hypertensive rat.

Neurogenic hypertension stems from an imbalance in autonomic function that shifts the central cardiovascular control circuits toward a state of dysfunction. Using the female spontaneously hypertensive rat and the normotensive Wistar-Kyoto rat model, we compared the transcriptomic changes in three autonomic nuclei in the brainstem, nucleus of the solitary tract (NTS), caudal ventrolateral medulla, and rostral ventrolateral medulla (RVLM) in a time series at 8, 10, 12, 16, and 24 wk of age, spanning the prehypertensive stage through extended chronic hypertension. RNA-sequencing data were analyzed using an unbiased, dynamic pattern-based approach that uncovered dominant and several subtle differential gene regulatory signatures. Our results showed a persistent dysregulation across all three autonomic nuclei regardless of the stage of hypertension development as well as a cascade of transient dysregulation beginning in the RVLM at the prehypertensive stage that shifts toward the NTS at the hypertension onset. Genes that were persistently dysregulated were heavily enriched for immunological processes such as antigen processing and presentation, the adaptive immune response, and the complement system. Genes with transient dysregulation were also largely region-specific and were annotated for processes that influence neuronal excitability such as synaptic vesicle release, neurotransmitter transport, and an array of neuropeptides and ion channels. Our results demonstrate that neurogenic hypertension is characterized by brainstem region-specific transcriptomic changes that are highly dynamic with significant gene regulatory changes occurring at the hypertension onset as a key time window for dysregulation of homeostatic processes across the autonomic control circuits.NEW & NOTEWORTHY Hypertension is a major disease and is the primary risk factor for cardiovascular complications and stroke. The gene expression changes in the central nervous system circuits driving hypertension are understudied. Here, we show that coordinated and region-specific gene expression changes occur in the brainstem autonomic circuits over time during the development of a high blood pressure phenotype in a rat model of human essential hypertension.

Differential Fractal and Circadian Patterns in Motor Activity in Spontaneously Hypertensive Rats at the Stage of Prehypertension.

One possible pathological mechanism underlying hypertension and its related health consequences is dysfunction of the circadian system-a network of coupled circadian clocks that generates and orchestrates rhythms of ≈24h in behavior and physiology. To better understand the role of circadian function during the development of hypertension, circadian regulation of motor activity is investigated in spontaneously hypertensive rats (SHRs) before the onset of hypertension and in their age-matched controls-Wistar Kyoto rats (WKYs). Two complementary properties in locomotor activity fluctuations are examined to assessthe multiscale regulatory function of the circadian control network: 1) rhythmicity at ≈24h and 2) fractal patterns-similar temporal correlation at different time scales (≈0.5-8h). Compared to WKYs, SHRs have more stable and less fragmented circadian activity rhythms but the changes in the rhythms (e.g., period and amplitude) from constant dark to light conditions are reduced or opposite. SHRs also have altered fractal activity patterns, displaying activity fluctuations with excessive regularity at small timescales that are linked to rigid physiological states. These different rhythmicity/fractal patterns and their different responses to light in SHRs indicate that an altered circadian function may be involved in the development of hypertension.

Psychological distress in relation to blood pressure among Andhra Pradesh state road transport corporation bus drivers, Vijayawada

Background: One of the major health problem worldwide is elevated blood pressure (BP). Prior research had shown that hypertensives experience psychological distress, although pre-hypertensives have not yet been subject to this research. Objectives were to assess the major risk factors of increasing BP among bus drivers and to assess psychological distress in relation to BP levels. Methods: A cross sectional study was conducted among Bus drivers aged above 20 years, study was carried out between July to October of 2022, a sample of 135 was taken. Inferential statistics such as Pearson Chi square test and an unpaired independent-sample t-test was used to assess the difference between pre-hypertensive and hypertensive individuals on GHQ score. Results: In the present study (n=135), 47% were normotensive, 34% were in hypertensive stage and 19% were in pre-hypertensive stage. On assessment of psychological distress in relation to BP among bus drivers the mean of (General health questionnaire) GHQ-12 was found to be 17.57 among hypertensives and 17.86 among pre-hypertensives. Two tailed significance value of 0.768 was observed between pre-hypertensive and hypertensive individuals indicating that psychological distress had significant effects. Conclusions: The prevalence of hypertension and pre-hypertension was among bus drivers, leading to cardio vascular diseases which in turn causes increased morbidity and mortality, lowering individual productivity and having an impact on the national economy. The prevalence of non-communicable diseases should be monitored by lifestyle changes and periodic screenings.

PS-C06-12: HETEROGENEITY AND OVERLAP OF THE LONGITUDINAL ASSOCIATIONS AMONG INCREASED ARTERIAL STIFFNESS, HYPERTENSION AND DIABETES MELLITUS: A 16-YEAR PROSPECTIVE OBSERVATIONAL STUDY

Background: Hypertension and diabetes mellitus frequently coexist; however, differences in the bi-directional longitudinal relationships of arterial stiffness with hypertension and diabetes mellitus have not yet been clarified. Methods: In this 16-year prospective observational study, 3981 middle-aged Japanese subjects without hypertension/diabetes mellitus at the study baseline underwent annual measurements of the blood pressure, serum glycosylated hemoglobin A1c (HbA1c), and brachial-ankle pulse wave velocity (baPWV). Results: By the end of the study period, 664, 779, 154 and 406 subjects developed hypertension, prehypertension, diabetes mellitus and prediabetes, respectively. Increased baPWV at the baseline was associated with a significant odds ratio for new onset of prehypertension/hypertension without (beta = 5.0 x 10–3, P < 0.01) or with (beta = 4.0 x 10–3, P < 0.01) coexisting prediabetes/diabetes mellitus; no such association was found with new onset of prediabetes/diabetes mellitus alone. Furthermore, baPWV showed significant longitudinal associations with the development of all of the above conditions. Conversely, elevated mean blood pressure, even in the pre-hypertensive range, showed a significant longitudinal association with increase of the baPWV. Conclusions: In middle-aged Japanese subjects, a vicious cycle may be triggered between elevated blood pressure, even from the prehypertensive stage, and arterial stiffening and development of diabetes mellitus may be observed as a cross phenomenon of this vicious cycle with a collateral event. Arterial stiffness may be a key element in the development of hypertension, so that its contribution to cardiovascular risk may be greater in patients with hypertension than in those with diabetes mellitus.

Interpretable hybrid model for an automated patient-wise categorization of hypertensive and normotensive electrocardiogram signals

Background and ObjectiveHypertension is critical risk factor of fatal cardiovascular diseases and multiple organ damage. Early detection of hypertension even at pre-hypertension stage is helpful in preventing the forthcoming complications. Electrocardiogram (ECG) has been attempted to observe the changes in electrical activities of the hearts of hypertensive patients. To automate the ECG assessment in the detection of hypertension, an interpretable hybrid model is proposed in this paper. MethodsThe proposed hybrid framework consists of one dimensional - Convolutional Neural Network architecture with four blocks of convolutional layers, maxpooling followed by dropout layers fused with Support Vector Machine classifier in the final layer. The implemented hybrid model is made explainable and interpretable using Local Interpretable Model-agnostic Explanations (LIME) method. The developed hybrid model is trained and tested for patient-wise classification of ECGs using online Physionet datasets and hospital data. ResultsThe proposed method achieved highest accuracy of 81.81% in patient-wise ECG classification of online datasets, and highest accuracy of 93.33% in patient-wise ECG classification of hospital datasets as normotensive and hypertensive. The visualization of results showed only one normotensive patient's ECG is misclassified (predicted) as hypertensive, with identification of patient number, among the 15 patients (8 normotensive and 7 hypertensive) ECGs tested. In addition, the LIME results demonstrated an explanation to the predictions of hybrid model by highlighting the features and location of ECG waveform responsible for it, thus making the decision of hybrid model more interpretable. ConclusionFurthermore, our developed system is implemented as an assisting automated software tool called, HANDI (Hypertensive And Normotensive patient Detection with Interpretability) for real-time validation in clinics for early capture of hypertensive and proper monitoring of the patients.

PS-C15-11: HYPERTENSION AND ITS CORRELATES AMONG SCHOOL ADOLESCENTS IN DELHI

Background: Hypertension is fast emerging as a major health problem amongst all school adolescents, particularly in urban areas. Regular screening of the students for this is required for preventing the emergence of complications later in life. Therefore the present study was undertaken with the objective to determine the prevalence of hypertension amongst urban school adolescents and its correlation with anthropometric measurements. Methods: A cross sectional study was conducted in a school in Central Delhi involving all 315 students of 9th and 11th standard. A proforma was filled by the students and anthropometric measurements along with blood pressure BP measurements were taken for each student. Data were analyzed using Epi info 2005 and SPSS 16.0. Results: Out of the total 315 students, 208 or 66% were boys and 107 or 34% were girls and the mean age was 14.31 SD 0.96 years. The overall prevalence of malnutrition was 24% and boys were found to be more obese as compared to girls. There were 5 students 1.6% who were found to have systolic hypertension while 17 or 5.4% were found to have diastolic hypertension while 4.1% n = 13 of the participants were systolic pre hypertensive and 26% n = 82 were in the stage of diastolic pre hypertension. Body mass index and gender were found to be independent predictors of systolic hypertension. Conclusions: Prevalence of hypertension and pre hypertension was high amongst the school children. BP check ups for children and adolescents are thus recommended to take remedial action on time

Exposure to Air Pollution during Pre-Hypertension and Subsequent Hypertension, Cardiovascular Disease, and Death: A Trajectory Analysis of the UK Biobank Cohort.

The associations between air pollution exposure and morbidity and mortality of cardiovascular diseases (CVDs) have been widely reported; however, evidence on such associations across different dynamic disease trajectories remain unknown. We examined whether ambient air pollution during the prehypertension (pre-HTN) stage could aggravate the progression from hypertension (HTN) to CVD, and consequent death. A total of 168,010 adults with pre-HTN ( systolic blood pressure or diastolic blood pressure) from the UK Biobank were included in this analysis. We used a multistate model to explore the associations between five air pollutants (, absorbance, , , and ) and the risk of six disease transitions (from pre-HTN to HTN, from pre-HTN to CVD, from pre-HTN to death, from HTN to CVD, from HTN to death, and from CVD to death). Mediation analyses were further conducted to explore the role of intermediate diseases in the dynamic progression of CVDs. During a median follow-up of 12 y, 13,743 (8.18%) of participants with pre-HTN developed HTN, whereas 12,825 (7.63%) and 4,467 (2.66%) directly developed CVD or died, respectively. Air pollution was positively associated with the dynamic disease progression. For example, a per-interquartile range increase of was significantly associated with the hazard ratios (HRs) of 1.105 [95% confidence intervals (CI): 1.083, 1.127], 1.045 (95% CI: 1.022, 1.068), and 1.086 (95% CI: 1.047, 1.126) in the transition from pre-HTN to HTN, CVD, and death, respectively. Higher levels of air pollution were associated with increased transition probability of disease progression. Mediation analyses indicated that intermediate diseases subsequently significantly mediated air pollutant-associated risk to develop more serious disease. This study provides evidence that air pollution might play a role in the early stages of CVD progression. Controlling air pollution might be an effective measure to prevent CVD progression and reduce the disease burden of CVD. https://doi.org/10.1289/EHP10967.

Study of risk factors and prevalence of hypertension among type 2 diabetes patients

According to the World Health Organization, hypertension is responsible for 13% of all deaths worldwide, making it a critical public health problem in developing and developed countries. Economic development, affluence, urbanization, and dietary westernization have contributed to a rise in the prevalence of type 2 diabetes mellitus (DM) and hypertension in South Asian countries. To study the prevalence of hypertension among adult type 2 diabetic patients and identify risk factors that may affect the development of hypertension in those patients. A cross-sectional study was conducted from May 2009 to May 2010 at the Department of Diabetology and Medicine Vinayaka Mission's Medical College & Hospital, Karaikal. 100 patients with Type 2 Diabetes of age 35 and above were screened and included in the study. Out of 100 patients with Diabetes Mellitus, 54 patients were hypertensive, and 46 were non-hypertensive. Hypertension was found to be more common in people aged 45 to 64.Our study reported that hypertension was present in 29% of males and 25% of females. Complications like neuropathy (9.3%) non-proliferative diabetic retinopathy (46.51%); proliferative diabetic retinopathy (4.65%); hypertensive retinopathy (2.33%); nephropathy (2.33%); ulcer foot (4.65%); coronary artery disease (27.9%) and stroke (2.33%) were observed in Diabetic patients and were identified as an independent risk factor for hypertension. It was also found that 31.94% of study populations were in the pre-hypertensive stage and 22.22% were in the second stage of hypertension. The prevalence of hypertension in patients with DM is high. Duration of diabetes was also one of the contributing factors for hypertension in Type 2 diabetes mellitus. It also concluded that the prevalence of hypertension increases with age advancement in DM.

The prevalence and socio-demographic correlates of hypertension among women (15\u201349\xa0years) in Lesotho: a descriptive analysis

BackgroundHypertensive disorders are among the leading conditions for severe maternal morbidity across all regions and have a major impact on health care costs. This study aimed to identify the prevalence and its associated socio-demographic correlates of hypertension among women of the reproductive ages in Lesotho.MethodsThe study used the Lesotho Demographic and Health Survey (2014 LDHS) data set. A total of 3353 women of childbearing age (15–49 years) whose blood pressure was measured were used for analysis. The blood pressure readings were categorized according to the JNC7 cut-offs. The dependent variable of this study is hypertension. Both bivariate and binary logistic regressions were performed to determine socio-demographic correlates of hypertension.ResultsResults from this study revealed that one out of every five respondents of the study had hypertension compared to 23% who were in the prehypertension stage. The situation adds to the overall future risk of hypertension. About 30% percent who were at the hypertension stage were either living with a partner or widowed. The odds of being hypertensive were significantly 9.78 times higher among women aged 45–49 years [CI: 6.38–15.00]. Other factors associated with hypertension among women of the reproductive ages were “living with a partner” [OR 3.55:95% CI: 1.76–7.16], widowed [OR 2.61:95% CI: 1.89–3.60], and residing in the Maseru district [OR 2.12: 95% CI: 1.49–3.03].ConclusionChances of being diagnosed with high blood pressure increased with an increase with the age of the respondents. Age was found to be the most definite positive significant socio-demographic correlate of hypertension among women in Lesotho. To control hypertension, primary prevention strategies should target the identified high-risk -older age groups, the ever-married as well as prehypertensive women.

Relationship between Serum Uric Acid Levels and Blood Pressure Levels in Patients Coming to Tertiary Care Teaching Hospital: A Cross Sectional Study

Background: Many studies have shown that high circulating uric acid (UA) levels lead to both hypertension and cardiovascular complications, leading to poor patient prognosis. People with metabolic syndrome (MetS), which is closely linked to hypertension, also tend to have high SUA levels. SUA levels elevate due to metS and hypertension share common pathophysiological features, so it has been difficult to confirm their involvement in the pathogenesis of hypertension. Therefore, the aim of this present study is to find out the association between the uric acid and blood pressure levels in both male and female patients of different age groups. Methods: It was 18 months, single-centered, cross-sectional study, conducted in the department of General Medicine, at National institute of medical sciences and research hospital. Blood samples were collected from 140 participants of both genders attending the department of Medicine with hypertensive and pre-hypertensive stages to analyze serum uric acid (SUA) level and lipid profile. The potential relationship between SUA and BP was assessed by descriptive statistics for analyzing quartiles and odd ratio. Results: Among 140 hypertensive patients, 66 of them were in the 61-80 age groups. Twenty percent of patients were under the age of 20 and one percent was over 87 years of age. 40 patients with pre-hypertension, 28 (70%) of patients having elevated SUA level, while 100 of patients with hypertension, 59(59%) of having elevated SUA level. It had also been found that the diagnosis duration of hypertension and hyperuricemia was causing the elevation of SUA levels in the patients. Conclusion: The present study indicates a direct relationship between SUA levels and hypertension. SUA levels were quite a bit higher in patients with hypertension in contrast to those with pre-hypertension, suggesting the severity of hypertension related to SUA levels.

Scaling a Community-Wide Campaign Intervention to Manage Hypertension and Weight Loss.

Public health impacts can be achieved when evidence-based interventions are implemented to those most in need. Too often implementation never or slowly occurs. The community-wide campaign intervention Tu Salud ¡Si Cuenta! has evidence of improving health outcomes related to chronic disease among low-income, Latinos. Using the RE-AIM Framework, this study examined if the scaled-up version of the intervention is associated with improvements in hypertension and obesity in 12 locations. Each element of the RE-AIM framework was examined. For “Effectiveness,” we examined outcomes overall and by implementing location. We used linear and logistic regression to assess if exposure in the intervention was associated with improvement in hypertension and weight loss. Participants were stratified into “low exposure” (2–3 outreach visits) vs. “high exposure” (4–5 outreach visits). Based on the RE-AIM Framework, the intervention “reached” its intended population of low-income Latinos, demonstrated “effectiveness” in improving hypertension and obesity, was “adopted” at a high level in all but one site, was “implemented” with fidelity to the intervention model with moderate success across locations, and showed high “maintenance” over time. For effectiveness specifically, we found that out of 5,019 participants, 2,508 (50%) had a baseline hypertensive blood pressure (BP) reading. Of the 2,508, 1,245 (49.9%) recovered to normal blood pressure or pre-hypertension stage by last follow-up. After adjusting for baseline BP and potential confounders in multivariable linear regression models, the high exposure group had significantly more reduction in systolic BP (adjusted mean difference in % change = −0.96; p = 0.002) and diastolic BP (adjusted mean difference in % change = −1.61; p < 0.0001) compared to the low exposure group. After controlling for baseline weight and other confounders, the high exposure group had significantly greater decrease in weight compared to the low exposure group (adjusted mean difference in % change = −1.28; p < 0.0001). Results from the multivariable logistic regression models indicated that compared to the low exposure group the high exposure group was more likely to achieve a clinically significant minimum 5% weight loss [adjusted odds ratio (OR) = 2.97; p < 0.0001). This study contributes evidence that a Community-Wide Campaign model holds promise for addressing hypertension and obesity among low-income Latinos.

Development of the hypersecretory phenotype in the population of adrenal chromaffin cells from prehypertensive SHRs.

The hypersecretory phenotype of adrenal chromaffin cells (CCs) from early spontaneously hypertensive rats (SHRs) mainly results from enhanced Ca2+-induced Ca2+-release (CICR). A key question is if these abnormalities can be traced to the prehypertensive stage. Spontaneous and stimulus-induced catecholamine exocytosis, intracellular Ca2+ signals, and dense-core granule size and density were examined in CCs from prehypertensive and hypertensive SHRs and compared with age-matched Wistar-Kyoto rats (WKY). During the prehypertensive stage, the depolarization-elicited catecholamine exocytosis was ~ 2.9-fold greater in SHR than in WKY CCs. Interestingly, in half of CCs the exocytosis was indistinguishable from WKY CCs, while it was between 3- and sixfold larger in the other half. Likewise, caffeine-induced exocytosis was ~ twofold larger in prehypertensive SHR. Accordingly, depolarization and caffeine application elicited [Ca2+]i rises ~ 1.5-fold larger in prehypertensive SHR than in WKY CCs. Ryanodine reduced the depolarization-induced secretion in prehypertensive SHR by 57%, compared to 14% in WKY CCs, suggesting a greater contribution of intracellular Ca2+ release to exocytosis. In SHR CCs, the mean spike amplitude and charge per spike were significantly larger than in WKY CCs, regardless of age and stimulus type. This difference in granule content could explain in part the enhanced exocytosis in SHR CCs. However, electron microscopy did not reveal significant differences in granule size between SHRs and WKY rats' adrenal medulla. Nonetheless, preSHR and hypSHR display 63% and 82% more granules than WKY, which could explain in part the enhanced catecholamine secretion. The mechanism responsible for the heterogeneous population of prehypertensive SHR CCs and the bias towards secreting more medium and large granules remains unexplained.

Pre-Hypertension and Its Determinants in Healthy Young Adults: Analysis of Data from the Korean National Health and Nutrition Examination Survey VII.

The purpose of this cross-sectional study was to identify risk factors in the normotensive and pre-hypertensive group based on the blood pressure results of healthy young adults from the Korean National Health and Nutrition Examination Survey 2018. The participants were 2225 healthy young adults between the ages of 19 and under 45, excluding those with a diagnosis of hypertension or taking antihypertensive medications. Of the 2225 participants, the normotensive group was 1498 (67.3%) and the pre-hypertensive group 727 (32.7%). Determinants of pre-hypertension were analyzed using multiple logistic regression based on a complex sample design. Factors related to pre-hypertension in young adults were age, smoking, waist circumference, diabetes, anemia, cholesterol levels including HDL cholesterol, and uric acid levels. Pre-hypertension is a pre-stage that can prevent the morbidity of hypertension through lifestyle control, so its management is very important. Furthermore, a young adult is a stage in the growth and development of human beings, in which lifestyles such as healthy behaviors, eating habits, and exercise are fixed. Therefore, it is very important to improve lifestyles such as diet, exercise, and smoking cessation and to control risk factors in young adults who are at the pre-hypertension stage for health promotion. Continuous health examinations should be conducted for young adults, and education that can be practiced based on clinical data through this should be implemented for community health.

Physiological Aspects of Cordillera Weaving in the Philippines

This novel study examined the physiological aspects of weaving among 20 female weavers from the Cordillera Region of Northern Luzon, Philippines. Demographic profile and anthropometric measures were gathered, heart rate (HR) and posture were continuously monitored while the weavers performed a 30-min weaving task. Data were analyzed using mean ± standard deviation and Pearson’s correlation coefficient to identify any relationship. Analysis was conducted using a commercial statistical package (SPSS version 25, IBM, Chicago, IL) with alpha set at 0.05 level. Data revealed that the weavers’ blood pressure is at the prehypertension stage, body fat percentage relative to age is average, BMI value is classified as overweight, and WHR value showed that they are at risk from metabolic disorders. Results also showed that the occupational demands of weaving presented low cardiovascular workload and increased task difficulty resulted to more forward lean among weavers. Additionally, there was a linear relationship between HR and posture. These findings suggest the potential for increased risk for musculoskeletal injuries with weaving.

Primary Aldosteronism: a Continuum from Normotension to Hypertension.

Primary aldosteronism (PA) is the most common cause of secondary hypertension. Emerging evidence suggests that PA is associated with cardiovascular, metabolic, and renal complications, that likely develop insidiously, due to prolonged inappropriate mineralocorticoid receptor activation. In this review, we discuss the expanding clinical and pathological spectrum of PA. Clinical and molecular studies conducted over the recent years reveal that PA traverses a series of contiguous stages. Pre-clinical, but hormonally overt PA has been identified in patients with normal blood pressure, and such patients harbor an increased risk of developing hypertension. Similarly, genetic and histopathological advancements have exposed a spectrum of PA pathology that corresponds to a continuum that spans from pre-clinical stages to florid PA. PA evolves from pre-hypertensive stages to resistant hypertension, along with serious cardiovascular and renal consequences. Early recognition of PA and targeted therapy will be essential for cardiovascular morbidity and mortality prevention in a large number of patients.

Abnormalities in emotional and motor reactions among young prehypertensive individuals: employing continuous blood pressure analysis.

Background:Essential hypertension is an important risk factor for cerebrovascular diseases and a major cause of premature death in industrialized societies. A predisposing factor for essential hypertension is prehypertension: blood pressure (BP) values at rest that are at the higher end of the normal range. Abnormally enhanced cardiovascular responses to motor and emotional tasks have been found as predictors of essential hypertension. Yet, knowledge regarding the BP reaction to aversive stimuli and motor reaction in prehypertension is limited.Methods:We compared the reaction to aversive and neutral stimuli inducing an emotional response (experiment 1) and to the isometric handgrip exercise (IHE) inducing a motor response (experiment 2), between prehypertensive and normotensive controls. BP reactions were measured and analyzed in a continuous fashion, in contrast to previous studies that averaged BP responses across blocks. We applied a multilevel B-spline model, a continuous analysis that enabled a better understanding of the BP time course and the detection of subtle differences between groups.Results:In both tasks, we found that prehypertensive individuals showed enhanced DBP reactions compared with normotensive controls; prehypertensive individuals exhibited lower BP responses to aversive pictures and higher BP responses to the IHE. These results are in line with previous studies with healthy or hypertensive participants and suggest abnormalities already in the prehypertensive stage.Conclusion:Considering the high frequency and health risks related to prehypertension, understanding the autonomic reactions to emotional and motor stimuli in this population is of clinical and theoretical importance and could serve as a behavioural marker to identify at-risk groups.

15. BODY MASS INDEX AND HYPERTENSION IN INDONESIAN HAJJ PILGRIMS

Background: Indonesia has the largest number of yearly hajj pilgrim around the world. Most of those pilgrims are elderly obese with comorbidity such as hypertension. Objective: The aim of this study is to determine correlation between body mass index and hypertension among East Java's pilgrims in 2017 to 2019. Method: This study is observational analytic as in cross sectional analysis from East Java pilgrims data between 2017 to 2019. Data was collected by trained hajj health worker and then analyzed by spearman rank correlation test. Body mass index was classified by World Health Organization (WHO) while hypertension by Joint National Committee (JNC) 8. Result: There was a total of 105.988 data was collected in which 392 data are invalid due to inappropriate value. Almost half (45.47%) of the pilgrims were normal body mass index yet only 4871 (4.6%) of the pilgrims were underweight. There were 38.403 (36.36%) pilgrims categorized as overweight while 14.301 (13.54%) were obese. However, only 54.120 (1.7%) had normal systolic blood pressure. Further, alarmingly, 31.096 (29.44%) were in pre hypertension stage. There were only 13.757 (13.02%) and 6623 (6.2%) pilgrims categorized having grade one and two hypertension respectively. From the spearmen test analysis result, there was a significant correlation between body mass index and hypertension (p = 0.000, r = 1). Conclusion: In sum, there was a strong linear significant relationship between body mass index and systolic blood pressure.

Community Empowerment towards Healthy Living through The Implementation of Healthy Living Community Movements (GERMAS)

Indonesia is currently facing a triple burden of disease where the incidence of non-communicable diseases is increasing. The condition is related to lifestyle include lack of physical activity, an unhealthy and unbalanced diet, and unhealthy lifestyle as smoking and alcohol consumption. To educate the community to implement healthy living, GERMAS is being promoted, emphasizing promotive and preventive efforts. The purpose of these activities was to educate and mobilize the community to implement healthy living by implementing GERMAS that focuses on physical activities, consuming vegetables and fruit, and checking health regularly. From the health status monitoring, 15.6% of participants were in the systolic prehypertension stage, and 34.4% were in the systolic hypertension stage, 19.0% with high cholesterol levels, 43.8% with high uric acid levels and 21.9% with high blood sugar levels. This activity was continued by giving education about balanced and healthy food, routine physical activities during three months and the use of their yards for planting vegetables and fruit and motivating the communities for consuming the healthy food daily. After three months, the health condition improved in which the number of participants with systolic hypertension and high blood sugar levels decreased to 30% and 12.5%, respectively. It was concluded that the implementation of healthy life society movement daily could reduce the biological risk factors leading to the reduction of non-communicable disease incidence.

Nutritional profile of Kolagur tribal women in Yercaud, Tamil Nadu, India: An exploratory study

Background: Malnutrition is a long-standing global health issue to which the tribal population are highly vulnerable. Timely diagnosis and appropriate treatment is crucial. Aim: The aim of the study is to assess the nutritional status of tribal women in Kolagur, Yercaud, using anthropometric, biochemical, clinical, and dietary assessment parameters. Subjects and Methods: An exploratory study was carried out among women (n = 100) between 18 and 60 years of age from Kolagur, a tribal village in Yercaud taluk, Salem district, Tamil Nadu, India. Information on sociodemographic profile of participants was collected using a structured interview schedule. Anthropometric, biochemical, clinical, and dietary parameters were assessed using appropriate standard techniques/tools. Nutrient intake was computed using Diet Cal software and the statistical analysis was done using IBM SPSS statistics software version 25. Results: Majority of the participants were malnourished of which 25% were underweight, 20% were obese, and 17% were overweight. The mean waist-to-hip ratio (mean ± standard deviation: 0.87 ± 0.13) was marginally higher than the normal cutoff value for women. The prevalence of anemia was much lower where only 21% had mild anemia, 5% had moderate anemia, and 1% had severe anemia. About 21% were prediabetic and 9% were diabetic. Majority (51%) of the participants had altered blood pressure levels with 20% in hypertension Stage 2, 19% in prehypertensive stage, and 12% in hypertension Stage 1. The mean intake of nutrients such as energy, thiamine, ascorbic acid, and folate was significantly higher than the recommended dietary allowances (RDA), whereas the mean intake of fat, retinol, riboflavin, pyridoxine, calcium, and iron was significantly lesser than the RDA. Conclusions: The findings of this study highlight the urgent need for well-planned nutrition-oriented health policies at the community level to eradicate the double burden of malnutrition.