Reduce Blood Pressure Levels Research Articles

Percutaneous Renal Denervation (RDN), is an Innovative Strategy in the Control of Refractory Blood Pressure. A Case Report.

Arterial hypertension (HBP) is a heterogeneous diseasecharacterized by havinga high degree of morbimortality in patients who suffer from it. Clinically it is diagnosedby taking blood pressure (BP) 1, when a value equal to or higherthan 130/80 mmHg is obtained.Among its classification there is "Refractory Arterial Hypertension" 4-5 which has a low incidence but with a high cardiovascular risk and costs to the health system. Given its high impact, minimally invasive strategies have been created that have had a significant effect in reducing blood pressure levels; this procedure is calledPercutaneous Renal Denervation (RDN) 6-7.

The Impact of Gender and Age on the Relationship between Body Mass Index and Hypertension among Middle-Aged Inhabitants of Kolkata, India

More than one billion people are hypertensive worldwide. This makes hypertension an issue of community health. Therefore, it should be our chief concern to identify the risk factors of hypertension and suggest essential preventive measures to reduce this public health burden. Diverse inquiries have uncovered the positive correlation between being overweight, obesity, and dyslipidemia with hypertension. Research suggests that Body Mass Index (BMI) and hypertension demonstrate a significant positive correlation. Excessive weight gain or visceral fat gain is the dominant risk factor for hypertension. Apart from this, several other factors like abdominal adiposity, family history, smoking etc. may be responsible for hypertension. In light of this context, the current article explores the relationship between adult residents of Kolkata's BMI and their hypertension levels. The study was performed among two age groups viz. 35 to 44 years and 45 to 54 years, as the problem is mostly uncommon for the young generation. The sample size of the present investigation was 200, having equal representation from both age and gender groups. The subjects were from middle socio-economic status families as inferred from their occupations. Systolic blood pressure (SBP), diastolic blood pressure (DBP), height, and weight were quantified. BMI was estimated from the measured height and weight. Descriptive statistics, correlation coefficients and ‘t’ tests were calculated. Impact of age and gender was determined on BMI and hypertension scores of the subjects. The results of the present study exhibit a constructive and significant association between the relevant variables. The correlation coefficient between body mass index (BMI) and SBP was 0.74, while that between BMI and DBP was 0.734. Both correlations were statistically significant at the 0.01 level of significance. The outcomes of the t-Test indicate that significant differences exist between the BMI, SBP, and DBP scores within the gender groups. The calculated t-values for BMI, SBP, and DBP were 7.946, 7.973, and 5.296, respectively, with all of them being significant at the 0.05 level of significance. Age was found to have no substantial impact on any of the three variables. These findings can aid in identifying individuals at risk and developing preventive strategies to mitigate the prevalence of obesity or overweight and subsequently reduce blood pressure levels among adults.

High-Intensity Interval Training Minimizes the Deleterious Effects of Arterial Hypertension on the Urinary Bladder of Spontaneously Hypertensive Rats.

Arterial hypertension promotes urological complications by modifying the functional capacity of the urinary bladder. On the other hand, physical exercise has been suggested as a nonpharmacological tool to improve blood pressure regulation. High-intensity interval training (HIIT) can effectively increase peak oxygen consumption, body composition, physical fitness, and health-related characteristics of adults; however, its action on the urinary bladder is little discussed. In the present study, we verified the effect of HIIT on the modulation of the redox state, morphology, and inflammatory and apoptotic processes of the urinary bladder of hypertensive rats. Spontaneously hypertensive rats (SHR) were divided into two groups: SHR sedentary and SHR submitted to HIIT. Arterial hypertension promoted an increase in the plasma redox state, modified the volume of the urinary bladder, and increased collagen deposition in detrusor muscle. It was also possible to identify, in the sedentary SHR group, an increase in inflammatory markers such as IL-6 and TNF-α in the urinary bladder, as well as a reduction in BAX expression. However, in the HIIT group, reduced blood pressure levels were observed, together with an improvement in morphology, such as a decrease in collagen deposition. HIIT also regulated the proinflammatory response, promoting increases in IL-10 and BAX expressions and in the number of plasma antioxidant enzymes. The present work highlights the intracellular pathways involved with the oxidative and inflammatory capacity of the urinary bladder and the potential effect of HIIT on the regulation of the urothelium and detrusor muscle of hypertensive rats.

Hypertension in China: epidemiology and treatment initiatives.

The past two to three decades have seen a steady increase in the prevalence of hypertension in China, largely owing to increased life expectancy and lifestyle changes (particularly among individuals aged 35-44 years). Data from the China hypertension survey conducted in 2012-2015 revealed a high prevalence of grade 3 hypertension (systolic blood pressure ≥180 mmHg and diastolic blood pressure ≥110 mmHg) in the general population, which increased with age to up to 5% among individuals aged ≥65 years. The risk profile of patients with hypertension in China has also been a subject of intense study in the past 30 years. Dietary sodium and potassium intake have remained largely the same in China in the past three decades, and salt substitution strategies seem to be effective in reducing blood pressure levels and the risk of cardiovascular events and death. However, the number of individuals with risk factors for hypertension and cardiovascular disease in general, such as physical inactivity and obesity, has increased dramatically in the same period. Moreover, even in patients diagnosed with hypertension, their disease is often poorly managed owing to a lack of patient education and poor treatment compliance. In this Review, we summarize the latest epidemiological data on hypertension in China, discuss the risk factors for hypertension that are specific to this population, and describe several ongoing nationwide hypertension control initiatives that target these risk factors, especially in the low-resource rural setting.

Bosentan Does Not Affect Renal Resistive Index in Scleroderma/Systemic Sclerosis Patients

Introduction: If properly evaluated, chronic kidney disease can be found in up to 50% of patients with systemic sclerosis (SSc). The renal resistive index (RRI) is a marker of intrarenal vascular resistance and can predict SSc-associated vasculopathy. This study aimed to determine the impact of bosentan, a nonselective endothelin-1 receptor antagonist, on RRI and kidney function in SSc patients with recurrent digital ulcers. Methods: Twenty-one patients (age 57 ± 9 years, 19 females) were recruited in a 16-week prospective open-label uncontrolled study. Standardized procedures were used to measure general clinical and laboratory characteristics, systolic, diastolic, and mean arterial pressure (MAP), pulse pressure (PP), diastolic to systolic blood pressure (D/S) ratio, and urinary endothelin-1 levels. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to calculate kidney function as an estimated glomerular filtration rate (eGFR). RRI was measured by Doppler ultrasound as the average of three samplings of intrarenal blood flow in different kidney regions of both kidneys. Patients with secondary causes of kidney disease or kidney diseases associated with albuminuria were excluded. Results: Bosentan treatment for 16 weeks did not change RRI (0.731 ± 0.049–0.730 ± 0.054, p = 0.925), but increased urine endothelin-1 to creatinine ratio (0.27 ± 0.15–0.49 ± 0.57 pg/mg, p = 0.032) and reduced MAP (123 ± 10–101 ± 11 mm Hg, p < 0.001), PP (76 ± 11–68 ± 10 mm Hg, p = 0.003), D/S ratio (0.563 ± 0.044–0.538 ± 0.031, p = 0.006), and eGFR (92 ± 20–84 ± 24 mL/min/1.73 m2, p = 0.003). Discussion/Conclusion: In conclusion, in patients with SSc complicated by digital ulcers and normal to mildly diminished kidney function, bosentan had no effect on intrarenal hemodynamics, but reduced blood pressure levels and kidney function.

S-01-3: SMART WELLNESS HOUSING AND BLOOD PRESSURE CONTROL

Objective: Mortality due to cardiovascular diseases (CVDs) rises sharply in winter, a phenomenon known as excess winter mortality. It is partially explained by cold exposure induced hypertension. Nevertheless, existing countermeasures for the prevention of hypertension and CVDs place emphasis only on improving lifestyle habits. Improving life environment has attracted attention recently because people spend 60–70% of their time at home. Therefore, we aimed to quantitatively evaluate the relationship between housing thermal environment and blood pressure (BP) in a real-world setting. Design and method: We conducted a nationwide prospective intervention study named the Smart Wellness Housing survey in Japan, as a nonrandomized controlled trial. The intervention was the thermal insulation retrofitting of homes. Participants were recruited by construction companies throughout all 47 prefectures of Japan. Home BP and indoor temperature were measured for 2 weeks before and after the intervention in winter (November-March) of FY 2014 to 2019. Results: Cross-sectional analyses before intervention involving about 2900 participants (1840 households) showed that systolic blood pressure (SBP) in the morning had significantly higher sensitivity to changes in indoor temperature (8.2 mmHg increase/10°C decrease) than that in the evening (6.5 mmHg increase/10°C decrease) in participants aged 57 years (mean age in this survey). Interaction terms between age/women and indoor temperature were significant, indicating that SBP in older residents and women was vulnerable to indoor temperature change. The association between BP variability and indoor temperature instability was also analyzed using the morning-evening (ME) difference as an index of diurnal variability and the standard deviation (SD) of 2-week data as an index of day-by-day variability. The analyses showed that the ME difference in indoor temperature was closely correlated with the ME difference in SBP (0.85 mmHg/°C). The SD of indoor temperature was also associated with the SD of SBP (0.61 mmHg/°C). In the comparison of before and after intervention, insulation retrofitting significantly reduced morning SBP by 3.1 mmHg. In addition, there was heterogeneity in the effect of insulation retrofitting on morning SBP in hypertensive patients compared with normotensive occupants (-7.7 versus -2.2 mmHg). Conclusions: Hypertension might be not only lifestyle diseases but also life-environment diseases. Residents should keep the indoor temperature high to reduce BP level and keep it stable to reduce BP variability through strategies such as installing high thermal insulation. We expect that these results will be useful to prevent excess winter mortality due to CVDs.

PS-C13-14: ARNI DECREASED NIGHTTIME BLOOD PRESSURE EVALUATED BY WRIST-TYPE NOCTURNAL MONITORING DEVICE IN A PATIENT WITH TREATMENT-RESISTANT HYPERTENSION AFTER RENAL DENERVATION

Angiotensin receptor-neprilysin inhibitor (ARNI), Sacubitril/Valsartan has been reported to decrease nighttime blood pressure (BP). Moreover, Sacubitril/Valsartan is expected to be useful in treatment resistant hypertension because neprilysin inhibition offers an additional effect to reducing BP levels. In this case report, we observed decreasing nighttime BP by changing from angiotensin-1 receptor blocker (ARB) and hydrochlorothiazide (HCTZ) to Sacubitril/Valsartan in a patient with sustained resistant hypertension despite he had been conducted the procedure of renal denervation. Additionally, we evaluated nighttime BP by newly developed wrist-type nocturnal BP monitoring device, Nightview (Omron HEM9601T, Omron health care, Kyoto, Japan). A 46 year old Asian male, who had underwent renal denervation 8-years ago, suffered for treatment-resistant hypertension despite of administration of multiple antihypertensive medications including combination agent of ARB/HCTZ, Ca-channel antagonist, beta-blocker, alpha-blocker, and mineralocorticoid receptor antagonist. His average of usual daytime (morning and evening) home BP level was 155/85 mmHg. We performed a 7-day consecutive nighttime BP measurement using wrist-type BP monitoring device, which also revealed nocturnal hypertension, 125/65 mmHg. To decrease his daytime or nighttime BP levels, we initiated administration of sacubitril/valsartan 400 mg instead of combination agent of ARB/hydrochlorothiazide (Candesartan 8 mg and Hydrochlorothiazide 6.25 mg). Then, we performed nighttime BP measurements using wrist-type device again, which revealed decreasing nighttime BP to 119/61 mmHg just after initiating Sacubitril/Valsartan instead of combination agent of ARB/HCTZ. His usual daytime home BP also decreased to 140/80 mmHg. Additionally, NT-pro BNP also decreased from 87 to 55 pg/mL. From these observations in this case report, ARNI is expected to improve BP control, especially nighttime BP level, in patients with uncontrolled treatment-resistant hypertension despite multiple drug and denervation therapy. ARNI may be also expected to prevent heart failure in resistant hypertension.

Effect of flaxseed supplementation on blood pressure: a systematic review, and dose-response meta-analysis of randomized clinical trials.

Many clinical trials have revealed that flaxseed supplementation might exert a potent antihypertensive influence, but the findings are inconsistent. In this regard, a meta-analysis was carried out to provide a more accurate estimate of the impact of flaxseed supplementation on blood pressure. We searched international databases including PubMed, Cochrane Library, Web of Science, Scopus, Embase, and Google Scholar till July 2022. A random-effects model was used to calculate weighted mean differences (WMDs). Non-linear dose-response analysis and meta-regression were performed. Meta-analysis of 33 trials (comprising 43 treatment arms) with 2427 participants revealed significant reductions in both systolic (WMD: -3.19 mmHg; 95% CI: -4.15 to -2.24, p < 0.001; I2 = 92.5%, p < 0.001) and diastolic blood pressure (WMD = -2.61 mmHg; 95% CI: -3.27, -1.94, p < 0.001; I2 = 94.1%, p < 0.001) following flaxseed supplementation. Greater effects on SBP and DBP were found in trials with an intervention duration of >20 weeks, ≥30 g day-1 of flaxseed, subjects with BMI 25-30 kg m-2, and in patients with hypertension. Supplementation with various flaxseed products significantly reduced SBP and DBP levels, confirming the hypothesis that flaxseed could be used as an effective supplement for blood pressure management, alongside routine medications.

Uncontrolled hypertension and obstructive sleep apnea: integrated treatment approach

The main goal in the arterial hypertension (AH) management is the target blood pressure (BP) achievement, as it leads to the cardiovascular risk reduction. At the same time, proper BP is achieved less than in 50% of all cases. In addition, there are two types of truly uncontrolled AH in population, such as resistant (RAH) and refractory (RFH) AH. Recent research suggests that RAH may be associated with changes in the renin-angiotensin-aldosterone system, while RFH appears to be more closely associated with sympathetic hyperactivation. These pathophysiological mechanisms are also active in patients with obstructive sleep apnea (OSA). Therefore, the prevalence of OSA in patients with RAH and RFH is very high, and treatment with continuous positive airway pressure (PAP-therapy) can reduce BP levels in such patients. The latter allows us to consider PAP-therapy as an additional method for the target BP achievement in patients with uncontrolled AH and OSA.

The potential of blood pressure telemonitoring: experience in the UK and Japan.

Hypertension is the most important and modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality worldwide, and a growing issue as the global population with hypertension increases (estimated to be 626 million women and 652 million men in 2019, almost double the number in 1990). In addition, global control rates for hypertension remain poor: 23% for women and 18% for men in 2019 (Lancet. 2021:957). Measures to reduce the number of poorly controlled hypertensive patients are urgently needed. Remarkable advances in healthcare technology have changed healthcare delivery dramatically in the last decade with out-of-office blood pressure (BP) telemonitoring being widely used in clinical research (Hypertension. 2020:1368). We have demonstrated the efficacy of BP telemonitoring and digital intervention for the management of hypertension in the Telemonitoring And Self-Management IN the control of Hypertension (TASMINH) trials (Lancet. 2010:163, JAMA. 2014:799, Lancet. 2018:949), the Home and Online Management and Evaluation of Blood Pressure (HOME BP) trial (BMJ. 2021:m4858), and the HERB Digital Hypertension 1(HERB-DH1) pivotal trial (Eur Heart J. 2021:4111). A recent meta-analysis found that home BP telemonitoring improved office systolic BP (SBP) by 3.99 mmHg and home BP telemonitoring plus additional support (e.g., counselling and medications management) also showed a reduction of office SBP by 2.44 mmHg versus home BP telemonitoring alone (J Hum Hypertens. 2017:427). This evidence suggests that BP telemonitoring is an optimal tool for reducing BP levels and that combining BP telemonitoring and co-interventions would be the most effective approach for the management of hypertension. There are additional benefits from BP telemonitoring system in clinical practice, including assessment of accurate and reliable out-of-office BP data, and ease of BP measurement and recording by patients without the need for manual systems. Furthermore, such systems can reduce nonadherence of antihypertensive medications and clinical inertia, both of which contribute to a treatment-resistant hypertension (J Hypertens. 2017:2346, J Hypertens. 2021:1238). In practical terms, telemonitoring also facilitates optimal BP management for patients living in geographically remote or poorly medically resourced areas (Hypertension. 2021:1927). In this session, through discussion of the evidence base and clinical experience in the UK and Japan, we will examine the prospects of BP telemonitoring systems for the future management of hypertension. We will examine how BP telemonitoring systems are used and affect BP control in both clinical trials and subsequent implementation. In addition, by comparing such work in the UK and Japan, we will assess the potential of BP telemonitoring systems as a solution to the inadequate BP control status worldwide.

Effects of Nitric Oxide Dump Exercise upon Blood Pressure Levels of Middle-aged Hypertension Patients: A Study of District Karak

The purpose of the current study was to evaluate the effects of Nitric Oxide Dump (NOD) exercise on Blood Pressure (BP) levels of hypertension patients. For this purpose, twenty (20) moderate hypertension patients of Takhte Nasrate, Karak District were selected as subjects at random. A randomized pretest-posttest Equivalent-Group Design was used in the current study. As a result, ten (10) subjects were included in the Experimental Group (EG) and the same number of subjects i.e. ten (10) were included in the Control Group (CG). The EG was given a 6-week NOD exercise for low intensity for 3 weeks, medium intensity for 3 weeks and high intensity for 1 week. Results indicated that NOD exercise helped in reducing the blood pressure levels of hypertension patients. The results obtained through the current study justify the use of nitric dump oxide exercise, as one of the important interventions to reduce blood pressure levels of hypertension patients.

Case Management for People with Stroke: Quasi experimental study

Objective: to compare the effect of intervention by nurse-case manager on risk factors and blood pressure in post-stroke people. Method: quasi-experimental study conducted over six months with 14 post-stroke patients in southern Brazil. The intervention with case management consisted of nursing consultations, individualized educational actions and referrals to other professionals, operationalized in three home visits and six telephone contacts. For data analysis, descriptive statistics and Fisher’s test were used, with a significance level of p≤0.05. Results: Reduction of smoking (p=0.0414), alcohol intake (p=0), sodium consumption (p=0.0024), fat (p=0.0027), carbohydrate (p=0.0203) and sugar (p=0.0111), increased physical activity (p=0.0382) and non-significant reduction of blood pressure levels were observed. Conclusion: Nurse-led case management is a valid strategy to follow people recovering from stroke.

Latihan Aktivitas Fisik Seperti Berjalan Setiap Hari pada Pasien Hipertensi

This study aims to determine the effect of walking physical activity on blood pressure in hypertension patients. This type of research is a systematic review, by reviewing several journals from the University of Indonesia library through CINAHL, Pubmed, Ebscohost, Springers, Wiley, and Scopus. The results of research from 11 literature searches that walking activity exercises can effectively reduce blood pressure levels, ranging from 6 minutes to 120 minutes per day, and 1200 minutes every week, can produce a better effect in hypertensive patients - the average decrease in SBP is significant between 2.6 mmHg and 22.6 mmHg. In conclusion, walking activity exercises are very useful and effective in reducing blood pressure levels, especially in hypertensive patients.&#x0D; &#x0D; Keywords: Physical Activity, Walking, Hypertension, Brisk Walking, Jogging

Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments

BackgroundHypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or controlling hypertension is lacking in the current literature. This study aims to summarize the evidence from natural and quasi-experiments that evaluated interventions used to prevent or control hypertension.MethodsWe searched PubMed, Embase and Web of Science for natural and quasi-experiments evaluating interventions used to prevent hypertension, improve blood pressure control or reduce blood pressure levels from January 2008 to November 2018. Descriptions of studies and interventions were systematically summarized, and a meta-analysis was conducted.ResultsThirty studies were identified, and all used quasi-experimental designs including a difference-in-difference, a pre-post with a control group or a propensity score matching design. Education and counseling on lifestyle modifications such as promoting physical activity (PA), promoting a healthy diet and smoking cessation consultations could help prevent hypertension in healthy people. The use of computerized clinical practice guidelines by general practitioners, education and management of hypertension, the screening for cardiovascular disease (CVD) goals and referral could help improve hypertension control in patients with hypertension. The educating and counseling on PA and diet, the monitoring of patients’ metabolic factors and chronic diseases, the combination of education on lifestyles with management of hypertension, the screening for economic risk factors, medical needs, and CVD risk factors and referral all could help reduce blood pressure. In the meta-analysis, the largest reduction in blood pressure was seen for interventions which combined education, counseling and management strategies: weighted mean difference in systolic blood pressure was − 5.34 mmHg (95% confidence interval [CI], − 7.35 to − 3.33) and in diastolic blood pressure was − 3.23 mmHg (95% CI, − 5.51 to − 0.96).ConclusionsInterventions that used education and counseling strategies; those that used management strategies; those that used combined education, counseling and management strategies and those that used screening and referral strategies were beneficial in preventing, controlling hypertension and reducing blood pressure levels. The combination of education, counseling and management strategies appeared to be the most beneficial intervention to reduce blood pressure levels.

Zofenopril: Blood pressure control and cardio-protection.

Current hypertension guidelines suggest various strategies to reduce blood pressure levels, thereby reducing cardiovascular events: combinations of drugs with different mechanisms of action, such as an angiotensin converting enzyme inhibitors (ACEIs) and a diuretic, are the cornerstone of the modern treatment of hypertension, also as initial therapy. Among ACEIs, zofenopril has been shown to be effective in the management of hypertension both as monotherapy and in combination with a diuretic: zofenopril/hydrochlorothiazide fixed dose combination is particularly useful to improve treatment adherence through simplification of treatment regimen. Moreover, thanks to the sulfhydryl group, zofenopril has some peculiar properties (higher lipophilicity and tissue penetration, lower bradykinin-dependent effect, higher affinity for, and more persistent binding to, tissue ACE, significant antioxidant effect), which may account for the cardio-protective effects of the drug demonstrated in both pre-clinical studies and randomized clinical trials. The positive impact of zofenopril on clinical outcomes has been extensively documented by the SMILE program, including several clinical trials in patients with different conditions of myocardial ischemia treated with zofenopril: the results of the SMILE program, demonstrating the benefits of zofenopril vs. placebo and other ACEIs, emphasize the importance of a differentiated approach to patients with ischemic heart disease, based on a careful choice of the adopted agent, in order to improve the overall impact of pharmacological treatment on clinical outcomes.

The Effects of Stevia Consumption on Gut Bacteria: Friend or Foe?

Stevia, a zero-calorie sugar substitute, is recognized as safe by the Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA). In vitro and in vivo studies showed that stevia has antiglycemic action and antioxidant effects in adipose tissue and the vascular wall, reduces blood pressure levels and hepatic steatosis, stabilizes the atherosclerotic plaque, and ameliorates liver and kidney damage. The metabolism of steviol glycosides is dependent upon gut microbiota, which breaks down glycosides into steviol that can be absorbed by the host. In this review, we elucidated the effects of stevia’s consumption on the host’s gut microbiota. Due to the lack of randomized clinical trials in humans, we included in vitro using certain microbial strains and in vivo in laboratory animal studies. Results indicated that stevia consumption has a potential benefit on the microbiome’s alpha diversity. Alterations in the colonic microenvironment may depend on the amount and frequency of stevia intake, as well as on the simultaneous consumption of other dietary components. The anti-inflammatory properties of stevioside were confirmed in vitro by decreasing TNF-α, IL-1β, IL-6 synthesis and inhibiting of NF-κB transcription factor, and in vivo by inhibiting NF-κB and MAPK in laboratory animals.

EFFECTIVENESS OF GINGER IN REDUCING PRESSURE LEVELS IN PERSONS WITH DIABETES:

Objective: to evaluate the effectiveness of ginger in reducing blood pressure in people with type 2 diabetes. Method: randomized, double-blind clinical trial, conducted with people with type 2 diabetes, in primary health care units. Were included individuals aged between 20 and 80 years, using oral antidiabetics and with glycated hemoglobin values between 6% and 10%. The participants were allocated in two distinct groups and randomized in blocks. In the experimental group, participants used 1.2 g of ginger, and in the control group, 1.2 g of a placebo, daily, for 90 days. 103 people completed the study, 47 in the experimental group, and 56 in the control group. Results: the participants in the experimental group showed a reduction in blood pressure values compared to the control group, although not statistically significant. Conclusion: in our analysis, the use of ginger was not able to reduce blood pressure levels in people with diabetes.

Long-Term Effectiveness of the TIME Intervention to Improve Diabetes Outcomes in Low-Income Settings: a 2-Year Follow-Up.

BackgroundWe previously found that a 6-month multidimensional diabetes program, TIME (Telehealth-Supported, Integrated Community Health Workers, Medication-Access) resulted in improved clinical outcomes.ObjectiveTo follow TIME participant clinical outcomes for 24 monthsParticipantsLow-income Latino(a)s with type 2 diabetesDesign and InterventionWe collected post-intervention clinical data for five cohorts (n = 101, mean n = 20/cohort) who participated in TIME programs from 2018 to 2020 in Houston, Texas.Main MeasuresWe gathered HbA1c (primary outcome), weight, body mass index (BMI), and blood pressure data at baseline, 6 months (intervention end), and semiannually thereafter until 24 months after baseline to assess sustainability. We also evaluated participant loss to follow-up until 24 months.Key ResultsParticipants decreased HbA1c levels during the intervention (p < 0.0001) and maintained these improvements at each timepoint from baseline to 24 months (p range: < 0.0001 to 0.015). Participants reduced blood pressure levels during TIME and maintained these changes at each timepoint from baseline until 18 months (systolic p range < 0.0001 to 0.0005, diastolic p range: < 0.0001 to 0.008) but not at 24 months (systolic: p = 0.065; diastolic: p = 0.85). There were no significant weight changes during TIME or post-intervention: weight (p range = 0.07 to 0.77), BMI (p range = 0.11 to 0.71). Attrition rates (loss to follow-up during the post-intervention period) were 5.9% (6 months), 24.8% (12 months), 35.6% (18 months), and 41.8% (24 months).ConclusionsIt is possible for vulnerable populations to maintain long-term glycemic and blood pressure improvements using a multiple dimensional intervention. Attrition rates rose over time but show promise given the majority of post-intervention timepoints occurred during the COVID-19 pandemic when low-income populations were most susceptible to suboptimal healthcare access. Future studies are needed to evaluate longitudinal outcomes of diabetes interventions conducted by local clinics rather than research teams.

Альдостеронсинтаза, поліморфізм її гена CYP11B2 при артеріальній гіпертензії і асоційованих з нею кардіоваскулярних захворюваннях (огляд літератури)

В огляді надані дані зарубіжної та вітчизняної літератури щодо патогенетичної ролі альдостерону, рівнів альдостеронсинтази і поліморфізмів гена даного ферменту у хворих на різні форми артеріальної гіпертензії, при асоційованих з нею захворюваннях серця і судин, фібриляції передсердь, метаболічному синдромі, патології нирок, головного мозку. Розглядаються функції альдостерону, рівнів альдостеронсинтази і поліморфізмів гена даного ферменту в серцево-судинному ремоделюванні, можливості застосування даних маркерів для диференційно-діагностичних цілей, перспективи терапевтичного використання інгібіторів альдостеронсинтази серед різних категорій хворих з ознаками артеріальної гіпертензії.

Hemodynamics and functional outcomes after resistance training in hypertensive and normotensive elderly: An experimental study

Aim: To evaluate the chronic effects of resistance training on resting blood pressure, handgrip strength, gait speed, and Timed Up and Go test (TUG) in normotensive and hypertensive elderly individuals. Methods: Experimental study based on TREND. Hypertensive patients were diagnosed by an independent doctor. Before and after 12 weeks of progressive resistance training, we evaluated blood pressure, heart rate, body composition, Timed Up and Go test, gait speed, and handgrip strength. Results: Sample consisted of 41 participants divided into two groups (normotensive n = 28; hypertensive n = 13). We observed significant values in the reduction of blood pressure levels only in the group of hypertensive participants. In functionality outcomes, we observed significant values in all tests and both groups. Outcomes contemplate effect sizes ranging from small to moderate. Conclusion: Progressive resistance training lowers resting blood pressure levels, increases handgrip strength, and improves physical functional performance. Although the normotensive group did not show a reduction in blood pressure levels, an improvement was observed in the functional physical tests.