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INTRODUCTION During the administration of general anesthesia, the procedures of direct laryngoscopy and endotracheal intubation result in a significant rise in heart rate, arterial pressure, and dysrhythmias in around 90% of patients. These modifications can provide a significant risk to patients with brain or coronary diseases. The aim of present study is to assess the attenuation of hemodynamic changes during laryngoscopy and endotracheal intubation with oral gabapentin versus oral clonidine. MATERIAL AND METHODS The present double blind randomized controlled trial was conducted among patient undergoing elective surgeries under general anesthesia at Govt. Mohan Kumaramangalam Medical College, during the study period of one year. 90 patients were distributed to three groups using sealed envelope technique. Group A of patients received single dose oral 150 µg clonidine, Group B of patients received single dose oral 200 µg clonidine and Group C patients received single dose oral 800 mg gabapentin . Hemodynamic parameters were noted at different time interval and results were analyzed. RESULTS The mean age of subjects was between the age group of 40-50 years and male were higher in number as compared to female. The heart rate was higher in the clonidine 200 group as compared to other two but results were non-significant with (P>0.05). No Significant difference in mean SBP, DBP and MAP was observed at all time intervals. (p>0.05). CONCLUSION Oral clonidine and gabapentin reduce direct laryngoscopy haemodynamics. Gabapentin has fewer adverse effects than clonidine. Compared to -200mcg, 150mcg has no adverse effects. [ABSTRACT FROM AUTHOR]

The mimesis of biological mechanisms by artificial devices constitutes the modern, rapidly expanding, multidisciplinary biomimetics sector. In the broader bioinspiration perspective, however, bioarchitectures may perform independent functions without necessarily mimicking their biological generators. In this paper, we explore such Bioarchitectonic notions and demonstrate three-dimensional photonics by the exact replication of insect organs using ultra-porous silica aerogels. The subsequent conformal systolic transformation yields their miniaturized affine 'clones' having higher mass density and refractive index. Focusing on the paradigms of ommatidia, the compound eye of the hornet Vespa crabro flavofasciata and the microtrichia of the scarab Protaetia cuprea phoebe, we fabricate their aerogel replicas and derivative clones and investigate their photonic functionalities. Ultralight aerogel microlens arrays are proven to be functional photonic devices having a focal length f ~ 1000 μm and f-number f/30 in the visible spectrum. Stepwise systolic transformation yields denser and affine functional elements, ultimately fused silica clones, exhibiting strong focusing properties due to their very short focal length of f ~ 35 μm and f/3.5. The fabricated transparent aerogel and xerogel replicas of microtrichia demonstrate a remarkable optical waveguiding performance, delivering light to their sub-100 nm nanotips. Dense fused silica conical clones deliver light through sub-50 nm nanotips, enabling nanoscale light–matter interactions. Super-resolution bioarchitectonics offers new and alternative tools and promises novel developments and applications in nanophotonics and other nanotechnology sectors. [ABSTRACT FROM AUTHOR]

This article explores the changing guidelines for treating hypertension and reducing cardiovascular disease (CVD) risk. Traditionally, medication was only recommended for individuals with high blood pressure (BP), but recent studies have shown that treatment can benefit those with lower BP values and other conditions. The article suggests using a risk-based approach, using CVD risk prediction scores, to determine who would benefit most from BP-lowering treatment. However, there are still questions about the optimal treatment threshold and the value of risk prediction in patients with preexisting conditions. The article emphasizes the importance of considering CVD risk when treating hypertension and suggests a cultural shift towards treating CVD risk rather than just hypertension. [Extracted from the article]

HTN is a known leading cause of kidney disease with over 20% of the population aged 20 years or older with HTN developing CKD. Complications from HTN and kidney disease contribute significantly to global mortality. In Kenya, data from WHO shows that about 4 million individuals suffer from CKD, with many progressing to kidney failure. The aim was to assess serum electrolyte abnormalities and kidney function among hypertensive patients at KNH. The study utilized cross-sectional retrospective data from KNH patient records. The CKD-EPI equation was used to calculate eGFR. Fisher et al.'s equation determined sample size. Data were stratified by variables such as DBP, age, sex, SBP, proteinuria, serum creatinine, urea levels, serum electrolytes, and eGFR. Data collection involved 189 patients: 82 males (43.4%) and 107 females (56.6%), with a median age of 54.00 years. 93 patients (49.20%) were <54 years and 96 (50.80%) were ≥54 years. 78.84% of HTN patients had abnormal serum creatinine levels, and 54.5% had abnormal serum urea levels. 58.7% showed proteinuria. Elevated sodium levels (>145 mmol/l) affected 39.68% of patients, while reduced potassium levels (<3.5 mmol/l) were found in 15.34%. 41.27% had elevated chloride levels above 106 mmol/l. CKD stages varied: 3.2% had G1, 17.5% had G2, 14.8% had G3a, 29.1% had G3b, 16.4% had G4, and 19.0% had G5. Reduced renal function, estimated using GFR, was prevalent among hypertensive patients (79.4%) (95% CI:72.9-82.9), notably those ≥54 years. In conclusion, the risk of progressive kidney disease was high amongst hypertensive patients and this was evident from the proportion of patients who have abnormal kidney function including proteinuria. Early screening and implementation of therapeutic strategies can improve patient's quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Central sleep apnea (CSA) is associated with increased mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF). Treatment of CSA with a certain type of adaptive servo-ventilation (ASV) device that targets minute ventilation (ASVmv) was found to be harmful in these patients. A newer generation of ASV devices that target peak flow (ASVpf) is presumed to have different effects on ventilation and airway patency. We analyzed our registry of patients with HFrEF-CSA to examine the effect of exposure to ASV and role of each type of ASV device on mortality. METHODS: This is a retrospective cohort study in patients with HFrEF and CSA who were treated with ASV devices between 2008 and 2015 at a single institution. Mortality data were collected through the institutional data honest broker. Usage data were obtained from vendors and manufacturers servers. Median follow-up was 64 months. RESULTS: The registry included 90 patients with HFrEF-CSA who were prescribed ASV devices. Applying a 3-h-per-night usage cutoff, we found a survival advantage at 64 months for those who used the ASV device above the cutoff (n = 59; survival 76%) compared to those who did not (n = 31; survival 49%; hazard ratio 0.44; CI 95%, 0.20 to 0.97; P = 0.04). The majority (n = 77) of patients received ASVpf devices with automatically adjusting end-expiratory pressure (EPAP) and the remainder (n = 13) received ASVmv devices mostly with fixed EPAP (n = 12). There was a trend towards a negative correlation between ASVmv with fixed EPAP and survival. CONCLUSION: In this population of patients with HFrEF and CSA, there was no evidence that usage of ASV devices was associated with increased mortality. However, there was evidence of differential effects of type of ASV technology on mortality.

Background: Glaucoma and hypertension are asymptomatic in their initial stages. However, management of blood pressure (BP) and intraocular pressure (IOP) may improve the treatment and visual prognosis of glaucoma. The interaction between BP and IOP is related to the ocular perfusion pressure (OPP), which is an important factor in blood flow to the optic nerve. Therefore, this study aims to compare the IOP in non-glaucomatous patients between the systemic hypertensive group and the normotensive group. Material and Methods: The present observational comparative study was conducted on 80 systemic hypertensive and 80 normotensive patients visiting the outpatient department (OPD) of the ophthalmology department at a tertiary care centre in Gwalior City between April 2023 to July 2023. IOP was measured using a non-contact tonometer and BP with a digital machine attached to the patient's left arm in the sitting position by taking two readings during the same visit of the day, and an average value was obtained. Statistical analysis was performed using IBM SPSS for Windows, Version 23.0 (IBM® Corporation, New York, United States). The Kolmogorov–Smirnov test, Chi-square test, Levene's test, independent samples t-test, Welch's t-test, One-Way ANOVA, and Tukey Honest Significant Difference (HSD) test were applied. P 140 mmHg and DBP >90 mmHg. Our findings suggest that lower systemic BP is associated with lower IOP at presentation, which can further prevent the risk of developing glaucoma.

Objectives: This prospective study tested the diagnostic accuracy, and absolute agreement with MRI of a low-dose CT protocol for left ventricular ejection fraction (LVEF) measurement. Furthermore we assessed its potential for combining it with Chest-Abdomen-Pelvis CT (CAP-CT) for a one-stop examination. Materials & methods: Eighty-two patients underwent helical low-dose CT. Cardiac magnetic resonance imaging (MRI) was the reference standard. In fifty patients, CAP-CT was performed concurrently, using a modified injection protocol. In these, LVEF was measured with radioisotope cardiography (MUGA). Patients >18 years, without contrast media or MRI contraindications, were included. Bias was measured with Bland-Altman analysis, classification accuracy with Receiver Operating Characteristics, and inter-reader agreement with Intra-Class Correlation Coefficient (ICC). Correlation was examined using Pearson's correlation coefficients. CAP image quality was compared to previous scans with visual grading characteristics. Results: The mean CT dose-length-product (DLP) was 51.8 mGycm, for an estimated effective dose of 1.4 mSv, compared to 5.7 mSv for MUGA. CT LVEF bias was between 2 % and 10 %, overestimating end-diastolic volume. When corrected for bias, sensitivity and specificity of 100 and 98.5 % for classifying reduced LVEF (50 % MRI value) was achieved. ICC for MUGA was significantly lower than MRI and CT. Distinction of renal medulla and cortex was reduced in the CAP scan, but proportion of diagnostic scans was not significantly different from standard protocol. Conclusion: When corrected for inter-modality bias, CT classifies patients with reduced LVEF with high accuracy at a quarter of MUGA dose and can be combined with CAP-CT without loss of diagnostic quality.

In this paper, an improved high-speed adaptive filter is proposed and implemented using a field-programmable gate array platform. Specifically, a new filter structure combining systolic and convex architectures has been analyzed and compared with conventional filter architectures. The new filter structure efficiently removes power line interference noise from electrocardiogram signals at high convergence speeds. The systolic architecture is used to improve the convergence speed of the filter, and the convex architecture is used in combination to improve the signal-to-noise ratio of the filter. One fast filter was designed using the retimed delay recursive least square algorithm (recursive least square filter design with systolic architecture), and it was combined with one slow filter designed using the least mean square algorithm based on convex combination architecture. The proposed filter architectures are assessed for electrocardiogram noise cancellation, obtained from the MIT-BIH database, and the performance is compared with various filter structures in terms of the signal-to-noise ratio, convergence speed, learning behaviors, and complexity. The results show an improvement in signal-to-noise ratio of 24.2% and an increase in convergence speed of 50% when compared with conventional filter structures. [ABSTRACT FROM AUTHOR]

Objectives: Systemic arterial hypertension is a common occurrence and can have serious adverse consequences in cats. Therefore, measuring blood pressure is very important. There are many indirect blood pressure measurement devices available. This study compared Doppler, oscillometric (petMAP Graphic II, SunTech Vet20, the Cardell Insight-X0000) and high-definition oscillometry devices for the non-invasive measurement of blood pressure in conscious cats. Methods: In this prospective study, blood pressure was measured in 32 cats using the different devices according to the recommendations of the American College of Veterinary Internal Medicine Consensus Statement. Blood pressures (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]), time to complete measurements, number of attempts needed, coefficient of variation (CV) between the blood pressure measurements of the different devices, ease of completing measurements and apparent stress level of the cat were assessed. Results: There was a significant difference between devices in the time taken to obtain blood pressure readings and the number of attempts necessary to obtain six reliable measurements. The CV of the Doppler device was significantly smaller than that of the rest of the devices, but there were no other differences between the devices. The mean SBP, DBP and MAP measured by the petMAP device were significantly higher than the measurements from the other devices. The perceived ease of measurement was not significantly different between the various machines. The perceived level of stress of measurement with the Doppler device was significantly higher compared with the other devices but did not lead to an increased SBP. Conclusions and relevance: Using a Doppler device to measure blood pressure in conscious cats is fast, relatively easy and gives reliable results. A disadvantage is that the Doppler device can only measure SBP, while oscillometric devices also provide DBP and MAP. However, in veterinary medicine, systolic hypertension is considered the most relevant. [ABSTRACT FROM AUTHOR]

Epileptic seizures can cause sudden blood pressure changes, requiring continuous monitoring. However, traditional blood pressure monitoring methods are often invasive and uncomfortable for the patient. In addition, it is difficult to measure blood pressure during seizures. This research aims to design a non-invasive, comfortable device to monitor blood pressure during epileptic seizures continuously. Photoplethysmography (PPG) signals from the sole of the patient's foot were used to extract blood pressure data. A smart patch was designed to be worn comfortably on foot for continuous monitoring during seizures. The results show that the average systolic and diastolic blood pressure errors were 2.838 and 4.494 mmHg during epileptic seizures, respectively. These blood pressure changes could be related to the onset of seizures, suggesting that the device and methodology could be combined with other measures to analyze and predict seizure activity. This research offers a non-invasive and comfortable solution for continuous blood pressure monitoring during seizures, which may affect seizure prediction and management. [ABSTRACT FROM AUTHOR]

Cardiac dysfunction due to hypertension (CDHTN) in pediatrics is not well described. We aimed to describe the presentation and outcomes of pediatric CDHTN and identify clinical features associated with resolution of dysfunction. A single-center retrospective cohort study of patients ≤ 21 years with CDHTN from January 2005–September 2020 was performed. Patients with systolic dysfunction without another cause, blood pressure > 95th percentile, and physician judgment that dysfunction was secondary to hypertension were included. Demographics, clinical characteristics, echocardiographic findings, and outcomes were examined using Fisher's exact and Mann–Whitney U tests. Multiple correspondence analysis was used to explore the relationship of resolution of dysfunction to clinical features. Thirty-four patients were analyzed at a median age of 10.9 (IQR 0.3–16.9) years. Patients were divided into groups < 1 year (n = 12) and ≥ 1 year (n = 22). Causes of hypertension were varied by age, with renovascular disease most common in infants (42%) and medical renal disease most common in older patients (77%). Echocardiography demonstrated mild LV dilation (median LV end-diastolic z-score 2.6) and mild LV hypertrophy (median LV mass z-score 2.4). Most patients (81%) had resolution of dysfunction, particularly infants (92%). One patient died and one patient was listed for heart transplant. None required mechanical circulatory support (MCS). No clinical features were statistically associated with resolution of dysfunction. Hypertension is an important but reversible cause of systolic dysfunction in children. Patients are likely to recover with low mortality and low utilization of MCS or transplantation. Further studies are needed to confirm features associated with resolution of dysfunction. [ABSTRACT FROM AUTHOR]

Aim: To describe the epidemiological, clinical and laboratory characteristics and clinical progress of patients hospitalized with heart failure (HF) who started treatment with empagliflozin before discharge. Methods: We performed a retrospective observational study of patients aged ≥18 years admitted to the Internal Medicine Department of University Hospital Jaen, Jaen, Spain with acute HF between 1May 2022 and 31 May 2023. Patients had to have a life expectancy of ≥1 year and have started treatment with empagliflozin during admission. Results: We included 112 patients (mean age, 85.2 ± 6.5 years; 67.9% women; 35.7 and 31.3% in NYHA functional classes III and IV; 73.2% with HF and preserved ejection fraction). Before admission, 80.4% were taking loop diuretics, 70.6% renin–angiotensin–aldosterone system inhibitors, 49.1% betablockers and 25% mineralocorticoid receptor antagonists. At admission, 94.6% were taking furosemide (15.2% at high doses, 36.6% at intermediate doses). The dose of furosemide was reduced at initiation of empagliflozin. At the end of follow-up, 13.4% of patients had died, 93.8% of the survivors continued treatment with empagliflozin and 26.8% had attended the emergency department with signs and symptoms of HF. Conclusion: Introduction of empagliflozin before discharge from hospital in patients admitted with HF made it possible to reduce the dose of diuretics during admission. The frequency of complications was as expected, and treatment was largely maintained.

This research letter discusses a study on the use of liquid biopsy, specifically plasma extracellular vesicles (EVs), to analyze the transcriptomes of different subtypes of acute decompensated heart failure (HF). The study aimed to identify distinct transcriptomes between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). The researchers found that specific plasma transcripts effectively distinguished between HF subtypes, but other EV transcripts were commonly dysregulated in both subtypes. The study suggests that EVs could be used as a "liquid biopsy" for cardiovascular diseases, but more specific markers are needed to assess HF status and multiorgan function. Another study discussed in this document used RNA sequencing to analyze circulating extracellular RNAs (exRNAs) in plasma samples from patients with HFpEF and HFrEF. The results showed that the transcriptomic profiles of exRNAs differed between the two subtypes, with HFrEF showing a signature centered on cardiomyocyte origin and HFpEF showing a broader, systemic disease profile. This study suggests that exRNAs could be used as biomarkers for subtype-specific diagnosis and treatment of heart failure. [Extracted from the article]

The article discusses the phosphodiesterase E3 dunce homolog, Drosophila (PDE4D) gene variant (rs2910829), ischemic heart disease in men, the mutant T allele, and ischemic heart disease. It emphasizes the potential of the PDE4D rs2910829 variant as a cardiovascular risk marker, and it emphasizes the importance of physiological parameters like blood pressure in identifying cardiovascular disease risk.

BACKGROUND: Hospitalization is recognized as a sentinel event in the disease trajectory of patients with heart failure (HF), but not all patients experiencing clinical decompensation are ultimately hospitalized. Outpatient intensification of diuretics is common in response to symptoms of worsening HF, yet its prognostic and clinical relevance, specifically for patients with HF with mildly reduced or preserved ejection fraction, is uncertain. METHODS: In this prespecified analysis of the DELIVER trial (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), we assessed the association between various nonfatal worsening HF events (those requiring hospitalization, urgent outpatient visits requiring intravenous HF therapies, and outpatient oral diuretic intensification) and rates of subsequent mortality. We further examined the treatment effect of dapagliflozin on an expanded composite end point of cardiovascular death, HF hospitalization, urgent HF visit, or outpatient oral diuretic intensification. RESULTS: In DELIVER, 4532 (72%) patients experienced no worsening HF event, whereas 789 (13%) had outpatient oral diuretic intensification, 86 (1%) required an urgent HF visit, 585 (9%) had an HF hospitalization, and 271 (4%) died of cardiovascular causes as a first presentation. Patients with a first presentation manifesting as outpatient oral diuretic intensification experienced rates of subsequent mortality that were higher (10 [8-12] per 100 patient-years) than those without a worsening HF event (4 [3-4] per 100 patient-years) but similar to rates of subsequent death after an urgent HF visit (10 [6-18] per 100 patient-years). Patients with an HF hospitalization as a first presentation of worsening HF had the highest rates of subsequent death (35 [31-40] per 100 patient-years). The addition of outpatient diuretic intensification to the adjudicated DELIVER primary end point (cardiovascular death, HF hospitalization, or urgent HF visit) increased the overall number of patients experiencing an event from 1122 to 1731 (a 54% increase). Dapagliflozin reduced the need for outpatient diuretic intensification alone (hazard ratio, 0.72 [95% CI, 0.64-0.82]) and when analyzed as a part of an expanded composite end point of worsening HF or cardiovascular death (hazard ratio, 0.76 [95% CI, 0.69-0.84]). CONCLUSIONS: In patients with HF with mildly reduced or preserved ejection fraction, worsening HF requiring oral diuretic intensification in ambulatory care was frequent, adversely prognostic, and significantly reduced by dapagliflozin. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the left ventricular (LV) systolic and diastolic parameters and left atrial (LA) mechanical functions of individuals engaging in recreational sports and resistance exercises on a weekly basis. Methods: A total of 43 male amateur athletes were included in this study, of which 24 performed resistance exercises (REs) (29.70 ± 8.74 year, weight: 81.70 ± 12.64 kg, height: 176.05 ± 7.73 cm, BMI: 27.64 ± 4.97 kg/m2), and 19 participated in recreational football training and were included in the recreational sports group (31.73 ± 6.82 year, weight: 86.00 ± 18.52 kg, height: 178.62 ± 4.95 cm, BMI: 25.55 ± 3.42 kg/m2). The exercises were standardized according to the weekly exercise frequency and volume. After recording the participants' demographic information, the LV systolic and diastolic parameters and LA mechanical functions were measured using echocardiography (ECHO) and Tissue Doppler Imaging. Results: Significant differences were observed in various cardiac parameters between the recreational sports group (REG) and resistance exercise Group (RSG). Specifically, the left ventricular (LV) diastolic diameter, LV end diastolic volume index (LVEDVi), and stroke volume index were notably higher in the REG compared to the RSG (t = 2.804, p =.010, effect size (ES) = 2.10; t = 3.174, p =.003, ES = 0.98; t = 3.36, p =.002, ES = 1.02, respectively). Notably, the RSG exhibited higher values for LV mass index (LVMi) and isovolumic relaxation time (IVRT) than the REG (t = 2.843, p =.007, ES = 0.87; t = 2.517, p =.016, ES = 0.76) in terms of LV systolic and diastolic parameters. Regarding left atrial (LA) mechanics, the REG demonstrated increased LA total emptying volume index, LA maximum volume index, LA volume before systole measured at the onset of the p-wave index, and conduit volume index compared to RSG (t = 2.419, p =.020, ES = 0.75; t = 2.669, p =.011, ES = 0.81; t = 2.111, p =.041, ES = 0.64; t = 2.757, p =.009, ES = 0.84, respectively). Conclusion: Our study revealed significant variations in LV and LA functions between REG and RSG. Our data suggest that REs led to substantial cardiac remodeling, altering myocardial structure and function. In contrast, the effect of recreational exercise on cardiac adaptation was less pronounced than that of resistance exercise. Consequently, we propose that individuals engaging in recreational exercise should consider modalities that impose higher cardiovascular demand for more effective cardiac conditioning. [ABSTRACT FROM AUTHOR]

Background: Roselle (Hibiscus sabdariffa L.) calyces have been used in traditional medicine as diuretics, mild laxatives, and antihypertensive agents but to date, a comprehensive study of its pharmacological activity and safety has not been conducted. Aims of the study: The current study aims to provide a comprehensive evaluation of the antihypertensive efficacy and toxicity profile of Roselle (H. sabdariffa L.) calyces extract. Utilizing animal models, the investigation assessed the dose-dependent pharmacological effects and safety of H. sabdariffa L. Results: The findings indicate that the extract exerts a significant antihypertensive effect at a dose of 250 mg/kg body weight (BW), lowering systolic and diastolic blood pressures by 10.12% and 11.63%, respectively. Ethyl acetate fractions administered at 112.5 mg/ kg BW demonstrated greater efficacy than n-hexane and aqueous fractions, suggesting that the active compounds likely possess semi-polar properties. Acute toxicity testing yielded an LD50 of 8.75 g/kg BW for male rats and 7.5 g/kg BW for female rats, classifying the extract as slightly toxic. The sub-chronic toxicity study shows that H. sabdariffa L. demonstrates an effect on bodyweight and urea levels in male and female rats, while the change in the blood parameters, creatinine level, and the liver index was only observed in female rats. Conclusions: These data suggest that H. sabdariffa L. extract exhibits therapeutic promise but should be administered cautiously, preferably at doses lower than 250 mg/kg BW, due to potential toxicity. [ABSTRACT FROM AUTHOR]

Abstract Background Globally, hypertension represents a major public health problem. The association between 25-hydroxyvitamin D (25[OH]D) levels and hypertension remains unclear. The current study aimed to investigate the association between serum 25(OH)D levels and hypertension among adults in Sudan. Methods A community-based cross-sectional study was conducted among adults in North Sudan. Sociodemographic and clinical data were collected using a questionnaire and face-to-face interviews. Serum 25(OH)D was measured using an enzyme-linked immunosorbent assay. Multivariate logistic regression and multiple linear regression analyses were performed. Results Of the total of 391 participants, 202 (51.7%) were females. The median (interquartile range [IQR]) of participants’ ages was 45(32–55) years. Of the total, 219(56.0%) had hypertension. The median (IQR) of serum25(OH)D was 13.3(9.9–19.7) ng/mL, and 295 (75.4%) participants had vitamin D deficiency (

Abstract Introduction Depression and increased blood pressure are significant burdens in elderly care. This study was conducted to discover the association between hypertension (HTN) and depression based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, southern Iran. Methods This study was carried out based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, a southern city in Iran. 2419 old adults were included in the study through multi-stage random sampling. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9), and blood pressure was measured using a standard mercury sphygmomanometer. Statistical analysis was conducted via chai-square, analysis of variance (ANOVA), and univariate and multivariate linear regression tests. Results The mean age of participants was 69.95 ± 6.95 years. The prevalence of depression was 23.8%. Diastolic blood pressure (DBP) decreased with increasing PHQ score (B=-0.001; 95%CI: -0.00 to -0.00, P-value = 0.011). In the final model adjusted for confounding variables, no significant association was found between depression score and DBP (B=-0.00; 95%CI: -0.00 to 0.00, P = 0.13). Conversely, in the final model, which included the confounding variable, SBP was significantly associated with depression. It was deduced that a variable acted as a negative confounder in this association; in a way that with increased depression score, SBP significantly decreased (B=-0.00; 95% CI: -0.00 to -0.00, P = 0.04). Conclusion Depression and its related medications could be significantly associated with controlled SBP. Health practitioners in primary health care centers must monitor the elderly inflicted with HTN for early symptoms of depression to help maintain blood pressure levels using medicinal and non-medicinal interventions.

Tekanan darah merupakan tekanan yang ditimbulkan pada pembuluh nadi atau arteri ketika darah dipompa dari jantung ke seluruh tubuh. Nilai dari tekanan darah dapat digunakan untuk dijadikan sebagai acuan dalam menetukan kondisi kesehatan tubuh. Untuk melakukan pengecekan terhadap nilai tekanan darah dapat dilakukan dengan menggunakan metode invasive dan non-invasive. Pengecekan tekanan darah perlu dilakukan secara langsung oleh tenaga medis dan pasien. Dengan perkembangan teknologi yang semakin pesat pengecekan ini dapat dilakukan oleh tenaga medis tanpa perlu bertemu langsung dengan pasien.Untuk melakukan monitoring ini dapat memanfaatkan smartphone untuk menampilkan informasi monitoring terhadap tekanan darah dari orang lain tanpa perlu melakukan pengecekan langsung menggunakan alat terhadap orang lain. Pada penelitian ini digunakan metode non-invasive dengan memanfaatkan pembacaan sinyal osilometrik dari perubahan tekanan pada cuff yang terbaca oleh sensor tekanan MPX5500DP untuk melakukan pembacaan tekanan darah yang kemudian ditampilkan pada perangkat android. Dengan menggunakan pendekatan menggunakan sinyal osilometrik ini akan diproses pada mikrokontroler Arduino UNO R3 untuk mencari nilai Mean Arterial Pressure, systole dan diastole menggunakan metode Maximum Amplitude Algorithm (MAA). Pada alat yang dikembangkan nilai hasil pemprosesan menggunakan metode MAA akan dikirimkan menggunakan modul bluetooth HC-05 untuk ditampilkan pada perangkat android. Pada pengujian sistem, didapatkan tingkat akurasi pembacaan nilai systole sebesar 78.23% dan tingkat akurasi pembacaan diastole sebesar 88.39% yang dibandingkan dengan pembacaan menggunakan tensimeter manual. Abstract Blood pressure is the pressure that exerted on the veins or arteries when blood is pumped from the heart to the rest of the body. The value of blood pressure can be used as a reference in determining the health condition of the body. To check the blood pressure values can be done using invasive and non-invasive methods. Checking blood pressure needs to be done directly by medical personnel and patients. With the rapid development of technology, this medical check can be done by medical personnel without the need to meet directly with patients. To do this medical monitoring, a smartphone can be used to display monitoring information on blood pressure from others without the need to check directly using the tool against others. In this study writer used a non-invasive method by utilizing oscillometric value readings of pressure changes in the cuff are read by the MPX5500DP pressure sensor to perform blood pressure readings are then displayed on the android device. By using this oscillometric value approach will be processed on the Arduino UNO R3 microcontroller to find the value of Mean Arterial Pressure, systole and diastole using the Maximum Amplitude Algorithm(MAA). In the developed tool, the result value of the processing using the MAA method will be sent using the bluetooth module HC-05 to be displayed on the android device. In testing the system, obtained the reading accuracy rate of systole value of 78.23% and diastole reading accuracy rate of 88.39% compared with readings using a manual tensimeter.

Background: Heart failure is a major burden in Australia in terms of morbidity, mortality and healthcare expenditure. Multiple evidence‐based therapies are recommended for heart failure with reduced ejection fraction (HFrEF), but data on physician adherence to therapy guidelines are limited. Aim: To compare use of HFrEF therapies against current evidence‐based guidelines in an Australian hospital inpatient population. Methods: A retrospective review of patients admitted with a principal diagnosis of HFrEF across six metropolitan hospitals in Sydney, Australia, between January 2015 and June 2016. Use of medical and device therapies was compared with guideline recommendations using individual patient indications/contraindications. Readmission and mortality data were collected for a 1‐year period following the admission. Results: Of the 1028 HFrEF patients identified, 39 were being managed with palliative intent, leaving 989 patients for the primary analysis. Use of beta‐blockers (87.7% actual use/93.6% recommended use) and diuretics (88.4%/99.3%) was high among eligible patients. There were large evidence‐practice gaps for angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB; 66.4%/89.0%) and aldosterone antagonists (41.0%/77.1%). In absolute terms, use of these therapies each increased by over 11% from admission. Ivabradine (11.5%/21.2%), automated internal cardiac defibrillators (29.5%/66.1%) and cardiac resynchronisation therapy (13.1%/28.7%) were used in a minority of eligible patients. Over the 1‐year follow‐up period, the mortality rate was 14.8%, and 44.2% of patients were readmitted to hospital at least once. Conclusion: Hospitalisation is a key mechanism for initiation of HFrEF therapies. The large evidence‐practice gaps for ACEI/ARB and aldosterone antagonists represent potential avenues for improved HFrEF management. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a known risk factor for hypertension. Baseline Heart Rate (HR) and blood pressure are known to scale linearly with Body Mass Index (BMI) values. Recent studies have reported an exaggerated acute response of blood pressure and HR to exercise. Aim: To assess the effect of isotonic exercise on cardiovascular parameters among individuals with different body mass indices in students at Osmania Medical College and look for any association between BMI and cardiovascular responses to isotonic exercise. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology at Osmania Medical College, Hyderabad, Telangana, India, from January 2022 to December 2023, involving 100 healthy individuals with different body mass indices in the age group of 17 years-30 years. The subjects were divided into four groups based on their BMI. Baseline HR, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were measured for all participants. Subsequently, the participants performed isotonic exercise for three minutes. Post-exercise HR, SBP, and DBP were measured immediately. One-way ANOVA was used to determine the significance of HR, SBP, DBP, Mean Arterial Pressure (MAP), and Pulse Pressure (PP) among the different BMI groups. A p-value of <0.05 was considered statistically significant. Results: A total of 100 subjects (28 males, 72 females) with a mean age of 18.64±0.92 years participated in the study. Significant differences were observed in pre-exercise HR (p=0.0002), SBP, DBP, and MAP (p<0.001), and post-exercise HR, SBP, DBP, and MAP (p<0.001) among the different BMI groups. Overweight and obese individuals showed an increased tendency for an exaggerated increase in HR. Changes in PP and MAP, affected by a combination of SBP and DBP, also showed statistical significance. Furthermore, there was an increased tendency for an exaggerated increase in blood pressure in the overweight and obese BMI groups. Conclusion: Individuals with higher BMI exhibit exaggerated increases in SBP, Mean and PP, as well as HR. Additionally, obese individuals demonstrated a significant elevation in DBP. The response of blood pressure and HR after exercise in overweight/obese individuals suggests a higher risk of developing hypertension and other cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Introduction: Depression and increased blood pressure are significant burdens in elderly care. This study was conducted to discover the association between hypertension (HTN) and depression based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, southern Iran. Methods: This study was carried out based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, a southern city in Iran. 2419 old adults were included in the study through multi-stage random sampling. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9), and blood pressure was measured using a standard mercury sphygmomanometer. Statistical analysis was conducted via chai-square, analysis of variance (ANOVA), and univariate and multivariate linear regression tests. Results: The mean age of participants was 69.95 ± 6.95 years. The prevalence of depression was 23.8%. Diastolic blood pressure (DBP) decreased with increasing PHQ score (B=-0.001; 95%CI: -0.00 to -0.00, P-value = 0.011). In the final model adjusted for confounding variables, no significant association was found between depression score and DBP (B=-0.00; 95%CI: -0.00 to 0.00, P = 0.13). Conversely, in the final model, which included the confounding variable, SBP was significantly associated with depression. It was deduced that a variable acted as a negative confounder in this association; in a way that with increased depression score, SBP significantly decreased (B=-0.00; 95% CI: -0.00 to -0.00, P = 0.04). Conclusion: Depression and its related medications could be significantly associated with controlled SBP. Health practitioners in primary health care centers must monitor the elderly inflicted with HTN for early symptoms of depression to help maintain blood pressure levels using medicinal and non-medicinal interventions. [ABSTRACT FROM AUTHOR]

Background: Globally, hypertension represents a major public health problem. The association between 25-hydroxyvitamin D (25[OH]D) levels and hypertension remains unclear. The current study aimed to investigate the association between serum 25(OH)D levels and hypertension among adults in Sudan. Methods: A community-based cross-sectional study was conducted among adults in North Sudan. Sociodemographic and clinical data were collected using a questionnaire and face-to-face interviews. Serum 25(OH)D was measured using an enzyme-linked immunosorbent assay. Multivariate logistic regression and multiple linear regression analyses were performed. Results: Of the total of 391 participants, 202 (51.7%) were females. The median (interquartile range [IQR]) of participants' ages was 45(32–55) years. Of the total, 219(56.0%) had hypertension. The median (IQR) of serum25(OH)D was 13.3(9.9–19.7) ng/mL, and 295 (75.4%) participants had vitamin D deficiency (< 20 ng/mL). In multivariable logistic regression, the adjusted odds ratio (AOR) for age = 1.05, 95% confidence interval (CI)1.03‒1.061, the AOR for being female = 2.02, 95% CI, 1.12‒3.66, and body mass index was AOR = 1.09, 95% CI, 1.05‒1.14, all of which were significantly associated with hypertension. However, serum 25(OH)D levels were not associated with hypertension (AOR = 1.01, 95% CI 0.99‒1.05, P = 0.317). In multiple linear regression, while systolic blood pressure was negatively associated with 25(OH)D (coefficient = − 0.28, P = 0.017), there was no significant association between serum 25(OH)D level and diastolic blood pressure (coefficient = − 0.10, P = 0.272) or mean blood pressure (coefficient =–0.03, P = 0.686). Conclusion: The current study revealed a negative association between vitamin D and systolic blood pressure. The mechanism of such an association needs further study. [ABSTRACT FROM AUTHOR]

The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available. The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids. In addition, ketone bodies provide "rescue fuel" for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing. The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss. The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area. [ABSTRACT FROM AUTHOR]

Background: Aerobic exercise is recommended for reducing blood pressure; however, recent studies indicate that stretching may also be effective. The authors compared 8 weeks of stretching versus walking exercise in men and women with high-normal blood pressure or stage 1 hypertension (ie, 130/85-159/99 mm Hg). Methods: Forty men and women (61.6 y) were randomized to a stretching or brisk walking exercise program (30 min/d, 5 d/wk for 8 wk). Blood pressure was assessed during sitting and supine positions and for 24 hours using a portable monitor before and after the training programs. Results: The stretching program elicited greater reductions than the walking program (P < .05) for sitting systolic (146 [9] to 140 [12] vs 139 [9] to 142 [12] mm Hg), supine diastolic (85 [7] to 78 [8] vs 81 [7] to 82 [7] mm Hg), and nighttime diastolic (67 [8] to 65 [10] vs 68 [8] to 73 [12] mm Hg) blood pressures. The stretching program elicited greater reductions than the walking program (P < .05) for mean arterial pressure assessed in sitting (108 [7] to 103 [6] vs 105 [6] vs 105 [8] mm Hg), supine (102 [9] to 96 [9] vs 99 [6] to 99 [7] mm Hg), and at night (86 [9] to 83 [10] vs 88 [9] to 93 [12] mm Hg). Conclusions: An 8-week stretching program was superior to brisk walking for reducing blood pressure in individuals with high-normal blood pressure or stage 1 hypertension. [ABSTRACT FROM AUTHOR]

Abstract Aims In heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), the prognosis appears better in non‐ischaemic than in ischaemic aetiology. Infrequent diagnostic work‐up for ischaemic heart disease (IHD) in HF is reported. In this study, we compared short‐term response to initiated guideline‐directed medical treatment (GDMT) in recent‐onset HFrEF of non‐ischaemic (non‐IHF) vs. ischaemic (IHF) aetiology and evaluated the frequency of coronary investigation. Methods and results Patients hospitalized with recent‐onset HFrEF [left ventricular ejection fraction (LVEF)

Introduction: Heart failure (HF) is a progressive chronic clinical syndrome. Thyroid dysfunction in HF patients has been reported in the literature. We aimed to explore the prevalence of thyroid dysfunction among acute left ventricular failure (LVF) patients admitted to our hospital. Materials and Methods: A retrospective study involving 78 patients diagnosed with acute LVF was conducted. Baseline information that included demographics, risk factors, clinical presentations, and biochemical data was recorded. A comparison of acute LVF patients with thyroid dysfunction to those with normal thyroid function was analyzed and documented. Results: About 29.5% (n = 23; 63.8 ± 11.4 years) of patients had normal thyroid function and 70.5% (n = 55; 65.3 ± 6 years) had thyroid dysfunction (P = 0.0003). The mean age of the cohort was 64.7 ± 12.4 years and 68% (n = 53) were men. Hypertension was the most common risk factor among both groups (56.5%, n = 13 vs. 67.3%, n = 37; P = 0.0006). Around 13% (n = 3) of patients with normal thyroid function and 20% (n = 11) of patients with thyroid dysfunction expired (P = 0.0325). The most common symptom seen in both groups was shortness of breath (28%, n = 16 vs. 72%, n = 41; P = 0009). There was a high prevalence of HF with reduced ejection fraction (60.8%, n = 14 vs. 65.5%, n = 36; P = 0.0018). Electrocardiography abnormalities were noted in 70.5% (n = 55) of patients of the cohort (65.2%, n = 15 vs. 72.7%, n = 40; P = 0.007). Irregularities in two-dimensional echocardiography and Doppler were seen in 76.5% (n = 59) of patients (69.6%, n = 16 vs. 78.2%, n = 43; P = 0.0004). Conclusions: Thyroid dysfunction can cause significant adverse effects on the heart. Early diagnosis and treatment of thyroid abnormalities can reduce and/or prevent the development of serious cardiac problems including HF.

Introduction: Obesity is a known risk factor for hypertension. Baseline Heart Rate (HR) and blood pressure are known to scale linearly with Body Mass Index (BMI) values. Recent studies have reported an exaggerated acute response of blood pressure and HR to exercise. Aim: To assess the effect of isotonic exercise on cardiovascular parameters among individuals with different body mass indices in students at Osmania Medical College and look for any association between BMI and cardiovascular responses to isotonic exercise. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology at Osmania Medical College, Hyderabad, Telangana, India, from January 2022 to December 2023, involving 100 healthy individuals with different body mass indices in the age group of 17 years-30 years. The subjects were divided into four groups based on their BMI. Baseline HR, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were measured for all participants. Subsequently, the participants performed isotonic exercise for three minutes. Post-exercise HR, SBP, and DBP were measured immediately. One-way ANOVA was used to determine the significance of HR, SBP, DBP, Mean Arterial Pressure (MAP), and Pulse Pressure (PP) among the different BMI groups. A p-value of

Objective: To investigate the effect of Tender Coconut Water (TCW) on the blood pressure (BP) of Primary hypertensive subjects. Materials and methods: 70 subjects were chosen at random for the 6-week intervention program. Forty subjects were selected as the experimental group and given 300ml per day for six weeks, while the control group was instructed to adhere to the same regimen. Both groups underwent an initial, two mid-intervention (every 15 days), and a final (post-intervention) blood pressure measurement. The obtained data was analyzed statistically. Results: The average systolic blood pressure of the experimental and control groups decreased from 145.8 mm Hg and 141 mm Hg, respectively, to 135.3 mm Hg and 140 mm Hg, respectively. The average diastolic blood pressure of the experimental and control groups decreased from 93.7 and 90.9 mmHg to 86.9 and 89.7 mmHg, respectively. Conclusion: Regardless of the aetiology of hypertension, TCW has a beneficial effect on blood pressure. TCW contains a high concentration of potassium, which induces vasodilation and enhances endothelial function. Recommendation: A complete medical and family history is recommended and should include values of blood pressure, risk factors, overall cardiovascular risk assessment, signs and symptoms of coexistent/hypertension illness, and symptoms of secondary hypertension.

Background: L-Carnitine may protect cardiac muscle against oxidative stress, hypoxia and ischemia. The aim of this study was to assess the effect of LCarnitine in improving systolic and diastolic function in patients with dilated cardiomyopathy. Methods: We studied 160 patients who were admitted to Critical Care Department, Zagazig University diagnosed as dilated cardiomyopathy. The patients were classified into 2 groups: Group I: Study Group: Includes 80 patients who received conventional anti failure measures plus L-Carnitine. L-Carnitine was given in a dose of 3gm/d divided in 3 doses, 1 gm at principal meals for up to 6 months. Group I subdivided into responders and non-responders. Group II: Placebo Group: Includes 80 patients who received conventional anti failure measures only. Serum carnitine and echocardiographic parameters as left ventricular ejection fraction (EF), global longitudinal strain (GLS) by speckle tracking echocardiography and E/E' using tissue Doppler imaging, were measured before the start of therapy, at 2 and 6 months later. Results: Comparing the study versus placebo groups, there was statistically significant increase in EF in group I at 2 months (39.3±8% vs 33.52±4.8%, p: 0.001) and after 6 months (40.33±8% vs 34.5±4.8%, p: 0.001) as compared to group II respectively. Regarding GLS (- %), group I exhibited significant improvement in GLS at 2 months as compared to group II (16.5±2.9 vs 7.7±2.8, p: 0.001) which continued after 6 months (18.8±3.6vs 8.2±1.5, p: 0.001) respectively. Regarding E/E' ratio, group I exhibited significant improvement in diastolic function at 2 and 6 months as compared to group II (p: 0.001) which continued after 6 months. There was no significant increase in levels of serum L carnitine in group I after 2 months (22.4±6.3 vs 19.4±2.5, p: 0.05) but there was significant increase in serum carnitine level after 6 months (35.8±10.1 vs 22.5±3.1, p: 0.01) as compared to group II. There was statistically positive significant correlation between EF and LCarnitine (r= 0.6, p=0.001). Conclusion: As a metabolic supplement the early administration of L-Carnitine plus conventional anti failure measures to patients with cardiomyopathy provides a significant improvement as regards clinical signs of heart failure and echocardiographic parameters namely EF, GLS and E/E' with consequent improvement in quality of life for these patients. [ABSTRACT FROM AUTHOR]

Foam rolling (FR) has recently become very popular among athletes and recreational exercisers and is often used during warm up prior to strength training (ST) to induce self-myofascial release. The purpose was to examine the acute effects of ST and FR performed in isolation or in combination on blood pressure (BP) responses during recovery in normotensive women. Sixteen normotensive and strength trained women completed four interventions: 1) rest control (CON), 2) ST only, 3) FR only, and 4) ST immediately followed by FR (ST + FR). ST consisted of three sets of bench press, back squat, front pull-down, and leg press exercises at 80% of 10RM. FR was applied unilaterally in two sets of 120 s to each of the quadriceps, hamstring, and calf regions. Systolic (SBP) and diastolic (DBP) BP were measured before (rest) and every 10 min, for 60 min, following (Post 10–60) each intervention. Cohen's d effect sizes were calculated to indicate the magnitude effect by the formula d = Md/Sd, where Md is the mean difference and Sd is the standard deviation of differences. Cohen's d effect-sizes were defined as small (≥0.2), medium (≥0.5), and large (≥0.8). There were significant reductions in SBP for ST at Post-50 (p < 0.001; d = −2.14) and Post-60 (p < 0.001; d = −4.43), for FR at Post-60 (p = 0.020; d = −2.14), and for ST + FR at Post-50 (p = 0.001; d = −2.03) and Post-60 (p < 0.001; d = −2.38). No change in DBP was observed. The current findings suggest that ST and FR performed in isolation can acutely reduce SBP but without an additive effect. Thus, ST and FR can both be used to acutely reduce SBP and, importantly, FR can be added to a ST regimen without furthering the SBP reduction during recovery. [ABSTRACT FROM AUTHOR]

ObjectivesThis study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF).BackgroundDespite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established.MethodsThis study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable and a 2-point decrease. To account for a loss to follow-up, data at the baseline and at the 12-month visit were analyzed separately (sensitivity analysis).ResultsA total of 1,846 patients were included. In linear regression, MMSE decrease was independently associated with higher baseline MMSE score (p

Hussein Alhawari,1 Sameeha AlShelleh,1 Hussam Alhawari,1 Saif Aldeen AlRyalat,2 Asim N Khanfar,1 Osama Alzoubi1 1Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan; 2Department of Special Surgery, School of Medicine, the University of Jordan, Amman, JordanCorrespondence: Hussein Alhawari, Division of Nephrology, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan, Email h.alhawari@ju.edu.joIntroduction: Hypertension is an important cause of morbidity and mortality worldwide. Undiagnosed hypertension is a serious issue that leads to increased morbidity and mortality. In this study, we aim to identify the prevalence of undiagnosed hypertension in the healthy Jordanian population, as well as identify predictors of high blood pressure readings in presumably healthy Jordanians.Materials and Methods: We recruited healthy visitors accompanying patients at our Jordan University Hospital Clinics ranging from 18 to 80 years of age. We measured each participant’s systolic and diastolic blood pressure at our outpatient clinics on two different days, one week apart. We also obtained demographic data, weight, height, smoking status, and family history of hypertension and cardiovascular diseases.Results: A total of 896 participants were included in this study with a mean age of 48 years. The median of systolic blood pressure readings was 125 mmHg, and the median of diastolic blood pressure readings was 83 mmHg. 38.5% had undiagnosed stage 1 hypertension and 30.5% had undiagnosed stage 2 hypertension according to the American College of Cardiology/American Heart Association guidelines. On the other hand, 25.4% had undiagnosed grade 1 hypertension and 5.1% had undiagnosed grade 2 hypertension according to the European Society of Hypertension guidelines.Conclusion: According to the ACC/AHA guidelines, 68.5% of previously healthy Jordanians met the criteria to be diagnosed with hypertension. Predictors of high systolic blood pressure were age, BMI and family history of CAD, while female gender is associated with a lower systolic blood pressure. For diastolic blood pressure, only BMI and family history of CAD were associated with significantly higher diastolic blood pressure, while female gender and exercise were significantly associated with lower diastolic blood pressure.Keywords: blood pressure, hypertension, systolic, diastolic

Abstract Background Sickle cell disease (SCD) is associated with an increased risk of cardiovascular disease that may be due to a variety of possible risk factors, including abnormal blood pressure. Blood pressure (BP) of children and adolescents with SCD has been reported to be lower compared to the BP of the general pediatric population. Methods To confirm this prior observation, we compared reference BP values for children with SCD with reference BP values of the general pediatric population. We hypothesized that children with SCD do not have lower BPs than children without SCD. Results Systolic BP differed for both males and females, over the different age groups between pediatric subjects with and without SCD. Systolic BP was higher in children with SCD, in both obese and non-obese populations. Diastolic BP did not differ between the groups. Conclusions Our analysis demonstrated that systolic BP values are indeed higher in children with SCD than in the general pediatric population. This finding is consistent with the most recent literature showing abnormal BP patterns in the SCD pediatric population utilizing 24-hour BP monitoring devices. This is an important step for recognizing abnormal BP as a risk factor for cardio- and neurovascular events in SCD.

Hypertension is a severe and highly prevalent disease. It is considered a leading contributor to mortality worldwide. Diagnosis guidelines for hypertension use systolic and diastolic blood pressure (BP) together. Mean arterial pressure (MAP), which refers to the average of the arterial blood pressure through a single cardiac cycle, can be an alternative index that may capture the overall exposure of the person to a heightened pressure. A clinical hypothesis, however, suggests that in patients over 50 years old in age, systolic BP may be more predictive of adverse events, while in patients under 50 years old, diastolic BP may be slightly more predictive. In this study, we investigated the correlation between cerebrovascular changes, (impacted by hypertension), and MAP, systolic BP, and diastolic BP separately. Several experiments were conducted using real and synthetic magnetic resonance angiography (MRA) data, along with corresponding BP measurements. Each experiment employs the following methodology: First, MRA data were processed to remove noise, bias, or inhomogeneity. Second, the cerebrovasculature was delineated for MRA subjects using a 3D adaptive region growing connected components algorithm. Third, vascular features (changes in blood vessel's diameters and tortuosity) that describe cerebrovascular alterations that occur prior to and during the development of hypertension were extracted. Finally, feature vectors were constructed, and data were classified using different classifiers, such as SVM, KNN, linear discriminant, and logistic regression, into either normotensives or hypertensives according to the cerebral vascular alterations and the BP measurements. The initial results showed that MAP would be more beneficial and accurate in identifying the cerebrovascular impact of hypertension (accuracy up to 95.2 % ) than just using either systolic BP (accuracy up to 89.3 % ) or diastolic BP (accuracy up to 88.9 % ). This result emphasizes the pathophysiological significance of MAP and supports prior views that this simple measure may be a superior index for the definition of hypertension and research on hypertension. [ABSTRACT FROM AUTHOR]

Aims: In heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), the prognosis appears better in non‐ischaemic than in ischaemic aetiology. Infrequent diagnostic work‐up for ischaemic heart disease (IHD) in HF is reported. In this study, we compared short‐term response to initiated guideline‐directed medical treatment (GDMT) in recent‐onset HFrEF of non‐ischaemic (non‐IHF) vs. ischaemic (IHF) aetiology and evaluated the frequency of coronary investigation. Methods and results: Patients hospitalized with recent‐onset HFrEF [left ventricular ejection fraction (LVEF) < 40%] between 1 January 2016 and 31 December 2019 were included. Treatment response was determined by use of a hierarchical clinical composite outcome classifying each patient as worsened, improved, or unchanged based on hard outcomes (mortality, heart transplantation, and HF hospitalization) and soft outcomes (± ≥10 unit change in LVEF, ± ≥30% change in N‐terminal pro‐B‐type natriuretic peptide, and ± ≥1 point change in New York Heart Association functional class) during 28 weeks of follow‐up. The associations between baseline characteristics and composite changes were analysed with multiple logistic regression. Among the 364 patients analysed, 47 were not investigated for IHD. Comparing non‐IHF (n = 203) vs. IHF (n = 114), patients were younger (mean age 61.0 vs. 69.4 years, P < 0.001) with lower mean LVEF (26% vs. 31%, P < 0.001), but with similar male predominance (70.4% vs. 75.4%, P = 0.363). For non‐IHF vs. IHF, the composite outcomes were worsened (19.1% vs. 43.9%, P < 0.001) and improved (74.2% vs. 43.9%, P < 0.001). After multivariable adjustments, IHF was associated with increased odds for worsening [odds ratio (OR) 2.94; 95% confidence interval (CI) 1.51–5.74; P = 0.002] and decreased odds for improvement (OR 0.35; 95% CI 0.18–0.65; P < 0.001). In cases without previous IHD or new‐onset myocardial infarction (n = 261), a decision for coronary investigation was made in 69.0%. Conclusions: In recent‐onset HFrEF, patients with non‐IHF responded better to GDMT than patients with IHF. Almost one‐third of patients selected for follow‐up at HF clinics were never investigated for IHD. [ABSTRACT FROM AUTHOR]

RationaleGq signaling in cardiac myocytes is classically considered toxic. Targeting Gq directly to test this is problematic, because cardiac myocytes have many Gq-coupled receptors.ObjectiveTest whether Gq coupling is required for the cardioprotective effects of an alpha-1A-AR (adrenergic receptor) agonist.Methods and resultsIn recombinant cells, a mouse alpha-1A-AR with a 6-residue substitution in the third intracellular loop does not couple to Gq signaling. Here we studied a knockin mouse with this alpha-1A-AR mutation. Heart alpha-1A receptor levels and antagonist affinity in the knockin were identical to wild-type. In wild-type cardiac myocytes, the selective alpha-1A agonist A61603-stimulated phosphoinositide-phospholipase C and myocyte contraction. In myocytes with the alpha-1A knockin, both A61603 effects were absent, indicating that Gq coupling was absent. Surprisingly, A61603 activation of cardioprotective ERK (extracellular signal-regulated kinase) was markedly impaired in the KI mutant myocytes, and A61603 did not protect mutant myocytes from doxorubicin toxicity in vitro. Similarly, mice with the α1A KI mutation had increased mortality after transverse aortic constriction, and A61603 did not rescue cardiac function in mice with the Gq coupling-defective alpha-1A receptor.ConclusionsGq coupling is required for cardioprotection by an alpha-1A-AR agonist. Gq signaling can be adaptive.

Abstract Aims This study aimed to evaluate the outcome and prognostic factors in patients with dilated cardiomyopathy (DCM) and long‐standing heart failure (LDCM) vs. recent‐onset heart failure (RODCM). Methods and results We compared 2019 patients with RODCM (duration

Abstract Background In order to evaluate right ventricular (RV) systolic and diastolic dysfunctions in patients with type 2 diabetes mellitus (T2DM) with poor glycemic control by layer specific global longitudinal strain (GLS) and strain rate (GLSr). Methods 68 T2DM patients and 66 normal controls were enrolled for the present study. RV layer specific GLS (GLSEpi, GLSMid and GLSEndo represent the epimyocardial, middle layer and endomyocardial strains, respectively) and GLSr (GLSr-S, GLSr-E and GLSr-A represent the systole, early-diastole and late-diastole strain rate) were calculated by averaging each of the three regional peak systolic strains and strain rates along the entire RV free-wall (RVFW), entire RV free-wall and septal wall (RVFSW) on RV-focused view. Results The absolute values of RV layer specific GLS (GLSEpi, GLSMid and GLSEndo) in RVFW in T2DM patients were significantly lower than normal controls (P

AimsLeft atrium (LA) dilation is associated with adverse cardiovascular (CV) outcomes. Blood stasis, thrombus formation and atrial fibrillation may occur, especially in heart failure (HF) patients. It is not known whether preventive antithrombotic treatment may decrease the incidence of CV events in HF patients with LA enlargement. We investigated the relationship between LA enlargement and CV outcomes in HF patients and the effect of different antithrombotic treatments.Methods and resultsTwo-dimensional echocardiography with LA volume index (LAVi) measurement was performed in 1148 patients with systolic HF from the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial. Patients were randomized to warfarin or aspirin and followed for 3.4 ± 1.7 years. While the primary aim of the trial was a composite of ischaemic stroke, death, and intracerebral haemorrhage, the present report focuses on the individual CV events, whose incidence was compared across different LAVi and treatment subgroups. After adjustment for demographics and clinical covariates, moderate or severe LA enlargement was significantly associated with total death (hazard ratio 1.6 and 2.7, respectively), CV death (HR 1.7 and 3.3), and HF hospitalization (HR 2.3 and 2.6) but not myocardial infarction (HR 1.0 and 1.4) or ischaemic stroke (1.1 and 1.5). The increased risk was observed in both patients treated with warfarin or aspirin. In warfarin-treated patients, a time in therapeutic range >60% was associated with lower event rates, and an interaction between LAVi and time in therapeutic range was observed for death (P = 0.034).ConclusionsIn patients with systolic HF, moderate or severe LA enlargement is associated with death and HF hospitalization despite treatment with antithrombotic medications. The possibility that achieving a more consistent therapeutic level of anticoagulation may decrease the risk of death requires further investigation.

Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) and cognitive decline. Elevations in blood pressure (BP) leading to HTN can be found in young adults with increased prevalence as people age. Oats are known to decrease CVD risk via an established effect of β-glucan on the attenuation of blood cholesterol. Many past studies on CVD and oats have also reported a decrease in BP; however, a thorough assessment of oats and BP has not been conducted. Moreover, oats deliver several beneficial dietary components with putative beneficial effects on BP or endothelial function, such as β-glucan, γ-amino butyric acid (GABA), and phytochemicals such as avenanthramides. We conducted a comprehensive search for systematic reviews, meta-analyses, and clinical intervention studies on oats and BP and identified 18 randomized controlled trials (RCTs) and three meta-analyses that supported the role of oats in decreasing BP. Emerging data also suggest oat consumption may reduce the use of anti-hypertensive medications. The majority of these studies utilized whole oats or oat bran, which include a vast array of oat bioactives. Therefore, we also extensively reviewed the literature on these bioactives and their putative effect on BP-relevant mechanisms. The data suggest several oat components, such as GABA, as well as the delivery of high-quality plant protein and fermentable prebiotic fiber, may contribute to the anti-HTN effect of oats. In particular, GABA is enhanced in oat sprouts, which suggests this food may be particularly beneficial for healthy BP management. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the effect of exposure to different sounds of various frequencies on the blood pressure level of participants. Methods: Present study involved 160 medical students belonging to four ethnic races (Malay, Chinese, Malaysian Indians, Sri Lankans). Informed consent and the record of normal blood pressure was obtained before the study. Participants were exposed to three different sounds (Traffic sounds of high noise frequency; Waterfall sound of moderate noise frequency; Night sound in woods of low noise frequency) with specified intervals. The systolic (SBP) and diastolic blood pressure (DBP) of all the participants were recorded after each exposure. Data of SBP and DBP was analysed statistically by repeated measures ANOVA using SPSS. Results: Results showed statistically significant (p<0.001) difference in the average SBP, DBP values from pre to post assessment in all different exposed sounds. While a significant difference (p<0.01) in the mean SBP values were noted for sound 1 and sound 3; the similar difference (p<0.05) in the average DBP values was noted only for sound 3 between the ethnicities. Data showed a rise in BP for sound 1 in all ethnicities except Malays, fall in BP upon the exposure to sound 2 and 3 among all the ethnicities. Conclusion: Exposure to different sounds was found to have a remarkable effect on individual's blood pressure. However, its comparison with ethnicities is quite variable. Adverse effects of various sound exposures on the blood pressure levels of student population is crucial in terms of their curricular and physiological activities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine effects of cuff overinflation on blood pressure (BP) measurements compared with the standardized 20 mm Hg above the loss of Korotkoff sounds when taking manual BP in adults. Methods: One hundred twelve participants were recruited. American Heart Association standard procedure guidelines were referenced. Baseline BP was measured using standard cuff inflation of 20 mm Hg above loss of systolic Korotkoff sounds, followed by BP measurements with cuff inflations of 40, 60, and 80 mm Hg above the loss of Korotkoff sounds. Results: Friedman's analysis of variance found statistically significant differences in systolic measurements between standard and all 3 over-inflation methods (P =.015). Post-hoc Wilcoxon signed-rank tests demonstrated significant difference in systolic measurements between standard cuff inflation and 60 and 80 mm Hg above the loss of Korotkoff sounds (P =.005,.003). Conclusions: This study reveals blood pressure cuff inflation 60 mm Hg past the loss of Korotkoff sounds creates statistically significant differences in systolic BP measurements as compared with recommended procedures. Higher cuff inflation levels may significantly change BP measurements and decrease accuracy of clinical decision-making and medical management. [ABSTRACT FROM AUTHOR]

There is an emerging need to design multi-precision floating-point (FP) accelerators for high-performance-computing (HPC) applications. The commonly-used methods are based on high-precision-split (HPS) and low-precision-combination (LPC) structures, which suffer from low hardware utilization ratio and various multiple clock-cycle processing periods. In this brief, a new multi-precision FP processing element (PE) is developed with proposed bit-partitioning method. Minimized redundant bits and operands are achieved. The proposed PE supports $16\times $ half-precision (FP16), $4\times $ single-precision (FP32) and $1\times $ double-precision (FP64) operations with 100% multiplication hardware utilization ratio. Besides, vector systolic structure is designed for PE array to increase the system-level throughput and energy efficiency. The proposed design is realized in a 28-nm process with 1.351-GHz clock frequency. Compared with the existing multi-precision FP methods, the proposed work exhibits the best energy-efficiency performance of 1193 GFLOPS/W at FP16, 317 GFLOPS/W at FP32 and 77.3 GFLOPS/W at FP64 with at least 22.3%, 30% and 3.3% improvement, respectively. [ABSTRACT FROM AUTHOR]