The unadjusted relationship between high ox-LDL/LDL-C and low ejection fraction was found significant , although the association with the other cardiovascular manifestations was found non-significant. In the adjusted model for the prediction of systolic cardiac dysfunction, high ox-LDL/LDL-C, old age and non-administration of vitamin D supplementation during dialysis session were found to be significant predictors after adjustment to the confounder. Moreover, the association between systolic cardiac dysfunction and non-administration of vitamin D derivatives during dialysis sessions was found significant . Conclusions: This study showed a significant association between high ox-LDL and systolic cardiac dysfunction in permanent hemodiafiltration therapy patients. This relationship seems to be influenced by aging and pharmaceutical therapy during dialysis sessions, including vitamin D derivatives.Introduction: Oxidized low-density lipoprotein (ox-LDL) is considered a main biomarker of oxidative stress, a common characteristic in end stage renal disease. We examined the relationship between ox-LDL serum concentrations and cardiovascular disease in permanent hemodiafiltration therapy patients. Methods: Ox-LDL values were measured by ELISA and were corrected for LDL-cholesterol (LDL-C) in 96 participants and in 45 healthy control subjects. We performed chi-square tests and adjusted models for the role of ox-LDL on cardiovascular morbidity including coronary artery disease, left ventricular hypertrophy, systolic, diastolic dysfunction and peripheral arterial disease. Results: ox-LDL/LDL-C values were significantly higher in patients than in control group ( Renal disease results in accelerated atherosclerosis and increased morbidity and mortality, mainly for cardiovascular causes due either to uremia-related risk factors, such as anemia, hyperparathyroidism, inflammation, oxidative stress and malnutrition , or to tCardiovascular disease is mainly characterized by vascular occlusive disease defined by myocardial infarction and cerebrovascular strokes. The underlying disease progresses through various mechanisms, including left ventricular hypertrophy, plaque formation, arterial stiffening and endothelial dysfunction . HoweverOxidative stress plays a significant role in the pathogenesis of cardiovascular disease, including heart failure (HF) . SeveralEnd-stage renal disease results in atherogenic diathesis, which is mainly associated with oxidative stress and inflammation . Lipid aIn this study, we considered the relationship between ox-LDL serum concentrations and the development of cardiovascular disease in patients attending for permanent outpatient hemodiafiltration therapy. The preliminary hypothesis-driven for this study was based on the research regarding significant risk factors for cardiovascular morbidity and mortality in these patients.This is a dual-center, retrospective and cross-sectional study of a cohort of 96 patients. The study was approved by the “Laiko, University General Hospital of Athens” and Renal Unit of “Diagnostic and Therapeutic Center of Athens Hygeia SA” Institutional Review Board. All participants provided informed oral consent prior to study enrollment.All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.62 males and 34 females were included in this study, on mean age 62.1 ± 14.3 years old. The median time in hemodiafiltration treatment was 5 years ± interquartile range 2.1–9.Patients < 18 years of age at initiation of dialysis and patients who had less than 6 months of follow-up were excluded from our study. We also excluded patients with autoimmune diseases, malignancy, infections, subjects without regular vascular hemodialysis access and the patients with interdialytic weight gain of more than 5% of total body weight. Other exclusion criteria included multiple intradialytic hypotensive episodes, cerebrovascular disease, atrial fibrillation and the need to change blood pressure medications.2 surface area by the high-flux same material synthetic membrane, defined by an ultra-filtration coefficient >20 mL/h [Participating subjects were attending for outpatient on-line-pre-dilution hemodiafiltration (on-lHDF) therapy, which was prescribed for 3-times weekly with a dialysis time of 4 h per session, a filter of 1.5 m>20 mL/h , using t>20 mL/h . PatientThe included patients were in a good status and they did not have interdialytic peripheral edema, interdialytic orthostatic hypotension or other characteristics of an inaccurate dry body weight.n = 40, a prevalence of 41.7%) were considered hypertensive, and each of them received anti-hypertensive medications, including calcium channel blockers, beta-blockers or inhibitors of angiotensin II receptors. Twenty-one of the studied patients were current smokers , but none of them had alcohol intake. Thirty-five of the enrolled patients (36.5%) preserved a residual renal function (RRF) with an interdialytic urine volume of more than 100 mL.The patients with pre-dialysis blood pressure ≥140/90 mmHg , coronary artery disease , congestive heart failure (CHF) and peripheral arterial disease . The coronary syndrome was documented by history of myocardial infarction, coronary artery angioplasty or bypass surgery, or clinical signs of angina pectoris. The congestive heart failure was defined by systolic dysfunction  or by the presence of diastolic dysfunction . The systolic function of the left ventricle (LV) was assessed by the measurement of ejection fraction (EF) and systolic dysfunction was defined as EF < 50%. The diastolic function of LV was assessed by determination of the maximum velocity of the early (E) and late (A) phase of ventricular filling and the calculation of the E/A ratio . The diastolic dysfunction of LV was defined as E/A ≤ 1.Cardiovascular morbidity was defined as the presence of left ventricular hypertrophy  and a set of clinical criteria including cool skin, reduced or lost ankle pulse on physical examination, symptomatic intermittent claudication, and by a history of past ischemic amputation or limb artery revascularization. The first and the current cardiovascular events during the study were recorded as one event for the studied cardiovascular manifestations.3 per os. Forty-seven of our subjects (a ratio of 49%) were being treated by intravenous administration of vitamin D supplementation by using calcitriol or paricalcitol during dialysis session, depending mainly on serum calcium and phosphate levels. None of the enrolled patients had received intravenous administration of iron during the last 2 months before the start of the study. The total of enrolled subjects was treated with erythropoietin-α or-β agent in combination to orally receiving trivalent iron .Calcium-free phosphate binders were prescribed. None of the enrolled patients was receiving statin or NaHCOIn our data, renal failure was caused by hypertensive nephrosclerosis at a ratio of 32.3%, chronic glomerulonephritis at a ratio of 28.1%, polycystic disease at a ratio 12.5%, diabetic nephropathy at a ratio equal to 11.5% and other causes at a ratio 15.6%.Blood was drawn at the same time point for each subject included in the study, just before the start of the mean weekly dialysis session in a 12 h fasting state from the vascular access. The received samples were centrifuged and the fresh serum was used for the biochemical measurements of the study. Serum was also conserved and processed for various assays.Albumin, glucose, calcium (Ca) corrected for the albumin levels, phosphate (P), cholesterol, triglycerides, low density lipoproteins (LDL) and high-density lipoproteins (HDL) were measured using spectrophotometric technique by Chemistry Analyzer . The LDL/HDL ratio and the Ca × P products were calculated. Hematological analyzer  was used for hemoglobin.Oxidized LDL (ox-LDL) serum concentrations were measured using enzyme linked immunoabsorbed assay (ELISA), Immundiagnostik AG., Stubenwald-Allee , in accordance to manufacturer’s specification. OxLDL values were measured in the enrolled subjects and in 45 healthy subjects, who were matched for age, gender and BMI with the group of patients. The ratio of ox-LDL/LDL-C was calculated. High-sensitivity C-reactive protein (hsCRP), monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-a (TNF-a) serum concentrations were also measured using ELISA, Immundiagnostik AG., Bensheim, Germany, Alpco Diagnostics, Anachem, Salem, NH, USA and Ani Biotech Oy, Orgenium, Helsinki, Finland, respectively, according to the specifications of the manufacturers. The concentrations of intact-parathormone (i-PTH) and insulin were measured by radioimmunoassays . Insulin resistance was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR) .Normalized protein catabolic rate for dry body mass (nPCR) was calculated from the urea generation rate . Body maThe mean of 12 measurements of pre-dialysis peripheral systolic and diastolic blood pressures (SBP and DBP respectively) was recorded during a treatment month using an automatic sphygmomanometer OMRON M4-I . Mean peripheral pre-dialysis BP (MBP) was calculated as: MBP = DBP + 1/3 (SBP − DBP).®  according to manufacturer’s specifications. In each subject, two sequences of measurements were performed, and the mean value was used for statistical analysis. Pulse pressure (PP) was derived. Ankle-brachial blood pressure index (ABI) was also calculated as the ratio of the lower values of ankle systolic pressure , divided by stabilized arm systolic pressure. ABI values less than 0.9 were rated as low indicating peripheral arterial disease (PAD) and values more than 1.4 were rated as high.Hemodynamic and echo-cardiographical measurements were also performed before the mid-week dialysis session in combination with blood tests after resting of the patients for at least 10 min. Arterial stiffness was measured as carotid-femoral pulse wave velocity (c-f PWV) and carotid augmentation index (Aix) using the SphygmoCor systemEcho-cardiographical assessment was conducted by a Hewlett Packard SONOS 2500 device using a 2.25 MHz transducer . All subjects were examined with the method of conventional M-mode and two-dimensional echocardiography by two cardiologists for the estimation of the hypertrophy of LV, systolic and diastolic dysfunction and of the ischemic findings according to the recommendations of the American Society of Echocardiography . The left-test for two groups and data that showed skewed distributions were compared with Mann-Whitney U-test. Correlations between variables were defined by Spearman coefficient and the relationships between categorical variables were defined by chi-square tests. p values less than 0.05 were considered significant. ROC curve analysis was used for the determination of ox-LDL cut off point related to systolic cardiac dysfunction. We built models by using logistic regression analysis examining the role of ox-LDL on cardiovascular disease manifestations adjusting for traditional and specific covariates for hemodialysis patients.Data were analyzed using SPSS 15.0 statistical package for Windows  and expressed as mean ± standard deviation or as median value (±inter-quartile range) for data that showed skewed distribution. Differences between mean values were assessed by using unpaired We corrected the measured by ELISA ox-LDL serum concentration for serum LDL-C with the calculation of the ratio ox-LDL/LDL-C.In p = 0.001 and r = 0.204, p = 0.04 respectively).Bivariate correlations showed that ox-LDL was significantly associated with both nPCR and serum albumin .2 = 7.6, p = 0.005), although the association with coronary artery disease, diastolic dysfunction, left ventricular hypertrophy, hypertension and peripheral vascular disease, was found non-significant.Categorical associations showed significant relationship between high value of ox-LDL/LDL-C and systolic cardiac dysfunction .In the logistic regression analysis model built for the prediction of systolic cardiac dysfunction, high ox-LDL/LDL-C, old age and non-administration of vitamin D supplementation during dialysis sessions were found to be significant predictors after adjustment to confounders . Moreovep = 0.01 and 92.1 ± 31.2 vs. 88.9 ± 42.3, p = 0.7, respectively).The association between non-administration of vitamin D supplementation during dialysis session and high ox-LDL/LDL-C was found non-significant. However, the patients receiving vitamin D derivatives had significantly lower ox-LDL than and similar LDL-C serum levels to the patients without vitamin D therapy  in dialysis patients, in agreement with the characteristics of our subjects, in spite of our exclusion criteria and the good status of our participants. Malnutrition has already been reported as a specific cardiovascular risk factor for this population of patients, and each of the MIA syndrome components worsens the survival of these patients . MoreoveOn the other hand, previously, it has been reported that oxidative stress is included into major determinants of metabolic disorders such as insulin resistance in hemodialysis patients, in combination with excess visceral fat and inflammation ,16. In tOxidative stress can be defined as a tissue injury resulting from an imbalance between the generation of oxidizing components and insufficient production of antioxidant mechanisms . PreviouIn maintenance hemodialysis patients, previous reports showed no association between ox-LDL and major adverse cardiac events . HoweverExamining the groups of our subjects with and without low ejection fraction, we observed that those with low EF were elder and they had significantly elevated arterial stiffness markers, such as c-f PWV, Aix and PP, thickness of left ventricle wall and characteristic of diastolic dysfunction defined by low E/A ratio in combination to higher ox-LDL, ox-LDL/LDL-C ratio and hsCRP than the patients with EF more than 50%.In combination with the important role of MIA syndrome, it has been established that arterial stiffness and vascular calcification are non-traditional cardiovascular risk factors in chronic kidney disease resulting in coronary arterial disease and heart failure . VasculaThe presence of MIA syndrome related to arterial stiffness and vascular calcification may be included in pathophysiological mechanisms which outline the relationship between high ox-LDL and systolic cardiac dysfunction in this study. The built adjusted model also supported the importance of elevated ox-LDL in conjunction to aging and non-administration of vitamin D during dialysis session for the prediction of systolic dysfunction. Furthermore, we observed a significant unadjusted association between low ejection fraction and non-administration of vitamin D supplementation during dialysis sessions, and the subjects who were regularly receiving vitamin D derivatives had significantly lower ox-LDL than the patients who were not receiving vitamin D supplementation, although they had similar LDL-C.In agreement, recently it has been reported that the usage of vitamin D derivatives in chronic kidney disease patients may prevent the elevated ROS production and the cytokine up-regulation by serum phosphate and may decrease the tissue factor expression in smooth muscle cells, resulting in beneficial cardiovascular effects ,27.This study showed a significant association between high ox-LDL and systolic cardiac dysfunction in permanent hemodiafiltration therapy patients. This relationship seems to be influenced by the aging and the pharmaceutical therapy during dialysis session including vitamin D derivatives.The important limitation of the study is its cross-sectional nature, which prevents the definition of the relationship between cause and effect in combination with the small number of included subjects. Also, the measurement of other markers of oxidative stress was unavailable.


Purpose: Glucocorticoid (GC) is known to be involved in the deterioration of kidney function both directly by affecting the glomeruli and renal tubules and indirectly by affecting cardiovascular function. Autonomous GC secretion is the main feature of primary adrenal hypercortisolism (PAHC). However, the ideal treatment option  for patients with PAHC has not been established yet. In this study, we assessed a time series of kidney function in patients with PAHC treated via laparoscopic adrenalectomy and investigated the predictive factors for kidney function 1 year after surgery.Methods: From September 1997 to July 2017, 175 laparoscopic adrenalectomies were performed for adrenal tumors at Akita University. Thirty patients, who were diagnosed as having PAHC via preoperative endocrinological evaluations and followed up for at least 1 year after surgery, were included in this study. Patients with severe complications or simultaneous aldosteronism were excluded. The mean age of the 30 patients was 57.5 years , and the right and left sides were affected in 9 and 21 patients, respectively.Results: In all, 18 patients were diagnosed as having Cushing's syndrome and 12 as having subclinical Cushing's syndrome. The steroid cover was required in all cases after surgery. The estimated glomerular filtration rate significantly improved  1 year after surgery. Patients showing 5% or more improvement in kidney function and those showing less than 5% improvement were compared. On performing univariate analyses, factors such as a longer operative time, heavy body mass index (BMI), and preoperative unsuppressed ACTH were associated with worse improvement in kidney function. No significant associations were observed regarding metabolic disorders, clinical symptoms, and gross proteinuria. On multivariate analysis, patients with a higher BMI (≥ 24 kg/m2) showed worse improvement in kidney function at 1 year after surgery .Conclusions: In PAHC patients, after 1 year of follow-up, kidney function improved in terms of estimated glomerular filtration rate. Therefore, this improvement seems to be delayed in overweight patients, suggesting its direct role in renal function. Primary adrenal hypercortisolism (PAHC) is characterized by autonomous cortisol secretion and is responsible for Cushing's syndrome (CS) and Subclinical Cushing's syndrome (SCS) . PatientGC, of that almost 95% activity is consisted of cortisol, is known to be involved in the deterioration of kidney function by directly affecting glomeruli and renal tubules and indirectly affecting cardiovascular function. In fact, some clinical investigations showed the negative effect of GC on kidney function in the general population. In diabetic patients, autonomous cortisol secretion affected kidney function negatively in a dose-dependent manner . Even afThe impact of GC excess on kidney function is less known in patients with PAHC. Haentjens P et al. reported the negative effects of GC on kidney function in CS patients and also showed that kidney dysfunction persisted even after surgery ; howeverWe assessed a time series of kidney function in patients with PAHC treated via laparoscopic adrenalectomy. The predictive factors for kidney function were investigated 1 year after surgery.We performed 175 laparoscopic adrenalectomies for adrenal tumors in Akita University from September 1997 to July 2017. Of those, 53 cases were included in this study; patients were diagnosed with PAHC on the basis of the preoperative endocrinological evaluations and followed up for at least 1 year after surgery. Exclusion criteria were simultaneous aldosteronism, major pre-existing complications, bilateral adrenal disease, or severe kidney dysfunction (preoperative eGFR <30 mL/min) . This stWe diagnosed with PAHC in accordance with the Japan Endocrine Society Criteria . In the Diabetes mellitus: Patients with hemoglobin A1c continuously over 6.5 mg/dl, fasting plasma glucose over 126 mg/dl, or requiring insulin and/or oral hypoglycemic agents.Dyslipidemia: Patients with high low-density lipoprotein cholesterol levels (≥140 mg/dl), hypertriglyceridemia (≥TG 150 mg/dL), and low high-density lipoprotein cholesterol levels (<40 mg/dL), or those who required oral statin treatment.Hypertension: Patients required oral antihypertensive drugs and/or blood pressure values > 140/90 mmHg.Psychoneurosis: Patients needed medication or had seen a psychiatrist.Proteinuria: Positivity was assessed by a dipstick urine method .Improvement in kidney function was defined as an increase in eGFR of at least 5% from the preoperative value 1 year after surgery.Kidney function was evaluated based on eGFR before and 1, 6, and 12 months after surgery. The eGFR was calculated using the following equation established for the Japanese population:2) = 194 × SCr−1.094 × Age−0.287 [× 0.739 ]. The reference range of the eGFR in Japanese is ≥60 mL/min/1.73 m2.eGFR .The data were expressed as mean ± standard deviation and Twenty-three patients were excluded from the analysis. 16 patients had a short follow-up (<1 year). Severe pre-existing complications were observed in 4 , and the simultaneous presence of excessive secretion of aldosteronism in 3 subjects. No patient was excluded owing to severe preoperative kidney dysfunction. Of the 30 patients, 18 were diagnosed with CS and 12 with SCS. The median age of the 30 patients was 57.5 years , and the right and left sides were affected in 9 and 21 patients, respectively . Supplemp = 0.012) (2) showed a worse improvement rate in kidney function 1 year after surgery    ; however= 0.012) , 3. On m= 0.012) . When th= 0.024) .2 to 84.1 mL/min/1.73 m2 (p = 0.012) after surgery. A high BMI (≥24 kg/m2) was an independent predictor of worse improvement rate in eGFR after surgery.The results of this study showed an improvement in eGFR after adrenalectomy in patients with PAHC. In this study, eGFR increased from 78.4 mL/min/1.73 mGC is known to cause deterioration in kidney function both directly by affecting glomerular and tubular function and indirectly by affecting the cardiovascular system . Excess Overweight was an independent risk factor for delayed improvement in kidney function in our study. Both indirect and direct mechanisms of the negative impact of obesity or overweight on kidney function can be explained. Kidney function independently improved following weight loss without affection by comorbidities after bariatric surgery . Adipose2 is overweight or not. Undoubtedly, a BMI of 24 kg/m2 is not obese or overweight in international consensus. However, a BMI of 25 kg/m2 or higher would be regarded as overweight in Japan (Practically, there is a debate regarding whether a BMI of 24 kg/min Japan . Moreovein Japan , 28. IndSeveral limitations of this study should be noted, including the retrospective nature and the limited number of patients. A relatively high number of patients were excluded because of the short follow-up period. This might influence the study results. However, our results show promising relevance for surgical treatment and warrant further research on kidney function in patients with PAHC.This study demonstrated the favorable outcomes of kidney function via laparoscopic adrenalectomy in patients with PAHC. Although PAHC patients have multiple metabolic disorders, kidney function was reversible. Our findings suggest that adrenalectomy is a reasonable treatment option for patients with PAHC. Future prospective studies with larger sample sizes are required to better understand the appropriate management for patients with PAHC.Human participants: Research involving human participants was supervised and approved by the Ethics Board of the Akita University Hospital.All the participants in this study provided written informed consent.KN: project development, data collection and management, data analysis, patient management, and manuscript writing. TN, SK, MS, SN, and TI: patient management. TH: project development, management, and manuscript editing.TH received honoraria from Novartis Pharm, Pfizer Co, GlaxoSmithKline, and Ono Pharma Co. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Hippophae rhamnoides L.) has been used to treat high altitude diseases. The effects of five-week treatment with total flavonoids of seabuckthorn  on cobalt chloride - and hypobaric chamber -induced high-altitude polycythemia in rats were measured. Total flavonoids decreased red blood cell number, hemoglobin, hematocrit, mean corpuscular hemoglobin levels, span of red blood cell electrophoretic mobility, aggregation index of red blood cell, plasma viscosity, whole blood viscosity, and increased deformation index of red blood cell, erythropoietin level in serum. Total flavonoids increased pH, pO2, SpO2, pCO2 levels in arterial blood, and increased Na+, HCO3−, Cl−, but decreased K+ concentrations. Total flavonoids increased mean arterial pressure, left ventricular systolic pressure, end-diastolic pressure, maximal rate of rise and decrease, decreased heart rate and protected right ventricle morphology. Changes in hemodynamic, hematologic parameters, and erythropoietin content suggest that administration of total flavonoids from seabuckthorn may be useful in the prevention of high altitude polycythaemia in rats.Seabuckthorn ( More than 140 million people live permanently at high altitude >2,500 m) in North America, Central America, South America, East Africa, and Asia ,500 m in,4. The pHippophae rhamnoides L. (seabuckthorn) possesses protective activity against hypoxia and curtails hypoxia-induced enhanced vascular leakage in the brain  .Heart tissues were fixed by immersion in 10% buffered formalin and embedded in paraffin for histological analyses. Seven-μm sections were stained with hematoxylin and eosin staining. The samples were coded and the slides were sent for light microscopic examination by a researcher who was unaware of the specimen identity.P < 0.05.Results were expressed as mean ± SD. Significant differences were established by one-way ANOVA using SPSS 13.0 , followeO2, SpO2, PaCO2 levels were partly increased, and Na+, HCO−, Cl− concentrations were increased, but K+ was decreased; partly increased mean arterial pressure, left ventricular systolic pressure, left ventricular end-diastolic pressure, left ventricular maximal rate of rise (+dP/dtmax) and decrease (−dP/dtmax), and partly decreased heart rate; right ventricle morphology was improved. Our results suggest that the effects of total flavonoids on hemodynamic, hematologic parameters, erythropoietin content may be related to its protective potential on HAPC.Our data collectively show that after five-week treatment with total flavonoids of seabuckthorn, RBC, hemoglobin, hematocrit, mean corpuscular hemoglobin levels, span of RBC electrophoretic mobility, aggregation index of RBC, plasma viscosity, whole blood viscosity were significantly decreased, and deformation index of RBC and erythropoietin in serum and heart was decreased; pH, Pa


Introduction: It is well known that regular physical activity improves cardiovascular health, and higher baroreflex sensitivity and heart rate variability are associated with cardiovascular health. Adolescence is the age when an individual’s behavior is easily modified; early intervention at this stage in terms of physical conditioning or training prevents future cardiovascular risk. Hence, we conceived the present study to assess and compare the baroreflex sensitivity and autonomic function between adolescent athletes and non-athletes.Methods: We recruited school going athletes (n = 30) and non-athlete boys (n = 30) in the 10–19 age group after obtaining their assent and consent from their parents. We assessed height, weight, heart rate, blood pressure, baroreflex sensitivity, and cardiac autonomic function. Comparison between groups was made using the unpaired t-test for height, weight, body mass index, heart rate, blood pressure, and baroreflex sensitivity and using Mann-Whitney U test for cardiac autonomic function parameters.Results: There was a trend for higher baroreflex sensitivity in athletes. Heart rate variability  was higher in athletes. The parasympathetic tone was higher in terms of higher RMSSD, and higher HF power. Parasympathetic reactivity was higher in athletes in terms of higher 30:15 ratio and EI ratio.Conclusion: Athletic level physical conditioning has a positive influence on baroreflex function and autonomic function that may prove beneficial to the adolescents’ cardiovascular health. Sedentary lifestyle increases the incidence and prevalence of chronic diseases, especially cardiovascular diseases. WHO predicted that, by 2020, cardiovascular disease will be the leading cause of death. The prevalence of cardiovascular diseases in adolescents is higher in developing countries. Physical activity not only improves physical fitness but also reduces cardiometabolic diseases . Herein,Baroreceptor reflex mechanism plays a vital role in the short-term regulation of arterial pressure, by the chronotropic effect on the heart and by reflex regulation of parasympathetic and sympathetic outflow to bring about homeostasis. Reduced baroreflex sensitivity (BRS) is associated with hypertension , obesityOscillations in the heart rate can be evaluated by heart rate variability (HRV), which is a non-invasive tool to assess the sympathetic and vagal influence on the heart. Available evidence suggests that assessment of BRS and heart rate variability reflects the cardiovascular risk of an individual . DecreasThis was a cross-sectional study conducted in Department of Physiology, JIPMER, Puducherry, India, in collaboration with CBSE board schools in Puducherry. The study commenced after obtaining approval from the Institute Ethics Committee for Human Studies (No. JIP/IEC/2013/3/177).We considered boys aged 10–19 years, studying in CBSE schools in Pondicherry for the study. Students with a history of cardiovascular, respiratory, or organic disorder which prevents subjects from doing maximal exercise, or on any drugs that could affect vascular and/or autonomic functions or suffering from any acute illness were excluded from the study. We obtained informed written consent from the guardians/parents and written assent from the boys who had met the inclusion criteria. We recruited 30 boys representing their school at state, national, or international level aerobic sports and have undergone athletic level physical conditioning for at least 1 year (Group 1), and 30 age-matched non-athlete students  were recruited as controls (Group 2).All the participants were requested to report to Autonomic function testing lab, Department of Physiology, JIPMER, Pondicherry, between 8 am and 11 am. We requested the participants to abstain from doing strenuous exercise, and taking caffeinated/alcoholic beverages 12 h before the recording and advised them to have good sleep the previous day of recording. The lab temperature was maintained at ±24°C and dimly lit. Participants were oriented toward the lab, and recording parameters were explained. Demonstration and practice sessions were given for all the procedures before starting the actual recording to alleviate their anxiety. Participants with poor sleep quality, flu, or minor ailments were requested to report on a later date to the recording. On the day of recording, participants were requested to report with an empty bladder, loose clothing, and we instructed them to have their breakfast 2 h before testing.2 (m2).Anthropometric parameters were measured by the International Society for the Advancement of Kinanthropometry (ISAK)-certified investigator. A wall-mounted stadiometer (VM Electronics Hardware Ltd) was used to measure the height accurate to the nearest 0.1 cm. Weight was measured using a digital weighing scale  accurate to the nearest 0.1 kg. Body mass index (BMI) was calculated using the Quetelet index – weight (kg)/heightBlood pressure (BP) and heart rate (HR) were measured after 10 min of rest in the sitting position. Heart rate was measured manually from the right radial artery. The BP (mm Hg) was recorded from the right arm using mercury sphygmomanometer . Recordings were taken thrice with 2-min rest intervals, and the average was taken as the final reading. All measurements were taken by the same investigator.We measured spontaneous BRS/resting BRS (spontaneous BP changes and HR changes that occur due to respiration) noninvasively by recording pulse rate and finger pressure using Finometer PRO . Following 10 min of supine rest, the finger arterial pressure cuff and brachial artery cuff were placed in the middle finger and 2 cm above the elbow, respectively. Finger arterial pressure waveform was continuously monitored using volume clamp method of Penaz and the Physiocal criteria of Wesseling. Height correction is done using Height correction unit to remove hydrostatic errors caused by the small changes in finger position. Brachial artery pressure (BAP) waveform and level were reconstructed (reBAP) from finger pressure waveform using generalized waveform inverse modeling , 1997.r2) is significant (p < 0.05), it is accepted as BRS estimate  was recorded following Taskforce on Heart Rate Variability-Standards of Measurement, Physiological Interpretation, and Clinical Use. . Subject2 and in normalized unit (nu) [LFnu = LF/(TP − VLF) × 100 and HFnu = HF/(TP − VLF) × 100 or HFnu = 1 − LFnu], Total power (TP) ms2 (TP = VLF + LF + HF) and the LF/HF ratio. The time domain measures include standard deviation of all NN intervals (SDNN), the sum of the squares of differences between adjacent RR intervals (RMSSD), adjacent RR interval differing by more than 50 ms (NN50) and its percentage (pNN50).After 5 min of supine rest, lead II electrocardiography (ECG) was recorded for 5 min at a sampling rate of 1,000 Hz. The data are visualized using AcqKnowledge® software version 4.1  in Windows-based PC. Ectopics and artifacts were removed manually from the recorded ECG, and RR intervals of 5-min epoch from the lead II ECG recorded are taken in text format. From the RR tachogram, HRV analysis was done using Kubios version 1.0 . The frequency domain analysis and time domain analysis were computed using Fast Fourier Transformation (FFT) and RR trend, respectively. The frequency domain indices computed were very low frequency , low frequency , and high frequency , both in absolute powers given as msRespiration was recorded as a separate channel through the same polygraph with appropriate recommended settings. Respiratory transducer belt  was placed over the abdomen and connected to respiratory amplifier module  and connected to universal interface module UIM100C. Abnormalities concerning the frequency of breathing were carefully analyzed during and after the recording. Any respiratory tracing showing a frequency of more than 24 breaths per min, i.e., 0.4 Hz, was destined to be removed. Exceptional data, if any, were specifically examined and a decision is made regarding the inclusion of the HRV of that subject. However, in this study, such exceptional data were not encountered.Lead II ECG was continuously monitored and recorded when necessary during the following procedures.We asked the subjects to perform forced timed breathing (FTB) at six breaths per minute, comprising inspiratory and expiratory cycles for 5 s each in the supine position . We instParticipants were asked to stand within 3 s from their supine position . The ratParticipants were made to sit comfortably in the couch. Maximal voluntary contraction during sustained isometric handgrip by the boys was measured using handgrip dynamometer . Isometric handgrip (IHG) test was evaluated at 30% of their maximal strength for 3-min duration. We measured BP during the maneuver in the contralateral arm. The vasoconstrictor response was calculated by calculating the difference between baseline diastolic blood pressure (DBP) and DBP at the end of 2 min during the maneuver .t-test. Short-term HRV parameters and autonomic reactivity test parameters did not pass the normality test and are expressed as median [interquartile range (IQR)] and compared using the Mann-Whitney U test. p <0.05 was considered to be statistically significant.Data were subjected to a normality test. Height, weight, BMI, HR, BP, and BRS values passed normality test and are expressed as mean ± standard deviation (SD) and compared using unpaired Student’s 2) (athletes – 19.05 ± 1.83 and non-athletes – 18.51 ± 1.19) were comparable.The anthropometric data including height (cm) , weight (kg)  and BMI (kg/mGroups were comparable based on HR (beats per minute) , systolic blood pressure (mm Hg)  and diastolic blood pressure (mm Hg) .In the present study, we have assessed BRS and autonomic function in adolescent athlete and non-athlete boys. Age, obesity, and gender are the major factors known to influence BRS  and autoBaroreflex sensitivity is measured in terms of change in the interbeat interval (IBI) in milliseconds per unit change in blood pressure in mm Hg. The increase or decrease in IBI in response to decrease or increase in blood pressure by baroreflex might be through any one limb (sympathetic or parasympathetic) of the autonomic nervous system or both together. However, the rapid change is feasible mainly through the parasympathetic limb. Baroreflex sensitivity reflects the complex interaction between the vascular and autonomic function to manage the blood pressure fluctuations of daily life within normal levels. In our study, we observed a trend toward higher BRS in the athlete group. This finding is supported by previous exercise intervention studies done in healthy adults  and healReduced BRS is shown to be associated with high blood pressure  and reseThe relation between cardiac sympathetic overactivity and its association with cardiovascular diseases such as hypertension and heart failure are well established. Sedentary individuals are shown to have higher sympathetic tone even at rest and higher reactivity to any stress . HoweverFurther, Rosenwinkel et al. have stated that the effect of exercise training on heart rate is mainly due to parasympathetic activity and the sympathetic activity has only minimal impact . This isRegular physical activity might be beneficial to improve the autonomic tone, which can further improve cardiovascular health as evidenced by higher vagal modulation among athletes than age-matched non-athletes.Lack of significant difference in baroreflex sensitivity and other parameters might be due to small sample size. Further, the non-athlete group is not a sedentary population; they were also physically active as part of school co-curriculum. Athlete group consisted of students with various levels of training and competitiveness; this could have influenced BRS and HRV values. We have not quantified the level of physical activity intensity, and its influence on HRV was not studied. The parameters that could have influenced the autonomic activity such as diet, academic stress, and environmental influence were not measured.A direct measurement such as that of muscle sympathetic nerve activity would help us in determining the effect of physical activity on the sympathetic nervous system.The datasets generated for this study are available on request to the corresponding author.SS, VS, VA, RR, and AG conceived and designed the analysis. SS, VS, RR, and AG collected the data and contributed data or analysis tools. SS, VS, and RR performed the analysis and wrote the paper.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


To explore a new treatment that can proceed from the whole, control blood pressure smoothly and coordinate the treatment of multiple factors causing blood pressure fluctuations.  We conducted a single-center, double-blinded, and randomized controlled clinical trial. 48 patients with acute Type B aortic dissection were randomly assigned into two groups: the experimental group, who received pinggan formula treatment, and the control group, who received placebo treatment. The drug was taken orally after meals three times a day. Only when the patients' blood pressure fluctuated, conventional antihypertensive drugs were given to maintain the blood pressure within the target range and the dosage was recorded to convert the DDD value. Meanwhile, the international standardized score was used to evaluate the defecation, sleep, pain, anxiety, and depression of patients in the two groups during the hospitalization. P=0.0219), defecation score ; P < 0.0001), sleep score ; P=0.0014), pain score ; P=0.0045), depression score ; and P < 0.0001) were significantly higher than that of the experimental group, and the difference was statistically significant.  Univariate analysis was conducted on variables that might affect the assessment results, and it was found that grouping factors had a significant impact on the outcome variables, that is, after the intervention, the mean value of DDDs used in the perioperative period in the control group was 2.19 . ( Pinggan formula has a clear therapeutic regulation effect on the overall hemodynamics of acute Stanford type B aortic dissection during the perioperative period and can be recommended as an auxiliary drug for conventional antihypertensive drugs at the current stage. Blood pressure (BP) control is a critical approach to reduce the complication in the perioperative treatment of acute Type B aortic dissection . The risIn this research paper, we examine the following hypothesis, namely, the application of “Pinggan formula” assisted blood pressure control therapy can (1) reduce the defined daily dose (DDD) of common antihypertensive drugs, (2) mediate factors such as constipation and pain and synergistically control the blood pressure, and (3) meet the blood control standards of Stanford type B aortic dissection under the condition of reduced amount of common antihypertensive drugs.This experiment is a parallel, random, double-blind controlled study conducted at Shanghai Changhai Hospital (experiment and control groups were assigned randomly in a 2 : 1 ratio). All patients in this study gave their written informed consent.This study started on January 2016 at Shanghai Changhai Hospital vascular surgery department, and all subjects were administrated to in-hospital treatment by outpatient and emergency department.The inclusion criteria are as follows: (1) the diagnosis met the criteria of acute Stanford type B aortic dissection and (2) initial onset.The exclusion criteria are (1) atypical aortic dissection, including aortic wall hematoma, and aortic ulcer, (2) after aortic surgery, (3) branch artery ischemia or near rupture , (4) retrograde tear involving ascending aorta, (5) pregnancy, (6) obvious liver impairment , and (7) obvious renal impairment (creatinine > 200 mmol/l and urea nitrogen > 50 mg/dl).α = 0.05; 84% effectiveness could be reached if there were 6 cases from the control group and 12 cases from the experimental group. Considering the possibility of dropping out and increasing the power, the sample size of the trial is expanded to 16 cases in the control group and 32 cases in the experimental group. A total of 48 patients need to be enrolled in this study, which is expected to be completed within 1 year.According to the results of the preliminary experiment, the main observational indicators  were 10.1 ± 6.8 and 18.6 ± 4.6 in the experimental and control group, respectively. The experimental group and control group were matched in a 2 : 1 ratio, and a two-sided test was adopted, when While recruiting subjects, independent third-party researchers used statistical software SPSS 18.0 and generated random number codes in a 2 : 1 ratio between the experimental and the control group. Both “Pinggan formula” and placebo were in granule form with the same appearance and taste. They were packaged in bags and numbered consecutively. Patients were randomly assigned by the envelope method and received a preprepared drug with the corresponding number.The subjects and researchers, including statisticians, outcome assessors, and data analysts, were unaware of the grouping information. Although the third party of the experiment was aware of the grouping information, they did not participate in the result evaluation or data analysis and were only responsible for the management of the distribution and recycle of the experimental drugs and the establishment of detailed records of drug distribution. In addition, all the researchers were trained on detailed procedures before the trial began, and they were asked to adhere strictly to the separation principle.Interventions started after subjects were enrolled and sequentially numbered. All patients were given Chinese herbal preparations according to their own number; the drug was taken orally after meals three times a day. Only when the patients' blood pressure fluctuated, that is, continuously (more than 15 minutes) exceeded the upper limit of blood pressure values , conventional antihypertensive drugs were given to maintain the blood pressure within the target range  and the dosage was recorded to calculate the DDD value. These hemodynamic parameters were monitored in a real-time manner by the ward EGC monitor.Each dose of “Pinggan formula” was decocted with a combination of Chinese herbs , and granules were then prepared and given three times a day after meals.The placebo of the control group was provided by the research center. The placebo in the control group was made of food coloring, maltodextrin, and lactose, with the same taste and dose as “Pinggan formula” and almost had no pharmacological effects. The administration method was also taking it three times a day after meals and making it feel the same as the experimental group.The dosage of granules in the experimental group and the placebo in the control group were both 27.8 g after the drug ingredients were concentrated.In the course of this study, a third-party inspector designated by the sponsor has been conducting regular on-site inspection visits to ensure that all contents of the study program were strictly observed and the research data were filled in correctly. Research participants were trained to unify recording methods and judgment criteria. The entire clinical trial process should be conducted under strict procedures. All observations and findings in clinical trials should be verified to ensure the reliability of data, to ensure that all conclusions were derived from the original data, and that appropriate data management measures were in place during clinical trial and data processing stages.Baseline conditions such as age, BMI, and gender were analyzed for the enrolled subjects. The dosage and administration time of antihypertensive agents for the two groups were carefully recorded during the patients' in-hospital stay. According to the defined daily dose (DDD) of antihypertensive drugs set by the WHO, the antihypertensive drug use frequency (DDDs) was calculated as daily consumption/DDD, the cumulative daily consumption of conventional antihypertensive drugs was obtained by summing the daily antihypertensive drug use frequency . For antBasic data of the two groups of patients  were analyzed by variance to ensure that the baseline data of the two groups of randomly assigned patients were consistent. The scores of routine antihypertensive drug dosage and defecation, sleep, pain, anxiety, and depression during hospitalization were recorded. Intervention factors, age, gender, BMI, and hypertension history were taken as independent variables to establish a univariate analysis model, and the changes of the above indicators were observed. In order to avoid the statistical error caused by confounding variables, multivariate regression analysis was conducted after adjusting and controlling the variables such as age, gender , BMI, whether avulsion was reversed , and history of hypertension  in the two groups to confirm the results of univariate analysis. All statistical analyses were performed using EmpowerStats software.A total of 48 patients with acute type B aortic dissection  were included in the study from January to December 2016 and were divided into experimental and control groups in a 2 : 1 ratio . Among tThe patients' baseline characteristics are shown in β=2.19) with statistical significance (P=0.0219), and the monitor showed that the blood pressure was maintained within the control range . This result indicated that “Pinggan formula” can effectively reduce the dosage of routine antihypertensive drugs in the absence of obvious fluctuation of patients' blood pressure. The results of the observational indicators showed that, when conventional antihypertensive drugs were used, the intervention of “Pinggan formula” and placebo produced significant differences in the evaluation results of some factors that might cause blood pressure fluctuations between the two groups , that is, the control and regulation of insomnia and pain that may cause fluctuations in blood pressure in the experimental group were significantly better than that in the control group. At the same time, it was found that age, gender, BMI, history of hypertension, etc., did not cause significant differences between the two groups in terms of evaluation indicators .After “Pinggan formula” and placebo intervention, the use of routine antihypertensive drugs (DDDs) during perioperative hospitalization differed between the two groups, the DDD value of the control group was higher than that of the experimental group (P=0.015) and depression index  at the initial baseline , defecation score ; P < 0.0001), sleep score , P=0.0014), pain score ; P=0.0045), and depression score ; P < 0.0001) were significantly higher than that in the experimental group, and the difference was statistically significant. But there were statistical differences in defecation and depression at the initial baseline (P=0.1438) was lower than that of the experimental group, but the difference was not statistically significant ; baseline , so the nificant .The mean DDDs, defecation score, sleep score, pain score, anxiety score, and depression score between the two groups were not significantly affected by age, gender, BMI, dissection avulsion, hypertension, or other factors .In order to exclude the error and influence of confounding variables on statistical results, all patients underwent multiple regression analysis after controlling variables such as age, gender, BMI, retrogradation level, and history of hypertension, adjusted model was obtained as shown in The main purpose of this study is to observe the control effect of traditional Chinese medicine “Pinggan formula” on perioperative blood pressure fluctuation of acute Stanford type B aortic dissection and its effect on assisting treatment of related risk factors that may cause blood pressure fluctuation.Acute Stanford type B aortic dissection mainly relies on surgical treatment and requires a long perioperative period. Uncontrollable hypertension, hypotensive, blood pressure fluctuation, pain, and other factors during the perioperative period can cause hemodynamic abnormalities and increase the incidence of adverse events such as vascular rupture and death . Based oUnder the guidance of the theory of Yin–Yang and five elements, Traditional Chinese Medicine (TCM) studies physiology, pathology, and pharmacology of the human body and their relationship with the natural environment from a dynamic and holistic perspective, seeking the most effective way to prevent and cure diseases . AccordiGastrodia elata, Uncaria, concha haliotidis, Rheum officinale, radix cyathulae, madder, frankincense, myrrh, Eucommia ulmoides Oliv, Lophatherum gracile, Gardenia, Scutellaria, caulis polygoni multiflori, and wild jujube seed. The “Pinggan formula” can clear the liver heat and liver yang, extinguish wind to arrest convulsions, pacify the liver to subdue yang, remove accumulation with purgation, clear the heat and purge fire, detoxicate and cool the blood, unblock the meridian and dissipate stasis, conduct blood downward, induce diuresis, cool and activate blood, dispel stasis, unblock the meridian, move Qi and relieve pain, tonify and replenish the liver and kidney, fortify the spleen and invigorate the stomach, and nourish the heart to tranquilize through mixing the ingredients in their proper proportion.There are many herbal ingredients in “Pinggan formula,” including: In clinical practice, on the basis of effectively maintaining stable blood pressure, “Pinggan formula” can also improve constipation, insomnia, pain, depression, and other risk factors that may cause fluctuations in blood pressure, so as to effectively regulate the perioperative blood pressure of acute aortic dissection as a whole. “Pinggan formula” has a clear therapeutic effect on constipation, which may be the cause of severe, intolerable diarrhea in 3 patients in the experimental group. The constipation of the remaining patients was improved without severe diarrhea.In the experiment of perioperative blood pressure control of acute type B aortic dissection with the assistance of Chinese medicine “Pinggan formula,” the comfort and living quality of the patients in the experimental group during the hospitalization were significantly improved, symptoms associated with aortic dissection such as insomnia, pain, constipation, and anxiety were significantly reduced, and the intensity of routine antihypertensive drugs  was significantly decreased. It can be considered that “Pinggan formula” has an advantage in synergistic control of perioperative blood pressure in patients with acute type B aortic dissection.The drug used in this experiment is a granular preparation made according to the Chinese characteristics. In the future, we aim to study Chinese medicine preparations suitable for Western human characteristics to regulate the blood pressure smoothly and safely.The study shows that the traditional Chinese medicine “Pinggan formula” can significantly reduce the dose of conventional antihypertensive drugs  while maintaining stable perioperative blood pressure  in patients with acute Stanford type B aortic dissection. At the same time, it can regulate and control pain, constipation, insomnia, and other factors that may cause blood pressure fluctuations and improve corresponding symptoms. That is to say, Pinggan formula might be an ideal Chinese medicine preparation for blood pressure control during the perioperative period of aortic dissection and can be recommended as an auxiliary drug for conventional antihypertensive drugs at the current stage.


Hypertension, diabetes mellitus and obesity share some characteristics in relation to diagnosis, management, and prevention. Overweight, obesity and waist-hip ratio (WHR) are associated with increased risk for development of diabetes and hypertension. Surveillance and regular screening exercises are essential in control and prevention of overweight, obesity, diabetes and hypertension. There is limited literature that reported on these health status parameters among university staff in low- and middle-income countries such as Nigeria. It is currently unclear whether Nigerian have a high or low proportion of metabolic risk factors. Therefore, the study aims to examine health status parameters and their predictors among university staff in Nigeria.The study used a cross-sectional descriptive design. Data were collected from 280 university staff in Nigeria. A self-administered questionnaire with sections for sociodemographic data and physical assessment was used to gather information from the participants. Data were analysed using the Statistical Package for Social Science (IBM-SPSS version 25). Univariable and multivariable logistic regression was conducted to explore the association between predictors and health status parameters of the participants.The response rate was 87.5%. University staff had mean systolic blood pressure of 132.04 mmHg ± 19.20 mmHg, diastolic blood pressure of 78.11 mmHg ± 10.81 mmHg, body mass index of 27.74 ± 5.22, waist-hip ratio of 0.88 ± 0.68 and random blood sugar of 98.65 ± 21.30 mg/dL. Predictors of high blood pressure were age  and gender  and predictors of body mass index were gender  and religion . Gender and age had statistically significant association with waist-hip ratio and random blood sugar respectively.The prevalence rates of high blood pressure and random blood sugar; overweight, obesity and risk WHR are on the increase compared to previous studies. Lifestyle modification, organized and explicit health campaigns coupled with regular screening and surveillance will contribute to the prevention and control of noncommunicable diseases.The online version of this article (10.1186/s12872-018-0918-x) contains supplementary material, which is available to authorized users. Health status is defined in relation to blood pressure, body mass index (BMI), waist-hip ratio (WHR) and random blood sugar (RBS). These health status parameters were used to assessed cardiometabolic disorders which include disorders in glucose regulation, central obesity, dyslipidaemia and hypertension . These cThe burden of noncommunicable diseases is well documented in low- and middle-income countries (LMICs) –4. EightCardiovascular diseases (CVDs) alone have a global annual death rate of 17.7 million (44.3%) and the figure for diabetes mellitus is about 4.0% . HyperteThe prevalence rate of diabetes in Africa varies between 1 to 3% and 5% to 6% among rural and urban dwellers respectively . AccordiOverweight and obesity are on the increase in LMICs  and willHigh blood pressure is a risk factor for stroke, ischaemic heart diseases, heart failure and chronic kidney diseases . CommonlOverweight and obesity increase the rates of premature mortality and morbidity from CVDs and worsen the prognosis of type 2 diabetes, chronic back pain and osteoarthritis . CVDs anThere is a paucity of data on health status that considers the four parameters that are important in the development of CVDs among university staff in Nigeria. Furthermore, there is limited literature that reported on blood pressure, BMI, WHR RBS among university staff , 32 in LThis study is a cross-sectional, descriptive study design that was conducted among university staff in Nigeria between October and December 2016. The selected university is the largest in term of spread, and student population. The university has a headquarters and over 70 satellite campuses with 2657 staff across the country as of 2016. The study settings were spread across the six geopolitical zones in Nigeria; Fig. G*Power 3  was usedA self-administered questionnaire  and the National Open University of Nigeria Health Research Ethics Review Committee (NHREC 04). An information sheet containing details of the survey was given to each participant. They were informed and assured that anonymity and confidentiality would be maintained. They were further assured that participation in this study was entirely voluntary, that they could withdraw from the study at any time, and that data from the survey would be used for scientific research purposes only.Age was recorded in years; average monthly income less than N100 000 was recorded as low income, N101 000–N200,000 as middle income and above N200 000 as high income. The sociodemographic variables under study were age, gender, religion, location of staff, average monthly income, marital status, designation and highest educational level.The health assessments section measured the cardiometabolic status . Participants were made to rest in a sitting position for between 5 and 10 min before taking the blood pressure test. A digital sphygmomanometer was used to measure blood pressure twice, with an interval of 10 min, and an average of the two was recorded as the participant’s blood pressure. The blood pressure readings of the participants were described as normal systolic blood pressure when systolic measured below 120 mmHg, systolic prehypertension was between 120 mmHg and 139 mmHg, and systolic hypertension was < 140 mmHg and above. Normal diastolic blood pressure was diastolic measuring < 80 mmHg, diastolic prehypertension was blood pressure measuring between 80 mmHg and 89 mmHg, and diastolic hypertension was blood pressure measuring 90 and above , 34. RBSp-value ≤ 0.05.Data were analysed using Statistical Package for Social Science (IBM-SPSS version 25). Continuous variables were summarized as the mean ± standard deviation. Categorical data were summarized using frequency, percentage and cross-tabulation. Univariable and multivariable logistic regression was conducted to explore the association between sociodemographic variables and health status parameters of the participants. We initially performed a univariable logistic regression to estimate the association between each of the cardiometabolic-status and sociodemographic characteristics of the participants. Only the sociodemographic variables that were significant were put in the final models for each health status parameter. Hence, all the health status parameters were regrouped into binary  as they were treated as the dependent variables. The blood pressure readings of the participants were therefore further classified as normal blood pressure when systolic measured < 140 and diastolic < 90, and as high blood pressure when systolic blood pressure ≥ 140 and diastolic ≥ 90. BMI was classified as normal BMI when calculated as < 18–24.9 and high BMI when the calculation was > 25.0. Four models were developed for each health status parameter and sociodemographic variable. Odds ratio (OR) was estimated with 95% confidence interval (CI). Cases with missing value/s were defined as no response, treated and expressed in frequency and percentage. However, in the regression analysis, missing cases were excluded and treated as missing. Statistical significance was determined at a Table Figure To determine the predictor(s) of participants’ health status we conducted univariable logistic regression to analyse the relationship between health status parameters  and predictors , with crude odds ratios and 95% confidence intervals being estimated for each predictor. We further conducted multivariable logistic regression for all the predictors that were significantly associated with each health status in the univariable analysis. Four models were developed for each of the health status parameters.The univariable logistic regression Table  shows thAge, gender, religion, marital status, designation and monthly income had statistically significant association with high BMI. The multivariable logistic regression results Table  further Table Table Our study assessed the health status of the university staff in Nigeria and its predictors. The study showed that quite a number of our study participants had elevated health status parameters. Age and gender were predictors of high blood pressure and gender and religion were predictors of BMI. Furthermore, worker’s location, marital status, monthly income, designation, highest education, religion, gender and age had statistically significant relationship with one or more measures of the health status As mentioned in the background of the study, overweight and obesity are linked to the development of CVDs, diabetes  and cancThe findings of our study are similar to another study conducted among university staff in south-west Nigeria where 75% of the study population had two or more cardiovascular risk factors . Also, aThis study findings reveal that religion had statistical significant impact on BMI and Muslim participants were less likely to have high BMI. Similar results were obtained among England and Australia population where religious denomination  and reliThe high prevalence of overweight 41.4%), obesity (31.8%) and risk WHR 67.9%) is worrisome because of their relationship with CVDs and diabetes [.4%, obes.9% is woThe findings from this study are therefore crucially important in guiding intervention programmes for the university staff and workers generally. Surveillance is crucial in the control and prevention of NCDs , 9, 47, One of the limitations of this study was that the testing for RBS was not good enough to predict prevalence of impaired glucose tolerance or diabetes among the study population. The difficulty was that participants were often too busy to attend following a two-hour post-feeding interval for the RBS testing so that the post-feeding interval was in most cases much longer. Hence it would be advisable to perform fasting blood sugar examination to evaluate the prevalence of diabetes among the study population.In conclusion the health status of the study population is borderline. The prevalence rates of high blood pressure and random blood sugar; overweight, obesity and risk WHR are on the increase compared to previous studies, with lifestyle behaviour of university staff  a possibAdditional file 1:Health status questionnaire (DOCX 14 kb)


The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline lowered the threshold defining hypertension and treatment target from 140/90 mmHg to 130/80 mmHg. We compared the 2017 ACC/AHA guideline and the Eighth Joint National Committee (JNC8) report with regard to the current status of hypertension using the Korean National Health and Nutrition Examination Survey. The association between blood pressure (BP) control and long-term major cardiovascular outcomes (MACEs) was analyzed using the Korea National Health Insurance Service cohort. In the cross-sectional study with 15,784 adults, the prevalence of hypertension was expected to be 49.2 ± 0.6% based on the definition suggested by the 2017 ACC/AHA guideline versus 30.4 ± 0.6% based on the JNC8 report. In a longitudinal analysis with 373,800 hypertensive adults for the median follow-up periods of 11.0 years, the adults meeting the target goal BP goal of 2017 ACC/AHA guideline were associated with 21% reduced risk of MACEs compared with adults, not meeting 2017 ACC/AHA BP goal but meeting JNC8 target goal. In conclusion, substantial increase of prevalence of hypertension is expected by the 2017 ACC/AHA guideline. This study also suggests endorsing the aggressive approach would lead to an improvement in cardiovascular care. The World Health Organization estimates that 40% of adults worldwide have hypertension3. Elevated systolic BP was responsible for 10.5 million deaths globally in 2016, and the burden from high BP is continuously increasing2. Elevated BP has been shown to account for 58.3% of deaths from hemorrhagic stroke and 54.5% of deaths from ischemic heart disease4.Elevated blood pressure (BP) is the leading cause of mortality and disease burden4. Every 20 mmHg systolic or 10 mmHg diastolic BP increase above the threshold has shown to double the risk of mortality from ischemic heart disease and stroke5. However, for decades, guidelines generally defined hypertension as a BP ≥ 140/90 mmHg, and suggested BP should be maintained at <140/90 mmHg9. The newly released 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults supports a more aggressive diagnostic and treatment approach10. The new guideline defines hypertension as a BP ≥ 130/80 mmHg and recommends hypertensive patients to maintain their BP under <130/80 mmHg.Epidemiologic studies have suggested that the relationship between BP and cardiovascular risks exists as low as 110–115 mmHg for systolic BP and 70–75 mmHg for diastolic BPet al. used the data from a nationwide survey in the United States to show that the prevalence of hypertension increased from 31.9% to 45.6% when applying the 2017 ACC/AHA guideline11. The radical changes in the recommendations have sparked fierce debates among researchers and practitioners14. In this study, we sought to estimate the potential impact of the new hypertension guideline on clinical practice in Korea. We specifically attempted to determine the following: how many people would be classified as having hypertension, how many among them would be recommended pharmacologic treatment, and whether more aggressive BP goals would lead to better cardiovascular outcomes.The impact of the new guideline is expected to be immense. Muntner 15. Detailed information on socioeconomic status, health and dietary behaviors, quality of life, healthcare utilization, anthropometric measures, and biochemical profiles are included in the database. Subjects representative of the Korean population were chosen for this study using a complex, stratified, multistage, cluster sampling method. BPs were measured three times on the subjects’ right arms using an appropriately sized arm cuff and mercury sphygmomanometer  after the subject rested in a seated position for at least 5 minutes. We calculated the final BP value from the average of the second and third measurements16. The sample weights were constructed by accounting for the complex survey design, survey non-response, and post-stratification. Among a total of 22,948 subjects who participated in the KNHANES VI between 2013 and 2015 , 15,784 adults aged 30 years or older were analyzed in this study.Data from KNHANES were used to estimate the current status of hypertension prevalence and control. KNHANES is a national surveillance constructed to assess the health and nutritional status in Korean population17. The National Health Insurance Service is the single insurance provider in Korea covering all citizens. Enrollees in the insurance system are entitled to standardized medical examinations biennially, including standardized self-reporting questionnaires on lifestyle, medical history, height, weight, blood pressure measurements, and laboratory tests. The cohort contains data of 514,866 subjects who underwent routine check-ups between 2002 and 2003, and includes demographic data, eligibility status, income levels, medical claims, and death records through the end of 2013. The Seoul National University Hospital Institutional Review Board approved this study (I-2018-150) and waived the mandate for obtaining informed consents. This study was conducted according to the relevant guidelines and national regulations.We selected hypertensive subjects from the NHIS-HEALS cohort8. The 2017 ACC/AHA guideline defines hypertension as a systolic BP ≥ 130 mmHg or a diastolic BP ≥ 80 mmHg, while previous guidelines, including the JNC8, have defined hypertension as a BP of 140/90 mmHg or higher9. The thresholds for pharmacologic antihypertensive treatment based on the guidelines are summarized in Supplementary Table The prevalence of hypertension and the percentage of adults requiring antihypertensive drug treatment were compared with 2017 ACC/AHA guideline and Eighth Joint National Committee (JNC8) report18. Any subjects who had experienced myocardial infarction (MI), heart failure (HF), or stroke before the diagnosis of hypertension were excluded from this analysis. Then, the study subjects were categorized into 3 groups according to BP levels achieved: (a) achieved BP below the target BP goal recommended by the 2017 ACC/AHA guidelines (2017 ACC/AHA group), (b) achieved BP below the target BP goal recommended by the JNC8 guidelines but above that of the 2017 ACC/AHA guidelines (JNC8 group), and (c) achieved BP above the goals provided by both guidelines (poor group).The data of patients with hypertension and follow-up BP records were extracted from the NHIS-HEALS cohort. Subjects were considered as having hypertension if: (a) hypertension was diagnosed once or more during a hospitalization, or at two or more outpatient clinic visits, (b) antihypertensive medications were prescribed for >6 months, or (c) BP readings were 130/80 mmHg or aboveStudy subjects were followed up until the occurrence of the primary endpoint, until death, or until the end of the cohort . Vital status was confirmed using the national administrative death records. The primary endpoint was major cardiovascular events, comprising a composite of cardiovascular death, MI, HF, and stroke. The secondary endpoints included all cause death and each separate component of the primary endpoint.15. The variables representing strata, cluster, and weight were included in the raw data. Cox proportional hazard models were used to evaluate the associations between levels of BP control and the occurrence of major cardiovascular events. We used restricted cubic spline curves to visualize the relationship between the independent and dependent variables using the ‘rms’ packages in the R program. We performed multivariable regression analyses with adjustments for age, sex, baseline systolic BP, baseline diastolic BP, body mass index, diabetes, dyslipidemia, malignancy, renal disease, liver disease, chronic pulmonary disease, rheumatic disease, and smoking status. Propensity score matching was performed using the aforementioned variables. A nearest match algorithm was constructed in 1:1 matching ratios using ‘MatchIt’ packages in the R program. Statistical analyses were conducted using SPSS Statistics  and R programming version 3.2.4 .Data were presented as mean ± standard error or % (number). Weights based on the complex sampling design of KNHANES were used for all the statistical analyses to avoid biased estimatesThe prevalence of hypertension was estimated to be 49.2% based on the BP criteria suggested by the 2017 ACC/AHA guidelines, which was a significant increase compared to the 30.4% prevalence rate based on the previous definitions Fig. .Figure 1The profiles of the subjects in each hypertension category were described in Supplementary Table As the 2017 ACC/AHA guideline suggested lower BP threshold for hypertension to underline the importance of the early initiation of non-pharmacological treatment, medical treatment was indicated partly in the subjects with newly classified hypertension. BP-lowering medications are recommended in 35.3% of adults by the 2017 ACC/AHA guidelines. This is in contrast with the JNC8 guideline which showed a small difference between the prevalence of hypertension (30.4%) and the proportion of subjects requiring medical treatment (29.4%). A total of 1.8 million subjects (6.0% of Korean adults) were recommended to newly start antihypertensive medications based on the new recommendations  are compared in Table A sensitivity analysis was done for 231,698 hypertensive patients who were taking BP-lowering medicines. The baseline characteristics showed relatively higher risk profiles than in the main analysis population  with the lowered BP threshold of ≥130/80 mmHg suggested by the 2017 ACC/AHA guideline. However, the number of adults for whom BP-lowering medical treatment was recommended was modestly increased (from 29.4% to 35.3%). We also found that hypertensive adults meeting the target BP goal of the 2017 ACC/AHA guideline were associated with a 23% reduced risk for of major cardiovascular events compared to adults meeting the JNC8 target BP only.22. This study showed that nearly a half of Korean adults would be diagnosed with hypertension based on the new guideline. but not all hypertensive adults would be recommended for pharmacologic treatment. A substantial proportion of them would be recommended for non-pharmacologic treatments initially. Numerically speaking, among the 5.6 million Korean adults who were newly diagnosed with hypertension, medical treatment was indicated in 1.8 million (32.2%) while non-pharmacological therapy was indicated in the remainder. Strong evidence exists supporting the efficacy and safety of non-pharmacological interventions such as weight reduction, healthy diet, sodium restriction, physical activity, and moderation in alcohol consumption25.The 2017 ACC/AHA guideline, which has adopted lower BP thresholds for the diagnosis of hypertension, underlines the importance of early preventive measures and non-pharmacologic interventions. Growing evidence from clinical trials and epidemiological studies suggests that lowering the BP below 140/90 mmHg may be associated with a reduced risk of adverse cardiovascular events20. The trial enrolled high-risk patients (mean Framingham 10-yr cardiovascular disease risk: 24.8%); thus, it is still uncertain whether the study findings can be generalized to populations that were not included in the trial. For example, the Heart Outcomes Prevention Evaluation (HOPE)-3, which enrolled intermediate-risk hypertensive patients without previous cardiovascular disease, failed to demonstrate a significant risk reduction with intensive antihypertensive therapy26. In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which exclusively enrolled diabetic patients and wherein the study protocol was similar with that of the SPRINT, the benefits of intensive BP control were not statistically significant19.It has long been debated whether tighter BP control results in better clinical outcomes. The SPRINT  showed that there were significant benefits to reducing systolic BPs < 120 mmHg compared to <140 mmHg, and strongly influenced the changes introduced in the 2017 AHA/ACC guideline recommendationsThe findings of our study correspond to the current evidence supporting intensive BP control in the general population. The study subjects exhibited a low-risk profile with no previous history of major cardiovascular events, and the actual 10-year event rate was as low as 7.9%. The magnitude of the risk reduction shown in this study (23%) was comparable to that of the SPRINT (27%) and the ACCORD trial (12%). The achieved BP in this study  was similar to, or lower than those in the SPRINT (121.4/68.7 and 134.6/76.3 mmHg) and the ACCORD trial (119.3/64.4 and 133.5/70.5 mmHg). In addition, we found no significant interactions according to the presence of diabetes or chronic renal disease.27. The control rate among all hypertensive patients in Korea is no higher than 42.9%9. Trying to maintain even lower BPs at <130/80 mmHg must be challenging11. This study also expected that tighter BP control would be required for more than 5 out of 6 Korean hypertensive patients if the new treatment targets are endorsed.The 2017 ACC/AHA guideline has raised practical issues. Previous studies have consistently shown poor status of hypertension control in the real world. Globally, less than a half of the subjects with hypertension are aware of the diagnosis, and less than a third of those being treated maintain BPs lower than 140/90 mmHg28. The Korean Society of Hypertension also released its preliminary guideline in 2018 (written in Korean language)29. Both guidelines maintained the previous definition of the cut-off for hypertension of BP ≥ 140/90 mmHg. The European guideline classified systolic BP 130‒139 mmHg and/or diastolic BP 85‒89 mmHg as “high normal” in, while Korean one defined “prehypertension” as systolic BP of 130‒139 mmHg or diastolic of BP 80‒89 mmHg. However, the new guidelines commonly recommend stricter BP control than recommended in their previous versions29. In line with the 2017 ACC/AHA guideline, the target systolic BP was lowered to 130 mmHg for high risk patients, although there are variations in details across hypertensive subgroups.Recently, the new European Guidelines for the treatment of high BP was presented at the 2018 European Society of Hypertension meeting (The full text will be published during the upcoming European Society of Cardiology congress)30. The 2017 ACC/AHA guideline also stresses the role of out-of-office and self-monitored BP measurements10. Third, achieved BPs were defined by the mean of randomly collected BP measurements rather than repeated measurements with predefined protocols. Fourth, lifestyle intervention was not considered in this study. Lifestyle changes such as a healthy diet, sodium restriction, potassium supplementation, increased physical activity, and a reduction in alcohol consumption have been shown to be effective in lowering BP. They have also been shown to have additional health benefits beside the BP-lowering effects. Finally, there may be other confounders that were not adjust for in this study such as initiation of antihypertensive medication and statin use.This study has several limitations. First, as the National Health Insurance Service Cohort is a real-world database, BP measurements could not be standardized. Second, BPs were measured during a single visit both in the KNHANES and the cohort. Repeated visits or ambulatory measurements have been shown to minimize the chance of misclassificationsIn conclusion, we estimated the potential implications and relevance of the 2017 ACC/AHA hypertension guideline in real-world clinical practices in the present study. A substantial number of adults who had not been considered hypertensive were classified as having hypertension. Approximately one third of them met the indication for pharmacologic antihypertensive treatment. Hypertensive adults meeting the target BP of 2017 ACC/AHA guideline was associated with a reduction in long-term cardiovascular events compared to those meeting the JNC8 guideline only. It can be assumed that endorsement of more aggressive BP control strategies as suggested by the 2017 ACC/AHA guideline might lead to improved cardiovascular outcomes.Supplementary information


There is an increasing burden of hypertension (HTN) across sub-Saharan Africa where HIV prevalence is the highest in the world, but current care models are inadequate to address the dual epidemics. HIV treatment infrastructure could be leveraged for the care of other chronic diseases, including HTN. However, little data exist on the effectiveness of integrated HIV and chronic disease care delivery systems on blood pressure control over time.Population screening for HIV and HTN, among other diseases, was conducted in ten communities in rural Uganda as part of the SEARCH study (NCT01864603). Individuals with either HIV, HTN, or both were referred to an integrated chronic disease clinic. Based on Uganda treatment guidelines, follow-up visits were scheduled every 4 weeks when blood pressure was uncontrolled, and either every 3 months, or in the case of drug stock-outs more frequently, when blood pressure was controlled. We describe demographic and clinical variables among all patients and used multilevel mixed-effects logistic regression to evaluate predictors of HTN control.Following population screening (2013–2014) of 34,704 adults age ≥ 18 years, 4554 individuals with HTN alone or both HIV and HTN were referred to an integrated chronic disease clinic. Within 1 year 2038 participants with HTN linked to care and contributed 15,653 follow-up visits over 3 years. HTN was controlled at 15% of baseline visits and at 46% (95% CI: 44–48%) of post-baseline follow-up visits. Scheduled visit interval more frequent than clinical indication among patients with controlled HTN was associated with lower HTN control at the subsequent visit . Hypertension control at follow-up visits was higher among HIV-infected patients than uninfected patients to have controlled blood pressure at follow-up visits .Improved HTN control was achieved in an integrated HIV and chronic care model. Similar to HIV care, visit frequency determined by drug supply chain rather than clinical indication is associated with worse HTN control.ClinicalTrials.gov: NCT01864603.The SEARCH Trial was prospectively registered with The online version of this article (10.1186/s12889-019-6838-6) contains supplementary material, which is available to authorized users. There is an increasing non-communicable disease (NCD) burden globally, with an estimated one billion people living with hypertension and about 9.4 million related deaths annually . Global HIV is more prevalent in SSA than anywhere else in the world  and the In this setting, lessons learned from the HIV chronic disease treatment model can be applied to the management of other chronic diseases such as hypertension. Integrated care systems are more convenient for patients, decrease stigma associated with healthcare, and could be more efficient for government and non-governmental funders. However, evidence-based care models for scaling up integrated HIV/NCD care are lacking . In partIn the Sustainable East Africa Research in Community Health (SEARCH) study (NCT01864603), population level screening of HIV and HTN was performed at community health campaigns, and individuals with either or both diseases were linked to integrated care at local health facilities , 20. TheWe studied 10 rural Ugandan communities participating in the intervention arm of the SEARCH Study. Communities selected for the SEARCH study in Uganda met initial eligibility criteria of a rural community, defined as one or more national geopolitical units, just above the village level (i.e. a parish) with a population of about 10,000 persons within the catchment area of a President’s Emergency Plan for AIDS Relief (PEPFAR)-supported HIV clinic in southwestern Uganda or Eastern Uganda and matched pairs were selected based on region, population density, occupational mix, access to transport routes, and number of trading centres . Among tWe defined HTN based on World Health Organization (WHO) guidelines as a systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg on any one of three measurements  or self-Participants who screened positive for hypertension at the CHC were referred to their local health facility for NCD management. An integrated chronic disease model of streamlined care designed to reduce patient level barriers and maximize health system efficiency  was implAt the clinic visit blood pressure was measured using electronic sphygmomanometers. Individuals with hypertension were managed using a clinical and medication management algorithm based on the Uganda Clinical Guidelines  Additio and 2. PThe primary outcome of interest for this analysis was hypertension control at follow-up clinic visits. Blood pressure control at 2 consecutive visits separated by at least 1 month was evaluated as a secondary outcome.We described univariate distributions of demographic and clinical variables overall and separately among HIV-infected and uninfected individuals. Demographic characteristics of those who linked to care were compared with those who screened positive for HTN at CHC and did not link to care using logistic regression adjusting for clinic site. We classified a scheduled visit as ‘more frequent than clinical indication’ if blood pressure was controlled and the next clinic visit was scheduled within 84 days. Late visits were defined as visits made more than 14 days after the scheduled date.We used a multilevel mixed-effects logistic regression  to evaluThis study and all consent procedures were approved by ethical review boards of Makerere University School of Medicine  and the University of California, San Francisco (USA). All participants provided verbal informed consent at the CHC in their preferred language with fingerprint biometric confirmation of agreement. Verbal consent was provided in lieu of written consent as the CHC activities presented no more than minimal risk of harm to subjects and did not involve procedures for which written consent would otherwise be provided, and because of limited literacy in the study population.Across ten communities, 34,704 residents aged ≥18 years were evaluated at baseline, of whom 2071 (6%) were HIV-infected [Fig. p < 0.001), older , and have Stage 2 hypertension at screening (p < 0.001) than those who did not link to NCD care. At their first clinic visit, 294/2038 (15%) of individuals were on blood pressure lowering medication, 714/2038 (35%) had Stage 2 hypertension, and 123/2038 (6%) were also being treated for diabetes. Among the 89 HIV-infected participants who linked to NCD care, 31 (36.9%) had HIV RNA < 400 copies/mL at baseline [Table Within one year, 45% (2038/4554) of individuals who screened positive for hypertension linked to NCD care during the baseline year Fig. . Among tOverall, the 2038 patients who linked to HTN care made 16,253 total visits over 3 years of follow-up; of these, 1587 patients contributed 15,653 visits after the initial linkage visit [Table Approximately two thirds of the patients 1333/2038) were treated with blood pressure lowering medicines and of these 65% (909/1333) were treated with 2 or more medications. Almost all  of those treated with medications were prescribed bendroflumethiazide (a thiazide diuretic) and 902/1333 (68%) were treated with nifedipine . The remaining third who were never prescribed blood pressure lowering medication were managed though counseling on lifestyles changes, including decreasing salt intake, exercise, and alcohol consumption [Table 33/2038 wAfter adjusting for age, sex, comorbid diabetes, hypertension stage at previous visit, medication prescribed at previous visit, HIV status, and clinic, scheduled visit interval outside of clinical indication was significantly associated with blood pressure control. Scheduled visit interval more frequent than clinical indication for patients with controlled HTN was associated with lower HTN control . Men  and patients age 50 years and older  were less likely to have controlled blood pressure at follow-up visits than women and patients less than 50 years old. Time in care (in months) was associated with higher odds of blood pressure control . HIV-infected patients were more likely than uninfected patients to have controlled blood pressure at follow-up visits  [Table To work towards hypertension control in SSA we need to optimize health systems for chronic care delivery. In this study of hypertension outcomes among patients referred to integrated chronic disease care after population-wide screening we found that blood pressure control increased more than threefold from 15% at baseline. Nevertheless, blood pressure was controlled in slightly less than half (46%) of all follow-up visits. We identified a modifiable systems factor, more frequent clinic visits precipitated by drug stock outs, as one of the barriers to hypertension control.Achieving hypertension control at a population level starts with screening and linkage to clinical care. After population-based screening, 45% of patients with prevalent hypertension were linked to NCD care. This number may underestimate true linkage, however, as individuals who were normotensive on presentation to clinic and not enrolled in NCD care were not counted, however they still fall short of ideal. Linkage to NCD care following screening remains a challenge across the region – a recent meta-analysis on hypertension in SSA estimated only 14–22% patients were in care following hypertension diagnosis [Our population who sought care were approximately two thirds female, while population-based screening demonstrated higher prevalence among men . Our cliWe found that hypertension control was achieved at 46% of follow-up visits. This is similar to findings of a multisite population population-based screening across 6 sites in South Africa, Kenya, Ghana, Burkina Faso, Sierra Leone where HTN control in 47% of those in treatment  and sligSimilar to findings that improved HIV outcomes are associated with extended intervals between scheduled clinic visits , 18, we Patients with dual diagnoses of HIV and hypertension were more likely to achieve normal blood pressure over time than those patients receiving care for hypertension only. Hypertension care was integrated into HIV clinic visits preventing redundant visits and HIV-infected patients also received extensive counseling about daily medication adherence and retention support which may have led to increased adherence among HIV-infected patients. These tools can be adapted to support engagement in care for other chronic disease to improve outcomes.Other integration initiatives can inform the successful integration of HIV and hypertension care. Integrated TB and HIV care leads to decreased both HIV and TB-associated morbidity and mortality . Co-locaOur data only captures individuals who are in care for hypertension treatment; outcomes following transfer or loss to care were not assessed. Nonetheless, understanding blood pressure control among those individuals receiving treatment is important to improving outcomes within the health care system. More detailed analysis of the effect of class of antihypertensive treatment would provide additional insight into mechanisms of blood pressure control, however the focus of this current analysis is on individual clinical factors and health systems factors that contribute to hypertension control. Additionally, blood pressure measured at clinic represents a single point in time and we thus have an incomplete picture of overall hypertension control in this population. Clinic-based blood pressure measurements potentially misclassify individuals with white coat hypertension  or masked hypertension  and the prevalence in SSA is estimated to be 15 and 11% respectively . HoweverOur study registered successes in population level screening for HIV and hypertension, in linkage to integrated chronic disease care and hypertension control for both HIV positive and HIV negative patients with hypertension. Our study contributes evidence to realize effective responses for HIV care and emerging NCDs, including hypertension, in SSA. However, there is need to continue to optimize the integrated care model to achieve ideal patient outcomes.Additional file 1:Hypertension Management Algorithm (PDF 70 kb)Additional file 2:Hypertension Drug Use Algorithm (PDF 172 kb)