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Moiz A, Zolotarova T, Eisenberg MJ. Outpatient management of essential hypertension: a review based on the latest clinical guidelines. Ann Med 2024; 56:2338242. [PMID: 38604225 PMCID: PMC11011233 DOI: 10.1080/07853890.2024.2338242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Background: Essential hypertension, a prevalent cardiovascular condition, poses a significant health burden worldwide. Based on the latest American clinical guidelines, half of adults in the United States have hypertension. Of these, only about a half are treated and about a quarter are adequately controlled for hypertension. Given its impact on morbidity and mortality, ensuring effective management of high blood pressure is crucial to reduce associated risks and improve patient outcomes.Objective: This review aims to provide a comprehensive and up-to-date summary of the latest cardiology guidelines and evidence-based research on essential hypertension, with a focus on guiding outpatient clinical practice.Methods: The review evaluates both non-pharmacological approaches and pharmacological interventions to offer clinicians practical insights. Notably, it emphasizes the importance of individualized treatment plans tailored to patients' specific risk profiles and comorbidities.Results: By consolidating the latest advancements in hypertension management, this review provides clinicians with an up-to-date reference, offering a nuanced understanding of treatment goals and strategies.Conclusion: Through the incorporation of evidence-based recommendations, healthcare practitioners can optimize patient care, mitigate potential complications, and improve overall outcomes in essential hypertension.
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Affiliation(s)
- Areesha Moiz
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Tetiana Zolotarova
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Mark J. Eisenberg
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
- Department of Medicine and Health Sciences, McGill University, Montreal, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada
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Subramanian A, Vernon KA, Zhou Y, Marshall JL, Alimova M, Arevalo C, Zhang F, Slyper M, Waldman J, Montesinos MS, Dionne D, Nguyen LT, Cuoco MS, Dubinsky D, Purnell J, Keller K, Sturner SH, Grinkevich E, Ghoshal A, Kotek A, Trivioli G, Richoz N, Humphrey MB, Darby IG, Miller SJ, Xu Y, Weins A, Chloe-Villani A, Chang SL, Kretzler M, Rosenblatt-Rosen O, Shaw JL, Zimmerman KA, Clatworthy MR, Regev A, Greka A. Protective role for kidney TREM2 high macrophages in obesity- and diabetes-induced kidney injury. Cell Rep 2024; 43:114253. [PMID: 38781074 DOI: 10.1016/j.celrep.2024.114253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/05/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Diabetic kidney disease (DKD), the most common cause of kidney failure, is a frequent complication of diabetes and obesity, and yet to date, treatments to halt its progression are lacking. We analyze kidney single-cell transcriptomic profiles from DKD patients and two DKD mouse models at multiple time points along disease progression-high-fat diet (HFD)-fed mice aged to 90-100 weeks and BTBR ob/ob mice (a genetic model)-and report an expanding population of macrophages with high expression of triggering receptor expressed on myeloid cells 2 (TREM2) in HFD-fed mice. TREM2high macrophages are enriched in obese and diabetic patients, in contrast to hypertensive patients or healthy controls in an independent validation cohort. Trem2 knockout mice on an HFD have worsening kidney filter damage and increased tubular epithelial cell injury, all signs of worsening DKD. Together, our studies suggest that strategies to enhance kidney TREM2high macrophages may provide therapeutic benefits for DKD.
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Affiliation(s)
- Ayshwarya Subramanian
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | | | - Yiming Zhou
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Jamie L Marshall
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Maria Alimova
- Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carlos Arevalo
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Fan Zhang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michal Slyper
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Julia Waldman
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Lan T Nguyen
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Dan Dubinsky
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jason Purnell
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Keith Keller
- Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Elizabeth Grinkevich
- Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ayan Ghoshal
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amanda Kotek
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Giorgio Trivioli
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK; Nephrology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nathan Richoz
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mary B Humphrey
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Isabella G Darby
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sarah J Miller
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yingping Xu
- Institute of Dermatology and Venereology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Astrid Weins
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthias Kretzler
- Internal Medicine, Department of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | | | - Jillian L Shaw
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kurt A Zimmerman
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Menna R Clatworthy
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK; Cellular Genetics, Wellcome Sanger Institute, Hinxton, UK; NIHR Cambridge Biomedical Research Center, Cambridge, UK; Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Cambridge, UK
| | - Aviv Regev
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Howard Hughes Medical Institute, Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Anna Greka
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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3
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Xie J, Ma YL, Gui MT, Yao L, Li JH, Wang MZ, Zhou XJ, Wang YF, Zhao MY, Cao H, Lu B, Fu DY. Efficacy of Huoxue Qianyang Qutan Recipe on essential hypertension: A randomized, double-blind, placebo-controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2024:S2095-4964(24)00331-5. [PMID: 38789290 DOI: 10.1016/j.joim.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Hypertension, a prevalent disease, is a significant risk factor for coronary heart disease. Huoxue Qianyang Qutan Recipe (HQQR), a traditional Chinese herbal remedy, has been used for treating hypertension over several years. OBJECTIVE This study assesses HQQR's efficacy for controlling blood pressure among patients with hypertension related to blood stasis, yang hyperactivity and phlegm. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS A randomized controlled trial was conducted at the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, China, from July 2020 to June 2022. Major components of HQQR were identified using thin-layer chromatography and high-performance liquid chromatography. Participants aged 18-80 years, exhibiting traditional Chinese medicine syndromes of blood stasis, yang hyperactivity or phlegm, along with grades 1 or 2 hypertension, were randomly categorized into two groups. The intervention group was given HQQR granules alongside conventional hypertension treatment, while the control group was given placebo granules in addition to conventional treatment for 12 weeks. MAIN OUTCOME MEASURES The primary outcome was clinic blood pressure, whereas secondary outcomes included metabolic indices (e.g., homeostasis model assessment of insulin resistance [HOMA-IR], total cholesterol [TC], low-density lipoprotein cholesterol and triglyceride), target organ damage indices (left ventricular mass index and urinary albumin creatinine ratio [UACR]) and inflammation indices (interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]). RESULTS HQQR's primary components were identified as salvianolic acid B, emodin and ferulic acid. Of the 216 participants (108 in each group), compared to the control, the intervention group exhibited significant improvements (P < 0.001) in clinic systolic blood pressure ([136.24 ± 7.63] vs [130.06 ± 8.50] mmHg), clinic diastolic blood pressure ([84.34 ± 8.72] vs [80.46 ± 6.05] mmHg), home systolic blood pressure ([131.64 ± 8.74] vs [122.36 ± 8.45] mmHg) and home diastolic blood pressure ([78.47 ± 9.53] vs [71.79 ± 6.82] mmHg). HQQR demonstrated a reduction in ambulatory blood pressure (24-hour systolic blood pressure: [133.75 ± 10.49] vs [132.46 ± 8.84] mmHg and 24-hour diastolic blood pressure: [84.12 ± 8.01] vs [82.11 ± 7.45] mmHg) and an improvement in HOMA-IR ([4.09 ± 1.72] vs [3.98 ± 1.44]), TC ([4.66 ± 1.47] vs [3.75 ± 1.81] mmol/L) and UACR (75.94 [5.12, 401.12] vs 45.61 [4.26, 234.26]). Moreover, HQQR demonstrated a decrease in hs-CRP (1.46 [0.10, 10.53] vs 0.57 [0.12, 3.99] mg/L) and IL-6 (6.69 [2.00, 29.74] vs 5.27 [2.00, 9.73] pg/mL), with no reported side effects (P < 0.001). CONCLUSION This study highlights the therapeutic potential of HQQR use in ameliorating blood pressure, glycolipid metabolism, and inflammation in patients with hypertension. TRIAL REGISTRATION ChiCTR2000035092 (https://www.chictr.org.cn/). Please cite this article as: Xie J, Ma YL, Gui MT, Yao L, Li JH, Wang MZ, Zhou XJ, Wang YF, Zhao MY, Cao H, Lu B, Fu DY. Efficacy of Huoxue Qianyang Qutan Recipe on essential hypertension: A randomized, double-blind, placebo-controlled trial. J Integr Med. 2024; Epub ahead of print.
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Affiliation(s)
- Jun Xie
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
| | - Yu-Long Ma
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
| | - Ming-Tai Gui
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Lei Yao
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jian-Hua Li
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Ming-Zhu Wang
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xun-Jie Zhou
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yi-Fan Wang
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
| | - Ming-Yi Zhao
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hui Cao
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Bo Lu
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
| | - De-Yu Fu
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
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Huang JS, Lu MS, Ramakrishnan R, Gao C, Zheng SY, Yang K, Guo YX, Lu JH, Qiu X, He JR. Weight status changes from childhood to adulthood were associated with cardiometabolic outcomes in adulthood. Acta Paediatr 2024. [PMID: 38714365 DOI: 10.1111/apa.17255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/09/2024]
Abstract
AIM Few studies have assessed the association between weight changes from childhood to adulthood and cardiometabolic factors in adulthood. The aim of this study was to explore the relationships between weight changes from childhood to adulthood and cardiometabolic factors in adulthood using national Chinese data. METHODS We included 649 participants from the China Health and Nutrition Survey from 1989 to 2009 and divided them into four groups by their body mass index from 6 to 37 years of age. They were selected using multistage random cluster sampling from 15 areas with large variations in economic and social development. Poisson regression models assessed associations between weight status changes and cardiometabolic outcomes in adulthood. RESULTS The risk of multiple abnormal cardiometabolic outcomes in adulthood was increased in the 126 subjects with normal weight in childhood but overweight or obesity in adulthood and the 28 with obesity at both ages, compared to the 462 with normal weight at both ages. There was insufficient evidence to demonstrate that the 33 who had weight issues as children, but not as adults, had an increased risk. CONCLUSION Being overweight or obese in both childhood and adulthood or during adulthood only increased the risk of abnormal cardiometabolic outcomes in adulthood. Larger studies need to investigate whether weight problems in childhood, but not adulthood, increase the risk.
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Affiliation(s)
- Jia-Shuan Huang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
- Paediatrics School, Guangzhou Medical University, Guangzhou, China
| | - Min-Shan Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chang Gao
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Si-Yu Zheng
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Paediatrics School, Guangzhou Medical University, Guangzhou, China
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kun Yang
- Paediatrics School, Guangzhou Medical University, Guangzhou, China
| | - Yi-Xin Guo
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin-Hua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Genua I, Sardà H, Pérez A. [Cardiometabolic effects of weight loss]. Aten Primaria 2024; 56:102953. [PMID: 38705132 PMCID: PMC11079448 DOI: 10.1016/j.aprim.2024.102953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
The prevalence of overweight and obesity, and, consequently, associated comorbidities, is increasing significantly worldwide. The guidelines recommend a percentage of weight loss> 5% to achieve beneficial effects on metabolic comorbidities associated with obesity. Furthermore, greater weight losses (> 10%) produce more significant improvements, and may even produce remission of some of these comorbidities. In this chapter, we review the evidence of the effect of weight loss through different strategies (lifestyle intervention, pharmacological treatment, or bariatric surgery) on the main cardiometabolic pathologies associated with excess adipose tissue (type 2 diabetes, high blood pressure, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, inflammation, cardiovascular diseases, and mortality).
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Affiliation(s)
- Idoia Genua
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Institut de Recerca de Sant Pau (IIB Sant Pau), Barcelona, España
| | - Helena Sardà
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Institut de Recerca de Sant Pau (IIB Sant Pau), Barcelona, España
| | - Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Institut de Recerca de Sant Pau (IIB Sant Pau), Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España.
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Jia G, Sowers JR, Whaley-Connell A. Obesity in Hypertension: The Role of the Expanding Waistline Over the Years and Insights Into the Future. Hypertension 2024; 81:687-690. [PMID: 38018438 PMCID: PMC10954419 DOI: 10.1161/hypertensionaha.123.21719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Guanghong Jia
- Department of Medicine-Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Research Service, 800 Hospital Dr, Columbia, MO, 65201, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, 65212, USA
| | - James R. Sowers
- Department of Medicine-Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Research Service, 800 Hospital Dr, Columbia, MO, 65201, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, 65212, USA
- Department of Medicine–Nephrology and Hypertension, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Adam Whaley-Connell
- Department of Medicine-Endocrinology and Metabolism, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Research Service, 800 Hospital Dr, Columbia, MO, 65201, USA
- Department of Medicine–Nephrology and Hypertension, University of Missouri School of Medicine, Columbia, MO 65212, USA
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Zhu Y, Wang Z. Association between joint physical activity and healthy dietary patterns and hypertension in US adults: cross-sectional NHANES study. BMC Public Health 2024; 24:855. [PMID: 38504199 PMCID: PMC10953194 DOI: 10.1186/s12889-024-18346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Lack of physical activity (PA), poor dietary habits, or other unhealthy lifestyle behaviors are potential modifiable risk factors for hypertension. It has been sufficiently demonstrated in previous studies that physical activity or healthy dietary patterns can reduce the risk of hypertension. However, no research focused on the joint effects of PA and healthy dietary patterns on hypertension in a representative sample of adults. METHODS We used data collected from the 2007-2018 National Health and Nutrition Examination Survey. Healthy dietary patterns were assessed with the Healthy Eating Index 2015 (HEI-2015), and PA was measured using the metabolic equivalent minutes per week reported in questionnaires. We created four lifestyle categories based on the HEI-2015 and PA: (1) unhealthy diet and physically inactive (less than recommended PA), (2) healthy diet but physically inactive, (3) unhealthy diet but physically active (recommended PA), (4) healthy diet and physically active. Logistic regression was used to evaluate the association between joint PA and HEI-2015 and hypertension. RESULTS A total of 24,453 participants were enrolled in the study. Compared with unhealthy diet and physically inactive individuals, only healthy diet and physically active participants (adjusted odds ratio [AOR]: 0.77, 95% CI 0.65-0.9) were negatively associated with hypertension, while healthy diet but physically inactive participants (AOR: 0.89, 95% CI 0.76-1.03) and unhealthy diet but physically active participants (AOR: 0.9, 95% CI 0.76-1.06) were not associated with hypertension. CONCLUSION In a representative sample of US adults, our findings suggest that individuals with recommended PA and healthy dietary patterns have a lower risk of hypertension than those with an unhealthy diet or less than recommended PA. Healthy eating habits and regular PA are potential preventive precautions against hypertension.
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Affiliation(s)
- Yanzhou Zhu
- Department of Geriatrics, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, 355000, China
| | - Zhigang Wang
- Department of Geriatrics, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, 355000, China.
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Bludorn J, Railey K. Hypertension Guidelines and Interventions. Prim Care 2024; 51:41-52. [PMID: 38278572 DOI: 10.1016/j.pop.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Hypertension remains one of the most prevalent conditions encountered in the primary care setting and is a major contributor to cardiovascular disease in the United States. This reality underscores the importance for primary care clinicians to have an understanding of hypertension guidelines, interventions, and population-based considerations. This article provides a succinct overview of hypertension guidelines, reviews guideline-informed approaches to hypertension screening, diagnosis, and treatment, and concludes with a thoughtful discussion of population-based considerations.
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Affiliation(s)
- Janelle Bludorn
- Duke Physician Assistant Program, Department of Family Medicine and Community Health, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914 Durham, NC 27710, USA.
| | - Kenyon Railey
- Duke Physician Assistant Program, Department of Family Medicine and Community Health, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914 Durham, NC 27710, USA
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9
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Bays HE, Hsia DS, Nguyen LT, Peterson CA, Varghese ST. Effects of phentermine / topiramate extended-release, phentermine, and placebo on ambulatory blood pressure monitoring in adults with overweight or obesity: A randomized, multicenter, double-blind study. OBESITY PILLARS (ONLINE) 2024; 9:100099. [PMID: 38304225 PMCID: PMC10831272 DOI: 10.1016/j.obpill.2024.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
Background A fixed-dose combination of phentermine and extended-release topiramate (PHEN/TPM - approved for weight management) has demonstrated in-clinic reduction of blood pressure (BP). Ambulatory BP monitoring (ABPM) may be a better predictor of cardiovascular disease risk than in-clinic BP. Methods This randomized, multicenter, double-blind study enrolled 565 adults with overweight/obesity. Inclusion criteria included participants willing to wear ABPM device for 24 h. Exclusion criteria included screening blood pressure >140/90 mmHg and antihypertensive medications not stable for 3 months prior to randomization. Participants received placebo (n = 184), phentermine 30 mg; (n = 191), or PHEN 15 mg/TPM 92 mg; (n = 190). 24-hour ABPM was performed at baseline and at week 8. The primary endpoint was mean 24-h systolic BP (SBP) as measured by ABPM, in the per protocol population. Results Participants were mostly female (73.5 %) and White (81.6 %), with a mean age of 53.4 years; 32.4 % had no hypertension diagnosis or treatment, 62.5 % had hypertension using 0 to 2 antihypertensive medications, and 5.1 % had hypertension using ≥ 3 antihypertensive medications. Baseline mean SBP/diastolic BP (DBP) was 123.9/77.6 mmHg. At week 8, mean SBP change was -0.1 mmHg (placebo), +1.4 mmHg (phentermine 30 mg), and -3.3 mmHg (PHEN/TPM). Between-group difference for PHEN/TPM versus placebo was -3.2 mmHg (95 % CI: -5.48, -0.93 mmHg; p = 0.0059). The between-group difference for PHEN/TPM versus phentermine 30 mg was -4.7 mmHg (95 % CI: -6.96, -2.45 mmHg; p < 0.0001). Common (>2 % in any treatment group) adverse events (i.e., dry mouth, constipation, nausea, dizziness, paresthesia, dysgeusia, headache, COVID-19, urinary tract infection, insomnia, and anxiety) were mostly mild or moderate. Conclusions In this randomized, multicenter, double-blind ABPM study, PHEN/ TPM reduced SBP compared to either placebo or phentermine 30 mg (Funding: Vivus LLC; ClinicalTrials.gov: NCT05215418).
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Mitsunami M, Wang S, Soria-Contreras DC, Mínguez-Alarcón L, Ortiz-Panozo E, Stuart JJ, Souter I, Rich-Edwards JW, Chavarro JE. Prepregnancy plant-based diets and risk of hypertensive disorders of pregnancy. Am J Obstet Gynecol 2024; 230:366.e1-366.e19. [PMID: 37598996 PMCID: PMC10875146 DOI: 10.1016/j.ajog.2023.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Plant-based diets have been associated with a lower risk of cardiovascular disease in nonpregnant adults, but specific evidence for their effects on risk of hypertensive disorders of pregnancy is scarce. OBJECTIVE This study aimed to evaluate the prospective association between adherence to plant-based diets before pregnancy and the risk for hypertensive disorders of pregnancy. We hypothesized that women with higher adherence to plant-based diets would have a lower risk for hypertensive disorders of pregnancy. STUDY DESIGN We followed 11,459 parous women (16,780 singleton pregnancies) without chronic diseases, a history of preeclampsia, and cancers who participated in the Nurses' Health Study II (1991-2009), which was a prospective cohort study. Diet was assessed every 4 years using a validated food frequency questionnaire from which we calculated the plant-based diet index (higher score indicates higher adherence) to evaluate the health associations of plant-based diets among participants while accounting for the quality of plant-based foods. Participants self-reported hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension. We estimated the relative risk of hypertensive disorders of pregnancy in relation to plant-based diet index adherence in quintiles using generalized estimating equations log-binomial regression while adjusting for potential confounders and accounting for repeated pregnancies for the same woman. RESULTS The mean (standard deviation) age at first in-study pregnancy was 35 (4) years. A total of 1033 cases of hypertensive disorders of pregnancy, including 482 cases of preeclampsia (2.9%) and 551 cases of gestational hypertension (3.3%) were reported. Women in the highest quintile of plant-based diet index were significantly associated with a lower risk for hypertensive disorders of pregnancy than women in the lowest quintile (relative risk, 0.76; 95% confidence interval, 0.62-0.93). There was an inverse dose-response relationship between plant-based diet index and risk for hypertensive disorders of pregnancy. The multivariable-adjusted relative risk (95% confidence interval) of hypertensive disorders of pregnancy for women in increasing quintiles of plant-based diet index were 1 (ref), 0.93 (0.78-1.12), 0.86 (0.72-1.03), 0.84 (0.69-1.03), and 0.76 (0.62-0.93) with a significant linear trend across quintiles (P trend=.005). This association was slightly stronger for gestational hypertension (relative risk, 0.77; 95% confidence interval, 0.60-0.99) than for preeclampsia (relative risk, 0.80; 95% confidence interval, 0.61-1.04). Mediation analysis suggested that body mass index evaluation for dietary assessment and pregnancy explained 39% (95% confidence interval, 15%-70%]) of the relation between plant-based diet index and hypertensive disorders of pregnancy and 48% (95% confidence interval, 12%-86%]) of the relation between plant-based diet index and gestational hypertension. CONCLUSION Higher adherence to plant-based diets was associated with a lower risk of developing hypertensive disorders of pregnancy. Much of the benefit seems to be related to improved weight control.
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Affiliation(s)
- Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Eduardo Ortiz-Panozo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Center for Population Health Research, National Institute of Public Health, Mexico
| | - Jennifer J Stuart
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Irene Souter
- Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Janet W Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
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11
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Higazi AAR, Maraga E, Baraghithy S, Udi S, Azar S, Saada A, Glaser B, Avrahami D, Abdeen S, Hamdan Z, Tam J, Fanne RA. Characterization of metabolic alterations in the lean metabolically unhealthy alpha defensin transgenic mice. iScience 2024; 27:108802. [PMID: 38318380 PMCID: PMC10839648 DOI: 10.1016/j.isci.2024.108802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/25/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Inflammation is consistently linked to dysmetabolism. In transgenic mice (Def+/+) model the neutrophilic peptide, alpha defensin, proved atherogenic. This phenotype occurred despite favorable cholesterol and glucose levels, and lower body weight and blood pressure. In this study, integration of metabolic&behavioral phenotyping system, endocrine, biochemical and mitochondrial assessment, pathological and immunohistochemical tests, and multiple challenge tests was established to explore the metabolic impact of alpha defensin. Compared to the control group, Def+/+ mice exhibited lower total energy expenditure and carbohydrate utilization, and higher fat oxidation. Their ACTH-cortisol and thyroid profiles were intact. Intriguingly, they had low levels of glucagon, with high ammonia, uric acid, triglyceride, and lactate. Mitochondrial evaluations were normal. Overall, defensin-induced hypoglucagonemia is associated with lipolysis, restricted glucose oxidation, and enhanced wasting. Def+/+ mice may be a useful model for studying the category of lean, apparently metabolically healthy, and atherosclerotic phenotype, with insight into a potential inflammatory-metabolic link.
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Affiliation(s)
- Abd Al-Roof Higazi
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Emad Maraga
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Saja Baraghithy
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Shiran Udi
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Shahar Azar
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Ann Saada
- Department of Genetics, Hadassah Medical Center, Jerusalem, Isarel
- Faculty of Medicine, Hebrew University, Jerusalem, Isarel
- Department of Laboratory Sciences, Hadassah Academic College, Jerusalem, Isarel
| | - Benjamin Glaser
- Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Dana Avrahami
- Department of Developmental Biology and Cancer Research, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Suhair Abdeen
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Zenab Hamdan
- Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Joseph Tam
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Rami Abu Fanne
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
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12
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Hall ME, Mace HP, Hall JE. Bariatric Surgery for Obesity Hypertension: A Gateway for Durable Blood Pressure Control. J Am Coll Cardiol 2024; 83:649-651. [PMID: 38325989 DOI: 10.1016/j.jacc.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA; Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | - Hunter P Mace
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - John E Hall
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
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13
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Schiavon CA, Cavalcanti AB, Oliveira JD, Machado RHV, Santucci EV, Santos RN, Oliveira JS, Damiani LP, Junqueira D, Halpern H, Monteiro FDLJ, Noujaim PM, Cohen RV, de Sousa MG, Bortolotto LA, Berwanger O, Drager LF. Randomized Trial of Effect of Bariatric Surgery on Blood Pressure After 5 Years. J Am Coll Cardiol 2024; 83:637-648. [PMID: 38325988 DOI: 10.1016/j.jacc.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. OBJECTIVES The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. METHODS We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. RESULTS A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). CONCLUSIONS Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension [GATEWAY]; NCT01784848).
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Affiliation(s)
- Carlos A Schiavon
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil; Hospital BP, A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil.
| | | | - Juliana D Oliveira
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil; Hospital BP, A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | - Renato N Santos
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil
| | | | - Lucas P Damiani
- Research Institute, Heart Hospital (hcor), São Paulo, Brazil
| | | | - Helio Halpern
- Surgical Center, Heart Hospital (hcor), São Paulo, Brazil
| | | | | | | | - Marcio G de Sousa
- Dante Pazzanese Institute of Cardiology, Department of Hypertension, São Paulo, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Otavio Berwanger
- Imperial College London, George Institute for Global Health UK, London, United Kingdom
| | - Luciano F Drager
- Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio Libanes, São Paulo, Brazil
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14
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Zhang S, Liu Z, Zhang H, Zhou X, Wang X, Chen Y, Miao X, Zhu Y, Jiang W. Effect and mechanism of Qing Gan Zi Shen decoction on heart damage induced by obesity and hypertension. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117163. [PMID: 37741474 DOI: 10.1016/j.jep.2023.117163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/15/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Qing Gan Zi Shen Decoction (QGZS) is a traditional Chinese formula. It has been extensively used for decades in the treatment of hypertension combined with metabolic diseases, but its cardioprotective effects and underlying mechanisms are poorly understood. AIM OF THE STUDY To explore the cardioprotective effects and potential mechanisms of QGZS in an animal model of obese hypertension. MATERIALS AND METHODS In this study, spontaneously hypertensive rats (SHRs) were utilized as an animal model to examine the effects of a high-fat diet and two concentrations of QGZS. Echocardiography, hematoxylin eosin (H&E) staining, and wheat germ agglutinin (WGA) staining were employed to assess the cardiac structure and function of the SHRs throughout a 16-week therapy period. Furthermore, Western blotting (WB) and immunofluorescence (IF) were employed to identify the levels of Nrf2 expression in the mitochondria, cytoplasm, and nucleus of the myocardium. Additionally, transmission electron microscopy and enzyme-linked immunosorbent assay (ELISA) were utilized to measure mitochondrial morphology and pro-inflammatory cytokine levels, respectively. Furthermore, Western blotting (WB), immunohistochemistry (IHC), and immunofluorescence (IF) techniques were employed to quantify the levels of marker proteins associated with myocardial fibrosis, cardiac inflammation, oxidative stress, and mitochondrial dysfunction. RESULTS QGZS inhibited weight gain and depressed systolic and mean arterial pressures in high-fat-fed SHRs. Echocardiographic results demonstrated that QGZS prevented the increase in left ventricular mass, restricted the growth of left ventricular diameter, and improved ejection fraction (EF), fractional shortening (FS), and the ratio of early diastolic peak velocity of transmitral flow (E) to late diastolic peak velocity (A) in high-fat-fed SHRs. This suggested that QGZS prevented ventricular remodeling and protected cardiac systolic and diastolic functions. H&E and WGA staining showed that QGZS improved cardiomyocyte disorders and restricted cardiomyocyte hypertrophy. The underlying mechanisms, QGZS attenuated the oxidative stress state, including reducing the generation of reactive oxygen species (ROS) in the myocardium, revitalizing the antioxidant enzyme system, and protecting mitochondrial function. Moreover, QGZS alleviated the pro-inflammatory state in high-fat-fed SHRs. What's more, QGZS significantly increased the expression level of Nrf2 in nuclei and mitochondria in rat heart tissues, exerting a proximate Nrf2 agonist effect. CONCLUSIONS QGZS exerted cardioprotective effects, in part due to its increasing expression of Nrf2 protein in the heart, which promoted Nrf2 nuclear expression.
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Affiliation(s)
- Shujie Zhang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China
| | - Zitian Liu
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China
| | - Han Zhang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China
| | - Xiaonian Zhou
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China
| | - Xiuming Wang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China
| | - Yan Chen
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China
| | - Xiaofan Miao
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China
| | - Yao Zhu
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China.
| | - Weimin Jiang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, PR China.
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15
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Arthur G, Ahmed N, Nichols K, Poupeau A, Collins K, Lindner V, Loria A. Human Soluble Prorenin Receptor Expressed in Adipose Tissue Improves Insulin Sensitivity and Endothelial Function in Obese Female Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.12.575451. [PMID: 38260688 PMCID: PMC10802596 DOI: 10.1101/2024.01.12.575451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Increased circulating levels of the soluble prorenin receptor (sPRR), a component of the renin angiotensin system (RAS), plays a role in obesity, glucose, and insulin homeostasis. However, elevated plasma sPRR in diabetic patients has been shown correlated with hyperglycemia in women but not men. Hence, the current study sought to understand the contribution of human sPRR (HsPRR) produced in the adipose tissue (Adi) on adipogenesis, and glucose and insulin balance in obesity settings. Adi-HsPRR mice were generated by breeding human sPRR-Myc-tag transgenic mice with mice expressing Adiponectin/Cre. The mouse model was validated by detecting 28kDa myc-tagged HsPRR by western blotting. Adipose HsPRR expression did not change circulating sPRR in female mice fed a standard chow diet or high fat diet (HFD) but increased plasma sPRR in male Adi-HsPRR mice fed a HFD compared to HFD-fed controls. Yet, Adi-HsPRR improved insulin sensitivity, vascular relaxation and the vasodilator agent Ang 1-7 in obese female mice but not in the male counterparts. Moreover, Adi-HsPRR expression reduced the expression of the adipogenic genes SREBP1C and CD36 only in gonadal white adipose from obese female mice, signifying that adipose tissue-derived HsPRR exerts a sex-specific effect on insulin sensitivity and endothelial function which seems independent of circulating sPRR.
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Affiliation(s)
- Gertrude Arthur
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY
| | - Nermin Ahmed
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY
| | - Kellea Nichols
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY
| | - Audrey Poupeau
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY
| | - Katelyn Collins
- School of Medical Sciences, University of Kentucky, Lexington, KY
| | | | - Analia Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY
- SAHA Cardiovascular Center, University of Kentucky, Lexington, KY
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Ivanytska TA, Kazakov YM, Petrov YY, Burmak YH, Ivanytskyi IV, Chekalina NI, Shut SV. Changes in the indicators of stiffness and remodeling of magistral arteries in young patients at the early stage of essential hypertension under conditions of syntropy with obesity. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:30-35. [PMID: 38518230 DOI: 10.36740/merkur202401105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Aim: The study and analysis of indicators of remodeling and rigidity of magistral vessels in young essential hypertension patients with abdominal obesity and determination of the detected changes as a possible criterion for their remodeling.. PATIENTS AND METHODS Materials and Methods: 98 young people with essential hypertension and obesity were included in the study. The structure of the carotid artery and its stiffness were assessed using the ultrasound method, and the level of abdominal fat was determined using dual-energy X-ray absorptiometry. RESULTS Results: Carotid Intima-Media Thickness in patients with essential hypertension reliably exceeded the corresponding indicator of the control group. We observed a significant increase in arterial stiffness indicators, which is explained by the increased stiffness of blood vessels in patients with obesity. During the correlation analysis, it was established that the relationship between the level of abdominal fat and the elasticity of the vascular wall was positive and strong, which indicated the dominant role of the abdominal type of obesity in the remodeling of the vascular wall in young patients with essential hypertension in combination with obesity. CONCLUSION Conclusions: In young patients at the early stage of the formation of essential hypertension, there are signs of a decrease in resilient-elastic properties and remodeling of magistral vessels, whose severity is significantly stronger in combination with abdominal obesity.
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17
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Ostrominski JW, Vaduganathan M, Selvaraj S, Claggett BL, Miao ZM, Desai AS, Jhund PS, Kosiborod MN, Lam CSP, Inzucchi SE, Martinez FA, de Boer RA, Hernandez AF, Shah SJ, Petersson M, Maria Langkilde A, McMurray JJV, Solomon SD. Dapagliflozin and Apparent Treatment-Resistant Hypertension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The DELIVER Trial. Circulation 2023; 148:1945-1957. [PMID: 37830208 DOI: 10.1161/circulationaha.123.065254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Apparent treatment-resistant hypertension (aTRH) is prevalent and associated with adverse outcomes in heart failure with mildly reduced or preserved ejection fraction. Less is known about the potential role of sodium-glucose co-transporter 2 inhibition in this high-risk population. In this post hoc analysis of the DELIVER trial (Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure), we evaluated clinical profiles and treatment effects of dapagliflozin among participants with aTRH. METHODS DELIVER participants were categorized on the basis of baseline blood pressure (BP), with aTRH defined as BP ≥140/90 mm Hg (≥130/80 mm Hg if diabetes) despite treatment with 3 antihypertensive drugs including a diuretic. Nonresistant hypertension was defined as BP above threshold but not meeting aTRH criteria. Controlled BP was defined as BP under threshold. Incidence of the primary outcome (cardiovascular death or worsening heart failure event), key secondary outcomes, and safety events was assessed by baseline BP category. RESULTS Among 6263 DELIVER participants, 3766 (60.1%) had controlled BP, 1779 (28.4%) had nonresistant hypertension, and 718 (11.5%) had aTRH at baseline. Participants with aTRH had more cardiometabolic comorbidities and tended to have higher left ventricular ejection fraction and worse kidney function. Rates of the primary outcome were 8.7 per 100 patient-years in those with controlled BP, 8.5 per 100 patient-years in the nonresistant hypertension group, and 9.5 per 100 patient-years in the aTRH group. Relative treatment benefits of dapagliflozin versus placebo on the primary outcome were consistent across BP categories (Pinteraction=0.114). Participants with aTRH exhibited the greatest absolute reduction in the rate of primary events with dapagliflozin (4.1 per 100 patient-years) compared with nonresistant hypertension (2.7 per 100 patient-years) and controlled BP (0.8 per 100 patient-years). Irrespective of assigned treatment, participants with aTRH experienced a higher rate of reported vascular events, including myocardial infarction and stroke, over study follow-up. Dapagliflozin modestly reduced systolic BP (by ≈1 to 3 mm Hg) without increasing risk of hypotension, hypovolemia, or other serious adverse events, irrespective of BP category, but did not improve the proportion of participants with aTRH attaining goal BP over time. CONCLUSIONS aTRH was identified in >1 in 10 patients with heart failure and left ventricular ejection fraction >40% in DELIVER. Dapagliflozin consistently improved clinical outcomes and was well-tolerated, including among those with aTRH. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03619213.
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Affiliation(s)
- John W Ostrominski
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.W.O., M.V., B.L.C., Z.M.M., A.S.D., S.D.S.)
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.W.O., M.V., B.L.C., Z.M.M., A.S.D., S.D.S.)
| | - Senthil Selvaraj
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.S., A.F.H.)
- Duke Molecular Physiology Institute, Durham, NC (S.S.)
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.W.O., M.V., B.L.C., Z.M.M., A.S.D., S.D.S.)
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.W.O., M.V., B.L.C., Z.M.M., A.S.D., S.D.S.)
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.W.O., M.V., B.L.C., Z.M.M., A.S.D., S.D.S.)
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (P.S.J., J.J.V.M.)
| | - Mikhail N Kosiborod
- St Luke's Mid America Heart Institute, University of Missouri-Kansas City (M.N.K.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.)
| | | | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (R.A.d.B.)
| | - Adrian F Hernandez
- Division of Cardiology, Duke University School of Medicine, Durham, NC (S.S., A.F.H.)
- Duke Clinical Research Institute, Duke University, Durham, NC (A.F.H.)
| | - Sanjiv J Shah
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (M.P., A.M.L.)
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (M.P., A.M.L.)
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (P.S.J., J.J.V.M.)
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.W.O., M.V., B.L.C., Z.M.M., A.S.D., S.D.S.)
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18
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Smith AP, Overton K, Rakotz M, Wozniak G, Sanchez E. Target: BP™: A National Initiative to Improve Blood Pressure Control. Hypertension 2023; 80:2523-2532. [PMID: 37855141 PMCID: PMC10651269 DOI: 10.1161/hypertensionaha.123.20389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
TARGET BP™ is a national initiative launched by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP) in the United States. TARGET BP™ provides support to health care organizations and health care teams, with no user fees, to improve the quality of care for adults with hypertension by providing education and resources and recognizing organizations committed to prioritizing and reporting their rate of BP control. Through Target: BP™, the American Heart Association and the American Medical Association also collaborate to align policy with evidence through federal, state, and institutional policy advocacy and raise public awareness through media campaigns. In 2022, Target: BP™ recognized 1309 health care organizations serving 8.4 million patients with hypertension for prioritizing BP control, 675 of which affirmed performance of evidence-based BP measurement activities and 551 of which reported BP control rates ≥70%. With the proportion of US adults with controlled BP falling to 48.2% from 2017 to 2020, Target: BP™ remains focused on regaining lost ground in national BP control rates by emphasizing accurate BP measurement, rapid treatment intensification, healthful lifestyle changes, and evidence-based use of self-measured BP monitoring. TARGET BP™ also emphasizes adoption of team-based care models and prioritizing equitable health outcomes. More than 1.37 million unique users have visited https://targetbp.org/ and downloaded 98 341 Target: BP™ resources from 2017 to 2022.
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Affiliation(s)
- Alison P. Smith
- Target: BP™ (A.P.S.), American Heart Association, Dallas, TX
- American Medical Association, Chicago, IL (A.P.S)
| | - Katherine Overton
- Outpatient Program Development (K.O.), American Heart Association, Dallas, TX
| | - Michael Rakotz
- Michael Rakotz, Improving Health Outcomes (M.R.), Chicago, IL
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19
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Rice B, Mbatidde L, Oluleye O, Onwuanyi A, Adedinsewo D. Managing hypertension in African Americans with heart failure: A guide for the primary care clinician. J Natl Med Assoc 2023:S0027-9684(23)00144-X. [PMID: 38135590 DOI: 10.1016/j.jnma.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.
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Affiliation(s)
- Bria Rice
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Lydia Mbatidde
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Anekwe Onwuanyi
- Department of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States.
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20
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Ndumele CE, Neeland IJ, Tuttle KR, Chow SL, Mathew RO, Khan SS, Coresh J, Baker-Smith CM, Carnethon MR, Després JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV, Rangaswami J. A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1636-1664. [PMID: 37807920 DOI: 10.1161/cir.0000000000001186] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome.
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21
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López-Moreno M, Garcés-Rimón M, Miguel-Castro M, Fernández-Martínez E, Iglesias López MT. Effect of Nutrition Education on Health Science University Students to Improve Cardiometabolic Profile and Inflammatory Status. Nutrients 2023; 15:4685. [PMID: 37960339 PMCID: PMC10648054 DOI: 10.3390/nu15214685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
The inadequate lifestyle associated with university life may have a negative impact on various cardiometabolic factors. The aim of this study was to evaluate the effect of a one-year nutrition education course on cardiometabolic parameters in undergraduate health science students. During the 2021-22 academic year, 1.30 h nutrition sessions were conducted twice a week. Capillary blood samples were collected and centrifuged to measure cardiometabolic and inflammatory biomarkers in serum. The sample studied consisted of 49 students: 20.4% male and 79.6% female. The nutritional intervention resulted in changes in dietary patterns, with increased consumption of vegetables, nuts and legumes. After the course, females showed an increase in HDL-cholesterol levels (p = 0.007) and no change in LDL-cholesterol levels (p = 0.189). On the other hand, males showed significant changes in HDL-cholesterol (p = 0.001) and LDL-cholesterol (p = 0.043) levels. The atherogenic index was also significantly reduced (p < 0.001) in both males (p = 0.009) and females (p = 0.002). Differences were also observed in the increase in vitamin D levels in both males and females, although the magnitude of the increase was greater in the men (Δ = 7.94, p = 0.016 in men vs. Δ = 4.96, p = 0.001 in women). The monocyte-to-HDL ratio (MHR) showed a significant reduction, although these differences were only significant in males. Students with low vitamin D levels had higher LDL-cholesterol values (p = 0.01) and atherogenic index (p = 0.029). Adjusted linear regression analysis showed a significant association between post-course vitamin D MHR (β = -0.42, IC: -0.29, -0.06, p < 0.01). These findings suggest the importance of including nutrition education programs during the university stage for the prevention of long-term health problems.
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Affiliation(s)
- Miguel López-Moreno
- Instituto de Investigación en Ciencias de Alimentación, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (M.L.-M.); (M.G.-R.); (M.M.-C.)
- Grupo de Investigación en Biotecnología Alimentaria, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Marta Garcés-Rimón
- Instituto de Investigación en Ciencias de Alimentación, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (M.L.-M.); (M.G.-R.); (M.M.-C.)
- Grupo de Investigación en Biotecnología Alimentaria, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Marta Miguel-Castro
- Instituto de Investigación en Ciencias de Alimentación, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (M.L.-M.); (M.G.-R.); (M.M.-C.)
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22
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Cosentino F, Verma S, Ambery P, Treppendahl MB, van Eickels M, Anker SD, Cecchini M, Fioretto P, Groop PH, Hess D, Khunti K, Lam CSP, Richard-Lordereau I, Lund LH, McGreavy P, Newsome PN, Sattar N, Solomon S, Weidinger F, Zannad F, Zeiher A. Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2023; 44:4141-4156. [PMID: 37448181 DOI: 10.1093/eurheartj/ehad445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.
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Affiliation(s)
- Francesco Cosentino
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Philip Ambery
- Late-stage Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Diabetes, Monash University, Melbourne, Australia
| | - David Hess
- Department of Physiology and Pharmacology, University of Western Ontario, Robarts Research Institute, London, ON, Canada
- Department of Pharmacology, University of Toronto, Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | | | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Philip N Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott Solomon
- Harvard Medical School, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France
| | - Andreas Zeiher
- Cardio Pulmonary Institute, Goethe University of Frankfurt, Frankfurt, Germany
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23
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Rulkiewicz A, Pilchowska I, Lisik W, Pruszczyk P, Wójcik S, Poboży M, Domienik-Karłowicz J. An Alarmingly High Number of Candidates for Bariatric Procedures among Professionally Active Poles and Its Strong Relationship with Cardiovascular Co-Morbidities-POL-O-CARIA 2022 Study. J Clin Med 2023; 12:6431. [PMID: 37892574 PMCID: PMC10607522 DOI: 10.3390/jcm12206431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Over recent years, the global healthcare system has experienced a notable increase in the prevalence of obesity and its associated health complications such as hypertension, type 2 diabetes, lipid disorders, etc. What is more, one of the significant phenomena is the increasing demand for bariatric procedures among individuals of working age due to the high prevalence of type III obesity and type II obesity with co-morbidities. This trend is pronounced in Poland, due to the increasing number of patients meeting the qualifying criteria for surgery among professionally active and inactive patients. The aim of this study is to characterize the alarmingly high number of candidates for bariatric procedures among professionally active Poles. In total, the results of 2,056,861 initial, control, and periodic visits as part of the occupational medicine certificate were analyzed-collected from 1,342,749 unique patients (51.7% men; mean age of whole group: 36.81, SD = 10.91). Statistical calculations were performed, qualitative data were assessed using percentage and occurrence counts, while qualitative data were described using mean (M), standard deviation (SD), median, skewness, kurtosis, and range values. Results with p < 0.05 were deemed significant. Chi-square analysis and one-way ANOVA (with Scheffe's post hoc test) were employed. Charts were created in the R program. It was noticed that there was a consistent rise in the proportion of individuals classified as candidates for bariatric procedures (an increase of 0.3%) alongside a notable decrease in the percentage of individuals maintaining a healthy body weight. Moreover, it is imperative to conduct yearly evaluations of the prevalence of obesity and its associated health conditions. It should be noted that hypertension occurred in 42.2% of patients, type 2 diabetes in 6.2% of patients, and lipid disorders in 8.4% of patients with third-degree obesity. This proactive approach is essential in order to adequately equip the healthcare system to address the increasing population of obese individuals, especially candidates for bariatric procedures.
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Affiliation(s)
| | - Iwona Pilchowska
- LUX MED, Postępu 21C, 02-676 Warsaw, Poland (S.W.)
- Department of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, 02-005 Warsaw, Poland;
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | | | - Marcin Poboży
- HealthCare Facility Cichowski-Poboży, 08-480 Maciejowice, Poland;
| | - Justyna Domienik-Karłowicz
- LUX MED, Postępu 21C, 02-676 Warsaw, Poland (S.W.)
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland;
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24
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Sidhu SK, Aleman JO, Heffron SP. Obesity Duration and Cardiometabolic Disease. Arterioscler Thromb Vasc Biol 2023; 43:1764-1774. [PMID: 37650325 PMCID: PMC10544713 DOI: 10.1161/atvbaha.123.319023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
Cardiovascular disease risk is known to be influenced by both the severity of a risk factor and the duration of exposure (eg, LDL [low-density lipoprotein] cholesterol, tobacco smoke). However, this concept has been largely neglected within the obesity literature. While obesity severity has been closely linked with cardiometabolic diseases, the risk of developing these conditions among those with obesity may be augmented by greater obesity duration over the life span. Few longitudinal or contemporary studies have investigated the influence of both factors in combination-cumulative obesity exposure-instead generally focusing on obesity severity, often at a single time point, given ease of use and lack of established methods to encapsulate duration. Our review focuses on what is known about the influence of the duration of exposure to excess adiposity within the obesity-associated cardiometabolic disease risk equation by means of summarizing the hypothesized mechanisms for and evidence surrounding the relationships of obesity duration with diverse cardiovascular and metabolic disease. Through the synthesis of the currently available data, we aim to highlight the importance of a better understanding of the influence of obesity duration in cardiovascular and metabolic disease pathogenesis. We underscore the clinical importance of aggressive early attention to obesity identification and intervention to prevent the development of chronic diseases that arise from exposure to excess body weight.
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Affiliation(s)
- Sharnendra K. Sidhu
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Jose O. Aleman
- Laboratory of Translational Obesity Research, Division of Endocrinology, Diabetes & Metabolism, New York University Grossman School of Medicine, New York, NY, USA
| | - Sean P. Heffron
- Center for the Prevention of Cardiovascular Disease, Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, USA
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25
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of intermittent fasting for adults with overweight or obesity.
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26
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Nederveen JP, Mastrolonardo AJ, Xhuti D, Di Carlo A, Manta K, Fuda MR, Tarnopolsky MA. Novel Multi-Ingredient Supplement Facilitates Weight Loss and Improves Body Composition in Overweight and Obese Individuals: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Nutrients 2023; 15:3693. [PMID: 37686725 PMCID: PMC10490028 DOI: 10.3390/nu15173693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Despite the growing recognition of the obesity crisis, its rates continue to rise. The current first-line therapies, such as dietary changes, energy restriction, and physical activity, are typically met with poor adherence. Novel nutritional interventions can address the root causes of obesity, including mitochondrial dysfunction, and facilitate weight loss. OBJECTIVE The objective of this study was to investigate the effects of a multi-ingredient nutritional supplement designed to facilitate mitochondrial function and metabolic health outcomes over a 12 wk period. METHODS Fifty-five overweight and/or obese participants (age (mean ± SEM): 26 ± 1; body mass index (BMI) (kg/m2): 30.5 ± 0.6) completed this double-blind, placebo-controlled clinical trial. Participants were randomized to 12 wks of daily consumption of multi-ingredient supplement (MIS; n = 28; containing 50 mg forskolin, 500 mg green coffee bean extract, 500 mg green tea extract, 500 mg beet root extract, 400 mg α-lipoic acid, 200 IU vitamin E, and 200 mg CoQ10) or control placebo (PLA, n = 27; containing microcrystalline cellulose) matched in appearance. The co-primary outcomes were bodyweight and fat mass (kg) changes. The secondary outcomes included other body composition measures, plasma markers of obesity, fatty liver disease biomarkers, resting energy metabolism, blood pressure, physical performance, and quality of life. The post-intervention differences between MIS and PLA were examined via ANCOVA which was adjusted for the respective pre-intervention variables. RESULTS After adjustment for pre-intervention data, there was a significant difference in weight (p < 0.001) and fat mass (p < 0.001) post-intervention between the PLA and MIS treatment arms. Post-intervention weight and fat mass were significantly lower in MIS. Significant post-intervention differences corrected for baseline were found in markers of clinical biochemistry (AST, p = 0.017; ALT, p = 0.008), molecular metabolism (GDF15, p = 0.028), and extracellular vesicle-associated miRNA species miR-122 and miR-34a in MIS (p < 0.05). CONCLUSIONS Following the 12 wks of MIS supplementation, weight and body composition significantly improved, concomitant with improvements in molecular markers of liver health and metabolism.
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Affiliation(s)
- Joshua P. Nederveen
- Department of Pediatrics, Faculty of Health Sciences, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada; (J.P.N.)
| | - Alexander J. Mastrolonardo
- Department of Pediatrics, Faculty of Health Sciences, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada; (J.P.N.)
| | - Donald Xhuti
- Department of Pediatrics, Faculty of Health Sciences, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada; (J.P.N.)
| | - Alessia Di Carlo
- Department of Pediatrics, Faculty of Health Sciences, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada; (J.P.N.)
| | - Katherine Manta
- Department of Pediatrics, Faculty of Health Sciences, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada; (J.P.N.)
| | - Matthew R. Fuda
- Department of Pediatrics, Faculty of Health Sciences, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada; (J.P.N.)
| | - Mark A. Tarnopolsky
- Department of Pediatrics, Faculty of Health Sciences, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada; (J.P.N.)
- Exerkine Corporation, McMaster University Medical Center (MUMC), Hamilton, ON L8N 3Z5, Canada
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27
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Barillas-Lara MI, Faaborg-Andersen CC, Quintana RA, Loro-Ferrer JF, Mandras SA, daSilva-deAbreu A. Clinical considerations and pathophysiological associations among obesity, weight loss, heart failure, and hypertension. Curr Opin Cardiol 2023:00001573-990000000-00089. [PMID: 37522803 DOI: 10.1097/hco.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW To describe the relationship between three pandemics: hypertension, obesity, and heart failure. From pathophysiology to treatment, understanding how these disease entities are linked can lead to breakthroughs in their prevention and treatment. The relevance of this review lies in its discussion of novel pharmacological and surgical treatment strategies for obesity and hypertension, and their role in the prevention and treatment of heart failure. RECENT FINDINGS Novel medications such as GLP-1 agonists have demonstrated sustained weight loss in patients with obesity, and concurrent improvements in their cardiometabolic profile, and possibly also reductions in hypertension-related comorbidities including heart failure. Surgical therapies including laparoscopic bariatric surgery represent an important treatment strategy in obese patients, and recent studies describe their use even in patients with advanced heart failure, including those with ventricular assist devices. SUMMARY These developments have deep implications on our efforts to understand, mitigate, and ultimately prevent the three pandemics, and offer promising improvements to quality of life, survival, and the cost burden of these diseases.
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Affiliation(s)
| | | | - Raymundo A Quintana
- Cardiovascular Imaging Section, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | | | - Stacy A Mandras
- Transplant Institute, Orlando AdventHealth, Orlando, Florida
| | - Adrian daSilva-deAbreu
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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28
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Oliveira JD, Schiavon CA, Oliveira JS, Santos RN, Damiani LP, Ikeoka D, Santucci EV, Machado RHV, Bortolotto LA, Berwanger O, Cavalcanti AB, Drager LF. Shorter History of Hypertension as a Predictor of Hypertension Remission after 3-years of Bariatric Surgery: Data from the GATEWAY Trial. Obes Surg 2023; 33:2485-2492. [PMID: 37392354 DOI: 10.1007/s11695-023-06711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Previous evidence explored predictors of hypertension (HTN) remission after bariatric but data are limited to observational studies and lack of ambulatory blood pressure monitoring (ABPM). This study was aimed to evaluate the rate of HTN remission after bariatric surgery using ABPM and to define predictors of mid-term HTN remission. METHODS We included patients enrolled in the surgical arm of the GATEWAY randomized trial. HTN remission was defined as controlled blood pressure (< 130 × 80 mmHg) evaluated by 24-h ABPM while no need of anti-hypertensive medications after 36 months. A multivariable logistic regression model was used to assess the predictors of HTN remission after 36 months. RESULTS 46 patients submitted Roux-en-Y gastric bypass (RYGB). HTN remission occurred in 39% (n = 14 out of 36 patients with complete data at 36 months). Patients with HTN remission had shorter HTN history than no remission group (5.9 ± 5.5 vs. 12.5 ± 8.1 years; p = 0.01). The baseline insulin levels were lower in patients who presented HTN remission, although not statistically significant (OR: 0.90; CI 95%: 0.80-0.99; p = 0.07). In the multivariate analysis, the HTN history (years) was the only independent predictor of HTN remission (OR: 0.85; 95% CI: 0.70-0.97; p = 0.04). Therefore, for each additional year of HTN history, the chance of HTN remission decreases by approximately 15% after RYGB. CONCLUSION After 3 years of RYGB, HTN remission defined by ABPM was common and independently associated with a shorter HTN history. These data underscore the need of early effective approach of obesity aiming greater impact in its comorbidities.
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Affiliation(s)
- Juliana D Oliveira
- Unidade de Hipertensão, Disciplina de Nefrologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr Eneas de Carvalho Aguiar, 255, São Paulo, CEP 05403-900, Brazil
- Research Institute - Heart Hospital (HCor) - São Paulo, São Paulo, Brazil
| | - Carlos A Schiavon
- Research Institute - Heart Hospital (HCor) - São Paulo, São Paulo, Brazil
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Julia S Oliveira
- Research Institute - Heart Hospital (HCor) - São Paulo, São Paulo, Brazil
| | - Renato N Santos
- Research Institute - Heart Hospital (HCor) - São Paulo, São Paulo, Brazil
| | | | - Dimas Ikeoka
- Research Institute - Heart Hospital (HCor) - São Paulo, São Paulo, Brazil
| | - Eliana V Santucci
- Research Institute - Heart Hospital (HCor) - São Paulo, São Paulo, Brazil
| | | | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Luciano F Drager
- Unidade de Hipertensão, Disciplina de Nefrologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr Eneas de Carvalho Aguiar, 255, São Paulo, CEP 05403-900, Brazil.
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
- Cardiology Center, Hospital Sírio Libanês, São Paulo, Brazil.
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Lyon J, Connell M, Chandrasekaran K, Srivastava S. Effect of synbiotics on weight loss and metabolic health in adults with overweight and obesity: A randomized controlled trial. Obesity (Silver Spring) 2023; 31:2009-2020. [PMID: 37424169 DOI: 10.1002/oby.23801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The study aimed to investigate the effect of synbiotics on body composition and metabolic health in individuals with excessive body weight. METHODS The 12-week randomized, double-blind, placebo-controlled clinical trial had individuals aged 30 to 60 years with BMI of 25 to 34.9 kg/m2 . In total, 172 participants were randomly allocated to either synbiotic V5 or V7 groups or the placebo group. The primary outcome was change in BMI and body fat percentage. Secondary outcomes were changes in weight, other metabolic health and inflammatory markers, gastrointestinal quality of life, and eating behaviors. RESULTS The V5 and V7 groups had a significant reduction in BMI (p < 0.0001) from baseline to the end of the study, as opposed to the nonsignificant change in the placebo group (p = 0.0711). This reduction in the V5 and V7 groups was statistically significant when compared individually with the change in the placebo group (p < 0.0001). This corresponded well with the decrease in body weight with V5 and V7 (p < 0.0001). In addition, compared with placebo, the increase in high-density lipoprotein was statistically significant in the V5 (p < 0.0001) and V7 groups (p = 0.0205). A similar trend was observed in the high-sensitivity C-reactive protein levels, with a statistically significant decrease in the V5 (p < 0.0001) and V7 (0.0005) groups. CONCLUSIONS The study demonstrates that synbiotic V5 and V7 were effective in reducing body weight in individuals with lifestyle modification.
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Affiliation(s)
- John Lyon
- Product Development Department, Veyl Ventures-DBA Netbus Inc., New York, New York, USA
| | - Mary Connell
- Research Department, Veyl Ventures-DBA Netbus Inc., New York, New York, USA
| | | | - Shalini Srivastava
- Clinical Development Department, Vedic Lifesciences Pvt. Ltd., Mumbai, Maharashtra, India
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30
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Jung MH, Ihm SH. Obesity-related hypertension and chronic kidney disease: from evaluation to management. Kidney Res Clin Pract 2023; 42:431-444. [PMID: 37551125 PMCID: PMC10407638 DOI: 10.23876/j.krcp.23.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/14/2023] [Accepted: 06/15/2023] [Indexed: 08/09/2023] Open
Abstract
With the recent obesity pandemic, obesity-related hypertension and its complications (e.g., heart failure, coronary disease, and chronic kidney disease [CKD]) are gaining attention in clinical and research fields. Obesity-related hypertension frequently precedes the onset of CKD and aggravates its progression. In this review, we discuss the role of visceral fat in the pathophysiology of obesity-related hypertension and the potential therapeutic strategies for its prevention and management. Various factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and inflammatory pathways, are intricately involved in the pathogenesis of obesity-related hypertension. These factors individually and jointly contribute to the development of hypertension (usually sodium-sensitive or resistant hypertension) and, ultimately, to the progression of CKD. From a clinical standpoint, a decline in renal function in advanced CKD further makes blood pressure control challenging since only a few options are available for blood pressure-lowering medications. Proactive lifestyle modification, pharmacological treatment for obesity, and bariatric surgery can be considered for obesity control and management. Furthermore, intensive blood pressure control is required to prevent and halt the development and progression of CKD.
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Grants
- 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, 2016E330 0201, 2016E3300202,2019E320100, 2019E320101, 2019 E320102, 2022-11-007 Korea Disease Control and Prevention Agency
- NRF-2019R1A2C2086276 National Research Foundation of Korea
- BCRI22042, BCRI22079 Chonnam National University Hospital Biomedical Research Institute
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Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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31
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da Cunha CLP. Obesity-Induced Hypertension. Arq Bras Cardiol 2023; 120:e20230391. [PMID: 37585897 PMCID: PMC10421596 DOI: 10.36660/abc.20230391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
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Reyneke GL, Beck EJ, Lambert K, Neale EP. The Effect of Non-Oil Seed Legume Intake on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2023; 14:637-651. [PMID: 37031751 PMCID: PMC10334154 DOI: 10.1016/j.advnut.2023.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023] Open
Abstract
Hypertension is a primary modifiable risk factor for CVD, whereby even small reductions in blood pressure (BP) can decrease risk for CVD events. Modification of dietary patterns is an established, nonpharmacologic approach for the prevention and management of hypertension. Legumes are a prevailing component of dietary patterns associated with lower BP in observational research, but there is a need to understand the effects of legume consumption on BP. This study aimed to synthesize evidence from randomized controlled trials (RCTs) for the effects of non-oil seed legume consumption on systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PROSPERO registration: CRD42021237732). We searched CINAHL, Cochrane, Medline, and PubMed scientific databases from inception through November 2022. A random-effects meta-analysis was conducted to assess the mean differences (MDs) for each outcome variable between legume-based and comparator diets. This review included 16 RCTs and 1092 participants. Studies ranged in duration (4-52 wk), participant age (17-75 y), and weekly legume dose (450-3150 g) in whole or powdered form. No significant overall effect between legume consumption and BP amelioration was observed in the meta-analysis (SBP-MD: -1.06 mm Hg; 95% CI: -2.57, 0.4410 mm Hg; I2 = 45%; DBP-MD: -0.48 mm Hg; 95% CI: -1.06, 0.10 mm Hg; I2 = 0%). The certainty of evidence was determined as low for SBP and DBP. Significant subgroup differences in SBP were found when studies were grouped according to participant BMI, with SBP reduction found for participants with overweight/obese BMI (MD -2.79 mm Hg, 95% CI: -4.68, -0.90 mm Hg). There is a need for large, high-quality trials to clearly define the benefits and mechanisms of legume consumption in BP management. Consideration of the relevance in individuals with obesity, overweight, and hypertension may also be warranted. This trial was registered at PROSPERO as CRD42021237732.
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Affiliation(s)
- Gynette L Reyneke
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia
| | - Eleanor J Beck
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia
| | - Elizabeth P Neale
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia.
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Rathomi HS, Dale T, Mavaddat N, Thompson SC. General Practitioners' Knowledge, Attitudes, and Practices of Dietary Advice for Weight Control in Their Overweight Patients: A Scoping Review. Nutrients 2023; 15:2920. [PMID: 37447247 PMCID: PMC10346254 DOI: 10.3390/nu15132920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This scoping review assessed the knowledge, attitudes, and practices of general practitioners (GPs) regarding dietary advice for weight management. A systematic search of PubMed, EMBASE, CINAHL, and MEDLINE was conducted for any qualitative, quantitative, and mixed-methods studies published in the past five years that informed GPs' dietary advice for weight control. Thirteen studies were included in the analysis after screening 881 papers. These studies tended to focus mostly on GPs' practices rather than their knowledge and attitudes. The most frequently mentioned dietary advice was to reduce calorie intake; however, 32 different types of dietary advice were identified in the literature, including approaches such as intermittent fasting and a ketogenic diet that are not recommended in current guidelines. GPs showed varying levels of knowledge and attitudes regarding the best dietary advice for patients. Further research is needed to better understand GP perspectives, with efforts to assist GPs in providing tailored advice based on the latest evidence to improve patient outcomes required.
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Affiliation(s)
- Hilmi S. Rathomi
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
- Faculty of Medicine, Universitas Islam Bandung, Bandung 40116, Indonesia
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
| | - Tanya Dale
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
| | - Nahal Mavaddat
- UWA Medical School, University of Western Australia, Crawley, WA 6009, Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
- School of Allied Health, University of Western Australia, Crawley, WA 6009, Australia
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Zhang M, Wu J, Wang Y, Wu J, Hu W, Jia H, Sun X. Associations between blood pressure levels and diabetic retinopathy in patients with diabetes mellitus: A population-based study. Heliyon 2023; 9:e16830. [PMID: 37484372 PMCID: PMC10360950 DOI: 10.1016/j.heliyon.2023.e16830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose To evaluate the associations of blood pressure levels with diabetic retinopathy (DR), proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) in patients with diabetes mellitus. Design A cross-sectional, population-based study. Subjects A total of 152,844 patients with diabetes from 90 major cities in 19 provincial regions of mainland China during 2018-2021 were finally recruited. Methods Blood pressure was graded into 5 levels: normal (without hypertension and <120/80 mmHg), normal high (without hypertension and ≥120/80 mmHg), HT-intensive (hypertension and <120/80 mmHg), HT-moderate (hypertension and blood pressure between 120/80 mmHg and 140/90 mmHg) and HT-high (hypertension and ≥140/90 mmHg). Logistic regression was employed to verify the associations of hypertension and blood pressure levels with DR, PDR and DME. The impacts of blood pressure levels on the outcomes were qualified with nomogram models. Main outcome measures The main outcome was DR. Results There were 16,685 (10.92%) participants having DR, 2841 (1.86%) having PDR, and 1566 (1.02%) having DME. There were 8126 (5.32%) patients without hypertension and 1350 (0.88%) patients with hypertension having blood pressure <120/80 mmHg. When compared to the normal group with covariates adjusted, an increased prevalence of DR was observed in normal high (adjusted odds ratio [OR] = 1.114, 95% confidence interval [CI] = 1.033-1.202), HT-moderate (adjusted OR = 1.163, 95% CI = 1.065-1.271), and HT-high (adjusted OR = 1.203, 95% CI = 1.114-1.300). Conclusions There were associations between hypertension and DR, PDR, and DME in the diabetic population. Increased prevalence of DR was found with blood pressure >120/80 mmHg in both patients with and without hypertension. A nomogram was developed for DR prediction based on blood pressure levels.
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Affiliation(s)
- Min Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinye Wu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimin Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Jiali Wu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Weiting Hu
- Shanghai Phoebus Medical Co. Ltd., Shanghai, China
| | - Huixun Jia
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
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Nadolsky K, Addison B, Agarwal M, Almandoz JP, Bird MD, DeGeeter Chaplin M, Garvey WT, Kyle TK. American Association of Clinical Endocrinology Consensus Statement: Addressing Stigma and Bias in the Diagnosis and Management of Patients with Obesity/Adiposity-Based Chronic Disease and Assessing Bias and Stigmatization as Determinants of Disease Severity. Endocr Pract 2023; 29:417-427. [PMID: 37140524 DOI: 10.1016/j.eprac.2023.03.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To focus on the intersection of perception, diagnosis, stigma, and weight bias in the management of obesity and obtain consensus on actionable steps to improve care provided for persons with obesity. METHODS The American Association of Clinical Endocrinology (AACE) convened a consensus conference of interdisciplinary health care professionals to discuss the interplay between the diagnosis of obesity using adiposity-based chronic disease (ABCD) nomenclature and staging, weight stigma, and internalized weight bias (IWB) with development of actionable guidance to aid clinicians in mitigating IWB and stigma in that context. RESULTS The following affirmed and emergent concepts were proposed: (1) obesity is ABCD, and these terms can be used in differing ways to communicate; (2) classification categories of obesity should have improved nomenclature across the spectrum of body mass index (BMI) using ethnic-specific BMI ranges and waist circumference (WC); (3) staging the clinical severity of obesity based on the presence and severity of ABCD complications may reduce weight-centric contribution to weight stigma and IWB; (4) weight stigma and internalized bias are both drivers and complications of ABCD and can impair quality of life, predispose to psychological disorders, and compromise the effectiveness of therapeutic interventions; (5) the presence and of stigmatization and IWB should be assessed in all patients and be incorporated into the staging of ABCD severity; and (6) optimal care will necessitate increased awareness and the development of educational and interventional tools for health care professionals that address IWB and stigma. CONCLUSIONS The consensus panel has proposed an approach for integrating bias and stigmatization, psychological health, and social determinants of health in a staging system for ABCD severity as an aid to patient management. To effectively address stigma and IWB within a chronic care model for patients with obesity, there is a need for health care systems that are prepared to provide evidence-based, person-centered treatments; patients who understand that obesity is a chronic disease and are empowered to seek care and participate in behavioral therapy; and societies that promote policies and infrastructure for bias-free compassionate care, access to evidence-based interventions, and disease prevention.
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Affiliation(s)
- Karl Nadolsky
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Brandi Addison
- South Texas Endocrinology and Metabolism Center, Corpus Christi, Texas
| | - Monica Agarwal
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Melanie D Bird
- American Association of Clinical Endocrinology, Jacksonville, Florida
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Benenson I, Prado K. Obesity-related hypertension: Implications for advanced nursing practice. Nurse Pract 2023; 48:8-15. [PMID: 37227309 DOI: 10.1097/01.npr.0000000000000055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
ABSTRACT Obesity increases the risk of hypertension and other cardiometabolic comorbidities. Lifestyle modifications are usually recommended, though lasting effects on weight and BP reduction are limited. Weight-loss medications, especially incretin mimetics, are effective for short- and long-term treatment. Metabolic surgery provides cure of obesity-related hypertension in some patients. NPs are well positioned to manage obesity-related hypertension to improve clinical outcomes of affected individuals.
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Barrios-Nolasco A, Domínguez-López A, Miliar-García A, Cornejo-Garrido J, Jaramillo-Flores ME. Anti-Inflammatory Effect of Ethanolic Extract from Tabebuia rosea (Bertol.) DC., Quercetin, and Anti-Obesity Drugs in Adipose Tissue in Wistar Rats with Diet-Induced Obesity. Molecules 2023; 28:molecules28093801. [PMID: 37175211 PMCID: PMC10180162 DOI: 10.3390/molecules28093801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Obesity is characterized by the excessive accumulation of fat, which triggers a low-grade chronic inflammatory process. Currently, the search for compounds with anti-obesogenic effects that help reduce body weight, as well as associated comorbidities, continues. Among this group of compounds are plant extracts and flavonoids with a great diversity of action mechanisms associated with their beneficial effects, such as anti-inflammatory effects and/or as signaling molecules. In the bark of Tabebuia rosea tree, there are different classes of metabolites with anti-inflammatory properties, such as quercetin. Therefore, the present work studied the effect of the ethanolic extract of T. rosea and quercetin on the mRNA of inflammation markers in obesity compared to the drugs currently used. Total RNA was extracted from epididymal adipose tissue of high-fat diet-induced obese Wistar rats treated with orlistat, phentermine, T. rosea extract, and quercetin. The rats treated with T. rosea and quercetin showed 36 and 31% reductions in body weight compared to the obese control, and they likewise inhibited pro-inflammatory molecules: Il6, Il1b, Il18, Lep, Hif1a, and Nfkb1 without modifying the expression of Socs1 and Socs3. Additionally, only T. rosea overexpressed Lipe. Both T. rosea and quercetin led to a reduction in the expression of pro-inflammatory genes, modifying signaling pathways, which led to the regulation of the obesity-inflammation state.
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Affiliation(s)
- Alejandro Barrios-Nolasco
- Laboratorio de Biología Celular y Productos Naturales, Escuela Nacional de Medicina y Homeopatía (ENMH), Instituto Politécnico Nacional, Guillermo Massieu Helguera 239, Col. La Escalera, Alcaldía Gustavo A. Madero, Ciudad de Mexico 07320, Mexico
| | - Aarón Domínguez-López
- Laboratorio de Biología Molecular, Escuela Superior de Medicina (ESM), Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de Mexico 11340, Mexico
| | - Angel Miliar-García
- Laboratorio de Biología Molecular, Escuela Superior de Medicina (ESM), Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de Mexico 11340, Mexico
| | - Jorge Cornejo-Garrido
- Laboratorio de Biología Celular y Productos Naturales, Escuela Nacional de Medicina y Homeopatía (ENMH), Instituto Politécnico Nacional, Guillermo Massieu Helguera 239, Col. La Escalera, Alcaldía Gustavo A. Madero, Ciudad de Mexico 07320, Mexico
| | - María Eugenia Jaramillo-Flores
- Laboratorio de Polímeros, Department de Ingeniería Bioquímica, Escuela Nacional de Ciencias Biológicas (ENCB), Instituto Politécnico Nacional, Wilfrido Massieu s/n esq. Manuel I. Stampa. Col. Unidad Profesional Adolfo López Mateos, Alcaldía Gustavo A. Madero, Ciudad de Mexico 07738, Mexico
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Gao Q, Li R, Chen Z, Yin W, Liao G, Zhang H, Wang J, Chen Y. Weight self-perception and weight loss attempts in Chinese cardiovascular patients and non-cardiovascular patients: evidence from a population-based study. BMC Public Health 2023; 23:707. [PMID: 37072724 PMCID: PMC10114385 DOI: 10.1186/s12889-023-15380-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Weight loss is a significant improvement for individuals with overweight or obesity, especially for cardiovascular patients. The driving effects of weight self-perception and attempts to lose weight are vital in weight management, yet weight misperception is a direct culprit for the undesirability of weight control and obesity prevention. This study aimed to investigate weight self-perception and misperception and weight loss attempts in Chinese adults, especially among cardiovascular and non-cardiovascular patients. METHODS We collected data from China HeartRescue Global Evaluation Baseline Household Survey 2015. Questionnaires were used to assess self-reported weight and cardiovascular patients. We used kappa statistics to check the consistency between weight self-perception and BMI. Logistic regression models were fitted to identify risk factors associated with weight misperception. RESULTS A total of 2690 participants were enrolled in the household survey, while 157 respondents were cardiovascular patients. According to questionnaire results, 43.3% of cardiovascular patients thought they were overweight and obese, while the percentage is 35.3% among non-cardiovascular patients. Kappa statistics indicated higher consistency of self-reported weight and actual weight among cardiovascular patients. Multivariate analysis showed weight misperception was significantly associated with gender, education level, and actual BMI. Lastly, 34.5% of non-cardiovascular patients and 35.0% of cardiovascular patients were trying to lose weight or keep weight. The majority of these people adopted combined strategies of controlling diet and exercise to lose or maintain weight. CONCLUSIONS Weight misperception was highly prevalent among cardiovascular or non-cardiovascular patients. Obese respondents, women, and individuals with lower education levels were more vulnerable to make weight misperception. However, no difference in the purpose of weight loss attempts was indicated among cardiovascular and non-cardiovascular patients.
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Affiliation(s)
- Qingyuan Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Ruotong Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, People's Republic of China
| | - Zhiteng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Wenyao Yin
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Guanghong Liao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Haifeng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China.
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China.
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China.
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China.
| | - Yangxin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, People's Republic of China.
- Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, 510120, People's Republic of China.
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Lingvay I, Mosenzon O, Brown K, Cui X, O'Neill C, Fernández Landó L, Patel H. Systolic blood pressure reduction with tirzepatide in patients with type 2 diabetes: insights from SURPASS clinical program. Cardiovasc Diabetol 2023; 22:66. [PMID: 36964557 PMCID: PMC10039543 DOI: 10.1186/s12933-023-01797-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/11/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide/ glucagon-like peptide-1 receptor agonist, is approved in the United States, Europe and Japan for the treatment of type 2 diabetes. Across the SURPASS-1 to -5 clinical studies, tirzepatide 5, 10 and 15 mg demonstrated significant improvements in glycated haemoglobin A1c (HbA1c) (- 1.9 to - 2.6%), body weight (- 6.6 to - 13.9%) and systolic blood pressure (SBP) (- 2.8 to - 12.6 mmHg) at the end of study treatment. METHODS Post-hoc mediation analyses were conducted to evaluate weight-loss dependent and weight-loss independent effects of tirzepatide on SBP reductions across the 5 SURPASS studies. The safety population (all randomized patients who took at least 1 dose of study drug) of each study was analyzed. Additional analyses were conducted at individual study level or pooled across 5 SURPASS trials. RESULTS The difference in mean SBP change from baseline at 40 weeks (total effect) between the tirzepatide and comparator groups was - 1.3 to - 5.1 mmHg (tirzepatide 5 mg), - 1.7 to - 6.5 mmHg (tirzepatide 10 mg) and - 3.1 to - 11.5 mmHg (tirzepatide 15 mg). These SBP reductions were primarily mediated through weight loss, with different degrees of contributions from weight-loss independent effects across the different trials. In the SURPASS-4 study, which enrolled patients with established cardiovascular disease, weight-loss independent effects explained 33% to 57% of difference in SBP change between tirzepatide and insulin glargine groups. In a pooled analysis of the SURPASS-1 to -5 studies, there was a significant (p < 0.001) but weak correlation (r = 0.18 to 0.22) between change in body weight and SBP. Reductions in SBP with tirzepatide were not dependent on concomitant antihypertensive medications at baseline as similar reductions were observed whether participants were receiving them or not (interaction p = 0.77). The largest SBP reductions were observed in the highest baseline category (> 140 mmHg), while those in the first quartile of baseline SBP category (< 122 mmHg) observed no further decrease in SBP. CONCLUSIONS Tirzepatide-induced SBP reduction was primarily mediated through weight loss, with different degrees of contributions from weight-loss independent effects across the different trials. SBP reduction was not dependent on antihypertensive medication use but dependent on baseline SBP value, alleviating theoretical concerns of hypotension.
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Affiliation(s)
- Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Xuewei Cui
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Hiren Patel
- Eli Lilly and Company, Indianapolis, IN, USA.
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Maruhashi T, Higashi Y. Current topic of vascular function in hypertension. Hypertens Res 2023; 46:630-637. [PMID: 36604472 PMCID: PMC9813887 DOI: 10.1038/s41440-022-01147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023]
Abstract
Vascular function assessment is useful for the evaluation of atherosclerosis severity, which may provide additional information for cardiovascular risk stratification. In addition, vascular function assessment is helpful for a better understanding of pathophysiological associations between vascular dysfunction and cardiometabolic disorders. In 2020 and 2021, although coronavirus disease 2019 (COVID-19) was still a worldwide challenge for health care systems, many excellent articles regarding vascular function were published in Hypertension Research and other major cardiovascular and hypertension journals. In this review, we summarize new findings on vascular function and discuss the association between vascular function and COVID-19, the importance of lifestyle modifications for the maintenance of vascular function, and the usefulness of vascular function tests for cardiovascular risk assessment. We hope this review will be helpful for the management of cardiovascular risk factors, including hypertension and cardiovascular diseases, in clinical practice.
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Affiliation(s)
- Tatsuya Maruhashi
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Yukihito Higashi
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.,Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
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41
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Holwerda SW, Gangwish ME, Luehrs RE, Nuckols VR, Thyfault JP, Miles JM, Pierce GL. Concomitantly higher resting arterial blood pressure and transduction of sympathetic neural activity in human obesity without hypertension. J Hypertens 2023; 41:326-335. [PMID: 36583358 PMCID: PMC9812452 DOI: 10.1097/hjh.0000000000003335] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Central (abdominal) obesity is associated with elevated adrenergic activity and arterial blood pressure (BP). Therefore, we tested the hypothesis that transduction of spontaneous muscle sympathetic nerve activity (MSNA) to BP, that is, sympathetic transduction, is augmented in abdominal obesity (increased waist circumference) and positively related to prevailing BP. METHODS Young/middle-aged obese (32 ± 7 years; BMI: 36 ± 5 kg/m2, n = 14) and nonobese (29 ± 10 years; BMI: 23 ± 4 kg/m2, n = 14) without hypertension (24-h ambulatory average BP < 130/80 mmHg) were included. MSNA (microneurography) and beat-to-beat BP (finger cuff) were measured continuously and the increase in mean arterial pressure (MAP) during 15 cardiac cycles following MSNA bursts of different patterns (single, multiples) and amplitude (quartiles) was signal-averaged over a 10 min baseline period. RESULTS MSNA burst frequency was not significantly higher in obese vs. nonobese (21 ± 3 vs. 17 ± 3 bursts/min, P = 0.34). However, resting supine BP was significantly higher in obese compared with nonobese (systolic: 127 ± 3 vs. 114 ± 3; diastolic: 76 ± 2 vs. 64 ± 1 mmHg, both P < 0.01). Importantly, obese showed greater increases in MAP following multiple MSNA bursts (P = 0.02) and MSNA bursts of higher amplitude (P = 0.02), but not single MSNA bursts (P = 0.24), compared with nonobese when adjusting for MSNA burst frequency. The increase in MAP following higher amplitude bursts among all participants was associated with higher resting supine systolic (R = 0.48; P = 0.01) and diastolic (R = 0.48; P = 0.01) BP when controlling for MSNA burst frequency, but not when also controlling for waist circumference (P > 0.05). In contrast, sympathetic transduction was not correlated with 24-h ambulatory average BP. CONCLUSION Sympathetic transduction to BP is augmented in abdominal obesity and positively related to higher resting supine BP but not 24-h ambulatory average BP.
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Affiliation(s)
- Seth W. Holwerda
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, Kansas
- KU Diabetes Institute, University of Kansas Medical Center, Kansas City, Kansas
- Kansas Center for Metabolism and Obesity, University of Kansas Medical Center, Kansas City, Kansas
| | - Megan E. Gangwish
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Rachel E. Luehrs
- Department of Kinesiology, North Central College, Naperville, Illinois
| | - Virginia R. Nuckols
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
| | - John P. Thyfault
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, Kansas
- KU Diabetes Institute, University of Kansas Medical Center, Kansas City, Kansas
- Kansas Center for Metabolism and Obesity, University of Kansas Medical Center, Kansas City, Kansas
| | - John M. Miles
- Department of Internal Medicine-Endocrinology and Metabolism, University of Kansas Medical Center, Kansas City, Kansas
| | - Gary L. Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
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A comparison study of prevalence, awareness, treatment and control rates of hypertension and associated factors among adults in China and the United States based on national survey data. GLOBAL HEALTH JOURNAL 2023. [DOI: 10.1016/j.glohj.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Ebadinejad A, Shahshahani M, Hosseinpanah F, Ghazy F, Khalaj A, Mahdavi M, Valizadeh M, Barzin M. Comparison of hypertension remission and relapse after sleeve gastrectomy and one-anastomosis gastric bypass: a prospective cohort study. Hypertens Res 2023; 46:1287-1296. [PMID: 36670229 DOI: 10.1038/s41440-023-01180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/27/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
This study aimed to assess the remission and relapse of hypertension (HTN) in hypertensive individuals who underwent sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) and identify the predictors of HTN remission and relapse following bariatric surgery. A prospective cohort study with a follow-up of 3 years was conducted on severely obese patients between 2013 and 2018. Hypertension remission was defined as the normalization of blood pressure (BP) with the discontinuation of medical treatment, and HTN relapse was defined as the need for the onset of antihypertensive drugs or the occurrence of BP impairment. A total of 787 hypertensive patients were included in this study. The cumulative incidence of HTN remission and relapse were 83.9% (95% CI: 81.6-86.5) and 31.4% (95% CI: 25.6-38.2), respectively. Remission and relapse were not significantly different among the patients undergoing either surgery (SG or OAGB). A higher remission rate was linked to a younger age and the use of fewer antihypertensive medications pre-operation. However, failure to successfully lose weight during the first year postoperative and weight regain predicted a higher risk of HTN relapse after 3 years. Following bariatric surgery, BP drops initially but then gradually rises. These alterations are responsible for about 31% relapse after 3 years in those who initially achieve remission. Patients who are younger and use less antihypertensive medications before surgery may benefit the most from bariatric surgery in terms of HTN. First-year successful weight loss and control of weight regain may prevent HTN relapse in the following years.
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Affiliation(s)
- Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahbod Shahshahani
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faranak Ghazy
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kennedy C, Hayes P, Salama S, Hennessy M, Fogacci F. The Effect of Semaglutide on Blood Pressure in Patients without Diabetes: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12030772. [PMID: 36769420 PMCID: PMC9917722 DOI: 10.3390/jcm12030772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
(1) Background: Recent advances in the pharmacological treatment of obesity with glucagon-like peptide-1 receptor agonists (GLP-1 RA) highlight the potential to target excess body weight to improve blood pressure (BP). This review aimed to determine the BP reduction in trials of semaglutide for weight reduction in patients without diabetes. (2) Methods: Relevant studies were identified via a search of research databases. Studies were screened to include randomized controlled trials (RCTs) of semaglutide versus a placebo in adults. Pooled and sensitivity analyses were performed, and risk of bias was assessed. (3) Results: six RCTs, with 4744 participants, were included in the final analysis. At baseline, the cohorts in these studies had a mean BP in the normotensive range. The mean difference in systolic BP was -4.83 mmHg (95% CI: -5.65 to -4.02), while that for diastolic BP was -2.45 mmHg (95% CI: -3.65 to -1.24). All included studies were of a high methodological quality. (4) Conclusions: A clinically significant reduction in BP was evident following semaglutide treatment in normotensive populations without diabetes. The effect of semaglutide in those with obesity and hypertension is as yet undetermined. Targeting excess body weight may be a novel therapeutic strategy for these patients.
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Affiliation(s)
- Cormac Kennedy
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
- Wellcome-HRB Clinical Research Facility, St James Hospital, D08W9RT Dublin, Ireland
- Department of Pharmacology, Trinity Health Sciences Centre, St James Hospital, D08W9RT Dublin, Ireland
- Correspondence:
| | - Peter Hayes
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Sulafa Salama
- Department of Pharmacology, Trinity Health Sciences Centre, St James Hospital, D08W9RT Dublin, Ireland
| | - Martina Hennessy
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
- Wellcome-HRB Clinical Research Facility, St James Hospital, D08W9RT Dublin, Ireland
- Department of Pharmacology, Trinity Health Sciences Centre, St James Hospital, D08W9RT Dublin, Ireland
| | - Federica Fogacci
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
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Compliance to Multidisciplinary Lifestyle Intervention Decreases Blood Pressure in Patients with Resistant Hypertension: A Cross-Sectional Pilot Study. J Clin Med 2023; 12:jcm12020679. [PMID: 36675608 PMCID: PMC9867179 DOI: 10.3390/jcm12020679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Hypertension is a common chronic medical condition. Treatment is not satisfactory in a significant proportion of patients with primary hypertension, despite the concurrent use of three or more medications with different mechanisms of action. Such treatment-resistant hypertension is a clinical challenge associated with poor prognosis and needs further investigation. The efficacy of lifestyle changes has not been established yet in patients with resistant hypertension, and educational efforts appear clinically irrelevant in patients who must achieve behavioral changes without supervision. A 6-month multidisciplinary pilot intervention enrolled 50 patients with established resistant hypertension. The aims were: (1) to examine whether intensive and supervised lifestyle changes contribute to decreasing blood pressure in this condition, and (2) to identify which components affect compliance and feasibility. The program provided intensive changes in nutrition, physical exercise, and control of sleep disturbances supervised by nutritionists, physiotherapists, and psychologists. Nurses and pharmacists followed up on adherence to the antihypertensive medication. The primary outcome was 24 h blood pressure control. Data in patients with full compliance (n = 30) indicate that lifestyle modifications in resistant hypertension significantly reduced 24 h both systolic and diastolic blood pressure (p < 0.01), body mass index (p < 0.01), medication burden (p = 0.04), improving physical fitness, and cardiovascular risk markers such as heart rate (p = 0.01) and augmentation index (p = 0.02). The adherence to the intervention was moderate, with an attrition rate of 12%. A modified version reducing visits and explorations will likely improve compliance and can be used to assess the long-term maintenance of these benefits in managing resistant hypertension by diverse healthcare providers.
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Parati G, Goncalves A, Soergel D, Bruno RM, Caiani EG, Gerdts E, Mahfoud F, Mantovani L, McManus RJ, Santalucia P, Kahan T. New perspectives for hypertension management: progress in methodological and technological developments. Eur J Prev Cardiol 2023; 30:48-60. [PMID: 36073370 DOI: 10.1093/eurjpc/zwac203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 01/14/2023]
Abstract
Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.
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Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | | | - David Soergel
- Cardiovascular, Renal, and Metabolic Drug Development, Novartis, Basel, CH 4056, Switzerland
| | - Rosa Maria Bruno
- Paris Cardiovascular Research Centre (PARCC-INSERM U970) & Université de Paris, Paris 75015, France
| | - Enrico Gianluca Caiani
- Politecnico di Milano, Electronics, Information and Bioengineering Department, Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), National Research Council of Italy (CNR), Milan 20133 & 24-10129, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen NO-5020, Norway
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg 66123, Germany
| | - Lorenzo Mantovani
- Value-based Healthcare Unit, IRCCS MultiMedica Research Hospital, University of Milan, Milan, Italy
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6HD, UK
| | - Paola Santalucia
- Italian Association Against Thrombosis and Cardiovascular Diseases (ALT Onlus), Milan 20123, Italy
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm SE 182 88, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm SE 182 88, Sweden
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Tan L, Long LZ, Ma XC, Yang WW, Liao FF, Peng YX, Lu JM, Shen AL, An DQ, Qu H, Fu CG. Association of body mass index trajectory and hypertension risk: A systematic review of cohort studies and network meta-analysis of 89,094 participants. Front Cardiovasc Med 2023; 9:941341. [PMID: 36684600 PMCID: PMC9846820 DOI: 10.3389/fcvm.2022.941341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/02/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Body mass index (BMI) trajectories, such as non-linear time trends and nonlinear changes in BMI with age, can provide information on the underlying temporal health patterns. The relationship between BMI trajectories and the risk of hypertension remains controversial. Methods PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched from their inception to January 31, 2022. We categorized BMI trajectories as "Stable high," "table normal," "Stable low," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)." The main outcome was the relative risk for the prevalence of hypertension in the different BMI trajectories. Potential sources of heterogeneity were examined using meta-regression and subgroup analysis. A publication bias test and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were also used. Results The 18 cohort studies included 89,094 participants. Compared with the "Stable normal" trajectory, "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension: [RR (95% CI)]: 1.80 (1.29 2.50), p < 0.001; 1.53 (1.27 1.83), p < 0.001; 1.30 (1.24 1.37), p = 0.001, respectively. The "Stable low" trajectory was associated with a reduced risk of hypertension [0.83 (0.79 0.83), p < 0.001]. The "Stable high" trajectory (surface under the cumulative ranking curve = 88.1%) had the highest probability of developing hypertension in the population. The certainty of the evidence for direct comparisons of the incidence of hypertension between various BMI trajectories was generally very low. Conclusion Our findings suggested that "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension, with the "Stable high" trajectory most likely associated with hypertension. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308575], identifier [CRD42022308575].
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Affiliation(s)
- Ling Tan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lin-zi Long
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao-chang Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,National Cardiovascular Clinical Medical Research Center of TCM, Beijing, China
| | - Wen-wen Yang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fei-fei Liao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Yu-xuan Peng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Jie-ming Lu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - A-ling Shen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Dong-qing An
- Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,National Cardiovascular Clinical Medical Research Center of TCM, Beijing, China,Hua Qu,
| | - Chang-geng Fu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,National Cardiovascular Clinical Medical Research Center of TCM, Beijing, China,*Correspondence: Chang-geng Fu,
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Yang C, Jia X, Wang Y, Fan J, Zhao C, Yang Y, Shi X. Trends and influence factors in the prevalence, intervention, and control of metabolic syndrome among US adults, 1999-2018. BMC Geriatr 2022; 22:979. [PMID: 36536296 PMCID: PMC9764589 DOI: 10.1186/s12877-022-03672-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
AIM We aimed to describe the trends in the prevalence, intervention, and control of metabolic syndrome (MetS) among US adults through 1999-2018. Additionally, the influence factors of MetS and its control were further explored. METHODS We included participants older than 20 using the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 (n = 22,114). The rate of prevalence, intervention, and control of MetS were caculated by survey weights. Joinpoint regression and survey-weighted generalized linear models were used to analyze trends and influence factors, respectively. RESULTS The prevalence of MetS increased from 28.23 to 37.09% during 1999-2018 (P for trend < 0.05). The former smoker (OR = 1.20, 95%CI: 1.07, 1.36) and current smoker (OR = 1.27, 95%CI: 1.11, 1.45) increased the prevalence of MetS. While vigorous activity (OR = 0.53, 95%CI: 0.47, 0.61) decreased it. Among MetS components, the prevalence of elevated blood-glucose (from 21.18 to 34.68%) and obesity (from 44.81 to 59.06%) raised (P for trend < 0.05), with an uptrend in the use of antidiabetic (from 9.87 to 28.63%) and a downtrend of vigorous activity (from 23.79 to 16.53%) (P for trend < 0.05). Decreased trends were observed in the control of Hb1Ac (< 7%) (from 87.13 to 84.06%) and BMI (<25 kg/m2) (from 11.36 to 7.49%). Among MetS underwent antidiabetic, 45-64 years old and male decreased the control of Hb1Ac (< 7%). The control of BMI (<25 kg/m2) among individuals with physical activity was reduced mainly in the population of younger (aged 20-44 years old), male, non-Hispanic black, middle income and smoker (former and current). CONCLUSIONS The prevalence of MetS increased significantly through 1999-2018. Elevated blood glucose and obesity were the main causes of MetS burden. Quitting smoking and increasing physical activity may decrease the prevalence of MetS. In the control of blood-glucose and obesity, we should screen out the focus population to modify treatment and improve lifestyle.
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Affiliation(s)
- Chaojun Yang
- grid.207374.50000 0001 2189 3846Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Xiaocan Jia
- grid.207374.50000 0001 2189 3846Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Yuping Wang
- grid.207374.50000 0001 2189 3846Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Jingwen Fan
- grid.207374.50000 0001 2189 3846Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Chenyu Zhao
- grid.207374.50000 0001 2189 3846Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Yongli Yang
- grid.207374.50000 0001 2189 3846Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
| | - Xuezhong Shi
- grid.207374.50000 0001 2189 3846Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001 Henan China
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Abstract
IMPORTANCE Hypertension, defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg, affects approximately 116 million adults in the US and more than 1 billion adults worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and death. OBSERVATIONS First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption. The BP-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy. The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk. First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic such as hydrochlorothiazide or chlorthalidone, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker such as enalapril or candesartan, and a calcium channel blocker such as amlodipine and should be titrated according to office and home SBP/DBP levels to achieve in most people an SBP/DBP target (<130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years). Randomized clinical trials have established the efficacy of BP lowering to reduce the risk of CVD morbidity and mortality. An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30%. Despite the benefits of BP control, only 44% of US adults with hypertension have their SBP/DBP controlled to less than 140/90 mm Hg. CONCLUSIONS AND RELEVANCE Hypertension affects approximately 116 million adults in the US and more than 1 billion adults worldwide and is a leading cause of CVD morbidity and mortality. First-line therapy for hypertension is lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption. When drug therapy is required, first-line therapies are thiazide or thiazidelike diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers.
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Affiliation(s)
- Robert M Carey
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
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Samson R, Ennezat PV, Le Jemtel TH, Oparil S. Cardiovascular Disease Risk Reduction and Body Mass Index. Curr Hypertens Rep 2022; 24:535-546. [PMID: 35788967 DOI: 10.1007/s11906-022-01213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Anti-hypertensive and lipid lowering therapy addresses only half of the cardiovascular disease risk in patients with body mass index > 30 kg/m2, i.e., obesity. We examine newer aspects of obesity pathobiology that underlie the partial effectiveness of anti-hypertensive lipid lowering therapy for the reduction of cardiovascular disease risk in obesity. RECENT FINDINGS Obesity-related insulin resistance, vascular endothelium dysfunction, increased sympathetic nervous system/renin-angiotensin-aldosterone system activity, and glomerulopathy lead to type 2 diabetes, coronary atherosclerosis, and chronic disease kidney disease that besides hypertension and dyslipidemia increase cardiovascular disease risk. Obesity increases cardiovascular disease risk through multiple pathways. Optimal reduction of cardiovascular disease risk in patients with obesity is likely to require therapy targeted at both obesity and obesity-associated conditions.
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Affiliation(s)
- Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | | | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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