2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281-1357. [PMID: 23817082 DOI: 10.1097/01.hjh.0000431740.32696.cc]

Pathophysiological and clinical aspects of the circadian rhythm of arterial stiffness in diabetes mellitus: A minireview

Several cross-sectional trials have revealed increased arterial stiffness connected with the cardiac autonomic neuropathy in types 2 and 1 diabetic patients. The pathophysiological relationship between arterial stiffness and autonomic dysfunction in diabetes mellitus is still underinvestigated and the question whether the presence of cardiac autonomic neuropathy leads to arterial stiffening or increased arterial stiffness induced autonomic nervous system impairment is still open. Both arterial stiffness and dysfunction of the autonomic nervous system have common pathogenetic pathways, counting state of the chronic hyperinsulinemia and hyperglycemia, increased formation of advanced glycation end products, activation of protein kinase C, development of endothelial dysfunction, and chronic low-grade inflammation. Baroreceptor dysfunction is thought to be one of the possible reasons for the arterial wall stiffening development and progression. On the contrary, violated autonomic nervous system function can affect the vascular tone and by this way alter the large arteries walls elastic properties. Another possible mechanism of attachment and/or development of arterial stiffness is the increased heart rate and autonomic dysfunction corresponding progression. This minireview analyzes the current state of the relationship between the diabetes mellitus and the arterial stiffness. Particular attention is paid to the analysis, interpretation, and application of the results obtained in patients with type 2 diabetes mellitus and diabetic cardiac autonomic neuropathy.

Systemic immune-inflammation index (SII) may be an effective indicator in predicting the left ventricular hypertrophy for patients diagnosed with hypertension

The development of left ventricular hypertrophy (LVH) induced by hypertension is considered a poor prognosis for patients. Similarly, high values of the systemic immune-inflammation index (SII) are correlated with high mortality and morbidity in cardiovascular events. Within this context, our study aimed to detect the association of SII with LVH caused by hypertension. The study included 150 patients diagnosed with hypertension in total and evaluated them as two separate groups with regard to left ventricular mass index (LVMI), including 56 patients (37.3%) with LVH and 94 patients (62.6%) with non-LVH. SII was calculated as platelet × neutrophil/lymphocyte counts. The SII values regarding the group with LVH were detected remarkably higher than those of the non-LVH group (p < 0.001). Additionally, the SII levels of patients with eccentric and concentric hypertrophy were detected higher than those of the normal ventricular geometry and concentric remodeling groups. About curve analysis of the receiver-operating characteristic (ROC), SII values above 869.5 predicted LVH with a sensitivity of 82.1% and specificity of 86.2% (AUC: 0.861; 95% CI: 0.792-0.930; p < 0.001). LVH can be predicted independently through the use of SII in patients diagnosed with hypertension, which may be a simple and easily calculable marker for judging LVH. Moreover, SII can serve as an accurate determinant for the prediction of LVH, in comparison to NLR and PLR.

Relations between white coat effect of blood pressure and arterial stiffness

The aim of this study was to analyze the relationship between brachial-ankle pulse wave velocity (b-a PWV) and white coat effect (WCE), that is the difference between the elevated office blood pressure (BP) and the lower mean daytime pressure of ambulatory BP, in a mixed population of normotention, untreated sustained hypertension, sustained controlled hypertension, sustained uncontrolled hypertension, white coat hypertension, white coat uncontrolled hypertension. A total of 444 patients with WCE for systolic BP (54.1% female, age 61.86 ± 13.3 years) were enrolled in the study. Patients were separated into low WCE (<9.5 mm Hg) and high WCE (≥9.5 mm Hg) according to the median of WCE. The subjects with a high WCE showed a greater degree of arterial stiffness than those with a low WCE for systolic BP values (P < .05). The b-a PWV were 17.2 ± 3.3 m/s and 18.4 ± 3.4 m/s in low WCE and high WCE, respectively. The b-a PWV increased with the increase of WCE, showing a positive correlation between them (P > .05 for non-linearity). The significant association between the high WCE and the b-a PWV was confirmed by the results of multiple regression analysis after adjusting for confounding factors (β = .78, 95% Cl .25-1.31, P = . 004). Similar results were observed in subgroups. In conclusion, WCE is significantly associated with arterial stiffness. More research is needed to determine the WCE and target organ damage.

Predictive Role of Soluble IL-6R, TNF-R1/2, and Cell Adhesion Molecules Serum Levels in the Preoperative and Adjuvant Therapy in Women with Nonmetastatic Breast Cancer: A Preliminary Study

Soluble cell adhesion molecules (sCAMs) are involved in the development of neoplastic diseases. sCAMs can block lymphocytes and promote angiogenesis and migration of breast cancer (BC) cells. Interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) enhance metastatic potential via upregulation of CAMs. We assessed soluble interleukin-6 receptor subunit alpha (IL-6Ra), TNF-R1, TNF-R2, E-selectin, P-selectin, VCAM-1, ICAM-1, and EpCAM in 89 women with stage I-III BC and 28 healthy women. Blood samples were obtained at the beginning of neoadjuvant/induction (N = 49) or adjuvant treatment (N = 40), and after 2 months. Surgery revealed complete response in 29.4% of patients, partial response in 67%, and stable disease in 5.9%. Achieving a pathological response was 4 times greater for baseline levels of sIL-6Ra >5.63 ng/mL [odds ratio (OR) = 4.1, 95% confidence interval (CI): 0.8-20.4, P = 0.08] and more than 6 times for soluble tumor necrosis factor receptor 1 (sTNF-R1) ≥ 0.97 ng/mL (OR = 6.2, 95% CI: 1.2-32.3, P < 0.05). Compared with the control group, serum sP-selectin, soluble epithelial cell adhesion molecule (sEpCAM), and sTNF-R2 concentrations were significantly higher in patients who started adjuvant therapy (P < 0.05) and preoperative therapy (P < 0.01). Baseline serum sIL-6Ra concentrations were significantly higher in patients before surgery than in patients after tumor resection (P < 0.05), independent of the follow-up time. The baseline serum soluble receptors of IL-6 (sIL-6R) and TNF-α (sTNF-R1) concentrations have a predictive value for preoperative therapy in patients with BC.

Diagnosing Arterial Stiffness in Pregnancy and Its Implications in the Cardio-Renal-Metabolic Chain

Cardio-renal and metabolic modifications during gestation are crucial determinants of foetal and maternal health in the short and long term. The cardio-renal metabolic syndrome is a vicious circle that starts in the presence of risk factors such as obesity, hypertension, diabetes, kidney disease and ageing, all predisposing to a status dominated by increased arterial stiffness and alteration of the vascular wall, which eventually damages the target organs, such as the heart and kidneys. The literature is scarce regarding cardio-renal metabolic syndrome in pregnancy cohorts. The present paper exposes the current state of the art and emphasises the most important findings of this entity, particularly in pregnant women. The early assessment of arterial function can lead to proper and individualised measures for women predisposed to hypertension, pre-eclampsia, eclampsia, and diabetes mellitus. This review focuses on available information regarding the assessment of arterial function during gestation, possible cut-off values, the possible predictive role for future events and modalities to reverse or control its dysfunction, a fact of crucial importance with excellent outcomes at meagre costs.

Abnormal ankle-brachial index, cardiovascular risk factors and healthy lifestyle factors in hypertensive patients: prospective cohort study from a primary care urban population

Background

Peripheral arterial disease (PAD) and arterial stiffness (AS) may be hypertension-mediated vascular lesions. Both are determined by an abnormal ankle-brachial index (ABI) and are predictors of cardiovascular disease (CVD) and mortality. We assessed the relationship in urban hypertensive patients between an abnormal ABI and an ideal cardiovascular health (CVH) score, plus other healthy factors, with unfavourable outcomes.

Methods

We studied 243 hypertensive patients from a primary care urban population, followed for two years. Clinical data, comorbid conditions, including hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC), hospitalizations and mortality were also recorded.

Results

A low prevalence of ideal CVH was observed in urban hypertensive patients. The ABI ≤ 0.9 group (n = 16) showed a higher proportion of prior CVD other than PAD, mortality and hospitalizations than the ABI > 1.4 group (n = 41), and a poorer lipid, metabolic and renal profile. An inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes (HMOD, HRC, death or hospitalization) was observed. Chronic kidney disease (CKD) and diabetes were independently associated with an ABI ≤ 0.9. Age, sex, diabetes, CKD, ABI ≤ 0.9 and ideal cholesterol were also associated with outcomes, but not other CVH metrics.

Conclusions

Besides a low prevalence of ideal CVH, an inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes was observed in hypertensive patients from an urban population. Stronger efforts to promote ideal CVH may improve outcomes in this particular population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01837-1.

Use of initial and subsequent antihypertensive combination treatment in the last decade: analysis of a large Italian database

OBJECTIVE

The aim of the study was to assess the use of antihypertensive combination treatment, both as the initial and as a subsequent therapeutic step, in a large Italian population.

METHODS

The residents of the Lombardy Region (Italy), aged 40 years or older, who were newly treated with antihypertensive drugs during 2012, 2015 and 2018 were identified and the drug treatment strategy (monotherapy and combination of two, three and more than three antihypertensive drugs) was assessed at treatment initiation, and after 6 months, 1, 2, and 3 years of treatment. Data were also analysed after stratification for demographic and clinical categories.

RESULTS

About 100 000 patients were identified for each cohort. Monotherapy was the most common initial treatment strategy (75%), followed by two-drug single-pill combination (16%), two-drug free combination (6%), and combination of at least three drugs (3%). Use of two and three or more antihypertensive drugs increased during follow-up and reached about 32% (two drugs) and 11% (>2 drugs) of the patients after 3 years from treatment initiation. Among patients prescribed a two-drug combination, the single-pill was the most common approach, whereas the use of the three-drug single-pill combination was extremely rare. There were no substantial differences in the use of combination treatment between the three cohorts and the results were similar in all demographic and clinical categories.

CONCLUSION

Our data show that in a real-life population use of antihypertensive drug combinations is low. They also show that, contrary to guideline recommendations, antihypertensive combination treatment did not show any noticeable increase in recent years.

Non-dipping pattern in early-stage diabetes: association with glycemic profile and hemodynamic parameters

Patients with longstanding diabetes exhibit diminished nocturnal blood pressure (BP) drop, yet this phenomenon remains understudied in the early stages of the disease. Eighty patients with newly diagnosed (<6 months) Diabetes Mellitus type 2 (T2DM) and 80 non-T2DM individuals underwent office and 24-h ambulatory BP measurements, estimation of hemodynamic parameters using impedance cardiography and blood tests. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk score was calculated. T2DM patients exhibited higher nighttime systolic blood pressure (SBP) (p = 0.028) and lower dipping (p < 0.001) compared to controls. In the total population, dipping correlated negatively with age, HbA_1c, ASCVD risk score, and positively with HDL Cholesterol and Velocity Index (VI), a marker of myocardial contractility (p < 0.05). Nighttime SBP correlated positively with ASCVD risk, BMI, HbA_1c, fasting glucose, eGFR, and negatively with VI (p < 0.05). After adjustment for other variables, HbA_1c (p = 0.03), eGFR (p = 0.02) and VI (p = 0.004) independently predicted non-dipping. Multivariate analysis revealed HbA_1c (p = 0.023), eGFR (p = 0.05), and VI (p = 0.006) as independent predictors of nighttime SBP. Patients diagnosed with T2DM concurrently present impaired circadian BP rhythm, which appears to be directly associated with impaired glycemic profile. The observed association with myocardial contractility might represent an additional mechanism for the aggravated cardiovascular risk in these patients.

A comparative evaluation of fixed dose and separately administered combinations of lisinopril and hydrochlorothiazide in treatment-naïve adult hypertensive patients in a rural Nigerian community

Background

Antihypertensive drugs administered as fixed dose combination (FDC) therapy compared to separately administered combination therapy have been proposed to improve treatment compliance/adherence, and therefore the efficacy of blood pressure (BP) control treatment.

Aim

The aim of this present study is to compare the blood pressure control, renal end-organ protection and medication compliance/adherence in patients receiving FDC and those receiving separately administered combinations of Lisinopril and Hydrochlorothiazide in treatment-naive hypertensive adult patients in a rural Nigerian community.

Method

ology: This randomized two-arm prospective longitudinal 8-week parallel-group study was carried-out for 6-month at the Ajegunle Community between April 2018 and October 2018. Efficacy variables included the changes from baseline in mean sitting systolic BP (MSSBP) and mean sitting diastolic BP (MSDBP). Medication safety, compliance/adherence and renal end-organ protection were assessed.

Results

The baseline characteristics of the two groups were similar. Prevalence of hypertension was found to be 32.9%. The mean blood pressure of all the participants was 165.6 ± 16.5 mmHg and 98.5 ± 11.5 mmHg for systolic BP and diastolic BP respectively, while the mean pulse rate of the participants was 85.0 ± 13.4 beats/min. At the 8-week end point, both regimens had achieved significant reductions from baseline in MSSBP (−33.18 and −37.16 mm Hg, respectively; both, P < 0.05) and MSDBP (−12.97 and −17.53 mm Hg; both, P < 0.05). Both regimens were generally well tolerated. Adherence was better in the FDC arm and there was no any reported case of proteinuria occurrence in both arms.

Conclusion

The high prevalence of hypertension in the community shows that there is unmet need in diagnosis and awareness of the disease. Both combination therapies were well tolerated; but the FDC antihypertensive therapy resulted in statistically significant amount of BP reductions than the separately administered combination antihypertensive therapy. Making FDCs available and affordable will help many hypertensive patients to achieve their target BP control goals easily.

Effects of Long-term Use of Proton Pump Inhibitors on Systemic Arterial Stiffness and Pulse Wave Velocity

BACKGROUND AND AIM

Proton pump inhibitors (PPIs) are among the most widely prescribed agents. Although PPIs are widely regarded as harmlesss, long-term use of PPIs (LTUPPI) can have the potential to increase the risk of developing cardiovascular (CV) disease (CVD). Pulse wave velocity (PWV) is a good indicator of arterial stiffness. Several studies show a relationship between LTUPPI and CVD. However, the association between LTUPPI and PWV or arterial stiffness has not been reported.

PATIENTS AND METHODS

Patients (n=64) with LTUPPI and controls (n=91) were included. PWV, glucose, creatinine, total cholesterol, triglyceride, low-density lipoprotein cholesterol, cholesterol, highdensity lipoprotein cholesterol, and magnesium levels were measured.

RESULTS

In the LTUPPI group, PWV was greater than in controls (9.08±2.04 vs. 7.77±1.52 m/s, respectively, p=0.01); 34.4% of patients and 8.8% of controls had PWV levels >10 m/s (p=0.000). Multiple logistic regression analysis showed age (p<0.001) and LTUPPI (p=0.024) as predictors of elevated PWV.

CONCLUSION

PWV values are increased in patients with LTUPPI compared to controls independently of conventional CV risk factors. Measurement of PWV and other arterial stiffness parameters in cases with LTUPPI may be useful to predict possible CVD. Studies involving greater numbers are needed to confirm these findings.

Telemonitoring and protocolized case management for hypertensive community dwelling older adults (TECHNOMED): a randomized controlled trial

BACKGROUND

Home blood pressure (BP) telemonitoring combined with case management leads to BP reductions in individuals with hypertension. However, its benefits are less clear in older (age ≥ 65 years) adults.

METHODS

Twelve-month, open-label, randomized trial of community-dwelling older adults comparing the combination of home BP telemonitoring (HBPM) and pharmacist-led case management, vs. enhanced usual care with HBPM alone. The primary outcome was the proportion achieving systolic BP targets on 24-h ambulatory BP monitoring (ABPM). Changes in HBPM were also examined. Logistic and linear regressions were used for analyses, adjusted for baseline BP.

RESULTS

Enrollment was stopped early due to coronavirus disease 2019. Participants randomized to intervention (n = 61) and control (n = 59) groups were mostly female (77%), with mean age 79.5 years. The adjusted odds ratio for ABPM BP target achievement was 1.48 (95% confidence interval 0.87-2.52, P = 0.15). At 12 months, the mean difference in BP changes between intervention and control groups was -1.6/-1.1 for ABPM (P-value 0.26 for systolic BP and 0.10 for diastolic BP), and -4.9/-3.1 for HBPM (P-value 0.04 for systolic BP and 0.01 for diastolic BP), favoring the intervention. Intervention group participants had hypotension (systolic BP < 110) more frequently (21% vs. 5%, P = 0.009), but no differences in orthostatic symptoms, syncope, non-mechanical falls, or emergency department visits.

CONCLUSIONS

Home BP telemonitoring and pharmacist case management did not improve achievement of target range ambulatory BP, but did reduce home BP. It did not result in major adverse consequences.

Comparison between Carotid Distensibility-Based Vascular Age and Risk-Based Vascular Age in Middle-Aged Population Free of Cardiovascular Disease

The concept of vascular age (VA) was proposed to provide patients with an understandable explanation of cardiovascular (CV) risk and to improve the performance of prediction models. The present study compared risk-based VA derived from Framingham Risk Score (FRS) and Systematic Coronary Risk Estimation (SCORE) models with value-based VA derived from the measurement of the common carotid artery (CCA) distensibility coefficient (DC), and it assessed the impact of DC-based VA on risk reclassification. In 528 middle-aged individuals apparently free of CV disease, DC was measured by radiofrequency-based arterial wall tracking that was previously utilised to establish sex- and age-specific reference values in a healthy population. DC-based VA represented the median value (50th percentile) for given sex in the reference population. FRS-based and SCORE-based VA was calculated as recommended. We observed a good agreement between DC-based and FRS-based VA, with a mean difference of 0.46 ± 12.2 years (p = 0.29), while the mean difference between DC-based and SCORE-based VA was higher (3.07 ± 12.7 years, p < 0.0001). When only nondiabetic individuals free of antihypertensive therapy were considered (n = 341), the mean difference dropped to 0.70 ± 12.8 years (p = 0.24). Substitution of chronological age with DC-based VA in FRS and SCORE models led to a reclassification of 28% and 49% of individuals, respectively, to the higher risk category. Our data suggest that the SCORE prediction model, in which diabetes and antihypertensive treatment are not considered, should be used as a screening tool only in healthy individuals. The use of VA derived from CCA distensibility measurements could improve the performance of risk prediction models, even that of the FRS model, as it might integrate risk prediction with additional risk factors participating in vascular ageing, unique to each individual. Prospective studies are needed to validate the role of DC-based VA in risk prediction.

Association of physical activity with vascular aging in a population with intermediate cardiovascular risk, analysis by sex: MARK study

Background

The aim of this study was to analyze the association of physical activity and its intensity with arterial stiffness and vascular aging and differences by sex in a Spanish population with intermediate cardiovascular risk.

Methods

Cross-sectional study. A total of 2475 individuals aged 35–75 years participated in the study. Brachial–ankle pulse wave velocity (baPWV) was measured using a VaSera VS-1500^® device. Based on the age and sex percentile presented by the participants, the latter were classified as follows: those with a percentile above 90 and presenting established cardiovascular disease were classified as early vascular aging (EVA); those with a percentile between 10 and 90 were classified as normal vascular aging (NVA) and those with a percentile below 10 were classified as healthy vascular aging (HVA). Physical activity was analyzed through the short version of the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ).

Results

The mean age of the participants was 61.34 ± 7.70 years, with 61.60% men. Of the total sample, 86% were sedentary (83% men vs 90% women). The total physical activity showed a negative association with baPWV (β = − 0.045; 95% CI − 0.080 to − 0.009). Intense physical activity showed a negative relationship with baPWV (β = − 0.084; 95% CI − 0.136 to − 0.032). The OR of the total physical activity and the intense physical activity carried out by the subjects classified as NVA with respect to those classified as HVA was OR = 0.946; (95% CI 0.898 to 0.997) and OR = 0.903; (95% CI 0.840 to 0.971), and of those classified as EVA it was OR = 0.916; (95% CI 0.852 to 0.986) and OR = 0.905; (95% CI 0.818 to 1.000). No association was found with moderate- or low-intensity physical activity.

Conclusions

The results of this study suggest that, when intense physical activity is performed, the probability of presenting vascular aging is lower. In the analysis by sex, this association is only observed in men.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13293-022-00456-w.

This study is the first to find a negative association between total physical activity and arterial stiffness and vascular aging in adults with intermediate cardiovascular risk.

This study also shows that the association of physical activity with arterial stiffness and vascular aging in adults with intermediate cardiovascular risk varies depending on its intensity, with a negative association being found only with intense physical activity.

In the analysis by sex, the results found suggest that the association is greater in men.

Predicting Renal Denervation Response in Resistant High Blood Pressure by Arterial Stiffness Assessment: A Systematic Review

Background: Accurately selecting hypertensive candidates for renal denervation (RDN) therapy is required, as one-third of patients who undergo RDN are non-responders. We aimed to systematically review the literature on RDN response prediction using arterial stiffness assessment, optimizing the selection of patients referred for interventional blood pressure lowering procedures. Methods: A literature search was performed in MEDLINE, Embase, Scopus, and Cochrane databases to retrieve potential eligible studies from the inception to 30 June 2022. Results: Ten studies were finally included in this systematic review. Studies consistently documented that invasive pulse wave velocity (PWV) was correlated with RDN’s significant success. Nevertheless, non-invasive ambulatory arterial stiffness index and PWV derived from ambulatory blood pressure monitoring were independent predictors of blood pressure response (p = 0.04 and p < 0.0001). In some studies, magnetic resonance imaging parameters of arterial stiffness (ascending aortic distensibility, total arterial compliance) were correlated with blood pressure reduction (AUC = 0.828, p = 0.006). Conclusions: Assessing arterial stiffness prior to RDN predicted procedural success, since stiffness parameters were strongly correlated with a significant blood pressure response. Our endeavor should be tackled as a step forward in selecting appropriate hypertensive patients scheduled for RDN therapy. Non-invasive measurements could be an alternative to invasive parameters for response prediction.

Effects of Exercise Training on PPARβ/δ Expression in Skeletal Muscle of Rats with Spontaneous Hypertension

PURPOSE

This study aimed to identify the relationship and mechanism between skeletal muscle peroxisome proliferator-activated receptor β/δ (PPARβ/δ) and spontaneous hypertension.

METHODS

Rats were divided into four groups ( n = 10): spontaneous hypertensive rats exercise group (SHR-E), spontaneous hypertensive rats sedentary group (SHR-S), Wistar-Kyoto control rats exercise group (WKY-E), and Wistar-Kyoto control rats sedentary group (WKY-S). Although the sedentary groups were placed on the treadmill without moving during the training sessions, the exercise groups were forced to run on a treadmill for 8 wk, 1 h·d -1 , 5 d·wk -1 . After training, the density and area of gastrocnemius microvessels were observed. PPARβ/δ, vascular endothelial growth factor A (VEGFA), superoxide dismutase 2 (SOD-2), and nitric oxide synthase in gastrocnemius were measured by real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot.

RESULTS

Except the sixth week of age, the systolic blood pressure of SHR-S was significantly higher than that of WKY-S at all time periods. Exercise significantly reduced systolic blood pressure in SHR rats. Compared with the SHR-S group, the WKY-S group had significantly higher PPARβ/δ protein level and density of skeletal muscle microvessels. Eight weeks of exercise increased the PPARβ/δ, SOD-2, VEGFA, and microvessel density and area in the skeletal muscle of SHR.

CONCLUSIONS

Exercise training promoted PPARβ/δ mRNA and protein-level expression of PPARβ/δ, SOD-2 and VEGFA in skeletal muscle, thus increasing the density and area of skeletal muscle blood vessels. These regulations contribute to the reduction of peripheral vascular resistance. This may be a potential mechanism of exercise to reduce blood pressure.

Urinary metabolomics profiling by cardiovascular risk factors in young adults: the African Prospective study on Early Detection and Identification of Cardiovascular disease and Hypertension study

AIM

Risk factors contributes to a dysregulated metabolism and may ultimately increase the predisposition for cardiovascular disease (CVD) development. To increase our understanding of mechanistic pathways associated with CVD risk, we profiled the urinary metabolome according to individual and clusters of CVD risk factors in comparison with a control group without any risk factors.

METHODS AND RESULTS

Healthy black and white women and men ( N  = 1202), aged 20-30 years with a detailed CVD risk factor profile were included. CVD risk groups: obese, physical inactive, smoking, excessive alcohol intake, masked hypertensive, hyperglycaemic, dyslipidemic and low socioeconomic status. CVD risk clusters were based on the presence of 1, 2 and 3 or more risk factors. Liquid chromatography-tandem mass spectrometry was used to obtain urinary metabolomics data (amino acids and acylcarnities). Compared with the control group, higher levels of metabolites associated with aromatic and branched chain amino acid metabolism including phenylalanine, tyrosine and leucine/isoleucine were found in the obese, masked hypertensive, hyperglycaemic, low socioeconomic groups (all q  ≤ 0.032) and 3+ CVD risk cluster (all P  ≤ 0.034). Metabolites associated with the y-glutamyl cycle including glycine, histidine, serine, glutamine, methionine, cystine and pyroglutamic acid were found in the hyperglycaemic, low socioeconomic groups (all q  ≤ 0.050), 2 and 3+ CVD risk clusters (all P  ≤ 0.041). Metabolites associated with energetics including acetylcarnitine (lower levels), hexanoylcarnitine and decanoylcarnitine were found in the low socioeconomic group, 1 and 3+ CVD risk clusters ( q / P  ≤ 0.050) ( β -oxidation). In addition to the above-mentioned amino acids, alanine and threonine were found in the hyperglycaemic, low socioeconomic groups, 2 and 3+ CVD risk clusters (all q / P  ≤ 0.047) (glycolysis). Creatine in the obese, hyperglycaemic groups (all q  ≤ 0.049) and 3+ CVD risk cluster (all P  ≤ 0.041) (creatine pathway).

CONCLUSION

Exposure to CVD risk factors is associated with a dysregulated metabolism in the above-mentioned pathways that may precede the development of CVD.

Impaired Endothelial Glycocalyx Predicts Adverse Outcome in Subjects Without Overt Cardiovascular Disease: a 6-Year Follow-up Study

We investigated whether disturbance of glycocalyx integrity is related with increased cardiovascular risk. In 600 healthy subjects, we measured perfused boundary region (PBR), a marker of glycocalyx integrity, in sublingual microvessels with diameter ranging 5-25 µm using a dedicated camera (Sideview Darkfield Imaging). Increased PBR indicates reduced glycocalyx thickness. We prospectively monitored the occurrence of cardiovascular events (MACE-death, myocardial infarction, and stroke) during a 6-year follow-up. Fifty-seven MACE were documented. Increased values of PBR5-25 predicted higher risk for MACE in a model including sex, age, hyperlipidemia, diabetes, hypertension, smoking, family history of coronary disease, treatment with ACEi/ARBs, or lipid-lowering agents (hazard ratio (HR), 6.44, p = 0.011; net reclassification improvement (NRI), 28%; C-statistic: 0.761). PBR5-25 was an independent and additive predictor of outcome when added in a model including the European Heart SCORE, diabetes, family history of CAD, and medication (HR, 4.71; NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01).Glycocalyx integrity is an independent and additive predictor to risk factors for MACE at 6-year follow-up in individuals without cardiovascular disease. ClinicalTrials.govIdentifier:NCT04646252. PBR5-25 was an independent and additive predictor of adverse cardiovascular events in a model including the European Heart SCORE, diabetes, family history of coronary disease, and medication (HR: 4.71, NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01, NRI:37.9%).

Markers of Focal and Diffuse Nonischemic Myocardial Fibrosis Are Associated With Adverse Cardiac Remodeling and Prognosis in Patients With Hypertension: The REMODEL Study

BACKGROUND

The prognostic significance of focal and diffuse myocardial fibrosis in patients with cardiovascular risk factors is unclear.

METHODS

REMODEL (Response of the Myocardium to Hypertrophic Conditions in the Adult Population) is an observational cohort of asymptomatic patients with essential hypertension. All participants underwent cardiovascular magnetic resonance to assess for myocardial fibrosis: nonischemic late gadolinium enhancement (LGE), native myocardial T1, postcontrast myocardial T1, extracellular volume fraction including/excluding LGE regions, interstitial volume (extracellular volume×myocardial volume), and interstitial/myocyte ratio. Primary outcome was a composite of first occurrence acute coronary syndrome, heart failure hospitalization, strokes, and cardiovascular mortality. Patients were recruited from February 2016 and followed until June 2021.

RESULTS

Of the 786 patients with hypertension (58±11 years; 39% women; systolic blood pressure, 130±14 mm Hg), 145 (18%) had nonischemic LGE. Patients with nonischemic LGE were more likely to be men, have diabetes, be current smokers, and have higher blood pressure (P<0.05 for all). Compared with those without LGE, patients with nonischemic LGE had greater left ventricular mass (66±22 versus 49±9 g/m²; P<0.001), worse multidirectional strain (P<0.001 for all measures), and elevated circulating markers of myocardial wall stress and myocardial injury, adjusted for potential confounders. Twenty-four patients had primary outcome over 39 (30-50) months of follow-up. Of all the cardiovascular magnetic resonance markers of myocardial fibrosis assessed, only nonischemic LGE (hazard ratio, 6.69 [95% CI, 2.54-17.60]; P<0.001) and indexed interstitial volume (hazard ratio, 1.11 [95% CI, 1.04-1.19]; P=0.002) demonstrated independent association with primary outcome.

CONCLUSIONS

In patients with hypertension, myocardial fibrosis on cardiovascular magnetic resonance is associated with adverse cardiac remodeling and outcomes.

Poor Physical Capacity Combined With High Body Fat Percentage as an Independent Risk Factor for Incident Hypertension in Chinese Suburb-Dwelling Older Adults

Background

This study examined the effects of poor physical capacity and high body fat percentage (BF%) on the incidence of hypertension in Chinese suburb-dwelling older adults.

Methods

This study was conducted on 368 Chinese suburb-dwelling participants aged ≥ 60 years without hypertension (mean age: 66.74 ± 5.59 years, 48.9% men). Poor physical capacity is defined by the Asian Working Group for Sarcopenia (AWGS) criteria as grip strength &lt; 26 kg for men and &lt; 18 kg for women or walking speed &lt;0.8 m/s. High BF% was defined as values that are greater than the upper tertile for BF% as stratified by sex. The outcome was the incidence of hypertension.

Results

Overall, 5.7% of subjects had both poor physical capacity and high BF%. After the average follow-up duration of 2 years, the incidence of hypertension was 39.7%, and those experiencing both poor physical capacity and high BF% had the highest incidence (81.0%). After multivariate adjustments, the incidence of hypertension was associated with the combination of poor physical capacity and high BF% [odds ratio (OR) = 6.43, 95% CI = 1.91–21.64] but not solely with poor physical capacity (OR = 1.11, 95% CI = 0.55–2.25) or only high BF% (OR = 1.37, 95% CI = 0.80–2.34).

Conclusion

The combination of poor physical capacity and high BF% can significantly increase the incidence of hypertension in Chinese suburb-dwelling older adults. For hypertension prevention, ideally, we should strive toward decreasing body fat mass while simultaneously improving physical capacity.

Nighttime mean arterial pressure is associated with left ventricular hypertrophy in white‐coat hypertension

White‐coat hypertension (WCH) is associated with increased cardiovascular risks. To investigate the relationship between WCH and left ventricular hypertrophy (LVH), the authors recruited 706 participants who underwent anthropometric measurements, blood laboratory analysis, 24h ambulatory blood pressure monitoring (ABPM), and echocardiography. The authors defined WCH as elevated office BP but normal ABPM over 24h, daytime, and nighttime periods. The authors compared the proportion of LVH between the true normotension (NT) and the WCH population, and further assessed the associations between BP indexes and LVH in the two groups, respectively. The proportion of LVH was significantly higher in the WCH group than in NT participants (19.70% vs. 13.12%, P = .036). In the NT group, 24h SBP, 24h PP, daytime SBP, daytime PP and SD of nighttime SBP were associated with LVH after adjustment for demographic and blood biochemical data (all P < .05). In the WCH population, LVH was associated with 24h SBP, nighttime SBP, nighttime MAP, and office SBP after adjustment (all P < .05). However, on forward logistic regression analysis with all the BP indexes listed above, only 24h SBP (OR = 1.057, 1.017–1.098, P < .001) in the NT group, and nighttime MAP (OR = 1.114, 1.005–1.235, P < .05) and office SBP (OR = 1.067, 1.019–1.117, P < .001) in the WCH group were still significantly associated with LVH. Our study suggests that the proportion of LVH is higher in WCH patients than in the NT population. Furthermore, elevated nighttime MAP and office SBP may play critical roles in the development of LVH in the WCH population.

Polysaccharide-protein complex from coelomic fluid of Dendrobaena veneta earthworm exerts a multi-pathway antiplatelet effect without coagulopathy and cytotoxicity

There is a pressing need to identify novel antiplatelet agents, an alternative to acetylsalicylic acid and thienopyridines, to broaden the prevention of cardiovascular events, the leading cause of global morbidity and mortality. Invertebrate coelomocytes structurally and functionally resemble the thrombocyte-like cells of vertebrates; therefore, the coelomic fluid in which they are suspended may contain agents controlling their clumping abilities. However, whether coelomocytes-free coelomic fluid may also affect human platelet activities was not a subject of any study. This study aimed to screen the in vitro antiplatelet and anticoagulant activities of the polysaccharide-protein complex from Dendrobaena veneta coelomic fluid (25-100 µg/mL) (PPC-DV). All tested fluid concentrations induced significant (42.4-52.5%) inhibition of adenosine-5'-diphosphate (ADP)-induced aggregation of human platelets at a level comparable to that of 140 µmol/L acetylsalicylic acid. Its relevant antiplatelet effect (27.2-45.9%) was also evidenced in the thrombin receptor-activating peptide-6 (TRAP-6) assay. Moreover, 50 and 100 µg/mL of PPC-DV inhibited arachidonic acid-inducible aggregation. No coagulopathic or cytotoxic effects of PPC-DV were observed. The study indicates that PPC-DV, at a concentration of at least 50 µg/mL, exerts a favorable antiplatelet effect by targeting at least three pathways (P2Y₁₂ receptor, cyclooxygenase-1, and protease-activated receptor-1), justifying further experimental and clinical investigations on its use in cardiovascular disease prevention.

Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study

BACKGROUND

Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa.

METHODS

We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies.

RESULTS

The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC.

CONCLUSION

In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.

Associations between Heart Rate Variability Parameters and Hemodynamic Profiles in Patients with Primary Arterial Hypertension, Including Antihypertensive Treatment Effects

Background: Autonomic nervous system (ANS) dysfunction is an important factor in the development and progression of arterial hypertension (AH) and may produce adverse hemodynamic sequelae. ANS function can be evaluated by analyzing heart rate variability (HRV). The purpose of this study was to assess the possible correlation between HRV and the hemodynamic profile of AH patients, including antihypertensive treatment effects after 12 months. Methods: The study was conducted on 144 patients with uncomplicated AH. The hemodynamic profile was assessed via echocardiography and impedance cardiography (ICG). The analyzed HRV parameters included SDNN, rMSSD, pNN50, low frequency (LF, 0.05–0.15 Hz), high frequency (HF, 0.15–0.4 Hz), total power (TP, the variance of all NN intervals), and the day, night, and 24-h low-to-high frequency ratios (LF/HF). Results: Analysis showed various correlations of HRV parameters both with arterial blood pressure and with the hemodynamic profile assessed via echocardiography and ICG. The HRV parameters of increased ANS activity showed a correlation with improved left ventricle function (LV) and lower LV afterload. Conclusions: Effective antihypertensive treatment demonstrated beneficial effects on both the ANS balance and the hemodynamic profile.

Relationship between lifestyle factors and hypertension: a cross-sectional analysis from the Gubbio study

BACKGROUND

Hypertension (HTN) is a well-established and a major risk factor for cardiovascular disease. Lifestyle behaviours for its prevention and control are recommended within worldwide guidelines. Their relationship with HTN need more investigations.

AIM

We aimed to investigate the associations between lifestyle, anthropometric and biological measurements and BP in the Gubbio residential study.

METHODS

Cross-sectional analyses were performed using data from Gubbio study. Information concerning lifestyle factors were collected using self-reported questionnaire and were further completed with a baseline clinical examination and blood exams. Three BP measurements were performed following a standard protocol. Age-adjusted and multivariable logistic regressions were used to examine the relationships between lifestyle parameters and HTN separately for each sex. We used heterogeneity test to observe sex differences.

RESULTS

There were 3,183 persons included (48% men, 43 ± 17 years old). Mean systolic BP (SBP) was 119 ± 16 mmHg and 10.6% were hypertensives. Age [OR: 129.70 (95%CI: 18.57-905.79) in women and OR: 8.37 (95%CI: 4.01-17.48) (p < 0.0001) in men] and BMI [OR: 2.14 (95%CI: 1.32-3.46) (p = 0.006) in women and OR: 1.81 (95%CI: 1.05-3.12), p = 0.03 in men], were positively associated with SBP in both sexes. Serum uric acid [OR: 3.86 (95%CI: 2.03-7.26), p = 0.04] was positively associated with HTN in women while fasting blood glucose [OR: 3.04 (95%CI: 1.55-5.97), p < 0.001] were associated to HTN only in men.

DISCUSSION

In addition to age, BMI is associated with HTN in both sexes while sex differences were observed in the associations between serum uric acid, fasting blood glucose and HTN.

Sarcopenia and cardiovascular risk indices: Its impact on cardiovascular events and mortality in dialysis patients

BACKGROUND

Sarcopenia is a common complication in end-stage renal disease. Low muscle strength and muscle mass are risk factors for cardiovascular disease and mortality in patients undergoing dialysis. We studied the relation between sarcopenia and pre-atherosclerotic markers and its effect on cardiovascular events and death in dialysis patients.

METHODS

We measured muscle strength, muscle mass, carotid intima-media thickness, and pulse wave velocity in 106 patients. Sarcopenia was diagnosed according to the EWGSOP-2 suggestions. Patients with low muscle strength and low muscle mass were considered sarcopenic. The follow-up period for cardiovascular events and mortality was 24 months.

RESULTS

The mean age and dialysis duration were 57.4 ± 16.6 and 6.5 ± 4.9 years, respectively. Of all patients, 53 (50%) were male and 70 (66%) were on hemodialysis treatment. Sarcopenia and low muscle strength were seen in 47.1% and 88.7%, respectively. Hemodialysis patients were more likely to be sarcopenic than peritoneal dialysis patients (p = 0.001). Ferritin and Kt/V levels were higher, and body mass index was lower significantly in sarcopenic patients (p < 0.001). There was no significant difference in carotid intima-media thickness and pulse wave velocity measurements between the groups (p = 0.62 and p = 0.68, respectively). There was no statistically significant difference in cardiovascular events and mortality in cases with and without sarcopenia (p = 0.43 and p = 0.17, respectively).

CONCLUSION

There was no association between sarcopenia and pre-atherosclerotic markers, cardiovascular events, and all-cause mortality in dialysis patients. Techniques to detect low muscle strength and muscle mass need standardization, and new specific cut-off levels must be defined for dialysis patients.

Risk of Chronic Disease after an Episode of Marasmus, Kwashiorkor or Mixed-Type Severe Acute Malnutrition in the Democratic Republic of Congo: The Lwiro Follow-Up Study

Background: Long-term impact of different forms of severe acute malnutrition (SAM) in childhood on the emergence of noncommunicable diseases (NCDs) is poorly known. Aim: To explore the association between subtypes of SAM during childhood, NCDs, and cardiovascular risk factors (CVRFs) in young adults 11 to 30 years after post-SAM nutritional rehabilitation. Methods: In this follow-up study, we investigated 524 adults (mean age 22 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Among them, 142 had a history of marasmus, 175 of kwashiorkor, and 207 had mixed-form SAM. These participants were compared to 407 aged- and sex-matched control adults living in the same community without a history of SAM. Our outcomes of interest were cardiometabolic risk markers for NCDs. Logistic and linear regressions models were sued to estimate the association between subtype of SAM in childhood and risk of NCDs. Results: Compared to unexposed, former mixed-type SAM participants had a higher adjusted ORs of metabolic syndrome [2.68 (1.18; 8.07)], central obesity [1.89 (1.11; 3.21)] and low HDL-C (High-density lipoprotein cholesterol) [1.52 (1.08; 2.62)]. However, there was no difference between groups in terms of diabetes, high blood pressure, elevated LDL-C (low-density lipoprotein cholesterol) and hyper TG (hypertriglyceridemia) and overweightness. Former mixed-type SAM participants had higher mean fasting glucose [3.38 mg/dL (0.92; 7.7)], reduced muscle strength [−3.47 kg (−5.82; −1.11)] and smaller hip circumference [−2.27 cm (−4.24; −0.31)] compared to non-exposed. Regardless of subtypes, SAM-exposed participants had higher HbA1c than unexposed (p < 0.001). Those with a history of kwashiorkor had cardiometabolic and nutritional parameters almost superimposable to those of unexposed. Conclusion: The association between childhood SAM, prevalence of NCDs and their CVRFs in adulthood varies according to SAM subtypes, those with mixed form being most at risk. Multicenter studies on larger cohorts of older participants are needed to elucidate the impact of SAM subtypes on NCDs risk.

The LDL Apolipoprotein B-to-LDL Cholesterol Ratio: Association with Cardiovascular Mortality and a Biomarker of Small, Dense LDLs

Background and Objective: Small, dense low-density lipoproteins (LDLs) are considered more atherogenic than normal size LDLs. However, the measurement of small, dense LDLs requires sophisticated laboratory methods, such as ultracentrifugation, gradient gel electrophoresis, or nuclear magnetic resonance. We aimed to analyze whether the LDL apolipoprotein B (LDLapoB)-to-LDL cholesterol (LDLC) ratio is associated with cardiovascular mortality and whether this ratio represents a biomarker for small, dense LDLs. Methods: LDLC and LDLapoB were measured (beta-quantification) and calculated (according to Friedewald and Baca, respectively) for 3291 participants of the LURIC Study, with a median (inter-quartile range) follow-up for cardiovascular mortality of 9.9 (8.7−10.7) years. An independent replication cohort included 1660 participants. Associations of the LDLapoB/LDLC ratio with LDL subclass particle concentrations (ultracentrifugation) were tested for 282 participants. Results: In the LURIC Study, the mean (standard deviation) LDLC and LDLapoB concentrations were 117 (34) and 85 (22) mg/dL, respectively; 621 cardiovascular deaths occurred. Elevated LDLapoB/LDLC (calculated and measured) ratios were significantly and independently associated with increased cardiovascular mortality in the entire cohort (fourth vs. first quartile: hazard ratio (95% confidence interval) = 2.07 (1.53−2.79)) and in statin-naïve patients. The association between calculated LDLapoB/LDLC ratio and cardiovascular mortality was replicated in an independent cohort. High LDLapoB/LDLC ratios were associated with higher LDL5 and LDL6 concentrations (both p < 0.001), but not with concentrations of larger LDLs. Conclusions: Elevated measured and calculated LDLapoB/LDLC ratios are associated with increased cardiovascular mortality. Use of LDLapoB/LDLC ratios allows estimation of the atherogenic risk conferred by small, dense LDLs.

Hand Grip Strength and Likelihood of Moderate-to-Severe Airflow Limitation in the General Population

Background and Objective

Sarcopenia is mainly results from aging; however, it is more prevalent in chronic airway disease such as obstructive pulmonary disease (COPD). Hand grip strength (HGS) can be used as an indicator to evaluate sarcopenia. We aimed to assess the association between HGS and severity of airflow limitation (AFL) in the general population.

Methods

We conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2018. Subjects aged ≥40 years who underwent both spirometry and HGS tests were included. AFL was defined by spirometry revealed forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) <0.70). A propensity score-matched comparison was performed, and the risk for moderate-to-very severe AFL was analyzed using logistic regression analysis.

Results

Among 15,950 subjects, 2277 (14.3%) had AFL with mean FEV₁ was 77.1% of the predicted value. Male was predominant in both individuals without AFL and with AFL (74.2% vs 73.5%, p = 0.613). The HGS was 32.9 ± 9.5 kg and 33.3 ± 9.5 kg in participants without AFL and with AFL (p = 0.109). However, HGS was significantly decreased as AFL getting more severe: 34.0 ± 9.6 kg in mild, 33.0 ± 9.5 kg in moderate, and 30.8 ± 8.5 kg in severe to very severe AFL group (p<0.001). As HGS decreased, adjusted odds for moderate-to-very severe AFL increased compared to those with mild AFL (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.951–0.987) and both without AFL and mild AFL group (aOR, 0.98; 95% CI, 0.967–0.995) in age-, sex-, and body mass index (BMI)-matched comparisons.

Conclusion

Lower HGS is significantly associated with moderate-to-very severe AFL in age-, sex-, and BMI-matched comparisons.

Association between tooth loss and hypertension: A systematic review and meta-analysis

OBJECTIVES

Poor oral health status may increase the risk of cardiovascular disease. However, whether a specific association exists between tooth loss and hypertension is inconclusive. Accordingly, a quantitative systematic review was conducted to investigate the relationship between tooth loss and hypertension.

METHODS

Systematic search, data analysis and quality assessment were conducted on relevant literature published in PubMed, Embase, Web of Science and Cochrane Libraries until October 2021. Odds ratio (OR) with 95% confidence interval (CI) was used as effect size to evaluate the association between tooth loss and hypertension. Meta-regression and subgroup analyses were performed to identify whether difference was associated with study-level factors.

RESULTS

Of the 56 studies selected, 28 studies in 16 different countries involving 1,224,821 individuals were eligible for the systematic review. After adjustment for confounding factors, individuals with tooth loss had a higher risk for hypertension (OR 1.20; 95%CI 1.10-1.30, I² = 40.02%). With respect to the risk of hypertension on tooth loss, individuals with hypertension still had a higher risk for tooth loss (OR 1.35; 95%CI 1.07-1.62, I² = 51.10%). Age limitation of the included population is the major source of heterogeneity. However, studies in which the population was limited to the elderly did not report an increase in association between tooth loss and hypertension compared with studies without age limitation.

CONCLUSIONS

The results suggest a bidirectional association between tooth loss and hypertension. Future longitudinal prospective studies are required to establish causality between tooth loss and hypertension.

CLINICAL SIGNIFICANCE

Subjects with severe tooth loss should be carefully monitored for the manifestation of hypertension. The oral health status of hypertensive patients should also be meticulous maintained to prevent unwarranted tooth loss.

Cardiovascular remodeling in obstructive sleep apnea: focus on arterial stiffness, left ventricular geometry and atrial fibrillation

INTRODUCTION

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is associated with increased risk of cardiovascular disease. The main interest of this clinical review is to discuss the cardiovascular consequences of OSA with a special focus on left ventricular (LV) function and structure, arterial stiffness and atrial fibrillation.

AREA COVERED

We present an overview of the definition, prevalence, and risk factors of OSA and outline the association between OSA and cardiovascular complications. We then briefly discuss echocardiographic assessment in OSA with focus on the left atrium and LV. Finally, we highlight the importance of adherence to continuous positive airway pressure (CPAP) therapy with regard to reducing the risk of cardiovascular disease.

EXPERT COMMENTARY

Although OSA has a strong association with cardiovascular complications, it is often underdiagnosed and undertreated. Patients with resistant hypertension and atrial fibrillation with poor therapeutic success after cardioversion or catheter ablation should be more often screened for OSA. Patients with nocturnal adverse cardiovascular events (stroke, arrhythmias, angina, coronary events) should be closely assessed with regard to OSA, and if confirmed, timely treated by lifestyle modification, CPAP, and aggressive antihypertensive treatment. Adherence to CPAP in OSA patients is essential in terms of reducing the risk of cardiovascular events.

Association between Neck Circumference and Subclinical Atherosclerosis among Chinese Steelworkers: A Cross-Sectional Survey

The purpose of this study was to determine whether neck circumference (NC) is associated with subclinical atherosclerosis among Chinese steelworkers in North China. A cross-sectional survey was conducted among steelworkers in northern China (n = 3467). Carotid intima-media thickness (CIMT) was measured at the distal wall of the common carotid artery proximal to the bifurcation point along a plaque-free segment 10 mm long on each side by B-ultrasound. The mean of the common CIMT was used bilaterally in this study. In the cross-sectional analysis, large NC was associated with the presence of abnormal CIMT. Logistic regression analysis was used to assess the relationship between NC tertiles and CIMT. The multivariable-adjusted odds ratio was 1.76 (95% CI: 1.40 to 2.22; p for trend <0.001) for the highest tertile versus the lowest tertile and was 1.07 (95% CI: 1.04 to 1.10; p < 0.001) per 1 standard deviation increment in NC. Among steelworkers in North China, relatively large NC level is associated with elevated odds of subclinical atherosclerosis.

Adipokines Level and Cognitive Function-Disturbance in Homeostasis in Older People with Poorly Managed Hypertension: A Pilot Study

Aim: To explore the network relationship between cognitive function, depressive symptom intensity, body composition, proxies of cognitive reserve, trophic factor, adipokines and myokines, physical performance and blood pressure in a group of older people with poorly managed hypertension (PMHTN) compared to a normotensive (NTN) group. Materials and methods: History of hypertension and blood pressure level were examined in older participants. Thirty-one subjects diagnosed with PMHTN (history of hypertension diagnosis and values of sBP or dBP over 140/90 mmHg) and eighteen NTN (lack of history of hypertension and sBP and dBP lower than 140/90 mmHg) participated. Participants completed physical and cognitive function assessments: including the Mini–Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and its two subtests Delayed Recall (DR) and Verbal Fluency (VF) and Trail Making Test Part B (TMT B). Factors associated with cognitive functioning: age, years of education, cognitive and travel activity were assessed using a questionnaire. Visceral fat was determined by bioimpedance testing and gait velocity and agility assessed using an Up and Go test. To summarize the strength and direction (negative or positive) of a relationship between two variables, Spearman’s rank correlation coefficient was used. Then, network graphs were created to illustrate the relationship between variables. Node strength (number of edges per node), neighbourhood connectivity (the average connectivity of all the neighbours of a node), stress (the number of shortest paths passing through each node) were compared in network from PMHTN group to network from NTN group. Results: Neighbourhood connectivity and stress were significantly higher in of the PMHTN network compared to NTN (6.03 ± 1.5 vs. 4.23 ± 2.5, p = 0.005 and 118.21 ± 137.6 vs. 56.87 ± 101.5, p = 0.02, accordingly). Conclusion: In older subjects with poorly managed hypertension, dyshomeostasis was observed, compared to normotensive subjects.

Long-Term Health Associated with Small and Large for Gestational Age Births among Young Thai Adults

We examined the long-term health outcomes associated with being born small for gestational age (SGA) or large for gestational age (LGA). A total of 632 young adults aged ≈20.6 years were recruited from a longitudinal study (Chiang Mai, Thailand) in 2010: 473 born appropriate for gestational age (AGA), 142 SGA, and 17 LGA. The clinical assessments included anthropometry, blood pressure (BP), lipid profile, and an oral glucose tolerance test (OGTT). Young adults born SGA were 1.8 and 3.2 cm shorter than AGA (p = 0.0006) and LGA (p = 0.019) participants, respectively. The incidence of short stature was 8% among SGA compared with 3% in AGA and no cases among LGA participants, with the adjusted relative risk (aRR) of short stature among SGA 2.70 times higher than that of AGA counterparts (p = 0.013). SGA participants also had a 2 h glucose 7% higher than that of the AGA group (105 vs. 99 mg/dL; p = 0.006). Young adults born LGA had a BMI greater by 2.42 kg/m² (p = 0.025) and 2.11 kg/m² (p = 0.040) than those of SGA and AGA, respectively. Thus, the rate of overweight/obesity was 35% in the LGA group compared with 14.2% and 16.6% of SGA and AGA groups, respectively, with corresponding aRR of overweight/obesity of 2.95 (p = 0.011) and 2.50 (p = 0.017), respectively. LGA participants had markedly higher rates of BP abnormalities (prehypertension and/or hypertension) with an aRR of systolic BP abnormalities of 2.30 (p = 0.023) and 2.79 (p = 0.003) compared with SGA and AGA groups, respectively. Thai young adults born SGA had an increased risk of short stature and displayed some impairment in glucose metabolism. In contrast, those born LGA were at an increased risk of overweight/obesity and elevated blood pressure. The long-term follow-up of this cohort is important to ascertain whether these early abnormalities accentuate over time, leading to overt cardiometabolic conditions.

Hypertension in Patients with Insulin Resistance: Etiopathogenesis and Management in Children

Insulin resistance (IR) is a key component in the etiopathogenesis of hypertension (HS) in patients with diabetes mellitus (DM). Several pathways have been found to be involved in this mechanism in recent literature. For the above-mentioned reasons, treatment of HS should be specifically addressed in patients affected by DM. Two relevant recently published guidelines have stressed this concept, giving specific advice in the treatment of HS in children belonging to this group: the European Society of HS guidelines for the management of high blood pressure in children and adolescents and the American Academy of Pediatrics Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Our aim is to summarize the main pathophysiological mechanisms through which IR causes HS and to highlight the specific principles of treatment of HS for children with DM.

Regulatory Effects of Statins on SIRT1 and Other Sirtuins in Cardiovascular Diseases

Adverse cardiovascular disease (CVD) outcomes, such as sudden cardiac death, acute myocardial infarction, and stroke, are often catastrophic. Statins are frequently used to attenuate the risk of CVD-associated morbidity and mortality through their impact on lipids and they may also have anti-inflammatory and other plaque-stabilization effects via different signaling pathways. Different statins, including atorvastatin, rosuvastatin, pravastatin, pitavastatin, and simvastatin, are administered to manage circulatory lipid levels. In addition, statins are potent inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase via modulating sirtuins (SIRTs). During the last two decades, SIRTs have been investigated in mammals and categorized as a family of nicotinamide adenine dinucleotide (NAD)-dependent histone deacetylases (HDACs) with significant oxidative stress regulatory function in cells-a key factor in extending cell lifespan. Recent work has demonstrated that statins upregulate SIRT1 and SIRT2 and downregulate SIRT6 in both in vitro and in vivo experiments and clinical trials. As statins show modulatory properties, especially in CVDs, future investigations are needed to delineate the role of SIRT family members in disease and to expand knowledge about the effects of statins on SIRTs. Here, we review what is currently known about the impact of statins on SIRTs and how these changes correlate with disease, particularly CVDs.

Impact of drug adherence on blood pressure response to alcohol-mediated renal denervation

PURPOSE

While poor drug adherence is frequent in patients with resistant hypertension, detailed analyses of the impact of drug adherence on the success of renal denervation are scarce. We report drug adherence at baseline, changes in drug adherence, and the influence of these parameters on blood pressure changes at 6 and 12 months in patients treated with alcohol-mediated renal denervation as part of the Peregrine study.

MATERIALS AND METHODS

Urinary detection of antihypertensive drugs was performed using high-performance liquid chromatography-tandem mass spectrometry. Full adherence, partial adherence, and complete non-adherence were defined as 0, 1, or ≥2 drugs not detected, respectively.

RESULTS

Renal denervation was performed in 45 patients with uncontrolled hypertension on ≥3 antihypertensive medications (62% men, age 55 ± 10 years). At baseline, the proportion of fully, partially, and non-adherent patients was 62% (n = 28), 16% (n = 7), and 22% (n = 10), respectively. At 6 months, adherence improved by 21% (n = 9), remained unchanged at 49% (n = 21), and worsened by 30% (n = 13). Mean 24-h systolic blood pressure decreased by 10 ± 13, 10 ± 4, and 14 ± 19 mmHg in fully, partially, and non-adherent patients (p = 0.77), and by 14 ± 14, 8 ± 11, and 14 ± 18 mmHg in patients who improved, maintained, or decreased adherence, respectively (p = 0.35). The results at 12 months were similar.

CONCLUSION

About 40% of patients with apparently treatment-resistant hypertension were not fully adherent at baseline, and adherence decreased further in 30%. Nevertheless, mean blood pressure changes after renal denervation were similar irrespective of drug adherence. Our results suggest that such patients may benefit from alcohol-mediated renal denervation, irrespective of drug adherence. These findings are hypothesis-generating and need to be confirmed in ongoing sham-controlled trials.

Combination and Novel Pharmacologic Agents for OAB

PURPOSE OF REVIEW

To evaluate recent literature on combination and novel pharmacologic therapies for overactive bladder (OAB).

RECENT FINDINGS

Combination therapies demonstrating greater efficacy than monotherapy include combination anticholinergics, anticholinergic plus β-3 agonist, and anticholinergic with behavioral modification, percutaneous tibial nerve stimulation, or sacral neuromodulation. Promising novel therapies include new bladder selective anticholinergics, new β-3 agonists, and gabapentin. OAB is a symptom complex caused by dysfunction in the interconnected neural, muscular, and urothelial systems that control micturition. Although several therapeutic targets and treatment options exist, complete resolution is not always achieved, discontinuation rate for medical therapy is high, and few patients subsequently progress to third-line treatment options. Recent literature suggests combination therapy diversifying therapeutic targets is more effective than targeting a single pathway and novel treatments targeting additional pathways have promising results.

Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients With Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020

Aims: We aimed to assess trends in glycosylated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) thresholds at initiation of glucose- and blood pressure-lowering medication among patients with type 2 diabetes and assess the influence of age and sex on these trends. Materials and Methods: We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients initiating a first non-insulin glucose-lowering or any blood pressure-lowering medication between 2015 and 2020 with an HbA1c or SBP measurement in the 120 days before initiation were included. We used multilevel regression analyses adjusted for potential confounders to assess the influence of calendar year, age or sex, and the interaction between calendar year and age or sex on trends in HbA1c and SBP thresholds at initiation of medication. Results: We included 2,671 and 2,128 patients in the analyses of HbA1c and SBP thresholds, respectively. The overall mean HbA1c threshold at initiation of glucose-lowering medication significantly increased from 7.4% in 2015 to 8.0% in 2020 (p < 0.001), and particularly in the younger age groups. Compared to patients ≥80 years, patients aged 60-69 years initiated medication at lower levels mainly in the early years. Patients <60 years and between 70-79 years initiated medication at similar levels as patients ≥80 years. Females initiated medication at lower levels than males throughout the study period (p < 0.001). The mean SBP threshold at initiation of blood pressure-lowering medication varied from 145 to 149 mmHg without a clear trend (p = 0.676). There were no differences in SBP thresholds between patients of different ages or sex. Conclusion: The rising trend in the HbA1c threshold for initiating glucose-lowering medication in the lower age groups was unexpected and requires further investigation. Males appear to receive less timely initiation of glucose-lowering medication than females. The lack of higher thresholds for the oldest age group or lower thresholds for the youngest age group in recent years is not in line with the age-related recommendations for personalized diabetes care and calls for health systems interventions.

Daily blood pressure profile and blood-brain barrier permeability in patients with cerebral small vessel disease

Cerebral small vessel disease (CSVD) plays an important role in cognitive impairment, stroke, disability, and death. Hypertension is the main risk factor for CSVD. The use of antihypertensive therapy has not resulted in the expected decrease in CSVD complications, which may be related to the underestimation of significance of daily blood pressure profile for blood–brain barrier (BBB) permeability. 53 patients with CSVD of varying severity (mean age 60.08 ± 6.8 years, 69.8% women, subjects with treated long-standing hypertension vs. normotensive subjects − 84.8% vs. 15.2%) and 17 healthy volunteers underwent ambulatory blood pressure monitoring (ABPM) and MRI, including T1-weighted dynamic contrast-enhanced magnetic resonance imaging for assessing BBB permeability. Most of ABPM parameters in CSVD patients did not differ from controls, but were associated with the severity of white matter hyperintensity (WMH) and the total CSVD score. BBB permeability in normal-appearing white matter (NAWM) and grey matter (GM) was significantly higher in CSVD patients, and the severity of BBB permeability remained similar in patients with different stages of WMH. Among BBB permeability parameters, the area under the curve, corresponding to an increase in the contrast transit time in NAWM, had the greatest number of correlations with deviations of ABPM parameters. BBB permeability in CSVD is a universal mechanism of NAWM and GM damage associated with a slight increase in ABPM parameters. It is obvious that the treatment of hypertension in patients with not severe WMH should be more aggressive and carried out under the control of ABPM.

Possibilities of Detecting Pre-clinical Forms of Atherosclerosis During Periodic Preventive Inspections in Organized Collectives at Workers of Machine Building Enterprises

Aim. To study the structural and functional features of the carotid and femoral arteries using ultrasound duplex scanning of them in patients with hypertension undergoing periodic preventive medical examination.Material and methods. Periodic preventive examination was carried out for 2431 employees (1311 men and 1120 women) aged 20-65 years using a specially developed questionnaire, blood pressure measurement, anthropometry, total cholesterol test. Hypertensive men were assessed for preclinical manifestations of atherosclerosis by ultrasound duplex scanning of the carotid and femoral arteries.Results. Hypertensive men (BP ≥140/90 mmHg and/or taking antihypertensive drugs; n=176, mean age 43.5 years) were included in the study. An increase in the thickness of the intima-media complex in the carotid arteries was found in 22.2% (n=38) people, in the femoral arteries – in 34.1% (n=60) people, in both basins – in 16.5% (n= 29) man. Atherosclerotic plaques in the carotid arteries were found in 40.3% of people (n=71), and in the femoral arteries – in 34.7% (n=61) of people, in both pools – in 23.9% (n=42) of men.Conclusion. Ultrasound diagnostic using modern ultrasound scanners is a highly informative method for non-invasive diagnosis of atherosclerosis in the arteries of the carotid and femoral basins in employees of a large industrial enterprise with arterial hypertension in the conditions of the medical and sanitary department. Carrying out these diagnostic approaches is advisable when organizing periodic medical examinations in order to improve primary prevention, as well as to prevent the aggravation of the identified pathological process, reduce complications, improve quality and increase life expectancy.

The Association Between Sublingual Varices and Cardiovascular Risk Factors

Objective

To study the association between sublingual varices (SV) and cardiovascular (CVD) risk factors.

Methods

A total of 989 consecutive dental patients aged 55-84 years participated in the study, which applied a survey about risk factors, diseases and medications. Digital photos of the lateral borders of the tongue, height, weight, waist, hip and blood pressure were registered, and blood samples were analyzed. Those with SV were compared with those without SV (nSV).

Results

Those with SV had more hypertension 41.8% vs 27.0% (p<0.0001), a higher systolic blood pressure (BP) 139.5 (SD 18.6) mmHg vs 134.3 (SD 18.8) mmHg (95% CI -7.73 ─ -2.72), more diabetes type 2 (DM-2) 7.4% vs 3.8% (p=0.014), a higher fasting plasma glucose 5.9 (SD 1.5) mmol/L vs 5.7 (SD 1.0) mmol/L (95% CI -0.42 ─ -0.05), more dyslipidemia 24.1% vs 17.7% (p=0.018), lower HDL 1.6 vs 1.7 (p=0.003), a greater waist circumference 97.0 cm vs 93.9 cm (95% CI -4.66 ─ -1.46), a greater waist/hip ratio 0.92 cm/cm vs 0.90 cm/cm (95% CI -0.03 ─ -0.01), and a higher BMI 26.6 kg/m² vs 26.0 kg/m² (95% CI -1.11 ─ -0.03). The following associations with SV were found in multivariate analysis: hypertension OR=1.6 (95% CI 1.19 ─2.13), a high systolic BP OR =1.5 (95% CI 1.11 ─2.13), a high fP-glucose OR= 1.8 (95% CI 1.03 ─3.21), a low HDL OR= 1.8 (95% CI 1.15 ─2.92), a greater waist circumference OR= 1.68 (95% CI 1.10 ─2.58), a greater waist/hip ratio OR=2.21 (95% CI 1.36 ─3.58), and a higher BMI OR=1.05 (95% CI 1.02 ─1.09).

Conclusion

This study shows an association between SV and a high BP, a high fP-glucose, hypertension, diabetes mellitus type 2, dyslipidemia, abdominal obesity, older age and smoking.

The Effect of Anthropometric Measurements on the Incidence of Atrial Fibrillation in Patients With Acute Myocardial Infarction

Background and objective Atrial fibrillation (AFib) is the most common supraventricular arrhythmia occurring after myocardial infarction (MI). Height, body weight, waist and hip circumference, and body mass index (BMI) are considered potential risk factors for the development of AFib. The aim of this study was to investigate the effect of BMI and waist circumference on the incidence of AFib in patients with acute MI. Methods This prospective, cross-sectional, observational study was conducted in the coronary intensive care unit (CICU) of a tertiary care university hospital between July 2014 and February 2016. Patients diagnosed with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) were included. Demographic, clinical, echocardiographic, and laboratory data, past medical history, and anthropometric measurements were recorded. Continuous electrocardiography (ECG) monitoring was performed for following up on the occurrence of AFib. Then, AFib predictors were identified using multiple regression analysis. Results AFib developed in 31 (9.3%) patients in the cohort. No significant difference was observed between patients with or without AFib in terms of BMI and waist circumference values (p=0.686 vs. p=0.728, respectively). Factors associated with AFib development as per the multivariate analyses included age (OR: 1.051, 95% CI: 1.013-1.09; p=0.008), pulse rate (OR: 1.043, 95% CI: 1.018-1.069; p=0.001), peak troponin T value (OR: 1.356, 95% CI: 1.135-1.619; p=0.001), and length of CICU stay (OR: 2.247, 95% CI: 1.163-4.340; p=0.016). Conclusion BMI and waist circumference measurements were similar in patients with and without AFib during acute MI. Age, pulse rate, peak troponin T, and duration of CICU stay were identified as independent predictors of AFib development.

Association of cardio-ankle vascular index and future major adverse cardiovascular events in older adults living with HIV

ABSTRACTIncreased arterial stiffness is an indicator of cardiovascular disease (CVD) and death in the general population. The cardio-ankle vascular index (CAVI) is a novel method for measuring arterial stiffness. This study investigated the utility of CAVI as a prognostic indicator of CVD and death in older adults living with HIV(OALHIV). Patients aged ≥50 taking antiretroviral treatment with no history of cardiovascular events enrolled from multiple centers in Chiang Mai, Thailand. Participants (N = 347) who underwent CAVI were followed up for five years. The primary endpoint was major adverse cardiovascular events (MACE): a composite of total deaths and hospitalizations due to myocardial infarction, coronary revascularization, stroke, and heart failure. Cox regression analysis determined between normal (<8) and high (≥8) CAVI against the incidence of MACE. Forty-five participants (13.0%) were diagnosed with MACE. The risk of MACE was more significant in high CAVI than normal CAVI (adjusted HR =  2.11, 95% confidence interval 1.06-4.20, p = 0.033). In OALHIV, CAVI was an independent prognosis of MACE, in addition to conventional CVD risk factors. CAVI-assisted to help identify high-risk patients showed the benefit of further evaluation and more intensive therapy to prevent CVD and death.

Is there a relationship between heart rate recovery and blood pressure in white coat hypertension?

Aim    Increasing evidence suggests that autonomic dysfunction may be involved in the etiology of white coat hypertension (WCH). The aim of this study was to evaluate cardiac autonomic function by using heart rate recovery (HRR) indices in patients with WCH classified according to their circadian rhythm type of blood pressure (BP).Material and methods    This cross-sectional study included 120 participants over the age of 18 yrs, including 50 patients diagnosed with WCH and 70 healthy controls with normal in- and out-of-office BP and without any known disease. Circadian rhythm types, i.e., dippers and non-dippers, were identified using ambulatory BP monitoring. The HRR indices were calculated by subtracting the 1st-minute (HRR1), 2nd-minute (HRR2), and 3rd-minute (HRR3) heart rates from the maximal heart rate recorded during stress testing.Results    The lesser decline in nighttime BP (6.4±2.14 and 13.3±2.2 mmHg, respectively; p&lt;0.001) and the smaller mean HRR1 (25.5±3.0 and 30.3±3.1 beats / min, respectively; p&lt;0.001) were evident in WCH non-dippers compared to WCH dippers. Linear regression analysis showed that HRR1 (β±SE=0.43±0.11; p&lt;0.001) and diastolic BP at maximum exercise (β±SE=0.14±0.07; p=0.040) are independent risk factors for the blunted decline in nighttime BP.Conclusion    Delayed recovery of heart rate after an exercise stress test is associated with non-dipper type of circadian rhythm of BP. This was more pronounced in WCH patients, and these patients are at risk of autonomic dysfunction.

Renal denervation in resistant hypertension: a review of clinical trials and future perspectives

A previous report using the National Health and Nutrition Examination Survey demonstrated an increase in the prevalence of resistant hypertension, which does not respond to traditional therapy and medication. Studies using various animal hypertensive models have demonstrated significant blood pressure (BP) reduction following renal artery denervation (RDN). Catheter-based RDN became available in clinical trials as a possible treatment option for resistant hypertension. Although first clinical trials of RDN have demonstrated the efficacy and safety of this treatment mortality for lowering BP in patients with resistant hypertension, the role of RDN has been questioned since the results of the Symplicity HTN-3 trial. Considering the ethnic differences demonstrated in the Symplicity HTN-Japan and Global Symplicity registry, by contrast, RDN might be an effective for resistant hypertension in Asian population. Here, we discuss RDN applications and technology, the old and new clinical evidence of RDN, patients' selection of RDN responder, and optimization of RDN procedure in this review. The available evidence demonstrates that RDN could be effective in carefully selected patients with resistant hypertension, paving the way for future research in this area.

The physical activity health paradox and risk factors for cardiovascular disease: A cross-sectional compositional data analysis in the Copenhagen City Heart Study

Background

Studies indicate that physical activity during leisure and work have opposite associations with cardiovascular disease (CVD) risk factors, referred to as the physical activity health paradox. We investigated how sedentary behaviour and physical activity types during leisure and work are associated with systolic blood pressure (SBP), waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C) in an adult general population sample using compositional data analysis.

Methods

Participants wore accelerometers for 7 days (right thigh and iliac crest; 24 h/day) and had their SBP, WC, and LDL-C measured. Accelerometer data was analysed using the software Acti4 to derive daily time spent in sedentary behaviour and physical activity types. The measure of association was quantified by reallocating time between sedentary behaviour and 1) walking, and 2) high-intensity physical activity (HIPA; sum of climbing stairs, running, cycling, and rowing), during both domains.

Results

In total, 652 participants were included in the analyses (median wear time: 6 days, 23.8 h/day). During leisure, the results indicated that less sedentary behaviour and more walking or more HIPA was associated with lower SBP, while during work, the findings indicated an association with higher SBP. During both domains, the findings indicated that less sedentary behaviour and more HIPA was associated with a smaller WC and lower LDL-C. However, the findings indicated less sedentary behaviour and more walking to be associated with a larger WC and higher LDL-C, regardless of domain.

Conclusions

During leisure, less sedentary behaviour and more walking or HIPA seems to be associated with a lower SBP, but, during work, it seems to be associated with a higher SBP. No consistent differences between domains were observed for WC and LDL-C. These findings highlight the importance of considering the physical activity health paradox, at least for some risk factors for CVD.

Dietary acid load and cardiovascular diseases

Diet affects the body's acid-base balance by providing acid or alkali precursors in the metabolism. The importance of the acid-base balance of the diet for cardiovascular diseases, which have become the most important cause of morbidity on the global scale, has started to take its place in the literature. The prediction of endogenous acid production in dietary acid-base balance is expressed as dietary acid load. Although the available information about the effect of dietary acid load on cardiovascular diseases is limited, possible mechanisms are indicated as excessive calcium and magnesium excretion from the kidneys, reduced urinary citrate excretion, and excessive cortisol production. Metabolic acidosis has an important role in the development of cardiometabolic abnormalities, especially insulin resistance. Studies examining the relationship between dietary acid load and cardiovascular disease are limited and there is an inconsistency between studies. Practices for determining risk factors for cardiovascular diseases and preventing their effects are very important for the protection and improvement of health. Considering dietary acid load when planning a diet for individuals with cardiovascular diseases can help increase the effectiveness of the diet. The purpose of this review is to examine the effect of dietary acid load on cardiovascular diseases.

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives

This systematic review aimed to synthesize the content, structure, and delivery characteristics of effective yoga interventions used for managing hypertension and to compare these characteristics with ineffective interventions.

Design and Method

The JBI and the PRISMA guidelines were followed in this systematic review. RCTs conducted among hypertensive adults were included. RCTs reporting at least one of the major components of yoga (i.e., asana, pranayama, and dhyana and relaxation practices) and comparing them with no intervention or any intervention were eligible. Sixteen databases were searched for published and unpublished studies without any date and language restrictions till March 15, 2021.

Results

The literature search yielded 13,130 records. 34 RCTs (evaluating 38 yoga interventions) met the inclusion criteria. Overall, included studies had low methodological quality mostly due to inadequate reporting. Yoga reduced SBP and DBP compared to a control intervention (MD -6.49 and -2.78; 95CI% -8.94- -4.04 and -4.11- -1.45, respectively). Eighteen, 14 and 20 interventions were effective in improving SBP, DBP, or either, respectively. 13 out of 20 effective interventions incorporated all the 3 major components of yoga and allocated similar durations to each component whereas ineffective interventions were more focused on the asana and duration of asana practice was longer. The most common duration and frequency of effective interventions were 45 min/session (in 5 interventions), 7 days/week (in 5 interventions), and 12 weeks (in 11 interventions) whereas the most common session frequency was 2 days a week (in 7 interventions) in ineffective interventions. Effective interventions were mostly center-based (in 15 interventions) and supervised (in 16 interventions) and this was similar with ineffective interventions.

Conclusion

Despite the low quality and heterogeneity of included studies, our findings suggest yoga interventions may effectively manage hypertension. The differences between the effective and ineffective interventions suggest that effective yoga interventions mostly incorporated asana, pranayama, and dhyana and relaxation practices and they had a balance between these three components and included regular practice. They were mostly delivered in a center and under supervision. Future studies should consider developing and evaluating an intervention for managing hypertension using the synthesized findings of the effective interventions in this review.

Systematic Review Registration

[PROSPERO], identifier [CRD42019139404].