Nevin Manimala

J Hypertens. 2022 Jun 1;40(Suppl 1):e4. doi: 10.1097/01.hjh.0000835316.96189.00.

ABSTRACT

OBJECTIVE: The nycterohemeral rhythm of blood pressure (BP) and heart rate has been associated with cardiovascular outcomes. However, long-term prognostic significance of BP at different levels of heart rates has rarely been studied. We therefore conducted the present analysis to investigate the prognostic values for cardiovascular outcome by the ambulatory BP parameters during different time windows.

DESIGN AND METHOD: We enrolled 5 large cohorts from whole world, including CARDIA, IDACO, JHS, SPRINT to find out independent prognostic factors for cardiovascular disease mortality, feature engineering and feature transformation were used. Several statistical and machine learning methods including the stepwise procedure, lasso penalty, and random survival forest with bootstrap technique were used to screen important candidates of risk factors. Models building are based on systolic BP replacement into the established Framingham risk score. Directly one to one replacement and indirectly two stage replacement methods are considered with variable diversity. C-statistics, NRI are used for model performance evaluation.

RESULTS: In model building procedure, nighttime BP combined with pulse pressure, morning-evening difference of SBP and weighted SBP consistently had a higher C-statistics than had office systolic BP. In validation datasets, equations incorporating mean BP and pulse pressure had best performance in C-index (0.754). In contrast, the C-index (higher is better), of the usual Framingham risk score with office systolic BP are 0.744. Furthermore, the best model had acceptable predicted accuracy based on model calibration statistics (p > 0.05).

CONCLUSIONS: Our study demonstrated that mean BP at night combined with pulse pressure, morning-evening difference of SBP and weighted SBP, throughout 24 hours had the largest predictive power of 20-year cardiovascular death in population with ABPM recordings. The transportability of the proposed cardiovascular risk function should be evaluated in future studies.

PMID:36027491 | DOI:10.1097/01.hjh.0000835316.96189.00

J Hypertens. 2022 Jun 1;40(Suppl 1):e317. doi: 10.1097/01.hjh.0000838844.45851.de.

ABSTRACT

OBJECTIVE: To compare the effects of intensive vs standard blood pressure (BP) targets on the mortality of hypertensive patients with chronic renal disease.

DESIGN AND METHOD: A bibliographic search of all relevant databases was carried out without restriction by language, year of publication or publication status.We considered randomized controlled clinical trials on patients older than 18 years, diagnosed with hypertension and chronic renal disease who were allocated to either “intensive” BP target (less than or equal to 130/80 mmHg) or “standard” BP target (less than or equal to 140-160/90-100 mmHg). Additionally, trials should include more than 50 participants per group followed during at least one year. Trials were not limited by any concomitant disease or baseline cardiovascular risk.We contacted trials’ authors to obtain Individual Patient Data and, if necessary, extracted information from chronic renal patients.COVIDENCE software was used for screening, the Cochrane Review Manager (RevMan web) for data synthesis and analysis, and the Cochrane Risk of Bias Tool (ROB2) to assess the risk of bias for each trial.

RESULTS: A total of 2298 records were identified by the bibliographic search. We obtained the full text of 29 publications from the pre-selected studies. Of these, six studies met the inclusion criteria and we obtained Individual Patient Data for all of them (AASK, SPRINT, HOT, ACCORD BP, MDRD, SPS3).There was no statistically significant difference in total mortality between the intensive and standard blood pressure target groups (RR 0.92, 95%CI 0.75-1.13, p = 0.42, 6 studies, 7,348 participants). In absolute terms, there were 5 additional deaths per 1000 participants in the standard target group (95% CI: 6 fewer to 16 more deaths per 1000 participants). Overall deaths were 227/3352 (6.8%) in the intensive target group vs 285/3996 (7.9%) in the standard target group (Figure).The quality of evidence was moderate according to the GRADE assessment.

CONCLUSIONS: Intensive blood pressure lowering targets in patients with arterial hypertension and chronic renal disease do not result in lower mortality compared to standard blood pressure lowering.

PMID:36027480 | DOI:10.1097/01.hjh.0000838844.45851.de

J Hypertens. 2022 Jun 1;40(Suppl 1):e315-e316. doi: 10.1097/01.hjh.0000838824.44837.1f.

ABSTRACT

OBJECTIVE: Metabolic syndrome (MetS) is a collection of disorders including diabetes, hypertension, obesity, and dyslipidemia that increase the risk of cardiovascular diseases and mortality. Several studies have discovered that, in addition to its angiotensin receptor blocker activity, telmisartan is a partial agonist of peroxisome proliferator-activated receptor-gamma (PPAR gamma), which is a nuclear receptor involved in the regulation of metabolic homeostasis. Evidence also exists that activators of PPAR exert anti-inflammatory, anti-oxidative, and anti proliferative effects on vascular walls. Therefore through PPAR gamma modulating activity, telmisartan can be a valuable agent for treating MetS.

DESIGN AND METHOD: The PubMed, EMBASE databases and Cochrane Central of Controlled Trials were searched through October 2021. We pooled data extracted from the included studies using the standardized mean difference (SMD). Study-specific estimates were combined using inverse variance-weighted averages of SMDs in both fixed- and random-effects models. Heterogeneity was evaluated using Cochran’s Q- and the I2-test. GRADE assess the study’s quality. All analyses were conducted using StatsDirect statistical software Version 2.8.0.

RESULTS: A total of 582 patients were enrolled in the 11 included randomized clinical trials (RCTs). The pooled analysis revealed significant reduction in the percent changes of homeostasis model assessment index (HOMA) (SMD = -0.24; 95% CI: -0.40 to -0.07; p = 0.0036), changes of fasting glucose (mg/dL) (SMD = -0.49; 95% CI: -0.94 to 0.05; p = 0.0283), insulin (mU/mL) (SMD = -0.21; 95% CI: -0.38 to -0.05; p = 0.0084), and a significant increase in percent changes of adiponectin (umg/mL) (SMD = 0.63; 95% CI: 0.34 to 0.92; p < 0.0001),among patients with metabolic syndrome randomized to telmisartan versus control therapy. There was minimal trial heterogeneity in the analyses for HOMA index (I2 = 21.1%), insulin (I2 = 0%) and adiponectin levels (I2 = 0.1%). However, there was considerable heterogeneity in the analysis for fasting glucose (I2 = 83.6%).

CONCLUSIONS: Our study suggests that the PPAR gamma modulating activity of telmisartan has the potential to be a valuable therapeutic agent for treating MetS.

PMID:36027475 | DOI:10.1097/01.hjh.0000838824.44837.1f

J Hypertens. 2022 Jun 1;40(Suppl 1):e315. doi: 10.1097/01.hjh.0000838820.36483.00.

ABSTRACT

OBJECTIVE: Metabolic syndrome (MetS) is a collection of disorders including diabetes, hypertension, obesity, and dyslipidemia that increase the risk of cardiovascular diseases and mortality. Several studies have discovered that, in addition to its angiotensin receptor blocker activity, telmisartan is a partial agonist of peroxisome proliferator-activated receptor-gamma (PPAR-gamma), which is a nuclear receptor involved in the regulation of metabolic homeostasis. Evidence also exists that activators of PPAR-gamma exert anti-inflammatory, anti-oxidative, and antiproliferative effects on vascular walls. Therefore through PPAR-gamma modulating activity, telmisartan can be a valuable therapeutic agent for treating MetS.

DESIGN AND METHOD: he PubMed, EMBASE databases and Cochrane Central of Controlled Trials were searched through October 2021. We pooled data extracted from the included studies using the standardized mean difference (SMD). Study-specific estimates were combined using inverse variance-weighted averages of SMDs in both fixed- and random-effects models. Heterogeneity was evaluated using Cochran’s Q- and the I2-test. GRADE tool was used to assess the study’s quality. All analyses were conducted using StatsDirect statistical software Version 2.8.0.

RESULTS: A total of 582 patients were enrolled in the 11 included randomized clinical trials (RCTs). The pooled analysis revealed significant reduction in the percent changes of homeostasis model assessment index (HOMA) (SMD = -0.24; 95% CI: -0.40 to -0.07; p = 0.0036), changes of fasting glucose (mg/dL) (SMD = -0.49; 95% CI: -0.94 to 0.05; p = 0.0283), insulin (mU/mL) (SMD = -0.21; 95% CI: -0.38 to -0.05; p = 0.0084), and a significant increase in percent changes of adiponectin (umg/mL) (SMD = 0.63; 95% CI: 0.34 to 0.92; p < 0.0001),among patients with metabolic syndrome randomized to telmisartan versus control therapy. There was minimal trial heterogeneity in the analyses for HOMA index (I2 = 21.1%), insulin (I2 = 0%) and adiponectin levels (I2 = 0.1%). However, there was considerable heterogeneity in the analysis for fasting glucose (I2 = 83.6%).

CONCLUSIONS: Our study suggests that PPAR-gamma modulating activity of telmisartan therapy has the potential to be a valuable therapeutic agent for treating MetS.

PMID:36027474 | DOI:10.1097/01.hjh.0000838820.36483.00

J Hypertens. 2022 Jun 1;40(Suppl 1):e314. doi: 10.1097/01.hjh.0000838808.45705.35.

ABSTRACT

OBJECTIVE: To evaluate the effects of Sacubitril-Valsartan on early renal function and vascular function in patients during perimenopause with hypertension.

DESIGN AND METHOD: This study was a prospective, randomized, positive control and open label test. The subjects were 427 perimenopausal women (30-65 years old) with mild or moderate hypertension who were treated in the Department of Cardiovascular Medicine of the Second Hospital of Lanzhou University. They were randomly assigned to Sacubitril-Valsartan group (n = 165) or valsartan group (n = 262) for 24 weeks. Renal function, urinary renal function and vascular function were evaluated at baseline and 24 weeks after treatment.

RESULTS: There was no significant difference in the clinical baseline data between patients with sacubitril-valsartan and patients with valsartan (P> 0.05). Comparison of the systolic blood pressure (oSBP) and diastolic blood pressure(oDBP)before and after treatment: the baseline vs. 24-week difference between the sacubitril-valsartan group and the valsartan group was statistically significant (p < 0.001). The carotid-femoral pulse wave velocity (cfPWV) in the vascular function indexes of the sacubitril-valsartan group was significantly improved (p < 0.001). The improvement of valsartan group was not obvious. Other vascular function parameters such as cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were not significantly improved in the two groups. Urinary microalbumin (MAU)was significantly improved in both blood renal function and urine renal function. The improvement was observed in the sacubitril-valsartan group (p < 0.001) and valsartan group (p = 0.027), but the improvement was stronger in the sacubitril-valsartan group (p < 0.001).

CONCLUSIONS: Sacubictril-valsartan has a stronger antihypertensive effect than valsartan in patients during perimenopause with hypertension, and can improve MAU and cfPWV in patients.

PMID:36027471 | DOI:10.1097/01.hjh.0000838808.45705.35

J Hypertens. 2022 Jun 1;40(Suppl 1):e314. doi: 10.1097/01.hjh.0000838800.92823.fc.

ABSTRACT

OBJECTIVE: It has been shown a significant difference in clinical characteristics of HTN and treatment response to antihypertensive therapy between males and females. The purpose of our article was to examine gender differences in the regulation of blood pressure (BP) by using ambulatory blood pressure monitoring (ABPM).

DESIGN AND METHOD: Two hundred seventy-five consecutive hypertensive patients were included in the study (146 females, mean age 64.11 ± 10.47 and 129 males, mean age 61.69 ± 13.59). All patients were on antihypertensive treatment for more than one year (average duration of HTN was 11.07 ± 8.24 years for women, and 10.31 ± 7.5 years for men). In all pts, AMBP was performed. The values obtained by AMBP were compared between the two groups.

RESULTS: There were no significant differences in the presence of coronary artery disease, obesity, diabetes mellitus, or heredity between the groups. There were more smokers among male patients (p = 0.007), while dyslipidemia was more present in female pts (p = 0.005). Male pts had higher values of systolic (124.05 ± 13.89 vs. 119.5 ± 16.58, p = 0.015) and diastolic BP (72.77 ± 8.42 vs. 69.24 ± 8.23, p = 0.001) and larger burden of high BP during the night (56.54 ± 35.52 vs. 33.11 ± 35.27, p = 0.000) compared to female pts. There were no significant differences in pulse pressure (PP) values between the male and female groups (51.17 ± 11.33 vs. 50.72 ± 10.38, p = 0.730). However, pathological values of PP (<40 mmHg or > 60 mmHg) were found in almost 1/3 of pts (34.92% in men and 28.57% in women). Also, there was no significant difference in dipping pattern but only 40 (31.01%) male and 50 (34.25%) female patients had dipper status. There was no statistically significant difference in antihypertensive therapy between the groups. The most commonly used drugs were the angiotensin-converting enzyme inhibitors (82.21% of all pts) and beta blockers (78.78%), while the angiotensin receptor blockers were the least used (15.98%).

CONCLUSIONS: Results indicate that women have better BP control than men. However, a high frequency of pathological PP values and disturbed dipping status detected by ABPM, in women as well as men, should highlight the importance of better BP management in both genders.

PMID:36027469 | DOI:10.1097/01.hjh.0000838800.92823.fc

J Hypertens. 2022 Jun 1;40(Suppl 1):e313. doi: 10.1097/01.hjh.0000838792.47980.37.

ABSTRACT

OBJECTIVE: To evaluate the 24-hour blood pressure (BP) control and the effect of the triple fixed combination (TFC) amlodipine / indapamide / perindopril on the arterial stiffness parameters according to 24-hour blood pressure monitoring (ABPM) data in patients with uncontrolled hypertension (HTN).

DESIGN AND METHOD: The study involved 78 patients with insufficient BP control, against the background of previous combination therapy. All patients received TFC amlodipine / indapamide / perindopril. The patient’s condition was assessed during 4 observation visits: visit 1- inclusion, visit 2 – 4 weeks, visit 3 -12 weeks, visit 4 – 24 weeks observation. At each visit, the achievement of the target BP level < 130/80 mm Hg was assessed, as well as the effect of therapy on the parameters of arterial stiffness (pulse wave velocity (PWVao), pulse pressure (PP), agumentation index (Aix), arterial stiffness index (ASI)) and central aortic pressure parameters (systolic aortic pressure (SBPao), diastolic pressure in the aorta (DBPao), central pulse pressure (PPao)) according to ABPM.

RESULTS: In subjects with HTN with ineffective antihypertensive therapythe initial office BP was 160.8 ± 10.3 / 91.5 ± 8.1 mm Hg. After 24 weeks of therapy with a TFC there was a significant decrease in blood pressure to 121.3 ± 3.5 / 73.6 ± 4.2 mm Hg (p < 0.001). According to ABPM data, mean values of daily BP significantly (p < 0.001) decreased from 153.9 ± 9.04 / 8.38 ± 9.18 to 120.3 ± 4.7 / 73.4 ± 4.7 mm Hg. Data analysis showed a decrease PWVao (11.39 ± 1.32 m/s vs 9.98 ± 0.91 m/s, p < 0,05) as well as ASI (174 (138, 253) vs 139 (107.196) mmHg; p < 0.001) and Aix -29,9 (-41,12) vs – 33,7 (-53, 9) p < 0,05. There was a statistically significant decrease in the parameters the central pressure in the aorta (Fig.1).

CONCLUSIONS: In patients with HTN and previous uneffective antihypertensive therapy the FTC amlodipine / indapamide / perindopril provided high antihypertensive effectiveness. Parameters of vascular stiffness can serve as criteria for quality control of blood pressure and can be used to assess the effectiveness of antihypertensive therapy.

PMID:36027467 | DOI:10.1097/01.hjh.0000838792.47980.37

J Hypertens. 2022 Jun 1;40(Suppl 1):e311-e312. doi: 10.1097/01.hjh.0000838780.75182.bb.

ABSTRACT

OBJECTIVE: To check adherence to the antihypertensive medication in patients with arterial hypertension and a possible impact of fixed-dose drug combinations, cardiovascular event in history, and diabetes on it.

DESIGN AND METHOD: In this cross-sectional study, every fifth patient with arterial hypertension in two family medicine practices in Zagreb, Croatia (found by Medicus search engine) was analyzed during February 2022. We included medical records of 210 patients (116 males, 94 females) from which we checked the number and type of used antihypertensive medication (single pill or fixed-dose drug combinations), statin use, diabetes type 2 or cardiovascular event in history, and the date of the last lab test results. The patient was considered adherent if she/he regularly ordered hers/his prescribed medication from January to December 2021. Chi-square and Student t-test were used for statistical analysis in Statistica 12.

RESULTS: There were no differences between genders. Women were slightly more adherent to the prescribed therapy than men (72.34 vs. 68.11%, P = 0.5076). Statins were prescribed in 65 (30.95%), fixed-dose combination in 139 (66.19%), 39 had diabetes (18.57%), and 28 patients had cardiovascular events in their medical history (13.33%). The adherence was not dependent on the patient’s age (66.75 vs. 66.64 years in adherent patients, P = 0.9509), the existence of diabetes (Chi2 = 1.093, 2, P = 0.2958) or previous cardiovascular event in medical history (Chi2 = 0.384, 2, P = 0.5351). Adherence correlated with the number of prescribed antihypertensive medications (r = 0.263; P < 0.05; and average 2.56 in adherent vs. 1.97 medication per day in non-adherent group, P < 0.001), especially if the therapy was in fixed-dose combination (Chi2 = 11.60, 2, P < 0.001). The age of the lab test results was less in adherent patients (1.25 vs. 1.86 years, P = 0.108). 116 patients (55.24%) had them in 2021, while 16 did not have any result in five and more years (7.14%).

CONCLUSIONS: The adherence to antihypertensive therapy was similar between genders and correlated with the number of prescribed medications with significantly better results in patients with fixed-dose combinations. The existence of the previous cardiovascular event and type 2 diabetes did not show any benefit on this type of adherence.

PMID:36027464 | DOI:10.1097/01.hjh.0000838780.75182.bb

JMIR Mhealth Uhealth. 2022 Aug 26;10(8):e39682. doi: 10.2196/39682.

ABSTRACT

BACKGROUND: The role of self-management in health promotion, as well as prevention and rehabilitation, is increasing through the use of mobile health (mHealth) apps. Such mHealth apps are also increasingly being used for self-management of low back pain (LBP), but their effectiveness has not been sufficiently explored.

OBJECTIVE: The aim of this scoping review was to provide an overview of the literature on self-management mHealth apps and their effects on the levels of pain and disability in people with LBP.

METHODS: We applied the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, including a priori research questions. A literature search was conducted in 2 databases (PubMed and PEDro) for studies published between January 1, 2015, and June 17, 2021. Interventional, cohort, or case series studies with an interventional period were included if the mHealth app included built-in self-management content, the app was used for self-management for people with LBP, and the study reported outcomes regarding pain and disability in people with LBP.

RESULTS: In total, 7 studies were selected for the review with overall 2307 persons with LBP, of whom 1328 (57.56%) were women. Among the studies (5/7, 71%) that reported the type of pain, 85% (390/459) of the participants were experiencing chronic LBP. A total of 5 different mHealth apps were identified, of which 4 contributed to a statistically significant reduction in LBP and clinically meaningful changes. Of the 7 studies, 4 (57%) used 4 different assessments for disability, of which 3 (75%) showed statistically significant improvements in the level of functional ability of participants in the experimental groups using an mHealth app with built-in self-management content for LBP.

CONCLUSIONS: This scoping review supports the conclusion that people with LBP may benefit from mHealth apps that provide self-management content. However, the generalizability of the findings is limited because of heterogeneity in the pain characterization of the included participants and the intervention durations. More high-quality studies with longer follow-up periods to investigate personalized mHealth approaches are recommended for LBP self-management.

PMID:36018713 | DOI:10.2196/39682

Phys Rev Lett. 2022 Aug 12;129(7):075001. doi: 10.1103/PhysRevLett.129.075001.

ABSTRACT

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin “burn propagation” into surrounding cold fuel, enabling the possibility of high energy gain. While “scientific breakeven” (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

PMID:36018710 | DOI:10.1103/PhysRevLett.129.075001