Reduction In Systolic Blood Pressure Research Articles

Role of Health Care Professionals in the Success of Blood Pressure Control Interventions in Patients With Hypertension: A Meta-Analysis.

Globally, only 13.8% of patients with hypertension have their blood pressure (BP) controlled. Trials testing interventions to overcome barriers to BP control have produced mixed results. Type of health care professional delivering the intervention may play an important role in intervention success. The goal of this meta-analysis is to determine which health care professionals are most effective at delivering BP reduction interventions. We searched Medline and Embase (until December 2023) for randomized controlled trials of interventions targeting barriers to hypertension control reporting who led intervention delivery. One hundred articles worldwide with 116 comparisons and 90 474 participants with hypertension were included. Trials were grouped by health care professional, and the effects of the intervention on systolic and diastolic BP were combined using random effects models and generalized estimating equations. Pharmacist-led interventions , community health worker-led interventions, and health educator-led interventions resulted in the greatest systolic BP reductions of -7.3 (95% CI, -9.1 to -5.6), -7.1 (95% CI, -10.8 to -3.4), and -5.2 (95% CI, -7.8 to -2.6) mm Hg, respectively. Interventions led by multiple health care professionals, nurses, and physicians also resulted in significant systolic BP reductions of -4.2 (95% CI, -6.1 to -2.4), -3.0 (95% CI, -4.2 to -1.9), and -2.4 (95% CI, -3.4 to -1.5) mm Hg, respectively. Similarly, the greatest diastolic BP reductions were -3.9 (95% CI, -5.2 to -2.5) mm Hg for pharmacist-led and -3.7 (95% CI, -6.6 to -0.8) mm Hg for community health worker-led interventions. In pairwise comparisons, pharmacist were significantly more effective than multiple health care professionals, nurses, and physicians at delivering interventions. Pharmacists and community health workers are most effective at leading BP intervention implementation and should be prioritized in future hypertension control efforts.

Equitable Care for Hypertension: Blood Pressure and Patient-Reported Outcomes of the RICH LIFE Cluster Randomized Trial.

Disparities in hypertension control are well documented but underaddressed. RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) was a 2-arm, cluster randomized trial comparing the effect on blood pressure (BP) control (systolic BP ≤140 mm Hg, diastolic BP ≤90 mm Hg), patient activation, and disparities in BP control of 2 multilevel interventions, standard of care plus (SCP) and collaborative care/stepped care (CC/SC). SCP included BP measurement standardization, audit and feedback, and equity-leadership training. CC/SC added roles to address social or medical needs. Primary outcomes were BP control and patient activation at 12 months. Generalized estimating equations and mixed-effects regression models with fixed effects of time, intervention, and their interaction compared change in outcomes at 12 months from baseline. A total of 1820 adults with uncontrolled BP and ≥1 other risk factors enrolled in the study. Their mean age was 60.3 years, and baseline BP was 152.3/85.5 mm Hg; 59.4% were women; 57.4% were Black, 33.2% were White, and 9.4% were Hispanic; 74% had hyperlipidemia; and 45.1% had type 2 diabetes. CC/SC did not improve BP control rates more than SCP. Both groups achieved statistically and clinically significant BP control rates at 12 months (CC/SC: 57.3% [95% CI, 52.7%-62.0%]; SCP: 56.7% [95% CI, 51.9%-61.5%]). Pairwise comparisons between racial and ethnic groups showed overall no significant differences in BP control at 12 months. Patients with coronary heart disease showed greater achievement of BP control in CC/SC than in SCP (64.0% [95% CI, 54.1%-73.9%] versus 50.8% [95% CI, 42.6%-59.0%]; P=0.04), as did patients in rural areas (67.3% [95% CI, 49.8%-84.8%] versus 47.8% [95% CI, 32.4%-63.2%]; P=0.01). Individuals in both arms experienced statistically and clinically significant reductions in mean systolic BP (CC/SC: -13.8 mm Hg [95% CI, -15.2 to -12.5]; SCP: -14.6 mm Hg [95% CI, -15.9 to -13.2]) and diastolic BP (CC/SC: -6.9 mm Hg [95% CI, -7.8 to -6.1]; SCP: -5.5 mm Hg [95% CI, -6.4 to -4.6]) over time. The difference in diastolic BP reduction between CC/SC and SCP over time was statistically significant (-1.4 mm Hg [95% CI, -2.6 to -0.2). Patient activation did not differ between arms. CC/SC showed greater improvements in patient ratings of chronic illness care (Patient Assessment of Chronic Illness Care score) over 12 months (0.12 [95% CI, 0.02-0.22]). Adding a collaborative care team to enhanced standard of care did not improve BP control but did improve patient ratings of chronic illness care.

Effectiveness of community-based interventions for prevention and control of hypertension in sub-Saharan Africa: A systematic review.

Hypertension poses a significant public health challenge in sub-Saharan Africa due to various risk factors. Community-based intervention for prevention and control of hypertension is an effective strategy to minimize the negative health outcomes. However, comprehensive systematic review evidence to inform effective community-based interventions for prevention and control of hypertension in low resource settings is lacking. This study aimed to synthesize the effectiveness of community-based interventions on prevention and control of hypertension in sub-Saharan Africa. A comprehensive search for studies was carried out on PubMed, CINAHL, Web of Science Core Collection, Embase, Scopus, and Google scholar databases. The result of the review was reported according to PRISMA guidelines. Studies published in English language were included. Two independent reviewers conducted critical appraisal of included studies and extracted the data using predefined excel sheet. Experimental, quasi experimental, cohort and analytical cross-sectional studies conducted on adults who have received community-based interventions for prevention and controls of hypertension in sub-Saharan Africa were included. In this systematic review, a total of eight studies were included, comprising of two interventional studies, two quasi-experimental studies, three cohort studies, and one comparative cross-sectional study. The interventions included health education, health promotion, home-based screening and diagnosis, as well as referral and treatment of hypertensive patients. The sample sizes ranged from 236 to 13,412 in the intervention group and 346 to 6,398 in the control group. This systematic review shows the effect of community-based interventions on reduction of systolic and diastolic blood pressure. However, the existing evidence is inconsistence and not strong enough to synthesize the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Hence, further primary studies need on the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Systematic review registration number: PROSPERO CRD42022342823.

Patient-Specific Factors Predicting Renal Denervation Response in Patients With Hypertension: A Systematic Review and Meta-Analysis.

The accurate selection of patients likely to respond to renal denervation (RDN) is crucial for optimizing treatment outcomes in patients with hypertension. This systematic review was designed to evaluate patient-specific factors predicting the RDN response. We focused on individuals with hypertension who underwent RDN. Patients were categorized based on their baseline characteristics. The primary outcome was blood pressure (BP) reduction after RDN. Both randomized controlled trials and nonrandomized studies were included. We assessed the risk of bias using corresponding tools and further employed the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the overall quality of evidence. A total of 50 studies were ultimately included in this systematic review, among which 17 studies were for meta-analysis. Higher baseline heart rate and lower pulse wave velocity were shown to be associated with significant antihypertensive efficacy of RDN on 24-hour systolic BP reduction (weighted mean difference, -4.05 [95% CI, -7.33 to -0.77]; weighted mean difference, -7.20 [95% CI, -9.79 to -4.62], respectively). In addition, based on qualitative analysis, higher baseline BP, orthostatic hypertension, impaired baroreflex sensitivity, and several biomarkers are also reported to be associated with significant BP reduction after RDN. In patients with hypertension treated with the RDN, higher heart rate, and lower pulse wave velocity were associated with significant BP reduction after RDN. Other factors, including higher baseline BP, hypertensive patients with orthostatic hypertension, BP variability, impaired cardiac baroreflex sensitivity, and some biomarkers are also reported to be associated with a better BP response to RDN.

Multiethnic Perspectives of Shared Decision-Making in Hypertension: A Mixed-Methods Study.

Shared decision-making (SDM) has the potential to improve hypertension care quality and equity. However, research lacks diverse representation and evidence about how race and ethnicity affect SDM. Therefore, this study aims to explore SDM in the context of hypertension management. Explanatory sequential mixed-methods design was used. Quantitative data were sourced at baseline and 12-month follow up from RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) participants (n=1212) with hypertension. Qualitative data were collected from semistructured individual interviews, at 12-month follow-up, with participants (n=36) selected based on their SDM scores and blood pressure outcome. Patients were cross- categorized based on high or low SDM scores and systolic blood pressure reduction of ≥10 or <10 mm Hg. Multinomial logistic regression analysis showed that predictors of SDM scores and blood pressure outcome were race and ethnicity (relative risk ratio [RRR], 1.64; P=0.029), age (RRR, 1.03; P=0.002), educational level (RRR, 1.87; P=0.016), patient activation (RRR, 0.98; P<0.001; RRR, 0.99; P=0.039), and hypertension knowledge (RRR, 2.2; P<0.001; and RRR, 1.57; P=0.045). Qualitative and mixed-methods findings highlight that provider-patient communication and relationship influenced SDM, being emphasized both as facilitators and barriers. Other facilitators were patients' understanding of hypertension; clinicians' interest in the patient, and clinicians' personality and attitudes; and barriers included perceived lack of compassion, relationship hierarchy, and time constraints. Participants with different SDM scores and blood pressure outcomes varied in determinants of decision and descriptions of contextual factors influencing SDM. Results provide actionable information, are novel, and expand our understanding of factors influencing SDM in hypertension.

Racial and ethnic differences in the risk of dementia diagnosis under hypothetical blood pressure-lowering interventions: The Multi-Ethnic Study of Atherosclerosis.

Substantial racial and ethnic disparities in hypertension and dementia exist in the United States. We evaluated the effect of maintaining systolic blood pressure (SBP) below clinical thresholds on dementia incidence. We included 6806 Multi-Ethnic Study of Atherosclerosis participants (44 to 84 years old). We implemented the parametric g-formula to simulate the hypothetical interventions to reduce SBP below 120 and 140mmHg over time, accounting for time-varying confounding. We estimated risk ratios (RRs) and risk differences for dementia incidence at 19 years. The RRs (95% confidence intervals [CIs]) comparing an intervention reducing SBP below 120mmHg to no intervention were 0.93 (0.87 to 0.99) for total sample, 0.95 (0.88 to 1.02) for White, 0.90 (0.79 to 1.02) for Black, 0.90 (0.78 to 1.05) for Latino, and 1.16 (0.83 to 1.55) for Chinese American participants. Results for lowering SBP below 140mmHg and with death as competing event were attenuated. The reduction of SBP below 120mmHg over time has modest effects on reducing dementia incidence. More work is needed to understand the heterogeneity across racial and ethnic groups. There is a potential beneficial effect in lowering SBP to reduce the risk of dementia, which may vary by race and ethnicity. The percentage of participants who would need intervention on blood pressure to meet clinical thresholds is greater for Black and Latino communities. Results are sensitive to the way that death is specified in the research question and analysis.

Clinical Benefit of Sacubitril/Valsartan for Hypertensive Patients in Daily Practice and Predictors of Its Antihypertensive Effect.

Background: The blood pressure (BP)-lowering effect of sacubitril/valsartan (Sac/Val) is greater than that of angiotensin II receptor blockers (ARBs) but in in real-world clinical practice, Sac/Val is used in a variety of patterns other than switching from ARBs. In the present study we investigated the effects of Sac/Val on BP and biochemical parameters when switching from or adding it to various antihypertensive drugs and examined what factors could be predictors of the antihypertensive effect of Sac/Val. Methods and Results: In 108 hypertensive patients treated with antihypertensive agents (including 4 naïve cases), clinic BP and various biochemical parameters were assessed before and after switching to/adding Sac/Val (200 mg/day). Systolic and diastolic BPs significantly decreased after treatment with Sac/Val (P<0.0001, respectively). As for biochemical parameters, alanine aminotransferase, triglycerides, C-reactive protein, and uric acid significantly decreased after administration of Sac/Val, but renal function, B-type natriuretic peptide, and plasma renin activity (PRA) did not change before or after treatment with Sac/Val. Multiple regression analysis revealed that low PRA and high baseline systolic BP were independent determinants of systolic BP reduction after Sac/Val treatment. Conclusions: Sac/Val is beneficial for poorly controlled hypertension in daily clinical practice and low PRA may be a predictor of the antihypertensive effect of switching to/adding Sac/Val.

Impact of Angiotensin Receptor Blockers (ARB) versus Other Antihypertensive Medication on Blood Pressure in Patients on Dialysis: A Meta-Analysis.

Hypertension is an important factor driving mortality among dialysis patients. Angiotensin-II receptor blocker (ARB) has been effective similarly to angiotensin-converting enzymes (ACEs) but with a low incidence of side effects. The meta-analysis included all published studies that investigated the effect of ARB on the hypertension in adult dialysis patients (≥18 years). Data extraction was guided by a predetermined checklist. Data sources of the retrieved studies were PubMed, MEDLINE, ScienceDirect, SCOPUS, Cochrane, Web of knowledge, and Google Scholar were systematically searched until February 2023. Using the RevMan 5 software, the mean difference for systolic and diastolic BP (SBP and DBP) and the risk ratio (RR) of the adverse events (AEs) were pooled from the selected studies. The random-effects model was used to compare the difference in the pre-and post-dialysis of the SBP and DBP. Data analyses were performed from December 2022 to February 2023. The primary outcome was the reduction in SBP and DBP in dialysis hypertensive patients who were on anti-hypertensive agents, and the secondary outcome was assessment of AE associated with the drug after dialysis (PROSPERO Registration: CRD42022355369). The initial search yielded 1,679 records, of which 84 studies underwent full-text evaluation, which identified 13 studies and 1,462 patients. The pooled standard MD for losartan with other anti-hypertensive agents, where the pre-dialysis SBP was 0.17 (95% confidence interval [CI]: -0.21-0.55) and the post-dialysis was 0.35 (95% CI: -0.17-1.02); yet, both are statistically non-significant, implies that there was no difference between Losartan and ARB drugs regarding the effect on the SBP. Diastolic BP for predialysis was -0.01 (95% CI: -0.65-0.63) and post-dialysis was 0.03 (95% CI: -0.24-0.30) and statistically non-significant. AEs by the ARB agents were lower compared to other anti-antihypertensive agents (relative risk [RR]: 1.01; 95% CI: 0.59-1.75) and statistically non-significant. This systematic review and meta-analysis of RCT demonstrated that ARB and other anti-hypertensive medications had similar impacts on the treatment of hypertension.

Synthesis, biosimulation and pharmacological evaluation of benzimidazole derivatives with antihypertensive multitarget effect

In this study, we synthesized a series of seven benzimidazole derivatives incorporating the structural acidic framework of angiotensin II (Ang II) type 1 receptor (AT1R) antagonists (ARA-II) employing a three-step reaction sequence. The chemical structures were confirmed by 1H NMR, 13C NMR and mass spectral data. Through biosimulation, compounds 1–7 were identified as computational safe hits, thus, best candidates underwent ex vivo testing against two distinct mechanisms implicated in hypertension: antagonism of the Ang II type 1 receptor and the blockade of calcium channel. Molecular docking studies helped to understand at the molecular level the dual vasorelaxant effects with the recognition sites of the AT1R and the L-type calcium channel. In an in vivo spontaneously hypertensive rat model (SHR), intraperitoneally administration of compound 1 at 20 mg/kg resulted in a 25 % reduction in systolic blood pressure, demonstrating both ex vivo vasorelaxant action and in vivo antihypertensive multitarget efficacy. ©2024 Elsevier.

Comparative Efficacy of Hypertension Management Strategies.

Hypertension (HTN) is a major cardiovascular risk factor and a significant contributor to disease burden in the United States. Despite therapeutic advances, gaps remain between clinical trials and practice. This study aims to bridge those gaps by evaluating antihypertensive strategies. This was a retrospective analysis of HTN patients seen at a hospital clinic from 2016 to 2022 with 3- and 12-month follow-up appointments. Demographics, history, blood pressure (BP), and medication regimen were recorded. Treatment strategies were categorized as follows: adding medication (AM), increasing dosage (ID), switching medications (SM), dropped medications (DrM), or no change (NC). Changes in systolic blood pressure (SBP) were compared using linear regressions to assess the efficacy of HTN management. Of 873 patient charts reviewed, 332 patients were included. The AM group had an adjusted ∆SBP of -11 mm Hg at 3 months ( p < 0.001) and -9 mm Hg at 12 months ( p = 0.006). The ID group had an ∆SBP of -8.5 mm Hg at 3 months ( p = 0.074) and -7 mm Hg at 12 months ( p = 0.3). ∆SBP between the AM and ID groups was not statistically significant ( p = 0.8). SM was associated with an ∆SBP of -3 mm Hg at 3 months ( p = 0.6) and -3 mm Hg at 12 months ( p = 0.7). There are meaningful differences in SBP reduction between antihypertensive medication adjustment strategies. AM had the greatest effect on lowering SBP, with ID having a slightly lesser effect. The difference in ∆SBP between the AM versus ID groups was not significant. While further study with a larger dataset is warranted, our findings highlight trends in the efficacy of HTN management strategies to help guide therapeutic regimens.

Assessment of Ultrasonographic Measurement of Inferior Vena Cava Collapsibility Index in the Prediction of Hypotension Associated with Tourniquet Release in Total Knee Replacement Surgeries under Spinal Anesthesia

Abstract This was a Prospective, observational study conducted on 60 patients with Total Knee Replacement (TKR); to characterize the collapsibility index of the IVC as a potential screening tool to identify patients who are candidate for hypotensive events after tourniquet release in TKR in an otherwise hemodynamically stable population. We found that; the mean age of all patients was (57 ± 5.6) years. Regarding gender of the patients, (58.3%) of patients were females; while (41.7%) were males. Regarding basic clinical data; the mean BMI of all patients was (25.7 ± 2.5); with (60%) of patients had DM, and (56.7%) had HTN. Regarding ASA class, (3.3%) had class I, (73.3%) had class II, and (23.3%) had class III. Regarding Baseline hemodynamic data; the average MAP was (104.6 ± 6) mmHg, the average RR was (10.5 ± 1.3) breath/min, and the average HR was (74.75 ± 7) beat/min. Regarding Data before tourniquet release; the average MAP was (102.3 ± 7.5) mmHg, the average RR was (10.7 ± 1.2) breath/min, and the average HR was (75.3 ± 6.5) beat/min, with average IVC-CI of (48.4 ± 7.7). Regarding Data 15-m after tourniquet release; the average MAP was (93.1 ± 9.3) mmHg, the average RR was (10.7 ± 1.4) breath/min, and the average HR was (76.45 ± 6.6) beat/min, with average IVC-CI of (51 ± 8.4). Regarding final outcome, (11.7%) of patients suffered Hypotension (PTRH). The 60 TKR patients were classified according to outcomes into 2 independent groups: group A IVCCI &amp;gt;55,5% (12 patients) and group B IVCCI &amp;lt;55,5% (48 patients). Regarding comparative study between the 2 groups as regards demographic data; no statistically significant differences were found except for ASA physical status of patients where group A had patients in ASA I class and most of its patients are ASA II while group B had no patients in ASA I class and a quarter of its patients were ASA III. Regarding comparative study between the 2 groups as regards hemodynamic and ultrasonographic data; no statistically different results were noted between groups in baseline readings. Results recorded before tourniquet release showed that IVC during inspiration reading was statistically lower while IVC collapsibility index was statistically higher in Group A when compared with group B . Results recorded 15 min after tourniquet release showed that IVC during inspiration reading was statistically lower while IVC collapsibility index was statistically higher in Group A when compared with group B, the IVC-CI before tourniquet release was not correlated with percent reduction in systolic blood pressure after tourniquet release in both groups with high (Group A) or low IVC-CI (Group B). Comparing patients who developed hypotension versus patients who did not, the 60 TKR patients were classified into hypotensive (7 patients) and normotensive (53 patients) groups. No statistically significant differences were found between hypotensive versus normotensive patients concerning demographic data and data recorded before tourniquet release. Baseline data showed significantly higher respiratory rate in hypotensive patients. Data recorded 15 min after tourniquet release showed statistically lower SBP, DBP and MAP, significantly higher HR and significantly lower IVC during inspiration and expiration in patients who developed hypotension. We studied different factors that may be included before tourniquet release that may predict the degree of PTRH by using ROC-curve analysis. IVC-CI before tourniquet release and BMI failed to be predictive factors for the occurrence of PTRH, while respiratory and heart rates before tourniquet release significantly predict the occurrence of PTRH. Performing multiple regression analysis using forward method showed that the increase in RR had an independent effect on increasing the probability of PTRH occurrence; with significant statistical difference (p &amp;lt; 0.039). Conclusion IVC-CI before tourniquet release is not a predictor for PTRH in patients undergoing TKR under spinal anesthesia.

Impact of sheetali pranayama with kumbhaka on blood pressure and cerebrovascular hemodynamics in patients with hypertension: A pilot randomized controlled trial

BackgroundHypertension is associated with sympathetic dominance and altered cerebrovascular structure, which in turn reduces cerebral blood flow. Literature suggests Sheetali pranayama reduces blood pressure and Kumbhaka (breath retention) increases cerebral blood flow. However, no studies reported effect of Sheetali with Kumbhaka on blood pressure and cerebrovascular hemodynamics. Thus, the objective of this study was to find the impact of Sheetali pranayama with Kumbhaka on blood pressure and cerebrovascular hemodynamics in patients with hypertension. Materials and methodsTwenty-four patients with hypertension aged 30–65 years were randomly allocated into pranayama group and control group. The pranayama group underwent Sheetali pranayama with Kumbhaka (with the ratio of 1:2:2; Inhalation; Kumbhaka: Exhalation respectively), whereas the control group underwent breath awareness for 10 minutes. Blood pressure and cerebrovascular hemodynamic were assessed before and after each intervention. ResultsResults showed a significant reduction in systolic blood pressure (SBP) (p=0.049) in the pranayama group compared to control group. Likewise, within-group analysis showed a significant reduction in SBP (p = 0.002) and DBP (p = 0.007) in pranayama group; a significant reduction in SBP (p = 0.020) in control group; and no significant changes in rest of the variables in the post-test assessments compared to its respective pre-test assessments. ConclusionTen minutes of Sheetali pranayama with Kumbhaka reduces blood pressure compared to breath awareness, without affecting the cerebrovascular hemodynamics in patients with hypertension.

Effectiveness of team-based care interventions in improving blood pressure outcomes among adults with hypertension in Africa: a systematic review and meta-analysis

ObjectiveWe evaluated the effectiveness of team-based care interventions in improving blood pressure (BP) outcomes among adults with hypertension in Africa.DesignSystematic review and meta-analysis.Data sourcePubMed, CINAHL, EMBASE, Cochrane Library, HINARI and...

Effect of oral administration of pregabalin on physiological and echocardiographic variables in healthy cats.

The aim of this study was to evaluate the efficacy of a single dose of oral pregabalin (PGB) for sedation and its impact on physiological and echocardiographic variables in healthy cats. This study was a randomised, blinded, crossover trial. Eight cats were randomly assigned to receive PGB or placebo, with a 1-week washout period between each administration. Cats in the treatment group received oral PGB at varying doses (low dose: 2.5 mg/kg, medium dose: 5 mg/kg, high dose: 10 mg/kg). Systolic blood pressure (SBP), pulse rate (PR), respiratory rate (RR) and sedation score were measured at intervals of 30 mins after administration. Echocardiography was performed 120 mins after administration. Oral administration of PGB 2.5 mg/kg and 5 mg/kg significantly increased sedation scores starting at 150 mins, while 10 mg/kg PGB showed a significant increase in sedation scores starting at 120 mins compared with placebo. PGB 5 mg/kg and 10 mg/kg resulted in a significant reduction in SBP compared with placebo, with minimal impact on PR and RR. In addition, PGB 10 mg/kg resulted in significant changes in the peak velocity of late diastolic transmitral flow (A) and the ratio of peak velocity of early diastolic transmitral flow and A; however, these changes were of marginal clinical significance. A single dose of oral PGB could cause mild to moderate sedation. Hypotension was more prevalent in the PGB 5 mg/kg and 10 mg/kg groups among the majority of cats, but it was less frequently observed in the PGB 2.5 mg/kg group.

Mediterranean Diet and Cardiometabolic Biomarkers in Children and Adolescents

No prior systematic review and meta-analysis has specifically verified the association of Mediterranean diet (MedDiet)-based interventions with biomarkers of cardiometabolic health in children and adolescents. To review and analyze the randomized clinical trials (RCTs) that assessed the effects of MedDiet-based interventions on biomarkers of cardiometabolic health among children and adolescents. Four electronic databases were searched (PubMed, Cochrane Library, Web of Science, and Scopus) from database inception to April 25, 2024. Only RCTs investigating the effect of interventions promoting the MedDiet on cardiometabolic biomarkers (ie, systolic blood pressure [SBP], diastolic blood pressure [DBP], triglycerides [TGs], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], glucose, insulin, and homeostatic model assessment for insulin resistance [HOMA-IR]) among children and adolescents (aged ≤18 years) were included. A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were extracted from the studies by 2 independent reviewers. Results across studies were summarized using random-effects meta-analysis. The effect size of each trial was computed by unstandardized mean differences (MDs) of changes in biomarker levels (ie, SBP, DBP, TGs, TC, HDL-C, LDL-C, glucose, insulin, HOMA-IR) between the intervention and the control groups. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Nine RCTs were included (mean study duration, 17 weeks; range, 8-40 weeks). These studies involved 577 participants (mean age, 11 years [range, 3-18 years]; 344 girls [59.6%]). Compared with the control group, the MedDiet-based interventions showed a significant association with reductions in SBP (mean difference, -4.75 mm Hg; 95% CI, -8.97 to -0.52 mm Hg), TGs (mean difference, -16.42 mg/dL; 95% CI, -27.57 to -5.27 mg/dL), TC (mean difference, -9.06 mg/dL; 95% CI, -15.65 to -2.48 mg/dL), and LDL-C (mean difference, -10.48 mg/dL; 95% CI, -17.77 to -3.19 mg/dL) and increases in HDL-C (mean difference, 2.24 mg/dL; 95% CI, 0.34-4.14 mg/dL). No significant associations were observed with the other biomarkers studied (ie, DBP, glucose, insulin, and HOMA-IR). These findings suggest that MedDiet-based interventions may be useful tools to optimize cardiometabolic health among children and adolescents.

The Effect of Edamame Jelly on Lowering Blood Pressure in Primary Hypertension Patients

Hypertension is the cause of death in Indonesia, with 23.8% of the 1.7 million population. Management of primary hypertension is non-pharmacological therapy carried out by modifying lifestyle, namely increasing consumption of nuts that contain bioactive components that are beneficial for sufferers of primary hypertension, such as edamame (Glycine max (L.) Merrill). This study aims to determine how giving edamame jelly reduces blood pressure in primary hypertension patients. This research was quasi-experimental and used a pre-post-test control group design. The study population consisted of outpatients at the Sumbersari Jember Community Health Center who met the inclusion and exclusion criteria, totaling 42 subjects. Subjects were randomly divided into treatment and control groups. The intervention group was given amlodipine 5 mg/day and edamame jelly 150 grams/day. The control group was only assigned 5 mg of amlodipine. Statistical tests use the Paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U-tests. The test results showed a significant difference in systolic and diastolic blood pressure between the control and treatment groups with a p-value &lt;0.001. The median systolic blood pressure of the control group was 147.5 mmHg, and that of the treatment group was 130 mmHg. The median diastolic blood pressure in the control group was 90 mmHg, and the treatment group's was 80 mmHg. The reduction in systolic blood pressure in the treatment group was 17.5 mmHg greater than in the control group. The decrease in diastolic blood pressure in the treatment group was 10 mmHg greater than in the control group. Giving 150 grams of edamame jelly/day for 30 days effectively reduces blood pressure in sufferers of primary hypertension.

Renal function after ureteral reconstruction surgery in patients with solitary kidney.

Ureteral strictures (US) could lead to impaired kidney function, which was alleviated by ureteral reconstruction surgery. However, solitary kidney (SK) patients with US were more complicated to treat. This study aimed to evaluate the impact of reconstruction surgery on renal function based on estimated glomerular filtration rate (eGFR) in patients with SK. We retrospectively enrolled patients who underwent reconstruction surgery between April 2014 to March 2022. eGFR was measured pre- and postoperatively. The 'static renal function' was defined as a change in eGFR of 20% or less at the last follow-up, and the 'worsening renal function group' was defined as a decrease of greater than 20%. A total of 61 SK patients were involved. The success rate of ureteral reconstruction surgery was 90.16% (55/61). The median follow-up time was 20.8 months (range, 3.7-109.2 months). The median eGFR was 65.5 (range, 15.1-99.9) and 65.3 (range, 3.8-123.4) mL/min/1.73 m2 at the baseline and the last follow-up. No statistically significant difference in eGFR was observed between the preoperative baseline and last follow-up visits (P=0.58). However, in patients with baseline renal dysfunction [chronic kidney disease (CKD) stage 3-5], the eGFR significantly improved at the last follow-up compared to the baseline (P=0.02). Three patients developed a 'worsening renal function' (4.92%). Besides, the systolic blood pressures (SBP) at follow-up significantly reduced compared to the preoperative baseline (P=0.002). Ureteral reconstruction surgery is an effective treatment to preserve renal function, which also achieves a high success rate and is associated with the reduction of SBP for SK patients with US.

Effects of beetroot juice on blood pressure in hypertension according to European Society of Hypertension Guidelines: A systematic review and meta-analysis

AimsIt has been suggested that nitrate-rich beetroot juice (BRJ) reduces blood pressure (BP) in various populations. We aimed to investigate the effect of BRJ on BP in adults with hypertension according to the European Society of Hypertension Guidelines (clinical BP ≥ 140/≥ 90 mmHg) and whether BRJ can be considered as an adjunct to hypertension drug treatment, by conducting a meta-analysis of randomized controlled trials. Data synthesisPubMed, SCOPUS, Medline Ovid, Cinahl, Cochrane Library and Web of Science were searched from inception until April 13, 2024 to identify randomized controlled trials of BRJ versus placebo, water, or no intake. Risk of bias was assessed using a standardized appraisal instrument from the Swedish Agency for Health Technology and Assessment of Social Services, which is based on the Cochrane risk-of-bias tool for randomized trials. The pooled BP effect size was calculated using random effects models and meta-regression. Certainty of evidence was assessed using GRADE. Eleven trials (349 patients) were included. BRJ yielded a significant reduction in clinical systolic BP compared with placebo mean difference (MD) −5.31 mmHg (95% CI –7.46, −3.16; I2 = 64%, GRADE ⊕⊕OO). There was no significant effect on clinical diastolic BP or 24-h BP outcomes, and the heterogeneity was moderate to high. ConclusionsDaily ingestion of 200–800 mg of nitrate from BRJ may reduce clinical systolic BP in hypertensive individuals with no sign of development of tolerance. Certainty of evidence is low, and results should be interpreted with caution.

Community-based intervention for obstructive sleep apnea in the general population: a randomized controlled trial.

To investigate the engagement and health outcomes of community-based intervention for obstructive sleep apnea (OSA) in the general population. We conducted a 3-month randomized controlled trial in two communities in southern China. We initially screened the general population for high-risk OSA and further diagnosis using home sleep testing. Eligible participants were randomly (1:1) assigned to either a control or continuous positive airway pressure-based integrated intervention group. The primary outcomes were multimodal indicators reflecting health outcomes, including health-related quality of life (Short Form-36 [SF-36]), sleep-related symptoms, and cardiometabolic risk. Of the 2484 participants screened, 1423 identified as having high-risk OSA were considered for telephone invitations to participate in the trial. Of these, 401 participants responded positively (28.2%), 279 were diagnosed with OSA, and 212 were randomized. The intervention significantly improved several domains of SF-36, including physical functioning (intergroup difference, 2.8; p = .003), vitality (2.3; p = .031), and reported health transition (6.8; p = .005). Sleep-related symptoms, including Epworth Sleepiness Scale (-0.7; p = .017), Fatigue Severity Scale (-3.0; p = .022), Insomnia Severity Index (-1.8; p < .001), and Pittsburgh Sleep Quality Index (-0.7; p = .032), also showed significant improvements. Although the intervention did not significantly alter glycolipid metabolism, ventricular function, or cardiac structural remodeling, it achieved a significant reduction in systolic (-4.5 mmHg; p = .004) and diastolic blood pressure (BP; -3.7 mmHg; p < .001). Community-based intervention for previously undiagnosed OSA in the general population yielded improvements in health-related quality of life, sleep-related symptoms, and BP. However, engagement in the intervention program was low. "Community Intervention Trial for OSA";URL: https://www.chictr.org.cn/showprojEN.html?proj=144927;Trial identification number: ChiCTR2100054800.

Effects of DASH diet with or without time-restricted eating in the management of stage 1 primary hypertension: a randomized controlled trial

BackgroundTime-restricted eating (TRE), a popular form of intermittent fasting, has shown benefits for improving metabolic diseases and cardiometabolic health. However, the effect of TRE in the regulation of blood pressure in primary hypertension remains unclear.MethodsA 6-week randomized controlled trial was conducted, in which a total of 74 stage 1 primary hypertensive patients without high-risk were randomly assigned to Dietary Approaches to Stop Hypertension (DASH) group (n = 37) or DASH + TRE group (n = 37). Participants in the DASH + TRE group were instructed to consume their food within an 8-h window. Scientific research platform in We Chat application was used to track participants. The primary outcome was blood pressure. The secondary outcomes included body composition, cardiometabolic risk factors, inflammation-related parameters, urinary Na+ excretion, other clinical variables and safety outcomes.ResultsThe reduction of systolic blood pressure and diastolic blood pressure were 5.595 ± 4.072 and 5.351 ± 5.643 mm Hg in the DASH group and 8.459 ± 4.260 and 9.459 ± 4.375 mm Hg in the DASH + TRE group. DASH + TRE group improved blood pressure diurnal rhythm. Subjects in DASH + TRE group had decreased extracellular water and increased urinary Na+ excretion. Furthermore, the decrease in blood pressure was associated with a reduction of extracellular water or increase in urinary Na+ excretion. In addition, safety outcomes such as nighttime hunger were also reported.ConclusionOur study demonstrated that 8-h TRE + DASH diet caused a greater decrease in blood pressure in stage 1 primary hypertensive patients than DASH diet. This study may provide novel insights into the benefits of lifestyle modification in the treatment of primary hypertension.Trial registrationhttps://www.chictr.org.cn/ (ChiCTR2300069393, registered on March 15, 2023).