Background: National Health and Nutrition Examination Survey (NHANES) data indicate only 50% with hypertension (HTN) have controlled blood pressure (BP) yet limited data are available regarding patient’s knowledge of and satisfaction with their BP control. Methods: We utilized MyHealthStory, an online health information exchange portal to identify a rural, diverse HTN population. Adult patients (≥ 18 yrs) were recruited from existing federally-qualified health center (FQHC) sites. The survey was sent via email to 5000 patients who voluntarily shared email addresses through MyHealthStory. Equal numbers of men and women of any race/ethnicity with a diagnosis of HTN and who consented to receive information about research in MyHealthStory were targeted. We developed the 21 question survey using Qualtrics. The first 300 patients who completed the survey were included. We compared a) patient-reported BP control (BP ≥ 140/90; or <140/90) and patient-reported satisfaction with BP control (yes=happy, no=unhappy) and b) patient reported BP control and perception of BP control (well controlled, uncontrolled); using McNemar’s test for paired nominal data. Results: Here we report data from the 238 completed surveys received from Caucasians (n=184, 61% female) and African Americans (n=54, 83% female). Among 117 Caucasians reporting BP, 51% (n=60) reported uncontrolled BP, 52% (n=61) reported perception of well controlled BP (p=0.49). A total of 77% (n=46) of patients who had uncontrolled BP reported satisfaction with their HTN care compared to 96% in those who had controlled BP ( P <0.0001). Among 32 African Americans reporting BP, only 13% (n=4) reported controlled BP but 31% (n=10) reported perception of well controlled BP (p=0.034). Among the 4 African Americans whose BP was controlled, all 4 reported satisfaction with their HTN care, while among the 28 patients who reported uncontrolled BP, 23 (82%) reported satisfaction with their HTN care ( P <0.0001). Conclusions: Among hypertensive individuals, our survey data suggest there is a substantial disconnection between reported BP control, perception of BP control and satisfaction with HTN treatment, suggesting need for improvement in patient education surrounding HTN treatment and BP control.
Background: Women frequently present with non-typical angina (NTA) making ischemia diagnosis and treatment challenging. We hypothesized that mortality would be higher in women with obstructive coronary artery disease (CAD) and NTA vs typical angina (TA). Methods: We studied 364 Women’s Ischemia Syndrome Evaluation (WISE) participants with signs and symptoms of ischemia and obstructive CAD, defined as ≥50% stenosis by WISE angiography core laboratory. TA was defined as sub-sternal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin, while NTA was defined as symptoms not meeting criteria for TA. Death was confirmed by National Death Index. Time to death was analyzed and plotted using Kaplan-Meier survival analyses. The analyses were adjusted by age using a Cox Proportional Hazards regression, and reported with a hazard ratio (HR) and 95% confidence interval (CI). Results: Overall, 249 (68%) NTA and 115 (32%) TA women had a mean age of 63 ± 12yrs and 21% were non-white. Women with NTA were more hypertensive (72% vs. 60%, p=0.03) and more often on angiotensin-converting enzyme inhibitor (37% vs 25%, p= 0.03) than women with TA. There was no difference in mean cholesterol level, CAD severity or body mass index between the two groups. Over a median of 8.8 years, 122 (34%) women died including 92 NTA and 30 TA (HR 1.5, 95% CI 1.006, 2.30) (Figure). Conclusions: Among WISE women with signs and symptoms of ischemia and obstructive CAD, NTA has a higher mortality compared to TA. These findings extend prior evidence that chest pain, including NTA, identifies higher risk in women with obstructive CAD. These data support intensive management and clinical follow up of women with obstructive CAD and NTA. Further evaluation regarding ischemic burden and treatment is ongoing to further understand the elevated NTA mortality.
Cardiovascular disease (CVD) prevalence remains elevated globally. We have previously shown that a one-week lifestyle "immersion program" leads to clinical improvements and sustained improvements in quality of life in moderate to high atherosclerotic CVD (ASCVD) risk individuals. In a subsequent year of this similarly modeled immersion program, we again collected markers of cardiovascular health and, additionally, evaluated intestinal microbiome composition. ASCVD risk volunteers (
Large elastic arteries stiffen with age, which predisposes older adults to increased risk for cardiovascular disease. Aerobic exercise training is known to reduce the risk for cardiovascular disease, but the optimal exercise prescription for attenuating large elastic arterial stiffening in older adults is not known.The purpose of this randomized controlled trial was to compare the effect of all-extremity high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on aortic pulse wave velocity (PWV) and carotid artery compliance in older adults.Forty-nine sedentary older adults (age = 64 ± 1 yr), free of overt major clinical disease, were randomized to HIIT (n = 17), MICT (n = 18), or nonexercise controls (CONT; n = 14). HIIT (4 × 4 min at 90% HRpeak interspersed with 3 × 3 min active recovery at 70% HRpeak) and isocaloric MICT (70% HRpeak) were performed on an all-extremity non-weight-bearing ergometer, 4 d·wk for 8 wk under supervision. Aortic (carotid to femoral PWV [cfPWV]) and common carotid artery compliance were assessed at pre- and postintervention.cfPWV improved by 0.5 m·s in MICT (P = 0.04) but did not significantly change in HIIT and CONT (P > 0.05). Carotid artery compliance improved by 0.03 mm·mm Hg in MICT (P = 0.001), but it remained unchanged in HIIT and CONT (P > 0.05). Improvements in arterial stiffness in response to MICT were not confounded by changes in aortic or brachial blood pressure, HR, body weight, total and abdominal adiposity, blood lipids, or aerobic fitness.All-extremity MICT, but not HIIT, improved central arterial stiffness in previously sedentary older adults free of major clinical disease. Our findings have important implications for aerobic exercise prescription in older adults.
Women with ischemia and no obstructive coronary artery disease (INOCA) are at increased risk for heart failure (HF) hospitalizations, which is predominantly HF with preserved ejection fraction (HFpEF). We aimed to identify predictors for the development of heart failure HF in a deeply phenotyped cohort of women with INOCA and long-term prospective follow-up.
Aging is associated with arterial remodeling and dysfunction which predispose older adults to increased risk for cardiovascular disease (CVD). Although aerobic exercise training is associated with decreased risk for CVD, the optimal exercise training regimen to induce vascular adaptations in older adults is unknown. In older adults, there is some evidence that aerobic exercise improves vascular function in the exercising limbs, but not in the non‐exercising limbs, suggesting that all‐extremity exercise might be advantageous in the aged population. The purpose of this study was to compare, in older adults, the effect of all‐extremity high‐intensity interval training (HIIT) vs. moderate‐intensity continuous training (MICT) on arterial structure and function in the exercising arms and legs. Thirty‐six sedentary adults (55 to 76 yrs of age, 64±1 yrs; mean±SE), free of major clinical disease, were randomized to HIIT (n=13), MICT (n=12), or non‐exercise control group (CONT; n=11). HIIT and MICT were performed on a non‐weight‐bearing all‐extremity ergometer (Airdyne, Schwinn) on 4 days/week for 8 weeks under supervision. HIIT consisted of 40 min of 4×4 min intervals at 90% of peak heart rate (HRpeak) interspersed by 3 min bouts at 70% of HRpeak, while MICT consisted of 47 min at 70% of HRpeak. At pre‐ and post‐intervention, limb pulse wave velocity (PWV) was assessed in the arm (brachial to radial artery) and leg (femoral to posterior tibial artery; Doppler flowmeters), and arterial compliance (ultrasonography and applanation tonometry), intima‐medial thickness (IMT; ultrasonography) and blood flow (Doppler) were assessed at the brachial and common femoral arteries. Blood flow significantly increased after HIIT, but not MICT, in the femoral artery (HIIT: 546.5±58.4 vs. 769.2±88.8 ml/min, P<0.01; MICT: 669.1±48.9 vs. 733.6±44.4 ml/min, CONT: 683.7±95.7 vs. 703.3±76 ml/min, P≥0.3; pre‐ vs. post‐intervention) while in the brachial artery blood flow remained unchanged (HIIT: 112.3±16.8 vs. 105.8±13.6 ml/min, MICT: 127.1±18.2 vs. 108.7±14.3 ml/min, CONT: 109.3±17.3 vs. 114.5±22.3 ml/min, P≥0.2). Arm and leg PWV, and brachial and femoral artery compliance and IMT were not influenced by the intervention (P≥0.9). In conclusion, 8 weeks of all‐extremity HIIT, but not MICT, improved femoral, but not brachial, blood flow in previously sedentary older adults.
