We analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trends of hypertension treatment and control rate in Korea over the past 10 years. In addition, we tried to investigate the effect of chronic medical conditions on hypertension management. We investigated the hypertension prevalence, awareness, treatment, and control rate from 2008 to 2017. KNHANES, which uses a stratified multistage sampling design, is a cross-sectional, nationally representative survey conducted by the Korean government. A total of 59,282 adults (≥ 20 years) were included, which was representative of the total population of around 40 million Koreans per year. The mean age was 50.7 ± 16.4 years and 42.6% were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity significantly increased over the 10 years. During this period, the hypertension treatment and control rate significantly improved. Hypertension treatment rate was significantly lower in the younger age group compared to the older age group, but the control rate among the treated patients was not significantly different between age groups. The treatment and control rates of hypertension were higher in patients with multimorbidity, which implies that it has a favorable effect on the treatment and control of hypertension. Hypertension treatment and control rate have improved over the past 10 years. The higher treatment and control rate in patients with multimorbidity suggest that the more aggressive surveillance might be associated with the improvement of hypertension treatment and control rate in Korea. A recent paper about the hypertension control rate in 12 high-income countries reported that hypertension awareness, treatment, and control rate have substantially improved since the 1980s and 1990s, most of which was achieved in the late 1990s and early 2000s. However, control rates have plateaued in the past decade, at levels lower than those seen in high-quality hypertension control programs2.Hypertension is a major risk factor for cardiovascular disease. Furthermore, blood pressure ≥ 120/80 mmHg leads to a greater risk of myocardial infarction, heart failure, stroke, and kidney disease. Although many nations tried to decrease the burden of hypertension, the number of individuals with elevated systolic blood pressure (≥ 110–115 mmHg) and the estimated associated deaths have increased substantially worldwide3. This is disappointing since during the previous 10-year period, the percentage of uncontrolled hypertension among adults who were taking prescribed hypertension medication decreased by 8%4.It has been reported that the prevalence of hypertension has remained stable over time. In the US, the prevalence of hypertension was unchanged from 1999 to 2016. The prevalence of controlled hypertension increased from 1999 to 2010 but then showed no change until 20165. The awareness rate increased from 25% in 1998 to 65% in 2007, but remained at 65% in 2016. The treatment rate increased from 22% in 1998 to 59% in 2007 and 61% in 2016, whereas the control rate increased from 5% in 1998 to 41% in 2007 and to 44% in 2016.In Korea, hypertension awareness, treatment, and control rate dramatically improved from 1998 to 2007, but have remained almost unchanged thereafterAll these data suggest that it is urgent to overcome the recent stagnation in hypertension control and to find a novel strategy to decrease the global burden of elevated blood pressure. To do that, it is important to identify factors associated with poor hypertension control. For this purpose, we investigated the trend of hypertension awareness, treatment, and control rate in the Korean population. We also tried to identify factors associated with hypertension management. More specifically, we looked into the effect of multimorbidity on the treatment and control rate of patients with hypertension in Korea.6.The data were derived from the Korean National Health and Nutrition Examination Survey (KNHANES). The KNHANES has been conducted periodically since 1998 to assess the health and nutritional status of non-institutionalized Koran civilians. The KNHANES is a cross-sectional and nationally representative survey conducted by the Division of Chronic Disease Surveillance, Korea Disease Control and Prevention Agency (KDCA). The survey consists of a health interview, nutrition, and health examination surveys. A stratified, multistage probability sampling design was used for the selection of household units. More specific design features and characteristics of KNHANES are described elsewhere in detailAmong the 64,853 subjects older than 20 years who participated in the survey between 2008 and 2017, 5571 subjects were excluded due to lack of data regarding blood pressure or hypertension treatment. Finally, 59,282 subjects, including 25,240 males (42.6%) were included in the analysis. All study procedures were carried out in accordance with relevant guidelines and regulations. All the surveys are conducted with the participants’ written consent. This study was approved by the Institutional Research Committee of Seoul National University Bundang Hospital (IRB No. X-1908-559-903).Blood pressure was measured by a trained nurse using a mercury sphygmomanometer  with an appropriately sized cuff after the participants sat for at least 5 min to stabilize blood pressure. During the measurement period, participants were seated leaning against the back of a chair with the feet flat on the floor. The participants’ right arm was positioned so that the middle of the cuff was at the heart level. Blood pressure was measured 3 times and the mean blood pressure of second, third measured value was used in the analysis of systolic and diastolic blood pressure.A fasting blood sample was taken in the morning after at least 8 h of fasting. The blood samples were centrifuged, refrigerated at the examination site, and transferred in iceboxes to a central laboratory. Blood chemistry tests were performed by appropriate methods using an auto-analyzer  9.The GFR (glomerular filtration rate) was calculated using the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation and impaired GFR was defined as an eGFR of 15–59 ml/min/1.73m2 was used to compare proportions. Uni- and multivariable logistic models were used to identify factors affecting prevalence and hypertension treatment. The temporal trends of the prevalence of chronic medical conditions as well as hypertension treatment and control rate were examined using the slope of the regression line. All statistical analyses were two-tailed and p-values < 0.05 were considered statistically significant.Statistical analyses were done with SPSS  or SAS . To calculate the total population that the sample would represent, we used stratified variables and sample weights designed by the KDCA. In order to confirm the changes in prevalence, we combined every two-year data using the integrated weight. Continuous variables were expressed as mean ± standard error or median and interquartile range and compared by unpaired Student’s t-test and one-way ANOVA. Discrete variables were expressed as counts and percentages, and the Rao-Scott χA total of 59,282 adults (≥ 20 years) were included in the analysis. The characteristics of study population are listed in Table Hypertension treatment and control rate improved over the last 10 years, but there was no significant improvement in the age-adjusted hypertension awareness rate. Hypertension control rate was 41.6 ± 1.24% in 2008–2009 and increased to 47.3 ± 1.17% in 2016–2017 for all hypertensive patients. In addition, the hypertension control rate among treated patients improved from 69.3 ± 1.26% in 2008–2009 to 73.0 ± 1.12% in 2016–2017  the prevalence of hypertension and other chronic medical conditions increased during the last 10 years; (2) compared with the middle or older age groups, the hypertension control rate was lower in the younger age group, mainly due to the lower treatment rate; (3) the hypertension control rate significantly improved in hypertensive patients having other medical conditions, suggesting that multimorbidity has a beneficial effect on hypertension treatment or control.Since the KNHANES participants were representative of the Korean population, we can conclude that the awareness, treatment, and control rate of Korean patients with hypertension improved during the past 10 years. To overcome the recent stagnation in hypertension treatment and control rate, we should focus on the younger age group and on patients without other medical conditions to improve the awareness and treatment rate.10.As a result of national projects for the improvement of hypertension control, there has been a substantial advance in the treatment of hypertension throughout the world. Among US adults, there was a decrease in age-adjusted hypertension prevalence, although the absolute burden increased. The age-adjusted control rate improved from 1999 to 2016 among adults treated for hypertension. However, the control rate did not improve among older adults or in patients with hypertension and diabetes mellitus, CKD, or high cardiovascular disease risk13. Accordingly, there has been a substantial decline in systolic and diastolic blood pressure in patients with hypertension and a high-risk profile. There was a rapid increase in the proportion of patients whose blood pressure met the criterion of less than 140/90 mmHg, even in octogenarians, in a study of primary care electronic health records of 265,225 participants from the UK Clinical Practice Research Datalink. That study showed that hypertension treatment intensified between 2001 and 2014. Blood pressure values decreased in both treated and untreated participants, with a substantial increase in the proportion of patients achieving conventional blood pressure targets among octogenarians14.In our study, the systolic and diastolic blood pressure levels were significantly lower in the older population, especially in patients with multiple comorbidities. Recent guidelines highlighted the importance of strict blood pressure control for patients with high cardiovascular risk or established cardiovascular disease. In addition, many guidelines recommended a target blood pressure of 130/80 mmHg instead of 140/90 mmHg for those patients15. As a result, patients with hypertension and other cardiovascular risk factors are regarded as a high-risk group and show resistance to hypertension treatment16.Hypertension rarely manifests alone; it is usually clusters with other chronic medical conditions, such as diabetes mellitus, obesity, hypercholesterolemia, and CKD. This clustering independently increases the risk of developing cardiovascular disease, even in individuals with high-normal blood pressureIn Korea, the clinical profile of patients with hypertension has been worsening over the last 10 years, namely in terms of the increased prevalence of comorbidities such as diabetes, obesity, and hypercholesterolemia. Moreover, the blood pressure, blood glucose, cholesterol, and BMI also significantly increased during this period. These data support the finding that the overall cardiovascular risk is currently higher compared to previous years in the Korean population.17. An improvement in hypertension control was also observed in Sweden18. More specifically, blood pressure decreased more among patients with greater cardiovascular risk. This constitutes a contradictory finding because previous data suggested that hypertensive patients having multimorbidity show resistance to drug treatment. This may be due to increased physicians’ awareness and intensification of hypertension treatment for high-risk patients. The importance of intensive blood pressure control for these patients or those with other chronic medical conditions has been highlighted in most of the clinical guidelines. Recent treatment guidelines are now beginning to incorporate the concept of global cardiovascular risk evaluation and management to improve patient outcomes and to recommend global risk assessment in all patients with hypertension13. Accordingly, the improvement in hypertension treatment and decrease in blood pressure might be associated with the change of primary care physicians’ attitude.However, the awareness, treatment, and control rate of hypertension have improved, especially in older patients with multiple medical conditions. These findings have been observed in other studies as well. In the PRESCAP study, the clinical profile of treated hypertensive patients has progressively worsened over the past decade in Spanish primary care settings. Despite that, blood pressure control rates significantly improved during that period19. In addition, low-risk patients with stage I hypertension also showed unfavorable cardiovascular outcomes, but hypertension control had a beneficial effect even in low-risk Korean patients.20 Previously, many physicians focused on the treatment of high-risk older patients. However, considering the poor treatment rate among younger patients, a new nationwide program should be implemented to enhance the hypertension awareness and treatment rate targeting younger patients. In line with this perspective, May Measurement Month (MMM), which is a global awareness campaign initiated by the International Society of Hypertension (ISH), put the spotlight on increasing access to blood pressure screening as potentially the most effective way to reduce hypertension’s adverse toll on health21. In addition, smartwatch or other wearable device have potential to detect hypertension early, thus possibly to improve the awareness of hypertension especially among the younger population.22 Further research whether smartwatch or wearable device based self-measurement of blood pressure can improve the awareness or treatment of hypertension should be developed and conducted.On the contrary, in this study, lower awareness and treatment rate were seen in the younger age group (20–39 years old) consistently during the past 10 years. However, the control rate among the treated patients was comparable to that of older age group. This result suggests that the low awareness and treatment rate in the younger age group should be overcome. In Korea, blood pressure higher than 130/80 mmHg among young adults has been associated with adverse clinical outcomesThis study has limitation. The definition of hypertension treatment was taking antihypertensive medications for ≥ 20 days/month; however, the data was obtained by the questionnaire. More accurate methods such as prescription check are required to assess the compliance of antihypertensive medication.In conclusion, hypertension treatment and control rate improved during the past 10 years in Korea. The higher hypertension treatment and control rate in patients with comorbidity suggest that more aggressive surveillance or treatment for these patients might be associated with the improvement in hypertension treatment and control rate in Korea. Further efforts to increase the treatment rate for younger patients without other medical conditions should be provided for the better control of hypertension in Korea.Supplementary information.


Vascular aging leads to arterial hypertension, which is the leading cause of cardiovascular mortality and morbidity in older adults. Blood pressure reduction is effective in reducing the cardiovascular risk and is safe in ambulatory older adults. It is important to note that blood pressure control in this group of patients is challenging because of comorbidities, polypharmacy, and frailty. Choice of pharmacotherapy is not simple and should be individualized. This process leads to an increase in large artery stiffness and isolated systolic hypertension, the predominant form of hypertension in older adults6. The number of older patients continues to increase dramatically to be 8.5% of the world’s current population and this percentage is expected to reach about 17% by 20507. Hence, appropriate management of hypertension in this vulnerable population is crucial.Hypertension is not a benign age-related phenomenon and indeed remains the leading cause of preventable cardiovascular mortality and morbidity16.Several randomized controlled trials have demonstrated that blood pressure (BP) lowering in systolic hypertension at an older age is effective in reducing the risk of fatal and non-fatal stroke, cardiovascular events, and death10. Reduction of BP significantly decreased the incidence of fatal stroke, all-cause mortality, any cardiovascular event, and heart failure. Another important study that included older individuals was the Systolic Blood Pressure Intervention Trial (SPRINT). Patients older than 50 years with SBP greater than 130 mm Hg and at least one additional cardiovascular risk factor  were enrolled. Patients were randomly assigned to intensive SBP lowering (<120 mm Hg) or routine SBP management (<140 mm Hg). The trial was concluded early because of overwhelming evidence of benefit. There was significant reduction of the primary outcome  . Among patients at least 75 years of age , primary outcomes for intensive versus routine BP management were 7.7% versus 11.2% (P <0.05). Rates of all-cause mortality were 5.5% versus 8.1%, respectively (P <0.05). There was a significantly increased risk of hypotensive events and metabolic derangements such as hyponatremia with intensive treatment. It is important to note that generalizability of results was limited as patients with diabetes mellitus, history of stroke, and heart failure within 6 months and residents of nursing homes were excluded and less than 40% of patients were female17. The SPRINT trial not only showed the clear benefit of hypertension treatment at an older age but also brought a new perspective to the intensive BP control controversy in this vulnerable population.One of the few interventions shown to reduce mortality risk in older individuals is BP reduction. One of the earlier hypertension trials in this group of individuals was the Hypertension in the Very Elderly Trial (HYVET). Individuals older than 80 years with an initial systolic BP (SBP) greater than 160 mm Hg were assigned to receive either treatment or placebo18; indeed, midlife hypertension is considered to be a major risk factor for dementia19.Another relevant clinical question when it comes to treating hypertension in older individuals is whether it is beneficial for cognitive function. Longitudinal observational data have shown a strong association between elevated BP and cognitive decline later in life22, others failed to show benefit and this was due in part to inadequate duration for follow-up25. A recently published sub-study of the SPRINT trial (SPRINT-MIND) did not show a significantly reduced risk of probable dementia with intensive BP control26. The study was terminated early and thus the cases of dementia were fewer than expected, and the study may have been underpowered for this endpoint. However, intensive BP control did significantly reduce the risk of mild cognitive impairment  and the combined rate of mild cognitive impairment or probable dementia , which were predefined secondary endpoints.Whereas several trials demonstrated a lower incidence of dementia with anti-hypertensive treatment in older individuals28; thus, the safety of BP reduction at an older age has been a controversial topic.Although the benefit of hypertension treatment in older adults has been clearly demonstrated, several cross-sectional studies have raised questions about the risk of hypotension and related cerebrovascular accidents, falls, and kidney failure29, although the BP target for treatment differed in European guidelines30. This recommendation was based on several anti-hypertensive therapy trials that included large numbers of older individuals34. Some patients with mild frailty were also included but most of these patients were ambulatory and able to travel to a clinic. In these trials, cardiovascular morbidity and mortality were reduced during BP lowering with different BP targets, including when the SBP treatment goal was less than 120 mm Hg. However, the risk of adverse outcomes, including orthostatic hypotension or falls, did not increase35. Both HYVET and SPRINT included patients who were frail but still living independently in the community, and both were stopped early for benefit.Recent US guidelines recommended initiation of anti-hypertensive drug therapy in older individuals with a BP greater than 130/80 mm Hg36, and evidence suggests that such treatment may not be safe37. These individuals might be at risk for adverse consequences; thus, it is important for the clinician to pursue an individualized approach. Clinicians should carefully titrate BP lowering in persons with a high comorbidity burden39.Thus, it is fair to say that BP control in ambulatory older patients seems to be safe. However, it is important to recognize that evidence-based recommendations for BP management are lacking in those who are very frail or institutionalized or those with cognitive impairment, several comorbidities, or polypharmacy. There is no evidence in the latter group that anti-hypertensive treatment reduces cardiovascular events or promotes established cognitive dysfunctionAnother important consideration is initiation of anti-hypertensive therapy with two agents. These individuals need to be monitored carefully for orthostatic hypotension and history of falls. BP must be measured both sitting and standing. Older persons may present with neurogenic orthostatic hypotension. This is particularly common in neurodegenerative disorders such as Parkinson’s disease and hence should be taken into consideration.40. BP control in older adults is challenging because of the presence of other comorbidities, polypharmacy, and frailty. Physicians should individualize management to weigh the benefits and potential harmful effects of such therapy.Lifestyle measures are important in addition to pharmacotherapy. These include sodium restriction—Dietary Approaches to Stop Hypertension (DASH) diet—and physical activity44.Common anti-hypertensive drugs, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and even beta-blockers, have been shown to be effective in older adultsIt is important to note that each commonly used drug class has additional benefit in the presence of different comorbidities, such as ACE inhibitors in diabetes mellitus and beta-blockers in coronary disease. Decisions should be based on efficacy, tolerability, cost-effectiveness of each drug, and the presence of specific comorbidities and polypharmacy and thus drug interactions.Beta-blockers should be used cautiously in older patients as these individuals are particularly sensitive to bradycardic effects. The main adverse effects of calcium channel blockers are related to edema and orthostatic hypotension. Also, constipation might be a significant limitation with diltiazem and verapamil. Nitrates are useful during hypertensive emergencies and angina; however, they are not preferred for long-term BP control at an older age. Owing to their side effect profile, peripheral agents such as hydralazine and minoxidil are not first-line agents. A centrally acting agent, clonidine, can be used for BP management. Owing to reflex hypertension when discontinued, oral clonidine is not advised; clonidine patch averts this problem. It has several side effects, including bradycardia and sedation, both of which are problematic in older and frail individuals. Diuretics should be used with caution as urinary incontinence can be a major concern in older adults.45.Another important consideration in the management of hypertension in older individuals is to use ambulatory BP monitoring instead of relying on single office measurements. The development of isolated systolic hypertension (and thus wide pulse pressure), white coat effect, different measurements between ambulatory and clinical BP, prevalence of orthostatic hypotension, and medication interactions are among the reasons that necessitate ambulatory BP monitoring46. Discontinuation of therapy might also be considered in older patients approaching the end of life, in whom the burden of therapy might exceed the purported benefit.Finally, another important consideration is de-escalation of anti-hypertensive medications in patients who are intolerant. The Discontinuation of Anti-hypertensive Treatment in Elderly people (DANTE) study showed that in older individuals with orthostatic hypotension, discontinuation of anti-hypertensives showed significant recovery from orthostasisRandomized clinical trials are needed in frail older individuals with hypertension residing in nursing homes to determine both the benefits and adverse effects of anti-hypertensive drug therapy in this vulnerable population.


Primary blast lung injury (PBLI) presents as a syndrome of respiratory distress and haemoptysis resulting from explosive shock wave exposure and is a frequent cause of mortality and morbidity in both military conflicts and terrorist attacks. The optimal mode of mechanical ventilation for managing PBLI is not currently known, and clinical trials in humans are impossible due to the sporadic and violent nature of the disease.A high-fidelity multi-organ computational simulator of PBLI pathophysiology was configured to replicate data from 14 PBLI casualties from the conflict in Afghanistan. Adaptive and responsive ventilatory protocols implementing low tidal volume (LTV) ventilation and airway pressure release ventilation (APRV) were applied to each simulated patient for 24 h, allowing direct quantitative comparison of their effects on gas exchange, ventilatory parameters, haemodynamics, extravascular lung water and indices of ventilator-induced lung injury.2O vs 8.6 cmH2O), but still significantly less than levels associated with increased mortality.The simulated patients responded well to both ventilation strategies. Post 24-h investigation period, the APRV arm had similar PF ratios (137 mmHg vs 157 mmHg), lower sub-injury threshold levels of mechanical power (11.9 J/min vs 20.7 J/min) and lower levels of extravascular lung water (501 ml vs 600 ml) compared to conventional LTV. Driving pressure was higher in the APRV group (11.9 cmHAppropriate use of APRV may offer casualties with PBLI important mortality-related benefits and should be considered for management of this challenging patient group. Primary blast lung injury (PBLI) results from explosive shock wave exposure and is a frequent cause of mortality and morbidity in both military conflicts and acts of terrorism . It is pCurrently, the globally recognised best practice for mechanical ventilation in casualties with acute lung injury (including PBLI) is the approach advocated by the ARDS network (ARDSnet) group . The ARDAirway pressure release ventilation (APRV) is an alternative mode of ventilation which is also currently in use for the management of hypoxic respiratory failure including ARDS in mechanically ventilated patients . APRV isRecent work utilising a porcine model of sepsis-induced ARDS compared LTV ventilation with APRV , 17. TheThe optimal mode of mechanical ventilation in PBLI is not currently known as this is the first work of this type. However, if we extrapolate findings from the ARDSnet trial , we can postulate that reducing inspiratory plateau pressures, inspired concentration of oxygen, extravascular lung water (EVLW) and ventilator-induced lung injury (VILI) may result in improved patient outcomes. In this study, we employ a high-fidelity computational simulator, trained to replicate data from 14 real human PBLI casualties, to compare the efficacy of APRV and LTV ventilation over the first 24 h following injury.Our PBLI simulator is a high-fidelity iterative computational model of human cardiopulmonary pathophysiology . It can For this study, we generated a bank of 14 in silico human casualties to act as virtual study subjects. A detailed clinical database describing 14 military casualties with PBLI was used to re-create each replica casualty . ClinicaAccording to the Berlin definition , seven oP) and mechanical power (MP) were also calculated at one hourly intervals. These novel indices are independent, dynamic and patient-centric targets for reducing VILI  in ARDS [P) is defined as the difference between plateau pressure (Pplat) and the total positive end expiratory pressure (PEEPt):One hour following injury , each subject was modelled for 24 h in each of the two ventilatory modes studied. Flexible, responsive and clinically realistic ventilation strategies were implemented for each mode, as described in Table  in ARDS –32. DrivPplat is calculated directly from the simulator and represents the end-inspiratory lung pressure. The PEEPt is taken as the end-expiratory lung pressure. A value of ΔP of 15 cmH2O or greater is strongly associated with mortality [The value of ortality .Mechanical power is an index that attempts to describe the total energy delivered to the lungs by the ventilator and is calculated as:VR is the ventilator set respiratory rate, VT is the tidal volume and Ppeak is the peak inspiratory pressure. Values of MP greater than 22 J/min have been shown to independently predict VILI and increased mortality [where ortality . All dat2, PaCO2) and arterial pH, as Bland Altman plots. The model was also calibrated to nominal values of cardiac output (CO), extravascular lung water (EVLW), mean arterial pressure (MAP) and mean pulmonary arterial pressures (MPAP) at the same time. These additional parameters are recorded in Table 2 values ranging from 12.0 to 14.3 kPa over the first 4 h of hospital treatment, and in the absence of a clinical explanation, the simulator was unable to replicate the data. The remaining 13 in silico casualties completed 24 h of ventilatory modelling with each ventilatory mode. An alkalosis management strategy to correct a pH of greater than 7.5 was not required.Figure 2), PaO2, PaCO2 and PF ratios (PaO2/FiO2). Values for both FiO2 and PaO2 stabilise by approximately hour 12 of the study and then remain static for the remainder of the trial. By the end of 24 h, a mean FiO2 of 0.70 (± 0.08) and 0.67(± 0.08) was applied, achieving a mean PaO2 of 10.24 (± 1.14) kPa and 9.58 (± 0.54) kPa in the LTV and APRV arms, respectively. This mean value is skewed above the trial target value of achieving a PaO2 of 9.0 kPa by two moderate cases responding very well to mechanical ventilation on the lowest FiO2 permitted by our ventilatory protocol (0.3). PaCO2 in the LTV arm remains lower than that seen in the APRV arm throughout the study with final mean values of 7.20 (± 0.45) kPa and 8.11 (± 0.40) kPa, respectively. PF ratios diverge and stabilise after approximately 10 h of mechanical ventilation with final mean values of 157 (± 42) mmHg and 137 (± 26) mmHg for LTV and APRV, respectively.Figure 2O and 27.1 (± 1.2) cmH2O, respectively. As dictated by our ventilatory protocol, mean tidal volume in the LTV group is 420 (± 2.79) ml (approximating to 6 ml/kg) at the end of the trial.Figure Figure 2O and 11.9 (± 0.8) cmH2O in LTV and APRV, respectively, within 8 h of mechanical ventilation. The mean plateau pressure in the LTV group is 25.1 (± 2.2) cmH2O. Predictably, extravascular lung water decreases in both arms of the study once mechanical ventilation is initiated and again reaches a stable value following approximately 8 h of mechanical ventilation. At 24 h, the mean extravascular lung water content in the LTV group is 600 (± 41) ml and 501 (± 38) ml for the APRV group. Figure VR, VT and the pressure component Ppeak − 0.5 × ∆P, separately. Figure VR from the power equation (Fig. Figure This study presents an examination of the potential outcomes for a cohort of patients suffering PBLI managed with two different ventilatory strategies during their first 24 h of mechanical ventilation. Our ventilatory protocol proved to be a reliable and robust decision-making framework. It achieved stable ventilated casualties within approximately 8–10 h despite significant lung injury in most cases.2O ceiling above which mortality is predicted to increase. Applied mechanical power, on the other hand, is significantly lower in the APRV group. Patients ventilated with APRV experienced lower levels of applied mechanical power to the respiratory system, with all the patients in the APRV arm below the 22 J/min threshold for increased mortality. In comparison, 4 out of 13 patients in the LTV arm breached this threshold. As an index of risk for VILI, the concept of mechanical power is of growing interest within the clinical community [The study suggests a good response to both LTV-directed mechanical ventilation and APRV in young otherwise healthy adults with PBLI. Epidemiological data gathered following the conflict in Afghanistan demonstrates a good response to LTV in young adult males with PBLI. This response is replicated in this modelling study. APRV also performs well and achieves the target arterial oxygenation and greater functional residual capacity implying reduced atelectasis. Our most important mortality-related outcomes are driving pressure and mechanical power. APRV applied a greater driving pressure than LTV throughout the study; however, in this cohort of patients, driving pressure in both modes of ventilation remained comfortably below the 15 cmHommunity , 36. OurWhile APRV performs as well as, and in some important respects better than LTV in this study, the clinically and statistically significant benefits relating to oxygenation that have been demonstrated in animal models of acute lung injury were not seen , 17. NotThe study has a number of limitations. The size of the study is limited to 13 patients, constrained by the availability of adequate clinical datasets. This represents the best data currently available and facilitates our observational and iterative study in which we do not seek to offer outcomes of statistical significance. The casualties are all young adult males with no prior physical co-morbidity and no other injuries. This should be considered when extrapolating the results described to the wider population. The pharmacological effects of the sedative drugs that would be required to facilitate mechanical ventilation are not modelled. As a result, our in silico casualties have an artificially normal native mean arterial blood pressure and cardiac output. To attenuate the effects of confounding factors, we further assume that the patients are fully sedated, autonomic reflex modules are not enabled and patient ventilation is fully determined by the ventilator, potentially reducing the impact on indices of VILI . AlthougThe results of this study suggest that PBLI casualties will respond well to either of the two modes of mechanical ventilation considered. APRV achieved the specified ventilatory targets with a lower PF ratio, sub-injury threshold levels of mechanical power, and lower levels of extravascular lung water compared to conventional LTV. Use of APRV may therefore offer casualties with PBLI important mortality-related benefits.


We aimed to describe the blood pressure patterns reported in patients with Parkinson’s disease, as measured by 24-h ambulatory blood pressure monitoring. (2) Methods: We conducted a systematic search on the PubMed database. Studies enrolling patients with Parkinson’s disease undergoing 24-h ambulatory blood pressure monitoring were included. Data regarding study population, Parkinson’s disease course, vasoactive drugs, blood pressure profiles, and measurements were recorded. (3) Results: The search identified 172 studies. Forty studies eventually fulfilled the inclusion criteria, with 3090 patients enrolled. Abnormal blood pressure profiles were commonly encountered: high blood pressure in 38.13% of patients (938/2460), orthostatic hypotension in 38.68% (941/2433), supine hypertension in 27.76% (445/1603) and nocturnal hypertension in 38.91% (737/1894). Dipping status was also altered often, 40.46% of patients (477/1179) being reverse dippers and 35.67% (310/869) reduced dippers. All these patterns were correlated with negative clinical and imaging outcomes. (4) Conclusion: Patients with Parkinson’s disease have significantly altered blood pressure patterns that carry a negative prognosis. Ambulatory blood pressure monitoring should be validated as a biomarker of PD-associated cardiovascular dysautonomia and a tool for assisting therapeutic interventions. Parkinson’s disease (PD) is the second most common neurodegenerative disorder, with a prevalence of 0.3% of the entire population in industrialized countries, reaching up to 4% in the highest age groups . The bioConsidering the high prevalence of high blood pressure (HBP) and cardiovascular disorders (CVD) in the elderly, these are likely comorbidities in PD patients, warranting a closer look at their interrelation. Although HBP does not seem to increase the risk of PD , it mighIn PD patients with autonomic dysfunction and/or HBP, BP measurement might lead to wrong assumptions unless properly performed. Mistaking supine hypertension (SH) for HBP (or vice versa) or missing HBP in case of coexistent OH are just two clinical scenarios that could lead to wrong treatment decisions. With PD symptoms fluctuating throughout the day, it is hard to believe that a conventional office BP measurement reflects the real BP profile of the patient, especially if white-coat effect and white-coat hypertension are superimposed. Therefore, out-of-office BP measurements such as home BP monitoring and ambulatory BP monitoring (ABPM) might be more suitable. Apart from being a better predictor of hypertension-mediated organ damage and cardiovascular outcomes than conventional office BP measurement, 24-h ABPM  provides useful information about nocturnal BP profiles and activity-related BP .We aimed to describe the BP patterns reported in patients with PD, as measured by 24-h ABPM, in conjunction with HBP and dysautonomia. We focused on 24-h, daytime and nighttime mean values of systolic BP (SBP) and diastolic BP (DBP), BP variability, dipping status, occurrence of OH and SH as well as HBP diagnosis, in an attempt to describe the circadian rhythm and variability of BP in PD. We hypothesized that these patients have abnormal BP patterns mainly due to autonomic impairment and/or superimposed HBP.The protocol for this systematic review was conceived a priori based on PRISMA 2009 Checklist.Study eligibility and search. We designed a systematic review based on the following research question:“What are the blood pressure patterns identified by 24-h ambulatory blood pressure monitoring in patients with Parkinson’s disease?”The target population consisted of adult patients diagnosed with PD. The intervention was ABPM performed during a minimum of 24 h. The outcomes were BP profiles , dipping status) and BP measurements .We conducted a systematic search on the PubMed database on the 31st of July 2020, scrutinizing the studies that enrolled patients with PD undergoing 24-h ABPM. We performed the search again on 2nd of December 2020 to identify any recently published studies meeting the inclusion criteria. Articles were included from inception. No restriction was applied, and the following search strategy was used:((((((((((((“blood pressure”[MeSH Terms] OR (“blood”[All Fields] AND “pressure”[All Fields])) OR “blood pressure”[All Fields]) OR “blood pressure determination”[MeSH Terms]) OR ((“blood”[All Fields] AND “pressure”[All Fields]) AND “determination”[All Fields])) OR “blood pressure determination”[All Fields]) OR (“blood”[All Fields] AND “pressure”[All Fields])) OR “blood pressure”[All Fields]) OR “arterial pressure”[MeSH Terms]) OR ) OR “arterial pressure”[All Fields]) OR (“blood”[All Fields] AND “pressure”[All Fields])) AND (((((((((((((“monitors”[All Fields] OR “monitorable”[All Fields]) OR “monitored”[All Fields]) OR “monitoring”[All Fields]) OR “monitorings”[All Fields]) OR “monitoring, physiologic”[MeSH Terms]) OR (“monitoring”[All Fields] AND “physiologic”[All Fields])) OR “physiologic monitoring”[All Fields]) OR “monitor”[All Fields]) OR “monitorings”[All Fields]) OR “monitorization”[All Fields]) OR “monitorize”[All Fields]) OR “monitorized”[All Fields]) OR “monitors”[All Fields])) AND (“Parkinson’s disease”[All Fields] OR “Parkinson Disease”[MeSH Terms])Studies that were not identified through this search strategy but were subsequently identified in the review studies were also considered for inclusion.Inclusion criteria were: any study  enrolling adult patients diagnosed with PD  who underwent an ABPM performed during a minimum of 24-h. Exclusion criteria were: studies with unavailable data on 24-h ABPM measurements or unsuitable reports , studies addressing invasive blood pressure monitoring or the cardiovascular effects of a recently prescribed (possible vasoactive) drug (unless they included data on prior BP profile), unavailability of full-text, other languages than English.Two authors (D.T. and L.C.) independently evaluated the studies and included the eligible ones, as stated above. Differences were discussed with the other authors until reaching a consensus. The first evaluation covered the abstracts, then the full-text articles were assessed whenever possible to select the relevant ones. Duplicates were excluded.Data regarding study population , PD progression and staging  score), potentially vasoactive drugs , BP profiles  and measurements  were extracted. We took into consideration both prior and newly diagnosed OH  and HBP (either by office BP measurement or ABPM), whereas 24-h ABPM was mandatory for BP measurements. For classifying BP profiles, we used the definitions provided by the guidelines and/or consensus statements, as follows:HBP: “office SBP values ≥ 140 mmHg and/or DBP values ≥ 90 mmHg” or ≥130/80 mmHg on 24-h ABPM [OH: “reduction in SBP of ≥20 mmHg or in DBP of ≥10 mmHg within 3 min of standing” SH: “In patients with proven OH, SH is defined as systolic BP of ≥140 mmHg and/or diastolic BP of ≥90 mmHg, measured after at least 5 min of rest in the supine position.” [NH: “nighttime BP ≥ 120/70 mmHg” Dipping: “nocturnal BP fall ≥10% of the daytime average BP value” . It inclFor variables reported as mean values (such as BP measurements) in several subgroups of the PD population, we calculated and recorded the weighted average. We also reported the total number of PD patients with HBP, OH, SH, NH and reduced/reverse dipping as well as their percentage out of the total number of patients evaluated in this regard; we emphasize the fact that these data were not available for all the studies. BP variability was evaluated by the coefficient of variation. Unless it was reported, we calculated the median 24-h, daytime and nighttime coefficient of variation for both SBP and DBP by dividing the reported standard deviation (SD) by the average BP level and multiplying by 100 whenever it was possible.The search on PubMed database identified 172 results, with one duplicate removed. Two additional studies were identified in a review study and were subsequently included. After screening by title and abstract, 88 studies were excluded. Those accepted were consequently read full-text and 40 studies fulfilled the inclusion criteria, as illustrated in the flow chart . All theDemographics and PD status are detailed in Intake of vasoactive drugs is listed in BP profiles are recorded in p = 0.19; 21.7% in OH vs. 26.5% in non-OH, p = 0.53) [p = 0.61; 38% in OH vs. 20% in non-OH, p = 0.04) [p = 1) [We identified 938 patients with HBP within PD group  in 26 studies, whereas 5 studies designated HBP as exclusion criterion for patient enrollment and 9 studies did not address this issue. It is curious that no subanalysis of PD patients with HBP was performed, therefore there is no available data regarding the interaction between HBP and OH in PD patients. In two studies, PD patients with OH had a slightly lower prevalence of HBP compared to non-OH patients  , in othe [p = 1) , which m [p = 1) .OH was found in 941 patients . In some studies, statistically significant associations were found between OH and clinical manifestations severity as well as abnormal imaging findings. OH was associated with more severe PD disease ,19,20, hSH was identified in 445 patients . One study found that in patients with early PD and SH the motor symptoms and cognitive decline seemed to be worse compared to non-SH patients . MoreoveDipping status is detailed in BP measurements are provided in Mean diurnal and nocturnal SBP/DBP load were reported only in 6 studies, whereas mean 24-h, diurnal, and nocturnal BP coefficient of variation were reported only in 7 studies. PD patients with higher BP fluctuations seemed to experience more commonly restless legs syndrome  and alteThis systematic review offers an insight into the published studies that address BP patterns in patients with PD, as measured by ABPM. Many patients showed dysregulation of the BP circadian rhythm, as reflected by the increased prevalence of NH (38.91%) with reduced (35.67%) or reverse dipping (40.45%). In healthy controls and HBP patients, this pattern was found to be intimately associated with cardiovascular events and end-organ damage, predisposing to hypertensive cardiomyopathy, vascular thickening and cerebral small vessel disease . Cognitiand15 mmHg in DBP vs. ≥20 mmHg in SBP or ≥ 10 mmHg in DBP) [Another finding of the studies included in this review is the high prevalence of OH, correlated with unfavorable outcomes such as more severe non-motor symptoms ,24,34,42 in DBP) ,52. Ther in DBP) . It is oWith 27.76% of BP patients experiencing SH, SH also seems to be a common manifestation in this population. SH is relevant since it exacerbates pressure natriuresis during sleep, leading to sleep disturbances, nocturia and worsening of morning OH . DealingThe main limitation of this systematic review arises from the design of the studies included  which does not allow us to establish causality between PD and the BP profiles. Another major limitation is the heterogeneity of the studies, both in terms of patient recruitment and manner of reporting the results. Notably, the inclusion and exclusion criteria for patient enrollment were significantly different among studies, with possible consequences on the BP patterns. For instance, HBP served as exclusion criterion in some studies, whereas in others it was not reported, consequently ignoring its interference with BP profiles. The intake of vasoactive drugs was also not consistently taken into consideration, with most of the studies not reporting it, withholding it or excluding the patients treated. Other potential confounders are the conditions predisposing to autonomic dysfunction  or altered nocturnal BP profiles  which were not evaluated consistently. Mean BP load and coefficient of variation were reported only in 6 and 7 studies, respectively, making it difficult to make assumptions in this regard. Although of minor importance, the fact that the studies defined daytime and nighttime either according to the patient’s diary or a prespecified schedule might also interfere with the results provided that the patient is not asleep at the predicted nighttime.Cardiovascular autonomic dysfunction is a common finding in patients with PD and has a negative impact on their quality of life, functionality and life expectancy, underpinning the need for proper assessment and management. ABPM is an accessible and feasible method for evaluating BP patterns. It can capture the extent of cardiovascular homeostasis disruption throughout a day in BP patients by offering insights into BP fluctuations and BP profiles regarding patient’s routine activities. It could also assist therapy based on real-life BP recordings. Although extensively validated for the assessment of HBP , ABPM ha


The netrin-1/creatinine ratio is increased in premature babies. Further studies examining the potential factors influencing kidney function are necessary to confirm its potential value in the diagnosis of subclinical kidney damage in premature newborns.There is a lack of a good marker for early kidney injury in premature newborns. In recent publications, netrin-1 seems to be a promising biomarker of kidney damage in different pathological states. The study aimed to measure the urinary level of netrin-1 depending on gestational age. A prospective study involved 88 newborns . Additionally, premature babies were divided for 2 groups: IA-28 babies born between 30–34 weeks of gestation and IB-32 born at 35–36 weeks. The median urinary concentration of netrin-1 was: IA- 63.65 (56.57–79.92) pg/dL, IB-61.90 (58.84–67.17) pg/dL, and II-60.37 (53.77–68.75) pg/dL, respectively. However urinary netrin-1 normalized by urinary concentration of creatinine were IA-547.9 (360.2–687.5) ng/mg cr., IB-163.64 (119.15–295.96) ng/mg cr., and II-81.37 (56.84–138.58) ng/mg cr., respectively and differ significantly between the examined groups ( Premature babies are exposed to kidney dysfunction. There is a lack of a good marker for early kidney injury in this group of children. In recent publications, netrin-1 seems to be a promising biomarker of kidney damage in different pathological states. We showed that the netrin-1/creatinine ratio is increased in premature babies which may have potential diagnostic value in the diagnosis of subclinical kidney damage in premature newborns.Worldwide data show that about 15 million premature babies are born each year . UnfortuIt is known that the primary cause of complications of early and late prematurity is immaturity. However, early detection and implementation of treatment in the event of perinatal problems can significantly reduce late multi-organ damage . Owing tNetrin-1 a 72 KDa laminin-related secreted protein, initially found in the central nervous system during neurogenesis is expressed in many tissues, including renal tissues. It is shown that netrin-1 promotes cell migration, angiogenesis, tissue morphogenesis, and takes a significant part in the regulation of the inflammatory process . It is uIn this study, we analyzed whether prematurity affects the function of renal tubules assessed by the tubular damage marker-netrin-1.This prospective study included 88 neonates hospitalized at the Department of Neonatology and Intensive Neonatal Care, Medical University of Bialystok, Poland between December 2017 and December 2018. Sixty newborns were born prematurely between 30–36 weeks of gestation. All these newborns were appropriate for gestational age (AGA) with the weight between the 10th and 90th percentile of birth weight for their gestational age using normalized growth curves . Their cIn the study group, urine samples were collected using single-use sterile bags . Urine was collected once in the first or second day of life. The blood samples were collected during routine practice in the Unit during the first or second day of life. We used S-Monovette 1.2 mL, Clotting Activator/Serum test tubes  to venous blood sampling. Blood cell morphology tests and blood biochemistry tests were performed immediately after taking blood samples. The urine samples obtained after centrifugation were kept in the fridge (4 °C) for maximum of 2 h and then frozen at −80 °C. We did not use repeated freeze-thaw cycles. The levels of urinary netrin-1 were measured using a commercially available ELISA kit  according to manufacturer’s instructions and were expressed in picograms per milliliter. According to specifications of this kit the detection range was 31.2–2000 pg/mL, the minimum detectable dose of netrin-1 was typically less than 12.4 pg/mL. The mean intra-assay coefficients of variation (CV) for urine netrin-1 were <10%, and inter-assay coefficients were <12%.The urinary concentrations of netrin-1 were normalized for the urinary concentrations of creatinine determined with Jaffé’s method to account for the potential confounding effects of urinary dilution and expressed in nanograms per milligram creatinine (ng/mg cr). The morphology and serum biochemistry tests were performed in the Department of Laboratory Diagnostics University Clinical Hospital in Bialystok.Estimated GFR (glomerular filtration rate) was calculated according to Schwartz formula for the term babies . p < 0.05. The results were analyzed with Statistica 13.3 package . Discrete variables were expressed as counts (percentage), continuous variables as median and quartiles (Q1–Q3). The Shapiro -Wilk test was used to determine normal distribution. Because the data were not normally distributed, Mann-Whitney U-test was used for intergroup comparisons of continuous variables. Spearman’s rank correlation coefficients were used to determine the direction and power of association between the urinary netrin-1/cr. ratio and other variables. The results were considered significant at p > 0.05). The study included 88 neonates: sixty babies born prematurely between 30–36 weeks of pregnancy and twenty-eight healthy newborns. Both groups were sex-matched  were significantly lower than in term newborns. All these newborns, however, were appropriate for gestational age and there were no statistically significant differences, even if the children were divided into 10–50 percentile and 51–90 percentile subgroups. Younger babies had lower Apgar scores at 1st and 3rd minute. All newborns had Apgar scores ≥ 8 at a 5th and 10th minute. No statistically significant differences were found in the delivery of premature babies in both examined groups.Blood morphology and biochemical tests did not show any deviations from the norm in both groups of preterm children. Younger newborns had statistically significantly higher leukocytosis, urea and alanine aminotransferase concentrations .p < 0.001). The eGFR was similar in premature babies and statistically significantly higher in term newborns , respectively , oxygen therapy), parenteral nutrition.p < 0.05) [Detecting kidney damage early and with the precise location is currently a priority in the diagnosis of kidney diseases. It allows to quickly implement the appropriate treatment, monitor its effectiveness and prognosis, and due to that increase, the chance for cure . Netrin- < 0.05) . Higher  < 0.05) . There a < 0.05) ,17,18. This prospective study was the first conducted to determine the values of urinary netrin-1 in premature newborns in good or stable clinical condition. In this study, we hypothesized that the prematurity could lead to renal tubular injury and urinary netrin-1 could be used as an early marker of tubular damage. It is known that there are several factors that can lead to tubular damage. We have therefore identified a group of 60 newborns with birth weight appropriate for gestational age and in clinical condition assessed as good or stable. None of the children required mechanical ventilation and drugs. They all had normal prenatal and postnatal ultrasound examination of the kidney and did not have any deviation in laboratory tests and parameters of renal function . In our p = 0.00; p = 0.00), respectively (p < 0.05) [p = 0.000; mean ± SD) [We showed that the median of urinary netrin-1 level did not differ between the examined groups. However, it is well-known that the values of urine parameters closely depend on water content or urinary concentration throughout the day, we used urine creatinine concentration to normalize the results . It turnectively . Al Mors < 0.05) . Övünç Han ± SD) . In the further analysis, we paid attention to other factors that might affect the function of the renal tubules. We did not find any relationship between the concentration of urinary netrin-1 or urinary netrin-1/cr. and gender, delivery, birth weight, percentile of birth weight, Apgar score, prenatal steroid therapy, respiratory disorders , parenteral nutrition. Considering the results of a study by Dakouane-Giudicelli et al. and Kang et al. who confirmed that netrin-1 plays a significant role in neurogenesis and angiogenesis, being a significant factor into the establishment of neurovascular networks in the developing kidney we suggest that the results of our study also show on the rule of netrin-1 as a marker of maturation of the kidneys in premature babies ,23.To the best of our knowledge, this is the first work suggesting that urinary netrin-1 normalized by urinary creatinine is a good marker of subclinical tubular damage in preterm newborns. It should be noted that this is a preliminary observation that should be confirmed in a multicenter study. Besides, it would be worthwhile to conduct a long-term study to analyze the netrin-1/cr value, especially in correlation with eGFR, in further stages of life. Because we are unable to exclude the influence of the kidney maturation process on netrin-1/cr value, it seems necessary to also analyze this value in premature babies in serious clinical condition.


Materials and Methods. This is a subgroup analysis of a randomised, sham-controlled, double-blinded, single-centre study. A RIPC or a sham procedure was performed noninvasively along with preparation for anaesthesia in patients undergoing open surgical lower limb revascularisation. The RIPC protocol consisted of 4 cycles of 5 minutes of ischaemia, with 5 minutes of reperfusion between every episode. Blood was collected for analysis preoperatively, 2, 8, and 24 hours after surgery, and urine was collected preoperatively and 24 hours after surgery.  Perioperative kidney injury affects 12.7% of patients undergoing lower limb revascularisation surgery. Remote ischaemic preconditioning (RIPC) is a potentially protective procedure against organ damage and consists of short nonlethal episodes of ischaemia. The main objective of this substudy was to evaluate the effect of RIPC on kidney function, inflammation, and oxidative stress in patients undergoing open surgical lower limb revascularisation. p = 0.021, p = 0.021, p = 0.021, p = 0.021, p = 0.021,  Data of 56 patients were included in the analysis. Serum creatinine, cystatin C, and beta-2 microglobulin increased, and eGFR decreased across all time points significantly more in the sham group than in the RIPC group (NCT02689414. Our finding of reduced release of kidney injury biomarkers may indicate the renoprotective effect of RIPC in patients undergoing open surgical lower limb revascularisation. The trial is registered with ClinicalTrials.gov  Perioperative kidney injury has been found to affect 12.7% of patients undergoing lower limb revascularisation surgery, and only 23.8% of them have a prior history of chronic kidney disease . Even smSome precautions and recommendations help to reduce kidney injury, e.g., avoiding nephrotoxic agents, hyperglycemia, and hypovolemia and close haemodynamic monitoring. Yet perioperative renoprotective agents and interventions are still lacking. Remote ischaemic preconditioning (RIPC), which consists of short nonlethal episodes, has been found to reduce organ damage including kidney injury. The main organoprotective effect of RIPC is considered to arise from attenuating the damage due to ischaemia-reperfusion. Ischaemia-reperfusion injury is believed to be mediated by calcium overload, oxidative stress (OxS), and inflammation .Although early studies have shown a renoprotective effect of RIPC in patients undergoing vascular surgery , 8, the This is a substudy within our large clinical trial conducted for evaluating the effect of RIPC on vascular stiffness and end-organ damage , 15. AmoNCT02689414).The study was carried out at the Department of Vascular Surgery, Clinic of Surgery, at Tartu University Hospital from January 1, 2016, to February 8, 2018. This clinical trial was randomised, double-blinded, and sham-controlled. Patients who underwent elective open surgical lower limb revascularisation  for claudication or critical limb ischaemia and who gave their full informed consent for participation were enrolled in the current study. The study was approved by the Research Ethics Committee of the University of Tartu and was registered in the ClinicalTrials.gov database  < 30 mL/min/1.73 mPatients were randomly and equally assigned to the sham or RIPC group in parallel. A stratified block design with block size 2 or 4 was used. A random allocation sequence was generated by the computer program WINPEPI (PEPI-for-Windows). Patients were stratified according to age (under or over 65 years) and the American Society of Anesthesiologists' (ASA) physical status classes 2, 3, or 4. Randomisation and opaque sealed envelopes were prepared by a third party. The envelopes were opened immediately before intervention.The protocol of RIPC consisted of four 5-minute episodes of upper limb ischaemia. For achieving ischaemia, pressure in the blood pressure cuff was raised for 5 minutes to 200 mmHg or, when the patient's blood pressure exceeded 180 mmHg, to a value that was 20 mmHg higher than the value of systolic blood pressure. In the sham group, pressure in the cuff was equal to venous pressure (10–20 mmHg). Between all episodes, there was a 5-minute period of reperfusion. Intervention was started along with preparation. Participation in the study did not influence any other aspects of surgery, anaesthesia, or medication use.The patient, patient's physician, surgeon, anaesthesiologist, and everyone else in the surgical team were blinded to the study intervention. The manometer scale was kept shielded.Blood samples were collected in the morning of surgery and at 2 hours, 8 hours, and approximately 24 hours of surgery, and urine samples were collected in the morning of surgery and 24 hours after surgery. The last blood and urine collection was set as close as possible to 24 hours after surgery on condition that the patient had fasted for at least 3 hours. The level of creatinine, urea, cystatin C, beta-2 microglobulin, and neutrophil gelatinase-associated lipocalin (NGAL) in blood was measured at all of the abovementioned time points, and the level of interleukin 18 (IL-18) and oxidized low-density lipoprotein (oxLDL) was measured preoperatively and at 8 hours and approximately 24 hours of surgery. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Urine samples were analysed for the level of kidney injury molecule 1 (KIM-1), liver-type fatty acid binding protein (L-FABP), isoprostanes, and creatinine. The level of isoprostanes was corrected for spot urine creatinine.μmol/L increase in creatinine within the trial, according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.AKI was diagnosed based on a more than 26.5 All patients were questioned about their previous and current health issues and medication use. In addition, an electronic health database and surgery protocols were used for completing the anamnesis.t-test or the Wilcoxon rank-sum test as appropriate. For statistical analysis of multiple repeated measures, analysis of variance (ANOVA) or multivariate analysis of variance (MANOVA) was used. Categorical variables were compared with the chi-squared test.Continuous variables were compared using Student's p values under 0.05 were considered significant. As the primary outcome of the study was arterial stiffness parameters, calculation of sample size was based on AIx [d on AIx . For botp value 0.058) and diabetic patients  and more patients were administered propofol , but there were no statistically significant differences between the groups . No adverse events due to RIPC were reported. In 4 patients (14%) from the sham group and in 1 (4%) patient from the RIPC group, AKI could be diagnosed based on the KDIGO criteria (p = 0.604).The mean time from the end of intervention to the beginning of surgery was 40 minutes in the RIPC group and 33 minutes in the sham group (p = 0.011), eGFR (p = 0.007), cystatin C (p = 0.038), and beta-2 microglobulin (p = 0.013) in the sham group through all time points  in the RIPC group through all time points. The change in creatinine, urea, cystatin C, and beta-2 microglobulin was not statistically significant in the RIPC group (p > 0.05), and the change in urea and NGAL was not statistically significant in the sham group (p > 0.05)  .p = 0.021) through all time points . The eGFR decreased significantly more in the sham group (p = 0.015). There was no significant change in urea between the groups through all time points (p = 0.067). The change in cystatin C and beta-2 microglobulin was significantly different between the groups . Creatinine, cystatin C, and beta-2 microglobulin increased and eGFR decreased significantly more in the sham group than in the RIPC group through all time points . Changes in creatinine, eGFR, urea, cystatin C, and beta-2 microglobulin through all time points are presented in p value 0.174).Creatinine increased significantly more in the sham group than in the RIPC group  and in the sham group , but there was no difference between the groups (p = 0.935). The change in L-FABP levels was not statistically significant in either group, nor was there any difference between the groups  and in the sham group , but their magnitude in both groups was similar . The change in oxLDL did not differ among the groups either (p = 0.880) and was nonsignificant both in the RIPC group (p = 0.220) and in the sham group (p = 0.216). The changes from the baseline to 24 hours after surgery are presented in The change in the level of urinary isoprostanes, corrected for creatinine, was statistically different between the groups (The results of the study showed a renoprotective effect of RIPC in patients undergoing open surgical lower limb revascularisation. The increase in creatinine, urea, cystatin C, and beta-2 microglobulin in serum was statistically lower in the RIPC group compared to the sham group. There was also a statistically significant increase in the urinary isoprostane/creatinine ratio in the RIPC group compared to the sham group. However, there occurred no significant difference in the changes in serum NGAL, adiponectin, IL-18, oxLDL, and MPO nor urinary KIM-1 and isoprostanes between the RIPC group and the sham group.Although perioperative kidney injury is related to higher mortality, cardiovascular morbidity, risk for chronic kidney injury, and longer need for hospitalisation, it has still remained an underdiagnosed and undertreated problem . Multipl2, who were at greater risk for AKI. We found no difference in the increase of urinary L-FABP and KIM-1 between the groups. Yet in both groups, the median level of KIM-1 exceeded the normal range value of 59-2146 pg/mL [Postoperative AKI has been found to occur in 12.7−49% of patients undergoing vascular surgery . Patient46 pg/mL . This inSurgery induces a systemic inflammatory response, whose extent has considerable variability among individuals. More pronounced inflammatory response is associated with higher risk for AKI . In our per se can influence many, if not all, kidney function markers. Creatinine also increases along with rhabdomyolysis and urea increases along with stress response. In addition to being a kidney injury marker, NGAL is an acute phase protein released by neutrophils and increased in both groups similarly. Presumably, the level of NGAL is influenced by the inflammatory response to surgery rather than by kidney injury. The most reliable kidney injury marker in our study was evidently cystatin C, which is also influenced by systemic inflammatory response.Even though surgery as well as surgery-related stress response can induce kidney injury, stress response There are increasingly more studies that have concluded that propofol may abolish RIPC's effect , 31. It Taken all together, we describe the detectable effect of RIPC in lowering kidney injury biomarkers. Based on this, RIPC might be a clinically valuable option to reduce the incidence of AKI especially because well-established procedures to decrease perioperative AKI are lacking. Reducing perioperative AKI could shorten hospital stay and ameliorate prognosis. Furthermore, RIPC is low-cost and based on our findings easily applicable and well tolerated by patients, which all ease the usage in clinical practice.The main limitation of our study is its small sample size. Also, there were differences between the two groups, although they were statistically nonsignificant. The number of women was larger in the sham group, and the female gender is associated with higher risk for postoperative AKI . Also, tTaken together, our study supports the evidence about the renoprotective effect of RIPC. However, the heterogeneity and small size of the study population reduce its credibility. Larger studies are needed to clarify the true effect of RIPC in kidney protection in patients undergoing open surgical lower limb revascularisation.


Enlarged uterus can compress the inferior vena cava and cause hypotension when lying supine. Previous studies have shown a positive association between the abdominal circumference and size of the uterus. Therefore, the aim of this study was to evaluate the relationship between abdominal circumference and incidence of hypotension during cesarean section under spinal anesthesia.  The study cohort comprised women undergoing cesarean section under spinal anesthesia. Patients were divided into two groups according to the median abdominal circumference (<101 cm and ≥101 cm). Hypotension was defined as a systolic blood pressure of <90 mmHg or mean arterial pressure of <65 mmHg. The primary outcome of this study was the relationship between the incidence of hypotension and the abdominal circumference after spinal anesthesia in term pregnant women. p=0.419). However, the decrease in mean arterial pressure and its percentage decrease from baseline were greater in the larger than in the smaller abdominal circumference group  in the smaller vs. 36.67 mmHg (23.34–43.34) in the larger abdominal circumference group, p=0.004; percentage decrease: 31.41% (22.74–39.22) in the smaller vs. 38.47% (28.00–44.81) in the larger abdominal circumference group, p=0.022).  The study cohort comprised 100 women. The incidence of hypotension did not differ between the groups (71.42% in the smaller vs. 78.43% in the larger abdominal circumference group,  Large abdominal circumference in pregnancy is associated with greater decreases in mean arterial pressure from baseline. However, the incidence of hypotension defined by standard criteria did not differ between larger and smaller abdominal circumference groups. A high level of sensory block after spinal anesthesia increases the incidence of hypotension in pregnant women . High abTCTR20181203001. Inclusion criteria were term pregnant women aged between 15 and 45 years with American Society of Anesthesiologists physical status 2-3 who underwent cesarean section under spinal anesthesia. Exclusion criteria were as follows: high-risk pregnancy, for example, placenta previa, abruptio placentae, eclampsia or preeclampsia, multiple pregnancy, and cardiovascular comorbidities.This prospective observational study was approved by the Ethical Clearance Committee on Human Rights Related to Research Involving Human Subjects, Ramathibodi Hospital (04-60-24). Written informed consent was obtained from all patients. This study was conducted at Ramathibodi Hospital, Bangkok, Thailand, from March to December 2018. The study was registered at T4 level of spinal anesthesia. Crystalloid fluids (500 mL) were infused with a coloading technique. Fluid management during the perioperative period was titrated by the anesthesiologist. The blood pressure including systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were obtained at baseline and every minute for 10 minutes after spinal anesthesia by noninvasive technique using Nihon Kohden's Life Scope G5™. The intravenous ephedrine was titrated as needed to achieve a mean arterial pressure (MAP) of at least 65 mmHg. The dosage of ephedrine was recorded. In this study, hypotension was defined as a systolic blood pressure of less than 90 mmHg or a MAP of less than 65 mmHg. Significant hypotension was defined as a 40% decrease in MAP from baseline [On the day of surgery, the AC of all patients was measured at the umbilical level in the supine position by one operator throughout the study. The spinal anesthesia was conducted with the standard technique by an attending anesthesiologist. In the operating room, all patients were monitored with standard monitoring, including automatic noninvasive blood pressure monitoring, three-lead electrocardiography, and pulse oximetry before initiation of spinal anesthesia. Then, spinal anesthesia was administered in the lateral position using 0.5% hyperbaric bupivacaine, doses being adjusted by the anesthesiologist performing the procedure. A 27-gauge Quincke-tip spinal needle was used. The level of spinal anesthesia was assessed by pinprick sensation. The operative table was adjusted to achieve baseline .The primary outcome of this study was the relationship between the incidence of hypotension and the abdominal circumference after spinal anesthesia in term pregnant women. The patients were divided into smaller abdominal circumference group  and larger abdominal circumference group (larger AC group) using the median value of the AC in this study.χ2 or Fisher's exact test was used to compare categorical variables. Quantitative variables were compared using the t-test when data were normally distributed and the Mann–Whitney U test when data were nonnormally distributed. Repeated-measure ANOVA was used to determine the changes in MAP over time between larger and smaller AC groups. Univariate analysis and multivariate regression analysis were used to identify independent risk factors for significant hypotension. Spearman's rho was used to test correlations between AC and maximal MAP change from baseline. p < 0.05 was considered to denote statistical significance.Nonparametric continuous variables are presented as median and interquartile range (IQR). Categorical variables are presented as number (percentage). The All statistical analyses were performed using SPSS software, version 24, for Windows .The sample size calculation was based on the previous study that found the correlation coefficient of 0.36 between maximal dermatomal level after spinal anesthesia and AC. The minimum of the sample size to identify this relationship was 58 to achieve 80% power with a significant level of 0.05. We increased the sample size to 100 due to the assumption of the close correlation between the maximal dermatomal level and the incidence of hypotension [T4 before skin incision did not differ between groups.The study cohort comprised 100 pregnant women. No one was excluded from the study after the inclusion criteria had been met. The median (IQR) of abdominal circumference was 101 (95–109) cm. Finally, a total of 49 cases were in the smaller AC group and 51 cases were in the larger AC group. The patient characteristics were similar in the two groups except for age, the patients being older, and the neonatal weight greater in the larger AC group . The aneT0) and over the following 10 minutes at one-minute interval after spinal anesthesia , MAP was not significantly different between the larger AC group and the smaller AC group (p=0.19) (see F (1.98) = 4.95; p=0.02) (see p=0.94).When analyzing the hemodynamic changes from baseline (.19) see . There w.02) see . Heart rT0–lowest MAP at any time point from T1 to T10) was higher in the larger AC group (see p=0.025). Among the 31 women who developed significant hypotension, larger AC was found to be an independent risk factor for significant hypotension  after adjusting for covariates of age, body mass index, baseline heart rate, American Society of Anesthesiologists physical status, intraoperative fluid, blood loss, and dose of hyperbaric bupivacaine using multiple logistic regression analysis . However, body mass index was not associated with the incidence of hypotension and significant hypotension. There was a significant univariate correlation between AC and the maximal decrease in MAP after spinal anesthesia .Body mass index was highly correlated with AC  after spinal anesthesia did not differ between pregnant women with larger and smaller abdominal circumference. However, in the larger AC group, the MAP decreased significantly from baseline. This finding may be attributable to the preemptive treatment of hypotension after spinal anesthesia before the delivery of the newborn. To minimize harm to the fetus caused by uteroplacental hypoperfusion, the anesthesiology team does not normally wait until a pregnant woman develops hypotension . To our T4. We measured the level of anesthesia only after completing the spinal anesthesia and just before the surgical incision. In a previous study, Kuok et al. found a correlation between the AC and sensory block level  [There are many possible mechanisms for the more decline in MAP in pregnant women with larger ACs. First, in a term pregnancy, the uterus is large enough to potentially cause aortocaval compression leading to decreased venous return and cardiac output when lying supine. In pregnant women, the AC reflects the size of the uterus; thus, the larger the AC, the greater the decline in MAP. Second, compression of the inferior vena cava by an enlarged uterus can result in engorgement of the epidural venous plexus, in turn decreasing the cerebrospinal fluid volume and narrowing the intrathecal space , 12 potep=0.003) . Howeverp=0.003) . Third, The AC can be measured easily and noninvasively and is also nonoperator dependent. Thus, we recommend including this variable to assist anesthesiologists to prepare for hypotensive events after spinal anesthesia in pregnant women. The AC can help to determine which pregnant women should receive early and aggressive hemodynamic treatment. Moreover, we recommend reducing local anesthetic doses on the basis of the AC to reduce the incidence of hypotension –18. AdjuThere was no relationship between the incidence of hypotension and abdominal circumference during cesarean section under spinal anesthesia. However, MAP in pregnant women with larger abdominal circumference significantly decreased from baseline after spinal anesthesia.


This study was conducted to determine the prevalence of metabolic syndrome (Mets) in schizophrenic patients in a 6-month period of treatment with antipsychotic medications.In this study, 60 volunteer schizophrenic patients were included. At the onset and 6 months after treatment with antipsychotic medications, fasting blood sugar (FBS), serum triglyceride (TG), high density lipoprotein (HDL), weight, waist circumference (WC), and blood pressure were determined. We defined Mets according to ATPIII criteria.After a 6-month treatment with antipsychotic drugs, the mean WC, serum TG, HDL, systolic and diastolic blood pressure increased but the changes of WC and HDL were statistically significant (p<0.05). We found that the percentage of patients with high WC, low HDL levels, and Mets increased after treatment which was statistically significant (p<0.05).It is recommended that nutritional and lifestyle changes intervention should be implanted for schizophrenic patients undergoing treatment. Schizophrenia is a neurodevelopmental disorder that affects 1% of the population around the world. Patients with schizophrenia have a lower life expectancy than the general population . EpidemiThis descriptive study was approved by the Ethics Committee of the Tabriz University of Medical Sciences (ID number 008819). In this study, 60 volunteer schizophrenic patients who were referred to the Bozorghmehr Outpatient Clinic were included. After explaining the study protocol for the patients, they signed a written informed consent. Inclusion criteria included patients with schizophrenia . Exclusion criteria included patients who had been previously treated with psychiatric drugs for more than a month, patients treated with lipid-lowering drugs and hypertension, patients with liver, kidney, diabetes, or thyroid diseases, cancer, or other hormonal disorders. Demographic information, including age, gender, marital status, and educational level was collected via a questionnaire.Biochemical factors: Blood samples were taken after an overnight fast of 12 hours. Fasting blood sugar (FBS), serum triglyceride (TG), and high-density lipoprotein (HDL) were assessed using Pars Azmoon kits by the enzymatic method.Anthropometric measurements: Height and weight were measured by mounted tape (the nearest to 1 mm) and Seca scale (the nearest 0.1 kg) respectively. Body mass index (BMI) was calculated by dividing weight (kg) by the square of height (m).According to National Institutes of Health (NIH) guidelines, waist circumference (WC) was measured. Women with a waist circumference ≥88 cm and men with a waist circumference of ≥102 cm were considered abdominally obese. Blood pressure measurements: In the sitting position, blood pressure was measured twice in each arm. There was a two minute rest between each measurement. The average of the two measurements in each arm was reported as blood pressure. Metabolic syndrome definition: MetS is defined according to the National Cholesterol Education Program’s Adult Treatment Panel III report (ATPIII) criteria , HDL-C <40 mg/dl in men and <50 mg/dl in women; elevated blood pressure ; and elevated fasting glucose≥100 .Statistical analysis: Data were analyzed by SPSS Version 11.5 . Descriptive statistics were performed for all study variables and are presented as mean±SD as well as number (percentage) where applicable. To compare variables before and after treatment, paired-t-tests and McNemar’s test were used to for quantitative and qualitative variables, respectively. Statistical significance was considered to be p<0.05.The baseline and demographic characteristics of the patients are indicated in  In this descriptive study, after a 6-month period of treatment of schizophrenia patients with antipsychotic medications, the prevalence of MetS and increases in serum HDL and WC as MetS components were statistically significant. Moreover, the percentage of patients with MetS at the beginning of the study was 5% that had increased to 27% after 6 months of treatment .These results are supported by another study which found that about 25% of Iranian patients with schizophrenia had MetS , in SpaiIn contrast to other studies, which reported that the incidence of diabetes was higher in schizophrenia patients in comparison with the general population , 18, ourIn conclusion, the percentage of schizophrenia patients with MetS, high WC, and low HDL increased significantly after a 6-month antipsychotic medication regimen. Therefore, patients with schizophrenia, when undergoing polypharmaceutical treatment, should be regularly monitored for metabolic syndrome risk factors, and nutritional and lifestyle interventions should be implemented for schizophrenic patients undergoing treatment with antipsychotic medications.


Hypertension is a prevalent comorbid condition in diabetes, affecting ∼20–60% of patients with diabetes, depending on obesity, ethnicity, and age. Adults with diabetes historically have two or three times higher rate of cardiovascular disease (CVD) than adults without diabetes.  The aim of this study was to assess blood pressure (BP) control and its predictors among hypertensive diabetic patients on follow-up at the chronic clinic of Nekemte Referral Hospital (NRH) in West Ethiopia. p value <0.05 levels. The patient's written informed consent was obtained after explaining the purpose and procedures of the study.  A cross-sectional study was conducted among hypertensive adult patients comorbid with diabetes taking antihypertensive drugs for at least one year in NRH. Both bivariable and multivariable analyses were done. The odds ratio, along with 95% confidence level, was estimated to identify factors associated with uncontrolled BP by using multivariable logistic regression analysis. The level of statistical significance was declared at p=0.032), duration with hypertension ≥5 years , cigarette smoking , nonadherence , and uncontrolled glycaemia  were independent predictors of uncontrolled blood pressure.  A total of 186 study participants were included in this study. The mean age of the participants was 51.2 ± 12.2 years. Blood pressure and blood glucose were controlled in 104 (55.9%) and 106 (57.0%) study participants, respectively. In the multivariable analysis, age ≥60 years (AOR = 4.537, 95% CI = 1.142–18.024,  Compared to the previous studies, BP was better controlled among hypertensive diabetic patients in the present study. Older age, longer duration with hypertension, cigarette smoking, nonadherence, and uncontrolled glycaemia were predictors of uncontrolled BP. Thus, interventions on modifiable factors should be done to improve BP control of patients' comorbid with diabetes. Hypertension is an extremely common comorbid condition in diabetes, affecting ∼20–60% of patients with diabetes, depending on obesity, ethnicity, and age . Good diHypertension is often present as part of the metabolic syndrome of insulin. The risk of both macrovascular and microvascular complications increases with the presence of hypertension –5. The rIn the United States (US), around 30.3 million adults have diabetes (9.4% of the US population) , 10.The eighth report of the Joint National Committee (JNC 8) recommends a target BP of <140/90 mm·Hg in patients with diabetes and most patients will require two or more antihypertensive medications to achieve goal BP –14. A quMultiple studies indicate common risk factors for poor control of hypertension include older age, obesity, longer duration with hypertension, nonadherence, smoking, alcohol intake, physical inactivity, chronic kidney disease, black race, and uncontrolled diabetes mellitus. Treatment of hypertension involves improving medication adherence, detection, and correction of secondary hypertension and addressing other patient characteristics , 15–23.Hence, this study aimed to determine the level of BP control and factors associated with uncontrolled BP among hypertensive diabetic patients, which will help the health care providers and regulatory body to work towards improving the management of hypertension in diabetic patients.A cross-sectional study was conducted for two months, from July 05 to September 2, 2018. All adult patients of hypertension with diabetes who attended chronic clinics of the NRH were the source of population, and all adult patients of hypertension with diabetes who attended chronic clinics of the NRH during the study period were the study population.All adult patients of hypertension with diabetes taking antihypertensive drugs for at least one year in NRH who came for follow-up during the study period and willing to participate were included in the study. Mentally disabled, those who are unable to hear, and seriously ill patients were excluded from this study.The required sample size was calculated using single population proportion formula, and the following assumptions were used in order to calculate the required sample size, 43.51% population proportion of controlled blood pressure , 95% conData were collected using an interviewer-administered pretested questionnaire that was adopted from different literatures –27, and p value <0.05 levels.Data were entered into Statistical Package for the Social Sciences (SPSS) version 20.0  for analysis. Both bivariable and multivariable analyses were done. The odds ratio, along with a 95% confidence level, was estimated to identify factors associated with uncontrolled BP by using multiple stepwise backward logistic regression model. The level of statistical significance was declared at Systolic and diastolic BPs were recorded during patients' visits, in a seated position, after a rest of at least 5 minutes. Two measures were recorded, in both arms, at 5-minute intervals, and the mean was recorded. The BP recordings at each visit were recorded retrospectively from patients' medical records, and then uncontrolled BP was determined by the average BP recordings across the six (6) months. Systolic BP of ≥140 mmHg and/or diastolic BP of ≥90 mmHg were used as uncontrolled BP .Fasting blood glucose was >130 mg/dL .Knowledge of hypertension was assessed by using a validated fact questionnaire about hypertension that was adopted from studies conducted by Pirasath et al. . There wThere were a total of 13 medication adherence questions in the data collection tool that was adopted from studies conducted by Obirikorang et al.  and JohoEthical clearance was obtained from the Institutional Research Ethics Review Committee of Wollega University, Institute of Health Sciences. This committee wrote a formal letter of permission to Nekemte Referral Hospital to seek its cooperation. Permission was obtained from the medical director's office of the hospital. The patient's written informed consent was obtained after explaining the purpose and procedures of the study. Data on the sociodemographic and clinical characteristics, knowledge, and adherence of the patients were collected to evaluate the blood pressure control and its determinants. Confidentiality was ensured during the data collection. Thus the name of the patient was not recorded.A total of 186 study participants were included in this study, from which 83 (44.6%) were males and 103 (55.4%) were females. The mean age of the participants was 51.2 ± 12.2 years. The largest groups by age were those from 40 to 59 years old, which constituted 101 (54.3%) patients. More than half (53.8%) of the respondents were from rural resident .This study identified that out of all antidiabetic therapy, oral hypoglycemic agents alone 103 (55.4%) were the most prescribed agents while 72 (38.7%) patients were on insulin alone and only 11 (5.9%) were taking both. The majority of the study participants had poor knowledge about hypertension 120 (64.5%) and were nonadherent to their treatment (128 (68.8%)). BP and blood glucose were controlled in 104 (55.9%) and 106 (57.0%) study participants, respectively. It was also observed that most of the patients (73.1%) had no comorbidity. The majority of the participants, 120 (64.5%), were on a single antihypertensive agent .β-blockers 27 (14.5%).In overall observation, the highest used antihypertensive drug by the study participants was ACE inhibitors 102 (54.8%) followed by diuretics 91 (48.9%), calcium channel blockers 47 (25.3%), and p < 0.25  were entered into the multiple stepwise backward logistic regression model to identify independent predictors of uncontrolled BP. In the multivariable analysis, age ≥60 years , duration with hypertension ≥5 years , cigarette smoking , nonadherence , and uncontrolled glycaemia  had shown statistical significance in predicting uncontrolled BP   and ChilThe most commonly prescribed drugs in the study were ACEI, followed by diuretics in 54.8% and 48.9% of patients, respectively. These findings were similar to studies from Ethiopia, India, Palestine, and Chile , 29, 33.Uncontrolled BP was more likely to occur in patients with age ≥60 years. This finding is consistent with studies from Ethiopia , South AThis study showed that patients with a longer duration of hypertension had a significant association with uncontrolled BP. Similar findings were reported from Ethiopia  and ChinIn the present study, cigarette smoking was significantly associated with uncontrolled BP. This finding is consistent with studies from Zimbabwe , Spain , and theIn this study, nonadherence was significantly associated with uncontrolled BP and nonadherent patients were around 6.584 times more likely to have uncontrolled BP than patients adherent to medications. A similar finding was reported from the study done in Ethiopia  and SoutPatients with poor glycemic control were more likely to have uncontrolled BP. Similar findings were reported from Ethiopia , Brazil This study was the first study conducted at Nekemte Referral Hospital located in West Ethiopia to determine blood pressure control among hypertensive diabetic patients. This study used data from patients' cards and face to face interviews which allowed us to have complete information to determine blood pressure control and identify associated factors.Limitations of this study were that self-reporting was used for measuring adherence and knowledge about hypertension. This method has the disadvantages of recalling bias and eliciting only socially acceptable responses and hence, may lead to the overestimation of some of the results, the short period, and small sample size. FBG was used to determine blood glucose instead of glycated hemoglobin due to inaccessibility. Since there is only one referral hospital in West Ethiopia during the study period, this study was done only in a single site.Compared to the previous studies, BP was better controlled among hypertensive diabetic patients in the present study. Older age, longer duration with hypertension, cigarette smoking, nonadherence, and uncontrolled glycaemia were predictors of uncontrolled BP. Thus, interventions should be done on modifiable factors to improve BP control of patients' comorbid with diabetes. This could be achieved through pharmacists whose responsibility is to deliver continuing medical education in the field of current pharmacotherapy and more strict control of BP is needed to reduce severe complications of diabetes and hypertension.