In 2019, there were about seventy-million Americans with uncontrolled high blood pressure (BP) or hypertension (HTN) (Kitt, Fox, Tucker & McManus, 2019). Hypertension is the leading cause of preventable deaths worldwide (Stephen, Halcomb, McInnes, Batterham & Zwar, 2019). Uncontrolled HTN contributes to stroke, myocardial infarction, and renal failure, and is the most modifiable risk factor for heart disease and death (American Academy of Family Physicians [AAFP], 2019; Oparil & Schmider, 2015). Patients living in rural America have an increased prevalence of HTN and their access to preventative health services is lower (Buford, 2016; Caldwell, Ford, Wallace, Wang & Takahashi, 2016). The increased prevalence of HTN in rural communities does not positively correlate with optimized blood pressure control, which poses a gap in care (Buford, 2016). A multidisciplinary collaboration between registered nurses (RNs) and providers may improve patient outcomes (Ford et al., 2018). The implementation of a collaborative HTN Clinic in a rural setting had the potential to improve BP outcomes by increasing access to services. The practice improvement project established a HTN Clinic as a collaborative effort between RNs and providers in a rural community. Providers and RNs were educated via modules regarding the protocol and participants took surveys before and after implementation to determine effectiveness and if the HTN Clinic should continue after conclusion of the practice improvement project. The HTN Clinic intervention implemented education for hypertensive patients with an emphasis on medication compliance and lifestyle modifications, as well as medication adjustments through nurse-led protocols. Despite a short duration of implementation and evaluation, positive results were observed. All HTN Clinic patients had improvement in BP measures and were controlled by the end of the four-week implementation period. Overall, patient access, wait times for appointments, and BP measures for all hypertensive patients improved after implementation. The providers’ and nurses’ knowledge increased through completion of a detailed curriculum. The provider and RN surveys indicated support for continuing the HTN Clinic to improve HTN management and clinic providers felt that the HTN Clinic helped improve their time with patients and quality metrics.

The beneficial effects of religion and spiritual factors on cardiovascular functioning have become an area of increasing research. Similarly, considerable research has also investigated the negative effects of marital distress on cardiovascular functioning. Little is known, however, about potential protective factors against the deleterious effects of marital distress on cardiovascular functioning. Social support has been identified as a potential buffer against the negative effects of marital distress on ambulatory blood pressure, and the current study hypothesized that spirituality, religiosity, and religious support would also buffer the negative effects of marital distress on ambulatory blood pressure. Fifty-eight married couples were recruited from both marital therapists and the community surrounding Brigham Young University. Participants wore ambulatory blood pressure monitors for 24 hours and completed questionnaires which measure marital distress, spirituality, religiosity, religious support and social support. It was found that for normotensive individuals (SBP < 120) spirituality, religious support, and social support have an additive effect of lowering blood pressure on individuals with high marital quality. No effect was found for spirituality, religiosity, or religious support buffering the negative effects of marital distress on ambulatory blood pressure. It was also found that men and women view the relationships between religiosity and social support, and religious support and social support differently. Specifically, social support is more highly related to religiosity and religious support in women compared to men. It appears that for happily-married individuals, spirituality, religious support and social support have an additive effect in lowering blood pressure.

The objective of this study was to examine possible correlations between sleep duration and sleep quality on health outcomes in the Marshallese community members in Northwest Arkansas. Little research has been conducted on the association between sleep health and health outcomes in Native Hawaiian Pacific Islanders, and even less so in the Marshallese populations. Using cross sectional date from a cluster randomized controlled trial study (n=374), I will examine whether sleep duration and sleep quality are associated with hypertension, type 2 diabetes, body mass index, and overall self-reported health rating in the Marshallese. Systolic and diastolic blood pressure, HbA1c levels, and height and weight were all measured for hypertension, type II diabetes, and BMI, respectively. General health status was determined by self-reported measures from the National Health and Nutritional Examination survey-derived questions. Sleep duration was categorized as very short sleep (0-4 hours), short sleep (4-7 hours), normal sleep (7-9 hours), and long sleep (9 or more hours). Sleep quality was determined by answers to the question: “Over the last two weeks, how many days have you had trouble sleeping or staying asleep?” For the continuous dependent variables (BMI, blood pressure, and HbA1c), median and interquartile range values were examined. For non-continuous variable (general health outcomes), the Spearman Correlation Coefficient was examined to determine association. Statistically significant associations were found between sleep duration and diastolic blood pressure and HbA1c, and sleep quality and general health. These associations among the Marshallese provide foundation for further longitudinal and intervention research on health disparities in Marshallese residents of the United States.

Background: During incremental exercise, systolic blood pressure (SBP) increases due to increasing cardiac output. However, the impact of workload on SBP has often been overlooked. Indexing the increase in SBP to the increase in workload could provide a way of accounting for this. Athletes often reach higher maximal SBP (SBPmax) than untrained subjects, which has been attributed to their superior cardiac capacity. How this affects the relation between SBP and workload is not established. Aim: We sought to characterise the novel metrics SBP/VO2-slope and SBP/Watt-slope in endurance athletes and to analyse possible correlations between these metrics and maximal oxygen uptake (VO2max) in a population of endurance athletes and healthy, non-athletic subjects. We also sought to compare the SBP response of athletes to values predicted by newly published reference equations accounting for workload. Methods: In 24 endurance athletes and 5 healthy non-athletes we assessed the workload-indexed blood pressure response during a graded bicycle ergometer test. SBPmax was defined as the last SBP during exercise, VO2max as the mean of the two highest consecutive VO2 measurements at end of exercise. Results: The mean SBP/VO2-slope was 31.1 ± 9.7 mmHg/l/min and the mean SBP/Watt-slope was 0.28 ± 0.08 mmHg/Watt. We found no significant correlation between VO2max and the SBP/VO2-slope or the SBP/Watt-slope, nor with SBP at 50 W or at 200 W. In males there was a significant correlation between VO2max and SBPmax. The endurance athletes had less steep SBP/Watt-slopes and higher SBPmax than predicted by reference equations.  Conclusion: The SBP/VO2-slope offers a precise way of indexing blood pressure to workload and could provide a valuable tool in future studies investigating the SBP response to exercise. Our results suggest that different reference equations than in the general population might be needed when evaluating the SBP response in athletes.

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension once felt to be rare in children is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements therapeutic lifestyle changes and pharmacologic therapies.

Hypertension guidelines recommend out of office blood pressure (BP) measurement especially 24- hour ambulatory measurement (ABPM), to diagnose and manage hypertension but this is not routinely performed in kidney transplant units. This study was to determine if 24-hour ABPM, compared with office BP in kidney transplant recipients, would be more informative regarding BP management, and if pulse wave analysis (PWA) would assist in risk stratification. This study included patients older than 18 years, with working graft kidney for >12 months, and without problems affecting BP measurement and interpretation. After performing office BP measurements, a 24-hour ABPM with additional capability of calculating pulse wave velocity (PWV),augmentation index and central BP was undertaken. Patients were assessed for controlled hypertension, uncontrolled hypertension, masked hypertension, nocturnal hypertension, white coat hypertension, and dipping BP status. Data were analysed using standard statistical tests. Of 30 patients, 15 were Black Africans and 15 were of Mixed Ancestry with a mean age of 48.9 years. Seventeen patients were males and 36.7% had controlled hypertension, 30% uncontrolled hypertension, 6.7% white coat hypertension and 33.3% masked hypertension, of whom 70% had isolated nocturnal hypertension. 70% had a non-dipping, 26.7% a reverse dipping and only 3.3% had a normal dipping BP pattern. The mean difference between brachia! systolic BP and central systolic BP was 10.4 mm Hg, whereas PWV and augmentation index were similar to healthy populations. CONCLUSION: In kidney transplant recipients, 24-hour ABPM was superior to office BP in defining hypertensive status that qualified for modification of therapy but PWA did not contribute to risk assessment.

The effect or indomethacin and its vehicle on blood pressure was studied in conscious rabbits during the infusion of three vasopressors. The cyclooxygenase inhibitor raised mean arterial pressure 12 (vehicle: 3) mm Hg during norepinephrine infusion, 5 (vehicle: 0) mm Hg during angioten- sin II infusion, and 5 (vehicle: −8) mm Hg during arginine vasopressin infusion. When saline was given in place of vasopressors, indomethacin failed to alter blood pressure. Since indomethacin elevated pressure in the presence, but not the absence, of all three vasopressors, the possibility that elevation of blood pressure per se stimulates synthesis of vasodilator prostaglandins was considered. A pressor action of indomethacin was observed in ganglion-blocked animals, in which absolute blood pressure remained below normotensive levels during angiotensin II infusion. Thus, indomethacin raised arterial pressure during the infusion of norepinephrine, angiotensin II, and vasopressin, and this action was not influenced by manipulation of blood pressure. These results suggest that each vasopressor promotes prostaglandin synthesis independently to a degree sufficient to restrain its pressor action.

The contribution of vasodilator prostaglandins and kinins to blood pressure regulation was studied during the infusion of different doses of angiotensin II in conscious rabbits. Angiotensin II was infused for 60 min. in each experiment. Indomethacin, a prostaglandin synthesis inhibitor, or Trasylol, a kallikrein inhibitor, was given at the 30 min. interval. Indomethacin caused a sustained increase in blood pressure during the infusion of pressor doses of angiotensin II. The range of the mean increase after prostaglandin synthesis inhibition was 3.4 to 6.0 and 3.0 to 9.4 mm Hg at angiotensin II infusion rates of 10 and 50 ng/kg/min respectively. In contrast, indomethacin did not alter blood pressure when the peptide was administered at subpressor levels. Trasylol did not alter blood pressure during infusion of angiotensin II. These results suggest that when blood pressure is maintained at supranormal levels by angiotensin II, the pressor action is attenuated by one or more prostaglandins; an event which is not mediated or assisted by changes in kinin metabolism

Vasodilator and vasodepressor properties of angiotensins have been reported, and mediation by prostaglandins or nitric oxide has been proposed. Other studies indicate that angiotensin AT2 receptors might mediate a depressor action, and the present study was designed to delineate and explore this possibility in a conscious rabbit model. Large intravenous boluses of angiotensin III (15 nmol/kg) produced a predictable pressor peak (82±4 mm Hg) followed by a depressor phase (20±3 mm Hg), whereas equipressor doses of angiotensin II were less effective at producing depressor responses. Angiotensin-(1-7) did not exert a depressor action, and the reduced potency of angiotensin IV (relative to angiotensin III) was similar for both the pressor and depressor phases (≈100-fold). It is clear that specific angiotensin IV or angiotensin-(1-7) receptors do not mediate depressor effects in this model. The AT1 antagonist losartan (1 mg/kg) blocked both the pressor and depressor components of the angiotensin III response, whereas the AT2 antagonist PD 123319 (35 mg/kg) had no effect on either element of the response. The data obtained with the angiotensin receptor subtype-selective compounds, losartan and PD 123319, suggest that the depressor action is an AT1-mediated effect and give no indication that AT2 receptors could be involved. Paradoxically, the greater potency of angiotensin III as a vasodepressor belies the conclusion that the response is AT1-mediated, because AT1 receptors have a greater affinity for angiotensin II versus angiotensin III.

Isolated systolic hypertension (ISH) is a growing health concern in the United States (US) black population. The stratified prevalence of untreated ISH has not been fully investigated in non-Hispanic blacks. Cross-sectional data on 4625 non-Hispanic blacks aged ≥18 years were collected from the National Health and Nutrition Examination Survey 1999-2010, representing a probability sample of the US civilian noninstitutionalized black population. The 6-year prevalence of ISH and 95% confidence intervals (CIs) were estimated by conducting weighted frequency and logistic procedures. The prevalence of untreated ISH was 11.2% among non-Hispanic black adults in 1999-2010. Individuals who received lower education (high school or below) had higher prevalence of untreated ISH than those with higher education (12.8% (95% CI: 11.3-14.2%) vs. 9.0% (95% CI: 7.5-10.6%)). The prevalence of untreated ISH was higher in young men than in young women (4.3% (95% CI: 3.3-5.4%) vs. 1.8% (95% CI: 0.9-2.7%)), and higher in middle-aged adults with lower education than in middle-aged adults with higher education (14.1% (95% CI: 11.4-16.7%) vs. 7.7% (95% CI: 5.5-9.8%)). Compared with 1999-2004, the prevalence of untreated ISH in 2005-2010 decreased for old individuals (27.7% vs. 40.8%), old men (24.4% vs. 40.0%) and old individuals who received higher education (21.4% vs. 40.7%). Untreated ISH is more prevalent in old blacks, and significant reduction of the prevalence in this group suggests that public health interventions, lifestyle modifications or health awareness are in the right direction.