Previous research on depressive symptoms with incident hypertension has yielded mixed results, and this relationship has not been studied in a diverse group of Hispanic/Latino adults.

We studied 5927 Hispanic/Latino adults aged 18-74 years from four U.S. cities who attended baseline (2008-2011) and follow-up (2014-2017) examinations of the Hispanic Community Health Study/Study of Latinos. Baseline depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-10; clinically relevant depressive symptoms were defined as ≥10 points. Blood pressure (BP) was measured using a standardized protocol at both examinations. Hypertension was defined as measured systolic BP ≥130 mmHg, or diastolic BP ≥80 mmHg, or self-reported antihypertension medication use. Analyses accounted for the complex survey design.

Among 5927 persons without hypertension at baseline, the six-year age-adjusted incidence rates of hypertension were 40 and 31 per 1000 person-years among those with and without elevated depressive symptoms, respectively. Persons with elevated depressive symptoms had a 25 % (p = .003) higher 6-year incidence of hypertension than those with fewer symptoms, after adjusting for sociodemographic and clinical covariates. There was an interaction between depressive symptoms and age (pinteraction < 0.05). Among adults aged 18-34 years without hypertension at baseline (n = 1748), those with elevated depressive symptoms had 80 % higher 6-year incidence of hypertension than those with fewer symptoms (p = .001).

These findings suggest that depressive symptoms are a risk factor for hypertension in young Hispanic/Latino adults. Early screening and treatment of depressive symptoms may aid in the prevention of hypertension.

The global population aged 80 years and older will reach approximately half a billion in the coming years, and cardiovascular prevention in this group of patients will become a global health challenge. In the era of evidence-based medicine, the use of lipid-lowering therapies (LLTs) in the elderly, particularly in primary and secondary cardiovascular prevention, remains an area of active research. Although there is broad consensus on the use of LLTs in the elderly to prevent recurrent cardiovascular events in secondary prevention, there is considerable debate about their use in primary prevention. Many efforts have been made to improve cardiovascular risk stratification in patients over 75 years of age in primary prevention. In recent years, some specific risk scores have been developed, including the Systematic Coronary Risk Evaluation 2 for Older Persons (SCORE2-OP). While there are very few specific warnings to consider for LLTs in the elderly, an important challenge in this patient population is to identify the turning point at which the disutility risk outweighs the potential benefits. However, despite the widespread recognition of the importance of this issue, there is a lack of guidance on how to identify patients who should be withdrawn from therapy. The aim of this narrative review is to examine the current state of knowledge regarding the indications for LLT in elderly patients, identify outstanding issues, and discuss future developments.

Cardiovascular diseases are a leading cause of global mortality, with hypertension as a major risk factor. Low control rates are often attributed to monotherapy, while evidence and clinical guidelines support the effectiveness of combination therapies. This study aimed to evaluate blood pressure changes and the achievement of target levels in patients treated with losartan/chlorthalidone (L/C) compared to losartan/hydrochlorothiazide (L/H).

A randomized, double-blind, prospective, multicenter clinical trial was conducted. Patients were assigned to one of two treatment groups, starting with a lower dose (50/12.5 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide). Blood pressure was evaluated at 30 days, and patients not meeting therapeutic goals were escalated to a higher dose (100/50 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide) and followed until the study end (60 days).

The study recruited 163 patients (83 for losartan/chlorthalidone [L/C] group and 80 for the losartan/hydrochlorothiazide [L/H] group), with a mean age of 53.1 years. Both treatment groups demonstrated significant reductions in systolic and diastolic blood pressure, with L/C achieving an average reduction in systolic blood pressure (SBP) of - 24.6 mmHg and - 13.3 mmHg for diastolic blood pressure (DBP), while L/H had reductions of - 25.3-mmHg and - 11.5 mmHg, respectively. The L/C group exhibited a higher likelihood of achieving blood pressure goals compared to the L/H. Adverse events were comparable between groups and were mostly mild.

The study showed that both combinations are effective for hypertension, with losartan/chlorthalidone demonstrating greater efficacy in reducing diastolic blood pressure and achieving target levels. Both treatments exhibited similar and favorable safety profiles.

NCT04927299. Registered August 6, 2021- https://clinicaltrials.gov/study/NCT04927299.

BackgroundThe extent to which hypertension-related excess risk of dementia can be mitigated or eradicated through lifestyle factor modification remains unclear.ObjectiveTo explore the association between lifestyle behaviors and hypertension-related excess risk of dementia.MethodsIn this prospective cohort study using data from the UK Biobank, participants were enrolled from 2006 to 2010 and followed up until December 2022. A healthy lifestyle score was constructed by assigning one point for each of the seven selected healthy lifestyle factors. The association of dementia risk in individuals with hypertension according to the healthy lifestyle score was compared to individuals without hypertension.ResultsThis study included 337,378 individuals. During a median follow-up of 13.6 years, 5390 participants developed dementia. A higher healthy lifestyle score was associated with a gradual decrease in the excess risk of dementia for individuals with hypertension compared to individuals without hypertension. Excess dementia risk was not detected among individuals with hypertension who adopted at least six healthy lifestyle factors (hazard ratio (HR) = 1.05 (95% confidence interval (CI): 0.96-1.14)) for six scores; HR = 0.93 (95% CI: 0.82-1.06 for seven scores). The protective association between adhering to all seven healthy lifestyle factors and dementia was significantly stronger for individuals <60 years old than for individuals ≥60 years old.ConclusionsFor individuals with hypertension who adopted at least six healthy lifestyle factors had no hypertension-related excess risk of dementia.

Our objective was to explore the effect of aerobic exercise on endothelial function in hypertensive and prehypertensive patients, and to ascertain the optimal duration and intensity of aerobic exercise. Data were synthesized using a random effects model to calculate the weighted mean difference (WMD) and 95% confidence interval (CI). Fifteen studies met the inclusion criteria. Aerobic exercise was found to significantly improve flow-mediated dilation (FMD) in prehypertensive and hypertensive patients (WMD, 2.23; 95% CI, 1.20-3.26; P  < 0.0001; I2  = 90%). Aerobic exercise, undertaken at a moderate or, even better, vigorous intensity, and lasting no less than 12 weeks, is an effective approach to improve flow-mediated dilation (FMD) in prehypertensive and hypertensive patients. The effect of aerobic exercise on endothelial function is influenced by participant characteristics: a better health status, a younger age, a larger basal body mass index, and a larger basal FMD were associated with larger improvement in FMD.

Ageing and hypertension both have substantial, well-documented effects on the cerebral vasculature. The effects of aerobic exercise on cerebrovascular function and development, although less well understood, have also recently received significantly increased attention. There is now clear evidence that aerobic exercise yields both short- and long-term changes to cerebrovascular health, with significant potential to improve population brain health. However, there has as yet been no mathematical model of this, making it challenging to quantify the effects of aerobic exercise. One reason for this is the very different time scales between exercise (minutes/hours) and cerebrovascular development (years/decades). Here, a new mathematical model is proposed, one that incorporates short-term changes within a longer time scale. The model is calibrated against various experimental data sources and used to quantify the effects of ageing, hypertension, and exercise interventions on lifetime cerebrovascular health. The model predicts that high-intensity exercise has a significant positive effect on cerebral health; that antihypertensive treatment has a significant positive effect even after prolonged periods of hypertension; and that different interventions can strongly interact with each other. This model provides the foundation for future quantitative investigations into the critical role of aerobic exercise and other interventions in cerebrovascular health. KEY POINTS: Exercise has a significant and lifetime positive effect on the cerebral vasculature, which can counterbalance the negative effects of ageing and hypertension. A new model is presented that incorporates the effects of all three effects on the cerebral vasculature, using multiple time scales to include both short- and long-term effects. The model is calibrated against a range of experimental data and used to quantify the effects of different exercise regimes on cerebrovascular health for the first time. This model can be used in future to explore the lifetime effects of different lifestyles and interventions on population brain health.

Biological age serves as a common starting point for various age-related diseases and can be associated with a wide range of cardiovascular outcomes. However, associations between cardiovascular biological age (CBA) and various types of cardiovascular disease (CVD) remain unclear.

Analyzing 262,343 UK Biobank participants, we constructed CBA based on composite biomarkers using the Klemera-Doubal method (denoted as KDM-CBA). We measured KDM-CBA acceleration as the difference between KDM-CBA and chronological age. We then examined the associations between KDM-CBA and 17 CVD types using Cox proportional hazard models. We used restricted cubic spline models to assess potential nonlinear associations of KDM-CBA and KDM-CBA acceleration with different types of CVDs. We observed that KDM-CBA (per 1SD increase) was associated with various CVD types, but with different extent (hypertension: hazard ratio (HR)=2.115, 95% confidence interval (CI): 2.083-2.148; coronary atherosclerosis: HR=1.711, 95% CI: 1.545-1.896). We observed similar results for KDM-CBA acceleration and KDM-CBA. KDM-CBA and KDM-CBA acceleration showed J-type nonlinear associations with nearly all CVD types (cutoff values of ≈55 and -1.7 years for KDM-CBA and KDM-CBA acceleration, respectively).

Our study showed that CBA is associated with increased incidence of CVD, which further validates aging as a common starting point for different CVD types as well as highlighting CBA's role as an early CVD indicator, providing valuable insights for CVD interventions.

Metabolomics approaches, such as Fourier transform infrared (FTIR) spectroscopy, nuclear magnetic resonance (NMR) spectroscopy, and mass spectrometry (MS), have emerged as powerful tools for studying cardiovascular diseases (CVD), including hypertension. The use of biological fluids, like plasma and serum, has garnered significant interest due to their accessibility and potential in elucidating disease mechanisms. This review aims to summarize the current literature on the application of metabolomics techniques (FTIR, NMR, and MS) in the study of hypertension, focusing on their contributions to understanding disease pathophysiology, biomarker discovery, and therapeutic advancements. A comprehensive analysis of metabolomic studies was performed, with a particular emphasis on the diversity of altered metabolites associated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and sex-related differences. Metabolomics techniques, including FTIR, NMR, and MS, provide comprehensive insights into the biochemical alterations underlying hypertension, such as amino acid and fatty acid metabolism impairment or inflammation and oxidative stress processes. This review underscores their role in advancing biomarker identification, deepening our understanding of disease mechanisms, and supporting the development of targeted therapeutic strategies. The integration of these tools highlights their potential in personalized medicine and their capacity to improve clinical outcomes.

Patients with diabetes had significant vascular resistance, which was explained by vascular remodeling and an increase in fluid volume as a result of hyperglycemia. Insulin resistance in type 2 diabetes impairs lipid catabolism, and obesity raises the risk of isolated systolic hypertension. However, in Ethiopia minimal study has been conducted to address the specific relationship between isolated systolic hypertension and type 2 diabetes. Therefore, this study aims to determine the magnitude and determinants of isolated systolic hypertension among type 2 diabetes patients in selected referral hospitals of Amhara region, Ethiopia. A multicenter institution-based cross-sectional study was conducted from September 1 and December 30, 2023. Referral hospitals were chosen using simple random sampling. Additionally, participants in the study were chosen from the designated referral hospitals using systematic sampling approaches. To collect clinical and sociodemographic data, an interviewer-administered questionnaire was utilized. Epi-data version-4.6 and Stata-14 were used for data entry and statistical analysis, respectively. The descriptive statistics were presented with tables and graphs. A binary logistic regression model was fitted to identify associated factors of isolated systolic hypertension. In the final model, statistical significance was decided at p ≤ 0.05, and the strength of association was indicated using an adjusted odds ratio with 95% CI. The analysis included 258 participants, and the prevalence of isolated systolic hypertension was found to be 21.3% (95% CI 18-27.1%). Older age (AOR = 4.64, 95%CI 1.31,16.36), fasting blood sugar of ≥ 130 mg/dl (AOR = 2.32, 95% CI; 1.04, 5.19), and BMI > 25 Kg/m2 (AOR = 2.75, 95% CI (1.33, 5.68)) were statistically significant factors of isolated systolic hypertension. The prevalence of isolated systolic hypertension (ISH) in this study was high, affecting large population of Type 2 Diabetes Mellitus (T2DM) patients. Older age, high body mass index (BMI), and elevated fasting blood sugar levels were identified as key determinants of ISH. The study emphasizes the need for regular monitoring and management of blood pressure in T2DM patients, particularly those who are older, and have higher BMI.

In the 21st century, the demographic shift toward an aging population has posed a significant challenge, particularly with respect to age-related diseases, which constitute a major threat to human health. Accordingly, the detection, prevention, and treatment of aging and age-related diseases have become critical issues, and the introduction of novel molecular recognition elements, called aptamers, has been considered. Aptamers, a class of oligonucleotides, can bind to target molecules with high specificity. In addition, aptamers exhibit superior stability, biocompatibility, and applicability, rendering them promising tools for the diagnosis and treatment of human diseases. In this paper, we present a comprehensive overview of aptamers, systematic evolution of ligands by exponential enrichment (SELEX), biomarkers associated with aging, as well as aptamer-based diagnostic and therapeutic platforms. Finally, the limitations associated with predicting and preventing age-related conditions are discussed, along with potential solutions based on advanced technologies and theoretical approaches.

Cardiovascular disease (CVD), such as hypertension and coronary artery disease, involves pathological changes in vascular signaling, function, and structure. Vascular signaling is regulated by multiple intrinsic and extrinsic factors that influence endothelial cells, vascular smooth muscle, and extracellular matrix. Vascular function is also influenced by environmental factors including diet, exercise, and stress, as well as genetic background, sex differences, and age. CVD is more common in adult men and postmenopausal women than in premenopausal women. Specifically, women during menopausal transition, with declining ovarian function and production of estrogen (E2) and progesterone, show marked increase in the incidence of CVD and associated vascular dysfunction. Mechanistic research suggests that E2 and E2 receptor signaling have beneficial effects on vascular function including vasodilation, decreased blood pressure, and cardiovascular protection. Also, the tangible benefits of E2 supplementation in improving menopausal symptoms have prompted clinical trials of menopausal hormone therapy (MHT) in CVD, but the results have been inconsistent. The inadequate benefits of MHT in CVD could be attributed to the E2 type, dose, formulation, route, timing, and duration as well as menopausal changes in E2/E2 receptor vascular signaling. Other factors that could affect the responsiveness to MHT are the integrated hormonal milieu including gonadotropins, progesterone, and testosterone, vascular health status, preexisting cardiovascular conditions, and menopause-related dysfunction in the renal, gastrointestinal, endocrine, immune, and nervous systems. Further analysis of these factors should enhance our understanding of menopause-related changes in vascular signaling by sex hormones and provide better guidance for management of CVD in postmenopausal women. SIGNIFICANCE STATEMENT: Cardiovascular disease is more common in adult men and postmenopausal women than premenopausal women. Earlier observations of vascular benefits of menopausal hormone therapy did not materialize in randomized clinical trials. Further examination of the cardiovascular effects of sex hormones in different formulations and regimens, and the menopausal changes in vascular signaling would help to adjust the menopausal hormone therapy protocols in order to enhance their effectiveness in reducing the risk and the management of cardiovascular disease in postmenopausal women.

While the associations of mid-life cardiovascular risk factors with late-life white matter lesions (WMH) and cognitive decline have been established, the role of cerebral haemodynamics is unclear. We investigated the relation of late-life (69-71 years) arterial spin labelling (ASL) MRI-derived cerebral blood flow (CBF) with life-course cardiovascular risk factors (36-71 years) and late-life white matter hyperintensity (WMH) load in 282 cognitively healthy participants (52.8% female). Late-life (69-71 years) high systolic (B = -0.15) and diastolic (B = -0.25) blood pressure, and mean arterial pressure (B = -0.25) were associated with low grey matter (GM) CBF (p < 0.03), and white matter CBF (B = -0.25; B = -0.15; B = -0.13, p < 0.03, respectively). The association between systolic blood pressure and GM CBF differed between sexes (male/female B = -0.15/0.02, p = 0.04). No associations were found with early- or mid-life cardiovascular risk factors. Furthermore, WMHs were associated with cerebral haemodynamics but not cardiovascular risk factors. These findings suggest that cerebral blood flow autoregulation is able to maintain stable global cerebral haemodynamics until later in life. Future studies are encouraged to investigate why cardiovascular risk factors have differential effects on haemodynamics and WMH, and their implications for cognitive decline.

High blood pressure in older adults poses significant risks, including cardiovascular disease, stroke, and renal failure; yet, its management is often overlooked. Nurse-led personalised interventions provide essential guidance, helping patients adhere to treatment plans and adopt lifestyle changes, improving outcomes and quality of life. A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched systematically (CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Scopus). Five research studies were included in this review, from five countries (India, Korea, China, Turkey and Thailand). Primary data were synthesised using descriptive and thematic analysis methodology. The five main themes from this review relate to nurse-led empowerment strategies for hypertension management, variability in blood pressure outcomes, the importance of tailored education and counselling, the role of regular follow-ups and support, and environmental support. Overall, nurse-led personalised interventions improve blood pressure management and patient engagement in older adults, highlighting the need for research into their long-term effectiveness and broader applicability.

Hypertension prevalence increases with age, reaching over 70% of people over age 65. The underlying mechanisms are poorly understood. This study interrogates a new signaling pathway in vascular smooth muscle of aged mice driven by p90 ribosomal S6 kinase, RSK2, and its role in increasing peripheral vascular resistance and blood pressure (BP).

Basal BP measurements were taken at 26-29 month (812-892 day) old mice with global deletion of RSK2 (Rsk2-/- prior to and following treatment with L-NAME. Cardiac function, vessel stiffness, myogenic responses, Ca2+events, contractility, immuno-staining, histology studies and western blotting were performed.

Resting BP and myogenic vasoconstriction were normal in aged global Rsk2-/- mice and elevated in wild type (WT) littermates. L-NAME treatment increased BP in aged Rsk2+/+ but not aged Rsk2-/- . Vessel stiffness and glycation collagen crosslinking increased in both aged Rsk2+/+ and Rsk2-/- compared to young vessels with no remodeling or increase in collagen content, even though BP in aged Rsk2-/- arterioles was normal. Increased vessel stiffness was dissociated from increased BP. Ca2+ transients increased and sensitivity to NO-induced relaxation decreased in aged Rsk2+/+ compared to young WT arterioles. IEL structures, eNOS and Hbα distribution at myoendothelial junctions were disturbed impairing vasorelaxation in aged Rsk2+/+ but not aged Rsk2-/- arterioles.

RSK2 plays a significant role in hypertension associated with aging by downregulating prorelaxant signaling and promoting procontractile events in the vasculature, offering potential new therapeutic targets.

Age-related oxidative stress is a critical factor in vascular dysfunction, contributing to hypertension and atherosclerosis. Smooth muscle cells and endothelial cells are particularly susceptible to oxidative damage, which exacerbates vascular aging through cellular senescence, chronic inflammation, and arterial stiffness. Gasotransmitters-hydrogen sulfide (H2S), nitric oxide (NO), and carbon monoxide (CO)-are emerging as promising therapeutic agents for counteracting these processes. This review synthesizes findings from recent studies focusing on the mechanisms by which H2S, NO, and CO influence vascular smooth muscle and endothelial cell function. Therapeutic strategies involving exogenous gasotransmitter delivery systems and combination therapies were analyzed. H2S enhances mitochondrial bioenergetics, scavenges ROS, and activates antioxidant pathways. NO improves endothelial function, promotes vasodilation, and inhibits platelet aggregation. CO exhibits cytoprotective and anti-inflammatory effects by modulating heme oxygenase activity and ROS production. In preclinical studies, gasotransmitter-releasing molecules (e.g., NaHS, SNAP, CORMs) and targeted delivery systems show significant promise. Synergistic effects with lifestyle modifications and antioxidant therapies further enhance their therapeutic potential. In conclusion, gasotransmitters hold significant promise as therapeutic agents to combat age-related oxidative stress in vascular cells. Their multifaceted mechanisms and innovative delivery approaches make them potential candidates for treating vascular dysfunction and promoting healthy vascular aging. Further research is needed to translate these findings into clinical applications.

Rhoifolin is a flavonoid found in various plant species, especially within the Rutaceae family, and is considered a dietary component due to its presence in edible plants. Its bioactive properties, such as cytotoxic and anticancer activities, have gained significant attention. This review aims to highlight the general properties and diverse bioactivities of rhoifolin, with a particular focus on its cytotoxic and anticancer effects. This is based on a comprehensive literature search, focusing on the presence of rhoifolin in different plant species and its biological activities, particularly its anticancer properties. Rhoifolin is widely distributed in the plant kingdom, especially in Citrus species. It exhibits a variety of bioactivities, including strong cytotoxic and anticancer effects. Recent studies have shown that rhoifolin can induce apoptosis and inhibit cancer cell proliferation, making it a promising candidate for anticancer therapies. Rhoifolin's diverse bioactivities, particularly its cytotoxic and anticancer properties, position it as a potential therapeutic agent. Further detailed investigations into its molecular mechanisms and well-designed clinical studies are needed to fully understand and utilize its therapeutic potential. See also the graphical abstract(Fig. 1).

We investigated whether the use of antihypertensive medication (AHM) is associated with in vivo Alzheimer's Disease (AD) pathologies in older adults with hypertension and examined if the effect differs by drug-class and blood-brain barrier (BBB) permeability of the drug.

This cross-sectional study recruited participants from the Korean Brain Aging Study for the Early Diagnosis and Prevention of Alzheimer's Disease. Participants comprised both cognitively normal and impaired older adults diagnosed with hypertension (n = 408). All participants underwent comprehensive clinical assessment and [11C] Pittsburgh Compound B positron emission tomography (PET) for measurement of cerebral β-amyloid (Aβ) deposition. Additionally, a subset of participants (n = 120) was subjected to [18F] AV-1451 PET to assess tau deposition.

The AHM group (n = 227) exhibited significantly lower Aβ deposition (B [SE] = -0.104 [0.037], p = 0.006) compared to the non-AHM group (n = 181), even after controlling for age, sex, apolipoprotein E ε4-positivity, vascular risk factors, and mean arterial blood pressure. Further analysis by AHM class showed an association between the use of renin-angiotensin system inhibitors (RASi) and less Aβ deposition (B [SE] = -0.143[0.049], p = 0.004). No significant relationships were observed between the use of BBB-permeable AHM and Aβ deposition. Additionally, associations between AHM use and tau deposition did not reach statistical significance.

Our findings suggest that AHM use may be associated with lower Aβ burden in older adults with hypertension. Further studies exploring the underlying mechanism, particularly related to RASi, may provide insights into new therapeutic targets for AD. ANN NEUROL 2025.

Hypertension is a critical public health issue worldwide. The identification of specific proteomic biomarkers in the Qatari population aims to advance personalized treatment strategies.

We conducted proteomic profiling on 778 Qatari individuals using an aptamer-based SOMAscan platform to analyze 1,305 biomarkers. Statistical analysis involved two-way ANOVA and association analyses with FDR correction, alongside pathway and gene-set enrichment analyses using Reactome and DisGeNET databases.

The study identified 26 significant protein biomarkers associated with hypertension. Notably, QORL1 and BMP1 were identified as novel protein biomarkers. Enrichment analysis linked these biomarkers to critical pathways involved in vascular biology, immune system responses, and pathologies like arteriosclerosis and coronary artery disease. Correlation analyses highlighted robust interactions, particularly between QORL1 and various Apolipoprotein E isoforms, suggesting these biomarkers play pivotal roles in the molecular mechanisms underlying hypertension.

This research enhances our understanding of the molecular basis of hypertension in the Qatari population and supports the development of precision medicine approaches for treatment.

In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus emerged and caused a worldwide pandemic, leading to measures being imposed by many countries to reduce its transmission. Singapore implemented the 'circuit breaker', which restricted all movements except for access to necessities and healthcare services. We aimed to investigate the impact of lockdown measures on the pattern of trauma and its effects.

An observational, retrospective, single-centre descriptive study was conducted using the trauma registry in Singapore General Hospital. It included patients above 18 years old who presented to the emergency department with trauma and were subsequently admitted. Patients admitted from 1 February 2020 to 31 July 2020 and those admitted during the same timeframe in 2019 were studied. Subgroup analyses were performed for patients aged ≥65 years and those <65 years.

A total of 1,037 patients were included for analysis. A 17.6% increase in trauma presentations was seen from 2019 to 2020. Patients aged ≥65 years accounted for the rise in admissions. The predominant mechanism of injury was falls at home for older patients and vehicular accidents in patients <65 years. There were no significant differences in injury severity score, intensive care/high-dependency unit admission rates, length of stay, mortality rate, and subsequent need for inpatient rehabilitation.

Our study provided information on differences in trauma presentations before and during the COVID-19 pandemic. Further studies are required to better inform on additional precautionary measures needed to reduce trauma and improve safety during future lockdowns and pandemics.

Salt sensitivity of blood pressure (SSBP) is a complex physiological trait characterized by changes in blood pressure in response to dietary salt intake. Aging introduces an additional layer of complexity to the pathophysiology of SSBP, with mitochondrial dysfunction, epigenetic modifications, and alterations in gut microbiota emerging as critical factors. Despite advancements in understanding these mechanisms, the processes driving increased salt sensitivity with age and their differential impacts across sexes remain unclear. This review explores the current understanding of salt sensitivity, delving into its underlying mechanisms, the role of inflammation, and the influence of aging and sex differences on these processes. We also aim to provide insights into the multifaceted nature of salt sensitivity and its implications for personalized treatment strategies in hypertension management.

Brain health is intimately connected to fluid flow dynamics that cleanse the brain of potentially harmful waste material. This system is regulated by vascular dynamics, the maintenance of perivascular spaces, neural activity during sleep, and lymphatic drainage in the meningeal layers. However, aging can impinge on each of these layers of regulation, leading to impaired brain cleansing and the emergence of various age-associated neurological disorders, including Alzheimer's and Parkinson's diseases. Understanding the intricacies of fluid flow regulation in the brain and how this becomes altered with age could reveal new targets and therapeutic strategies to tackle age-associated neurological decline.

To investigate the impact of SARS-CoV-2 infection on liver function and prognosis in patients with HBV infection.

A total of 154 HBV-positive patients (HBV ( +) group) and 154 HBV-negative patients (HBV (-) group) diagnosed with COVID-19 at Taizhou Hospital between December 10, 2022, and January 31, 2023, were included in this study. Clinical characteristics, treatment, and laboratory findings were collected from patients at three time points: before (T1), during (T2), and at the time of discharge (T3) from SARS-CoV-2 infection.

Compared to the HBV (-) group, the HBV ( +) group had a longer hospital stay (15 (9-22) days vs. 9 (5-16) days). Longitudinal comparisons of laboratory indicators from T1 to T3 showed a continuous decline in TP and ALB levels and a continuous increase in PT and TT levels in the HBV ( +) group. BUN levels increased during T2 and decreased thereafter. These differences were considered statistically significant (P < 0.05). Notably, the HBV ( +) group had a higher proportion of indicators elevated > 3 ULN from T1 to T2, including ALT (1.95%/5.19%), AST (3.25%/12.99%), ALP (1.95%/3.25%), GGT (4.55%/9.09%), TBIL (6.49%/9.09%), and DBIL (18.18%/22.73%). In the HBV (-) group, the elevations were mainly concentrated within 1-2 ULN, including AST (12.99%/22.08%), DBIL (10.39%/21.43%), BUN (12.99%/22.08%), CREA (20.13%/29.22%), and PLT (7.79%/14.94%). Furthermore, the incidence of liver injury from T1 to T3 was higher in the HBV ( +) group compared to the HBV (-) group (15.7% (20/127) vs. 7.2% (11/152), P < 0.05). Multivariate analysis showed that liver cirrhosis (HR = 4.847, 95% CI: 1.224-19.20, P = 0.025) and liver cancer (HR = 8.333, 95% CI: 2.156-32.209, P = 0.002) were independent risk factors for liver injury in the presence of SARS-CoV-2 infection.

SARS-CoV-2 infection has a higher proportion of liver injury in HBV-infected patients, affecting hepatic protein synthesis function. Those with cirrhosis and hepatocellular carcinoma are at higher risk of severe liver injury.

There is lack of predictive models for the risk of severe complications during hospitalization in patients with acute myocardial infarction (AMI). In this study, we aimed to create a nomogram to forecast the likelihood of in-hospital severe complications in AMI.

From August 2020 to January 2023, 1024 patients with AMI including the modeling group (n=717) and the validation group (n=307) admitted in Changsha Central Hospital's emergency department. Conduct logistic regression analysis, both univariate and multivariate, on the pertinent patient data from the modeling cohort at admission, identify independent risk factors, create a nomogram to forecast the likelihood of severe complications in patients with AMI, and assess the accuracy of the graph's predictions in the validation cohort.

Age, heart rate, mean arterial pressure, diabetes, hypertension, triglycerides and white blood cells were seven independent risk factors for serious complications in AMI patients. Based on these seven variables, the nomogram model was constructed. The nomogram has high predictive accuracy (AUC=0.793 for the modeling group and AUC=0.732 for the validation group). The calibration curve demonstrates strong consistency between the anticipated and observed values of the nomogram in the modeling and validation cohorts. Moreover, the DCA curve results show that the model has a wide threshold range (0.01-0.73) and has good practicality in clinical practice.

This study developed and validated an intuitive nomogram to assist clinicians in evaluating the probability of severe complications in AMI patients using readily available clinical data and laboratory parameters.

The association between omeprazole and hypertension is poorly documented. The summary of product characteristics of omeprazole approved by major regulators did not mention hypertension as an adverse drug event. Triggered by a locally reported case, this study was conducted to assess the possible causal relationship between omeprazole and hypertension.

Globally reported cases of hypertension following use of omeprazole submitted to the World Health Organization global database, VigiBase, were retrieved on 5 March 2024 and analyzed descriptively. Besides this, a literature search was made to identify preclinical, clinical, and epidemiological information on the association between omeprazole and hypertension or increased blood pressure using different data sources. Relevant information, gathered from different data sources, was finally systematically organized into an Austin Bradford-Hill causality assessment framework to assess the causal relationship between omeprazole and hypertension.

VigiBase indicated a total of 1043 cases of hypertension related to omeprazole from 36 different countries. In the global database, a statistical signal was triggered (IC025: 0.12) on association of omeprazole and hypertension. From the 1043 cases, 65.0% and 10.6% were reported as 'serious' and 'fatal', respectively. Hypertension resolved following withdrawal of omeprazole in 85 cases and recurred after re-introduction of the suspect drug in 14 cases. In 225 cases, omeprazole was the only suspected drug, while in 122 cases, omeprazole was the sole drug administered. When only these 122 cases were considered, 29 cases had positive dechallenge, four cases were with positive rechallenge and the median time-to-onset was 2 days. Literature search identified a possible biological mechanism and some experimental evidence that indicates omeprazole could possibly cause hypertension.

Currently available totality of evidence suggests there is a possible causal relationship between omeprazole and hypertension. Hence, it is recommended to monitor and report any incidence of hypertension related to omeprazole, and further epidemiological studies are recommended to corroborate the suggested causal association.

18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) allows noninvasive assessment of glucose metabolism and radiodensity in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). We aimed to address the effects of ageing and metabolic factors on abdominal adipose tissue.

We retrospectively analyzed data from 435 healthy men (mean 42.8 years) who underwent a health check-up programme twice, at baseline and the 5-year follow-up. The mean standardized uptake value (SUV) was measured using SAT and VAT and divided by the liver SUV. The mean Hounsfield units (HU) of the SAT and VAT were measured from the CT scans. The effects of clinical variable clusters on SUVR were investigated using Bayesian hierarchical modelling; metabolic cluster (BMI, waist-to-hip ratio, fat percentage, muscle percentage*-1, HOMA-IR), blood pressure (systolic, diastolic), glucose (fasting plasma glucose level, HbA1c) and C-reactive protein.

All the clinical variables changed during the 5-year follow-up period. The SUVR and HU of the VAT increased during follow-up; however, those of the SAT did not change. SUVR and HU were positively correlated with both VAT and SAT. SAT and VAT SUVR were negatively associated with metabolic clusters.

Ageing led to increased glucose metabolism and radiodensity in VAT, but not in SAT. VAT may reflect the ageing process more directly than SAT. Glucose metabolism was higher and radiodensity was lower in VAT than in SAT, probably owing to differences in gene expression and lipid density. Both glucose metabolism and radiodensity of VAT and SAT reflect metabolic status.

Adrenocorticotropic hormone (ACTH), in addition to the renin-angiotensin-aldosterone axis, is a potent aldosterone stimulator, suggesting a potential contribution to conditions associated with increased ACTH concentrations. This study aims to systematically review and synthesize the scientific evidence of alterations of plasma aldosterone concentrations in response to ACTH stimulation during the cosyntropin (Synacthen) test and define the range of aldosterone response.

A systematic search of PubMed, Medline, and Google Scholar databases according to PRISMA guidelines was performed. Only studies that assessed the alterations in plasma aldosterone concentrations following ACTH stimulation in healthy individuals were included. We incorporated studies that utilized the doses of 1 μg, 250 μg, 0.125 μg/m2, or 0.5 μg/m2 of ACTH. Out of 1599 initially assessed articles, 17 were deemed relevant to our research. The selected articles were assessed by two independent investigators based on the predetermined inclusion and exclusion criteria. Finally, eight full-text articles were included.

The analyzed studies revealed a significant increase in plasma aldosterone concentrations in healthy subjects after ACTH stimulation, irrespective of the ACTH dose. The peak aldosterone concentration after the 250 μg dose occurred at 30 min, whereas smaller doses exhibited an earlier peak, at around 15 min. On average, plasma aldosterone concentration increased by 125.5% after the 1 μg and 0.5 μg/m2 doses, and by 189.6% after 250 μg.

The presented evidence strongly supports the contribution of ACTH to aldosterone secretion regulation beyond the renin-angiotensin-aldosterone axis. Establishing a normal aldosterone response threshold following standardized ACTH stimulation could aid in identifying individuals with ACTH-dependent aldosterone hypersecretion and guide personalized and effective treatment strategies.

The intricate neurofluid dynamics and balance is essential in preserving the structural and functional integrity of the brain. Key among these forces are: hemodynamics, such as heartbeat-driven arterial and venous blood flow, and hydrodynamics, such as cerebrospinal fluid (CSF) circulation. The delicate interplay between these dynamics is crucial for maintaining optimal homeostasis within the brain. Currently, the widely accepted framework for understanding brain functions is the Monro-Kellie's doctrine, which posits a constant sum of intracranial CSF, blood flow and brain tissue volumes. However, in recent decades, there has been a growing interest in exploring the dynamic interplay between these elements and the impact of external factors, such as daily changes in body position. CSF circulation in particular plays a crucial role in the context of neurodegeneration and dementia, since its dysfunction has been associated with impaired clearance mechanisms and accumulation of toxic substances. Despite the implementation of various invasive and non-invasive imaging techniques to investigate the intracranial hemodynamic or hydrodynamic properties, a comprehensive understanding of how all these elements interact and are influenced by body position remains wanted. Establishing a comprehensive overview of this topic is therefore crucial and could pave the way for alternative care approaches. In this review, we aim to summarize the existing understanding of intracranial hemodynamic and hydrodynamic properties, fundamental for brain homeostasis, along with factors known to influence their equilibrium. Special attention will be devoted to elucidating the effects of body position shifts, given their significance and remaining ambiguities. Furthermore, we will explore recent advancements in imaging techniques utilized for real time and non-invasive measurements of dynamic body fluid properties in-vivo.

In older adults with hypertension, hip fractures accompanied by preoperative acute heart failure significantly elevate surgical risks and adverse outcomes, necessitating timely identification and management to improve patient outcomes.

This study aims to enhance the early recognition of acute heart failure in older hypertensive adults prior to hip fracture surgery by developing a predictive model using logistic regression (LR) and machine learning methods, optimizing preoperative assessment and management.

Employing a retrospective study design, we analyzed hypertensive older adults who underwent hip fracture surgery at Hebei Medical University Third Hospital from January 2018 to December 2022. Predictive models were constructed using LASSO regression and multivariable logistic regression, evaluated via nomogram charts. Five additional machine learning methods were utilized, with variable importance assessed using SHAP values and the impact of key variables evaluated through multivariate correlation analysis and interaction effects.

The study included 1,370 patients. LASSO regression selected 18 key variables, including sex, age, coronary heart disease, pulmonary infection, ventricular arrhythmias, acute myocardial infarction, and anemia. The logistic regression model demonstrated robust performance with an AUC of 0.753. Although other models outperformed it in sensitivity and F1 score, logistic regression's discriminative ability was significant for clinical decision-making. The Gradient Boosting Machine model, notable for a sensitivity of 95.2%, indicated substantial capability in identifying patients at risk, crucial for reducing missed diagnoses.

We developed and compared efficacy of predictive models using logistic regression and machine learning, interpreting them with SHAP values and analyzing key variable interactions. This offers a scientific basis for assessing preoperative heart failure risk in older adults with hypertension and hip fractures, providing significant guidance for individualized treatment strategies and underscoring the value of applying machine learning in clinical settings.

Metabolic syndrome (MetS) is the primary cardiovascular risk factor, making it a global issue. Our objective was to assess the association between the age at menarche (AAM) and MetS and its components in different generations of women.

In this cross-sectional study, 5500 eligible women aged ≥ 20 who participated in the Tehran lipid and glucose study in 2015-2017 were selected. Participants were divided into groups by birth cohorts (BC) (born ≤ 1959, 1960-1979, and ≥ 1980) and AAM (≤ 11, 12-15, and ≥ 16 years, early, normal, and late, respectively). The status of MetS and its components were compared amongst participants using logistic regression.

Normal AAM (12-15 years) was considered the reference group. The adjusted model revealed that AAM ≤ 11 is associated with a higher risk of 34% (95% confidence interval (CI): 1.04, 1.71) in MetS, and the prevalence of MetS in the early menarche group was higher in BCI, and BCII (odds ratio (OR): 1.87; 95% CI: 1.04, 3.36 and OR: 1.33; 95% CI: 1.00, 1.89, respectively). Those with late menarche demonstrated a lower risk (OR:0.72; 95% CI: 0.57, 0.91) of abdominal obesity, and early menarche showed a higher risk (OR: 1.45; CI: 1.14, 1.86). This higher risk in early menarche was observed in BCI and BCII (OR: 1.76; 95% CI: 1.16, 2.66 and OR: 1.80; 95% CI: 1.23, 2.64, respectively). However, the protective effect of late menarche was observed in BC II and BC III (OR: 0.74; 95% CI: 0.54, 1.00 and OR: 0.64; 95% CI: 0.44, 0.96, respectively).

The influential effect of AAM on metabolic disturbances varies amongst different generations.

The relationship between sedentary behaviors and elevated blood pressure remains inconclusive, and the socioeconomic mechanisms underlying the linkage are rarely discussed. Since retirement is often associated with behavioral changes that impact health, this study aims to provide evidence on changes in leisure sedentary time after the statutory retirement age on elevated blood pressure, along with the socioeconomic mechanisms.

We utilized data from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS), focusing on males aged 55-65 employed in the formal sector. Leisure sedentary time, the independent variable, was measured based on self-reported data, while diastolic (DBP) and systolic (SBP) blood pressure were the dependent variables. Using statutory retirement policy as an exogenous variation, we employed a continuous difference-in-differences (DID) framework and a propensity score matching difference-in-differences (PSM-DID) approach to examine the relationship between changes in leisure sedentary time after the statutory retirement age and elevated blood pressure. The analysis was conducted using ordinary least squares (OLS). To address potential endogeneity, we applied the instrumental variable (IV) method via two-stage least squares (2SLS).

Our findings indicate an increase in diastolic blood pressure after statutory retirement, attributed to increased leisure sedentary time. However, there was no significant increase in systolic blood pressure. Moreover, physical activity did not appear to offset this rise in blood pressure, while higher educational attainment and having family members employed in the medical field helped mitigate its negative effects.

This study highlights the potential adverse impact of increased leisure sedentary time on diastolic blood pressure among middle-aged men in the formal sector, while also exploring the socioeconomic factors that may alleviate these effects. These results provide a foundation for public health initiatives aimed at addressing the rising prevalence of sedentary behavior and its association with blood pressure issues.

Hypertension incidence increases with age and represents one of the most prevalent risk factors for cardiovascular disease. Clonal events in the hematopoietic system resulting from somatic mutations in driver genes are prevalent in elderly individuals who lack overt hematologic disorders. This condition is referred to as age-related clonal hematopoiesis (CH), and it is a newly recognized risk factor for cardiovascular disease. It is not known whether CH and hypertension in the elderly are causally related and, if so, what are the mechanistic features.

A murine model of adoptive bone marrow transplantation was employed to examine the interplay between Tet2 (ten-eleven translocation methylcytosine dioxygenase 2) clonal hematopoiesis and hypertension.

In this model, a subpressor dose of Ang II (angiotensin II) resulted in elevated systolic and diastolic blood pressure as early as 1 day after challenge. These conditions led to the expansion of Tet2-deficient proinflammatory monocytes and bone marrow progenitor populations. Tet2 deficiency promoted renal CCL5 (C-C motif ligand 5) chemokine expression and macrophage infiltration into the kidney. Consistent with macrophage involvement, Tet2 deficiency in myeloid cells promoted hypertension when mice were treated with a subpressor dose of Ang II. The hematopoietic Tet2-/- condition led to sodium retention, renal inflammasome activation, and elevated levels of IL (interleukin)-1β and IL-18. Analysis of the sodium transporters indicated NCC (sodium-chloride symporter) and NKCC2 (Na+-K+-Cl- cotransporter 2) activation at residues Thr53 and Ser105, respectively. Administration of the NLRP3 (NLR family pyrin domain containing 3) inflammasome inhibitor MCC950 reversed the hypertensive state, sodium retention, and renal transporter activation.

Tet2-mediated CH sensitizes mice to a hypertensive stimulus. Mechanistically, the expansion of hematopoietic Tet2-deficient cells promotes hypertension due to elevated renal immune cell infiltration and activation of the NLRP3 inflammasome, with consequences on sodium retention. These data indicate that carriers of TET2 CH could be at elevated risk for the development of hypertension and that immune modulators could be useful in treating hypertension in this patient population.

Antihypertensive drugs are known to lower cardiovascular mortality, but the role of different types of antihypertensive drugs in lifespan has not been clarified. Moreover, the underlying mechanisms remain unclear.

To minimize confounding, we used Mendelian randomization to assess the role of different antihypertensive drug classes in longevity and examined the pathways via proteins. Genetic variants associated with systolic blood pressure (SBP) corresponding to drug-target genes were used as genetic instruments. The genetic associations with lifespan were obtained from a large genome-wide association study including 1 million European participants from UK Biobank and LifeGen. For significant antihypertensive drug classes, we performed sex-specific analysis, drug-target analysis, and colocalization. To examine the mediation pathways, we assessed the associations of 2291 plasma proteins with lifespan, and examined the associations of drug classes with the proteins affecting lifespan. After correcting for multiple testing, genetically proxied beta-blockers (BBs), calcium channel blockers (CCBs), and vasodilators were related to longer life years (BBs: 2.03, 95% CI 0.78-3.28 per 5 mmHg reduction in SBP, CCBs: 3.40, 95% CI 1.47-5.33, and vasodilators: 2.92, 95% CI 1.08-4.77). The beneficial effects of BBs and CCBs were more obvious in men. ADRB1, CACNA2D2, CACNB3, CPT1A, CPT2, and EDNRA genes were related to extended lifespan, with CPT2 further supported by colocalization evidence. Eighty-six proteins were related to lifespan, of which four proteins were affected by CCBs. CDH1 may mediate the association between CCBs and lifespan.

Beta-blockers, CCBs, and vasodilators may prolong lifespan, with potential sex differences for BBs and CCBs. The role of CCBs in lifespan is partly mediated by CDH1. Prioritizing the potential protein targets can provide new insights into healthy aging.

Adversity early in life can modify the trajectory for disease risk extending decades beyond the event. Preterm birth produces persistent cardiovascular alterations that may appear maladaptive in adulthood. We have previously hypothesized that those born preterm may exhibit cardiovascular vulnerability in the climate change context. Further, this vulnerability may be present as early as childhood. We aimed to identify the early signs of cardiovascular dysfunction at childhood-equivalent age using our animal model of preterm birth. Using a whole-body thermal stress test, guinea pigs aged 35-d and 38-d (equivalent to 8-10-year-old children) and born at term or preterm gestations were exposed to progressive hyper- (TC = 41.5°C) and hypo-thermia (TC = 34°C; normothermia TC = 39°C). Comprehensive cardiovascular monitoring included ECG, blood pressure, microvascular perfusion, blood gas, and catecholamine profile, as well as skin and core body temperature. Preterm-born animals exhibited attenuated vascular responses to hyperthermic stress, and a significant elevation in systolic blood pressure in response to hypothermic stress. Such responses are similar to those observed in elderly populations and indicate the presence of cardiovascular dysfunction. This is the first study to demonstrate the impact of preterm birth on the cardiovascular response to both heat and cold stress. Further, this dysfunction has been observed at an earlier age than that achievable using traditional stress testing techniques. The present findings warrant further investigation.

Hypertension (HT) is a common chronic disease in older adults. It not only leads to dizziness and other symptoms affecting balance in older adults with HT but also affects the hemodynamics of the cerebral cortex. At present, potential neural mechanisms of balance control in older adults with HT are still unclear. Therefore, this study aimed to explore the differences in the center of pressure (COP) and cerebral cortex activation between older adults with HT and normotension (NT) during standing balance tasks. This study May provide guidance for the early detection of the risk of falls among older adults with HT and the development of clinical rehabilitation strategies.

In this cross-sectional study, 30 older adults with NT (NT group) and 27 older adults with HT (HT group) were subjected to three conditions: task 1, standing with eyes open on a stable surface; task 2, standing with eyes closed on a stable surface; and task 3, standing with eyes open on the surface of the foam pad. Cortical hemodynamic reactions were measured using functional near-infrared spectroscopy, and COP parameters were measured using a force plate.

The mean velocity of the COP in the medial-lateral direction in the NT group was significantly higher than that in the HT group (F = 5.955, p = 0.018) during task 3. When proprioception was disturbed, the activation of the left premotor cortex and supplementary motor cortex in the HT group was significantly lower than that in the NT group (F = 14.381, p < 0.001).

The standing balance function of older adults with HT does not appear to be worse based on COP parameters than those of older adults with NT. This study revealed that the changes in the central cortex related to standing balance appear to be more indicative of balance control deficits in older adults with HT than changes in peripheral COP parameters, suggesting the importance of the early evaluation of cortical activation in older adults with HT at risk of falls.

The relationship between the dietary inflammatory index and blood pressure has been evaluated in European and American populations. This association remains unexplored in Mexico, where outcomes may differ due to the populace's ancestral heritage and its diverse dietary habits.

We used the Health Workers Cohort Study (2004 to 2018). DII intake was assessed using a food frequency questionnaire. Blood pressure was measured following standardized procedures and techniques. Fixed-effects linear regression and Cox regression models were utilized as the statistical approaches.

In the first approach, we observed a positive association between changes in DII intake and changes in both systolic (SBP β: 3.23, 95% CI 1.11, 5.34) and diastolic blood pressure (DBP β: 1.01, 95% CI -0.43, 2.44). When stratified by hypertension, these associations were magnified in participants with hypertension (SBP β: 6.26, 95% CI 2.63, 9.89; DBP β: 1.64, 95% CI -0.73, 4.02). In the second approach, interactions between sex and age categories were explored. Participants in the highest DII category were associated with an increased risk of hypertension, particularly among young women (HR: 3.16, 95% CI 1.19, 8.43).

Results suggest that a pro-inflammatory diet is associated with an increase in blood pressure over time among Mexican population.

Despite the growth in the older population, there is a noticeable research gap regarding integrative health systems for older people and their impact on longevity in nonagenarians. This study aimed to evaluate the effect of an integrative health system consisting of medical services, recreational facilities, and housing on longevity in a population of nonagenarians in Northern Mexico.

This was a cross-sectional, retrospective, descriptive-analytical study in which we measured and analyzed medical history such as number of hospitalizations, visits to geriatric consultation, hypertension, history of chronic pain, polypharmacy, dementia, rheumatic disease, diabetes mellitus, insomnia, depression, ischemic cardiomyopathy, among others. We also measured social engagement and number of caregivers. A logistic regression was performed to evaluate the predictors of mortality in this population.

We included one hundred and ninety-five nonagenarians with a mean (SD) age of 94 (4.2) years and of which 112 (55.7%) were female. The findings from logistic regression analysis indicated that a higher frequency of hospitalizations was associated with an elevated mortality risk (OR = 1.272, p = 0.049). Conversely, increased visits to geriatric consultation services as primary care were linked to a reduced mortality risk (OR = 0.953, p = 0.002). Additionally, social engagement displayed a protective effect (OR = 0.336, p = 0.05).

This study highlighted the role of systemic health approaches in extending life through insights into nonagenarian patients' involvement in primary care, as measured by consultation frequency, and participation in social activities, mitigating mortality risks. Meanwhile, it emphasized the potential consequences of higher hospitalization rates on increased mortality risk.

Patients with coronavirus disease 2019 (COVID-19) infection frequently have hypertension as a co-morbidity, which is linked to adverse outcomes. Antihypertensives may affect the outcome of COVID-19 infection.

To assess the effects of antihypertensive agents on the outcomes of COVID-19 infection.

A total of 260 patients were included, and their demographic data and clinical profile were documented. The patients were categorized into nonhypertensive, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), calcium channel blocker (CCB), a combination of ACEI/ARB and CCB, and beta-blocker groups. Biochemical, hematological, and inflammatory markers were measured. The severity of infection, intensive care unit (ICU) intervention, and outcome were recorded.

The mean age of patients was approximately 60-years-old in all groups, except the nonhypertensive group. Men were predominant in all groups. Fever was the most common presenting symptom. Acute respiratory distress syndrome was the most common complication, and was mostly found in the CCB group. Critical cases, ICU intervention, and mortality were also higher in the CCB group. Multivariable logistic regression analysis revealed that age, duration of antihypertensive therapy, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and interleukin 6 were significantly associated with mortality. The duration of antihypertensive therapy exhibited a sensitivity of 70.8% and specificity of 55.7%, with a cut-off value of 4.5 years and an area under the curve of 0.670 (0.574-0.767; 95% confidence interval) for COVID-19 outcome.

The type of antihypertensive medication has no impact on the clinical sequence or mortality of patients with COVID-19 infection. However, the duration of antihypertensive therapy is associated with poor outcomes.

The influence of atrial fibrillation (AF) and blood pressure (BP) on brain lesions and cognitive function is unclear. We aimed to investigate the association of BP with different types of brain lesions and cognitive decline in patients with AF.

Overall, 1,213 AF patients underwent standardized brain magnetic resonance imaging at baseline and after 2 years, as well as yearly neurocognitive testing. BP was measured at baseline and categorized according to guidelines. New lesions were defined as new or enlarged brain lesions after 2 years. We defined cognitive decline using three different neurocognitive tests. Logistic and Cox regression analyses were performed to examine the associations of BP with new brain lesions and cognitive decline.

The mean age was 71 ± 8.4 years, 74% were male and mean BP was 135 ± 18/79 ± 12 mmHg. New ischemic lesions and white matter lesions were found in 5.4% and 18.4%, respectively. After multivariable adjustment, BP was not associated with the presence of new brain lesions after 2 years. There was no association between BP and cognitive decline over a median follow-up of 6 years when using the Montreal Cognitive Assessment or Digit Symbol Substitution Test. However, BP categories were inversely associated with cognitive decline using the Semantic Fluency Test, with the strongest association in patients with hypertension grade 1 [Hazard Ratio (95% Confidence Interval) 0.57(0.42 to 0.77)], compared to patients with optimal BP (p for linear trend: 0.025).

In a large cohort of AF patients, there was no association between BP and incidence of brain lesions after 2 years. Also, there was no consistent association between BP and cognitive decline over a follow-up of 6 years.

https://clinicaltrials.gov/study/NCT02105844, Identifier (NCT02105844).