Some experimental and clinical studies suggest a possible role of irisin in central and peripheral regulation of blood pressure. The purpose of the study was to assess the associations between serum irisin levels, total and visceral fat, metabolic parameters, and blood pressure pattern during 24-h monitoring (ABPM).In 206 patients with essential hypertension receiving standard antihypertensive treatments, we assessed anthropometric indices; serum irisin, blood lipids , glucose and insulin; body composition including lean mass and total, visceral, android and gynoid fat using a dual-energy x-ray absorptiometry; ABPM; and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR).Baseline irisin levels were within normal reference ranges and comparable between the genders. There were no significant correlations of irisin with age, anthropometric variables, lipids, HOMA-IR, body composition, as well as 24-h blood pressure and dipping status. In univariate analysis, age, fat mass and distribution, lipids and glucose, HOMA-IR, and nocturnal blood pressure fall were poor predictors of irisin levels. These neutral associations were not affected by age, gender, and treatment modality.In young adult hypertensives, serum concentration of irisin was within a normal range and not associated with total and regional fat, blood lipids, insulin resistance, as well as 24-h blood pressure and the magnitude of its nocturnal fall. In contrast, when it was given intravenously, blood pressure was lowered but cardiac contractibility was not affected  – is mainly involved in the regulation of energy metabolism by activating thermogenesis to increase energy expenditure . In addiaffected . These faffected ,12. Base1-blockers (n=12) given either as a monotherapy or in combinations. The study complied with all applicable institutional regulations regarding the ethical use of human volunteers in research and the terms of the Declaration of Helsinki. The Pomeranian Medical University Ethics Committee approved the study protocol, and all participants gave their written consent.We included 206 young adult subjects  aged 18-35 years who were diagnosed in our tertiary care unit with primary hypertension. The subjects with endocrine disorders, history of malignancy, nutrition disorders, and rapid weight changes (≥ 5 kg) within the last 12 months, as well as pregnant women and patients receiving medications or dietary supplements known to affect body composition  were excluded. Patients with secondary or spurious isolated systolic hypertension were also excluded. All subjects received standard antihypertensive drugs  includin2. Waist-to-hip ratio (WHR) was calculated as WHR=WC/HC. A 24-h ambulatory blood pressure monitoring (ABPM) was recorded using the Spacelabs device . Automated blood pressure measurements were performed every 20 min during the day and every 30 min during nighttime (between 22.00 and 06.00). Based on a percent difference between daytime and nocturnal mean SBP, we identified the following blood pressure patterns: dipping , non-dipping (<10%), extreme dipping (>20%) and reverse dipping  (Height (rounded to the nearest 0.5 cm), weight, waist circumference (WC) and hip circumference (HC) were measured. Body mass index (BMI) was calculated as BMI=weight/heightdaytime) ,14.After an overnight fast, lipid profiles including serum levels of triglycerides (TG) and total, low-density-lipoprotein (LDL-C)-, and high-density-lipoprotein (HDL-C)-cholesterol, glucose, and insulin were assessed. From insulin and glucose measurements, a Homeostatic-Model-Assessment Insulin Resistance Index (HOMA-IR) was calculated. Serum irisin was assessed by ELISA using recombinant antibodies .Body composition was assessed using dual-energy X-ray absorptiometry (DXA)  using the automatic whole-body scan mode. We analyzed total body (TBF), android, and gynoid fat, as well as lean mass (LM), which in DXA is a surrogate measure of muscle mass. Visceral fat (VF) was computed by the CoreScan application dedicated to GE Healthcare DXA devices. Body composition parameters were analyzed using age-, gender-, race-, and instrument-specific reference values for VF ,16 and TTraditional metabolic risk factors were defined using the following International Diabetes Federation diagnostic criteria for metabolic syndrome in populations of European descent : (a) WC t tests; otherwise, non-parametric Mann-Whitney U-tests and Kruskall-Wallis tests were used. Differences in serum irisin levels between patients receiving monotherapy from the main three antihypertensive drug classes were compared using ANOVA. Correlations between pairs of quantitative variables were assessed using Pearson’s linear correlations or Spearman’s rho correlations for normally and non-normally distributed variables, respectively. Using a post-hoc analysis, the statistical power of the study with 206 subjects was sufficient to detect with 80% probability the true effect size of an association between quantitative variables corresponding to a correlation coefficient of 0.20. Statistical analyses were performed using Statistica .Descriptive statistics included means ± standard deviation (SD) for continuous variables and frequency distributions for categorical variables. Variables with normal distribution were compared using parametric Student’s 2), WC, VF, and TBF. In approximately 20-25% of patients, mean values of SBP and DBP measured during a 24-h period, daytime and nighttime, were above recommended targets . Similarly, differences in irisin serum concentrations between the patients with excess TBF% and VF defined as the values >1 SD from age- and gender-specific cut offs , no significant correlations were found between irisin and ABPM  and bodyvia activation of nuclear factor E2-related factor-2 (The association of circulating irisin levels with blood pressure in humans has not yet been fully elucidated. Using different populations, some studies found irisin to be positively correlated with both SBP and DBP -7 or solfactor-2 , suggestWe could not demonstrate the associations of irisin with body fat and its compartments, as well as obesity-dedicated measures such as BMI, waist and hip circumferences and waist-to-hip ratio. In addition, a novel finding of this study was that VF, which is known to be involved in the development of atherogenic lipid profiles, abnormal glucose tolerance, elevated blood pressure, and other abnormalities frequently related to metabolic syndrome ,24 was nOur study had some limitations. Firstly, the study is lacking a control group. This is because we investigated the association of irisin with nocturnal fall in blood pressure, and as non-dipping blood pressure is rare among healthy individuals, we focused on a group of young hypertensives, which comprised both dippers and non-dippers. Secondly, we did not assess the level of physical activity. However, although some studies proposed irisin to be an exercise hormone , other qIn summary, our study demonstrated that in young adults with hypertension serum concentration of irisin was normal and not associated with total and regional fat, blood lipids, insulin resistance, as well as 24-h blood pressure and its nocturnal fall.


Due to the increased use of common and non-invasive abdominal imaging techniques over the last few decades, the diagnosis of about 60% of renal tumors is incidental. Contrast-enhancing renal nodules on computed tomography are diagnosed as malignant tumors, which are often removed surgically without first performing a biopsy. Most kidney nodules are renal cell carcinoma (RCC) after surgical treatment, but a non-negligible rate of these nodules may be benign on final pathology; as a result, patients undergo unnecessary surgery with an associated significant morbidity. Our study aimed to identify a subgroup of patients with higher odds of harboring benign tumors, who would hence benefit from further diagnostic examinations  or active surveillance. We performed a retrospective review of the medical data, including pathology results, of patients undergoing surgery for solid renal masses that were suspected to be RCCs . Owing to the widespread use of common and non-invasive imaging techniques, the incidental diagnosis of kidney tumors has become increasingly common. Considering that a non-negligible rate of these tumors is found to be benign after surgery at pathological examination, it is crucial to identify features that can correctly diagnose a mass as benign or not. According to our study results, female sex and tumor size ≤ 3 cm were independent predictors of benign disease. Contrary to that demonstrated by other authors, increasing patient age was also positively linked to a greater risk of malign pathology. The exponential increase in the use of common and non-invasive abdominal imaging techniques  over the last few decades has led to a similar increase in the number of small, often asymptomatic, renal tumors incidentally detected that generally migrate to the lower clinical stage ,2. All oThis retrospective study was conducted at the Department of Urology of Umberto I Hospital; written informed consent was obtained from each patient. The study sample was composed of patients who underwent surgery for the removal of a suspected renal cell carcinoma. Overall, 307 patients at our department met the inclusion criteria for enrollment in the study. The patients underwent radical or partial nephrectomy  due to the pre-operative suspicion of RCC, according to the radiographic aspect of the renal mass on ultrasonography and CT scan. All operations (laparoscopic or open) were performed using a transperitoneal or retroperitoneal approach based on the patient’s history of abdominal surgery, habitus, tumor location and surgeon preference. Furthermore, in the case of partial nephrectomy, for better preserving the kidney function, the off-clamp technique was chosen in all cases (with patients under controlled hypotension). If a pre-operative diagnosis could not be made with the above imaging techniques, magnetic resonance (MR) was performed to provide further details. Three criteria were used to raise suspicion of renal cell carcinoma for surgical treatment: (1) solid enhanced nodules (showing an increase of 10 Hounsfield units at CT scan); (2) absence of intratumor fat in the kidney lesions in order to exclude angiomyolipomas and (3) complicated renal cysts of type III or IV (Bosniak classification ). ExclusTreatment-independent patient characteristics considered in this study were sex, age and year of treatment. Variables related to the treatment were intervention type, removal type and kidney location (left vs. right), while the renal tumor was characterized by its histology and size. The primary goal of the study was the histological characterization of the tumor into benign or malign , and all analyses were directed towards understanding its relationship with the other variables with the aim of identifying subgroups in the data which present reduced malignancy risk. The statistical analysis was divided into two main steps. First, numbers and proportions were reported for categorical variables, while continuous variables were described by their mean and standard deviation. This was followed by an exploration of the correlation between the various variables via a correlation map that was constructed using Spearman’s correlation test. In the second part of the analysis, both univariate and multivariate logistic regression were used to evaluate the impact of each variable on the probability of malignancy. In both cases, age and tumor size were considered both as continuous variables and as categorized variables. All statistical analyses were carried out using the RStudio graphical interface version 2021.09.2 Build 328 with R version 3.5.2 .p = 0.019) coefficient difference when compared to the reference group of ≤3 cm, while age < 50 years was the only age category with a statistically significant coefficient difference when compared to the reference group of ≥70 years. In univariate analysis, the year of intervention was also positively associated with an increase in malignancy risk. The results are reported uncorrected for multiple testing. Correlation analysis, presented in Males represented the majority of the patients at 60.6%. The overall mean age (SD) was 60 (13) years. The number of malignant cases was 212, which represented 69% of the cases overall. The majority of malign cases were attributed to RCC at 72.6%, with papillary tumors at 12.3%, chromophobe tumors at 7.5% and other types of malign tumors comprising 7.5% of malign cases. For the benign conditions, 35.8% were oncocytomas, 22.1% were pyelonephritis, 11.6% were angiomyolipomas, 10.5% were hydronephrosis and 20% were other types of benign conditions. In the past, according to urologists, >90% of solid renal masses were RCC at surgery. However, daily results show that, after surgical treatment, up to 27% of suspected kidney nodules are diagnosed as benign tumors by pathologists, and this scenario must be carefully evaluated if we consider that, due to the widespread use of common and non-invasive imaging techniques, the incidental diagnosis of kidney mass has become increasingly common. So, for this reason, it is crucial to identify features that can correctly diagnose a mass as benign or not. In our study, the patient’s age and tumor size were considered both as continuous variables and categorized variables, which allowed for a more comprehensive understanding of the factors influencing the likelihood of malignancy. The use of logistic regression allowed for the identification of variables that were strongly associated with malignancy, which could be used to develop strategies for assessing risk in different subgroups. It is commonly believed that the problem of diagnosis can be solved with the use of renal biopsy. However, Patel et al.  reportedIn conclusion, the incidental diagnosis of small renal tumors represents a challenge to urologists due to the likelihood that many of these tumors are benign or show less aggressive behavior. We identified a subgroup of patients, namely young women affected by tumors ≤ 3 cm, with a significantly reduced probability of harboring malignant tumors. Thus, according to our findings, significant predictive factors for benign kidney pathology include younger age (<50 years), female gender and small tumor size (≤3 cm), and the choice of renal biopsy and active surveillance may therefore be more strongly recommended for the patients with these characteristics.


SLCO1B1 c.521T>C with simvastatin-induced muscle toxicity is well characterized. However, different statins are subject to metabolism and transport also by other proteins exhibiting clinically meaningful genetic variation. Our aim was to investigate associations of SLCO1B1 c.521T>C with intolerance to atorvastatin, fluvastatin, pravastatin, rosuvastatin, or simvastatin, those of ABCG2 c.421C>A with intolerance to atorvastatin, fluvastatin, or rosuvastatin, and that of CYP2C9*2 and *3 alleles with intolerance to fluvastatin.The association of We studied the associations of these variants with statin intolerance in 2042 patients initiating statin therapy by combining genetic data from samples from the Helsinki Biobank to clinical chemistry and statin purchase data.SLCO1B1 c.521C/C genotype with simvastatin intolerance both by using phenotype of switching initial statin to another as a marker of statin intolerance  and statin switching along with creatine kinase measurement . No significant association was observed with atorvastatin and rosuvastatin. The sample sizes for fluvastatin and pravastatin were relatively small, but SLCO1B1 c.521T>C carriers had an increased risk of pravastatin intolerance defined by statin switching when compared to homozygous reference T/T genotype .We confirmed the association of The current results can inform pharmacogenetic statin prescribing guidelines and show feasibility for the methodology to be used in larger future studies. Lipid-lowering 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) are among the most widely used drugs in the world. They are used both in primary and secondary prevention to reduce cardiovascular risk. Even though statins are generally well tolerated, their most typical adverse effects include muscular toxicity ranging from relatively common muscle pain  to very rare but potentially life-threatening rhabdomyolysis . Statin-SLCO1B1) and atorvastatin, fluvastatin and rosuvastatin by breast cancer resistance protein   and statin switcher with CK measurement  phenotypes (Table P = 0.035).The median follow-up time for simvastatin initiators was 532 days. Of the total 916 simvastatin users, 232 were classified as statin switchers and of those, 22 had a temporally qualifying CK measurement  or combination of prescribing patterns with clinical chemistry measurements (CK measurements) indicative of intolerance to statin therapy. Our definitions differed somewhat from similar previous studies based on electronic medical records without information about patient-reported symptoms for intolerance ,33. We ilevation . Thus, oSLCO1B1 c.521T>C carriers had a higher risk of pravastatin intolerance based on statin switching phenotype when compared to reference allele homozygotes. It is noteworthy that the effect was observed in our cohort with low-moderate pravastatin doses as 40 mg is the highest approved dose of pravastatin in Europe rather than 80 mg available in the USA. In a previous pharmacogenetic study of statin efficacy and safety, 143 patients received 10 mg/day pravastatin for 8 weeks followed by 40 mg/day for 8 weeks [SLCO1B1 c.521T>C SNV showed no association with the composite adverse event. The median follow-up time in our study was more than 2 years in pravastatin initiators, which may partly explain the differing results. Although most statin-induced muscle symptoms occur during the first months of statin usage, myotoxicity can occur even years after statin initiation [In addition to simvastatin, we observed that heterozygous or homozygous  8 weeks . Of thesitiation .SLCO1B1 c.521T>C SNV associates with atorvastatin-induced adverse effects [We observed no statistically significant increase in statin intolerance risk for atorvastatin, fluvastatin or rosuvastatin with the studied genotypes. For atorvastatin, no signals were evident for genotype-driven increased risk in our cohort of 780 atorvastatin users who most often had 10 and 20 mg prescribed as a starting dose. An earlier meta-analysis of 13 studies with a total of 1550 patients found that the  effects ,32. In t effects –13,17,35SLCO1B1 genotype was not associated with clinically reported myalgia in a clinical trial setting with rosuvastatin dose of 20 mg [The rosuvastatin cohort consisted of only 184 patients who had most often 5 or 10 mg prescribed starting dose with no tendencies for increased risk in carriers of the candidate risk alleles. The findings are in line with the JUPITER trial in which the of 20 mg . The medCYP2C9*2 and *3 alleles and the ABCG2 c.421C>A SNV significantly increase the risk of these adverse reactions, with odds ratios between 2.4 and 6.6 [SLCO1B1 c.521T>C SNV may increase the risk of fluvastatin intolerance also among general hypercholesterolemic patients, but further studies are required to confirm the findings.For fluvastatin, there was a trend towards increased risk of statin intolerance with a point estimate of HR at 1.88 in carriers of 2–4 risk alleles, but perhaps due to low sample size, the finding was not statistically significant. A previous study in renal transplant recipients with 52 cases of fluvastatin-induced adverse muscular or liver symptoms and 52 matched controls, showed that the  and 6.6 . Our datOur study has some limitations mainly related to its epidemiological and retrospective nature. Obviously, some prescribing changes occurring in our study are not related to statin intolerance and cases of true intolerance cannot be identified from the data. In any case, the study answers the clinical question of how the studied genotypes are related to statin switching. Furthermore, we eliminated obvious causes of confounding in prescribing patterns due to administrative factors by excluding time frames where atorvastatin and rosuvastatin were switched to other statins due to changes in reimbursement policies. The study population consisted of biobank-consented patients with available DNA samples who initiated statin therapy between 1998 and 2016. As the Helsinki Biobank became operational in 2015, the majority of the study subjects had initiated their statin therapy before giving biobank consent and samples to the biobank, presenting a possibility for immortal time bias. For the current study design, this is not of major concern, however, as the study outcome was not related to survival. Moreover, the genotype frequencies observed were in the Hardy-Weinberg equilibrium and match those reported for the Finnish population , State funding for university-level health research, and the Sigrid Jusélius Foundation .There are no conflicts of interest.


Following adjustments for confounders, a higher BMI was independently associated with lower FVC  as part of the treatment plan for patients with asthma to improve lung function.Introduction: Obesity is a common comorbidity in patients with asthma and has a significant impact on health and prognoses. However, the extent to which overweight and obesity impact asthma, particularly lung function, remains unclear. This study aimed to report on the prevalence of overweight and obesity and assess their impacts on spirometry parameters in asthmatic patients. Methods: In this multicentre, retrospective study, we reviewed the demographic data and spirometry results of all adult patients with confirmed diagnoses of asthma who visited the studied hospitals’ pulmonary clinics between January 2016 and October 2022. Results: In total, 684 patients with confirmed diagnoses of asthma were included in the final analysis, of whom 74% were female, with a mean ± SD age of 47 ± 16 years. The prevalence of overweight and obesity among patients with asthma was 31.1% and 46.0%, respectively. There was a significant decline in spirometry results in obese patients with asthma compared with patients with healthy weights. Furthermore, body mass index (BMI) was negatively correlated with forced vital capacity (FVC) (L), forced expiratory volume in one second (FEV Asthma, a common pulmonary disease, is characterised by airway hyperresponsiveness, inflammation and remodelling, and it is associated with variable airflow limitation and the presence of respiratory symptoms that vary over time and in intensity. Asthma affects around 300 million people worldwide, and it is expected that closer to 400 million people will have this condition by 2025 . Patient2), is the most widely used screening tool to determine overweight and obesity [2 are considered to be overweight, while individuals with BMIs of 30 kg/m2 and higher are classified as obese [2), class II, or moderate (35–39.9 kg/m2), and class III, or morbid (above 40 kg/m2) [Obesity is one of the most common asthma comorbidities  and is d obesity . Accordias obese . Obesity0 kg/m2) .Obesity is prevalent among adults and children with asthma worldwide . Althoug1), ratio of FEV1 to forced vital capacity (FEV1/FVC), FVC and forced expiratory flow at 25% and 75% of the pulmonary volume (FEF 25–75%).Although the impact of obesity on lung function, including spirometry parameters in adults with asthma, has been reported in previous studies, there is still controversy over whether obesity further worsens airway obstruction ,8,9. ThiPreliminary reports suggest that both asthma and obesity can lead to worsening of respiratory symptoms and increased risk of hospitalisation. However, the prevalence of obesity and the extent to which overweight and obesity impact lung function, particularly spirometry parameters among patients with asthma in Saudi Arabia, has not been studied. Therefore, this study aimed to report on the prevalence of overweight and obesity and assess their impacts on spirometry parameters in asthmatic patients.This multicentre, retrospective study was conducted to investigate the impact of overweight and obesity on spirometry parameters among patients with asthma. The data collection process was carried out between 1 April 2022 and 31 October 2022 at King Abdulaziz University hospital and two Ministry of Health hospitals in Saudi Arabia.We retrospectively reviewed the electronic medical records of 1156 outpatients with confirmed asthma diagnoses who had scheduled visits and consultations with specialists and were treated between 1 January 2016 and 31 October 2022. We collected spirometry results and demographic data . Demographic data were collected at the time spirometry was performed. Only patients with multidisciplinary-team-confirmed diagnoses of asthma made in accordance with current nationally and internationally accepted criteria were included in the current study . In the 1, ratio of FEV1/FVC, FEF 25–75% and PEF. If the patient had more than one spirometry test performed between 1 January 2016 and 31 October 2022, only the most recent result was included.Only spirometry tests performed in accordance with the current American Thoracic Society/European Respiratory Society guidelines were included in the current study . All spi2 ; (2) patients with BMI values of 25 to 29.9 kg/m2 (overweight); (3) patients with BMI values of 30 to 34.9 kg/m2 (mild or class I obesity); (4) patients with BMI values of 35 to 39.9 kg/m2 (moderate or class II obesity); and (5) patients with BMI values of 40 kg/m2 or above (morbid or class III obesity) [Height and weight were routinely measured in the clinics, with patients barefoot and wearing light clothing, using a medical scale . We only collected BMI values based on the heights and weights measured before spirometry was performed. All asthmatic patients included in the current study were divided into five groups in accordance with WHO and CDC classifications: (1) patients with BMI values of 18.5 to 24.9 kg/mobesity) .Prior to the start of this study, ethical approval (HA-02-J-008) was obtained from the Unit of Biomedical Ethics Research Committee at the Faculty of Medicine in King Abdulaziz University, Saudi Arabia.t test to compare the mean differences between the two independent data sets. The correlation of BMI with spirometry measures  was determined using Pearson’s correlation coefficient. A multiple linear regression model was also performed to determine the factors associated with spirometry measures. p < 0.05 was regarded as statistically significant.In this study, Stata (version 16) was used for data management and analysis. Figures were generated using GraphPad Prism (version 9). The results are presented as numbers (%) and arithmetic means ± SD for categorical and continuous variables, respectively, unless otherwise stated. The normality of the data was graphically assessed. A one-way ANOVA was performed to compare the mean differences between lean, overweight and specifically classed obesity groups. This was followed by an unpaired Student’s 2 or without acceptable spirometry results, a total of 684 asthma patients met our inclusion criteria and were included in the final analysis , 31% had a BMIs between ≥25 and <30 kg/m2 (overweight) and 46% had BMIs of ≥30 kg/m2 . The prevalence of obesity alone and obesity including overweight in patients with asthma was 46% and 77%, respectively. The mean ± SD BMI was statistically significantly greater in females than males . The proportion of female patients was higher in the overweight (75%) and obesity (87%) groups compared with lean subjects (66%). The baseline characteristics for the study population are shown in The mean ± SD age of the study population was 47 ± 16 years, and there were more females (74%) than males. Of the 684 included patients, 23% had BMIs between ≥18.5 and <25 kg/mp < 0.001), FEV1 , FEF 25–75%  and PEF   .1 L, FEF 25–75% L/s and PEF L/s) differed significantly according to BMI groups   compared with normal weight. In addition, mean FVC was found to be significantly decreased in class II and class III, but not in class I, compared with overweight .In order to determine whether a progressive decline in spirometry values was observed as BMI increased, we divided asthmatic patients into four different groups based on their BMI values. A one-way ANOVA showed that the means of the spirometry measures  A–D. Unpa1 did not significantly differ between asthmatic patients with normal weight and overweight    compared with normal BMI. When compared with overweight patients, mean FEV1 remained unchanged in those with class I and class II obesity but was significantly reduced in asthmatic patients with class III obesity (p < 0.05)  but not in overweight patients as compared with normal weight (2.41 ± 0.10 L/s)  compared with normal weight (5.33 ± 0.14 L/s). It was also interesting to find that PEF only decreased in patients with class III obesity when compared with overweight patients (p < 0.05)  B. Howeve < 0.05) B. Furthe.10 L/s) C. Intere < 0.05) D.1 (L) following adjustments for age and gender  and , respectively. In addition, simple regression models showed that BMI was associated with FEF 25–75%  and PEF . However, the associations were nullified upon further adjustments for age and gender (A multiple linear regression model was performed to assess the independent associations of BMI with spirometry measures. BMI was significantly associated with FVC (L) and FEVd gender .1, FVC, PEF and FEF 25–75%) in obese patients with asthma compared with normal-weight asthma patients. In addition, we found that BMI was negatively correlated with all spirometry measures and that a higher BMI was independently associated with lower FVC and lower FEV1. These findings suggest that obesity can reduce lung function, ultimately leading to poor asthma control, and also highlight the importance of using a nonpharmacological approach  as part of the treatment plan for patients with asthma to improve lung function and, ultimately, asthma management and overall quality of life.To the best of our knowledge, this study is the first to determine overweight and obesity prevalence in asthmatic patients and to assess the impact of overweight and obesity on spirometry measures among asthmatic patients in Saudi Arabia. The main findings of the current study showed that the prevalence of overweight and obesity among patients with asthma was 31% and 46%, respectively. Our findings also demonstrated that there was a significant decline in spirometry results  and obesity (46%) are prevalent in patients with asthma are similar to a previous study reporting that the prevalence of obesity among patients with asthma is 52% in the Netherlands  but cont1, FVC, PEF and FEF 25–75%) in asthmatic patients with obesity compared with patients with normal weight, suggesting that obesity may ultimately impair lung function in patients with asthma. This is likely due to the fact that obesity can cause mechanical compression of the diaphragm, as well as the chest cavity [Obesity has been suggested to be associated with an increased asthma exacerbation rate, but it is unclear whether airflow obstruction is directly responsible for the deterioration of asthma symptoms. Our findings demonstrated a reduction in spirometry parameters  than male patients. This finding is supported by a previous study conducted in the US, showing that overweight and obesity are more prevalent in females with asthma  than in males . OverweiThis study has a number of strengths. First, most studies have assessed the impact of overweight and obesity on lung function in patients with self-reported asthma. The current study only included patients whose diagnoses of asthma were made and confirmed in accordance with current nationally and internationally accepted criteria. Second, we only included patients with spirometry tests performed in accordance with the current American Thoracic Society/European Respiratory Society guidelines. In addition, two trained respiratory therapists reviewed all spirometry tests and further excluded tests that were not acceptable and reproducible. Third, some previous studies have relied on self-reported height and weight. In the current study, BMI was calculated based on height and weight measured using medical scales in pulmonary clinics under the supervision of a trained nurse or respiratory therapist.The current study is not without limitations. First, we were unable to study lung volumes and diffusion capacity as these tests are either unavailable or not routinely performed in our pulmonary clinics for patients with asthma. Second, it is known that the use of asthma maintenance therapies  can lead to better asthma control and improvement in asthma symptoms and lung function. In the current study, all patients were on inhaled corticosteroids as a maintenance therapy to control asthma symptoms. However, it remains critical in the current study to determine the doses of inhaled corticosteroids, the levels of patient adherence to therapies and whether those patients were on other asthma control therapies due to the unavailability of these data. Thus, it is important to acknowledge that spirometry parameters can also be affected by patient non-adherence to therapies and/or types of therapy added on to existing inhaled corticosteroid treatment. Third, the prevalence of overweight and obesity was assessed in this study based on BMIs calculated from height and weight measured before spirometry was performed. Although BMI is currently considered to be the gold standard and is used by international organisations  to classify overweight and obesity, it should be noted that it lacks the ability to differentiate between fat and lean mass and does not take into account the differences in fat distribution. This is unlikely to affect the results of this study, as previous studies have shown that abdominal and thoracic fat have a differential effect on lung volumes . There iObesity is an asthma comorbidity that can eventually contribute to worsening respiratory symptoms. We report here that the prevalence of obesity and overweight in asthmatic patients is high, and that obesity can lead to a reduction in lung function in patients with asthma. In addition to pharmacological therapies, our findings highlight the importance of using non-pharmacological add-on therapies  as part of the treatment plan for patients with asthma to improve lung function and, ultimately, asthma symptoms and overall quality of life. Further studies are needed to explore the impact of different lifestyle strategies on the treatment of asthma patients.1 and FVC. These observations suggest that weight loss may reduce the severity of asthma and that early obesity prevention and healthy lifestyles should be implemented through routine screening in primary care to improve lung function, thereby leading to improvements in asthma management, as well as quality of life.Overweight and obesity are highly prevalent in asthma patients, and, more importantly, they can reduce lung function, characterised mainly by reduced FEV


In a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up.Twenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012–2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12–36 months after renal denervation.2 -1.7%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response.The average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0 episodes/h, in oxygen desaturation index 6.5 episodes/h, in the average SpOAlthough the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.The online version contains supplementary material available at 10.1186/s12890-023-02757-1. Obstructive sleep apnea (OSA) characterized by the repetitive episodes of upper airway complete (apneas) or partial (hypopneas) collapse during sleep, is the most common type of sleep-disordered breathing (SDB) . OSA is Activation of sympathetic nervous system resulting from intermittent hypoxia and hypercapnia, altered chemoreflex, and repeated arousals, is considered a key mechanism underlying the association between OSA and blood pressure (BP) increase . OSA-relRenal denervation (RDN) was implemented as a treatment option in resistant HTN substantiated by the experimental and clinical evidence of the reduced central sympathetic activity  and, conDue to the high sympathetic drive, OSA patients are considered a promising group who could benefit from RDN. Moreover, other protective effects of RDN are widely investigated including reduction in ventricular arrhythmias , 20, atrIn 2011, Witkowski et al. , in a smHowever, the available data are very limited and controversial, the persistence and clinical relevance of the AHI change are questionable, and the majority of the studies are limited by 3–6 months follow-up.We aimed to test the hypothesis that the severity of SDB decreases at long-term follow-up post-RDN and this change is associated with the better BP response.The objective of this study was to assess the long-term dynamics of SDB in patients with resistant HTN after RDN and their association with BP change at extended follow-up.In an open prospective single-center study, we included patients with suspected resistant HTN referred to the center at Almazov National Medical Research Center  which is recognized as one of the ESH hypertension excellence centers. These patients were recruited for endovascular radiofrequency RDN in 2012–2019 as per inclusion/non-inclusion criteria.Inclusion criteria were: age 20–65 years old; BP ≥ 140/90 mmHg despite regular intake of at least 3 antihypertensive drugs in appropriate doses including a diuretic, and informed consent.2); renal stenosis or anatomical features, e.g. diameter of the renal artery < 4 mm, fibromuscular dysplasia; renal angioplasty with stenting for renovascular HTN in the past; severe concomitant diseases  > 40 kg/m2, liver diseases, any oncological diseases in past 5 years, rheumatoid diseases, open surgery in the last year); drug use, alcohol abuse; pregnancy (or planned pregnancy), lactation; and cognitive decline, inability to follow the protocol. For this analysis, the available sleep study at baseline and follow-up was an additional inclusion criterion.Non-inclusion criteria were: secondary endocrine HTN; severe kidney dysfunction (estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73mAmong 70 patients who underwent RDN, 41 patients had valid baseline sleep study, while 28 patients had both baseline and follow-up sleep studies , and later the updated version of the protocol was approved in 2018 by the Local Ethics Committee of Almazov National Medical Research Centre (protocol №2018-12-11). All patients signed informed consent before the enrollment in the study.All patients underwent physical examination, anthropometry, office BP measurements, ambulatory blood pressure monitoring (ABPM), fasting blood tests for renal function assessment , lipids and glucose, urine for microalbuminuria, renal Doppler ultrasonography , renal CT scan , and sleep study.2 (m2) (the Quetlet equation). Obesity was diagnosed in case of BMI ≥ 30 kg/m2.Among anthropometric measurements, we assessed height (accuracy up to 0.5 cm), weight (accuracy up to 100 g), and waist and hip circumferences (in cm) and calculated body mass index (BMI): weight (kg)/heightOffice BP measurements were performed at all visits according to the guidelines on the management of HTN of the European Society of Cardiology/European Society of Hypertension (ESC/ESH) : after 5Ambulatory BP monitoring (ABPM) was performed with the use of a certified oscillometric device . The measurements were performed every 15 min during the day (08:00–22:00), and every 30 min during night (22:00–08:00). The nighttime period was later corrected according to the patient’s diary. The data were considered valid when at least 70% measurements were successful. We assessed average 24-hour BP, daytime and nighttime BP, daytime and nighttime BP load (%), circadian BP profile. According to the ESC/ESH guidelines the following diagnostic thresholds were considered: mean 24-hour BP ≥ 130/80 mm Hg; mean daytime BP ≥ 135/85 mm Hg; and mean nighttime BP ≥ 120/70 mm Hg. Circadian BP profile was assessed separately for systolic and diastolic BP by the equation: 100×(mean BPday-mean BPnight)/mean BPday . For quantitative analysis a circadian coefficient was calculated by formular mean BPnight/mean BPday .The following blood tests were assessed in a fasting state: lipids, serum creatinine, glucose, and insulin . The lipid panel included the total cholesterol (TC), low-density lipoproteins (LDL). Dyslipidemia was diagnosed when the total cholesterol was 6.0 mmol/l and higher and/or LDL was 3.0 mmol/L and higher or in case of the intake of hypolipidemic drugs . ImpaireIn-hospital unattended full polysomnography (PSG) was performed at cardiology department before RDN and at 1-year follow-up. The recordings included the following traces: electroencephalogram, electrooculogram, electromyogram of chin muscles, electrocardiogram, oronasal airflow , pulseoximeter, snoring, thoracic and abdominal respiratory movements, and body position. The baseline and follow-up recordings were scored manually by experienced specialists  according to the Scoring rules of the American Academy of Sleep Medicine version 2.5 .None of the patients with SDB used non-invasive ventilation .All patients underwent renal angiography via Seldinger technique followed by bilateral RDN. Three specialized endovascular ablation systems were used: Symplicity flex™  in 22 patients, Vessix™ Renal Denervation System  in 27 patients, and Symplicity Spyral™ Renal Denervation system  in 21 patients.By the Symplicity flex™  radiofrequency ablations were applied from distant to proximal part of the renal arteries under electrode temperature control (40–75°С), with the maximal output power of 8 W. The maximum of 8 applications were performed at > 5 mm distance in a spiral pattern, each lasting for about 120 s with the total duration of the procedure up to 35-45-minutes.In the Vessix™ Renal Denervation System, balloon catheters with 4-, 5- and 6-mm diameter depending on the diameter of renal artery were used. Radiofrequency generator monitored impedance, and in case of the inadequate electrode contact, the electrode switched off automatically. Each application lasted for 30 s, temperature 65–68 °С, power 1 W.The Symplicity Spyral™ device monitors temperature and impedance and regulates power (6 W), duration of applications is 60 s. All procedures were performed by well experienced and properly trained operators .Upon completion of the procedure, femoral artery was compressed. For 12 h the patients were monitored at the intense care unit followed by 2-5-day stay at the cardiology department. Two-month dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg OD) was prescribed to all patients.Acute kidney injury (contrast-induced nephropathy) was diagnosed according to KDIGO criteria , mainly The follow-up visits were performed regularly at 3, 6, 12, 24, 36 months. In this analysis, the long-term follow-up data (> 1 year) are presented.At follow-up visits clinical investigation included physical examination, anthropometry, office BP measurements, ABPM, blood tests. Follow-up sleep study (full polysomnography at the sleep lab) was performed within 12–36 months after RDN. Antihypertensive therapy was re-evaluated and modified if needed (upon the discretion of investigator on case-by-case basis), but not earlier than 1 month after the procedure.2 levels) from baseline to the follow-up assessment by PSG. We also assessed the association between change in sleep apnea parameters and BP change. The BP response was evaluated as the decrease of BP by at least 5 mmHg from the baseline (ΔBP = BPfollow−up – BPbaseline).In this analysis, the primary outcome was the mean change in the main indices of SDB severity  for non-normally distributed variables. Due to the sample size < 50, the Shapiro-Wilk test was applied to assess the distribution.2 (included separately as independent variables), with the adjustments for other potential confounders . The results for the estimated potential predictors are presented as the odds ratio (OR) and 95% confidence interval (95% CI). The two-sided p-value < 0.05 (in case of multiple testing for 3 groups < 0.005) was accepted to define the validity of the statistical hypothesis. The software SPSS 20.0 was used to perform the statistical analysis.We applied a frequency analysis (the chi-square) to assess the contingency between the nominal and categorical variables. We applied MacNemar test for the paired nominal variables. The continuous variables were compared by Mann-Whitney U test, and for paired data we applied Wilcoxon signed-rank test. Spearman’s rank correlation coefficient was used to assess the association between the parameters of interest. Logistic regression analysis was used to assess the associations between circadian BP profile status  and indices of AHI severity – AHI, ODI, mean SpOn = 28) had higher values of the baseline office BP compared to the patients not included in the analysis (n = 42), the ABPM data were comparable in these subgroups. Otherwise, they did not differ by the main clinical and instrumental parameters.Out of forty-one patient with baseline sleep study, twenty-eight patients (including 16 patients with SDB at baseline) underwent sleep study at follow-up  and without other associated cardiovascular diseases. Every second patient was obese, every third patient had type 2 diabetes mellitus, and the majority of patients had dyslipidemia. Based on the initial ABPM data, all patients demonstrated stable HTN, none of them had masked or white-coat pattern.n = 16, AHI 17.3 /h) and without SDB ). The groups were matched by age, sex and important clinical parameters . The most frequently prescribed medications were RAAS blockers, calcium antagonists, centrally acting agents, and beta-blockers .In the present analysis, the average follow-up comprised 30.1 ± 8.4 months and was similar in SDB and non-SDB groups  which was mainly explained by the lower use of centrally acting medications (18 (64%) vs. 9 (32%), p = 0.021)  or eGFR (p = 0.074) were noted. There was no significant change in BMI from baseline (p = 0.79)  Table ; Fig. 2.p = 0.13). All cases were classified as obstructive episodes. The distribution of the cases by OSA severity at baseline and follow-up was the following: severe (4 vs. 7 patients), moderate (7 vs. 8 patients), and mild (5 vs. 7 patients), respectively. Indices of SDB severity increased significantly, including AHI, oxygen desaturation index (ODI), mean and minimal O2 saturation (SpO2), hypoxia burden (Table p = 0.939) and hypopneas index (p = 0.009) which were classified as obstructive ones. Both AHI in REM (rapid eye movement sleep) and NREM sleep increased. Similarly, the mean change in ODI was 6.5  episodes/h. The average SpO2 showed a slight change by -1.7 %. No correlation between the delta BMI and the delta AHI, ODI or average SpO2 was found . Patients with positive and negative changes in AHI did not differ in the main clinical parameters either at baseline or at follow-up (data not presented).Although the number of patients with verified SDB increased at follow-up 16 vs. 22), the SDB status (yes/no) changed insignificantly: one patient with baseline SDB demonstrated no OSA at follow-up and 3 patients without baseline SDB demonstrated AHI ≥ 5 episodes/h at follow-up .The number of non-dippers in SDB (baseline) group increased from 9 to 12 patients, while it remained the same in non-SDB group : r = 0.51 (p = 0.019), r = 0.50 (p = 0.020), and r=-0.47 (p = 0.030), respectively. Regression analysis confirmed the association of circadian systolic BP profile status with the mean hypoxemia values SpO2 , p = 0.035), but not for AHI or ODI .The baseline AHI, ODI and mean SpOThe follow-up indices of SDB severity did not show association with the circadian BP profile coefficients at follow-up visit. These indices did not correlate with the BP response either.Our study demonstrated that at 3-year follow-up after RDN there is a worsening of OSA, i.e. an increase in the severity indices . However, these changes are not associated with the BP response.To our knowledge our study is the first to assess sleep parameters over 1 year after RDN. Our results do not support the previously suggested hypothesis of the beneficial effect of RDN on OSA. Since none of the previous studies has demonstrated a potential of RDN in OSA deterioration, we presume our patients experienced conventional progression of the disease.p = 0.001), suggesting a significant improvement in OSA severity. Few studies reported improvement in other parameters of OSA severity, i.e. a decrease in daytime sleepiness assessed by Epworth sleepiness scale (ESS) [2 saturation [On the other hand, the controversial results can be explained by the high variability in cohort characteristics in different studies. Thus, Shantha and Pancholy  performele (ESS) , an incrturation , 33, 34,Several studies enrolled CPAP-users , 25, 35,Intriguingly, a study which involved patients without CPAP-therapy did not confirm beneficial effects of RDN on OSA characteristics. Daniels et al.  did not p < 0.001) and diastolic BP (p = 0.012), but not for office heart rate, mean 24-hour, daytime and nighttime ABPM values. Unlike the data from the post-hoc analysis of the Symplicity HTN-3 study [2 values and corresponds to the well-known association between OSA and lack of nocturnal dipping [In our cohort, BP response at 3-year follow-up remained significant for both office systolic , while the second one had severe OSA with the AHI 59/h remaining the same at follow-up. The exclusion of these patients from analysis did not affect the results. Various types of RDN catheter systems were used in published studies with no report on any differences in the impact on OSA severity to date.Another factor potentially associated with the RDN efficacy  is the type of the RDN catheter system. In our cohort, unipolar catheter Simplicity Flex™ was used in 17 patients, balloon technology multi-electrode catheter Vessix™ – in 9, and spiral catheter Symplicity Spyral™ – in 2 patients. So the majority of patients were operated by the unipolar system which might be of lower efficacy efficiency , 16. Thep = 0.79). The changes in body composition and fat distribution could play a role [The studies which support the beneficial effect of RDN on OSA severity suggest that RDN resulting in a decrease in sympathetic drive leads to a reduced extracellular fluid volume associated with the lower rostral fluid shift during sleep in recumbent position . Moreovey a role , but we y a role , it rarey a role , and somy a role . In the y a role . In contAlthough we have not found a clear positive impact of RDN on OSA, the lack of BP elevation associated with the “natural” OSA progression may reflect a positive effect of RDN in this cohort of patients. Indeed, OSA progresses over time and in the lack of appropriate correction by CPAP therapy, one might expect the progression of cardiovascular regulation disturbance as well, resulting in non-response to the RDN procedure. Our findings contradict this assumption revealing the preserved effect of RDN on BP suppression despite the progression of OSA.The strengths of our study include a comprehensive evaluation of the patients, and exclusion of secondary HTN, full in-lab PSG both at baseline and a follow-up scored by the same expert specialists, long-term follow-up of the cohort and the fact that none of the patients used CPAP-therapy either at baseline or during follow-up.Our study has certain limitations which should be considered when interpreting the results. These include a non-randomized trial design, rather small sample size and loss to follow-up, the lack of short-term PSG assessment. The latter could result in missing short-term changes. The lack of a comparison to an untreated group is an important limitation, as we cannot exclude that AHI would have increased even more over 30 months in an untreated comparison cohort. However, as indicated earlier the worldwide data demonstrate no significant changes in apnea index  over up to 5 years , 45. NevAt long-term (> 12 months) follow-up after renal denervation the severity of obstructive sleep apnea is not attenuated, but worsened with the increase in apnea-hypopnea and desaturation indices and the decrease in mean nocturnal oxygen saturation.Although the severity of OSA worsens at > 12 months follow-up after RND, this is not associated with hypertension exaggeration. The potential clinical relevance of the observed changes in OSA severity and their association with the type of renal denervation system used require further assessment.Below is the link to the electronic supplementary material.Table 1. Characteristics of the included and non-included patients. Table 2. Antihypertensive and concomitant therapy at baseline and follow-up. Table 3. Blood pressure response depending on sleep-disordered breathing presence at baselineSupplementary Material 1:


Hypertension occupies a unique position in public health care, because it is the major cause of cardiovascular disease and the mostfrequent non-communicable disorder seen in primary care globally. The prevalence, treatment, and control rates of hypertension varygreatly by ethnicity. Such disparities are mostly linked to genetic variances, although lifestyle and socioeconomic level mayinfluence health behaviours such as food - both of which appear to be substantial factors. East Asian communities have distinct ethnictraits. Hypertensive individuals are more likely to have salt sensitivity together with modest obesity. East Asians have a greaterprevalence of stroke  and no ischemic heart failure (HF) than Westerners. These problems are typical inboth untreated and treated hypertensive patients. White coat hypertension affects 10%-30% of people who visit clinics for high bloodpressure, whereas masked hypertension affects 10%-15% of people .With substantial hypertension populations in India and China,clinical studies in these areas are necessary to determine whether existing treatment techniques are effective. All patients withsuspected or confirmed hypertension should receive regular lifestyle advice from their doctors, including recommendations for diet andexercise. Expert counsel and more frequent monitoring might be necessary. Hypertension occupies a unique position in public health care, because it is the major cause of cardiovascular disease and the mostfrequent non-communicable disorder seen in primary care globally. Raised blood pressure, in the absence of good prevention andmanagement, dramatically increases the risk of stroke, myocardial infarction, chronic kidney disease, heart failure, dementia, renalfailure, and blindness. There is an urgent need for stake holders across the health system, including individuals and families,researchers, and decision makers to collaborate to improve prevention, screening and detection, diagnosis and evaluation, awareness,treatment and medication adherence, management and control for people with or at risk of hypertension. Meeting this requirement willcontribute to lowering the burden of hypertension-related illness, preventing complications and reducing the need for hospitalizationand costly therapies .Hypertension (HT) is one of the most frequent Non-Communicable Diseases and a serious public health problem, accounting for 19% ofall NCD fatalities worldwide . After aHypertension in adults  is defined as systolic blood pressure (SBP) of 140 mm of Hg or greater and / or greater and / ordiastolic blood pressure (DBP) of 90mm of Hg or greater, based o the average of two or more properly measured, seated BP readings oneach of two or more visits. According to most main standards, hypertension should be diagnosed when a person's systolic blood pressure(SBP) in the office or clinic is 140 mm Hg and/or their diastolic blood pressure (DBP) is 90 mm Hg after repeated testing.High-normal blood pressure is meant to identify individuals who may benefit from lifestyle modifications and who may requirepharmaceutical therapy if convincing reasons exist. Isolated systolic hypertension, characterized as high SBP (140 mm Hg) and low DBP(90 mm Hg), and is frequent in both children and the elderly. Isolated systolic hypertension is the most prevalent kind of essentialhypertension in young people, including children, adolescents, and young adults. It is, however, more prevalent among the elderly, whohave stiffness of the major arteries as well as an increase in pulse pressure. Individuals who have been diagnosed with verifiedhypertension (grades 1 and 2) should be given adequate pharmacological therapy .The prevalence, treatment, and control rates of hypertension vary greatly by ethnicity. Such disparities are mostly linked togenetic variances, although lifestyle and socioeconomic level may influence health behaviours such as food - both of which appear tobe substantial factors.East Asian communities have distinct ethnic traits. Hypertensive individuals are more likely to have salt sensitivity together withmodest obesity. East Asians have a greater prevalence of stroke  and no ischemic heart failure (HF) thanWesterners . MorningUnhealthy diets ,physical inactivity, cigarette and alcohol use, and being overweight or obese are all modifiable risk factors. A family history ofhypertension, age over 65, and co-existing disorders such as diabetes or renal disease are non-modifiable risk factors.Hypertension is referred to be a "silent killer". Most hypertensive persons are unaware of their condition since there are nowarning signs or symptoms. As a result, it is critical that blood pressure be checked on a regular basis. Early morning headaches,nosebleeds, abnormal heart rhythms, visual alterations, and ear buzzing are some of the symptoms that might arise. Fatigue, nausea,vomiting, disorientation, anxiety, chest discomfort, and muscle tremors are all symptoms of severe hypertension. The only approach toidentify hypertension is to have blood pressure measured by a medical expert. It is quick and painless to have your blood pressurechecked. Individuals can test their own blood pressure using automated instruments, but an examination by a health expert is necessaryfor risk assessment and the identification of related diseases .The usage of the workplace and out of the office (home or ambulatory) measurements identifies the Individuals with white coathypertension who has high BP solely in the office (non-elevated ambulatory or home BP), whereas those with masked hypertension have noelevated BP in the office but elevated BP outside of the office (ambulatory or home). These problems are typical in both untreated andtreated hypertensive patients. White coat hypertension affects 10%-30% of people who visit clinics for high blood pressure, whereasmasked hypertension affects 10%-15% of people ,14,15.These individuals have a cardiovascular risk that falls between that of normotensives and that of chronic hypertensives. Repeatedoffice and out-of-office blood pressure readings are required to confirm the diagnosis. Drug therapy may not be suggested if theirtotal cardiovascular risk is modest and there is no hypertension-mediated organ damage (HMOD). They should, however, be supplementedwith lifestyle changes, since they may result in long-term hypertension that need pharmacological therapy ,17These individuals have the same risk of cardiovascular events as chronic hypertensives. The diagnosis must be confirmed withadditional in-office and out-of-office measures. Masked hypertension may need medication therapy to regulate out-of-office bloodpressure ,19,20.All patients with suspected or confirmed hypertension should receive regular lifestyle advice from their doctors, includingrecommendations for diet and exercise. Even if a combined pill is used, dual therapy  is not advisedin the beginning because NICE found insufficient evidence regarding the risks and benefits of this approach and suggests furtherresearch is needed. At the very least, patients with hypertension should have an annual review to talk about their blood pressure,lifestyle, symptoms, and medication. If BP control with a single agent is insufficient, a second medication should be added. At thehighest tolerated doses, step three treatment combines an ACE/ARB, CCB, and thiazide-like diuretic. Resistant hypertension is the termused to describe patients who continue to have high blood pressure despite this. Adherence should be examined, and ABPM or HBPM bloodpressure readings should be validated. If additional therapy is required, patients with potassium levels below 4.5 mmol/l may benefitthe most from low-dose spironolactone, while those with higher potassium levels may benefit more from an alpha- or beta-blocker. Expertcounsel and more frequent monitoring might be necessary .


Background: The prevalence of asthma is 9% among adults in Qatar, and its severity can be attributed to intrinsic and extrinsic factors such as environmental changes. As part of the project to investigate the association between air pollution and asthma severity, the rate of exacerbations in adult patients with asthma has been studied in Qatar.Methods: Retrospective data of patients with asthma (16-70 years) from January 2019 to December 2021 was retrieved from Cerner medical records. Frequencies of exacerbations in inpatient and outpatient departments were analyzed using means ± SD and median (IQR) for descriptive data and frequency and percentage for categorical data. Exacerbations were divided into single, double, and more than double for each quarter of the year (January 2019-December 2021) using SPSS and Minitab statistical packages.Results: A total of 6977 exacerbations visits (representing 6558 patients) were identified during the study period. The mean ± SD age was 41±14.3 years, with a female: male ratio of almost 1:1. The patients from the MENA region, including Qataris, presented 67% compared to 33% from the Indian subcontinent and other countries. The number of patient visits for hospitalization due to exacerbations showed a distinctive pattern during the three years. The highest record of asthmatics with exacerbations was observed in 2019 (42.7%) compared to half the rate in 2020 and 2021 , respectively. The single exacerbation group was almost five times higher than 2 or >2 exacerbation groups in all years (2019-2021).Conclusion: This preliminary overview provides the rate of exacerbation episodes in patients with asthma in Qatar. One cause of these exacerbations can be attributed to air quality changes. The drop in the exacerbation rate observed in 2020-2021 could be explained by COVID-19 lockdown regulations or patients’ adherence to prescribed meds. We aim to propose preventive and therapeutic strategies to alleviate asthmatics’ symptoms and improve their quality of life.


There has been little change in morbidity and mortality in traumatic brain injury (TBI) in the last 25 years. However, literature has emerged linking impaired cerebrovascular reactivity  with poor outcomes post-injury. Thus, cerebrovascular reactivity  is emerging as an important continuous measure. Furthermore, recent literature indicates that autonomic dysfunction may drive impaired cerebrovascular reactivity in moderate/severe TBI. Thus, to improve our understanding of this association, we assessed the physiological relationship between PRx and the autonomic variables of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) using time-series statistical methodologies. These methodologies include vector autoregressive integrative moving average (VARIMA) impulse response function analysis, Granger causality, and hierarchical clustering. Granger causality testing displayed inconclusive results, where PRx and the autonomic variables had varying bidirectional relationships. Evaluating the temporal profile of the impulse response function plots demonstrated that the autonomic variables of BRS, ratio of low/high frequency of HRV and very low frequency HRV all had a strong relation to PRx, indicating that the sympathetic autonomic response may be more closely linked to cerebrovascular reactivity, then other variables. Finally, BRS was consistently associated with PRx, possibly demonstrating a deeper relationship to PRx than other autonomic measures. Taken together, cerebrovascular reactivity and autonomic response are interlinked, with a bidirectional impact between cerebrovascular reactivity and circulatory autonomics. However, this work is exploratory and preliminary, with further study required to extract and confirm any underlying relationships. There has been little change in morbidity and mortality in moderate and severe traumatic brain injury (TBI) over the past 25 years . TBI remImpaired cerebral autoregulation in moderate/severe TBI is a secondary injury mechanism that leads to ongoing neural insult . LiteratAutonomic dysfunction after moderate/severe TBI has been well documented and is associated with poor global outcome . FurtherUnderstanding the relationship between cerebrovascular reactivity and autonomic function is an important step to improve TBI care. The directional relationship between PRx and autonomic response portends to future targeted therapeutic development that is aimed at the prevention and reduction of secondary injury insult burden. Past work has shown that autonomic response drives factors associated with cerebrovascular reactivity, however dysautonomia has shown to be exacerbated by increases in intracranial pressure . Beyond Thus, using the prospectively maintained high-resolution data set from the Winnipeg Acute TBI Laboratories, we aim to examine the temporal and causal relationship between PRx and autonomic functionality in more detail using advanced time-series methodologies. The goal of this project is to comprehensively evaluate the time-series statistical properties of cerebrovascular reactivity and autonomics, focusing on the impact they have on each other. This will leverage the fact that circulatory phenomena respond in a fashion which may be assessed using the approach of linear interdependent time-series. Thus, using time-series analysis allows us to comment on what aspects of autonomic function drives cerebrovascular reactivity and gives a more complete picture of physiological response.Data were accessed retrospectively from the maintained TBI database at the Winnipeg Acute TBI Laboratories, University of Manitoba. For this study, patient data were collected from June 2018 up to December 2020. All patients suffered from moderate to severe TBI (moderate = Glasgow Coma Score (GCS) 9—12, and severe = GCS of 8 or less). All patients in this cohort were admitted to the intensive care unit where they were sedated, intubated and were on volume-controlled mode of ventilation (with constant PEEP), during the course of cerebral physiologic data collection. All patients had both invasive intracranial pressure (ICP) and arterial blood pressure (ABP) monitoring conducted, per the Brain Trauma Foundation guidelines .Data were collected following a full approval by the University of Manitoba Health Research Ethics Board .For this study, admission demographic information was extracted following the existing prognostic models in TBI . Such devia an intra-parenchymal strain gauge probe . All signals were captured simultaneously, synchronized and digitized via an A/D converter , sampled at a frequency of 100 Hertz (Hz) or higher using the Intensive Care Monitoring (ICM+) software . Signal artifacts were removed using manual methods before further processing and analysis. This ensured that all analyzed blood pressure had the distinct full wave beat, with all other data removed.All patients had high-frequency digital signals recorded throughout their ICU stay. ABP was obtained through radial or femoral arterial lines connected to pressure transducers . ICP was acquired via the moving correlation coefficient between 30 consecutive 10-s mean windows of the parent signals (ICP and MAP), updated every minute according to previously validated methods  (2) , blood pressure variability (BPV) and the baroreflex sensitivity (BRS). Each of these autonomic response variables (ARVs) were determined for each minute, calculated over both a 5 and 15-min window. These time windows were chosen because 5 min is a common time window for HRV (30) and a 15-min window is the minimum for a short BPV . For spe2) . For HRV2) . This re2) (2) . Thus, eDue to the similarity in the final results between the time windows, all further data demonstrated will be of the 15-min windows.HRV was derived from ABP by finding the power in 3 bandwidth categories; very low frequency , low frequency  and high frequency  . The intWe also calculated the ratio between low and high frequency,  which represents minor sympathetic vagal balance or sympathetic modulations (though further investigation is still required) . The rooThere were two methods of BPV found; the standard deviation of BPV in the time domain and the spectral domain analysis of BPV. The standard deviation of BPV was found in three main groups; mean blood pressure (BPV_M), systolic blood pressure (BPV_S) and diastolic blood pressure (BPV_D) over the moving time window .Furthermore, we assessed the spectral domain of the systolic blood pressure variability in three domain frequency ranges: low frequency , high frequency  and total  . Though Finally, the baroreflex sensitivity (BRS) was calculated using a modification of the sequential cross-correlation method. ABP was used to find systolic peaks and the heart beat period, then a linear regression between the 10-s series of heart beat period and the corresponding 10-s series of systolic blood pressure over the time window results in the BRS . BRS mayWe implemented a wide variety of time-series tests and models to assess both functionality and associated causality between the individual ARVs and PRx. To help elucidate the uses of these methods as well as the limitations and pitfalls of such techniques, we will give an overview of the methods. However, a full conceptual understanding of these individual methodologies can be found from their respective literature .The three major methods used were: vector autoregressive integrated moving average (VARIMA) impulse response function plots (IRF), Granger Causality Testing and Hierarchical Clustering. These methods were chosen for their exploratory nature and their use in previous analyses of temporal physiology within TBI .IRF are used to graphically demonstrate the causal effect of an impulse on a system. For our uses we created VARIMA models to represent the relationship between PRx and each ARV. Then we created a simulated impulse on the VARIMA model from each respective ARV on PRx and vice versa. In this way we graphically demonstrated the patient specific interaction between each ARV and PRx.In order to derive a VARIMA model in an effective manner  but also to evaluate the accuracy of a VARIMA model, we performed a Box-Jenkin’s autoregressive integrative moving average (ARIMA) model for each patients’ PRx and all ARVs .Initially, PRx and ARVs were evaluated for time stationarity using the: autocorrelation function (ACF) plots, partial autocorrelation function (PACF) plots and Kwiatkowski–Phillips–Schmidt–Shin (KPSS). The augmented Dickey-Fuller (ADF) was used to test for root trend. Note we assume that all variables have some aspect that is both interdependent and linear, due to the interconnection of circulatory/vascular function.auto.arima (a pre-built R function) was used to determine the upper order limit for tested ARIMA models  . A formuSince the ACF and PACF did not indicate any cyclical trends in the variables, with ADF and KPSS indicating that all variables were stationary, we employed basic VARMA models with autoregressive order of four and moving average order of four. This was based on the findings from individual patient ARIMA models of ARVs for each patient and past work evaluating the ARIMA models of ICP and MAP .A VARIMA model autoregressive order of four was chosen given the optimal ARIMA models for many ARVs was less than two, as well as previous studies found that most patient’s ICP and MAP had an autoregressive order of two . Thus, aNext, the coefficients derived from these VARIMA models were employed to derive the IRF plots between PRx and an individual ARV. The IRF plots provide a descriptive graphical representation of the impact of PRx on an ARV, and an ARV on PRx, by using the previously generated VARIMA models and modelling a one unit orthogonal impulse of one variable on the other, and vice versa . DepicteDue to the high variability in the IRF plots and the difficulty that arises with simple graphical interpretations of large datasets, a simple method to help separate models into two categories (“more responsive” verses “less responsive”) was used. To do this the impulse response was normalized with respect to its original variable data. Then identified if the response was greater than an absolute value of 0.001 threshold  after 10 min . In this way, we could infer if the impulse created a stronger response within the subsequent variables and differentiate responses.Granger causality testing is used to identify the assistance of one interdependent variable to predict another interdependent variable, beyond the degree to which the variable predicts itself . In thisp-values for all ARVs vs. PRx   .The entire database was subdivided based on some simple parameters and re-evaluated to see if the VARIMA IRF analysis or Granger causality test displayed any outlying groups. Parameters included were age , Glasgow outcome scale extended (GOSE) at 6 months , Marshall computer tomography (CT) score , sex , the first 24 h only and the first 72 h only. Due to the similarity between the first 24 h only, 72 h only and the full time; all data presented will be of the full time.https://www.R-project.org/). The alpha was set at 0.05 for significance. No multiple error correction test was performed at this time as the analysis is in the preliminary exploratory phase. The patient population was summarized using simple descriptive statistics, including median/mean and standard deviation/IQR where applicable.All statistical analyses were conducted using R (R Core Team (2016). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL p-values for each variable. This gives the overarching relationship between the PRx and each ARV.For the Granger causality test, we performed a Mann-Whitney U comparison test between the F-statistics of PRx on an ARV and an ARV on PRx over the entire population. As well we bar plotted the number of significant A total of 47 patients were included in this study. The mean age was 43.5 ± 23.5 years, with 37 (80.9%) being males. The median admission total GCS score was 6 (IQR: 3.5–9), and motor sub-scores were 4 (IQR: 1.5–5). Six patients (12.8%) presented with bilaterally unreactive pupils, and ten (21.3%) unilaterally unreactive pupils. The median duration of digital signal recording was 2.67 (IQR: 1.35–5.74) days. To assess the relationship between PRx and ARVs, we employed VARIMA modelling with an IRF. VARIMA models of autoregressive order 4 and moving average order 4 were employed for each patient for the first 24 h only, 72 h only and the full data. IRF plots provide a descriptive visualization of the relationship between each ARV and PRx  in the “more responsive” category were; HRV_VLF, SBPV_HF, SBPV_TOT, BPV_M, and BPV_D. Likewise for PRx on APVs demonstrating over five patients in the “more responsive” category only had BRS and HRV_VLF.p-values . In general, across the population, we found that the Granger causality test was inconclusive, with bidirectional causal features between PRx and ARVs seen across the cohort. In addition, some patients favored PRx impacting ARVs, though some showed the alternative causal relationship and not all directional relationships reached significance. p-values, for every patient using the entire data set of full time. Of note, the causal direction of the relationship was not significantly changed when evaluating only the first 24 or 72 h of data.To assess the directional response between ARVs and PRx, we performed a Granger causality test comparing data sets for all patients. The Mann-Whitney U comparisons test between PRx and ARVs are in p-value was HRV_RMS in the first 24 and 72 h only. From p-value significant patients from PRx on APV to APV on PRx. This may indicate a more impactful response from PRx in these relationships.The only variable that had a significant From the VARIMA IRF, PRx impulse most often caused a decrease in BRS. All other variables failed to have a consistent common PRx impulse response.Finally, the hierarchical clustering analysis helped confirm the connection that the variables had with one another. Though there was significant heterogeneity in the individual plots, PRx was most associated with BRS and HRV_LF_HF in a majority of patients. For an example plot, Sub-group analysis failed to demonstrate any significant findings or finding that would be consider different from the full data. Dividing patients into sex, <60 vs. ≥60 age groups and six-month GOSE of <2 vs. ≥2 did not identify any significant outliers or an increased percentage of responsive patients. However, nearly all VARIMA IRF plots with a significant response (either PRx on an ARV or vice versa) had a Marshall CT score of 4 or higher.We compared cerebrovascular reactivity as measured through PRx with various ARVs like HRV, BPV and BRS. We evaluated underlying behaviors by employing complex time-series analyses, like: ARIMA, VARIMA, IRF plots, Granger causality testing, and hierarchical clustering. Through this evaluation of PRx and ARVs, some exploratory insights into the association in physiological responses were illustrated. The preliminary evidence supports the idea that certain ARVs may have a clinically relevant association with impaired PRx. Further, results here help outline the framework for the role that systemic autonomic response has on cerebral autoregulation. However, the insights here must be tempered by the following limitations inherent with the use of any continuous ABP waveform method but in particular those of a spectral nature.2-induced increases in CBF  . Furthern > 5). This implies that autonomics may, in fact, be responsible for causing derangements in cerebrovascular reactivity and may be important in achieving optimal CBF. Furthermore, from the associated nature of BRS, HRV_VLF and HRV_LF_HF, the sympathetic autonomic efferent response may be the primary autonomic factor associated with PRx response  . LikewisFinally, nearly all VARIMA IRF plots with a significant response (either PRx on an ARV or vice versa) had a Marshall CT score of 4 or higher. This may indicate intracranial injury burden as a driver of the autonomic/cerebrovascular reactivity relationships, which is in keeping with recent literature supporting the strong association between diffuse acceleration-deceleration injury patterns and the development of cerebral autoregulation impairment/failure .In summation, there appears to be a directional impact of PRx on ARVs as assessed through Granger causality and IRF plots in some patients. Despite corroboration through various statistical approaches, the outcome of this study should be interpreted as only a preliminary exploration into the interconnected nature between ARVs and cerebrovascular reactivity. The responses themselves are significantly heterogeneous from patient to patient, with the IRF showing both positive and negative responses in PRx values. Thus, future work continuously analyzing PRx and ARVs would benefit from large cohorts separated into key demographical groups, with the use of clustering methodology to isolate homogeneous physiological factors. Key among these groups would be patients with impaired vs intact cerebrovascular reactivity. The heterogeneity in patient response, coupled with the small cohort size, leaves these statistical models quite limited in their overall assessment.As this was an exploratory analysis of the ARVs and PRx, many overarching limitations could be assessed. First, this is a retrospective analysis of a relatively small prospectively collected dataset. As such, our findings should only be considered exploratory and preliminary. Further, the results here may not be generalizable to other TBI populations and requires validation in larger multi-center high-frequency physiologic datasets. Second, patient injury severity and treatment heterogeneity could have influenced the physiologic signal response and is something that will require more tailored and refined datasets, with the use of clustering methodology to isolate homogeneous physiological factors. Third, the nature of these ARVs and their connection with cerebral autoregulation is severely limited, with the individual variables themselves still up to interpretation as to which aspect of the autonomic nervous system they truly represent . Thus, aFinally, the statistical methodology employed was computationally tasking and, as such, implementing such methodologies on larger cohorts would benefit from more robust central computing services.Using statistical methods like ARIMA, VARIMA IRF, Granger causality and hierarchical clustering, we evaluated the temporal relationship between ARVs and cerebrovascular reactivity (as measured through PRx) in moderate/severe TBI patients. Granger causality testing demonstrated inconclusive results, with bidirectional relationships between PRx and ARVs in most of the cohort studied. However, the ARVs of BRS, HRV_LF_HF and HRV_VLF all demonstrated a stronger connection to PRx than other ARVs, indicating that the sympathetic autonomic response may be connected to cerebrovascular reactivity derangements. Finally, BRS was consistently one of the most responsive ARVs to PRx, possibly demonstrating a unique connection. However, this work is exploratory and preliminary, with further examination required to extract any underlying relationships.


Background: Peripheral vascular disease (PVD) is an atherosclerotic disease associated with increased morbidity and mortality among chronic kidney disease (CKD) patients. However, despite the substantial burden of PVD in CKD, local data are lacking.Objective: To determine the prevalence and predictors of PVD in predialysis CKD patients.Method and Materials: The study was cross-sectional. One hundred fifty hypertensive CKD patients and age- and sex-matched hypertensive non-CKD subjects were consecutively enrolled at the renal unit of Delta State University Teaching Hospital (DELSUTH), Oghara. Structured questionnaires were used to obtain information on participants' demographic data and health status. PVD was defined by an ankle-brachial index of < 0.9 or > 1.4 in either lower extremity. eGFR was calculated from serum creatinine using the MDRD equation.Results: The mean ages of the study and control groups were 48±14 and 51±15years, respectively. The sex ratio was 3:2 in favour of males for both the study and control groups. The majority of the study group was in CKD stage 4 (44%). The prevalence of PVD was higher among the CKD group compared with controls (24.0% vs. 14.7%). Of the CKD patients with PVD, 11.1% were symptomatic. Predictors of PVD in the study group were eGFR , diastolic BP , MAP , urinary ACR  and smoking history .Conclusion and Recommendation: PVD is common and largely asymptomatic in CKD patients. The predictors of PVD in this study were eGFR, diastolic BP, mean arterial pressure (MAP), urinary albumin to creatinine ratio (ACR), and smoking. A proactive assessment of PVD and early intervention in CKD patients is needed. The global burden of chronic kidney disease (CKD) has assumed epidemic proportions worldwide in the last decade, and this has been associated with a considerable increase in morbidity and mortality ,2. Data Peripheral vascular disease (PVD) is an atherosclerotic disease associated with increased morbidity and mortality among chronic kidney disease (CKD) patients ,7. CKD iConversely, albuminuria, which is a surrogate for generalized endothelial dysfunction and an independent cardiovascular risk factor, is strongly associated with medial arterial calcification (MAC), which is responsible for higher-than-normal or false-normal ABI in CKD patients . Ankle-bThe burden of PVD in selected populations, such as hypertensive and diabetic patients, has been well-studied in Nigeria ,15. HoweAnkle-Brachial Index (ABI) is the most cost-effective and risk-free atherosclerosis tool in clinical settings. The ankle-brachial index is an objective, simple, reliable, and non-invasive method of diagnosing PVD. Its simplicity, non-invasiveness, and affordability make ABI an easily performed procedure in the office or consulting room . The ankSimilarly, in the Chronic Renal Insufficiency Cohort (CRIC) study involving stage 3 or greater CKD patients, 15% of participants had an ABI < 0.9, with only 7% of those with ABI-defined PVD presenting with a classical history of intermittent claudication . Among CThe study was hospital-based descriptive cross-sectional. A total of 150 hypertensive CKD patients as well as age- and sex-matched hypertensive non-CKD subjects, were consecutively enrolled at the renal and cardiology units of Delta State University Teaching Hospital (DELSUTH), Oghara. DELSUTH is a 250-bed state-owned tertiary hospital in Delta State, South-Southern Nigeria. The hospital serves as the main referral center in Delta State and the neighboring states of Edo, Bayelsa, Anambra, and Ondo. Interviewer-administered structured questionnaires were used to obtain information on the demographic data and health status of participants, such as duration of hypertension, history of diabetes mellitus, history of CKD, and smoking. The brachial and ankle systolic pressures were obtained using the automated oscillometric method with Omron M3 Intellisense after having the participant rest for at least 10 minutes. An automated sphygmomanometer cuff of appropriate size (about 12.5cm wide) was applied evenly on the bare arm, with the lower edge at 2.5cm above the antecubital fossa. A cuff about 15cm wide was used for all obese participants. Readings were taken in a supine position on both arms (the higher of the two arms was the reference pressure). The brachial artery was palpated and located. Doppler gel was applied to the skin over the localized brachial artery, and the Doppler probe was held at about 50 degrees to the artery to enhance the quality of the signal obtained . The ABIBlood samples were obtained for the fasting serum lipid profile, fasting blood sugar, and serum creatinine. Urine samples were obtained for the urinary albumin/creatinine ratio (UACR). Estimated GFR was calculated from serum creatinine using the Modification of Diet in Renal Disease (MDRD) equation . CKD wasData analysisIBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. was used for data management and analysis. Continuous variables were expressed as the mean (SD) for unskewed data or the interquartile range for skewed data. Differences in continuous and categorical variables between the CKD and non-CKD groups were assessed by the student's t-test and chi-square analysis, respectively. A p-value of <0.05 was considered statistically significant.Predictors and associations were determined by multiple linear regression and logistic regression analysis, respectively.Sociodemographic and health characteristics of the study populationOne hundred and fifty hypertensive CKD subjects and one hundred and fifty hypertensive non-CKD comparative participants who fulfilled the inclusion criteria were recruited. The mean ages of the study and comparative groups were 48.6113.93 years and 51.015.45 years, respectively . Eighty-nine percent of the hypertensive CKD group and 84% of the hypertensive non-CKD comparative group were younger than 65 years of age. Forty-six-point-seven percent of the study group and 54.7% of the comparative group were in the 45-64 years age group. There was no significant difference in the age distribution between the study and the comparative group  , packed cell volume (PCV), serum calcium, and albumin compared to the non-CKD group.On the other hand, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure, serum phosphate, serum calcium-phosphate product, UACR, and serum creatinine were significantly higher among the hypertensive CKD group than the hypertensive non-CKD group.There was no significant difference in the mean age and ankle-brachial index between the CKD group and the comparative group Table .The most common causes of CKD were hypertensive nephrosclerosis (36%), chronic glomerulonephritis 32%), and diabetic nephropathy (22.6%)  Table .In this study, the prevalence of PVD generally increased with deteriorating renal functions, being lowest in CKD stage 2 and highest in CKD stage 5 at 8% and 47%, respectively, p = 0.013  is the leading cause of morbidity and mortality in patients at every stage of chronic kidney disease ,2. The iPeripheral vascular disease is an indicator of systemic atherosclerosis, and CKD is a recognized risk factor for atherosclerosis due to the increased prevalence of both traditional and non-traditional risk factors of atherosclerosis among the CKD population. The prevalence of PVD is dependent on several factors, particularly the method of diagnosis, age as well as the gender of the population studied.In this study, the mean ages of the CKD and non-CKD groups were 49.61 ± 13.93 years and 51.04 ± 15.45 years, respectively, which are comparable with earlier studies that reported the mean ages of CKD patients as being between the 3rd and 5th decades . Thus, CFifty-nine point three percent 59.3%) of the CKD group in this study presented at CKD stage 4; only 13.3% were at CKD stage 2. This confirms an earlier report by Ulasi et al. in a south-east Nigerian study, in which the majority of the patients studied presented in CKD stages 4 and 5 [% of the The prevalence of PVD (defined as an ABI less than 0.9 or greater than 1.4) of 24% in the hypertensive CKD group was significantly higher than in the comparative group, as was expected. The finding in this study is consistent with that described in the NHANES study but higher than the 15% prevalence in the Chronic Renal Insufficiency Cohort (CRIC) study involving 3612 predominantly stage 3 CKD patients ,24. The This study, despite its strength of being the first on PVD in the CKD population in South-South Nigeria, had limitations, such as the ABI used in the evaluation of PVD is associated with falsely elevated values in CKD. Toe-Brachial Index (TBI), which correlates better with PVD in CKD, was not done due to logistics. Similarly, because it is a single-center cross-sectional study, patient selection might be biased, and our conclusion should not be generalized. However, the findings in the study will not only provide local data but also be a platform for future studies on the subject.PVD is common and largely asymptomatic in CKD patients. The burden of CKD alone is worrisome, let alone complications with PVD when they occur. The predictors of PVD in this study were eGFR, diastolic BP, MAP, urinary ACR, and smoking. Therefore, the index study not only strengthens the prevalence of PVD in CKD patients but also advocates a need for proactive assessment of PVD and early intervention in CKD patients.