Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.

OBJECTIVE: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. METHODS: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. RESULTS: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. CONCLUSIONS: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

One body, two faces: How double standards influence body evaluation in women with binge-eating disorder compared to mentally healthy women with higher weight and average weight.

OBJECTIVE: Research has found evidence that women with anorexia nervosa (AN) and bulimia nervosa (BN) apply different standards for themselves than for others when evaluating bodies, an aspect of a disturbed body image. This study investigates whether women with binge-eating disorder (BED) likewise show self-deprecating double standards (DS). METHODS: Women with BED (n = 40), women with higher weight (n = 40) and women with average weight (n = 40) viewed a presentation of different builds, including their individual ideal body, which were presented once with participants' own and once with an unknown woman's face. After each presentation, participants rated their emotional response regarding arousal and valence, and evaluated the body's attractiveness, body fat and muscle mass. DS were defined as the difference in ratings of the same body with one's own and the unknown face. RESULTS: Women with BED showed a higher degree of negative emotions in response to a thin and a high-weight build, rated lower levels of body attractiveness for an athletic build, and displayed more arousal for almost all builds presented with their own compared to with another face. While women with BED showed a higher burden on measures of eating pathology and body image than the other groups, DS were not more pronounced in women with BED. DISCUSSION: The findings contradict DS as a characteristic feature of BED, but underline "normative" DS for higher-weight/high-weight builds, reflecting weight stigmatization. Psychoeducation on these DS might complement cognitive-behavioral therapy in BED in order to reduce negative emotions. PUBLIC SIGNIFICANCE: A bias in body evaluation has been proven in women with anorexia and BN, but no research has examined this in women with BED. This study provides evidence of DS in body evaluation in women with BED, compares the extent of DS between women with BED, higher weight, and average weight, and investigates individual body ideals in women with BED and higher weight.

[Psychometric Evaluation of the German-Language Version of the Feedback on Physical Appearance Scale on Female Adolescents With Eating Disorders Plus Adolescents and Women Without Eating Disorders]. / Psychometrische Überprüfung der deutschsprachigen Version der Feedback on Physical Appearance Scale an weiblichen Jugendlichen mit Essstörungen sowie Jugendlichen und Frauen ohne Essstörungen.

Negative body-related feedback is associated with increased body dissatisfaction. The English-language version of the Feedback on Physical Appearance Scale (FOPAS) is an instrument to assess verbal and non-verbal body-related feedback, but a German-language version has not been validated yet. The aim of this study was to evaluate the psychometric properties of its German-language version in a sample of adolescents with eating disorders (n=88) and in a sample of adolescents (n=123) and women (n=228) without eating disorders. Confirmatory factor analyses showed a moderate model fit from the English-language original study. All samples showed acceptable internal consistencies. The retest reliability was also mostly acceptable. Significant positive correlations with questionnaires on eating disorder symptoms (criterion validity), teasing (convergent validity) as well as the expected negative correlation with self-esteem indicated good validity. In addition, the FOPAS was able to differentiate between adolescents with and without eating disorders. To sum up, the German-language FOPAS appears to be suitable to assess verbal and non-verbal body-related feedback in research and practice.

Emotion regulation ability compensates for the depression-related negativity bias.

Emotion regulation ability (ERA) enables individuals to disengage from negative stimuli. In this study, we investigated the role of ERA in the depression-related negativity bias. Seventy-four individuals with major depressive disorder and eighty-three nonclinical individuals were screened for depressiveness using the Beck Depression Inventory. ERA was assessed using the Action Orientation After Failure Subscale of the Action Control Scale. We used a classical Stroop task variant, wherein the color words were preceded by either a self-relevant positive (success-related), negative (failure-related), or neutral word prime. The expected depressiveness × emotional prime interaction did not reach significance but the expected ERA × emotional prime interaction did. The latter effect was qualified by a three-way interaction between ERA, depressiveness, and emotional prime. Specifically, ERA predicted the negativity bias in individuals with high depressiveness scores. Using the Johnson-Neyman technique, we found that this effect was significant at the level of mild to moderate depression and beyond. Thus, poor ERA in individuals with depression may cause the depression-related negativity bias, whereas (at least) moderate ERA may protect individuals with depression from this bias. Future studies should assess ERA in individuals with depressive symptomatology and investigate how it influences their everyday functioning and treatment outcomes.

Perceived Impact of Covid-19 Across Different Mental Disorders: A Study on Disorder-Specific Symptoms, Psychosocial Stress and Behavior.

The recent outbreak of the coronavirus disease (Covid-19) has plunged countries across the world into crisis. Both in the general population and in specific subgroups such as infected people or health care workers, studies have reported increased symptoms of anxiety, depression and stress. However, the reactions of individuals with mental disorders to Covid-19 have largely been neglected. The present study therefore aimed to investigate the perceived impact of Covid-19 and its psychological consequences on people with mental disorders. In this online survey, participants were asked to evaluate their disorder-specific symptoms, perceived psychosocial stress and behaviors related to Covid-19 in the current situation and retrospectively before the spread of Covid-19. The study included participants with self-identified generalized anxiety disorder (GAD), panic disorder and agoraphobia (PA), illness anxiety disorder (IA), social anxiety disorder (SAD), depression (DP), obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), eating disorders (ED), schizophrenia spectrum and other psychotic disorders (SP), other non-specified mental disorder (other) as well as mentally healthy controls (HC). The results of bayesian parameter estimation suggest that the symptom severity of DP, GAD, IA and BDD has deteriorated as a reaction to Covid-19. Across all mental disorders and HC, self-reported psychosocial stress levels were higher during the outbreak of Covid-19 compared to before. A reduced frequency of social contacts and grocery shopping was found for all participants. People with self-identified mental disorders showed higher personal worries about Covid-19 and a higher fear of contagion with Covid-19 than did HC. According to our findings, Covid-19 may reinforce symptom severity and psychosocial stress in individuals with mental disorders. In times of pandemics, special support is needed to assist people with mental disorders and to prevent symptom deterioration.

Personality, Stress, and Intuition: Emotion Regulation Abilities Moderate the Effect of Stress-Dependent Cortisol Increase on Coherence Judgments.

OBJECTIVE: Findings on the relationship between hypothalamus-pituitary-adrenocortical (HPA) activity and cognitive performance are inconsistent. We investigated whether personality in terms of emotion regulation abilities (ERA) moderates the relationship between stress-contingent HPA activity and accuracy of intuitive coherence judgments. METHOD: ERA and cortisol responses to social-evaluative stress as induced by a variant of the Trier Social Stress Test were measured in N = 49 participants (32 female, aged 18 to 33 years, M = 22.48, SD = 3.33). Subsequently, in a Remote Associates Task they provided intuitive judgments on whether word triples, primed by either stress-reminding or neutral words, are coherent or not. RESULTS: Under relative cortisol increase participants low in ERA showed reduced performance whereas individuals high in ERA showed increased performance. By contrast, under conditions of low cortisol change, individuals low in ERA outperformed those high in ERA. CONCLUSION: Personality can moderate the link between stress and cognition such as accurate intuition. This can happen to a degree that existing effects may not be become apparent in the main effect (i.e. without considering personality), which highlights the necessity to consider personality in stress research, ERA in particular. We discuss the findings with respect to individual differences in neurobehavioral mechanisms potentially underlying ERA and corresponding interactions with cognitive processing.

Post-stroke depression and functional impairments - A 3-year prospective study.

BACKGROUND: Post-Stroke Depression (PSD) is a severe condition, affecting about 30% of stroke survivors within a five-year period after stroke. Post-stroke functional impairments (FI) and social support are associated with PSD. It is inconclusive, whether one of the factors, post-stroke FI and PSD, shows a stronger predictive value on the respective other over time. The aims of the present study were to 1) investigate the relationship between PSD, FI, and social support of stroke patients in a 3-year prospective design, and 2) address methodological shortcomings of previous studies. METHODS: We investigated 174 stroke survivors and assessed PSD with a structured clinical interview and a dimensional symptom rating scale. We conducted regression analyses and applied the approach of multiple imputations (MI) for missing data due to dropout during follow-up. RESULTS: PSD prevalence was 32.2% in the acute phase after stroke. Individuals with a PSD in this phase revealed a fivefold higher risk for PSD 3 years later. FI in the acute phase did not additionally contribute to the prediction of PSD at follow-up. Compared to individuals without PSD in the acute phase, individuals with PSD had an increased risk for FI at follow-up. Limitations regarding sample characteristics, design, and dropout are discussed. CONCLUSIONS: Results indicate that PSD rather than FI represents a crucial risk factor for negative long-term consequences regarding physical and psychological health after stroke. Post-stroke treatment might be optimized by a routine assessment of PSD and FI after stroke and considering the results for personalized treatment options.

[Therapy Resistant and Refractory Hypertension]. / Therapieresistente und ­refraktäre Hypertonie.

Hypertension is defined as resistant to treatment when treatment fails to lower office systolic and diastolic blood pressure values to < 140/90 mmHg. The treatment strategy should include lifestyle measures and appropriate doses of three or more drugs acting by different mechanisms including a diuretic. An updated definition of treatment resistance includes all patients with ≥ 4 antihypertensive agents of different classes irrespective of their on-treatment blood pressure. The term "refractory" hypertension has been suggested for patients with uncontrolled blood pressure on ≥ 5 antihypertensive drugs including the thiazide-like diuretic chlorthalidone and the mineralocorticoid receptor antagonist spironolactone. "Pseudo resistance" especially due to white coat hypertension and non-adherence with the prescribed medication has to be ruled out to be able to identify patients with "true" treatment resistance. Therefore, before distinguishing true from pseudo resistance, the term "apparent" resistance should be used. While the prevalence of apparent resistance may be in the range of 10-15 % of treated patients, the exact prevalence of true resistance remains unknown due to the lack of appropriate studies but is likely to be rather small including a high proportion of patients with secondary forms of hypertension. Once identified most patients with true treatment resistance should receive intensified drug treatment primarily by expanded diuretic usage. Thus, resistant hypertension is primarily a diagnostic challenge: identifying patients with true resistance and those with secondary hypertension.

Body-oriented gaze behaviors in men with muscle dysmorphia diagnoses.

Although muscle dysmorphia (MD) has been added as a specifier for body dysmorphic disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, experimental research on psychopathological mechanisms is lacking. Because models of eating disorders (EDs) suggest parallels between MD and ED, body-oriented attentional biases, which are prominent in ED models, have been identified as potentially important maintaining factors. Specifically, we predicted the existence of biases toward subjectively negative areas of one's own body and positive areas of a bodybuilder in MD. We tracked gaze behaviors of 24 men with MD diagnoses, 24 weight-training controls, and 24 non-weight-training controls during exposure to pictures of their own body, an average male body, a lean-muscular body, and a hypermuscular body. Moreover, state body image and affect were assessed at baseline and after each stimulus. Partially supporting our hypotheses, men with MD diagnoses and non-weight-training controls, but not weight-training controls, displayed significant biases toward subjectively negative areas of their own body. Only men with MD diagnoses displayed biases toward positive areas of the hypermuscular body and reacted with a large, significant deterioration in state body image and affect. Attentional biases possibly contribute to the negative effects of critical examinations of one's body and of upward comparisons. There seems to be a specific positive bias toward subjectively ideal hypermuscular bodies in MD in conjunction with a negative bias toward oneself. Insofar as this pattern might maintain the severe muscularity dissatisfaction, it should be explicitly targeted by cognitive-behavioral interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Body Dissatisfaction, Importance of Appearance, and Body Appreciation in Men and Women Over the Lifespan.

Body image disturbance is associated with several mental disorders. Previous research on body image has focused mostly on women, largely neglecting body image in men. Moreover, only a small number of studies have conducted gender comparisons of body image over the lifespan and included participants aged 50 years and older. With regard to measurement, body image has often been assessed only in terms of body dissatisfaction, disregarding further aspects such as body appreciation or the importance of appearance. The aim of this cross-sectional study was to explore different aspects of body image in the general German-speaking population and to compare men and women of various ages. Participants completed an online survey comprising questionnaires about body image. Body dissatisfaction, importance of appearance, the number of hours per day participants would invest and the number of years they would sacrifice to achieve their ideal appearance, and body appreciation were assessed and analyzed with respect to gender and age differences. We hypothesized that body dissatisfaction and importance of appearance would be higher in women than in men, that body dissatisfaction would remain stable across age in women, and that importance of appearance would be lower in older women compared to younger women. Body appreciation was predicted to be higher in men than in women. General and generalized linear models were used to examine the impact of age and gender. In line with our hypotheses, body dissatisfaction was higher in women than in men and was unaffected by age in women, and importance of appearance was higher in women than in men. However, only in men did age predict a lower level of the importance of appearance. Compared to men, women stated that they would invest more hours of their lives to achieve their ideal appearance. For both genders, age was a predictor of the number of years participants would sacrifice to achieve their ideal appearance. Contrary to our assumption, body appreciation improved and was higher in women across all ages than in men. The results seem to suggest that men's and women's body image are dissimilar and appear to vary across different ages.

[Treatment Targets in Hypertension]. / Therapieziele bei der Hypertoniebehandlung.

The optimal target blood pressure (BP) in the treatment of hypertensive patients remains controversial. Recently, the systolic blood pressure trial (SPRINT) has proposed that a target systolic blood pressure of < 120 mmHg provides prognostic benefit in elderly hypertensive patients at high cardiovascular risk. The results of SPRINT contrast with several other intervention trials which have investigated the effect of intense BP lowering (Secondary Prevention of Small Subcortical Strokes [SPS3], Action to Control Cardiovascular Risk in Diabetes [ACCORD], Heart Outcomes Prevention Evaluation [HOPE]-3). The differences in outcomes in SPRINT vs. other intervention trials are, to a large extend, due to an "unobserved" BP measurement procedure utilized in the SPRINT trial. Thus, a BP goal of < 120 mmHg, at least by conventional BP measurement, remains unproven. Independent of SPRINT the controversial evidence with respect to BP targets calls for further studies and, possibly, for more individualized treatment goals.

Effects of the exposure to self- and other-referential bodies on state body image and negative affect in resistance-trained men.

Previous body image research suggests that first, exposure to body stimuli can negatively affect men's body satisfaction and second, body concerns are associated with dysfunctional gaze behavior. To date, however, the effects of self- vs. other-referential body stimuli and of gaze behavior on body image in men under exposure conditions have not been investigated. Therefore, 49 weight-trained men were presented with pictures of their own and other bodies of different builds (i.e., normal, muscular, hyper-muscular) while being eye-tracked. Participants completed pre- and post-exposure measures of body image and affect. Results indicated that one's own and the muscular body negatively affected men's body image to a comparable degree. Exposure to one's own body also led to increased negative affect. Increased attention toward disliked own body parts was associated with a more negative post-exposure body image and affect. These results suggest a crucial role of critical self-examination in maintaining body dissatisfaction.

Mega clinical trials which have shaped the RAS intervention clinical practice.

Following extensive clinical research, drugs affecting the renin-angiotensin system have been used for the treatment of patients with congestive heart failure, myocardial infarction, hypertension, diabetic nephropathy, chronic renal failure and for reducing the risk of developing major cardiovascular (CV) events. This review examines all mega trials (those involving >1000 patients) and smaller pivotal trials involving angiotensin-converting enzyme inhibitors (ACE-Is; 25 mega trials) and angiotensin receptor blockers (ARBs; 27 mega trials) to provide perspective on the huge database of evidence that has accumulated on the use of these drugs. Our review demonstrates that ACE-Is and ARBs are generally as effective as conventional therapies in the treatment of hypertension, but offer additional cardioprotective benefits in patients with heart failure, and in those who have experienced myocardial infarction. Also, both ACE-Is and ARBs are capable of renal protection in addition to their blood-pressure-lowering effects. Although ACE-Is and ARBs provide major benefits to CV patients, doubts remain over the concept of blood-pressure-independent CV protection offered by both classes of drugs. ACE-Is and ARBs appear to be equally effective with respect to morbidity and mortality endpoints, but ARBs are better tolerated. Considering the available evidence, the combined use of an ACE-I and ARB should be avoided and full doses of either ACE-I or ARB should be aimed for as evidence suggests they provide a greater prognostic benefit.

Pharmacological interventions into the renin-angiotensin system with ACE inhibitors and angiotensin II receptor antagonists: effects beyond blood pressure lowering.

Hypertension is recognized as an important risk factor for cardiovascular morbidity and mortality. Lowering of blood pressure has been shown to minimize the risk of cardiovascular events, with the majority of antihypertensives demonstrating a similar ability to reduce coronary events and stroke for a given reduction in blood pressure. Agents that modify the activity of the renin-angiotensin system (RAS) have been proposed to exhibit additional effects that might go beyond simple blood pressure lowering. The RAS is a crucial system that regulates extracellular fluid volume and blood pressure. Proposed potential benefits of RAS blockade that go beyond blood pressure lowering include a reduction in platelet aggregation and thrombosis, blunting of cardiac and vascular remodeling, favorable metabolic effects and reno- and cerebro-protection. However, factors such as treatment adherence, duration of action of antihypertensive agents and differences in effects on central versus brachial blood pressure may also result in apparent differences in efficacy of different antihypertensives. The aim of this review article is to examine the available data from clinical studies of antihypertensive drugs for evidence of effects that might legitimately be claimed to go beyond simple blood pressure lowering.

Relative frontal brain asymmetry and cortisol release after social stress: The role of action orientation.

Social evaluation is a potent stressor and consistently leads to an activation of the hypothalamic-pituitary-adrenal system. Here, we investigated whether individual differences in action orientation influence the relationship between the cortisol response to social-evaluative threat and relative left frontal electroencephalographic (EEG) alpha asymmetry as a brain marker of approach motivation. Forty-nine participants were exposed to a camera-based variant of the Trier Social Stress Task while salivary cortisol and resting EEG frontal alpha asymmetry were assessed before and after stress induction. Higher relative left frontal activity was associated with higher changes in cortisol levels as measured by the area under curve with respect to increase, particularly in individuals low in action orientation. We discuss the role of the left frontal cortex in coping, the potential role of oxytocin, and negative health consequences when the left-frontal coping process becomes overstrained.

Effects of treatment withdrawal on brachial and central aortic pressure after direct renin inhibition or angiotensin receptor blockade.

INTRODUCTION: Whilst sustained lowering of brachial systolic blood pressure (Br-SBP) and central aortic systolic pressure (CASP) have been demonstrated in patients with hypertension, effects of treatment withdrawal on these parameters have not been investigated. The ASSERTIVE study previously reported more sustained control of Br-SBP with aliskiren versus telmisartan in patients with hypertension, following 7-days treatment withdrawal. In this ASSERTIVE sub-study, we hypothesised that aliskiren would similarly exert more sustained control of CASP than telmisartan during treatment withdrawal. METHODS: We investigated the effects of treatment withdrawal on both Br-SBP and CASP following 12-weeks treatment with either aliskiren (300 mg) or telmisartan (80 mg). Br-SBP and CASP were measured at the end of treatment, and at days 2 and 7 following treatment withdrawal in 303 patients (CASP randomised set). RESULTS: Of the CASP randomised set, 94 patients completed CASP measurements at all time points (CASP completer set). After 7 days of treatment withdrawal, aliskiren demonstrated lesser increases in both Br-SBP and CASP than telmisartan; Br-SBP change: -2.0±1.6 vs. +5.6±1.7 mmHg, p = 0.001; CASP change: -0.4±1.6 vs. +4.6±1.7 mmHg, p = 0.041, n = 94. Similar findings were obtained for the CASP randomised set. CONCLUSIONS: Following treatment withdrawal, aliskiren demonstrated more sustained control of both brachial and central SBP than telmisartan.