The May Measurement Month (MMM) initiative is an annual global screening campaign started in 2017 by the International Society of Hypertension highlighting the importance of regular measurements of blood pressure (BP). Here we report on the results of the MMM campaign done in Belgium during the month of May in 2017, 2018, 2019, 2022 and 2023.

Participants ≥18 years were recruited through opportunistic sampling in 12 sites (mostly hospital entrances) across Belgium. Apart from standardised BP recordings by trained staff, data were collected on demographics, lifestyle factors and comorbidities. Hypertension was defined as raised BP (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) and/or taking antihypertensive medication.

Data were collected from 5,926 participants aged 51.5 years on average. Mean (SD) systolic and diastolic BP were 125.9 (17.6) mmHg and 79.4 (10.9) mmHg with 25.8% exceeding the 140/90 mmHg threshold. Age-standardised prevalences of hypertension were 45.4% in men and 36.9% in women. Among the 2,468 individuals with hypertension, 78.5% had been previously diagnosed and 1,578 of those with known hypertension, received antihypertensive treatment. Only about half of those being treated (56.3%) did achieve the target of systolic/diastolic BP <140/90 mmHg. Inadequate therapeutic control was independently associated with increasing age and higher body mass index. Untreated hypertension was significantly associated with male sex, age, body mass index and alcohol use.

Despite the limited representativeness of the sample, these data suggest that the 'rule of halves' for hypertension no longer holds true in Belgium and that therapeutic control of hypertension is still suboptimal.

Hypertension is a global health concern, and antihypertensive medications are vital for its management. This study examined evolving trends in antihypertensive medication usage among adults with hypertension from 1999 to 2020.

Data from 10 National Health and Nutrition Examination Survey (NHANES) survey cycles were obtained for adults aged 18 years and older with hypertension. The study analysed demographic, drug classification and demographic variables. All statistical analyses, including logistic regression, were used to assess trends.

Among 18,221 hypertensive participants, diverse characteristics were observed. The use of angiotensin-converting enzyme inhibitors increased from 26.18% in 1999 to 32.76% in 2020 (linear p = 0.001). Angiotensin receptor blocker use rose from 10.36% to 26.57%. Beta blocker usage increased from 28.98% in 1999 to 42.50% in 2010, plateauing at approximately 40% from 2011 to 2020 (quadratic p < 0.001). Calcium channel blocker (CCB) utilisation increased from 16.70% in 1999 to 20.46% in 2020 (linear p < 0.001). Diuretic (DU) use decreased from 32.70% in 1999 to 26.34% in 2020 (quadratic p = 0.009). The use of antihypertensive medications varies across different demographic groups and comorbidities.

ACEI, ARB and CCB usage increased, while DU usage decreased. BB utilisation stabilised at a high rate. Antihypertensive drug use displayed diverse trends across demographic groups and comorbidities.

Amlodipine (AM), widely used for the treatment of hypertension and angina, consists of two enantiomers: (S)-AM and (R)-AM. The extensive use of this medication has raised concerns regarding environmental contamination, but the enantioselective toxicity of AM in aquatic organisms has not been adequately investigated. This study aimed to examine the enantioselective toxicity of AM using zebrafish (Danio rerio) embryos, focusing on acute toxicity and developmental toxicity. Neither enantiomer exhibited acute toxicity at the tested concentrations (0.25-20 mg/L). With respect to ocular development, (R)-AM reduced eye volume at the highest tested concentration. The lens-to-eye volume ratio showed a significant increase in embryos treated with both enantiomers compared to the control. Enantioselective toxicity was evident in cardiac function, as (S)-AM-induced heart dysfunction, despite both enantiomers displaying similar patterns of heart development-related gene expression. Severe defects in ISV formation were observed in both (S)-AM and (R)-AM treatments, indicating that AM exposure may result in abnormal blood vessel formation in other fish. Metabolomic analysis indicated that exposure to either enantiomer led to the upregulation of most metabolic pathways, except for starch and sucrose metabolism. Further research needs to confirm enantioselective toxicity under chronic conditions at environmentally relevant concentrations of AM.

Studies showed angiotensin II type 2 receptor/angiotensin II type 4 receptor (AT2R/AT4R) stimulatory antihypertensive was associated with a lower risk of dementia and cognitive impairment compared to the inhibitory one. This study aimed to identify the racial and ethnic differences in using these agents among the USA adults with hypertension.

A cross-sectional study was conducted using data from the Medical Expenditure Panel Survey (MEPS, 2016-2019). Individuals with a diagnosis of hypertension or self-reported hypertension and without dementia or Alzheimer's disease diagnosis were included in the analysis. We applied two multivariable logistic regressions to compare racial/ethnic differences in AT2R/AT4R stimulatory antihypertensive use and AT2R/AT4R inhibitory antihypertensive use, adjusting for covariates.

Twenty-four thousand five hundred eighty-one individuals with hypertension and without dementia or Alzheimer's disease were identified. Among non-Hispanic Whites, 72.39% were using AT2R/AT4R inhibitory antihypertensive agents, vs. 66.97% using AT2R/AT4R stimulatory antihypertensive agents. In contrast, both non-Hispanic Black and Asian Americans were using more AT2R/AT4R stimulatory agents than inhibitory ones (16.40% vs. 12.16% and 4.79% vs. 3.43%, respectively). Compared to non-Hispanic White, non-Hispanic Black (OR 1.980, 95% CI 1.839-2.132) and non-Hispanic Asian Americans (OR 1.545, 95% CI 1.356-1.761) were significantly associated with higher odds of prescribing AT2R/AT4R stimulatory agents, while Hispanics (OR 0.744, 95% CI 0.685-0.808) were associated with lower odds of prescribing AT2R/AT4R inhibitory agents compared to non-Hispanic Whites.

The results showed that the high-dementia risk populations like non-Hispanic Black and Asian American races are proportionally prescribed with higher use of low-dementia risk antihypertensive agents, compared to non-Hispanic Whites.

Fruit juice-antihypertensive drug interactions can lead to subtherapeutic or supratherapeutic outcomes. This systematic review and meta-analysis assesses such interactions and their potential clinical relevance.

PubMed, Scopus, and Science Direct databases were searched from their inception through June 2024. Eligible studies were those that investigated the effects of fruit juice on the pharmacokinetics of antihypertensive drugs. I2 was used to determine heterogeneity among studies, and a random effect model was employed for meta-analysis. This review adhered to PRISMA guidelines and was registered in PROSPERO (CRD42022340159).

Fifty-one studies were included. Most of them were open-label crossover trials. Grapefruit juice (GFJ), an inhibitor of organic-anion-transporting polypeptide (OATP) transporters and cytochrome P450 (CYP) 3A4, significantly decreased the AUC and Cmax of aliskiren and celiprolol by approximately 80-90 %. Conversely, the AUC and Cmax of calcium channel blockers decreased with variable degrees when co-administered with GFJ. Apple and orange juices have comparable effects on certain medications. Most studies had small sample sizes and were of moderate quality. Hemodynamic effects were not assessed in most studies; thus, the clinical significance of these interactions remains uncertain and should be further investigated.

Co-administration of fruit juice with antihypertensive drugs can result in an increase or decrease in drugs' bioavailability, depending on the drugs' metabolism route and the involvement of transporters. Though further studies are needed to confirm clinical relevance in hypertensive patients, it is advised to avoid co-consumption of fruit juice with drugs showing significant changes in pharmacokinetic parameters to prevent subtherapeutic or supratherapeutic effects.

This study aimed to investigate awareness of having hypertension, diabetes and dyslipidaemia and their associated factors among US adults.

Data from the National Health and Nutrition Examination Survey, including 21,399 adults aged ⩾20 years (pregnant women excluded) collected between 2011 and 2018, were used. Blood pressure was measured using a Baumanometer calibrated mercury true gravity wall model sphygmomanometer. Serum total cholesterol levels were measured using enzymatic assays. The percentage of haemoglobin A1C (HbA1c), which reflects long-term blood glucose levels, was measured and used to identify diabetes. Participants self-reported whether they were told by a doctor that they have hypertension, dyslipidaemia and diabetes. Awareness was defined as alignment between objective and self-reported measures for having the conditions. Sampling weights and the Taylor series linearisation variance estimation method were used in the analyses.

The findings showed that 64.06% of people with hypertension, 54.71% of those with dyslipidaemia and 78.40% of those with diabetes were aware of having the respective condition. Age, sex and health insurance were associated with awareness of having all three conditions, but marital status was not associated with any outcome. Weight status was associated with awareness of having hypertension and dyslipidaemia, whereas ethnicity was associated with awareness of having hypertension and diabetes. Relative family income was only associated with awareness of having hypertension.

Large proportions of US adults with hypertension, dyslipidaemia and diabetes are not aware of having the conditions. Interventions targeting groups at higher risk of being unaware of these conditions are needed.

Hypertension is one of the leading preventable causes of premature death. Although it can be effectively managed with relatively simple interventions, up to 50% of individuals with hypertension in low- and middle-income countries (LMICs) remain undiagnosed. Key factors influencing the health-seeking behaviour of patients with hypertension include household wealth, knowledge about hypertension, perceptions of treatment effectiveness, and access to blood pressure measurement. However, evidence on the facilitators and barriers to hypertension diagnosis in low-income households within LMICs remains inconsistent. This study aims to describe the characteristics and health-seeking behaviours of individuals with undiagnosed hypertension in low-income households in the Philippines and identify the factors influencing undiagnosed hypertension. The study included 516 people with hypertension from low-income households in the Philippines as part of the RESPOND study. Characteristics of participants with undiagnosed hypertension were compared to those with diagnosed hypertension to identify determinants of undiagnosed cases. A follow-up survey one year later gathered data on whether undiagnosed participants had subsequently received a formal diagnosis. In this study, 26.6% of people with hypertension in low-income households were undiagnosed. Over one year, only 25.4% of these undiagnosed individuals received a formal diagnosis. Factors associated with lower odds of undiagnosed hypertension included belief in the effectiveness of Western medicine, recent blood pressure measurement, receipt of health information in the preceding year, presence of comorbidities, and participation in social organisations. Conversely, living in rural areas, employment, and belief in the effectiveness of traditional medicine were linked to higher odds of remaining undiagnosed. A substantial proportion of people with hypertension in low-income households in the Philippines remain undiagnosed. Addressing this issue requires a multifaceted approach targeting the social determinants of health and addressing specific barriers to hypertension diagnosis. Insights from this study can inform strategies to improve hypertension control in other LMICs.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of community health worker-led interventions on controlling blood pressure for people with hypertension.

This study aimed to explore the association between TyG and the prevalence of hypertension in US adults aged 18-60.

Data was obtained from the National Health and Nutrition Examination Survey (NHANES) covering the circles from 2009 to 2018, involving 12,309 adults aged 18 to 60. The biomarkers studied in this article included weight, body mass index (BMI), waist circumference (WC), weight-adjusted waist index (WWI), waist-to-height ratio (WHtR), triglyceride-glucose index (TyG), triglyceride glucose-body mass index (TyG-BMI), triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-weight (TyG-Weight), and triglyceride glucose-waist to height ratio (TyG-WHtR). Participants were categorized into a non-Hypertension group (n = 7,076) and a Hypertension group (n = 5,233). A weighted multiple logistic regression model was employed to evaluate the association between biomarkers and hypertension. Restricted cubic splines (RCS) were utilized to examine the non-linear association between biomarkers and the risk of developing hypertension. Threshold effect analysis was used to determine the inflection point. Receiver operating characteristic (ROC) curves were generated to assess the predictive performance of biomarkers for hypertension. Additionally, subgroup and interaction analyses were conducted to confirm the reliability of the associations observed.

Our analysis revealed that after adjusting for multiple variables, the risk of hypertension increased by 12% for each unit increase in TyG-WHtR (P < 0.001). The RCS results showed a positive nonlinear association between TyG-WHtR and hypertension, with an inflection point of 5.79. Similar associations were also observed with WWI, WHtR, and TyG. The ROC curve analysis demonstrated that TyG-WHtR had the best predictive performance for hypertension (AUC: 0.6946, 95% CI: 0.6853-0.7039, Cut-off Value: 4.831, all P for comparison < 0.001). Subgroup analysis revealed that the association between TyG-WHtR and hypertension remains robust (all P for interaction > 0.05).

There is a significant association between WWI, WHtR, TyG, and TyG-WHtR with hypertension in American adults aged 18 to 60, with TyG-WHtR demonstrating the best predicted performance.

Not applicable.

BackgroundThe extent to which hypertension-related excess risk of dementia can be mitigated or eradicated through lifestyle factor modification remains unclear.ObjectiveTo explore the association between lifestyle behaviors and hypertension-related excess risk of dementia.MethodsIn this prospective cohort study using data from the UK Biobank, participants were enrolled from 2006 to 2010 and followed up until December 2022. A healthy lifestyle score was constructed by assigning one point for each of the seven selected healthy lifestyle factors. The association of dementia risk in individuals with hypertension according to the healthy lifestyle score was compared to individuals without hypertension.ResultsThis study included 337,378 individuals. During a median follow-up of 13.6 years, 5390 participants developed dementia. A higher healthy lifestyle score was associated with a gradual decrease in the excess risk of dementia for individuals with hypertension compared to individuals without hypertension. Excess dementia risk was not detected among individuals with hypertension who adopted at least six healthy lifestyle factors (hazard ratio (HR) = 1.05 (95% confidence interval (CI): 0.96-1.14)) for six scores; HR = 0.93 (95% CI: 0.82-1.06 for seven scores). The protective association between adhering to all seven healthy lifestyle factors and dementia was significantly stronger for individuals <60 years old than for individuals ≥60 years old.ConclusionsFor individuals with hypertension who adopted at least six healthy lifestyle factors had no hypertension-related excess risk of dementia.

Evaluating diet in terms of health and environmental impact is crucial to transform current food systems to encourage a healthier and more sustainable approach.

In this study, we analyzed the association between a healthy and sustainable dietary pattern and sociodemographic factors in adults from Mexico, the US and Canada.

This cross-sectional study included adults aged ≥ 20 years. We assessed the dietary quality on health and environment dimensions using the World Index for Sustainability and Health (WISH). Dietary information was collected using a 24-hour recall from national surveys in Mexico, the US, and Canada. Compliance with the recommendations of 13 food groups was estimated to obtain a total score of 130. Multiple linear regression models were used to estimate the association between the total score and sociodemographic factors.

The total WISH score was low in Mexico (47.6 ± 0.78), Canada (44.2 ± 0.29) and the US (41.3 ± 0.31). The highest scores in protective foods were whole grains (4.8 ± 0.25) in Mexico, in limiting foods the lowest scores were: red meat (4.4 ± 0.10) and added sugars (3.0 ± 0.10) in the US and saturated fat in Canada (5.5 ± 0.09). Being female (β: 2.4, 95% CI 1.4, 3.5); or over 60 years old (β: 3.1, 95% CI 1.8, 4.3) and having a higher educational level (β: 2.5, 95% CI 1.4, 3.6) were associated with higher scores.

Mexico, the US, and Canada have an unhealthy and high environmental impact dietary pattern. The groups with lower compliance are men, younger individuals, and those with lower educational attainment.

This review aims to evaluate the impact of novel aldosterone synthase inhibitors, the first new class of antihypertensives in more than 20 years, on the management of resistant hypertension. We highlight the problem of resistant hypertension in clinical practice and describe the challenging history and development of aldosterone synthase inhibitors. The review highlights clinical trial evidence to-date for all agents in this class, with a key focus on the two most mature agents baxdrostat and lorundrostat which are currently in pivotal Phase 3 trials. Both agents have demonstrated significant dose-dependent reductions in blood pressure, particularly in patients with resistant hypertension and crucially, with a minimal impact on cortisol levels. They have also shown promise with marked blood pressure reductions in patients with varying physiological profiles and few adverse events at optimised doses. However, as would be expected, both drugs are associated with increases in serum potassium levels, necessitating careful monitoring.

Atrial fibrillation/flutter (AF/AFL) remains a significant global public health issue, with its development influenced by metabolic, behavioral, and environmental risk factors However, comprehensive analyses of temporal and geographic variations in AF/AFL burden attributed to risk factors remain lacking.

This study reveals the geographic and temporal distribution of the burden of AF/AFL attributable to specific risk factors at global, regional, and national levels from 1990 to 2021, providing a scientific basis for developing targeted prevention and control policies.

We extracted data on AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the Global Burden of Disease (GBD) database for the years 1990 to 2021. The burden of AF/AFL caused by metabolic, behavioral, and environmental risk factors stratified by age, sex, region, and country. Long-term trends in the AF/AFL burden associated with specific risk factors were assessed using the average annual percentage change (AAPC).

Over the past 32 years, high body mass index has been the primary contributor to the rising AF/AFL burden, with AAPCs of ASMR and ASDR at 1.66 (95% CI: 1.63-1.68) and 1.68 (95% CI: 1.67-1.70), respectively. The most significant increase occurred in males aged 30-34. The burden related to high sodium diets and lead exposure is also rising, particularly in females aged 65-69. Smoking showed the greatest decrease, with AAPCs of ASMR and ASDR at -0.66 (95% CI: -0.68 to -0.65) and -0.72 (95% CI: -0.72 to -0.71), most significantly in women aged 30-34. High systolic blood pressure decreased overall, but increased in individuals aged 34-49. East Asia saw the largest increase in burden from high body mass index, with AAPCs of ASMR at 8.28 (95% CI: 8.18-8.37) and ASDR at 8.22 (95% CI: 8.18-8.26). In 2021, China had the highest AF/AFL deaths and DALYs attributed to high systolic blood pressure, high sodium diets, smoking, and lead exposure.

From 1990 to 2021, high body mass index became the primary driver of the rising global AF/AFL burden, particularly affecting East Asia and young and middle-aged adults. In contrast, the burden associated with smoking showed the greatest decline. In 2021, China had the highest AF/AFL burden due to various risk factors. Given the regional variations and characteristics of high-risk populations, policymakers should develop targeted yet comprehensive prevention strategies. These measures should include promoting healthy dietary habits, strengthening global surveillance systems, and fostering data-sharing collaborations to mitigate this growing epidemic.

This systematic review and meta-analysis is an update to prior research to evaluate the effects of yoga for managing prehypertension and hypertension.

Medline/PubMed, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from their inception until April 5th 2024. Randomized-controlled trials (RCTs) that compared yoga to any control intervention in participants with diagnosed prehypertension (120-139/80-89 mmHg) or hypertension (≥140/ ≥ 90mmHg) were included. Mean differences (MD) and 95% confidence intervals (CI) were calculated. Risk of Bias was assessed using the Cochrane tool.

30 RCTs with 2283 participants were included. Very low quality of evidence was found for positive effects of yoga on systolic blood pressure (SBP, 26 RCTs, n = 2007; MD = -7.95 mmHg, 95% CI = -10.24 to -5.66, p < 0.01), diastolic blood pressure (DBP, 23 RCTs, n = 1836; MD = -4.93 mmHg, 95% CI = -6.25 to -3.60, p < 0.01) and heart rate (HR, 14 RCTs, n = 1118; MD = -4.43 mmHg, 95% CI = -7.36 to -1.50, p < 0.01) compared to waitlist control. Compared to active control, very low quality of evidence was found for positive effects yoga on SBP (5 RCTs, n = 306; MD = -4.16 mmHg, 95%CI = -10.76 to 2.44, p = 0.22), DBP (5 RCTs, n = 306; MD = -1.88 mmHg, 95%CI = -3.41 to -0.36, p = 0.02) and HR (2 RCT, n = 128; MD = -5.16 mmHg, 95% CI = -8.39 to -1.92, p < 0.01). Overall, the studies showed a high degree of heterogeneity. The effects found were robust against selection, detection and attrition bias.

Yoga may be an option for lowering blood pressure in people with prehypertension to hypertension. More and larger high-quality studies are needed to substantiate our findings.

This study aimed to detect early left atrial (LA) function abnormalities in young hypertensive patients with a normal two-dimensional LA volume index (2D-LAVI) using four-dimensional auto LA quantification technology (4D Auto LAQ) and to analyse correlations between LA strain parameters and clinical metabolic indicators.

This study enrolled 70 young patients who underwent standard hypertension treatment or diagnosis at the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, from October 2023 to July 2024 and 41 control volunteers enrolled during the same period. LA volume and strain parameters were evaluated with a 4D Auto LAQ. A correlation analysis was conducted between the clinical and strain parameters.

Compared with the control group, young hypertensive patients presented significantly greater LA minimum volume (LAVmin), LA minimum volume index (LAVImin) and LA pre-atrial volume (LAVpreA) values (all p < 0.001). The LA ejection fraction (LAEF) was reduced in young hypertensive patients (57.85%±4.47% vs. 50.44%±5.96%, p < 0.001), along with LA reservoir longitudinal strain (25.00% [20.50-29.50%] vs. 20.00% [16.00-24.25%], p < 0.001), LA conduit longitudinal strain (-16.32%±4.19% vs. -11.37%±4.65%, p < 0.001), LA contraction longitudinal strain (-12.27%±2.85% vs. -9.60 ± 4.12, p < 0.001), LA reservoir circumferential strain (34.32%±6.90% vs. 28.41%±6.95%, p < 0.001), LA conduit circumferential strain (-17.90%±4.84% vs. -11.46%±4.96%, p < 0.001), and LA contraction circumferential strain (-18.54%±4.85% vs. -16.23%±6.11%, p < 0.05). Multivariate linear regression analysis revealed that body mass index (BMI), triglyceride (TG), and uric acid (UA) were negatively and independently correlated with LA longitudinal strain.

In young hypertensive patients with normal 2D-LAVI, while LAVmin, LAVImin and LAVpreA are elevated, the LAEF and LA reservoir, conduit, and contraction strain are notably reduced. The application of 4D Auto LAQ technology may highlight altered values in young hypertensive patients with normal 2D-LAVI. 4D Auto LAQ may serve as a valuable tool for clinicians in the early detection and assessment of LA dysfunction in young hypertensive patients.

Hypertension is defined as the sustained elevation of blood pressure to levels greater than 140/90 mmHg. It is a leading cause of cardiovascular morbidity and mortality worldwide, accounting for 13% of total deaths and 7% of the global burden of disease. This condition can be significantly reduced by strictly adhering to various self-care practices for hypertension management, including compliance with prescribed antihypertensive medications, reducing salt intake, consuming a balanced diet, avoiding harmful alcohol use, engaging in regular physical exercise, and quitting tobacco smoking.

The aim of this study is to determine self-care practices and associated factors, as well as to explore barriers to these practices among hypertensive patients in public hospitals in Bahir Dar city, Northwest Ethiopia.

An institution-based descriptive cross-sectional study, triangulated with qualitative research, was conducted from March 12 to April 12, 2021. A total of 415 participants were selected from three study settings. Data collected from a structured questionnaire were entered into EpiData v3.01 and analyzed using SPSS version 21. Both univariable and multivariable binary logistic regression analyses were performed. The statistical significance of associations between variables was determined using odds ratios with 95% confidence intervals (CIs) and p-values below 0.05. Eight purposively selected individuals participated in the qualitative component of the study.

Good self-care practices for hypertension were observed in 44.8% of participants. Significant predictors of good hypertension self-care practices included age ≥ 60, education level of secondary school or higher, employment in government positions, controlled blood pressure, good knowledge about hypertension, strong social support, and a positive perceived health status, with Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI) of 3.04 (1.26, 7.33), 7.82 (2.79, 21.98), 1.53 (1.53, 14.90), 3.14 (1.70, 5.80), 2.27 (1.17, 4.41), 2.71 (1.31, 5.61), and 2.56 (1.35, 4.85), respectively. Major identified barriers included lack of emotional stability and stress, financial problems, lack of commitment, lack of attention, and inadequate counseling from health professionals.

Less than half of the participants demonstrated good self-care practices for managing hypertension. Strategies, programs, and guidelines should be developed to help clients understand the importance of multi-dimensional well-being in relation to various aspects of hypertension self-care practices. Furthermore, all patients should receive comprehensive and tailored information on recommended self-care practices and be assessed for barriers to adherence to these practices.

Hypertension is an age-related pathology that causes a decline in the function of all organ systems, including the reproductive system, due to its association with increased oxidative stress and inflammation. The inflammatory cytokine levels increase as a result of hypertension and cause inflammation and tissue injury. Although high-intensity interval training (HIIT) has shown promise as a nondrug treatment for hypertensive individuals, its effects on the reproductive system of hypertensive individuals remain unknown. The aim of this study was to investigate the effects of HIIT on plasma hormone concentrations and the expression of inflammatory mediators in the testes of spontaneously hypertensive rats (SHRs). Male SHRs were divided into 2 groups: SHR (control, n=8) and HIIT (SHRs subjected to HIIT on a treadmill for 8 weeks, n=9) groups. The expression of inflammatory mediators (TNFα and IL-6) in the testes and testosterone, prolactin, and corticosterone concentrations in plasma were measured. No difference in TNFα expression was found between the groups. The groups also showed no significant differences in hormone levels. However, SHRs that underwent HIIT showed lower immunostaining for IL-6 in their testes than did SHRs that did not undergo HIIT training (P < 0.05) and the HIIT group presented lower lower systolic blood pressure than did the SHR group. We concluded that HIIT for two months reduces the BSP and IL-6 levels in the testes of hypertensive rats.

Elevated blood pressure (BP) and hypertension are common in children and adolescents, significantly increasing the risk of cardiovascular disease (CVD) in adulthood. Accurately assessing the prevalence and significance of pediatric hypertension requires a clear definition. The use of age-, sex-, and height-dependent percentiles to define pediatric hypertension began in 1977. Since then, several national and international clinical practice guidelines have refined its classification, diagnosis, and management, with notable contributions from The Fourth Report in 2004, the European Society of Hypertension (ESH) in 2016, and the American Academy of Pediatrics (AAP) in 2017. The 2017 AAP guideline redefined pediatric hypertension, increasing the number of children classified with elevated BP or hypertension. Despite these advancements, a universal diagnostic criterion for pediatric hypertension is still lacking. This review aims to summarize recent research on pediatric hypertension, focusing on evolving definitions, persistent knowledge gaps, and future directions. Addressing pediatric hypertension early with a lifespan approach is essential to reducing the global prevalence of hypertension and its associated CVD burden. The need for continued study and innovative strategies is underscored by research gaps in the prevention, detection, classification, and treatment of pediatric hypertension.

This study aimed to assess the medical care strategies for primary Hypertension in Iraqi adults through a hospital-based problem-oriented plan to improve patient outcomes by identifying and addressing medical problems.

This cross-sectional study was conducted in a hospital setting of Iraqi adults diagnosed with primary hypertension. Data collection involved patient interviews, medical record reviews, and measurements of blood pressure (BP). The assessment of medical problem-oriented plans (MPOPs) was performed using the validated Alsayed_v1 tool, which includes three main components: the assessment of treatments, the MPOP classification system, and the care plan.

The study participants of 80 Iraqi patients had a mean age of 52.3 years, with 55% male and 45% female. Common comorbid conditions included diabetes mellitus (40%), chronic kidney disease (30%), and coronary artery disease (20%). The most commonly prescribed antihypertensive medications were angiotensin-converting enzyme inhibitors (ACEI) (75.00%). On average, participants were taking 2.087 antihypertensive medications (SD = 0.60), with the majority (63.75%) using a combination of two medications. However, the average BP among participants was 148/92 mmHg, indicating uncontrolled hypertension in most cases (90%). The study identified an average of 3.2 MPOPs per patient, with the most common being inappropriate drug selection (25%), incorrect dosage regimen (20%), and non-adherence to treatment (15%). The chi-squared analysis revealed a significant association between gender and blood pressure status (Χ² = 4.366, p = 0.037). Additionally, the study identified 233 MPOPs across four categories: Indication (23.18%), Effectiveness (53%), Safety (7%), and Patient-related issues (17%). A multiple regression analysis was performed to identify predictors of the number of MPOPs with which heart failure was a significant predictor (β = 4.931, p = 0.003).

The findings highlight the complexity of managing hypertension in Iraqi adults and underscore the need for personalized treatment plans to address the medical problems. Implementing a problem-oriented approach in clinical practice can lead to better BP control and improved health outcomes. This study provides valuable insights for healthcare providers and policymakers to enhance hypertension management strategies in Iraq. However, the study's findings should be interpreted with caution due to limitations such as a relatively small and specific sample, reliance on self-reported data, and the cross-sectional design, which restricts causal inference.

Hypertension is associated with vascular injury characterized by vascular dysfunction, remodeling, and stiffening, which contributes to end-organ damage leading to cardiovascular events and potentially death. Innate (macrophages and dendritic cells), innate-like (γδ T cells) and adaptive immune cells (T and B cells) play a role in hypertension and vascular injury. Perivascular adipose tissue that is the fourth layer of the blood vessel wall is an important homeostatic regulator of vascular tone. Increased infiltration of immune cells in perivascular adipose tissue in hypertension results in generation of oxidative stress and production of cytokines that may cause vascular injury. This review presents an overview of the role of the different immune cells that infiltrate the perivascular adipose tissue and are involved in the pathophysiology of hypertension.

Studies demonstrate that consuming plant-based diets has beneficial effects on several health outcomes. However, the evaluation of the healthiness of plant-based diets and the incidence of hypertension has still been little explored in the literature.

Thus, this study aimed to evaluate the association between plant-based diet indices and the incidence of hypertension in Brazilian adults and test whether the interaction between hPDI, sociodemographic, and lifestyle variables modifies this association.

This longitudinal study included 3192 (F = 2125, average age 34 years) participants from the Cohort of Universities of Minas Gerais (CUME Study, Brazil, 2016-2022). Dietary intakes were assessed using a validated food frequency questionnaire. We measured three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). Participants were classified as new cases of hypertension if they were free of this disease at baseline, had a systolic blood pressure ≥ 140 mmHg, a diastolic blood pressure ≥90 mmHg, were using antihypertensive medications, or had a diagnosis of hypertension by a physician in at least one of the follow-ups. Crude and adjusted Cox regression models were used to evaluate the relationship between plant-based diet indices and hypertension incidence and a multiplicative interaction was tested.

The incidence of hypertension was 19,8/1000 person-years total. The mean follow-up time was 3.36 years. There was an inverse association between the highest quintiles of hPDI (HR = 0.56, 95% CI = 0.37-0.86; HR = 0.55, 95% CI = 0.35-0.88) and hypertension. In subgroup analysis, inverse associations between hPDI and hypertension risk were stronger in participants who were insufficiently active and overweight (p-interaction < 0.05).

Greater consumption of healthful plant foods, reduced consumption of animal-source foods, and less consumption of unhealthful plant foods are important for hypertension prevention in the Brazilian population.

To determine long-term trends in the incidence of hypertension.

Healthy adults in Olmsted County, Minnesota, from 1962 to 2012 were identified and studied with follow-up through 2024. One blood pressure (BP) reading for each calendar year (as available) through follow-up was identified. Hypertension was defined by BP ≥130/80 mm Hg or ≥140/90 mm Hg in 2 different calendar years or by use of antihypertensive medication. Analyses were adjusted for calendar period, age, sex, race, tobacco smoking, nontobacco substance use, depression/anxiety, dyslipidemia; family history of diabetes mellitus or hypertension, body mass index, systolic and diastolic BP, and fasting blood glucose level. Cumulative incidence estimates of hypertension accounted for death as a competing risk and were adjusted to characteristics of the 2000-2012 subcohort.

There were 8323 healthy adults studied (mean age, 39 years). Risk factors for hypertension were older age, male sex, Black race, past and current tobacco smoking, current substance use, depression/anxiety, family history of diabetes or hypertension, higher systolic and diastolic BP, higher blood glucose level, higher body mass index, and period. For the baseline periods of 1963-1969, 1970-1979, 1980-1989, 1990-1999, and 2000-2012, the adjusted 20-year cumulative incidence of hypertension defined by BP ≥130/80 mm Hg was 45%, 47%, 54%, 70%, and 67%; by BP ≥140/90 mm Hg was 22%, 24%, 26%, 35%, and 33%; and by medication use alone was 13%, 12%, 13%, 17%, and 19%, respectively.

A large increase in the incidence of hypertension among healthy adults occurred in the 1990s, with subsequent stabilization.

Hypertension control is the crucial indicator for cardiovascular disease programs. We conducted a baseline cross-sectional survey to estimate hypertension awareness, treatment, and control in the selected districts in 2018-19, where the India Hypertension Control Initiative is being implemented. We conducted cross-sectional surveys in nine project districts for 18-69 years age group. The sample size was 624 per district. The study population was individuals with raised BP/diagnosed HT. We estimated the proportion and 95% confidence intervals (CI) for each district's awareness, treatment, and control. We computed unadjusted and adjusted prevalence ratios (APR) with 95% CI for factors associated with BP control. Hypertension was defined as systolic blood pressure (SBP) > = 140 or diastolic blood pressure (DBP) > = 90 mmHg or treatment in the previous two weeks. Control was defined as SBP < 140 and DBP < 90 mmHg. Among 7047 who had hypertension, 52.4% were aware, 40.8% were on treatment, and 14.5% had BP control. BP control was below 5% in two districts, 5-15% in three districts, and more than 15% in four districts. Among hypertensives aware of the diagnosis, the factors (APR with 95% CI) associated with control were lack of alcohol consumption [1.28 (1.09-1.52)], recent visit to government [1.98 (1.57-2.50)] or private facility [1.99 (1.61-2.46)] and treatment with single drug [2.40 (1.98-2.90)] or multiple drugs [2.84 (2.27-3.55)]. The simple, rapid population-based surveys can document awareness, treatment, and control changes. Improving access to treatment for hypertension through the public or private sector should be a high priority for India.

To evaluate the effects of mobile apps with tailored recommendations on changes in blood pressure (BP) and drug adherence.

This study is a randomized, open-label, multicenter trial to evaluate the efficacy of self-monitoring of BP (SMBP) with a mobile application-based feedback algorithm (SMBP app with feedback) compared with SMBP alone. Patients with uncontrolled hypertension aged 19 years or older were randomly assigned. In the control group, the patients only measured their BP at home using the mobile app combined with a Bluetooth BP monitor and received standard care, whereas in the intervention group, the patients could also receive alerts for BP measurement and additional recommendations from the app using a feedback algorithm in response to the obtained BP value. The primary end point was the change in mean home systolic BP at 24 weeks.

From September 1, 2019, through July 8, 2020, 184 patients were randomized into 2 groups: SMBP app with feedback (n=97) and SMBP alone (n=87). At 24 weeks, the mean ± SD home systolic BP reduction from baseline was significantly greater in the SMBP app with feedback group than in the SMBP alone group (-22.4±13.5 vs -17.2±13.3 mm Hg; P=.02). The SMBP app with feedback group had higher drug adherence and proportion of adherence of 95% or greater than the SMBP alone group.

The SMBP app with feedback is superior to SMBP alone in terms of systolic BP reduction and improved drug adherence in patients with hypertension. Given the high cost of traditional interventions between patients and health care professionals, feedback through mobile apps could potentially be a useful tool in the management of hypertension.

clinicaltrials.gov Identifier: NCT04470284.

We aimed to investigate the association between systolic blood pressure (SBP) and risk of incident chronic kidney disease (CKD) using marginal structural model (MSM) to reflect mutual effects of exposure and confounders on the outcome.

A total of 195,970 adults with an estimated glomerular filtration rate (eGFR) of >60 mL/min/1.73 m2 and no proteinuria were included from a nationally representative sample cohort of Korean population. SBPs were measured through national health examinations. Primary outcome was incident CKD, defined as a composite of events of a decrease in eGFR to <60 mL/min/1.73 m2 or a newly developed proteinuria for at least two consecutive measurements. The association between SBP and risk of CKD was examined using Cox model, time-dependent Cox model, and MSM.

During a follow-up of 5 years, CKD occurred in 3,355 participants (1.7%). With SBP treated as a continuous variable, each 10-mmHg increment was associated with higher risk for incident CKD, regardless of analytical models used. Compared to SBP group of 120-129 mmHg, hazard ratios (95% confidence intervals) for incident CKD for SBP groups of <110, 110-119, 130-139, and ≥140 mmHg in MSM were 0.70 (0.62-0.80), 0.85 (0.77-0.95), 1.16 (1.05-1.27), and 1.63 (1.47-1.80), respectively.

In this nationwide study, we found a significant relationship between higher SBP and higher risk of incident CKD. Further studies are warranted to verify the potential significance of high SBP as a preventable risk factor for the development of CKD in those with preserved renal function.

When evaluating the effectiveness of a drug, a randomized controlled trial (RCT) is often considered the gold standard due to its ability to balance effect modifiers through randomization. While RCT assures strong internal validity, its restricted external validity poses challenges in extending treatment effects to the broader real-world population due to possible heterogeneity in covariates. In this paper, we introduce a procedure to generalize the RCT findings to the real-world trial-eligible population based on the adaption of existing statistical methods. We utilized the augmented inversed probability of sampling weighting (AIPSW) estimator for the estimation and omitted variable bias framework to assess the robustness of the estimate against the assumption violation caused by potentially unmeasured confounders. We analyzed an RCT comparing the effectiveness of lowering hypertension between Songling Xuemaikang Capsule (SXC) - a traditional Chinese medicine (TCM), and Losartan as an illustration. Based on current evidence, the generalization results indicated that by adjusting covariates distribution shift, although SXC is less effective in lowering blood pressure than Losartan on week 2, there is no statistically significant difference among the trial-eligible population at weeks 4-8. In addition, sensitivity analysis further demonstrated that the generalization is robust against potential unmeasured confounders.

The Extension for Community Healthcare Outcomes (ECHO) model was adapted for hypertension education of community health extension workers in the Federal Capital Territory, Nigeria, and delivered as a 7-part series.

This study aims to evaluate implementation outcomes of the hypertension ECHO series mapped to the first 3 levels of the Kirkpatrick model. Outcomes included reach, appropriateness (level 1), effectiveness (level 2), and penetration (level 3).

From August 2022 to April 2023, 7 hypertension ECHO sessions were delivered via Zoom (Zoom Video Communications, Inc) to a health care worker audience including targeted community health extension workers at 12 primary health centers (PHCs) in the Hypertension Treatment in Nigeria Program. Health care workers provided demographic information, engaged in pre- and postsession knowledge quizzes, and shared feedback during live sessions. Surveys were sent to health care workers at 12 PHCs approximately 1 month after each session to ask about the use of the presented material and focus group discussions were performed with these health care workers after the ECHO program concluded. Qualitative and quantitative results were evaluated using an explanatory sequential mixed methods design wherein qualitative data were used to help explain outcomes and variability among participants.

Across 7 ECHO sessions, a total of 1407 live participants were documented. Participants largely found the program was acceptable, with more than 97% of respondents reporting that the session was useful. Postsession knowledge scores increased (range: 2.3%-10.5%) relative to presession scores demonstrating moderate effectiveness. Among 12 PHCs, most (more than 70%) health care workers applied information learned in each session to provide patient care. In 6 focus group discussions, with 31 health care workers (n=15; 48% community health extension workers), participants reported that network connectivity and clinical demands were barriers to live participation and expressed preferences for blended training and asynchronous resources.

Results show that a hypertension ECHO program adapted for community health extension workers effectively increased knowledge among participants and was useful to a majority. Insights gained may inform the scaling of remote hypertension education programs for community health extension workers in similar settings.

ClinicalTrials.gov NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154.

Hypertension is a primary modifiable risk factor for cardiovascular death and disability. Accurate blood pressure (BP) measurement is essential for the diagnosis and treatment of hypertension. Conventional BP measurement with cuff devices is recommended but difficult for patients to perform due to inconvenience, discomfort, and challenges with appropriate cuff sizing and measurement protocols. The emergence of cuffless BP devices provides an opportunity to address many of these problems, including inconvenience, patient comfort, positional requirements, and continuous measurement.

Cuffless BP measurement devices are appealing to patients and clinicians, but validation of these technologies is essential before they can be deployed for clinical use. Key issues that remain include accuracy with risk of undertreatment or overtreatment, equitable access for low- and middle-income countries and minoritized populations, data privacy concerns, and how the devices will be deployed in clinical practice.

Clinicians and patients should only use validated BP cuff devices until cuffless BP measurement devices are appropriately tested and validated.

This research investigates the relationships between the composite dietary antioxidant index (CDAI) and the likelihood of cardiovascular disease (CVD) and mortality in older adults with hypertension. Utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the potential mediating role of the triglyceride-glucose (TyG) index in these relationships.

A cohort of 5,276 participants, aged 65 years or older and diagnosed with hypertension, was extracted from the NHANES database. The main outcomes examined were the odds of CVD and mortality, utilizing data from the National Center for Health Statistics (NCHS). Multivariate logistic regression models were utilized to evaluate the relationship between CDAI and CVD. Cox proportional hazards regression models and Kaplan-Meier survival curves were utilized to analyze the relationship between CDAI and mortality. Mediation analysis was conducted to assess the potential intermediary role of TyG-related indicators-specifically TyG, TyG-BMI, TyG-WC, and TyG-WHtR- in the connection between CDAI and mortality.

The mean CDAI for the study participants was 1.88 ± 3.90, and the average age was 74.15 ± 5.96 years. During an average follow-up duration of 109.51 months, 4,712 cases of CVD and 725 recorded deaths were observed. In the fully adjusted models, CDAI showed a negative association with both CVD (Odds Ratio [OR] = 0.94, 95% Confidence Interval [CI] = 0.92-0.97) and mortality (Hazard Ratio [HR] = 0.95, 95% CI = 0.93-0.97). Mediation analysis indicated that the TyG-BMI, TyG-WC, and TyG-WHtR indices accounted for 33.1%, 34.3%, and 19.1% of the relationship between CDAI and mortality, respectively.

A higher CDAI demonstrated an inverse association with both CVD and mortality in elderly hypertensive individuals. The relationship was partially mediated by TyG-related indices, indicating that increased antioxidant intake may lead to improved health outcomes and a decreased risk of poor prognosis in this population.

Objective: Our study aims to develop a personalized nomogram model for predicting the risk of nonalcoholic fatty liver disease (NAFLD) in hypertension (HTN) patients and further validate its effectiveness. Methods: A total of 1250 hypertensive (HTN) patients from Guangxi, China, were divided into a training group (875 patients, 70%) and a validation set (375 patients, 30%). LASSO regression, in combination with univariate and multivariate logistic regression analyses, was used to identify predictive factors associated with nonalcoholic fatty liver disease (NAFLD) in HTN patients within the training set. Subsequently, the performance of an NAFLD nomogram prediction model was evaluated in the separate validation group, including assessments of differentiation ability, calibration performance, and clinical applicability. This was carried out using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: The risk-prediction model for the HTN patients concomitant with NAFLD included oral antidiabetic drugs (OADs) (OR = 2.553, 95% CI: 1.368-4.763), antihypertensives (AHs) (OR = 7.303, 95% CI: 4.168-12.794), body mass index (BMI) (OR = 1.145, 95% CI: 1.084-1.209), blood urea nitrogen (BUN) (OR = 0.924, 95% CI: 0.860-0.992), triglycerides (TGs) (OR = 1.474, 95% CI: 1.201-1.809), aspartate aminotransferase (AST) (OR = 1.061, 95% CI: 1.018-1.105), and AST/ALT ratio (AAR) (OR = 0.249, 95% CI: 0.121-0.514) as significant predictors. The AUC of the NAFLD risk-prediction model in the training set and the validation set were 0.816 (95% CI: 0.785-0.847) and 0.794 (95% CI: 0.746-0.842), respectively. The Hosmer-Lemeshow test showed that the model has a good goodness-of-fit (p-values were 0.612 and 0.221). DCA suggested the net benefit of using a nomogram to predict the risk of HTN patients concomitant with NAFLD is higher. These results suggested that the model showed moderate predictive ability and good calibration. Conclusions: BMI, OADs, AHs, BUN, TGs, AST, and AAR were independent influencing factors of HTN combined with NAFLD, and the risk prediction model constructed based on this could help to identify the high-risk group of HTN combined with NAFLD at an early stage and guide the development of interventions. Larger cohorts with multiethnic populations are essential to verify our findings.

Dementia is a leading cause of death and disability worldwide. Here we tested the effectiveness of blood pressure (BP) reduction on the risk of all-cause dementia among 33,995 individuals aged ≥40 years with uncontrolled hypertension in rural China. We randomly assigned 163 villages to a non-physician community healthcare provider-led intervention and 163 villages to usual care. In the intervention group, trained non-physician community healthcare providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic BP goal of <130 mm Hg and a diastolic BP goal of <80 mm Hg, with supervision from primary care physicians. Over 48 months, the net reduction in systolic BP was 22.0 mm Hg (95% confidence interval (CI) 20.6 to 23.4; P < 0.0001) and that in diastolic BP was 9.3 mm Hg (95% CI 8.7 to 10.0; P < 0.0001) in the intervention group compared to usual care. The primary outcome of all-cause dementia was significantly lower in the intervention group than in the usual care group (risk ratio: 0.85; 95% CI 0.76 to 0.95; P = 0.0035). Additionally, serious adverse events occurred less frequently in the intervention group (risk ratio: 0.94; 95% CI 0.91 to 0.98; P = 0.0006). This cluster-randomized trial indicates that intensive BP reduction is effective in lowering the risk of all-cause dementia in patients with hypertension. ClinicalTrials.gov: NCT03527719 .

Background and objectives: Hypertension remains a leading global cause of cardiovascular morbidity and mortality, with suboptimal blood pressure (BP) control despite available treatments. Monotherapy often fails to achieve target BP, necessitating combination therapies. Quadruple low-dose combination therapy (quadpill) has emerged as a potential strategy to enhance efficacy while minimizing side effects. This systematic review evaluates the effectiveness and safety of quadpill therapy compared to standard monotherapy and dual therapy. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus from inception till January 2025 for randomized controlled trials (RCTs) investigating quadruple therapy in hypertensive patients. Studies comparing quadpill therapy with monotherapy, dual therapy, or placebo were included. Data on BP reduction, achievement of target BP, and adverse events were extracted and analyzed. The Cochrane Risk of Bias tool (RoB-2) was used to assess study quality. Results: Five RCTs were included in the current systematic review. Quadpill therapy resulted in greater reductions in systolic BP (SBP and diastolic BP (DBP) compared to monotherapy and dual therapy across all time points. The proportion of patients achieving target BP (<140/90 mmHg) was significantly higher in the quadpill group. The safety profile was favorable, with adverse event rates comparable to those in monotherapy and dual therapy groups. Notable adverse effects included mild dizziness, edema, and biochemical alterations (elevated fasting glucose and uric acid levels), but these did not lead to significant treatment discontinuation. Conclusions: Quadruple low-dose combination therapy is a promising approach for improving BP control while maintaining a favorable safety profile. Early initiation of quadpill therapy could mitigate treatment inertia and improve long-term cardiovascular outcomes.

The 2021 Kidney Disease: Improving Global Prognosis (KDIGO) guidelines set a target systolic blood pressure (SBP) of 120 mmHg for chronic kidney disease (CKD) patients. This paper aims to compare mortality outcomes in CKD patients following the 2021 KDIGO guidelines versus the 2012 KDIGO guidelines. We used the National Health and Nutrition Examination Survey (NHANES) database to categorize CKD patients into four groups: "above 2021 KDIGO only", "above 2012 KDIGO only", "above both targets" and "controlled with both targets". We compared differences in all-cause and cardiovascular deaths among these groups. In total, 10,612 CKD patients from the 2001-2018 NHANES database were identified. Subsequently, 2,226 patients lacking mortality information and 1,157 without crucial laboratory data were excluded. 7,229 CKD patients were enrolled, with 50.67% above both targets, 27.1% controlled within both targets, 1.01% above the 2012 KDIGO target, and 21.22% only above the 2021 KDIGO target. In multivariate analyses, the risk of all-cause mortality was not statistically significant (hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.8-1.02, P = 0.11) for patients above the 2021 KDIGO target only compared to those controlled with both targets. Similar results were found for cardiovascular deaths. The 2021 KDIGO guidelines did not differentiate high-risk CKD populations in terms of all-cause death and cardiovascular death, compared with the 2012 KDIGO guidelines.

Hypertension is a leading global cause of morbidity and mortality and is increasing in low- and middle-income countries, where unawareness of hypertension is a primary obstacle to management. Community health workers (CHWs) in combination with mobile health (mHealth) tools are increasingly used in LMIC health systems to strengthen primary care infrastructure. In this study, we applied this care model to hypertension in rural Guatemala by comparing the accuracy of CHWs equipped with an mHealth clinical decision support application in diagnosing hypertension to concurrent physician evaluation.

We performed a prospective diagnostic accuracy study in which adults from rural Guatemalan communities were assessed independently by a CHW aided by a mHealth application and a physician. Assessment included medical history; measurement of blood pressure, height and weight; and determination of hypertension status. CHW-physician agreement on hypertension status and past medical history elements was assessed by Kappa analysis and proportional agreement, with a priori thresholds of Kappa = 0.61 and agreement of 90%. Agreement on patient measurements was evaluated using Bland-Altman and regression analyses.

Of 359 participants enrolled, 47 (13%) were confirmed to have hypertension and another 11 (3%) had possible hypertension. CHW-physician agreement was high for hypertension diagnosis, with Kappa = 0.8 (95% CI = 0.72, 0.88) and overall agreement 92.8% (95% CI = 90.1%, 95.4%). Bland-Altman analysis showed small biases toward lower systolic blood pressure, higher height, and lower BMI measurements by CHWs. Most patient history characteristics showed moderate to almost perfect (Kappa: 0.41-1) agreement between physicians and CHWs.

In this study based in rural Guatemala, CHWs using a mHealth clinical decision support application were found to screen adult patients for hypertension with similar accuracy to a physician. This approach could be adapted to other low-resource settings to reduce the burden of undiagnosed and untreated hypertension.

Identifying influences on engagement with blood pressure (BP) checks can assist with intervention design for hypertension detection. This systematic review searched four databases (Embase, Emcare, MEDLINE and Web of Science) for papers published from 2015 to 2023 (PROSPERO ID: CRD42023398002). Eligible studies reported influences on BP checks in community or primary care settings. Data were coded and mapped using the Action, Actor, Context, Target, Time framework and Behaviour Change Wheel. Analysis of 18 studies generated eight themes: (1) 'Difficult-to-use devices with no accessible information on how to use them' (2) 'Lack of awareness about hypertension and BP checks', (3) 'Stigma and disconnect with identity' (4) 'Beliefs about the value of BP checks', (5) 'Fear and uncertainty', (6) 'Lack of appropriate and comfortable local services' (7) 'Financial cost of engaging with BP check services' and (8) 'Social contacts or health professional recommended a check'. Knowledge, identity, emotions, social contacts and environmental factors are key behavioural influences on adults' engagement with BP checks. Potential intervention strategies include education on hypertension, addressing misconceptions about BP checks, increasing access to BP check services and harnessing the influence of social norms, social connections and trusted sources to improve engagement.

The Non-Exercise Estimated Cardiorespiratory Fitness (NEE-CRF) method has gained attention in recent years due to its simplicity and effectiveness. Hypertension and all-cause mortality are significant public health issues worldwide, highlighting the importance of exploring the association between NEE-CRF and these two conditions.

The data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS) were utilized to validate the association between NEE-CRF and hypertension as well as all-cause mortality. NEE-CRF was calculated using a sex-specific longitudinal non-exercise equation. To investigate the relationship between hypertension and all-cause mortality, multivariable regression analysis, generalized additive models, smooth curve fittings, and threshold effect analysis were employed. Logistic regression was used for hypertension analysis, while Cox proportional hazards regression was applied for all-cause mortality. Additionally, we conducted stratified analyses and interaction tests among different groups.

In the NHANES, after fully adjusting for covariates, each unit increase in NEE-CRF was associated with a 24% reduction in the risk of hypertension (OR: 0.76, 95% CI: 0.74-0.78) and a 12% reduction in the risk of all-cause mortality (HR: 0.88, 95% CI: 0.79-0.86). Subgroup analyses showed that the relationship between NEE-CRF and both hypertension and all-cause mortality remained negatively correlated across different subgroups. The negative association was also validated in the CHARLS.

Higher NEE-CRF levels may reduce the risk of developing hypertension and all-cause mortality.

YouTube is among the most highly used internet video sharing platforms worldwide.

The aim in this study was to conduct a social media content analysis of Dietary Approaches to Stop Hypertension (DASH) diet videos on YouTube.

Specific search parameters were input into YouTube, and 101 videos were evaluated for quality and viewer exposure/engagement metrics independently by 3 content experts using the DISCERN instrument, a 16-item instrument designed to assess quality, reliability, and dependability of an online source. Scores were aggregated for analysis.

The majority (n = 69, 68.3%) of the videos were categorized as educational and came from a nonprofit source (n = 35, 34.7%). Although multiple speakers were the most frequent speaker type (n = 30, 29.7%), influencers/actors, dietitians, and healthcare providers were relatively equally distributed across the category (25.7%, 22.8%, and 21.8% respectively). Correlation analysis evaluating video's views, comments, and likes indicates that these video metrics are not correlated with video quality. However, the length of video was moderately and positively associated (P = .01) with the 4 DISCERN parameters of quality.

Study findings suggest that videos on DASH diet offered via YouTube could potentially be an inexpensive venue to promote healthful dietary practices and educate clients. Existing YouTube content on DASH diet demonstrates significant variability in quality ratings based on DISCERN. Providers should direct individuals to engage with high-quality educational DASH diet videos on YouTube that are created with qualified health professionals and are shared by reputable institutions.

Previous studies have reported a significant relationship between the baseline Chinese visceral adipose index (CVAI) and the risk of new-onset hypertension (NOH). However, the long-term effect of the CVAI and the risk of NOH remains uncertain. This study aimed to investigate the association between the cumulative CVAI and the risk of NOH.

Data were obtained from the China Health and Retirement Longitudinal Study from 2011 to 2020. In total, 2,836 Chinese participants ≥45 years were included. Multivariable logistic regression analysis as well as restricted cubic spline regression analysis were performed to assess the association of the cumulative CVAI, visceral adiposity index (VAI), and lipid accumulation product (LAP) with the risk of NOH. Furthermore, receiver operating characteristic (ROC) curve analysis was used to determine the area under the ROC curves between the risk of NOH and the adiposity indices to compare the predictive powers of the cumulative CVAI, VAI, and LAP for NOH.

During the 5-year follow-up period, 433 cases of NOH were recorded. The cumulative CVAI, VAI, and LAP were positively associated with the risk of NOH. After adjusting for potential confounders, as compared to the lowest quartile of the cumulative CVAI, VAI, and LAP, the participants in the highest quartile had a significantly higher risk for NOH (odds ratio = 1.74, 1.46, and 1.95; 95% confidence interval = 1.25-2.42, 1.05-2.03, and 1.39-2.75, respectively). ROC analysis revealed that the cumulative CVAI had the highest relationship with the risk of NOH.

The cumulative CVAI was positively associated with an increased risk of NOH in middle-aged and elderly Chinese populations. In addition, the performance of the cumulative CVAI to predict NOH was superior to other visceral obesity indices. Monitoring long-term changes to the CVAI may assist with early identification of individuals at high risk of NOH.