Seventh Report Research Articles

Committee on the Elimination of Discrimination against Women: Concluding observations on the combined seventh and eighth periodic reports of Germany

Committee on the Elimination of Discrimination against Women: Concluding observations on the combined seventh and eighth periodic reports of Germany

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

Higher serum uric acid level increases risk of prehypertension in subjects with normal glucose tolerance, but not pre-diabetes and diabetes

Although the association between serum uric acid (SUA) levels and prehypertension has been reported in previous studies, it is unknown whether their relationship is similar in subjects with diabetes, pre-diabetes and normal glucose tolerance (NGT). This study thus aimed to investigate the relationship between SUA and prehypertension in subjects with different glycemic status, including NGT, pre-diabetes and diabetes. A total of 12 010 participants were included after excluding subjects with blood pressure ⩾140/90 mm Hg, history of hypertension, leukaemia, lymphoma, hypothyroidism, medication for hypertension and hyperuricemia and missing data. Subjects were divided into four groups based on SUA quartiles (male Q1: ⩽345.0, Q2: 345.0-392.6, Q3: 392.6-440.2, Q4: ⩾440.2 μmol l(-1) and female Q1: ⩽249.8, Q2: 249.8-285.5, Q3: 285.5-333.1, Q4: ⩾333.1 μmol l(-1)). Diabetes, pre-diabetes and NGT were assessed according to the 2010 American Diabetes Association diagnostic criteria. Normotension and prehypertension were defined according to the JNC-7 (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) criteria. The SUA was significantly higher in prehypertensive subjects as compared with normotensive subjects. SUA, as a continuous variable, was positively associated with prehypertension in subjects with NGT but not pre-diabetes and diabetes. Besides, NGT subjects with the highest quartile of SUA exhibited a higher risk of prehypertension after adjustment for other confounding factors. In pre-diabetes and diabetes groups, none of SUA quartiles was significantly related to prehypertension. SUA was significantly associated with an increased risk of prehypertension in subjects with NGT but insignificantly in subjects with pre-diabetes and diabetes.

Protein Foods Group and 3-Year Incidence of Hypertension: A Prospective Study From Tehran Lipid and Glucose Study

Dietary factors play an important role in the development of hypertension (HTN). In this study, we aimed to determine the possible effect of protein foods group and its subgroups on risk of HTN after 3-year follow-up in Iranian adults. Prospective study in framework of the Tehran Lipid and Glucose Study. A total of 1,152 healthy adults, aged 20 to 84years participated and were followed-up for 3years. Usual dietary intake was assessed using a 168-item validate semiquantitative food frequency questionnaire at baseline and again after 3years. Protein foods group was considered as the sum of meats, poultry, seafood, eggs, beans and peas, nuts, and seeds. Blood pressure was measured at baseline and after 3years, and HTN was diagnosed by the seventh report of Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VII). To assess the odds ratio of HTN in each tertile of protein foods group and its subgroup, a multivariate logistic regression adjusted for potential confounding variables was used. Mean age of participants was 36.0±11.2years, and mean intake of protein foods group was 855±343g/week (range 70.5-3,450g/week). After 3years of follow-up, the incidence of HTN was 12.5%. There was no significant association between dietary intakes of the protein foods group, meats, poultry, seafood, beans and peas, and nuts and seeds and the occurrence of HTN over 3years. However, 3-year incidence of HTN was significantly decreased in the highest tertile of eggs in compared with the lowest (odds ratio: 0.54; 95% confidence interval: 0.32-0.91; P for trend=.02). Our findings indicated that egg consumption could have favorable effect against development of HTN.

Application of “rule of halves” in an urban adult population, Himachal Pradesh: A study from North India

Introduction: Approximately half of most common chronic disorders are undetected that half of those detected are not treated, and that half of those treated are not controlled. This is true of hypertension as well: The “rule of halves.” However, the relevance of this is being questioned now.Objective: The aim of the present study was to assess the applicability of the rule of halves in an urban adult population in North India to evaluate its relevance in establishing levels of awareness, thus control of hypertension in general population.Materials and Methods: A cross-sectional community survey was done to include 187 men and 213 women aged >20 years of age in Shimla city, Himachal Pradesh. Hypertension was assessed using standardized recording, structured schedule on diagnosis and antihypertensive drug treatment according to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.Results: The data were expressed in percentages, and Chi-square test was used to list the significance of sociodemographic factors. Of the total 400 participates, 208 individuals (52%) had hypertension. The prevalence of self-reported hypertension was 35% (139/400). However, the prevalence of self-reported hypertension (aware) among diagnosed patients of hypertension on examination by investigator was 139/208.Conclusion: The relevance of “rule of halves” in establishing the levels of awareness and control of hypertension is undervalued and cannot be undermined especially in context of developing countries.

The Effect of a Comprehensive Provider and Patient Intervention to Improve Blood Pressure Control.

Purpose: To examine the comprehensive provider and patient intervention (CPPI) compared to usual care (UC) on blood pressure control among newly diagnosed hypertensive patients treated in a nurse practitioner practice. Data Sources: CPPI included provider and patient education, electronic health record messages about the guidelines of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, Treatment of High Blood Pressure (JNC-7), and patient counseling. Blood pressure control (intervention group; CPPI) was assessed and compared to levels of newly diagnosed patients prior to the intervention (usual care group; UC). One-way analysis of variance (ANOVA) tested for between-group differences and independent samples t test tested for within-group differences in blood pressure readings measured at initial visit and 12-week follow-up visit. Conclusions: There were no significant differences between the groups for mean blood pressure on Weeks 1 and 12. Patients in CPPI showed slightly greater improvement in blood pressure classification compared to UC. Follow-up phone calls allowed for identification of barriers for adherence with follow-up appointments. Implications for Practice: JNC-7 provides an evidence-based approach to diagnosis and management of hypertension. Understanding patient barriers to adherence with treatment may lead to more effective programs that address individual patient needs.

Antihypertensive use, prescription patterns, and cost of medications in a Teaching Hospital in Lagos, Nigeria

Hypertension has been reported as the strongest modifiable risk factor for cardiovascular morbidity and mortality. The aim of the study was to identify the most prescribed antihypertensive drugs, its patterns, comorbidities, cost of medications, and laboratory investigations. This study was a cross-sectional, descriptive study of hypertensive patients conducted at the Lagos State University Teaching Hospital, Ikeja. A total of 200 case notes were retrieved from the medical records unit over a period of 8 weeks. Information on antihypertensive prescriptions and comorbidities was retrieved. The average cost of medications and laboratory investigations was calculated. Statistical Analysis Tool Used: SPSS software version 16. The mean age of the patients was 58.44 ± 12.65 years. Of the 200 patients, 5 (2.5%) were on monotherapy and 195 (97.5%) were on combination therapy. One hundred and twenty (60%) patients had comorbidities which included congestive heart failure 55 (27.5%), diabetes mellitus 22 (11%), hyperlipidemia 15 (7.5%), and cardiovascular disease 13 (6.5%). The various classes of antihypertensive drugs prescribed were diuretics 128 (64.0%), beta-blockers 126 (63.0%), calcium channel blockers 106 (53.0%), angiotensin-converting enzymes inhibitors 103 (51.5%), angiotensin receptor blockers 33 (16.5%), alpha blockers 9 (4.5%), and fixed drug combinations 2 (1.0%). The average cost per month of the antihypertensive medications was ₦ 2045 (US$10.2). Antihypertensive prescription pattern was in accordance with the seventh report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure. Community-based insurance scheme should be encouraged and effective implementation of integrated noncommunicable diseases screening into the primary health care services would be helpful.

The Increase in Animal Mortality Risk following Exposure to Sparsely Ionizing Radiation Is Not Linear Quadratic with Dose.

IntroductionThe US government regulates allowable radiation exposures relying, in large part, on the seventh report from the committee to estimate the Biological Effect of Ionizing Radiation (BEIR VII), which estimated that most contemporary exposures- protracted or low-dose, carry 1.5 fold less risk of carcinogenesis and mortality per Gy than acute exposures of atomic bomb survivors. This correction is known as the dose and dose rate effectiveness factor for the life span study of atomic bomb survivors (DDREFLSS). It was calculated by applying a linear-quadratic dose response model to data from Japanese atomic bomb survivors and a limited number of animal studies.Methods and ResultsWe argue that the linear-quadratic model does not provide appropriate support to estimate the risk of contemporary exposures. In this work, we re-estimated DDREFLSS using 15 animal studies that were not included in BEIR VII’s original analysis. Acute exposure data led to a DDREFLSS estimate from 0.9 to 3.0. By contrast, data that included both acute and protracted exposures led to a DDREFLSS estimate from 4.8 to infinity. These two estimates are significantly different, violating the assumptions of the linear-quadratic model, which predicts that DDREFLSS values calculated in either way should be the same.ConclusionsTherefore, we propose that future estimates of the risk of protracted exposures should be based on direct comparisons of data from acute and protracted exposures, rather than from extrapolations from a linear-quadratic model. The risk of low dose exposures may be extrapolated from these protracted estimates, though we encourage ongoing debate as to whether this is the most valid approach. We also encourage efforts to enlarge the datasets used to estimate the risk of protracted exposures by including both human and animal data, carcinogenesis outcomes, a wider range of exposures, and by making more radiobiology data publicly accessible. We believe that these steps will contribute to better estimates of the risks of contemporary radiation exposures.

Prevalence and Correlates of Prehypertension Among Adults in Urban South India.

Prehypertension is one of the most common conditions affecting human beings worldwide. It is associated with several complications including hypertension. The blood pressure between normal and hypertension is prehypertension as per the Seventh Report Joint National Committee (JNC-7) classification. The current study was done to measure the magnitude of prehypertension and to study their sociodemographic correlates in the urban field practice area of Kasturba Medical College, Mangalore, India, among 624 people aged ≥20 years. The measurements of blood pressure were done (JNC 7 criteria) with the anthropometric measurements and lifestyle factors. Data analysis was done using Statistical Package for Social Sciences version 16. Adjusted odds ratios were calculated. Overall, 55% subjects had prehypertension and 30% had hypertension. Prehypertension was higher among males. Those from the higher age groups, those from upper socioeconomic status, obese individuals, and those with lesser physical activity had significantly higher association with prehypertension, and it was least among those who never used tobacco and alcohol.

Association of anxiety and depression with hypertension control: a US multidisciplinary group practice observational study.

The presence of a mental health disorder with hypertension is associated with higher cardiovascular disease mortality than hypertension alone. Although earlier detection of hypertension has been demonstrated in patients with anxiety and depression, the relationship of mental health disorders to hypertension control is unknown. Our objective was to evaluate rates and predictors of incident hypertension control among patients with anxiety and/or depression compared with patients without either mental health diagnosis. A 4-year retrospective analysis included 4362 patients, at least 18 years old, who received primary care in a large academic group practice from 2008 to 2011. Patients met The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure criteria and had a hypertension diagnosis. Kaplan-Meier analysis estimated the probability of achieving control for patients with and without anxiety and/or depression. Cox proportional hazard models were fit to identify predictors of time to control. Overall, 13% (n = 573) had a baseline diagnosis of anxiety and/or depression. Those with anxiety and/or depression demonstrated more primary care and specialty visits than those without either condition. After adjustment, patients with anxiety and/or depression had faster rates of hypertension control (hazard ratio [HR] 1.22; 1.07-1.39] than patients without either diagnosis. Other associations of faster hypertension control included female gender (HR 1.32; 1.20-1.44), absence of tobacco use (HR 1.17; 1.03-1.33), Medicaid use (HR 1.27; 1.09-1.49), and a higher Adjusted Clinical Group Risk Score (HR 1.13; 1.10-1.17), a measure of healthcare utilization. Greater healthcare utilization among patients with anxiety and/or depression may contribute to faster hypertension control.

Triamterene in the Treatment of Hypertension: More Than Just Potassium Sparing?

H ypertension is the most commonly encountered chronic medical condition in primary care practice and is a major risk factor for stroke and coronary artery disease. For decades, thiazide diuretics have been a recommended first line option for antihypertensive therapy. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommended thiazides as first line therapy unless a compelling indication existed for another agent. JNC-8 recommends diuretics as one of four acceptable first line options for non-black patients without chronic kidney disease (other options include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, or calcium channel blockers), and as one of two acceptable options for African American patients without chronic kidney disease (the other option is calcium channel blockers). Hypokalemia frequently results from the administration of thiazide diuretics. This effect is more common with chlorthalidone than hydrochlorothiazide (HCTZ) or indapamide, and occurs in a dose dependent fashion. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), one of the largest trials of antihypertensive therapy (n=33,357), mean potassium levels at 4 years fell 0.2 mEq/L among chlorthalidone treated patients, and potassium fell below 3.5 mEq/L in 8.5% of patients at 4 years (as opposed to 1.9 % of amlodipine treated patients). Hypokalemia, when it occurs, usually appears within the first 2 weeks after initiating diuretic therapy. If hypokalemia occurs, clinicians have the option of beginning potassium chloride replacement therapy (typical doses are 20–40 mEq per day for patients with normal renal function), or beginning a potassium sparing diuretic. Potassium sparing diuretics include triamterene and amiloride (epithelial sodium channel inhibitors) and spironolactone and eplerenone (mineralocorticoid receptor antagonists). The choice of potassium replacement or a potassium-sparing diuretic has been typically left to the discretion of the clinician, as no evidence has suggested that the addition of potassium-sparing diuretics provides additional value in terms of blood pressure lowering or a reduction in cardiovascular events. From the patient perspective, a disadvantage of potassium replacement is the requirement to add either large pills that are often difficult to swallow, or a salty tasting solution to the thiazide. No studies exist of triamterene as monotherapy for the treatment of hypertension. In a recent Cochrane systematic review, authors evaluated the blood pressure lowering effect of potassium-sparing diuretics that block the epithelial sodium channel when given in combination with another antihypertensive agent. Only six trials of 496 patients existed; all six studies were performed in the 1980s. Two trials (n=211) evaluated the incremental benefit of triamterene 50mg per day when added to chlorthalidone at 25 to 50 mg per day. The addition of triamterene provided no incremental reduction in systolic blood pressure (−0.01, 95 % CI −3.63 to 3.61), or diastolic blood pressure (+0.20, 95 % CI −2.01 to 2.41), but total sample sizes were too small to draw any meaningful conclusions. In this issue of JGIM, Tu and colleagues queried a large network electronic medical record system to determine the incremental blood pressure lowering effect of triamterene. They identified 17,291 patients with a diagnosis of hypertension over an 8-year period and divided these patients into those with and without a pharmacy claim for triamterene. Patients who received triamterene were more likely to be female or African American, and less likely to have diabetes, coronary artery disease, congestive heart failure, a history of stroke, or chronic obstructive pulmonary disease. A direct comparison of the blood pressure values in these two groups would be confounded by substantial selection bias due to the nonrandom assignment between the groups. Tu et al. used a novel approach to attempt to correct for limitations inherent in these observational data. They used propensity score matching to estimate the probability that a patient would receive a particular treatment, based on logistic regression that adjusted for 14 clinical characteristics. They then stratified patients into quartiles of estimated propensity and compared the recorded blood pressures for those who had or had not received triamterene. They evaluated separately the impact of adding triamterene to HCTZ or to combinations of drugs that included HCTZ. They present no data on chlorthalidone use; in their network, triamterene was most commonly prescribed as a fixed combination pill with HCTZ (initial dose was HCTZ 25 mg daily and triamterene 37.5 mg daily). Published online September 18, 2015

The Changing Tide of Title to Cultural Heritage Objects in UK Museums

Abstract:UK museums are required to present themselves as the ethical guardians rather than simply the owners of their collections (Museums Association Code of Ethics principles 1.0 and 1.3). Museums which are members of the International Council of Museums are required, when acquiring objects for their collections, to ensure that they obtain valid title, rather than simply strict legal title, to the object (ICOM Code of Ethics, principle 2.2). This notion of valid title focuses on the relationship between the current possessor (the museum) and the object. However, one can also see the concept of claimants having moral claims to cultural heritage objects developing in the context of the notion of the “rightful owner” which is a term increasingly deployed to signify the person who has a valid moral, rather than legal, claim to the cultural heritage object (Seventh Report of the Culture Media and Sport Select Committee 1999-2000 [193]).Since 2000 the UK has introduced mechanisms to resolve, in limited circumstances, moral claims to cultural objects of which their owners were dispossessed during the Nazi era. This paper analyses the way in which a concept of moral title can be seen to have developed in the context of the resolution of Nazi era claims by the UK’s Spoliation Advisory Panel. To this end the paper analyses: how far the moral entitlement is linked with the legal title to the object; and whether moral title arises from the morally abhorrent dispossession that befell the claimant or his ancestor or whether it results from the recommendation of the Spoliation Advisory Panel. It is argued that the development of the notion of moral title poses challenges for the future, but an understanding of its role may also inform the resolution of disputes involving cultural heritage objects outside the context of the Nazi era.

Elevated Serum Level of Interleukin 17 in a Population With Prehypertension.

Cytokines play an important role in the pathogenesis of hypertension. The authors hypothesized that interleukin 17 (IL-17) might contribute to the prehypertensive state. This study evaluated the relationship between serum levels of IL-17 and prehypertension. A total of 394 participants were enrolled, after excluding for hypertension or treated hypertension, and divided into two groups (optimal blood pressure [BP] and prehypertension) based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classification of BP. Optimal BP was defined as systolic BP <120 mm Hg and diastolic BP <80 mm Hg. Prehypertension was defined as systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg. IL-17A levels were determined by enzyme-linked immunosorbent assay. The mean serum IL-17 concentration in the prehypertension group was significantly higher than in the optimal BP group. The cohort was divided into quartiles Q1 (≤3.5 ng/L), Q2 (3.60 to 6.10 ng/L), Q3 (6.20 to 10.00 ng/L), and Q4 (≥10.10 ng/L) based on IL-17 levels. The Q2 to Q4 groups had increasing odds ratios for having prehypertension compared with the Q1 group. Elevated serum IL-17 was accompanied by a rise in systolic BP. Thus, increased serum IL-17 levels are associated with prehypertension.

Burden of Clostridium difficile infection in the United States.

for the CHIPS Study Group Since publication of their article, the authors report no further potential conflict of interest. 1. Lewis G, ed. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer — 2003-2005: the seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: The Confidential Enquiry into Maternal and Child Health (CEMACH), December 2007 (http://www.hqip.org.uk/ assets/NCAPOP-Library/CMACE-Reports/18.-December-2007 -Saving-Mothers-Lives-reviewing-maternal-deaths-to-make -motherhood-safer-2003-2005-Executive-Summary.pdf).

Hypertension Outcomes at a Student-Run Clinic for the Uninsured

Background: Hypertension is a potent risk factor for cardiovascular disease in the uninsured. Medical student-run free clinics are increasingly managing chronic conditions like hypertension, but there are limited data addressing the quality of care such clinics provide. This study evaluates hypertension outcomes at the East Harlem Health Outreach Partnership (EHHOP), a student-run clinic affiliated with Mount Sinai School of Medicine, in comparison to publicly and privately insured populations.Methods: A retrospective cohort analysis of EHHOP patients with hypertension (N=65) was performed. Results were compared to New York State Medicaid (N=10,117) and commercial insurance patients (N=7,669) with hypertension. The primary outcome measure was percent of patients controlled &lt;140/90 mmHg. Secondary analyses in the EHHOP sample evaluated control below individual JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) goal, blood pressure trends, and factors associated with control.Results: At their most recent visits, 57% of EHHOP, 58% of Medicaid, and 59% of commercial insurance patients were controlled &lt;140/90 mmHg. In the EHHOP sample, 47.7% (31/65) of patients met their individual goal, including 35.7% (10/28) of diabetics. The mean change in blood pressure at EHHOP was -12.3 mmHg systolic (95% CI 5.7-18.9; p&lt;0.01) and -6.8 mmHg diastolic (95% CI 2.9-10.5; p&lt;0.01) over a mean follow-up of 16.2 months.Conclusions: Though limited by small sample size, results suggest that hypertension control at EHHOP is equivalent to other care settings. Results also demonstrate that EHHOP patients with hypertension experience clinically meaningful reductions in blood pressure. The study supports student-run free clinics as a model for delivering quality healthcare to vulnerable populations.

Effects of psychological stress on hypertension in middle-aged Chinese: a cross-sectional study.

We examined the effect and relative contributions of different types of stress on the risk of hypertension. Using cluster sampling, 5,976 community-dwelling individuals aged 40–60 were selected. Hypertension was defined according to the Seventh Report of the Joint National Committee, and general psychological stress was defined as experiencing stress at work or home. Information on known risk factors of hypertension (e.g., physical activity levels, food intake, smoking behavior) was collected from participants. Logistic regression analysis was used to determine the associations between psychological stress and hypertension, calculating population-attributable risks and 95% confidence intervals (CIs). General stress was significantly related to hypertension (odds ratio [OR] = 1.247, 95% CI [1.076, 1.446]). Additionally, after adjustment for all other risk factors, women showed a greater risk of hypertension if they had either stress at work or at home: OR = 1.285, 95% CI (1.027, 1.609) and OR = 1.231, 95% CI (1.001, 1.514), respectively. However, this increased risk for hypertension by stress was not found in men. General stress contributed approximately 9.1% (95% CI [3.1, 15.0]) to the risk for hypertension. Thus, psychological stress was associated with an increased risk for hypertension, although this increased risk was not consistent across gender.

Will Team-Based Care Really be Implemented?

Team-based care is an effective strategy to improve BP in primary care.1, 2 The most recent meta-analysis evaluated 39 randomized controlled trials in 14,224 patients and found pharmacist interventions reduced systolic BP 7.6 mm Hg (95% CI:−9.0 to −6.3 mm Hg) compared to usual care.3 The authors concluded that pharmacist interventions were highly effective but that additional studies are still needed to determine the most efficient methods of implementation.3 Nearly all previous studies were efficacy studies conducted under optimal conditions. The National Heart, Lung, and Blood Institute has committed extensive funding to evaluate if interventions known to be effective in efficacy studies conducted under optimal conditions will be implemented in usual care scenarios.

Antihypertensive Effect of Aliskiren as Related to BMI in Young Female Egyptian with Metabolic Syndrome

Background : In view of the potential benefit of direct renin inhibition, this clinical research article was designed to assess blood pressure lowering to the target blood pressure in 100 young (18-25 years) Egyptian female patients with metabolic syndrome (MS) and with body mass index of ≥30 kg/m 2 treated with aliskiren in multiple primary care units of female and child health all around Egypt. Methods : At an initial visit, physicians assessed baseline blood pressure (BP), (HR), risk factors, signs of end organ damage and prior antihypertensive medication. Patients were prescribed aliskiren 40 mg/kg/day orally. Efficacy and tolerability were measured by assessing blood pressure, and side effects at a further visit after two months. Blood pressure target was defined according to the Seventh Report of the Joint National Committee on Prevention, Detection, evaluation and Treatment of High Blood Pressure (JNC7) that recommends a BP treatment goal of <130/80 mmHg for patients MS with diabetes mellitus (DM). Results : Mean sitting systolic blood pressure/mean sitting diastolic blood pressure was lowered equally effectively (systolic/diastolic, p=1.0/0.8) in patients with metabolic syndrome (-22.0± 15.8/-10.9 ±9.6mmHg). Side effects were reported in 1% of all cases, none of them was life threatening. Conclusion : Aliskiren administration for 2 months at a dose of 40 mg/kg/day orally was effective in young Egyptian female who were hypertensive with MS.

Significantly increased visceral adiposity index in prehypertension.

BackgroundThe prevalence of prehypertension has increased in China, and prehypertension frequently progress to hypertension over a short time period; both have become public health problems. Therefore, this study was conducted to determine the relationship between the Visceral Adiposity Index (VAI) and blood pressure (BP) in China.MethodsA cross-sectional epidemiological survey was conducted in China using a stratified random cluster sampling method. Sex-specific VAI quartile cut-off points were used as follows: 0.88, 1.41, 2.45 in males and 0.85, 1.33, 2.22 in females. Prehypertension and hypertension were each defined according to The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines. A multivariate logistic analysis was conducted to analyze the relationship among VAI, prehypertension and hypertension.ResultsThe ORs for prehypertension and hypertension in the upper quartiles of the VAI were 1.514 (1.074-2.133), P=0.018 and 1.660 (1.084-2.542), P=0.020, in males, after adjusting for age, education, smoking habits, alcohol consumption, physical activity, serum creatinine, fasting glucose, and plasma insulin. Following further adjustments for the above confounders, chronic kidney disease, and diabetes, the ORs for prehypertension and hypertension in the upper quartile of the VAI were 1.660 1.533 (1.086-2.165), P=0.015, and 1.743 (1.133-2.680), P=0.011, in males. The ORs for prehypertension and hypertension in the upper quartile of the VAI were 1.691 (1.223-2.338), P=0.001, and 1.682 (1.162-2.435), P=0.006, in females, after adjusting for age, education, smoking habits, alcohol consumption, physical activity, serum creatinine, fasting glucose, and plasma insulin. Following further adjustments for the above confounders, chronic kidney disease, and diabetes, the ORs for prehypertension and hypertension in the upper quartile of the VAI were 1.688 (1.220-2.334), P=0.002, and 1.657 (1.141-2.406), P=0.008, in females.ConclusionsA higher VAI was positively associated with both prehypertension and hypertension in both males and females. It is both essential and urgent that clinicians take steps to control and prevent visceral adiposity.

Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk.

To determine the relationship between clinically relevant blood pressure (BP) groups and nonalcoholic fatty liver disease (NAFLD) presence and severity especially in the milieu of other metabolic risk factors. From a Brazilian cohort of 5362 healthy middle-aged men and women who presented for yearly physical examination and testing, the cross-sectional relationship between BP categories and NAFLD was assessed. BP groups were categorized as normal, prehypertension (PHT), and hypertension (HTN) according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classification. NAFLD was ultrasound diagnosed, excluding persons with alcohol consumption more than 20 g/day. NAFLD severity was estimated using the Fibrosis-4 (FIB-4) risk score. The prevalence of NAFLD was 36.2%. Participants with NAFLD were older (mean 46 vs. 42 years, P < 0.001) and had elevated BMI (mean 29.0 vs. 24.7 kg/m, P < 0.001). The prevalence of NAFLD among persons with normal BP, PHT, and HTN was 16.5, 37.5, and 59.3%, respectively. In multivariate analyses, PHT and HTN were associated with elevated odds of NAFLD (PHT-adjusted odds ratio 1.3, 95% confidence interval 1.1, 1.6; HTN-adjusted odds ratio 1.8, 95% confidence interval 1.4-2.3) compared with normal BP. Among nonobese hypertensive patients, BP control (BP < 140/90 mmHg) was independently associated with 40% lower odds of prevalent NAFLD. Compared with hypertensive patients, both normotensive individuals and prehypertensive patients were more likely to have a low fibrosis risk (FIB-4 ≥ 1.3). Prevalent NAFLD may be seen early in the development of hypertension, even in the absence of other metabolic risk factors. Controlling BP among nonobese hypertensive patients may be beneficial in preventing or limiting NAFLD.