Significant Reduction In Blood Pressure Research Articles

Real-World Clinical Experience of Oral Semaglutide in a Secondary Diabetes Clinic in the UK: A Retrospective Observational Study

Real-World Clinical Experience of Oral Semaglutide in a Secondary Diabetes Clinic in the UK: A Retrospective Observational Study

Exercise Effects on Maternal Vascular Health and Blood Pressure during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis.

This systematic review aimed to assess the effects of exercise training during pregnancy and the postpartum period on maternal vascular health and blood pressure (BP). The outcome of interest were pulse wave velocity (PWV), flow-mediated dilation (FMD), and BP from pregnancy until 1-year postpartum. Five databases, including Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library, were systematically searched from inception to August 2023. Studies of randomized controlled trials (RCTs) comparing the effects of prenatal or postpartum exercise to a non-exercise control group were included. The risk of bias and the certainty of evidence were assessed. Random-effects meta-analyses and sensitivity analyses were conducted. In total, 20 RCTs involving 1,221 women were included. Exercise training, initiated from week 8 during gestation or between 6-14 weeks after delivery, with the program lasting for a minimum of 4 weeks up to 6 months, showed no significant impact on PWV and FMD. However, it resulted in a significant reduction in systolic BP (SBP) (MD: -4.37 mmHg; 95% CI: -7.48 to -1.26; p = 0.006) and diastolic BP (DBP) (MD: -2.94 mmHg; 95% CI: -5.17 to -0.71; p = 0.01) with very low certainty. Subgroup analyses revealed consistent trends across different gestational stages, types of exercise, weekly exercise times, and training periods. Exercise training during pregnancy and the postpartum period demonstrates a favorable effect on reducing maternal BP. However, further investigations with rigorous methodologies and larger sample sizes are needed to strengthen these conclusions.

Blood pressure reduction through brain delivery of nanoparticles loaded with plasmid DNA encoding angiotensin receptor shRNA.

Elevated brain angiotensin II activity plays a key role in the development of neurogenic hypertension. While blood pressure control in neurogenic hypertension has been successfully demonstrated by regulating central angiotensin II activity, current techniques involving cerebrovascular injections of potential therapeutic agents are not suitable for clinical translation. To address this gap, we present the synthesis of dual-functionalized liposomes functionalized with targeting ligand and cell penetrating peptide. Functionalized liposomes were synthesized using the thin film hydration technique and loaded with plasmid DNA encoding shRNA targeted towards Angiotensin II receptors (PEAS), via the post-insertion method. The synthesized liposomes had a cationic surface charge, an average size of 150 nm, and effectively entrapped over 89% of loaded PEAS. These liposomes loaded with PEAS demonstrated biocompatibility and efficient delivery to brain-derived cell lines, resulting in a remarkable reduction of over 70% in receptor expression within 7 days. To assess the therapeutic potential, spontaneously hypertensive rats were administered intravenous injections of functionalized liposomes loaded with PEAS, and the changes in mean arterial pressure were monitored for 45 days. Remarkably, this treatment led to a significant (p < 0.001) reduction in blood pressure of over 30 mmHg compared to saline-treated rats.

Natural resources can help reducing cardiovascular risk: randomized controlled study

Cardiovascular diseases are the leading cause of death globally accounting for 32 % of all global deaths. Addressing modifiable risk factors, including hypertension and stress, remains paramount in the prevention of CVD. This study aimed to assess the impact of the balneotherapy on blood pressure, heart rate, electrocardiogram parameters, utilization of antihypertensive medications, and stress levels. Methodology. Multicenter randomized controlled single-blind parallel group trial was made in 6 Lithuania resort centers. 373 participants with the stress level &gt; 3 (10, VAS) randomly divided into 6 groups in two clusters for receiving a 6- or 11-day complex treatment using natural resources – mineral waters, peloids, salt, nature therapy; follow-up period was 6 months. The BP, HR, ECG, stress level and other parameters were analyzed in 131 participants who passed a full course of investigation. Results. The significant reduction of systolic blood pressure after treatment (7.8 mmHg) and during 6 months (7.3 mmHg) together with diastolic 5.5 after 6 month and heart rate (4 b/min) was achieved in 11-day ambulatory balneotherapy group. Increase in the activity of the parasympathetic nervous system was observed, which is reflected by an increase in the duration of the ECG indicators. The stress level decreased by up to 43%, and stress management improved by up to 41% following inpatient treatment. Conclusion. Therapy using natural resources could stand for additional cardiovascular disease prevention and management method in integrative therapy.

Continuous glucose monitoring for glycaemic control and cardiovascular risk reduction in patients with type 2 diabetes not on insulin therapy: A clinical trial.

To evaluate the impact of the Dexcom G6 continuous glucose monitoring (CGM) device on glycaemic control and cardiometabolic risk in patients with type 2 diabetes mellitus (T2DM) at high cardiovascular risk who are not on insulin therapy. Adults with T2DM with glycated haemoglobin (HbA1c) >7% and body mass index (BMI) ≥30 kg/m2 not using insulin were enrolled in a two-phase cross-over study. In phase 1, CGM data were blinded, and participants performed standard glucose self-monitoring. In phase 2, the CGM data were unblinded, and CGM, demographic and cardiovascular risk factor data were collected through 90 days of follow-up and compared using paired tests. Forty-seven participants were included (44% women; 34% Black; mean age 63 years; BMI 37 kg/m2; HbA1c 8.4%; 10-year predicted atherosclerotic cardiovascular disease risk 24.0%). CGM use was associated with a reduction in average glucose (184.0 to 147.2 mg/dl, p < .001), an increase in time in range (57.8 to 82.8%, p < .001) and a trend towards lower glucose variability (26.2 to 23.8%). There were significant reductions in HbA1c, BMI, triglycerides, blood pressure, total cholesterol, diabetes distress and 10-year predicted risk for atherosclerotic cardiovascular disease (p < .05 for all) and an increase in prescriptions for sodium-glucose cotransporter 2 inhibitors (36.2 to 83.0%) and glucagon-like peptide-1 receptor agonists (42.5 to 87.2%, p < .001 for both). Dexcom G6 CGM was associated with improved glycaemic control and cardiometabolic risk in patients with T2DM who were not on insulin. CGM can be a safe and effective tool to improve diabetes management in patients at high risk for adverse cardiovascular outcomes.

The efficacy and safety of GLP-1 receptor agonists in youth with type 2 diabetes: a meta-analysis

BackgroundGlucagon-like peptide 1 receptor agonists have been proven to be effective in adults with diabetes and children with obesity. However, children with type 2 diabetes constitute an underrepresented subpopulation with limited treatment options. This meta-analysis aimed to determine more precise estimates of the efficacy and safety of glucagon-like peptide-1 agonists in pediatric type 2 diabetes mellitus.MethodsThree databases were searched (PubMed, Embase, and Cochrane Central Register of Controlled Trials) for trials published until the end of March 2024. The search indexing terms included 3 categories: [1] type 2 diabetes mellitus [2], youth, and [3] glucagon-like peptide-1 receptor agonist (GLP-1 RA). Randomized controlled trials in youth with type 2 diabetes (age ≤ 18 years) that assessed anthropometric and metabolic parameters were included. A total of 1119 nonduplicate studies were retrieved, and 137 full-text articles were screened. The data were analyzed using mean differences (MDs) with 95% CIs and odds ratios (ORs) with 95% CIs. For outcomes with low heterogeneity, a fixed-effects model was used. Otherwise, we applied a random effects model. Our outcomes were Hb1Ac, fasting blood glucose (FBG), blood pressure, weight, and side effects.ResultsFive studies comprehending 415 children and adolescents were included. On average, GLP-1 RA reduced HbA1c levels (-1.01%; 95% CI, -1.26 to -0.76), fasting blood glucose levels (-1.88 mmol/L; 95% CI, -2.51 to -1.26), and body weight (-1.6 kg; 95% CI, -2.83 to -0.36). No significant reductions in systolic blood pressure (MD -0.19 mmHg; 95% CI, -3.9 to 3.52 mmHg) or diastolic blood pressure (MD 0.3 mmHg; 95% CI, -2.33 to 2.93 mmHg) were observed. Despite a higher incidence of side effects, withdrawal rates from the studies remained low.ConclusionsWithin this specific population, GLP-1 RAs exhibit a notable association with substantial reductions in HbA1c, FBG, and body weight. The administration of these medications is concurrent with an elevated incidence of side effects, which are predominantly gastrointestinal and tolerable.Trial registrationPROSPERO identifier: CRD42023393020.

A Randomized Controlled Trial to Assess the Effectiveness of Warm Foot Soak Therapy on Reduction of Blood Pressure among Hypertensive Patients

Introduction : Hypertension is known as the “silent killer” because of its uncertain symptom. Therefore, early detection efforts are needed such as regular blood pressure check and effective management. Both Pharmacological and Non-pharmacological management strategies for hypertension. This study aimed to determine the effectiveness of one of the non-pharmacological management : “warm water foot soak therapy” in reduction of blood pressure among hypertensive patients. Method : Experimental study design - Randomized Controlled Trial was conducted among 60 hypertensive patients using convenient sampling technique. Participants were randomly and equally allocated into Experimental and Control group with the help of computer generated randomization list. Sequentially Numbered Opaque Sealed Envelope (SNOSE) were used for allocation concealment. Experimental group received “Warm foot soak therapy” of both feet for 10-15 cm above ankle in warm water of temperature 37-40 degree Celsius for 15 minutes, once a day for 3 consecutive days. Before and after intervention blood pressure assessment were taken in both groups. Data were analyzed using SPSS ver. 27 Result : Homogenity of socio-demographic, clinical and pre-intervention blood pressure among both groups were statistically established using chi-square test (p&gt; 0.05). Paired t test concluded that, warm foot soak therapy were having statistically significant effect on blood pressure ( p &lt; 0.05) and there was a significant reduction in blood pressure among hypertensive patients (p=0.01). The study also discovered that there is no significant association between selected sociodemographic &amp; clinical variables with pre-interventional change in blood pressure except for the dietary pattern (Veg) in both groups &amp; presence of comorbidity (DM) in experimental group among hypertensive patients at level of significance 0.05. Conclusion : The study demonstrated that warm foot soak therapy have an effect on reduction of blood pressure among hypertensive patients.

Antihypertensive Potential of Japanese Quail (Couturnix Couturnix Japonica) Egg Yolk Oil (QEYO) in Sprague Dawley Rats.

Oils from animal sources have been used for centuries in the management of diseases. This research was conducted to screen the ex vivo and in vivo toxicity of quail egg yolk oil (QEYO) extracts and assess their effects on the management of hypertension in rats. QEYO was extracted using gentle heating (GH) and n-hexane (NHN). The extracts were subjected to toxicity testing using the hen's egg test on chorioallantoic membrane (HET-CAM) and bovine corneal histology test. Acute and sub-chronic toxicity (28 days) were evaluated in rats. Hypertension was induced in rats by administering 80 mg/kg of Nω-L-Arginine Methyl Ester (L-NAME) per day for 28 days. Treatments commenced on the 14th day; Nifedipine at 30 mg/kg and 1 mL of distilled water were administered as positive and negative controls. Blood pressure (BP), lipid profiles, and oxidative stress markers were quantified. No irritation was observed using the HET-CAM test in the egg treated with both extracts. Bovine corneal histology showed no lesions in all treated groups. No signs of toxicity were observed in either acute or sub-chronic toxicity studies. A significant reduction in blood pressure was observed in rats treated with the extracts (p < 0.05). Changes in total cholesterol (TC), triglycerides (TGs), low-density lipoproteins (LDLPs), and high-density lipoproteins (HDLPs) were not significant compared to the control (p > 0.05). Oxidative stress markers (SOD and CAT) increased significantly in the treated groups compared to the control, while the malondialdehyde levels decreased (p < 0.05). QEYO was safe in both ex vivo and in vivo studies and can be said to have the potential to lower blood pressure as well as cardio-protective effects in hypertensive rats. This research provides evidence based on which QEYO could be used safely as an adjuvant therapy in eye drops and cosmetics and can be considered an effective choice for preventing hypertension.

Surgical versus medical management of patients with primary hyperaldosteronism and indeterminate adrenal vein sampling: A 10-year experience of the Cleveland Clinic.

In patients with primary hyperaldosteronism (PA), adrenal vein sampling (AVS) can identify patients suitable for unilateral adrenalectomy. However, in AVS with an indeterminate aldosterone-to-cortisol lateralization (ACL) ratio of 3.0-4.0, clinical guidance is unclear. The authors screened all patients undergoing AVS at the Cleveland Clinic from October 2010 to January 2021 and identified 18 patients with indeterminate ACL results. Ten underwent adrenalectomy and eight continued medical management. The surgical group was younger (58.5 vs. 68 years, p=.17), and more likely to have a unilateral imaging adrenal abnormality (90% vs. 38%, p=.043) and a lower contralateral suppression index (0.63 vs. 1.1, p=.14). Post-treatment, the surgical group had a significant reduction in diastolic blood pressure (-5.5mmHg, p=.043) and aldosterone (4.40 vs. 35.80ng/mL, p=.035) and required fewer anti-hypertensive medications (2 vs. 3, p=.015). These findings may support the benefit of adrenalectomy in a select group of patients with indeterminate ACL.

Long-Term effects of physical activity on weight loss, metabolic parameter and blood pressure in subjects undergoing bariatric surgery: a 5-year follow-up study.

Backgroundbariatric surgery stands as an effective intervention for weight loss and improved metabolic control in obesity, although over time there is a proportion of weight regain and type-2-diabetes (T2D) relapse. Aims: to explore the role of physical activity (PA) after surgery and its impact on metabolic parameters during a 5-year follow-up. Methods148 individuals who underwent bariatric surgery completed scheduled examinations over 5-years. Physical assessments and laboratory tests were conducted pre-surgery and annually thereafter. PA levels were evaluated using the International Physical Activity Questionnaire. Resultsparticipants were split into the PA group, who engaged in regular physical activity, and No-PA group, who remained sedentary throughout. In T2D individuals before surgery, PA group showed significant reductions in blood pressure and a lower T2D recurrence (6.7% vs 36%) compared to No-PA group. In normoglycemic individuals, the PA group led to sustained BMI reduction and improved blood pressure control (p<0.001) compared to No-PA group, for the entire duration of follow-up. Conclusionsregular PA demonstrated cardio-metabolic benefits post-bariatric surgery. Integrating PA into post-bariatric care could enhance long-term outcomes.

Incidence of hyperkalemia in anuric hemodialysis patients treated with sacubitril/valsartan.

Sacubitril/valsartan is increasingly used in hemodialysis patients due to its cardioprotective benefits. However, its impact on serum potassium levels in anuric patients undergoing hemodialysis remains controversial. We conducted a retrospective data from patients undergoing hemodialysis at two dialysis centers. A total of 71 out of 332 patients receiving hemodialysis treatment were enrolled. Mean serum potassium (mean value of 6-8 determinations), peak serum potassium (maximum K value observed during follow-up observations), and other biochemical parameters were recorded at baseline and during the follow-up period. After 6 months of follow-up, mean serum potassium increased from 4.84 ± 0.45 mmol/L at baseline to 5.07 ± 0.46 mmol/L at 3 months and 5.04 ± 0.46 mmol/L at 6 months (p < 0.001). Notably, no significant group differences were found in peak serum potassium concentrations between baseline and 6 months after sacubitril/valsartan therapy (5.69 ± 0.56 vs. 5.75 ± 0.41, p = 0.419). Prior to starting sacubitril/valsartan treatment, none of the patients had severe hyperkalemia; however, after 3 and 6 months of sacubitril/valsartan therapy, two (2.80%) and three (4.20%) patients experienced severe hyperkalemia, respectively; however, this difference was not statistically significant. Additionally, there was a significant reduction in blood pressure; however, serum sodium, bicarbonate, and Kt/V values did not change significantly during either period. Sacubitril/valsartan therapy is associated with an increase in serum potassium levels in anuric hemodialysis patients. Nevertheless, the proportion of patients with severe hyperkalemia did not increase significantly. This suggests that the use of sacubitril/valsartan in anuric patients on hemodialysis is relatively safe.

Reduction in systolic blood pressure following dietary fibre intervention is dependent on baseline gut microbiota composition

Uncontrolled hypertension is a primary cause of non-communicable diseases and death globally(1). The gut microbiota plays a role in hypertension and dietary interventions high in fibre have been shown to lower blood pressure (BP)(2). Not all participants respond to dietary fibre interventions, for reasons which are unclear. Here we aimed to identify responders of a high fibre intervention based on their baseline gut microbiome. Twenty treatment-naive participants with hypertension received either placebo or 40g per day of prebiotic acetylated and butyrylated high amylose maize starch (HAMSAB) supplementation for 3 weeks in a phase II randomised cross-over double-blind placebo-controlled trial. Blood pressure was monitored at baseline and each endpoint by 24-hour ambulatory BP monitoring, with those experiencing a reduction between timepoints of ≥ 2 mmHg classified as responders. Baseline stool samples were collected and the V4-V5 region of the 16S gene sequenced. Taxonomy was assigned by reference to the SILVA database. The MaAsLin2 package was used for assessing the relationship between baseline gut microbiota and response to dietary intervention. Overall participants had significant reduction in 24-hour systolic BP (–6.1 mmHg, p = 0.03), with 14 individuals classified as responders and six individuals as non-responders. 13 genera were found to be differentially abundant between responders and non-responders. Genera significantly enriched in responders included Dialister (β = 1.29, q = 1.921x10-134), Coprococcus (β = 1.26, q = 3.282x10-121), Bifidobacterium (β = 1.67, q = 1.11x10-81), Ruminococcus (β = 0.161, q = 1.11x10-8) and Roseburia (β = 0.82, q = 4.275x10-2). Participants who experienced a decrease in systolic BP following a dietary fibre intervention had increased level of bacterial genera known to contain species that produce short-chain fatty acids (e.g. Bifidobacterium, Roseburia and Ruminococcus) at baseline. These data suggest that baseline microbiota composition contributes to the response to dietary fibre intervention trials in people with hypertension.

Effect of needling at an acupuncture point zusanli (ST-36) on blood pressure and heart rate variability in patients with hypertension: A randomized placebo-controlled study

BackgroundAcupuncture is a traditional healing system used to prevent and treat hypertension in many countries. Acupuncture point “Zusanli (ST-36)” is used to nourish blood and yin. However, no known studies reported the effect of needling at only ST-36 on cardiovascular parameters. ObjectivesThis study was performed to find the effectiveness of ST-36 on blood pressure (BP) and heart rate variability (HRV) in patients with hypertension. MethodsA total of 100 participants with primary hypertension aged between 30 years and70 years were randomly assigned into either acupuncture group (AG) or control group (CG). AG underwent only one session of bilateral needling at ST-36 acupuncture point for duration of 20 minutes, while the CG underwent only one session of bilateral needling at non-acupuncture point for the same duration. ResultsResults of the study showed a significant reduction in systolic blood pressure, pulse pressure and mean arterial pressure in the AG compared to the CG. In addition, a significant increase in intervals between adjacent QRS complexes (R-R interval), and a significant reduction in heart rate were observed in AG, unlike CG. ConclusionsNeedling at ST-36 acupuncture point may improve cardiovascular function better than needling at non-acupuncture points in patients with hypertension.

Effects of Vitamin D Supplementation on Central Hemodynamic Parameters and Autonomic Nervous System in Obese or Overweight Individuals.

Previous studies have been inconsistent in demonstrating beneficial cardiovascular effects of vitamin D supplementation. To evaluate the effects of vitamin D3 supplementation on central hemodynamic parameters and autonomic activity in obese/overweight individuals with low vitamin D levels (<30ng/dl). Adults 40-65 years old with body mass index ≥25<40 kg/m2 were enrolled in this prospective, randomized, double-blind clinical trial (NCT05689632). Central hemodynamics was assessed using the oscillometric method (Mobil-O-Graph®), and heart rate variability using a Polar heart rate monitor (Kubios® software). Patients (n=53) received a placebo in the control group (CO, n=25) or vitamin D3 (VD, n=28) 7000 IU/day, and were evaluated before (W0) and after 8 weeks (W8) with a significance level of 0.05. The groups were homogeneous regarding age (51±6 vs 52±6 years, p=0.509) and vitamin D levels (22.8±4.9 vs 21.7±4.5ng/ml, p=0.590). At W8, the VD group had significantly higher levels of vitamin D (22.5 vs 35.6ng/ml, p<0.001). Only the VD group showed a significant reduction in systolic blood pressure (SBP; 123±15 vs 119±14mmHg, p=0.019) and alkaline phosphatase (213±55 vs 202±55mg/dl, p=0.012). The CO group showed an increase in augmentation pressure (AP: 9 vs 12 mmHg, p=0.028) and augmentation index (AIx: 26 vs 35%, p=0.020), which was not observed in the VD group (AP: 8 vs 8 mmHg, AIx: 26 vs 25%, p>0.05). VD group showed an increase in the parasympathetic nervous system index (PNSi) (-0.64±0.94 vs -0.16±1.10, p=0.028) and the R-R interval (866±138 vs 924±161 ms, p= 0.026). In this sample, eight weeks of daily vitamin D supplementation resulted in an improvement in blood pressure levels and autonomic balance.

Effect of Sacha Inchi Oil on Human Blood Pressure and Lipid Profile: A Preliminary Study in Malaysia

This uncontrolled pre-post study aimed to assess changes in blood lipid profiles and blood pressure resulting from a 2-month consumption of Sacha Inchi Oil (SIO) (Plukenetia volubilis). Investigating the effects of SIO on Malaysians is essential for tailoring interventions to the local context, considering genetic, cultural, and dietary differences. A total of 13 adult participants, comprising 8 males and 5 females aged 35 to 74 years old, took part in this intervention study. Each participant was instructed to consume 2 softgels daily, with each softgel containing 530 mg of SIO. Blood lipid profiles and blood pressure were measured at baseline and at the end of the 2-month period, utilizing venipuncture for blood tests and a sphygmomanometer for blood pressure assessment. The results indicated a significant reduction in Systolic Blood Pressure (SBP) levels following SIO supplementation (2 softgels daily) (p&lt;0.05). However, there were no notable improvements in Diastolic Blood Pressure (DBP), Total Cholesterol (TC), Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C), and Triglycerides (TG) after the 2-month supplementation. In conclusion, the daily supplementation of 2 softgels of SIO (1,060 mg) for 2 months demonstrated a beneficial effect on blood pressure, particularly in reducing SBP. These findings serve as preliminary data for future research into the potential health benefits of SIO in the Malaysian population.

Prediction of endogenous mineralocorticoid receptor activity by depressor effects of mineralocorticoid receptor antagonists in patients with primary aldosteronism.

Patients with primary aldosteronism have an increased risk of developing cardiovascular disease. The response to mineralocorticoid receptor antagonists varies among individuals, indicating diverse mineralocorticoid receptor activities in these patients. This study explored the factors linked to the efficacy of blood pressure reduction through mineralocorticoid receptor antagonists in patients with primary aldosteronism. We examined the relationship between the reduction in blood pressure and patient characteristics in a group of 41 patients with primary aldosteronism (24 males, mean age 55 ± 13 years, including 34 patients diagnosed with bilateral primary aldosteronism) before and after undergoing treatment with mineralocorticoid receptor antagonists. Significant reductions in office blood pressure were observed 3 and 6 months after treatment initiation. Single correlation analyses showed that the urinary chloride-to-potassium ratio displayed the strongest positive association with blood pressure reduction, surpassing plasma aldosterone concentration, plasma renin activity, and urinary sodium-to-potassium ratio, at 3 and 6 months. Multiple correlation analyses revealed a consistent and independent positive correlation between the urinary chloride-to-potassium ratio and blood pressure reduction at 3 and 6 months. The optimal threshold for the urinary chloride-to-potassium ratio with respect to its ability to lower blood pressure, was determined as 3.18. These results imply that the urinary chloride-to-potassium ratio may be independently associated with the effectiveness of blood pressure reduction facilitated by mineralocorticoid receptor antagonists. Moreover, it could potentially serve as a valuable predictor of the effectiveness of these agents and function as an indicator of endogenous mineralocorticoid receptor activity in patients with primary aldosteronism.

Efektivitas Senam Iringan Gamelan Terhadap Tekanan Darah Lansia Dengan Hipertensi

Background: Hypertension is a cardiovascular disease that attacks many elderly people and increases the risk of death. The aging process causes elderly people to decrease their activity, resulting in the emergence of obesity, fat accumulation in blood vessels, and increased blood pressure. Data in the area supported by the Srondol Semarang Community Health Center in 2020 shows that hypertension is in first place on the list of the top 10 diseases there. One intervention that is safe and popular with the elderly and can help control blood pressure in the elderly is gamelan accompaniment exercise because it can increase blood flow and oxygen supply throughout the body, increase the elasticity of blood vessels and provide a relaxing effect. The aim of this study was to determine the effectiveness of gamelan accompaniment to blood pressure in elderly people with hypertension. This research method is a pre-experimental one group pre and post test design and sampling using purposive sampling technique. The population of this study were elderly people who were recorded as suffering from hypertension at the Srondol Semarang Community Health Center. The research instrument used a digital spygmomanometer and video of gamelan accompaniment of exercises. The research stages consist of preparation, implementation and processing of research data. The steps taken at the preparation stage were literature studies, field surveys, discussions with lecturers and experts, developing procedures for implementing gamelan accompaniment exercises, expert reviews, and socializing the implementation of gamelan accompaniment exercises to the elderly and their families. The implementation stage was carried out by collecting data on elderly people registered at the Srondol Semarang Community Health Center, pre and post tests by measuring blood pressure using a spigmomanometer, implementing gamelan accompaniment exercises in accordance with the prepared SOP, observing the implementation of gamelan accompaniment exercises with an observation sheet. Then, at the data processing stage, a test was carried out on the effectiveness of gamelan accompaniment exercises on the blood pressure of elderly people with hypertension. The targeted output is publication in national journals indexed by Sinta and HAKI. The TKT target for implementing this gamelan accompaniment exercise is at level 2. The results of the study show a significant reduction in systolic and diastolic blood pressure (p value 0.0001) with an error level (α) of 0.05, namely from 163.25 mmHg to 146.75 mmHg and from 100 .50 mmHg to 89.25 mmHg. Gamelan accompaniment exercises were concluded to be effective in lowering blood pressure in elderly people with hypertension

Effectiveness of moderate to vigorous physical activity among stroke risk predicted population. A pilot study

Background. The increasing prevalence of stroke, particularly among younger populations in countries like India, necessitates effective preventive strategies. Modifiable risk factors such as hypertension, diabetes, and smoking contribute significantly to stroke incidence. This study focuses on the implementation of a 12-week moderate to vigorous physical activity (MVPA) program to address these risk factors and reduce stroke incidence. Methodology. The study involved a structured MVPA intervention among individuals at risk of stroke, emphasizing consistent adherence to the protocol. Key outcomes, including systolic blood pressure, fasting blood glucose, and total cholesterol levels, were monitored. Cardiovascular fitness improvements were assessed using the Cooper's Run Test. The study also examined the feasibility and acceptability of the MVPA intervention through participant adherence rates. Results. The MVPA group exhibited significant reductions in systolic blood pressure, fasting blood glucose, and total cholesterol levels compared to the control group. These findings underscore the efficacy of MVPA in managing major stroke risk factors. Additionally, participants demonstrated enhanced cardiovascular endurance, highlighting the program’s positive impact on overall cardiovascular health. High adherence rates in the MVPA group indicated the feasibility of implementing structured exercise protocols for individuals at risk of stroke. Conclusion. This pilot study demonstrates the effectiveness of a 12-week MVPA program in reducing key stroke risk factors and improving cardiovascular fitness among individuals at risk of stroke. The findings emphasize the importance of structured exercise interventions in stroke prevention efforts. While promising, further research with larger sample sizes and longer durations is necessary to establish the sustained benefits and feasibility of such interventions. Implementing tailored MVPA programs holds significant potential for mitigating stroke risk, offering valuable insights for global stroke prevention strategies.

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus: A real-world experience.

Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are a class of drugs with modest antidiabetic efficacy, weight loss effect, and cardiovascular benefits as proven by multiple randomised controlled trials (RCTs). However, real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse. To study the comparative efficacy and safety of SGLT-2i using real-world clinical data. We evaluated the comparative efficacy data of 3 SGLT-2i drugs (dapagliflozin, canagliflozin, and empagliflozin) used for treating patients with type 2 diabetes mellitus. Data on the reduction of glycated hemoglobin (HbA1c), body weight, blood pressure (BP), urine albumin creatinine ratio (ACR), and adverse effects were recorded retrospectively. Data from 467 patients with a median age of 64 (14.8) years, 294 (62.96%) males and 375 (80.5%) Caucasians were analysed. Median diabetes duration was 16.0 (9.0) years, and the duration of SGLT-2i use was 3.6 (2.1) years. SGLT-2i molecules used were dapagliflozin 10 mg (n = 227; 48.6%), canagliflozin 300 mg (n = 160; 34.3%), and empagliflozin 25 mg (n = 80; 17.1). Baseline median (interquartile range) HbA1c in mmol/mol were: dapagliflozin - 78.0 (25.3), canagliflozin - 80.0 (25.5), and empagliflozin - 75.0 (23.5) respectively. The respective median HbA1c reduction at 12 months and the latest review (just prior to the study) were: 66.5 (22.8) & 69.0 (24.0), 67.0 (16.3) & 66.0 (28.0), and 67.0 (22.5) & 66.5 (25.8) respectively (P < 0.001 for all comparisons from baseline). Significant improvements in body weight (in kilograms) from baseline to study end were noticed with dapagliflozin - 101 (29.5) to 92.2 (25.6), and canagliflozin 100 (28.3) to 95.3 (27.5) only. Significant reductions in median systolic and diastolic BP, from 144 (21) mmHg to 139 (23) mmHg; (P = 0.015), and from 82 (16) mmHg to 78 (19) mmHg; (P < 0.001) respectively were also observed. A significant reduction of microalbuminuria was observed with canagliflozin only [ACR 14.6 (42.6) at baseline to 8.9 (23.7) at the study end; P = 0.043]. Adverse effects of SGLT-2i were as follows: genital thrush and urinary infection - 20 (8.8%) & 17 (7.5%) with dapagliflozin; 9 (5.6%) & 5 (3.13%) with canagliflozin; and 4 (5%) & 4 (5%) with empagliflozin. Diabetic ketoacidosis was observed in 4 (1.8%) with dapagliflozin and 1 (0.63%) with canagliflozin. Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c, body weight, and better than those reported in RCTs, with low side effect profiles. A review of large-scale real-world data is needed to inform better clinical practice decision making.

Furosemide to lower antenatal severe hypertension: a randomized placebo-controlled trial

BackgroundHypertensive disorders of pregnancy are a leading cause of perinatal morbidity, and timely treatment of severely elevated blood pressure is recommended to prevent serious sequelae. In acute hypertension marked by increased blood volume, it is unknown whether diuretics used as an adjunct to antihypertensive medications leads to more effective blood pressure control. ObjectiveTo evaluate whether the addition of intravenous furosemide to first-line antihypertensive agents reduces systolic blood pressure in acute-onset, severe antenatal hypertension with wide (≥60 mmgHg) pulse pressure. Study DesignIn this double-blinded randomized trial, participants received 40 milligrams of intravenous furosemide or placebo in addition to a first-line antihypertensive agent. The primary outcome was mean systolic blood pressure during the first hour after intervention. Secondary outcomes included corresponding diastolic blood pressure; systolic blood pressure, diastolic blood pressure, and pulse pressure at 2 hours after intervention; total reduction from qualifying blood pressure, duration of blood pressure control, need for additional antihypertensive doses within 1 hour, and electrolytes and urine output. A sample size of 35 subjects per group was planned to detect a 15-mmHg difference in blood pressure. ResultsBetween January 2021 and March 2022, 65 individuals were randomized, 33 to furosemide and 32 to placebo. Baseline characteristics were similar between groups. There was no difference in the primary outcome of mean 1-hour systolic blood pressure (147 [14.8] vs 152 mmHg [13.8], P=.200). We found a reduction in 2-hour systolic blood pressure (139 [18.5] vs 154 mmHg [18.4], P=.007) and a decrease in 2-hour pulse pressure (55 [12.5] vs 67 [15.1], P=.003) in the furosemide group. Subgroup analysis according to hypertension type showed a significant reduction in mean 1-hour systolic blood pressure, 2-hour systolic blood pressure, and 2-hour pulse pressure among patients with new-onset but not pre-existing hypertension. Urine output was greater in the furosemide group with no difference in electrolytes and creatinine before and after intervention. ConclusionIntravenous furosemide in conjunction with a first-line antihypertensive agent did not significantly reduce systolic blood pressure in the first hour after administration. However, both systolic blood pressure and pulse pressure at 2 hours were decreased in the furosemide group. These findings suggest that a one-time dose of intravenous furosemide is a reasonable adjunct to achieve blood pressure control, particularly in patients in whom increased volume is suspected.