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Background: Hypertension is a significant risk factor for cardiovascular and chronic kidney diseases. Its management in young people remains limited. Device-based therapies, such as low-level tragus stimulation (LL-TS), a noninvasive method that reduces sympathetic activity, have recently been explored for resistant hypertension., Methods and Results: This trial involved patients with Grade 1 hypertension with no other medical history. LL-TS (20 Hz, 1 mA, 1 h/day) was applied for 3 months on the tragus (Intervention group [IG]) or earlobe (Control group [CG]). Blood pressure and outcomes were assessed at the first, second, and third months. Among 40 patients, 21 were in IG and 19 in CG. Baseline systolic blood pressure was similar between IG (142.62±8.18 mm Hg) and CG (143.00±8.61 mm Hg), P =0.89. Post-LL-TS, systolic blood pressure showed significant reductions in IG compared with CG at the first (IG: 134.47±5.95 mm Hg, CG: 141.28±6.78 mm Hg, P =0.002), second (IG: 132.50±7.51 mm Hg, CG: 140.62±7.15 mm Hg, P =0.001), and third months (IG: 128.81±7.13 mm Hg, CG: 136.51±7.96 mm Hg, P =0.003). diastolic blood pressure also differed significantly: first month (IG: 85.34±5.81 mm Hg, CG: 89.74±6.32 mm Hg, P =0.03), second month (IG: 82.12±5.22 mm Hg, CG: 88.57±7.11 mm Hg, P =0.002), and third month (IG: 80.71±5.96 mm Hg, CG: 87.55±5.26 mm Hg, P =0.001). Heart rate was unchanged ( P >0.05). Only 0.01% of IG subjects reported site irritation, with no serious adverse events., Conclusions: LL-TS led to significant blood pressure reductions in young patients with essential hypertension. Further larger trials are needed to confirm the safety and efficacy of LL-TS., Registration: URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2000038448.

Background: Hypertension is a leading contributor to cardiovascular disorders globally. There has been a recent upsurge in non-pharmacological management involving mindfulness-based meditation (MBM) in lowering blood pressure (BP) among the hypertensive population; however, the level of supportive evidence among patients primarily diagnosed with hypertension remain limited. Therefore, this systematic review aimed to synthesize the evidence of randomized controlled trials (RCTs) on the effect of MBM on BP explicitly in adults primarily diagnosed with elevated blood pressure or hypertension., Methods: A database search of RCTs was conducted in PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science until December 2023. The effect size score was calculated for variables of interest followed by qualitative analysis., Results: Nine studies with 543 participants (mean age 54.9±9.0) met the pre-specified eligibility criteria. Eight trials reported MBM convincing in lowering the systolic BP (p=0.001-0.020) and 6 in reducing the diastolic BP (p=0.001-0.01) among this target population. There was a disparity of gender in 7 studies and 4 trials did not report the ethnicity of participants. The methodological quality of the trials was gratifying, however, most studies presented with absence of allocation concealment and blinding of outcome assessors, fragmentary reporting of data, and high attrition rate that potentially affected the validity of trials., Conclusion: MBM interventions may serve as an early preventive and supportive measure for adults with elevated BP or hypertension. However, more robust and rigorous trials with a larger, homogeneous sample and long-term follow-up are necessary to quantify the magnitude of this intervention. Moreover, the methodological issues may affect the overall quality and reliability of MBM interventions; hence, future studies must also address the risk of bias due to inadequate blinding and high attrition through treatment concealment and personalized engagement measures., Competing Interests: Declaration of Competing Interest All the authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Various digital therapeutic products have been validated and approved since 2017. They have demonstrated efficacy and safety as a new therapeutic modality in various disorders or conditions. Hypertension is a common but serious condition that can be prevented or controlled with lifestyle changes and medicines. Although a digital therapeutic in hypertension is validated and approved in Japan, whether digital therapeutics (DTx) can significantly improve sustainable lifestyle changes is still a controversial topic. Most studies did not discuss the long-term gain challenges. In this review, the authors discuss the definition of DTx, and analyze the motivation, engagement and adherence challenges of DTx in hypertension. Some ongoing artificial intelligence (AI)-enabled or cognitive behavioral therapy (CBT)-based digital interventions and behavioral strategies for implementing sustainable lifestyle changes are identified and analyzed. With AI-enabled interventions and behavioral strategies, DTx might be one of the effective approaches to make sustainable lifestyle changes., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Background: The number of people with dementia is increasing in Japan, and establishing evidence for preventing dementia is necessary., Methods: This study was a randomized controlled trial in cognitively normal community-dwelling older adults aged 65 to 85 with diabetes and/or hypertension. Participants were randomly assigned in a 1:1 ratio. The intervention group underwent 90 min of group-based weekly physical exercise, cognitive training, nutritional counseling, and vascular risk management for 18 months. The primary endpoint was the change in a cognitive composite score calculated by averaging the z-scores of seven neuropsychological tests from baseline to 18 months., Results: We randomly assigned 203 participants to two groups, and 178 (87.7%) completed the 18-month follow-up. There was a significant group difference in the cognitive composite score change at 18 months (mean difference 0.16, 95% confidence interval: 0.04 to 0.27; p = 0.009)., Discussion: An 18-month multimodal intervention for older adults at risk of dementia could improve their cognitive function. The trial was registered in the Clinical Trial Registration System (UMIN000041938)., Highlights: Japan-Multimodal Intervention Trial for Prevention of Dementia (J-MINT) PRIME Tamba was a randomized controlled trial to prevent dementia. We provided a multifactorial intervention based on the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial methodology. The primary outcome, the cognitive composite score, improved with our intervention. Executive function/processing speed and memory improved in the intervention group. Intervention adherence was high, and no serious adverse events occurred., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Renal denervation (RDN) is a neuromodulation therapy performed using an intraarterial catheter in patients with hypertension. Recent randomized sham-operated controlled trials have shown that RDN has significant antihypertensive effects in patients with resistant, uncontrolled, and/or drug-naïve hypertension. Based on available evidence, the European Society of Hypertension 2023 guidelines include a Class II recommendation for the use of RDN in individuals with resistant and uncontrolled hypertension. The US Food and Drug Administration approved two devices, the ultrasound-based ReCor Paradise TM RDN system and the radiofrequency-based Medtronic Symplicity Spyral TM RDN system, as adjunctive therapy for patients with resistant and uncontrolled hypertension. The indications for RDN and incorporation of RDN into clinical practice will grow as clinical evidence accumulates. This mini review summarizes latest findings focusing on the safety and effectiveness of RDN for treating hypertension in the absence and presence of antihypertensive drugs, and discusses the indications for RDN. This mini review focuses on the safety and effectiveness of RDN for treating hypertension in the absence and presence of antihypertensive drugs. The indications for RDN and incorporation of RDN into clinical practice will grow as clinical evidence accumulates and should be reviewed and updated., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Navigating cancer care is complex and is exacerbated by pre-existing comorbidities managed by multiple providers. In this quality improvement study, we evaluated changes in perceived care coordination, navigation, and chronic illness care with community health worker (CHW) and mHealth support among Black breast cancer and prostate cancer patients with hypertension and/or diabetes. We collected patient and provider surveys on chronic illness care coordination at baseline and six months and found improvements in multiple domains. These findings support engaging CHWs to improve care coordination among cancer patients with comorbidities and demonstrate a use case of importance with emerging navigation reimbursement policies., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Professional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. Amid increased recognition of the role racism plays in shaping inequitable healthcare delivery, many researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. Critiques highlight how racism influences the evidence that guidelines are based on and its interpretation. However, few have used a systematic methodology to examine race-based recommendations. This review examines hypertension guidelines, a condition affecting nearly half of all adults in the United States (US), to understand how guidelines reference and develop recommendations related to race., Methods: A systematic scoping review of all professional guidelines on the management of essential hypertension published between 1977 and 2022 to examine the use and meaning of race categories., Results: Of the 37 guidelines that met the inclusion criteria, we identified a total of 990 mentions of race categories. Black and African/African American were the predominant race categories referred to in guidelines (n = 409). Guideline authors used race in five key domains: describing the prevalence or etiology of hypertension; characterizing prior hypertension studies; describing hypertension interventions; social risk and social determinants of health; the complexity of race. Guideline authors largely used race categories as biological rather than social constructions. None of the guidelines discussed racism and the role it plays in perpetuating hypertension inequities., Discussion: Hypertension guidelines largely refer to race as a distinct and natural category rather than confront the longstanding history of racism within and beyond the medical system. Normalizing race as a biological rather than social construct fails to address racism as a key determinant driving inequities in cardiovascular health. These changes are necessary to produce meaningful structural solutions that advance equity in hypertension education, research, and care delivery., (© 2024. The Author(s).)

Hypertension is the leading modifiable risk factor for cardiovascular disease, but less than 50% have their blood pressure controlled. A possible avenue to support hypertension management is a holistic approach, using non-pharmacological interventions. Since hypertension is mediated in part by dysregulation of the autonomic nervous system (ANS), biofeedback may help improve hypertension management by targeted self-regulation and self-awareness of parameters that regulate the ANS. This systematic review aimed to assess the effectiveness of biofeedback on blood pressure in hypertensive patients. The review was pre-registered on PROSPERO and followed the PICO strategy. A total of 1782 articles were retrieved, 20 met the inclusion criteria. Sample sizes ranged from 15 to 301 participants; with a median age of 49.3 (43.3-55.0) years and 45% were female. There was a significant effect of biofeedback on systolic (-4.52, Z = 2.31, P = 0.02, CI [-8.35, -0.69]) and diastolic blood pressure (-5.19, Z = 3.54, P = 0.0004, CI [-8.07, -2.32]). Six different biofeedback modalities were used, with biofeedback delivered by psychologists, trained therapists and research assistants. There was no publication bias, heterogeneity was rated as substantial and data quality was rated to be poor. This review demonstrated that biofeedback had a significant effect on blood pressure. However, this should be viewed in the context of included studies being limited by heterogeneity and dated literature, meaning the research does not reflect the current biofeedback technology such as wearable devices. Future research should incorporate these technologies with robust methodology to fully understand the effect of biofeedback on hypertension., (© 2024. The Author(s).)

Background: Mobile health (mHealth) implementation is crucial for developing sustainable healthcare systems, but it faces the challenge of user acceptance. Extending traditional acceptance models allows for the cognitive, emotional and social aspects of engaging with mHealth to be captured, creating a more comprehensive understanding of users' intentions to use it in the future. User-centred intervention studies based on users' real experiences with mHealth are essential for accurate assessments and for improving upon studies that rely merely on anticipated mHealth use., Methods: An intervention study was conducted with 103 patients with at least one chronic condition (type 2 diabetes and/or arterial hypertension) who had used an mHealth service for three months. They were recruited through purposive sampling at a community health centre in Slovenia. Path analysis was applied to the survey data collected after a three-month testing period to validate an explanatory model with eight hypotheses., Results: The intensity of mHealth use affected usability, which in turn affected acceptability, the psychosocial impacts of engagement with mHealth and intention for future use. The results showed that the intensity of mHealth use did not affect mHealth acceptability. Likewise, acceptability did not affect the psychosocial impacts of engagement with mHealth or the intention for its future use. Notably, perceptions of the psychosocial impacts of mHealth had no significant effect on the intention for future use., Conclusion: Usability and intensity of use play a central role in the post-intervention usage of mHealth, offering valuable insights for policymakers and healthcare providers involved in the delivery of mHealth-based treatment to patients with chronic diseases., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

More than 1.5 billion people worldwide have arterial hypertension. Hypertension increases the risks of death and cardiovascular disease, such as atrial fibrillation and heart failure. The autonomic nervous system plays an essential role in hypertension development and disease progression. While lifestyle factors, such as obesity and obstructive sleep apnea, predispose to hypertension by increasing sympathetic activity, hypertension itself maintains the autonomic nervous imbalance, providing the substrate for atrial fibrillation and heart failure. Therefore, autonomic nervous system modulation either by direct targeting or indirect treatment of comorbidities has the potential to treat both hypertension and related atrial and ventricular end-organ damage. We discuss interventions for the modulation of the autonomic nervous system for hypertension and related cardiac end-organ damage, including pharmacological adrenergic beta-receptor blockade, renal denervation, carotid baroreceptor stimulation, low-level vagal stimulation, and ablation of ganglionated plexuses. In summary, the literature suggests that targeting the autonomic nervous system potentially represents a therapeutic approach to prevent atrial and ventricular end-organ damage in patients with hypertension. However, clinical trials specifically designed to test the effect of autonomic modulation on hypertension-mediated cardiac end-organ damage are scarce., Competing Interests: None.

This is the first consensus statement of the Joint Committee on Renal Denervation of the Japanese Society of Hypertension (JSH)/Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT)/Japanese Circulation Society (JCS). The consensus is that the indication for renal denervation (RDN) is resistant hypertension or "conditioned" uncontrolled hypertension, with high office and out-of-office blood pressure (BP) readings despite appropriate lifestyle modification and antihypertensive drug therapy. "Conditioned" uncontrolled hypertension is defined as having one of the following: (1) inability to up-titrate antihypertensive medication due to side effects, the presence of complications, or reduced quality of life. This includes patients who are intolerant of antihypertensive drugs; or (2) comorbidity at high cardiovascular risk due to increased sympathetic nerve activity, such as orthostatic hypertension, morning hypertension, nocturnal hypertension, or sleep apnea (unable to use continuous positive airway pressure), atrial fibrillation, ventricular arrythmia, or heart failure. RDN should be performed by the multidisciplinary Hypertension Renal Denervation Treatment (HRT) team, led by specialists in hypertension, cardiovascular intervention and cardiology, in specialized centers validated by JSH, CVIT, and JCS. The HRT team reviews lifestyle modifications and medication, and the patient profile, then determines the presence of an indication of RDN based on shared decision making with each patient. Once approval for real-world clinical use in Japan, however, the joint RDN committee will update the indication and treatment implementation guidance as appropriate (annually if necessary) based on future real-world evidence., (© 2024. The Author(s).)

This systematic review and meta-analysis aimed to evaluate the effectiveness of spiritually based interventions on blood pressure (BP) among adults. A systematic search was performed using the PubMed, Scopus, and Cochrane databases to identify studies evaluating spiritual interventions, including meditation, transcendental meditation, mindfulness meditation, and yoga, for high BP among adults up to January 1, 2022. The inclusion criteria were (a) randomized controlled trials (RCTs), (b) studies in English or Persian, (c) studies conducted among adults (≥ 18 years), and (d) studies reporting systolic or diastolic BP. Given the high heterogeneity of these studies, a random effect model was used to calculate the effect sizes for the RCTs. In total, the systematic review included 24 studies and the meta-analysis included 23 studies. As some of studies reported two or more outcome measurements, separate estimates of each outcome were extracted for that study (24 datasets). Fifteen trials reported the mean (SD) systolic blood pressure (SBP), and 13 trials reported the mean (SD) diastolic blood pressure (DBP). In addition, 13 studies reported means (SDs) and six trials reported mean changes in DBP. A significant decrease was found in systolic BP following intervention ((WMD (weighted mean difference) =  - 7.63 [- 9.61 to - 5.65; P < 0.001]). We observed significant heterogeneity among the studies (I 2  = 96.9; P < 0.001). A significant decrease was observed in DBP following the interventions (WMD =  - 4.75 [- 6.45 to - 3.05; P < 0.001]). Spiritually based interventions including meditation and yoga had beneficial effects in reducing both SBP and DBP. Reducing BP can be expected to reduce the risk of cardiovascular diseases., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Though considered a best practice, there is substantial variation in how integrated behavioral health (IBH) services are structured. This study examined the impact of IBH structure on health outcomes among individuals with serious mental illness (SMI) and chronic disease receiving care in community health centers (CHCs). Data from the ADVANCE network identified 8,548 individuals with co-occurring SMI diabetes and 16,600 with an SMI and hypertension. Logistic regression tested whether IBH type impacted disease specific health outcomes among these populations. Among those with diabetes or hypertension, colocated care was associated with better health outcomes related to HbA1c, blood pressure control, and BMI compared to less coordinated and unintegrated care, though there was significant variation in this relationship across SMI diagnoses. Results reflect that colocation of primary care and behavioral health may improve outcomes for individuals with bipolar disorder or major depression and chronic disease, but that CHC-based integrated care may not be optimized for individuals with schizophrenia., (© 2024. The Author(s).)

Purpose: The aim of this study is to prospectively evaluate whether individual and group Therapeutic Patient Education (TPE) can reduce the need to intensify treatment of diabetes and hypertension in newly diagnosed type 2 diabetic patients., Methods: A total of 937 patients were recruited and followed-up for 42.7 ± 21.5 months. TPE was a structured comprehensive education delivered by trained nurses: 322 patients received individual TPE (ITPE), 291 underwent group TPE (GTPE), and 324 were in Usual Care (UC). The primary endpoints were intensification of diabetes treatment and intensification of hypertension treatment., Results: The rate of diabetes treatment intensification was 40.1% in patients receiving ITPE, 47.8% in patients undergoing GTPE, and 64.2% in patients in UC (p < 0.001). The rate of hypertension treatment intensification was 24.2% in patients following ITPE, 31.3% in patients receiving GTPE, and 41.0% in patients in UC (p < 0.001). Multivariate analysis showed that both ITPE and GTPE were associated with reduced intensification of diabetes (ITPE: HR:0.51; 95% IC:0.40-0.64; p < 0.001 - GTPE: HR:0.46; 95% IC:0.44-0.70; p < 0.001) and hypertension medication (ITPE: HR:0.45; 95% IC:0.34-0.61; p < 0.001 - GTPE: HR:0.49; 95% IC:0.38-0.65; p < 0.001). The association was independent of age, sex, BMI, HbA1c, and presence of hypertension at baseline., Conclusions: TPE, delivered as both individual and group sessions, represents an effective tool to reduce the need to intensify treatment of both diabetes and hypertension. Therefore, it can ensure better control of diabetes and hypertension with fewer medications. This could reduce adverse effects and costs and improve quality of life and medication taking in patients with type 2 diabetes., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: This study aimed to examine the effects of a six-week of concurrent training using high-intensity interval plus resistance training on flow-mediated dilation and pulse wave velocity in hypertensive, elevated blood pressure, or normotensive. A secondary goal was to analyze the inter-individual variability., Methods: A randomized controlled clinical trial was executed with 60 adult participants distributed across six groups: three control groups of hypertensive, elevated blood pressure, or normotensive and other three experimental hypertensive, elevated blood pressure, and normotensive groups, each comprising n=10 individuals. Participants underwent a six-week intervention of concurrent exercise using high-intensity interval plus resistance training three-weekly. Flow mediated dilation and pulse wave velocity and secondary vascular assessments were conducted before and after the intervention., Results: The hypertensive exercise group exhibited a significant increase in flow mediated dilation (Δ+7.7%; p=0.003) and a reduction in pulse wave velocity (Δ-1.2ms -1 ; p<0.0001). The normotensive exercise group also showed a significant increase in flow mediated dilation (Δ+8.4%, p=0.002)., Conclusion: The six-week concurrent exercise using high-intensity interval plus resistance training protocol, characterized by its clinical time-efficiency, was effective in improving endothelial function, as demonstrated by increased flow mediated dilation, and in reducing arterial stiffness, indicated by decreased pulse wave velocity., (Copyright © 2024 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Hypertension, a widespread cardiovascular issue, presents a major global health challenge. Traditional diagnosis and treatment methods involve periodic blood pressure monitoring and prescribing antihypertensive drugs. Smart technology integration in healthcare offers promising results in optimizing the diagnosis and treatment of various conditions. We investigate its role in improving hypertension diagnosis and treatment effectiveness using machine learning algorithms for early and accurate detection. Intelligent models trained on diverse datasets (encompassing physiological parameters, lifestyle factors, and genetic information) to detect subtle hypertension risk patterns. Adaptive algorithms analyze patient-specific data, optimizing treatment plans based on medication responses and lifestyle habits. This personalized approach ensures effective, minimally invasive interventions tailored to each patient. Wearables and smart sensors provide real-time health insights for proactive treatment adjustments and early complication detection., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Hypertension is a leading contributor to mortality in low-middle income countries including Haiti, yet only 13% achieve blood pressure (BP) control. We evaluated the effectiveness of a community-based hypertension management program delivered by community health workers (CHWs) and physicians among 100 adults with uncontrolled hypertension from the Haiti Cardiovascular Disease Cohort. The 12-month intervention included: community follow-up visits with CHWs (1 month if BP uncontrolled ≥140/90, 3 months otherwise) for BP measurement, lifestyle counseling, medication delivery, and dose adjustments. Primary outcome was mean change in systolic BP from enrollment to 12 months. Secondary outcomes were mean change in diastolic BP, BP control, acceptability, feasibility, and adverse events. We compared outcomes to 100 age, sex, and baseline BP matched controls with standard of care: clinic follow-up visits with physicians every 3 months. We also conducted qualitative interviews with participants and providers. Among 200 adults, median age was 59 years, 59% were female. Baseline mean BP was 154/89 mmHg intervention versus 153/88 mmHg control. At 12 months, the difference in SBP change between groups was -12.8 mmHg (95%CI -6.9, -18.7) and for DBP -7.1 mmHg (95%CI -3.3, -11.0). BP control increased from 0% to 58.1% in intervention, and 28.4% in control group. Four participants reported mild adverse events. In mixed methods analysis, we found community-based delivery addressed multiple participant barriers to care, and task-shifting with strong teamwork enhanced medication adherence. Community-based hypertension management using task-shifting with CHWs and community-based care was acceptable, and effective in reducing SBP, DBP, and increasing BP control., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

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., (Copyright © 2023 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Hypertension (HT), or high blood pressure is one of the most common and main causes in cardiovascular diseases, which is also related to a series of detrimental diseases in humans. Deficiencies in effective treatment in HT are often associated with a series of diseases including multi-infarct dementia, amputation, and renal failure. Therefore, identifying anti-hypertension peptides has the vital realistic significance. Although many bioactive peptides have been developed to reduce blood pressure, they are time-consuming and laborious. In views of the obstacles of the intrinsic methods in antihypertensive peptide (AHTP) classification, computational methods are suggested as a supplement to identify AHTPs. In this study, we develop a comprehensive feature representation algorithm based on pretrained model and convolutional neural network and apply the deep ensemble model to construct the prediction model. The new predictor is used to identify AHTPs in benchmark and independent datasets. It has been shown in the independent test set that the performance is better than the recent methods. Comparative results indicate that our model can shed some light on hypertension therapy and gains more insights of classifying AHTPs. The implements and codes can be found in https://github.com/yuanying566/AHPred-DE. [ABSTRACT FROM AUTHOR]

Background: Telemedicine has emerged as an effective approach for managing hypertension, particularly in rural areas where healthcare access is limited. This review evaluates telemedicine's role in providing essential remote healthcare services for hypertension management., Objective: We determined the effectiveness of telemedicine versus the usual care in hypertension management among adults living in rural settings., Methods: We conducted a systematic review of randomized controlled trials (RCTs) focusing on adults aged 18 and older with hypertension (blood pressure ≥ 140/90 mmHg) using telehealth services in rural or community-based settings. We searched nine databases, including PubMed, ScienceDirect, and ProQuest, up to April 2024, without restrictions on language or publication year, focusing only on human subjects. Five pairs of reviewers independently screened and selected studies using predefined eligibility criteria. Methodological quality was assessed using the Revised Cochrane Collaboration Risk of Bias tool, and data synthesis was performed using a random-effects model due to study heterogeneity. Evidence quality was evaluated using the GRADE approach., Results: Nine randomized trials were included. Pooled data showed no clinically significant differences between telehealth and control groups in improving systolic blood pressure (SBP), diastolic blood pressure (DBP), and their changes over time. The mean difference (MD) of SBP in five trials was 0.78 mmHg lower (95% CI: 2.49 lower to 0.94 higher), and the SBP change showed a mean reduction of 2.29 mmHg (95% CI: 4.76 lower to 0.19 higher). DBP in five trials had a mean increase of 0.46 mmHg (95% CI: 0.73 lower to 1.64 higher), and DBP change in six trials showed a mean decrease of 0.83 mmHg (95% CI: 2.34 lower to 0.68 higher). Additionally, telehealth showed varying impacts on BMI and HbA1c levels, with one study reporting a higher BMI increase in the intervention group, while two other studies indicated that mobile health improved HbA1c levels and controlled blood pressure as effectively as standard care., Limitations: Study heterogeneity, selection, and performance biases, as well as varying healthcare contexts, limited the generalizability of findings., Conclusion: Telemedicine is as effective as usual care in managing hypertension among adults in rural settings, providing a viable solution for improving healthcare access in these areas. Future research should address biases and explore long-term impacts to optimize telemedicine's effectiveness in diverse populations., (© 2024 John Wiley & Sons Ltd.)

Hypertension is responsible for more than two million deaths due to cardiovascular disease annually in Latin America (LATAM), of which one million occurs before 70 years of age. Hypertension is the main risk factor for cardiovascular morbidity and mortality, affecting between 20 and 40% of LATAM adults. Since the publication of the 2017 LASH hypertension guidelines, reports from different LATAM countries have confirmed the burden of hypertension on cardiovascular disease events and mortality in the region. Many studies in the region have reported and emphasized the dramatically insufficient blood pressure control. The extremely low rates of awareness, treatment, and control of hypertension, particularly in patients with metabolic disorders, is a recognized severe problem in LATAM. Earlier implementation of antihypertensive interventions and management of all cardiovascular risk factors is the recognized best strategy to improve the natural history of cardiovascular disease in LATAM. The 2024 LASH guidelines have been developed by a large group of experts from internal medicine, cardiology, nephrology, endocrinology, general medicine, geriatrics, pharmacology, and epidemiology of different countries of LATAM and Europe. A careful search for novel studies on hypertension and related diseases in LATAM, together with the new evidence that emerged since the 2017 LASH guidelines, support all statements and recommendations. This update aims to provide clear, concise, accessible, and useful recommendations for health professionals to improve awareness, treatment, and control of hypertension and associated cardiovascular risk factors in the region., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Cardiovascular disease (CVD) affects adults globally. People with intellectual disabilities (PWID) may be at higher risk of CVD and associated risk factors (e.g. obesity, hypertension, and diabetes). We developed Pay Attention to Hypertension (PAtH), a cardiovascular health promotion intervention, and tested its impact on changes in blood pressure (BP), lifestyle behaviours and health-related empowerment among PWID., Methods: PAtH was developed with a Special Olympics community organisation that supports PWID in developing self-confidence and social skills through participation in sports. The 6-month intervention consisted of 1-h individualised virtual sessions delivered monthly by nursing students/novice nurses. Sessions covered specific themes, including monitoring BP, adopting healthy lifestyles and managing stress, and were individually tailored to the capacities and needs of participants. A single group pre-post-intervention design was used to assess the intervention's effects among participants who completed the intervention and data collection. Data included baseline and follow-up BP measurements from 7-day logbooks and questionnaires assessing lifestyle behaviours [physical activity (PA), screen time and diet], and health-related empowerment., Results: Seventy-four participants were included in the analyses. Between baseline and follow-up, there were no changes in systolic and diastolic BP, PA or leisure screen time. The proportion of participants who reported adding salt when cooking decreased from baseline to follow-up (19.7% vs. 12.7%, P = 0.034), and we found improvements for several items measuring health-related empowerment (P ≤ 0.003)., Conclusion: Improvements in health-related empowerment were found following PAtH. More intensive interventions may be needed to result in changes in lifestyle behaviours and BP. The integration of adapted cardiovascular health promotion initiatives within well-established community organisations such as Special Olympics is a promising avenue to contribute to cardiovascular health promotion among PWID., (© 2024 The Author(s). Journal of Intellectual Disability Research published by John Wiley & Sons and MENCAP.)

Objectives: Tobacco use disproportionately affects Alaska Native people. Physical activity may aid quitting smoking and provides health benefits. We tested telemedicine-delivered heart health interventions in Alaska's Norton Sound region., Methods: Alaska Native adults (N = 299, 51.5 % male, 60.5 % Inupiaq) with hypertension and/or hypercholesterolemia who smoked daily were randomized to intervention on smoking and physical activity (group 1) or traditional diet and medication adherence (group 2). Intention to change was not required for participation. Stage-tailored mailed workbooks and personalized reports were supported by telehealth counseling at baseline, 3, 6, and 12 months. Study outcomes were assessed at baseline, 3-, 6-, 12-, and 18-months (i.e., 6-months after the final counseling session). Smoking outcomes were self-reported 7-day point prevalence abstinence (7d-PPA), 1 bioconfirmed with urine anabasine; 24-hour quit attempts; and 50 % reduction in smoking. Self-reported physical activity outcomes were metabolic equivalent of task (MET) minutes and meeting moderate-to-vigorous physical activity (MVPA) guidelines., Results: At baseline, participants averaged 12.4 (SD = 10.0) cigarettes/day, with 19.4 % prepared to quit smoking, and 81.6 % meeting MVPA guidelines. During the study, most (70.2 % group 1; 63.5 % group 2) reported a 24-hr quit attempt (p = 0.219), and Group 1 (53.6 %) was more likely than Group 2 (28.4 %) to use nicotine replacement therapy (NRT), OR = 2.92, p < 0.001. At 18-months, 40.5 % (group 1) and 32.5 % (group 2) had reduced their smoking by half or more (p = 0.343), and 10.8 % vs. 7.9 % (group 1 vs. 2) reported 7d-PPA with 4 % vs. 6 % (group 1 vs. 2) bioconfirmed. Time and baseline stage of change predicted 7d-PPA (p's≤.015), with no group effect (p = 0.325). Activity levels did not significantly differ by group or time., Conclusions: Telemedicine counseling supported NRT use but did not significantly affect behavioral outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Arterial hypertension (AH) is a major cause of cardiovascular diseases (CVD), leading to dysfunction of many organs, including the heart, blood vessels and kidneys. AH is a multifactorial disease. It has been suggested that the development of each factor is influenced by oxidative stress, which is characterized by a disturbed oxidant-antioxidant balance. Excessive production of reactive oxygen species (ROS) and an impaired antioxidant system promote the development of endothelial dysfunction (ED), inflammation and increased vascular contractility, resulting in remodeling of cardiovascular (CV) tissue. The hope for restoring the proper functioning of the vessels is placed on antioxidants, and pharmacological strategies are still being sought to reverse the harmful effects of free radicals. In our review, we focused on the correlation of AH with oxidative stress and inflammation, which are influenced by many factors, such as diet, supplementation and pharmacotherapy. Studies show that the addition of a single dietary component may have a beneficial effect on blood pressure (BP) values; however, the relationship between the antioxidant/anti-inflammatory properties of individual dietary components and the hypotensive effect is not clear. Moreover, AH pharmacotherapy alleviates the increased oxidative stress, which may help prevent organ damage. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) has become a serious health problem in developing countries. The family has an important role in maintaining blood pressure (BP) at home, and sodium diet compliance in people with HTN needs to be developed. Therefore, this research aimed to evaluate the effectiveness of a family self-management program (FSMP) in HTN management and compliance with sodium consumption in rural areas of Indonesia. Study Design: A parallel-group, single-blind randomized controlled trial., Methods: One hundred twenty-six eligible participants were randomly allocated to an intervention (n=63) and a control group (n=63). Participants in the intervention group received a 24-week (6-month) FSMP intervention. The primary outcome measures included the systolic and diastolic BP, the Score Sodium Questionnaire (SSQ), and the Morisky Medication Adherence Scale 8 (MMAS-8). The Knowledge of Health Care for HTN questionnaire and the Efficacy and Behavior Toward Health Care for Patients with HTN questionnaire were used to assess the secondary outcome., Results: The final results were analyzed from 121 participants (n=61 intervention and n=60 control group). The repeated analysis of variance (ANOVA) test results demonstrated significant effects on the management of HTN and adherence to sodium consumption as indicated by systolic ( P =0.004) and diastolic BP ( P =0.006), SSQ ( P <0.001), MMAS 8 ( P <0.001), caregivers' knowledge ( P <0.001), caregivers' self-efficacy ( P <0.001), and caregivers' behaviors ( P =0.005)., Conclusion: The FMSP emerges as a promising strategy for managing BP and adherence to sodium consumption in people with HTN through the support of family caregivers and selfmanagement activities., (© 2024 The Author(s); Published by Hamadan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence., Objective: This study aimed to explore patient-users' perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany., Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis., Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users' hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it., Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings., Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s., (©Felix Muehlensiepen, Dunja Bruch, Frances Seifert, Eileen Wengemuth, Martin Heinze, Sebastian Spethmann, Susann May. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.09.2024.)

Background: Cardiovascular disease (CVD) is a leading cause of premature death, with hypertension, diabetes, and dyslipidemia as major risk factors. Effective self-management (SM) is crucial for controlling these conditions and improving quality of life. This study examines stakeholders' experiences and expectations of SM education to enhance program development., Methods: This study employed a qualitative grounded theory approach to explore the perspectives of three stakeholder groups: 19 patients with hypertension, type 2 diabetes, and dyslipidemia, 11 primary healthcare providers, and five provincial health policymakers and managers. Data were collected via semi-structured patient interviews and focus group discussions(FGDs) with health professionals. Coding and analysis were conducted separately using Corbin and Strauss principles with ATLAS. ti version 9.0 software., Results: Most patients were women (68%) aged 50-60 years (37%), with education levels from illiterate to master's degree; 32% had completed primary school. Most were housewives (52%), and 12 had multiple chronic diseases. Healthcare providers included six community health workers and five primary care physicians, with average experience of 12 and 19 years, respectively. Health policymakers and managers averaged 25 years of experience. Patient interviews and FGDs resulted in 12 and 13 subthemes, respectively, with five subthemes common to both sources. These subthemes were grouped into broader main themes, including "effective content design," "effective presentation and delivery," "characteristics and conditions of involved parties," and "educational needs," collectively reflect the central concept of "effective self-management education"., Conclusion: Although the core concept and its main themes were evident and consistent across stakeholder groups, significant variations in subthemes from each stakeholder emerged. This underscores the importance of considering diverse viewpoints and highlights that, while overarching concepts may seem uniform, exploring the details of stakeholder perspectives is crucial for understanding their nuanced opinions. Effective education should integrate these insights, focusing on tailored communication, interactivity, and active monitoring., Competing Interests: No conflicts of interest were present in conducting this research, as confirmed by all authors., (Copyright: © 2024 Soleimani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Hypertension is one of the most prevalent chronic diseases in the United States and can increase a person's risk of stroke and other cardiovascular complications. Yet only 1 in 4 people with high blood pressure in the United States have their blood pressure managed. To improve hypertension control, we supported 9 health centers in Texas with the implementation of the Healthy Heart Ambassador Blood Pressure Self-Monitoring (HHA) Program., Methods: We provided health center training using the HHA Program Facilitation Training Guide, recorded barriers to implementing the HHA program, and employed strategies to overcome those barriers., Results: There were 68 staff members from the health centers trained to deliver the HHA program. Three health centers successfully implemented all three major components of HHA, three were able to implement two components, two adopted two components, and one withdrew due to insufficient capacity. Capability, technology infrastructure, and motivation were among the barriers most referenced., Conclusion: Clinic non-physician team members delivering the HHA program will need training and ongoing technical assistance to overcome implementation barriers., (© 2024. The Author(s).)

Background: Despite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. "EMERALD" is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions., Methods: The EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and  (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions., Discussion: This study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector's contribution to addressing the growing burden of non-communicable diseases in China., Trial Registration: The study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024)., (© 2024. The Author(s).)

As people living with HIV experience increased life expectancy, there is a growing concern about the burden of comorbid non-communicable diseases, particularly hypertension. This brief describes the current policy landscape on the management of HIV and hypertension in Akwa Ibom State, Nigeria, stakeholder engagement meetings, and the resulting five policy recommendations rooted in an ongoing research study designed to integrate hypertension management into HIV care across primary health centers in the State. In order to identify the current gaps in integrated care, discussion sessions with three stakeholder groups (i.e., healthcare providers, patient advocacy groups, and policy makers) were held separately in November 2022. The discussions were purposed to brainstorm policy-level solutions for integrating hypertension into HIV treatment. After all the sessions were concluded, there were five recommendations provided by the stakeholders for integrating HIV and hypertension care in the Akwa Ibom State. Stakeholders unanimously agreed with the need to integrate hypertension care for HIV impacted communities in the State. Specifically, stakeholders recommended to: (1) engage retired community health nurses as mentors; (2) actively link communities to integrated care in clinics; (3) integrate hypertension management with HIV education; (4) expand health insurance accessibility; and (5) formally integrate hypertension management into primary healthcare centers in Akwa Ibom State., (© 2024. The Author(s).)

We sought to evaluate the acceptability and feasibility of a culturally tailored food box intervention for improving blood pressure (BP), food security and Body Mass Index (BMI) among Chickasaw Nation adults with uncontrolled hypertension. As part of the Chickasaw Healthy Eating Environments Research Study (CHEERS), we administered a group randomized pilot study in four tribal communities (two intervention, two control). Participants in the intervention communities received six heart-healthy food boxes, culturally tailored to traditional Chickasaw diet and current food context. Outcomes were measured over 6 months. We enrolled 262 participants, and 204 with complete data on key variables were included in the analysis. The food boxes were very popular, and we achieved high retention for follow-up data collection. Intervention community participants had 2.6 mmHg lower mean systolic BP and improved diet quality and BMI compared with control participants, although, as expected for a pilot study, the differences were not statistically significant. The culturally tailored diet intervention and randomized trial study design were acceptable and feasible for Chickasaw Nation adults with uncontrolled hypertension. Our findings support the value of tribal-food bank partnerships as a potential approach for reducing food insecurity and hypertension-related disparities in Native American communities., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Background: The growing use of mobile health applications (apps) for managing diabetes and hypertension entails an increased need to understand their effectiveness among different population groups. It is unclear if efficacy and effectiveness trials currently provide evidence of differential effectiveness, and if they do, a summary of such evidence is missing. Our study identified to what extent sociocultural and socioeconomic inequalities were considered in effectiveness trials of mobile health apps in diabetic and hypertensive patients and if these inequalities moderated app effectiveness., Methods: We built on our recent umbrella review that synthesized systematic reviews (SRs) of randomized controlled trials (RCTs) on the effectiveness of health apps. Using standard SR methodologies, we identified and assessed all primary RCTs from these SRs that focused on diabetes and/or hypertension and reported on health-related outcomes and inequality-related characteristics across intervention arms. We used the PROGRESS-Plus framework to define inequality-related characteristics that affect health opportunities and outcomes. We used harvest plots to summarize the subgroups (stratified analyses or interaction terms) on moderating effects of PROGRESS-Plus. We assessed study quality using the Risk of Bias 2 tool., Results: We included 72 published articles of 65 unique RCTs. Gender, age, and education were the most frequently described PROGRESS-Plus characteristics at baseline in more than half of the studies. Ethnicity and occupation followed in 21 and 15 RCTs, respectively. Seven trials investigated the moderating effect of age, gender or ethnicity on app effectiveness through subgroup analyses. Results were equivocal and covered a heterogenous set of outcomes. Results showed some concerns for a high risk of bias, mostly because participants could not be blinded to their intervention allocation., Conclusions: Besides frequently available gender, age, and education descriptives, other relevant sociocultural or socioeconomic characteristics were neither sufficiently reported nor analyzed. We encourage researchers to investigate how these characteristics moderate the effectiveness of health apps to better understand how effect heterogeneity for apps across different sociocultural or socioeconomic groups affects inequalities, to support more equitable management of non-communicable diseases in increasingly digitalized systems., Registration: https://osf.io/89dhy/ ., (© 2024. The Author(s).)

The relationship between glaucoma and hypertension is complex. Intraocular pressure is the main modifiable risk factor for glaucoma. Literature describes hypertension as being linked to glaucomatous damage, although the mechanisms are not fully understood. Therefore, glaucoma screening is recommended for hypertensive individuals over 60 years old. The relationships between ocular, arterial pressure, and ocular perfusion pressure, and their impact on optic nerve perfusion, make coordinated management of these elements crucial. Hypertension, hypotension, extreme variability, nocturnal dipping, and overtreatment with antihypertensive drugs can increase the incidence and/or progression of glaucoma. This critical review discusses the causative, clinical, and therapeutic elements to consider in the management of these two pathologies., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Individuals with high blood pressure in India often miss essential follow-up visits. Missed visits contribute to gaps across the hypertension care continuum and preventable cardiovascular disease. Widespread misconceptions around hypertension care and treatment may contribute to low follow-up attendance rates, but to date, there is limited evidence of the effect of interventions to debunk such misconceptions on health-seeking behavior. We conducted a randomized controlled trial to measure whether combining information debunking commonly-held misconceptions with a standard reminder reduces missed follow-up visits among individuals with high blood pressure and investigated whether any observed effect was moderated through belief change., Methods: We recruited 388 patients with uncontrolled blood pressure from the outpatient wards of two public sub-district hospitals in Punjab, India. Participants randomly assigned to the intervention arm received two WhatsApp messages, sent 3 and 1 days before their physician-requested follow-up visit. The WhatsApp message began with a standard reminder, reminding participants of their upcoming follow-up visit and its purpose. Following the standard reminder, we included brief debunking statements aimed at acknowledging and correcting common misconceptions and misbeliefs about hypertension care seeking and treatment. Participants in the control group received usual care and did not receive any messages., Results: We did not find evidence that the enhanced WhatsApp reminders improved follow-up visit attendance (Main effect: 2.2 percentage points, p-value = 0.603), which remained low across both treatment (21.8%, 95% CI: 15.7%, 27.9%) and control groups (19.6%, 95% CI: 14.2%, 25.0%). Participants had widespread misconceptions about hypertension care but our debunking messages did not successfully correct these beliefs (p-value = 0.187)., Conclusions: This study re-affirms the challenge of continuity of care for chronic diseases in India and suggests that simple phone-based health communication methods may not suffice for changing prevalent misconceptions and improving health-seeking behavior., Trial Registration: The trial began on July 18th. We registered the trial on July 18th (before recruitment began), including the main outcomes, on the German Clinical Trial Register [Identifier: DRKS00029712] and published a pre-analysis plan in the Open Science Framework [osf.io/67g35]., (© 2024. The Author(s).)

Background: Healthcare workers (HCWs) including community health extension workers (CHEWs) in the Federal Capital Territory, Nigeria participated in a hypertension training series following the Extension for Community Healthcare Outcomes (ECHO) model which leverages technology and a practical peer-to-peer learning framework to virtually train healthcare practitioners. We sought to evaluate the patient-level effects of the hypertension ECHO series., Methods: HCWs from 12 of 33 eligible primary healthcare centers (PHCs) in the Hypertension Treatment in Nigeria Program (NCT04158154) were selected to participate in a seven-part hypertension ECHO series from August 2022 to April 2023. Concurrent Hypertension Treatment in Nigeria Program patient data were used to evaluate changes in hypertension treatment and control rates, and adherence to Nigeria's hypertension treatment protocol. Outcomes were compared between the 12 PHCs in the ECHO program and the 21 which were not., Results: Between July 2022 and June 2023, 16,691 PHC visits were documented among 4340 individuals (ECHO: n = 1428 [33%], non-ECHO: n = 2912 [67%]). Patients were on average (SD) 51.5 (12.0) years old, and one-third were male (n = 1372, 32%) with no differences between cohorts in either characteristic (p ≥ 0.05 for both). Blood pressures at enrollment were higher in the ECHO cohort compared to the non-ECHO cohort (systolic p < 0.0001 and diastolic p = 0.0001), and patients were less likely to be treated with multiple medications (p < 0.0001). Treatment rates were similar at baseline (ECHO: 94.0% and Non-ECHO: 94.7%) and increased at a higher rate (interaction p = 0.045) in the ECHO cohort over time. After adjustment for baseline and within site variation, the difference was attenuated (interaction p = 0.37). Over time, control rates increased and medication protocol adherence decreased, with no differences between cohorts. Staffing levels, adult patient visits, and rates of hypertension screening and empanelment were similar between ECHO and non-ECHO cohorts (p ≥ 0.05 for all)., Conclusions: The ECHO series was associated with moderately increased hypertension treatment rates and did not adversely affect staffing or clinical capacity among PHCs in the Federal Capital Territory, Nigeria. These results may be used to inform strategies to support scaling hypertension education among frontline HCWs throughout Nigeria, and use of the ECHO model for CHEWs., Trial Registration: The Hypertension Treatment in Nigeria Program was prospectively registered on November 8, 2019 at www., Clinicaltrials: gov (NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154 )., (© 2024. The Author(s).)

Background: Hypertension is a significant risk factor for cardiovascular disease, with a higher prevalence among African Americans (AA) than other racial groups. The impact of community-based interventions on managing blood pressure (BP) in AA communities is not fully understood. The purpose of this review was to synthesize literature on community-based physical activity (PA) programs designed to manage BP in AA populations., Methods: We conducted a scoping review by searching 4 databases (PubMed, CINAHL, MEDLINE, and APA PsycInfo) and reference lists of studies. Search terms included community PA, community-based, hypertension, high BP, AA, Black Americans, PA, and exercise. Inclusion criteria were studies (1) conducted in the United States and (2) published in English language from January 2013 to September 2023, with community-based interventions that included PA for BP management among AA aged ≥18 years., Results: Search results yielded 260 studies, of which 11 met the inclusion criteria. BP decreased over time in studies that incorporated PA, faith-based therapeutic lifestyle changes with nutritional education. The duration of the PA interventions varied, with moderate to vigorous PAs implemented for 12 weeks or longer having a greater impact on BP management., Conclusions: Evidence suggests that community-based PA programs can potentially reduce BP among AA. PA programs incorporating faith-based therapeutic lifestyle change with nutritional education appear to reduce BP. Practitioners should consider multicomponent community-based PA initiatives to improve BP outcomes in AA communities.

Background: Hypertension affects one-third of adults in the United States and is the leading risk factor for death. Underserved populations are seen disproportionately in the emergency department (ED) and tend to have worse blood pressure (BP) control. For adults, a lack of hypertension knowledge is a common barrier to hypertension control, while social support is a strong facilitator, and providing information that is culturally sensitive and relevant is especially important in this context. The youth experience increased confidence when given the responsibility to provide health education and care navigation to others. As such, we planned a randomized controlled trial (RCT) for the effectiveness of a digital youth-led hypertension education intervention for adult patients in the ED with hypertension, focusing on change in BP and hypertension knowledge., Objective: In preparation for an RCT, we conducted a formative study to determine acceptable and easily comprehensible ways to present hypertension information to adults with hypertension and optimal ways to engage youth to support adults on how to achieve better hypertension control., Methods: After creating an intervention prototype with 6 weekly self-guided hypertension online modules, we recruited 12 youth (adolescents, aged 15-18 years) for 3 focus groups and 10 adult ED patients with hypertension for individual online interviews to garner feedback on the prototype. After completing a brief questionnaire, participants were asked about experiences with hypertension, preferences for a hypertension education intervention, and acceptability, feasibility, obstacles, and solutions for intervention implementation with youth and adults. The moderator described and showed participants the prototyped intervention process and materials and asked for feedback. Questionnaire data were descriptively summarized, and qualitative data were analyzed using the template organizing style of analysis by 3 study team members., Results: Participants showed great interest in the intervention prototype, thought their peers would find it acceptable, and appreciated its involvement of youth. Youth with family members with hypertension reported that their family members need more support for their hypertension. Youth suggested adding more nutrition education activities to the intervention, such as a sodium tracker and examples of high-sodium foods. Adults discussed the need for a hypertension support intervention for themselves and the expected benefits to youth. They mentioned the overwhelming amount of hypertension information available and appreciated the intervention's concise content presentation. They suggested adding more mental health and smoking cessation resources, information about specific hypertension medications, and adding active links for health care information., Conclusions: Based on focus groups and interviews with participants, a youth-led digital hypertension intervention is an acceptable strategy to engage both adults with hypertension and youth. Incorporating participant suggestions into the intervention may improve its clarity, engagement, and impact when used in a subsequent RCT., (©Sara W Heinert, Kelvin Guzman-Baez, Affan Aamir, Ananya Penugonda, Benjamin F Crabtree, Kathryn Greene, Carolyn J Heckman, Phillip Levy, Pamela Ohman Strickland, Shawna V Hudson. Originally published in JMIR Formative Research (https://formative.jmir.org), 06.09.2024.)

Introduction: Hypertension is a major cause of premature death worldwide as it is an important risk factor for coronary artery disease, myocardial infarction, heart failure and stroke. Although an estimated 1.3 billion adults suffer from hypertension, less than half of them are diagnosed correctly and therefore receive sufficient treatment. Furthermore, only one fifth of those treated reach the therapy target of normotension. This significant deficit underlines the need for new therapy concepts to improve long-term health outcomes. Several studies have shown positive effects of digital health programmes in the disease management of ambulatory, long-term hypertension treatment. More research is needed to explore the abilities of digital health programmes as an innovative pathway in ambulatory healthcare.The eXPLORE study aims to evaluate the feasibility of a clinical trial on the impact of a supplementary digital therapy programme for the treatment of primary arterial hypertension., Methods and Analyses: The eXPLORE study collects data in the setting of a prospective randomised controlled trial to evaluate methodological feasibility for larger-scaled follow-up research. The study compares a digital therapy programme using a smartphone application that is based on functions and algorithms creating tasks and recommendations based on individual health data to standard care for the treatment of primary arterial hypertension. The study period is 180 days, with a 90-day in-life phase followed by a 90-day follow-up phase. Baseline and follow-up data (3 months, 6 months follow-up) of all participants included is collected via questionnaire surveys as well as self-administered blood pressure monitoring. Patient inclusion, initial data acquisition and follow-up were carried out in an innovative remote setting. The study was initiated in November 2022 and is currently ongoing. Study outcome measures are changes in mean blood pressure, health literacy and self-sufficient health behaviour., Ethics and Dissemination: The eXPLORE study is carried out in accordance with all applicable legal regulations. Cost-effectiveness is assured by continuous evaluation and documentation over the course of the study. All health-relevant data from the eXPLORE study will be provided for analyses and publication to the investigators of LMU Hospital. The study was approved by the local ethics committee of LMU Munich (project nr.: 22-0115)., Trial Registration: NCT05580068., Protocol Version: 1.5, 28.08.2023., Competing Interests: Competing interests: PW is an employee of iATROS., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Non-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra., Methods: A convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion., Results: Out of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55-118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden., Conclusion: The economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions., (© 2024. The Author(s).)

Acupuncture can reduce blood pressure, heart rate (HR), and ameliorate cardiac damage by modulating the excitability of the sympathetic nervous system, but the exact mechanism of this effect remains unclear. This study investigated the potential mechanisms of acupuncture in the treatment of cardiac damage in hypertension. Spontaneously hypertensive rats (SHR) were used as the hypertension model with Wistar-Kyoto rats as the control. Manual acupuncture, electroacupuncture, and metoprolol were used as interventions. Systolic and diastolic blood pressure (SBP, DBP) plus HR were monitored with cardiac structure determined using Masson staining. Angiotensin II (Ang II) and norepinephrine in myocardium were detected with ELISA as was Ang(1-7) and gamma aminobutyric acid (GABA) in the rostral ventrolateral medulla (RVLM). Expression of mRNA for collagen type I (Col-I), Col-III, actin α1 (ACTA1), and thrombospondin 4 (THBS4) in myocardium was detected using real-time PCR. Expression of angiotensin converting enzyme (ACE), Ang II, angiotensin II type 1 receptor (AT1R), ACE2, and Mas receptor (MasR) proteins in RVLM was monitored using western blot. After manual acupuncture and electroacupuncture treatment, SHRs showed decreased SBP, DBP and HR, reduced myocardial damage. There was decreased expression of the ACE/Ang II/AT1R axis, and increased expression of the ACE2/Ang(1-7)/MasR axis within the RVLM. GABA levels were increased within the RVLM and norepinephrine levels were decreased in myocardial tissue. Metoprolol was more effective than either manual acupuncture or electroacupuncture. Acupuncture directed against hypertensive cardiac damage may be associated with regulation of ACE/Ang II/AT1R and the ACE2/Ang(1-7)/MasR pathway within the RLVM to reduce cardiac sympathetic excitability., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage., Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction., Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction., Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5% (4/91) of the apps achieved a demand fulfillment rate exceeding 80% (8/10). Overall, user satisfaction in both countries was low., Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility., (©Yunfan He, Han Chen, Peng Xiang, Min Zhao, Yingjun Li, Yongcheng Liu, Tong Wang, Jun Liang, Jianbo Lei. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.09.2024.)

Background: Diabetes Mellitus coexisting with hypertension has received significant global attention and remains a public health challenge in the past two decades. The states of hyperinsulinemia and insulin resistance have been postulated as causes or consequences of hypertension. Evidence shows that alternative systems of medicine can play a significant role in achieving glycemic control. This study aimed to compare and evaluate the impact of yoga and naturopathy-based lifestyles on patients with diabetes mellitus and diabetes mellitus with hypertension., Methods: Sixty subjects were recruited into two groups, group 1 (diabetes mellitus with hypertension) and group 2 (diabetes mellitus) based on the inclusion and exclusion criteria. Both the groups underwent naturopathy and yoga intervention for ten days. The glycemic profile and heart rate variability (HRV) of the patients were assessed at the baseline and 10 days after the intervention., Results: Study resulted in a significant change in both time domain and frequency domain variables (HRV, FBS, and PPBS) in both group 1 and group 2 (P < .05, for all) but the mean difference was more in group 2 with a significant difference between the two groups, P < .05. The diastolic blood pressure significantly decreased only in group 2, whereas the systolic blood pressure decreased in both groups without any difference between the two groups., Conclusion: The results of the present study show that integrated yoga and naturopathy management significantly help in glycemic control and autonomic functions in both groups.

Hypertension is the top cause of preventable deaths in the African region. The burden of hypertension is increasing in Ghana, along with other countries in the African continent. Many people with hypertension in Ghana are unfortunately unaware of their diagnosis, and those who are aware often have poorly controlled blood pressure. The current situation is a signal of critical gaps in hypertension care in Ghana that need to be urgently addressed to curb this epidemic. The World Heart Federation (WHF), sponsored by Resolve to Save Lives, responded to this need by organising advocacy roundtables on hypertension in selected countries in sub-Saharan Africa to scale up hypertension management efforts in these countries. The roundtable on hypertension in Ghana was organised in collaboration with the Ghanaian Society of Cardiology (GSC) and the Stroke Association Support Network (SASNET) Ghana. A country mapping detailing the current situation and evolution of hypertension in Ghana over the years formed the basis of the roundtable discussions. The roundtable convened diverse stakeholders in hypertension care in Ghana to discuss the roadblocks to hypertension management in Ghana, proffer solutions to address them and chart a course with timelines for action. Major roadblocks to the management of hypertension in Ghana identified included inadequate financing for cardiovascular disease (CVD) care, inadequate capacity for CVD care across all levels of the healthcare system and insufficient education to empower people with hypertension for optimal self-care., Funding: The roundtable was funded through a grant by Resolve to Save Lives through the World Heart Federation., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Purpose: The impact of digital health on medically underserved patients is unclear. This study aimed to determine the early impact of a digital innovation to grow quality care through an interprofessional care team (DIG IT) on the blood pressure (BP) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of medically underserved patients., Methods: This was a 3-month, prospective intervention study that included patients aged 40 years or more with BP of 140/90 mmHg or higher who received care from DIG IT from August through December 2021. Sociodemographic and clinical outcomes of DIG IT were compared with historical controls (controls) whose data were randomly extracted by the University of California Data Warehouse and matched 1:1 based on age, ethnicity, and baseline BP of the DIG IT arm. Multiple linear regression was performed to adjust for potential confounding factors., Results: A total of 140 patients (70 DIG IT, 70 controls) were included. Both arms were similar with an average age (SD) of 62.8 (9.7) years. The population was dominated by Latinx (79.3%) persons, with baseline mean BP of 163/81 mmHg, and mean ASCVD risk score of 23.9%. The mean (SD) reduction in systolic BP at 3 months in the DIG IT arm was twice that of the controls (30.8 [17.3] mmHg vs 15.2 [21.2] mmHg; P <.001). The mean (SD) ASCVD risk score reduction in the DIG IT arm was also twice that of the controls (6.4% [7.4%] vs 3.1% [5.1%]; P = .003)., Conclusions: The DIG IT was more effective than controls (receiving usual care). Twofold improvement in the BP readings and ASCVD scores in medically underserved patients were achieved with DIG IT., (© 2024 Annals of Family Medicine, Inc.)

Renal sympathetic denervation (RDN) is an interventional supplement to medical treatment in patients with arterial hypertension. While the first sham-controlled trial, SYMPLICITY HTN‑3 was neutral, with improved procedural details, patient selection and follow-up, recent randomized sham-controlled trials of second-generation devices show a consistent blood pressure lowering effect of RDN, as compared to sham controls. These new data and the recent U.S. Food and Drug Administration (FDA) premarket approval of two RDN devices are the basis for the present recommendations update.This joint position paper from the Austrian Society of Hypertension, together with the Austrian Society of Nephrology and the Working Group of Interventional Cardiology from the Austrian Society of Cardiology includes an overview about the available evidence on RDN and gives specific recommendations for the work-up, patient selection, pretreatment, procedural management and follow-up in patients undergoing RDN in Austria. Specifically, RDN may be used in clinical routine care, together with lifestyle measures and antihypertensive drugs, in patients with resistant hypertension (i.e. uncontrolled blood pressure on 3 antihypertensive drugs) and in those with uncontrolled hypertension, after adequate work-up, if institutional, patient-related and procedural conditions are fulfilled., (© 2024. The Author(s).)

Objectives: To assess the impact of educational intervention by nurses guided by Orem's theory to reinforce the self-care abilities of patients experiencing myocardial infarction., Methods: The prospective, quasi-experimental case-control study was conducted from September 2020 to April 2021 at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, and comprised myocardial infarction and heart failure patients with comorbidities diabetes mellitus and hypertension. The patients were randomised into experiment group A and control group B. Group A received educational intervention one day before and one day after discharge in line with the American Heart Association guidelines. Two 30-45-minute sessions of seven modules were conducted. Group B received routine information from ward staff. Assessment was done at baseline and first month and second month post-intervention using the Heart Failure Self-Care Index version 6.2. Data was analysed using SPSS 21., Results: Of the 80 patients, 40(50%) were in group A; 27(76.5%) males and 13(32.5%) females. The remaining 40(50%) patients were in group B; 20(50%) males and 20(50%) females. The overall age of the sample ranged 36-65 years and 48(60%) had a previous history of heart failure. The mean score of maintenance, management, confidence and overall self-care were significantly higher in group A compared to group B (p<0.05)., Conclusion: Nursing self-care educational intervention based on Orem's theory was found to be highly effective among patients of myocardial infarction and heart failure with respect to their self-efficacy ability.

Hypertension does not recognize obvious pathogenic causes in the majority of patients (essential hypertension). However, a secondary underlying cause of hypertension can be recognized in 5-10% of unselected hypertensive patients, and this prevalence may increase to more than 20% in patients with hypertension that is difficult to control or frankly resistant to treatment. In children, secondary hypertension is most often due to aortic coarctation, distal thoracic or abdominal aortic stenosis, or specific gene mutations. In adults or elderly individuals, secondary hypertension is most often due to atherosclerotic renal artery stenosis, primary hyperaldosteronism, and Cushing's disease or syndrome. Parenchymal nephropathy and hyperparathyroidism can cause hypertension at all ages, while pheochromocytoma and paraganglioma tend to occur more often in adolescents or young adults. In general, secondary hypertension should be suspected in subjects with: (a) onset of hypertension under 30 years of age especially if in the absence of hypertensive family history or other risk factors for hypertension; (b) treatment-resistant hypertension; c) severe hypertension (>180/110 mmHg), malignancy, or hypertensive emergencies; d) rapid rise in blood pressure values in previously well controlled patients. Any clinical signs suspicious or suggestive of hypertension from endocrine causes, a "reverse dipping" or "non-dipping'" profile at 24 h ambulatory blood pressure monitoring not justified by other factors, signs of obvious organ damage may be helpful clues for diagnosis. Finally, patients snoring or with clear sleep apnea should also be considered for possible secondary hypertension.