Background: The initial systolic blood pressure (SBP) in patients with acute heart failure (AHF) can be used as a guide when choosing specific pharmacologic treatments by helping identify the underlying type of HF (e.g., HF with preserved ejection fraction). Clinical experience and research data from our medical center suggests that AHF with elevated SBP may be presenting less frequently than in the past. This may call into question the utility of initial SBP as a clinical guide. The goal of this Master’s Thesis is to test the hypothesis that the frequency of AHF patients with a SBP>160mmhg has declined over time. Methods: This observational study compares data from 4 cohorts of adult patients admitted with AHF in central MA. Data were obtained from a contemporary (2011-2013) study of patients with AHF as well as from the 1995, 2000, 2006 Worcester Heart Failure Study (WHFS) cohorts. The Framingham criteria the diagnostic criterion for AHF. The main outcome was the proportion of patients with AHF with a SBP > 160 mmHg who presented in each of the 4 study cohorts and was examined by multivariate logistic regression. Results: 2,366 patients comprised the study population. The average age was 77 years, 55% were female, 94% white, and 75% had prior HF. In 1995 33.6% of AHF patients had a SBP >160 mmHg compared to 19.5% in 2011-2013 (p160 mmHg in 2006 (0.64, (0.42-0.96)) and 2011-13 (0.46, (0.28-0.74)). Conclusion: The proportion of patients with AHF and an initial SBP >160 mmHg has significantly declined over time. This may warrant a reexamination of the utility of SBP to inform diagnosis and treatment in patients with AHF.

Intimate partner violence (IPV) is a public health issue that transcends cultures and nationalities. Women and men have been impacted by sexual violence through rape and other types of IPV. Each year, women experience IPV before and during pregnancies and are impacted by physical and psychological outcomes as a result. The purpose of the study was to examine the impact of IPV on the health outcomes of diabetes (Types 1, 2, and gestational), high blood pressure before pregnancy, and depression/anxiety among adult women before and during pregnancy. The social ecological model provided the framework for this quantitative cross-sectional study that included national data from the Pregnancy Risk Assessment Monitoring System between 2012 and 2015. A series of binary logistic regressions was conducted. Findings indicated significant predictive relationships between IPV and diabetes before pregnancy (OR = 1.20, 95% CI = 1.01-1.43), high blood pressure before pregnancy (OR = 1.65, 95% CI =1.47-1.85), and depression/anxiety before and during pregnancy, respectively (OR = 3.14, 95% CI 2.91-3.35 and OR = 9.03, 95% CI 7.37-11.05) after controlling for age, income, and race. A social change implication of this study is that results from this project may assist in increasing societal knowledge of what IPV is and its physical and psychological impacts on women before and during pregnancy.

This thesis presents an improved oscillotonometric system for the measurement of human blood pressure. The study included: 1. The design of a hydraulic occlusive cuff, 2. The investigation of the wave forms taken from the blood pressure measurements, and 3. The design of a mechanism for the simulation of human blood pressure pulse. In this study, an experimental system consisting of a rigid shell occlusive cuff, a constant volume displacement pump, a transducer, and a chart recorder was designed and used for data collection.

The currently accepted methods for measuring systemic blood pressure are either highly accurate but invasive in nature or clinically convenient but prone to observer-related errors. A new oscillometric method uses sensitive signal conditioning and sensing equipment with a non-invasive arm cuff to record arterial pulsations. The goal of this study is to establish more reliable criteria for the identification of systolic and diastolic pressures from oscillometric data.

BACKGROUND: Metabolic syndrome, elevated blood pressure (BP), elevated cholesterol and type 2 diabetes mellitus are health conditions that increase cardiometabolic risk (CMR). Sleep, physical activity, diet, are modifiable risk factors for the prevention of cardiometabolic disorders. Dietary fiber which is associated with higher fruit and vegetable intakes is known to lower the effects of obesity-related health issues. Further, these foods have an abundance of beneficial vitamins and minerals as well as low energy density. There is controversial, however, regarding the effect of fruit juice intake on CMR, particularly due to its lower fiber content. The objectives of this research were to estimate the effect of intakes of whole fruit and fruit juice on CMR, including effects on Body Mass Index (BMI), overweight/obesity, hypertension/prehypertension, lipid, and blood glucose levels. METHODS: The National Heart, Lung, and Blood Institute’s National Growth and Health Study (NGHS) cohort of white and black girls ages 9-10 years at baseline participated in a 10-year longitudinal study. Cardiometabolic outcomes included repeated measures of adiposity (e.g., body mass index (BMI)), and blood pressure, as well as laboratory measures such as fasting glucose and lipid levels. Linear regression and logistic regression were used to assess the association of fruit intake and fruit juice intake on CMR, while adjusting for age, race, tv/video, total vegetables, lean meat, and % calories from fat. Statistical Analysis Software (SAS Institute 15.2) analysis of data was performed. Results were considered statistically significant when p-value was <0.05. RESULTS: For girls in NGHS, BMI at the end of adolescence (ages 17-20 years) averaged to 21.3 kg/m2 for those who ate ≥0.75 cups of fruit and 22.1 kg/m2 for girls who ate <0.25 cups fruit. Similarly, girls with higher fruit juice consumption (≥0.75 cup-equivalents of juice per day) had a statistically significantly lower BMI than those with the lowest juice intake (<0.25 cup-eq/day). For each additional cup of whole fruit consumed on average per day between the ages of 9-17 was associated with 0.18 kg/m2 lower BMI (p<0.0001), after adjusting for age, race, tv/video viewing, total vegetable, lean meat intake, and % calories from fat. Adolescent girls (17 years or older) who drank < 0.25 or 0.25 - < 0.5 cup equivalent fruit juice were 1.60 or 1.63 (respectively) times more likely to become overweight (p-value 0.0005). Neither fruit intake nor fruit juice was associated with elevated fasting glucose risk or with high LDL risk. Whole fruit consumption was associated with a beneficial effect on HDL-cholesterol. Those with low whole fruit intake had a 1.42-fold increased risk of low HDL. CONCLUSIONS: These results indicate that 100% fruit juice and whole fruit consumption are both associated with beneficial effects on BMI and blood pressure among adolescent girls, suggesting that these foods may aid in the prevention of obesity and hypertension in the early adult years. KEY WORDS: adolescents, adiposity, body mass index, blood pressure, cardiometabolic health, dietary fiber, dyslipidemia, juice, glucose, metabolic syndrome, obesity, fruit.

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING / Bibliography: leaves 94-97. / by Daniel Michael Chernoff. / M.S.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19969号 / 社医博第74号 / 新制||社医||9(附属図書館) / 33065 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 小池 薫, 教授 福田 和彦, 教授 木村 剛 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20275号 / 医博第4234号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 横出 正之, 教授 小西 靖彦, 教授 山下 潤 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13233号 / 論医博第2173号 / 新制||医||1036(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川村 孝, 教授 横出 正之, 教授 福原 俊一 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Cardiovascular disease (CVD) is the leading cause of death in the United States, and hypertension has been recognized as a major contributor to its manifestation and progression. Vascular smooth muscle cells control the tone and elasticity of vessels and their dysfunction in hypertension contributes to arterial remodeling and subsequent end organ damage. Evidence has indicated that the Endoplasmic Reticulum (ER) Unfolded Protein Response (UPR) may be compromised in hypertension, while the contribution of protein aggregate formation (a main driver of UPR activation) is undefined. Glucose regulated protein-78 (GRP78), a residential ER chaperone, acts to aid in the proper folding of nascent peptides during translation, while also acting as the primary signal transducer for UPR. We hypothesize overexpression of GRP78 can protect against Angiotensin II induced protein aggregation in vascular smooth muscle cells (VSMCs) to reduce pathological ER UPR signaling and hypertensive vascular remodeling. To test this hypothesis, we investigated protein aggregate induction by Ang II stimulation as well as ER UPR activation, and if overexpression of the ER-resident chaperone glucose regulated protein 78 (GRP78) could protect against these as well as VSMC remodeling markers: hypertrophy, collagen production and inflammation. Utilizing pre-amyloid oligomer (PAO) immunofluorescence staining to identify Ang II induction of amyloid in VSMCs, we found amyloid accumulation was maximal at 48h post stimulation, which could be prevented with adenoviral overexpression of GRP78. Ang II significantly induced ER stress markers p-IRE1α, p-PERK and cleaved ATF6 in VSMCs. Overexpression of GRP78 was able to attenuate these ER stress responders. Interestingly, shotgun proteomic analysis of triton X-100 insoluble aggregate fractions revealed proteostasis machinery enriched in Ang II treated VSMC aggregates (HSP70, VCP, CryAB), which were attenuated with GR78 overexpression. To investigate pathological VSMC remodeling markers, we found that Ang II induced VSMC collagen production, immune cell adhesion, VCAM-1 expression, and hypertrophy (via protein synthesis) which was attenuated by GRP78 overexpression. Utilizing a VSMC-promoter derived GRP78 overexpression mouse model (GRP78TG SM22α Cre-/- or GRP78TG SM22α Cre+/-), we investigated the effect of ER stress inhibition on Ang II induced vascular remodeling. Importantly, hypertrophy and fibrosis in the aorta and the cardiac vasculature were assessed by Masson’s Trichrome and Sirius red staining and found to be increased in Cre-/- mice, while Cre+/- were significantly protected. These effects were accompanied with a significant reduction in Ang II-induced aortic amyloid burden (PAO) and ER UPR signaling. Blood pressure was monitored via tail cuff which revealed GRP78 Cre+/- mice were not protected against Ang II induced hypertension. Overall, these findings indicate that VSMC protein aggregation activates the ER stress response and contribute to hypertensive vascular remodeling. Furthermore, therapeutically targeting this mechanism via overexpression of GRP78 may elude new pharmacological interventions for arterial stiffness, while addressing fundamental questions about the mechanisms involved. / Biomedical Sciences