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Are There Interindividual Responses of Cardiovascular Disease Risk Markers to Acute Exercise? A Replicate Crossover Trial. Med. Sci. Sports Exerc., Vol. 56, No. 1, pp. 63-72, 2024. Purpose: Using a replicated crossover design, we quantified the response heterogeneity of postprandial cardiovascular disease risk marker responses to acute exercise. Methods: Twenty men (mean (SD) age, 26 (6) yr; body mass index, 23.9 (2.4) kg·m−2 ) completed four 2-d conditions (two control, two exercise) in randomized orders. On days 1 and 2, participants rested and consumed two high-fat meals over 9 h. Participants ran for 60 min (61 (7)% of peak oxygen uptake) on day 1 (6.5 to 7.5 h) of both exercise conditions. Time-averaged total area under the curve (TAUC) for triacylglycerol, glucose, and insulin were calculated from 11 venous blood samples on day 2. Arterial stiffness and blood pressure responses were calculated from measurements at baseline on day 1 and at 2.5 h on day 2. Consistency of individual differences was explored by correlating the two replicates of control-adjusted exercise responses for each outcome. Within-participant covariate-adjusted linear mixed models quantified participant-by-condition interactions and individual response SDs. Results: Acute exercise reduced mean TAUC-triacylglycerol (−0.27 mmol·L-1 ·h; Cohen’s d = 0.29, P = 0.017) and TAUC-insulin (−25 pmol·L-1 ·h; Cohen’s d = 0.35, P = 0.022) versus control, but led to negligible changes in TAUC-glucose and the vascular outcomes (Cohen’s d ≤ 0.36, P ≥ 0.106). Small-to-moderate, but nonsignificant, correlations were observed between the two response replicates (r = −0.42 to 0.15, P ≥ 0.066). We did not detect any individual response heterogeneity. All participant-by-condition interactions were P ≥ 0.137, and all individual response SDs were small with wide 95% confidence intervals overlapping zero. Conclusions: Large trial-to-trial within-subject variability inhibited detection of consistent interindividual variability in postprandial metabolic and vascular responses to acute exercise. [ABSTRACT FROM AUTHOR]

To determine differences in glucose control and cardiovascular disease risk factors following three weeks of added soda, 100% fruit juice, or water in apparently healthy, college-aged adults. Thirty-six adults (18 males; 18 females) between the ages of 18 and 30 years of age. A 3-arm randomized controlled parallel-arm trial; at baseline and after three weeks consuming the assigned beverage, participants completed glucose control and cardiovascular disease risk factor assessments. There were no significant differences between beverage conditions for glucose control or cardiovascular disease risk factors (ps > 0.05). There were no significant changes in caloric intake or differences in caloric intake between conditions, p = 0.17. In healthy, young adults, under free-living conditions, short-term consumption of two commercially packaged servings of SBs did not lead to significant glucose control or cardiovascular disease risk factor changes, indicating potential compensation and/or resilience to negative short-term effects. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Limited research has assessed how virtual care (VC) affects cardiovascular disease (CVD) risk management, especially in community clinic settings. This study assessed change in community clinic patients' CVD risk management during the COVID-19 pandemic and CVD risk factor control among patients who had primarily in-person or primarily VC visits. STUDY DESIGN: Retrospective interrupted time-series analysis. METHODS: Data came from an electronic health record shared by 52 community clinics for index (March 1, 2019, to February 29, 2020) and follow-up (July 1, 2020, to February 28, 2022) periods. Analyses compared follow-up period changes in slope and level of population monthly means of 10-year reversible CVD risk score, blood pressure (BP), and hemoglobin A1c (HbA1c) among patients whose completed follow-up period visits were primarily in person vs primarily VC. Propensity score weighting minimized confounding. RESULTS: There were 10,028 in-person and 6593 VC patients in CVD risk analyses, 9874 in-person and 5390 VC patients in BP analyses, and 8221 in-person and 4937 VC patients in HbA1c analyses. The VC group was more commonly younger, female, White, and urban. Mean reversible CVD risk, mean systolic BP, and percentage of BP measurements that were 140/90 mm Hg or higher increased significantly from index to follow-up periods in both groups. Rate of change between these periods was the same for all outcomes in both groups, regardless of care modality. CONCLUSIONS: Among community clinic patients with CVD risk, receiving a majority of care in person vs a majority of care via VC was not significantly associated with longitudinal trends in reversible CVD risk score or key CVD risk factors. [ABSTRACT FROM AUTHOR]

Background: The association between different sedentary behaviors and hypertension risk remains unclear. We aimed to explore the relationship between different domains of sedentary behaviors and new‐onset hypertension, investigate whether genetic susceptibility to hypertension modifies the relationship, and examine the extent to which the relationship is mediated by body mass index (BMI) and grip strength. Methods: 212 714 participants without baseline hypertension in the UK Biobank were enrolled. The three major sedentary behaviors (TV‐watching, nonoccupational computer use, and driving) were measured using touch screen questionnaires. The primary outcome was new‐onset hypertension. Results: During a median follow‐up of 11.9 years, 13 983 participants developed hypertension. There was a linear positive association between TV‐watching time and new‐onset hypertension (p for nonlinearity =0.868). A J‐shaped association was found for nonoccupational computer use time and driving time with new‐onset hypertension, with an inflection point of 0.5 h/day for both (both p for nonlinearity <0.001). Polygenetic risk scores for hypertension (based on 118 related single‐nucleotide polymorphisms) did not significantly modify these associations (all p‐interactions >0.05). Furthermore, the detrimental effects of long‐term sedentary behaviors on hypertension were mediated by BMI by 21%–30%, and the beneficial effects of limited sitting time (within 0.5 h/day) for driving and nonoccupational computer use were mediated by grip strength by 6–25%. Conclusions: There was a positive association for hands‐independence sedentary behavior (TV‐watching), and a J‐shaped association for hands‐dependence sedentary behaviors (nonoccupational computer use and driving) with new‐onset hypertension, regardless of genetic risks of hypertension. These relationships were partly mediated by BMI and grip strength. [ABSTRACT FROM AUTHOR]

Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Methods: In adult participants without cardiac arrhythmias and minimal interarm blood pressure difference (systolic arterial pressure (SAP) < 15 mmHg or diastolic arterial pressure (DAP) < 10 mmHg), three pairs of 30 s BP measurements with the OptiBP™ (test method) were simultaneously compared using three pairs of measurements with the non-invasive oscillometric brachial cuff (reference method) on the opposite arm over a period of four consecutive weeks at a rate of two measurements per week (one in the morning and one in the afternoon). The agreement of BP values between the two technologies was analyzed using Bland–Altman and error grid analyses. The performance of the smartphone application was investigated using the International Organization for Standardization (ISO) definitions, which require the bias ± standard deviation (SD) between two technologies to be lower than 5 ± 8 mmHg. Results: Among the 65 eligible volunteers, 53 participants had adequate OptiBP™ BP values. In 12 patients, no OptiBP™ BP could be measured due to inadequate signals. Only nine participants had known chronic arterial hypertension and 76% of those patients were treated. The mean bias ± SD between both technologies was −1.4 mmHg ± 10.1 mmHg for systolic arterial pressure (SAP), 0.2 mmHg ± 6.5 mmHg for diastolic arterial pressure (DAP) and −0.5 mmHg ± 6.9 mmHg for mean arterial pressure (MAP). Error grid analyses indicated that 100% of the pairs of BP measurements were located in zones A (no risk) and B (low risk). Conclusions: In a cohort of volunteers, we observed an acceptable agreement between BP values obtained with the OptiBPTM and those obtained with the reference method over a four-week period. The OptiBPTM fulfills the ISO standards for MAP and DAP (but not SAP). The error grid analyses showed that 100% measurements were located in risk zones A and B. Despite the need for some technological improvements, this application may become an important tool to measure BP in the future. [ABSTRACT FROM AUTHOR]

Objective: Accurate blood pressure measurement is critical for diagnosing and treating hypertension. Our study investigated the medical faculty students’ adherence to international blood pressure measurement recommendations. Methods: Three hundred fifteen final-year medical students from University and due to graduate in 2021 and 2022 were included in the study. These were asked 21 questions evaluating the different blood pressure measurement steps. The responses were then compared with the guideline recommendations. Results: Of the students, 55.2% were women and 65.7% were 2021 graduates. The majority (69.2%) of the students preferred aneroid devices, while 19.7% selected mercury devices for measurement, and 47.6% paid attention to calibration and validation during device selection. Most participants (92.1%) reported taking measurements sitting, with the back supported and the legs uncrossed. While 62.9% measured blood pressure from both arms at the initial visit, only 37.8% investigated all affecting factors before measurement. Seventy-four percent of the students answered the cuff deflation rate correctly. Approximately half (55.2%) recorded the measured values by rounding them up or down to the nearest even number. Although more than 50% of students answered most of the questions in line with the guidelines, only 1 student completed all the steps appropriately. Conclusion: The results of this study showed that students did not fully comply with the measurement recommendations. Considering the importance of accurate blood pressure measurement to public health, it would be beneficial to reorganize the medical education curriculum and repeat it regularly. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the cardiometabolic and physical effects of 2 timematched high-intensity programs in a real-world environment. Forty-three active and healthy adults (sex =31 men and 12 women; age = 27 + 5 years; peak heart rate [HRpeak] = 190.7 + 10.6 beat·min-1) were randomized to 2 very low-volume protocols (;8 minutes): sprint interval training (SIT) (n=15), burpee interval training (BIT) (n=15), and control (CON) (n=13). Subjects in SIT and BIT performed 5 days of 10 3 4 second "all-out" efforts with 30 seconds of recovery. Body composition, blood pressure, countermovement jump (CMJ), 10-m sprint, shuttle run test (SRT), autonomic modulation, self-efficacy, and intention were evaluated before and after training. Sprint interval training elicited a higher %HRpeak, energy expenditure, rating of perceived exertion category ratio 10 scale, and feeling scale than BIT (p, 0.05). SRTdistance was significantly improved in SIT (p = 0.03, d = 0.62), whereas CMJ height was significantly enhanced in BIT (p=0.0014, d=0.72). Self-efficacy progressively worsened for SIT than for BIT as sessions increased, and significant differences were found in 5X week frequency between protocols (p=0.040, d50.79). No differences in intention to engage were detected between the regimens (p. 0.05). No changes were observed in body composition, blood pressure, 10-m sprint, SRTV-O2max, or autonomic variables with training (p. 0.05). Results exhibit that extremely low-volume SIT improved running performance, whereas BIT increased the vertical jump. [ABSTRACT FROM AUTHOR]

Introduction: The effect of clothing on the recording of blood pressure in a normotensive and hypertensive population remains essential to diagnosing and managing. Methods: This is a cross-sectional study to measure blood pressure using a validated oscillometric sphygmomanometer in two populations. The records were made over the thicker sleeve arm and non-sleeved arm (either on bare arm or indicating the removal of the outermost garment). Clothing was categorized according to how patients attended the outpatient clinic based on the real world. Results: A total of 75 patients were included with a diagnosis of hypertension whose mean age was 67.1 years (SD ± 16.3). The group of normotension included 63 patients whose mean age was 21.1 years (SD ± 2.2). There was not variability related to technique or inherent to the condition of the subject on the first and second measurements of blood pressure. In the comparative analysis, the group with normotension did not report a significant difference in systolic or diastolic blood pressure due to the effect of clothing during the first or second measurement (p > 0.05). In the group with hypertension, a significant difference was observed in the first measurement, between the group over-the-sleeve and non-sleeved arm (systolic blood pressure, p: 0.021 and diastolic, p: 0.001). However, when the variable order of measurement was analyzed by randomizing the initial registry with or without clothing was not found a statistical difference. Conclusion: Clothing does not a significant difference in the measure of blood pressure in a normotensive or hypertensive population. [ABSTRACT FROM AUTHOR]

Introduction: Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health. Aim: This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults. Methods: Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30–49 years and 49,617 men aged 30–54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator. Results: We found that women who were married in childhood had 1.06 (95% CI 1.01–1.10) and 1.22 (95% CI 1.16–1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups. Conclusions: These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Obesity is considered a widespread concern internationally. Few studies have investigated the relationships between dairy consumption and hypertension and obesity. Therefore, this study examined the above concern in students. Methods: This cross-sectional study was conducted on 292 male students (18--30 y) living in the dormitories of Tabriz University of Medical Sciences. Students were selected via the multistage stratified random sampling method. Demographic information, anthropometric measurements, blood pressure (BP) readings, and a semi-quantitative validated questionnaire assessing dairy consumption (including a 24-hour dietary record covering 2 typical days and a holiday) were collected. After all the questionnaires were reviewed, they were coded and analyzed with Nutritionist IV software. Results: The average age of the subjects was 22.36 years. The mean±SD values of body mass index (BMI), waist circumference, waist-to-hip ratio, and waist circumference-to-standing height ratio were 22.68±2.58 kg/m², 80.95±7.81 cm, 0.85±0.04, and 0.46±0.04 among the studied population, respectively. The mean±SD values of systolic and diastolic blood pressure were 111.84±10 mm Hg and 70.99±8 mm Hg, respectively. Milk consumption was associated with a low waist circumference (95% credible interval, 1.005 to 4.580; P=0.046). The odds of hypertension (defined as BP>120/90 mm Hg) were 2.686 times higher in the overweight and obese group than in the normal BMI group. The risk of hypertension was 1.045 times higher for individuals with abdominal obesity than for those who did not consume dairy products. Conclusion: Milk consumption was associated with a low waist circumference. The correlations between systolic blood pressure and anthropometric factors were statistically significant. BMI, waist circumference, and waist-to-hip ratio were positively associated with systolic blood pressure. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate long-term outcomes in patients who underwent carotid artery stenting (CAS) for symptomatic or asymptomatic high-grade stenosis. Methods: A total of 1158 patients (asymptomatic, n = 636; symptomatic, n = 522) underwent CAS at our center between 2009 and 2020. A total of 560 patients or contacts (asymptomatic, n = 316; symptomatic, n = 244) were interviewed by telephone to evaluate long-term outcomes with a mean follow-up of 5 years. Mortality from all causes, myocardial infarction, and stroke, as well as comorbidities influencing their occurrence, including overall survival and stroke-free survival, were examined. Results: The overall survival rate for all-cause mortality was 91.6% at 1 year, 77.1% at 5 years, and 55.7% at 10 years. A total of 39 (6.9%) patients had an ischemic stroke during long-term follow-up. The stroke-free survival rates at 1 year, 5 years, and 10 years were 97.9%, 92.7%, and 86.6%, respectively. Stroke-free survival and overall survival did not differ significantly between the symptomatic and asymptomatic groups (overall survival, p = 0.304; stroke-free survival, p = 0.336). Regular physical activity reduced the risk of stroke and death and was associated with better long-term clinical outcomes. Age at treatment and diabetes mellitus were statistically significantly associated with death during follow-up. Conclusion: Long-term follow-up data confirmed the effectiveness and durability of CAS as a therapy option for both symptomatic and asymptomatic patients. In patient selection for CAS, special consideration should be paid to patient age, ability to engage in physical activity, and diabetes mellitus. [ABSTRACT FROM AUTHOR]

Recently, many studies have confirmed the effects of different forms of aerobic exercise on the withdrawal syndrome of people with drug use disorders, but few studies report the health promotion benefits of high-intensity intermittent aerobic exercise on people with methamphetamine use disorders. In a randomized controlled trial, 54 MA dependencies were randomly assigned to the control group and aerobic exercise group. The aerobic exercise group received high-intensity intermittent aerobic calisthenics intervention (75% to 85% HR max) 40 min/time three times a week, while the control group only performed routine forced withdrawal life. The blood pressure, heart rate variability (HRV), and respiratory function of people with methamphetamine use disorder were tested at baseline, 8th week, and 12th week. 1) Throughout the intervention process, the exercise group's SBP and DBP were not significantly different from those of the control group, but in the 12th week, the exercise group's SBP and DBP were significantly lower than the values at the 8th week. 2) The exercise group's SDNN and RMSSD were significantly higher than those of the control group at the 8th week and the 12th week, and the exercise group's SDNN and RMSSD at the 8th week were significantly higher than their respective baseline levels. 3) The exercise group's LFn continued to decline during the intervention and was significantly lower than the control group at the 12th week, while the HFn continued to rise during the intervention and was significantly higher than the control group at the 12th week. 4) After exercise intervention, the exercise group's VO 2max , VO 2/ HR peak , and AT were significantly higher than those of the control group, but there was no significant difference between maximal voluntary ventilation (MVV), and the control group. A 12-week high-intensity intermittent aerobic exercise could effectively improve the physical function of people with methamphetamine use disorder and has strong health promotion benefits. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The purpose of this study was to investigate the effect of wearing a transfemoral prosthesis (FP) on blood pressure regulation in response to postural change. Methods: We enrolled seven persons with a transfemoral amputation who underwent a head-up tilt test while wearing an FP (PROS test) and without wearing an FP (control [CON] test). Systolic blood pressure (SBP), heart rate variability, and muscle blood flow using near-infrared spectroscopy were measured continuously. Results: In the CON (no FP) test, SBP decreased fromsupine to standing positions in all participants (P = 0.001). In contrast, in the PROS (wearing an FP) test, SBP increased (P = 0.001) during the postural change. Conclusions: The findings suggest that a transfemoral prosthesis increases peripheral vascular resistance in the lower limbs and stimulates the baroreflex, helping to stabilize the circulatory dynamics upon postural change. Clinical Relevance: Because circulatory dynamics may be hampered in persons with a transfemoral amputation, wearing a prosthesis not only assists in ambulation but can also play a significant role in blood pressure regulation during activities of daily living. [ABSTRACT FROM AUTHOR]

Background: Blood pressure variability (BPV) in pregnancy is a significant concern, particularly in women with cardiac risk factors. This study aims to analyze BPV in this highrisk group to improve maternal and fetal outcomes. Objectives: The primary objective was to assess the patterns of BPV in pregnant women with cardiac risk factors. Secondary objectives included identifying demographic and clinical factors influencing BPV. Methods: In this cross-sectional study, 200 pregnant women with identified cardiac risk factors were enrolled. Blood pressure measurements were taken across different times of the day and stages of pregnancy. Data on demographic, lifestyle, and clinical factors were also collected. Statistical analyses were performed to understand the variability and its correlates. Results: Significant BPV was observed in the study group, with higher variability in the third trimester. Factors such as age, BMI, and history of hypertension were associated with increased BPV. Women with higher BPV showed a trend towards adverse pregnancy outcomes, although this was not statistically significant. Conclusion: This study highlights the importance of monitoring BPV in pregnant women with cardiac risk factors. Tailored management strategies considering these variability patterns may be beneficial in optimizing maternal and fetal health outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Metabolic syndrome is a constellation of metabolic abnormalities that includes central obesity, hypertension, elevated fasting glucose, low high-density lipoprotein (HDL) cholesterol, high triglyceride (National Cholesterol Education Program Adult Treatment Panel III [NCEP ATP III]). It is associated with increased risk of coronary artery disease and stroke. Regardless of the existing controversies in diagnosis and definition, the metabolic syndrome is still considered to be a useful diagnostic tool in primary care prevention. A very few studies have been done in this topic in Gujarat, most of the data are from western population. So, no useful data is available regarding association of various parameters of metabolic syndrome particularly in our setup and area. AIMS AND OBJECTIVES: To study clinical profile of metabolic syndrome and its individual components in Type 2 diabetic and non-diabetic subjects. We also want to compare the distribution of metabolic syndrome by using the different criteria (ATP-III and IDF), compare the association of hypercholesterolemia and hypertension with type 2 diabetes mellitus and to compare the distribution of metabolic syndrome with hyperglycaemia and establishing its strong association with Type 2 DM by comparing them with non-diabetics. MATERIALS AND METHODS: we include the patients with T2DM with age >20 years and should be on treatment. We exclude the patient with T2DM age < 20 years, pregnant women, patient on long term steroid therapy, patient with severe complications, moribund patients and patient refusal. We took Waist Circumference Measurements, Blood Pressure Measurement and biochemical tests. DISCUSSION: Present study highlights the prevalence of metabolic syndrome in two different group, diabetic and non-diabetic. It is evident from the study that diabetic patients have higher prevalence of Mets than normal people. It is also concluded that hypertension, hyperlipidemia and central obesity are also closely related with metabolic syndrome. CONCLUSION: In this study, we have completed our data in our hospital with limited number of patients. When we are calculating the prevalence, larger sample size is recommended. So, we can apply the same for generalized population. Same like diabetic patients, we can also compare the prevalence of metabolic syndrome in hypertensive and non-hypertensive patients by dividing the study population into both groups. [ABSTRACT FROM AUTHOR]

To evaluate the agreement between noninvasive arterial blood pressure (NIBP) measured from the tongue and thoracic limb with invasive blood pressure (IBP), and to compare NIBP measured from the tongue and thoracic limb in anaesthetized horses. Prospective clinical study. A group of eight client-owned healthy horses anaesthetized for scheduled procedures, American Society of Anesthesiologists classification I–II, weighing (mean ± standard deviation) 498 ± 91 kg and aged 7.8 ± 6.75 years. Animals were premedicated with intravenous (IV) romifidine (0.04–0.08 mg kg–1) and methadone (0.1 mg kg–1). General anaesthesia was induced IV with ketamine (2.5 mg kg–1) and midazolam (0.05 mg kg–1) and maintained with isoflurane. The facial artery was catheterized for IBP measurements. Systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures were recorded from the NIBP tongue , NIBP limb and IBP every 20 minutes during the procedure. Agreement between NIBP and IBP was evaluated based on the American College of Veterinary Internal Medicine criteria and American Association for Medical Instrumentation criteria using the Bland–Altman method. The mean bias and precision between IBP and NIBP measured from the tongue met the standards for all pressure ranges (< 10 mmHg and < 15 mmHg, respectively). NIBP measurements from the tongue and thoracic limb tended to underestimate IBP measurements. During hypotension, MAP tongue and DAP tongue overestimated IBP, but both precision and accuracy met the criteria. The overall accuracy and precision of NIBP limb was poorer than NIBP tongue. The percentage of NIBP tongue that differed from IBP by < 10 mmHg was higher than that recorded with NIBP limb for SAP (46% versus 25%), MAP (77% versus 28%) and DAP (79% versus 19%). The tongue is a clinically suitable alternative for assessing arterial blood pressure compared with the thoracic limb and can reliably detect hypotension in healthy anaesthetized horses. [ABSTRACT FROM AUTHOR]

Cystic endometrial hyperplasia (CEH)–pyometra complex is the most common uterine infection in adult and elderly bitches and can cause renal dysfunction. The aim of this study was to measure and compare urinary creatinine, urea, symmetric dimethylarginine (SDMA), urinary protein–creatinine ratio (UPC), measurement of systolic blood pressure (SBP), and Doppler velocimetry of renal arteries in patients with CEH–pyometra complex before and after an average of 6 months of treatment, evaluating the possibility of the changes persisting. The evaluation was conducted at two moments: M1 (at the diagnosis of CEH–pyometra, n = 36) and M2 (after an average of six months of treatment, n = 16). For the control group, eight bitches with no changes in blood tests or history of conditions underwent Doppler ultrasound evaluation of the renal arteries. At both M1 and M2, we measured creatinine, urea, and serum SDMA, UPC, SBP, and Doppler ultrasound of the renal arteries. Patients were evaluated according to the following groups: azotemic (AZO) and non‐azotemic (NAZO), and open and closed cervix pyometra. The parameters were compared between animals present in both moments presented as M1R (bitches that were in M1 and M2) and M2. Statistical significance was considered when p <.05. The medians found for creatinine in M1 were as follows: 1.15 mg/dL, being 1.8 mg/dL for AZO (12/36) and 0.95 mg/dL for NAZO (24/36); and in M2: 0.85 mg/dL (16/16), being 1.15 mg/dL for AZO (4/16) and 0.8 mg/dL for NAZO (12/36). For urea, in M1 it was 36 mg/dL (32/36), with AZO being 103 mg/dL (11/32) and 33 mg/dL in NAZO (21/32); and in M2 32 mg/dL (16/ 16), being 29 mg/dL for AZO (4/36), and 31 mg/dL for NAZO (3/15). The median SDMA measured in M1R was 17 μg/dL (15/16), with AZO being 31 μg/dL (3/15), and NAZO being 16.5 μg/dL (12/15); and in M2, SDMA was 12 μg/dL (16/16), with AZO being 12.5 μg/dL (4/16), and NAZO being 12 μg/dL (12/16). The median UPC measured in M1 was 1.15 (10/36), with AZO being 0.25 (1/10), and NAZO being 1.38 (9/10); and in M2, it was 0.2 (13/16), being 0.1 in AZO (4/13), and 0.2 (9/16) in NAZO. For SBP, in M1, it was 118 mmHg (30/36), with AZO being 102 mmHg (10/30) and 133 mmHg in NAZO (20/30); and in M2 142.5 mmHg (12/16), being 155 mmHg for AZO (4/12), and 140 mg/dL for NAZO (8/12). When comparing animals with open and closed cervixes, a difference was found between SDMA measurements (p =.001). There was a distinction between PI and RI of the left and right kidneys consecutively (p =.007; p =.033; p =.019; p =.041). Correlations found in M1: SDMA × PI RIM DIR (r = 0.873; p =.002), SDMA × PSV RIM ESQ (r = 0.840; p =.004), SDMA × EDV RIM ESQ (r = 0.675; p =.046). With this study, we conclude a return to normality of renal biomarkers and clinical parameters after six months. Yet, there is a persistence of Doppler velocimetric measurements between the two moments. Thus, this parameter is not suitable for identifying and classifying chronic kidney injury in bitches with pyometra. [ABSTRACT FROM AUTHOR]

Background/Local Problem: Hypertension is a major risk factor for heart diseases and stroke among Americans; only 25% have this under control nationwide. Methods: This quality improvement project evaluated the outcomes of team-based care in hypertension control by registered nurses and certified nurse practitioners in a primary care setting. Pre/post–data analysis of blood pressure (BP) control, and BP knowledge, was done. Intervention: The team provided education and counseling based on knowledge assessment during visits and used unattended automated blood pressure measurement (uAOBPM) techniques to measure BP. Results: There was a significant reduction in systolic and diastolic BP control (P < .001). There was a statistically significant increase in disease knowledge score pre- and postintervention (P < .001). Conclusion: The team-based care approach improved patients’ BP control and knowledge of the disease. The uAOBPM technique could be incorporated into clinical settings for accurate BP measurements. [ABSTRACT FROM AUTHOR]

Introduction: Visfatin and nesfatin are active proteins that are involved in the regulation of physiological functions such as glucose metabolism and inflammatory response. This study aimed to assess the influence of visfatins and nystatins gene variants on the occurrence of the full metabolic syndrome or its components. Material and methods: The research cohort comprised 285 diabetic patients, 132 men and 153 women. Specific DNA segments were amplified and labelled, and the rs 4730153 gene of visfatin and the rs 1330 gene of nesfatin were analysed. Real-Time PCR was conducted using fluorescence-labelled probes. Results: The AA genotype of visfatin (rs 4730153) shows a positive association with glucose concentration or pharmacological treatment in patients with type 2 diabetes, compared to AG and GG genotypes. The GG genotype of nesfatin (rs 1330) shows a positive association with incidents of metabolic syndrome, compared to the AA genotype. Conclusions: Visfatin polymorphism in rs 4730153 may be associated with inappropriate glucose concentration. Nesfatin polymorphism in rs 1330 may be associated with metabolic syndrome. Further studies in a larger group of patients are necessary to completely assess this association. [ABSTRACT FROM AUTHOR]

Background & Objective: Studies have shown contradictory results regarding the use of pregabalin and melatonin as analgesic agents. Because the analgesic effects of these drugs as preemptive have not been compared in abdominal hysterectomy, one of the most common surgical procedures in women with moderate to severe pain, under general anesthesia. The aim of this study was to compare the pretreatment effects of melatonin and pregabalin on postoperative pain intensity in total abdominal hysterectomy (TAH). Materials & Methods: Ninety Patients were randomly divided into three groups (N=30): the first group received oral melatonin (6 mg), the second group received pregabalin (50 mg), and the third one who took no drug. Serum melatonin and betaendorphin levels were measured before and after the surgery. Pain intensity was assessed by the Numerical Rating Scale at 1,6,12, and 24 hours after the surgeries. Results: At 12 hrs after the surgery, mean pain intensity in the melatonin group was significantly lower than the pregabalin group, and in the pregabalin group was significantly lower than the third group (P<0.05). At 24 hrs after the TAH, the mean pain intensity in the melatonin group was significantly lower than the third group (P<0.05). Conclusion: injection preventive melatonin is more effective than pregabalin to reduce pain throughout the first 24 hrs after the TAH. [ABSTRACT FROM AUTHOR]

The presence of metabolic syndrome (MetS) increases the risk of developing type 2 diabetes, cardiovascular diseases, and mortality. MetS is associated with increased leukocyte or erythrocyte counts. In 16- to 20-year-old males (n = 1188) and females (n = 1231) without signs of overt inflammation, we studied whether the presence of MetS and its components results in elevated blood cell counts. The leukocyte, erythrocyte, and thrombocyte counts significantly but weakly correlated with the continuous MetS score, MetS components, uric acid, and C-reactive protein levels both in males (r = −0.09 to 0.2; p < 0.01) and females (r = −0.08 to 0.2; p < 0.05). Subjects with MetS had higher leukocyte (males: 6.2 ± 1.3 vs. 6.9 ± 1.2 × 109/L; females 6.6 ± 1.5 vs. 7.5 ± 1.6 × 109/L; p < 0.001), erythrocyte (males: 5.1 ± 0.3 vs. 5.3 ± 0.3 × 1012/L; females: 4.5 ± 0.3 vs. 4.8 ± 0.3 × 1012/L; p < 0.001), and platelet counts (males: 245 ± 48 vs. 261 ± 47 × 109/L; females: 274 ± 56 vs. 288 ± 74 × 109/L; p < 0.05) than those without MetS. With the exception of platelet counts in females, the blood counts increased with the number of manifested MetS components. Phenotypes with the highest average leukocyte, erythrocyte, or platelet counts differed between sexes, and their prevalence was low (males: 0.3% to 3.9%; females: 1.2% to 2.7%). Whether functional changes in blood elements accompany MetS and whether the increase in blood counts within the reference ranges represents a risk for future manifestation of cardiometabolic diseases remain unanswered. [ABSTRACT FROM AUTHOR]

Background: Noninvasive left ventricular (LV) pressure‐volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV‐loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). Methods: A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2−6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax) reflecting contractility, Ea, ventriculoarterial coupling (Ea/Emax), SW, potential energy, external power, energy per ejected volume, and efficiency. Results: All PV‐loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax: 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p =.024), ventriculoarterial coupling (Ea/Emax: 1.27 ± 0.61 versus 0.73 ± 0.17, p <.001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p <.001). These variables correlated to both MaR and IS (Emax: r2 = 0.25 and r2 = 0.29; Ea/Emax: r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). Conclusions: Noninvasive PV‐loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW. [ABSTRACT FROM AUTHOR]

Aim: The lifestyle habits of young people are often associated with that of middle-aged and older adults, and intervention from a young age is important for the prevention of lifestyle-related diseases. Hypertension is a lifestyle-related disease, and an increasing number of patients are suffering from it. Therefore, in this study, we investigated the factors that cause fluctuations in blood pressure in university students. Subject and methods: The survey was conducted from 2011 to 2019 and included 14,720 male and 6,039 female university students. The questionnaire included items such as age, sex, weight control orientation, and lifestyle habits. Height, weight, and systolic and diastolic blood pressures were measured. Body mass indices (BMI) were calculated, and the participants were classified as underweight, normal body type, or obese. In addition, abnormal blood pressure (ABP) was defined as systolic/diastolic blood pressure above 120 and/or 80 mmHg. Results: A multivariate logistic regression analysis revealed that ABP was significantly associated with snacking (odds ratio, 95% confidence interval 0.68, 0.52–0.90) in males with underweight; sleep duration ≥ 6 h (1.10, 1.02–1.19), snacking (0.84, 0.75–0.96), and weight decreasing orientation (1.22, 1.12–1.32) in males with normal body types; exercise habits (0.75, 0.56–1.00) in females with normal body types. Conclusion: The present study revealed different risk factors by body type associated with ABP in Japanese university students. In particular, weight loss orientation in a standard-bodied male may be a risk factor for ABP. Our study suggests that interventions by body type may prevent lifestyle-related diseases. [ABSTRACT FROM AUTHOR]

Background: The search for the ideal sedative during regional anesthesia continues. Propofol is widely as a sedative intraoperatively. It may cause troublesome hemodynamic changes. Dexmedetomidine is an a2 agonist with sedative, anxiolytic, and analgesic properties. In this study, we compared dexmedetomidine with propofol as sedatives during surgeries under brachial plexus block. Materials and Methods: In our study, 70 American Society of Anesthesiologists I Class and II patients about to undergo upper limb surgeries under brachial plexus block were blinded and randomly allocated to receive either propofol (Group P) or dexmedetomidine (Group D) infusion. Brachial plexus block was performed, and after confirmation of adequate sensory and motor block, an initial loading dose of the drug was administered over 10 min, followed by a maintenance dose till the end of the surgery. Titration of the rate of infusion was done so as to maintain Ramsay Sedation Score (RSS) of 3-4 and Bispectral Index (BIS) of 60-80. Hemodynamic and respiratory parameters were monitored intraoperatively. Adverse effects such as hypotension, bradycardia, respiratory depression, and incidence of oversedation and undersedation were also noted. The collected data were evaluated using appropriate statistical tests in SPSS version 22®. P <0.05 was considered statistically significant. Results: The RSS remained at 4 in Group P from 20 min onward and for Group D, RSS remained at 3 after 30 min. Post-induction, there was a reduction in BIS in both the groups, but patients in Group P showed statistically significant lower values of BIS when compared with Group D. The fall in mean arterial pressure was more in Group P as compared to Group D. Nine (25.71%) incidences of hypotension were seen in Group P and none in Group D. The decrease in heart rate was more profound in Group D as compared with Group P and one incidence of bradycardia observed in Group D. The respiratory rate was relatively stable in Group D as compared to Group P. The oxygen saturation (SpO2) values in the majority of the patients in both groups were above 92%, but three patients in Group P had SpO2 <92%. In Group P, 6 (17.14%) incidences of oversedation and 8 (22.85%) incidences of undersedation were observed. In Group D, 7 (20%) incidences of undersedation with no incidence of oversedation were observed. Conclusion: Dexmedetomidine at recommended doses has a better sedative property with less effect on hemodynamics and respiration as compared to propofol. [ABSTRACT FROM AUTHOR]

The development of cuffless blood pressure monitoring devices is attracting attention. The method of measuring vessel diameter from ultrasound A-mode waveforms is expected to be applied to daily blood pressure measurement due to the simplicity of the device. On the other hand, there is a problem in that the received intensity of the reflected wave from the blood vessel wall decreases due to displacement caused by body movement, resulting in incorrect measurement of the vessel diameter. In this paper, we examine how displacement of the positional relationship between the sensor and the blood vessel affects the measurement of blood vessel diameter and present a solution to the sensitivity reduction caused by angular displacement in the direction of the vessel axis by sending ultrasonic waves radially in the direction of the vessel axis. As a verification, a prototype sensor with an acoustic lens was fabricated. Evaluation of the sensor using a silicone resin tube model of a blood vessel showed that it maintained received intensity of about 50%of the strongest received intensity over a range of ±10°and the calculated blood vessel diameter was accurate to±0.05mm over a range of ±10°. Since this technology does not require a complex system, it is expected to be applied to devices that daily blood pressure measurement without the patient’s consciousness. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a critical public health challenge globally, especially in urban settings where lifestyle factors contribute significantly to its prevalence. Understanding its prevalence among middle-aged adults is vital for early intervention and management. Objectives: This study aims to determine the prevalence of hypertension and identify its associated demographic and lifestyle factors among 300 middle-aged adults in urban areas. Methods: A cross-sectional study was conducted among 300 randomly selected middle-aged adults from urban localities. Blood pressure measurements were taken, and a structured questionnaire was used to gather data on demographics, dietary habits, physical activity, and health history. Descriptive and inferential statistics were employed to analyze the data. Results: The study found a high prevalence of hypertension among the participants. Key factors associated with higher rates of hypertension included age, obesity, sedentary lifestyle, and high salt intake. The data indicated a significant need for targeted public health strategies to address these risk factors. Conclusion: Hypertension is prevalent among middle-aged adults in urban areas, with several modifiable lifestyle factors contributing to its high rate. The study emphasizes the need for urban health initiatives focusing on awareness, lifestyle modification, and regular screening to mitigate the risk of hypertension and related complications. [ABSTRACT FROM AUTHOR]

We aimed to investigate the association of main meals' specific protein intake with cardiometabolic risk factors, including general and abdominal obesity, serum lipid profile, and blood pressure (BP). This cross-sectional study was conducted on 850 subjects aged 20–59 years. Dietary intakes were assessed by completing three 24-h recalls, and the protein intake of each meal was extracted. Anthropometric measures, lipid profile, fasting blood sugar and BP were measured. Multivariate logistic regression controlling for age, physical activity, sex, marital status, smoking status, BMI and energy intake was applied to obtain OR and CI. The mean age was 42 years, and the mean BMI of the participants was 27·2. The mean protein intake for breakfast, lunch and dinner was 12·5, 22·2 and 18·7 g/d, respectively. After adjustment for confounders, higher protein intake was not associated with any of the cardiometabolic risk factors, including LDL-cholesterol, HDL-cholesterol, total cholesterol (TC), TAG, body weight, BP and fasting plasma glucose, in any of the three main meals consumed within a day. Adherence to a higher protein intake at each meal was not associated with cardiometabolic risk factors in Iranian adults. Further prospective studies are needed to justify our findings. [ABSTRACT FROM AUTHOR]

Aim: Mild cognitive impairment (MCI) is the prodromal phase of dementia. The objective of this study was to determine whether specific antihypertensives were associated with conversion from MCI to dementia. Methods: In this retrospective study, a chart review was conducted on 335 older adults seen at the University of Alberta Hospital, Kaye Edmonton Seniors Clinic who were diagnosed with MCI. At the point of diagnosis, data was collected on demographic and lifestyle characteristics, measures of cognitive function, blood pressure measurements, use of antihypertensives, and other known or suspected risk factors for cognitive decline. Patients were followed for 5.5 years for dementia diagnoses. A logistic regression analysis was then conducted to determine the factors associated with conversion from MCI to dementia. Results: Mean age (± standard deviation) of the study participants was 76.5 ± 7.3 years. Patients who converted from MCI to dementia were significantly older and were more likely to have a family history of dementia. After controlling for potential confounders including age, sex, Mini Mental Status Exam scores and family history of dementia, patients who were on beta-blockers (BBs) had a 57% reduction in the odds of converting to dementia (OR: 0.43, 95% CI: 0.23, 0.81). Conclusions: In this study, BB use was protective against conversion from MCI to dementia. Further studies are required to confirm the findings of our study and to elucidate the effect of BBs on cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Hypertension, a major public health concern, has been increasing in prevalence worldwide, especially in urban communities. Understanding its prevalence and identifying the risk factors in urban settings are essential to develop targeted interventions. Objective: To determine the prevalence of hypertension among adults residing in urban communities and to identify associated risk factors. Methods: A cross-sectional study was conducted in selected urban communities. A structured questionnaire was administered to participants aged 18 and above. Blood pressure measurements were taken using standardized protocols. Hypertension was defined based on the World Health Organization criteria. Descriptive statistics, chi-square tests, and multivariable logistic regression were utilized to determine the prevalence and identify significant risk factors. Results: Out of the 150 participants included in the study, 40% were found to be hypertensive. Several risk factors were identified, including age, obesity, and history of smoking. Obesity was associated with a 2.5-fold increased risk of hypertension (OR = 2.50, 95% CI: 0.86-7.25) Conclusion: Hypertension is prevalent among adults in urban communities. Multiple modifiable and non-modifiable risk factors were identified. Public health strategies targeting these risk factors can potentially reduce the burden of hypertension in urban settings. [ABSTRACT FROM AUTHOR]

Background: Concern exists regarding the renal safety of blocking the renin-angiotensin system (RAS) during acute illness, especially in the presence of volume depletion and hemodynamic instability. Methods: We explored the impact of loop diuretics and RAS blockers on the likelihood of developing acute kidney injury (AKI) or acute kidney functional recovery (AKR) among inpatients. Adjusted odds ratio for AKI, AKR and mortality was calculated, using logistic regression models, with subgroup analysis for patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2, corrected for blood pressure measurements. Results: 53,289 patients were included. RAS blockade was associated with reduced adjusted odds ratio for both AKI (0.76, CI 0.70-0.83) AKR (0.55, 0.52-0.58), and mortality within 30 days (0.44, 0.41-0.48), whereas loop diuretics were associated with increased risk of AKI (3.75, 3.42-4.12) and mortality (1.71, 1.58-1.85) and reduced AKR (0.71, 0.66-0.75). Comparable impact of RAS blockers and loop diuretics on renal outcomes and death was found among 6,069 patients with eGFR < 30 ml/min/1.73m². RAS inhibition and diuretics tended to increase the adjusted odds ratios for AKI and to reduce the likelihood of AKR in hypotensive patients. Conclusions: Reduced blood pressure, RAS blockers and diuretics affect the odds of developing AKI or AKR among inpatients, suggesting possible disruption in renal functional reserve (RFR). As long as blood pressure is maintained, RAS inhibition seems to be safe and renoprotective in this population, irrespective of kidney function upon admission, and is associated with reduced mortality. [ABSTRACT FROM AUTHOR]

The measurement of vital signs such as blood pressure plays a key role in human health. Usually, we encounter some problems when we check them in the traditional way; for example, it is impossible to check continuously, and measuring vital signs requires direct contact with the patient, which can be uncomfortable for certain individuals. In this research, we present a vision-based system for estimating blood pressure using pulse transit time (PTT) and the Eulerian video magnification (EVM) technique to amplify tiny color variations caused by blood flow to calculate arterial pulse waves traveling between two arterial sites. Calculating the PTT by processing the video signal for each subject, an oscillometer BP device was used to evaluate the performance between measurements in different conditions, including rest, exercise, and during recovery. Mean systolic BP was 115 mmHg at rest, 137 mmHg during high-intensity exercise, and 114 mmHg during recovery, respectively. The average value of diastolic blood pressure did not change significantly before, during, and after exercise. When we compared the systolic and diastolic blood pressure with ground-truth results, our system showed an accuracy of 91% for systolic blood pressure and 90% for diastolic blood pressure. [ABSTRACT FROM AUTHOR]

The monitoring of physiological parameters is a crucial topic in promoting human health and an indispensable approach for assessing physiological status and diagnosing diseases. Particularly, it holds significant value for patients who require long-term monitoring or with underlying cardiovascular disease. To this end, Visual Contactless Physiological Monitoring (VCPM) is capable of using videos recorded by a consumer camera to monitor blood volume pulse (BVP) signal, heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2) and blood pressure (BP). Recently, deep learning-based pipelines have attracted numerous scholars and achieved unprecedented development. Although VCPM is still an emerging digital medical technology and presents many challenges and opportunities, it has the potential to revolutionize clinical medicine, digital health, telemedicine as well as other areas. The VCPM technology presents a viable solution that can be integrated into these systems for measuring vital parameters during video consultation, owing to its merits of contactless measurement, cost-effectiveness, user-friendly passive monitoring and the sole requirement of an off-the-shelf camera. In fact, the studies of VCPM technologies have been rocketing recently, particularly AI-based approaches, but few are employed in clinical settings. Here we provide a comprehensive overview of the applications, challenges, and prospects of VCPM from the perspective of clinical settings and AI technologies for the first time. The thorough exploration and analysis of clinical scenarios will provide profound guidance for the research and development of VCPM technologies in clinical settings. [ABSTRACT FROM AUTHOR]

Preterm birth is a live birth that occurs before 37 completed weeks of pregnancy. Approximately 11% of babies are born preterm annually worldwide. Blood pressure (BP) monitoring is essential for managing the haemodynamic stability of preterm infants and impacts outcomes. However, current methods have many limitations associated, including invasive measurement, inaccuracies, and infection risk. In this narrative review, we find that artificial intelligence (AI) is a promising tool for the continuous measurement of BP in a neonatal cohort, based on data obtained from non-invasive sensors. Our findings highlight key sensing technologies, AI techniques, and model assessment metrics for BP sensing in the neonatal cohort. Moreover, our findings show that non-invasive BP monitoring leveraging AI has shown promise in adult cohorts but has not been broadly explored for neonatal cohorts. We conclude that there is a significant research opportunity in developing an innovative approach to provide a non-invasive alternative to existing continuous BP monitoring methods, which has the potential to improve outcomes for premature babies. [ABSTRACT FROM AUTHOR]

This paper describes a signal quality classification method for arm ballistocardiogram (BCG), which has the potential for non-invasive and continuous blood pressure measurement. An advantage of the BCG signal for wearable devices is that it can easily be measured using accelerometers. However, the BCG signal is also susceptible to noise caused by motion artifacts. This distortion leads to errors in blood pressure estimation, thereby lowering the performance of blood pressure measurement based on BCG. In this study, to prevent such performance degradation, a binary classification model was created to distinguish between high-quality versus low-quality BCG signals. To estimate the most accurate model, four time-series imaging methods (recurrence plot, the Gramain angular summation field, the Gramain angular difference field, and the Markov transition field) were studied to convert the temporal BCG signal associated with each heartbeat into a 448 × 448 pixel image, and the image was classified using CNN models such as ResNet, SqueezeNet, DenseNet, and LeNet. A total of 9626 BCG beats were used for training, validation, and testing. The experimental results showed that the ResNet and SqueezeNet models with the Gramain angular difference field method achieved a binary classification accuracy of up to 87.5%. [ABSTRACT FROM AUTHOR]

Objectives: To examine the discrepancy between ‘told’ and screened blood pressure (BP) category, and the association between body composition and told BP category. Methods: Between 08/2019-03/2020 college students (n=1057) were asked what category they had previously been told their BP falls into prior to having their BP and body composition (waist circumference, body mass index (BMI), and body fat percentage) objectively assessed. Results: A disproportionate number (>80%) who were told that they had normal BP were categorized as having elevated BP. Men told they had borderline/high BP had less favorable body compositions than those told they had low/normal BP. Less favorable body composition was associated with increased likelihood of men being told that they had borderline/high BP. Conclusions: Better BP screening policies and procedures would ensure healthcare providers discuss elevated BP with emerging adults regardless of body composition and avoid missing opportunities to delivery of early and cost-effective interventions. [ABSTRACT FROM AUTHOR]

Identifying causal factors to intervene on to delay age‐related declines in cognitive function is urgently needed. We examined associations between non‐exercise testing cardiorespiratory fitness (NETCRF; estimated using sex, age, body mass index, resting heart rate, and physical activity) at 45 years and cognitive function outcomes (immediate and delayed verbal memory; verbal fluency; visual processing speed) at 50 years in 8130 participants from the 1958 British birth cohort. In unadjusted models, higher NETCRF was associated with better cognitive function across all outcomes. When adjusted for confounding factors, associations disappeared. In this cohort, associations between 45 years NETCRF and 50 years cognitive function likely result from confounding factors. [ABSTRACT FROM AUTHOR]

Context: Paediatric and adolescent hypertension is becoming a public health concern as it contributes to the development of cardiovascular diseases. However, the problem largely remains undiagnosed. This makes early detection and institution of appropriate preventive measures difficult. The existing diagnostic guidelines and management policies for paediatric hypertension are complex. They have individual specific cut-offs (based on age, gender and height), making their interpretation difficult. Aims: The present study aims to gain insights into paediatrician's perspectives on childhood hypertension. Settings and Design: Qualitative Studies using Key Informant Interviews (KIIs) were conducted with paediatricians to know about their perspectives on blood pressure assessment in children and adolescents, its barriers, their experience, practices and expectations for main streaming hypertensive screening in national health programmes. The interviews were audio recorded after taking their consent. Statistical Analysis Used: Grounded theory was used to analyse transcripts. Results: A total of 40 providers within the public and private health sector were invited to participate; 36 consented and completed the interviews. There was a perception of increased prevalence of paediatric hypertension. Several system, provider and patient-level barriers, like unavailability of paediatric-sized cuffs, and complicated guidelines for interpreting blood pressure, prevented screening and accurate diagnosis. Conclusions: Despite the lack of guidelines for screening, paediatricians still recommended lifestyle interventions. They expressed concerns about implementing standard guidelines for screening. They also expressed the need for a clinical assessment tool to assist in accurate diagnosis. They were willing to contribute to the development and implementation of training programme for health providers to overcome barriers to blood pressure measurement in children. [ABSTRACT FROM AUTHOR]

Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992–1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course. [ABSTRACT FROM AUTHOR]

Accurate blood pressure (BP) measurement is essential for the correct diagnosis and management of hypertension (HTN) especially in the elderly population. As with of all BP devices, the accuracy of cuffless devices must be verified. This study (NCT04027777) aimed to evaluate the performance of a wrist cuffless optical BP device in an elderly population cohort in different body positions with auscultation as the reference measurement. Patients aged 65-85 years with different BP categories but without diabetes were recruited. After an initial calibration based on auscultatory measurements, BP estimation from the Aktiia Bracelet (Aktiia SA, Switzerland) were compared to reference double-blinded auscultatory measurements in sitting, standing and lying positions on four separate visits distributed over one month. In the absence of a universal standard for cuffless BP device at the time of the study, modified ISO81060-2 criteria were used for performance analysis. Thirty-five participants were included in the analysis fulfilling the inclusion requirements of ISO 81060-2. A total of 469 paired measurements were obtained with overall 83% acceptance rate. Differences (mean ± SD) between Aktiia Bracelet and auscultation for systolic BP were -0.26 ± 9.96 mmHg for all body positions aggregated (sitting 1.23 ± 7.88 mmHg, standing -1.81 ± 11.11 mmHg, lying -1.8 ± 9.96 mmHg). Similarly, differences for diastolic BP were -0.75 ± 7.0 mmHg (0.2 ± 5.55 mmHg, -5.35 ± 7.75 mmHg and -0.94 ± 7.47 mmHg, respectively). Standard deviation of the averaged differences per subject for systolic/diastolic BP was 3.8/2.5 mmHg in sitting and 4.4/3.7 mmHg for all body positions aggregated. Overall, this study demonstrates a similar performance of the Aktiia Bracelet compared to auscultation in an elderly population in body positions representative of daily activities. The use of more comfortable, non-invasive, and non-occlusive BP monitors during long periods may facilitate e-health and may contribute to better management of HTN, including diagnosis and treatment of HTN, in the elderly. Accuracy of blood pressure measurements is essential in the diagnosis and the follow-up of patients with high blood pressure. As with any blood pressure measuring device, a validation is necessary. In this study including a elderly population, we compared values obtained by the cuffless Aktiia Bracelet (Aktiia SA, Switzerland) after an initial calibration with the reference auscultatory method during four separate study days distributed over one month. We show that the accuracy of the Aktiia Bracelet is similar to auscultation. The accuracy varies depending on the position in which the measurement is performed. Overall, the accuracy is not modified by a higher age category. The use of a cuffless device in the elderly population characterized by high prevalence of hypertension may facilitate the follow-up of blood pressure with more comfort and minimal constraints. [ABSTRACT FROM AUTHOR]

To share a Latin-American perspective of the use of telemedicine, together with blood pressure measurements outside the medical office, as a potential contribution to improving access to the health system, diagnosis, adherence, and persistence in hypertension treatment. A document settled by a Writing Group of Mexico Hypertension Experts Group, Interamerican Society of Hypertension, Epidemiology and Cardiovascular Prevention Council of the Interamerican Society of Cardiology, and National Cardiologist Association of Mexico In almost all Latin American countries, the health sector faces two fundamental challenges: (1) ensure equitable access to quality care services in a growing population that faces an increase in the prevalence of chronic diseases, and (2) optimise the growing costs of health services, maintaining equity, accessibility, universality, and quality. Telehealth proposes an innovative approach to patient management, especially for chronic conditions, intending to provide remote consultation, education, and follow-up to achieve measurements and goals. It is a tool that promises to improve access, empower the patient, and somehow influence their behaviour about lifestyle changes, improving prevention and reducing complications of hypertension. The clinical practitioner has seen increased evidence that the use of out-of-office blood pressure (BP) measurement and telemedicine are helpful tools to keep patients and physicians in contact and promote better pharmacological adherence and BP control. A survey carried out by medical and scientific institutions showed that practitioners are up-to-date with telemedicine, had internet access, and had hardware availability. A transcendent issue is the need to make the population aware of the benefits of taking blood pressure to avoid complications of hypertension, and in this scenario, promote the creation of teleconsultation mechanisms for the follow-up of patients diagnosed with hypertension. What is the context? In almost all Latin American countries, the health sector faces two fundamental challenges: (1) ensure equitable access to quality care services in a growing population that faces an increase in the prevalence of chronic diseases, and (2) optimise the growing costs of health services, maintaining equity, accessibility, universality, and quality. What is new? Telehealth proposes an innovative approach to patient management, especially for chronic conditions, intending to provide remote consultation, education, and follow-up to achieve measurements and goals. It is a tool that promises to improve access, empower the patient, and somehow influence their behaviour about lifestyle changes, improving prevention and reducing complications of hypertension. What is the impact? Needs are always infinite, and resources are finite, so according to the World Health Organisation (WHO), advances in electronic, information, and communication technology point to more significant equity in the provision of services, considering the effectiveness, possibility of refining the rationalisation of health spending, and improving health care for remote populations. A transcendent issue is the need to make the population aware of the benefits of taking blood pressure to avoid complications of hypertension, and in this scenario, promote the creation of teleconsultation mechanisms for the follow-up of patients diagnosed with hypertension. [ABSTRACT FROM AUTHOR]

24-hour ambulatory blood pressure monitoring (24ABPM) is state of the art in out-of-office blood pressure (BP) monitoring. Due to discomfort and technical limitations related to cuff-based 24ABPM devices, methods for non-invasive and continuous estimation of BP without the need for a cuff have gained interest. The main aims of the present study were to compare accuracy of a pulse arrival time (PAT) based BP-model and user acceptability of a prototype cuffless multi-sensor device (cuffless device), developed by Aidee Health AS, with a conventional cuff-based oscillometric device (ReferenceBP) during 24ABPM. Ninety-five normotensive and hypertensive adults underwent simultaneous 24ABPM with the cuffless device on the chest and a conventional cuff-based oscillometric device on the non-dominant arm. PAT was calculated using the electrocardiogram (ECG) and photoplethysmography (PPG) sensors incorporated in the chest-worn device. The cuffless device recorded continuously, while ReferenceBP measurements were taken every 20 minutes during daytime and every 30 minutes during nighttime. Two-minute PAT-based BP predictions corresponding to the ReferenceBP measurements were compared with ReferenceBP measurements using paired t-tests, bias, and limits of agreement. Mean (SD) of ReferenceBP compared to PAT-based daytime and nighttime systolic BP (SBP) were 129.7 (13.8) mmHg versus 133.6 (20.9) mmHg and 113.1 (16.5) mmHg versus 131.9 (23.4) mmHg. Ninety-five % limits of agreements were [-26.7, 34.6 mmHg] and [-20.9, 58.4 mmHg] for daytime and nighttime SBP respectively. The cuffless device was reported to be significantly more comfortable and less disturbing than the ReferenceBP device during 24ABPM. In the present study, we demonstrated that a general PAT-based BP model had unsatisfactory agreement with ambulatory BP during 24ABPM, especially during nighttime. If sufficient accuracy can be achieved, cuffless BP devices have promising potential for clinical assessment of BP due to the opportunities provided by continuous BP measurements during real-life conditions and high user acceptability. What is the context? Hypertension is a major risk factor for cardiovascular and cerebrovascular end-organ damage, morbidity, and mortality world-wide. Accurate measurement of blood pressure is essential for the diagnosis and management of hypertension. What is new? Cuffless blood pressure devices that allow measurement of blood pressure without a pressure cuff is a promising and novel method of blood pressure estimation. The objective of this study is to assess whether pulse arrival time alone can be used to estimate blood pressure accurately during 24-hour ambulatory blood pressure monitoring, using a prototype cuffless device placed on the chest. Our analysis shows that a general model based on pulse arrival time overestimated ambulatory blood pressure, especially during nighttime. User acceptability was higher with the cuffless device compared to a conventional cuff-based oscillometric device during 24-hour ambulatory blood pressure monitoring. What is the impact? This study provides further evidence that accurate blood pressure estimations cannot be achieved by using pulse arrival time alone as a surrogate for blood pressure measurements. [ABSTRACT FROM AUTHOR]

Ambulatory, cuff-less blood pressure (BP) measurement devices are a promising trend to alleviate the strains of conventional, cuff-based BP determination. Cuff-less devices circumvent discomfort and nocturnal arousal reactions which can be triggered by cuff inflation from conventional, cuff-based ambulatory blood pressure measurement devices. Mitigating these discomforts is especially desirable when performing measurement in children. In this study we want to assess the clinical validity of a cuff-less BP measurement device for 24-h measurements in children and adolescents. We compared the simultaneously retrieved BP data of the cuff-less SOMNOtouch NIBP and the cuff-based Mobil-O-Graph in 24-h use in 90 children in the range from 5 to 17 years old. A total of 1218 valid measurement pairs showed a mean deviation of 0.99 mmHg (limits of agreement: 21.44/-19.46) for systolic and 3.03 mmHg (limits of agreement: 24.37/−18.31) for diastolic BP values. Patient-specific difference of means was within 15 mmHg in 97.7% (systolic BP) and 93.2% (diastolic BP) patients. 25.6% of nocturnal cuff inflations led to determinable, BP-relevant arousal reactions. The SOMNOtouch NIBP demonstrated little measurement deviation of mean BP compared to the cuff-based technique over a broad spectrum of 24-h, ambulatory BP measurements in children and adolescents. Cuff-less blood pressure measurement relieves the issue of nocturnal arousal reactions which are shown to be frequently induced by cuff-based measurements. Driven by these promising results, we encourage ongoing efforts to create enough evidence on cuff-less BP measurement to promote it into broad clinical application. What is known about the topic? Hypertension is of increasing relevance in children and adolescents Blood pressure measurement is difficult, especially in younger individuals What this study adds? The study investigated the accuracy of a cuff-less blood pressure (BP) measurement device, SOMNOtouch™ NIBP, in children and adolescents for 24-h measurements, in comparison to a traditional cuff-based device. The experiment involved 90 participants aged between 5 and 17 years old, with both devices worn simultaneously for 24 h. The results indicated that the cuff-less device showed a minor average deviation in BP measurements. The mean deviation for systolic and diastolic BP values was 0.99 mmHg and 3.03 mmHg, respectively. About 25.6% of night-time cuff inflations in traditional devices led to significant arousal reactions. The study concluded that the cuff-less device had a slight measurement deviation and could alleviate issues like nocturnal arousal reactions that are common with cuff-based devices. These findings suggest the potential for broad clinical application of cuff-less BP measurement devices, especially in children and adolescents, to reduce discomfort and improve patient adherence. However, more research is needed to solidify these findings. [ABSTRACT FROM AUTHOR]

Hypertension should be confirmed with the use of home BP measurement (HBPM) or 24h ambulatory BP measurement (ABPM). The aim of our study was to compare measurements obtained by OBPM, HBPM and ABPM in individuals with elevated OBPM participating in the population-based Swiss Longitudinal Cohort Study (SWICOS). Participants with OBPM ≥140/90 mmHg assessed their BP using HBPM and ABPM. The cut-off for hypertension was ≥135/85 mmHg for HBPM, ≥130/80 mmHg for ABPM. White-coat hypertension (WCH) was defined as normal HPBM and ABPM in participants not taking antihypertensive drugs. Uncontrolled hypertension was defined as hypertension in HBPM or ABPM despite antihypertensive treatment. Of 72 hypertensive subjects with office BP ≥140/90 mmHg and valid measurements of HBPM and ABPM, 39 were males (aged 62.8 ± 11.8y), 33 were females (aged 57.4 ± 14.2y). Hypertension was confirmed with HBPM and ABPM in 17 participants (24%), with ABPM only in 24 further participants (33%), and with HBPM only in 2 further participants (3%). Participants who had hypertension according to ABPM but not HBPM were younger (59 ± 11 y versus 67 ± 16 y; p < 0.001) and more frequently still working (83% versus 23%; p < 0.001). The prevalence of WCH was 28%. Among the 32 subjects taking antihypertensive drugs, uncontrolled hypertension was found in 49%. This population-based study found a high prevalence of WCH and potential uncontrolled hypertension among individuals with elevated OBPM. This study, therefore, supports the ESH recommendations of complementing OBPM by ABPM or HBPM. The use of HBPM instead of ABPM for the confirmation of hypertension in individuals with elevated OBPM might lead to underdiagnosis and uncontrolled hypertension, in particular in the younger working population. In these individuals, this study suggests using ABPM instead of HBPM. What is already known? Comparing blood pressure measurements in the doctor's office or clinic (OBPM) with out-of-office measurements (either self-measurement at home (HBPM) or ambulatory over 24 hours during both day and night times (ABPM)) improves the accuracy of hypertension diagnosis. Why was the study done? This study was done to provide additional information by comparing HBPM and ABPM in individuals with elevated OPBMs (≥140/≥90mmHg), who participated in the Swiss Longitudinal Cohort Study (SWICOS) What was found? Our study confirmed differences between office and out-of-office measurements. In 60% of the study participants, ABPM or HBPM confirmed the elevated OBPM but only around half of these participants were treated with antihypertensive drugs. A high proportion of the participants (28%) had white coat hypertension. What does this study add? Our study adds to the literature already available on this issue by reporting on data obtained from a cohort of individuals living in a countryside area of Southern Switzerland. This study also showed that HBPM might underestimate BP in the younger working population. How might this impact on clinical practice? The findings of this population-based study support the European Society of Hypertension recommendations for wider use of out-of-office blood pressure measurement for the confirmation of hypertension in individuals with elevated OBPM to avoid underdiagnosis and uncontrolled hypertension. In the young working population, ABPM should be used instead of only HBPM to confirm hypertension. [ABSTRACT FROM AUTHOR]

Discrepancies exist between guideline recommendations and real-world practice of blood pressure (BP) measurements. The aim of this study was to assess, with a nationwide, questionnaire-based survey, the current practice of BP measurement and associated BP values in German medical practices. A nationwide survey in German medical practices was performed in the period from 10 May 2021 to 15 August 2021. The questionnaire was divided into five sections. The current office BP (OBP) values as well as the current drug therapy were recorded. In addition, the implementation of office BP (OBP) and home BP monitoring (HBPM) was queried. For analysis, questionnaires were scanned and automatically digitised. A total of 7049 questionnaires were analysed, the majority of which came from general practitioners (66%) and internal medicine practices (34%). The average OBP (SD) was 140.0 (18)/82.7 (11) mmHg. 40.8% of treated patients had OBP in the controlled range, with monotherapy (34.7%) or dual combination therapy (38.2%) prescribed in most cases. OBP was taken from a single measurement in 66.3% of cases, and in 21.8% from 23 measurements. OBP was mostly measured after a rest period (87.1%) and in a separate room (80.4%). HBPM was performed in 62.3% of patients; however, in 24.9% of the participants HBP measurements were recorded once a week or less. In this nationwide survey in German medical practices, BP control remains at below 50%, while monotherapy is prescribed in around one third of patients. Moreover, office measurements and HBPM are often not performed according to current guideline recommendations. What is the context? Elevated blood pressure (hypertension) is an important risk factor for diseases such as stroke or heart attack. However, sufficient drug therapy can significantly reduce the risk of complications such as a stroke. An adequate blood pressure measurement is the basis for diagnostics and successful therapy. In order to measure blood pressure as accurately as possible, recommendations for performing blood pressure measurements (at home as well as in the office) have been published by medical societies. Research suggests that blood pressure is not always measured according to these recommendations. However, there are no current studies for Germany. What is new? In this study, we analysed the results of a survey in which medical practices and pharmacies throughout Germany were asked about blood pressure measurement and blood pressure therapy. The key results of our study suggest that: • The blood pressure of many participants with known hypertension is not within the desired target range. • Office blood pressure measurements are often not performed as suggested by guidelines. This mainly affects time-consuming work steps such as repeating the measurement several times. • Home blood pressure is not recorded in a structured form, as suggested, but rather according to a random pattern by the patient. What is important? This study suggests that blood pressure control is not sufficient in the study participants. Furthermore, blood pressure measurement as an important tool for hypertension management is frequently not performed as proposed by guidelines. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the development of early diabetic retinopathy (DR) findings, a microvascular complication, between patients with isolated type 1 diabetes mellitus (T1DM) (Group 1), concurrent T1DM and autoimmune thyroiditis (AT) (Group 2), and healthy controls (Group 3), who were matched for age, sex, number, and body mass index for comparison. Methods: This was a prospective observational study that included individuals aged 10-20 years, and patients in Groups 1 and 2 had been followed up for =5 years. None of them developed clinical DR during the follow-up period. Optical coherence tomography angiography (OCTA) was used to evaluate the foveal avascular zone (FAZ) and parafoveal vascular density (PVD) for the development of early DR. OCTA findings were compared between patients and healthy controls. Results: Thirty-five individuals were included in each of the groups. The mean FAZ and PVD differed significantly between the three groups (FAZ, p=0.016; PVD, p=0.006). The mean FAZ was higher in Groups 1 and 2 than in Group 3 (p=0.013 and p=0.119, respectively). The mean PVD was lower in Groups 1 and 2 than in Group 3 (p=0.007, respectively). No significant difference was found between Groups 1 and 2 in terms of the mean FAZ and PVD (p=0.832 and p=0.653, respectively). The mean glycated hemoglobin (HbA1c) level was significantly correlated with FAZ and PVD (FAZ: r=0.496, p<0.001; PVD: r=-0.36, p=0.001). Conclusion: In patients with T1DM who did not develop clinical DR, OCTA findings revealed an increase in FAZ, which was associated with higher HbA1c levels. The mean PVD was significantly lower in the group with coexisting AT and T1DM than in the control group. These results suggest that the coexistence of AT and T1DM can contribute to the development of microvascular complications. However, studies with larger patient series are required. [ABSTRACT FROM AUTHOR]

It would be useful to develop a reliable method for the cuffless measurement of blood pressure (BP), as such a method could be made available anytime and anywhere for the effective screening and monitoring of arterial hypertension. The purpose of this study is to evaluate blood pressure measurements through a CardioQVARK device in clinical practice in different patient groups. Methods: This study involved 167 patients aged 31 to 88 years (mean 64.2 ± 7.8 years) with normal blood pressure, high blood pressure, and compensated high blood pressure. During each session, three routine blood pressure measurements with intervals of 30 s were taken using a sphygmomanometer with an appropriate cuff size, and the mean value was selected for comparison. The measurements were carried out by two observers trained at the same time with a reference sphygmomanometer using a Y-shaped connector. In the minute following the last cuff-based measurements, an electrocardiogram (ECG) with an I-lead and a photoplethysmocardiogram were recorded simultaneously for 3 min with the CardioQVARK device. We compared the systolic and diastolic BP obtained from a cuff-based mercury sphygmomanometer and smartphone-case-based BP device: the CardioQVARK monitor. A statistical analysis plan was developed using the IEEE Standard for Wearable Cuffless Blood Pressure Devices. Bland–Altman plots were used to estimate the precision of cuffless measurements. Results: The mean difference between the values defined by CardioQVARK and the cuff-based sphygmomanometer for systolic blood pressure (SBP) was 0.31 ± 3.61, while that for diastolic blood pressure (DBP) was 0.44 ± 3.76. The mean absolute difference (MAD) for SBP was 3.44 ± 2.5 mm Hg, and that for DBP was 3.21 ± 2.82 mm Hg. In the subgroups, the smallest error (less than 3 mm Hg) was observed in the prehypertension group, with a slightly larger error (up to 4 mm Hg) found among patients with a normal blood pressure and stage 1 hypertension. The largest error was found in the stage 2 hypertension group (4–5.5 mm Hg). The largest error was 4.2 mm Hg in the high blood pressure group. We, therefore, did not record an error in excess of 7 mmHg, the upper boundary considered acceptable in the IEEE recommendations. We also did not reach a mean error of 5 mmHg, the upper boundary considered acceptable according to the very recent ESH recommendations. At the same time, in all groups of patients, the systolic blood pressure was determined with an error of less than 5 mm Hg in more than 80% of patients. While this study shows that the CardioQVARK device meets the standards of IEEE, the Bland–Altman analysis indicates that the cuffless measurement of diastolic blood pressure has significant bias. The difference was very small and unlikely to be of clinical relevance for the individual patient, but it may well have epidemiological relevance on a population level. Therefore, the CardioQVARK device, while being worthwhile for monitoring patients over time, may not be suitable for screening purposes. Cuffless blood pressure measurement devices are emerging as a convenient and tolerable alternative to cuff-based devices. However, there are several limitations to cuffless blood pressure measurement devices that should be considered. For instance, this study showed a high proportion of measurements with a measurement error of <5 mmHg, while detecting a small, although statistically significant, bias in the measurement of diastolic blood pressure. This suggests that this device may not be suitable for screening purposes. However, its value for monitoring BP over time is confirmed. Furthermore, and most importantly, the easy measurement method and the device portability (integrated in a smartphone) may increase the self-awareness of hypertensive patients and, potentially, lead to an improved adherence to their treatment. Conclusion: The cuffless blood pressure technology developed in this study was tested in accordance with the IEEE protocol and showed great precision in patient groups with different blood pressure ranges. This approach, therefore, has the potential to be applied in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: According to a survey conducted by the Indonesian Gerontology Doctor Association in 2022, 37.8% of the elderly population in Indonesia have a history of hypertension. In addition to medication therapy, hypertension can be controlled through non-pharmacological therapy, including soaking the feet in warm water. The purpose of this study is to investigate the use of soaking the feet in warm water to reduce blood pressure in elderly hypertensive patients in Jatikalang, Prambon District. Method: This pre-experimental study uses a one-group pre-test and post-test strategy. The population for this study consists of 46 elderly hypertensive patients. The technique of sampling is purposive, resulting in a sample size of 42 elderly patients. The instruments used are a questionnaire and an observation sheet. Data analysis was done by the Wilcoxon test. Results: The systolic blood pressure before soaking the feet in warm water was 140.98 mmHg, and the diastolic blood pressure was 83.29 mmHg. The results of the analytical test yielded 0.000 (a pvalue) for systolic blood pressure, and 0.000 for blood pressure of diastolic. Conclusions: Soaking the feet in warm water reduces the blood pressure of elderly hypertensive patients. It is hoped that this therapy can be used as an additional treatment for hypertension patients, allowing the community to perform it at home for 15 minutes daily, to lower blood pressure at a low cost. [ABSTRACT FROM AUTHOR]

Background: Many authors have noted the lack of knowledge on the causal relationship between the degree of physical activity, the dynamics, and outcomes of diseases, as well as the influence of sports history on the rehabilitation potential of former athletes.Purpose: Assessment of the functional state of the cardiovascular system according to the indicators of electrocardiography, polycardiography, echocardiography and the level of physical performance in masters athletes.Patients and Methods: The study included a main group consisting of 100 athletes, who had undergone electrocardiography, poly-electrocardiography, ultrasound echocardiography, heart rate and blood pressure measurement to determine their level of physical performance. The subjects were then divided into 2 groups. The first group included 75 people who continue to be active in regular sports activities. The second group consisted of 25 people who completely stopped training or had only occasional, unsystematic physical activities. A control group of 31 people, consisting of people of the same age who had not been involved in sports earlier, was examined according to the same program.Results: The data obtained by us show that sports activities do contribute to the increasing stability of the body and maximize the deployment of the capabilities of the circulatory system, including their long-term preservation in masters athletic. Athletes who have stopped training have signs of age-related changes in the heart and blood vessels, which seem to be more frequent and earlier than those who continue training. A higher degree of myocardial contractility (in 90.67% of cases) can also be seen in the main group.Conclusion: Masters athletes and those who stopped training after completing their sports career, should have notably thorough medical supervision and undergo regular annual in-depth examination. [ABSTRACT FROM AUTHOR]