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Background & Objective: Hypertension is the most important Cardio-Vascular risk factor, and also the most common cause of heart failure, stroke and renal failure. This semi-experimental study aimed at determining the effect of education, by means of Health Belief Model (HBM), on nurse’s staff knowledge, attitude and their practice toward hypertension. Materials & Methods: This semi-experimental study was done on 136 nurse’s staff selected by stratified random sampling. Data collection instrument were a questionnaire and a check-list. At first, the subjects’ knowledge, attitude and their Practice were studied by a questionnaire and a check list, and then a HBM-based educational program was carried out. For three months, Afterwards, their knowledge, attitude and practice were measured and compared with pretest findings. In statistical analysis, Wilcox on test, independent t test, ANOVA and Pearson correlation. Results: Before education the mean score of knowledge, benefit perceived, barrier perceived, threat perceived, attitude and practice was 9.68, 23.76, 25.63, 22.82, 71.99 and 4.55 respectively. After education these scores reached 16.66, 26.06, 28.94, 24.98, and 80.08 and 4.83. Based on the results, nurse’s staff training via HBM led to high knowledge, positive attitude and practice improvement (p<0.05).The difference between this research variables such as age, gender, marital status, record of service and family background was not significant, But there was significant difference between variables (occupational levels, educational levels, and hospital ward) and knowledge and practice. Furthermore, the relation between hospital ward and attitude was positive (p<0.05). Conclusion: In terms of the results, it is a necessity for nurse’s staff to participate in a HBM based educational program.

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Background & Objective: More than 50% of patients with hypertension will have end organ damage (such as: CHF, retinopathy ,CVA or renal failure).Left ventricular hypertrophy (LVH) is an independent risk factor for death and cardiovascular disease .Both renal dysfunction and LVH are signs of end organ damage so we carried out this study to evaluate the correlation between LVH in echocardiography and kidney function in patients with essential hypertension. Materials & Methods: This descriptive analytic study was carried out on 102 patients whome reffered to 5 Azar hospital in Gorgan- Iran, suffering from essential hypertension and had proved LVH in echocardiography with no other disease during 2005-6. Kidney and urinary tract assessment such as serum BUN, Creatinine level and kidney sonography was done on subjects. Left ventricular hypertrophy was defined as a left ventricular mass index (LVMI)>=135g/m2 in men and>=110g/m2 in women. Renal function was estimated by means of the serum Creatinine level and proteinuria and sonographic findings of kidney and urinary tract. Data was analysed by Spss-11.5 and Chi-Squre test. Results: The average age of patients were 60±8.8. 58%, 36% and 7% of patients had mild, moderate and sever LVH respectivly. The means of Creatinine and BUN level were 1.09±1.12 mg/dl and 20.6±10.76 mg/dl had direct correlation with kidney dysfunction (P<0.05). There was a significant relationship between LVH severity and presentse of Kidney scar in sonography (P<0.05). Conclusion: This study showed that a very large fraction of the subjects with essential hypertension have kidney problems. Therefore, serum BUN and Creatinine level and sonographic scar of kidney can be reliable markers for assessing and controlling target organ damages that are induced by Essential hypertension.

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Background & Objective: Glucose Amino Glycans (GAG) are unbranched polysacharides, major components of the basement membrane and play a key role in their molecular organization and function, also have an important role in the pathogenesis of some diseases such as hypertension. Hypertention is probably the most important health problem in several countries. But there is not yet a reliable indicator for early diagnosis of hypertension. The goal of this study was the measurement of serum and 24-h urinary GAG as an exact and early diagnostic marker. Materials & Methods: In this case – control study, 24-h urine and serum samples collected from the 53 patients and 38 persons as matched control normotensive group. Then amount of GAG was measured with spectrophotometery method. Results: Our findings showed that there is a direct relation between 24-h urinary GAG excretion and systolic blood pressure and it increases with increase of systolic blood pressure. Also amount of serum GAG increases in hypertensive patients in comparison with control group. Conclusion: This study showed that the concentration of GAG in sera and 24-h of urine samples increase in systolic hypertention.

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Background and Objective: Hypertension is considered as a major public health problem in most countries due to its association with ischemic heart disease. The aim of this study was to determine people awareness of hypertension in Golestan province of Northern Iran.

Materials and Methods: This cross sectional population based study carried out on 2497 subjects (15-65 years old) including 1500 men and 1247 women in Golestan province- Northern Iran during 2006. The subjects were chosen by proportional-cluster sampling based on sex and age groups. The subjects were interviewed, antropometric indexes and serum biochemical factors were evaluated. Blood pressure was measured three times with 5 minutes interval and defined based on JNC-7 classification. Serum cholesterol and fast blood sugar (FBS) were determined using laboratory kits (enzymatic methods), and spectrophotometery technique. Data was analyzed by SPSS-16 software and Chi-Square test.

Results: In general, the prevalence of hypertension in this region was 23.9%. with higher rate among women urban area by 3.3% and 5% respectively. Only 48.7% of hypertensive patients were aware of their disease and that was significantly more in women than men (P<0.001). Low physical activity, chronical age, diabetes, hypercholesterolemia, general obesity, central obesity and illiteracy were the risk factor for hypertension morbidity (P<0.05).

Conclusion: This study showed, in spite of prevalency of hypertension among 20% of subjects in this area only 48.7% of them were aware about their disorder.

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Background and Objective: There is a genetic background for polycystic ovary syndrome (PCOS). Due to increase metabolic disorders, lipoproteins, impaired glucose tolerance, and hypertension in PCOS patients, this study was done to determine the cardiovascular risk factors in first relative member of patients with polycystic ovarian syndrom in Shiraz, Iran. Materials and Methods: This case - control study was carried out on 107 parents and siblings of women with PCOS as cases and 107 non-PCOS parents and siblings of women as controls in Shiraz, Iran during 2007-08. Demographic characteristic, BMI, obesity and blood pressure were recorded for all subjects. Serum lipoproteins including total cholestrol, triglyceride, LDL, HDL and fasting blood sugar were measured in cases and controls. Data were analyzed using SPSS-16.5, independent t-test, Chi-Square and Kappa tests. Results: 35.3%, 26.5%, 11.76% and 5.8% of fatheres in cases were considered as overweight class I, class II, class III of obesity, respectively when compared to controls. This differecne was significant (P<0.05). Waist –hip ratio in mothers in cases (25.6%) and controls (17.9%) were higher than 0.85. Waist –hip ratio among the sisters in case and control groups were 23.5% and 17.6%, respectively (P<0.05). Hypertension was observed in 12.2% of cases and 3.7% of controls. This difference was not significant. High level of triglyceride were determined in 14.94% of cases and 6.5% of controls. A significant correlation was found between BMI and diabete II in case and control groups (P<0.05). Disorder in glucose tolerance test (GTT) in case and control goups were 19.62% and 7.47%, respectively (P<0.05). The obesity was found in 18.7%, 6.54% in cases and controls with disorder in GTT (P<0.05). Conclusion: This study showed that obesity, central obesity, high level of serum lipoproteins and hypertension among first relative member of patients with PCOS are significantly higher than the controls.

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Background and Objective: The silent brain infarctions are common in first-ever stroke. Some recent studies show the possible role of silent brain infarction in ischemic stroke. The aim of this study was to evaluate the frequency of silent brain infarction in acute first-ever ischemic stroke and its association with stroke risk factors. Materials and Methods: This descriptive - analytical study was carried out on 203 (94 males, 109 females) patients with acute first-ever ischemic stroke in Shafa hospital in Kerman, Iran during 2010. The diagnosis of ischemic stroke was made by physical examination and was confirmed by MRI and CT Scan. A questionnaire containing demographic information and risk factors including hypertension, diabetes, hyperlipidemia, cigarette smoking, ischemic and non-ischemic heart disease for stroke as well as presence of silent stroke was completed for each patient. Data were analyzed using SPSS-16 and logistic regression test. Results: The mean age of patients was 62.56±17.35 years. Among our patients history of hypertension, hyperlipidemia, cigarette smoking, diabetes, history of ischemic heart disease, history of other cardiac disease and silent stroke were observed in 66 (32.5%), 26 (12.8%), 16 (7.9%), 40 (19.7%), 27 (13.3%), 16 (7.9%) and 31 (15.3%), respectively. The probability of silent stroke among patient with hyperlipidemia, was 3.7 times more than those without hyperlipidemia (95%CI: 1.556-12.780, P<0.05). There was no significant correlation between silent stroke and the above risk factors. Conclusion: Silent stroke was found in 15% of patients with ischemic stroke. Control of hyperlipidemia can have a vital role in the prevention of silent stroke.

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Background and Objective: Coronary artery diseases are one of the main causes of mortality and morbidity. This study was done to determine the prevalence of risk factors for coronary artery diseases in patients referred to angiography center in Sari, Northern Iran. Materials and Methods: This descriptive study was performed on 2540 patients referred to angiography center in Sari city, northern Iran, during 2005-10. Risk factors including diabetes, hypertension, hyperlipidemia, smoking, Family history, CRP and also ECG changes, type and number of involved artery and the severity of vascular involvement were recorded for each patient. Results: Hypertension, hyperlipidemia, diabetes, smoking were seen in 40.8%, 40.5%, 29.1%, 12.5% of patients, respectively. Positive family history and CRP were found in 10% and 3.4% of the patients, respectively. 23.8% of patients had abnormal ECG. One, two and three vessel diseases were observed in 26.5%, 48.3%, 48.3% of cases, respectively. Left anterior descending artery constriction was seen in 75.8% and 80.4% of males and females, respectively. A significant relationship was found between diabetes and left coronary circumflex (P<0.04) and left anterior descending artery (P<0.03) constriction. Conclusion: Diabetes, hypertension, hyperlipidemia, smoking, family history, abnormal ECG are among the risk factors of coronary artery diseases in this area.

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Background and Objective: Cardiovascular autonomic neuropathy (CAN) is the most common and important type of diabetic autonomic neuropathy. Silent myocardial infarction, respiratory failure and increased mortality are the outcomes of CAN. This study was carried out to screen the cardiovascular autonomic neuropathy in non- insulin dependent diabetics patients. Method: This descriptive - analytic study was carried on 70 (22 males, 48 females) non- insulin dependent diabetics’ patients. Resting heart rate, heart rate variability, orthostatic changes in heart rate, blood pressure and corrected QT interval were recorded for each subject. The final findings were categorized as follow: 0=normal, 1=borderline and 2=CAN positive. Results: 10 (14.3%) of patients were normal, 35 (50%) of patients were borderline and 25 (35.7%) of patients were considered cardiovascular autonomic neuropathy positive. There was significant differences between duration of diabetes and three CAN scores (P<0.05). The systolic blood pressure alterations showed the maximum correlation with CAN scores (r=0.509). Conclusion: In our study, the rate of cardiovascular autonomic neuropathy was higher than other reports. The most important risk factor for cardiovascular autonomic neuropathy was more than 10 years history of diabetes mellitus.

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Background and Objective: Hypertension in long time can cause cardiovascular disorders and increase chance of stroke. This study was done to determine the association between some dietary factors and risk of hypertension. Methods: This cross-sectional study was conducted on the fourth phase (2008-11) of Tehran lipid and glucose study (TLGS). In this study 6089 subjects (2807 males and 3282 females), aged 19-70 years, were participated and dietary, demographic, anthropometric and blood pressure of each subject were collected. Dietary intake was assessed using a validated and reliable food frequency questionnaire with 147-items. Odds ratio for hypertension according to quartiles of dietary factors was determined using logistic regression with adjustment for confounder variables. Results: The rate of hypertension was 29.8%. Mean of weight, body mass index, waist circumference, prevalence of abdominal obesity and alliteration in the hypertensive subjects were significantly higher than normotensive subjects (P<0.05). There was a non significant direct relationship between energy density, total fat and saturated fat. Higher consumption of fiber was associated with lower risk of hypertension (OR: 0.62, 95% CI: 0.37-0.97). The risk of hypertension increased in the highest quartiles of dietary protein (OR: 1.20, 95% CI: 1.02-1.43). Odds ratio for hypertension was higher among subjects whom consumed lower fruits and nuts than those subjects with higher fruits consumption (OR: 1.33, 95% CI: 1.15-1.85) and nuts (OR: 1.21, 95% CI: 1.02-1.42). Conclusion: High consumption of fiber could protect against hypertension while some dietary factors such as high consumption of protein could increase risk of hypertension.

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Background and Objective: Modification of life style, nutrional regiment and insulin therapy is used for improvement of pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). This study was done to evaluate the effect of the dietary approaches to stop hypertension (DASH) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus. Methods: In this clinical trial study, 52 women with GDM were randomly divided into DASH and control groups for 4 weeks. The control diet contained 45-55% carbohydrates, 15-20% protein and 25-30% total fat. The DASH was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg/day sodium. The numbers of women whom commenced insulin therapy after dietary intervention, the mode of delivery and prevalence of polyhydramnios were assessed. The length, weight and head circumference of infants were measured during the first 24 h after birth. Results: 46.2% of women in the DASH group needed to have a cesarean section, this rate for the control group was 80.8% (P<0.05). The percentage of those who needed to commence insulin therapy after intervention was 23% for DASH group vs 73% for controls (P<0.05). Infants born to mothers on the DASH group had significantly lower body weight (3222.7 vs 3818.8 g, P<0.05), head circumference (34.2 vs 35.1 cm, P<0.05) and ponderal index (2.50 vs 2.87 kg/m3, P<0.05) compared to those born to mothers on the control diet. Conclusion: Consumption of dietary approaches to stop hypertension for 4 weeks among pregnant women with GDM resulted in improved pregnancy outcomes.

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Background and Objective: The comorbidity of type 2 diabetes mellitus (T2DM) and hypertension may exacerbate chronic inflammation and regular exercise training considered as an important therapeutic approach for such patients. This study was done to evaluate the eight weeks effects of regular exercise training on apelin and tumor necrosis factor alpha (TNF-a) plasma levels in hypertensive postmenopausal women with T2DM.
Methods: This quasi-experimental study was conducted on 20 postmenopausal women with hypertension and T2DM. Subjects non-randomlly allocated into intervention and control groups. Training program consisted of 25-40 minutes of aerobic exercise at 50-70 percent of maximal heart rate, 3 sessions per week for 8 weeks. The plasma level of apelin, TNF-a and glucose was measured, subsequently.
Results: 8 weeks exercise training was significantly reduced apelin, TNF-a, and glucose levels in the intervention group compared to the control group (P<0.05).
Conclusion: Aerobic exercise can mediate some of its favorable effects on hypertension pathological conditions associated with type 2 diabetes mellitus by reducing plasma apelin and TNF-a levels.

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Background and Objective: Hypertension is associated with changes in the structure and function of the vessels. This study was done to evaluate the effect of aerobic training with Garlic consumption on matrix metalloproteinase-3, 9 (MMP-3, MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in obese postmenopausal women with hypertension.
Methods: This double-blind clinical trial study was done on 36 obese postmenopausal women with hypertension. Participants were randomly divided into 4 groups including control group, Garlic consumption, aerobic training and training with Garlic consumption. Subjects in training groups participated in a progressive aerobic training for eight weeks, three sessions a week (55% to 65% of the reserved heart rate and for 30 to 55 min). Garlic and training with Garlic groups consumed 1000 mg of garlic supplement for eight weeks (after breakfast and dinner). Two days before and after the protocol, blood samples were taken in fasting state.
Results: The level of MMP-3 and MMP-9 were significantly decreased in Garlic, aerobic training and training with Garlic groups in compared to the control group (P<0.05). Also, the level of MMP-3 in the training with Garlic was significantly reduced in compared to the training and the Garlic groups (P<0.05). MMP-9 in the training with Garlic was significantly reduced in compared to the Garlic group (P<0.05). However, TIMP-1 level were significantly increased in the Garlic, training and training with Garlic in comparison with control group (P<0.05).
Conclusion: Aerobic training alone and in combination with Garlic affect on extracellular matrix thorough reduction of MMP-3, MMP-9 and increasing TIMP-1, improves systolic blood pressure in obese postmenopausal women with hypertension.

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Background and Objective: Considering hypertension as the most prevalent comorbidity among patients diagnosed with COVID-19, this study intended to investigate clinical characteristics and in-hospital mortality risk factors among COVID-19 patients with hypertension history.
Methods: This descriptive-analytical study was conducted on 527 hypertensive patients (277 male and 250 female) a mean age of 64.73±13.13 years infected with COVID-19 and hospitalized at Sayyad Shirazi Hospital, Gorgan Iran from February to September 2020. The patients’ data were extracted from the hospital information system and completed by patients’ medical records and telephone calls. The association between the risk factors and in-hospital mortality was identified by employing the logistic regression analysis in three various models, including model 1 (demographic data and patients’ history), model 2 (model 1 plus vital signs and pulse oximetry measurement at hospital admission) model 3 (model 2 plus laboratory findings at hospital admission). Each model individually described the odds ratios (ORs) with 95% confidence intervals (95% CIs) for every risk factor. Furthermore, a corrected area under the receiver-operating characteristics curve (AUC) was estimated to evaluate the model’s discriminatory power.
Results: Among 527 hospitalized patients, 88 patients (16.6 %) died during 6.48 days of hospitalization, of which 47 patients were men. In model 1, opium consumption (CI95%=1.16-3.85, OR=2.11) and cognitive impairment at admission (CI95%=0.98-5.40, OR=2.30) were significantly associated with higher mortality (AUC=0.65). In model 2, after adding vital signs and oxygen saturation, cognitive impairment association lost its association, and only opium consumption (CI95%=1.09-3.19, OR=1.87) and oxygen saturation (CI95%=0.90-0.95, OR=0.93) were associated with in-hospital mortality. (AUC=0.73). In model 3, after incorporating laboratory findings, with an AUC of 0.79 (CI95%=0.70-0.90), each percent higher oxygen saturation at admission was associated with a 7% decrease in in-hospital mortality (CI95%=0.88-1.00, OR=0.93). Although opium consumption and higher creatinine level lead to higher mortality, the associations were not significant.
Conclusion: Regarding the association of oxygen saturation at admission with in-hospital mortality among hypertensive patients diagnosed with COVID-19, the pulse oximetry measurement data upon admission would be crucial in evaluating these patients.