Association of Dietary Approaches to Stop Hypertension diet and Mediterranean diet with blood pressure in less-developed ethnic minority regions

Objective: We aimed to investigate the association of Dietary Approaches to Stop Hypertension (DASH)-style diet and Mediterranean-style diet with blood pressure in less-developed ethnic minority regions (LMERs). Design: Cross-sectional study. Setting: Dietary intakes were assessed by a validated food frequency questionnaire. Dietary quality was assessed by the DASH-style diet score and the alternative Mediterranean-style diet (aMED) score. The association between dietary quality and blood pressure was evaluated using multivariate linear regression model. We further examined those associations in subgroups of blood pressure level. Participants: A total of 81433 adults from the China Multi-Ethnic Cohort (CMEC) study were included in this study. Results: In the overall population, compared with the lowest quintile, the highest quintile of DASH-style diet score was negatively associated with systolic BP (coefficient: −2.78, 95% CI: −3.15 to −2.41; P-trend<0.001), while the highest quintile of aMED score had a weaker negative association with systolic BP (coefficient: −1.43, 95% CI: −1.81 to −1.05; P-trend<0.001). Both dietary indices also showed a weaker effect on diastolic BP (coefficient for DASH-style diet: −1.06, 95% CI: −1.30 to −0.82; coefficient for aMED: −0.43, 95% CI: −0.68 to −0.19). In the subgroup analysis, both dietary indices showed a stronger beneficial effect on systolic BP in the hypertension group than in either of the other subgroups. Conclusion: Our results indicated that the healthy diet originating from Western developed countries can also have beneficial effects on blood pressure in LEMRs. DASH-style diet may be a more appropriate recommendation than aMED as part of a dietary strategy to control blood pressure, especially in hypertensive patients.

Methodological Aspects of Meta-Analyses Assessing the Effect of Blood Pressure–Lowering Treatment on Clinical Outcomes

Systematic reviews and meta-analyses are often considered the highest level of evidence, with high impact on clinical practice guidelines. The methodological literature on systematic reviews and meta-analyses is extensive and covers most aspects relevant to the design and interpretation of meta-analysis findings in general. Analyzing the effect of blood pressure–lowering on clinical outcomes poses several challenges over and above what is covered in the general literature, including how to combine placebo-controlled trials, target-trials, and comparative studies depending on the research question, how to handle the potential interaction between baseline blood pressure level, common comorbidities, and the estimated treatment effect, and how to consider different magnitudes of blood pressure reduction across trials. This review aims to address the most important methodological considerations, to guide the general reader of systematic reviews and meta-analyses within our field, and to help inform the design of future studies. Furthermore, we highlight issues where published meta-analyses have applied different analytical strategies and discuss pros and cons with different strategies.

Evaluation of the effectiveness of drug treatment in patients with arterial hypertension and insomnia

Objective: chronic sleep disturbance is a comorbid condition with arterial hypertension, often combined with affective disorders, anxiety, depression. Forced sleep deprivation in patients with hypertension indicates a high activity of the renin‑angiotensin‑aldosterone system (RAAS) and desynchronosis of biological rhythms caused by a probable deficit in melatonin secretion during the night. Timely elimination of any pathological process associated with insomnia and arterial hypertension (AH) in the early stages of its development is a prerequisite for the effectiveness of therapy. Therefore, initial therapy should help neutralize the adverse effects of RAAS and improve the 24‑hour blood pressure (BP) profile. The aim of this study was to determine the therapeutic effect of monotherapy with an angiotensin converting enzyme (ACE) inhibitor, As well as in combination with a synthetic analogue of melatonin, on the course of hypertension and parameters of systemic hemodynamics in patients with first degree hypertension with insomnia at the onset of the disease. Combined therapy with an ACE inhibitor and a synthetic analogue of MT in patients with hypertension and insomnia was accompanied by an improvement in the clinical state, achievement of the target blood pressure level in most patients, positive dynamics of central blood pressure parameters and indicators reflecting the rigidity of peripheral arteries.

The pathomorphology of the renal cortex depending of arterial hypertension duration course

The kidneys autopsy material of persons with arterial hypertension in different duration was examined. Morphometry of the renal corpuscle area and cortical and juxtamedullary nephrons vascular glomeruli was performed. There were 4 groups - a control group (with a normal blood pressure level), and groups with arterial hypertension - the initial stage (group 2), arterial hypertension for 5-10 years (group 3), long-term arterial hypertension - more than 10 years (group 4). It was found that cortical nephrons are distinguished by earlier and more pronounced hyperplasia of the vascular glomerulus, they are more rapidly exposed to sclerosis, which appears in the 5-10th year of the course of the disease. The hyperplasia of the vascular glomerulus components is progressively increasing in juxtaglomerular nephrons, they are less susceptible to sclerosis processes. Key words: arterial hypertension, juxtaglomerular apparatus, juxtamedullary nephrons, vascular glomerulus.

Efficacy of Mrudu Samvahana (Forehead Massage) over Takra Dhara (Buttermilk Dripping Therapy) in Anxiety and Stress Induced Essential Hypertension – A Randomized Clinical Trial.

Blood pressure level measuring above 140/90 mm of Hg is termed as hypertension. Hypertension is associated with various risk factors and also is mainly responsible for mortality in industrialized countries. The treatment for hypertension in modern science is palliative in nature. Many of these, along with its effectiveness in controlling the blood pressure, cause adverse side effects; hence the need for the hour is an alternate therapy with no potential side effects. Ayurveda has potential medicines to alleviate hypertension without causing any side effects. The study was to evaluate clinical efficacy of two Ayurveda procedures Mrudu Samvahana and Takradhaara in essential hypertension. The study included a total of 40 patients, attending the Outpatient department of KLE Ayurveda hospital, randomized into Group A and Group B of 20 each. The patients in group A received Mrudu samvaahana with Murchita tila taila which was performed 20 minutes per day for 7 days. The patients in group B received Takra dhara with Amalaki siddha takra which was performed 40 minutes per day for 7 days. Statistical analysis revealed that both groups Mrudu Samvahana and Takradhara showed significant (P< 0.0001) results determined by unpaired T test in objective parameters. Between the group assessment. revealed that Takra dhara has shown better results compared to mrudu samvahana in reduction of systolic and diastolic blood pressure. (P<0.0048).

Hypertension-mediated organ damage and established cardiovascular disease in patients with hypertension: the China Hypertension Survey, 2012–2015

Hypertension is a major health burden worldwide. However, there is limited data on the status of hypertension-mediated organ damage (HMOD) and established cardiovascular (CV) disease in Chinese hypertensive patients. The aim of this study is to determine the prevalence of HMOD and established CV disease in a nationally representative population in China. A stratified multistage random sampling method was used in the China Hypertension Survey and 21,243 participants aged 35 or older were eligible for analysis in this study. For each participant, the demographic information and a self-reported medical history were acquired. Blood pressure was measured with the electronic device 3 times on the right arm, supported at heart level, after the participant was sitting at rest for 5 min. Samples of blood and urine were tested. 2-D and Doppler echocardiography were used to assess the heart’s function and structures. Sampling weights were calculated based on the 2010 China population census data. Overall, the weighted prevalence of asymptomatic HMOD was 22.1%, 28.9%, 23.1%, 6.4%, and 6.2% for wide pulse pressure, left ventricular hypertrophy, microalbuminuria, chronic kidney disease, and abnormal ankle-brachial index, respectively. For the established CV disease, the weighted prevalence was 1.8%, 1.3%, 2.0%, and 1.1% for stroke, coronary artery disease, heart failure, and atrial fibrillation, respectively. The prevalence of asymptomatic HMOD and established CV disease was greater with higher blood pressure level (P < 0.05), rather than ankle-brachial index. Compared to those with uncontrolled hypertension, the prevalence of asymptomatic HMOD was lower in patients with controlled hypertension. In summary, the prevalence of HMOD in Chinese people aged 35 or older was very common, indicating a substantial future burden of both morbidity and mortality from hypertension in China. Clinical trial registration number: ChiCTR-ECS-14004641.

A geodatabase of blood pressure level and the associated factors including lifestyle, nutritional, air pollution, and urban greenspace

Objectives Hypertension is a prevalent chronic disease globally. A multifaceted combination of risk factors is associated with hypertension. Scientific literature has shown the association among individual and environmental factors with hypertension, however, a comprehensive database including demographic, environmental, individual attributes and nutritional status has been rarely studied. Moreover, an integrated spatial-epidemiological approach has been scarcely researched. Therefore, this study aims to provide and describe a geodatabase including individual-based and socio-environmental data related to people living in the city of Mashhad, Iran in 2018. Data description The database has been extracted from the PERSIAN Organizational Cohort study in Mashhad University of Medical Sciences. The data note includes three shapefiles and a help file. The shapefile format is a digital vector storage format for storing geometric location and associated attribute information. The first shapefile includes the data of population, air pollutants and amount of available green space for each census block of the city. The second shapefile consists of aggregated blood pressure data to the census blocks of the city. The third shapefile comprises the individual characteristics data (i.e., demographic, clinical, and lifestyle). Finally, the fourth file is a guide to the previous data files for users.

Intrauterine L-NAME Exposure Weakens the Development of Sympathetic Innervation and Induces the Remodeling of Arterial Vessels in Two-Week-Old Rats

Nitric oxide (NO) has been shown to stimulate differentiation and increase the survival of ganglionic sympathetic neurons. The proportion of neuronal NOS-immunoreactive sympathetic preganglionic neurons is particularly high in newborn rats and decreases with maturation. However, the role of NO in the development of vascular sympathetic innervation has never been studied before. We tested the hypothesis that intrauterine NO deficiency weakened the development of vascular sympathetic innervation and thereby changed the contractility of peripheral arteries and blood pressure level in two-week-old offspring. Pregnant rats consumed NOS inhibitor L-NAME (250 mg/L in drinking water) from gestational day 10 until delivery. Pups in the L-NAME group had a reduced body weight and blood level of NO metabolites at 1–2 postnatal days. Saphenous arteries from two-week-old L-NAME offspring demonstrated a lower density of sympathetic innervation, a smaller inner diameter, reduced maximal active force and decreased α-actin/β-actin mRNA expression ratio compared to the controls. Importantly, pups in the L-NAME group exhibited decreased blood pressure levels before, but not after, ganglionic blockade with chlorisondamine. In conclusion, intrauterine L-NAME exposure is followed by the impaired development of the sympathetic nervous system in early postnatal life, which is accompanied by the structural and functional remodeling of arterial blood vessels.

The Prevalence of Hypertension in the Population without Awareness of the Disease: Data from a Rural Town of Shandong Province, China

Objective. To understand the prevalence of hypertension in the population without awareness of hypertension in a rural area, a cross-sectional study was carried out. Methods. Blood pressures were measured in residents over 60 years during the National Basic Public Health Service project carrying on in a rural town of Shandong province. Combined with detail information of the hypertension disease history, the status of prevalence of hypertension was calculated. Basic information and clinical laboratory examinations were analyzed with Student’ t or t’ or chi-square test for univariate analysis. Multinomial logistic analysis was used in exploring multiple variables. Results. According to the individual history and blood pressure levels, the awareness rate of hypertension in the population over 60 years old was 50.3% (1285/2554, 95% CI: 48.3–52.3%). The prevalence of hypertension was 55.1% (1270/2304, 95% CI: 53.1–57.2%) in the population without awareness of hypertension, in which the proportion of stage 1 hypertension was 58.8% (747/1270), stage 2 hypertension was 28.9% (367/1270), and stage 3 hypertension was 12.3% (156/1270). The prevalence of hypertension in men was 54.4% (611/1124, 95% CI: 51.4–57.3%), which was almost the same as that in women (55.8%, 659/1180, 95% CI: 53.0–58.7%) (X2 = 0.515, P = 0.473 ). The prevalence of hypertension increased with age (X2trend = 11.848, P = 0.001 ). Age, BMI, total cholesterol, triglyceride, and drinking rate were positively correlated with the prevalence of hypertension, that is, the higher the level of these factors, the higher the prevalence of hypertension; on the contrary, LDL and smoking rate might be negatively correlated with the prevalence of hypertension, which means, the higher the prevalence of hypertension, the lower the level of these two indicators. Binary and multinominal logistic results showed that age, BMI, and drinking had stronger effects on the higher blood pressure level. Conclusions. The awareness rate of hypertension among the elderly in a rural area needs to be further improved. In the prevention and control of hypertension, close attention should be paid to the group of elder, high BMI index, high levels of total cholesterol and triglyceride, and drinking habits.