Diastolic Blood Pressure Values Research Articles

Ability and accuracy of patient-performed blood pressure monitoring among pregnant women in urban Ghana

Patient-performed blood pressure monitoring in pregnancy is rarely performed in low- and middle-income country settings, including Ghana. The clinical efficacy of home blood pressure monitoring relies on a pregnant patient being able to independently execute the correct steps to position and use a blood pressure monitor and to achieve accurate blood pressure measurements. This study aimed to (1) assess whether pregnant women can correctly use an automatic blood pressure monitor to check their blood pressure before and after a brief training and (2) determine whether blood pressure values measured by pregnant women using an automatic monitor are similar to values measured by a healthcare provider using a standard clinic monitor. This was a cross-sectional study conducted at the Korle Bu Teaching Hospital, a tertiary hospital in Accra, Ghana. Participants were adult pregnant women presenting for their first prenatal care visit. Data collection was performed by 2 Ghanaian physicians. Information on demographics, obstetrical history, and past medical history was collected. A brief training was provided on the correct use of the blood pressure monitor, including a verbal script, annotated photographs, and a hands-on demonstration. Pre- and posttraining assessments using a 9-item checklist of correct preparation, position, and use of an automatic blood pressure monitor were performed. Following a modified British Hypertension Society protocol, a series of 4 blood pressure measurements were taken, alternating between provider performed using a clinic monitor and patient performed using an automatic monitor intended for individual use and validated in pregnancy. Among 176 participants, the mean age was 31.5 years (±5.6), and 130 (73.9%) were multiparous. Regarding socioeconomic characteristics, 128 (72.7%) were married, 171 (97.2%) had public insurance, and 87 (49.7%) had completed ≤9 years of formal education. Regarding clinical blood pressure issues, 19 (10.9%) had a history of a hypertensive disorder in a previous pregnancy, and 6 (3.4%) had chronic hypertension. Before receiving any training, 21 participants (12.1%) performed all 9 steps correctly to prepare, position, and use the automatic blood pressure monitor. Comparing pretraining vs posttraining ability, statistically significant increases were seen in the correct performance of each step and the mean number of steps performed correctly (6.1±1.8 vs 9.0±0.2, respectively; P<.001) and proportion performing all 9 steps correctly (12.1% vs 96.6%, respectively; P<.001). The mean difference between doctor-performed and patient-performed blood pressure measurements was 5.6±4.8 mm Hg for systolic blood pressure values and 3.4±3.08 mm Hg for diastolic blood pressure values, with most differences within 5 mm Hg for both systolic blood pressure values (102/176 [58.0%]) and diastolic blood pressure values (141/176 [80.1%]). After a brief training, pregnant women in Ghana demonstrated that they are able to use an automatic blood pressure monitor to check their blood pressure correctly and accurately.

ABILITY OF A CUFFLESS 24 HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT DEVICE TO TRACK BLOOD PRESSURE CHANGES COMPARED TO A CUFF-BASED DEVICE

Objective: There is an increasing number of cuffless blood pressure (BP) measurement devices on the market. Beneath the absence of generally accepted validation protocols for these devices, the ability of these devices to track changes in BP levels over 24h in relation to an initial calibration BP is unknown. Aim of this study was to analyse this ability in a cuffless 24h BP device using pulse transit time. Design and method: We prospectively enrolled 166 participants for simultaneously performed cuffless (TestBP, Somnotouch NIBP) and cuff-based (RefBP, Spacelabs 90217A or IEM Mobil-o-graph) 24h BD measurements. Main exclusion criteria were atrial fibrillation or an inter-arm difference of &gt;10 mmHg. TestBP calibration was based on initial RefBP measurement (CalibBP). As surrogate parameters for tracking individual changes in BP levels after the CalibBP, we used the difference between CalibBP and mean 24h, awake and asleep BP measured by RefBP and TestBP. Additionally, we analysed the relationship between the difference of CalibBP and RefBP vs the difference between RefBP and TestBP. Results: Mean (±SD) age was 51.2 (15.1) years and 53% were male. Mean (±SD) difference between CalibBP and mean 24h BP by RefBP / TestBP were 7.4 (13.2) versus 1.8 (8.3) mmHg for systolic (p &lt; 0.0001) and 6.6 (6.8) versus 1.6 (5.8) mmHg for diastolic (p &lt; 0.0001). Corresponding ranges for CalibBP-RefBP were -35 – 55 mmHg vs. -14 – 34 for CalibBP-Test BP. Figure 1 shows a near linear relationship between the difference between CalibBP and RefBP and the difference between RefBP and TestBP for systolic and diastolic BP values. Red line indicates the theoretical situation that TestBP follows CalibBP without tracking changes in BP levels, green line an ideal agreement of RefBP and TestBP. Conclusions: This is the first study to show the lower ability of the cuffless BP device to track changes of BP levels after an initial calibration measurement compared to a standard cuff-based device over 24h. Additionally, the difference between the RefBP and the TestBP was nearly linearly associated with the difference between a CalibBP and the changes of the BP level.

SEX DIFFERENCES IN PULSE WAVE AND SUBENDOCARDIAL VIABILITY RATIO IN HYPERTENSIVE PATIENTS

Objective: Myocardial ischemia represents the main cause of morbidity and mortality in hypertensive patients in both women and men, although some difference in pathophysiology and in the exposure to risk factors may explain the lower global cardiovascular risk of women. Sex differences in the structure and function of the cardiovascular system may affect the aortic pressure wave and the functional balance in myocardial perfusion determined by central aortic pressure, which may lead to myocardial ischemia and type 2 myocardial infarction. Design and method: In a population of 318 treated hypertensive patients (162 females, 156 males) referring to a single Hypertension centre (University of Trieste, Italy), we measured peripheral blood pressure and performed arterial applanation tonometry (PulsePen, DiaTecne, Italy) to determine central blood pressure waveform, aortic pulse wave velocity (PWV), augmentation index (AIx), pulse wave separation analysis with timing and amplitude of forward (fT, fP) and backward reflected (bT, bP) waves, and the subendocardial viability ratio (SEVR), i.e. the ratio between diastolic and systolic pressure-time index, as a risk marker of myocardial ischemia. Results: Despite similar peripheral systolic and diastolic blood pressure values, heart rate and PWV between sexes, females showed a longer forward pressure wave duration (119.8±38.6 vs 105.0±30.4 ms, p&lt;0.0001) and lower amplitude (52.7±19,4 vs 57.1±19.3 mmHg, p = 0.039) compared to males. Backward pressure waved were similar in timing and amplitude between males and females. The difference in forward wave caused a marked higher AIx (19.5±12.4 vs 11.9±14.9, p&lt;0.0001) and a lower SEVR (101.6±24.4 vs 108.5±27.7, p = 0.018) in women compared to men. Conclusions: Hypertensive women and men showed significant differences in forward pressure wave, causing a significant increase in AIx and a decreased SEVR in women compared to men. This may have important implications in sex-specific risk and myocardial ischemia.

MACHINE LEARNING CLASSIFICATION ON BLOOD PRESSURE VARIATION FOR THE RISK OF COGNITIVE IMPAIRMENT: A CROSS-SECTIONAL STUDY FROM A BLOOD PRESSURE MANAGEMENT COHORT IN HONG KONG

Objective: The evidence for the association between blood pressure variability (BPV) with cognitive impairment is still uncertain in the Asia population. This study explored whether a machine learning classification on BPV is associated with cognitive impairment among the elderly in Hong Kong. Design and method: Random samples of 573 participants were selected from a community-based cohort for blood pressure management in July 2021. Participants regularly measured blood pressure. K-means clustering methods were applied to group the standard deviation of BPV into high, medium, and low variations. This method considered both systolic and diastolic blood pressure variations. For cognitive functions, participants were assessed by the shorted version of the Montreal Cognitive Assessment Version, i.e., 5-min MoCA (Hong Kong validated version). Mild cognitive impairment (MCI) was defined with adjustment of age and education according to the 5-min MoCA. BPV was defined as the standard deviation of systolic and diastolic blood pressure values. Logistic and quantile regression models were conducted to explore the association of MCI with systolic or diastolic BPV and a combined BPV classification. Odds ratios (OR) were adjusted for age, gender, educational background social economic status, and other medical histories, including hypertension, hyperlipidemia, diabetes, and stroke. Results: The 573 participants had a mean age of 72 years with 86% of females. The median follow-up period was eight months with a median number of 19 blood pressure records. Systolic BPV increases the risk of MCI (adjusted OR, 95% CI = 1.18, 1.05 to 1.31), but not diastolic BPV. The quantile regression found that the magnitude of association is more substantial among the population with lower cognitive function (Figure 1). With reference to the machine learning classification, participants with high BPV were shown to have a 5.5 times higher risk of MCI than those with low BPV. Conclusions: Participants with higher systolic BPV are shown to be associated with poorer cognitive function, and therefore, long-term management of blood pressure variability is also important to reduce the risk of cognitive impairment.

ROLE OF NATRIURESIS AND FRAILTY IN BLOOD PRESSURE REGULATION IN ELDERLY PEOPLE

Objective: The objective of the study is to investigate, in elderly people, the relationship between natriuresis, frailty and blood pressure (BP). Design and method: The FRASNET geriatric population (1204 subjects) is an Italian observational cohort that includes frail (35%), pre-frail (37.3%) and robust (27.7%) subjects. They have been characterised for BP, renal function, sodium intake (by Kawasaki formula), anthropometric data, cognitive status, quality of life, comorbidities, and chronic therapies. ANOVA and conditional inference tree analyses have been carried out. Results: 745 participants out of 1203 (60%) were under anti-hypertensive treatment. Increased visceral fat, male sex and lower number of medications taken are risk factors for suboptimal control of BP (71.4%). An inferential analysis evidenced (Fig. 1) a first node between male and female, a second one according to age (75 y), a third with natriuresis (217 mEq/24h). Non-frail subjects presented the highest values for both systolic and diastolic BP; the frail group presents systolic BP values below the threshold of 140 mmHg. BPs are negatively correlated with frailty status (systolic p = 0.048, diastolic p &lt;0.001, Figure 2). Conclusions: Frailty and blood pressure follow an inverse tendency: the higher the severity of the frail status, the lower the blood pressure. The relationship between BP and natriuresis is preserved only in young women whereas in very old people (&gt;75 y) is no more present. This evidence is supported by physiological explanations and suggest to be cautious in salt reduction intake in elderly people.

ASSOCIATION OF PLASMA METANEPHRINES LEVELS WITH CARDIOMETABOLIC RISK IN ESSENTIAL HYPERTENSIVE INDIVIDUALS

Objective: The aim of the study was to evaluate a possible relationship between plasma metanephrine concentrations and some surrogate parameters of cardio-metabolic damage such as carotid intima media thickness (IMT), cardiac left ventricular mass (LVM) and left ventricular hypertrophy (LVH) in patients with essential hypertension (EH). Design and method: From January 2021 to September 2022, we consecutively enrolled 719 essential hypertensive patients (367 men and 352 women, mean age 52.2 ± 15 years) without cardiovascular complications, distinguishing patients in quartiles according to plasma metanephrine concentration (PMC). Results: compared with the first quartile, the highest PMC quartile was associated with the highest levels of of 24-h μalbuminuria (20.1 ± 8.9 mg/24 h and 11.4 ± 6.2 mg/24 h, p = 0.04), serum creatinine (0.96 ± 0.2 mg/dl vs 0.90 ± 0.22 mg/dl; p = 0.002), plasma calcium (9.5 ± 0.4 mg/dl vs 9.38 ± 0.4 mg/dl; p = 0.004) and a lower prevalence of metabolic syndrome (18% vs 32%; p = 0.001). More male hypertensives belonged to the fourth quartile than to the first quartile (64% vs 43%, p&lt;0.001). Moreover, we found that the fourth PMC quartile was associated with higher values of 24h-ABPM diastolic blood pressure (78.8 ± 9.0 mmHg vs 76.3 ± 9.1 mmHg; p = 0.007), higher values of left ventricular myocardial mass indexed for body surface area (LVMi) (89.0 ± 27.0 g/m2 vs 81.8 ± 21.9 g/m2; p = 0.01) and left ventricular hypertrophy (LVH) (18% vs 11%, p = 0.031) prevalence than the first PMC quartile. PMC was also found to be an independent predictor of the presence of LVH and μalbuminuria. Conclusions: Our results revealed that higher PMC values are strongly associated with increased LVMi and μalbuminuria that, together with elevated blood pressure values, are strictly correlated with higher risk of atherosclerosis and cardiovascular complications.

TREATMENT OF HYPERTENSION WITH COMBINATION OF IRBESARTAN AND AMLODIPINE: A REAL-LIFE OBSERVATION STUDY (ON-TRACK STUDY)

Objective: The On-Track study (Old versus New blood pressure TaRget Achievement under Irbesatan/Amlodipine Combination: General Practice WorK experience) is a real life study conducted to evaluate the fixed combination of Irbesartan and Amlodipine. The aim of this study was to assess the efficacy of the fixed combination Irbesartan/Amlodipine in reducing blood pressure (BP) and achieving target BP and its safety profile. Design and method: This is an observational, prospective, multicenter study which included patients with newly diagnosed and untreated hypertension (BP higher or equal to 140/90 mmHg) or uncontrolled hypertension on monotherapy or uncontrolled hypertension with any two-drug combination other than irbesartan/Amlodipine. Patients included were prescribed the combination drug Irbesartan/Amlodipin at different doses and followed up for 6 months. Results: A total of 1012 patients were included in this study in the intention-to-treat analysis. 536 patients were treated with Irbesartan/Amlodipine 150/5, 421 patients with Irbesartan/Amlodipine 300/5, and 55 patients with Irbesartan/Amlodipine 300/10. Systolic and diastolic blood pressure (SBP and DBP) values were recorded for patients at inclusion and at each study visit. There was a significant decrease of mean SBP at 6 months compared to SBP at inclusion ( 167.4±16.8 mm Hg 128.6±8.5 mm Hg, p&lt;0.001) and of DBP ( 91.7±10.0 mmHg vs 76.4±6.2 mmHg p &lt; 0.001). At six months the target BP of &lt; 140/90 mm Hg was achieved in 87.1 % of patients, and the target BP &lt; 130/80 mm Hg was achieved in 39.5 % of patients. The rate of adherence to treatment was 88.5 %. Adverse events were reported in 22.3 % of patients mainly oedema in 11 % of cases. None of the patients in the study reported a serious adverse event that would have led to discontinuation of treatment Conclusions: This study confirms the efficacy of the irbesartan-amlodipine fixed-dose combination when applying the old targets of BP but more efforts should be done to achieve new target BP. We noticed a good tolerability and adherence to treatment of patients under this drug combination.

MICROCIRCULATION AND BLOOD PRESSURE/HEART RATE RESPONSE DURING EXERCISE STRESS TESTING IN HYPERTENSIVE PATIENTS

Objective: A hypertensive response during exercise has been associated with adverse cardiovascular outcomes in general population and hypertensive patients. On the other hand, microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients. Design and method: We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope. Results: A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson's r = -0.365, p = 0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson's r = -0.364, p = 0.024) as well as between heart rate increase from stage 1 to 2 and capillary density Pearson's r = -0.746, p = 0.013). Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase. Conclusions: These findings suggest that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.

NOVEL BIOMARKERS AND ECHOCARDIOGRAPHIC FINDINGS IN ACUTE RHEUMATIC FEVER PATIENTS

Aim: Acute rheumatic fever (ARF) is an inflammatory disease that develops after Group A Streptococcal (GAS) tonsillopharyngitis in genetically susceptible individuals. We aimed to examine the clinical, laboratory, and echocardiographic findings of the patients diagnosed and followed up with ARF. &#x0D; Methods: 55 patients under the age of 18 who were hospitalized and followed up with the diagnosis of ARF between January 2017 and January 2019 were included in this retrospective study. All cases were diagnosed with ARF according to the 2015 revised Jones criteria according to the intermediate-risk group. Gender, age, time of admission, physical examination findings, laboratory findings, echocardiographic findings, and data meeting major and minor diagnostic criteria of all patients diagnosed with ARF were recorded. Echocardiography and electrocardiography were performed on all patients. Inflammatory biomarkers were calculated using laboratory parameters. The data before the treatment and at the 8th week of the treatment were compared.&#x0D; Results: 31 (56.4%) of the patients were female and 24 (43.6%) were male, the mean age was 13.70±2.44 years (7-18 years). The highest number of patients was in the 9-14 age group. The most frequent hospital admission season was winter. Arthritis and carditis were the most common major criteria. Post-treatment body weight, height, body mass index, and systolic and diastolic blood pressure values of the patients were statistically significantly higher than before treatment (p

0465 Difficulty initiating and maintaining sleep is associated with increased blood pressure in people with obstructive sleep apnea

Abstract Introduction Approximately 30-50% of people with obstructive sleep apnea (OSA) have difficulty initiating and/or maintaining sleep (DIMS). The co-occurrence of OSA and DIMS is associated with worse mental health and quality of life compared to OSA alone. This study investigated potential associations between OSA and regular sleep disturbances (defined over multiple months) with blood pressure and hypertension. Methods A validated under-mattress sleep analyzer (WITHINGS) monitored sleep in 12,287 participants over ~6-months at home. The mean apnea-hypopnea index (AHI), sleep onset latency (SOL) and wake after sleep onset (WASO) were calculated over the recording period. OSA was defined as an average AHI ≥ 15 events/hour. DIMS was defined as an average SOL ≥30 min and/or WASO ≥ 45min. Participants were categorized into those with neither condition (control), OSA-alone, DIMS-alone, and OSA+DIMS. Blood pressure measurements were recorded using a home monitor to define hypertension based on mean systolic blood pressure ≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between OSA+DIMS and hypertension were investigated using regression analyses controlled for age, sex, and BMI. Results Participants were middle-aged (Mean±SD; 50±12 y), mostly men (88%) and overweight (BMI; 28±6 kg∙m-2). The prevalence of DIMS-alone, OSA-alone and OSA+DIMS was 10%, 21% and 8%, respectively. OSA-alone was associated with (mean [95%CI]) 4.5 [4.1, 5.0] and 2.6 [2.3, 2.93] mmHg higher systolic and diastolic blood pressure values compared to control. OSA+DIMS was associated with a 5.9 [5.3, 6.6] and 3.7 [3.3, 4.2] mmHg difference compared to control, and the increased difference was greater than OSA-alone (systolic: +1.4 [0.8, 2.0]; diastolic: +1.12 [0.7, 1.6] mmHg; p-values &amp;lt; 0.001).Furthermore , OSA-alone and OSA+DIMS were associated with a 37 [22 to 54] and a 60 [36 to 88] % increase in hypertension prevalence compared to control, respectively. OSA+DIMS had a greater increase in hypertension prevalence (17% [-1 to 38%]) compared to OSA-alone. Conclusion OSA when combined with difficulties initiating and maintaining sleep, consistent with insomnia symptomology, was associated with higher blood pressure and increased hypertension prevalence compared to OSA-alone. Support (if any)

Continuous cuffless blood pressure monitoring using photoplethysmography-based PPG2BP-net for high intrasubject blood pressure variations

Continuous, comfortable, convenient (C3), and accurate blood pressure (BP) measurement and monitoring are needed for early diagnosis of various cardiovascular diseases. To supplement the limited C3 BP measurement of existing cuff-based BP technologies, though they may achieve reliable accuracy, cuffless BP measurement technologies, such as pulse transit/arrival time, pulse wave analysis, and image processing, have been studied to obtain C3 BP measurement. One of the recent cuffless BP measurement technologies, innovative machine-learning and artificial intelligence-based technologies that can estimate BP by extracting BP-related features from photoplethysmography (PPG)-based waveforms have attracted interdisciplinary attention of the medical and computer scientists owing to their handiness and effectiveness for both C3 and accurate, i.e., C3A, BP measurement. However, C3A BP measurement remains still unattainable because the accuracy of the existing PPG-based BP methods was not sufficiently justified for subject-independent and highly varying BP, which is a typical case in practice. To circumvent this issue, a novel convolutional neural network(CNN)- and calibration-based model (PPG2BP-Net) was designed by using a comparative paired one-dimensional CNN structure to estimate highly varying intrasubject BP. To this end, approximately 70%, 20%, and 10% of 4185 cleaned, independent subjects from 25,779 surgical cases were used for training, validating, and testing the proposed PPG2BP-Net, respectively and exclusively (i.e., subject-independent modelling). For quantifying the intrasubject BP variation from an initial calibration BP, a novel ‘standard deviation of subject-calibration centring (SDS)’ metric is proposed wherein high SDS represents high intrasubject BP variation from the calibration BP and vice versa. PPG2BP-Net achieved accurately estimated systolic and diastolic BP values despite high intrasubject variability. In 629-subject data acquired after 20 minutes following the A-line (arterial line) insertion, low error mean and standard deviation of 0.209pm 7.509 and 0.150pm 4.549;textrm{mmHg} for highly varying A-line systolic and diastolic BP values, respectively, where their SDSs are 15.375 and 8.745. This study moves one step forward in developing the C3A cuffless BP estimation devices that enable the push and agile pull services.

EFFECT OF SITAGLIPTIN ON BLOOD PRESSURE IN PRE-HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES

Objective: To determine the effects of Sitagliptin on pre-hypertensive type-2 diabetes mellitus patients.&#x0D; Methods: This Quasi-Experimental study was conducted at Medical inpatient and outpatient department and Diabetic Clinic of Mayo Hospital, Lahore, from February 2019 till January 2020. A total of 146 patients were included in study. Blood pressure (BP) was recorded at baseline and then at 3, 6 and 12 months of treatment. Patients were called for follow up at 3 and 6 months, their BP was checked and haemoglobin A1c (HbA1c) was also sent to check for glycemic control. At 12 months, final follow up was called. BP and HbA1c of every patient were checked and recorded. The blood pressure values at baseline, 3 months, 6months and 12 months were comparatively analyzed by using a paired t-test and p-value of 0.05 was considered significant.&#x0D; Results: Total 146 patients of type-2 diabetes with HbA1c ≤ 9 % not taking sitagliptin previously were selected for this study. Mean age of the patients was 57.5±10.7 years. Total 93(63.7%) were males and 53(36.3%) females. There was statistical difference of HbA1c, systolic and diastolic blood pressure values (p&lt;0.05) after 3 months, 6 months and 12months of sitagliptin therapy as compared to baseline.&#x0D; Conclusions: Sitagliptin therapy significantly decreases blood pressure and levels of HbA1c in type 2 diabetic-hypertensive patients.

Comparison of SCORE and SCORE 2 model for cardiovascular risk stratification in men and women from high risk European country

Abstract Funding Acknowledgements Type of funding sources: None. European Society of Cardiology has recently introduced new SCORE 2 algorhythm for cardiovascular risk assessment in apparently healthy individuals. However, there are limited data from high risk countries on CV risk stratification and potential gender differences in risk estimation using SCORE 2 model. The aim of the current study was to compare risk prediction using SCORE 2 and previous SCORE model and to assess the potential gender differences in risk estimation. Methods Our study included 1361 apparently healthy individuals (mean age 56±9 years, 61% women) without known CV disease or risk factors aged 40 to 70 years old. Data on CV risk factors were prospectively collected in 20 primary care centers throughout Serbia from January 2020 to December 2020. CV risk was assessed both by SCORE and SCORE 2 model. Based on CV risk profile individuals were stratified in three categories: low to intermediate, high and very high risk category. Results In overall population using SCORE model 57.6% of individuals were in low-intermediate group, 20.9% were classified as high risk group and 21.5% as very high risk group. By the use of SCORE 2 model 1046/1361 (77%) individuals were shifted to higher risk category (Figure). In comparison to men women had lower both systolic (139 ± 19 mmHg vs 144 ± 18 mmHg in men p &amp;lt; 0.001) and diastolic (84 ± 9 mmHg vs 88 ± 10mmHg in men, p &amp;lt; 0.001 )blood pressure, lower BMI (26.4 ± 0.5 kg/m2 vs 27.4 ± 5.0 kg/m2 in men, p= 0.036) and higher values of HDL cholesterol (1.5 ± 0.5 mmol/L vs. 1.3 ± 0.4 mmol/L in men, p &amp;lt; 0.001). Smoking was more prevalent in men (49%) than in women (42%), p=0.04. There were no gender differences in age (56 ± 9 years for both genders) and non-HDL cholesterol ( 4.86 ± 1.24 mmol in men vs. 4.75 ± 1.23 mmol/l in women, p= 0.100). More women (85.9%) than men (62.6%) were shifted in higher risk category using SCORE 2 in comparison to SCORE (p &amp;lt; 0.001) (Figure). Conclusion By the use of SCORE 2 instead of SCORE prediction model for CV risk stratification in contemporary high risk European population significant proportion of apparently healthy individuals are shifted to higher risk category. In spite of having better CV risk factors profile, more women than men were shifted in higher risk category.

Blood Pressure Correlates with Serum Leptin and Body Mass Index in Overweight Male Saudi Students.

The precise association of serum leptin (Lep) with the body mass index (BMI) and blood pressure (BP) is not well known for understanding their involvement in health and disease. Hence, the present study was conducted to investigate the association of BP, BMI and serum Lep levels in young normal-weight (NW) and overweight (OW) male Saudi students. The NW (n: 198) and OW (n: 192) male subjects in the age range of 18-20 years were consulted. The BP was measured with a mercury sphygmomanometer. Leptin Human ELISA Kits were employed for the determination of the serum Lep levels. The mean ± SD values of BMI (kg/m2), Lep (ng/mL), systolic BP (SBP; mmHg), and diastolic BP (DBP; mmHg) all showed significant differences for young OW vs. NW subjects as: 27.52 ± 1.42 vs. 21.49 ± 2.03; 10.70 ± 4.67 vs. 4.68 ± 1.91; 121.37 ± 2.59 vs. 118.51 ± 1.54 and 81.44 ± 1.97 vs. 78.79 ± 1.44, respectively. All associations (among BMI, Lep, SBP and DBP) showed a positive linear and significant correlation, except the nonsignificant correlation of BMI and SBP for the NW group. Other variables showing significant variation for NW vs. OW subjects were: interleukin-6, high sensitivity C-reactive protein, apelin (APLN) and resistin. Serum APLN correlated significantly with Lep, BMI, SBP and DBP in lower and higher levels of BMI, with considerable progressive patterns in both the NW and OW groups and subgroups. The present study in young Saudi male students presents significant variations for BP and serum leptin levels, and a significant positive linear association among serum leptin, BMI and BP.

Role of serum renalase levels in predicting the presence of metabolic syndrome in patients with polycystic ovary syndrome

ObjectiveThis study was designed to compare the serum renalase levels of polycystic ovary syndrome (PCOS) women with and without metabolic syndrome (MS) and those of healthy non-PCOS women. Materials and methodsSeventy-two patients diagnosed with PCOS and age-matched 72 healthy non-PCOS were included in the study. The PCOS group was divided into two groups as having metabolic syndrome or not. General gynecological and physical examination findings and laboratory results were recorded. Renalase levels in serum samples were determined using Enyzme-Linked ImmunoSorbent Assay method. ResultsMean serum renalase level was significantly higher in PCOS patients with MS compared with both PCOS patients without MS and healthy controls. Additionally, serum renalase correlates positively with body mass index, systolic and diastolic blood pressure, serum triglyceride and homeostasis model assessment-insulin resistance values among PCOS women. However, systolic blood pressure was found to be the only significant independent factor that can affect the serum renalase levels. A serum renalase level of 79.86 ng/L had a sensitivity of 94.7% and specificity of 46.4% in discriminating PCOS patients with metabolic syndrome from healthy women. ConclusionsSerum renalase level increases in women with PCOS in the presence of metabolic syndrome. Therefore, monitoring the serum renalase level in women with PCOS can predict the metabolic syndrome that may develop.

Subfatin, asprosin, alamandine and maresin-1 in cerebral ischemia, intracranial and subarachnoid hemorrhages.

Cerebrovascular diseases (CVDs) remain an important public health issue due to the increasing number of deaths worldwide. Changes in the synthesis and release of peptides in CVDs may play an important role in elucidating the physiopathology of the disease. Therefore, this study was to investigate the fate of maresin-1 (MaR-1), subfatin (SUB), asprosin (ASP), and alamandine (ALA) levels in patients with cerebral infarction (CI), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH) evaluated within the scope of CVDs, and voluntary healthy controls. The study participants were divided into 4 groups: CI patients, ICH patients, SAH patients, and healthy volunteers. The diagnosis of CVDs was made based on the National Institutes of Health Stroke Scale (NIHSS), Intracerebral Hemorrhage Score (ICHS), Botterel-Hunt-Hess Scale (BHHS), and cranial computed tomography (CT). The levels of MaR-1 (ng/mL), SUB (ng/mL), ASP (ng/mL), and ALA (pg/mL) in the blood samples collected from the participants were studied using the ELISA method. Other parameters included in the study were obtained from the patient records of our hospital. The comparison of MaR-1 [(control 1.38 ± 0.14), SAH (0.98 ± 0.087), CI (0.67 ± 0.04), ICH (0.51 ± 0.03)], SUB [(control (13.2 ± 1.4), SAH (10.1 ± 1.2), CI (7.9 ± 0.8), ICH (5.8 ± 0.5)], and ALA [(control (67.2 ± 7.9), SAH (58.2 ± 4.3), CI (42.1 ± 3.7), and ICH (34.2 ±3.9)] values revealed a significant decrease compared to the control values. The comparison of the ASP values of SAH, CI, and ICH patients and control values (11.6 ± 1.2) showed significantly higher asprosin values in SAH (13.8 ± 1.1), CI (15.4 ± 1.2) and ICH (28.9 ± 2.8) patients. Similarly, systolic blood pressure (SBP), diastolic blood pressure (DBP), and glucose levels of CKD patients were also high. Decreased MaR-1, SUB, ALA and increased ASP compared to the control values may play a role in the physiopathology of these diseases. MaR-1, SUB, ALA, and ASP differences between SAH, CI and ICH patients may also guide clinicians along with SBP, DBP and glucose values.

Визначення толерантності до фізичного навантаження і резервів організму в дітей шкільного віку з ожирінням та артеріальною гіпертензією

Determining of tolerance to physical exertion (TPE) in children with various diseases is an important diagnostic aspect of modern medicine. This area helps to improve the prognostic capabilities of doctors and improve approaches to therapeutic interventions in patients with various pathologies. In pediatrics, there are limited data on the study of TPE in patients with hypertension and no data at all in children with a combination of hypertension and obesity. Purpose - to assess the level of TPE and body reserves in school-age children with obesity and arterial hypertension. Materials and methods. 112 patients aged 9-18 took part in the study. All patients were divided into four groups. The Group 1 (control) included children with normal blood pressure and normal body weight; the Group 2 included patients with arterial hypertension and normal body weight; the Group 3 - with normal arterial pressure and obesity; the Group 4 - with a combination of arterial hypertension and obesity. Results and conclusions. If patients have hypertension or obesity, a decrease in VO2max is noted, which is more pronounced when these pathologies are comorbid. Obese boys have a tendency to increase maximum systolic blood pressure during bicycle ergometry (158.2±8.4 mmHg) compared to healthy children (149.4±10.5 mmHg). The average values of maximum diastolic blood pressure during bicycle ergometry in all studied groups did not differ significantly from the average values of the control group. Obesity is accompanied by a more pronounced decrease in vascular reserves than arterial hypertension, the comorbidity of these diseases in patients is associated with the deterioration of these reserves in comparison with patients who have only one disease. The obtained results indicate a decrease in cardiac reserves when the patient has comorbidities of arterial hypertension and obesity. At the same time, the presence of only one of the named diseases in the patient is not accompanied by a significant decrease in indicators compared to the control group. In patients with arterial hypertension, a less effective use of myocardial reserves and an increased demand for myocardial oxygen during work compared to healthy children are noted. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Method-comparison study between a watch-like sensor and a cuff-based device for 24-h ambulatory blood pressure monitoring

The use of 24-h ambulatory blood pressure monitoring (ABPM) has been continuously increasing over the last decades. However, cuff-based devices may cause discomfort, particularly at night, leading to potentially non-representative blood pressure (BP) values. We investigated the feasibility of a cuff-less BP monitoring solution in 67 subjects undergoing conventional 24-h ABPM. A watch-like optical sensor was attached at the upper arm or wrist at the contralateral side of the cuff. Systolic (SBP) and diastolic BP (DBP) values were estimated from the measured optical signals by pulse wave analysis. Average 24-h, daytime and nighttime BP values were compared between the conventional monitor and the cuff-less sensor. The differences between both methods—expressed as mean ± standard deviation (95% limits of agreement)—were of − 1.8 ± 6.2 mmHg (− 13.9, 10.3) on SBP and − 2.3 ± 5.4 mmHg (− 13.0, 8.3) on DBP for 24-h averages, of − 1.5 ± 6.6 mmHg (− 14.4, 11.4) on SBP and − 1.8 ± 5.9 mmHg (− 13.4, 9.9) on DBP for daytime averages, and of 0.4 ± 7.5 mmHg (− 14.4, 15.1) on SBP and − 1.3 ± 6.8 mmHg (− 14.7, 12.0) on DBP for nighttime averages. These results encouragingly suggest that cuff-less 24-h ABPM may soon become a clinical possibility.

The Influence of FAM13A and PPAR-γ2 Gene Polymorphisms on the Metabolic State of Postmenopausal Women

Recently, we have observed two significant pandemics caused by communicable (COVID-19) and non-communicable factors (obesity). Obesity is related to a specific genetic background and characterized by immunogenetic features, such as low-grade systemic inflammation. The specific genetic variants include the presence of polymorphism of the Peroxisome Proliferator-Activated Receptors gene (PPAR-γ2; Pro12Ala, rs1801282, and C1431T, rs3856806 polymorphisms), β-adrenergic receptor gene (3β-AR; Trp64Arg, rs4994), and Family With Sequence Similarity 13 Member A gene (FAM13A; rs1903003, rs7671167, rs2869967). This study aimed to analyze the genetic background, body fat distribution, and hypertension risk in obese metabolically healthy postmenopausal women (n = 229, including 105 lean and 124 obese subjects). Each patient underwent anthropometric and genetic evaluations. The study has shown that the highest value of BMI was associated with visceral fat distribution. The analysis of particular genotypes has revealed no differences between lean and obese women except for FAM13A rs1903003 (CC), which was more prevalent in lean patients. The co-existence of the PPAR-γ2 C1431C variant with other FAM13A gene polymorphisms [rs1903003(TT) or rs7671167(TT), or rs2869967(CC)] was related to higher BMI values and visceral fat distribution (WHR > 0.85). The co-association of FAM13A rs1903003 (CC) and 3β-AR Trp64Arg was associated with higher values of systolic (SBP) and diastolic blood pressure (DBP). We conclude that the co-existence of FAM13A variants with C1413C polymorphism of the PPAR-γ2 gene is responsible for body fat amount and distribution.

Systolic blood pressure in acute ischemic stroke and impact on clinical outcomes.

Stroke is one of the largest healthcare burdens in the United States and globally. It continues to be one of the leading causes of morbidity and mortality. Patients with acute ischemic stroke (AIS) often present with elevated blood pressure (BP). The objective of our study was to evaluate the association of systolic blood pressure (SBP) in the emergency department (ED) with stroke severity in patients with AIS. This observational study was conducted at an ED with an annual census of 80,000 visits, approximately half (400) of which are for AIS. The cohort consisted of adult patients who presented to the ED within 24h of stroke symptom onset. BP was measured at triage by a nurse blinded to the study. Stroke severity was measured utilizing the National Institutes of Health Stroke Scale (NIHSS). Statistical analyses were performed utilizing JMP 14.0. This study was approved by our medical school's institutional review board. Patients with higher SBP had significantly lower NIHSS scores (p=0.0038). This association was significant even after adjusting for age and gender. By contrast, diastolic blood pressure (DBP) did not appear to impact stroke severity. There was no difference in the DBP values between men and women. Higher SBP was also significantly associated with being discharged home as well as being less likely to die in the hospital or discharged to hospice. The DBP did not demonstrate this association. Neither the SDP nor the DBP were significantly associated with the hospital length of stay (LOS). In multivariate models that included age, gender, basal metabolic index (BMI), comorbidities, and ED presentation, elevated SBP was associated with better prognosis. In this cohort of patients presenting with stroke-like symptoms to the ED, higher SBP was associated with lower stroke severity and higher rates of being discharged to home rather than hospice or death.