Systolic Blood Pressure Research Articles

Efficacy of Olmesartan/Amlodipine Single-Pill Combination on 24-h Mean Systolic Blood Pressure Measured by Ambulatory Monitoring in Non-Responders to Valsartan or Candesartan Monotherapy.

The aim of this study was to evaluate the efficacy of olmesartan/amlodipine (OLM/AML) single-pill combination (SPC) therapy using ambulatory blood pressure monitoring (ABPM) in non-responders to valsartan or candesartan monotherapy. Isolated systolic hypertension (ISH) is the most prevalent form of hypertension in middle-aged and elderly individuals. Patients aged over 55 years who did not achieve the target systolic blood pressure (SBP < 140mmHg) with valsartan 80mg or candesartan 8mg for at least 4 weeks were included. Doses were escalated from 20/5mg to 40/5mg and finally to 40/10mg of OLM/AML SPC until patients reached the target SBP. Efficacy was assessed via ABPM by comparing baseline values with those in the 12th week. Office blood pressure (OBP) and brachial-ankle pulse wave velocity (baPWV) were assessed at baseline, weeks 4, 8, and 12. Fifty-four patients (average age 64 ± 6 years; 33 males) participated. The 24-h mean BPs decreased significantly from an average of 146.2 ± 12.7/93.3 ± 9.2mmHg to 129.7 ± 14.3/83.4 ± 10.7mmHg (p < 0.001), and pulse pressures (PPs) from ABPM were reduced (p < 0.001). Additionally, significant reductions in night-time SBP standard deviations (SDs) (14.7 ± 4.7vs. 12.5 ± 3.9, p = 0.029) were observed at 12 weeks compared to baseline. OBPs significantly dropped from 151.1 ± 9.7/89.3 ± 8.3mmHg to 125.5 ± 13.8/77.8 ± 8.8mmHg after 12 weeks of SPC therapy (p < 0.001). Reductions in PPs of OBP and baPWVs were also observed. OLM/AML SPC therapy effectively reduced the 24-h mean BP, as measured by ABPM, in hypertensive patients over 55 years old who failed to achieve a target SBP (< 140mmHg) with angiotensin receptor blocker (ARB) monotherapy using valsartan 80mg or candesartan 8mg. Trial Registration: ClinicalTrials.gov identifier: NCT01713920.

Gastroesophageal reflux disease influences blood pressure components, lipid profile and cardiovascular diseases: Evidence from a Mendelian randomization study.

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder associated with a range of cardiovascular and metabolic complications. However, the relationship between GERD and blood pressure components, lipid profile, and cardiovascular diseases remains unclear. Leveraging genetic variants associated with GERD as instrumental variables, we performed this Mendelian randomization (MR) analyses. Blood pressure components, lipid profile parameters, as well as cardiovascular diseases were considered as outcomes. Furthermore, we conducted reverse MR analysis to explore the association of these factors with the risk of GERD. Our MR analysis discovered a potential causal influence of GERD on blood pressure components, with genetically predicted GERD positively associated with systolic blood pressure (β = 0.053, P = 0.036), diastolic blood pressure (β = 0.100, P < 0.001), and mean arterial pressure (β = 0.106, P < 0.001). Additionally, genetically predicted GERD showed a significant impact on lipid profile, leading to increased genetically predicted levels of low-density lipoprotein (LDL) cholesterol (β = 0.093, P < 0.001), and triglycerides (β = 0.153, P < 0.001), while having a negative effect on high-density lipoprotein (HDL) cholesterol (β = -0.115, P = 0.002). Furthermore, our study indicated a noteworthy causal association between genetically predicted GERD and increased risk of myocardial infarction [odds ratio (OR) = 1.272, P = 0.019)] and hypertension (OR = 1.357, P < 0.001). No significant association was found between GERD and pulse pressure, total cholesterol, heart failure, and atrial fibrillation (P > 0.05). Reverse MR analysis indicates that blood pressure components, lipid profile, and cardiovascular diseases do not lead to an increased risk of GERD (all P > 0.05). Furthermore, mediation MR analysis reveals that LDL cholesterol (proportion mediated: 19.99%, 95% CI: 4.49% to 35.50%), HDL cholesterol (proportion mediated: 11.71%, 95% CI: 5.23% to 18.19%), and hypertension (proportion mediated: 35.09%, 95% CI: 24.66% to 45.53%) mediated the effect of GERD on myocardial infarction, while other factors did not participate in this pathway. This MR study provides evidence supporting a causal relationship between GERD and alterations in blood pressure components, lipid profile, and increased risk of cardiovascular diseases.

PROSPECTIVE ASSOCIATIONS OF PHYSICAL ACTIVITY AND SEDENTARY TIME IN ADOLESCENCE WITH CARDIOMETABOLIC RISK IN YOUNG ADULTHOOD.

Purpose: The relationship between sedentary time, physical activity, and cardiometabolic risk factors during the transition from adolescence to adulthood remain uncertain. We examined the prospective associations of sedentary time and physical activity at age 15 with cardiometabolic risk markers at age 24.Methods: We used data from the Physical Activity among Norwegian Children Studies (PANCS). Sedentary time, moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were measured by accelerometry. Outcomes included body mass index (BMI), waist circumference, visceral fat, maximal oxygen uptake (VO2max), systolic blood pressure, LDL-cholesterol, insulin, high-sensitivity CRP, and a clustered risk Z-score. The prospective associations were modelled through regression.Results: A total of 731 boys and girls participated at age 9 (2005-2006) and 15 (2011-2012), and 258 of these participated again at age 24 (2019-2021). Multiple imputation was performed for all eligible individuals (n = 708). Each standard deviation increase (min/day) in sedentary time at age 15 was associated with lower VO2max at age 24 (β: -1.6 ml/kg/min; 95%CI: -2.8, -0.5). Each standard deviation increase (min/d) in MVPA (β: 1.6 ml/kg/min; 95%CI: 0.8, 2.4) and VPA (β: 1.6 ml/kg/min; 95%CI: 0.8, 2.4) at age 15 were associated with higher VO2max at age 24. VPA in adolescence was further inversely associated with visceral fat mass (β: -41 g; 95%CI: -78, -3), insulin level (β: -4.3 pmol/L; 95%CI: -8.2, -0.4), and the clustered risk Z-score (β: -0.09; 95%CI: -0.18, -0.01) in young adulthood. Childhood BMI modified the association of both MVPA and VPA with clustered risk, with the greatest magnitude of association observed in the highest BMI tertile.Conclusions: Physical activity, especially of vigorous intensity, during adolescence appear to beneficially affect cardiometabolic health in young adulthood. These health benefits may be most pronounced among overweight/obese youth.

Patient-specific multifactorial mortality risk assessment using classification and regression tree analysis in the context of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring is essential for understanding blood pressure patterns beyond clinical visits, aiding in risk assessment, treatment evaluation, and managing hypertension. This retrospective cohort study aimed to identify risk factors for all-cause mortality and major cardiovascular events in patients who underwent ambulatory blood pressure monitoring. Eligible participants aged 18 or older, with an estimated glomerular filtration rate (eGFR) > 60ml/min/1.73m2, who underwent ambulatory blood pressure monitoring for various reasons, were included in the study. Data were gathered through telephone interviews, electronic health records, and the national health record system. Descriptive analysis and classification and regression tree modeling were used to uncover significant risk factors related to all-cause mortality and cardiovascular events, and to assess the model's performance compared to traditional Cox survival analysis. The study included 1291 patients, primarily male (51.8%) with a mean age of 61.1 ± 15.2years. During a mean follow-up of 46.9months, 76 (5.9%) patients died of any cause, and 195 (15.1%) had a cardiovascular event. The highest survival rates were observed in patients with a diastolic blood pressure (BP) dipping percentage between -2% and 29%, nighttime systolic BP variability below 32mmHg, and age below 72. Conversely, smokers with a diastolic BP dipping percentage below -10% showed the lowest survival rates. The best cardiovascular outcomes were observed in patients with diastolic BP dipping above -11%, nighttime mean systolic BP < 144mmHg, no statin use, normotensive status, and daytime mean heart rate ≥ 60bpm. Conversely, the worst outcomes were seen in patients with diastolic BP dipping below -11% and a morning surge ≥ 14mmHg. In all-cause mortality and cardiovascular event analysis, the combined model demonstrated excellent calibration and predictive power, like the classification and regression tree model and traditional analysis. These findings highlight the potential of a combined model for assessing mortality and cardiovascular event risk in patients who have undergone ambulatory blood pressure monitoring.

Assessment of Plasma Levels of Calcium, Creatinine and Glucose among Hypertensive Patients in Edo State, Nigeria

The present study needs to assess the plasma levels of calcium, creatinine and blood glucose among hypertensive patients in Edo State, Nigeria in order to ascertain whether plasma levels of these parameters are associated with hypertension in this population which will provide improved insight on proper management of hypertensive conditions. Several hereditary and lifestyle factors, including nutrition, influence blood pressure. In this regard, sodium is an important mineral that, in addition to its functions in fluid balance, action potential generation, digestive secretions, and nutrient absorption, also plays a key role in blood pressure regulation, with lower sodium intake linked to lower systolic and diastolic blood pressure. patients compared with their non-hypertensive counterparts. This could be as a result of an overactive parathyroid gland leading to excessive secretion of parathyroid hormone and the attendant increase in plasma calcium level. Regular screening for the plasma level of calcium, creatinine and blood glucose should be considered as routine tests for hypertensive patients. Adequate awareness of the risk of ignoring these parameters in hypertensive patients should be ensured.

Centre-level fluid management practices in the BISTRO trial and their lack of association with participant fluid status and blood pressure in non-anuric haemodialysis patients.

Fluid assessment and management is a key aspect of good dialysis care and is affected by patient-level characteristics and potentially centre-level practices. In this secondary analysis of the BISTRO trial we wished to establish whether centre-level practices with the potential to affect fluid status were stable over the course of the trial and explore if they had any residual associations with participant's fluid status. Two surveys (S) of fluid management practices were conducted in 32 participating centres during the trial, (S1: 2017-18 and S2: 2021-22). Domains interrogated included: dialysate sodium concentration, (D-[Na+]), fluid and salt intake, residual kidney function, use of diuretics, incremental start, approaches to fluid assessment, management and dialysate temperature, (D-oC). Associations of these practices with the closeness of the participant's post-dialysis target weight to their normally hydrated weight, pre- and post-dialysis systolic (SBP) and diastolic blood pressure, (DBP), were analysed using intra-class correlations and multilevel modelling with adjustment for visit, age, sex and comorbidity burden. Variations in centre practices were reported but did not change during the trial, apart from some relaxation in salt and fluid restriction in S2. For our measures of fluid status, measured 2501 times in 439 non-anuric incident haemodialysis patients, centre-level intraclass correlations were extremely low, whereas patient-level correlations ranged between 0.12 and 0.47, strongest for pre- and post-dialysis-SBP, less so for post-dialysis-DBP. Multi-level analysis found no associations between D-[Na+], or assessment methods of fluid status. In S2, one centre, routinely using a D-Co of 35°C had more divergence between the target and normally hydrated weight, but this was not observed in S1, and no other associations were found. Centre-level fluid management practices were stable over the course of the BISTRO trial, and in contrast to patient-level factors, no centre-level associations were detected with fluid status or blood pressure. This may be because the trial imposed a standardised approach to fluid assessment in all trial participants who at least initially had residual kidney function, potentially over-riding the effects of other centre practices. Survey responses revealed substantial scope for developing and evaluating standardised protocols to optimise fluid management.

Associations between Leisure and Work Time Activity Behavior and 24 H Ambulatory Blood Pressure among Aging Workers.

Purpose: The associations between work time, leisure-time, and non-workday physical activity (PA) and sedentary behavior (SED) and 24 h ambulatory blood pressure (BP) are not well known. Therefore, the aim of this study was to evaluate the associations between domain-specific activity behavior and 24 h blood pressure.Methods: A hundred and fifty-six aging workers (mean age 62.4 [SD 1.0] years, BMI 26.2 [4.5] kg/m2, 84 % women, 75 % non-manual occupation) from the Finnish Retirement and Aging study (FIREA) were included. Standing, light and moderate-to-vigorous PA (LPA and MVPA, respectively), and SED were measured using thigh-worn accelerometers and work time, leisure-time, and non-workdays were distinguished using a diary. Ambulatory 24 h BP was analyzed as mean daytime and nighttime systolic and diastolic BP, and the nocturnal BP dipping percentage was calculated. Associations were examined with linear regression analysis adjusting for age, sex, occupation, work time mode, job strain, BMI, BP medication, and accelerometer wear time.Results: Higher work time SED associated with lower nighttime diastolic BP (B = -0.92, 95% CI -1.83, -0.01). In addition, higher work time standing associated with higher daytime diastolic BP (B = 1.34, 95% CI 0.03, 2.65) and higher work time LPA with less diastolic BP dipping (B = -3.57, 95% CI -6.80, -0.34). MVPA in any domain was not associated with ambulatory BP.Conclusions: Higher work time SED associated with a more favorable diastolic BP, and higher work time PA associated with more adverse diastolic BP among aging workers. In conclusion, work time, rather than leisure time or non-workday, activity behavior seems to associate with 24 h ambulatory BP.

Cost-Effectiveness of Radiofrequency Renal Denervation for Uncontrolled Hypertension in Japan.

Radiofrequency renal denervation (RF RDN) is a novel therapy for uncontrolled hypertension. In the recent sham-controlled SPYRAL HTN-ON MED study, office-based systolic blood pressure (oSBP) and nighttime BP were reduced significantly. This study examined the cost-effectiveness of RF RDN in the context of the Japanese healthcare system based on this latest clinical evidence. Clinical events, costs, and quality-adjusted life-years (QALYs) were projected using a decision-analytic Markov model adjusted to Japanese incidence data. Risk reduction in clinical events from changes in oSBP was calculated based on a published meta-regression of 47 trials of intentional hypertension treatment. Demographics and results from the SPYRAL HTN-ON MED trial (oSBP effect size -4.9mmHg vs. sham) were utilized in the base case analysis. Additional scenarios were explored including the potential added benefit of improved night-time control. Costs were sourced from claims data and published literature. The incremental cost-effectiveness ratio (ICER) was evaluated against a cost-effectiveness threshold of ¥5000000 per QALY gained. RF RDN was projected to reduce clinical events (10-year relative risks: 0.80 for stroke, 0.88 for myocardial infarction, and 0.75 for heart failure). Over lifetime, RF RDN added 0.36 QALYs at the incremental cost of ¥923723, resulting in an ICER of ¥2565236 per QALY gained. Under the assumption of added night-time benefit, the ICER decreased to ¥2155895 per QALY. Cost-effectiveness findings were robust across all tested scenarios. The findings of this model-based analysis suggest that RF RDN can provide meaningful clinical event reductions and is a cost-effective treatment option in the Japanese healthcare system.

Personalized tourniquet pressure versus uniform tourniquet pressure in trauma orthopedic surgery of extremities: a prospective randomized controlled study

BackgroundTourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and PTIP based on systolic blood pressure (SBP) in extremity fracture patients.Materials and methodsPatients with fresh extremity fractures requiring tourniquets during surgeries were prospectively enrolled and randomly assigned to the UTIP and PTIP groups. The inflation pressure was set to 250 mmHg for the upper extremities and 300 mmHg for the lower extremities in the UTIP group and SBP plus 50 mmHg for the upper extremities and SBP plus 100 mmHg for the lower extremities in the PTIP group. The primary outcome was a hemostatic effect evaluated by the surgeon (satisfied or dissatisfied). Other secondary outcomes included postoperative changes in limb swelling and tourniquet-related complications.ResultsA total of 144 patients were enrolled and randomly assigned to the UTIP group or the PTIP group, and each group has 72 patients (36 upper limb and 36 lower limb). Totally, the hemostasis effect of the PTIP group was worse than that of the UTIP group by non-inferiority test. The hemostatic effect of upper limb fractures with SBP plus 50 mmHg for tourniquet inflation pressure was also worse than that with 250mmHg; however, there was no statistically significant difference between 300mmHg and SBP plus 100 mmHg in the lower limb group hemostasis effect due to a lack of power. Also, no difference was observed in the incidence of complications (p = 1.000) and postoperative changes in limb swelling during 2 days after surgery (upper limb: P1 = 0.546, P2 = 0.545; lower limb: P1 = 0.408, P2 = 0.857) between the PTIP and UTIP group.ConclusionIn the surgery of limb fractures, setting SBP + 50mmHg as tourniquet pressure may not be sufficient for upper limbs. Also, we found no difference between the SBP + 100mmHg and the unified 300mmHg for lower limb surgeries.

A Review on Machine Learning Deployment Patterns and Key Features in the Prediction of Preeclampsia

Previous reviews have investigated machine learning (ML) models used to predict the risk of developing preeclampsia. However, they have not addressed the intended deployment of these models throughout pregnancy, nor have they detailed feature performance. This study aims to provide an overview of existing ML models and their intended deployment patterns and performance, along with identified features of high importance. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search was performed in January and February 2024. It included all papers published before March 2024 obtained from the scientific databases: PubMed, Engineering Village, the Association for Computing Machinery, Scopus, and Web of Science. Of a total of 198 identified studies, 18 met the inclusion criteria. Among these, 11 showed the intent to use the ML model as a single-use tool, two intended a dual-use, and two intended multiple-use. Ten studies listed the features of the highest importance, with systolic and diastolic blood pressure, mean arterial pressure, and hypertension frequently mentioned as critical predictors. Notably, three of the four studies proposing dual or multiple-use models were conducted in 2023 and 2024, while the remaining study is from 2009. No single ML model emerged as superior across the subgroups of PE. Incorporating body mass index alongside hypertension and either mean arterial pressure, diastolic blood pressure, or systolic blood pressure as features may enhance performance. The deployment patterns mainly focused on single use during gestational weeks 11+0 to 14+1.

Maternal EGCG intervention mitigates chronic hypertension during pregnancy in spontaneously hypertensive rats without adverse effects on pregnancy outcomes

Background: Chronic hypertension during pregnancy is a significant concern, associated with increased risks of maternal-fetal morbidity and mortality. Epigallocatechin gallate (EGCG), a compound known for its cardioprotective properties, has gained attention as a potential health supplement due to its favorable safety profile. Objective: This study aims to investigate the effects of maternal EGCG supplementation on elevated blood pressure and pregnancy outcomes in a rodent model of chronic hypertension, specifically using spontaneously hypertensive rats (SHR). Furthermore, the study explores the influence of maternal EGCG supplementation on the blood pressure of SHR offspring during early postnatal development. Methods: SHR dams received oral EGCG at 30 mg/kg body weight. Systolic blood pressure (SBP) monitored weekly throughout gestation period and until postpartum day 21. Pregnancy outcomes - litter size, pup viability, and birth weights - were recorded. SBP in weaned SHR offspring was monitored from 5 to 13 weeks of age to assess long-term effects of maternal EGCG treatment. Daily cage-side observations evaluated general health, behavior, and signs of toxicity. Plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, and creatinine were analyzed to evaluate liver and kidney function. Results: EGCG treatment in SHR dams progressively reduced maternal SBP throughout gestation and the postpartum period. However, EGCG administration did not affect pregnancy outcomes (gestation duration, litter size, and birth weights). Markers of liver and kidney function (ALT, AST, urea, and creatinine) showed no signs of organ injury in EGCG-treated groups. Contrary to expectations, SBP in SHR offspring exposed to perinatal EGCG did not decrease compared to control groups, indicating maternal EGCG did not alter the offspring's hypertension predisposition. Conclusion: Maternal EGCG supplementation effectively lowered blood pressure in hypertensive dams without compromising pregnancy outcomes or causing liver and kidney damage. These findings suggest that EGCG may be a safe cardioprotective supplement during pregnancy. However, perinatal EGCG exposure did not alter the inherent genetic predisposition to hypertension in SHR offspring. Keywords: Theaceae; Camellia sinensis; green tea; catechins, EGCG; hypertension, pregnancy outcomes, perinatal, spontaneously hypertensive rats, chronic hypertension during pregnancy

Take Two: Second Systolic Blood Pressure Provides Prognostic Information in Trauma

Abstract Introduction: An initial systolic blood pressure (SBP1) of &lt;110 mmHg has been shown to predict mortality. However, SBP1 may not reflect hemodynamic changes during initial resuscitation. We aimed to determine if the second recorded blood pressure (SBP2) could provide additional prognostic value. Methods: An 8-year retrospective chart review was performed including patients who underwent trauma activations at a single institution. The initial systolic blood pressure (SBP 1) and second systolic blood pressure (SBP 2) were analyzed. Difference between the first and second systolic blood pressure (ΔSBP) was defined as SBP2 − SBP1. The primary outcome was inhospital mortality, and the secondary outcome was receipt of ≥2 units of blood in the first 4 h of admission. Univariable analysis and logistic regression analysis were performed to assess the relationship of SBP2 and ΔSBP with the study outcomes. Regression model fit was assessed by the likelihood ratio test and Akaike information criterion. Results: Eight thousand seven hundred and ninety-eight patients were included with 12% and 13% presenting with SBP1 &lt;110 mmHg and SBP2 &lt;110 mmHg, respectively. Four hundred and six (5%) died and 327 (4%) received ≥2 units of blood in the first 4 h. The addition of ΔSBP to regression models improved model fit in explaining the primary and secondary outcomes. Subgroup analysis found that the addition of ΔSBP improved model fit for those with penetrating mechanism of injury and those with Injury Severity Score of ≥9, but not for those with blunt moderate or severe traumatic brain injury. Conclusion: SBP2 offers additional prognostic value in predicting trauma outcomes. Incorporating subsequent hemodynamic data during resuscitation beyond the initial SBP in trauma databases should be considered.

Clinical profiles and shortterm outcomes of women with peripartum and dilated cardiomyopathies

Background: We aimed to compare the clinical and sociodemographic characteristics, rate of left ventricular reverse remodeling (LVRR), heart failure hospitalization and allcause mortality of women with peripartum and dilated cardiomyopathies (PPCM and DCM respectively) in Nigeria. Methods: This was a prospective longitudinal study and a total of 130 patients (65 for each group) were recruited consecutively and followed up for 6 months. Results: PPCM patients were younger, but the DCM patients had higher frequency of atrial fibrillation and complete left bundle branch block, higher mean left atrial and LV dimensions, higher LV filling pressures, and worse renal dysfunction, respectively, at baseline. At the end of the 6month followup, 15 female DCM vs 21 PPCM patients (p=0.684) had achieved LVRR, 13 DCM vs 11 PPCM patients (p=0.098) were hospitalized for heart failure, and 10 DCM vs 5 PPCM patients (p=0.098) had died. The odds for achieving LVRR was independently increased by systolic blood pressure (SBP) &gt;100 mmHg and tricuspid annular plane systolic excursion &gt;16 mm at baseline in PPCM patients, and by use of angiotensin converting enzyme inhibitors at baseline in female DCM patients. The odds for mortality were increased by tachycardia and pericardial effusion and reduced by the use of loop diuretics at baseline in DCM patients, and SBP &lt;90 mmHg at baseline increased it by 9fold in PPCM patients. Conclusions: Our results suggest that women with DCM and PPCM differ significantly in their demographic and clinical characteristics, and predictors of clinical outcomes.

Longer-term effects of intermittent fasting on body composition and cardiometabolic health in adults with overweight and obesity: A systematic review and meta-analysis.

The aim of the present study was to investigate the effects of long-term intermittent fasting (IF) on body composition and cardiometabolic health in adults with overweight and obesity. PubMed, Web of Science, and Scopus were searched from inception to March 2024 to identify original randomized trials that investigated the effects of IF versus either a control diet (CON) and/or continuous caloric restriction (CR). Participants were adults with overweight and obesity and intervention durations were ≥ 6 months. Overall, a total of 24 studies involving 2032 participants were included in the meta-analysis. Compared with CON, IF significantly reduced body weight [WMD: -2.84 kg], BMI [WMD: -1.41 kg.m2], fat mass [WMD: -3.06 kg], fat-free mass [WMD: -0.81 kg], waist circumference [WMD: -3.85 cm], visceral fat [SMD: -0.37], fasting glucose [WMD: -0.14 mmol/l], triglycerides [WMD: -0.12 mmol/l], and diastolic blood pressure [WMD: -2.24 mmHg]. Conversely, IF significantly increased high-density lipoproteins [WMD: 0.04 mmol/l] when compared with CON, but had no effects on insulin, hemoglobin A1c%, total cholesterol, low-density lipoprotein, or systolic blood pressure. Compared with CR, IF significantly reduced fat mass [WMD: -0.70 kg], body fat percentage [WMD: -0.59%], and DBP [WMD: -0.91 mmHg], and increased HDL [WMD: 0.03 mmol/l], with no other significant effects. Subgroup analyses showed that the mode of IF and intervention duration were the primary moderators of IF effects on the markers. In adults with overweight or obesity, IF and CR are comparably effective for reducing body weight and adiposity, as well as for improving cardiometabolic health markers.

Machine Learning-Based Prediction for Incident Hypertension Based on Regular Health Checkup Data: Derivation and Validation in 2 Independent Nationwide Cohorts in South Korea and Japan.

Worldwide, cardiovascular diseases are the primary cause of death, with hypertension as a key contributor. In 2019, cardiovascular diseases led to 17.9 million deaths, predicted to reach 23 million by 2030. This study presents a new method to predict hypertension using demographic data, using 6 machine learning models for enhanced reliability and applicability. The goal is to harness artificial intelligence for early and accurate hypertension diagnosis across diverse populations. Data from 2 national cohort studies, National Health Insurance Service-National Sample Cohort (South Korea, n=244,814), conducted between 2002 and 2013 were used to train and test machine learning models designed to anticipate incident hypertension within 5 years of a health checkup involving those aged ≥20 years, and Japanese Medical Data Center cohort (Japan, n=1,296,649) were used for extra validation. An ensemble from 6 diverse machine learning models was used to identify the 5 most salient features contributing to hypertension by presenting a feature importance analysis to confirm the contribution of each future. The Adaptive Boosting and logistic regression ensemble showed superior balanced accuracy (0.812, sensitivity 0.806, specificity 0.818, and area under the receiver operating characteristic curve 0.901). The 5 key hypertension indicators were age, diastolic blood pressure, BMI, systolic blood pressure, and fasting blood glucose. The Japanese Medical Data Center cohort dataset (extra validation set) corroborated these findings (balanced accuracy 0.741 and area under the receiver operating characteristic curve 0.824). The ensemble model was integrated into a public web portal for predicting hypertension onset based on health checkup data. Comparative evaluation of our machine learning models against classical statistical models across 2 distinct studies emphasized the former's enhanced stability, generalizability, and reproducibility in predicting hypertension onset.

Circular RNA circ_0022707 impedes the progression of preeclampsia via the miR-3135b/GHR/PI3K/Akt axis.

Preeclampsia (PE) is a severe pregnancy complication linked to maternal and fetal health, yet its underlying causes and pathogenesis remain elusive. Circular RNA (circRNA), a form of non-coding RNA, is implicated in the progression of PE; nevertheless, the specific mechanism is not fully elucidated. This study aimed to identify and validate circRNAs that are pivotal in the pathophysiology of PE. Firstly, we constructed a ceRNA network using datasets from the GEO database and identified circ_0022707 as our study target. Then, using qRT-PCR analysis, we validated that circ_0022707 was downregulated in preeclamptic placentas compared to those of normal pregnant women. In situ hybridization assays revealed that circ_0022707 existed in placental villous trophoblast cells. Additionally, Pearson correlation analysis revealed a negative relationship between the expression of circ_0022707 and PE-related indicators (systolic and diastolic blood pressure, along with 24-h proteinuria levels). Furthermore, gain-of-function experiments confirmed that circ_0022707 could promote trophoblast cell proliferation and cell cycle progression while suppressing apoptosis. In vivo experiments using a preeclampsia-like mouse model also demonstrated that circ_0022707 administration could mitigate preeclampsia-like symptoms. Mechanistically, we confirmed that circ_0022707 functions through the miR-3135b/GHR/PI3K/Akt pathway in trophoblast cells. Overall, our study has provided insight into the important function of circ_002707 in the development of PE, enhancing our understanding of the disease's mechanism and proposing a viable therapeutic strategy for PE.

The Efficacy of Active Warming in Prehospital Trauma Care: A Systematic Review and Meta-Analysis

Background/Objectives: Hypothermia can affect multiple organ systems and reduce patient comfort and is an independent predictor of mortality in trauma patients. Early prevention and management prehospitally is critical and can be approached by “warming” patients using active and/or passive measures. Therefore, this systematic review aimed to determine the efficacy of prehospital active warming (AW) in trauma patients. Methods: MEDLINE, Embase, Web of Science and CENTRAL were searched up to June 2024 for studies meeting our inclusion and exclusion criteria. Six studies were identified: four randomised controlled trials (RCTs), a non-randomised trial and an observational study. A risk-of-bias assessment was conducted using either the Cochrane Risk of Bias 2 tool or the ROBINS-I tool. Results: For the primary outcome of end core body temperature (CBT), our meta-analysis calculated a statistically significant mean difference of 0.62 °C ([95%CI: 0.17, 1.07], p = 0.007), favouring AW. For the secondary outcomes of end heart rate and end systolic blood pressure, the mean differences favoured the AW and control groups, respectively, but were not statistically significant (p = 0.45 and p = 0.64). Two of the four RCTs had an overall moderate to high risk of bias, whilst the two observational studies had a high risk of bias. Conclusions: Overall, our results suggest that AW may be effective at managing CBT, but our results are limited by a small sample size, a serious/high overall risk of bias and variable study characteristics. Larger, high-quality studies are needed to inform clinical practice and guidelines.

Health outcomes reported by healthcare providers and clients of a community-based medically tailored meal program

BackgroundMedically tailored meal (MTM) programs provide home-delivered meals to people living with serious illness and poor nutritional status. Client outcome studies have found evidence of decreased healthcare utilization and cost savings associated with MTM program participation, and inconclusive evidence of change in health measures. The purpose of this study was to use a novel observational framework to describe the client profile and change in health outcomes using routinely collected health and program data from a community-based MTM program at MANNA (Philadelphia, PA).MethodsClients reported their self-rated health and experiences of food insecurity and malnutrition. Healthcare providers reported clients’ body mass index, systolic blood pressure, and hemoglobin A1C. These health outcomes, measured at program intake and 3–6 months later, were linked with administrative data for 1,959 clients who completed at least two months of MTM services in 2020, 2021, and 2022.ResultsClients exhibited substantial heterogeneity in demographics and health status at intake. Self-reported malnutrition risk decreased significantly over program duration (p < .001). Nearly one-third of clients with poor health reported improvement over time. Over 60% of clients with obesity experienced stable BMI. Clients with hypertension experienced significant improvements in systolic blood pressure (p < .001). Clients with diabetes and available data (n = 45) demonstrated significant reduction in hemoglobin A1C (p = .005).ConclusionWe found evidence that participation in MANNA’s MTM program was associated with favorable health outcomes for clients with serious illness and nutritional risk. Community-based organizations can maximize the completeness of their data by focusing on routinely collected internal data like validated health screeners and surveys.

Oscillatory blood pressure values in newborn infants: observational data over gestational ages.

Normative blood pressure (BP) values on preterm infants exist but are based on small cohorts of infants. Utilizing electronic medical records (EMR), we can explore earlier gestational ages (GA) and follow their progression to 40 weeks corrected gestational age (CGA). A retrospective cohort study of infants within the SSM Health System from 7/01/2013 through 6/30/2023. Infants born at >22 0/7 weeks but < 41 weeks GA were included if any BP measurements existed (n=29,323 infants, 1.4 million BPs). Data was extracted electronically from EMR using Microsoft SQL. Systolic BP (SBP), mean arterial pressures (MAP), and Diastolic BP (DBP) were determined for each week of life from birth and percentile ranges (1st to 99th) for infants alive at CGA, and BP patterns for GA determined. Percentiles for SBP, DBP and MAP are provided. There is a rapid increase in BP at all gestations during the first two weeks, thus BP values are higher at any CGA in infants born at an earlier GA than infants born at that GA. For MAP values between the 5th and 10th percentile, the GA is appropriate for first week then use CGA + 5 mmHg. After the first week, 2.8 X CGA is between 90 and 95 percentile for SBP. . . The BP is dependent on the gestational age at birth and the corrected gestational age when it is measured. SBP, MAP, and DBP all increase rapidly in the two weeks of life prior to a gradual increase over time.

Adherence to antihypertensive medications in Omani patients: a comparison of drug biochemical analysis and the Morisky Medication Adherence Scale

Background: Medication nonadherence is a major risk factor for suboptimal or failed hypertension pharmacologic therapy. Objective: To determine the nonadherence rate to antihypertensive medications using high-performance liquid chromatography–tandem mass spectrometry (LC–MS/MS) and the self-reported Morisky Medication Adherence Scale (MMAS). Methods: This study used a prospective cross-sectional cohort design. Patients with hypertension aged ≥18 years and prescribed at least one antihypertensive medication were recruited from an outpatient hypertensive clinic at a tertiary healthcare institution in Oman. Adherence was assessed using LC–MS/MS urine analysis and the MMAS. Results: In total, 162 patients completed the MMAS questionnaire and provided urine samples for LC–MS/MS analysis. The overall mean age of the cohort was 55 ± 13 years, and 57% of the patients were men. The mean systolic and diastolic blood pressures were 146 ± 18 mmHg and 79 ± 10 mmHg, respectively. Using the MMAS method, 65% of the patients reported nonadherence. However, LC–MS/MS analysis revealed that only 27% of the patients were nonadherent. The adherent group by LC–MS/MS had significantly lower systolic (P = 0.026) and diastolic blood pressures (P &lt; 0.001) than the nonadherent group, whereas no differences were observed using the MMAS method. There was weak or no agreement between the MMAS and LC–MS/MS results (P = 0.142). Conclusion: Almost one-fourth of our patients with hypertension were nonadherent to their medications. There was a weak concordance between the MMAS and LC–MS/MS methods in detecting medication nonadherence. Further research into noninvasive convenient adherence scales or methods and their correlations with LC–MS/MS analysis is warranted.