Global and national high blood pressure burden and control

Hypertension and associated factors among patients with diabetes mellitus attending a follow-up clinic in central Ethiopia

Hypertension and diabetes mellitus are highly prevalent chronic diseases worldwide, and their coexistence presents a growing public health challenge, particularly in low-resource settings like Ethiopia. Thus, this study aimed to assess hypertension and its associated factors in patients with diabetes mellitus attending a follow-up clinic in central Ethiopia. A health facility-based cross-sectional study was conducted. Study participants were selected using a systematic random sampling method. Data were collected through a structured, interviewer-administered questionnaire and patient record reviews. A binary logistic regression model was employed to examine the association between hypertension and the explanatory variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to estimate the strength of associations, and statistical significance was determined at a p-value of < 0.05. A total of 379 patients with diabetes mellitus participated in the study. The prevalence of hypertension was 34.6% (95% CI: 29.8-39.4). Being aged 41-60 years (AOR = 2.26, 95% CI: 1.23-4.15), having type 2 diabetes (AOR = 3.83, 95% CI: 1.07-13.65), the presence of comorbidities (AOR = 2.72, 95% CI: 1.59-4.67), and poor medication adherence (AOR = 2.06, 95% CI: 1.12-3.77) were statistically significant factors associated with hypertension among diabetes mellitus patients. More than one-third of patients with diabetes mellitus had hypertension. Older age, type 2 diabetes, the presence of comorbidities, and poor medication adherence were factors associated with hypertension. Regular blood pressure checks, especially for older patients, managing comorbidities, and improving medication adherence through education and simpler regimens are recommended.

An Exploratory Randomised Trial to Assess the Effect of Nadi Shodhan Pranayama as an Adjunct Versus Standard Non-pharmacological Management in Hypertensives

Background

Nadi shodhan pranayama, which is also known as Anulom-vilom pranayama or alternate nostril breathing, has been demonstrated to elicit a decrease in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate, owing to its stress-reducing effects. One of the most promising quantitative markers of autonomic activity is heart rate variability (HRV).

Purpose

This study was done to study the immediate and long-term effects of 10 minutes of nadi shodhan pranayama, preceded by two minutes of yogic deep abdominal breathing, on blood pressure and other autonomic parameters.

Methods

Baseline parameters of BP, HRV, Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety Rating Scale (HAM-A) were measured at first visit. Patients were randomised into test and control groups, and the test group was given intervention. BP and HRV were measured once again immediately after intervention for test subjects. After six weeks, BP, HRV, PSQI and HAM-A were repeated.

Results

Immediately after the intervention, the test group showed a significant reduction in SBP, DBP and mean heart rate (MHR) with an increase in R-R interval, standard deviation of the NN interval (SDNN), the square root of the mean squared differences of successive NN intervals and high frequency. At follow-up, the test group had a lower SBP and low frequency/high frequency ratio and a higher SDNN and total power, compared to the control group.

Conclusion

The practice of nadi shodhan pranayama, preceded by two minutes of yogic deep abdominal breathing, reduced the systolic and diastolic BP and improved HRV-related autonomic parameters, in patients of hypertension on pharmacological therapy, immediately after 10 minutes of practice and after 10 minutes of daily practice for six weeks.

Appropriateness of Web-Based Resources for Home Blood Pressure Measurement and Their Alignment With Guideline Recommendations, Readability, and End User Involvement: Environmental Scan of Web-Based Resources

BACKGROUND

High blood pressure (≥140/90 mm Hg) is the most prominent mortality risk factor worldwide. Home blood pressure measurement (HBPM) is recommended for blood pressure (BP) management. HBPM is most effective to improve BP management when delivered with patient education. It is unknown whether web-based resources are appropriate for patient education for HBPM. Patient education should provide accurate, evidence-based information, communicate at an eighth grade reading level, and involve end users in development to meet the needs of adults of all health literacy levels. Using these criteria, this study aimed to determine the appropriateness of web-based HBPM resources.

OBJECTIVE

This study aimed to determine whether web-based resources are appropriate for HBPM education based on three research questions: (1) Do web-based resources provide evidence-based information that aligns with guideline recommendations? (2) Do they communicate at an appropriate reading level? (3) Do they involve end users in their development?

METHODS

An environmental scan of web-based resources for HBPM was conducted on Google (October 2022) using search terms developed with consumers (n=6). Resources were included if they were identified on the first page of the search findings, not paywalled, and in English. Resource appropriateness was appraised based on three criteria: (1) alignment of resource content to 23 recommendations for HBPM from 6 international guidelines, (2) being at an appropriate grade reading level as determined by a health literacy assessment software, and (3) having evidence of end user involvement in resource development.

RESULTS

None of the identified resources (n=24) aligned with all 23 of the guideline recommendations. All resources aligned with the recommendation to measure BP when seated, while few aligned with the recommendation to use a validated BP device (n=9, 38%). All resources exceeded the recommended eighth grade reading level (mean 11.8, range 8.8-17.0) and none reported evidence of patient end user involvement in development.

CONCLUSIONS

None of the web-based resources met the criteria for appropriate education to support adults to measure BP at home. Resources should be developed with end users using health literacy tools and multimodal communication methods to ensure they are appropriate to meet the needs of patients.

The Long-Term Blood Pressure Trends Following a Remote Hypertension Intervention: A Secondary Analysis of the Digital Care Transformation - Remotely Delivered Hypertension Management Program

BACKGROUND

Hypertension is a major cardiovascular risk factor, yet traditional care often results in suboptimal blood pressure (BP) control at the population level. We implemented a remote hypertension management program that monitored home BP and titrated medications per algorithm. This study assessed the program's long-term effects by examining participants' office BP up to 42 months post-enrollment.

METHODS

Participants of the remote hypertension program were categorized into 4 groups: (1) enrolled-maintenance (achieved goal home BP of ≤130/80 mm Hg), (2) enrolled-early exit (left before achieving goal BP), (3) education-only (lifestyle modifications and medications compliance), and (4) white coat hypertension group (high office BP but normal home BP). Office BP readings of participants were collected up to 42 months post-enrollment. A linear mixed-effects regression model estimated mean BP levels and studied factors associated with above-goal systolic BP in the maintenance group.

RESULTS

Office BP readings from 3601 participants (mean age, 61±11 years; 57% female; 60% white; 52% atherosclerotic cardiovascular disease) were extracted from electronic health records and analyzed. All groups sustained office BP below their qualifying values (P<0.001) over 42 months. In the maintenance group, 89.7% of participants maintained systolic BP at goal, compared with 63.5% in the early exit group, 69.4% in the education-only group, and 90.7% in the white coat hypertension group. Age >50 years was associated with above-goal systolic BP in the maintenance group.

CONCLUSIONS

Participants who achieved BP control through the remote hypertension program maintained goal systolic BP in 90% of cases up to 42 months post-enrollment. These findings highlight the long-term benefits of remote, intensive management programs for effective hypertension control.

Bioequivalence of China- and Germany-manufactured bisoprolol (Concor®) tablets in fasted and fed healthy Chinese participants: a randomized, open-label, two-way, crossover study

Background

The bioequivalence of Concor® (Merck Healthcare KGaA, Darmstadt, Germany), a bisoprolol-containing tablet, manufactured in China and Concor® tablets manufactured in Germany has not been previously reported.

Methods

This single-center, open-label, randomized, two-period, two-sequence, crossover trial (28 February 2023-19 May 2023) compared the pharmacokinetics and safety of bisoprolol 5-mg tablets manufactured in China (test product) with those of bisoprolol 5-mg tablets manufactured in Germany (reference product) in healthy Chinese adults under fasted and fed conditions. Primary endpoints were Cmax, AUC0-tlast, and AUC0-∞.

Result

The mean (coefficient of variation percentage) Cmax in the fasted group was 21.2 (15.0) ng/mL (test product) and 22.1 (17.0) ng/mL (reference product). Under fed conditions, the respective Cmax values were 22.7 (18.8) ng/mL and 22.8 (15.2) ng/mL. The mean and coefficient of variation percentage for AUC were also similar between the two products. The geometric least squares mean ratio (90% confidence interval) for the test/reference product was 0.9565 (0.9006-1.0158) ng/mL for Cmax, 0.9761 (0.9370-1.0168) h·ng/mL for AUC0-tlast, and 0.9807 (0.9429-1.0200) h·ng/mL for AUC0-∞ in fasted conditions and 0.9966 (0.9289-1.0691) ng/mL for Cmax, 0.9672 (0.9220-1.0145) h·ng/mL for AUC0-tlast, and 0.9693 (0.9253-1.0155) h·ng/mL for AUC0-∞ in fed conditions, which met the pre-defined criteria for bioequivalence. No serious treatment-emergent adverse events or deaths were observed.

Conclusion

This study compared the bioequivalence of bisoprolol 5-mg tablets manufactured in China to that of the tablets manufactured in Germany among healthy Chinese adults.

Systematic Review Registration

identifier CTR20230391.

Phone-based telemonitoring of arterial hypertension versus usual care: the HOROSCOPE study

The Horoscope trial aimed to assess the efficacy of home blood pressure (BP) telemonitoring (TLM) in controlling BP reduction in hypertensive patients compared with usual care. This is a multi-center, prospective randomized, parallel-group trial comparing TLM with usual care during a period of 6 months in patients with hypertension. We included 525 patients randomly assigned in a 1-1 ratio to telemonitoring (TLM group; n = 260) or usual care (control group; n = 265). After 6 months of follow up, mean values of 24-h systolic and diastolic blood pressure decreased in both TLM and control groups. The mean decrease was significantly greater in the TLM group vs control group (-3.29 mmHg Vs -1.19; p = 0.009) and (-2.9 mmHg Vs, -0.07; p = 0.002) for systolic and diastolic blood pressure, respectively. This study shows that TLM results in significant BP reduction compared to usual care in a Tunisian population of patients with hypertension. Our findings highlight the importance of integrating telemedicine in the management of hypertensive patients; it has the potential to improve the quality of the delivered care and to prevent cardiovascular consequences of uncontrolled BP.

Health Equity of Hypertension Management Between Local Residents and Internal Migrants in Shenzhen, China: Cross-Sectional Study

Background

With hypertension emerging as a global public health concern, taking measures to alleviate its burden is urgently needed. The hypertension management program (HMP) in China is a standardized policy to help people with hypertension to improve their health levels and reduce health inequalities. However, studies focusing on details regarding participation in this program remain scarce.

Objective

This study aims to investigate the participation rates in HMPs in China and examine the health disparities in hypertension management between local residents and internal migrants in Shenzhen.

Methods

This study used the medical record of Shenzhen, Guangdong, China. We included adults with new-onset diagnosis of hypertension after 2017 and focused on patients who have a record in the community health center. We described the basic characteristics of people diagnosed with hypertension, including age, gender, marital status, occupation, education level, and health insurance type. Enrolled rate, follow-up rate, and adherence rate were used to measure the engagement with this program at the city, district, and community levels.

Results

Of the 1,160,214 hypertensive patients, 29.70% (344,526/1,160,214) were local residents, while 70.3% (815,688/1,160,214) were internal migrants. In addition, 55.36% (642,250/1,160,214) were enrolled in the HMP. Of those, 57.52% (369,439/642,25) were followed up. In addition, 62.59% (231,217/369,439) of followed up individuals were adherents. Internal migrants demonstrated a significantly higher participation in the HMP, especially for the enrolled rate (local residents: 156,085/344,526, 45.30% vs internal migrants: 486,165/815,688, 59.60%) and adherence rate (local residents: 44,044/84,635, 52.04% vs internal migrants: 187,173/284,804, 65.72%). Apart from that, local, single, and younger individuals had lower rates compared to their counterparts. There also existed within-district and within-community variation among enrolled, follow-up, and adherence rates.

Conclusions

Based on our research, individuals with different demographic and socioeconomic characteristics and in different regions had different enrolled, follow-up, and adherence rates. Internal migrants in Shenzhen showed a significantly higher participation in the HMP. Given these findings, there exists the potential to enhance the outreach and engagement of local, single, and younger populations through targeted promotional strategies.

The influence of different forms of apple products on all-cause mortality in patients with hypertension

Objective

Apple consumption has a positive effect on human health. Some studies have shown that an appropriate amount of apple intake can reduce the incidence of hypertension. However, few studies have investigated whether eating different forms of apples has the same benefits as eating whole apples. This study is aimed to evaluate the effect of different forms of apple on all-cause mortality in patients with hypertension.

Methods

The study included 2,368 patients with hypertension. All participants were followed up for at least 10 years. Cox regression model was constructed to analyze the correlation between apple, apple juice, and apple sauce consumption and all-cause mortality in patients with hypertension.

Results

The consumption of apples 3-6 times/week was associated with a 48% reduction in the risk of all-cause mortality in patients with hypertension (HR = 0.52, 95% CI: 0.37-0.72, p < 0.001). However, the consumption of apple juice (HR = 1.02, 95% CI: 0.67-1.56, p = 0.930) and sauce (HR = 1.28, 95% CI: 0.59-2.74, p = 0.531) tended to increase the risk of death in patients with hypertension, although this study did not obtain a statistically result.

Conclusion

Moderate consumption of whole apples is associated with a reduced risk of all-cause death in patients with hypertension, whereas apple juice and sauce may increase the risk of death.

Long-acting nifedipine in the management of essential hypertension: a review for cardiologists

Calcium channel antagonists, specifically long-acting nifedipine formulations, play a crucial role in treating hypertension and angina. Originally used for angina, nifedipine has been widely employed as an antihypertensive medication for over 40 years. It offers rapid action and oral bioavailability with minimal maternal or fetal side effects, making it suitable for treating hypertensive crises during pregnancy. However, it can cause a sudden drop in blood pressure and tachycardia. Long-acting formulations, such as gastrointestinal therapeutic systems, gradually release nifedipine over 24 hours, mitigating these issues. This review aims to assess the clinical efficacy and safety of long-acting nifedipine formulations in managing essential hypertension, with a focus on improving blood pressure control and addressing challenges in uncontrolled and resistant hypertension. Furthermore, long-acting nifedipine provides therapeutic advantages beyond hypertension management, showing efficacy in treating comorbid conditions such as chronic kidney disease and diabetes. Global studies support its efficacy, suggesting that a shift toward the use of long-acting nifedipine can help address the global hypertension problem and enhance the quality of life for hypertensive patients.

Association between community walkability and hypertension: Evidence from the Wuhan Chronic Disease Cohort Study

While community walkability is recognized as a key environmental factor for health status, evidence linking it specifically to hypertension is rather limited. To fill the knowledge gap, we concluded a cross-sectional study among 6421 eligible participants from the Wuhan Chronic Disease Cohort. A well-developed algorithm was performed to evaluate community walkability across Wuhan, quantified as Walk Score. We then calculated each participant residential Walk Score using the geographic information system. The logistic and linear regression models were conducted to determine the relationship between walkability, hypertension and blood pressure, respectively. We further performed the mediation analysis to explore potential mechanisms. After adjusting for extra confounders, we observed a higher community walk score was associated with a lower hypertension risk (OR = 0.73; 95% CI: 0.63, 0.84), a lower systolic blood pressure (β = -3.152 mmHg; 95% CI: -4.25, -2.05), a lower diastolic blood pressure (β = -2.237 mmHg; 95% CI: -2.95, -2.53) and a lower mean arterial pressure (β = -2.976 mmHg; 95% CI: -3.75, -2.20). The effect of community walkability on hypertension was partially mediated by body fat rate. Our study indicates a positive correlation between high walkability and a reduced odds of hypertension in China. This highlights the potential role of urban design in hypertension prevention, emphasizes the need for walkability-focused planning strategies to foster healthier communities, and guides future interventions and research to mitigate hypertension.

Longitudinal analysis of blood pressure control and influencing factors among 32 701 primary care hypertensive patients with or without diabetes: a prospective cohort study in Jianye District, China

BACKGROUND

We aimed to explore the variation in blood pressure (BP) control in primary care hypertensive patients with or without diabetes, and investigate potential factors associated with inadequate BP control during follow-up.

METHODS

Primary care hypertensive patients with and without diabetes were recruited in 2020 from Jianye District of Nanjing and prospectively followed up until 2023. Effective BP control was measured in terms of consistent normal readings of systolic BP <140 mmHg and of diastolic BP <90 mmHg based on the most recent assessment during the follow-up period. We used the negative binomial model with total person-years as an offset to evaluate whether the study population would achieve BP control after the 3-y follow-up period in terms of rate ratio (RR) and 95% CI. We further conducted subgroup analysis based on the absence or presence of clinically confirmed diabetes and BP stability at baseline.

RESULTS

Of a total of 32 701 patients with hypertension, compared with those without comorbid diabetes and stable BP at baseline, patients with comorbid diabetes and unstable BP at baseline were less likely to have effective BP control at follow-up (adjusted RR=2.01, 95% CI 1.89 to 2.15). We observed an elevated risk of ineffective BP control at follow-up in those aged 60-70 y (1.69; 95% CI 1.56 to 1.83) or ≥70 y (1.73; 95% CI 1.59 to 1.88), females (1.09; 95% CI 1.03 to 1.16), those with a higher waist-to-height ratio (1.25; 95% CI 1.17 to 1.34), overweight/obese in terms of body mass index (1.16; 95% CI 1.09 to 1.23) or regularly consuming alcohol (1.26; 95% CI 1.16 to 1.37). Higher educational attainment indicated a reduced risk of ineffective BP control at follow-up (0.68; 95% CI 0.63 to 0.75).

CONCLUSIONS

Achieving effective BP control remains a persistent challenge, especially for patients with comorbid hypertension and diabetes. In the absence of any novel strategies for hypertension care, the existing multidisciplinary care approaches could be repurposed and integrated for effective management of the aforementioned comorbid conditions in primary care settings.

Association between urinary sodium-to-potassium ratio, elevated blood pressure phenotypes and microalbuminuria: Tehran Lipid and Glucose Study

This cross-sectional study investigated the associations between urinary sodium (UNa) to potassium (UK) ratio, different phenotypes of elevated blood pressure (BP), and microalbuminuria (MAU) in a cohort of the Tehran Lipid and Glucose Study (TLGS). Adult participants (n = 1782, mean age of 43.0 ± 13.7 years and 46.0% were men) were recruited (2015-2017) for measurements of spot urinary metabolites, i.e., Na, K, creatinine (Cr), microalbumin, and BP. Multinomial logistic regression was used to estimate the relative risk ratios (RRR) of elevated BP phenotypes [i.e., isolated systolic (ISH), diastolic (IDH), and systolic-diastolic (SDH) hypertension], and binary logistic regression was used to estimate odds ratios (ORs) of MAU across quintile categories and per each SD-increment of UNa-K ratio. Mean UNa, UK, and its ratio was 137 ± 57.4, 72.1 ± 36.6 mmol/L, and 2.31 ± 1.41, respectively. Subjects with UNa-K > 3.14 had higher prevalence of ISH (3.4 vs. 1.1%), SDH (11.0 vs. 6.2%), and MAU (14.1 vs. 6.2%) (P for all < 0.05). Highest compared to the lowest UNa-K ratio values (> 3.14 vs. <1.23) was associated with an increased probability of SDH (RRR = 1.79, 95% CI 1.09-3.19) and MAU (OR = 2.53, 95% CI 1.23-5.20). Every 1 SD-increment of the UNa-K ratio was associated with a 29 and 38% increased chance of having SDH and MAU, respectively. Our findings imply that a high UNa-K ratio may be a potential risk factor for elevated BP and renal dysfunction.

Associations between various anthropometric indices and hypertension and hyperlipidaemia: a cross-sectional study in China

BACKGROUND

This study aims to explore the association and determine the distinguished potential of anthropometric adiposity indices in screening for hypertension and hyperlipidaemia in the Chinese population.

METHODS

A recent nationwide cross-sectional study, called the Thyroid Disorders, Iodine State, and Diabetes Epidemiological Survey (TIDE 2015-2017), provided the newest data on the relationships between anthropometric adiposity indices and hypertension and hyperlipidaemia and included 65,231 subjects. The area under the curve (AUC) was used to assess the feasibility of using these indices to distinguish hypertension and hyperlipidaemia. After age stratification, a restricted cubic spline (RCS) fitted for generalized linear regression was used to visualize the relationships of the body mass index (BMI), waist circumference (WC), the waist-to-height ratio (WHtR), the body roundness index (BRI), and the "a body shape index" (ABSI) with hypertension and hyperlipidaemia.

RESULTS

The results showed that there were significant differences in the BMI, WC, the WHtR, the BRI, and the ABSI among the different age groups (P < 0.0001). After adjusting for sex, age, education, income, smoking status, urban or rural residence, and ethnicity in model, The WHtR and BRI had greater discriminatory power in identifying hypertension (AUC = 0.665, 95% confidence interval (CI) 0.660-0.671 for both), hypercholesterolaemia (AUC = 0.629, 95% CI 0.624-0.634 for both), and high low-density lipoprotein cholesterol (LDL-C; AUC = 0.659, 95% CI 0.653-0.664 for both) status in the overall population. When distinguishing hypertriglyceridaemia among the general population, the BMI (AUC = 0.711, 95% CI 0.706-0.716) and WC (AUC = 0.715, 95% CI 0.710-0.720) had greater discriminatory ability than the other anthropometric indices did. The BMI (AUC = 0.631, 95% CI 0.625-0.637) had the highest power for low high-density lipoprotein cholesterol (HDL-C) status in the general population.

CONCLUSIONS

Several anthropometric indices show significant correlation with hypertension and hyperlipidaemia. The WHtR and BRI were better in distinguishing hypertension, hypercholesterolaemia and high LDL-C status, while the BMI was better in hypertriglyceridaemia and low HDL-C status. The use of combined indices, such as the BMI, WC, the WHtR and the BRI, can be included in an individual's medical history and can be used as tools for cardiovascular health screening, which may yield superior results for public health.

Association between medication adherence and blood pressure control and factors associated with antihypertensive medication adherence in the Melaka Tengah District: A cross-sectional survey

Introduction

The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence.

Methods

This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28).

Results

A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P<0.005). The multivariate analysis showed that the determinants for antihypertensive medication non-adherence were Malay ethnicity, secondary education, farther distance from the clinic, experience of side effects of antihypertensive medications, concern about long-term side effects and usage of alternative medicine (P<0.05). Taking multiple antihypertensive medications was the only factor associated with uncontrolled blood pressure (P<0.05).

Conclusion

Addressing issues on medication adherence is important to ensure blood pressure control. The factors associated with non-adherence should be closely monitored to improve blood pressure control and prevent adverse health outcomes. Single-pill combination antihypertensive medications are encouraged to reduce pill burden and improve blood pressure control.

Guardians under pressure, a spotlight on hypertension among healthcare workers in Kinshasa, Democratic Republic of Congo: a cross-sectional study

BACKGROUND

Hypertension is one of the main risk factors for cardiovascular disease impacting over a billion people worldwide. Work environment factors could adversely affect workers' cardiovascular health, including contributing to hypertension. Healthcare workers who treat patients are also affected. In the Democratic Republic of Congo, limited studies explored the work environment factors associated with hypertension. This study aimed to examine hypertension prevalence and determine the associated risk factors among healthcare workers in Kinshasa.

METHODS

A cross-sectional study was conducted in Kinshasa's healthcare facilities from December 2023 to January 2024 among healthcare workers selected by multistage stratified random sampling. Data was collected through a structured questionnaire using a modified WHO STEPwise approach and Karasek questionnaire. Anthropometric parameters, blood pressure, and fasting blood sugar were measured. The prevalence of hypertension was assessed. All sociodemographic, occupational, and lifestyle variables associated with hypertension were included in multivariable logistic regression analysis at the 5% significance level.

RESULTS

The study encompassed 614 participants, comprising 55.2% females and 44.8% males. The mean age of participants was 38.8 ± 10.4 years, ranging from 20 to 78 years. The prevalence of hypertension was 22.6% and over half of those with hypertension (56.1%) were unaware of their condition. Of the known hypertensive participants before the study, 60.7% had uncontrolled blood pressure. In the multivariable analysis, identified risk factors for hypertension were age ≥ 40 years (aOR = 2.75, 95% CI: 1.64-4.61), seniority ≥ 10 years (aOR = 2.65, 95% CI: 1.54-4.58), multiple job holding (aOR = 3.11, 95% CI: 1.81-5.34), job stress (aOR = 1.84, 95% CI: 1.17-2.89), physical inactivity (aOR = 1.67, 95% CI: 1.03-2.68), overweight (aOR = 1.75, 95% CI: 1.06-2.90) and obesity (aOR = 3.75, 95% CI: 2.10-6.70).

CONCLUSION

Our results underline an important prevalence of hypertension among healthcare workers in Kinshasa, despite their medical knowledge of the causes and the risks. A healthy lifestyle among healthcare workers is fundamental for ensuring the efficiency and productivity of the healthcare system. Regulating multiple job holding and implementing a hypertension prevention intervention encompassing their holistic support is crucial for reducing job stress and promoting well-being.

Factors associated with suboptimal adherence to antihypertensive medication: Cross-sectional study using nationally representative databases

Suboptimal adherence to antihypertensive medication is a major challenge in controlling blood pressure. However, limited studies exist on suboptimal adherence to hypertension, especially in Korea. This study investigates factors associated with suboptimal adherence, including non-treatment and non-adherence. Study populations were collected from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2021. Participants were classified into three groups based on treatment and adherence to antihypertensive medication using a self-reported questionnaire. Multivariable adjusted logistic regression analysis was performed using KNHANES data to investigate associations for suboptimal adherence with covariates. In KNHANES, the adherent, non-adherent, and non-treatment groups consisted of 13,831 (92.8 %), 460 (3.1 %), and 612 (4.1 %) subjects, respectively. In the adjusted model, age, hypertension diagnosis duration, diabetes, dyslipidemia, and high hemoglobin levels were associated with receiving treatment. Older age, longer hypertension diagnosis duration, comorbid diabetes mellitus, and ischemic heart disease were associated with adherence. This study showed the characteristics of non-adherent and non-treatment hypertensive patient groups in Korea. Based on this study, further individualized health interventions are required.

Dose-response relationship between body mass index and hypertension: A cross-sectional study from Eastern China

Background

A high body mass index (BMI) increases the risk of hypertension. However, little is known about the dose-dependent association between BMI and hypertension. Therefore, this study investigated the prevalence of hypertension in 7568 subjects from the Jiangsu Province, Eastern China, and analyzed the dose-response relationship between BMI and hypertension risk.

Methods

The eligible subjects completed a structured questionnaire and clinical biochemical indicators were measured according to standardized protocols. Multivariate logistic regression models were used to evaluate the association between BMI and hypertension. Restricted cubic spline (RCS) analysis was used to analyze the dose-response relationship between BMI and hypertension risk. Moreover, sensitivity analysis was performed to verify the robustness of our findings.

Results

The prevalence of hypertension was 35.3 % in the total population. BMI was significantly associated with systolic and diastolic blood pressure. The fully-adjusted odds ratio (OR) with 95 % confidence interval (CI) for hypertension was 1.17 (1.15, 1.19) for every 1 kg/m2 increase in BMI. Furthermore, the OR (95 % CI) for hypertension in the highest BMI group (Obesity) was 4.14 (3.45, 4.96) after adjusting for covariates compared with the normal group. Multivariable adjusted RCS analysis showed a positive and linear dose-response relationship between BMI and hypertension risk both in male and female populations (all P for non-linearity > 0.05).

Conclusion

Our study demonstrated a positive and linear dose-response relationship between BMI and the risk of hypertension. The results of this study provide evidence for BMI-related clinical interventions to reduce the risk of hypertension.

An assessment of variation in quality of hypertension guidelines across income settings using the AGREE II tool

Background

Hypertension affects over one billion people worldwide, posing a significant global health burden. Clinical practice guidelines could play a key role in guiding healthcare providers in improving hypertension management. However, how the quality of hypertension CPGs differs across country income settings is not well understood. This study aims to explore variation in the quality of hypertension CPGs, comparing low-, middle-, and high-income countries, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.

Methods

A Medline and grey literature search was conducted to identify hypertension CPGs in English from every country from January 2012 to September 2022. Two reviewers independently assessed and scored each CPG against the AGREE II tool. Results were described and the Kruskal-Wallis test was used to test for statistically significant difference in the domain scores across country income groups.

Results

Forty-three CPGs were included for analysis from across income settings. Guidelines from HICs scored higher in four out of the six domains. The highest scoring domain was 4: "clarity and presentation" (median score 83%), the lowest scoring was domain 6 "editorial independence" (median score 0%). Statistically significant differences between income settings were observed for domain 3 "rigour of development" (p <0.001), domain 4 "clarity and presentation" (p = 0.03) and domain 6 "editorial independence" (p = 0.04).

Conclusions

Whilst some variation exists in guideline quality across country income levels, the greatest degree of variation exists across the domains of the AGREE II tool. Global efforts to improve the quality of hypertension guidelines should focus on the transparent statement of editorial independence of guideline committees and apply rigorous replicable methods in the authoring of guidelines. Establishing national and international communities of practice to collaborate across income settings may reduce duplication of resource, allow for shared learning and promote the development of high-quality hypertension CPGs.

Ocular biomarkers: useful incidental findings by deep learning algorithms in fundus photographs

BACKGROUND/OBJECTIVES

Artificial intelligence can assist with ocular image analysis for screening and diagnosis, but it is not yet capable of autonomous full-spectrum screening. Hypothetically, false-positive results may have unrealized screening potential arising from signals persisting despite training and/or ambiguous signals such as from biomarker overlap or high comorbidity. The study aimed to explore the potential to detect clinically useful incidental ocular biomarkers by screening fundus photographs of hypertensive adults using diabetic deep learning algorithms.

SUBJECTS/METHODS

Patients referred for treatment-resistant hypertension were imaged at a hospital unit in Perth, Australia, between 2016 and 2022. The same 45° colour fundus photograph selected for each of the 433 participants imaged was processed by three deep learning algorithms. Two expert retinal specialists graded all false-positive results for diabetic retinopathy in non-diabetic participants.

RESULTS

Of the 29 non-diabetic participants misclassified as positive for diabetic retinopathy, 28 (97%) had clinically useful retinal biomarkers. The models designed to screen for fewer diseases captured more incidental disease. All three algorithms showed a positive correlation between severity of hypertensive retinopathy and misclassified diabetic retinopathy.

CONCLUSIONS

The results suggest that diabetic deep learning models may be responsive to hypertensive and other clinically useful retinal biomarkers within an at-risk, hypertensive cohort. Observing that models trained for fewer diseases captured more incidental pathology increases confidence in signalling hypotheses aligned with using self-supervised learning to develop autonomous comprehensive screening. Meanwhile, non-referable and false-positive outputs of other deep learning screening models could be explored for immediate clinical use in other populations.

Effectiveness of community-based interventions for prevention and control of hypertension in sub-Saharan Africa: A systematic review

Hypertension poses a significant public health challenge in sub-Saharan Africa due to various risk factors. Community-based intervention for prevention and control of hypertension is an effective strategy to minimize the negative health outcomes. However, comprehensive systematic review evidence to inform effective community-based interventions for prevention and control of hypertension in low resource settings is lacking. This study aimed to synthesize the effectiveness of community-based interventions on prevention and control of hypertension in sub-Saharan Africa. A comprehensive search for studies was carried out on PubMed, CINAHL, Web of Science Core Collection, Embase, Scopus, and Google scholar databases. The result of the review was reported according to PRISMA guidelines. Studies published in English language were included. Two independent reviewers conducted critical appraisal of included studies and extracted the data using predefined excel sheet. Experimental, quasi experimental, cohort and analytical cross-sectional studies conducted on adults who have received community-based interventions for prevention and controls of hypertension in sub-Saharan Africa were included. In this systematic review, a total of eight studies were included, comprising of two interventional studies, two quasi-experimental studies, three cohort studies, and one comparative cross-sectional study. The interventions included health education, health promotion, home-based screening and diagnosis, as well as referral and treatment of hypertensive patients. The sample sizes ranged from 236 to 13,412 in the intervention group and 346 to 6,398 in the control group. This systematic review shows the effect of community-based interventions on reduction of systolic and diastolic blood pressure. However, the existing evidence is inconsistence and not strong enough to synthesize the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Hence, further primary studies need on the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Systematic review registration number: PROSPERO CRD42022342823.

Religious minority status and risk of hypertension in women: Evidence from Bangladesh

Discrimination based on religion and communal violence against religious minorities have been on the rise worldwide. Despite growing incidences of violence against religious minorities, little is known on the relationship between minority status and population health outcomes in the low-and-middle income countries (LMICs). This study intends to fill this gap by assessing the prevalence of hypertension among religious minority women in Bangladesh, a South Asian country with high levels of social hostilities involving religion. Using data from the Bangladesh Demographic and Health Survey (BDHS) 2017-18, we examined whether religious minority women had a differential risk of having hypertension. We estimated logistic regression models to obtain the odds in favor of being hypertensive among women aged 18-49 years and compared the odds for religious minority women with that of their non-minority counterparts. We then estimated linear regression models to examine how average systolic- and diastolic-blood pressure measures differ across minority and non-minority women. We found that the odds of being hypertensive for minority women were 1.43 (95 % CI: 1.14-1.79) times that of their non-minority counterparts. The adjusted odds ratio was very similar, 1.45 (95 % CI: 1.14-1.84), when various sociodemographic and other risk factors were accounted for. The conditional average SBP and DBP levels were respectively 3.42 mmHg (95 % CI: 1.64-5.20) and 1.44 mmHg (95 % CI: 0.37-2.51) higher among minority women. Thus, we found evidence that religious minority women in Bangladesh had a disproportionately higher risk of having hypertension compared to their non-minority peers. These results call for further research on psychological distress from systematic discrimination and collective trauma among religious minorities in Bangladesh.

Association between brominated flame retardants (PBDEs and PBB153) exposure and hypertension in U.S. adults: results from NHANES 2005-2016

BACKGROUND

Brominated Flame Retardants (BFRs) have attracted widespread concern due to their environmental persistence and potential toxicity. This study aims to examine the association between BFRs exposure and hypertension.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2016 for the cross-sectional analysis. To evaluate the individual and combined impacts of BFRs exposure on hypertension, we utilized multivariate models, including generalized additive models, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models.

RESULTS

9882 individuals (48% male) aged ≥ 20 were included in the final analysis, of whom 4114 had hypertension. After controlling for potential covariates, higher serum concentrations of PBDE100 (OR: 1.26; 95% CI: 1.01, 1.57) and PBDE153 (OR: 1.50; 95% CI: 1.18, 1.88) were significantly associated with hypertension. A nonlinear relationship between PBDE28 and hypertension was observed (P = 0.03). Moreover, BFRs mixture were positively associated with the prevalence of hypertension in both the WQS (β:1.09; 95% CI: 1.02, 1.17; P = 0.02) and BKMR models.

CONCLUSION

Our study suggested that BFRs exposure is positively associated with hypertension in the general population. To confirm this association and elucidate the mechanisms, further research is required.

Electronic cigarettes and cardiovascular disease: epidemiological and biological links

Electronic cigarettes (e-cigarettes), as alternative nicotine delivery methods, has rapidly increased among youth and adults in recent years. However, cardiovascular safety is an important consideration regarding e-cigarettes usage. e-cigarette emissions, including nicotine, propylene glycol, flavorings, nitrosamine, and metals, might have adverse effects on cardiovascular health. A large body of epidemiological evidence has indicated that e-cigarettes are considered an independent risk factor for increased rates of cardiovascular disease occurrence and death. The incidence and mortality of various types of cardiovascular disease, such as cardiac arrhythmia, hypertension, acute coronary syndromes, and heart failure, have a modest growth in vapers (users of e-cigarettes). Although the underlying biological mechanisms have not been fully understood, studies have validated that oxidative stress, inflammation, endothelial dysfunction, atherosclerosis, hemodynamic effects, and platelet function play important roles in which e-cigarettes work in the human body. This minireview consolidates and discusses the epidemiological and biological links between e-cigarettes and various types of cardiovascular disease.

Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients

Introduction

The hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown.

Methods

In this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60-79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision.

Results

There were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p > 0.05), while significant differences were found in norepinephrine consumption between the two groups (p < 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 μg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 μg·kg-1·min-1) and Group A (0.06 ± 0.02 μg·kg-1·min-1) (p = 0.004).

Conclusion

Our study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=141081, ChiCTR2100053583.

Influencing factors of hospitalization cost of hypertension patients in traditional Chinese medicine hospitals

Objectives

This study aimed to analyze the influencing factors of hospitalization cost of hypertensive patients in TCM (traditional Chinese medicine, TCM) hospitals, which can provide a scientific basis for hospitals to control the hospitalization cost of hypertension.

Methods

In this study, 3,595 hospitalized patients with a primary diagnosis of tertiary hypertension in Tianshui City Hospital of TCM, Gansu Province, China, from January 2017 to June 2022, were used as research subjects. Using univariate analysis to identify the relevant variables of hospitalization cost, followed by incorporating the statistically significant variables of univariate analysis as independent variables in multiple linear regression analysis, and establishing the path model based on the results of the multiple linear regression finally, to explore the factors influencing hospitalization cost comprehensively.

Results

The results showed that hospitalization cost of hypertension patients were mainly influenced by length of stay, age, admission pathways, payment methods of medical insurance, and visit times, with length of stay being the most critical factor.

Conclusion

The Chinese government should actively exert the characteristics and advantages of TCM in the treatment of chronic diseases such as hypertension, consistently optimize the treatment plans of TCM, effectively reduce the length of stay and steadily improve the health literacy level of patients, to alleviate the illnesses pain and reduce the economic burden of patients.

Associations of serum uric acid with hypertension status, stages, phenotypes and progressions among Chinese middle-aged and elderly

BACKGROUND AND AIMS

No consensus has been reached on the association between serum uric acid (SUA) and hypertension. This study aimed to investigate the associations between SUA and hypertension, including its status, stages, phenotypes and progressions, among middle-aged and older Chinese.

METHODS AND RESULTS

Data were obtained from the China Health and Retirement Longitudinal Study 2011-2015. Binary logistic regression was used to evaluate the association between SUA and hypertension status. Multinomial logistic regression was used to explore the associations of SUA with hypertension stages, phenotypes and hypertension status progressions. Models were adjusted for potential confounders and stratified by sex. A total of 7931 individuals aged ≥45 years were included, with 39.16 % of hypertension. Significant associations were found of SUA with stage2 and above hypertension (quartile 4 [Q4] vs quartile 1 [Q1]: odds ratio 1.78, 95 % confidence interval 1.31-2.42, P < 0.001), and systolic diastolic hypertension (SDH) (Q4 vs Q1: 1.53, 1.14-2.06, P = 0.005). In sex stratification, significant associations were found between SUA and stage2 and above hypertension and SDH only for men. Moreover, higher quartiles of baseline SUA showed increased risks of maintained hypertension from 2011 to 2015 (Q3 vs Q1: 1.23, 1.03-1.48, P = 0.024; Q4 vs Q1: 1.73, 1.43-2.10, P < 0.001).

CONCLUSION

Higher SUA was associated with hypertension and maintained hypertension among Chinese middle-aged and elderly. Sex-specific associations of SUA with hypertension stages and phenotypes were observed. Regular measurement of SUA in clinical practice may indicate hypertension and its progression, particularly among men.

Global, regional, and national burden of inflammatory bowel disease and its associated anemia, 1990 to 2019 and predictions to 2050: An analysis of the global burden of disease study 2019

AIM

Inflammatory bowel disease (IBD) exhibited a global increase in incidence over the past decade. Understanding global burden of IBD can offer valuable insights for shaping future management strategies. We aimed to provide a comprehensive assessment of global burden of IBD from 1990 to 2019 and predictions to 2050.

METHODS

Data on prevalence, incidence, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs) and IBD-attributable impairment factor (anemia) were extracted from the Global Burden of Diseases (GBD) 2019. Subgroup analyses were performed based on gender, geographical regions, and the Socio-Demographic Index (SDI). Joinpoint model, Bayesian age-period-cohort model and decomposition methodology were utilized to evaluate the temporal trends from 1990 to 2019, forecast the disease burden up to 2050 and decompose incidence, prevalence, YLDs and DALYs of IBD by population age structure, population growth and epidemiologic changes.

RESULTS

From 1990 to 2019, number of prevalence, DALYs, YLDs for IBD and number of prevalence for IBD-related-anemia increased significantly. Age-standardized rates of incidence, prevalence, DALYs, and YLDs showed declining trends, with this decline anticipated to continue until 2050 for both genders. The IBD burden remained high in countries with high and high-middle SDI. Besides, countries with low, low-middle, and middle SDI were experiencing an increasing burden. Number and ASR of prevalence and YLDs of IBD related anemia increased with SDI Decomposition analysis indicated that population growth was the primary contributing factor, followed by population aging.

CONCLUSION

Due to population growth and aging, the burden of IBD is projected to continue rising until 2050, which emphasizes the urgency of addressing the evolving public health challenge posed by IBD.

Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China

Objective

Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence.

Methods

This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment.

Results

A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11-1.72, P = 0.004).

Conclusions

HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients' misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.

Paving a Path to Equity in Cardiorenal Care

Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.

Higher Nocturnal Blood Pressure and Blunted Nocturnal Dipping Are Associated With Decreased Daytime Urinary Sodium and Potassium Excretion in Patients With CKD

Introduction

Sodium homeostasis is intimately associated with blood pressure (BP) rhythm, and potassium excretion is closely associated with sodium excretion in the general population. However, the association between circadian sodium and potassium pattern excretion and nocturnal BP in patients with chronic kidney disease (CKD) is not elucidated.

Methods

We evaluated the correlation between the day-to-night ratio of urinary sodium and potassium excretion rate, nocturnal blood pressure, and nocturnal BP dipping in a CKD cohort.

Results

A total of 3152 (56.76% males, mean age 47.63 years) individuals with CKD were included in the study. Patients in quartile 1 (with the lowest ratio) exhibited a 12 mmHg or 9 mmHg higher nocturnal systolic blood pressure (SBP) and blunted SBP dipping than those in quartile 4 when urinary sodium or potassium excretion rate was divided into day-to-night ratios (both P < 0.001). In multivariate analyses, lower day-to-night ratio of urinary sodium was independently linked to higher nocturnal SBP and blunted SBP dipping (linear regression coefficient (95% confidence interval [CI]): -6.89 (-9.48 to -4.31), and -3.64 (-5.48 to -1.80), respectively; both P < 0.001). Similarly, compared with the highest quartile of day-to-night ratio of urinary potassium excretion rate, linear regression coefficient (95% CI) for the lowest quartile was -5.60 (-8.13 to -3.07) for nocturnal SBP, and -2.47 (-4.28 to -0.67) for SBP dipping (both P < 0.001). Moreover, urine flow rate and concentrates of sodium or potassium in the urine were positively associated with urinary sodium or potassium excretion during daytime (P < 0.001).

Conclusion

A higher nocturnal BP and a blunted nocturnal BP dipping were both independently linked to a lower excretion of sodium or potassium during the day in patients with CKD. Furthermore, a decreased urine flow rate and a diminished capacity to concentrate sodium or potassium in the urine appear to be the key contributors to a low day-to-night ratio of urinary sodium excretion or potassium rate.

Medication adherence among people living with hypertension and diabetes in Puno, Peru: A secondary analysis of formative data of the ANDES trial

Background

Hypertension is the leading modifiable risk factor for premature death globally despite the existence of evidence-based and cost-effective treatments. Medication nonadherence is cited as the main cause of treatment failure for hypertension. In Peru, adherence to anti-hypertensive medications of individuals with both hypertension and type 2 diabetes (T2D) is not well studied. The few studies that have investigated differences in anti-hypertensive medication adherence among patients with and without T2D have demonstrated both positive and negative effects.

Methods

In a cross-sectional study in Puno, Peru, we compared anti-hypertensive medication adherence in individuals with hypertension between those with and without comorbid T2D. The primary outcome was adherence to anti-hypertensive medications as assessed by the Hill-Bone Compliance scale. The primary exposure variable was comorbidity status (i.e., having hypertension and diabetes vs. hypertension alone).

Results

Of the 204 participants with hypertension (mean age 67 ± 11 years, 60% female), 42 (21%) had comorbid diabetes. Participants with comorbid disease had higher overall anti-hypertensive adherence scores (49.5 ± 2.8 vs. 48.0 ± 4.1 points; p<0.001) and higher medication adherence scores (32.8 ± 2.2 vs. 31.3 ± 3.7 points; p<0.01) when compared to those with hypertension alone. In multivariable regression, comorbid diabetes and monthly income above 250 soles (68 USD) were associated with higher Hill-Bone Compliance scale scores by 1.5 ± 0.7 points (p=0.025) and 2.0 ± 0.7 points (p<0.01), respectively.

Conclusions

Participants with comorbid hypertension and diabetes exhibited higher adherence to anti-hypertensive medications when compared to those with hypertension alone, suggesting that individuals with comorbid disease are more likely to adhere to anti-hypertensive medications.

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

BACKGROUND

Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients.

OBJECTIVES

This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan.

METHODS

A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs.

RESULTS

We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29-3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63)], and presence of depressive symptoms [AOR 1.65 (1.14-2.38)].

CONCLUSION

Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.

Association of blood trihalomethane concentrations with hypertension in US adults: A nationwide cross-sectional study

Trihalomethanes (THMs), as the most common species of disinfection byproducts in chlorinated water, have been associated with hypertensive disorders in pregnancy. However, there is sparse epidemiological evidence regarding the possible link between THMs exposure and hypertension in general adults. In the present study, we aimed to characterize the associations between THMs exposure and hypertension in general adults. We performed cross-sectional analyses of 15,135 adults from the 1999-2018 National Health and Nutrition Examination Survey. In the general US adults, the median blood concentrations of the chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform (TBM) were: 4.80 pg/mL, 0.71 pg/mL, 0.44 pg/mL and 0.71 pg/mL, respectively. And adults in the highest tertile of blood TBM and DBCM had odds ratios of 1.20 (95 % confidence intervals: 1.02, 1.42) and 1.15 (1.01, 1.30), respectively, for hypertension, compared with adults in the lowest tertile. Also, significant positive associations between blood brominated THM concentrations (sum of TBM, BDCM and DBCM) and prevalent hypertension were observed. In addition, significant interactions with BMI were demonstrated for Br-THMs (P for interaction = 0.017). Our study provides epidemiological evidence supporting a positive association between blood THMs and hypertension by using the nationally representative data, highlighting the need for further investigations to deepen our findings and elucidate the underlying mechanisms.

Predictors of long-term absence of coronary artery calcium in individuals with high blood pressure: results from the MESA study

BACKGROUND & AIMS

Individuals with high blood pressure (BP) have varying risks of cardiovascular events due to other coexisting factors. We aimed to identify the predictors of long-term absence of coronary artery calcium (CAC) in individuals with high BP, which is an indicator of healthy arterial aging and can guide preventive strategies.

METHODS

We analyzed data from participants with high BP (≥120/80 mm Hg) in the Multi-Ethnic Study of Atherosclerosis who had baseline CAC = 0 and underwent a second CAC scanning after 10 years. We used multivariable logistic regression to evaluate the association between various risk factors for atherosclerotic cardiovascular disease (ASCVD) and long-term CAC = 0. We also calculated the area under the receiver operating characteristic curve (AUC) to predict the phenotype of healthy arterial aging in this population.

RESULTS

We included 830 participants (37.6% male, mean ± SD age of 59.4 ± 8.7 years). During follow-up, 46.5% of participants (n = 386) had CAC = 0, and they were younger and had fewer metabolic syndrome components. Adding ASCVD risk factors to the demographic model (age, sex, and ethnicity) moderately increased the predictive value for long-term CAC = 0 (AUC: demographic model + ASCVD risk factors vs. demographic model alone, 0.653 vs. 0.597, p < .001; category net reclassification improvement = 0.104, p = .044; integrated discrimination improvement = 0.040, p < .001).

CONCLUSION

In individuals with high BP and initial CAC = 0, over 40% maintained CAC = 0 during a 10-year follow-up, which was associated with fewer ASCVD risk factors. These findings may have implications for preventive strategies in individuals with high BP.Clinical Trial registration number: The MESA was registered at clinical trials. gov as NCT00005487.KEY MESSAGESNearly half (46.5%) of individuals with high blood pressure (BP) maintained a long-term absence of coronary artery calcium (CAC) during a 10-year follow-up, and this was associated with a 66.6% lower risk of atherosclerotic cardiovascular disease (ASCVD) events compared to those who developed incident CAC.Individuals with high BP, who are usually assumed to have an increased risk of ASCVD, exhibit significant heterogeneity in their ASCVD risk; those who maintain CAC = 0 have a lower ASCVD risk.Adding overall ASCVD risk factors to demographic information resulted in a moderate improvement in predicting long-term CAC = 0.

Hypertension prevalence in Iran's elderly according to new criteria: the Tehran Geriatric Eye Study

Purpose

To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors.

Methods

A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications.

Results

Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension.

Conclusion

A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.

Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review

BACKGROUND

Hypertension remains one of the leading risk factors for cardiovascular disease. Contrasting with the high-income countries where the rates of hypertension decline, it increases in Sub-Saharan African countries. The age group most affected by hypertension is the working population. Several studies carried out in Europe, North America, and Asia, underline the influence of job stress on the occurrence of hypertension. The objective of this review was to explore current knowledge about hypertension and job stress in Sub-Saharan Africa.

METHODS

We conducted a scoping review using Arksey and O'Malley's framework to synthesize findings. We searched in PubMed, Scopus, and ProQuest databases. The inclusion criteria were peer-reviewed manuscripts published on March 1, 2023, conducted among workers in Sub-Saharan Africa, reported hypertension and job stress, and using quantitative methodologies. Data were assessed independently by two researchers.

RESULTS

In total, 295 articles were identified from databases. Of these, only 12 articles met the inclusion criteria and were included in the review (9 cross-sectional studies and 3 case-control studies). These studies focused on sectors reported as stressful (health, banking, education, and industries). The prevalence of hypertension varied from 14.3% to 45.9%, with a high proportion of hypertensive participants (35.4%-70.6%) who were unaware that they had hypertension. Job stress was significantly associated with hypertension (OR = 2.4 [1.5-4.4]) and stress management was inversely associated with hypertension (r = -0.14, p < 0.05). However, no study reported an existing workplace health promotion program implemented, especially regarding cardiovascular disease risk factors.

CONCLUSION

Data available in the literature show that stressful working conditions may be associated with hypertension. We are faced with an increasing prevalence of hypertension among workers in Sub-Saharan Africa, where a large proportion of them are unaware that they have hypertension. Thus, there is a need to implement workplace prevention and health promotion strategies in Sub-Saharan Africa.

Anthropometric indexes for predicting high blood pressure in Turkish adults

Purpose

It is controversial which anthropometric indexes are the best in predicting the risk of hypertension and how anthropometric measurements are related to blood pressure (BP). This study aimed to evaluate the relationship between BP and anthropometric indexes and to determine the best predictors for hypertension risk.

Methods

This cross-sectional study was conducted with 415 consecutive participants (161 men, mean age: 33.4 years) aged 18-88 years in Istanbul, Turkey. Weight, height, waist circumference (WC), and neck circumference (NC) and BP were measured by well-trained personnel. Waist-to-height ratio (WHtR) and body mass index (BMI) were calculated. Pearson correlation, linear regression, and multivariate analyses were used to assess the relationship between anthropometric measurements and SBP, DBP, using the Statistical Package for the Social Sciences version 23.0.

Results

The systolic BP (SBP) and diastolic BP (DBP) were related to weight, WC, NC, BMI, and WHtR (P < 0.05). Linear regression analyses showed BMI and WC as independent risk factors for SBP with an increase by 1.11 mmHg in men (P = 0.036) and 1.59 mmHg in women (P = 0.001) in SBP when BMI increased 1 unit, while SBP increases by 0.2 mmHg when WC increases by 1 unit regardless of gender (P = 0.013).

Conclusion

Our results showed that BMI and WC are related to BP and important predictors of hypertension risk. Therefore, the uses of BMI and WC are recommended as screening tools for the prediction of hypertension risk among Turkish adults.

The Activities of the Slovenian Strategic Council for Nutrition 2023/24 to Improve the Health of the Slovenian Population and the Sustainability of Food: A Narrative Review

The health status of individuals in Slovenia across age groups is a matter of concern, as current unsustainable lifestyle choices are already leading to various chronic noncommunicable diseases (NCDs). Outdated national dietary guidelines, their inconsistent implementation, and a lack of structural changes represent obstacles to promoting healthy and sustainable nutrition. Limited access to and rising prices of healthy, sustainable foods, in addition to the high availability of low-priced, highly processed foods, increase the risk of NCDs. The lack of systematic health monitoring and early disease detection poses a challenge. Global and local environmental issues, resistance, and/or the inability to adopt healthier diets hinder individuals from changing their nutritional behaviours. In this narrative review, we provide an overview of the current situation in Slovenia as well as planned activities initiated by the Slovenian government and the Prime Minister's Strategic Council for Nutrition, aiming to make progress in supporting healthy and sustainable nutrition, limiting food waste, and increasing the availability of healthier foods for all. Improving the sustainability of the Slovenian food system can contribute to several Sustainable Development Goals (SDGs), ensuring Slovenia's commitment to internationally agreed-upon targets. This could lead Slovenia to take a role as a pilot country in testing and implementing the necessary systemic changes, which could be further applied in other countries.

Hypertension Control Status Among Patients Receiving Treatment From Selected Primary Health Centres in Puducherry: A Cohort-Analysis Approach

BACKGROUND

 High blood pressure (hypertension) is a major risk factor contributing to 60% of premature deaths caused by non-communicable diseases. In India, a mere 15% of the hypertensive population achieves optimal blood pressure control. Effective monitoring of hypertension is crucial for mitigating the morbidity and mortality associated with cardiovascular diseases.

OBJECTIVE

This study employed a cohort analysis approach to determine the control status of hypertension and identify factors associated with hypertension among individuals seeking care at selected primary health centres (PHCs) in Puducherry from January 2019 to December 2022.

METHODOLOGY

We assessed treatment records of 1127 patients with hypertension registered at PHCs in both urban and rural areas between 2019 and 2022. Information on socio-demographic details and blood pressure readings was collected to assess the control status of hypertension on a quarterly and six-monthly basis. Additionally, 436 patients were interviewed to identify factors associated with uncontrolled hypertension.

RESULTS

Control rates of hypertension varied among PHCs on a quarterly and six-monthly basis. The rural PHC achieved the highest quarterly control rate of 80% in Q4 2020, while the urban PHC had the lowest rate of 44% in Q1 2020. Similarly, the highest six-monthly control rate of 78% was observed in Q3 2019 at both rural and urban PHCs, with the lowest rate of 44% in Q1 2020 at the urban PHC.  Conclusion: Analysing data obtained from regular monitoring of hypertension control status allows healthcare providers to identify patterns, trends, and correlations. It assists providers in making informed decisions regarding treatment adjustments, medication choices, lifestyle recommendations, and policy changes. This approach is expected to improve control status for hypertension, leading to the ultimate goal of better health outcomes for patients.

The effect of postpartum lifestyle interventions on blood pressure: a systematic literature review

Postpartum lifestyle modification is recommended to hypertension risk. We conducted a systematic literature review to assess the evidence for postpartum lifestyle interventions to reduce blood pressure. We searched for relevant publications from 2010 through November 2022. Two authors independently conducted article screening and data extraction; a third resolved discrepancies. Ultimately, nine studies met inclusion criteria. Most were randomized controlled trials and had sample sizes <100. In all but one of the eight studies reporting race data, nearly all participants identified as White. None of the studies reported a significant intervention effect on blood pressure. However, most interventions were associated with improvements in other outcomes, such as physical activity. Overall, the evidence for postpartum lifestyle interventions to reduce blood pressure is limited to a handful of studies characterized by small sample sizes and a lack of racial diversity. Additional research with larger samples, more diverse populations, and intermediate outcomes is warranted.

High Prevalence of Uncontrolled Hypertension Among Afghan Hypertensive Patients: A Multicenter Cross-Sectional Study

Background

Despite striking advances in the management of hypertension, blood pressure (BP) control remains suboptimal worldwide. Sustainable Development Goals (SDGs) call for 80% control rates by 2030, highlighting the urgency for improvements in hypertension control.

Objective

We aimed to determine the prevalence of uncontrolled hypertension (≥140/90 mmHg) and assess its associated factors in Afghan hypertensive patients.

Methods

We conducted this multicenter cross-sectional study at three Afghan public hospitals in Afghanistan. We recruited hypertensive patients (n=950) on antihypertensive medications (AHMs) from August to December 2022. We analyzed only complete datasets (853). We employed the 14-item Hill-Bone compliance scale to assess compliance with AHMs. We performed multivariable logistic regression analyses to determine factors associated with uncontrolled hypertension.

Results

The mean age (±SD) of the patients was 47.5 (± 9.5) years and males constituted 50.5% (431) of the study sample. The prevalence of uncontrolled hypertension in this study was 77.3% (95% CI: 74.2-79.9%). Factors associated with uncontrolled hypertension and their adjusted OR (95% CI) were physical inactivity: 3.45 (1.87-6.35), current smoking: 3.04 (1.50-6.15), high salt intake: 3.57 (1.9-6.7), presence of comorbid medical disease: 2.22 (1.20-4.08), higher BMI: 3.32 (1.12-9.88), poor compliance to AHMs: 8.50 (4.62-15.6), and presence of depressive symptoms: 1.99 (1.2-3.27).

Conclusion

The prevalence of uncontrolled hypertension was high in the present study. Factors associated with uncontrolled hypertension may epitomize potential targets for public/individual health interventions in Afghanistan.

Approach to Diagnosis and Management of Hypertension: A Comprehensive and Combined Pediatric and Adult Perspective

The global prevalence of primary hypertension has been increasing both in children and in the adolescent and adult populations and can be attributed to changes in lifestyle factors with an obesity epidemic, increased salt consumption, and sedentary lifestyles. Childhood blood pressure is the strongest predictor of adult hypertension. Although hypertension in adults is associated strongly with an increased risk for cardiovascular disease, chronic kidney disease, and mortality, outcomes in children are defined less clearly. In adults, major guidelines agree on a threshold of less than 120/80 mm Hg as the optimal blood pressure (BP) and recommend a target of less than 130/80 mm Hg for treatment in most cases. In children, international pediatric guidelines recommend using thresholds based on the normative distribution of BP in healthy normal-weight children. Out-of-office BP assessment is extremely useful for confirming the diagnosis of hypertension and monitoring response to treatment. Lifestyle modifications are instrumental whether coupled or not with pharmacologic management. New agents such as nonsteroidal mineralocorticoid-receptor antagonists, aminopeptidase A inhibitors, aldosterone synthase inhibitors, and dual endothelin antagonists hold significant promise for resistant hypertension. The transition from pediatric to adult care can be challenging and requires careful planning and effective coordination within a multidisciplinary team that includes patients and their families, and pediatric and adult providers.

Effectiveness and Tolerability of Bisoprolol/Perindopril Single-Pill Combination in Patients with Arterial Hypertension and a History of Myocardial Infarction: The PRIDE Observational Study

INTRODUCTION

This study assessed the real-life effectiveness of a single-pill combination (SPC) of bisoprolol/perindopril for controlling blood pressure (BP) and symptoms of angina in patients with hypertension and a history of myocardial infarction (MI).

METHODS

Eligible patients with arterial hypertension and a history of MI were aged 18-79 years and had initiated bisoprolol/perindopril SPC within 3 months of study enrollment as part of routine Russian clinical practice. The primary endpoint was mean change in systolic and diastolic BP (SBP/DBP) at week 12 compared with baseline (data collected retrospectively). Secondary endpoints were assessed at weeks 4 and 12 and included mean change in resting heart rate (HR), proportion of patients reaching target level of resting HR, antianginal effectiveness of the SPC, and proportion of patients reaching target BP levels.

RESULTS

A total of 504 patients were enrolled, of whom 481 comprised the full analysis set (mean age 61.4 ± 8.9 years, 68% men). Mean baseline SBP/DBP and HR values were 148.9 ± 16.8/87.7 ± 11.0 mmHg and 77.4 ± 10.5 bpm, respectively. Mean durations of hypertension and CAD were 12.8 ± 8.4 and 6.1 ± 6.3 years, respectively, and time since MI was 3.8 ± 5.3 years. At week 12, SBP/DBP had decreased by 24.9/12.2 mmHg (P < 0.001 vs baseline). Target BP (< 140/90 mmHg) was achieved by 69.8% and 95.9% of patients at weeks 4 and 12, respectively, and target HR (55-60 bpm) by 17.3% and 34.5% at weeks 4 and 12 versus 3.1% at baseline (P < 0.001). Reductions in angina attacks, nitrate consumption, and improvements in HR were statistically significant. Treatment was well tolerated.

CONCLUSION

Treatment of symptomatic patients with CAD, hypertension, and a history of MI with a bisoprolol/perindopril SPC was associated with significant decreases in SBP/DBP and a high proportion of patients achieving BP treatment goals. This was accompanied by improvements in angina symptoms and reductions in HR in a broad patient population representative of those seen in everyday clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT04656847.

Prevalence of Cardiovascular Risk Factors and Related Medical and Lifestyle Interventions Among Italian Cardiovascular Specialists: A Proof-of-Concept Study

INTRODUCTION

Physicians and researchers in the cardiovascular field are constantly engaged in the promotion of guidelines-directed preventive measures, but whether they are themselves adherent to the same recommendations was only sporadically examined.

AIM

To assess awareness of self-exposure to cardiovascular risk factors and related management among cardiovascular specialists.

METHODS

During the National Conference of the Italian Society of Hypertension (October 2022), a pilot observational study on consecutive volunteer cardiovascular specialists was conducted. Participants underwent standard sitting and standing blood pressure (BP) measurements and answered a questionnaire regarding modifiable/non modifiable cardiovascular risk factors and related treatments. Based on self-declarations and actual measurements, BP was classified as optimal, normal, high-normal BP, and new hypertension in untreated participants, and as treated/untreated pre-existing hypertension. Controlled hypertension was defined as BP < 140/90 mmHg; age-adjusted lower targets were also applied, according to guidelines.

RESULTS

In total, 62 participants (30 F, mean age 43.2 ± 14.8 years) were enrolled; 79% reported regular physical activity; 53% of women and 38% of men were on a low-salt diet. After smoke (19.4%), dyslipidemia was the second most common risk factor (17.7%), often occurring with high BP (26.3%) and left untreated (36.7%). Pre-existing hypertension (11.3%) was often uncontrolled (57.1%) and associated with non-adherence to guidelines-directed lifestyle recommendations. About one in 12 participants was unaware of having high measured BP values.

CONCLUSIONS

Despite the specific professional exposure, a margin for improvement in self cardiovascular risk factors awareness and management remains in this exploratory sample of cardiovascular specialists. This pilot research anticipates forthcoming, larger studies during national and international conferences.

Edible mushrooms as potential functional foods in amelioration of hypertension

Edible mushrooms are popular functional foods attributed to their rich nutritional bioactive constituent profile influencing cardiovascular function. Edible mushrooms are omnipresent in various prescribed Dietary Approaches to Stop Hypertension, Mediterranean diet, and fortified meal plans as they are rich in amino acids, dietary fiber, proteins, sterols, vitamins, and minerals. However, without an understanding of the influence of mushroom bioactive constituents, mechanism of action on heart and allergenicity, it is difficult to fully comprehend the role of mushrooms as dietary interventions in alleviating hypertension and other cardiovascular malfunctions. To accomplish this endeavor, we chose to review edible mushrooms and their bioactive constituents in ameliorating hypertension. Hypertension and cardiovascular diseases are interrelated and if the former is managed by dietary changes, it is postulated that overall heart health could also be improved. With a concise note on different edible varieties of mushrooms, a particular focus is presented on the antihypertensive potential of mushroom bioactive constituents, mode of action, absorption kinetics and bioavailability. Ergosterol, lovastatin, cordycepin, tocopherols, chitosan, ergothioneine, γ-aminobutyric acid, quercetin, and eritadenine are described as essential bioactives with hypotensive effects. Finally, safety concerns on allergens and limitations of consuming edible mushrooms with special reference to chemical toxins and their postulated metabolites are highlighted. It is opined that the present review will redirect toxicologists to further investigate mushroom bioactives and allergens, thereby influencing dietary interventions for heart health.

Inflammatory markers in patients with hypertension

Hypertension is a chronic disease with high levels of morbidity and disability. Elevated blood pressure can lead to many complications and is the main risk factor for stroke, heart failure and nephropathy. Factors associated with hypertension and inflammatory response differ from those associated with vascular inflammation. The immune system plays a vital role in the pathophysiology of hypertension. Inflammation is particularly relevant in the progression of cardiovascular diseases, which has led to extensive research on inflammatory markers and indicators.

Real-World Effectiveness and Safety of Two-Drug Single Pill Combinations of Antihypertensive Medications for Blood Pressure Management: A Follow-Up on Daily Cardiology Practice in Douala, Cameroon

INTRODUCTION

Hypertension is the leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Current guidelines recommend using two or more antihypertensive agents in single pill combinations (SPCs) to treat hypertension, but data from African patients that support these recommendations are lacking. We assessed the effectiveness and tolerance of three SPCs in lowering blood pressure (BP) amongst hypertensive patients in Douala.

METHOD

All patients included in the hypertension registry of the Douala General Hospital and the Douala Cardiovascular Center between January 2010 and May 2020, and receiving a two-drug SPCs (renin-angiotensin system inhibitors (RAASi) + diuretics (DIU), calcium channel blockers (CCB) + RAASi, or DIU + CCB) were tracked from baseline through 16 weeks. Our primary outcome was a decrease in systolic BP (SBP) from baseline up to 16 weeks after initiation of treatment. A mixed linear repeated model was used to evaluate the change of SBP from baseline to week 16, while controlling for age, gender, and baseline SBP. Statistical significance was set at p < 0.05.

RESULTS

Of 377 participants on two-drug SPCs, 123 were on CCB + DIU, 96 on RAASi + CCB, and 158 on RAASi + DIU. The mean age was 54.6 (± 11.2) years. At baseline, participants on RAASi + CCB presented with slightly higher SBP compared to the other two groups. Overall, the SBP decreased by 34.3 (± 14.2) mmHg from baseline values and this was comparable across the three groups of SPCs (p = 0.118). The control rate after 16 weeks of follow-up was 62.3% with no significant difference between groups. The occurrence of adverse events was 3.4% and was comparable among the three groups.

CONCLUSION

The three two-drug SPCs were highly effective in reducing and controlling BP with low and similar rates of adverse effects. Long-term data documenting safety and whether these agents exert a differential cardiovascular effect in addition to and independent of their BP-lowering effect are needed for SSA populations.

The effect of systemic hypertension on prostatic artery resistive indices in patients with benign prostate enlargement

Background

To investigate the effect of systemic hypertension on the prostatic artery resistive indices by a comparative ultrasonographic evaluation of the prostate gland in normotensive and hypertensive patients with benign prostatic enlargement (BPE).

Materials and methods

The participants had BPE and presented at the outpatient urologic clinic of a tertiary hospital. They were divided into normotensive and hypertensive groups. Each group had fifty patients. Calculation of international prostate symptom score, measurement of blood pressure, and transrectal ultrasonographic evaluation were done.

Results

The mean age for the normotensive and hypertensive groups were 66.9 ± 9.8 and 66.0 ± 10.7 years, respectively (P = 0.662). Patients with hypertensive BPE had a significantly higher mean transitional zone volume, transitional zone index, presumed circle area ratio, quality of life score, and prostatic arterial resistive indices than the age-matched normotensive BPE patients.

Conclusion

Patients with BPE and with hypertension had significantly higher prostate arteries resistive indices than normotensives with BPE. Even in patients with BPE and controlled hypertension, the prostatic artery resistance indices were still elevated than that of normotensive men with BPE.

Hypertension Control Cascade and Regional Performance in India: A Repeated Cross-Sectional Analysis (2015-2021)

Background The weak control cascade of hypertension from the time of screening till the attainment of optimal blood pressure (BP) control is a public health challenge, particularly in resource-limited settings. The study objectives were to (1) estimate the change in the rate of prevalence of hypertension, the yield of newly diagnosed cases, initiation of treatment, and attainment of BP control in the age group 15 to 49 years; (2) ascertain the magnitude and predictors of undiagnosed hypertension, lack of initiation of treatment, and poor control of those on antihypertensive therapy; and (3) estimate the regional variation and state-level performance of the hypertension control cascade in India. Methodology We analyzed demographic and health surveillance (DHS) data from India's National Family Health Survey Fifth Series (NFHS-5), 2019-2021, and NFHS-4 (2015-2016). The NFHS-5 sample comprised 695,707 women and 93,267 men in the age group of 15 to 49 years. Multiple logistic regressions were performed to find the associated predictors, and respective adjusted odds ratios (aORs) were reported. Results The prevalence of hypertension (cumulative previously diagnosed and new cases) among individuals aged 15 to 49 years was 22.8% (22.6%, 23.1%; n = 172,532), out of which 52.06% were newly diagnosed cases. In contrast, in NFHS-4, the prevalence of hypertension among individuals aged 15 to 49 years was 20.4% (20.2%, 20.6%; n = 153,384), of which 41.65% were newly diagnosed cases. In NFHS-5, 40.7% (39.8% and 41.6%) of the previously diagnosed cases were on BP-lowering medications compared to 32.6% (31.8%, 33.6%) in NFHS-4. Furthermore, in NFHS-5, controlled BP was observed in 73.7% (72.7% and 74.7%) of the patients on BP-lowering medication compared to 80.8% (80.0%, 81.6%) in NFHS-4. Females compared to males (aOR = 0·72 and 0·007), residents of rural areas (aOR = 0·82 and 0·004), and those belonging to the socially disadvantaged groups were not initiated on treatment despite awareness of their hypertension status indicative of poor treatment-seeking behavior. Furthermore, increasing age (aOR = 0·49, P < 0·001), higher body mass index (aOR = 0·51, P < 0·001), and greater waist-to-hip ratio (aOR = 0·78, P = 0·047) were associated with uncontrolled hypertension in patients on antihypertensive drug therapy. Conclusions Hypertension control cascade in India is largely ineffectual although screening yield and initiation of antihypertensive treatment have improved in NFHS-5 compared to NFHS-4. Identification of high-risk groups for opportunistic screening, implementing community-based screening, strengthening primary care, and sensitizing associated practitioners are urgently warranted.