Intensive blood pressure lowering and the risk of new-onset diabetes in patients with hypertension: a post-hoc analysis of the STEP randomized trial.

AIMS: The strategy of blood pressure intervention in the elderly hypertensive patients (STEP) trial reported the cardiovascular benefit of intensive systolic blood pressure (SBP) control in patients with hypertension. The association between intensive SBP lowering and the risk of new-onset diabetes is unclear. This study aimed to evaluate the effect of intensive SBP lowering on the incidence of new-onset diabetes. METHODS AND RESULTS: Participants in STEP who had baseline fasting serum glucose (FSG) concentrations <7.0 mmol/L and no history of diabetes or hypoglycaemic medication use were included. The primary outcome was new-onset diabetes defined as the time to first occurrence of FSG concentrations ≥7.0 mmol/L. The secondary outcome was new-onset impaired fasting glucose (FSG: 5.6-6.9 mmol/L) in participants with normoglycemia. A competing risk proportional hazards regression model was used for analysis. The cohort comprised 5601 participants (mean age: 66.1 years) with a mean baseline SBP of 145.9 mmHg. Over a median follow-up of 3.42 years, 273 (9.6%) patients in the intensive SBP group (target, 110 to <130 mmHg) and 262 (9.5%) in the standard SBP group (target, 130 to <150 mmHg) developed diabetes (adjusted hazard ratio, 1.01; 95% confidence interval (CI), 0.86-1.20). The adjusted hazard ratio for the secondary outcome was 1.04 (95% CI, 0.91-1.18). The mean highest FSG concentration during the follow-up was 5.82 and 5.84 mmol/L in the intensive and standard groups, respectively. CONCLUSION: Intensive SBP lowering is not associated with an altered risk of new-onset diabetes or impaired fasting glucose in hypertensive patients. REGISTRATION: STEP ClinicalTrials.gov, number: NCT03015311.

There is no significant association between intensive SBP lowering and the risk of new-onset diabetes or impaired fasting glucose in hypertensive patients aged 60­80 years.Our findings improve the understanding of the benefits and risks of implementing an intensive SBP treatment strategy in the clinic for older hypertensive patients.Our findings suggest that clinicians should continue to implement intensive SBP lowering strategies, without worrying about an altered risk of new-onset diabetes in their patients.

Production and characterization of alkaline protease from hemoglobin-degrading Bacillus pumilus NJM4 to produce fermented blood meal.

The aim of the research was to isolate the hemoglobin-degrading bacterial strain to produce fermented blood meal and to characterize the protease produced by this strain. The strain NJM4, a kind of hemoglobin-degrading bacterial strain, was isolated by blood agar plates from slaughterhouse and identified as a Bacillus pumilus by physiological, biochemical, and morphological characteristics and by 16S rRNA gene sequencing. Bacillus pumilus NJM4 could degrade hemoglobin up to 85% in 36 h under the laboratory conditions. The optimal conditions for protease production was achieved at an initial pH level of 8.67, inoculum size of 4%, incubation temperature of 37 °C, and agitation rate 200 rpm. The optimum pH and temperature of hemoglobin-degrading proteases were at 9.0 and 50 °C, respectively. The protease activity was slightly decreased in presence of Ca(2+) and DTT. It was significantly inhibited in the presence of PMSF and EDTA identifying it as alkaline serine-metalloproteinase. Bacillus pumilus NJM4 and hemoglobin-degrading proteases provide potential use for biotechnological process of fermentation and enzymolysis blood meal as animal feed supplement.

Changes in Home Blood Pressure Monitored Among Elderly Patients With Hypertension During the COVID-19 Outbreak: A Longitudinal Study in China Leveraging a Smartphone-Based Application.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted clinical care worldwide. Evidence of how this health crisis affected common conditions like blood pressure (BP) control is uncertain. METHODS: We used longitudinal BP data from an ongoing randomized clinical trial to examine variations in home BP monitored via a smartphone-based application (app) in a total of 7394 elderly patients with hypertension aged 60 to 80 years stratified by their location in Wuhan (n=283) compared with other provinces of China (n=7111). Change in morning systolic BP (SBP) was analyzed for 5 30-day phases during the pandemic, including preepidemic (October 21 to November 20, 2019), incubation (November 21 to December 20, 2019), developing (December 21, 2019 to January 20, 2020), outbreak (January 21 to February 20, 2020), and plateau (February 21 to March 21, 2020). RESULTS: Compared with non-Wuhan areas of China, average morning SBP (adjusted for age, sex, body mass index) in Wuhan patients was significantly higher during the epidemic growth phases, which returned to normal at the plateau. Between-group differences in ΔSBP were +2.5, +3.0, and +2.1 mm Hg at the incubation, developing, and outbreak phases of COVID-19 (P<0.001), respectively. Sensitivity analysis showed a similar trend in trajectory pattern of SBP in both the intensive and standard BP control groups of the trial. Patients in Wuhan also had an increased regimen change in antihypertensive drugs during the outbreak compared with non-Wuhan patients. Expectedly, Wuhan patients were more likely to check their BP via the app, while doctors were less likely to monitor the app for BP control during the pandemic. CONCLUSIONS: Our data demonstrate that the COVID-19 pandemic was associated with a short-term increase in morning SBP among elderly patients with hypertension in Wuhan but not other parts of China. Further study will be needed to understand if these findings extended to other parts of the world substantially affected by the virus. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03015311.