Reduction In Systolic Blood Pressure Research Articles

The effect of telehealth on clinical outcomes in patients with hypertension and diabetes: A meta-analysis of 106,261 patients.

Telemedicine, propelled by recent technological advancements, has transformed healthcare delivery, notably benefiting patients with chronic non-communicable diseases (NCDs) such as systemic arterial hypertension and diabetes mellitus. This meta-analysis of randomized clinical trials aimed to assess the efficacy of telehealth-based interventions on disease control rates and clinical parameters among NCD patients, including systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) levels. We conducted searches in PubMed, Scopus, Web of Science, and the Cochrane Database for interventional studies that compared tele-monitoring with usual care in patients with hypertension and type 2 diabetes mellitus. Odds ratios with 95% confidence intervals (CIs) were computed. Our meta-analysis included 75 studies, encompassing a total of 106,261 patients, with 50,074 (47.12%) receiving usual care and 56,187 (52.88%) receiving tele-monitoring care. The telemedicine group was associated with a statistically significant reduction in SBP (mean difference (MD) -4.927 mmHg; 95% CI -6.193 to -3.660; p < 0.001; I² = 90%), DBP (MD -2.019 mmHg; 95% CI -2.679 to -1.359; p < 0.001; I² = 54%), FBG (MD -0.405 mmol/L; 95% CI -0.597 to -0.213; p < 0.001; I² = 32%), and HbA1c (MD -0.418%; 95% CI -0.525 to -0.312; p < 0.001; I² = 76%). Our meta-analysis shows that telehealth technologies notably enhance blood pressure and blood glucose control. This supports integrating telemedicine into clinical protocols as a valuable complementary tool for managing hypertension and diabetes mellitus comprehensively.

Heterogeneity in Health Outcomes in the Strong Hearts, Healthy Communities-2.0 Multilevel Intervention in a Community-Randomized Trial: An Exploratory Study of Moderators

Background/Objectives: Multilevel interventions have demonstrated efficacy in improving obesity and other related health outcomes. However, heterogeneity in individual responses indicates the need to identify the factors associated with responses and non-responses to multilevel interventions. The objective of this report is to identify the potential sources of heterogeneity through the exploration of the moderation effects of participant characteristics (sociodemographic and baseline physical/mental health) in the Strong Hearts, Healthy Communities-2.0 (SHHC-2.0) intervention. Methods: SHHC-2.0 is a 24-week multilevel intervention to improve people’s diet and physical activity evaluated using a cluster-randomized, controlled trial design conducted with women aged 40 and older living in rural communities with an elevated risk of cardiovascular disease, defined as having a BMI &gt; 30, or a BMI 25–30 plus &lt; 1 weekly occurrence of 30 min of physical activity during leisure time. Linear mixed models were used to compare the between-group changes in the outcomes (weight, systolic blood pressure, hemoglobin A1c [HbA1c], and triglycerides), with an interaction term included for each potential moderator. Results: Within the sociodemographic characteristics, there were no differences in effectiveness by age, income, or baseline BMI status, but the participants with a high school education or less experienced less weight loss. Among their health history, only a history of hypertension was associated with differential outcomes; those with a history of hypertension demonstrated a greater reduction in systolic blood pressure. The participants with elevated depressive symptoms demonstrated greater weight loss and a greater reduction in the HbA1c level. Conclusions: SHHC-2.0 was effective across a wide range of participants. The identified moderators (i.e., education level) may inform the future tailoring of the SHHC intervention to optimize the outcomes among participant subgroups, while more broadly, our findings can serve to inform the development and dissemination of multilevel interventions.

Association between pulse pressure and risk of acute kidney injury after intracerebral hemorrhage.

The aim of this study was to determine whether pulse pressure (PP), an indicator of arterial stiffness, was independently associated with the risk of acute kidney injury (AKI) following intracerebral hemorrhage (ICH). We enrolled patients with acute ICH from a multicenter stroke registry in Fukuoka, Japan, from June 2007 to September 2019. The mean PP, measured three times on the third day after admission, was categorized into three groups based on tertiles: G1 < 54 mmHg, G2 54-64 mmHg, and G3 ≥ 65 mmHg. AKI was defined as an increase of ≥0.3 mg/dL or ≥150% in serum creatinine levels above baseline during hospitalization. The associations between PP and AKI were evaluated using logistic regression analyses. Overall, 1512 patients with acute ICH (mean age: 69.8 ± 13.5 years; 56.4% men) were included in the analysis. The incidence rates of AKI were 5.6%, 11.0%, and 13.2% in groups G1, G2, and G3, respectively. The odds ratio (95% confidence interval) of AKI was significantly elevated in G2 (1.77 [1.07-2.91]) and G3 (1.82 [1.10-3.03]) compared to G1, even after adjusting for initial systolic blood pressure (SBP) values on admission and subsequent SBP reductions. This significant association was observed in patients with an initial SBP < 200 mmHg (P for heterogeneity, 0.045) and those receiving intravenous antihypertensive therapy in the acute stage (P for heterogeneity, 0.03). High PP should be recognized as a novel potential risk factor for AKI following ICH. High pulse pressure was significantly associated with an increased risk of acute kidneyinjury following intracranial hemorrhage. Pulse pressure should be recognized as anovel potential risk factor and one of the predictors of acute kidney injury afterintracranial hemorrhage.

Therapeutic effects of Huangqi formula (Eefooton) in chronic kidney disease: clinical research and narrative literature review.

The study aimed to assess the clinical effects of employing the Huangqi formula (Eefooton; EFT) for chronic kidney disease (CKD) treatment. A narrative literature review was undertaken to elucidate the specific ingredients of EFT and their potential impact on renal health. A retrospective observational study investigated EFT treatment in outpatients with stable CKD (stages 3B to 5) from March 2019 to March 2021. Patients received 20 mL of EFT thrice daily for 6 months, along with standard treatment. Control groups were matched to the EFT cohort. Regular assessments of renal, liver functions, and lipid profiles were conducted. Serum creatinine (Cr) and eGFR levels consistently improved in stage 3B CKD patients at each follow-up visit. At 6 months, improvement in Cr and eGFR was observed for stage 4 and 5 CKD. Stage 3B CKD patients exhibited notable reductions in systolic blood pressure after 3 and 6 months of EFT treatment. Remarkably, a substantial decrease in HbA1C was noted in stage 4 CKD individuals after three months of therapy. Additionally, stage 4 CKD patients saw a significant reduction in LDL levels after both 3 and 6 months of EFT treatment. A literature review on EFT ingredients indicated that the positive effects of EFT might be associated with its anti-inflammatory, antioxidant, and anti-fibrotic properties. This research demonstrated that incorporating EFT alongside standard treatment enhanced renal function in individuals with CKD. EFT is proposed as a feasible complementary treatment for CKD patients, emphasizing the importance of early intervention.

Effectiveness of Physical Exercise Program on Reducing Blood Pressure in Hypertension Patients

Hypertension is a chronic disease, called the silent killer. WHO data shows that the number of people with hypertension continues to increase. In Riau Province, the prevalence of hypertension increased from 20.9% (2013) to 29.1% (2018). Hypertension will cause various complications such as encephalopathy, heart disease, hemorrhagic stroke, kidney failure, heart failure, and others. Action needs to be taken to reduce the increasing number of hypertension cases. Objective: This study examines the effectiveness of a physical exercise program in reducing blood pressure in hypertension patients at the Pangkalan Kuras II Health Center. Method: It used a pre-test and post-test experimental design involving 101 hypertensive patients, primarily aged 46-64 years (85.1%) and mostly female (86.14%). The program included walking three times a week and exercising twice a week for three weeks. Blood pressure was measured using a manual device. The majority of participants had grade II hypertension. Result: The Wilcoxon Signed Rank Test showed significant reductions in both systolic (4.72 mmHg) and diastolic (3.13 mmHg) blood pressure, with a p-value of 0.000. Conclusions: This numbers indicates that regular physical exercise, such as walking and exercise, effectively lowers blood pressure in hypertensive patients.

Combination of ultrasound-guided pectoral nerve block I and serratus anterior plane block for attenuation of surgical stress response during modified radical mastectomy: A prospective interventional randomized controlled trial

Background: General anesthesia with multimodal analgesia is the standard anesthetic management during modified radical mastectomy. In this study, a combined ultrasound-guided pectoral nerve block (PECS I) and serratus anterior plane (SAP) block were used for surgical stress response attenuation and post-operative analgesia. Aims and Objectives: This study aimed to compare the efficacy of combined PECS I and SAP block to intravenous (IV) multimodal analgesia in attenuating surgical stress response and post-operative analgesia in patients who underwent modified radical mastectomy with axillary clearance. The primary objective was to estimate the intraoperative fentanyl requirement to reduce autonomic response due to surgical stimulus. The intraoperative vitals, post-operative numeric rating scale pain score, post-operative analgesic use in the recovery room, and incidence of post-operative nausea vomiting were the secondary objectives. Materials and Methods: Thirty-six consenting patients were randomized into two groups. After induction of general anesthesia, Group B patients received ultrasound-guided PECS I and SAP block whereas Group C patients received IV analgesics only. Intraoperative fentanyl dosage to keep the systolic blood pressure (SBP) and heart rate (HR) within 20% of baseline were noted in the both groups. Intraoperative vitals, post-operative pain score, analgesic requirement, and incidence of post-operative nausea, and vomiting were also recorded in the both groups. Results: Surgical stress response attenuation was achieved with a lower dosage of fentanyl in Group B compared to Group C (intraoperative fentanyl [mean±SD], 116.11±25.70 μg vs. 134.44±20.07 μg, P=0.023). Compared to Group C, intraoperative reduction in SBP and HR was higher in Group B (SBP reduction [mean±SD], 24.03±12.5 mm of Hg vs. 15.2±13.05 mm of Hg, P=0.045 and HR reduction [mean±SD], 18.61±6.6 beats/min vs. 10.73±10.03 beats/min, P=0.009, respectively). The apparently higher pain scores in the control group were statistically insignificant. Conclusion: A combined PECS I and SAP block attenuates intraoperative autonomic stress response due to the surgical stimulus with significantly less opioid requirement.

Cardiopulmonary coupling predictors of blood pressure response to positive airway pressure therapy

The effect of continuous positive airway pressure (CPAP) treatment on reducing cardiovascular disease risk in sleep apnea subjects remains inconclusive. It is plausible that pathological respiratory chemoreflex activation (high loop gain) is a predictive signal biomarker. To determine whether narrow band (e-LFCNB%) metric derived from cardiopulmonary coupling analysis is related with blood pressure reduction after CPAP. A secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES). The elevated low frequency coupling - narrow band (e-LFCNB %) metric derived from cardiopulmonary coupling analysis detects periodic breathing (as a surrogate for high loop gain), and was estimated in baseline polysomnogram. Linear regression analysis was performed to identify the potential association between e-LFCNB% of total sleep time and the observed reduction in blood pressure following the specified treatment. A total of 388 subjects received CPAP and had e-LFCNB % measurements. At 2 months, 90/322 subjects had e-LFCNB ≥ 4% at baseline. At 6 months 137/313 subjects had e-LFCNB higher than 2% at baseline. For morning systolic blood pressure, e-LFCNB ≥ 4% [β: 2.534, standard error (SE): 1.198, p: 0.035] was positively related with the extent of systolic blood pressure reductions after 2 months CPAP treatment and e-LFCNB ≥ 2% was marginally related with systolic blood pressure decrement after 6 months (β: 2.162, SE: 1.173, p: 0.066). For the morning diastolic blood pressure, e-LFCNB ≥ 2% predicted reductions at 6 months of treatment (β: 1.883, SE: 0.888, p: 0.035). e-LFCNB % (probable high loop gain) was positively related to systolic blood pressure reduction (short-term) and diastolic blood pressure reduction (longer-term), following CPAP.

Firsthand data acquisition for hypertension, its amelioration by extract of Bougainvillea spectabilis and formulation of nanoparticles

Hypertension is a widespread cardiovascular condition characterized by persistently elevated blood pressure, leading to serious health complications such as heart disease, stroke, and renal failure. This study investigates the antihypertensive properties of Bougainvillea spectabilis extract, focusing on its potential mechanisms of action and therapeutic efficacy. Using a controlled experimental design, hypertensive rats were treated with varying doses of Bougainvillea spectabilis extract. Blood pressure measurements were taken before and after treatment using a non-invasive tail-cuff method. Phytochemical analysis of the extract revealed a rich composition of bioactive compounds, including flavonoids, alkaloids, and tannins, known for their cardioprotective and vasodilatory effects. Results demonstrated a significant reduction in both systolic and diastolic blood pressure in treated subjects compared to the control group. Additionally, improvements in endothelial function were observed, indicated by increased nitric oxide levels and decreased oxidative stress markers. Histological analysis of vascular tissues showed enhanced integrity and reduced inflammation. These findings suggest that Bougainvillea spectabilis extract exerts a dual action: promoting vasodilation and improving endothelial health. The results support the potential of Bougainvillea spectabilis as a natural antihypertensive agent, highlighting the need for further research to elucidate its mechanisms and evaluate its clinical applicability in managing hypertension.

Short-term effects of denervation in the treatment of hypertension: A meta-analysis excluding drug interferences.

To evaluate the short-term efficacy of denervation in treating hypertension with the exclusion of drug-interfering factors. An electronic search was conducted across 8 databases, including MEDLINE, PubMed, Cochrane Library, and EMBASE, for articles on denervation in the treatment of medication-naïve hypertension published from inception to May 2024. All data were meta-analyzed using RevMan 5.3 software. Four studies, comprising a total of 752 subjects, were screened according to the inclusion and exclusion criteria. Meta-analysis indicated that, compared to the sham-operated group, the denervation group showed a significant reduction in short-term 24-hour ambulatory systolic blood pressure and office systolic blood pressure (OSBP) as well as office diastolic blood pressure (ODBP). No significant safety events were identified. Denervation has the potential to reduce blood pressure in the short-term for patients with medication-naïve hypertension, demonstrating an acceptable safety profile. This offers hope for patients who are intolerant to drug therapy or unwilling to take lifelong medication. However, its long-term effects require further study. Future research should focus on expanding the sample size and prolonging the follow-up period to further solidify its role in the treatment of hypertension.

Resveratrol Butyrate Esters Reduce Hypertension in a Juvenile Rat Model of Chronic Kidney Disease Exacerbated by Microplastics

Background: Resveratrol is recognized as a promising nutraceutical with antihypertensive and prebiotic properties; however, its bioavailability in vivo is limited. To enhance its bioactivity, we developed resveratrol butyrate esters (RBEs). This study investigates whether RBEs can mitigate hypertension induced by chronic kidney disease (CKD) and exacerbated by microplastics (MPs) exposure in juvenile rats. Methods: Three-week-old male Sprague Dawley rats were fed either regular chow or 0.5% adenine chow for three weeks. The adenine-fed CKD rats (N = 8 per group) received either 5 μM MPs (10 mg/L) or MPs combined with RBE (25 mg/L) in their drinking water from weeks 3 to 9. Results: Our results indicate that MP exposure worsened CKD-induced hypertension, while RBE treatment resulted in a reduction in systolic BP by 15 mmHg (155 ± 2 mmHg vs. 140 ± 1 mmHg, p &lt; 0.05). The combined exposure to adenine and MPs was associated with nitric oxide (NO) deficiency, which RBE treatment alleviated. Additionally, our findings revealed that RBE modulated both the classical and nonclassical renin–angiotensin system (RAS), contributing to its protective effects. We also observed changes in gut microbiota composition, increased butyric acid levels, and elevated renal GPR41 expression associated with RBE treatment. Conclusions: In conclusion, in this juvenile rat model of combined CKD and MP exposure, RBE demonstrates antihypertensive effects by modulating NO levels, the RAS, gut microbiota, and their metabolites.

Effects of saffron (Crocus sativus L.) supplementation on cardiometabolic Indices in diabetic and prediabetic overweight patients: a systematic review and meta-analysis of RCTs.

The incidence of diabetes mellitus (DM) is increasing worldwide, and there is growing interest in the potential use of natural compounds as an alternative treatment for managing DM. Several research studies have investigated the impact of saffron consumption on managing and improving metabolic profiles in patients with DM, and they have shown promising results. The study aims to systematically review and perform a meta-analysis to evaluate the potential effects of saffron and its extract on cardiometabolic indicators in diabetic and prediabetic overweight patients. We conducted a comprehensive systematic review and meta-analysis, searching PubMed, Scopus, Web of Science, Embase, and Google Scholar for all relevant studies published before April 20, 2024. We extracted weighted (WMD) or standardized (SMD) mean differences (before-after) and 95% confidence intervals (95%CI) of the outcomes and conducted meta-analyses using R. The study protocol was registered in PROSPERO (CRD42024538380). Out of the studies screened, 15 RCTs were selected for inclusion in the systematic review and meta-analysis. These studies collectively involved 869 participants, 438 in the intervention group and 431 in the control group. Notably, our results showed that saffron supplementation led to significant changes in FBS (MD: - 8.75mg/dL, 95% CI [- 14.75; - 2.76], P < 0.01), HbA1C (MD: - 0.34%, 95% CI [- 0.39; - 0.9], P < 0.01), TG (MD: - 13.28 mg/dL, 95% CI [- 22.82; - 3.75], P < 0.01), SBP (MD: - 5.33 mmHg, 95% CI [- 8.99-1.67], P = 0.04), DBP (MD: - 1.02 mmHg, 95% CI [- 3.91; 1.86], P = 0.03), AST (MD: - 1.32 IU/L, 95% CI [- 1.72, - 0.93], P < 0.01) levels in T2DM patients compared to placebo or no supplementation, indicating its potential as a therapeutic intervention. However, there was no significant effect on Insulin secretion (MD: - 0.15 µU/ml, 95% CI [- 2.1763; 1.8689], P = 0.88), HOMA (MD: - 0.35%, 95% CI [- 1.34;0.63], P = 0.48), TC (MD: - 4.86 mg/dL, 95% CI [- 9.81-0.09], P = 0.54), HDL (MD: 0.18 mg/dL, 95% CI [- 0.93; 1.29], P = 0.74), LDL (MD: - 1.77 mg/dL, 95% CI [- 5.99-2.45], P = 0.41), TNF-α (MD: - 0.34 pg/mL, 95% CI [- 0.99-0.30], P = 0.29), creatinine (MD: 2.83 mg/dL, 95% CI [2.29, 3.37], P = 0.31) and BUN (MD: - 0.44 mg/dL, 95% CI [- 1.43, 0.55], P = 0.38). Saffron may improve specific CMI indices in overweight patients with diabetes or prediabetes, including significant reductions in FBS, HbA1C, TG, SBP, and AST. However, it did not significantly affect HDL, TC, LDL, insulin secretion, HOMA, DBP, TNF-α, ALT, Cr, or BUN. Further research with more trials and extended follow-up periods is needed to confirm and expand these findings.

The association between ozone exposure and blood pressure in a general Chinese middle-aged and older population: a large-scale repeated-measurement study

BackgroundThe relationship between ozone (O3) exposure and blood pressure (BP) remains inconclusive. Given the scarcity of Chinese epidemiological data, more research on this association is of paramount importance, particularly among middle-aged and older Chinese populations.MethodsThis study involved 10,875 participants (median age: 60.0 years) in Xiamen, China, from 2013 to 2019, with 34,939 repeated BP measurements. Air pollutant exposure data, including O3, particulate matter, nitrogen dioxide, sulfur dioxide, and carbon monoxide were derived from China High Air Pollutants and High-resolution Air Quality Reanalysis datasets using a k-nearest neighbor algorithm. The relationship between mixed air pollutant exposure and BP was evaluated using Bayesian kernel machine regression model. The effects of daily-specific O3 exposure on BP were assessed by distributed lag models integrated into a linear mixed-effects framework. The mediating role of total cholesterol (TC), serum total bilirubin (STB), triglyceride (TG), and low-density lipoprotein (LDL) were examined using multilevel mediation analysis with a fully adjusted model.ResultsMixed air pollutant exposure was positively correlated with BP, with O3 being a predominant contributor exhibiting an inverse effect. O3 exposure had immediate effects on pulse pressure (PP), while systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) showed delayed responses, with 3-, 14-, and 8-day lags, respectively. During the study period of up to 30 days, each 10 μg/m3 increase in maximum daily 8-h average O3 concentration was associated with reductions in SBP (β = − 1.176 mm Hg), DBP (− 0.237 mm Hg), PP (β = − 0.973 mm Hg), and MAP (β = − 0.544 mm Hg). Stronger correlations were observed in the older participants (aged ≥ 65 years), overweight/obese individuals, smokers and alcohol consumers, and those with hypertension or type 2 diabetes mellitus. STB and LDL mediated these effects, while TC and TG played mitigating roles.ConclusionsShort-term O3 exposure is negatively associated with BP in middle-aged and older Chinese individuals. The findings provide preliminary evidence for the impact of O3 exposure on BP regulation and underscore the urgent need to reassess public health policies in response to O3 pollution.

Effects of Mentha on blood pressure: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials

BackgroundMentha consumption may associated with blood pressure improvement in humans, but the recent evidence from randomized controlled trials (RCTs) showed inconsistent results. The present study provides a systematic review and meta-analysis of RCTs to investigate the effect of Mentha on blood pressure.MethodsTo cover all relevant literature, a complete search was conducted across PubMed, ISI Web of Science, and SCOPUS databases before March 2024 using PRISMA guidelines. In addition, Google Scholar, SID databases, the reference lists of the related reviews, and meta-analyses were searched for this purpose. Also, a “snowball search” was applied to include other relevant trials that may have been missed. A random-effects model was used for quantitative data synthesis, with weight mean difference (WMD) and 95% confidence intervals (CI). Standard methodologies were utilized to assess kappa statistics between the authors, GRADE evidence profiles, heterogeneity, meta-regression, sensitivity analysis, and publication bias.ResultsOut of 476 publications identified, seven RCTs were eligible and included in this systematic review and meta-analysis. There was perfect agreement in study selection between the reviewers (К statistic, 0.86; p < 0.001). Meta-analysis showed a 1.227 mmHg reduction in systolic blood pressure (SBP) (95% CI: -6.61,4.16, p = 0.655), 2.997 mmHg reduction in long-term SBP (95% CI: -8.00,2.00, p = 0.241), 1.830 mmHg reduction in diastolic blood pressure (DBP) (95% CI: -5.06,1.40, p = 0.268), and 2.857 mmHg reduction in long-term DBP (95% CI: -6.01, 0.30, p = 0.076) after Mentha consumption in intervention group compared to control. In sub-group analysis, a statistically and clinically significant reduction in SBP and DBP was observed in the participants with ages above 30 years and in the participants with SBP > 130 mmHg or DBP > 80 mmHg.ConclusionsOur findings showed that Mentha consumption might not have a statistically significant effect on lowering SBP, DBP, long-term SBP, and long-term DBP. However, it can lead to a clinically significant reduction in both long-term SBP and long-term DBP. Besides, Mentha may have potential benefits for patients with pre-hypertension and hypertension. Nevertheless, further well-designed RCTs are needed to confirm our results.PROSPERO Registration No: CRD42023459490

Sublingual Sufentanil Tablet for Analgesia in Emergency Medical Services and Search and Rescue Agencies

Objectives Pain management in the potentially austere search and rescue (SAR) and emergency medical services (EMS) environments can be challenging. Intravenous (IV) and intramuscular (IM) routes of administration may be less practical. This study assesses the efficacy and safety of the sublingual sufentanil tablet (SST) in prehospital settings and hypothesizes that its use will reduce pain while maintaining a reasonable safety profile. Methods This was a retrospective case analysis examining patient records from Teton County Search and Rescue, Grand Teton National Park EMS, and Jackson Hole Fire/EMS from 2021-2023, based on the criteria that they were administered SST in a prehospital setting. Cases in which SST was used were examined to assess patient characteristics, injury classification, patient reported pain scale before and after SST, other medications administered, and vital signs. Results Seventy patients met the inclusion criteria. Six individuals were excluded due to missing one or more of the key variables, and the analysis was carried out with the remaining (N = 64 cases). The mean pain score decreased from 8.0 ± 1.9 before medication administration to 5.5 ± 2.5 after administration, reflecting a statistically significant difference of 2.6 ± 2.1 (p < 0.001). The results also revealed statistically significant reductions in heart rate (HR) and systolic blood pressure (SBP) following SST administration (mean HR dropped by 4.2 ± 9.1 beats/min, p = 0.004, and mean SBP dropped by 11.1 ± 21.8 mmHg, p = 0.01). Changes in vital signs, although statistically significant, were not clinically significant and did not necessitate additional monitoring or intervention in any patients. Conclusions Our study demonstrated that SST administration led to a significant reduction in pain scores and exhibited a favorable safety profile regarding vital signs, including SBP, HR, respiratory rate (RR), and O2 saturation. These findings support the utilization of SST for pain management in the prehospital setting, particularly in austere environments where traditional routes of administration may be impractical.

Association of oxidative balance score with blood pressure, all-cause and cardiovascular disease mortality among hypertensive patients: a prospective study

Objective: The oxidative balance score (OBS) has emerged as a novel marker for assessing oxidative stress status. This study aimed to investigate the association of OBS with systolic blood pressure (SBP), diastolic blood pressure (DBP), all-cause, and cardiovascular disease mortality in hypertensive patients. Methods: We conducted an analysis of data from 7602 hypertensive patients from the National Health and Nutrition Examination Survey (NHANES) 2005–2018. Multiple linear regression, Cox proportional hazards models, Kaplan–Meier survival curves, restricted cubic spline, and subgroup analysis were used to examine the association between OBS and SBP, DBP, estimated pulse wave velocity (ePWV), and mortality risk. Results: The results showed that individuals in the highest OBS quartile (27 ≤ OBS ≤ 40) had a significant 2.41 mmHg reduction in SBP compared to the lowest quartile (5 ≤ OBS ≤ 15) (P trend &lt; 0.001). Compared to the lowest quartile, individuals in the highest OBS quartile had a 29% lower risk of all-cause mortality and a 44% lower risk of cardiovascular disease mortality (P trend &lt; 0.001). This inverse association persisted irrespective of antihypertensive medication use. OBS is inversely associated with SBP, all-cause, and cardiovascular disease mortality in hypertensive patients. Conclusion: This finding provides new evidence and suggestions for those with poor blood pressure control and low OBS (&lt;15) to adjust their diet and lifestyle reasonably.

Response of Blood Pressure to Renal Denervation Is Not Associated With Genetic Variants.

Renal denervation lowers blood pressure (BP) in patients with uncontrolled hypertension. We conducted an unbiased genomic screen to identify genetic variants that may associate with BP response to renal denervation (RDN). Patients (n=268) with uncontrolled resistant hypertension (baseline BP, 166±21/90±15 mm Hg) who underwent endovascular RDN using the Symplicity catheter (Medtronic, Inc, Santa Rosa, CA) were included. Reduction in 24-hour ambulatory systolic BP was assessed at 6 months and divided into 2 groups: above and below the median response of 6.0 mm Hg, taking preintervention 24-hour ambulatory BP and regression to the mean into account. Whole exome sequencing assessing 249 669 variants, was conducted using Illumina NovaSeq technology read on a NovaSeq S4 Flow Cell device. We did not identify individual gene variants associated with BP response following RDN. These findings were confirmed after adjustment for sex and in a sensitivity analysis looking at tertiles of BP response. We also explored specific variants in AGT, ADD1, ADRB1, ADRB2, and SCNN1A that have been proposed as potential candidate genes for response and found no association (all P>0.13). Gene ontology analysis of variants across the 2 responder groups highlighted differences in biologic processes such as cell adhesion and molecular function such as protein tyrosine kinase activity. The response to RDN, in terms of 24-hour BP reduction, was not associated with the genetic profile of patients with resistant hypertension. These data do not support the use of a genetic score to identify potential responders to RDN.

Catheter-Based Renal Denervation for Resistant Arterial Hypertension: 10-Year Real-World Follow-Up Data.

This analysis of real-world data examines the efficacy, safety, and long-term outcomes of renal denervation in hypertensive patients for up to 10 years. Sixty-five consecutive patients underwent renal denervation (RDN) (single operator) for uncontrolled resistant hypertension. Efficacy was defined as the interindividual change of office (OBPM) and ambulatory blood pressure monitoring (ABPM) at 1, 6, 12 months, 2-4 and 5-10 years after RDN. Medication changes, renal function, and device generation disparities were analyzed. Of these patients, 42 received RDN with a first-generation device, while 23 underwent the procedure with a second-generation device. Baseline demographics included a predominantly male cohort (57.6%) with an average age of 60.3 years. The mean number of medications at baseline was 4.3. OBPM at baseline was 169.0/87.4mmHg, and ABPM at baseline was 153.4/88.4mmHg. Post-procedure, significant reductions in systolic blood pressure (SBP) were observed in both OBPM and ABPM at 1 month (OBPM 147.9/82.8mmHg; ABPM 141.3/83.0mmHg [SBP, p<0.001]), sustained up to 10 years (OBPM 153.1/84.3mmHg; ABPM 138/80.1mmHg [SBP, p<0.001]). After 1 year around half of patients had a controlled OBPM and 24h ABPM <135/85mmHg, which was associated with a higher number of ablation spots (31.5±14.8vs. 15.5 ± 6.5, p = 0.002) and occurred more often when treated with a second-generation device (2 [12.5%] vs. 7 [77.8%], p=0.002). Renal function displayed a minor physiological decline over 5-10 years. No major complication occurred. Renal denervation demonstrated sustained significant reductions in systolic OBPM and ABPM up to 10 years post-procedure. Controlled blood pressure at 1 year was associated with a higher number of mean ablated spots and the use of a second-generation device. The procedure exhibited a favorable safety profile, indicating its viability in managing hypertension without significant renal function compromise.

Abstract 4131381: Comparison of Dietary Macronutrient Interventions for Weight and Cardiovascular Risk Factor Reduction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trial

Background: Dietary interventions play a crucial role in weight management and reducing cardiovascular risk factors. Our study aims to compare the effectiveness of four dietary macronutrient interventions on weight loss and cardiovascular (CV) risk factor reduction through a systematic review and network meta-analysis. Methods: We conducted a comprehensive literature search on PubMed, Scopus, Embase, and Cochrane Library up till May 2024 to identify randomized controlled trials (RCTs) comparing four macronutrient dietary interventions including Mediterranean Diet (MD), Keto, Dietary Approaches to Stop Hypertension (DASH), and Intermittent Fasting (IF) with study period ≥ 6 months or 24 weeks. The primary outcomes of interest were weight loss, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Body Mass Index (BMI), High density lipoprotein (HDL), Low density Lipoprotein (LDL), cholesterol levels and C-reactive protein (CRP) levels. Outcomes were reported as standard mean difference (SMD). Results: Our analysis identified 50 studies enrolling 5368 patients (MD=3554; DASH=838; Keto=206; IF=770). Regarding BP outcome, MD and DASH had significant reduction in SBP and DBP respectively (MD [SBP]: -0.76 mmHg vs DASH [DBP]: -1.92 mmHg) respectively. In contrast, IF showed a significant rise in SBP (0.87). MD participants also had significant weight loss (-1.06 kg) and a moderate decrease in BMI (-0.79) when compared with other diets. Furthermore, IF, keto, and MD showed moderate increase in HDL levels (0.61, 0.77 and 0.33) respectively. In contrast, DASH resulted in a moderate decline in HDL levels (-0.92). IF and MD resulted in modest decline in LDL levels (-0.45 and -0.42) respectively. In contrast, Keto demonstrated non-significant rise in LDL (0.35). DASH showed a significant decrease in triglycerides (-3.02). Lastly, MD demonstrated a significant reduction in CRP (-0.89). Conclusions: MD and DASH were superior to other dietary interventions in terms of weight loss and CV risk factors. Further research is required to tailor specific types of dietary interventions and assess their long-term efficacy on weight loss and CV risk reduction.

Abstract 4137479: Integrating Ambulatory Care Pharmacists into Value-Based Primary Care: A Scalable Model for Addressing Cardiometabolic Disease

Background: Chronic disease is common, costly, and complicated. In the shift to value-based payment models, interventions to engage patients and improve disease control are necessary to reduce morbidity, mortality, and cost. The use of ambulatory pharmacists has demonstrated improved management of chronic diseases. Traditionally, ambulatory pharmacists are employed by healthcare systems. In this study, we test if integrating ambulatory pharmacists hired, trained, and managed by a retail pharmacy into value-based primary care (VBPC) clinics improves care. Hypothesis: Integrating a Walgreens pharmacist empowered by collaborative drug therapy management agreements (CDTM) into Village Medical (VMD) clinics will improve indicators of chronic disease control. Aims: Improve hemoglobin A1c (HbA1c) in patients with type 2 diabetes (T2D) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements in patients with hypertension (HTN). Methods: An ambulatory pharmacist was embedded into VMD clinics in Phoenix, Arizona under the supervision of VMD primary care providers via a CDTM. The pharmacist provided education, coaching, and medication management by prescribing and titrating therapies for treating T2D and HTN - enabled by access to pharmacy dispensing data. β was generated from difference-in-differences (DID) analyses with propensity score matched controls. Results: 125 patients had T2D, and 43 patients had HTN in the intervention group with 250 and 86 in the matched control group, respectively. The mean age was 65 years, 54% were female, 2% non-English speaking, and 29% racial/ethnic minorities. The average baseline HbA1c was 9% in the intervention group and 10% in the matched cohort. The average baseline SBP was 146 mmHg in the intervention group and 142 mmHg in the matched cohort. The β in the T2D group was -1.61% (p&lt;0.001) while the β in the HTN group was -10.2 mmHg (p&lt;0.01) for SBP and -2.0 mmHg (p=0.42) for DBP. Conclusion: We saw significant reductions in SBP and HbA1c in the pharmacist-managed group compared with matched controls. These results demonstrate that pharmacist integration into VBPC clinics may improve measures of chronic disease known to be associated with morbidity and mortality.

Abstract 4116298: Once Weekly Utreglutide (GL0034), a Glucagon-like Peptide-1 Receptor Agonist, at 4 × 450 µg Doses Reduces Blood Pressure, Lipids, and Body Weight in Post-menopausal Females: A Phase I Study

Background: Utreglutide (GL0034), a novel, once weekly glucagon-like peptide-1 receptor agonist (GLP-1RA), previously demonstrated significant reductions in body weight (BW) after a single dose ascending study in individuals with obesity . BW reductions after pharmacological treatment of obesity with GLP-1RA is associated with blood pressure (BP) lowering effects. Aim: This phase I study assessed the safety, tolerability, and cardio-metabolic effects of utreglutide after multiple ascending doses in post-menopausal female volunteers with overweight and obesity. Methods: In this randomized, double-blind, placebo-controlled study 12 post-menopausal female volunteers with overweight/obesity, aged 18 to 65 years old with a body mass index (BMI) ≥26 kg/m 2 were randomized (9:3) to subcutaneous utreglutide fixed doses (4 × 450 µg); or placebo once weekly for four weeks. Safety, tolerability, and key cardio-metabolic parameters were assessed. Biomarker measurements included oral glucose tolerance test (OGTT) insulin and glucose area under the curve (AUC), systolic- and diastolic BP, lipid profile (triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), and non-high-density lipoprotein (non-HDL), creatinine, potassium, BW and leptin. Results: Utreglutide was generally well tolerated and related adverse effects were mainly gastrointestinal with dose-dependent nausea, vomiting and decreased appetite. Reductions in OGTT AUCs of insulin ( p &lt;0.05) and glucose ( p &lt;0.01) were noted on Day 23 after four weeks treatment with Utreglutide. This was accompanied by a decrease ( p &lt;0.001) in mean systolic and diastolic BP on Day 23 from baseline (BL). On Day 23, significant reductions in TC ( p &lt;0.01), LDL ( p &lt;0.05) and non-HDL ( p &lt;0.05) were observed. BW reduction versus BL ( p &lt;0.001) was 2.0 kg and 1.8 kg respectively on Day 29 and End of Study (EoS). Leptin levels significantly reduced from BL on Day 23 ( p&lt; 0.01) and EoS ( p &lt;0.001). No significant changes were observed for TG, creatinine and potassium (Table). Conclusions: Once weekly utreglutide dosing for four weeks at a dose of 450 µg in post-menopausal females with overweight and obesity, demonstrated clinically relevant reductions of systolic and diastolic BP. This was associated with improved performance of OGTT AUC of insulin and glucose, lipids, BW and leptin with an overall good tolerability and with potential to demonstrate cardio-metabolic benefits.