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ABSTRACT Introduction Methods Results Conclusions This study tests the hypothesis that self‐reported somatic symptoms are associated with biomarkers of stress, including elevated blood pressure and suppressed immune function, among Shuar adults living in the Ecuadorian Amazon.Research was conducted in three Shuar communities in the Upano Valley of the Ecuadorian Amazon and included the collection of biomarkers and a structured morbidity interview. Participants self‐reported somatic symptoms such as headaches, body pain, fatigue, and other bodily symptoms. We examined whether the number of somatic symptoms reported was associated with measures of immune (Epstein–Barr virus [EBV] antibodies) and cardiovascular (blood pressure) functioning in 97 Shuar adults (37 women, 60 men; ages 18–65 years). Multivariate linear regression analyses were used to examine the relationships among somatic symptoms and stress biomarkers, controlling for age, sex, body mass index (BMI), active infection, level of education, and income.Controlling for relevant covariates, Shuar adults reporting the highest level of somatic symptoms (three symptoms) were more likely to exhibit elevated systolic (β = 0.20, p = 0.04) and diastolic blood pressure (β = 0.23, p = 0.03), in comparison to adults reporting no symptoms. Shuar adults reporting two symptoms, compared to no symptoms, were more likely to exhibit elevated EBV antibody concentrations (β = 0.34, p = < 0.01).These preliminary findings demonstrate that somatic symptoms reported by Shuar men and women are associated with physiological measures widely associated with chronic psychosocial stress. These findings complement the cross‐cultural literature in medical anthropology documenting the close connection between the expression of somatic symptoms and stressful life circumstances and highlight the important role that human biologists can play in exploring biocultural phenomena. [ABSTRACT FROM AUTHOR]

Current understanding of the cerebral vascular response to variations in blood pressure (BP) among individuals with hypertension is limited. The aim of this meta-analysis was to determine the correlation between hypertension, risk of stroke, and cerebral blood flow (CBF). We reviewed studies published between 2000 and 2023 from PubMed, Google Scholar, and Science Direct that compared mean CBF in normotensive (NTN) and hypertensive (HTN) patients. A random effects model was used to construct the risk ratio (RR), 95% confidence interval (CI), forest plot, and inverse variance weighting. Additionally, a mixed-effects meta-regression was employed to examine the impact of study-specific patient variables. This meta-analysis included eight prospective cross-sectional studies published from 2002 to 2023. It revealed a significant average difference in the standard mean CBF of −0.45 (95% CI −0.60 to −0.30, I2 = 69%, P < 0.00001), distinguishing NTN from HTN subjects. A RR of 0.90 (95% CI 0.63 to 1.30, I2 = 89%, P = 0.04) indicated a significant decrease in CBF among individuals with hypertension. We found a statistically significant relationship between changes in diastolic and systolic BPs and the mean CBF (R −0.81, P = 0.001 and R = −0.90, P = 0.005, respectively). Our research demonstrates a strong relationship between elevated BP and reduced CBF, with hypertension reducing CBF compared to NTN individuals, by increasing cerebrovascular resistance.

Abstract Background Short sleep duration, defined as

Background Avocado leaves ( Persea americana Mill.) have been traditionally used as antihypertensive. Various studies have tested the benefits of the Persea americana Mill. in treating hypertension but still using extracts not yet using nanoparticles. Therefore, this study aims to study the effectiveness of avocado leaf extract, including the nanoparticles, on salt-induced hypertensive Wistar rats in inhibiting the ACE enzyme, which causes decreasing systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as increasing urine volume. Methods This study used an experimental in vivo study design involving 24 white male Wistar rats ( Rattus norvegicus), aged 2–3 months, weighing 130–250 g, and of a healthy condition with active movement. The samples were randomly divided into six treatment groups and post-test only research design with control group design. Results The result of the study showed that the extract contained a quercetin of 1129.597 ppm and 10 mineral compounds, including potassium, with the highest content. The analysis of antioxidant activity using the 2,2-diphenyl-1-picrylhydrazyl method showed that the antioxidant activity at IC 50 was 44.734 ppm. The P. americana leaf extract nanoparticles had the most significant result in reducing blood pressure in Wistar rats induced by 16% NaCl for 14 days SBP to normal was by 68.75 mmHg (175.00±21.57 mmHg to 106.25±9.21 mmHg) and 55.25 mmHg (128.42±25.75 mmHg to 73.17±15.75 mmHg), respectively. Also, avocado leaf extract caused the decrease of SBP from 164.92±7.16 mmHg to 116.83±6.36 mmHg and DBP from 118.42±16.24 mmHg to 82.83±6.47 mmHg. The P. americana leaf extract nanoparticles resulted in the most urine volume at 13.5 ml, with the highest DAI value of 2.25. The ACE inhibitor test using the ELISA method showed that the P. americana leaf extract and the nanoparticle extract inhibition against the ACE enzyme were 60.0±12.1 % and 59.5±3%, respectively. The mean serum nitrate as a result of P. americana leaf extract (K4) and nanoparticles of P. americana leaf extract (K5) were 44.0±9.0 μmol/L and 41.1±11.5 μmol/L, respectively. The mean of serum nitrite was led by P. americana leaf extract (K4), and nanoparticles of P. americana leaf extract (K5) were 83.7±24.0 μmol/L and 81.0±23.2 μmol/L, sequentially. Conclusions The study showed that the leaf extract and nanoparticle extract of Persea americana Mill. was effective as an antihypertensive.

Background: Short sleep duration, defined as < 7 h sleep on weeknights, affects 40% of the US adult population, contributing to the increased risk for cardiometabolic diseases, decreased safety, and poorer mental health. Despite the prevalence of short sleep duration, few studies have tested interventions to extend sleep duration. The objective of this study is to test the effects of a behavioral sleep extension intervention on sleep duration, blood pressure, and other measures of cardiometabolic health among adults with elevated blood pressure or hypertension. Methods: This is a single-blind, randomized controlled trial to determine the impact of a behavioral sleep extension intervention on sleep duration and cardiometabolic health among individuals with short sleep duration (< 7 h per night) and elevated blood pressure or hypertension (SBP 120–150 mmHg or DBP 80–90 mmHg). After completing the screening, participants will be randomly assigned to either a sleep coaching (intervention) or health education (control) group. The participants will have weekly contact for either coaching or education for 8 weeks (intervention period) followed by monthly coaching or education for the next 2 months (maintenance period). Participants will complete assessment visits, actigraphy, and 24-h ambulatory blood pressure recording at baseline/screening, 8 weeks, and 6 and 12 months. The primary outcome is sleep duration at 8 weeks, and the secondary outcome is blood pressure at 8 weeks. Discussion: The results of this study will determine the effects of behavioral sleep extension on sleep and cardiometabolic health among adults with short sleep duration and elevated BP/hypertension. The results will inform the feasibility and efficacy of behavioral sleep extension and provide information needed for future multi-site effectiveness studies. Trial registration: ClinicalTrials.gov NCT04766424. Registered on 21 February 2021. [ABSTRACT FROM AUTHOR]

Background: The prime challenge of physicians in 21st century is cardiovascular disease (CVD). Cardiovascular disease principally ischemic heart disease and stroke are the leading cause of mortality and majordisability in the world. The most important modifiable risk factors of CVDs are dyslipidemia, obesity and hypertension. The effects of unhealthy diet and physical inactivity include abnormal blood lipids, obesity and hypertension. Objective: To evaluate & correlate the pattern of lipid profile & blood pressure in obese & non-obese patients. Materials and methods: This is a cross-sectional study based on a database of 180 adults who received routine health screening. Subjects (n=180) include both male and female age between 20- 50 years who were willing to participate in the study, having body mass index (BMI) > 18.5 kg/m², were considered. Subjects who are known case of obesity secondary to hypothyroidism, Cushing’s syndrome, hypothalamic disease, pregnant, congestive cardiac failure, renal failure, cirrhosis with as cites and those on lipid lowering drugs or any drugs affecting lipid metabolism were also excluded. Subjects who are on antihypertensive drugs were also excluded. Statistical analysis: The data are expressed in numbers as means ± SD. The t test was used to compare continuous variables, such as obesity indicators and biochemical parameters, between the two groups. Statistical analyses were performed using SPSS version 26.0 (SPSS Inc.,). A p value < 0.05 was considered statistically significant. Result: Blood pressure was elevated in Gr-III as compared to Gr-I+II (p<0.001). Serum Cholesterol, triglycerides, LDL, VLDL were elevated in Gr-III as compared to Gr-I+II (p<0.001). HDL was decreased in Gr-III compared Gr-I+II (P<0.001). In our study shows comparison of lipid profile parameters and blood pressure parameters between nonobese (Gr-I+II) and obese subjects(Gr-III). Elevated cholesterol, triglycerides, LDL, VLDL in Gr-III as compared to Gr-I+II. It also shows elevated blood pressure parameters in Gr-III compared to Gr-I+II. Conclusion: Obese persons are prone to develop elevated serum cholesterol, triglyceride, LDL and VLDL cholesterol as compare to non-obese. There is a positive correlation of serum cholesterol, triglyceride, LDL and VLDL level with body mass index in this study, and there is negative correlation of serum HDL level with body mass index. The mean values of blood pressure parameters are more in obese subjects as compared to non-obese subjects. [ABSTRACT FROM AUTHOR]

In genetic association studies, the multivariate analysis of correlated phenotypes offers statistical and biological advantages compared to analyzing one phenotype at a time. The joint analysis utilizes additional information contained in the correlation and avoids multiple testing. It also provides an opportunity to investigate and understand shared genetic mechanisms of multiple phenotypes. Bivariate logistic Bayesian LASSO (LBL) was proposed earlier to detect rare haplotypes associated with two binary phenotypes or one binary and one continuous phenotype jointly. There is currently no haplotype association test available that can handle multiple continuous phenotypes. In this study, by employing the framework of bivariate LBL, we propose bivariate quantitative Bayesian LASSO (QBL) to detect rare haplotypes associated with two continuous phenotypes. Bivariate QBL removes unassociated haplotypes by regularizing the regression coefficients and utilizing a latent variable to model correlation between two phenotypes. We carry out extensive simulations to investigate the performance of bivariate QBL and compare it with that of a standard (univariate) haplotype association test, Haplo. score (applied twice to two phenotypes individually). Bivariate QBL performs better than Haplo. score in all simulations with varying degrees of power gain. We analyze Genetic Analysis Workshop 19 exome sequencing data on systolic and diastolic blood pressures and detect several rare haplotypes associated with the two phenotypes. [ABSTRACT FROM AUTHOR]

In genetic association studies, the multivariate analysis of correlated phenotypes offers statistical and biological advantages compared to analyzing one phenotype at a time. The joint analysis utilizes additional information contained in the correlation and avoids multiple testing. It also provides an opportunity to investigate and understand shared genetic mechanisms of multiple phenotypes. Bivariate logistic Bayesian LASSO (LBL) was proposed earlier to detect rare haplotypes associated with two binary phenotypes or one binary and one continuous phenotype jointly. There is currently no haplotype association test available that can handle multiple continuous phenotypes. In this study, by employing the framework of bivariate LBL, we propose bivariate quantitative Bayesian LASSO (QBL) to detect rare haplotypes associated with two continuous phenotypes. Bivariate QBL removes unassociated haplotypes by regularizing the regression coefficients and utilizing a latent variable to model correlation between two phenotypes. We carry out extensive simulations to investigate the performance of bivariate QBL and compare it with that of a standard (univariate) haplotype association test, Haplo.score (applied twice to two phenotypes individually). Bivariate QBL performs better than Haplo.score in all simulations with varying degrees of power gain. We analyze Genetic Analysis Workshop 19 exome sequencing data on systolic and diastolic blood pressures and detect several rare haplotypes associated with the two phenotypes.

Introduction: This study tests the hypothesis that self-reported somatic symptoms are associated with biomarkers of stress, including elevated blood pressure and suppressed immune function, among Shuar adults living in the Ecuadorian Amazon., Methods: Research was conducted in three Shuar communities in the Upano Valley of the Ecuadorian Amazon and included the collection of biomarkers and a structured morbidity interview. Participants self-reported somatic symptoms such as headaches, body pain, fatigue, and other bodily symptoms. We examined whether the number of somatic symptoms reported was associated with measures of immune (Epstein-Barr virus [EBV] antibodies) and cardiovascular (blood pressure) functioning in 97 Shuar adults (37 women, 60 men; ages 18-65 years). Multivariate linear regression analyses were used to examine the relationships among somatic symptoms and stress biomarkers, controlling for age, sex, body mass index (BMI), active infection, level of education, and income., Results: Controlling for relevant covariates, Shuar adults reporting the highest level of somatic symptoms (three symptoms) were more likely to exhibit elevated systolic (β = 0.20, p = 0.04) and diastolic blood pressure (β = 0.23, p = 0.03), in comparison to adults reporting no symptoms. Shuar adults reporting two symptoms, compared to no symptoms, were more likely to exhibit elevated EBV antibody concentrations (β = 0.34, p = < 0.01)., Conclusions: These preliminary findings demonstrate that somatic symptoms reported by Shuar men and women are associated with physiological measures widely associated with chronic psychosocial stress. These findings complement the cross-cultural literature in medical anthropology documenting the close connection between the expression of somatic symptoms and stressful life circumstances and highlight the important role that human biologists can play in exploring biocultural phenomena., (© 2024 The Author(s). American Journal of Human Biology published by Wiley Periodicals LLC.)

Background Long-term chemical drug consumption to treat hypertension may have side effects because the levels are sometimes difficult for the body to tolerate. Therefore, some people have used plants as herbal medicine, including avocado leaves ( Persea americana Mill.) as antihypertensive. This study aims to find out the differences in the effectiveness of modern drugs and natural antihypertensive ingredients in avocado leaf extract (containing flavonoids and quercetin compounds) in inhibiting the ACE enzyme, which causes decreasing systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as increasing urine volume. Methods This study used an experimental in vivo study design involving 24 white male Wistar rats ( Rattus norvegicus), aged 2–3 months, weighing 130–250 g, and of a healthy condition with active movement. The samples were randomly divided into six treatment groups and post-test only research design with control group design. Results The result of the study showed that avocado leaf extract was effective in reducing blood pressure in Wistar rats with hypertension induced by 16% NaCl for 14 days. SBP fell from 164.92 mmHg to 116.83 mmHg and DBP from 118.42 mmHg to 82.83 mmHg. One-way ANOVA test value significance SBP p=0.000 and Kruskal–Wallis test value of DBP p=0.030, Kruskal–Wallis test urine volume value of p=0.002. The statistical test results proved that avocado leaf extract significantly reduced the blood pressure and increased the urine volume in hypertensive rats. The ACE inhibitor test, performed using an ELISA, showed that the extract inhibition against the ACE enzyme was 60.0±12.1%, serum nitrate levels 41.1±11.5. The decrease in blood pressure occurred because the extract contained a quercetin compound discovered by the high-performance liquid chromatography (HPLC) method of 1129.597 ppm. Conclusions The study showed that the leaf extract of Persea americana Mill. was effective as an antihypertensive.

Introduction: There is a lack of data describing the blood pressure response (BPR) in welltrained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing. Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a noninvasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests. Results: At lactate threshold (281 ± 56W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r² of 0.81 ± 17. Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing. [ABSTRACT FROM AUTHOR]

Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing.Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests.Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r2 of 0.81 ± 17.Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing.

In this study, single-channel photoplethysmography (PPG) signals were used to estimate the heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP). A deep learning model was proposed using a long-term recurrent convolutional network (LRCN) modified from a deep learning algorithm, the convolutional neural network model of the modified inception deep learning module, and a long short-term memory network (LSTM) to improve the model's accuracy of BP and HR measurements. The PPG data of 1,551 patients were obtained from the University of California Irvine Machine Learning Repository. How to design a filter of PPG signals and how to choose the loss functions for deep learning model were also discussed in the study. Finally, the stability of the proposed model was tested using a 10-fold cross-validation, with an MAE ± SD of 2.942 ± 5.076 mmHg for SBP, 1.747 ± 3.042 mmHg for DBP, and 1.137 ± 2.463 bpm for the HR. Compared with its existing counterparts, the model entailed less computational load and was more accurate in estimating SBP, DBP, and HR. These results established the validity of the model. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of telmisartan and atenolol in management of patients with essential hypertension. Study Design: Randomized comparative trial. Place and Duration of Study: Department of Medicine Combined Military Hospital Peshawar, from Feb 2010 to Aug 2010. Material and Methods: One hundred & eighty patients diagnosed with essential hypertension fulfilling the inclusion criteria were included in study using consecutive non-probability sampling after taking informed consent. Patients were allocated to either telmisartan or atenolol group by using a table of random numbers. Follow up of patients was carried out in 4 visits with recording of sitting systolic and diastolic blood pressures. Results: Among total of 180 patients, 60% were females and 40% were males. Majority were between age group 56-75 years. Reduction of both systolic and diastolic blood pressures at the end of eight weeks was significantly greater with telmisartan as compared to atenolol (p-value=0.000 and 0.016 respectively). Conclusion: At the end of eight weeks of treatment, telmisartan was more effective than atenolol in lowering systolic and diastolic blood pressure.

Measurement of blood pressure (BP) from photoplethysmograph (PPG) signal has been investigated by several researchers in recent years. Use of PPG signal for BP measurement has advantages over conventional cuff-based sphygmomanometric methods. Signals from two different measurement instruments, such as electrocardiogram (ECG) and photoplethysmogram, are mostly used to determine BP. In this article, a novel approach for determining BP by measurement of only one signal, viz., PPG, is presented. Two specific methods have been discussed for determining mean arterial blood pressure (MABP), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The first method, presented in , needs an initial value of BP while the second method uses a learning-based nonparametric regression technique. PPG signals from more than 150 volunteers have been used to assess the BP. Mean and standard deviation of error magnitudes in measuring DBP is 2.12 ± 1.79 mmHg. [ABSTRACT FROM AUTHOR]

Background: Underlying diseases and aggressive procedures, such as different types of surgery and care, for patients with critical conditions in intensive care units (ICU) may be associated with physiological disorders. Objectives: This study intended to determine the effect of therapeutic touch on physiological variables of patients undergoing mechanical ventilation in ICU. Methods: This randomized clinical trial with a control group was conducted on 60 mechanically ventilated patients hospitalized in internal and adult intensive care units of educational hospitals of Zanjan University of Medical Sciences from 22 November 2014 to 22 June 2015. Patients were randomly divided into the intervention and placebo groups. Therapeutic touch was administered in four sessions. Physiological variables, such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Heart Rate (HR) were recorded in both groups before and after each therapeutic touch session. Data was analyzed using SPSS 21. Results: The results from comparison of physiological variables in the intervention group before each session showed a significant reduction only in heart rate (p

The renin‐angiotensin system (RAS) is an ever‐evolving endocrine system with considerable checks and balances on the production and catabolism of angiotensin peptides most likely due to the manifold effects of angiotensins. We aimed to explore the effects of different inhibitors of RAS on blood pressure and expression of inflammatory factors in patients with coronary heart disease (CHD). We initially searched PubMed, EMBASE and Cochrane Library electronic databases with nine eligible randomized controlled trials enrolled. Direct and indirect evidence was combined to calculate the weighted mean difference value and draw surface under the cumulative ranking curves. The results demonstrated that, compared with placebo and enalapril, ramipril had a better effect on reducing systolic blood pressure after short‐term usage of drugs (<12 months), while perindopril had better effects on reducing diastolic blood pressure and C‐reactive protein expression. Furthermore, after long‐term usage of drugs (≥12 months), there was no significant difference among olmesartan, quinapril and candesartan in the treatment of patients with CHD. Perindopril and ramipril had better effects on inhibiting blood pressure and expression of inflammatory factors among eight inhibitors after short‐term usage of drugs (<12 months); while quinapril had better effects on reducing blood pressure and expression of inflammatory factor after long‐term usage of drugs, and there was little difference in the effects between olmesartan and candesartan (≥12 months). Perindopril may have better short‐term effects on reducing blood pressure and expression of inflammatory factor, while quinapril may have better long‐term effects on reducing blood pressure and expression of inflammatory factor. Perindopril may have better short‐term effects on reducing blood pressure and expression of inflammatory factor, while quinapril may have better long‐term effects on reducing blood pressure and expression of inflammatory factor. [ABSTRACT FROM AUTHOR]

Abstract Background Hypertension is the primary out-auditory adverse outcome caused due to occupational noise exposure. This study investigated the associations of noise exposure in an occupational setting with blood pressure and risk of hypertension. Methods A total of 1,390 occupational noise-exposed workers and 1399 frequency matched non-noise-exposed subjects were recruited from a cross-sectional survey of occupational noise-exposed and the general population, respectively. Blood pressure was measured using a mercury sphygmomanometer following a standard protocol. Multiple logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of noise exposure adjusted by potential confounders. Results Noise-exposed subjects had significantly higher levels of systolic blood pressure(SBP) (125.1 ± 13.9 mm Hg) and diastolic blood pressure (DBP) (77.6 ± 10.7 mm Hg) than control subjects (SBP: 117.2 ± 15.7 mm Hg, DBP: 70.0 ± 10.5 mm Hg) (P 0.05). Conclusions Occupational noise exposure was associated with higher levels of SBP, DBP, and the risk of hypertension. These findings indicate that effective and feasible measures should be implemented to reduce the risk of hypertension caused by occupational noise exposure.

Objective: To compare the efficacy of telmisartan and atenolol in management of patients with essential hypertension. Study Design: Randomized comparative trial. Place and Duration of Study: Department of Medicine Combined Military Hospital Peshawar, from Feb 2010 to Aug 2010. Material and Methods: One hundred & eighty patients diagnosed with essential hypertension fulfilling the inclusion criteria were included in study using consecutive non-probability sampling after taking informed consent. Patients were allocated to either telmisartan or atenolol group by using a table of random numbers. Follow up of patients was carried out in 4 visits with recording of sitting systolic and diastolic blood pressures. Results: Among total of 180 patients, 60% were females and 40% were males. Majority were between age group 56-75 years. Reduction of both systolic and diastolic blood pressures at the end of eight weeks was significantly greater with telmisartan as compared to atenolol (p-value=0.000 and 0.016 respectively). Conclusion: At the end of eight weeks of treatment, telmisartan was more effective than atenolol in lowering systolic and diastolic blood pressure. [ABSTRACT FROM AUTHOR]

We sought to investigate whether the polymorphisms rs243865 (− 1306C > T); rs243866 (− 1575G > A) and rs2285053 (− 735C > T) in metalloproteinases 2 - MMP-2 gene and rs17576 (Q279R), rs17577 (Q668R) and rs3918242 (− 1562C > T) in MMP-9 gene are associated with clinical outcomes in obese resistant hypertensive (RH) subjects. One hundred and twenty RH were enrolled in this cross-sectional study and divided into obese ( n = 63) and non-obese ( n = 57) according to body mass index. Genotypes were determined by real-time PCR using TaqMan probes. We determined pulse wave velocity (PWV), microalbuminuria and left ventricular mass index (LVMI) to assess TODs. Obese and non-obese RH had similar allele, genotype and haplotype distributions for all polymorphisms assessed but obese RH subjects carrying the low frequency allele for SNPs in MMP-2 gene had higher ambulatory diastolic blood pressure. Also, PWV and LVMI were higher in subjects carrying the low frequency allele for SNPs in MMP-2 gene. Regarding MMP-9 gene, office diastolic BP levels were higher in the AA genotype individuals compared to the G allele group for rs17576 polymorphism, while the opposite was found regarding the microalbuminuria level. Independent multiple linear regression analyses revealed that both A allele for rs243865 and T allele for rs243866 in MMP-2 gene were associated with ambulatory diastolic levels in obese RH subjects, apart from potential confounders. Our study suggests that rs243866/rs243865 in the MMP-2 gene are related to BP levels in obese RH subjects, although TODs present in this population seem to be dependent of a combination of other factors besides the genetic polymorphisms. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the exposure-response (E-R) relationships of blood pressure (BP) and heart rate (HR) changes in healthy adults taking methylphenidate (MPH). Intensive time profiles of BP and HR from healthy adults in placebo and MPH treatment arms of seven clinical trials from the FDA internal database were utilized for this analysis. The analysis model contains a circadian component for placebo effect and an E-R component to describe drug effect. Internal validation was performed using goodness-of-fit plots and visual predictive check. A meta-database based on a systemic literature search was constructed and used for external validation of the developed models. We found that circadian models could quantify the time profiles of BP/HR in placebo arms. Linear models could describe the correlations between MPH concentrations, and BP/HR changes. The BP and HR changes were highly dependent on the shapes of MPH pharmacokinetic (PK) profiles without an apparent time delay. MPH has the greatest effect on HR, followed by systolic BP, and diastolic BP. Internal validation revealed that the developed models could adequately describe the circadian rhythms of HR and BP in placebo arms and the E-R relationships of MPH. External validation showed the models had good predictive capability of the literature data. In conclusion, the developed models adequately characterized the circadian rhythm and the MPH induced effects on BP and HR. The changes in BP and HR were highly correlated with MPH blood levels with no apparent delay. The time courses of BP and HR are similar to the MPH PK profiles. As a result, the immediate-release formulation may yield larger maximum BP and HR effect than the extended-release formulation under similar dose. [ABSTRACT FROM AUTHOR]

Objectives: To document the prevalence and etiology of sustained blood pressure elevation in children. Methods & results: It is a school-based prospective cross-sectional study involving healthy school children in age group of 5–15 years (both sexes). Children with any acute or chronic illnesses and the intersexes were excluded from the study group. Total number of hypertensive children were 37. Of these 37 cases, 23 hypertensive cases were boys and 14 were girls. All these hypertensive children maintained their blood pressure above +2SD for the corresponding age and sex. Male and female ratio of hypertensive cases was 62:38. All were primary hypertensives as per working definition. Majority belonged to Class II socio-economic status. Conclusion: Hypertension in children is very rare with a prevalence of 0.38% and majority had primary hypertension.

Objective: To find out the normal range of blood pressure among school-children (aged 5-15 years) and the relationship of blood pressure with variables such as age and weight. Material & Methods: This is a school-based prospective cross-sectional study. Healthy school-children aged 5-15 years from primary and secondary schools in Kolkata were selected for the study. The individuals with any acute or chronic illnesses or the intersexes were excluded. Their age, weight, blood pressure and socioeconomic status were determined. Results: Blood pressure (both systolic and diastolic) showed almost upward linear relationship with age and weight in both boys and girls in the age group of 5-15 years. At 15 years, girls achieved higher blood pressure than boys did. The present study also showed that girls recorded higher blood pressure than boys in the weight range of 41-45 kg (For all “r” values, p

In medical practice, blood pressure is intensively studied parameter and often measured for diagnosis at primary healthcare level. In this paper, the state-of-the-art Bluetooth technology has been used for designing an innovative wireless blood pressure monitoring system to display the systolic and diastolic blood pressure values on Android-based smartphone. A pilot study was undertaken on 12 healthy subjects to validate the performance of developed prototype by comparing with OMRON HEM-7111 and mercury sphygmomanometer. Comparison shows an accuracy of 98.63% and 97.13% with OMRON HEM-7111 and 98.99% and 98% with mercury sphygmomanometer for systolic blood pressure and diastolic blood pressure, respectively. Bias value in Bland-Altman plots gives good level of agreement within 95% confidence limits. The developed prototype device mean and standard deviation of differences is less than 5 and 8 mmHg, respectively, and it fulfills the recommendation criteria as per the requirement of the Association for Advancement of Medical Instruments protocol. [ABSTRACT FROM PUBLISHER]

Rationale & Objective: The association between short-term blood pressure variability (BPV) and kidney outcomes is poorly understood. This study evaluated the association between short-term BPV and kidney disease outcomes in people with hypertension., Study Design: Prospective observational cohort study., Setting & Participants: 1,173 hypertensive participants in the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (2013-2018) Study with estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m 2 ., Exposure: Short-term BPV assessed by average real variability (ARV)., Outcome: Composite kidney disease outcome (30% decline in eGFR from baseline, new occurrence of eGFR <60mL/min/1.73m 2 , or onset of UACR >300mg/g)., Analytical Approach: Multivariable Cox regression analyses to evaluate the association between systolic and diastolic BP ARV (SBP-ARV and DBP-ARV) and outcomes., Results: During a median follow-up of 5.4 [4.1-6.5] years, 271 events of the composite kidney disease outcome occurred (46.5 per 1,000 person-years). Multivariable Cox analysis revealed that the highest SBP-ARV and DBP-ARV tertiles were associated with a higher risk of the composite kidney disease outcome than the lowest tertiles, independent of the 24-hour SBP or DBP levels (HR, 1.64 [95% CI, 1.16-2.33], and 1.60 [95% CI, 1.15-2.24] for SBP-ARV and DBP-ARV, respectively). These associations were consistent when SBP-ARV and DBP-ARV were treated as continuous variables (HR per 1.0-unit greater SBP-ARV, 1.03 [95% CI, 1.01-1.06]; HR per 1.0-unit greater DBP-ARV, 1.04 [95% CI, 1.01-1.08]). These associations were consistent, irrespective of subgroups (age, sex, 24-hour SBP or DBP, and moderate albuminuria). However, other measures of short-term BPV including SD, coefficient of variation, and dipping patterns were not associated with the composite kidney disease outcome., Limitations: Observational study design, the use of single measurement of 24-hour BP, lack of information on changes in antihypertensive medication during the follow-up., Conclusions: Short-term BPV is associated with the development of a composite kidney disease outcome in hypertensive patients., (Copyright © 2022 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Abstract: Chronic glomerulonephritis (CGN) is one of the most severe kidney diseases. Genes of vascular reactivity are thought to play an important role in development and progression of CGN. In this study, we analyzed association of genes of vascular homeostasis with hypertension and renal survival of CGN patients. The study sample included 238 patients with CGN and 304 healthy subjects of population control. Ten polymorphisms of ten genes of vascular homeostasis were genotyped through polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) analysis and TaqMan assays. Association of the genotypes with renal survival was analyzed by the Kaplan–Meier estimator. Genotypes 311SC and 311SS of the PON2 gene, (−1166)AC and (−1166)CC of the AGTR1 gene, (+46)AA of the ADRB2 gene, and 198KK and 198KN of the EDN1 gene were associated with decreased rate of renal survival of the patients. Polymorphisms S311C PON2, (−1166)A/C AGTR1, (+46)G/A ADRB2, and K198N EDN1 were associated with the accelerated decline in kidney function in the CGN patients. [Copyright &y& Elsevier]

Abstract: Objective: To determine if cognitive processing, and subjective and physiological responses to stress and relaxation differed between an irritable bowel syndrome (IBS) group and control group. How these variables relate to the severity of IBS symptoms was also determined. Methods: Twenty-one IBS participants and 20 controls provided cognitive (attention and processing), subjective (perceived stress and vigour), and physiological (heart rate, blood pressure, and skin conductance) data during a relaxation and stress phase. Logistic regression analyses determined which variables are related to the IBS group and hierarchical linear regression assessed how the variables are related to the severity of IBS symptoms. Results: Subjective and cognitive factors (drowsiness at baseline, total vigour, and reduced Stroop colour-naming accuracy for negative words) are significantly related to IBS, χ2 (3, N =41)=23.67, p <.001, accurately categorising 85% of participants. IBS symptom severity was associated with both subjective (drowsiness at baseline and a smaller reduction in tiredness from relaxation to stress) and physiological (smaller increase in systolic blood pressure from baseline to stress phase and lower skin conductance at baseline) variables. This model predicted IBS severity, F (4, 16)=11.20, p <.001, and accounted for 74% of the variability in scores. Conclusions: A negative attention bias, which may be related to a negative self-schema, as well as perceived low vigour were important in categorising IBS. Low subjective vigour and reduced physiological reactivity to both relaxation and stress conditions were associated with IBS severity, suggestive of illness-related allostatic load. [Copyright &y& Elsevier]

Background: Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C gene polymorphisms are associated with the risk of patent ductus arteriosus (PDA) congenital heart defects. This study aimed to determine the association of these polymorphisms in patients with isolated PDA and in non-PDA patients group without congenital heart disease. Methods: This retrospective case-controlled study was undertaken in 17 patients with isolated PDA and a control non-PDA group consisting of 34 subjects without congenital heart disease. MTHFR gene polymorphisms were analysed using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). In addition, the genotype distribution of the MTHFR gene was compared among different ethnicities using the HapMap database. Results: In contrast to the MTHFR C677T polymorphism, differences in the MTHFR A1298C genotype were observed between the two groups (P =0.002); a greater proportion of the PDA patients had the MTHFR 1298CC and 1298AA genotypes as compared to the non-PDA control group. After merging the data obtained from the Taiwanese participants with that from the HapMap database, genetic diversity of the MTHFR 1298AA genotype was observed. Conclusions: Thus, the MTHFR A1298C polymorphism is associated with isolated PDA in Taiwan. Larger studies are necessary to evaluate the prognostic value of determining MTHFR polymorphism in PDA. [Copyright &y& Elsevier]

Abstract: Aims: Oxidative stress and neurohumoral factors play important role in the development of hypertension-induced vascular remodeling, likely by disregulating kinase cascades and transcription factors. Oxidative stress activates poly(ADP-ribose)-polymerase (PARP-1), which promotes inflammation and cell death. We assumed that inhibition of PARP-1 reduces the hypertension-induced adverse vascular changes. This hypothesis was tested in spontaneously hypertensive rats (SHR). Methods and results: Ten-week-old male SHRs and wild-type rats received or not 5mg/kg/day L-2286 (a water-soluble PARP-inhibitor) for 32weeks, then morphological and functional parameters were determined in their aortas. L-2286 did not affect the blood pressure in any of the animal groups measured with tail-cuff method. Arterial stiffness index increased in untreated SHRs compared to untreated Wistar rats, which was attenuated by L-2286 treatment. Electron and light microscopy of aortas showed prominent collagen deposition, elevation of oxidative stress markers and increased PARP activity in SHR, which were attenuated by PARP-inhibition. L-2286 treatment decreased also the hypertension-activated mitochondrial cell death pathway, characterized by the nuclear translocation of AIF. Hypertension activated all three branches of MAP-kinases. L-2286 attenuated these changes by inducing the expression of MAPK phosphatase-1 and by activating the cytoprotective PI-3-kinase/Akt pathway. Hypertension activated nuclear factor-kappaB, which was prevented by PARP-inhibition via activating its nuclear export. Conclusion: PARP-inhibition has significant vasoprotective effects against hypertension-induced vascular remodeling. Therefore, PARP-1 can be a novel therapeutic drug target for preventing hypertension-induced vascular remodeling in a group of patients, in whom lowering the blood pressure to optimal range is harmful or causes intolerable side effects. [Copyright &y& Elsevier]

Abstract: High blood pressure is associated with exposure to multiple chemical and non-chemical risk factors, but epidemiological analyses to date have not assessed the combined effects of both chemical and non-chemical stressors on human populations in the context of cumulative risk assessment. We developed a novel modeling approach to evaluate the combined impact of lead, cadmium, polychlorinated biphenyls (PCBs), and multiple non-chemical risk factors on four blood pressure measures using data for adults aged ≥20 years from the National Health and Nutrition Examination Survey (1999–2008). We developed predictive models for chemical and other stressors. Structural equation models were applied to account for complex associations among predictors of stressors as well as blood pressure. Models showed that blood lead, serum PCBs, and established non-chemical stressors were significantly associated with blood pressure. Lead was the chemical stressor most predictive of diastolic blood pressure and mean arterial pressure, while PCBs had a greater influence on systolic blood pressure and pulse pressure, and blood cadmium was not a significant predictor of blood pressure. The simultaneously fit exposure models explained 34%, 43% and 52% of the variance for lead, cadmium and PCBs, respectively. The structural equation models were developed using predictors available from public data streams (e.g., U.S. Census), which would allow the models to be applied to any U.S. population exposed to these multiple stressors in order to identify high risk subpopulations, direct intervention strategies, and inform public policy. [Copyright &y& Elsevier]

Abstract: Aim: Based on reports of exaggerated blood pressure responses to whole-body exercise in patients with metabolic syndrome (MetSyn), we tested the hypothesis that MetSyn adults would exhibit augmented sympathetic and pressor responses to mechanoreflex and metaboreflex activation when compared with healthy, age-matched control subjects. Methods: We studied 12 adults with MetSyn (34±3years) and 12 healthy control subjects (34±3years). Heart rate (HR; ECG), blood pressure (BP; finger photoplethysmography), and MSNA (microneurography of the peroneal nerve) were measured during: (1) static handgrip exercise at 15% of maximal voluntary contraction (MVC), and (2) static handgrip exercise at 30% MVC to fatigue, followed by post-exercise ischemia (PEI). Increases in MSNA, HR, and BP were assessed. Results: During static exercise at both 15 and 30% MVC, increases in MSNA, HR, and BP were not different between groups. MSNA remained significantly elevated from baseline during PEI and responses were not different between groups. Conclusion: Sympathetic and pressor responses to mechanoreflex and metaboreflex activation are not augmented in younger adults with MetSyn. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this work was to meta-analyze prospective studies that have evaluated the effect of a Mediterranean diet on the development of type 2 diabetes. Materials/Methods: PubMed, Embase and the Cochrane Central Register of Controlled Trials databases were searched up to 20 November 2013. English language publications were allocated; 17 original research studies (1 clinical trial, 9 prospective and 7 cross-sectional) were identified. Primary analyses were limited to prospective studies and clinical trials, yielding to a sample of 136,846 participants. A systematic review and a random effects meta-analysis were conducted. Results: Higher adherence to the Mediterranean diet was associated with 23% reduced risk of developing type 2 diabetes (combined relative risk for upper versus lowest available centile: 0.77; 95% CI: 0.66, 0.89). Subgroup analyses based on region, health status of participants and number of confounders controlling for, showed similar results. Limitations include variations in Mediterranean diet adherence assessment tools, confounders’ adjustment, duration of follow up and number of events with diabetes. Conclusions: The presented results are of major public health importance, since no consensus exists concerning the best anti-diabetic diet. Mediterranean diet could, if appropriately adjusted to reflect local food availability and individual’s needs, constitute a beneficial nutritional choice for the primary prevention of diabetes. [Copyright &y& Elsevier]

Abstract: Background: Mortality from coronary heart disease in Korea has increased continuously, but there are few comprehensive national data on trend in the prevalence of risk factors for cardiovascular disease in this population. We examined the trends in the prevalence of major risk factors for cardiovascular disease, including smoking, obesity, hypertension, diabetes, and hypercholesterolemia, from 1998 through 2012 in a representative Korean population. Methods: Using data from the Korea National Health and Nutrition Examination Survey I (1998) to V (2010–2012), we selected the adults aged ≥30yr who participated in both a health examination and health interview survey. Results: From 1998 to 2012, significant decrease in the prevalence of hypertension was observed in both men (32.5 to 31.5%) and women (26.9 to 24.3%). Smoking rates decreased only in men (65.1 to 47.0%), whereas the prevalence of diabetes did not change over time. Conversely, the prevalence of hypercholesterolemia significantly increased from 7.2% to 12.6% for men and from 8.4% to 14.9% for women, whereas the rates of awareness and treatment for hypercholesterolemia were relatively lower than that of hypertension and diabetes. During the period, prevalence of obesity significantly increased from 26.8% to 38.1% only in men. Conclusions: The increased prevalence of hypercholesterolemia and obesity may have contributed to the increasing trend in the mortality from coronary heart disease in Korea. Further population-based surveillance of blood cholesterol levels and obesity needs to be performed, and national strategies for improvement of these factors should be established in Korea. [Copyright &y& Elsevier]

Summary: Objective: To test whether a brief mindfulness meditation training intervention buffers self-reported psychological and neuroendocrine responses to the Trier Social Stress Test (TSST) in young adult volunteers. A second objective evaluates whether pre-existing levels of dispositional mindfulness moderate the effects of brief mindfulness meditation training on stress reactivity. Methods: Sixty-six (N =66) participants were randomly assigned to either a brief 3-day (25-min per day) mindfulness meditation training or an analytic cognitive training control program. All participants completed a standardized laboratory social-evaluative stress challenge task (the TSST) following the third mindfulness meditation or cognitive training session. Measures of psychological (stress perceptions) and biological (salivary cortisol, blood pressure) stress reactivity were collected during the social evaluative stress-challenge session. Results: Brief mindfulness meditation training reduced self-reported psychological stress reactivity but increased salivary cortisol reactivity to the TSST, relative to the cognitive training comparison program. Participants who were low in pre-existing levels of dispositional mindfulness and then received mindfulness meditation training had the greatest cortisol reactivity to the TSST. No significant main or interactive effects were observed for systolic or diastolic blood pressure reactivity to the TSST. Conclusions: The present study provides an initial indication that brief mindfulness meditation training buffers self-reported psychological stress reactivity, but also increases cortisol reactivity to social evaluative stress. This pattern may indicate that initially brief mindfulness meditation training fosters greater active coping efforts, resulting in reduced psychological stress appraisals and greater cortisol reactivity during social evaluative stressors. [Copyright &y& Elsevier]

Abstract: Introduction: Hypertension is highly prevalent in black South Africans in which morbidity and mortality from stroke are on the increase. Elevated blood pressure and haemostatic markers can induce changes in blood rheology and endothelial function which could result in a procoagulant state that increases the risk for cerebrovascular disease. Information about the coagulation and fibrinolytic systems of people from African descent are limited. We therefore, investigated the haemostatic profile and its relationships with blood pressure in black South Africans. Materials and methods: We measured ambulatory blood pressure and haemostatic markers of 201 black and 208 white school teachers. The haemostatic markers included measurements representing coagulation and fibrinolysis (von Willebrand factor, fibrinogen, plasminogen activator inhibitor-1, fibrin D-dimer and clot lysis time). Results: Black participants displayed significantly higher blood pressure, von Willebrand factor, fibrinogen, plasminogen activator inhibitor-1 and D-dimer levels and longer clot lysis times (p≤0.001). Single, partial and multiple regression analyses showed that systolic (p≤0.011) and diastolic blood pressure (p=0.010) correlated positively with D-dimer in black participants, while systolic (p≤0.001) and daytime diastolic blood pressure (p=0.011) correlated negatively with clot lysis time in white participants. Conclusion: The black population had a more prothrombotic profile, with higher levels of coagulation markers and inhibited fibrinolysis, than the white study participants. The positive association between blood pressure and elevated D-dimer in the blacks may contribute to the high prevalence of hypertension and related increased cardiovascular and cerebrovascular risk in this group. [Copyright &y& Elsevier]

Abstract: Aims: Few representative population-based data are available regarding glycaemic and HbA1c thresholds for detecting diabetic retinopathy (DR) in Asia. We investigated the association between DR and fasting plasma glucose (FPG) and HbA1c levels among Korean adults. Methods: Using data from the Korea National Health and Nutrition Examination Survey (2011), a total of 5212 adults (≥19 years old) were analysed. When participants had diabetes mellitus and/or a suspicion of DR in two-field nonmydriatic fundus photography, seven standard photographs were obtained after pupil dilatation (75.9% of men, 75.0% of women among the subjects). DR was defined as the presence of ≥1 retinal microaneurysms or blot haemorrhages with or without more severe lesions. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off value for HbA1c or FPG. Results: The overall glycaemic thresholds for DR were 6.3mmol/l for FPG and 6.2% (44mmol/mol) for HbA1c. The optimal thresholds did not differ by age group. The sensitivities and specificities were 82.6% and 91.2% for FPG and 93.9% and 89.7% for HbA1c, respectively. The diagnostic discrimination was better for HbA1c than FPG for DR—area under curve: 0.908 for FPG and 0.953 for HbA1c (p =0.007). After being controlled for other covariates, the odds ratio for the risk of DR increased significantly in a consistent way from 6.2% (44mmol/mol) for HbA1c and 6.3mmol/l for FPG. Conclusions: According to these nationally representative data, the current diabetes diagnostic values for FPG and HbA1c based on DR may be lower for the Korean population. [Copyright &y& Elsevier]

Summary: Background & aims: Weight gain in breast cancer patients during treatment is prevalent; the metabolic implications of this weight gain are poorly understood. We aimed to characterize glucose metabolism in breast cancer patients near the initiation of chemotherapy. Methods: Stage I–II breast cancer patients (n = 8) were evaluated near the initiation of chemotherapy and compared with a group of age- and body mass index-matched, as well as a group of young healthy, non-malignant females. Fasting blood samples (analyzed for lipids and cytokines) were taken and an oral glucose tolerance test was performed. Body composition, waist circumference, diet, cardiovascular fitness and muscle strength were evaluated. Results: Breast cancer patients were abdominally obese (mean ± SD: 94.6 ± 14.0 cm), overweight (28.8 ± 6.0 kg/m2) and dyslipidemic (triacylglycerides: 1.84 ± 1.17 mM; high-density lipoprotein cholesterol: 1.08 ± 0.23 mM). Compared to non-malignant matched females, fasting glucose and insulin concentrations were similar but fasting c-peptide was greater in patients (2.6 ± 1.2 ng/mL vs. 1.9 ± 0.8 ng/mL, p = 0.005). Glucose was elevated to a greater extent in patients during the oral glucose tolerance test compared with all non-malignant females. During the glucose tolerance test, c-peptide, but not insulin, remained elevated in patients compared with all non-malignant females. No differences in body composition, serum cytokines, nutrition or exercise capacity between patients and matched, non-malignant females emerged. Conclusions: Breast cancer patients present with unhealthy metabolic features early in the disease trajectory. Future investigations need to examine the underlying mechanisms and the potential longitudinal changes following chemotherapy. [Copyright &y& Elsevier]

Background: Pulmonary capillary wedge pressure (PCWP) is routinely used as an indirect measure of the left atrial pressure (LAP), although the accuracy of this estimate, especially under pathological hemodynamic conditions, remains controversial. Objectives: The aim of this prospective study was to investigate the reliability of PCWP for the evaluation of LAP under different hemodynamic conditions. Methods: Simultaneous left and right heart catheterization data of 117 patients with pure mitral stenosis, obtained before and immediately after percutaneous mitral comissurotomy, were analyzed. Results: A strong correlation and agreement between PCWP and LAP measurements was demonstrated (correlation coefficient = 0.97, mean bias ± CI, 0.3 ± −3.7 to 4.2 mm Hg). Comparison of measurements performed within a 5-minute interval and those performed simultaneously revealed that simultaneous pressure acquisition yielded better agreement between the 2 methods (bias ± CI, 1.82 ± 1.98 mm Hg). In contrast to previous observations, the discrepancy between the 2 measures did not increase with elevated PCWP. Multiple regression analysis failed to identify hemodynamic confounders of the discrepancy between the 2 pressures. The ability of PCWP to distinguish between normal and elevated LAP (cutoff set at 12 and 15 mm Hg, respectively), as tested by receiver operating characteristics analysis, demonstrated a remarkably high diagnostic accuracy (area under the curve: 0.989 and 0.996, respectively). Conclusions: Although the described limits of agreement may not allow the interchangeability of PCWP and LAP, especially at lower pressure ranges, our data support the clinical use of PCWP as a robust and accurate estimate of LAP. [Copyright &y& Elsevier]

Abstract: Objective: To comparatively evaluate traditional liver tests and fetuin A as predictors of cardiometabolic risk, we studied associations between serum alanine transaminase (ALT), γ-glutamyl transferase (GGT), aspartate aminotransferase (AST) and fetuin-A and anthropometric, metabolic, and cardiovascular parameters cross-sectionally at baseline, and prospectively, after 2-years of follow-up. Research Design and Methods: 616 randomly enrolled young healthy participants in the Cyprus Metabolism Study, including all 93 subjects who participated in the follow-up study 2years after baseline assessment, were included in this study. Results: In the cross-sectional study, serum ALT and GGT were strongly correlated with anthropometric, cardiovascular, and metabolic variables, while serum AST was only correlated with waist circumference and waist-to-hip ratio. Fetuin-A was correlated with anthropometric variables, systolic blood pressure (SBP), insulin, and homeostasis model of assessment-insulin resistance (HOMA-IR) in the unadjusted model. In the fully adjusted model, both serum ALT and GGT levels remained positively correlated with total and low-density lipoprotein (LDL) cholesterol. GGT levels also remained correlated with triglycerides. ALT levels remained strongly positively correlated with insulin (r=0.17, p<.0001) and HOMA-IR (r=0.16, p=0.0001). Serum fetuin-A levels were no longer significantly correlated with any variables. Prospectively, ALT and GGT were predictors of anthropometric variables and LDL cholesterol, while baseline levels of AST and fetuin-A were not predictors of any variables at 2-year follow-up. Conclusions: We confirmed associations of ALT and GGT levels but failed to demonstrate an independent association between fetuin-A and cardiometabolic risk factors in young healthy men. Traditional liver tests (LFTs) are thus better than fetuin-A predictors of metabolic risk factors cross-sectionally and prospectively in young healthy adults. [Copyright &y& Elsevier]

The continuous and noninvasive blood pressure (BP) measurement based on pulse transit time (PTT) doesn't need cuff and could monitor BP in real time for a long period. However, PTT is just a time index derived from electrocardiogram (ECG) and photoplethysmogram (PPG), while BP-related information within the PPG waveform has seldom been taken into consideration. We hypothesized that PPG waveform feature might be useful for BP estimation. Nine healthy subjects took part in an exercise stress test, including baseline resting, exercise on bicycle ergometry and recovering resting. ECG of lead V5 and PPG from left finger were collected simultaneously, and systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded from a cuff sphygmometer on the right wrist. The correlation coefficients were obtained between BP (SBP, DBP and pulse pressure (PP)) and PPG morphological indices (total 15 indices in terms of waveform amplitude, time span and area ratio). Five PPG indices were correlated with both SBP and PP (absolute value of correlation coefficient |r| > 0.6) and were further tested for the capability to BP estimation, which were: (1) PTT, time delay between the R peak of ECG and the foot point of PPG; (2) RSD, time ratio of systole to diastole; (3) RtArea, area ratio of systole to diastole; (4) TmBB, time span of PPG cycle; (5) TmCA, diastolic duration. Comparisons were made between the measured BP and the estimated BP by regression lines and quadratic curve fitting, respectively. As a result, the mean errors of SBP liner fitting with RSD, RtArea, TmBB and TmCA respectively were 5.5, 5.4, 5.2, 5.1 mmHg, which were smaller than that with PTT of 5.8 mmHg. And the mean errors of SBP quadratic curve fitting with RSD, RtArea, TmBB and TmCA were all 5.1 mmHg, which were smaller than that with PTT of 5.7 mmHg. The mean errors of multiple regression for SBP, PP and DBP was 4.7, 4.7, 3.5 mmHg respectively, which were more accurate than the regression with single PTT of 5.8, 5.3, 5.2 mmHg respectively. However, PPG-based SBP and DBP could under estimate cuff pressure by 8 mmHg and over estimate by 10 mmHg respectively, which is a clinically significant error. In conclusion, the combination of time span (PTT, time ratio of systole to diastole, time span of PPG cycle and diastolic duration) and waveform morphology (area ratio of systole to diastole) could improve the performance of PPG-based BP estimation. [ABSTRACT FROM AUTHOR]

Highlights: [•] 3351 individuals had genotype data for 58 tag-SNPs in NOS1, NOS2 and NOS3 genes. [•] 4 SNPs were associated with CHD and 5 SNPs with hypertension. [•] Only NOS1 rs3782218’s association with CHD held for Bonferroni correction. [•] Haplotype analysis suggests the T-allele of rs3782218 is a marker for a true effect. [Copyright &y& Elsevier]

Objectives: This study sought to investigate the interaction between blood pressure (BP) and heart rate (HR) reduction and changes in left ventricular (LV) structure and function following renal sympathetic denervation (RDN). Background: Hypertension results in structural and functional cardiac changes. RDN reduces BP, HR, and LV mass and improves diastolic dysfunction. Methods: We evaluated LV size, mass, and function before and 6 months after RDN in 66 patients with resistant hypertension and analyzed results in relation to systolic BP (SBP) and HR. Results: SBP decreased by 11 ± 3 mm Hg in the first, 18 ± 5 mm Hg in the second, and 36 ± 7 mm Hg in the third tertile of SBP at baseline (p < 0.001). HR decreased by 13 ± 4 beats/min, 8 ± 3 beats/min, and 11 ± 6 beats/min in tertiles of SBP (p for interaction between tertiles = 0.314). In all SBP tertiles, LV mass index (LVMI) decreased similarly (LVMI −6.3 ± 2.2 g/m2.7, −8.3 ± 2.1 g/m2.7, and −9.6 ± 1.9 g/m2.7; p for interaction = 0.639). LVMI decreased unrelated to HR at baseline (p for interaction = 0.471). The diastolic parameters E-wave deceleration time, isovolumetric relaxation time, and E′-wave velocity improved similarly in all tertiles of SBP and HR. Changes in LV mass and function were also unrelated to reduction in SBP or HR. Vascular compliance improved dependently on BP but independently of HR reduction. Conclusions: In patients with resistant hypertension, LV hypertrophy and diastolic function improved 6 months after RDN, without significant relation to SBP and HR. These findings suggest a direct effect of altered sympathetic activity in addition to unloading on cardiac hypertrophy and function. [ABSTRACT FROM AUTHOR]

Background & Aims: Approximately 50% of hypertensive patients have non-alcoholic fatty liver disease (NAFLD), but whether change in fatty liver status over time modifies risk of developing hypertension is uncertain. Our aim was to determine whether a change in fatty liver status (either development of new fatty liver, or resolution of existing fatty liver) over five years modified risk of incident hypertension at five year follow-up. Methods: 11,448 patients without hypertension were examined at baseline and at five year follow-up, using a retrospective cohort study design. Fatty liver status (absent or present) was assessed at baseline and follow-up using standard ultrasound criteria. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for incident hypertension at follow-up were estimated controlling for potential confounders, compared to the reference group (patients who did not have fatty liver at either baseline or follow-up). Results: 911 patients developed incident hypertension. Incident fatty liver developed during follow-up in 1418 patients and fatty liver at baseline resolved during follow-up in 684 patients. Developing incident fatty liver was associated with incident hypertension, even after adjustment for multiple confounders (aOR=1.60 (95% CI 1.30, 1.96; p <0.001). Further adjustment for change in body mass index between baseline and follow-up only slightly attenuated this association (aOR=1.36 (95% CI 1.10, 1.67; p =0.004). With resolution of fatty liver at follow-up, risk of incident hypertension was not different from the reference group (aOR=1.21 (95% CI 0.90, 1.63; p =0.21). Conclusions: Development of incident fatty liver is associated with increased risk of hypertension. [Copyright &y& Elsevier]

Abstract: The underlying mechanisms of cardiotoxicity of 3,4-methylenedioxymethylamphetamine (MDMA, “ecstasy”) abuse are unclear. Autophagy exerts either adaptive or maladaptive effects on cardiac function in various pathological settings, but nothing is known on the role of autophagy in the MDMA cardiotoxicity. Here, we investigated the mechanism through which autophagy may be involved in MDMA-induced cardiac contractile dysfunction. Rats were injected intraperitoneally with MDMA (20mg/kg) or saline. Left ventricular (LV) echocardiography and LV pressure measurement demonstrated reduction of LV systolic contractility 24h after MDMA administration. Western blot analysis showed a time-dependent increase in the levels of microtubule-associated protein light chain 3-II (LC3-II) and cathepsin-D after MDMA administration. Electron microscopy showed the presence of autophagic vacuoles in cardiomyocytes. MDMA upregulated phosphorylation of adenosine monophosphate-activated protein kinase (AMPK) at Thr172, mammalian target of rapamycin (mTOR) at Thr2446, Raptor at Ser792, and Unc51-like kinase (ULK1) at Ser555, suggesting activation of autophagy through the AMPK-mTOR pathway. The effects of autophagic inhibitors 3-methyladenine (3-MA) and chloroquine (CQ) on LC3-II levels indicated that MDMA enhanced autophagosome formation, but attenuated autophagosome clearance. MDMA also induced release of cathepsins into cytosol, and western blotting and electron microscopy showed cardiac troponin I (cTnI) degradation and myofibril damage, respectively. 3-MA, CQ, and a lysosomal inhibitor, E64c, inhibited cTnI proteolysis and improved contractile dysfunction after MDMA administration. In conclusion, MDMA causes lysosome destabilization following activation of the autophagy-lysosomal pathway, through which released lysosomal proteases damage myofibrils and induce LV systolic dysfunction in rat heart. [Copyright &y& Elsevier]

Objectives: This study coupled 2 strategies—trait extremes and genome-wide pooling—to discover a novel blood pressure (BP) locus that encodes a previously uncharacterized thiamine transporter. Background: Hypertension is a heritable trait that remains the most potent and widespread cardiovascular risk factor, although details of its genetic determination are poorly understood. Methods: Representative genomic deoxyribonucleic acid (DNA) pools were created from male and female subjects in the highest- and lowest-fifth percentiles of BP in a primary care population of >50,000 patients. The peak associated single-nucleotide polymorphisms were typed in individual DNA samples, as well as in twins/siblings phenotyped for cardiovascular and autonomic traits. Biochemical properties of the associated transporter were evaluated in cellular assays. Results: After chip hybridization and calculation of relative allele scores, the peak associations were typed in individual samples, revealing an association between hypertension, systolic BP, and diastolic BP and the previously uncharacterized solute carrier SLC35F3. The BP genetic association at SLC35F3 was validated by meta-analysis in an independent sample from the original source population, as well as the International Consortium for Blood Pressure Genome-Wide Association Studies (across North America and western Europe). Sequence homology to a putative yeast thiamine (vitamin B1) transporter prompted us to express human SLC35F3 in Escherichia coli, which catalyzed [3H]-thiamine uptake. SLC35F3 risk-allele homozygotes (T/T) displayed decreased erythrocyte thiamine content on microbiological assay. In twin pairs, the SLC35F3 risk allele predicted heritable cardiovascular traits previously associated with thiamine deficiency, including elevated cardiac stroke volume with decreased vascular resistance, and elevated pressor responses to environmental (cold) stress. Allelic expression imbalance confirmed that cis variation at the human SLC35F3 locus influenced expression of that gene, and the allelic expression imbalance peak coincided with the hypertension peak. Conclusions: Novel strategies were coupled to position a new hypertension-susceptibility locus, uncovering a previously unsuspected thiamine transporter whose genetic variants predicted several disturbances in cardiac and autonomic function. The results have implications for the pathogenesis and treatment of systemic hypertension. [Copyright &y& Elsevier]

Abstract: Background: Recently, the American Heart Association developed a set of 3 ideal cardiovascular (CV) health factors. However, information on whether associations of uric acid (UA) with the CV health factors is influenced by sex, age, and body mass index (BMI) is limited. Methods: We conducted a cross-sectional analysis using a cohort of 10,420 people aged 20–100years, who underwent health checkups in 2009. CV health factors were defined as untreated total cholesterol (TC)<200mg/dl, untreated systolic/diastolic blood pressure (BP)<120/80mmHg, and untreated fasting plasma glucose (FPG)<100mg/dl. Results: The association of UA with each CV health factor was gender-specific. The interaction terms (gender×UA level) comparing change in prevalence of each CV health factor between the 1st and 4th UA quartiles showed a significantly greater reduction among women (all P<0.01). In addition, the interactions between UA levels and age on prevalence of each CV health factor were statistically significant (all P<0.01). Furthermore, absolute reductions in the prevalence of ideal levels of BP, and TC across ordinal UA quartiles were greater in obese individuals than in overweight and normal-weight individuals (all P<0.01). Finally, UA showed a bell-curved relation with the prevalence of ideal FPG among all BMI categories. Conclusions: Elevated UA inversely associated with each CV health factor and these associations were influenced by gender, age and BMI. Elevated UA levels should alert clinical suspicion for a potential coexistence of low frequency of CV health factors. [Copyright &y& Elsevier]