Systematic Development of an AI Chatbot for Physical Activity Habit Formation in Prehypertension Individual Integrating Needs, Theories, and Evidence.

Prehypertension, an early stage in the development of hypertension, impacts a substantial segment of the adult population worldwide. Addressing this issue, our study introduces HabitBot, an AI-driven chatbot tailored to encourage physical activity (PA) habits among individuals with prehypertension. HabitBot combines natural language processing with multidisciplinary approaches, drawing from both theoretical frameworks and empirical studies. The chatbot development followed a systematic, five-phase process: comprehensive needs assessment, literature review on behavior change theories, analysis for selecting effective behavior change techniques (BCTs), prototype design through intervention mapping, and refining the intervention based on user feedback. The outcome includes a prototype that integrates the Health Action Process Approach and Habit Formation Theory, utilizing twelve identified BCTs effective in fostering PA habits. User feedback further refined the chatbot across multiple dimensions such as user interface, content accessibility, and privacy. HabitBot exemplifies an innovative integration of behavior change strategies with advanced language model technology, paving the way for digital health interventions in chronic disease prevention. Future studies should assess its long-term efficacy in habit formation and explore its applicability to various demographic groups.

Arterial stiffness is associated with prehypertension in both non-hypertensives and treated hypertensives-A matched case control study.

BACKGROUND: Prehypertension (PHT) is a cardiovascular health risk defined by blood pressure (BP). Arterial stiffness (AS) provides beyond brachial BP inference on vascular ageing and pulse wave analysis (PWA) can measure it non-invasively.We compared association between AS and PHT using age and gender matched case-controls. METHODS: This is a sub analysis of previous PWA studies of hypertensives and non-hypertensives. Using oscillometric PWA by Mobil-o-Graph (IEM, Stolberg, Germany), parameters of AS (augmentation pressure and index, reflection magnitude, aortic pulse wave velocity, pulse pressure amplification), brachial hemodynamics (BH), and central hemodynamics (CH; aortic BP, cardiac output related parameters, stroke work) were derived. Age and gender matched case controls were compared as: 1) Nonhypertensives with BP at prehypertensive level (PHT) versus normotensives (NT) (n = 217 each), 2) Under treatment hypertensives with BP at prehypertensive level (PHT-T) versus untreated, nonhypertensives with BP at prehypertensive level (PHT-UT) (n = 74 each). RESULTS: PHTs had higher AS, BH and CH than NTs, with statistical significance for all but few parameters. PHT-T had comparable BH but higher AS, CH than PHT-UT with significance for few parameters. CONCLUSION: Pulse wave analysis derived arterial stiffness is associated with prehypertension compared to normal, after age and gender matching. In hypertensives, arterial stiffness is significantly higher despite being treated to prehypertension level as compared to control. It hints arterial stiffness to be better parameter than brachial BP to study prehypertension.

Obesity and risk of hypertension in preadolescent urban school children: insights from Pakistan.

BACKGROUND: Childhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertension or hypertension at follow-up among preadolescent school children in urban Karachi, Pakistan. METHODS: This is a sub study with cohort design embedded within a feasibility trial on School Health Education Program in Pakistan (SHEPP) in preadolescents aged 6-11 years, attending two private schools conducted from 2017 to 2019. Hypertension or prehypertension at follow-up were the outcomes and obesity or central obesity at baseline were the exposure variables. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Obesity was defined as body mass index for-age and sex ≥ 95th percentile, whereas central obesity was determined by waist circumference measurements ≥ 85th percentile of age, sex, and height specific cut-offs. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for hypertension and prehypertension. RESULTS: Analysis was conducted for 908 participants, evenly distributed with 454 boys and 454 girls. Hypertension was observed in 19.8% of the preadolescents, with rates of 18.5% in boys and 21.0% in girls. Prehypertension was found in 16.8% of preadolescents, with 18% among boys and 16% among girls. Additionally, 12.8% of preadolescents were classified as obese and 29.8% had central obesity. Obesity at baseline was associated with hypertension at followup (OR 8.7, 95% CI 3.5, 20.4) in the final model after adjusting for age, gender, physical activity, sedentary behavior, fruits, vegetable intake and hypertension at baseline. Central obesity at baseline also yielded high odds, with prehypertension (OR 1.9, 95% CI 1.4, 2.8) and hypertension (OR 2.7, 95% CI 1.9, 3.9) at follow up in the final model. CONCLUSION: This study highlights a concerning prevalence of hypertension and prehypertension among preadolescent school-going children. Obesity and central obesity at baseline emerged as significant predictive factors for hypertension or prehypertension at followup within this cohort. The findings emphasize the urgency of implementing comprehensive school health education programs aimed at early detection and effective management of hypertension during childhood and adolescence in school settings.

Fidelity to and utility of a home blood pressure self-monitoring regime in people with pre-hypertension: results from the REVERSE study.

INTRODUCTION: Around 40% of adults have pre-hypertension (120-139/80-89mmHg) increasing their risk of developing hypertension and associated cardiovascular conditions. Guidance on pre-hypertension management focuses on improving lifestyle. Self-monitoring may improve awareness and understanding of blood pressure (BP) for people with pre-hypertension, allowing them to modify their lifestyle risks. AIM: To determine the fidelity to and utility of a home BP self-monitoring regime in people with pre-hypertension. METHOD: This sub-study is part of a larger prospective, non-randomised feasibility study. Individuals with pre-hypertension were identified via GP records and pharmacy NHS Health Checks in Northwest England. Participants received training for home BP self-monitoring. They were asked to complete two readings (leaving a 5-minute interval) on the first three days of the month for six months, colour-code their readings and take action using a simple algorithm, then send them to the research team within 7 days. RESULTS: Eighty participants (aged 40-79, mean=59) enrolled. The majority were female (n=45, 56%), White British (n=79, 99%), and had not previously monitored their BP (n=55, 69%). Seventy-five (94%) participants completed the training. Sixty-one (81%) received online training and 14 (19%) opted for a face-to-face session. Sixty-one (81%) completed all six months of readings, 51 (68%) also returned them on time. All in-person training participants completed all six months of readings on time. Reasons for non-compliance to the protocol included battery issues, forgetting, and struggling to find a consistent time for readings. CONCLUSION: Home BP self-monitoring can be feasible and easily implementable for people with pre-hypertension - however, some barriers were identified.

The relationship between liver enzymes, prehypertension and hypertension in the Azar cohort population.

BACKGROUND: The incidence of hypertension (HTN) as a worldwide health problem is rising rapidly. Early identification and management of pre-HTN before HTN development can help reduce its related complications. We evaluated the relationship between liver enzymes levels and pre-HTN/HTN in the Azar cohort population. METHOD: This cross-sectional study was based on data from the large Azar cohort study and a total of 14,184 participants were included. Pre-HTN and HTN were defined based on the American Heart Association guideline. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) levels were measured by Pars Azmoon kits. The relationship between pre-HTN/HTN and liver enzyme levels was evaluated by logistic regression. RESULTS: Of 14,184 participants, 5.7% and 39.6% had pre-HTN and HTN, respectively. In the adjusted model, AST levels of 19-23 IU/l were associated with an elevated risk of pre-HTN (OR [95% CI]: 1.24 [1.04-1.48]). A dose-response increase was seen in pre-HTN in relation to ALT, with the highest OR in the third tertile (1.34 [1.09-1.63]). The odds of pre-HTN also increased with GGT in the third tertile (1.25[1.03-1.52]). In addition, the odds of HTN increased with increased levels of AST, ALT, ALP, and GGT, such that the highest ORs were recorded in the third tertile (OR 1.22 [1.09-1.37], 1.51 [1.35-1.70], 1.19 [1.07-1.34], and 1.68 [1.49-1.89], respectively). Among these enzymes, GGT had the highest OR regarding HTN. CONCLUSION: This study indicates that AST, ALT, ALP and GGT levels were associated with pre-HTN (except for ALP) and HTN, independent of known risk factors. Hence, it may be possible to use liver enzymes to predict the incidence of pre-HTN and HTN, empowering primary care providers to make the necessary interventions promptly.

Prevalence of modifiable risk factors for cardiovascular disease among school-going children and adolescents in Eldoret, Kenya.

Introduction: Cardiovascular disease (CVD) prevalence in Kenya is rising. Overweight, pre-hypertension and physical inactivity at younger ages is contributory. These risk factors are inadequately documented among Kenyan children and adolescents, hampering CVD prevention. Methods: this cross-sectional study randomly sampled 384 participants from Eldoret, Kenya. After ethical considerations, physical activity was assessed. Body mass index (BMI), Waist-Hip-Ratio (WHR) and Waist-Height-Ratio (WHtR) were determined, and blood pressure (BP) was measured. Results: participants were 14.6±2.7 years, and 62.6% were female. Eight percent had BMI ≥25.0 kg/m2. Of these, 87% were in secondary schools. Using SBP, 27.9% had CVD risk (42.5% and 20% for males and females ≥13 years and 26.5% and 27% for those <13 years, respectively). For DBP, 12.8% had elevated-to-hypertensive BP (13.2% and 8.3% for males and females ≥13 years and 11.8% and 25.4% for those <13 years, respectively). Combining SBP and DBP, 8.1%, mostly males, had elevated-to-hypertensive BP. Using respective WHR cutoffs of 0.90 and 0.85, 31% (boys) and 15.6% (girls) were at CVD risk. For WHtR, 39.6% of boys were >0.463 cut-off (0.493±0.02) against 32.4% for girls >0.469 cut-off (0.517±0.05). Of these, 52.6% (boys) and 69.7% (girls) were in secondary schools. Overall, 45% of participants were sports-inactive and 77.2% did minimal physical activities. Conclusion: among school-going children and adolescents in Eldoret, Kenya, the prevalence of CVD risk factors was high, especially among boys and in high schools. Large proportions had elevated BP, BMI, WHR and WHtR, and, further, were sedentary, posing a high CVD risk. Lifestyle interventions to mitigate this are urgently needed.

Assessing levels of uric acid and other cardiovascular markers in prehypertensive and hypertensive adults.

INTRODUCTION: Although some studies have reported the association between uric acid (UA) and hypertension, evidence on prehypertension is still lacking. Therefore, the objective of this study was to determine the levels of UA and other cardiovascular markers among prehypertensive and hypertensive patients and assess their risk for developing arterial hypertension. METHODS: 157 individuals were recruited: 67 normotensive, 23 pre-hypertensive and 67 hypertensive. Blood samples were collected to measure biochemical parameters and anthropometric measurements and blood pressure were evaluated. We calculated the product of lipid accumulation and the visceral adiposity index to assess cardiovascular risk. RESULTS: Our data showed an increase in UA levels in normotensives (4.9±1.3mg/dL), prehypertensives (5.2±1.3mg/dL) and hypertensives (5.9±1.6mg/dL) (p=0.004). We found a higher frequency of hyperuricemia in the hypertensive group (34.3%) than in the normotensive group (13.4%, p<0.05). Hypertensive volunteers had lower levels of HDL-C (p=0.004 and p=0.003) and higher body mass indexes (p<0.001 and p=0.007), glucose (p<0.001 and p=0.033), triglycerides (p=0.001 and p=0.005), visceral adiposity index (p<0.001 and p=0.002) and lipid accumulation product (p<0.001 and p=0.007) than normotensive and prehypertensive participants. We also observed that individuals with UA≥6.2mg/dL had an increased risk of hypertension of 4.77 (p=0.003) compared to individuals with levels≤4.3mg/dL. CONCLUSION: Our results showed that UA is associated with increased blood pressure and unfavorable changes in anthropometric and biochemical parameters, which represent risk factors for hypertension and cardiovascular diseases.

Proteomic Analysis of Prehypertensive and Hypertensive Patients: Exploring the Role of the Actin Cytoskeleton.

Hypertension is a pervasive and widespread health condition that poses a significant risk factor for cardiovascular disease, which includes conditions such as heart attack, stroke, and heart failure. Despite its widespread occurrence, the exact cause of hypertension remains unknown, and the mechanisms underlying the progression from prehypertension to hypertension require further investigation. Recent proteomic studies have shown promising results in uncovering potential biomarkers related to disease development. In this study, serum proteomic data collected from Qatar Biobank were analyzed to identify altered protein expression between individuals with normal blood pressure, prehypertension, and hypertension and to elucidate the biological pathways contributing to this disease. The results revealed a cluster of proteins, including the SRC family, CAMK2B, CAMK2D, TEC, GSK3, VAV, and RAC, which were markedly upregulated in patients with hypertension compared to those with prehypertension (fold change ≥ 1.6 or ≤-1.6, area under the curve ≥ 0.8, and q-value < 0.05). Pathway analysis showed that the majority of these proteins play a role in actin cytoskeleton remodeling. Actin cytoskeleton reorganization affects various biological processes that contribute to the maintenance of blood pressure, including vascular tone, endothelial function, cellular signaling, inflammation, fibrosis, and mechanosensing. Therefore, the findings of this study suggest a potential novel role of actin cytoskeleton-related proteins in the progression from prehypertension to hypertension. The present study sheds light on the underlying pathological mechanisms involved in hypertension and could pave the way for new diagnostic and therapeutic approaches for the treatment of this disease.

Demographic and Socioeconomic Predictors of Prehypertension and Hypertension in the Adult Population: Serbian National Health Survey.

Background and Objectives: Prehypertension and hypertension are the most common cardiovascular disorders worldwide and are increasingly considered one of the most serious public health problems, particularly in developing countries. The objective of this study was to determine the frequency and demographic and socioeconomic predictors of prehypertension and hypertension in the adults in Serbia, and to examine the relationship between prehypertension and hypertension and health behavior determinants (smoking, alcohol use, physical activity) and individual aspects of health (a health self-assessment, multimorbidity, BMI, depressive symptoms). Materials and Methods: The research is part of the fourth National Population Health Survey conducted in 2019, which was conducted by the Republic Institute of Statistics, in cooperation with the Institute of Public Health of Serbia and the Ministry of Health of the Republic of Serbia. As a research instrument, questionnaires were used in accordance with the methodology of the European Health Survey. For the purposes of this research, data on the adult population aged 20 and over were used. Results: Women are at a reduced risk for both prehypertension (OR = 0.328) and hypertension (OR = 0.349) by nearly 70%. Similarly, those aged below 60 years have a lower risk for prehypertension and those younger than 40 years have a lower risk for hypertension (OR = 0.995), whereas people with a lower education have a 4.3 times higher risk of prehypertension (OR = 4.323) and a 1.6 times higher risk of hypertension (OR = 1.614). The poor have a 1.4 times higher risk of prehypertension (OR = 1.413) and a 1 times higher risk of hypertension (OR = 1.035). People with multimorbidity have a 1.2 times higher risk of both prehypertension (OR = 1.218) and a 4.8 times higher risk of hypertension (OR = 4.867). Conclusions: Male gender, lower education, poverty, age and the presence of multimorbidity are significant predictors of prehypertension and hypertension in the Serbian adult population, so preventive strategies should be aimed at these sensitive population groups.

Comparison of Heart Rate Variability in Thai Older Adults with Hypertension, Pre-Hypertension, and Normotension.

Objectives: This study aims to compare HRV variables across three cohorts: normotensive (NT), prehypertensive (pre-HT), and hypertensive (HT) and to assess the relationship between the blood pressure (BP) and HRV parameters. Methods: Employing a cross-sectional design, 64 older participants were categorized based on the Joint National Committee's criteria into NT (n = 10), pre-HT (n = 33), and HT (n = 21) groups. Anthropometric data, lipid profiles, and HRV indices were evaluated. HRV data were obtained from the Polar V800 chest strap device using HRV Kubios software for data analysis of short-term recordings lasting 10 minutes. This analysis encompasses both time and frequency domain assessments. The time domain includes the standard deviation of NN intervals (SDNN), the root mean square of successive RR interval differences (RMSSD), and the percentage of successive RR intervals differing by over 50 ms (pNN50). The frequency domain includes low frequency (LF), high frequency (HF), and the ratio of LF-to-HF power (LF/HF). Data were statistically analyzed via one-way analysis of variance (ANOVA) and Pearson correlation. Results: The HT group exhibited significantly lower values in SDNN, pNN50, LF power, and HF power in comparison to the NT group (P < 0.05). Moreover, the HT group had a significantly lower SDNN value compared to the pre-HT group (P < 0.05). Inverse associations were uncovered between systolic and diastolic blood pressure and SDNN, pNN50, and HF power (P < 0.05). Multiple regression further highlighted the significance of systolic and pulse pressure concerning HF power (P < 0.05). Conclusions: HRV indices are reduced in Thai older adults with HT compared with those with NT. Monitoring HRV in older adults can provide valuable insights into autonomic function and cardiovascular disease risk.

District-Wise Heterogeneity in Blood Pressure Measurements, Prehypertension, Raised Blood Pressure, and Their Determinants Among Indians: National Family Health Survey-5.

Objective: The objective of the study was to determine the prevalence and determinants of ever-measured blood pressure, prehypertension, and raised blood pressure at national, state and district levels in India. Methods: We analysed data from the National Family Health Survey (NFHS-5), on 743,067 adults aged 18-54 years. The sample consisted of 87.6% females and 12.4% males. We estimated prevalence rates and determined adjusted odds ratios for various dependent variables related to blood pressure. Geographical variations were visualized on the map of India, and multivariate logistic regression was employed at state and district levels, with significance set at p < 0.05. Results: The prevalence of ever-measured blood pressure varied widely, from 30.3% to 98.5% across districts, with southern and northern regions showing higher rates. Prehypertension affected 33.7% of the population, with varying prevalence across districts. Raised blood pressure was there in 15.9%, with notably higher rates in southern region (16.8%). Determinants included age, gender, education, wealth, lifestyle, obesity, and blood glucose levels. Conclusion: These findings demonstrate the subnational variations in blood pressure, can guide evidence-based interventions at the state and district level, towards reducing the burden of raised blood pressure and enhancing overall population health.

Prevalence of cardiometabolic risk factors according to urbanization level, gender and age, in apparently healthy adults living in Gabon, Central Africa.

BACKGROUND: The prevalence of cardiometabolic risk factors (CMRFs) is increasing in sub-Saharan Africa and represents a serious public health issue. Accurate data are required to implement adapted prevention programs and healthcare strategies. Thus, the aim of this study was to estimate the prevalence rates of CMRFs according to the level of urbanization, age and gender in Gabon. METHODS: A cross-sectional study was conducted in northern (Bitam), western coast (Libreville, Melen) and southeast (Koulamoutou) areas of Gabon using the World Health Organization's (WHO) stepwise approach for the surveillance of chronic disease risk factors. Participants over 18 years of age, without known underlying disease, living in rural and urban areas of Gabon were included. Sociodemographic, biological, and behavioral data were collected. Univariate and multivariate analysis were used to identify the CMRFs. RESULTS: Of the 978 participants, 499 lived in urban and 479 in rural areas. Their median age was 38[28-50] years. Tobacco (26.1% vs 6.2%; p < 0.01) and excessive alcohol consumption (19.4% vs 9.6%; p < 0.01) predominated in rural than in urban areas, respectively. Urban dwellers had more often insufficient physical activity than rural people (29.5% vs 16.3%; p < 0.01). In total, 79.9% of participants aged under 54 years had a high blood pressure;10.6% of the younger participants had pre-hypertension. Metabolic syndrome was more frequent in women (21.7%) than in men (10.0%) (p < 0.01); 6.4% of men and 2.5% of women had a high Framingham score (p = 0.03). Finally, 54.0% of the participants had three or four CMRFs. The multivariate analysis showed that men were more likely to be smokers and to be at risk of pre-hypertension or high blood pressure (p < 0.01). Women were more likely to be obese or to have a metabolic syndrome (p < 0.01). Living in urban areas was also a risk factor for hypertension, diabetes, metabolic syndrome and high LDL cholesterol level. CONCLUSION: The prevalence of CMRFs was high in the study population. Disparities were observed according to urban and rural areas, gender and age. National prevention and healthcare strategies for cardiometabolic diseases in Gabon should consider these observed differences.

Prevalence of Pre-Hypertension/Hypertension and Its Associated Factors Among Adults in the Wolaita Zone of Southern Ethiopia: A Cross-Sectional Study.

Preventing the development of high blood pressure and resulting complication requires estimating the prevalence of prehypertension/hypertension and identifying associated risk factors. Information about pre-hypertension/hypertension in Ethiopia, especially in the southern region, is scarce, and limited knowledge exists regarding the prevalence and risk factors associated with pre-hypertension/hypertension. Objective of this study was to assess prevalence of pre-hypertension/hypertension and its associated factors among adults in Wolaita Zone of Southern Ethiopia, 2023. This cross-sectional study was conducted among adults attending outpatient departments in governmental hospitals in South Ethiopia in 2023. Face-to-face interviews were used to gather information on sociodemographic data, dietary and behavioral patterns, and medical history. Digital weighing scales, Stadiometers, and digital sphygmomanometers were used to measure height, blood pressure, and weight, respectively. Epi-Data version 3.1 was used to enter the data before exporting it to SPSS version 25 for analysis. To find factors associated with prehypertension/hypertension, binary logistic regressions were conducted and odds ratios with 95% confidence intervals were computed. The overall prevalence of prehypertension/hypertension was 42.8% (95% confidence interval: 39.56, 49.47). Factors associated with prehypertension/hypertension in this study were older age, male gender, obesity, diabetes mellitus comorbidity, alcohol drinking, and family history of hypertension. Lifestyle modification is demanded for pre-hypertensive/hypertensive patients to prevent progression to severe complications, including premature death and permanent disabilities.

Chinese Visceral Adiposity Index Predict Prehypertension Progression and Regression: A Prospective Cohort Study Involving Middle-Aged and Older Adults.

BACKGROUND: Limited data are published on the relationship of the Chinese visceral adiposity index (CVAI) with prehypertension progression or regression. Therefore, we investigated this association through the China Health and Retirement Longitudinal Study. METHODS: Participants with prehypertension were assigned to two groups according to baseline CVAI, and after 4 years of follow-up, their blood pressure was analyzed for deterioration or improvement. We constructed logistic regression models for assessing the association of CVAI with the progression or regression of prehypertension. A restricted cubic spline (RCS) model was utilized for determining the dose-response association. Subgroup analysis and sensitivity analysis were also conducted. RESULTS: The study included 2,057 participants with prehypertension. During the follow-up, 695 participants progressed to hypertension, 561 participants regressed to normotension, and 801 participants remained as prehypertensive. An association was observed between a high CVAI value and a higher incidence of progression to hypertension and between a high CVAI value and a lower incidence of regression to normotension (OR = 1.66 and 0.58, 95% CI: 1.35-2.05 and 0.47-0.73, respectively). The RCS model exhibited a linear association between CVAI and prehypertension progression and regression (all P for non-linear > 0.05). The results of the subgroup and sensitivity analyses agreed with those of the primary analysis. CONCLUSIONS: A significant association was noted between CVAI and prehypertension progression and regression. Thus, as part of the hypertension prevention strategy, monitoring CVAI is crucial in individuals with prehypertension.

Medical nutrition therapy provided by a dietitian improves outcomes in adults with prehypertension or hypertension: a systematic review and meta-analysis.

BACKGROUND: Hypertension is an important risk factor for cardiovascular disease (CVD). Interventions with dietitians can help modify dietary intake and reduce hypertension risk. OBJECTIVES: We aimed to examine the following research question: In adults with prehypertension or hypertension, what is the effect of medical nutrition therapy (MNT) provided by a dietitian on blood pressure (BP), CVD risk and events, and anthropometrics compared with standard care or no intervention? METHODS: MEDLINE, CINAHL, and Cochrane Central databases were searched for randomized controlled trials (RCTs) published in peer-reviewed journals from 1985-2022. Risk of bias was assessed using version 2 of the Cochrane tool for RCTs. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed for each outcome using the Grading of Recommendations, Assessment and Evaluation method. RESULTS: Forty articles representing 31 RCTs were included and analyzed. MNT provided by a dietitian may reduce systolic [mean difference (MD): -3.63 mmHg; 95% confidence interval (CI): -4.35, -2.91 mmHg] and diastolic (MD: -2.02 mmHg; 95% CI: -2.56, -1.49 mmHg) BP (P < 0.001) and body weight (MD: -1.84 kg; 95% CI: -2.72, -0.96 kg; P < 0.001) and improve antihypertensive medication usage, relative risk of stroke (MD: 0.34; 95% CI: 0.14, 0.81; P = 0.02), and CVD risk score [standardized mean difference (SMD): -0.20; 95% CI: -0.30, -0.09; P < 0.001] compared with control participants, and COE was moderate. Additionally, MNT may reduce arterial stiffness (SMD: -0.45; 95% CI: -0.71, -0.19; P = 0.008) and waist circumference (SMD: -1.18 cm; 95% CI: -2.00, -0.36; P = 0.04), and COE was low. There was no significant difference in risk of myocardial infarction between groups. Dietitian interventions reduced BP and related cardiovascular outcomes for adults with prehypertension or hypertension. CONCLUSIONS: Dietitians play a critical role in improving cardiometabolic risk factors for adults with elevated BP; thus, improved payment for and access to MNT services has the potential to significantly impact public health. This review was registered at PROSPERO as CRD42022351693.

Effect of sacubitril/valsartan on the hypertensive heart in continuous light-induced and lactacystin-induced pre-hypertension: Interactions with the renin-angiotensin-aldosterone system.

This study investigated whether sacubitril/valsartan or valsartan are able to prevent left ventricular (LV) fibrotic remodelling and dysfunction in two experimental models of pre-hypertension induced by continuous light (24 hours/day) exposure or by chronic lactacystin treatment, and how this potential protection interferes with the renin-angiotensin-aldosterone system (RAAS). Nine groups of three-month-old male Wistar rats were treated for six weeks as follows: untreated controls (C), sacubitril/valsartan (ARNI), valsartan (Val), continuous light (24), continuous light plus sacubitril/valsartan (24+ARNI) or valsartan (24+Val), lactacystin (Lact), lactacystin plus sacubitil/valsartan (Lact+ARNI) or plus valsartan (Lact+Val). Both the 24 and Lact groups developed a mild but significant systolic blood pressure (SBP) increase, LV hypertrophy and fibrosis, as well as LV systolic and diastolic dysfunction. Yet, no changes in serum renin-angiotensin were observed either in the 24 or Lact groups, though aldosterone was increased in the Lact group compared to the controls. In both models, sacubitril/valsartan and valsartan reduced elevated SBP, LV hypertrophy and fibrosis and attenuated LV systolic and diastolic dysfunction. Sacubitril/valsartan and valsartan increased the serum levels of angiotensin (Ang) II, Ang III, Ang IV, Ang 1-5, Ang 1-7 in the 24 and Lact groups and reduced aldosterone in the Lact group. We conclude that both continuous light exposure and lactacystin treatment induced normal-to-low serum renin-angiotensin models of pre-hypertension, whereas aldosterone was increased in lactacystin-induced pre-hypertension. The protection by ARNI or valsartan in the hypertensive heart in either model was related to the Ang II blockade and the protective Ang 1-7, while in lactacystin-induced pre-hypertension this protection seems to be additionally related to the reduced aldosterone level.

Exploring the impact of prenatal perfluoroalkyl and polyfluoroalkyl substances exposure on blood pressure in early childhood: A longitudinal analysis.

Previous research investigating the correlation between prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and subsequent blood pressure (BP) in offspring has yielded limited and contradictory findings. This study was conducted to investigate the potential relationship between maternal PFAS levels during pregnancy and subsequent BP in early childhood. A total of 129 expectant mothers from the Shanghai Birth Cohort were included in the study. Using high-performance liquid chromatography/tandem mass spectrometry, we measured ten PFAS compounds in maternal plasma throughout the pregnancy. When the children reached the age of 4, we examined their systolic BP (SBP) and diastolic BP (DBP), along with mean arterial pressure (MAP) and pulse pressure (PP). Data interpretation employed multiple linear and logistic regression models, complemented by Bayesian kernel machine regression (BKMR).We found that the majority of PFAS concentrations remained stable during pregnancy. The linear and BKMR models indicated a positive relationship between the PFAS mixture in maternal plasma and offspring's DBP and MAP, with perfluorohexanesulphonic acid (PFHxS) having the most significant influence (PFHxS and DBP [first trimester:ß=3.03, 95%CI: (1.01,5.05); second trimester: ß=2.35, 95%CI: (0.94,3.75); third trimester: ß=2.57, 95%CI:(0.80,4.34)]; MAP [first trimester:ß=2.55, 95%CI: (0.64,4.45); second trimester: ß=2.28, 95%CI: (0.95,3.61); third trimester: ß=2.35, 95%CI:(0.68,4.01)]). Logistic regression highlighted an increased risk of prehypertension and hypertension in offspring with higher maternal PFHxS concentrations during all three trimesters [first trimester: OR=2.53, 95%CI:(1.11,5.79), second trimester: OR=2.05, 95%CI:(1.11,3.78), third trimester: OR=3.08, 95%CI:(1.40,6.79)]. A positive correlation was identified between the half-lives of PFAS and the odds ratio (OR) of prehypertension and hypertension in childhood (ß=0.139, P=0.010). In conclusion, this research found maternal plasma PFAS concentrations to be positively associated with BP in offspring, with PFHxS showing the most significant influence. This correlation remained consistent throughout pregnancy, and this effect was proportional to the half-lives of PFAS.

[Impact of Anthropometric Indices of Obesity on the Risk of Incident Hypertension in Adults with Prehypertension: A Secondary Analysis of a Cohort Study].

PURPOSE: This study aimed to investigate the impact of anthropometric indices of obesity (body mass index [BMI], waist circumference, waist hip ratio, and body fat percentage) on the incidence of hypertension in adults with prehypertension. METHODS: A longitudinal study design using secondary data form the Korean Genome and Epidemiology Study was employed. The study included 1,838 adults with prehypertension tracked every two years from 2001 to 2018. Statistical analyses, including frequency assessments, number of cases per 1,000 person-years, log-rank tests, Kaplan-Meier curves, and Cox's proportional hazards regression, were conducted using SPSS version 25. RESULTS: Over the observation period (15,783.6 person-years), 1,136 individuals developed hypertension. The incidence of hypertension was significantly higher in the obesity groups defined by BMI (hazard ratio [HR] = 1.33), waist circumference (HR = 1.34), waist hip ratio (HR = 1.29), and body fat percentage (HR = 1.31) compared to the non-obese group. These findings indicate an increased risk of hypertension associated with obesity as measured by these indices. CONCLUSION: The study underscores the importance of avoiding obesity to prevent hypertension in individuals with prehypertension. Specifically, BMI, waist circumference, waist hip circumference, and body fat percentage were identified as significant risk factors for hypertension. The results suggest the need for individualized weight control interventions, emphasizing the role of health professionals in addressing the heightened hypertension risk in this population.

Risk of heart disease and stroke among individuals with prehypertension or blood pressure progression: a national population-based cohort study.

OBJECTIVE: The purpose of our study was to analyze the association of blood pressure and blood pressure progression with heart disease and stroke among Chinese population. METHOD: We included a total of 10 122 adults aged 45 years and above free of heart disease or stroke at baseline from the China Health and Retirement Longitudinal Study cohort. We used Cox proportional hazards models to analyze the relationship between cardiovascular risk and prehypertension in subjects with or without progression to hypertension. RESULT: During a mean follow-up of 6.5 years, 1972 subjects were either diagnosed with heart disease or had a stroke (composite outcome). Compared with individuals with normotension at baseline, the fully adjusted hazard ratio (HR) [95% confidence interval (CI)] was 1.25 (1.10-1.42) and 1.52 (1.34-1.74) for composite outcome in individuals with prehypertension and hypertension at baseline, respectively. The subjects who progressed to hypertension had higher risk of cardiovascular outcomes than those who remained at normal blood pressure or prehypertension in a fully adjusted model. The subjects who progressed from prehypertension to hypertension had 1.72 times higher risk [HR (95% CI): 1.72 (1.37-2.16)] of cardiovascular outcomes than those who remained at normal blood pressure or prehypertension in a fully adjusted model. CONCLUSION: The cardiovascular risk of subjects with prehypertension is higher than that of subjects with normal blood pressure. After a diagnosis of hypertension, subjects who progressed from normal blood pressure to hypertension had an increased risk of heart disease and stroke.