Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of The Obesity Society and the American Society of Hypertension

Obesity-Related Disorders in Türkiye: A Multi Center, Retrospective, Cross-Sectional Analysis from the OBREDI-TR Study

Objectives: Obesity is a significant public health concern, as it is associated with the development of numerous chronic diseases. The prevalence of obesity and attendant diseases has been increasing over recent years. This study attempted to ascertain the frequency of chronic diseases in obese patients in Türkiye for the first time on this scale. Methods: A retrospective study was conducted, with patients admitted to the internal medicine outpatient clinics or obesity centers between December 2023 and December 2024 included in this study. Participants were recruited from seven regions, 20 provinces, and 28 centers, and the inclusion criteria were met by those aged 18 years and over with a body mass index (BMI) of 30 kg per square meter (kg/m2) or above. Their status, with respect to chronic diseases, and their anthropometric parameters were documented. Results: The total number of patients was 10,121, with a mean age of 45.2 ± 13.92. Of these, 7222 (71.35%) were female. The prevalence of type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia (DL), coronary artery disease (CAD), obstructive pulmonary disease (OPD), obstructive sleep apnea syndrome (OSAS), and fatty liver disease (FLD) was found to be 35.01%, 78.19%, 12.37%, 10.32%, 5.88%, and 75.12%, respectively. A subsequent analysis of the prevalence of these diseases by region revealed a statistically significant variation between regions (p < 0.001 for all regions). Conclusions: This study represents a substantial contribution to the existing body of knowledge in this field, particularly with regard to the identification of the current chronic disease rate of obese patients in Türkiye.

Prolonged Hospital Stay in Hypertensive Patients: Retrospective Analysis of Risk Factors and Interactions

Background/Objectives: Arterial hypertension (HT) is a leading modifiable risk factor for cardiovascular diseases, often contributing to prolonged lengths of hospital stay (LOHS), which place significant strain on healthcare systems. This study aimed to analyze the factors associated with prolonged lengths of hospital stay in patients with HT, focusing on key biochemical and clinical predictors. Methods: This retrospective study included 356 adult patients hospitalized in the Cardiology Department of the University Hospital in Wroclaw, Poland, between January 2017 and June 2021. Data collected included demographic characteristics, body mass index (BMI), comorbidities, and laboratory parameters. Logistic regression models were used to identify predictors of prolonged LOHS, defined as four or more days, and to evaluate interactions between variables. Results: Lower levels of low-density lipoprotein cholesterol (LDL-c) and elevated concentrations of high-sensitivity C-reactive protein (hsCRP) were identified as significant predictors of prolonged LOHS, with each 1 mg/dL decrease in LDL-c increasing the odds of prolonged LOHS by 1.21% (p < 0.001) and each 1 mg/L increase in hsCRP raising the odds by 3.80% (p = 0.004). An interaction between sex and heart failure (HF) was also observed. Female patients with HF had 3.995-fold higher odds of prolonged LOHS compared to females without HF (p < 0.001), while no significant difference was found among male patients with or without HF (p = 0.890). Conclusions: The predictors of prolonged LOHS in patients with HT include lower levels of LDL-c, elevated hsCRP, and the interaction between sex and heart failure (HF). Specifically, female patients with HF demonstrated significantly higher odds of prolonged LOHS compared to females without HF, while this relationship was not observed in male patients.

Pregnancy After Metabolic Bariatric Surgery: Risks and Rewards for Mother and Child

As the prevalence of obesity increases worldwide, and lifestyle modification or pharmaceutical treatment yields insufficient results for patients with severe obesity, an increasing number of patients opt for metabolic bariatric surgery as an effective and durable treatment of this disease. Seeing as 80% of these patients are women, many of whom are of reproductive age, pregnancies after metabolic bariatric surgery become increasingly common. Metabolic bariatric surgery has many benefits for overall health and pregnancy outcomes, but certain risks are also reported. This leads to the rise of a new population of patients with their own specific needs regarding follow-up. This review discusses the various benefits and risks of these types of surgery for pregnancy. We provide an overview of the current state of the evidence and look into future research goals.

Rising Prevalence of Obesity and Primary Hyperaldosteronism: Co-incidence or Connected Circumstances Leading to Hypertension? A Narrative Review

While obesity and its associated complications, mainly diabetes and hypertension, have been the largest public health problems of modern world, the emerging data suggests an increasing prevalence of primary hyperaldosteronism (PA) as one of the most common undiagnosed causes of hypertension. We believe that rising prevalence of PA in the era of high rates of obesity is likely not a chance finding but is deeply intersected with the rising rates of obesity. Higher serum aldosterone concentrations and urinary aldosterone excretion have been observed in patients with increased body mass index or larger waist circumference. The in vitro and pre-clinical studies suggest that adipocytes not only synthesize and secrete aldosterone but also release factors which stimulate production of aldosterone from adrenal glands. Aldosterone excess causing ligand-dependent activation of the mineralocorticoid receptor (MR) has increasingly been recognized as one of the important mechanisms of obesity-related hypertension. The aldosterone excess in these cases can be labelled as acquired hyperaldosteronism to differentiate it from the non-obesity related classical cases of PA. Because of serious consequences, recognizing aldosterone excess in obesity is important, as it gives a more compelling reason for weight loss and guidance to choosing pharmacotherapy wisely. Dietary sodium restriction and mineralocorticoid receptor antagonists play important roles in the management of PA associated with obesity.

Elucidating shared genetic association between female body mass index and preeclampsia

The prevalence of obesity is steadily rising and poses a significant challenge to women's health. Preeclampsia (PE), a leading cause of maternal and fetal mortality, is significantly linked to a high body mass index (BMI). However, the shared genetic architecture underlying these conditions remains poorly understood. In this study, we used summary-level data from large-scale genome-wide association studies of BMI (N = 434,794) and PE (Ncases = 8185; Ncontrols = 234,147) to assess the shared genetic architecture between them. Our findings revealed a significant genetic correlation between BMI and PE, with an estimated sample overlap of approximately 0.8%. We identified roughly 1100 shared genetic variants, with the most notable region of local genetic correlation located in 16q12.2. Enrichment analyses highlighted endothelial dysfunction as a key biological mechanism linking BMI and PE. Additionally, RABEP2 was identified as a novel shared risk gene. Mendelian randomization analysis demonstrated a bidirectional causal relationship between BMI and PE, with blood pressure identified as a key mediator. We identified the shared genetic foundation between BMI and PE, providing valuable insights into the comorbidity of these conditions and offering a new framework for future research into comorbidity.

The weight-adjusted-waist index predicts all-cause and cardiovascular mortality in hypertension

Background

Weight-adjusted-waist (WWI) is a novel indicator of obesity that reflects the degree of central obesity in the human body.

Objectives

The study aimed to explore the relationship between WWI and mortality in hypertensive individuals.

Methods

Cross-sectional data from the 2001-2018 National Health and Nutrition Examination Survey (NHANES) dataset were used in this study. The relationship between WWI and mortality was assessed using a weighted Cox proportional risk model; the nonlinear relationship was explored using restricted cubic splines. The robustness of the results was verified by subgroup and sensitivity analyses.

Results

A cohort of 11,556 people with a diagnosis of hypertension was included in this study. As a continuous variable, WWI was linked to higher rates of mortality from all-cause (HR = 1.23, 95% CI = 1.14, 1.33) and cardiovascular disease (CVD) (HR = 1.43, 95% CI = 1.23, 1.66) with hypertension in Model 3 adjusted for variables. Using WWI as a tertile categorical variable, individuals in the highest tertile had a 33% higher risk of all-cause death (HR = 1.33, 95% CI = 1.14, 1.56) and a 65% higher risk of CVD death (HR = 1.65, 95% CI = 1.19, 2.27) than individuals in the lowest tertile. According to the subgroup analysis, almost all groups showed a consistent positive correlation between WWI and mortality related to all-cause and CVD.

Conclusion

In adults with hypertension, there is a positive association between WWI and all-cause and CVD mortality.

Burn injury in obesity: Examination of the Burn Care Quality Platform's (BCQP) available data on obese patients to determine burn-related outcomes

INTRODUCTION

Literature examining the impact of obesity on burn injury remains mixed. Previous examination of the National Burn Repository, now the BCQP, in obesity-related burn research is limited. The aim of this work was to provide an assessment of the BCQP dataset to examine the effect of obesity on burn-related outcomes.

MATERIALS AND METHODS

A retrospective review of the BCQP dataset from 2015-2018 was conducted. The primary outcome measure was mortality. Secondary outcomes included overall length of stay (LOS), ICU LOS, and total hospital costs. Patients were grouped as obese or non-obese and were further stratified by total body surface area burned (TBSA) for comparison purposes. Multiple logistic regression (MLG) was used to compare the effect of several independent variables on mortality, ICU LOS > 7days, hospital LOS > 10 days, and total hospital costs > $200,000.

RESULTS

Of 41,031 patients in the analysis, 3845 (9.37 %) were obese. Obese patients had a higher mean TBSA (p = 0.01), longer overall LOS (p < 0.001), ICU LOS (p < 0.001), and total hospital costs (p < 0.001). MLG found obesity to be an independent predictor of ICU LOS > 7 days, hospital LOS > 10 days, and total hospital costs > $200,000. Obesity was not an independent predictor of mortality in burn patients, even when stratified by burn size.

CONCLUSIONS

The presence of obesity in this dataset was not found to be a predictor of mortality for any burn size, but was a predictor of overall LOS, ICU LOS, and total hospital costs. Including obesity-related variables in databases may improve analysis in obesity-related burn research.

Sex-specific association of weight-adjusted waist index with mortality in stroke survivors: A national longitudinal cohort study

BACKGROUND AND AIMS

The weight-adjusted waist index (WWI) is a novel indicator of obesity, and its association with mortality in stroke patients remains unknown. We aimed to explore these associations through a national longitudinal cohort study.

METHODS AND RESULTS

We included stroke survivors from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 who were followed up until December 31, 2019. The study outcomes were all-cause and cardiovascular disease (CVD) mortality in stroke patients. A total of 1427 stroke patients were enrolled, and after a median follow-up duration of 83 months, 624 stroke patients died, including 251 from CVD. Kaplan‒Meier survival analyses indicated that WWI was significantly associated with the probability of survival over time in stroke patients (log-rank tests, both p < 0.0001). After adjusting for confounders, WWI was significantly and positively associated with all-cause and CVD mortality after stroke. Restricted cubic spline analysis revealed that WWI was linearly associated with all-cause mortality and nonlinearly associated with CVD mortality. Stratified analyses suggested that sex significantly influenced the effect of WWI on all-cause mortality in stroke patients. Additional body mass index (BMI) adjustments did not significantly change the results.

CONCLUSION

WWI was positively associated with all-cause and CVD mortality in stroke patients, independent of BMI. These effects were present only in men. These findings suggest that WWI is an independent prognostic factor in stroke patients and that maintaining appropriate WWI values can help improve the prognosis of stroke survivors.

Childhood body size, adulthood adiposity, underlying mechanisms, and risk of incident hypertension: a prospective cohort study of 180,527 participants

BACKGROUND

Mechanisms underlying the association of life-course adiposity with incident hypertension in adulthood have not been comprehensively investigated. In this study, we aimed to investigate the potential biochemical and metabolomic mechanisms underlying the association between adiposity and incident hypertension.

METHODS

A total of 180,527 participants from the UK Biobank aged 37 to 73 years were included. Associations of childhood body size or adulthood adiposity status as well as child-adult weight status change with incident adulthood hypertension were estimated by multivariate Cox proportional regression models.

RESULTS

Participants with childhood thinner body size and adulthood obesity had the highest risk of incident hypertension (hazard ratio, HR = 3.09, 95% CI = 2.88-3.32) compared with those with "average → normal" pattern, followed by those with "average → obese" pattern (HR = 2.45, 95% CI = 2.31-2.61) and "plumper → obese" pattern (HR = 2.82, 95% CI = 2.62-3.02). Of note, those with "plumper → normal" pattern (HR = 1.11, 95% CI = 1.00-1.23) and "thinner → normal" pattern (HR = 1.17, 95% CI = 1.10-1.24) had the second and third lowest risk of incident hypertension. Adulthood overweight (mediation proportion: 58.7%, 95% CI: 40.4-74.8%) or obesity (mediation proportion = 46.7%, 95% CI: 29.4-64.9%) largely mediated the association between childhood plumper body size and hypertension. The association between adiposity and hypertension was mediated by biochemical indices (e.g., liver function, immunometabolism) and metabolites (e.g., alanine aminotransferase, apolipoprotein A) (mediation proportions ranging from 3.2 to 23.4%).

CONCLUSIONS

Thinner or plumper body size in childhood increases the risk of incident adulthood hypertension, and adulthood adiposity partly mediated this association, suggesting the importance of maintaining normal weight across the life course. Several biochemical indices and metabolites mediated these associations providing clues to underlying biological mechanisms.

Prevalence and risk factors of the most common multimorbidity among Canadian adults

BACKGROUND

The number of persons living with multimorbidity-defined as the co-occurrence of at least two chronic conditions in the same individual-is growing globally, especially in developed countries. Traditionally, this increase has been attributed to a growing aging population, sedentary lifestyle, obesity, low socioeconomic status, and individual genetic susceptibility.

OBJECTIVE

To investigate the prevalence and associated risk factors of the most common multimorbidity (MCM) among Canadian middle-aged and older adults.

METHOD

Relevant data on all 30,097 middle-aged and older Canadian adults (aged 45 to 85 years) from the Canadian Longitudinal Study on Aging were used for this study. To identify the specific sociodemographic risk factors associated with the MCM, we used survey-specific logistic regression.

FINDINGS

Overall, co-occurrence of osteoarthritis and hypertension was identified as the MCM among Canadian adults aged 45+ with an estimated prevalence of 16.5%. The results from multivariate analysis showed that seven factors were significantly associated with increased odds of the MCM, which included increasing age, being retired from work (retired vs not retired), poorer rating of perceived health, (very good, good, poor vs excellent), increasing problems with sleep quality (satisfied, dissatisfied vs neutral), and abnormal body-mass index (underweight, overweight, obese vs normal). Also, residents in other urban centres had significantly lower odds than those in urban core. Persons living in Atlantic Canada, Ontario and Quebec were at increased odds of having the MCM compared to those in British Columbia. The odds of the MCM associated with increasing age was significantly higher among Females (OR = 1.12, 95% CI = 1.11-1.13) than Males (OR = 1.08, 95% CI = 1.07-1.10).

CONCLUSION

Multimorbidity is a common feature among Canadian adults. The identification of the most prevalent patterns and associated risk factors in this study provides fresh insights into the etiology, progression, and possible prevention of the MCM among Canadian adults.

Urine exosome biomarkers of obesity after Lekhana Basti treatment - Report of a pilot study

BACKGROUND

Obesity is a rising risk factor for various diseases including cardiovascular diseases and Cancer. The limitations of targeted obesity-treatment approaches employed in the clinic presently underscore the importance of developing integrative management strategies for identification of specific biomarkers of obesity.

OBJECTIVES

Given the specificity of exosome/extracellular vesicle (EV) biomarkers, we aimed here to identify the EV biomarkers of Ayurveda treatment - Lekhana Basti - for Obesity.

METHODOLOGY

A total of eighteen 24-h urine samples from 6 participants with BMI>30 kg/m2 were used in this study, collected over 3 time-points during the Lekhana basti (medicated enema for obesity) treatment. Urine EV were isolated using Polyethylene Glycol (PEG). The proteins were resolved by 1-d gel electrophoresis and identified using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) and quantified by label-free methods. Significant Protein-Protein Interactions, KEGG pathway analysis and enrichment, functional gene ontology (GO) annotation were identified and shortlisted in comparison to Obesity reference genes from DisGeNET.

RESULTS

With UniProt as a reference subsequent to LC-MS/MS-identification, a total of 210 exosome proteins were identified. Seventy-three proteins were overexpressed in pathway enrichment analysis. Further, GO functional annotation identified 15 common proteins involved. Finally, the 8 hub proteins associated with obesity were identified and their differential expression profile compared between three different time-points during Lekhana Basti treatment. Six protein markers overexpressed during obesity were downregulated post Lekhana Basti treatment, while 2 markers increased in abundance post-treatment.

CONCLUSION

To our knowledge, this is the first study to isolate and identify urine EV protein abundance profiles from obese female participants of India. The study results indicate significant changes in the differential expression profile of 8 hub proteins involved in obesity, after Lekhana Basti treatment. The biomarker signature of the pilot study indicates the role of Ayurveda treatment and the possible pathways involved in the treatment of Obesity. Further, this study underlines the specificity of urine exosomes/EV as diagnostic markers as well as the potential of Ayurveda treatment in effective management of obesity.

Effectiveness of a Knowledge Level of Hypertension on Blood Pressure Control, Treatment Adherence, and Physical Activity of Hypertensive Individuals

Individuals' knowledge and attitudes about hypertension are important in controlling blood pressure (BP) and reducing hypertension-related mortality and morbidity. The current study aimed to investigate the effect of hypertension knowledge level on treatment adherence, BP control, and physical activity of hypertensive individuals. This prospective and cross-sectional study was conducted in the Family Medicine clinic of a tertiary healthcare institution between October 2023 and April 2024. The study included 218 patients with essential hypertension. The BP of all patients was measured with a calibrated mercury sphygmomanometer, and the patients were divided into two groups: uncontrolled BP and controlled BP. The Hypertension Knowledge Level Scale (HK-LS), General Practice Physical Activity Questionnaire (GPPAQ), and Modified Morisky Medication Adherence Scale (MMMAS-6) were administered to all participants. Although 40.8% (n = 89) of the patients had their BP under control, 59.2% (n = 129) did not. The median weight of the participants whose BP was not under control was higher than those whose BP was under control (p < 0.05). A significant positive correlation was found between the hypertension knowledge score and the Morisky total score, Morisky motivation, and Morisky knowledge scores. There was a significant negative correlation between the GPPAQ score and both systolic and diastolic BP, as well as a significant positive correlation with hypertension knowledge levels. Assessing the knowledge level of hypertensive patients about their disease, recognizing their lifestyles, and questioning their habits is crucial for recommending individualized health interventions tailored to the needs and characteristics of this population.

Investigation and management of resistant hypertension: British and Irish Hypertension Society position statement

People living with resistant hypertension (RH) are at high risk of adverse cardiovascular events. The British and Irish Hypertension Society has identified suspected RH as a condition for which specialist guidance may improve rates of blood pressure control and help clinicians identify those individuals who may benefit from specialist review. In this position statement we provide a practical approach for the investigation and management of adults with RH. We highlight gaps in the current evidence and identify important future research questions. Our aim is to support the delivery of high-quality and consistent care to people living with RH across the UK and Ireland.

Obesity paradox in patients with reduced ejection fraction eligible for device implantation - an observational study

AIMS

Patients with obesity have an overall higher cardiovascular risk, at the same time obesity could be associated with a better outcome in a certain subgroup of patients, a phenomenon known as the obesity paradox. Data are scarce in candidates for cardiac resynchronization therapy (CRT). We aimed to investigate the association between body mass index (BMI) and all-cause mortality in patients eligible for CRT.

METHODS

Altogether 1,585 patients underwent cardiac resynchronization therapy between 2000-2020 and were categorized based on their BMI, 459 (29%) patients with normal weight (BMI < 25 kg/m2), 641 (40%) patients with overweight (BMI 25- < 30 kg/m2) and 485 (31%) with obesity (BMI ≥ 30 kg/m2). The primary endpoint was all-cause mortality, heart transplantation, and left ventricular assist device implantation. We assessed periprocedural complications and 6-month echocardiographic response.

RESULTS

Normal-weight patients were older compared to patients with overweight or obesity (70 years vs. 69 years vs. 68 years; P ‹0.001), respectively. Sex distribution, ischaemic aetiology, and CRT-D implantation rates were similar in the three patient groups. Diabetes mellitus (BMI < 25 kg/m2 26% vs. BMI 25- < 30 kg/m2 37% vs. BMI ≥ 30 kg/m2 48%; P ‹0.001) and hypertension (BMI < 25 kg/m2 71% vs. BMI 25- < 30 kg/m2 74% vs. BMI ≥ 30 kg/m2 82%; P ‹0.001) were more frequent in patients with overweight and obesity. During the mean follow-up time of 5.1 years, 973 (61%) reached the primary endpoint, 66% in the BMI < 25 kg/m2 group, 61% in the BMI 25- < 30 kg/m2 group and 58% in the BMI ≥ 30 kg/m2 group (log-rank P‹0.05). Patients with obesity showed mortality benefit over normal-weight patients (HR 0.78; 95%CI 0.66-0.92; P = 0.003). The obesity paradox was present in patients free from diabetes, atrial fibrillation, and ischemic events. Periprocedural complication rates did not differ in the three groups (BMI < 25 kg/m2 25% vs. BMI 25- < 30 kg/m2 28% vs. BMI ≥ 30 kg/m2 26%; P = 0.48). Left ventricular ejection fraction improved significantly in all patient groups (BMI < 25 kg/m2 median ∆ -LVEF 7% vs. BMI 25- < 30 kg/m2 median ∆ -LVEF 7.5% vs. BMI ≥ 30 kg/m2 median ∆ -LVEF 6%; P < 0.0001) with a similar proportion of developing reverse remodeling (BMI < 25 kg/m2 58% vs. BMI 25- < 30 kg/m2 61% vs. BMI ≥ 30 kg/m2 57%; P = 0.48); P = 0.75).

CONCLUSIONS

The obesity paradox was present in our HF cohort at long-term, patients underwent CRT implantation with obesity and free of comorbidities showed mortality benefit compared to normal weight patients. Patients with obesity showed similar echocardiographic response and safety outcomes compared to normal weight patients.

Mitigation of Subsequent Ovariectomy Responses through Prior Exercise Training in Rats

It is well known that cardiometabolic dysfunction gradually increases after menopause, and the sedentary lifestyle can aggravate this condition. Therefore, we compared the effects of aerobic exercise training during the premenopausal period and after ovariectomy (OVX) on metabolic, hemodynamic, and autonomic parameters in an experimental rat model of menopause. The female rats were divided into four groups: control (C), sedentary OVX (SO), trained OVX (TO), and previously trained OVX (PTO). The PTO group was trained for 4 weeks prior to+8 weeks after OVX, and the TO group trained only after OVX on a motor treadmill. Autonomic modulation was evaluated, white adipose tissue (WAT) was removed and weighed, and lipolysis was assessed. The citrate synthase activity in the soleus muscle was analyzed. The trained groups prevented the impairment of baroreceptor reflex sensitivity in relation to SO; however, only PTO reduced the low-frequency band of the pulse interval compared to SO. PTO reduced the weight of WAT compared to the other groups; lipolysis in PTO was similar to that in C. PTO preserved muscle metabolic injury in all types of fibers analyzed. In conclusion, this study suggests that exercise training should be recommended in a premenopausal model to prevent cardiometabolic and autonomic menopause-induced deleterious effects.

Protective Effects of the Food Supplement Flexovital in a Model of Cardiovascular-Kidney-Metabolic Syndrome in Mice

Background/Objectives: The prevalence of cardiovascular-kidney-metabolic (CKM) syndrome is increasing rapidly, and cardiovascular complications pose significant risks in individuals with kidney disease and metabolic dysfunction. Understanding the mechanisms of CKM disorders is crucial, as is the discovery of novel preventive treatments. This study aimed to examine the therapeutic effects of a specially formulated nitric oxide-enhancing food additive in a mouse model of CKM syndrome induced by unilateral nephrectomy (UNX) in combination with chronic Western diet (WD) feeding. Methods: C57BL/6J mice underwent UNX and were fed a WD high in salt, sugar, and fat for 12 weeks, compared to sham-operated mice on standard chow. One group of UNX+WD mice received Flexovital (FLX), a food additive containing extracts of Rhodiola rosea and beetroot, and the amino acids L-arginine and L-citrulline. CKM parameters were assessed both in vivo and ex vivo alongside histological and biochemical analyses. Results: The UNX+WD mice showed an increase in body fat mass, the fat/lean mass ratio, and adipocyte area, of which most were significantly reduced by FLX. Elevated fasting glucose levels were also reduced by FLX, which tended towards improving glucose clearance. Elevated arterial blood pressure and endothelial dysfunction in UNX+WD mice were significantly reduced by FLX. FLX improved GFR and reduced glomerular and tubular injuries in UNX+WD mice. Additionally, FLX increased the P/O ratios of oxidative phosphorylation in the isolated renal mitochondria of UNX+WD mice. Conclusions: In this model of CKM syndrome, FLX effectively prevented the onset and progression of CKM dysfunctions induced by UNX+WD, as well as the associated organ injuries. These promising results highlight the need for validation in upcoming human trials.

Atherogenic Index of Plasma (AIP): The Most Accurate Indicator of Overweight and Obesity Among Lipid Indices in Type 2 Diabetes-Findings From a Cross-Sectional Study

BACKGROUND

This study aimed to evaluate the relationships of conventional and calculated lipid indices with obesity or overweight in patients with type 2 diabetes (T2D).

METHODS

In this cross-sectional study, all participants were categorised into three groups: normal weight (18 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Conventional lipid indices, including triglyceride (TG), total cholesterol, LDL-C and HDL-C, were measured. Lipid indices, including the atherogenic index of plasma (AIP), non-HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HLD-C/HDL-C (atherogenic index, AI) and lipoprotein combine index (LCI), were calculated. The associations of these lipid indices with obesity and overweight status were evaluated using univariate and multivariate multinomial logistic regression analyses.

RESULTS

In this study, 2661 patients with T2D, including 651 patients with normal weight, 1144 with overweight, and 866 with obesity, were recruited. According to a multinomial logistic regression analysis after adjustment for multiple confounders, the odds ratio (OR) was greater for the AIP than for other conventional and calculated lipid indices in overweight and obese patients with T2D. The AIP had a significant relationship with overweight, with an OR of 4.79 (95% CI: 1.65-13.85), and it had a significant relationship with obesity, with an OR of 13.64 (95% CI: 3.96-47.04). According to the ROC curve, with a cut-off value of 0.68, AIP could predict obesity with 82% sensitivity and 55% specificity (AUC = 0.770, 95% CI: 0.729-0.812, p < 0.001).

CONCLUSION

Compared with other conventional and calculated lipid markers, the AIP is most strongly associated with obesity and overweight in patients with T2D.

Obesity and Sympathetic Overactivity in Young Individuals With Hypertension: Clinical Perspective of Indian Healthcare Providers

INTRODUCTION

To understand the current clinical practices followed by healthcare professionals (HCPs) among populations with hypertension and obesity with sympathetic overactivity and develop strategies to improve the management of hypertension.

METHODS

A standard questionnaire was formulated based on high sympathetic overactivity and/or obesity in young patients with hypertension to gather information on the perception and practices of HCPs toward the management of young patients with hypertension who have high sympathetic overactivity and/or obesity. HCPs throughout India were selected. The key insights and recommendations from the panel discussion were summarized in a report that helped to develop strategies to improve the management of young hypertension patients with high sympathetic overactivity/obesity.

RESULTS

A total of 1170 HCPs participated in the survey and in panel discussion meetings. According to 53% of HCPs, patients with hypertension with increased sympathetic overactivity or stress are most commonly aged 41-60 years. These patients have a higher likelihood of developing stroke (60%), alcoholism (46%), and sleep apnea (41%). Moreover, these HCPs also opined that patients with hypertension and obesity are at greater risk of developing coronary artery disease and chronic kidney disease (69%) and often require multiple antihypertensive drugs (60%). For the management of hypertension in obese patients with sympathetic overactivity, a combination of telmisartan and cardio-selective beta-blockers is the preferred treatment (66%). Additionally, a combination of telmisartan and metoprolol is recommended to control sympathetic overactivity in obese patients with hypertension.

CONCLUSION

Sympathetic overactivity is becoming more common in young adults with hypertension, and the combination of telmisartan and cardio-selective beta-blockers is the best treatment option for these patients. This approach may help to effectively manage hypertension and reduce the risk of complications associated with sympathetic overactivity. The limitation of the study is its reliance on self-reported data from HCPs, which may introduce bias.

Associations between daytime napping, sleep duration, and depression and 15 cardiovascular diseases: a Mendelian randomization study

Background

Numerous studies have documented the effects of daytime napping, sleep duration, and depression on cardiovascular diseases (CVDs). However, the evidence has been gleaned from observational studies that might be riddled with confounding variables and the possibility of reverse causation bias. Therefore, the present study employed a Mendelian randomization (MR) methodology to meticulously explore the relationships between daytime napping, sleep duration, and depression, and the risk profiles of CVDs.

Methods

Genome-wide significant genetic variants associated with daytime napping, sleep duration, and depression were used as the instrumental variables (IVs). Data on the genetic correlations between these IVs and 15 CVDs were derived from the United Kingdom (UK) Biobank, Finnish Genome Studies, and other large-scale collaborations. We conducted both univariate and multivariate MR analyses to assess the overall effects and mediated relationships after adjusting for potential confounders, including body mass index (BMI), smoking status, and type 2 diabetes. The effect sizes were estimated using inverse variance-weighted (IVW) regression.

Results

The MR analysis revealed that an increased risk of heart failure (HF) [odds ratio (OR): 1.366; 95% confidence interval (CI): 1.013-1.842; P=0.04], coronary atherosclerosis (OR: 1.918; 95% CI: 1.257-2.927; P=0.003), myocardial infarction (MI) (OR: 1.505; 95% CI: 1.025-2.211; P=0.04), and coronary artery disease (CAD) (OR: 1.519; 95% CI: 1.130-2.043; P=0.006) was significantly associated with genetically predicted daytime napping. Prolonged sleep duration was found to be related to a reduced risk of HF (OR: 0.995; 95% CI: 0.993-0.998; P=2.69E-04), peripheral vascular disease (PVD) (OR: 0.984; 95% CI: 0.971-0.997; P=0.02), and CAD (OR: 0.997; 95% CI: 0.994-0.999; P=0.006). Additionally, a statistically significant positive relationship was observed between depressive disorders and the occurrence of atrial fibrillation (AF) (OR: 1.298, 95% CI: 1.065-1.583, P=0.01), indicating a heightened susceptibility. The multivariable MR analyses substantiated the reliability of the observed associations between daytime napping and the incidence of HF and CAD, following adjustments for genetically predicted BMI and smoking. The sensitivity analysis did not reveal any evidence of horizontal pleiotropy or heterogeneity, thus supporting the validity of the study's results.

Conclusions

This MR investigation posits a potential causal nexus between daytime napping, sleep duration, and depression, and the genesis of CVDs, offering new perspectives on the prevention and management of CVDs.

Association between weight-adjusted waist index with incident stroke in the elderly with hypertension: a cohort study

The objective of this study was to ascertain the relationship between the weight-adjusted waist index (WWI) and the risk of stroke in an elderly hypertensive population, a relationship that has not been previously elucidated. The Cox regression model was employed to assess the correlation between baseline WWI measurements and the incidence of stroke. To further elucidate the shape of the association between baseline WWI and stroke, restricted cubic splines were employed. Furthermore, subgroup analyses and interaction tests were carried out to investigate potential heterogeneities. Our study cohort comprised 4962 hypertensive individuals aged 60 years or older with no prior history of stroke. Over a median follow-up of 3.2 years, we found 547 new-onset stroke cases. After adjusting for confounding variables, the Cox regression analysis revealed a positive association between baseline WWI and the risk of stroke, with hazard ratios (HRs) escalating progressively as WWI values increased. When compared to the lowest quartile of WWI, the highest quartile demonstrated an HR of 1.87 (95% CI, 1.44-2.42) for stroke. Subgroup analyses confirmed the consistency of this relationship across different demographic and clinical strata. The study findings indicate that an elevated WWI is significantly related with a higher risk of new-onset stroke among elderly patients with hypertension. These results underscore the importance of WWI as a potential risk stratification tool. To confirm these results and explore the causal mechanisms behind the observed correlation, more study is necessary.

The Effect of Changes in the Body Mass Index After Total Knee and Hip Arthroplasty on Patient Functional Scores

Introduction High body mass index (BMI) often causes immobility and functional impairment before arthroplasty. Patients expect weight loss post-surgery due to increased mobility, but paradoxically, studies show that weight may not decrease and might even increase postoperatively. This study aims to evaluate if patients lose weight after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to examine the impact of BMI change on functional scores. Methods We analyzed 459 patients who underwent primary TKA and THA between January 2018 and December 2022, with a two-year follow-up. Patients with incomplete data or bariatric surgery were excluded. Demographic characteristics, BMI, Oxford scores, comorbidities, corticosteroid use, physiotherapy, and surgery type (unilateral or bilateral) were assessed. Results Patients showed a significant increase in BMI postoperatively, especially those with comorbidities and younger age. Throughout the entire follow-up period, the BMI value of the knee group was higher than that of the hip group. Comorbidities significantly influenced BMI increase, while corticosteroid use and physiotherapy follow-up did not. Oxford scores improved postoperatively, but the presence of comorbidities and physiotherapy follow-up negatively impacted score changes. A negative correlation between BMI change and Oxford score change was observed (p = 0.013), indicating that increased BMI is associated with less improvement in functional scores. This correlation was significant for hip arthroplasty patients (p = 0.000), but not for knee arthroplasty patients (p = 0.822). Conclusions BMI changes post-TKA and THA are influenced by various clinical and demographic factors. Increased BMI negatively affects functional outcomes, particularly in hip arthroplasty patients. Comorbidities significantly influenced weight gain, while oral corticosteroid use had no notable effect on BMI. Patients undergoing bilateral procedures experienced lower BMI increases. The hip group gained more weight, but the knee group's BMI remained higher throughout the follow-up. In terms of Oxford scores, comorbidities, corticosteroid use, affected joints, and age did not significantly impact outcomes. Patients under physiotherapist supervision showed smaller score increases. While bilateral procedure patients achieved higher scores, simultaneous bilateral procedures did not lead to greater increases. These findings highlight the importance of weight control and rehabilitation in improving postoperative recovery and quality of life.

The role of glucagon-like peptide-1 receptor agonists (GLP1-RAs) in the management of the hypertensive patient with metabolic syndrome: a position paper from the Korean society of hypertension

Obesity is the one of the most important components of metabolic syndrome. Because obesity related hypertension accounts for two thirds of essential hypertension, managing obesity and metabolic syndrome is a crucial task in the management of hypertension. However, the current non-pharmacological therapies have limitations for achieving or maintaining ideal body weight. Recently, glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated excellent weight control effects, accompanied by corresponding reductions in blood pressure. GLP1-RAs have shown cardiovascular and renal protective effects in cardiovascular outcome trials both in primary and secondary prevention. In this document, the Korean Society of Hypertension intends to remark the current clinical results of GLP1-RAs and recommend the government and health-policy makers to define obesity as a disease and to establish forward-looking policies for GLP1-RA treatment for obesity treatment, including active reimbursement policies.

Placental pathology and fetal growth outcomes in pregnancies complicated by maternal obesity

BACKGROUND

The rising prevalence of maternal obesity presents a significant health concern because of the possible implications for obstetric complications and neonatal outcomes. Understanding the impact of obesity on placental structure and function as well as fetal growth and infant outcomes is important to improve the care of these potentially high-risk pregnancies. This study aimed to determine the effect of elevated maternal BMI on histopathologic patterns of placental injury and its consequences on fetal growth.

METHODS

Data were collected from an ongoing cohort of maternal-infant dyads in the UCSD Obstetric Registry spanning 2011-2020. Maternal characteristics, including BMI, hypertensive disease and diabetes, placental gross and histopathology, and infant characteristics, including sex and birthweight, were recorded and analyzed. ANOVA and chi-square tests were used in initial analyses, followed by log-binomial and linear regression models adjusted for relevant confounders to determine associations between maternal BMI, specific patterns of placental injury, and infant birthweight percentiles.

RESULTS

Among 1366 maternal-infant dyads, placentas from mothers with overweight and obesity were heavier and demonstrated higher adjusted relative risks of chronic villitis (CV), decidual vasculopathy, intervillous thrombosis, and normoblastemia. Placental efficiency, determined by fetal-placental weight ratio, was decreased with increasing BMI. Maternal obesity was associated with higher rates of preterm birth and higher birthweight percentiles. Multiple placental lesions, including maternal (MVM) and fetal vascular malperfusion (FVM), exhibited significant effects on birthweight percentiles; however, only MVM showed a differential effect based on maternal obesity.

CONCLUSIONS

Presence of obesity in pregnancy is associated with increased rates of placental patterns of injury, decreased placental efficiency, and increased birthweight percentiles. While placental lesions, such as CV, have the potential to negatively impact fetal growth, the resulting birthweight percentiles demonstrate a more complex relationship between maternal obesity and fetal growth, that likely involves placental and fetal adaptation to the altered in utero environment.

Association of conventional cigarette smoking, heated tobacco product use and dual use with hypertension

BACKGROUND

Heated tobacco products (HTPs) have emerged as alternatives to conventional cigarettes. However, their health effects remain largely unknown. This study aimed to prospectively explore the association between the use of cigarettes and HTPs and the risk of hypertension.

METHODS

This cohort study analysed data from 30 152 workers (82.0% men, mean age 42.9 ± 11.0 years) who were initially free of hypertension, participating in the Japan Epidemiology Collaboration on Occupational Health Study. Participants were categorized into five groups based on their self-reported tobacco product use: never smokers, past smokers, exclusive cigarette smokers, exclusive HTP users and dual users of cigarettes and HTPs. Hypertension cases were identified using three data points from annual health checkup data collected between 2019 and 2021. Cox proportional hazards regression models were used to investigate the association between tobacco product use and hypertension.

RESULTS

During a mean follow-up of 2.6 years (range: 0.1-4.0 years), 3656 new cases of hypertension were identified. Compared with never smokers, the risk of hypertension was higher among exclusive cigarette smokers [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.13-1.41] and exclusive HTP users (HR 1.19, 95% CI 1.06-1.34). There was also a suggestion of increased risk of hypertension among dual users (HR 1.16, 95% CI 0.98-1.38). Furthermore, the risk of hypertension increased with the intensity of cigarette/HTP use in all tobacco product users.

CONCLUSIONS

Similarly, both cigarette smoking and HTP use elevate the risk of hypertension. HTPs should not be regarded as less harmful alternatives to traditional cigarettes for preventing hypertension.

Usefulness of the ECORE-BF Scale to Determine Atherogenic Risk in 386,924 Spanish Workers

BACKGROUND

Cardiovascular diseases are the leading cause of death worldwide. Obesity and atherosclerosis are considered risk factors for this pathology. There are multiple methods to evaluate obesity, in the same way as there are different formulas to determine atherogenic risk. Since both pathologies are closely related, the objective of our work was to evaluate whether the ECORE-BF scale is capable of predicting atherogenic risk.

METHODS

Observational, descriptive, and cross-sectional study in which 386,924 workers from several autonomous communities in Spain participated. The association between the ECORE-BF scale and five atherogenic risk indices was evaluated. The relationship between variables was assessed using the chi-square test and Student's t test in independent samples. Multivariate analysis was performed with the multinomial logistic regression test, calculating the odds ratio and 95% confidence intervals, with the Hosmer-Lemeshow goodness-of-fit test. ROC curves established the cut-off points for moderate and high vascular age and determined the Youden index.

RESULTS

The mean values of the ECORE-BF scale were higher in individuals with atherogenic dyslipidemia and the lipid triad, as well as in those with elevated values of the three atherogenic indices studied, with p <0.001 in all cases. As atherogenic risk increased across the five evaluated scales, the prevalence of obesity also significantly increased, with p <0.001 in all cases. In the ROC curve analysis, the AUCs for atherogenic dyslipidemia and the lipid triad were above 0.75, indicating a good association between these scales and the ECORE-BF. Although the Youden indices were not exceedingly high, they were around 0.5.

CONCLUSIONS

There is a good association between atherogenic risk scales, atherogenic dyslipidemia, and lipid triad, and the ECORE-BF scale. The ECORE-BF scale can be a useful and quick tool to evaluate atherogenic risk in primary care and occupational medicine consultations without the need for blood tests.

The Global Burden of Resistant Hypertension and Potential Treatment Options

Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains .140 mmHg or .90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.

Development and validation of a predictive model for severe white matter hyperintensity with obesity

Purpose

The purpose of the present study was to identify predictors of severe white matter hyperintensity (WMH) with obesity (SWO), and to build a prediction model for screening obese people with severe WMH without Nuclear Magnetic Resonance Imaging (MRI) examination.

Patients subjects and methods

From September 2020 to October 2021, 650 patients with WMH were recruited consecutively. The subjects were divided into two groups, SWO group and non-SWO group. Univariate and Logistic regression analysis were was applied to explore the potential predictors of SWO. The Youden index method was adopted to determine the best cut-off value in the establishment of the prediction model of SWO. Each parameter had two options, low and high. The score table of the prediction model and nomogram based on the logistic regression were constructed. Of the 650 subjects, 487 subjects (75%) were randomly assigned to the training group and 163 subjects (25%) to the validation group. By resampling the area under the curve (AUC) of the subject's operating characteristics and calibration curves 1,000 times, nomogram performance was verified. A decision curve analysis (DCA) was used to evaluate the nomogram's clinical usefulness. By resampling the area under the curve (AUC) of the subject's operating characteristics and calibration curves 1,000 times, nomogram performance was verified. A decision curve analysis (DCA) was used to evaluate the nomogram's clinical usefulness.

Results

Logistic regression demonstrated that hypertension, uric acid (UA), complement 3 (C3) and Interleukin 8 (IL-8) were independent risk factors for SWO. Hypertension, UA, C3, IL-8, folic acid (FA), fasting C-peptide (FCP) and eosinophil could be used to predict the occurrence of SWO in the prediction models, with a good diagnostic performance, Areas Under Curves (AUC) of Total score was 0.823 (95% CI: 0.760-0.885, p < 0.001), sensitivity of 60.0%, specificity of 91.4%. In the development group, the nomogram's AUC (C statistic) was 0.829 (95% CI: 0.760-0.899), while in the validation group, it was 0.835 (95% CI: 0.696, 0.975). In both the development and validation groups, the calibration curves following 1,000 bootstraps showed a satisfactory fit between the observed and predicted probabilities. DCA showed that the nomogram had great clinical utility.

Conclusion

Hypertension, UA, C3, IL-8, FA, FCP and eosinophil models had the potential to predict the incidence of SWO. When the total score of the model exceeded 9 points, the risk of SWO would increase significantly, and the nomogram enabled visualization of the patient's WMH risk. The application prospect of our models mainly lied in the convenient screening of SWO without MRI examination in order to detect SWO and control the WMH hazards early.

Hypertension is associated with reduced resting-state medial temporal lobe dynamic network flexibility in older African Americans

Hypertension disproportionately affects African Americans and is a risk factor for Alzheimer's disease (AD). We investigated the relationship of blood pressure (BP) with medial temporal lobe (MTL) dynamic network flexibility (a novel AD biomarker) and cognitive generalization in older African Americans. In a cross-sectional study, 37 normotensive (systolic BP <130 mmHg, 82.5% F, 64.4 ± 4.9 years; 14.3 ± 2.1 years of education) versus 79 hypertensive (systolic BP ≥130 mmHg, 79.5% F, 66.8 ± 4.1 years; 14.0 ± 0.2 years of education) participants were enrolled. All participants completed a 10-min resting-state functional magnetic resonance imaging scan to assess MTL dynamic network flexibility and two generalization tasks to assess cognition. Anthropometrics and aerobic fitness (via 6-min walk test) were also determined. There was no difference in BMI (29.7 ± 6.4 vs. 31.9 ± 6.3 kg/m2, p = 0.083) or aerobic fitness (15.5 ± 2.6 vs. 15.1 ± 2.6 mL/kg/min; p = 0.445) between normotensive and hypertensive groups. However, normotensive participants had higher MTL dynamic network flexibility compared to hypertensive participants (0.42 ± 0.23 vs. 0.32 ± 0.25 mL, p = 0.040), and this was associated with higher mean arterial blood pressure (r = -0.21, p = 0.036). Therefore, hypertensive older African Americans demonstrated lower MTL dynamic network flexibility compared to their normotensive counterparts independent of BMI and aerobic fitness. Further studies are required to determine how blood pressure mediates AD risk in African Americans.

Direct and indirect effects of adiposity on markers of autonomic nervous system activity in older adults

Several cardiovascular disease (CVD) risk factors (e.g., hypertension, poor glycemic control) can affect and be affected by autonomic nervous system (ANS) activity. Since excess adiposity can influence CVD development through its effect on hypertension and diabetes mellitus, it is important to determine how adiposity and altered ANS activity are related. The present study employed structural equation modeling to investigate the relation between adiposity and ANS activity both directly and indirectly through biological variables typically associated with glycemic impairment and cardiac stress in older adults. Utilizing the Atherosclerosis Risk in Communities (ARIC) dataset, 1,145 non-smoking adults (74±4.8 yrs, 62.8% female) free from known CVD, hypertension, and diabetes and not currently taking beta-blockers were evaluated for fasting blood glucose (FBG), insulin, and HbA1c concentrations, waist circumference (WC), blood pressure (BP), and markers of ANS activity. WC was recorded just above the iliac crest and was used to reflect central adiposity. Resting 2-minute electrocardiograph recordings, pulse wave velocity, and ankle-brachial index data were used to assess the root mean square of successive differences in RR intervals (RMSSD) and the pre-ejection period (PEP), markers of parasympathetic and sympathetic activity, respectively. FBG, insulin, and HbA1c inferred a latent variable termed glycemic impairment (GI), whereas heart rate and diastolic BP inferred a latent variable termed cardiac stress (CS). The structural equation model fit was acceptable [root mean square error of approximation = 0.050 (90% CI = .036, .066), comparative fit index = .970, Tucker Lewis Index = 0.929], with adiposity having both significant direct (β = 0.208, p = 0.018) and indirect (β = -.217, p = .041) effects on PEP through GI. Adiposity displayed no significant direct effect on RMSSD. CS displayed a significant pathway (β = -0.524, p = 0.035) on RMSSD, but the indirect effect of WC on RMSSD through CS did not reach statistical significance (β = -0.094, p = 0.137). These results suggest that adiposity's relation to ANS activity is multifaceted, as increased central adiposity had opposing direct and indirect effects on markers of sympathetic activity in this population of older adults.

Secular trends of population-attributable fractions of obesity for hypertension among US population by sex and race/ethnicity: Analysis from NHANES 1999-2018

Obesity is a major risk factor of hypertension, therefore quantifying the contribution of obesity to hypertension is necessary. The current study aimed to investigate the changes in population-attributable fractions (PAFs) of hypertension associated with general obesity and abdominal obesity over the recent 2 decades among the US population, as well as important sub-populations. This report was performed based on national-level cross-sectional data for 46,535 adults aged 18 years and older and 20,745 children aged 8-17 from the US National Health and Nutrition Examination Survey 1999-2018. The PAFs of hypertension due to general obesity and abdominal obesity were calculated by sex, race/ethnicity, and survey year. The linear regression analysis was used to evaluate the secular trends of PAFs over the years. The prevalence of general obesity and abdominal obesity presented significantly increasing trends during the past 2 decades in the US. The PAFs of hypertension due to general obesity increased steadily from 11.9 % to 15.1 % in women with a slope of 0.38 % (95 % CI: 0.31 - 0.45 %) and from 8.4 % to 13.4 % in men with a slope of 0.46 % (95 % CI: 0.36 - 0.56 %). Similar increasing trends were also observed for the PAFs due to abdominal obesity in both women and men. Additionally, there were significantly different trends of PAFs in various races/ethnicities. Over the past 2 decades, the contributions of obesity to hypertension were gradually rising among US population, which emphasizes the importance of controlling weight to further reduce the burden of hypertension.

Impact of Body Mass Index on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis

Background: Obesity is a risk factor for many diseases, diagnosed by calculating body mass index (BMI). Methods: To find an association between BMI and mortality in adults, we searched PubMed for articles published in the 21st century. Our review included 82 original studies, comprising 2.7 million patients and 23.4 million patient years. Results: The meta-analysis showed a U-shaped relationship between BMI and all-cause mortality risk, with the lowest mortality in the BMI range of 25-30 kg/m2. Subgroup analysis showed a J-shaped relationship, with greater risk in the highest BMI range (>35 kg/m2). Among the elderly, BMI values <20 kg/m2 were associated with the highest risk. Among diabetic patients, a U-shaped relationship was noticed, again with the highest risk in the lowest (<20 kg/m2) and highest BMI range (>35 kg/m2). Among patients with cardiovascular disease, the risk increased with BMI values <25 kg/m2 but did not noticeably change for BMI exceeding that value. Among cancer patients, the relationship was less pronounced than in other subgroups, with a slightly higher risk (>35 kg/m2). Conclusions: Our results show that the lowest mortality is observed among patients with BMI 25-30 kg/m2. Reduction of body mass should not be a universal recommendation in clinical practice, but it should be individualized.

Arsenic Exposure-Related Hypertension in Bangladesh and Reduced Circulating Nitric Oxide Bioavailability

BACKGROUND

Hypertension is a major cause of death worldwide. Although arsenic exposure has been associated with the risk of hypertension, this association appears nonuniform due to inconsistent results from studies conducted in different populations. Moreover, hypertension is a complex condition with multiple underlying mechanisms and factors. One factor is impaired production and bioavailability of vascular nitric oxide (NO). However, the implications of the effects of arsenic exposure on circulating NO and its association with hypertension in humans are largely unknown.

OBJECTIVE

We investigated the dose-response relationship between arsenic exposure and hypertension with vascular NO levels as a potential mediator of arsenic-related hypertension in individuals exposed to a broad range of arsenic.

METHODS

A total of 828 participants were recruited from low- and high-arsenic exposure areas in Bangladesh. Participants' drinking water, hair, and nail arsenic concentrations were measured by inductively coupled plasma mass spectroscopy. Hypertension was defined as a systolic blood pressure (SBP) value of ≥ 140 and a diastolic (DBP) value of ≥ 90  mmHg . Serum NO levels reflected by total serum nitrite concentrations were measured by immunoassay. A formal causal mediation analysis was used to assess NO as a mediator of the association between arsenic level and hypertension.

RESULTS

Increasing concentrations of arsenic measured in drinking water, hair, and nails were associated with the increasing levels of SBP and DBP. The odds of hypertension were dose-dependently increased by arsenic even in participants exposed to relatively low to moderate levels (10 - 50 μ g / L ) of water arsenic [odds ratios (ORs) and 95% confidence intervals (CIs): 2.87 (95% CI: 1.28, 6.44), 2.67 (95% CI: 1.27, 5.60), and 5.04 (95% CI: 2.71, 9.35) for the 10 - 50 μ g / L , 50.01 - 150 μ g / L , and > 150 μ g / L groups, respectively]. Causal mediation analysis showed a significant mediating effect of NO on arsenic-related SBP, DBP, and hypertension.

CONCLUSION

Increasing exposure to arsenic was associated with increasing odds of hypertension. The association was mediated through the reduction of vascular NO bioavailability, suggesting that impaired NO bioavailability was a plausible underlying mechanism of arsenic-induced hypertension in this Bangladeshi population. https://doi.org/10.1289/EHP13018.

Metabolic Insights into Caffeine's Anti-Adipogenic Effects: An Exploration through Intestinal Microbiota Modulation in Obesity

Obesity, a chronic condition marked by the excessive accumulation of adipose tissue, not only affects individual well-being but also significantly inflates healthcare costs. The physiological excess of fat manifests as triglyceride (TG) deposition within adipose tissue, with white adipose tissue (WAT) expansion via adipocyte hyperplasia being a key adipogenesis mechanism. As efforts intensify to address this global health crisis, understanding the complex interplay of contributing factors becomes critical for effective public health interventions and improved patient outcomes. In this context, gut microbiota-derived metabolites play an important role in orchestrating obesity modulation. Microbial lipopolysaccharides (LPS), secondary bile acids (BA), short-chain fatty acids (SCFAs), and trimethylamine (TMA) are the main intestinal metabolites in dyslipidemic states. Emerging evidence highlights the microbiota's substantial role in influencing host metabolism and subsequent health outcomes, presenting new avenues for therapeutic strategies, including polyphenol-based manipulations of these microbial populations. Among various agents, caffeine emerges as a potent modulator of metabolic pathways, exhibiting anti-inflammatory, antioxidant, and obesity-mitigating properties. Notably, caffeine's anti-adipogenic potential, attributed to the downregulation of key adipogenesis regulators, has been established. Recent findings further indicate that caffeine's influence on obesity may be mediated through alterations in the gut microbiota and its metabolic byproducts. Therefore, the present review summarizes the anti-adipogenic effect of caffeine in modulating obesity through the intestinal microbiota and its metabolites.

Selecting, optimizing and externally validating a preexisting machine-learning regression algorithm for estimating waist circumference

Obesity, typically defined by the body mass index (BMI), has well known negative health effects. However, the BMI has serious deficiencies in predicting the adverse risks associated to obesity. Waist circumference (WC) is an alternative to define obesity and a better disease predictor according to the literature. However, old databases often lack this information, it is inaccurate (collected via self-report) or it is incomplete. Thus, this study accurately assesses WC using machine learning. The novel approaches are: 1) predictor variables (weight, height, age and sex) likely to appear in most data sets are used. 2) Publicly available data (including non-adults) and algorithms are used. 3) Systematic methods for data cleanup, model selection, hyperparameter optimization and external validation are performed. DATA ARE CLEANED: one variable per column, no special codes, missing values or outliers. Preexisting regression algorithms are gaged by cross-validation, using one data set. The hyperparameters of the best performing algorithm are optimized. The tuned algorithm is externally validated with other data sets by cross-validation. In spite of the limited number of features, the tuned algorithm outperforms prior WC approximations, using the same or similar predictor variables. The tuned algorithm enables using data where WC is not measured, is incomplete or is unreliable. A similar approach would be useful to estimate other variables of interest.

How well do obesity indices predict undiagnosed hypertension in the Persian cohort (Shahedieh) adults community population of all ages?

Background and Aims

Hypertension is the leading preventable risk factor for cardiovascular disease, chronic kidney disease and cognitive impairment, and mortality and disability worldwide. Since prevention, early detection, and treatment of blood pressure improve public health, the aim of present study was to determine the best obesity indices and estimate the optimal cut-off point for each one to predict the risk of elevated/stage 1 and undiagnosed hypertension in the population of center of Iran based on American ACC/AHA 2020 guidelines.

Methods

This cross-sectional study was performed on 9715 people who enrolled in 2018 in Persian Adult Cohort in Shahedieh area of Yazd, Iran in 2018. The anthropometric indices including body mass index (BMI) and waist circumference (WC), wrist circumference, hip circumference, waist-to-hip ratio, and waist-to height ratio of individuals, were extracted. The receiver operating characteristic curve was utilized to determine the optimum cut-off point of each anthropometric index to predict hypertension stages and compare their predictive power by age-sex categories. Statistical analysis was done using SPSS version 23.0.

Results

The results showed that BMI has the best predictive power to recognize the risk of elevated/stage 1 hypertension for female (area under the curve [AUC] = 0.72 and optimal cut-off = 30.10 kg/m2) and WC for male (AUC = 0.66 and optimal cut-off = 93.5 cm) in 35-45 age group. BMI had the best predictive power for the risk of undiagnosed hypertension for 35-45 years old male (AUC = 0.73 and optimal cut-off = 28.90 kg/m2) and female (AUC = 0.75 and optimal cut-off = 5.10 kg/m2), and hip circumference revealed similar predictive power for female as well (AUC = 0.75 and optimal cut-off = 112 cm).

Conclusion

Based on our findings, BMI and WC, which are simple, inexpensive, and noninvasive means, are the best markers to predict the risk of elevated/stage 1 and undiagnosed hypertension in young Iranians. It shows that the approach of reducing hypertension prevalence through primary prevention, early detection, and enhancing its treatment is achievable.

Association of TyG index and central obesity with hypertension in middle-aged and elderly Chinese adults: a prospective cohort study

Triglyceride glucose index (TyG) and waist circumstance have been well documented to be highly correlated with hypertension. However, the joint effect of waist circumstance and TyG on the risk of hypertension is unknown in middle-aged and elderly Chinese adults. The purpose of this study was to investigate the association between TyG and the risk of new-onset hypertension in middle-aged and elderly Chinese individuals with different waist circumstances. The multicentred prospective cohort study was conducted in 28 provinces of China including a total of 5865 eligible participants aged ≥ 45 years old. Cox regression was performed to examine the relationship of TyG index and hypertension with adjustments for the pertinent variables. Besides, the relationship was explored in different groups on the basis of waist circumstance. There was no significant correlation between TyG index and new-onset hypertension after adjustment for pertinent variables (hazards ratio [HR]: 0.99; 95% confidence interval [CI]: 0.80-1.24). When the association was explored in different waist circumstance groups, multivariate cox regression analyses revealed that TyG was an independent factor positively associated with the risk of hypertension in central obesity prophase group (HR: 1.57; 95% CI 1.13-2.16). Among individuals with central obesity, relative to population with lower TyG (Q1: 4.96-8.18), people who had higher TyG (Q3: 8.52-8.95; Q4: 8.95-12.14) were associated with significantly lower HR for hypertension. There was no conspicuous correlation between TyG index with new-onset hypertension in normal waist circumstance (HR: 1.05; 95% CI 0.84-1.30). The research demonstrated the positive relationship of TyG with risk of hypertension among individuals with central obesity prophase, negative relationship of TyG with hypertension among population with central obesity and inconspicuous correlation of TyG with hypertension among individuals with normal waist. In conclusion, the study findings supported the combined effects of TyG index and waist circumference in predicting hypertension in middle-aged and elderly Chinese individuals.

Smilax china L.: A review of its botany, ethnopharmacology, phytochemistry, pharmacological activities, actual and potential applications

ETHNOPHARMACOLOGICAL RELEVANCE

Smilax china L., an extensively used traditional Chinese medicine, is known as Baqia in China. It has been used to treat various inflammatory disorders, particularly pelvic inflammation.

AIM OF THE REVIEW

The present paper aims to provide an up-to-date review at the advancements of the investigations on the ethnopharmacology, phytochemistry, pharmacological effect and actual and potential applications of S. china. Besides, the possible tendency and perspective for future research of this plant are discussed, as well.

MATERIALS AND METHODS

This article uses "Smilax china L." "S. china" as the keyword and collects relevant information on Smilax china L. plants through electronic searches (Elsevier, PubMed, ACS, CNKI, Google Scholar, Baidu Scholar, Web of Science), relevant books, and classic literature about Chinese herb.

RESULTS

134 chemical constituents, among which steroid saponins and flavonoids are the predominant groups, have been isolated and identified from S. china. S. china with its active compounds is possessed of wide-reaching biological activities, including anti-inflammatory, anti-cancer, anti-oxidant, detoxify nicotine, anti-diabetes, anti-obesity, anti-hyperuricaemia, anti-hypertension, promoting skin wound and barrier repair and anti-bacterial activity. Besides, S. china is also applied to other fields, such as food industry and detection technology.

CONCLUSIONS

Based on the review of the existing phytochemical studies on Smilax china L., the structural characterization of Smilax china L. extract can continue to be the focus of future research. Pharmacological studies in vitro and in vivo have demonstrated some of the traditional uses of Smilax china L. extract, while other traditional uses still need to be confirmed by research.

Obesity in Hypertensive Patients Is Characterized by a Dawn Phenomenon in Systolic Blood Pressure Values and Variability

One of the causes of hypertension is excess weight gain, which can also affect the course of this disease. Both the diagnosis and management of hypertension commonly use ambulatory blood pressure monitoring; the results of which correlate more strongly with cardiovascular diseases and cardiovascular death than office blood pressure monitoring. We evaluated blood pressure values and their variability from hour to hour to see if and when they differed between hypertensive patients with and without obesity. The study included 1345 patients who underwent 24 h ambulatory blood pressure monitoring and then were divided into groups according to body mass index and waist circumference. The obtained data were analyzed according to the subjects' wake-up time, and short-term blood pressure variability parameters were calculated as the mean of the absolute values of the differences between consecutive measurements. The systolic blood pressure in obese subjects was significantly higher between 1 and 5 h before waking than in normal-weighted individuals. In turn, the variability in systolic and diastolic blood pressure was higher with increasing body mass index. The difference in systolic blood pressure values and blood pressure variability was most prominent in the last 5 h of sleep in obese patients.

A Focused Group Perspective of Risk Factors for Hypertension Among Middle-Aged Adults in Rural Areas of Anambra State, Nigeria

PURPOSE

Recent records by the World Health Organization show that hypertension is more prevalent in Africa than in other parts of the world, and remains the foremost common risk factor for cardiovascular-related diseases, stroke, renal diseases, and death. However, little is known about the risk factors for hypertension by people from rural areas, especially among middle-aged adults. Therefore, the study examined the knowledge of the risk factors for hypertension among middle-aged adults in rural areas of Anambra state, Nigeria.

MATERIALS, AND METHOD

Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). Two key themes stood out from the data collection guides. These are "awareness of hypertension and its' symptoms" and "knowledge of risk factors of hypertension".

RESULTS

The findings showed that the participants were aware of hypertension but lacked in-depth knowledge of the risk factors for the disease. Most participants did not believe that intake of certain foods like starchy foods and excess alcohol consumption could lead to one being hypertensive.

DISCUSSION AND CONCLUSION

There is a need for social workers to sensitize and enlighten the middle-aged adults in the study area on the risk factors for the disease.

Predictors of Cardiac Autonomic Dysfunction in Obesity-Related Hypertension

INTRODUCTION

Cardiac Autonomic Dysfunction (CAD) is an overlooked cardiovascular risk factor in individuals with obesity-related hypertension. Despite its clinical significance, there is a notable lack of clarity regarding the pathophysiological correlates involved in its onset and progression.

AIM

The present study aimed to identify potential predictors of CAD in obesity-related hypertension.

METHODS

A total of 72 participants (34 men and 38 women) were enrolled. Comprehensive evaluations were conducted, including cardiac autonomic function assessments, body composition estimation and biochemical analysis. Participants were categorized as CAD-positive or CAD-negative based on Ewing's criteria for autonomic dysfunction. Univariate logistic regression analysis was performed to identify potential predictors for CAD. Multivariate logistic regression models were further constructed by adjusting clinically relevant covariates to identify independent predictors of CAD.

RESULTS

Multivariate logistic regression analysis revealed that resting heart rate (HRrest), (odds ratio, confidence interval: 0.85, 0.78-0.93; p = 0.001) and percentage body fat (BF%), (odds ratio, confidence interval: 0.78, 0.64-0.96; p = 0.018) were significant independent predictors of CAD. Receiver Operating Characteristic curve analysis depicted optimal cut-off values for HRrest and BF% as > 74.1 bpm and > 33.6%, respectively. Multicolinearity analysis showed variance inflation factors (VIF) below the cautionary threshold of 3.

CONCLUSIONS

The HRrest and BF% emerged as significant independent predictors of CAD in obesity-related hypertension. Therapeutic strategies should target HRrest < 74.1 bpm and BF% < 33.6% to mitigate CAD risk in this population. Future trials are required to establish causal relationships and may consider additional confounding variables in obesity-related hypertension.

Obesity does not alter vascular function and handgrip exercise hemodynamics in middle-aged patients with hypertension

Lifestyle modification including exercise training is often the first line of defense in the treatment of obesity and hypertension (HTN), however, little is known regarding how these potentially compounding disease states impact vasodilatory and hemodynamic responses at baseline and exercise. Therefore, this study sought to compare the impact of obesity on vascular function and hemodynamics at baseline and during handgrip (HG) exercise among individuals with HTN. Non-obese (13M/7F, 56 ± 16 yr, 25 ± 4 kg/m2) and obese (17M/4F, 50 ± 7 yr, 35 ± 4 kg/m2) middle-aged individuals with HTN forwent antihypertensive medication use for ≥2 wk before assessment of vascular function by brachial artery flow-mediated dilation (FMD) and exercise hemodynamics during progressive HG exercise at 15-30-45% maximal voluntary contraction (MVC). FMD was not different between Non-Obese (4.1 ± 1.7%) and Obese (5.2 ± 1.9%, P = 0.11). Systolic blood pressure (SBP) was elevated by ∼15% during the supine baseline and during HG exercise in the obese group. The blood flow response to HG exercise at 30% and 45% MVC was ∼20% greater (P < 0.05) in the obese group but not different after normalizing for the higher, albeit, nonsignificant differences in workloads (MVC: obese: 24 ± 5 kg, non-obese: 21 ± 5 kg, P = 0.11). Vascular conductance and the brachial artery shear-induced vasodilatory response during HG were not different between groups (P > 0.05). Taken together, despite elevated SBP during HG exercise, obesity does not lead to additional impairments in vascular function and peripheral exercising hemodynamics in patients with HTN. Obesity may not be a contraindication when prescribing exercise for the treatment of HTN among middle-aged adults, however, the elevated SBP should be appropriately monitored.NEW & NOTEWORTHY This study examined vascular function and handgrip exercise hemodynamics in obese and nonobese individuals with hypertension. Obesity, when combined with hypertension, was neither associated with additional vascular function impairments at baseline nor peripheral hemodynamics and vasodilation during exercise compared with nonobese hypertension. Interestingly, systolic blood pressure and pulse pressure were greater in the obese group during supine baseline and exercise. These findings should not be ignored and may be particularly important for rehabilitation strategies.

Targeting Hypertension: A Review on Pathophysiological Factors and Treatment Strategies

Hypertension is one of the primary causes of cardiovascular diseases and death, with a higher prevalence in low- and middle-income countries. The pathophysiology of hypertension remains complex, with 2% to 5% of patients having underlying renal or adrenal disorders. The rest are referred to as essential hypertension, with derangements in various physiological mechanisms potentially contributing to the development of essential hypertension. Hypertension elevates the risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and mortality. First-line therapy for hypertension is lifestyle change, which includes weight loss, a balanced diet that includes low salt and high potassium intake, physical exercise, and limitation or elimination of alcohol use. Blood pressure-lowering effects of individual lifestyle components are partially additive, enhancing the efficacy of pharmaceutical treatment. The choice to begin antihypertensive medication should be based on the level of blood pressure and the existence of a high atherosclerotic CVD risk. First-line hypertension treatment includes a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker. Addressing hypertension will require continued efforts to improve access to diagnosis, treatment, and lifestyle interventions.

Mediating effect of cumulative lipid profile burden on the effect of diet and obesity on hypertension incidence: a cohort study of people aged 35-65 in rural China

BACKGROUND AND OBJECTIVES

Cumulative lipid profile burden is designed to dynamically measure lipid accumulation, and its effect on hypertension has been poorly studied. Our main purpose was to investigate the effect of cumulative lipid profile burden on the incidence of essential hypertension (EH) and to investigate whether cumulative lipid burden mediates the pathogenesis of the effects of diet and obesity on EH.

SUBJECTS AND METHODS

A total of 1295 participants were included in the study, which started in 2017. The average follow-up time was 2.98 years. A total of 240 EH patients occurred during the follow-up period.

RESULTS

The HR (95% CI) of the highest quartile in cumulative Total cholesterol (TC), triglyceride (TG) and high density lipoprotein (HDL) burden were 1.747 (1.145 - 2.664), 1.502 (1.038 - 2.173), 0.615 (0.413 - 0.917) for incidence of EH respectively, compared to the respective reference groups. Participants with EH consumed more red meat and refined grains, and red meat was positively associated with cumulative TC burden. BMI and Waist-To-Height Ratio (WHtR) increased the incidence of EH, and obesity was positively correlated with cumulative TG burden. Mediating analysis showed that cumulative TG had a partial mediating effect in the causal relationship between obesity and EH, and Mendelian randomization (MR) also proved this result. Diet was not found to influence EHn through cumulative lipid profile burden.

CONCLUSIONS

The cumulative TG burden partially mediates the effect of obesity on EH.

Invasively measured and estimated central blood pressure using the oscillometric algorithm Antares in patients with and without obesity

BACKGROUND

Obesity is a global health concern and risk factor for cardiovascular disease. The assessment of central blood pressure (cBP) has been shown to improve prediction of cardiovascular events. However, few studies have investigated the impact of obesity on cBP in adults, and invasive data on this issue are lacking. This study aimed to evaluate cBP differences between patients with and without obesity, identify cBP determinants, and evaluate the accuracy of the algorithm Antares for non-invasive cBP estimation.

METHODS

A total of 190 patients (25% female; 39% with BMI ≥30kg/m2; age: 67±12 years) undergoing elective cardiac catheterization were included. cBP was measured invasively and simultaneously estimated non-invasively using the custo screen 400 device with integrated Antares algorithm.

RESULTS

No significant cBP differences were found between obese and non-obese patients. However, females, especially those with obesity, had higher systolic cBP compared to males (P<0.05). Multiple regression analysis showed that brachial mean arterial pressure, pulse pressure, BMI, and heart rate predicted cBP significantly (adjusted R2 = 0.82, P<0.001). Estimated cBP correlated strongly with invasive cBP for systolic, mean arterial, and diastolic cBP (r = 0.74-0.93, P<0.001) and demonstrated excellent accuracy (mean difference <5 and SD <8 mmHg).

CONCLUSIONS

This study discovered no significant difference in cBP between obese and non-obese patients. However, it revealed higher cBP values in women, especially those with obesity, which requires further investigation. Additionally, the study highlights Antares' effectiveness in non-invasively determining cBP in obese individuals. This could improve the diagnosis and treatment of hypertension in this special patient population.

The Impact of Body Mass Index, Residual Beta Cell Function and Estimated Glucose Disposal Rate on the Development of Double Diabetes and Microvascular Complications in Patients With Type 1 Diabetes Mellitus

Background The clinical impact of body mass index (BMI), residual beta cell function and estimated glucose disposal rate (eGDR) in the development of double diabetes (DD) and microvascular complications are largely unknown. We aimed to assess whether BMI, residual beta cell function measured by plasma "C" peptide and insulin resistance measured by eGDR have any impact on the development of DD and microvascular complications in patients with type 1 diabetes mellitus (T1DM). Methods It is a cross-sectional observational study involving 113 T1DM patients of more than five years duration who were classified into two groups: normal BMI (18.5-22.9 kg/m2) and overweight/obese group (≥ 23kg/m2) based on Asian BMI classification. Based on their eGDR values, they were grouped into four categories: ≥ 8, 6-7.99, 4-5.99, and < 4 mg/kg/min. The prevalence of DD based on eGDR values was determined. Their BMI and different eGDR categories were compared with the prevalence of diabetic retinopathy and nephropathy and their odds ratio (OR) was calculated. Results The median and interquartile range (IQR) of the eGDR of the overweight/obese group was significantly lower than the normal BMI group (5.3 [3.96-8.15] vs 8.72 [6.50-9.77 mg/kg/min], p < 0.001). The prevalence of DD in the overweight/obese T1DM group and normal BMI group was 75% and 33.3% respectively. The OR of retinopathy and nephropathy in the overweight/obese group was 3.28 (p = 0.007) and 3.01 (p = 0.015) respectively when compared to the normal BMI group. The OR of retinopathy and nephropathy in T1DM patients with eGDR < 4 mg/kg/min was 17.13 (p = 0.001) and 18.5 (p = 0.001) respectively. The lower the eGDR values, the higher the prevalence of retinopathy and nephropathy regardless of HbA1c levels. Conclusion As overweight and obesity are increasingly becoming more prevalent in T1DM, the eGDR will better predict the development of DD and microvascular complications irrespective of HbA1c levels. It is more useful as a variable and easily inducted into routine clinical practice. However, residual beta cell function was not useful in predicting the development of microvascular complications.

CircHIPK2 facilitates phenotypic switching of vascular smooth muscle cells in hypertension

Hypertension is a clinical syndrome characterized by increased systemic arterial blood pressure, affecting about 1.4 billion people currently worldwide with only one in seven cases adequately controlled. It is the main contributing factor of cardiovascular diseases (CVDs), often co-existing with other CVDs risk factors to impair the structure and function of important organs such as heart, brain, and kidney, and ultimately lead to multi-organ failure. Vascular remodeling is a critical process in the development of essential hypertension, and phenotype switching of vascular smooth muscle cells (VSMCs) was reported contributing substantially to vascular remodeling. circHIPK2 is a circular RNA (circRNA) derived from the second exon of homeodomain-interacting protein kinase 2 (HIPK2). Several studies revealed that circHIPK2 functions in various diseases by serving as a microRNA (miRNA) sponge. However, the functional roles and molecular mechanisms of circHIPK2 in VSMC phenotype switching and hypertension are not clear. In the present study, we showed that the expression of circHIPK2 was significantly upregulated in the VSMCs of hypertensive patients. Functional studies showed that circHIPK2 promoted the Angiotensin II (AngII)-induced VSMC phenotype switching by acting as the sponge of miR-145-5p, thereby upregulating the expression of a disintegrin and metalloprotease (ADAM) 17. Collectively, our study provides a new therapeutic target for hypertension.

Resistant hypertension: consensus document from the Korean society of hypertension

Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients.

Identification of risk factors for hypertension in overweight and obese people and analysis of risk factor interactions: an R-based analysis

Objective

This study identified the independent risk factors for hypertension in overweight and obese people and also analyzed the interaction between the risk factors.

Methods

A total of 5,098 overweight and obese people were enrolled in this study. First, the clinical metabolic characteristics of hypertension and control groups were compared. The logistic regression (LR) and classification and regression trees (CRT)-based decision tree (DT) models were used to screen the independent risk factors for hypertension in overweight and obese people. The multiplicative and additive scale analyses were used to analyze the two risk factors with interaction from the perspective of statistics and biological interaction. Finally, the receiver operating characteristic (ROC) and calibration curves were used to analyze the accuracy and identification ability of the LR and DT models.

Results

Age, UA, FPG, SBP, Cr, AST, TG, and FPG were higher in the hypertension group than in the control group (P < 0.05). The results of LR revealed that NAFLD, FPG, age, TG, LDL-c, UA, and Cr were positively correlated with hypertension in overweight and obese people, and GFR was negatively correlated with hypertension in overweight and obese people (P < 0.05). The DT model suggested that the risk factors of age, FPG, and UA interacted with each other. The multiplicative single and multiple factor analysis for FPG + UA, age + UA, age + FPG revealed a positive multiplicative interaction (P < 0.05, B ≠ 0, OR > 1). The additive single and multiple factor analysis for age + UA indicated a positive additive interaction. The ROC and calibration curve analysis indicated that the CRT decision tree, FPG + UA, age + UA, and age + FPG have certain accuracy and discrimination ability.

Conclusion

The independent risk factors for hypertension in overweight and obese people included NAFLD, FPG, age, TG, LDL-c, UA, and Cr. Among these, age + UA exhibited synergistic interaction, thereby providing a reference for the prevention and control of hypertension in overweight and obese people.

Effects of cardiac rehabilitation on obese hypertensive patients: A controlled trial

INTRODUCTION

The relationship between obesity and hypertension is clearly known and cardiac rehabilitation (CR) is shown as an effective treatment method in both obese and hypertensive patients. The aim of this study is to reveal the effect of CR on obese hypertensive patients by comparing them with non-obese hypertensive patients.

METHODS

Eighty eligible, volunteer participants with hypertension (SBP ≥140mmHg and/or DBP ≥90mmHg) were enrolled in this study. The patients were divided into 2 groups according to their BMI values: obese (BMI ≥30kg/m2) hypertensive patients and non-obese (BMI <30kg/m2) hypertensive patients. The CR program, in which aerobic exercise training was the main part, was performed on the patients. At the end of the 10-week CR program, the resting SBP and DBP values were measured.

RESULTS

A total of 74 patients (37 obese and 37 non-obese) completed the study. After CR significant improvements were achieved in all evaluated parameters compared to pre-CR values. When the amounts of changes before and after CR were compared, the decrease in SBP was found to be significantly higher in obese patients compared to non-obese patients (p=.003). Higher BMI was associated with more reduction in SBP (r=0.287, p=0.013).

CONCLUSIONS

Exercise-based CR effectively reduced SBP in obese and non-obese hypertensive patients. However, it was more effective in obese patients compared to non-obese patients.

The Increase in Childhood Obesity and Its Association with Hypertension during Pandemics

There has been a major ongoing health impact of the COVID-19 pandemic on children's lives, including lifestyle and overall health. Enforcement of prevention measures, such as school closures and social distancing, has significantly affected children's daily routines and activities. This perspective manuscript aims to explore the rise in childhood obesity and its association with hypertension during pandemics. The COVID-19 pandemic has led to significant disruptions in children's routines, including reduced physical activity, increased sedentary behavior, and changes in dietary patterns. These factors, coupled with the psychological impact of the pandemic, have contributed to an alarming increase in childhood obesity rates. This paper has highlighted the concerning increase in childhood obesity and hypertension during pandemics. The disruptions caused by the COVID-19 pandemic, including reduced physical activity, increased sedentary behaviors, and changes in dietary patterns, have contributed to the rise in these health conditions. It is crucial to recognize the long-term consequences of childhood obesity and hypertension and the urgent need for a comprehensive approach to address them.