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BACKGROUND Excessive dietary sodium intake is an independent risk factor for hypertension and cardiovascular disease (CVD). Despite the large body of evidence concerning the effects of dietary interventions on blood pressure (and CVD outcomes), trials have often reported low adherence to lower sodium intake, likely due in part to heterogeneous blood pressure responses. To address these challenges in dietary interventions, recent clinical findings have suggested a personalized dietary approach combining metabolomics, genetics, and digital health technologies for the prevention and treatment of chronic diseases including hypertension. Precision nutrition, also called personalized nutrition, seeks to deliver more preventive and practical dietary advice than ‘one-size-fits-all’ guidelines and weigh the personal risk of developing specific diseases. In addition, one important single‐nucleotide polymorphism that influences blood pressure in humans is the salt sensitivity (SS) factor. However, the evidence on how the SS variant influences urinary metabolite profiles and blood pressure control following a low sodium diet intervention among individuals with hypertension is currently lacking. OBJECTIVE Therefore, the purpose of this randomized controlled trial is to pilot a 2-month low sodium diet program to improve urinary metabolite profiles and blood pressure control. METHODS A total of 60 hypertensive patients will be randomized assigned to either a low sodium diet group (n=20) or standard care group (n=10) for 2 months. Outcomes of interest include post-intervention changes in targeted urinary metabolite profiles, urinary sodium excretion, and blood pressure. RESULTS This study is approved by the University of Texas Health Science Center at San Antonio Institutional Review Board (#HSC20200054H). To date, interventionist training is completed, and participant enrollment began in April 2021. Thus far, we recruited 21 participants and expect preliminary results to be available in fall 2022. CONCLUSIONS This study will provide essential evidence on which to base a future larger clinical trial and could eventually be translated into an approach to improve the health of millions of Americans with hypertension. CLINICALTRIAL Clinicaltrials.gov NCT04764253

Objective To examine associations of self-care and the quality of life (QOL) in patients with Parkinson's disease (PD) and their caregivers dyads. Background Patients with PD engage in self-care with motor and non-motor symptom experiences. There is insufficient knowledge about associations of self-care and QOL in patients with PD and their caregivers though PD patients and family caregivers are interdependent. Method: A total of 73 PD patients and primary family caregivers from the Korean Parkinson's Disease Association or who visited outpatient clinics of the tertiary hospitals in Korea participated in this study. Dyad members completed the survey of the self-care (the Self-Care of Chronic Illness Inventory and Caregiver Contribution to Self-Care of Chronic Illness Inventory) and QOL (Parkinson’s Disease Quality of Life Questionnaire and The Parkinson’s Disease Questionnaire-Care). The comparisons of self-care and quality of life within two dyad members were conducted via paired t-test and Pearson's correlation using SPSS 26.0 Result: PD patients reported significantly higher levels of self-care maintenance (78.34 vs. 70.21, patients vs. caregiver respectively, p Conclusion The self-care efficacy of patients and the contribution of caregivers to self-care management can affect the QOL of both patients and caregivers. A dyadic approach for the intervention of self-care management is crucial to improve the QOL of patients with PD and caregivers.

Background: Although symptoms in patients (pts) with heart failure (HF) are often viewed in isolation, pts usually have multiple, concurrent symptoms. Identification of symptom clusters could improve pts’ recognition of worsening HF, and enhance pt care. Given gender differences in outcomes in HF, examination of potential differences in clusters and their impact on outcomes is reasonable. Purpose: To identify HF symptom clusters in women and men and examine the impact of clusters on total number of all-cause hospitalizations per pt during 12 month follow-up. Methods: Data from 513 pts with HF (61 ± 12 yrs, 31.7% female, 53.6% NYHA III/IV) were used. Seven symptoms (i.e., edema, dyspnea, fatigue, trouble sleeping, worry, depression, and memory problems) were analyzed for clustering using an agglomerative hierarchical clustering approach and Ward’s method. Validity of cluster solution was assessed with split-sample replication. Symptoms were clustered, and pts were grouped based on symptom burden in clusters. Results: Two symptom clusters were identified in both men and women: physical symptom cluster - dyspnea, fatigue, trouble sleeping; and emotional/cognitive symptom cluster - worry, memory problems, depression. Pts were grouped into 4 based on their symptom burden in each of the 2 clusters: low burden related to both clusters; burden from physical cluster > than that from emotional cluster; burden from the emotional cluster > than that from physical cluster; and high and equal burden from both clusters. ANOVA revealed a difference in number of hospitalizations in both men and women based on the groups (p=.002); there were no gender differences. Pts in group 3 (emotional symptoms > than physical) were most frequently hospitalized (1.8 ± 2.8 hospitalizations/pt in group 3 compared to 1.7 ± 2.5/pt in group 4 vs .88 ± 1.6/pt in group 2 vs .66 ± 1.3/pt in group 1; post hoc Tukey indicates p Conclusion: HF symptoms cluster in two identifiable groups: a physical and an emotional/cognitive cluster. Pts with the most burden from the emotional cluster have the worst outcomes, suggesting that increased attention needs to be paid by clinicians to emotional symptoms and the fact that they occur in clusters.

Background: Medication nonadherence is presumed to be related to poor clinical outcomes including emergency department (ED) visits, rehospitalization and mortality, yet this relationship has not been tested using objective adherence measures in patients with heart failure (HF). Therefore, it is unknown which objective indicators of medication adherence predict clinical outcomes and how self-reported adherence measures compare to objective measures in predicting clinical outcomes. Objective: The purpose of this study was to determine which indicators of medication adherence are predictors of event-free survival in patients with HF. Methods: A total of 134 patients with HF (70% male, 61 ±12, 61% NYHA III/IV) were enrolled in this 6-month longitudinal predictive study. Medication adherence was measured using an objective measure, the Medication Event Monitoring System (MEMS) and self-reported adherence from the Medical Outcomes Studies Specific Adherence Scale. Four indicators of adherence were assessed by the MEMS: dose-count, percentage of prescribed doses taken; dose-days, percentage of days the correct number of doses taken; dose-time, percentage of doses taken on schedule; and therapeutic coverage, percentage of time therapeutic drug action maintained. Events (ED visits, rehospitalization, and mortality) were obtained by patient/family interview and hospital databases. Results: In Cox regression, three of the four MEMS indicators, dose-count, dose-day, and therapeutic coverage, predicted time to first event before and after controlling age, gender, ejection fraction, NYHA, angiotensin-converting enzyme inhibitor use, and beta-blocker use ( p = .004, .008, and < .001, respectively). Self-report medication adherence did not predict outcomes ( p = .402). Conclusions: The percentage of prescribed doses taken, percentage of days the correct number of doses taken, and overall therapeutic coverage predicted event-free survival. Neither the percentage of doses taken on schedule nor self-reported adherence predicted outcomes. Healthcare providers should assess specific behaviors related to medication taking rather than a global patient self-assessment of patient adherence.