Use of FGF21 analogs for the treatment of metabolic disorders: a systematic review and meta-analysis

ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far.

Quantitative relationship between physical activity and antihypertensives in elderly women / Relación cuantitativa entre actividad física y antihipertensivos en ancianas / Relação quantitativa entre atividade física e anti-hipertensivos em idosas

ABSTRACT Introduction: Physical activity is an important tool to manage systemic arterial hypertension. However, less is known about the relationship of physical activity with the number of antihypertensive drugs used by older adults. Objective: The aim of this study was to compare the number of antihypertensive drugs used by older female adults (aged ≥ 60 years) with a low level of physical activity with the number used by those with a high level of physical activity, and to verify how many participants used more than two antihypertensive drugs. Methods: Twenty-eight physically active older women with systemic arterial hypertension who participated in a physical activity program for community-dwelling older female adults were divided into two groups: participants who presented lower habitual physical activity levels were placed in group 1 and participants that presented higher habitual physical activity levels were placed in group 2, according to the Baecke questionnaire. In addition, the number of antihypertensive drugs used by participants was collected. Results: The number of prescribed antihypertensive drugs was 2.0 (median) for both groups investigated. There was no significant difference between groups regarding the number of antihypertensive tablets prescribed (p>0.05). Although there was no statistical difference, a higher proportion of participants from the lower physical activity group used more than two antihypertensive drugs. Conclusion: The level of habitual physical activity did not affect the number of antihypertensive tablets used by hypertensive elderly women. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMEN Introducción: La actividad física es una herramienta importante para el manejo de la hipertensión arterial sistémica. Sin embargo, se sabe poco sobre la relación de la actividad física con la cantidad de medicamentos antihipertensivos utilizados por las ancianas. Objetivo: El objetivo de este estudio fue hacer una comparación entre el número de medicamentos antihipertensivos utilizados por mujeres adultas mayores (≥ 60 años) y bajo nivel de actividad física con el número utilizado por aquellas con alto nivel de actividad física, y verificar cuántas de las participantes usaron más de dos medicamentos antihipertensivos. Métodos: Veintiocho ancianas físicamente activas con hipertensión arterial sistémica que participaron en un programa de actividad física para mujeres adultas mayores residentes en la comunidad fueran divididas en dos grupos: las participantes que presentaron niveles más bajos de actividad física habitual se ubicaron en el grupo 1 y las participantes que presentaron los mayores niveles de actividad física se ubicaron en el grupo 2, según el cuestionario de Baecke. Además, se recogió el número de medicamentos antihipertensivos utilizados por las participantes. Resultados: El número de comprimidos antihipertensivos prescritos fue de 2,0 (mediana) para ambos grupos investigados. No hubo diferencia significativa entre los grupos en cuanto al número de medicamentos antihipertensivos prescritos (p>0,05). Aunque no hubo diferencia estadística, una mayor proporción de participantes del grupo de menor actividad física usó más de dos medicamentos antihipertensivos. Conclusión: El nivel de actividad física habitual no afectó el número de comprimidos antihipertensivos utilizados por las ancianas hipertensas. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

RESUMO Introdução: A atividade física é uma importante ferramenta no manejo da hipertensão arterial sistêmica. No entanto, pouco se sabe sobre a relação entre a atividade física e a quantidade de anti-hipertensivos usados por idosos. Objetivo: O objetivo deste estudo foi realizar uma comparação entre o número de anti-hipertensivos usados por idosas (≥ 60 anos) com baixo nível de atividade física com o número usado por aquelas com alto nível de atividade física, verificando quantas participantes usaram mais de dois anti-hipertensivos. Métodos: Vinte e oito idosas fisicamente ativas com hipertensão arterial sistêmica que participavam de um programa de atividade física para idosas da comunidade foram divididas em dois grupos: as participantes que apresentaram níveis mais baixos de atividade física habitual foram colocadas no grupo 1 e as participantes que apresentaram maiores níveis de atividade física foram colocados no grupo 2, de acordo com o questionário de Baecke. Ademais, coletou-se o número de medicamentos anti-hipertensivos utilizados pelas participantes. Resultados: O número de fármacos anti-hipertensivos prescritos foi de 2,0 (mediana) para ambos os grupos investigados. Não houve diferença significativa entre os grupos quanto ao número de comprimidos anti-hipertensivos prescritos (p>0,05). Embora não tenha havido diferença estatística, uma maior proporção de participantes entre o grupo de menor atividade física utilizava mais de dois anti-hipertensivos. Conclusão: O nível de atividade física habitual não afetou a quantidade de comprimidos anti-hipertensivos utilizados pelas idosas hipertensas. Nível de evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

Hearing loss and its relationship with blood pressure among workers exposed to noise in a brewery / 公共卫生与预防医学

Objective To investigate the health status of workers exposed to noise in a brewery in Beijing and to analyze the relationship between hearing loss and blood pressure. Methods A total of 949 noise-exposed workers in a brewery who participated in occupational health examination were selected as the investigation subjects. A survey was conducted to investigate the pure tone hearing threshold and abnormal blood pressure of the workers with different characteristics, and to analyze the relationship between the two. Results Among the noise-exposed workers, the detection rates of hearing abnormality, hypertension, and increased systolic and diastolic blood pressure were 73.55%, 52.37%, 43.84% and 46.47%, respectively. The detection rates of hearing abnormality, indicators of hypertension, high frequency hearing threshold abnormality and increased binaural high frequency hearing threshold on average in males were higher than those in females (P 0.05), the detection rates of other hearing abnormality, indicators of hypertension, speech frequency hearing threshold abnormality, high frequency hearing threshold abnormality，increased binaural high frequency hearing threshold on average and the weighted value of the better ear's hearing threshold all increased or had an increasing trend with the increase of age or working years (P< 0.05). The detection rates of hypertension in the groups with high frequency hearing threshold abnormality and increased binaural high frequency hearing threshold on average were higher than those in the normal group (P＜0.05). Conclusion The noise-exposed workers in the brewery have hearing impairment, which is related to the occurrence of hypertension. It is recommended to strengthen the publicity and education on noise protection and take protective measures to reduce the occurrence of occupational noise injury.

Mental Health of Elderly Hypertensive Patients in Primary Health Care: An Integrative Review

Introduction: The global context highlights several challenges and manifestations stemming from population aging, among which mental health care for elderly people stands out. Primary health care (PHC), the largest gateway to Brazil's health care network, is strategic in promoting health and care, and in preventing diseases such as systemic arterial hypertension (SAH). It is known that elderly people with SAH present various symptoms of psychological distress and mental disorders that can aggravate cardiac symptoms. This can lead to health, social, and financial impacts on the lives of elderly people and their families. Objective: To identify the evidence on mental health care for hypertensive elderly people in PHC. Materials and methods: This is an integrative literature review; data was collected in January 2023 from the following databases: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus, and APA PsycINFO. The studies included were those available in full, in Spanish, English, and Portuguese, and which answered the research question elaborated following the PICo strategy. The article's search and selection processes were performed independently by two trained researchers through peer review. The Prisma guidelines were followed. Results: The studies found were published between 2008 and 2020 and showed two analysis categories: integrated care provided by the multi-professional team and measures that emphasize health-related quality of life. The studies highlighted integrated care management programs, qualification of the bond and territorialization, health measures that have an impact on psychological suffering, and group activities. Conclusions: Mental health care provided in an integrated and shared manner, combined with health activities and groups, is a powerful tool for elderly hypertensive patients in PHC. These strategies still have some challenges in certain contexts, but the review emphasizes the importance of consolidating this form of care, provided in PHC and has outcomes at all levels of care.

Introducción: el contexto mundial destaca diversos desafíos y manifestaciones del envejecimiento de la población, entre ellos la atención a la salud mental de los ancianos. La atención primaria de salud (APS), la mayor puerta de entrada a la red asistencial de Brasil, es estratégica en la promoción de la salud, el cuidado y la prevención de enfermedades como la hipertensión arterial sistémica (HSA). Se sabe que los ancianos con HSA presentan diversos síntomas de angustia psicológica, así como trastornos mentales que pueden agravar los síntomas cardíacos. Esto puede tener repercusiones sanitarias, sociales y económicas en la vida del anciano y su familia. Objetivo: Identificar las evidencias sobre la atención a la salud mental de los ancianos hipertensos en APS. Materiales y método: se trata de una revisión bibliográfica integradora; los datos se recogieron en enero de 2023 de las siguientes bases de datos: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus y APA PsycINFO. Se incluyeron estudios disponibles en su totalidad, en español, inglés y portugués, que respondieran a la pregunta de investigación elaborada a la luz de la estrategia PICo. La búsqueda y selección de artículos fue realizada de forma independiente por dos investigadores capacitados mediante revisión por pares. Se siguieron las recomendaciones Prisma. Resultados: los estudios encontrados fueron publicados entre 2008 y 2020, y mostraron dos categorías de análisis: atención integrada por el equipo multiprofesional y acciones que enfatizan la calidad de vida relacionada con la salud. Los estudios encontrados destacaron los programas de gestión integrada de la atención, la cualificación del vínculo y la territorialización, las acciones sanitarias que inciden en el sufrimiento psicológico y las actividades grupales. Conclusiones: la atención a la salud mental realizada de forma integrada y compartida, articulada con actividades y grupos de salud, es poderosa para los pacientes hipertensos ancianos en APS. Estas estrategias aún presentan algunos desafíos en algunos contextos, pero la revisión refuerza la importancia de consolidar esta atención, que se realiza en APS y tiene resultados en todos los niveles de atención.

Introdução: o contexto global evidencia diversos desafios e manifestações do envelhecimento populacional, dos quais destaca-se o cuidado em saúde mental da pessoa idosa. A atenção primária à saúde (APS), maior porta de entrada na rede de atenção à saúde do Brasil, é estratégica na promoção à saúde, ao cuidado e à prevenção de agravos, como a hipertensão arterial sistêmica (HAS). Sabe-se que a pessoa idosa com HAS manifesta diversos sintomas de sofrimento psíquico, bem como transtornos mentais que podem agudizar os sintomas cardíacos. Esse fato pode causar impactos de saúde, sociais e financeiros na vida da pessoa idosa e sua família. Objetivo: identificar as evidências sobre o cuidado em saúde mental ao idoso hipertenso na APS. Materiais e método: trata-se de uma revisão integrativa da literatura; a coleta de dados ocorreu em janeiro de 2023, nas seguintes bases de dados: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus e APA PsycINFO. Incluíram-se estudos disponíveis na íntegra, em espanhol, inglês e português, que respondessem à questão de pesquisa elaborada à luz da estratégia PICo. A busca e a seleção dos artigos foram executadas por dois pesquisadores treinados, de modo independente, mediante discussão por pares. As recomendações do Prisma foram seguidas. Resultados: os estudos encontrados foram publicados de 2008 a 2020 e evidenciaram duas categorias de análise: cuidados integrados pela equipe multiprofissional e ações que enfatizam a qualidade de vida relacionada à saúde. Destacaram-se nos estudos encontrados programas de gestão do cuidado integrado, qualificação do vínculo e territorialização, ações de saúde que impactam no sofrimento psíquico e atividades de grupo. Conclusões: o cuidado em saúde mental realizado de maneira integrada e compartilhada articulado com atividades de saúde e grupos são potentes para os idosos hipertensos na APS. Essas estratégias ainda apresentam alguns desafios em alguns contextos, no entanto a condução da revisão reforça a importância da consolidação desse cuidado, que acontece na APS e tem desfechos em todos os níveis de atenção.

El porcentaje de grasa corporal y su relación con la presión arterial en adultos de áreas rurales y urbanas

Fundamento: el exceso de grasa corporal se encuentra marcado por un desequilibrio permanente entre el consumo de alimentos y el gasto energético de los seres humanos que generan diversos riesgos para salud, entre ellos el aumento de la presión arterial. Objetivo: determinar la relación entre el porcentaje de grasa corporal y la presión arterial en adultos de áreas rurales y urbanas del municipio del Carmen de Chucurí, Colombia. Método: se realizó un estudio descriptivo y correlacional con enfoque cuantitativo a una muestra escogida de forma aleatoria, compuesta por 406 sujetos para los habitantes del sector rural y 409 del sector urbano entre los 18 y 40 años del municipio Carmen Chucurí. Se evaluó la masa corporal, con la utilización de la herramienta denominada impedancia eléctrica y el equipo marca OMRON HBF-514C y la presión arterial y se utilizó el tensiómetro digital OMRON HEM-4030. Resultados: el principal hallazgo de esta investigación fue la asociación positiva y significativa entre el porcentaje de grasa corporal y la presión arterial diastólica en hombres y mujeres rurales del municipio Carmen de Chucurí. Conclusiones: el porcentaje de grasa corporal se asocia positiva y significativamente con la presión arterial diastólica en hombres y mujeres rurales del municipio Carmen de Chucuri, para los demás parámetros analizados no fue evidente una correlación significativa.

Foundation: excess body fat is marked by a permanent imbalance between food consumption and energy expenditure of human beings that generate various health risks, including increased blood pressure. Objective: determine the relationship between the percentage of body fat and blood pressure in adults from rural and urban areas of the municipality of Carmen de Chucurí, Colombia. Method: a descriptive and correlational study with a quantitative approach was carried out on a randomly chosen sample, composed of 406 subjects for the inhabitants of the rural sector and 409 of the urban sector between 18 and 40 years of age from the Carmen Chucurí municipality. Body mass was evaluated, with the use of the tool called electrical impedance and the OMRON HBF-514C brand equipment, and blood pressure and the OMRON HEM-4030 digital blood pressure monitor was used. Results: the main finding of this research was the positive and significant association between the percentage of body fat and diastolic blood pressure in rural men and women in the Carmen de Chucurí municipality. Conclusions: the percentage of body fat is positively and significantly associated with diastolic blood pressure in rural men and women of the Carmen de Chucuri municipality; for the other parameters analyzed, a significant correlation was not evident.

Audiological, Phonatory and Cardiac Correlates of Individuals Exposed to Low-Frequency Noise or at Risk of Vibroacoustic Disease

Abstract Introduction Low-frequency noise (LFN) is hazardous to hearing. Long-term exposure to LFN may lead to vibroacoustic disease (VAD), which not only affects a specific organ but the physiological function of entire systems, such as the auditory, phonatory, respiratory, and cardiac systems. Moreover, VAD may lead to many psychological problems and hence affect the quality of life. Objective To investigate the adverse effects of LFN on hearing, acoustic and perceptual correlates of the voice, blood pressure, cardiac rate, and anxiety level. Method A total of 20 subjects exposed to LFN and 20 not exposed to LFN were included, and a detailed case history was recorded. The patients were submitted to pure tone audiometry, otoscopic examination, acoustic and perceptual analyses of the voice, maximum phonation time, and an assessment of the s/z ratio. We also assessed blood pressure, and the results of a voice-related quality of life questionnaire and of the Hamilton anxiety rating scale. Results The results indicate that LFN had an adverse impact on the high-frequency threshold. The present study found a significant difference in shimmer and harmonics-to-noise ratio (HNR) values. Few subjects had high blood pressure and showed the sign of anxiety on the Hamilton anxiety rating scale. Conclusion Low-frequency noise has adverse effects on entire systems of the body and causes many psychological issues, which, in turn negatively affect quality of life.

Morbilidad oculta por hipertensión arterial en adolescentes. Importancia del monitoreo ambulatorio de presión arterial / Hidden morbidity due to arterial hypertension in adolescents. Importance of ambulatory blood pressure monitoring

El diagnóstico de un niño o adolescente como hipertenso no es tarea fácil. El principal medio para el diagnóstico de hipertensión arterial sigue siendo la presión arterial tomada en el consultorio, pero por su escasa reproducibilidad, este método tiene algunas limitaciones. Existen otros menos usados en el medio pediátrico, pero más reproducibles y confiables, como el monitoreo ambulatorio de la presión arterial, el cual permite disminuir el subdiagnóstico de hipertensión arterial. La investigación se realizó a partir de un pesquisaje efectuado con el objetivo de identificar la morbilidad oculta de hipertensión arterial en adolescentes con exceso de peso, en el área de salud del Policlínico «Chiqui Gómez Lubián», Santa Clara, Villa Clara. El caso reviste importancia para la Atención Primaria de Salud, promueve la utilización de un método diagnóstico que mejora la correcta clasificación y tratamiento de la hipertensión en edades tempranas para contribuir a la prevención de complicaciones posteriores

Diagnosing a child or an adolescent as hypertensive is not an easy task. The main way to diagnose arterial hypertension continues to be at the doctor´s office, but due to its poor reproducibility, this method has some limitations. There are other less used methods in the pediatric setting, but are more reproducible and reliable, such as ambulatory blood pressure monitoring, which makes it possible to reduce the underdiagnosis of arterial hypertension. We present a case of a male adolescent who was detected during a screening, with the objective of identifying hidden morbidity of arterial hypertension in overweight adolescents, in the health area at "Chiqui Gómez Lubián" Polyclinic, in Santa Clara, Villa Clara. The case is of great important for primary health care, promotes the use of a diagnosis method that improves the correct classification and treatment of hypertension at an early age and contributes to the prevention of subsequent complications

Tasa metabólica basal y presión arterial en adultos normotensos e hipertensos de la población peruana, 2022

Objetivo: analizar la correlación y variaciones en los niveles de la tasa metabólica basal (TMB) con la presión arterial sistólica y diastólica en adultos normotensos e hipertensos de la población peruana. Metodología: se realizó un estudio observacional, analítico, retrospectivo y transversal en base a datos de la encuesta nacional demográfica y de salud-2022 (ENDES) que estuvo conformada por 18032 mujeres y 13646 hombres mayores de 18 años. Las variables fueron: sexo, TMB, presión arterial sistólica y diastólica. Se realizó la prueba chi-cuadrado, t de Student, Odds ratio crudo y ajustado por regresión logística binaria y la correlación de Spearman. Resultados: las mujeres con presión sistólica alta tuvieron una tasa TMB de 1130 mientras que en normotensas fue de 1246. Las mujeres con TMB baja tuvieron hipertensión con mayor frecuencia que las mujeres con TMB normal. En hombres, la hipertensión se presentó con mayor frecuencia en el grupo de TMB normal. En adultos hipertensos, la presión sistólica y la TMB se correlacionaron baja y negativamente, siendo más negativa en mujeres, mientras que la presión diastólica se correlacionó baja y positivamente en ambos sexos, siendo mayor en mujeres. En normotensos, la correlación entre presión sistólica y TMB fue muy baja y positiva en mujeres, mientras que en hombres fue baja y positiva mientras que la correlación entre presión diastólica y TMB fue baja y positiva en ambos sexos. Conclusiones: la TMB baja se asocia a hipertensión en mujeres, mientras que en hombres la hipertensión está asociada a una TMB normal. Asimismo, la TMB se correlaciona negativamente con la presión arterial en hipertensos y positivamente en normotensos de la población peruana.

Objective: To analyze the correlation and variations in the levels of the basal metabolic rate (BMR) with systolic and diastolic blood pressure in normotensive and hypertensive adults in the Peruvian population. Methodology: An observational, analytical, retrospective, and cross-sectional study was carried out based on data from the national demographic and health survey-2022 (ENDES), which consisted of 18,032 women and 13,646 men over 18 years of age. The variables were: sex, BMR, systolic and diastolic blood pressure. The chi-square test, Student's t test, crude Odds ratio and adjusted by binary logistic regression and Spearman correlation were applied. Results: Women with high systolic pressure had a TMB rate of 1130 while in normotensive women it was 1246. Women with low TMB had hypertension more frequently than women with normal TMB. In men, hypertension occurred more frequently in the normal TMB group. In hypertensive adults, systolic pressure and BMR were low and negatively correlated, being more negative in women, while diastolic pressure was low and positively correlated in both men and women, being higher in women. In normotensive individuals, the correlation between systolic pressure and BMR was very low and positive in women, while in men it was low and positive while the correlation between diastolic pressure and BMR was low and positive in men and women. Conclusions: Low BMR is associated with hypertension in women, while in men hypertension is associated with a normal BMR. Likewise, BMR is negatively correlated with blood pressure in hypertensives and positively in normotensives in the Peruvian population.

Risk Factors for In-Hospital Mortality from Cardiac Causes After Acute Myocardial Infarction

Abstract Background: Risk stratification on admission of patients with acute ST-elevation myocardial infarction (STEMI) is considered a clear strategy for effective treatment, early intervention, and survival. Objective: The purpose of this study was to determine the risk factors for in-hospital mortality from cardiac causes after STEMI. Methods: Observational, retrospective, longitudinal study, with a quantitative approach, based on data from the medical records of individuals diagnosed with STEMI treated at the Emergency Room of a large hospital in the state of Minas Gerais, Brazil, from January 2011 to July 2016. The outcome of interest was 30-day in-hospital mortality from after STEMI. For statistical analysis, the Pearson's chi-square test, Spearman's correlation and multivariable Cox-regression analysis were used, with a significance level of α = 0.05. Results: Of the 459 patients, 55 (12%) died from cardiac causes within 30 days after STEMI. Mean admission SBP of these patients was 109.08mmHg. The incidence of death was higher in women (23.7%), patients with systemic arterial hypertension (SAH) (13.8%) and elderly patients (16.5%). The elderly — heart rate (HR) = 3.54 — and women — HR = 2.55 — had a statistically significant higher risk of progressing to death when compared to younger adults and men. The highest admission SBP had a protective effect (HR = 0.97), reducing the chance of death by 3%. Conclusion: SBP on admission, female gender and advanced age were significant risk factors for death within 30 days after STEMI.

Awareness and recommendation of home blood pressure measurement among physicians in India: Results from Asia HBPM survey 2020

Background: Awareness of hypertension and blood pressure (BP) control rates are still low in India. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including the prevention of cardiovascular diseases(CVD) and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India. Materials and methods: As part of Asia HBPM Survey 2020, a cross-sectional survey was conducted among healthcare providers from India between June 2020 to June 2021. The questionnaire consisted of 37 questions and sub-questions related to HBPM awareness and recommendations to patients. Results: A total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. 31.3% of physicians instruct their patients to measure their BP before taking antihypertensive drugs, while around 30% of physicians gave no instructions. The reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34.4%) and home BP (15.1%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 34.9% of their patients own HBPM device and 30.4% of the patients measure their own BP at home. Conclusion: The survey reveals that HBPM instructions to the patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM use among patients. Clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians

Blood Pressure Values in Apparently Healthy Sudanese Population

Introduction: Blood pressure is one of the most often measured clinical parameters, and assessment of blood pressure has a considerable impact on diagnostic decisions. Objectives: To establish blood pressure normal reference values in Sudanese. Methods: A cross-sectional study was conducted from September 2016 to November 2018. Eight hundred eighty-eight healthy adult Sudanese between the ages of 18 and 60 (203 men and 685 women) were randomly selected from the states of Khartoum, Northern, Gezira, Red Sea, and North Darfur. Clinical, anthropometric, and blood pressure measurement data were collected. Results: The mean for all volunteers was 113.93 ± 9.917 mmHg, systolic blood pressure (SBP) and 75.29 ± 6.79 mmHg, diastolic blood pressure (DBP). SBP in men was 118.6 + 7.642 mmHg compared to 112.53 + 9.121 mmHg in women, while DBP in men was 77.51 + 5.984 mmHg compared to 74.63 + 6.844 mmHg in women. Beside the gender variations, blood pressure values also showed geographical variability. There was a positive connection between blood pressures (SBP and DBP), BMI, and age. (P < 0.05) was used for significance. Conclusion: Blood pressure of Sudanese was found to be within the normal international range with gender and geographical variability. It showed positive correlation with age and BMI.

Factors Associated With Hypertension and Cardiovascular Parameters in Children With Infrequently Relapsing Nephrotic Syndrome

Objective: To assess the prevalence of hypertension in children with infrequently relapsing nephrotic syndrome (IRNS) and its association with dyslipidemia, and end organ damage including left ventricular hypertrophy (LVH), at relapse and after steroid induced remission. Methods: Prospective observational study conducted in 83 children aged 1-12 years with IRNS, presenting in relapse. Blood pressure, fundus examination, blood and urine investigations were done at relapse and then at 4 weeks of therapy. Echocardiography at 4 weeks was performed for assessment of LVH and relative wall thickness (RWT) for concentric geo-metry (CG). Results: 27 patients (32.5%) developed hypertension, out of which 21 patients (25.3%) had stage I hypertension. Hypertension in first episode (63.0%, P<0.01) and in previous relapses (87.5%, P<0.001) was significantly associated with hypertension in the current episode. 12 patients had a positive family history of hypertension, of which 8 (66.7%) were classified under the hypertensive group (P=0.016). Concentric geometry (CG) was found in 28% of hypertensive and 5.5% of non-hypertensive children (P=0.011). On regres-sion analysis, a lower Up:Uc at the time of relapse was found to have a protective role for development of hypertension. Conclusion: One third children with IRNS had hypertension at relapse and a high proportion of hypertensive patients had CG pattern on echocardiography.

Hemodynamic Responses to Recorded Maternal Voice Among Sedated Children in the Pediatric Intensive Care Unit: An Open-Label Randomized Controlled Trial

Objective: To assess the effect of maternal audiotaped voice on clinical parameters of sedated children. Methods: A randomized controlled trial was conducted on 25 sedated critically ill children admitted to the pediatric intensive care unit. An audiotaped maternal voice was played to the children in the experimental group (n=13) via a headphone for 15 minutes, twice a day for 3 days. Children in the control group (n=12) received routine care without any additional auditory stimulation. Clinical and hemodynamic variables were recorded at 5 minutes interval three times. Results: Significant changes were observed in the mean (SD) heart rate (per minute) at 10 minutes [129.83 (19.14) vs 124.29 (14.90), P=0.051], respiratory rate at 5 minutes [44.38 (17.79) vs 34.65 (7.64), P=<0.001] and 10 minutes [42.79 (13.89) vs 35.44 (7.65) P=<0.001], systolic blood pressure at 5 minutes [95.24 (15.01) vs 101.02 (19.83) P=0.045], and mean blood pressure at 15 minutes [68.66 (13.61) vs 73.61 (17.59) P=0.051] mmHg between the experimental and the control group, respectively. Conclusion: Listening to recorded maternal voice had a positive effect on clinical parameters of sedated critically ill children.

Correlation of body mass index with handgrip strength and blood pressure indices among young adults

Objectives: Hand grip strength (HGS) is an important quantitative measure to evaluate the overall muscle strength of an individual. It is affected by factors such as age, sex, body mass index (BMI) and cardiovascular risk factors such as obesity and hypertension. This study aims to find out the correlation of BMI with HGS and blood pressure indices among young adults. Materials and Methods: Three hundred and eighty-two medical students between the age group of 18–20 years with no history of systemic illness, musculoskeletal disorder, hand pain or deformity were selected. Informed consent was obtained. Biodata and anthropometric measurements were documented in a proforma. HGS and endurance of the dominant hand were measured using a hand-held dynamometer. Blood pressure was recorded using a mercury sphygmomanometer. Data on BMI was sub grouped into underweight, normal weight, overweight and obese participants to compare the HGS among them. Results: There was a statistically significant negative correlation between BMI and HGS (r = ?0.513; P < 0.01), BMI and grip strength ratio (r = ?0.750; P < 0.01), and between BMI and handgrip endurance (r = ?0.359; P < 0.01). Statistically significant decrease in HGS was found among underweight (29.36 ± 7.01), overweight (26.18 ± 5.45) and obese participants (20.48 ± 3.12) with Kruskal–Wallis value ?2 = 14.231. Furthermore, a statistically significant positive correlation was found between BMI and systolic blood pressure (r = 0.603; P < 0.01), BMI and diastolic blood pressure (r = 0.514; P < 0.01), BMI and pulse pressure (r = 0.228; P < 0.01) and between BMI and mean arterial pressure (r = 0.572; P < 0.01). Conclusion: BMI was found to be negatively correlated with HGS and positively correlated with blood pressure indices. This can influence the compatibility of medical students with the physical and emotional stress of course. Determinants such as grip span, hand span, skeletal muscle bulk, and arm and calf muscle circumference are to be considered for further research to improve the endurance of young adults.

Presión arterial en recién nacidos sanos de término y pretérmino tardío en la Ciudad de México / Blood pressure in healthy term and late preterm newborns in Mexico City

Resumen Objetivo: Describir medidas de presión arterial sistólica (PAS), diastólica (PAD) y media (PAM) en recién nacidos sanos de término y pretérmino tardío para establecer parámetros de normalidad. Método: Estudio transversal realizado en el cunero fisiológico del Hospital Español, Ciudad de México. Se incluyeron 551 pacientes recién nacidos sanos. Las tomas de PA fueron realizadas dentro de las primeras 48 horas de vida con método oscilométrico. Posterior a la evaluación de normalidad, se realizó un análisis descriptivo de la población y cálculo de percentiles (25, 50 y 75) específicos para cada semana de gestación. Todos los análisis fueron realizados en STATA v14.2. Resultados: Los recién nacidos de sexo masculino tuvieron un valor medio de PAS de 64.6 mmHg en la semana 35 de gestación, este valor aumentó a 69.8 mmHg en la semana 40. El valor de la PAD fue de 42.6 mmHg en la semana 35 de gestación, disminuyendo a 40.8 mmHg para la semana 40. Los valores medios de PAS en los recién nacidos de sexo femenino fueron de 65.5 mmHg en la semana 35, teniendo un incremento a 73.5 mmHg en la semana 40. El valor de la PAD en la semana 35 de gestación fue 38 mmHg, incrementando a 41.3 mmHg en la semana 40. Conclusiones: Los valores de PA en recién nacidos sanos se modifican con la edad gestacional y el sexo. Estos resultados pueden servir como referencia para otros médicos ubicados en países o ciudades con alturas similares a la Ciudad de México.

Abstract Objective: Describe the measurements of systolic, diastolic and mean blood pressure in healthy term and late preterm newborns to establish normal values. Methods: Cross-sectional study carried out in the nursery of the Hospital Español, located in Mexico City. A sample of 551 healthy newborns were included in the study. Blood pressure (BP) measurements were taken within the first 48 hours of life with the oscillometric method. After the evaluation of normality, a descriptive analysis of the population and calculation of percentiles (25, 50 and 75) specific for each week of gestation was performed. All analyzes were performed in STATA v14.2. Results: Male newborns had a mean SBP value of 64.6 mmHg at week 35 of gestation, this value increased to 69.8 mmHg at week 40; the systolic blood pressure (SBP) value was 42.6 mmHg at week 35 of gestation, which decreased to 40.8 mmHg at week 40. The mean SBP values in female newborns were 65.5 mmHg at week 35, increasing to 73.5 mmHg at week 40; the diastolic blood pressure (DBP) value at week 35 of gestation was 38 mmHg, increasing to 41.3 mmHg at week 40. Conclusions: The BP values in healthy newborns are modified by the gestational age and sex of the patients. These results can serve as a reference for other physicians located in countries or cities with a similar altitude than the one in Mexico City.

Associação entre parto cesáreo e pressão arterial elevada em pré-escolares: um estudo transversal / Association between cesarean section and high blood pressure among early elementary schoolchildren: a cross-sectional study / Asociación entre los partos por cesárea y la presión arterial alta en preescolares: un estudio transversal

O parto cesáreo é apontado como fator de risco para diversas doenças crônicas. Neste estudo, objetivou-se averiguar a associação entre parto cesáreo e pressão arterial (PA) de crianças de 6 anos. Trata-se de estudo transversal conduzido em Feira de Santana (BA), com 635 pares de mãe e filho. O tipo de parto foi categorizado em cesárea e vaginal. A PA foi aferida por meio de esfigmomanometria e considerada elevada quando atingiu níveis iguais ou maiores ao percentil 90 para idade, sexo e altura. Razões de prevalência brutas (RPbruta) e ajustadas (RPajustada) e respectivos intervalos de confiança de 95% (IC95%) foram estimados via regressão logística múltipla. A cesariana ocorreu em 46,5% dos casos, as prevalências de pressão arterial sistólica (PAS) e diastólica (PAD) elevadas foram de 17,2% e 5,6%, respectivamente. O excesso de peso foi verificado em 28,6% das crianças. A maior prevalência de PAS elevada foi observada entre as crianças que nasceram por cesariana (61%) em relação às que nasceram por parto vaginal (RPbruta: 1,51; IC95%: 1,07-2,14; RPajustada: 1,61; IC95%: 1,05-2,46). A idade materna ao nascimento da criança foi fator de interação na associação principal, assim, as crianças nascidas via parto vaginal exibiram maior prevalência de PAS elevada, comparadas às nascidas via cesárea. O parto cesáreo se associou à PAS elevada aos 6 anos de idade.

Cesarean delivery is considered a risk factor for several chronic diseases. This study aimed to investigate the association between cesarean section and blood pressure (BP) in 6-year-old children. This is a cross-sectional study carried out in Feira de Santana, (BA) with 635 mother-child pairs. The type of birth was categorized into cesarean and vaginal. The BP was measured by using sphygmomanometry and considered high when it reached levels equal or higher than the 90th percentile for age, gender, and height. Crude (PRcrude) and adjusted (PRadjusted) prevalence rate and respective 95% confidence intervals (95%CI) were estimated by multiple logistic regression. Cesarean section occurred in 46.5% of the cases, the prevalence of high systolic (SBP) and diastolic (DBP) blood pressure were 17.2% and 5.6%, respectively. Excess weight was verified in 28.6% of the children. The highest prevalence of high SBP was among children who were born by cesarean section (61%) compared with those who were born vaginally (PRcrude: 1.51; 95%CI: 1.07-2.14; PRadjusted: 1.61; 95%CI %: 1.05-2.46). Maternal age at the birth of the child was an interaction factor in the main association, thus, children born vaginally had a higher prevalence of elevated SBP, compared with those born via cesarean section. Cesarean section was associated with increased SBP at six years of age.

El parto por cesárea presenta un factor de riesgo para varias enfermedades crónicas. El objetivo de este estudio fue investigar la asociación entre el parto por cesárea y la presión arterial (PA) en niños de 6 años de edad. Se trata de un estudio transversal, realizado en Feira de Santana, en Bahía (Brasil), con 635 pares de madre e hijo. El tipo de parto se clasificó en cesárea y vaginal. La PA se midió mediante esfigmomanometría y se consideró alta cuando alcanzó niveles más altos o iguales al percentil 90 para edad, sexo y talla. Las razones de prevalencia crudas (RPcrudas) y ajustadas (RPajustadas) y los respectivos intervalos de confianza del 95% (IC del 95%) se estimaron mediante regresión logística múltiple. La cesárea ocurrió en el 46,5%, las prevalencias de presión arterial sistólica (PAS) y diastólica (PAD) altas fueron el 17,2% y el 5,6%, respectivamente. El exceso de peso se presentó en el 28,6% de los niños. La mayor prevalencia de PAS alta se observó entre los niños nacidos por cesárea (61%) en comparación con los nacidos por vía vaginal (RPcruda: 1,51; IC95%: 1,07-2,14; RPajustada: 1,61; IC95%: 1,05-2,46). La edad materna al nacimiento del niño fue un factor de interacción en la principal asociación, así, los niños nacidos por vía vaginal tuvieron una mayor prevalencia de PAS elevada en comparación con los nacidos por cesárea. El parto por cesárea se asoció con un aumento de la PAS a los 6 años de edad.

Analysis of Association of Brain Natriuretic Peptide Levels and Blood Pressure Variability

Objective: The present study aimed to investigate the relationship between brain natriuretic peptide (BNP) levels and blood pressure variability among hypertensive patients aged over 40 years. Methods: The study recruited 120 patients from a cardiology outpatient clinic who had been diagnosed with hypertension and taking antihypertensive medication for at least 6 months. Demographic and clinical information, blood pressure measurements, and blood samples were collected to measure BNP levels. The standard deviation of the mean arterial pressure over 24 hours was calculated as a measure of blood pressure variability. Linear regression was used to examine the association between BNP levels and blood pressure variability while controlling for age, sex, BMI, and medication history. Results: The study found a significant positive association between BNP levels and blood pressure variability (?=0.31, p=0.002), even after controlling for other variables. The linear regression model explained 20% of the variance in blood pressure variability (R2=0.20, F=9.52, p<0.001). Conclusion: The findings suggest that higher BNP levels are associated with increased blood pressure variability among hypertensive patients. Further studies are needed to explore the underlying mechanisms and the potential implications of this association.

Determining the Association between 24-Hour Blood Pressure Variability and Major Adverse Cardiac Events (MACE) in Hospitalized Patients with Acute Myocardial Infarction: A Prospective Study

Acute myocardial infarction (AMI) is a challenging cardiovascular disease leading to a high rate of mortality. Some cardiomyocytes in AMI were affected by ischemia and necrosis, resulting in a decrease in myocardial contractility, an acute proinflammatory response, and an increase in sympathetic tone. In the meantime, proinflammation and endothelial dysfunction are induced by high blood pressure variability (BPV), which increases left ventricular workload, heart rate, and myocardial oxygen demand. As a result, a high BPV and the pathological effects it causes are likely to affect the onset of acute cardiac complications in AMI and the physiological function of the heart [1]. Patients Pulse changeability (BPV) has been fundamentally concentrated on through the crystal of congestive cardiovascular breakdown (CHF) and hypertension, yet not in that frame of mind of an intense coronary condition (ACS). This study means to explore the relationship between transient BPV and major unfavorable heart occasions (MACE) in AMI patients. The following order can be used to define MACEs: Death > shock > cerebrovascular stroke > heart failure > hypertensive crisis > life-threatening arrhythmias .This prospective study used the weighted standard deviation of 24-hour ambulatory blood pressure monitoring readings to include 74 patients who were hospitalized in the cardiology department at ARRAZI hospital MOHAMED VI, MARRAKECH between September 2022 and February 2023. Results: The average systolic BPV value which was estimated as standard deviation (SD) and average real variability (ARV) was more significant in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 12,78 mmHg and 11,61 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.45 mmHg and 7,23 mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE, unlike patients who didn’t experienced MACE for whom the ARV was nearly the same for patient with and without HBP. Conclusion: MACE was higher in the group BPV of AMI patients than that of non-MACE AMI patients. There was no significant association between BPV ??and MACE during the acute phase of AMI, however the BPV was significantly more important for HBP patient who experienced MACE, which leads us to think that the screening of BPV in HBP patient may by a predictive factor for the development of MACEs.

Nivel de conocimiento de los estudiantes del tercer curso en Odontología de la UNAN-León, sobre trastornos de presión arterial y manejo odontológico / Level of knowledge third year dentistry students UNAN-León about blood pressure disorders and dental management

Las patologías cardiovasculares constituyen la causa más frecuente de muerte en el mundo, las más comunes son hipertensión e hipotensión. En la consulta odontológica, los pacientes con trastornos de presión arterial requieren diferentes protocolos de atención. En el tercer curso de odontología se tiene el primer contacto con pacientes, al haber estudiado y aprobado la parte teórica del manejo odontológico. Según los antecedentes encontrados, no existen investigaciones que abarquen ambos trastornos de la presión arterial, por lo que se realizó un estudio descriptivo de corte transversal para determinar el nivel de conocimiento en estudiantes del tercer curso Odontología UNAN-León, sobre trastornos de la presión arterial y su manejo odontológico en el segundo semestre del año 2021, por una encuesta tipo examen a estudiantes inscritos en cirugía bucal I, 55 estudiantes fueron encuestados. Se determinó que 50.9% tienen un nivel de conocimiento regular, seguido por 27.3% con nivel bueno, 12.7% deficiente y 9.1% obtuvo nivel de conocimiento excelente sobre los trastornos de presión arterial. Según investigaciones previas en odontología, la mayoría de los estudiantes presentaba un nivel de conocimiento deficiente sobre hipertensión arterial. Por lo que es importante evaluar periódicamente los niveles de conocimiento sobre éstos y otros trastornos que pueden presentarse en la consulta dental (AU)

Cardiovascular diseases are the most common cause of death world, hypertension and hypotension are very common nowadays. In the dental office, patients with blood pressure disorders require different care protocols. Students of the third year of dentistry have their first contact with patients, having studied and approved the theoretical part of dental management. According to antecedents researched, there are no investigations that cover both blood pressure disorders. So a descriptive cross-sectional study was made to determine the knowledge of third-year dentistry students UNAN-León, about blood pressure disorders and their dental management in the second semester of the year 2021, by an exam-type survey of students registered in oral surgery I, with 55 students surveyed. It determined that 50.9% have a regular level of knowledge, followed by 27.3% with a good level, 12.7% poor and 9.1% has an excellent level of knowledge about blood pressure disorders. According to previous research in dentistry faculty, the majority of students have a poor level of knowledge about high blood pressure. Therefore, it's important to evaluate periodically the levels of knowledge about these and other disorders that may occur in the dental office (AU)

ASSOCIATION BETWEEN BLOOD PRESSURE AND HAND GRIP STRENGTH AMONG ADULT POPULATION VISITING A TERTIARY CARE CENTRE – A CROSS–SECTIONAL STUDY

Introduction: It has been suggested that isometric handgrip resistance exercise be used as the first line treatment for hypertension. This cross-sectional study sought to better understand the association between adult individual's systolic and diastolic blood pressures with hand grip strength. The present study is a cross-s Methods: ectional study done among 240 healthy participants aged 19-40 years. Clearance was obtained from Institutional Ethical Committee. Blood pressure was recorded following standard precautions. The average of the maximum handgrip strength from both hands were taken into consideration. General linear models were used to examine the association between handgrip strength and blood pressure. Data was analyzed by Independent t test and Pearson correlation test using software, SPSS version 26. Handgrip strength was significantly and positively associated Results: with systolic blood pressure (P<0.001), diastolic blood pressure (P<0.001) and body mass Index (P<0.05). There was an increase in systolic blood pressure, diastolic blood pressure and body mass index with increase in handgrip strength. High systolic and diastolic blood pressures w Conclusion: ere associated with increased handgrip strength in both men and women. This aids in controlling blood pressure and might have implications for early prevention