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BACKGROUND: The flow reaching the vocal folds may be lower than that at the output of high-flow nasal cannula (HFNC) system. This could be due to upper-respiratory obstruction, oxygen leakage, or other factors. The objective of this study was to observe the effect of flow through a nasopharyngeal airway on intrapharyngeal pressure (IPP) in subjects undergoing fiberoptic bronchoscopy (FOB). METHODS: Patients scheduled for FOB were invited to participate. Measurements were performed at flows of 0-60 L/min; the subjects wore WN-N95 folding medical protective masks (N95) and either underwent FOB or not. IPP at each flow was recorded following 15 s of ventilation, and the cross-sectional area (CSA) of the gastric sinus was measured before and after FOB. Hypoxemia, reflux aspiration, and other pertinent events were recorded. RESULTS: Sixty subjects undergoing FOB at the Affiliated Hospital of Jiaxing University participated in this trial from October 2022-September 2023. IPP increased significantly with an increase in flow and also increased after placing the N95 mask with the same flow (P < .001). When results from before to after FOB were compared, the difference in CSA was statistically significant 263.6 (220.7-300.5) mm² vs 305.5 (275.4-329.5) mm², P < .001, but the difference in the risk of reflux aspiration was not statistically significant (0% vs 6.7%, P = .13). Complication rates during treatment were 8.3% for hypoxemia, 0% for reflux aspiration, 1.7% for hypertension, 1.7% for hypotension, 6.7% for tachycardia, 5% for bradycardia, and 10% for postoperative nausea and vomiting. CONCLUSIONS: HFNC can provide effective oxygen therapy for people undergoing FOB, and increases in IPP with flow in the range of 0-60 L/min may not increase the risk of reflux aspiration. [ABSTRACT FROM AUTHOR]

• We confirmed the predictive value of ESC/EAS 2019 risk stratification in a Portuguese cohort. • Total ASCVD events, fatal and non-fatal, were included in the analysis. • Poor LDL-C goal attainment was observed by the time patients entered risk categories. • Moderate intensity statins were the most frequently prescribed for all risk categories. • Individual risk criteria had a significant impact on cardiovascular outcomes. Cardiovascular (CV) risk scores identify individuals at higher long-term risk of CV events that may benefit from more aggressive preventive interventions. To assess the association of CV-risk categories and criteria with long-term CV events. Observational cohort study between 2000–2019 on patients aged 40–80 years, followed by 14 primary care centers assisted by 1 hospital in Portugal. Follow-up began when electronic health records data allowed for CV-risk classification and dynamic reassessment per 2019 ESC/EAS Guidelines. Inclusion criteria required at least one appointment with a primary care physician within three years before follow-up initiation. We assessed the 10-year adjusted hazard-ratio of combined CV death and non-fatal atherosclerotic cardiovascular disease (ASCVD) hospitalization, across SCORE risk categories and criteria, using Cox proportional hazards models adjusted for sex, age, competing comorbidities, and medication. The study included 161 681 observations from 87 035 unique patients. During the observation period, 71 787 patients were classified as low/moderate, 51 476 as high and 38 418 as very-high CV-risk categories. In the very-high group, prevalent comorbidities were hypertension (69%), hypercholesterolemia (69%) and type 2 diabetes (61%), and 13% were hospitalized for ASCVD. The adjusted 10-year hazard ratio of the composite of CV death or ASCVD hospitalization was 2.10 (95% CI: 1.91–2.32) for high-risk and 3.56 (95% CI: 3.21–3.96) for very-high-risk patients (low-risk as reference). Our study reinforces the prognostic relevance of CV-risk stratification for long-term prediction of CV death and ASCVD hospitalization in an unselected cohort, independently of sex, age, competing comorbidities and medication. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy (HDP) are maternity-related increases in blood pressure (eg, gestational hypertension, preeclampsia, and eclampsia). Compared with women of other races in high-income countries, Black women have a comparatively higher risk of an HDP. Intersectionality helps to provide a deeper understanding of the multifactorial identities that affect health outcomes in this high-risk population. Objective: In this review, we sought to explore the literature on HDP risk factors in Black women living in high-income countries and to assess the interaction of these risk factors using the conceptual framework of intersectionality. Methods: We conducted this review using the Arksey and O'Malley methodology with enhancements from Levac and colleagues. Published articles in English on HDP risk factors with a sample of not less than 10% of Black women in high-income countries were included. Six databases, theses, and dissertations were searched from January 2000 to July 2021. A thematic analysis was used to summarize the results. Results: A final total of 36 studies were included from the 15 480 studies retrieved; 4 key themes of HDP risks were identified: (1) biological; (2) individual traditional; (3) race and ethnicity, geographical location, and immigration status; and (4) gender related. These intersectional HDP risk factors intersect to increase the risk of HDP among Black women living in high-income countries. Conclusion: Upstream approaches are recommended to lower the risks of HDP in this population. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to examine the hypothesis that periodontal disease is associated with chronic non-communicable diseases. Methods: In this cross-sectional study, we evaluated the periodontal health condition of the population, based on the community periodontal index, as well as the number of missing teeth and the presence of systemic health conditions. We quantified the association between oral health and the presence of chronic diseases using simple logistic regression, adjusting for confounding factors including age, smoking, and overweight. Results: The study population consisted of 334 volunteers, aged between 19 and 81 years. In patients over 45 years old, periodontal disease was found to be significantly associated with hypertension and diabetes. Furthermore, in female patients, periodontal disease was significantly associated with hypertension, diabetes, and cancer. Conclusion: Our findings indicate that periodontal disease is positively and significantly associated with both arterial hypertension and diabetes, independent of potential confounding factors. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia is a major cause of maternal and fetal morbidity and mortality, accounting for approximately 25% of maternal deaths in Latin America. Preeclampsia is a state of systemic inflammation due to an immunologic imbalance between proinflammatory and regulatory T cells, leading to multiorgan damage. Objective: To describe the clinical features, biochemical markers, and acute phase reactants of inflammation in hypertensive disorders of pregnancy. Materials and methods: An observational, cross-sectional, prospective study was conducted in hypertensive pregnant patients hospitalized at the Women's Hospital of Culiacan, Mexico, from March 2021 to January 2022. These patients were classified according to the type of hypertension based on 24-hour urine protein determination. A toxicologic profile including uric acid, lactate dehydrogenase (LDH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum lipids, and total leukocytes was obtained to calculate the neutrophil-lymphocyte ratio of patients in each of the study groups. The body mass index (BMI) was also calculated. Data were analyzed using Stata Intercooled 13.1. Results: The mean age of the included patients was 25.43±6.5 years, gestational age was 37.35±2.73, 35.9% were primigravida, and 16.07% were adolescents. Among the 397 cases, 23.17% had severe preeclampsia, 24.69% had non-severe pre-eclampsia, 27.2% had gestational hypertension, and 24.94% were healthy controls. Neutrophil-lymphocyte ratio, uric acid, urea, LDH, and CRP were higher in the most severe cases of hypertensive disease. Changes in serum magnesium levels were mainly observed in severe preeclampsia. Conclusions: In this study, biochemical and inflammatory markers were higher in severe forms of hypertensive disorders of pregnancy. [ABSTRACT FROM AUTHOR]

Aim and Objective: To study the prevalence and risk factors of prehypertension and hypertension among adolescents (18–19 years) at the entry level of professional course. Materials and Methods: After institutional ethics committee approval and informed consent from participants, the data were collected and entered into the Excel sheet. Appropriate statistical analysis was applied. The final result was statistically interpreted. Results: A total of 273 student participants were included in the study. There were 104 males and 169 females. One hundred and seven participants were 18 years old and 168 were 19 years old. Male: female ratio is 1:1.6. Prehypertension was seen in 91 (33.3%) and hypertension was observed in 34 (12.57%). Seven (20.6%) cases had a family history of hypertension. Twenty-two (8.1%) had addictive habits. Inadequate physical activity was seen in 32 (94.1%) of cases who had hypertension. Poor sleep quality was seen in hypertensives (17; 50%). In our study also, there was no statistically significant association between gender and systolic blood pressure and diastolic blood pressure (P > 0.05). There is a statistical significance association between the gender and body mass index (BMI) but not between BMI and hypertension status. There was statistically significant association was there between prehypertension and hypertension with habits. Conclusion: Change in habits and dietary modification will have impact on the development of prehypertension and or hypertension among adolescents. More emphasis must be given to screen adolescents at college entry. Adolescents are best target age group for primordial prevention. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the impact of anthropometric indices of obesity (body mass index [BMI], waist circumference, waist hip ratio, and body fat percentage) on the incidence of hypertension in adults with prehypertension. Methods: A longitudinal study design using secondary data form the Korean Genome and Epidemiology Study was employed. The study included 1,838 adults with prehypertension tracked every two years from 2001 to 2018. Statistical analyses, including frequency assessments, number of cases per 1,000 person-years, log-rank tests, Kaplan-Meier curves, and Cox's proportional hazards regression, were conducted using SPSS version 25. Results: Over the observation period (15,783.6 person-years), 1,136 individuals developed hypertension. The incidence of hypertension was significantly higher in the obesity groups defined by BMI (hazard ratio [HR] = 1.33), waist circumference (HR = 1.34), waist hip ratio (HR = 1.29), and body fat percentage (HR = 1.31) compared to the non-obese group. These findings indicate an increased risk of hypertension associated with obesity as measured by these indices. Conclusion: The study underscores the importance of avoiding obesity to prevent hypertension in individuals with prehypertension. Specifically, BMI, waist circumference, waist hip circumference, and body fat percentage were identified as significant risk factors for hypertension. The results suggest the need for individualized weight control interventions, emphasizing the role of health professionals in addressing the heightened hypertension risk in this population. [ABSTRACT FROM AUTHOR]

Hypertension is common and is a cause of morbidity and mortality around the world. Many affected are unaware that they have a problem, and it is found opportunistically when their blood pressure is recorded during a consultation for another problem. If the disease is inadequately treated, it can have potentially fatal outcomes. Nurses and non-medical prescribers are likely to come across patients with raised blood pressure readings during routine clinic appointments. This article hopes to give them a better understanding of the condition, its treatment and complications, with the aim of reducing the risk of serious problems and improving outcomes for all those affected by this potentially dangerous condition. [ABSTRACT FROM AUTHOR]

In recent years, multiple novel and improved therapies have become available to treat alopecia disorders. Whereas many therapeutics are entirely new, some medications, such as oral minoxidil, have been available for years and are just now being revisited as potentially valuable hair loss treatments. This article discusses the risks, benefits, and potential side effects of the off-label use of low-dose oral minoxidil. It compares low-dose oral minoxidil with topical minoxidil, a well-established and FDA-approved treatment for androgenetic alopecia, but one that is often associated with poor overall adherence. Finally, nursing considerations in the education and care of patients with alopecia disorders and associated medications are discussed. [ABSTRACT FROM AUTHOR]

Insertion/deletion polymorphism of the angiotensin converting enzyme (ACE) gene is a key component of the Renin-Angiotensin-Aldosterone System (RAAS). It has been proposed as an independent factor for hypertension and other cardiovascular diseases. Consequently, it has been extensively studied in various populations. The aim of this study is to investigate I/D polymorphism of ACE gene and its connection to hypertension in population of Tuzla Canton (Bosnia & Herzegovina). The study included 60 hypertensive subjects and 60 healthy control subjects with no risk factors for hypertension. I/D polymorphism was genotyped by polymerase chain reaction followed by gel electrophoresis and data obtained were statistically analysed using Chi square test. Odd's ratios were calculated with a 95% confidence interval. P-value <0.05 was considered significant. Odd's ratios were calculated with a 95% confidence interval. P-value <0.05 was considered significant. Higher frequency of genotype D/D and allele D was determined in subjects with hypertension compared to control subjects but there is no statistical significance (p>0.05). However, statistically significant association was found in compared groups of subjects with genotypes DD + ID, in regards to genotype I/I (p<0.05). The results indicate the conclusion that ACE I/D polymorphism cannot be considered the main risk factor for development of hypertension, but its influence should be investigated together with other genetic and acquired risk factors that are associated with hypertension. This research contributes to the ongoing exploration of molecular-genetic associations with hypertension. [ABSTRACT FROM AUTHOR]

The article presents the discussion on comparison between normal-weight workers, overweight or obese employees in Spain exhibited a higher prevalence of risk factors for cardiovascular disease. Topics include employees being covered by a health insurance company undergone initial medical exams; and evidence exists regarding the effects of other factors, such as sleep habits, smoking, and alcohol consumption.

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Nine percent of youth with type 1 diabetes have LDL-hypercholesterolemia. • High LDL-C is associated with family history for premature CVD/hypercholesterolemia. • Youths with LDL-hypercholesterolemia have unfavorable CV risk profile. Mortality and morbidity in people with Type 1 diabetes (T1D) is mainly caused by cardiovascular disease (CVD). Early treatment of cardiovascular risk factors (CVRFs) is of great importance. To analyze the prevalence of LDL-hypercholesterolemia and other CVRFs in youth with T1D. Clinical and laboratory parameters, and vascular thickness measurement were obtained in youth with T1D (age 6-18 years, T1D duration >1 year) attending a diabetes clinic. LDL-hypercholesterolemia, microalbuminuria and arterial hypertension were defined as CVRFs. A total of 333 youth (48% girls; age: 13.3 years [10.3-15.5], median [interquartile range]) participated in the study. The T1D duration was 5.9 years [3.5-9.4] with HbA1c of 7.4% [6.8-8.0]. Intima media thickness (N=223) was 538.0 µm [470.0-618.0]). LDL-hypercholesterolemia was present in 30 participants (9%; 18 girls; age: 14.3 years [11.2-15.7]). None of the participants had persistent microalbuminuria, although 59 (18.3%) had elevated albumin excretion in a random urine specimen. LDL-hypercholesterolemia was associated with increased blood pressure (p<0.05), insulin requirement (p<0.05), HbA1c (p<0.05), triglyceride (p<0.001) and total cholesterol (p<0.001), and a family history of premature CVD (p<0.001), but negatively correlated with HDL cholesterol levels (p<0.05). Sex, pubertal status, duration of diabetes, type of therapy, and physical activity did not differ between participants with and without LDL- hypercholesterolemia. Arterial hypertension was present in 11 participants (3.3%; 4 girls; age: 14.1 years [11.1-16.1]). LDL-hypercholesterolemia affected 9% of youth with T1D in this cohort and was associated with other CVRFs. A holistic therapeutic concept for these young people is essential. [ABSTRACT FROM AUTHOR]

In three socioeconomically diverse regions of rural India, we determined the optimal cut-offs for definition of overweight, the prevalence of overweight, and the relationships between measures of overweight and risk of hypertension. Villages were randomly sampled within rural Trivandrum, West Godavari, and Rishi Valley. Sampling of individuals was stratified by age group and sex. Cut-offs for measures of adiposity were compared using area under the receiver operating characteristic curve. Associations between hypertension and definitions of overweight were assessed by logistic regression. Of 11 657 participants (50 % male; median age 45 years), 29.8 % had hypertension. Large proportions were overweight as defined by body mass index (BMI) ≥ 23 kg/m2 (47.7 %), waist circumference (WC) ≥ 90 cm for men or ≥ 80 cm for women (39.6 %), waist-hip ratio (WHR) ≥ 0.9 for men or ≥ 0.8 for women (65.6 %), waist-height ratio (WHtR) ≥ 0.5 (62.5 %), or by BMI plus either WHR, WC or WHtR (45.0 %). All definitions of overweight were associated with hypertension, with optimal cut-offs being at, or close to, the World Health Organization (WHO) Asia-Pacific standards. Having overweight according to both BMI and a measure of central adiposity was associated with approximately twice the risk of hypertension than overweight defined by only one measure. Overweight, as assessed by both general and central measures, is prevalent in rural southern India. WHO standard cut-offs are appropriate in this setting for assessing risk of hypertension. However, combining BMI with a measure of central adiposity identifies risk of hypertension better than any single measure. The risk of hypertension is significantly greater in those centrally and generally overweight than those overweight by a single measure. • Approximately half of adult residents in rural South India have overweight or obesity. • Having overweight is positively associated with risk of hypertension in rural South India. • The WHO Asia Pacific BMI cut-offs for overweight are appropriate for assessing risk of hypertension in rural South India. • Combined general and central adiposity is associated with twice the risk of hypertension than either form of adiposity alone. [ABSTRACT FROM AUTHOR]

Depending on end-organ involvement, hypertensive crisis is classified as hypertensive urgency or hypertensive emergency. The recognition of a hypertensive crisis will lead to the adequate reduction of blood pressure to ameliorate the incidence of end-organ damage. Hypertensive crises result from dysfunction in the renin-angiotensin-aldosterone system and damage to the vascular bed. They occur commonly in the emergency department setting and can lead to increased mortality rates if not treated. Registered nurses play a vital role in assessing patients and administering medications during hypertensive crises. This article will outline the assessment strategies that registered nurses should implement in critical care units while patients are receiving antihypertensive drugs. We will also underscore the significance of monitoring specific laboratory values to mitigate the potential side effects of these drugs and exclude them when contraindicated. [ABSTRACT FROM AUTHOR]

Patients with early chronic kidney disease (CKD) or underlying risk factors are often unaware of their kidney test results, common causes of CKD, and ways to lower risk of disease onset/progression. To test feasibility of a pharmacist-led intervention targeting patient education and risk factors in patients with early CKD and those at risk for CKD. Ambulatory care pharmacists in community-based primary care clinics delivered kidney health education, ordered labs, and recommended medication adjustments. We identified patients with a moderate rate of decline (≥2 mL/min/1.73 m2 per year) in estimated glomerular filtration (eGFR) at-risk for CKD or early stage CKD. An interactive workbook was designed to teach patients about kidney test results and self-management of risk factors including hypertension, type 2 diabetes, cigarette smoking, and chronic oral nonsteroidal anti-inflammatory drug use. Outcomes included visit uptake, completion of annual albuminuria screening, and initiation of guideline-directed medications for CKD. Patients were surveyed pre- and post-intervention for kidney health knowledge and perceptions regarding pharmacist-provided information. Our sample of 20 participants had a mean eGFR of 59 mL/min/1.73 m2 and the mean eGFR decline was −4.6 mL/min/1.73 m2 per year. There were 47 visits during the pilot period from February 2021 to October 2021. Thirteen patients were missing albuminuria screening within 12 months; 2 of 9 patients with resulting labs had new microalbuminuria and were started on renoprotective medications. Patients had improved understanding of their kidney function test results and most did not consider the information scary or confusing. Barriers to enrollment included fewer participants with multiple risk factors for CKD. The pharmacists were able to engage patients in learning the importance of monitoring and self-management of kidney health. A collaborative practice agreement may enhance a similar intervention that includes initiation of renoprotective medications. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a heterogeneous disease that is modified by many risk factors, most notably hypertension. Although its negative effects on the retinal, renal, cardiovascular, and peripheral nervous systems are well known, its impact on cognitive performance has received less attention. It has been shown that diabetes is linked to mild cognitive impairment, a transitional stage between normal aging and dementia. Methods: In this case-control study, 150 patients, which were further divided into three groups of 50 patients each with 50 patients who fulfilled the American Diabetes Association's (ADA) Guidelines 2018 for diabetes were in Group A, 50 patients who fulfilled both ADA Guidelines 2018 for diabetes and Joint National Committee 7 (JNC 7) Guidelines for hypertension in Group B while 50 healthy subjects in Group C, were included after applying the exclusion criteria and were subjected to cognitive assessment by Montreal cognitive assessment (MoCA) test. Results: In the diabetic arm of the study (n = 100), 65% (n = 65) of the patients had cognitive impairment as compared to the control group (n = 50), where only 12% (n = 6) of the patients had cognitive decline (P < 0.001). The mean MoCA scores were lowest in patients who had concomitant diabetes and hypertension (23.86 ± 1.78) as compared to patients having diabetes alone (24.76 ± 1.38) while the control group had the highest mean MoCA score (27.46 ± 1.69) (P < 0.001). Age correlated negatively with MoCA while no correlation was observed with gender distribution and area of residence. Duration of diabetes correlated negatively with MoCA scores in Group A (-0.874) (P < 0.001) and Group B (-0.801) (P < 0.001). Duration of hypertension also showed a negative correlation with MoCA scores in Group B (-0.745) (P < 0.001). A negative correlation was also observed between glycated hemoglobin and MoCA scores in Group A (-0.665) (P = 0.001) and Group B (-0.567) (P = 0.034). Conclusions: In conclusion, the incidence and severity of cognitive impairment was more in patients having concomitant diabetes and hypertension as compared to patients having diabetes alone, thus signifying the additional burden and contribution of hypertension to the cognitive decline. [ABSTRACT FROM AUTHOR]

The National Institute for Clinical Excellence (NICE) has just released its latest guidelines to assess and predict health risk, such as type 2 diabetes, hypertension or cardiovascular disease. Their latest advice is "Keep the size of your waist to less than half of your height". We believe this advice is flawed and will seriously and unfairly penalize shorter people and lull taller people into a false sense of security. In this short communication, we provide this evidence. We consider this a serious oversight by NICE and feel strongly that this evidence needs to be made available in the public domain. [ABSTRACT FROM AUTHOR]

Background: Depression is a risk factor for hypertension, yet few studies have been conducted in African American women. Objective: We conducted a secondary analysis of depressive symptoms and high blood pressure among African American women from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure longitudinal study (N = 250). Methods: Logistic regression was used to examine depressive symptoms and blood pressure, adjusting for education, employment, and racism/discrimination. Growth curve modeling was used to investigate longitudinal associations between depressive symptoms and systolic (SBP) and diastolic (DBP) blood pressures at 4 time points (T1–T4). Results: Depressive symptoms at baseline were not prospectively associated with hypertension prevalence. Participants with Beck Depression Inventory scores higher than 10 had higher estimated marginal SBP and DBP over time compared with participants with lower scores. Conclusion: Depressive symptoms were not associated with hypertension prevalence at T4, but they were associated with higher estimated marginal SBP and DBP. Future research is needed to elucidate mechanisms and implications for clinical care and prevention. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Health related quality of life (HRQoL) is a determinant of physical, social and emotional well-being post-stroke. Objectives: This study aimed to correlate self-reported HRQoL with activities of daily living (ADL) and stroke severity. Method: A longitudinal observational study was conducted at a rehabilitation centre in the Western Cape, South Africa. Stroke inpatients were sampled over 6 months. The Euro-QoL Five Dimensions instrument (EQ5D-3L) for self-reported HRQoL, Barthel Index (BI) for function and independence in ADL, and modified Rankin Scale (mRS) for stroke severity were administered on admission and discharge. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25. Results: Of the 54 potential participants, 49 met inclusion criteria and 41 completed reassessments (median age 48 years [interquartile range {IQR} 39–60]; median length of stay 53 days [IQR 46–60]). Most participants had infarctions (89.90%); with hypertension or diabetes risk factors (73.47% and 28.57%, respectively). The BI and mRS scores improved significantly (p < 0.001) with very strong correlation between scores (rs = -0.874, p < 0.001); indicating a trend of decreased stroke severity as function improved. The EQ5D Visual Analog Scale (VAS) scores (p < 0.001) and domains mobility, self-care, usual activities (p < 0.001) and pain/discomfort (p = 0.034) improved significantly. The anxiety/depression domain showed a non-significant change (p = 0.378). A weak negative significant correlation existed between EQ5D VAS and mRS scores (rs = -0.362; p = 0.02); indicating a trend that HRQoL was not improving to the degree stroke severity decreased. A weak positive significant correlation was seen between EQ5D VAS and BI scores (rs = 0.329; p = 0.036). Conclusion: Although an improvement was noted in HRQoL, EQ5D VAS scores tended not to improve as strongly, despite significant improvements in function and stroke severity. These findings demonstrate the need for psychological support and pain management interventions for adjustment post-stroke. [ABSTRACT FROM AUTHOR]

Background/purpose: Hypertension is a risk factor of incident diabetes. In 2017, the ACC/AHA updated the definition of hypertension to above 130/80 mmHg, while the 2018 ESC/ESH guideline and the JNC7 criteria remained the cutoff of 140/90 mmHg. This study was aimed to investigate how different cutoffs of hypertension affect the association of hypertension to incident diabetes and the progression of insulin resistance.Methods: A total of 1177 subjects without diabetes at baseline were followed for 4.5 years. Diabetes was diagnosed by the results of oral glucose tolerance tests and hemoglobin A1c, or if anti-diabetic agents were used.Results: Hypertension by both criteria was associated with incident diabetes. Change of HOMA2-IR every 5 years (ΔHOMA2-IR/5 yr) was higher in subjects with hypertension than those without (adjusted p = 0.044). Subjects with treated hypertension had the highest risk of diabetes (HR 2.98, p < 0.001) and ΔHOMA2-IR/5 yr, compared with subjects with normal blood pressure. However, the associations of hypertension, HR of incident diabetes and ΔHOMA2-IR/5 yr were attenuated by the 2017 ACC/AHA criteria, as compared with that by the JNC7 and 2018 ESC/ESH criteria.Conclusion: Hypertension by both criteria is associated with incident diabetes and accelerated progression of insulin resistance, and the associations are attenuated by the 2017 ACC/AHA criteria. [ABSTRACT FROM AUTHOR]

Hypertension is a major modifiable risk factor for cardiovascular diseases and all-cause death globally and in Africa. The prevalence of hypertension in Nigeria is 28.9%. In Nigeria, analytical studies to determine risk factors and potential biomarkers of hypertension are lacking. This study was conducted to determine lifestyle, anthropometric, socio-demographic, and biochemical risk factors associated with hypertension in Lagos, Nigeria. This case–control study was conducted among 410 participants, aged 18–65 years. A well-structured questionnaire was used to collect data from cases and controls. Anthropometric and blood pressure measurements were taken. Blood samples were also collected for biochemical analysis. Logistic regression analysis was used to determine risk factors associated with hypertension. Data obtained were analyzed using SPSS version 25.0. P-value less than 0.05 was considered statistically significant. In total, 205 hypertensive cases and 205 normotensive controls were recruited. The mean ± SD age of the participants was 39.25 ± 11.49 years. Overall, 180 (44%) of participants were female. Logistic regression analysis indicated that obesity (OR = 3.324, 95% CI = 1.693–6.527, P= 0.000), family history (OR = 2.861, 95% CI = 1.731–4.729, P= 0.000), hypercholesterolemia (OR = 2.940, 95% CI = 1.577–5.480, P= 0.001), insufficient fruits and vegetables intake (OR = 0.152, 95% CI = 0.085–0.273, P= 0.000), frequent intake of dietary salt (OR = 0.400, 95% CI = 0.198–0.810, P= 0.011), and smoking status (OR = 3.709, 95% CI = 1.061–12.964, P= 0.040) were significantly associated with hypertension. Population-based approaches to reduce exposure to hypertension risk factors are required for effective prevention and control of hypertension and cardiovascular diseases in Lagos, Nigeria. [ABSTRACT FROM AUTHOR]

• The study resurveyed subjects every 4–5 years to capture dynamic changes. • The long-term stability of MHO may be an exception, not the norm. • The 4.4-year predicted probability of transition from the MHO to MUO phenotype was 0.19. • One-third of the MHO subjects were unhealthy after 12–15 years. • Metabolic deterioration of the metabolite BMI phenotype conferred an increased risk of CVD. The prognostic significance of obesity phenotypes is under debate, and few studies have characterized their transition trajectories. This study examined the natural courses of different phenotypes and their associations with cardiovascular disease risks. A total of 1827 participants were followed for 14 years and re-evaluated every 4–5 years. Four metabolite BMI phenotypes were determined according to overweight or obesity (BMI ≥ 24 kg/m2) and metabolic health status (≤1 Adult Treatment Panel III criteria, excluding waist circumference). Cardiovascular risks were assessed by evaluating baPWV and hypertension, diabetes and chronic kidney disease (CKD) development. More than 20% of participants changed their initial phenotypes within 5 years. One-third of healthy overweight/obese (MHO) individuals became unhealthy, and only 10.6% regressed to a healthy normal weight (MHN) at the end of follow-up. Compared with MHN participants, MHO participants had higher odds of increased baPWV (OR: 1.18, 95% CI, 0.42–3.33) and increased risks of incident hypertension (HR: 1.87, 95% CI, 1.18–2.98) and diabetes (HR: 2.61, 95% CI, 1.35–5.03). Metabolic deterioration during follow-up resulted in an increased risk of baPWV and clinical diseases. The natural trajectory of metabolite BMI phenotypes is time-varying, and interventions for both healthy and unhealthy overweight/obese individuals should be widely recommended. [ABSTRACT FROM AUTHOR]

The mechanical properties of human aortas are linked to the layered tissue and its microstructure at different length scales. Each layer has specific mechanical and structural properties. While the ground substance and the elastin play an important role in tissue stiffness at small strain, collagen fibers carry most of the load at larger strains, which corresponds to the physiological conditions of the aorta at maximum pulsatile blood pressure. In fact, collagen fibers are crimped in the unloaded state. Collagen fibers show different orientation distributions when they are observed in a plane that is tangent to the aortic wall (in-plane section) or along a direction orthogonal to it (out-of-plane section). This was systematically investigated using large images (2500 × 2500 µm) with high resolution obtained by second harmonic generation (SHG) in order to homogenize tissue heterogeneity after a convergence analysis, which is a main goal of the study. In addition, collagen fibers show lateral interactions due to entanglements and the presence of transverse elastin fibers, observed on varying length scales using atomic force microscopy and a three-dimensional rendering obtained by stacking a sequence of SHG and two-photon fluorescence images; this is another important contribution. Human descending thoracic aortas from 13 heartbeat donors aged 28 to 66 years were examined. Uniaxial tensile tests were carried out on the longitudinal and circumferential strips of the aortic wall and the three separated layers (intima, media and adventitia). A structurally-motivated material model with (i) a term to describe the combined response of ground substance and elastin and (ii) terms to consider four families of collagen fibers with different directions was applied. The exclusion of compressed fibers was implemented in the fitting process of the experimental data, which was optimized by a genetic algorithm. The results show that a single fiber family with directional and dispersion parameters measured from SHG images can describe the mechanical response of all 39 layers (3 layers for each of the 13 aortas) with very good accuracy when a second (auxiliary) family of aligned fibers is introduced in the orthogonal direction to account for lateral fiber interaction. Indeed, all observed distributions of collagen directions can be accurately fitted by a single bivariate von Mises distribution. Statistical analysis of in-plane and out-of-plane dispersion of fiber orientations reveals structural differences between the three layers and a change of collagen dispersion parameters with age. The stiffness of healthy young aortas is adjusted so that a diameter expansion of about 10 % is possible during the heartbeat. This creates the Windkessel effect, which smooths out the pulsating nature of blood flow and benefits organ perfusion. The specific elastic properties of the aorta that are required to achieve this effect are related to the microstructure of the aortic tissue at different length scales. An increase in the aortic stiffness, in addition to reducing cyclic expansion and worsening perfusion, is a risk factor for clinical hypertension. The present study relates the microstructure of healthy human aortas to the mechanical response and examines the changes in microstructural parameters with age, which is a key factor in increasing stiffness. [Display omitted] [ABSTRACT FROM AUTHOR]

We aimed to investigate the association between polymorphism of DRD2/ANKK1 gene with MetS and its components. Women (n = 531, aged 19–50 years) from the North-west of Iran were included by cluster sampling method. Polymorphisms of ANKK1 and DRD2 genes were defined in the study population. D/D (OR: 3.16; 95%CI: 1.31−7.60) and I/D (OR: 1.76; 95%CI: 1.12−2.78) genotypes of DRD2 (rs1799732) increased risk of MetS compared to I/I genotype. The D/D genotype of DRD2 (rs1799732) increased odds of hypertriglyceridemia in the study population. T/T (OR: 6.72; 95%CI: 1.99−22.71) and C/T (OR: 4.42; 95%CI: 2.79−7.01) genotypes of ANKK1 (rs1800497) increased risk of MetS compared to C/C genotype. Also, C/T genotype increased the odds of HTN, high FBS, high TG and low HDL-C levels compared to C/C genotype. These polymorphisms can affect the MetS components via their relation to the signaling of dopaminergic pathways and eating behaviors. [ABSTRACT FROM AUTHOR]

Background: Poor sleep is a confirmed risk factor for hypertension (HTN), and Black/African American (AA) women have among the highest rates of HTN in the United States. Objective: We examined the relationship between sleep and blood pressure (BP) among Black/AA mother-child dyads using data from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study. Methods: Data for this study were derived from 250 Black/AA mother-child dyads from low-income neighborhoods, collected via 4 home visits over 2 years. Mothers reported poor sleep, including reports of sleeping worse than usual and nighttime awakenings. Recordings of BP were obtained for mother and child. Mother BP was scored as normal (<120/<80 mm Hg), elevated (120--129/<80 mm Hg), stage 1 HTN (130--139/80--89 mm Hg), or stage 2 HTN (systolic ≥140 or diastolic ≥90 mm Hg). Generalized linear models examined the relationships between mother-reported poor sleep variables and both mother and child BP. Adjusted models examining mother BP controlled for the mother's age, education, marital status, smoking, body mass index, and depression symptoms. Results: In adjusted models, nighttime awakenings were associated with stage 2 HTN (b = 2.70, 95%confidence interval [CI], 0.54--4.86, P < .05). Compared with children whosemother who had normal BP, children whosemother had elevated BP had higher diastolic BP (b = 0.37; 95%CI, 0.19--0.54; P < .001).Mother elevated BPwas associated with both child systolic BP (b = 2.49; 95%CI, 0.44--4.53; P < .05) and diastolic BP (b = 2.07; 95%CI, 0.39--3 .76; P < .05).Mother stage 1 HTN was associated with both child systolic BP (b = 2.16; 95%CI, 0.29--4.03; P < .05) and diastolic BP (b = 3.91; 95%CI, 2.40--5.42; P < .001).We detected a significant interaction betweenmother stage 2 HTN and mother nighttime awakenings in predicting higher child diastolic BP (b = 8.16; 95% CI, 0.65--15.68; P < .05). Conclusions: We found evidence for an association between mothers' nighttime awakenings and very high BP. Our study also illuminated a strong relationship between high mother BP and high child BP. Finally, our study found preliminary support for the potentially mediating role of mothers' nighttime awakenings in predicting the relationship between mother stage 2 HTN and child BP. [ABSTRACT FROM AUTHOR]

Mobile crowd sensing (MCS) makes full use of the sensing and wireless communication capabilities of smart mobile devices to collect real-time information effectively. It makes it possible to monitor people's health condition in real time. Our health information collected through MCS can be used to improve healthcare service. Hypertension is a widespread chronic disease, and preventing hypertension can effectively reduce the incidence of cardiovascular disease. In this paper, we propose a hypertension risk assessment approach based on mobile crowd sensing, which allows for real time health monitoring and warning. In order to stimulate the enthusiasm of MCS volunteers, optimized communication model is used to reduce the communication cost of non-data-users. Additionally, the current hypertension risk status of patients will be feed back to them in real time. In our approach, binary logistic regression is used to select risk factors of hypertension, and then the risk factors are used as the inputs of BP neural network to construct the risk prediction model. Furthermore, the hypertension risk is further divided into low risk, medium risk and high risk through cumulative distribution function. 4498 samples from a community health service center in Hefei area were used to evaluate the performance of the proposed approach. The experimental results show that the proposed approach can provide real-time, effective monitoring and dynamic feedback of the hypertension risk, offering a novel clinical tool for the early warning of hypertension. The proposed approach also provides a general framework for risk assessment of other chronic diseases. [ABSTRACT FROM AUTHOR]

Aging is a major risk factor for hypertension and atherosclerosis, and vascular smooth muscle cell (VSMC) senescence can promote aging‐related vascular diseases. Sirtuin‐1 (SIRT1) and AMP‐activated protein kinase (AMPK) were previously reported to modulate vascular senescence; however, its effects have not been well characterized. To determine the nature of the interaction between SIRT1 and AMPK in VSMC senescence, we investigated the effects of SRT1720 on its downstream targets of SIRT1 and the phosphorylation of AMPKα at Ser485. During Adriamycin‐induced VSMC senescence, SRT1720 increased the activity of SIRT1 and AMPKα phosphorylation at Ser485 via the cAMP–protein kinase A (PKA) pathway. Telomere length and telomerase reverse transcriptase expression were increased by SIRT1 activation with SRT1720. Taken together, these data show that activation of the SIRT1/cAMP–PKA/p‐AMPKα (Ser485) pathway may be an effective antisenescence mechanism for VSMCs. [ABSTRACT FROM AUTHOR]

Objectives Infantile spasms can have irrecoverable adverse effects on a child's brain. Adrenocorticotropic hormone (ACTH) is the most common first-line medication for the treatment of infantile spasms. However, the suitable dose and duration of treatment continue to be debated among specialists. Since high doses of ACTH, which are commonly used, can produce more side effects, lower doses are preferred. The aim of this study was to determine the effect and extent of complications caused by high and low doses of ACTH in children with infantile spasms. Materials & Methods This clinical trial was performed on 32 infants with infantile spasms, aged 1.5-18 months. The subjects were divided into high- and lowdose ACTH groups. Treatment continued for two months. The therapeutic effects and complications were then compared over 18 months. Results The results indicated no significant difference between the groups in terms of the short-term prognosis of convulsions, final prognosis of patients with spasm relapse, EEG changes after treatment, and posttreatment development of hypertension. On the other hand, there was a significant difference in the frequency distribution of restlessness intensity and becoming Cushingoid, which were more frequent in the high-dose group. Conclusion The results indicated that high- and low-dose ACTH are equally effective in controlling spasms, yet the low dose causes fewer side effects. [ABSTRACT FROM AUTHOR]

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Background: The Global Status Report 2017 reveals that 11% of Indians indulge in binge drinking. Chronic alcohol intake may lead to cardiac problems and hypertension. The aim of this study was to evaluate cardiovascular risk among asymptomatic chronic alcoholics. Methods: A total of 80 asymptomatic chronic alcoholics of South Indian origin, from the psychiatry ward of Sri Ramachandra Institute of Higher Education and Research, India were diagnosed with alcohol dependence syndrome(ADS). Group I includes alcoholics for 10 years or less and group II includes alcoholics for more than 10 years. Alcohol consumption was measured using the DSM IV criteria. Blood pressure (BP) and electrocardiographic (ECG) data were measured on admission and 2 weeks later. The paired t-test compared a significant outcome of the two sets of data at p = 0.05 level of significance. Results: Forty percent of the patients were found to be hypertensive and only 2.5% were found to be prehypertensive on admission. The mean age of the hypertensives was 46.9 and nonhypertensives was 42.1 The difference in the BP evaluated after 2 weeks was staggering - systolic BP had a mean fall of 6.1 mm Hg (p < 0.001) and diastolic BP 2.25 mm Hg (p = 0.001). The electrocardiogram results showed significant changes like left ventricular hypertrophy, abnormal T waves, and QT prolongation. Conclusions: Chronic alcoholism is a major criterion for heart abnormalities such as elevated BP and left ventricular enlargement, and our study supports this as we see that alcohol consumption for more than 10 years shows significant deterioration. Further clinical observations and long-term prospective studies are needed to confirm these observations. [ABSTRACT FROM AUTHOR]

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Purpose: The aim of this descriptive correlational pilot study was to investigate the relationship between hypertension, sleep deprivation, and risk of Alzheimer's disease in a rural, older, underserved, and ethnically diverse cohort. Sample: Residents (n = 52) from three independent subsidized housing units for retired farmer workers, located in a rural Florida area known as the Glades, volunteered for the study. Methods: A quantitative descriptive approach using Pearson correlations, t-tests, and scatter plot analysis was applied to surveys and Mini-CogTM results. Findings: About a quarter (23.1%) of the participants were identified as being at risk for cognitive impairment. Hypertension risk correlated moderately with cognitive impairment risk (r = 0.40, p = 0.01). However, in this ethnically, diverse cohort, sleep quality did not significantly influence either blood pressure or cognitive status. This is contrary to other studies that have found an increased risk of Alzheimer's disease among persons with hypertension (Carnevale, Perrotta, Lembo, & Trimarco, 2015) and insufficient sleep (Brzecka et al., 2018). Implications: These results suggest that further investigation is needed to examine if rural living or culture moderates Alzheimer's disease risk factors of diminished sleep and hypertension. Future findings could impact the design of interventions aimed at reducing AD risk in diverse rural settings. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma is associated with chronic kidney disease as well as with common risk factors including hypertension and diabetes mellitus. Localized renal cell carcinoma is treated surgically and in these cases has a favorable prognosis. In particular, in those individuals with small renal masses (≤4 cm), preservation of kidney function should be prioritized. Postoperative chronic kidney disease or end-stage renal disease prevention should include baseline kidney function and risk factor assessment, nontumor renal biopsy, as well as counseling on treatment options to discuss maximizing kidney function preservation. Postnephrectomy prognosis can be determined with repeat laboratory and clinical assessment. Ultimately, early involvement of the nephrologist in a multidisciplinary team including the urology team will enable the reduction of postsurgical kidney disease related morbidity and potentially mortality. [ABSTRACT FROM AUTHOR]

• This cohort study enrolled middle-aged Japanese men without hypertension. • Obesity with low moderate/vigorous physical activity (MVPA) predicted hypertension. • Obesity with maintained MVPA was not associated with hypertension onset. • The step count did not affect hypertension risk. • Our results suggest the importance of MVPA to prevent hypertension in obese subjects. The combined effects of physical inactivity and obesity on hypertension have been recognized; however, previous studies evaluated physical activity using questionnaires. We aimed to examine the effects of physical activity, measured using an accelerometer, and obesity on hypertension onset. At baseline, 426 middle-aged Japanese men who were not on antihypertensive medications were included. Physical activity was measured for 7 consecutive days using an accelerometer. Mean daily moderate to vigorous physical activity (MVPA) and step count (SC) were calculated. Low MVPA and low SC were each defined as the first tertile. Obesity was defined as ≥25 kg/m2 of body mass index. The onset of hypertension was defined as receiving antihypertensive agents during the 4-year follow-up. The combined effects of obesity and physical inactivity on hypertension were examined using Cox regression analysis. Potential confounders included age, smoking, alcohol consumption, daily salt intake, dyslipidemia, diabetes mellitus, and systolic and diastolic blood pressures. Cox regression analysis revealed that both obesity and low MVPA predicted hypertension in patients, independent of confounders (hazard ratio [HR]: 2.64, 95% confidence interval [CI]: 1.08–6.42, p = 0.033), unlike obesity alone (HR: 1.50, 95% CI: 0.50–3.26, p = 0.590). Stratification by obesity and SC revealed similar hypertension risks among the two groups (Obesity with low SC [HR: 2.10, 95% CI 0.88–5.24, p = 0.089]; Obesity without low SC [HR: 1.72, 95% CI 0.93–4.01, p = 0.082]). Here, findings suggest that the coexistence of obesity and decreased MVPA may increase the risk of hypertension onset. [ABSTRACT FROM AUTHOR]

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INTRODUCTION Hypertension is one of the most studied risk factors for cardiovascular disease in adults; in children and adolescents, its global prevalence changes with age, from 1%-3% in children to 3.2% in adolescents. In adults, in addition to hypertension, several biochemical markers of cardiovascular risk have been identified. Con- firming an association between these and hypertension in childhood and adolescence would allow for more timely diagnosis and monitoring of cardiovascular disease, since the presence of both the markers and hypertension would imply increased risk. OBJECTIVE Confirm an association between biochemical risk markers of cardiovascular disease and hypertension in children aged 8 to 11 years. METHODS A cross-sectional study of 373 children aged 8-11 years was conducted in 3 primary schools in the city of Santa Clara in central Cuba. The variables examined were age, sex, height, blood pressure, cholesterol, triglycerides, lipoproteins and apolipoproteins. The children were classified as normotensive, prehypertensive or hypertensive, based on blood pressure readings and percentiles for age, sex and height. Descriptive statistics were calculated for quantitative variables. A bivariate analysis, tests of independence for qualitative variables and a means comparison for quantitative variables (ANOVA and its nonparametric alternative, the Kruskal Wallis test) were performed. Fisher's F-test and its associated probability value were employed. RESULTS Some 32.2% of the children were prehypertensive and 5.1% hypertensive. Cholesterol and triglyceride values were significantly higher in hypertensive than in normotensive children (p = 0.028 and p = 0.047, respectively). HDL numbers were higher in normotensive children (p = 0.001), and LDL numbers and the LDL/ HDL ratio were higher in the hypertensive children, with differences between groups (p = 0.001 for both variables). There were differences between the three blood pressure categories for lipoprotein(a) and ApoA (p <0.001 and p = 0.001), for ApoB and for the ApoB/ApoA ratio (p <0.001 for both variables), with lower ApoA values and higher ApoB and ApoB/ApoA values in the hypertensive children. CONCLUSIONS The biochemical risk markers most strongly associated with hypertension in children are ApoB values, LDL, lipoprotein(a), and LDL/HDL and ApoB/ApoA ratios. [ABSTRACT FROM AUTHOR]

Objectives: To describe the distribution of social factors, lifestyle habits and anthropometric measurements according to hypertension and Type-2 diabetes. Methods: A cross-sectional study was conducted in Gaza City, Palestine that included 379 patients (20-60 years) who had hypertension and/or diabetes. Three groups of patients were involved; 106 hypertensive (HT), 109 diabetic (T2DM) and 164 hypertensive diabetics (HT + T2DM). Results: The HT + T2DM group were older and had a higher body mass index compared to HT and T2DM groups. There were 62.3% patients who were female, 49.2% were highly educated HT patients, and 49.3% patients had a low level of education and were HT + T2DM. There were 55.8% patients who lived in large families. Patients who were passive smokers or never smoked before were mostly HT + T2DM, while active smokers and past smokers had T2DM. There were 48.2% patients who were highly physically active who had HT, 40.9% whom were moderately active had T2DM, and 53.8% of patients who had a low level of activity were HT + T2DM. Multivariate linear regression showed that having a diseased mother, living in a large family, being a past or passive smoker, or never having smoked, having a low or moderate level of activity, and having HT or HT + T2DM, were significantly associated with an increased body mass index. Conclusion: Parental health/disease conditions and environmental factors (social network and lifestyle habits) played the greatest role in the development of obesity and disease. [ABSTRACT FROM AUTHOR]

Abstract Pediatric lipid screening and management with the aim of reducing and preventing adult disease is an internationally accepted concept, and guidelines have been published in several countries. However, implementation by the practicing pediatric community in the United States has been less than expected and delays have been attributed to uncertainty among providers. Reduced screening rates have also been reported for conditions contributing to arterial wall pathology such as obesity, hypertension, and prediabetes despite accumulating evidence that detection and intervention can lead to risk reversal. Consistent with graded and evidence-based national guidelines for comprehensive cardiovascular risk assessment and management, we present how the American Heart Association ideal cardiovascular health (ICVH) model can be integrated with lipid screening, and how it can be compatible with comprehensive pediatric lipidology practice and enhanced familial hypercholesterolemia detection. Since being introduced and retrospectively validated in adults and children in cross-sectional studies, ICVH evaluates thresholds for seven ideal health metrics representing measurements of obesity, dyslipidemia, diabetes risk, and blood pressure, and includes exercise, diet, and smoking behaviors. When each metric is valued as a point, the maximum health score is 7, but national surveys have shown unacceptable low scores in adolescence. Inverse correlation of scores with arterial structural change supports use of ICVH as a collection of treatable targets forming a cardiovascular prevention construct including and supporting lipid screening in pediatric settings, but implementation in clinical practice requires more expertise and administrative support than lipid screening alone. Highlights • There is a recognized need for pediatric cardiovascular risk screening. • "Ideal cardiovascular health" provides a framework for risk management. • Screening for genetic and acquired lipid disorders can be integrated with ideal cardiovascular health. • Resources and support for effective implementation is needed. [ABSTRACT FROM AUTHOR]

Obstructive Sleep Apnoea (OSA) is a sleep-related breathing disorder caused by the partial or complete obstruction of the upper airways. Left untreated, OSA can impact detrimentally on a person's quality of life, and is a risk factor for hypertension, cardiovascular morbidity and stroke. We report on a case of OSA treated by Maxillo-Mandibular Advancement (MMA) surgery and review the literature in relation to available treatment options. A 55-year-old male was referred to the Auckland District Health Board Oral and Maxillofacial Surgery Department for assessment and management of his debilitating OSA. Throughout most of his adult life he had been affected, and reported adverse effects on his work, family and social life. He had tried multiple medical and surgical management options, none of which provided him with any long-term improvement. MMA enlarges the pharyngeal space by expanding the skeletal framework. He proceeded to MMA surgery, with advancement of his maxilla 8 mm and mandible 18 mm and significant improvement in quality of life. This type of surgery should be considered when medical therapy has failed or is poorly tolerated, and when other surgical options have been discounted. [ABSTRACT FROM AUTHOR]

Background: Hypertension is an important public health problem worldwide. There is lack of data on uncontrolled blood pressure in developing countries. Objectives: To determine the magnitude and predicting factors of uncontrolled blood pressure in hypertensive patients attending Gondar university hospital, Ethiopia. Methods: A hospital-based cross-sectional survey was conducted from July 2015 to March 2016. All hypertensive patients were followed and the blood pressure levels were measured. Binary logistic regression analysis was done to determine the predictors of uncontrolled blood pressure. A p-value of <0.05 was set at priori with 95% confidence interval to test the level of significance. Results: Of the total 578 hypertension patients, 543 (93.9%) fulfilled the study criteria and were included in the final analysis. The mean age of the participants was 55.96±14.6 years. Nearly two-third (58.2%) of the participants were females. More than one-tenth (11.4%) of the respondents had uncontrolled blood pressure. High salt intake carried six times more risk of uncontrolled blood pressure. Elderly individuals had lower risk as compared to young age group. However, comorbidities were not related with uncontrolled blood pressure. Conclusions: Blood pressure control was relatively high in the hospital studied. High salt intake was strongly linked with uncontrolled blood pressure. Individuals with high salt intake should be followed for their medication experience and disease knowledge. [ABSTRACT FROM AUTHOR]

Nothing to disclose. Family Heart Foundation. Elevated lipoprotein(a) [Lp(a)] is a well-recognized, independent risk factor for atherosclerotic cardiovascular disease (ASCVD) that is estimated to be present in 20% of the general population according to an NLA 2019 Scientific Statement, "Use of Lipoprotein(a) in Clinical Practice: A Biomarker Whose Time Has Come." Nonetheless, this genetic lipoprotein is rarely assessed. To characterize individuals receiving Lp(a) measurement and their providers using real-world data within the Family Heart Foundation integrated dataset of Americans screened or treated for ASCVD. A cohort of individuals with at least one Lp(a) measurement and sufficient healthcare data was identified within an extensive dataset of >112 million individuals with laboratory data and diagnostic, procedural, and prescription claims from 2012-2019. Demographics (mean +/- standard deviation), ASCVD history, and healthcare provider at time of Lp(a) measurement were characterized. Probable familial hypercholesterolemia (FH) status was determined using a validated machine learning model. Lp(a) was rarely measured; 0.3% (n=335,726) of individuals had at least one Lp(a) measurement; they were aged 59.9 +/- 39.7 years, female (52.5%), Black (7.8%), Hispanic (7.1%), White (53.6%), and Other/Unknown (31.5%). Risk factors included hypertension (53.7%), hyperlipidemia (50.6%), and diabetes (24.6%). Cardiovascular history included ASCVD-only (29.1%), probable FH with ASCVD (1.2%), probable FH without ASCVD (1.7%), diagnosed FH with ASCVD (0.4%), diagnosed FH without ASCVD (0.6%), or no ASCVD or FH (70.8%). A small number of healthcare providers (n=629 of 810,119; <0.1%) were responsible for ordering the Lp(a) lab tests for 50% of individuals with a measurement; these providers most frequently specialized in internal medicine (26%), family medicine (23%), and internal medicine/CVD (14%), or were Physician Assistants & Advanced Practice Nursing Providers/Nurse Practitioner/Family (5%). Within this classification system, lipidology was not represented as a separate specialty. Measurement of Lp(a) was rare within a large US healthcare dataset. Individuals who had Lp(a) assessed were older and had ASCVD risk factors; 31% had ASCVD. Ordering Lp(a) was concentrated within a very small number of all healthcare providers. Additional research is needed to characterize the barriers and facilitators related to ordering Lp(a) by healthcare providers for individuals with ASCVD and/or risk factors. [ABSTRACT FROM AUTHOR]

Preeclampsia is a serious complication of pregnancy characterized by the development of vasospasm, hypertension and often associated with proteinuria after the 20th week of gestation. Because termination of pregnancy results in the most efficacious resolution of preeclampsia, it is a leading cause of premature delivery worldwide. In pregnancy, 14,15-epoxyeicosatrienoic acids (EETs) have been shown to facilitate uterine blood flow during preeclampsia, in which the classic vasodilator agents such as nitric oxide and prostacyclin are reduced. EETs are converted to dihydroxyeicosatrienoic acids (DHETs) by the activity of soluble epoxide hydrolase (sEH). We tested the hypothesis that sEH activity is increased in preeclampsia by measuring urinary 14,15-DHET in healthy and preeclamptic pregnant women. Urine samples were collected and incubated with or without β-glucuronidase to enable the measurement of both the glucuronidated and free forms of 14,15-DHET, which were quantified using a 14,15-DHET ELISA. Levels of total (free+glucuronidated) 14,15-DHET, which is a measurement of EET-dependent sEH activity, were higher in urine samples obtained from preeclamptic women compared to healthy pregnant women. Considering the fact that free+glucuronidated 14,15-DHET levels are increased in urine of preeclamptic women, we hypothesize that sEH expression or activity is augmented in these patients, reducing EET and increasing blood pressure. Moreover we suggest that novel anti-hypertensive agents that target sEH might be developed as therapeutics to control high blood pressure in women with preeclampsia. [ABSTRACT FROM AUTHOR]

Systemic Arterial Hypertension (SAH) is a risk factor for 9.4 million deaths worldwide. In Brazil, the condition attributes an annual cost of approximately USD640,000,000 to the SUS. The epidemiological and economic analysis of Pharmaceutical Care (PC) in the management of hypertensive patients showed an improvement in blood pressure control, a reduction of the risk of SAH complications, and an investment return of over USD1.7 million after ten years. Therefore, this article aims to present a pharmacoeconomic tool capable of assisting decision making in the implementation of PC in the SUS. A systematic review is being conducted for the robustness of the estimation of clinical and epidemiological impact of SAH, its results will be tabulated and applied in the improvement of the tool together with the direct medical and non-medical costs, indirect costs and costs of the SAH. In addition, a Markov model will be designed to estimate the incidence of cardiovascular diseases and SAH’s associated diseases by studies of proteomics that address the Human Network Disease. We hope to validate this auxiliary tool and thus to improve blood pressure control among hypertensive patients, quality of life, to reduce comorbidities and deaths, as well as optimizing the use of health resources. [ABSTRACT FROM AUTHOR]

Background It remains unclear whether treatment of dyslipidemia with 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) reduces the risk of developing hypertension. Objective In this post-hoc analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study, a large-scale primary prevention trial with pravastatin, we examined the preventive effect of pravastatin on the future development of hypertension in patients with hypercholesterolemia. Methods Of the overall (MEGA) Study population, 3397 nonhypertensive patients at baseline were enrolled in this study. The patients were randomly assigned to either the diet alone group (n = 1722) or the diet plus pravastatin group (n = 1675) and then were followed-up for a median of 36 months to determine new-onset hypertension. Results During the follow-up period, 1595 patients developed hypertension (49.1% in the diet alone group and 44.7% in the diet plus pravastatin group). After adjusting for multiple covariates, the diet plus pravastatin group showed a 10% reduction in the risk of developing hypertension (hazard ratio 0.90, 95% confidence interval 0.81–0.998), compared with the diet alone group. Subgroup analyses revealed that the preventive effect of pravastatin on the development of hypertension was pronounced in patients aged ≥60 years, men, those with chronic kidney disease or diabetes mellitus and those without obesity. Conclusions Pravastatin reduced the risk of developing hypertension in Japanese patients with hypercholesterolemia. The risk reduction of cardiovascular disease with statins could be partly explained by their preventive effect on the development of hypertension. [ABSTRACT FROM AUTHOR]