Current international guidelines recommend blood pressure (BP) thresholds for patients eligible for endovascular thrombectomy (EVT). Previous studies have suggested that both low and high admission BPs are associated with poor functional outcome after EVT. However, the association between admission BP and outcomes after EVT remains poorly understood.The aim of this study was to investigate the relationship between admission systolic BP (SBP) and outcomes in patients treated with EVT and to assess whether this association is modified by IV thrombolysis (IVT) treatment and recanalization status. In this observational, international, multicenter cohort study, we used data from the EVA-TRISP registry. Consecutive patients treated with EVT with available admission SBP were included. The primary outcome was 90-day functional outcome. Secondary outcomes included 90-day mortality, 24-hour NIH Stroke Scale (NIHSS), successful recanalization, and symptomatic intracranial hemorrhage (sICH). We used multivariable regression to study the relation between admission SBP and outcomes and to assess effect modification by IVT treatment and recanalization status. We included 10.963 EVT patients. At baseline, the mean age was 72.8 years (SD 13.5), 50.2% were female and the median NIHSS at presentation was 15 (interquartile range 9-19). The association between admission SBP and functional outcome, mortality, and 24-hour NIHSS score was U-shaped, and the nadir was around 150 mm Hg. Below 150 mm Hg, every 10 mm Hg decrease in SBP was associated with higher odds of poor functional outcome (adjusted odds ratio (aOR) 1.07 [95% CI 1.02-1.11]) and mortality (aOR 1.17 [1.12-1.23]). Above 150 mm Hg, every 10 mm Hg increase in SBP was associated with higher odds of poor functional outcome (aOR 1.05 [1.01-1.08]), mortality (aOR 1.04 [1.01-1.09]), and higher 24-hour NIHSS score (β-coefficient 0.28 [0.17-0.40]). We found a positive linear relationship between admission SBP and sICH (1.04 [1.01-1.08]). IVT treatment modified the association between admission SBP and outcomes after EVT. In 5544 EVT-only treated patients, there was no longer a clear association between higher admission SBP values and worse outcome. Lower and higher admission SBP was associated with worse outcomes in the complete cohort. In EVT-only patients, this association was less evident, suggesting that high admission BP alone should not always delay or preclude treatment with EVT in otherwise eligible patients.

This study aimed to investigate whether residual kidney function (RKF) influences perioperative hemodynamic stability in hemodialysis patients. Although anesthesiologists have had the clinical impression that RKF contributes to more stable blood pressure during induction of general anesthesia, this association has not been demonstrated. We hypothesized that RKF was associated with less hypotension at induction. We conducted a single-center retrospective study of hemodialysis patients undergoing elective surgery under general anesthesia. RKF was defined as urine output ≥ 100mL/day. The primary outcome was the lowest systolic blood pressure (SBP) during induction. Propensity score matching was performed. Independent predictors of hypotension were identified using multivariable logistic regression. Of 1,086 patients screened, 882 were analyzed (RKF + 335; RKF- 527). After matching, 160 patients were included in each group. In the matched cohort, the lowest SBP was higher in the RKF + group (111 ± 32 vs. 105 ± 30mmHg; p = 0.044). In the full cohort, both the lowest SBP (112 ± 30 vs. 103 ± 29mmHg; p < 0.001) and the decrease (28 ± 33 vs. 37 ± 31mmHg; p < 0.001) were more favorable in the RKF + group, with lower phenylephrine use (0.09 ± 0.19 vs. 0.16 ± 0.35mg; p = 0.001). Logistic regression confirmed RKF, surgery type, and preoperative SBP as independent predictors. RKF was associated with higher SBP at induction of general anesthesia, independent of anesthetic and vasopressor doses. Preoperative assessment of RKF may help identify dialysis patients at risk of induction-related hypotension.

Sacubitril/valsartan is a combined neprilysin inhibitor/angiotensin II receptor blocker which simultaneously potentiates the beneficial effects of natriuretic peptides while blocking angiotensin II accumulation. Numerous studies suggest that sacubitril/valsartan has better renal protective effects compared to valsartan but the evidence remains inconsistent. This study compared renal and blood pressure (BP)-lowering effects of sacubitril/valsartan versus valsartan in rats with adenine-induced chronic kidney disease (CKD). This model replicates slow progression and structural and functional characteristics of human CKD. Male Wistar rats (n = 24) were divided into four groups and treated for 35 days as follows: group 1 served as control; group 2 received 0.25% adenine; group 3 received adenine plus sacubitril/valsartan; group 4 received adenine plus valsartan. Adenine significantly increased systolic BP. It also significantly increased the urinary albumin/creatinine ratio, N-acetyl-β-D-glucosaminidase (NAG), plasma urea, creatinine, uric acid, and neutrophil gelatinase-associated lipocalin (NGAL) while reducing creatinine clearance. Additionally, adenine significantly increased inflammatory markers, decreased antioxidant activity, and induced tubular necrosis, dilatation, and interstitial inflammation. Sacubitril/valsartan significantly reduced systolic BP, with greater effects than valsartan. Both treatments reversed adenine-induced alterations in urinary albumin/creatinine ratio, NAG, plasma urea, creatinine, NGAL, and creatinine clearance, with more pronounced improvements in urea, NAG, and creatinine clearance observed with valsartan. Furthermore, both treatments ameliorated inflammatory and antioxidant changes to a comparable extent. Both treatments showed histopathological improvements, but these were more marked with valsartan. To conclude, both sacubitril/valsartan and valsartan effectively mitigated adenine-induced CKD changes, with sacubitril/valsartan producing greater systolic BP reduction and valsartan showing more pronounced renoprotective effects.

Cardiovascular events occur 20 years earlier in Sub-Saharan Africa compared to Europe. The risk factors for atherosclerosis differ between population groups and according to age. We compared the main correlates of carotid intima-media thickness (IMT, an index of atherosclerosis) in young and older adults of African ancestry. Hemodynamic (central and peripheral arterial pressures) and metabolic factors (lipids, glucose, glycated haemoglobin), smoking status and carotid IMT were determined in 573 adult Africans. In young (age<35years, n = 181) and middle-aged (35-59years, n = 231) adults, carotid IMT was associated with hemodynamic and metabolic cardiovascular risk factors on bivariate analyses. In older (age≥60years, n = 161) adults only hemodynamic factors were associated with carotid IMT. After adjustments for confounders, lipids were not associated with carotid IMT at any adult age. Carotid IMT was independently associated with backward wave pressure (Pb, p = 0.001) and age (p = 0.006) in young adults; with hemodynamics (central systolic blood pressure, p = 0.003; Pb, p = 0.02), age (p = 0.0002), body mass index (BMI, p = 0.005) and heart rate (p = 0.007) in middle-aged adults; and with Pb (p < 0.0001), male sex (p = 0.03), and HR (p = 0.04) in older adults. Increased carotid IMT was related to Pb in young (odds ratio [OR] = 1.233, p = 0.0003) and older (OR = 1.086, p = 0.0059) adults, and BMI (OR = 1.089, p = 0.0005) in middle-aged adults. Improvements in predictive performance for detecting increased carotid IMT were shown with Pb in young (p = 0.0032) and older (p = 0.0031) adults, and with BMI (p = 0.0004) in middle-aged adults. In conclusion, in African adults in Sub-Saharan Africa, carotid IMT is associated with hemodynamic factors, but not lipids. Moreover, in young adults, carotid IMT is primarily associated with hemodynamic factors.

Introduction Beverage intake is an important yet understudied contributor to blood pressure (BP) and proteinuria. This is particularly relevant in sub-Saharan Africa, where rapid shifts toward sugar-sweetened beverages (SSBs) and ultra-processed beverages, driven by affordability and aggressive marketing, are occurring alongside a high burden of Chronic Kidney Disease (CKD) within resource-limited health systems. Additionally, there are cultural differences within African populations that make beverage patterns in sub-Saharan Africa differ across populations and from Western cultures. Methods We conducted a cross-sectional analysis of 494 participants in the Diet, CKD, and APOL1 (DCA) Study cohort in West Africa. We assessed beverage consumption from 24-h dietary recalls and patterns using principal component analysis. We analyzed associations of beverage patterns with systolic BP (SBP), diastolic BP (DBP), and proteinuria using univariate and multivariable linear mixed-effects regression models. We adjusted for covariates, such as clinical site (random effect), socio-demographic factors, and lifestyle factors. Results We identified 4 unique beverage patterns: (i) SSB and Alcohol, (ii) Milk and Alcohol, (iii) SSB and Water without Alcohol, and (iv) Milk and Milk Products. No beverage patterns showed consistent association with SBP or DBP, and sensitivity analyses of individual beverages yielded null findings. In adjusted analyses, the Milk and Milk Products beverage pattern showed a positive association with SBP (Tertile 2 vs. 1: β = 5.61 mm Hg; 95% CI: 1.54–9.57) and a directionally consistent but not significant association in tertile 3 vs. tertile 1. An exploratory interaction suggested a stronger positive association of this pattern with SBP among individuals with diabetes. Conclusion The Milk and Milk Products beverage pattern may be associated with higher SBP in adults with CKD in West Africa, with a potentially stronger association among those with diabetes. Given that no associations remained significant after false discovery rate correction, these findings should be interpreted cautiously. Future studies are needed to confirm these findings and clarify their long-term implications for kidney and cardiovascular health.

Cardiovascular diseases (CVDs) represent a growing public-health challenge in India, where nearly one in four deaths is CVD-related. Accurate risk stratification underpins targeted prevention, yet laboratory-dependent tools are often impractical in resource-limited settings. The World Health Organization (WHO) and GLOBORISK initiatives both offer non-laboratory-based 10-year CVD risk algorithms alongside their laboratory-based counterparts. We aimed to compare laboratory- and non-laboratory-based WHO and GLOBORISK CVD risk scores, assess their concordance, and examine relationships with sub-clinical atherosclerosis in a rural Indian cohort. We conducted a cross-sectional analysis of 2,465 adults (1,184 men, 1,281 women) aged 40-74 years from the third wave (2010-12) of the Andhra Pradesh Children and Parents Study (APCAPS). Participants with prior CVD were excluded. Ten-year CVD risk was calculated using sex-specific WHO (South Asia) and India-calibrated GLOBORISK models, both laboratory-based (age, sex, smoking, systolic blood pressure, diabetes, total cholesterol) and non-laboratory-based (age, sex, smoking, systolic blood pressure, BMI) algorithms. Categorical agreement was quantified via percentage agreement and quadratic weighted kappa (κ); continuous agreement by Bland-Altman analysis. We also evaluated linear associations between each risk score (categorical and continuous) and three sub-clinical atherosclerosis markers: carotid intima-media thickness (CIMT), pulse-wave velocity (PWV), and augmentation index (AIx), through sex-stratified multi-level linear regression with random intercept at the household level, adjusting for multiple testing (p < 0.01). Median WHO-CVD-risk was 6.0% (IQR 4% - 9%) in men and 3.0% (2% - 4%) in women for both lab and non-lab models; median GLOBORISK-CVD-risk was 12.0% (9% - 16%) for lab-model vs. 15.0% (10% - 16%) for non-lab-model in men and 5.0% (3% - 9%) for lab-model vs. 5.0% (3% - 9%) for non-lab-model in women. Categorical agreement was substantial to almost perfect: WHO κ = 0.82 (overall), GLOBORISK κ = 0.72. Bland-Altman analyses demonstrated mean differences <1% between lab- and non-lab-based scores, though non-lab models underestimated risk by 4.2% in diabetics and 1.2% in participants with total cholesterol ≥200 mg/dL. Both risk scores showed positive, dose-response relationships with CIMT, PWV, and AIx (p-trend<0.001), with each SD increase in CVD-scores associated with clinically meaningful increases in all three markers of sub-clinical atheroscerosis. Non-laboratory-based WHO and GLOBORISK CVD risk scores exhibit high overall agreement with laboratory-based models and correlate strongly with subclinical atherosclerosis in rural India. However, modest underestimation in high-risk subgroups (diabetics, hypercholesterolemia) warrants cautious interpretation. These findings support the feasibility of non-lab risk assessment in resource-constrained settings, while underscoring the need for prospective validation against hard cardiovascular outcomes prior to large-scale implementation.

Patients with adrenal insufficiency require glucocorticoid replacement therapy either as hydrocortisone in multiple daily doses or low-dose prednisolone once daily. Data on the long-term safety, cardiovascular risk, and quality of life (QoL) outcomes of prednisolone remain limited. In this prospective longitudinal cohort study, patients with adrenal insufficiency underwent a pre-specified switch from multiple-daily dose hydrocortisone to once-daily low-dose prednisolone (2-4mg) as part of routine clinical care and followed for at least four months. Cardiovascular risk was assessed using anthropometric and biochemical markers (lipid profile, HbA1c, C-reactive protein, blood pressure, waist and hip circumference). QoL was evaluated using a modified SF-36 questionnaire. Baseline and follow-up measures were compared using paired t-tests or non-parametric equivalents. Of the 62 enrolled patients, 48 completed follow-up. Mean age was 54.5 ± 13 years; 56% were female; 83% had secondary adrenal insufficiency. After at least four months on prednisolone, weight decreased significantly (90.6 kg to 89.6 kg, p=0.007), accompanied by a reduction in systolic blood pressure (-5 mmHg, p=0.032). Lipid parameters, HbA1c, and CRP remained unchanged (p>0.05). Energy scores improved significantly (+9 points, p=0.003), and patients reported increased treatment convenience (p=0.002). Low-dose once-daily prednisolone offers comparable cardiovascular risk to hydrocortisone while improving treatment convenience, systolic blood pressure, and SF-36 subjective energy scores. These findings support its use as a potentially preferable alternative in patients with adrenal insufficiency.

Introduction: The acute effects of aerobic exercise with blood flow restriction (AE+BFR) on systolic, diastolic, and mean blood pressure remain scarce and inconsistent in the literature. Objective: To systematically review the acute effects of AE+BFR on systolic (SBP), diastolic (DBP), and mean blood pressure (MBP) in adults and older adults. Methods: Searches were conducted in October 2025 in PubMed, EMBASE, Cochrane Library, LILACS, Scopus, and gray literature. Randomized controlled trials comparing the acute effects of a single session of AE+BFR with conventional aerobic exercise (AE-C) on blood pressure were included. Two independent reviewers performed study selection, data extraction, and assessment of risk of bias (RoB 2) and certainty of evidence (GRADE). Results: Eight studies, totaling 130 participants, were included. The qualitative synthesis indicated that seven studies found no differences in SBP, DBP, or MBP after AE+BFR compared with AE-C. One study reported an increase in DBP immediately after AE+BFR (79.23 ± 10.56 vs. 69.69 ± 8.79 mmHg; p = 0.001). All studies showed some concerns regarding risk of bias, and the certainty of evidence was rated as very low for all three outcomes. Conclusions: Most studies indicate that AE+BFR does not acutely change SBP, DBP, or MBP compared with conventional aerobic exercise. However, the small number of studies, heterogeneity of protocols, and very low certainty of evidence suggest that the findings should be interpreted with caution.

Introduction: Triage data plays an essential role in the initial assessment and prioritization of emergency patients. However, the association between triage parameters and short- term mortality remains underexplored. Evaluating 24-hour and 48-hour mortality may serve as an indicator of the effectiveness of triage and early resuscitation efforts. Objectives: To determine the relationship between emergency department triage parameters and short-term mortality (24-hour and 48-hour) among patients treated at an academic teaching hospital. Methods: A retrospective cohort study was conducted on all patients admitted to the emergency department from January to February 2024. Demographic and clinical data obtained during triage were analyzed. Bivariate and multivariate binary logistic regression analyses were performed to identify factors associated with 24-hour and 48-hour mortality. Results: A total of 1,976 patients were included. The 24-hour and 48-hour mortality rates were 1% and 5%, respectively. Significant predictors of 24-hour mortality were triage category (OR = 4.42; 95% CI 1.93–10.09), respiratory rate (OR = 1.09; 95% CI 1.02–1.16). Predictors of 48-hour mortality included age (OR = 1.02; 95% CI 1.008–1.036), triage category (OR = 3.23; 95% CI 2.23–4.67), respiratory rate (OR = 1.08; 95% CI 1.03–1.13), systolic blood pressure (OR = 0.98; 95% CI 0.97–0.99), and mental status (OR = 3.58; 95% CI 2.11–6.07). Conclusion: Several routinely collected data during initial admission to the emergency unit are independently associated with both 24-hour &amp; 48-hour mortality. These results highlight that triage data can serve as meaningful predictors of early mortality and may support rapid risk stratification, resource allocation, and operational decision-making in the Emergency Department.

Objective This study aims to investigate the effects of probiotic supplementation on blood glucose, lipids and pressure in patients with coronary heart disease (CHD) through systematic review and meta-analysis, combined with sequential trial analysis, and to assess its safety. Methods A systematic search was conducted across five English-language databases: PubMed, Embase, Cochrane Library, Web of Science, and MEDLINE. The search period spanned from the inception of each database to May 31, 2,025. The baseline characteristics and data from the included studies were extracted and analyzed. Meta-analysis and trial sequential analysis (TSA) were performed using RevMan 5.3 and TSA 0.9.5.10 beta, respectively. Results A total of nine studies involving 478 patients were included in this meta-analysis. The pooled results demonstrated that, compared with the placebo group, probiotic supplementation significantly reduced levels of low-density lipoprotein cholesterol (LDL-C) [mean difference [MD] −11.16, 95% confidence interval [CI] −18.82 to −3.50, P = 0.004], total cholesterol (TC) (MD −9.32, 95% CI −18.01 to −0.63, P = 0.04), fasting blood glucose (FBG) (MD −7.82, 95% CI −15.60 to −0.04, P = 0.05), and insulin (MD −2.47, 95% CI −4.16 to −0.78, P = 0.004), and increased high-density lipoprotein cholesterol (HDL-C) levels (MD 2.24, 95% CI 0.61 to 3.87, P = 0.007). No significant effects were observed on very-low-density lipoprotein cholesterol (VLDL-C) (MD −2.89, 95% CI −6.83 to 1.05, P = 0.15), triglyceride (TG) (MD −13.45, 95% CI −28.60 to 1.70, P = 0.08), homeostasis model assessment of insulin resistance (HOMA-IR) (MD −0.43, 95% CI −1.13 to 0.28, P = 0.23), QUICK (MD 0.00, 95% CI −0.00 to 0.01, P = 0.25), systolic blood pressure (SBP) (MD −1.99, 95% CI −4.97 to 1.00, P = 0.19), diastolic blood pressure (DBP) (MD −1.23, 95% CI −3.32 to 0.86, P = 0.25), or the incidence of adverse events (MD 2.00, 95% CI 0.20 to 20.49, P = 0.56). Trial sequential analysis confirmed that the evidence for LDL-C and insulin was sufficient to reach firm conclusions. Conclusion Probiotics have been shown to significantly reduce LDL-C and insulin levels in patients with CHD without increasing the risk of adverse events. However, the impact of probiotics on other metabolic parameters such as TC, FBG, and HDL-C remains inconclusive and requires further investigation through well-designed studies. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ PROSPERO CRD420251272111.

The Mediterranean and a low carbohydrate diet are two popular dietary approaches recommended for cardiovascular and metabolic health, respectively. This trial will compare the combined effect of these diets to either approach alone for the treatment of the metabolic syndrome (MetS). Males and females (n=222), 30-75 years, with at least three MetS risk factors will be randomised to one of 3 diets: i) Traditional Mediterranean (∼55% of energy carbohydrate [CHO]:15% Protein [Pro]: 30% Fat), ii) Lower Carbohydrate (∼35%CHO:20%Pro:45%Fat), or iii) Lower Carbohydrate Mediterranean (∼35%CHO:20%Pro:45%Fat) diet for 12-weeks. The primary outcome measure is the MetS Severity Z Score (MetS-Z), a composite score of risk factors, sex and ethnicity. MetS-Z will be calculated pre and post intervention using fasted blood samples for plasma triglycerides, HDL-cholesterol and glucose, systolic blood pressure, body weight and waist circumference measures. The findings from this trial will offer new insights into the most effective dietary strategy for managing diabetes and reducing cardiovascular risk in individuals with metabolic syndrome.

Objective: This meta-analysis aimed to evaluate the impact of psychological interventions on the intraoperative outcomes in patients undergoing transcatheter arterial chemoembolization (TACE) for liver cancer. Methods: A comprehensive search was conducted using computer databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and Wanfang Database. Reference lists of relevant studies were also reviewed to ensure completeness. The quality of included studies was assessed using the Jadad scoring system. Meta-analysis was performed using RevMan 5.2.7, a statistical software provided by the Cochrane Collaboration. Results: A total of eight studies comprising 790 patients were included, comparing psychological intervention groups with control groups. The meta-analysis revealed significant differences favoring the psychological intervention group in systolic blood pressure (MD = −15.95 mmHg, 95% CI: −22.31 to −9.25, P &lt; 0.0001), heart rate (MD = −10.68 bpm, 95% CI: −13.87 to −7.48, P &lt; 0.0001), anxiety scores (MD = −2.39, 95% CI: −3.35 to −1.43, P &lt; 0.0001), and the incidence of intraoperative anxiety (OR = 0.32, 95% CI: 0.19 to 0.52, P &lt; 0.0001) compared to the control group. Conclusion: Psychological interventions significantly alleviated negative emotions in patients undergoing TACE for liver cancer, contributing to better intraoperative stability in the control group. These findings suggest that psychological support may facilitate the smooth conduct of the TACE and potentially enhance overall treatment outcomes.

Background: Early mortality risk stratification is essential in acute pulmonary embolism (PE). Integrating clinical variables with biomarkers may enhance prognostic accuracy beyond established tools. Methods: In a retrospective cohort of 322 patients with confirmed acute PE, we evaluated syncope, right-ventricular (RV) dysfunction, systolic blood pressure (SBP) and biochemical markers as candidate predictors of in-hospital mortality. A penalized logistic regression model using LASSO (least absolute shrinkage and selection operator) was developed and internally validated with five-fold cross-validation and 200 bootstrap repetitions. Discrimination, calibration and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), Brier score and decision-curve analysis (DCA). Results: In-hospital mortality was 5.6% (n = 18). LASSO retained four predictors: syncope, RV dysfunction, lower SBP and higher troponin levels. The optimism-corrected AUC was 0.70 (95% CI 0.63–0.77), with strong calibration (Brier score 0.066). DCA showed that the model provided greater net benefit than treat-all, treat-none, and sPESI strategies across threshold probabilities of approximately 7–25%, supporting its potential value for early triage. NT-proBNP, D-dimer and lactate did not add incremental predictive information after penalization. Conclusions: A simple, interpretable model integrating clinical parameters and troponin demonstrates good predictive performance and favorable clinical utility for early mortality risk estimation in acute PE. External validation is required before broader implementation.

Understanding the pathophysiology of type 2 diabetes subtypes (severe insulin-deficient diabetes, severe insulin-resistant diabetes, mild obesity-related diabetes, and mild age-related diabetes) before diagnosis can enable precision prevention. We estimated the associations of seven biomarkers with type 2 diabetes subtypes prior to diagnosis. We analyzed 69,725 observations from 9,661 adults without diabetes (median follow-up 10 years [range 0-17 years]) from four U.S. cohorts. Time-dependent Cox models estimated cause-specific hazard ratios (HRs) of seven pathophysiological biomarkers (BMI [kg/m2], systolic blood pressure [SBP] [per 10 mmHg], HbA1c [%], LDL cholesterol [per 10 mg/dL], homeostatic indices [HOMA2 of β-cell function (HOMA2-%B) (per 10 units) and HOMA2 of insulin resistance (HOMA2-IR)], and estimated glomerular filtration rate [eGFR] [per 10 mL/min/1.73 m2]) with incidence of type 2 diabetes and subtypes, adjusting for demographic and clinical covariates. Model performance was evaluated using participants' first and random visits before last follow-up. Of the pooled cohort, 1,569 individuals developed type 2 diabetes. BMI (HR 1.03 [95% CI 1.02, 1.04]), SBP (HR 1.09 [95% CI 1.05, 1.13]), HbA1c (HR 2.46 [95% CI 1.73, 3.52]), HOMA2-%B (0.89 [95% CI 0.87, 0.91]), HOMA2-IR (HR 1.92 [95% CI 1.78, 2.07]), and LDL cholesterol (HR 1.02 [95% CI 1.00, 1.04]), but not eGFR (HR 1.02 [95% CI 0.98, 1.07]), were independently associated with diabetes. Associations were similar across subtypes. Models based on single time points demonstrated a high C-index (0.81-0.90) but modest F1 scores (0.26-0.51) and varying sensitivity and calibration (slope 0.22-1.24). Pathophysiological biomarkers were prospectively associated with type 2 diabetes and subtypes, but single-time-point measurements before diagnosis could not reliably distinguish subtypes at diagnosis.

Background/Objectives: Skin carotenoid measurements have been proposed as an indicator to reflect of fruit and vegetable intake, but evidence from occupational settings remains limited. The primary aim of this study was to assess the association between fruit and vegetable intake and skin carotenoid levels in the workplace. The secondary aim was to examine the association of skin carotenoid levels with blood glucose levels and blood pressure (BP). Methods: This cross-sectional study included Japanese workers aged ≥20 years between 2022 and 2023. Skin carotenoid levels were measured, dietary intake was assessed using self-administered questionnaires, and data from workplace health check-up records were collected. Multiple regression analysis was conducted to examine the association between skin carotenoid levels and fruit and vegetable intake in 210 participants. Associations between skin carotenoid levels and log-transformed glycated haemoglobin (HbA1c), fasting blood glucose (FBG), systolic BP, and diastolic BP levels were examined in 162, 158, and 183 participants, respectively. Results: Skin carotenoid levels were positively associated with the number of vegetable dishes consumed and the frequency of fruit intake. A slight positive association was observed with HbA1c levels (partial regression coefficient = 0.00012), whereas no associations were found with FBG or BP. Conclusions: Skin carotenoid levels reflect self-reported fruit and vegetable intake, supporting their potential use as a non-invasive dietary assessment tool in workplace nutrition education. However, the associations observed with HbA1c were very small and of limited clinical significance, and the results should be interpreted with caution.

Background: Electronic cigarette adoption has transformed nicotine delivery patterns globally, with 15% prevalence among youth aged 13-15 years. The cardiovascular implications of combined electronic cigarette and combustible tobacco use remain incompletely characterized. We examined the associations of combined smoking and/or vaping versus no nicotine exposure with elevated blood pressure (BP) and hypertension prevalence using nationally representative United States data from 2021-2023. Methods: Data from the US National Health and Nutrition Examination Survey (NHANES) 2021-2023 cycle, which included 6,262 individuals aged ≥12 years old with complete smoking/vaping status: any smoking and/or vaping (n=1,190) versus no smoking or vaping (n=5,072) were used. Elevated BP was classified as ≥120/70mmHg and hypertension as ≥140/90mmHg, and history of smoking and/or vaping were collected with questionnaire. Multivariable logistic regression and mediation path analysis were conducted. Results: Among 6,262 participants (mean age 42.2 years [SD 21], 63.3% female), smokers/vapers had significantly higher prevalence of elevated BP compared to non-smokers/non-vapers (54.4% vs 39.2%, p<0.001) and hypertension (15.4% vs 11.8%, p<0.001). In fully adjusted models, smoking/vaping was associated with increased odds of elevated BP (aOR: 1.34, 95%CI: 1.12-1.60, p=0.001) and hypertension (aOR: 1.46, 95% CI: 1.06-1.99, p<0.001). Smoking/vaping was associated with a 1.05 mmHg higher diastolic BP (p<0.001) but had no association with systolic BP. Mediation analysis revealed that higher total cholesterol partly mediated (6.7% mediation effect) the relationship between smoking/vaping and diastolic BP. Conclusions: Combined smoking and/or vaping exposure was associated with higher odds of elevated BP and hypertension compared to no nicotine use. The selective diastolic BP elevation suggests an increased peripheral vascular resistance as the primary mechanism; however, longitudinal studies examining these direct vascular mechanisms are warranted.

The present study aimed to assess whether the exercise stress test influences the results of ambulatory blood pressure monitoring (ABPM) in individuals who undergo both examinations on the same day, and whether the intensity reached during the test affects the blood pressure values obtained through ABPM. A total of 190 adults participated in the study, which included two analyses: performing the tests on the same day (n=145) versus on different days (n=45) and reaching submaximal (n=95) versus maximal (n=50) heart rate during the exercise stress test. Performing the exercise stress test and ABPM on the same day did not affect maximum systolic blood pressure during wakefulness (p=0.5307) or sleep (p=0.7383), maximum diastolic pressure during wakefulness (p=0.2691) or sleep (p=0.3974), minimum systolic pressure during wakefulness (p=0.4615) or sleep (p=0.5584), or minimum diastolic pressure during wakefulness (p=0.1289) or sleep (p=0.8075). When comparing the intensity of effort reached, there were no differences in maximum systolic pressure during wakefulness (p=0.1029) or sleep (p=0.2149), maximum diastolic pressure during wakefulness (p=0.2062) or sleep (p=0.1851), minimum systolic pressure during wakefulness (p=0.7964) or sleep (p=0.8991), and minimum diastolic pressure during wakefulness (p=0.8864) or sleep (p=0.4892). No differences were found in ABPM blood pressure values between individuals who performed the exercise stress test on the same day and those who did so on different days. Additionally, the intensity reached during the test, whether submaximal or maximal, did not influence ABPM results.

ObjectivesA comparative assessment of systolic blood pressure (SBP) measurement was carried out for anaesthetised and conscious cats by using two non-invasive approaches based on the Doppler method and a newly developed oscillometric instrument.MethodsSystemic blood pressure (SBP) was recorded on 131 occasions in 26 cats entering a shelter environment. Six of these cats were monitored while under a general anaesthetic for elective procedures and the rest were conscious during routine health assessment. A paired approach was followed using the Doppler method followed immediately by the oscillometric approach. Mean values and coefficient of variations were calculated. A normal distribution was confirmed before a standard Bland-Altman analysis was completed.ResultsThe mean SBP ± standard deviation for the 131 paired readings was 113.3 ± 23.9 mmHg and 116 ± 26.7 mmHg for the Doppler and oscillometric methods respectively. The small difference in means was not significant. Anaesthetised cats had significantly lower SBP values than those that were conscious. The data set for 16 cats with three replicated paired measurements and a subset of 12 with five such replicated measurements also provided similar normally distributed mean values and a high correlation coefficient. The Bland-Altman plot suggested a positive bias of the oscillometric approach of + 3.07 ± 12.3 mmHg (limits of agreement of -21.0 to 27.1 mmHg) and + 4.93 ± 9.38 mmHg (limits of agreement of -13.5 to 23.3 mmHg) for the 16 and 12 cat subgroups respectively. There was 100% agreement between the two methods in allocation to a hypertension class.Conclusions and relevanceThe results establish that the new AutoCAT+ instrument met some of the guidelines for assessing such instruments for veterinary use with cats with a normal range of blood pressure. Further work is needed with a larger data set spanning hypotension to hypertension for complete validation.

Incidence and Risk Factors for Venous Thromboembolism in Hemodynamically Unstable Pelvic Fractures.

Abstract Introduction Elderly patients undergoing surgery for neck of femur (NOF) fractures are at high risk of post-operative hypotension due to reduced physiological reserve. Hypotension in this context is associated with an increased risk of cardiovascular events and impaired recovery. Therefore, senior clinicians often pre-emptively hold angiotensin-converting enzyme inhibitors (ACE-Is) and calcium channel blockers (CCBs) for 48 hours post-operatively, but this practice is inconsistently followed by resident doctors. We audited the prevalence and impact of this practice and introduced an intervention to improve consistency. Methods A two-cycle audit was conducted on an orthogeriatric ward. Inclusion criteria were patients aged &amp;gt;65 requiring surgery for NOF fractures. Data collected included antihypertensive use on admission, whether antihypertensives were held post-operatively, systolic blood pressure on post-operative days (POD) 1–3, episodes of moderate (90–100 mmHg) and severe (&amp;lt;90 mmHg) systolic hypotension, and potential confounders (haemoglobin drop, fluid resuscitation, age). Ethical approval was waived. After the first cycle, an intervention was introduced: (1) an induction teaching session for resident doctors and (2) a revised post-op proforma prompting holding of ACE-Is and CCBs. Results Twenty-four patients were included pre-intervention, and 25 post-intervention. 75% of patients were taking at least one antihypertensive on admission. Already in the first cycle, patients in whom antihypertensives were held pre-emptively had significantly fewer days of severe hypotension in POD 1–3 (0.36 vs. 0.64 days, p = 0.03). Prior to the intervention, antihypertensives were appropriately held in 40% of cases. Post-intervention, this rose to 88% (p = 0.04). The average number of days with severe hypotension decreased from 0.62 to 0.28 (p = 0.03), and hypotension incidence fell from 35% to 28% (p = 0.01). Conclusion Pre-emptively withholding ACE-Is and CCBs post-operatively for 48 hours in elderly patients reduces the incidence and duration of hypotension. Teaching and documentation prompts can embed this practice into routine care and improve post-operative outcomes.