Influence of Physical Activity on Hypertension and Cardiac Structure and Function

Physiological modeling of autonomic regulation of cardiac system under graded exercise

BACKGROUND AND OBJECTIVE

Dysfunction of the autonomic nervous system (ANS) plays a critical role in the progression and assessment of cardiovascular diseases, neurological disorders, and various other pathologies. Therefore, a quantitative assessment of ANS function is vital for personalized medicine in these diseases. However, direct measurements of ANS activity can be costly and invasive, prompting researchers to adopt indirect methods for quantitative evaluation. These methods typically involve mathematical techniques, such as statistical analysis and mathematical modeling, to interpret cardiovascular fluctuations in response to external stimuli.The purpose of this study is to develop a non-invasive mathematical method that quantitatively assesses ANS function during graded exercise.

METHODS

In this study, we present a physiological mathematical model for autonomic regulation of the cardiac system under graded exercise, which recognizes the crucial role of the ANS in controlling heart rate during physical activity. The model utilizes the metabolic equivalent of walking as the input and heart rate as the output, with model parameters serving as quantitative measures of personalized ANS function. Experimental data were collected from groups with different health statuses and genders. Mann-Whitney U non-parametric tests were conducted on the model parameters to assess performance between individuals who frequently engage in aerobic exercise (15 participants, aerobic exercise frequency of more than 4 times/week) and those who barely exercise (15 participants, aerobic exercise frequency of 1 time per week or less), as well as between male and female participants.

RESULTS

The experimental results indicate that our model effectively quantitatively assesses ANS function across groups with different health statuses and genders (P < 0.05). Additionally, the model provides precise estimations of heart rate, yielding a Root Mean Square Error of 2.79 beats per minute, a Mean Absolute Error of 2.18 beats per minute, and an R-squared value of 0.93.

CONCLUSION

Our findings suggest that the proposed physiological mathematical model offers a non-invasive and user-friendly tool for measuring ANS function and monitoring cardiovascular health. This approach is feasible for home application, thereby reducing the need for professional supervision, and supports the early detection and personalized management of cardiovascular diseases. As a result, it enhances clinical decision-making and improves patient outcomes.

Diabetes and hypertension

Over 4 million people in the UK are living with diabetes; the majority have type 2 diabetes and over two-thirds also have hypertension. Diabetes and hypertension increase the risk of complications such as stroke, myocardial infarction and premature death, and they also elevate mortality rates. This article uses a case history approach to illustrate the difficulty and methods for managing diabetes and hypertension in a reluctant patient. Drawing on practical clinical experience, it underscores the complex barriers to effective patient engagement and sustained adherence. The article also explores evidence-based strategies that can improve outcomes despite patient resistance.

The impact of different forms of exercise on intraocular pressure, blood flow, and the risk for primary open angle glaucoma

Primary open angle glaucoma (POAG) is a chronic disease characterized by progressive optic nerve damage and irreversible loss of vision, often diagnosed at late stages. Elevated intraocular pressure (IOP) is the major risk factor for its onset and progression while older age, myopia, genetic factors, blood pressure (BP), and reduced ocular blood flow (OBF) have also been linked to the disease. Different forms of exercise are known to have significant, but variable, effects on IOP, BP, ocular perfusion pressure (OPP), OBF and oxygen metabolism, and ultimately the risk for development and progression of POAG. While population-based studies lack agreement regarding the relationship between exercise and POAG status, data suggests that resistance training causes a short-term increase in IOP, BP, and OPP. Conversely, aerobic exercise has been shown to cause a short-term decrease in IOP and increase in BP and OPP. Research also suggests that following an exercise program over an extended period may lead to a long-term decrease in IOP, however its cessation results in a prompt return to baseline levels. Data suggests normal vascular autoregulation ensures minimal change in OBF following extended exercise unless OPP rises ∼70% above baseline. Although exercise may alter IOP, BP, and OBF, both acutely and chronically, it is currently uncertain if physical activity significantly alters risk for the onset and progression of POAG.

Impact of postpartum physical activity on cardiometabolic health, breastfeeding, injury and infant growth and development: a systematic review and meta-analysis

OBJECTIVE

To examine the relationship between postpartum physical activity and maternal postnatal cardiometabolic health, breastfeeding, injury, and infant growth and development.

DESIGN

Systematic review with random-effects meta-analysis and meta-regression.

DATA SOURCES

Eight online databases were searched up until 12 January 2024.

ELIGIBILITY CRITERIA

Studies of all designs in all languages were eligible (except case studies and reviews) if they contained information on the population (postpartum people), intervention (frequency, intensity, duration, volume, or type of exercise, alone ('exercise-only') or in combination with other intervention components (eg, dietary; 'exercise+co-intervention'), comparator (no or low volumes of physical activity), and outcomes: hypertension, diabetes, cardiometabolic risk factors (systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, high density lipoproteins, low density lipoproteins, and triglycerides, glycated hemoglobin (HbA1C), glucose and insulin concentration), breastfeeding (breast milk quality and volume), infant growth (length and weight) and development, or postpartum injury.

RESULTS

46 unique studies (n=8766 participants) from 20 countries were included. Moderate certainty of evidence showed exercise+co-interventions reduced the odds of developing diabetes by 28% (7 randomised controlled trials (RCTs), n=2496; OR 0.72 95% CI 0.54, 0.98, I2 12%), reduced SBP (10 RCTs, n=2753; mean difference (MD) -2.15 95% CI -3.89 to -0.40, I2 73%) and DBP (9 RCTs, n=2575; MD -1.38 95% CI -2.60 to -0.15, I2 66%) compared with controls. Infant growth and development, breast milk quality and quantity, and risk of injury were not different between exercise and control groups.

CONCLUSIONS

Physical activity improves cardiometabolic health without adversely impacting breast milk supply or quality, infant growth or maternal injury.

School neighborhood deprivation is associated with a higher prevalence of hypertension

OBJECTIVES

To examine the association between socioeconomic characteristics of school neighborhoods and the prevalence of hypertension in adolescents.

STUDY DESIGN

We performed a secondary data analysis of over 21,000 adolescents who participated in a school BP surveillance program between 2000 and 2017. BP status was confirmed by BP measurements on up to 3 occasions to diagnose sustained hypertension according to standard pediatric hypertension guidelines. We assessed school neighborhood socioeconomic status (SES) via the area deprivation index (ADI), a composite measure of area-level socioeconomic deprivation and categorized into quartiles. Q1 represented schools in neighborhoods with the least social deprivation while Q4 represented neighborhood with the most socioeconomic deprivation. We performed a cross-sectional analysis using both univariate and multivariable regression analyses.

RESULTS

Of 21,392 children included in our analysis, the prevalence of sustained hypertension was 2.6 %. Hispanics and African Americans were overrepresented in the schools in more deprived neighborhoods. The highest sustained hypertension rate was observed among students attending Q3 (5.5 %) and Q4 (4.2 %) schools compared to Q1 (2.7 %) and Q2 (2.0 %) schools (p < 0.001). Multivariable regression analysis showed that being male, obese, and attending school in a disadvantaged neighborhood were significantly associated with an increased prevalence of hypertension.

CONCLUSIONS

Our findings suggest that school neighborhood deprivation measured by ADI may be a risk factor for hypertension and may contribute to the racial/ ethnic disparities observed in hypertension prevalence in adolescents.

Effects of nutrition education, physical activity and motivational interviewing interventions on metabolic syndrome among females of reproductive age in Wakiso district, central Uganda: a randomised parallel-group trial

BACKGROUND

The prevalence of metabolic syndrome (MetS) has increased significantly in sub-Saharan African countries, including Uganda. Females are disproportionately affected by MetS compared to males. This study evaluated the effects of 12 weeks of community-based nutrition education (NE), physical activity (PA), and motivational interviewing (MI) interventions on MetS and its components among females of reproductive age in central Uganda.

METHODS

We conducted a randomised parallel-group trial involving 120 females aged 15-49 years with MetS in Wakiso district, central Uganda. Participants were recruited between April and May 2023 and were randomly assigned to either the intervention (n = 60) or the control (n = 60) group. The 12-week intervention included NE, PA, and MI. The outcomes included changes in MetS and its components. Data were collected at baseline and endline using a modified STEPS questionnaire to assess sociodemographic factors, blood pressure (BP), waist circumference (WC), fasting blood glucose (FBG), triglycerides, HDL cholesterol (HDLC), and other variables. A generalised linear model was used to evaluate the impact of time and study groups on metabolic outcomes. Analyses were conducted using intention-to-treat in Stata (SE/14.0), at a p-value of < 0.05.

RESULTS

The group x time interaction showed significant positive effects on MetS and its components at the endline. The intervention group had significantly lower odds of MetS compared to the control group [OR = 0.588, 95% CI (0.501, 0.690), p-value < 0.0001)]. The intervention showed reduced mean diastolic BP (coeff=-4.556, 95% CI (-9.035, -0.077), p-value = 0.046), reduced mean FBG (coeff=-1.012, 95% CI (-1.553, -0.470), p < 0.001), and increased mean HDLC (coeff = 0.139, 95% CI (0.015, 0.262), p-value = 0.028). Additionally, the intervention group had significantly higher odds of daily fruit and vegetable intake compared to the control group (OR = 6.31, 95% CI: 1.18-33.64,p = 0.031), increased moderate-intensity recreational activity (Coeff = + 155.65 min/week, 95% CI:19.11-292.22, p = 0.025) and reduced sedentary time by 43.94 min per day (Coeff= -43.94, 95% CI: -87.75 to- 0.13, p = 0.049).

CONCLUSIONS

The community-based interventions significantly improved MetS outcomes among females of reproductive age in Uganda. Scaling up this package of interventions should be explored.

TRIAL REGISTRATION

ISRCTN, ISRCTN17445597. Registered 06 June 2024 - Retrospectively registered, https://www.isrctn.com/ISRCTN17445597 .

Chronic rose oxide and exercise synergistically modulate cardiovascular and autonomic functions in hypertensive rats

With the alarming rise in cases of arterial hypertension worldwide, there is an urgent need to develop combined therapies to mitigate this scenario. Rose oxide (RO), a monoterpene with anti-inflammatory and hypotensive properties, emerges as an alternative. The present study is the first to evaluate the effect of RO administered chronically and combined with physical exercise (swimming) since both have been reported to have beneficial impacts on hypertension. Male SHR and Wistar rats (aged 12 weeks) received RO for 34 consecutive days (orally; 100 mg/kg). The progression of systolic arterial pressure (SAP) was monitored through tail-cuff plethysmography. Twenty-four hours before the end of the treatment, the animals were anesthetized, and the femoral artery and vein were cannulated to record the pulsatile arterial pressure and to administer drugs, respectively. Hemodynamic and autonomic parameters and baroreflex sensitivity and intrinsic heart rate (IHR) were evaluated. Treatment with RO, administered alone or combined with exercise, reduced SAP and mean arterial pressure in SHR. The swimming protocol did not prevent increases in BP, but when combined with RO, it improved autonomic control, assessed through heart rate variability and parasympathetic tone. IHR was attenuated in SHR, and none of the treatments reversed this response. Therefore, combining RO with physical exercise may enhance their antihypertensive effects, improving autonomic function, reducing oxidative stress and inflammation, providing synergistic cardiovascular benefits, improving metabolic health, promoting a comprehensive lifestyle intervention, and potentially allowing for reduced medication dosages. This multifaceted approach could offer a more effective and sustainable strategy for managing hypertension.

Retrospective observational study of the association between changes in physical activity and frailty in middle-aged and older adults: evidence from the Korean Longitudinal Study of Aging (2006-2022)

OBJECTIVES

This study aimed to investigate the relationship between changes in physical activity and frailty among middle-aged and older adults in Korea, using panel data from the 2006-2022 Korean Longitudinal Study of Aging (KLoSA).

DESIGN

Retrospective observational study.

SETTING

For this longitudinal panel study, data were sourced from the KLoSA dataset.

PARTICIPANTS

We analysed data from 5594 participants (2855 males and 2739 females) extracted from KLoSA data collected between 2006 and 2022.

PRIMARY AND SECONDARY OUTCOME MEASURES

The frailty index was calculated based on 6 clinical domains comprising 34 age-related health deficits. Changes in physical activity were categorised as persistently inactive, decreased, increased or persistently active. Logistic regression analysis using generalised estimating equations was conducted to assess the association between changes in physical activity and frailty.

RESULTS

The persistently active group (OR=0.45, 95% CI: 0.40 to 0.50) showed a lower likelihood of frailty than did the persistently inactive group. In the group that increased their physical activity, the OR was 0.57 (95% CI: 0.52 to 0.63), and higher ORs were observed for current smokers and those residing in rural areas.

CONCLUSIONS

This study demonstrated that persistent and increased physical activity is associated with lower frailty in middle-aged and older adults in Korea. Therefore, participation in physical activity in the older adults is one of the important ways to prevent frailty.

Daily-life walking speed, running duration and bedtime from wrist-worn sensors predict incident dementia: A watch walk - UK biobank study

OBJECTIVE

To determine if wrist-worn sensor parameters can predict incident dementia in individuals aged 60 + years and to compare prediction with other tools.

DESIGN

Observational cohort study.

SETTING

Community PARTICIPANTS: The cohort comprised 47,371 participants without dementia, aged 60 + years, who participated in the UK Biobank study (mean age=67 ± 4 years; 52 % female).

MEASUREMENTS

Nineteen digital biomarkers were extracted from up-to-7-day wrist-worn sensor accelerometry data at baseline. Univariable and multivariable Cox proportional hazard models examined associations between sensor parameters and prospectively diagnosed dementia.

RESULTS

Median follow-up was 7.5 years (interquartile range: 7.0 to 9.0 years), during this time 387 participants (0.8 %) were diagnosed with dementia. Among the gait parameters, slower maximal walking speed had the strongest association with incident dementia (32 % decrease in hazard for each standard deviation increase) followed by lower daily step counts (30 % decrease) and increased step-time variability (17 % increase). While adjusting for age and sex, running duration, maximal walking speed and early bedtime were identified as independent and significant predictors of dementia. The multivariable prediction model performed comparably to the ANU-ADRI and UKB-Dementia Risk Score models in the UK Biobank cohort.

CONCLUSIONS

The study findings indicate that remotely acquired parameters from wrist-worn sensors can predict incident dementia. Since wrist-worn sensors are highly acceptable for long-term use, wrist-worn sensor parameters have the potential to be incorporated into dementia screening programs.

A systematic review of measurement tools and senior engagement in urban nature: Health benefits and behavioral patterns analysis

The engagement of senior citizens with urban nature has been shown to provide multiple health benefits and mitigate health issues associated with demographic aging. This review utilized the PRISMA methodology to systematically analyze the relationship between monitoring tools, seniors' behaviors in urban nature, and influencing factors. The main findings are as follows: (1) 4 main types, including self-reports, on-site observations, sensors, and third-party data, and 24 sub-types of measurement tools: ranging from questionnaires to crowdsourced imagery services. Self-reports capture participants' awareness of behaviors, on-site observations record various types of behaviors, sensors collect indicators to detect the body's direct responses, and third-party data provide representative behavior data from large samples. (2) 4 categories and 45 types of behaviors: physical and sports behaviors, leisure and recreational behaviors, relaxation, and passive behaviors, social and care behaviors, based on their characteristics and purposes. Physical and sports behaviors are the most common types for the elderly in urban nature, with walking being the most frequently measured behavior. (3) 36 influencing factors: ranging from diabetes risk to balanced meal habits, classified into 4 categories from physical and vitality health to social and lifestyle health. Physical and vitality health are the most affected category, receiving more academic attention. Gardening is identified as having the most health benefits. This review provides a classification of tools and behaviors, and a detailed discussion of future trends in the field. It provides actionable insights for researchers, urban designers, city managers, and policymakers to select the appropriate measurement tool from 24 sub-tools to better understand behaviors of elderly people in urban nature. It can also help them select the right type of behavior from 45 sub-behaviors to investigate in line with their research goals to improve seniors' health and well-being.

Feasibility of Using Rebound Exercise in Community-Dwelling Adults With Neurological Disorders

Rebound exercise (RE) increases mobility in hospitalized adults with neurological disorders (AwND), but its feasibility in community settings remains largely unexplored. This study evaluates the practicality of implementing RE in the community, particularly for AwND. The feasibility study involved 53 community-dwelling AwND engaging in RE sessions for 30 min, once- or twice-weekly, over 12 weeks. Feasibility was assessed through recruitment rates, adherence, attrition, and participant feedback. The study measured blood pressure (BP), walking speed (WS), and physical activity level (PAL) at baseline, 6 weeks, and 12 weeks. Repeated measures ANOVA and the Friedman tests were used to test for significant differences across the time points. The study demonstrated high recruitment (70.59%) and retention (98.1%) rates, with most participants (76.9%) preferring once-weekly sessions due to time constraints. There were no reported injuries or adverse events. Most participants were older adults (50%), females (67.3%), and retired (55.8%). Significantly lower resting BP (p < 0.001), higher WS (p < 0.001), and PAL (p = 0.000) were observed after 12 weeks of RE. In conclusion, RE is a feasible, safe, and acceptable intervention for supervised community-dwelling AwND and could be a valuable tool for promoting PAL in this population.

"Can physical activity reduce the risk of having tinnitus?"

OBJECTIVE

Tinnitus, the perception of sound without an external source, affects many adults, impacting quality of life. While factors like hearing loss and psychological distress are linked to tinnitus, the relationship with physical activity remains unclear. This study aimed to explore the association between physical activity, sedentary behaviour, and the presence of tinnitus.

DESIGN

This study is a cross-sectional study. The participants completed the long form of the International Physical Activity Questionnaire. Adjusted logistic regression models were used to investigate associations between (components of) physical activity and the presence of tinnitus, and odds ratios (ORs) were calculated.

STUDY SAMPLE

This study involved 3004 participants (2751 tinnitus patients, 253 healthy controls).

RESULTS

Engaging in moderate or vigorous-intensity physical activity during leisure time for more than 2.5 hours per week was associated with a reduced risk of having tinnitus (OR = 0.515, p < 0.001). Conversely, individuals who reported sitting for more than 7 hours per day had a significantly higher risk of having tinnitus (OR = 2.366, p < 0.001).

CONCLUSIONS

The study suggests a potential protective effect of leisure-time physical activity against tinnitus and highlights the importance of reducing sedentary behaviour. Further research is needed to confirm these findings and to understand underlying mechanisms.

Beneficial Effects of Exercise on Hypertension-Induced Cardiac Hypertrophy in Adolescents and Young Adults

PURPOSE OF REVIEW

Hypertension-induced cardiac hypertrophy is widely known as a major risk factor for increased cardiovascular morbidity and mortality. Although exercise is proven to exert overall beneficial effects on hypertension and hypertension-induced cardiac hypertrophy, there are some concerns among providers about potential adverse effects induced by intense exercise, especially in hypertensive athletes. We will overview the underlying mechanisms of physiological and pathological hypertrophy and delineate the beneficial effects of exercise in young people with hypertension and consequent hypertrophy.

RECENT FINDINGS

Multiple studies have demonstrated that exercise training, both endurance and resistance types, reduces blood pressure and ameliorates hypertrophy in hypertensives, but certain precautions are required for hypertensive athletes when allowing competitive sports: Elevated blood pressure should be controlled before allowing them to participate in high-intensity exercise. Non-vigorous and recreational exercise are always recommended to promote cardiovascular health. Exercise-induced cardiac adaptation is a benign and favorable response that reverses or attenuates pathological cardiovascular remodeling induced by persistent hypertension. Exercise is the most effective nonpharmacological treatment for hypertensive individuals. Distinction between recreational-level exercise and competitive sports should be recognized by medical providers when allowing sports participation for adolescents and young adults.

Cardiorespiratory Fitness and Cardiometabolic Risk Factors in Children and Adolescents From Southwest Colombia: Association Patterns Considering Adiposity

BACKGROUND

Little is known about the cardiorespiratory fitness (CRF)-cardiometabolic risk relationship in Latin American pediatric populations across different age/sex groups, especially when considering the potential effects of adiposity on the association. We evaluated cross-sectional associations between VO2max and cardiometabolic risk variables (CMRV), and verified whether the associations were independent of adiposity markers in school-aged children and adolescents from Cali, Colombia.

METHODS

The sample consisted of 1206 children aged 5-17 years. CMRV were fasting glucose, HDL and LDL cholesterol, triglycerides, systolic, and diastolic pressure. Logistic regressions were conducted for associations of age/sex-specific tertiles of VO2max with age/sex-specific highest tertiles of CMRV (except HDL-C, lowest tertile) and a CMR cluster (> 2 CMRV in extreme tertiles), adjusting for socioeconomic stratum, and adiposity markers (BMI, body fat percentage, and waist circumference).

RESULTS

Overweight/obesity ranged from 15% to 18% with no difference by sex. In children aged 5-11 years, high VO2max (highest tertile vs. lowest) was inversely associated with the CMR cluster [Odds ratio (95% confidence interval): 0.18 (0.06-0.47), p < 0.05] independently of adjustment for any adiposity marker in boys but not in girls. In the age group of 12-17 years, there were initially significant VO2max- CMR cluster and VO2max- CMRV associations but attenuated by adiposity adjustment. In girls, high VO2max was inversely associated with high systolic blood pressure regardless of adjustment for adiposity markers.

CONCLUSION

VO2max is inversely associated with cardiometabolic risk, but adiposity influences the association. The adiposity-independent association among younger boys requires further research. Interventions to tackle cardiometabolic risk in childhood may primarily focus on reducing excess adiposity, and secondarily on improvement of CRF.

Hypertension in Young Asymptomatic University Students: Impact of Parental History, Physical Inactivity, and Diet

Introduction Non-communicable diseases such as hypertension have emerged as a major public concern over the past two decades due to lifestyle changes. Patients with prehypertension have a greater risk of developing coronary artery disease, myocardial infarction, and stroke. Hypertension is a major modifiable risk factor for premature death worldwide. Evidence about the prevalence of hypertension and related variables, however, is sparse among university students in areas with limited resources. This study was conducted with an aim to evaluate the impact of parental history, physical inactivity, and diet on the blood pressure readings of university students. Methodology For this study, 337 university students aged between 18 and 30 years (102 males and 235 females) were randomly selected. The data was collected through a structured questionnaire, which gathered information about the lifestyle habits of the participating students. Trained students measured the participant's blood pressure according to a standardized procedure. Results Of the total participants, 50.7% (n= 171) were normotensive, 36.8% (n= 124) were prehypertensive, and 12.5% (n= 42) were hypertensive. Males were more prone to developing prehypertension (54.9%) while females were more likely to develop hypertension (12.7%). The consumption of sugared beverages and Western fast food showed a statistically significant relationship with increased blood pressure. A significant relationship was also seen between the duration of exercise and hypertension (p-value =0.007) Conclusion Hypertension and prehypertension are common among university students. The risk factors for these conditions include a positive family history, being male, increased intake of fast food and sugar-sweetened beverages, and reduced duration of regular exercise. These findings emphasize the significance of implementing targeted health education programs aimed at fostering healthy lifestyle practices among young adults.

Assessing Exercise Habits of Cardiovascular Risks in Middle-Aged Adults: A Descriptive Study

Background

Cardiovascular problems are the leading cause of death among adults in our country. These illnesses primarily affect metropolitan populations, particularly in major cities. To prevent these diseases, efforts have focused on identifying and controlling cardiovascular risk factors such sedentary lifestyle.

Aim

The study aimed to assess the exercise habits of cardiovascular risks middle-aged adults.

Materials and Methods

The research approach used in this study was quantitative approach with descriptive design. Purposive sampling technique was used to select the samples. Totally 60 cardiovascular patients were recruited from Saveetha Medical College and Hospital Thandalam, Chennai. Data were gathered by using structured questionnaires and risk score calculator. Collected data were analyzed by using descriptive and inferential statistics.

Results

The above Table 1 shows that 59 (98.33%) had moderate level of physical activity and 1 (1.67%) had high level of physical activity among middle-aged adults. The mean and standard deviation of physical activity among middle-aged adults was 62.26 ± 5.92. The median was 62.0 with minimum score of 38.0 and maximum score of 73.0. The demographic variable age (χ 2 = 6.610, P = 0.037) had statistically significant association with level of physical activity among middle-aged adults at P < 0.05 level and the other demographic variables had not shown statistically significant association with level of physical activity among middle-aged adults.

Conclusion

Physical activity promotion and support should be a global priority because of the health benefits it provides for adults.

Prevention and treatment of hypertensive left ventricular hypertrophy

PURPOSE OF REVIEW

Left ventricular (LV) hypertrophy (LVH) is a well recognized target organ adaptation to longstanding uncontrolled hypertension and other cardiovascular risk factors. It is also a strong and independent predictor of many cardiovascular disorders.

RECENT FINDINGS

This focused review explores the current concepts in screening, diagnosis, prevention, and treatment of LVH in patients with hypertension. Currently, the primary screening and diagnostic tools for LVH are ECG and 2D echocardiography. Implementing machine learning in the diagnostic modalities can improve sensitivity in the detection of LVH. Lifestyle modifications, blood pressure control with antihypertensive therapy, and management of comorbidities aid in preventing and reversing LV remodeling.

SUMMARY

LVH is a common and often silent complication of hypertension. Prevention and reversal of LV remodeling are crucial for cardiovascular risk reduction in patients with hypertension.

Effect of physical activity on free fatty acids, insulin resistance, and blood pressure in obese older women

PURPOSE

Obesity is characterized by a progressive increase in body fat accompanied by insulin resistance (IR) and elevated blood pressure (BP), and presents significant health risks, particularly in aged individuals. This study aimed to evaluate the effects of physical activity (PA) on free fatty acid (FFA) levels, IR, and BP in obese older women.

METHODS

Twenty-three participants were randomly assigned to either the control group (CON, n = 11) or the physical activity group (PA, n = 12). The PA group was provided with a target of achieving >7,000 steps/day for 5 days each week. Body composition, FFA levels, IR, and BP were measured at pre- and post- of the 12-week intervention.

RESULTS

The analysis revealed a statistically significant interaction between FFA (p < 0.01), IR (p < 0.01), and SBP (p < 0.001). FFA (p < 0.5), IR (p < 0.5), and systolic blood pressure (SBP) (p < 0.01) were significantly decreased in the PA group compared to those in the CON group, which showed no significant changes in FFA, IR, and SBP.

CONCLUSION

PA significantly decreased FFA, IR, and SBP in older women with obesity. Therefore, PA is an effective intervention for the prevention and management of obesity and cardiovascular diseases in obese older women.

An Indian classical dance form, Kathak in maintaining handgrip strength symmetry and reducing the risk of hypertension

BACKGROUND

The present paper aimed to study handgrip strength (HGS) asymmetry and its association with hypertension in a sample of Kathak dancers and non-dancers of North India.

METHODS

Data on HGS and blood pressure were collected from 206 Kathak dancers and 235 age-matched controls, using standardized protocols. Pearson correlation coefficients assessed the association between HGS and hypertension, and binary logistic regression identified the risk of developing hypertension.

RESULTS

HGS asymmetry was higher among non-dancers. In Kathak dancers, systolic blood pressure (SBP) was positively correlated with HGS and negatively correlated with HGS asymmetry whereas diastolic blood pressure (DBP) was negatively correlated with both HGS and HGS asymmetry. Dancers with high HGS, have significantly reduced risk of developing hypertension. Non-dancers with HGS asymmetry were 1.8 times more likely to report hypertension, relative to dancers.

CONCLUSION

Kathak may be used as an alternative method for maintaining HGS symmetry and reducing the risk of developing hypertension.

Association between intensity of physical activity and cognitive function in hypertensive patients: a case-control study

Previous studies have shown that a higher intensity of physical activity (PA) is associated with a lower risk of cognitive impairment (CI), whereas hypertension is associated with higher CI. However, there are few studies on the association between PA intensity and cognitive function in hypertensive patients. This study investigated the association between PA intensity and cognitive function in hypertensive patients. A total of 2035 hypertensive patients were included in this study, including 407 hypertensive patients with CI and 1628 hypertensive patients with normal cognitive function matched 1:4 by age and sex. The International Physical Activity Questionnaire-Long Form and the Mini-mental State Examination were used to evaluate PA intensity, total metabolic equivalents, and cognitive function in patients with hypertension. Multivariate logistic regression was used to analyze the correlation between PA intensity and CI in hypertensive patients. The Spearman correlation coefficient was used to analyze the correlation between PA intensity and the total score of each component of the MMSE and the correlation between PA total metabolic equivalents and cardiac structure in hypertensive patients. After adjusting for all confounding factors, PA intensity was negatively associated with CI in hypertensive patients (OR = 0.608, 95% CI: 0.447-0.776, P < 0.001), and this association was also observed in hypertensive patients with education level of primary school and below and junior high school and above (OR = 0.732, 95% CI: 0.539-0.995, P = 0.047; OR = 0.412, 95% CI: 0.272-0.626, P < 0.001). The intensity of PA in hypertensive patients was positively correlated with orientation (r = 0.125, P < 0.001), memory (r = 0.052, P = 0.020), attention and numeracy (r = 0.151, P < 0.001), recall ability (r = 0.110, P < 0.001), and language ability (r = 0.144, P < 0.001). PA total metabolic equivalents in hypertensive patients were negatively correlated with RVEDD and LAD (r = - 0.048, P = 0.030; r = - 0.051, P = 0.020) and uncorrelated with LVEDD (r = 0.026, P = 0.233). Higher PA intensity reduced the incidence of CI in hypertensive patients. Therefore, hypertensive patients were advised to moderate their PA according to their circumstances.

Socio-demographic and lifestyle factors associated with hypertension in Nigeria: results from a country-wide survey

With the rising prevalence of hypertension, especially in Africa, understanding the dynamics of socio-demographic and lifestyle factors is key in managing hypertension. To address existing gaps in evidence of these factors, this study was carried out. A cross-sectional survey using a modified WHO STEPS questionnaire was conducted among 3782 adult Nigerians selected from an urban and a rural community in one state in each of the six Nigerian regions. Among participants, 56.3% were women, 65.8% were married, 52.5% resided in rural areas, and 33.9% had tertiary education. Mean ages (SD) were 53.1 ± 13.6 years and 39.2 ± 15.0 years among hypertensive persons and their normotensive counterparts respectively. On lifestyle, 30.7% had low physical activity, 4.1% consumed tobacco currently, and 35.4% consumed alcohol currently. In comparison to unmarried status, being married (OR = 1.88, 95% CI: 1.41-2.50) or widowed (OR = 1.57, 95% CI: 1.05-2.36) was significantly associated with hypertension, compared with never married. Compared with no formal education, primary (OR = 1.44, 95% CI: 1.12-1.85), secondary (OR = 1.37, 95% CI: 1.04-1.81), and tertiary education (OR = 2.02, 95% CI: 1.57-2.60) were associated with hypertension. Low physical activity (OR = 1.23, 95% CI: 1.05-1.42), alcohol consumption, (OR = 1.18, 95% CI: 1.02-1.37), and unemployment status (OR = 1.42; 95% CI: 1.07-1.88) were also associated with hypertension. Our study indicates an association of socio-demographic and lifestyle factors with hypertension, hence, there is a need for counselling, health education and policy formulation and implementation targeting these factors to prevent and control hypertension.

Combined Influence of Eight Lifestyle Factors on Metabolic Syndrome Incidence: A Prospective Cohort Study from the MECH-HK Study

Although previous studies have shown significant associations between individual lifestyles and metabolic syndrome, limited studies have explored the combined effect of lifestyles. The purpose of this study was to investigate whether a combined lifestyle score was associated with metabolic syndrome incidence in Hong Kong Chinese women. This prospective cohort study included 1634 women (55.9 ± 8.6 years) without baseline metabolic syndrome, diabetes, myocardial infarction, or stroke. Eight lifestyle factors (smoking, physical activity, sedentary time, sleep, stress, fatigue, diet, and alcohol) were included by assigning 0 (unhealthy) or 1 point (healthy). The overall score was the sum of these points, ranging from 0 (the least healthy) to 8 points (the healthiest). Metabolic syndrome was diagnosed by the joint interim statement. During a 1.16-year follow-up, 179 (11.0%) new metabolic syndrome cases were identified. The incidences for the 0-3-point, 4-point, 5-point, and 6-8-point groups were 12.8% (79/618), 11.5% (42/366), 9.4% (29/309), and 8.5% (29/341), respectively. Compared to the lowest combined lifestyle score group, the highest group had a 47% reduced metabolic syndrome incidence, with an adjusted odds ratio and 95% confidence interval of 0.53 (0.33-0.86) (p = 0.010). These findings indicate that a higher combined lifestyle score was associated with a lower metabolic syndrome incidence in this population.

Screening for hypertension in adults: protocol for evidence reviews to inform a Canadian Task Force on Preventive Health Care guideline update

PURPOSE

To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening in a primary care setting for hypertension in adults aged 18 years and older. This protocol outlines the scope and methods for a series of systematic reviews and one overview of reviews.

METHODS

To evaluate the benefits and harms of screening for hypertension, the Task Force will rely on the relevant key questions from the 2021 United States Preventive Services Task Force systematic review. In addition, a series of reviews will be conducted to identify, appraise, and synthesize the evidence on (1) the association of blood pressure measurement methods and future cardiovascular (CVD)-related outcomes, (2) thresholds for discussions of treatment initiation, and (3) patient acceptability of hypertension screening methods. For the review of blood pressure measurement methods and future CVD-related outcomes, we will perform a de novo review and search MEDLINE, Embase, CENTRAL, and APA PsycInfo for randomized controlled trials, prospective or retrospective cohort studies, nested case-control studies, and within-arm analyses of intervention studies. For the thresholds for discussions of treatment initiation review, we will perform an overview of reviews and update results from a relevant 2019 UK NICE review. We will search MEDLINE, Embase, APA PsycInfo, and Epistemonikos for systematic reviews. For the acceptability review, we will perform a de novo systematic review and search MEDLINE, Embase, and APA PsycInfo for randomized controlled trials, controlled clinical trials, and observational studies with comparison groups. Websites of relevant organizations, gray literature sources, and the reference lists of included studies and reviews will be hand-searched. Title and abstract screening will be completed by two independent reviewers. Full-text screening, data extraction, risk-of-bias assessment, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers. Results from included studies will be synthesized narratively and pooled via meta-analysis when appropriate. The GRADE approach will be used to assess the certainty of evidence for outcomes.

DISCUSSION

The results of the evidence reviews will be used to inform Canadian recommendations on screening for hypertension in adults aged 18 years and older.

SYSTEMATIC REVIEW REGISTRATION

This protocol is registered on PROSPERO and is available on the Open Science Framework (osf.io/8w4tz).

Life's Essential 8 and Incident Hypertension Among US Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Life's Essential 8 (LE8) is a new metric to define cardiovascular health. We aimed to describe LE8 among Hispanics/Latinos and its association with incident hypertension.

METHODS AND RESULTS

The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a study of Hispanic/Latino adults aged 18 to 74 years from 4 US communities. At visit 1 (2008-2011), information on behavioral and clinical factors (diet, smoking status, physical activity, sleep duration, body mass index, blood pressure, cholesterol, fasting glucose, and medication use) were measured and used to estimate an LE8 score (range, 0-100) for 14 772 participants. Hypertension was defined as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg, or self-reported use of antihypertensive medications. Among the 5667 participants free from hypertension at visit 1, we used Poisson regression models to determine the multivariable adjusted association between LE8 and incident hypertension in 2014 to 2017. All analyses accounted for the complex survey design of the study. Mean population age was 41 years, and 21.6% (SE, 0.7) had high cardiovascular health (LE8 ≥80). Mean LE8 score (68.2; SE, 0.3) varied by Hispanic/Latino background (P<0.05), ranging from 72.6 (SE, 0.3) among Mexican Americans to 62.2 (SE, 0.4) among Puerto Ricans. Each 10-unit decrement in LE8 score was associated with a 22% increased risk of hypertension over ≈6 years (incident density ratio, 1.22 [95% CI, 1.16-1.29]).

CONCLUSIONS

Only 1 in 5 Hispanic/Latino adults had high cardiovascular health, and LE8 varied substantially across Hispanic/Latino background groups. Improvements in other components of cardiovascular health may result in a lower risk of developing hypertension.

Association between medication adherence and health-related quality of life of patients with hypertension and dyslipidemia

PURPOSE

Τo evaluate the association between medication adherence and health-related quality of life (HRQoL) of patients with hypertension and dyslipidemia in Greece.

METHODS

In a multicenter, cross-sectional, non-interventional study, a total of 721 hypertensive and 463 dyslipidemic adult outpatient patients were recruited during the COVID-19 pandemic using consecutive sampling. The EQ-5D-5L instrument was used to measure HRQoL, and medication adherence was assessed with the Adherence Starts with Knowledge 20 questionnaire. Multiple linear stepwise regressions using robust standard errors were employed.

RESULTS

Approximately 28% of hypertensive and 16% of dyslipidemic patients had not been fully adherent during the previous week, while the estimates were 49 and 34%, respectively when the previous month was considered. The HRQoL domain with the highest prevalence of problems was anxiety/depression, followed by mobility and usual activities for both conditions; HRQoL was lower in dyslipidemic patients. Higher medication non-adherence was independently associated with lower EQ-VAS in hypertension and a lower EQ-5D index in dyslipidemia. Other significant risk factors of impaired HRQoL and general health were lack of exercise, longer duration of disease, and multimorbidity, while a curvilinear effect of BMI and age was observed. Also, female gender, employment, and marriage worked as protective factors for hypertensive patients and education for dyslipidemic participants.

CONCLUSION

Medication adherence is suboptimal in patients with hypertension and, in particular, with dyslipidemia in Greece. Moreover, poor medication adherence has a detrimental impact on patients' HRQoL. Therefore, improving treatment outcomes and patients' HRQoL in a sustainable way requires a better understanding of the factors influencing medication adherence.

Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides an overview of the mechanisms and treatment of obesity and hypertension.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

Mechanisms contributing to obesity-related hypertension include unhealthful nutrition, physical inactivity, insulin resistance, increased sympathetic nervous system activity, renal dysfunction, vascular dysfunction, heart dysfunction, increased pancreatic insulin secretion, sleep apnea, and psychosocial stress. Adiposopathic factors that may contribute to hypertension include increased release of free fatty acids, increased leptin, decreased adiponectin, increased renin-angiotensin-aldosterone system activation, increased 11 beta-hydroxysteroid dehydrogenase type 1, reduced nitric oxide activity, and increased inflammation.

Conclusions

Increase in body fat is the most common cause of hypertension. Among patients with obesity and hypertension, weight reduction via healthful nutrition, physical activity, behavior modification, bariatric surgery, and anti-obesity medications mostly decrease blood pressure, with the greatest degree of weight reduction generally correlated with the greatest degree of blood pressure reduction.

Effect of resistance training and high-intensity interval training on metabolic parameters and serum level of Sirtuin1 in postmenopausal women with metabolic syndrome: a randomized controlled trial

BACKGROUND

The present study analyzes the influence of resistance training (RT) and high-intensity interval training (HIIT) on metabolic indices and serum levels of Sirtuin1 (SIRT1) in postmenopausal women who suffer from the metabolic syndrome (MetS).

METHODS

45 postmenopausal women aged 45-65 years with MetS were divided into two intervention groups (RT and HIIT) and one control group, each consisting of 15 people. The RT group performed resistance training for both the upper and lower body, while the HIIT group completed 3 min(min) of high-intensity training at 80-90% of their maximum heart rate (HRmax), followed by moderate walking for 3 min at 55-65% of HRmax. These sessions were conducted for a duration of eight weeks and three times a week, with the samples being collected at the baseline and at the end of the treatment, i.e., week 8.

RESULTS

The results showed that weight, waist circumference, body mass index, fat mass, low-density lipoprotein, triglyceride, cholesterol, fasting blood sugar (FBS), hemoglobin A1c (HbA1C), systolic and diastolic blood pressure decreased, and SIRT1 increased significantly in both training groups. Systolic blood pressure, cholesterol, HbA1C, and FBS decreased more in the HIIT group. Skeletal muscle mass and 1-repetition maximum (1-RM) increased more in the RT group.

CONCLUSIONS

RT and HIIT serve as one of the most effective strategies for therapeutically treating patients with metabolic syndrome.

TRIAL REGISTRATION

IRCT, IRCT20221120056548N1. Registered 23 November 2022 - Retrospectively registered.

Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis

INTRODUCTION

The combined clinical impact of muscle mass, muscle function, and adipose mass on hospitalisation events, especially those that have exact causes, such as cardiovascular diseases (CVDs), had been rarely studied in patients on haemodialysis (HD). This study aimed to determine the influence of lean tissue index (LTI), fat tissue index (FTI), and hand grip strength (HGS) on the risk of CVD-related hospitalisation in patients undergoing chronic HD.

METHODS

This multi-centre observational study enrolled a total of 2,041 clinically stable patients aged >18 years and who had undergone HD for at least 3 months at 17 HD units in 2019. The follow-up period was up to 2 years. LTI and FTI were assessed using a body composition monitoring machine, and HGS was measured by a CAMRY® dynamometer. Cox regression models were fit to estimate the associations of body composition and HGS with CVD-related hospitalisation risk.

RESULTS

During a mean follow-up of 22.6 months, CVD-related hospitalisation occurred in 492 patients. Compared with the non-CVD group, patients with CVD-related hospitalisation were older; had lower diastolic blood pressure; were more likely to have a history of diabetes; had worse activity status scores and lower levels of LTI, HGS, serum uric acid, and serum creatinine; and had higher FTI levels, body mass index, and extracellular water/intracellular water ratio. In the Cox regression models, low LTI and high FTI were independently associated with CVD-related hospitalisation in both men and women. In men, low HGS was an independent risk factor for CVD-related hospitalisation. When patients were further stratified into four distinct groups according to the sex-specific median values of LTI and FTI, the combination of low LTI and high FTI was an independent risk factor for CVD-related hospitalization (hazard ratio [HR] = 1.79 in men, 95% confidence interval 1.26-2.55; HR = 2.48 in women, 95% confidence interval 1.66-3.71; reference: high LTI/low FTI group).

CONCLUSIONS

Among patients on chronic HD, low LTI, and high FTI were associated with CVD-related hospitalisation in men and women, whereas HGS was an independent risk factor for CVD-related hospitalisation in men but not in women. Combining low LTI and high FTI increased the association with hospitalisation risk and was an independent predictor of CVD-related hospitalisation.

Interplay between chronic widespread pain and lifestyle factors on the risk of type 2 diabetes: longitudinal data from the Norwegian HUNT Study

INTRODUCTION

Chronic widespread pain (CWP) and diabetes commonly co-occur; however, it is unclear whether CWP infers an additional risk for diabetes among those with known risk factors for type 2 diabetes. We aimed to examine if CWP magnifies the effect of adverse lifestyle factors on the risk of diabetes.

RESEARCH DESIGN AND METHODS

The study comprised data on 25 528 adults in the Norwegian HUNT Study without diabetes at baseline (2006-2008). We calculated adjusted risk ratios (RRs) with 95% CIs for diabetes at follow-up (2017-2019), associated with CWP and body mass index (BMI), physical activity, and insomnia symptoms. The relative excess risk due to interaction (RERI) was calculated to investigate the synergistic effect between CWP and adverse lifestyle factors.

RESULTS

Compared with the reference group without chronic pain and no adverse lifestyle factors, those with BMI ≥30 kg/m2 with and without CWP had RRs for diabetes of 10.85 (95% CI 7.83 to 15.05) and 8.87 (95% CI 6.49 to 12.12), respectively; those with physical activity <2 hours/week with and without CWP had RRs for diabetes of 2.26 (95% CI 1.78 to 2.88) and 1.54 (95% CI 1.24 to 1.93), respectively; and those with insomnia symptoms with and without CWP had RRs for diabetes of 1.31 (95% CI 1.07 to 1.60) and 1.27 (95% CI 1.04 to 1.56), respectively. There was little evidence of synergistic effect between CWP and BMI ≥30 kg/m2 (RERI=1.66, 95% CI -0.44 to 3.76), low physical activity (RERI=0.37, 95% CI -0.29 to 1.03) or insomnia symptoms (RERI=-0.09, 95% CI -0.51 to 0.34) on the risk of diabetes.

CONCLUSIONS

These findings show no clear interaction between CWP and adverse lifestyle factors on the risk of diabetes.

Association Between Big Five Personality Traits and Hypertension in Saudi Patients: A Case Control Study

BACKGROUND

The association between personality traits and hypertension is complex and has so far not been studied in depth.

OBJECTIVE

The present study aims to explore the connection between the Big Five personality traits and hypertension.

METHODS

This case control study includes 310 participants, and the relationship between personality traits and hypertension was investigated in normotensive and hypertensive patients by the Big Five Inventory-10. We examined the association of each of the Big Five personality traits in hypertensive patients and a control group using binary logistic regression analysis.

RESULTS

The findings of the study revealed that amongst the Big Five personality factors, low conscientiousness (OR: 1.09, 95% CI: 0.92-1.29, P<0.005) and high neuroticism (OR: 0.54, 95% CI: 0.45-0.66, P<0.001) were related with high risk of hypertension. Male, older people, and physically inactive individuals have been found to be at a higher risk of hypertension. No significant relationship was found between hypertension and marital status, education, or smoking habits.

CONCLUSION

These results suggested that a low score in conscientiousness trait and a high neuroticism score may be an additional risk factor of hypertension. Thus, it may be worthy to investigate further in order to identify patients at risk and develop a more individual treatment strategy. Cognitive behavioral therapy and pharmacological options can be used preemptively in high-risk patients.

The Physiological and Molecular Links Between Physical Activity and Brain Health: A Review

There is currently an epidemic of sedentary behavior throughout the world, leading to negative impacts on physical health and contributing to both mortality and burden of disease. The consequences of this also impact the brain, where increased levels of cognitive decline are observed in individuals who are more sedentary. This review explores the physiological and molecular responses to our sedentary propensity, its contribution to several medical conditions and cognitive deficits, and the benefits of moderate levels of physical activity and exercise. Also presented is the recommended level of activity for overall physical health improvement.

Associations of Urban Built Environment with Cardiovascular Risks and Mortality: a Systematic Review

With rapid urbanization, built environment has emerged as a set of modifiable factors of cardiovascular disease (CVD) risks. We conducted a systematic review to synthesize evidence on the associations of attributes of urban built environment (e.g. residential density, land use mix, greenness and walkability) with cardiovascular risk factors (e.g. hypertension and arterial stiffness) and major CVD events including mortality. A total of 63 studies, including 31 of cross-sectional design and 32 of longitudinal design conducted across 21 geographical locations and published between 2012 and 2023 were extracted for review. Overall, we report moderately consistent evidence of protective associations of greenness with cardiovascular risks and major CVD events (cross-sectional studies: 12 of 15 on hypertension/blood pressure (BP) and 2 of 3 on arterial stiffness; and longitudinal studies: 6 of 8 on hypertension/BP, 7 of 8 on CVD mortality, 3 of 3 on ischemic heart disease mortality and 5 of 8 studies on stroke hospitalization or mortality reporting significant inverse associations). Consistently, walkability was associated with lower risks of hypertension, arterial stiffness and major CVD events (cross-sectional studies: 11 of 12 on hypertension/BP and 1 of 1 on arterial stiffness; and longitudinal studies: 3 of 6 on hypertension/BP and 1 of 2 studies on CVD events being protective). Sixty-seven percent of the studies were rated as "probably high" risk of confounding bias because of inability to adjust for underlying comorbidities/family history of diseases in their statistical models. Forty-six percent and 14% of the studies were rated as "probably high" risk of bias for exposure and outcome measurements, respectively. Future studies with robust design will further help elucidate the linkages between urban built environment and cardiovascular health, thereby informing planning policies for creating healthy cities.

The evidence of effectiveness of isometric resistance training on the management of hypertension in adults: an umbrella review

Hypertension is the leading risk factor for cardiovascular disease yet also one of the most readily preventable causes of death. Isometric resistance training (IRT) has gained increasing popularity in recent times as a viable nonpharmacological management option for hypertension. Whilst there have been several reviews on this topic, with varying findings, this umbrella review aimed to summarize the current evidence underpinning the effectiveness of IRT for hypertension. Quantitative systematic reviews and meta-analyses published in English were considered for inclusion. Commercially produced and grey literature was searched between December 2021 and January 2022. Methodological quality of included reviews was determined using the AMSTAR 2 critical appraisal tool. Customized data extraction tools were developed for this review and data were synthesized using the National Health and Medical Research Council FORM Framework. Twelve reviews published between 2011 and 2021 of varying methodological quality were identified. Isometric handgrip exercise training with four sets of 2-min contractions and 1 min rest period between each set was the most utilized intervention, undertaken three times per week for at least 8 weeks. Collectively, there is consistent evidence to indicate IRT has positive impacts on SBP and DBP as well as mean arterial pressure. These positive impacts were reported for normotensive as well as hypertensive individuals. Given IRT is a readily available, easy-to-use intervention with minimal financial cost, it could be considered a viable treatment option for people with, and at risk of, hypertension.

A lifestyle pattern characterised by high consumption of sweet and salty snacks, sugar sweetened beverages and sedentary time is associated with blood pressure in families at risk for type 2 diabetes mellitus in Europe. The Feel4Diabetes Study

BACKGROUND

Individuals from families at high-risk for type 2 diabetes mellitus (T2DM) are also at high risk for hypertension (HTN) and cardiovascular disease. Studies identifying lifestyle patterns (LPs) combining dietary, physical activity or sedentary variables and examining their possible role with respect to developing blood pressure (BP) are limited. The present study aimed to examine the association of different LPs with BP levels in families at high risk for T2DM in Europe.

METHODS

In total, 1844 adults (31.6% males) at high-risk for T2DM across six European countries were included in this cross-sectional study using data from the baseline assessment of the Feel4Diabetes Study. BP measurements and dietary and physical activity assessments were conducted, and screen times were surveyed. LPs were revealed with principal component analysis of various data regarding diet, physical activity, screen time and smoking.

RESULTS

Three LPs were identified. LP3 (high consumption of sweet and salty snacks, sugar sweetened soft drinks and juices, and high amount of screen time) was positively associated with diastolic BP (B, 0.52; 95% confidence interval = 0.05-0.99) and the existence of HTN (odds ratio = 1.12; 95% confidence interval = 1.00-1.25). Participants in the highest tertile of LP3 spent mean 3 h of screen time, consumed 1.5 portions of sweet and/or salty snacks and 1 L of soft drinks on a daily basis, were associated with 12% higher risk of HTN.

CONCLUSIONS

Focusing on the combination of eating and lifestyle behaviours may more accurately identify, and therefore guide preventive measures tailored to the specific needs of high-risk populations.

Opportunities and challenges for sweat-based monitoring of metabolic syndrome via wearable technologies

Metabolic syndrome is a prevalent condition in adults over the age of 65 and is a risk factor for developing cardiovascular disease and type II diabetes. Thus, methods to track the condition, prevent complications and assess symptoms and risk factors are needed. Here we discuss sweat-based wearable technologies as a potential monitoring tool for patients with metabolic syndrome. We describe several key symptoms that can be evaluated that could employ sweat patches to assess inflammatory markers, glucose, sodium, and cortisol. We then discuss the challenges with material property, sensor integration, and sensor placement and provide feasible solutions to optimize them. Together with a list of recommendations, we propose a pathway toward successfully developing and implementing reliable sweat-based technologies to monitor metabolic syndrome.

Metabolic syndrome is a risk factor for developing cardiovascular disease and type II diabetes. Lyzwinski, Elgendi and colleagues discuss the potential role of sweat-based wearable technologies for monitoring metabolic syndrome along with engineering challenges towards implementation and optimization

Exercise and cardiovascular health: A state-of-the-art review

Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We discuss the CV adaptations to exercise, focusing on the physiological changes in the heart and vasculature. We review the impact and benefits of exercise on specific CV prevention, including type II diabetes, hypertension, hyperlipidemia, coronary artery disease, and heart failure, in addition to CVD-related and all-cause mortality. Lastly, we evaluate the current PA guidelines and various modes of exercise, assessing the current literature for the effective regimens of PA that improve CVD outcomes.

Conversational Agents and Avatars for Cardiometabolic Risk Factors and Lifestyle-Related Behaviors: Scoping Review

BACKGROUND

In recent years, there has been a rise in the use of conversational agents for lifestyle medicine, in particular for weight-related behaviors and cardiometabolic risk factors. Little is known about the effectiveness and acceptability of and engagement with conversational and virtual agents as well as the applicability of these agents for metabolic syndrome risk factors such as an unhealthy dietary intake, physical inactivity, diabetes, and hypertension.

OBJECTIVE

This review aimed to get a greater understanding of the virtual agents that have been developed for cardiometabolic risk factors and to review their effectiveness.

METHODS

A systematic review of PubMed and MEDLINE was conducted to review conversational agents for cardiometabolic risk factors, including chatbots and embodied avatars.

RESULTS

A total of 50 studies were identified. Overall, chatbots and avatars appear to have the potential to improve weight-related behaviors such as dietary intake and physical activity. There were limited studies on hypertension and diabetes. Patients seemed interested in using chatbots and avatars for modifying cardiometabolic risk factors, and adherence was acceptable across the studies, except for studies of virtual agents for diabetes. However, there is a need for randomized controlled trials to confirm this finding. As there were only a few clinical trials, more research is needed to confirm whether conversational coaches may assist with cardiovascular disease and diabetes, and physical activity.

CONCLUSIONS

Conversational coaches may regulate cardiometabolic risk factors; however, quality trials are needed to expand the evidence base. A future chatbot could be tailored to metabolic syndrome specifically, targeting all the areas covered in the literature, which would be novel.

Cognitive Behavioral Therapy Enhances Survival in Cardiac Patients Aged Under 60: 14-YEAR OUTCOMES OF THE BEATING HEART PROBLEMS PROGRAM TRIAL

PURPOSE

To optimize recovery and improve prognosis, people who have had an acute cardiac event (ACE) need support to manage their cardiac risk. In 2008, we conducted a randomized controlled trial (RCT) of Beating Heart Problems (BHP) , an 8-wk group program based on cognitive behavioral therapy (CBT) and motivational interviewing (MI), designed to improve behavioral and mental health. This study investigated 14-yr mortality status for RCT participants in order to evaluate the survival impact of the BHP program.

METHODS

In 2021, mortality data on 275 participants from the earlier RCT were obtained from the Australian National Death Index. Survival analysis was undertaken to investigate differences in survival for participants in the treatment and control groups.

RESULTS

Over the 14-yr follow-up period, there were 52 deaths (18.9%). For those aged <60 yr, there was a significant survival benefit to program participation, with 3% deaths in the treatment group and 13% deaths in the control group ( P = .022). For those aged ≥60 yr, the death rate was identical in both groups (30%). Other significant predictors of mortality included older age, higher 2-yr risk score, lower functional capacity, lower self-rated health, and having no private health insurance.

CONCLUSIONS

Participation in the BHP conferred a survival benefit for patients aged <60 yr but not for participants overall. The findings highlight the long-term benefit of behavioral and psychosocial management of cardiac risk through CBT and MI for those who are younger at the time of their first ACE.

Household disorder and blood pressure in mother-child dyads: A brief report

High blood pressure (BP) is the leading risk factor for cardiovascular disease (CVD). Although factors outside the home, such as crime and noise, have been associated with high BP in women and children, it is unknown if disorder within the home (household disorder) influences BP. We tested the hypothesis that women and children with more household disorder would have higher BP, independent of age, race, sodium intake, and body mass index (BMI). This study was a secondary analysis of data from mother-child dyads (n = 216). Mothers were 87% African American, 34 ± 5 years old, with BMI 33.59 ± 9.43 kg/m². Children were 7 ± 2 (range: 4-10) years of age with BMI z score 0.60 ± 2.07. Household disorder was measured by the Confusion Hubbub and Order Scale. Mother-child dyads were assessed for weight, height, BP (adults), BP percentile (children), energy intake, and sodium intake. The relationship between household disorder and BP was evaluated using Pearson's partial correlation coefficients. In fully adjusted models, household disorder was positively associated with systolic BP for mothers (r = 0.15, p < .05) and tended to be positively associated with diastolic BP (r = 0.11, p = .10). For the children, household disorder was not associated with systolic or diastolic BP percentile. This study's results suggest that household disorder is positively associated with higher BP in adult women, but not their children. Nevertheless, these data suggest that interventions to address household disorder could benefit maternal BP and potentially improve long-term CVD outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Is COVID-19 induced reductions in the level of physical activity associated with increased depressive symptoms in patients with hypertension?

BACKGROUND

Studies have reported that the coronavirus 2019 (COVID-19) outbreak led to reduced levels of physical activity, but this has been rarely studied in patients with hypertension. This study investigated the association between depressive symptoms and changes in physical activity of patients with hypertension during the COVID-19 outbreak.

METHODS

Data were from the Korea Community Health Survey (KCHS), conducted between August to November 2020. The KCHS is a nationwide cross-sectional survey that evaluates information on various sociodemographic, economic, and health related variables. Depressive symptoms were measured using the Patient Health Questionnaire-9. Physical activity was measured using a questionnaire inquiring whether participants experienced any changes in physical activity after the pandemic. The association between depressive symptoms and changes in physical activity level were analyzed using a multivariable logistic regression analysis.

RESULTS

Out of 55,203 patients, 39.6% responded that they had experienced lower levels of physical activity due to the pandemic and showed increased likelihoods of depressive symptoms (OR 1.33, 95% CI 1.14-1.54) than individuals who responded that they had performed similar levels of physical activity. This tendency was stronger in patients that did not receive treatment for hypertension (OR 2.07, 95% CI 1.02-4.23) than those who did receive treatment with marginal significance (p-value of interaction term: 0.1241).

CONCLUSIONS

Decreased levels of physical activity due to the outbreak was experienced by a noticeable proportion of patients with hypertension and was associated with increased likelihoods of depressive symptoms.

Strength training for arterial hypertension treatment: a systematic review and meta-analysis of randomized clinical trials

Cardiovascular diseases are the leading cause of death in the world and arterial hypertension (AH) accounts for 13.8% of deaths caused by cardiovascular diseases. Strength training interventions could be an important alternative tool for blood pressure control, however, consistent evidence and the most effective training protocol for this purpose are yet to be established. The current study used the Cochrane methodology to systematically review randomized controlled trials (RCTs) that investigated the effect of strength training on blood pressure in hypertensive patients. A systematic search was conducted in the PubMed, EMBASE, Scopus, Cochrane Library, and World Health Organization databases. This review included controlled trials that evaluated the effect of strength training for 8 weeks or more in adults with arterial hypertension, published up to December 2020. Data are described and reported as the weighted mean difference of systolic and diastolic pressure and a 95% confidence interval. Protocol registration: PROSPERO registration number CRD42020151269. A total of 14 studies were identified, including a combined total of 253 participants with hypertension. The meta-analysis showed that mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased significantly after strength training interventions. The strongest effect of strength training on decreasing blood pressure was observed in protocols with a moderate to vigorous load intensity (> 60% of one-repetition maximum-1RM), a frequency of at least 2 times per week, and a minimum duration of 8 weeks. We concluded that strength training interventions can be used as a non-drug treatment for arterial hypertension, as they promote significant decreases in blood pressure.

A systematic review and meta-analysis protocol on hypertension prevalence and associated factors among bank workers in Africa

Objective

This systematic review and meta-analysis will investigate the pooled prevalence of hypertension and associated factors among bank workers in Africa.

Methods

Studies published with full texts in English will be searched in the PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, African Journals Online, and Google Scholar databases. Checklists from the Joanna Briggs Institute will be used to assess the studies' methodology quality. Data extraction, critical appraisal, and screening of all retrieved articles will be conducted by two independent reviewers. Statistical analysis will be performed using STATA-14 software packages. A random effect will be employed to demonstrate pooled estimates of hypertension among bank workers. For determinants of hypertension, an effect size with a 95% confidence interval will be analyzed.

Results

Data extraction and statistical analyses will begin after identifying the most pertinent studies and evaluating their methodological quality. Data synthesis and the presentation of the results are scheduled for completion by the end of 2023. After the review is completed, the results will be presented at relevant conferences and published in a peer-reviewed journal.

Conclusion

Hypertension is a major public health concern in Africa. More than 2 out of 10 people aged older than 18 years suffer from hypertension. A number of factors contribute to hypertension in Africa. These factors include female gender, age, overweight or obesity, khat chewing, alcohol consumption, and family history of hypertension and diabetes mellitus. To address the alarming rise in hypertension in Africa, behavioral risk factors should be given primary attention.

Protocol registration

This systematic review and meta-analysis protocol is registered in PROSPERO with the registration ID and link as follows: CRD42022364354;CRD-register@york.ac.ukhttps://www.york.ac.uk/inst/crd.

Aerobic exercise combined with resistance exercise training improves cardiopulmonary function and blood lipid of patients with breast cancer: A systematic review and meta-analysis

BACKGROUND

To compare the therapy effects following the aerobic exercise combined with resistance exercise training (AET + RET) and common care treatment for patients with breast cancer.

METHODS

Articles about the effects of AET + RET on the breast cancer patients in 4 online databases were searched. The differences of cardiopulmonary function, blood pressure, blood lipid, and body mass index between the AET + RET treatment and the usual care treatment were compared.

RESULTS

Totally, 8 articles were involved into the meta-analysis. The qualities of the 8 articles were medium. The combination results showed that AET + RET increased the VO2peak (weighted mean difference (WMD) = 2.93 mL/kg/min; 95% CI: 0.38, 5.49; P = .02) and VO2max (WMD = 6.98 mL/kg/min; 95% CI: 2.04, 15.92; P = .01), demonstrating its improving effects in cardiopulmonary function. Moreover, the AET + RET decreased the TG (WMD = -57.95 mg/dL; 95% CI: -112.25, -3.64; P = .04), demonstrating its improving effects in blood lipid. While or the HRpeak, RERpeak, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, and body mass index, there are no significant differences between the AET + RET and usual care treatment (P < .05).

CONCLUSION

Our results demonstrated that AET + RET can significantly improve the cardiopulmonary function and blood lipid for breast cancer patients.

Changes in Prevalence and Determinants of Self-Reported Hypertension among Bangladeshi Older Adults during the COVID-19 Pandemic

The present study aimed to assess the changes in the prevalence and determinants of self-reported hypertension among older adults during the COVID-19 pandemic in Bangladesh. This repeated cross-sectional study was conducted on two successive occasions (October 2020 and September 2021), overlapping the first and second waves of the COVID-19 pandemic in Bangladesh. The survey was conducted through telephone interviews among Bangladeshi older adults aged 60 years and above. The prevalence of hypertension was measured by asking a question about whether a doctor or health professional told the participants that they have hypertension or high blood pressure and/or whether they are currently using medication to control it. We also collected information on the socio-economic characteristics of the participants, their cognitive ability, and their COVID-19-related attributes. A total of 2077 older adults with a mean age of 66.7 ± 6.4 years participated in the study. The samples were randomly selected on two successive occasions from a pre-established registry developed by the ARCED Foundation. Thus, the sample in the 2021-survey (round two; n = 1045) was not the same as that in the 2020-survey (round one; n = 1031) but both were drawn from the same population. The findings revealed that the prevalence of hypertension significantly increased across the two periods (43.7% versus 56.3%; p = 0.006). The odds of hypertension were 1.34 times more likely in round two than in the round one cohort (AOR 1.34, 95% CI 1.06-1.70). We also found that having formal schooling, poorer memory or concentration, and having had received COVID-19 information were all associated with an increased risk of hypertension in both rounds (p < 0.05). The findings of the present study suggest providing immediate support to ensure proper screening, control, and treatment of hypertension among older adults in Bangladesh.

Associations between dynapenia, cardiovascular hospitalizations, and all-cause mortality among patients on haemodialysis

BACKGROUND

Low muscle strength is associated with adverse clinical outcomes in patients undergoing haemodialysis (HD). No studies have reported the association between dynapenia, defined by both low handgrip strength (HGS) and quadriceps isometric strength (QIS), and long-term clinical outcomes in patients on HD. We examined the associations between dynapenia, cardiovascular (CV) hospitalizations, and all-cause mortality in the HD population.

METHODS

This retrospective study used data from outpatients undergoing HD at two dialysis facilities between October 2002 and March 2020. We defined low muscle strength as an HGS of <28 kg for men and <18 kg for women and a QIS of <40% dry weight. Furthermore, we categorized dynapenia into three groups: robust ('high HGS and high QIS'), either low HGS or low QIS ('low HGS only' or 'low QIS only'), and dynapenia ('low HGS and low QIS'). The outcomes were all-cause mortality and a composite of CV hospitalizations and mortality. Cox proportional hazards and negative binomial models were used to examine these associations.

RESULTS

A total of 616 patients (mean age, 65.4 ± 12.2 years; men, 61%) were included in the analyses. During the follow-up (median, 3.0 years), a total of 163 deaths and 288 CV hospitalizations occurred. Patients with the either low HGS or low QIS [hazard ratio (HR), 1.75; 95% confidence intervals (CIs), 1.46-2.10] and dynapenia (HR, 2.80; 95% CIs, 2.49-3.14) had a higher risk of mortality than those in the robust group. When compared with the robust group, the either low HGS or low QIS [incidence rate ratio (IRR): 1.41, 95% CI: 1.00-1.99] and dynapenia (IRR: 2.04, 95% CI: 1.44-2.89) groups were associated with a significantly higher incident risk of CV hospitalizations.

CONCLUSIONS

Dynapenia (muscle weakness in both upper and lower extremities) was associated with increased risks of all-cause mortality and CV hospitalizations among patients on HD. Screening for dynapenia using both HGS and QIS may be useful for prognostic stratification in the HD population.

Association of High Blood Pressure With Physical Activity, Screen-Based Sedentary Time, and Sedentary Breaks in a 2-Year Cohort of Community Dwelling Adults

Objective: This study analyzed the association of high blood pressure (HBP) with physical activity, sedentary behavior, and sedentary breaks in 2-year follow-up.

Methods: A sample of 331 middle-aged and older adults (mean age of 59.6 ± 17.3 years) was randomly selected and assessed at baseline and after 2 years of follow-up. HBP was considered as ≥140/90 mmHg values of systolic and diastolic blood pressure. Physical activity, sedentary behavior, and sedentary breaks were assessed by questionnaire. Age, sex, socioeconomic status, and body mass index were covariates.

Results: Continuous HBP was observed in 26.3% of sample between baseline and follow-up. Adults who reported continuously high sedentary breaks at leisure activities were less likely to have HBP (OR = 0.34, p = 0.011), as well as those who remained high physically active (OR = 0.41, p = 0.016), even after mutual adjustment. No association was observed between high sedentary behavior and HBP at follow-up.

Conclusion: Community dwelling adults who were high active and performed frequent sedentary breaks were less likely to have HBP in 2-year follow-up. Strategies for HBP control should considered both physical activities and leisure sedentary breaks in adult population.

Hypertension in Women: A South-Asian Perspective

Introduction

Hypertension is an important contributor to cardiovascular disease related morbidity and mortality. Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in both men and women.

Materials and Methods

Numerous databases, i.e., PubMed, ScienceDirect, etc., were searched using keywords to identify relevant studies to our narrative review. The findings from the most pertinent articles were summarized and integrated into our narrative review on hypertension in women.

Results

The pathophysiology of essential hypertension is still being delineated in both men and women; there are multiple sex specific factors in association with the development of hypertension in women, including age, combined oral contraceptives (COCs), polycystic ovarian syndrome (PCOS), preeclampsia, etc. There are several sex specific considerations in antihypertensives drug choices.

Discussion

Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in women. Medical treatment and adherence is uniquely challenging for South Asian women due to a variety of socio-cultural-economic factors. Further research is warranted to identify optimal sex-specific treatment options that will improve the control of hypertension and decrease the risk of subsequent cardiovascular disease in both genders.

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.

Adherence to Self-Care among Patients with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis

Background

Self-care adherence for hypertensive patients is a cornerstone for the control of it and prevention of its complications. However, there are inconsistent findings for self-care adherence of hypertensive patients in Ethiopia. Thus, this systematic review and meta-analysis was done to determine the pooled estimate self-care adherence.

Methods

This systematic review and meta-analysis was reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. An intensive search of online databases such as PubMed (MEDLINE), CINHAL, Google Scholar, and advanced Google search was made to access both published and unpublished articles that report self-care adherence among hypertensive patients in Ethiopia. The pooled estimate was done with STATA version 11 metan commands in a 95% confidence interval. The presence of heterogeneity and publication bias were detected by I² and Egger's test, respectively. A random-effect model was obtained, and subgroup analysis was done for the management of heterogeneity.

Result

A total of 24 articles with a total of 7224 participants were included in the final systematic review and meta-analysis. The pooled estimate of overall self-care adherence among hypertensive patients was 36.98% (95% CI: 27.13–46.83). In subgroup analysis, the highest overall self-care adherence was observed in the Amhara region at 53% (95% CI: 46.54, 59.47). The pooled estimate of self-care dimensions such as medication adherence, low-salt diet, physical activity, smoking abstinence, alcohol abstinence, and weight management was 62.71%, 65.96%, 47.28%, 92.53%, 67.59%, and 52.54%, respectively.

Conclusion

The pooled estimate of good self-care adherence among hypertensive patients was low. From the dimensions of self-care, the lowest level was in physical activity and the highest level was in smoking abstinence. Comparing all regions, the lowest level of overall self-care adherence was observed in Addis Ababa, Tigray region, and South Nations and Nationalities of Ethiopia. Screening of adherence to self-care and health education should be provided to every patient during every visit.