Lifestyle treatment of hypertension: compliance and results on blood pressure, endothelial and vascular function

Raised blood pressure (BP) levels is the leading cause of death globally. Essential Hypertension (EH) is a major risk factor for cardiovascular events. Lifestyle modification is an important component of EH therapy. The aim of this parallel, randomized controlled study was to examine the effect of a 6-month intensive nutritional treatment compared to the usual care and to correlate that with the levels of BP, the endothelial and the vascular function. To this end, we enrolled 91 newly diagnosed, according to the European Society of Hypertension (ESH) criteria, adult patients with early stage 1 EH. Primary outcomes included measurements of BP and central hemodynamics. endothelial dysfunction (Asymmetric Dimethylarginine), carotid intima media-thickness (IMT), carotid stiffness (β-stiffness factor/ carotid PWV), biochemical and 24-h urine profile. Secondary outcomes included dietary analysis, anthropometry, physical activity (PA) and Basal Metabolic Rate. In total 81 Patients were randomized and divided into two groups. In the first group (n=41) participants acted as controls, receiving standard advise concerning lifestyle modifications. The second group formed the intervention group (n=40), receiving intensive lifestyle treatment. Out of the 81 patients randomized in total, five patients were excluded from the analyses due to Goldberg criterion for misreporting energy intake. Thus, a total of 38 patients formed the samples in each group. Among patients in the intervention group, post-treatment BP (office and 24h), was significantly improved compared to the baseline (p < 0,001), and to the control group (p<0,05) at the end of the six months period. Central BP was also improved in the intervention group, compared to the control group, according to the 24h measurements (p=0,02 and p=0,011, respectively) and to the daytime records (p=0,001 and p=0,012, for SBP and DBP respectively). Six months of intensive treatment was efficient in improving ADMA levels (p<0,001). When compared to the standard care group, intensive intervention participants improved ADMA levels (p<0,001), cIMT (p=0,046), β-stiffness index (p=0,007) and carotid PWV (p=0,007). In the intensive treatment group, a significant improvement in the lipidemic profile, as well as in the urinary Na losses at the end of the treatment was noted compared to the controls (p<0,001 for total cholesterol and Na urinary losses, p<0,05 for triglycerides and LDL). Somatometry in the intervention group showed a reduction in all indices (weight, circumferences, FFM, FM) at the end of treatment, compared to baseline (p<0,001). The intensive treatment group at the end of the period improved Dietary Inflammatory Index (p=0,027), MedDiet and Salt score (p<0,001), when compared with the control group. Multivariate analysis revealed that variations in the ADMA levels can be explained indepedently and positively by the DII alterations and changes in the MedDiet score are related significantly and negatively with variations in the intensive treatment group for 24-h and day peripheric and central BP. This study showed that adhering to an intensive lifestyle intervention, supported by a dieticician, can improve BP, arterial stiffness parameters, sub-clinical atherosclerosis and endothelial dysfunction among patients with early stage I EH. Future RCT's need to focus more on the impact of lifestyle modification treatment on EH.Η αρτηριακή υπέρταση (ΑΥ) αποτελεί τον κυριότερο παράγοντα για την εμφάνιση ΚΡΔ νόσου. Η αλλαγή του τρόπου ζωής είναι σημαντική στην αντιμετώπιση της ΑΥ. Στόχος της συγκεκριμένης παράλληλης, τυχαιοποιημένης κλινικής μελέτης ασθενών - μαρτύρων ήταν η διερεύνηση της συμμόρφωσης των ασθενών με ΑΥ σταδίου Ι στα υγιεινοδιαιτητικά μέτρα και η συσχέτιση αυτής με την ΑΠ, την ενδοθηλιακή και την αγγειακή λειτουργία. Οι πρωτεύοντες μετρούμενοι παράγοντες ήταν η ΑΠ (ιατρείου, 24-ωρη), οι κεντρικές αιμοδυναμικές παράμετροι (cBP, PP), τα επίπεδα ασύμμετρης διμεθυλαργινίνης (ADMA), το πάχος έσω-μέσου χιτώνα, η καρωτιδική σκληρία, το βιοχημικό προφίλ και τα ούρα 24-ωρου. Oι δευτερεύοντες μετρούμενοι παράγοντες περιλάμβαναν την διατροφική ανάλυση, την σωματομετρία, την εκτίμηση της ΦΔ και του βασικού μεταβολισμού. Συνολικά 81 ασθενείς τυχαιοποιήθηκαν και τοποθετήθηκαν σε μία από τις δύο ομάδες. Στην πρώτη ομάδα (n=41), που ήταν οι μάρτυρες, δόθηκαν υγιεινοδιαιτητικές συστάσεις με βάση τις οδηγίες της ESH. Στη δεύτερη ομάδα (n=40) έγινε παρέμβαση με εντατικοποιημένη υγιεινοδιαιτητική εκπαίδευση, επίσης με βάση τις οδηγίες της ESH. Αποκλείστηκαν 5 συμμετέχοντες λόγω του κριτηρίου Goldberg και προέκυψαν δύο ομάδες των 38 ασθενών. Η ομάδα της ΕΠ βελτίωσε σημαντικά την ΑΠ (ιατρείου και 24-ωρη), σε σύγκριση με την έναρξη (p<0,001) και σε σύγκριση με τις ΒΟ (p<0,05), στο τέλος του εξαμήνου. Ακόμη, η εντατικοποιημένη παρέμβαση στους ασθενείς βελτίωσε τα επίπεδα ADMA (p<0,001), τα οποία είχαν διαφορά και με τα αντίστοιχα των ΒΟ στο τέλος του εξαμήνου (p<0,001). Οι κεντρικές αιμοδυναμικές παράμετροι (cBP, PP) βελτιώθηκαν στην ομάδα της ΕΠ, σε σύγκριση με την έναρξη και με τις ΒΟ, στο τέλος του εξαμήνου (p<0,05). Συγκριτικά με την έναρξη, η ομάδα της ΕΠ μείωσε την καρωτιδική σκληρία (β-stiffness index, carotid PWV) (p<0,001, και για τους δύο δείκτες). Κατά τη σύγκριση των δύο ομάδων στο εξάμηνο η ΕΠ, σε σχέση με την ομάδα των ΒΟ, μείωσε σημαντικά τους δείκτες ΙΜΤ (p=0,046), β-stiffness index (p=0,007) και carotid PWV (p=0,007). Συγκριτικά με την ομάδα των ΒΟ η ΕΠ είχε διαφορά στο τέλος του εξαμήνου, στη μείωση της ολικής χοληστερόλης και στο Να ούρων 24-ώρου (p<0,001), αλλά και στα τριγλυκερίδια και τη LDL (p<0,05). Οι σωματομετρικοί δείκτες βελτιώθηκαν στο τέλος του εξαμήνου στην ομάδα της ΕΠ, σε σύγκριση με την έναρξη (p<0,001). Η διατροφική ανάλυση έδειξε βελτίωση των δεικτών αξιολόγησης για την ομάδα της ΕΠ σε σύγκριση με τις ΒΟ στο τέλος του εξαμήνου (p=0,027 για Salt score, p<0,001 για τους δείκτες MedDiet score/Dietary Inflammatory Index). Η πολυπαραγοντική ανάλυση έδειξε ότι οι μεταβολές του δείκτη Dietary Inflammatory Index επηρεάζουν θετικά και ανεξάρτητα τις μεταβολές των επιπέδων ADMA. Επιπλέον, μεταβολές στο δείκτη MedDiet score επηρεάζουν αρνητικά και ανεξάρτητα τις μεταβολές στη περιφερική και κεντρική ΑΠ 24-ώρου και ημέρας. Στην παρούσα μελέτη δείχθηκε ότι η εκπαίδευση στα υγιεινοδιαιτητικά μέτρα σε νεοδιαγνωσμένους ασθενείς με ιδιοπαθή ΑΥ σταδίου Ι, μειώνει τα επίπεδα ΑΠ και βελτιώνει την ενδοθηλιακή και αγγειακή λειτουργία. Τέλος, απαιτούνται επιπρόσθετες τυχαιοποιημένες κλινικές μελέτες που διερευνούν την επίδραση της εκπαίδευσης στα υγιεινοδιαιτητικά μέτρα σε ασθενείς με ΑΥ

Bioelectrical Impedance Vector Analysis of Young Elite Team Handball Players

Team handball is a highly dynamic sport where physical demands differ between categories and roles. Thus, physical characteristics are fundamental for the final performance. This study aims to (a) characterize a sample of young male and female elite team handball players with a non-athletic reference population; (b) to generate their 50%, 75%, and 95% percentiles of the bioelectrical variables. The study included 55 young elite team handball players (Males, n = 37, age = 17.0 &plusmn; 1.2 yrs, height = 185.8 &plusmn; 7.3 cm, weight = 82.0 &plusmn; 11.0 kg, body mass index (BMI) = 23.7 &plusmn; 2.5; Females, n = 18, age = 17.8 &plusmn; 0.9 yrs, height = 171.2 &plusmn; 6.4 cm, weight = 67.4 &plusmn; 7.2 kg, BMI = 23.0 &plusmn; 2.0). Height and bioelectrical variables were assessed in a state of euhydration and standard conditions. Bioelectrical impedance vector analysis (BIVA) was used to characterize the bioelectrical vector (BIA vector) distribution pattern for each group. Compared to the reference values, BIA vector showed statistically significant differences in males U17 (n = 19, T2 = 51.0, p &lt; 0.0001), males U19 (n = 18, T2 = 82.0, p &lt; 0.0001) and females U19 (n = 18, T2 = 85.8, p &lt; 0.0001). Male groups were also bioelectrically different (T2 = 13.7, p = 0.0036). BIVA showed specific bioelectrical characteristics in young male and female elite handball players. This study provides an original data set of bioelectrical impedance reference values of young male and female elite team handball players. Our result might help to interpret individual bioimpedance vectors and define target regions for young handball players

Association of Urinary Sodium Excretion with Vascular Damage: A Local Kidney Effect, Rather Than a Marker of Generalized Vascular Impairment

Evidence suggests that increased salt consumption induces blood pressure- (BP) mediated organ damage, yet it remains unclear whether it reflects a generalized micro- and macrovascular malfunction independent of BP. We studied 197 newly diagnosed and never-treated individuals with hypertension, intermediate hypertensive phenotypes, and normal BP, classified by use of 24-hour ambulatory BP monitoring. Sodium excretion and microalbuminuria were estimated in 24-hour urine samples, dermal capillary density was estimated from capillaroscopy, and arterial stiffness was estimated with pulse wave velocity (PWV) and augmentation index (AIx). Sodium excretion correlated with microalbuminuria (p<0.001) and 24-hour and day- and nighttime systolic BP, but not with office blood pressure, arterial stiffness, or capillary density. In the multivariate analysis, the association with microalbuminuria was maintained (p=0.007). In a population free from the long-standing effects of hypertension, increased salt intake appears to be associated with early signs of vascular kidney damage, rather than a diffuse micro- and macrovascular impairment

Cardiorespiratory Fitness Predicted by Fibrinogen and Leptin Concentrations in Children with Obesity and Risk for Diabetes: A Cross-Sectional Study and a ROC Curve Analysis

Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. The ability to exercise is affected by adiposity, and this mechanism involves low-grade chronic inflammation and homeostatic stress produced mainly in adipocytes, which can result in abnormal adipokine secretion. To date, the gold standard for cardiorespiratory fitness assessment is considered to be the maximum oxygen uptake (VO2max). The aim of the present study was to assess the prognostic value of hematological parameters of childhood obesity, as potential predictors of cardiorespiratory fitness (VO2max), using a sample of children and adolescents with obesity and risk for diabetes. A total of 84 clinically healthy children and adolescents were recruited, of which 21 were considered lean, 22 overweight and 41 obese, with a mean age of 12.0 ± 1.9, 11.4 ± 2.0, and 11.2 ± 2.1 years old, in each weight status category, respectively. Age and sex did not differ between groups. Hematologic testing was performed after 12 h of fasting including glucose, serum lipids, insulin, hc-CRP, adiponectin, leptin and fibrinogen levels. Cardiorespiratory capacity for exercise was assessed to determine VO2max, using a cycle ergometer. The VO2max was negatively correlated with progressive strength to the BMIz (−0.656, p ≤ 0.001), hs-CRP (r = −0.341, p ≤ 0.002), glucose (r = −0.404, p ≤ 0.001) and insulin levels (r = −0.348, p ≤ 0.001), the homeostasis model assessment of insulin resistance (HOMA-IR) (r = −0.345, p ≤ 0.002), as well as to the leptin (r = −0.639, p ≤ 0.001) and fibrinogen concentrations (r = −0.520, p ≤ 0.001). The multivariate analysis revealed that only leptin and fibrinogen concentrations could predict the VO2max adjusted for the BMIz of participants. The receiver operating characteristic (ROC) curve for the diagnostic accuracy of leptin, hs-CRP and fibrinogen concentrations for the prediction of VO2max revealed a good diagnostic ability for all parameters, with leptin being the most promising one (area under the curve (AUC): 99%). The results verify that in children with obesity, VO2max may be predicted from hematological parameters (leptin and fibrinogen), possibly bypassing more invasive methods

The length and number of sedentary bouts predict fibrinogen levels in postmenopausal women

Menopause is associated with adverse changes in coagulation homeostasis. We aimed to investigate the association between objectively measured sedentary behavior (SB) and SB bouts (i.e., number and length of SB bouts) vs. fibrinogen levels in post-menopausal women. Fifty-three post-menopausal women (age 59.8 ± 6.2 years, BMI 27.3 ± 4.4) wore a multisensory device (Sensewear Mini Armband, BodyMedia, Inc., Pittsburgh, PA) for 5 days, to measure SB and physical activity (PA). Blood samples were collected to measure serum fibrinogen. Fibrinogen was directly correlated with SB (r = −0.48, p 1 h) of SB (r = −0.59, p < 0.01; r = −0.51, p < 0.01, respectively), and inversely correlated with moderate to vigorous-intensity physical activity (r = −0.39, p < 0.01). Furthermore, fibrinogen was also directly correlated with BMI (r = −0.28, p < 0.05). In postmenopausal women without prevalent cardiovascular disease, the number of prolonged and uninterrupted sedentary bouts is directly correlated with increased fibrinogen levels, regardless of PA and BMI. This result suggests the importance of delivering new strategies to counteract the increase of sedentariness and inactivity of the postmenopausal population

Impact of Intensive Lifestyle Treatment (Diet Plus Exercise) on Endothelial and Vascular Function, Arterial Stiffness and Blood Pressure in Stage 1 Hypertension: Results of the HINTreat Randomized Controlled Trial

Lifestyle modification is an important component of essential hypertension (EH) therapy. The aim of the Hypertension Intensive Nutrition Treatment (HINTreat) parallel, randomized controlled trial was to examine the effect of a 6-month intensive lifestyle treatment (ILT) (diet plus exercise with monthly visits) compared to the usual care. A total of 76 adults with stage 1 EH were randomized (38 in each group). Dietary analysis, anthropometry, physical activity, biochemical and urine profile, blood pressure (BP), asymmetric dimethylarginine (ADMA), central hemodynamics, &beta;-stiffness index and carotid intima media-thickness were evaluated. The dietary inflammatory index (DII) was calculated for each participant from the intake of 29 nutrients/food components. At the end of the trial, participants in the ILT group reduced their 24h urinary Na excretion (p &le; 0.001), daytime systolic BP (p &le; 0.048) and mean carotid &beta;-stiffness index (p &le; 0.005) and ameliorated their lipidemic profile compared to the standard care. Univariate analysis for the total sample showed a strong association between DII and ADMA levels (&beta; = 0.089, p &le; 0.01). ILT is effective in improving the inflammatory components of the diet and selected cardiometabolic parameters, including arterial stiffness

The Beneficial Effect of the Mobile Application Euglyca in Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

Background: Euglyca is a mobile application which we developed for children and adolescents suffering type 1 diabetes mellitus (T1DM) for calculation of the appropriate insulin bolus dose by importing in the equation carbohydrates, lipids, glucose levels, and personalized parameters. Aim of this study is to evaluate the efficacy of this application on patients&apos; glycemic control and satisfaction. Subjects and Methods: Eighty children and adolescents (aged 13.5 +/- 2.8 years old, mean +/- standard deviation) with T1DM were included in the study and were randomly and equally assigned in two groups. Patients were asked to use Euglyca for the calculation of the bolus insulin dose in the E group and to pursue their routine calculations in the C group (controls). At baseline and at 3, 6, and 12 months following the initial visit, glycated hemoglobin (HbA1c) values, percentages of hypoglycemias, hyperglycemias, and normoglycemias were determined for each patient, while Diabetes Treatment Satisfaction Questionnaire (DTSQ) was used to assess patients&apos; treatment satisfaction at baseline and at 6 and 12 months. Results: Children and adolescents in the E group had a statistically significant decrease in HbA1c values and increase in percentages of normoglycemias and DTSQ scores, in comparison to children and adolescents in the C group. In the E group, a statistically significant positive linear correlation was found between DTSQ score and percentages of normoglycemias and a statistically significant negative correlation between changes in percentages of normoglycemias (Delta normoglycemias) and changes in HbA1c (Delta HbA1c). Conclusions: The use of the mobile application Euglyca contributes to the improvement of glycemic control and treatment satisfaction of children and adolescents with T1DM

Serum Concentrations and Dietary Intake of Vitamin B₁₂ in Children and Adolescents on Metformin: A Case–Control Study

The International Society of Pediatric and Adolescent Diabetes (ISPAD) recommends metformin (MET) use for metabolic disturbances and hyperglycemia, either in combination with insulin therapy or alone. A caveat of MET therapy has been suggested to be biochemical vitamin B12 deficiency, as seen mainly in studies conducted in adults. In the present case–control study, children and adolescents of different weight status tiers on MET therapy for a median of 17 months formed the cases group (n = 23) and were compared with their peers not taking MET (n = 46). Anthropometry, dietary intake, and blood assays were recorded for both groups. MET group members were older, heavier, and taller compared with the controls, although BMI z-scores did not differ. In parallel, blood phosphorus and alkaline phosphatase (ALP) concentrations were lower in the MET group, whereas MCV, Δ4-androstenedione, and DHEA-S were higher. No differences were observed in the HOMA-IR, SHBG, hemoglobin, HbA1c, vitamin B12, or serum 25(OH)D3 concentrations between groups. Among those on MET, 17.4% exhibited vitamin B12 deficiency, whereas none of the controls had low vitamin B12 concentrations. Participants on MET therapy consumed less energy concerning their requirements, less vitamin B12, more carbohydrates (as a percentage of the energy intake), and fewer fats (including saturated and trans fats) compared with their peers not on MET. None of the children received oral nutrient supplements with vitamin B12. The results suggest that, in children and adolescents on MET therapy, the dietary intake of vitamin B12 is suboptimal, with the median coverage reaching 54% of the age- and sex-specific recommended daily allowance. This low dietary intake, paired with MET, may act synergistically in reducing the circulating vitamin B12 concentrations. Thus, caution is required when prescribing MET in children and adolescents, and replacement is warranted

Effects of Activity Tracker-Based Counselling and Live-Web Exercise on Breast Cancer Survivors during Italy COVID-19 Lockdown

Background: To prevent and fight the increase of daily sedentary time and to promote and stimulate the positive effects of physical activity and exercise on health, both traditional interventions and new strategies are important for breast cancer survivors (BCS). The research goal was to compare the effects of weekly personal feedback, based on objectively measured physical activity, on the trends of both daily sedentary time and on the physical activity of BCS (E(−) group) with those of an intervention also including online supervised physical exercise sessions (E(+) group), during the Italy COVID-19 lockdown. Methods: The Italian COVID-19 emergency allowed the possibility to also observe the effects of social and personal limitations. A total of 51 BCS were studied over an 18-week period and had an objective registration of day-to-day sedentary time, physical activity, and sleep. Both subsamples received weekly or fortnight personal feedback. Data were analysed considering four key periods, according to the COVID-19 emergency steps. Results: Statistical analysis showed an additive effect for sedentary time and a multiplicative effect both for light-to vigorous and light-intensity physical activities. The E(−) group had a high overall sedentary time and a different trend of light-to vigorous and light-intensity physical activities, with a reduction from the 1st to the 2nd periods (national and personal restrictions), showing a significant rise just at the end of the national restrictions. Conclusions: The use of an activity tracker and its accompanying app, with the reception of weekly tailored advice and supervised online physical exercise sessions, can elicit proper physical activity recomposition in BCS in the COVID-19 era