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: Introduction: Recent evidence has raised questions about whether newer HIV treatment regimens, including dolutegravir (DTG) and tenofovir alafenamide (TAF), are associated with increases in blood pressure (BP). Methods: We assessed changes in BP by treatment regimen and evaluated the relative contribution of kidney function and weight gain to these changes among participants in the ADVANCE phase‐3 trial clinical trial in South Africa (study dates: January 2017–February 2022). Our primary outcome of interest was a change in systolic BP (SBP) at 96 and 192 weeks, among those not receiving antihypertensive medication. The secondary outcome was treatment‐emergent hypertension at these same time points, defined as BP ≥140/90 mmHg on two occasions, or initiation of antihypertensive medication after week 4 among individuals without hypertension at enrolment. We used linear regression to evaluate the relationship between change in estimated glomerular filtration rate (eGFR) and change in SBP; and Poisson regression to evaluate the relationship between change in eGFR and treatment‐emergent hypertension at each time point. All models were adjusted for age, sex, treatment group and change in body mass index (BMI). Results: Over 96 weeks, the average changes in SBP were 1.7 mmHg (95% CI: 0.0−3.4), −0.5 mmHg (95% CI: −2.2 to 1.7) and −2.1 mmHg (95% CI: −3.8 to 0.4) in the TAF/emtricitabine (FTC)/DTG, tenofovir disoproxil fumarate (TDF)/FTC/DTG and TDF/FTC/efavirenz (EFV) groups, respectively. This difference was significant for the TAF/FTC/DTG compared to the TDF/FTC/EFV group (p = 0.002). Over 96 weeks, 18.2% (95% CI: 13.4–22.9), 15.4% (95% CI: 11.0–19.9) and 13.3% (95% CI: 8.9–17.6) of participants developed treatment‐emergent hypertension, respectively. In adjusted models, there was no significant relationship between change in eGFR and either outcome. Change in BMI was significantly associated with an increase in SBP, while age was associated with an increased risk of treatment‐emergent hypertension. Adjustment for BMI also mitigated the unadjusted relationship between HIV treatment regimen and SBP where present. Conclusions: In the ADVANCE cohort, weight gain and age accounted for increases in BP and risk of treatment‐emergent hypertension. HIV treatment programmes may need to integrate the management of obesity and hypertension into routine care. Clinical Trial Number: NCT03122262, INTRODUCTION The evolution of antiretroviral therapy in the last decade has seen the introduction of integrase‐strand transfer inhibitors (INSTIs) in fixed‐dose combinations with tenofovir prodrugs, either tenofovir disoproxil fumarate (TDF) [...]

Byline: Khaja. Sherfudeen, Senthil. Kaliannan, Mohamed. Noor Mohamed, Nirmal. Sankarlal Introduction In the lateral decubitus position (LDP), the blood pressure of the dependent arm is more compared to the non-dependent [...]

Purpose To describe the management of arterial partial pressure of carbon dioxide (PaCO.sub.2) in severe traumatic brain-injured (TBI) patients, and the optimal target of PaCO.sub.2 in patients with high intracranial pressure (ICP). Methods Secondary analysis of CENTER-TBI, a multicentre, prospective, observational, cohort study. The primary aim was to describe current practice in PaCO.sub.2 management during the first week of intensive care unit (ICU) after TBI, focusing on the lowest PaCO.sub.2 values. We also assessed PaCO.sub.2 management in patients with and without ICP monitoring (ICP.sub.m), and with and without intracranial hypertension. We evaluated the effect of profound hyperventilation (defined as PaCO.sub.2 < 30 mmHg) on long-term outcome. Results We included 1100 patients, with a total of 11,791 measurements of PaCO.sub.2 (5931 lowest and 5860 highest daily values). The mean (± SD) PaCO.sub.2 was 38.9 (± 5.2) mmHg, and the mean minimum PaCO.sub.2 was 35.2 (± 5.3) mmHg. Mean daily minimum PaCO.sub.2 values were significantly lower in the ICP.sub.m group (34.5 vs 36.7 mmHg, p < 0.001). Daily PaCO.sub.2 nadir was lower in patients with intracranial hypertension (33.8 vs 35.7 mmHg, p < 0.001). Considerable heterogeneity was observed between centers. Management in a centre using profound hyperventilation (HV) more frequently was not associated with increased 6 months mortality (OR = 1.06, 95% CI = 0.77-1.45, p value = 0.7166), or unfavourable neurological outcome (OR 1.12, 95% CI = 0.90-1.38, p value = 0.3138). Conclusions Ventilation is manipulated differently among centers and in response to intracranial dynamics. PaCO.sub.2 tends to be lower in patients with ICP monitoring, especially if ICP is increased. Being in a centre which more frequently uses profound hyperventilation does not affect patient outcomes., Author(s): Giuseppe Citerio [sup.1] [sup.2], Chiara Robba [sup.3] [sup.4], Paola Rebora [sup.1] [sup.5], Matteo Petrosino [sup.5], Eleonora Rossi [sup.6], Letterio Malgeri [sup.7], Nino Stocchetti [sup.8] [sup.9], Stefania Galimberti [sup.1] [sup.5], [...]

Objectives To examine the effects of physical activity (PA) in adults with or without prehypertension at baseline on systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension risk by gender. Methods A total of 5986 men and 6525 women ([greater than or equal to]18 years old) without hypertension-related disease at baseline who attended surveys from China Health and Nutrition Survey (1991-2015) at least twice were selected. In terms of the nested data structure, three-level random intercept growth model and three-level logistic regression were used to estimate the relationship between the PA and SBP/DBP or hypertension risk. Results The incidence of hypertension increased from 10.86% in 1991 to 20.34% in 2015, and the median of PA dropped from 408 MET·h/week in 1991 to 104 MET·h/week in 2015. After adjusting confounders, PA in the third and fourth quartiles decreased SBP (by 0.98 and 0.96 mm Hg, p < 0.05) and DBP (by 0.30 and 0.38 mm Hg, p < 0.05), and it reduced the odds of hypertension by 12 and 15% (p < 0.05), compared with PA in the lowest quartile. For normotensive women in the third quartile of PA and prehypertensive women in the fourth quartile of PA, the risk of hypertension was reduced 15 and 22%, compared with women in the lowest quartile of PA. Conclusions Physical activity should be improved to the relatively high level to be effective in controlling blood pressure. Normotensive women had an association between physical activity and SBP, DBP, and the risk of hypertension., Author(s): Qinpei Zou [sup.1] [sup.2] , Huijun Wang [sup.1] , Chang Su [sup.1] , Wenwen Du [sup.1] , Yifei Ouyang [sup.1] , Xiaofang Jia [sup.1] , Zhihong Wang [sup.1] , [...]

Background Overweight and higher BMI are known to be related to increased blood pressure (BP) and additionally associate with lowered urine pH values even at comparable total daily acid loading. Since a reduced urine pH level at a given total acid load indicates an impaired renal net acid excretion capacity (NAEC) and renal function also relates to BP, we hypothesized that NAEC may be one mediator of the body fat-BP association. Methods Ammonium, titratable acid, pH, creatinine, and urea were measured in 24-h urine samples among 9-15-year-old adolescents of the DONALD Study. NAEC was determined as residual of the body surface area-corrected net acid excretion on urine pH (NAEC1) or body surface area-corrected ammonium excretion on urine pH (NAEC2). Markers of body fatness were determined anthropometrically and systolic and diastolic BP sphygmomanometrically. Multilinear regressions were used to examine cross-sectionally the body fat-NAEC and prospectively the NAEC1-BP associations. Results All body fat parameters were inversely associated with both NAEC1 and NAEC2 among youth (P [less than or equal to] 0.01). In a separate prospective analyses, to check for possible mediation, higher adolescent NAEC1 was significantly associated with lower systolic BP in male adults only (P = 0.04), but this association was attenuated to a trend (P = 0.07) in multivariable-adjusted models. Conclusions Independent of systemic acid load, NAEC, i.e., the kidney's function to eliminate acids is reduced with higher body fatness, and may also contribute as a mediator in the body fatness-BP relation., Author(s): Danika Krupp [sup.1], Yifan Hua [sup.1], Jonas Esche [sup.1], Thomas Remer [sup.1] Author Affiliations: (1) DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study Center, Department of Nutritional Epidemiology, Institute [...]