Despite considerable advances in pharmacological treatments, hypertension remains a major cause of premature morbidity and mortality worldwide since elevated blood pressure (BP) adversely influences cardiovascular and renal outcomes. Accordingly, the current hypertension guidelines recommend the adoption of dietary modifications in all subjects with suboptimal BP levels. These modifications include salt intake reduction and a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean diet (MedDiet), independently of the underlying antihypertensive drug treatment. However, dietary modifications for BP reduction in adults with prehypertension or hypertension are usually examined as stand-alone interventions and, to a lesser extent, in combination with other dietary changes. The purpose of the present review was to summarize the evidence regarding the BP effect of salt restriction in the context of the DASH diet and the MedDiet. We also summarize the literature regarding the effects of these dietary modifications when they are applied as the only intervention for BP reduction in adults with and without hypertension and the potent physiological mechanisms underlying their beneficial effects on BP levels. Available data of randomized controlled trials (RCTs) provided evidence about the significant BP-lowering effect of each one of these dietary strategies, especially among subjects with hypertension since they modulate various physiological mechanisms controlling BP. Salt reduction by 2.3 g per day in the DASH diet produces less than half of the effect on systolic blood pressure (SBP)/diastolic blood pressure (DBP) (-3.0/-1.6 mmHg) as it does without the DASH diet (-6.7/-3.5 mmHg). Although their combined effect is not fully additive, low sodium intake and the DASH diet produce higher SBP/DBP reduction (-8.9/-4.5 mmHg) than each of these dietary regimens alone. It is yet unsettled whether this finding is also true for salt reduction in the MedDiet.

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Background Nonalcoholic fatty liver disease (NAFLD) represents the most frequent cause of chronic hepatic disease and independently determines hypertension and future cardiovascular events. Increased blood pressure variability (BPV) assessed by 24-hour blood pressure (BP) monitoring including mean arterial morning surge have been also associated with increased rates of cardiovascular events. Purpose To compare different BPV measures in hypertensive patients with and without NAFLD. Methods Consecutive newly diagnosed untreated hypertensive patients without history of cardiovascular disease underwent clinic and ambulatory BP measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. BPV was derived by assessment of standard deviation (SD) of systolic and diastolic BP (24-h, daytime and nighttime), average real variability (ARV) of systolic and diastolic BP, coefficient of variation (CV) of systolic BP (24-h, daytime), weighted SD (wSD) of systolic BP (24-h, daytime), maximum BP and mean arterial morning surge. Results Among 146 hypertensive patients (mean age 57±11 years, 64 men, 24-h mean systolic/diastolic BP 140±10/84±9 mmHg) those with NAFLD (n=76) compared to the non-NAFLD group (n=70) were younger (54.7±10.1 vs 58.6±11.2 years, respectively, p=0.03), male gender was more prevalent (42 vs 22 respectively, p=0.004), and body mass index was more increased (33.2±4.1 vs 27.0±3.5 kg/m2, p<0.001). Moreover, NAFLD patients compared to those without NAFLD were characterized by higher levels of mean arterial pressure morning surge (12.4±8.9 vs 8.7±8.5 mmHg, p=0.03), but the remaining BPV measures were not different between the two groups. NAFLD was a determinant of both diastolic BP ARV (B=0.34, p=0.007) and mean arterial morning surge (B=0.47, p=0.006) after adjustment. Conclusions Mean arterial pressure morning surge was significantly higher in hypertensive patients with NAFLD compared to their non-NAFLD counterparts, while whole day BPV measures were not increased in NAFLD except for ARV of diastolic BP. Our findings may partially explain the increased cardiovascular risk of comorbid NAFLD in hypertension. FUNDunding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Background/Introduction Few studies have examined the relationship between exercise and adherence to antihypertensive medication, examining all possible factors contributing to blood pressure control. Purpose The purpose of our study was to access the possible dependence relationship among hypertensive patients visiting the Behavioral Cardiology Unit in a Tertiary Hospital. Methods The study population consisted of patients reporting to the Behavioral Cardiology Unit in a Tertiary Hospital during a period of 6 months in 2021. In terms of holistic approach, all patients underwent a thorough clinical in-depth interview, using the Morisky Medication Adherence Scale (MMAS8), the Frail Questionnaire Screening Tool (Frailty Score) and the Patient Health Questionnaire-4 (PHQ-4). All patients also provided full history of exercise (at least 150 minutes of physical activity or 75 minutes of intense activity per week), while completing the Duke Activity Status Index (DASI). Results The population consisted of 42 hypertensive patients, 54.8% of them were females, with a mean age of all patients at 55.8±15.2 years. Body Mass Index was averaging at 27.6 kg/m2. Salt consumption above the daily suggested amount (>5gr/day) was reported by 60% of patients, binge drinking by 43% of them, while 43% had a history of active smoking. High adherence was reported by 17 patients (46%), medium adherence by 14 (37.8%) and low adherence by 6 (16.2%). Results indicate a relationship between exercise and adherence to medication. More specifically, Chi-Square test showed statistical significance between exercise and medium medication adherence in MMAS8 (MMAS8: 6-7, p=0.033). Moreover, statistical analysis showed significant relationship between exercise, frailty and PHQ-4 score. Particularly, patients with absence of exercise showed higher level of PHQ-4 score (F=7.07, p=0.011). Conclusions Our study highlights the possible dependency relationship of exercise and adherence to medication. Results indicate that patients with good adherence to medication have better behavioral activation. There is need for further research in this domain, to confirm the findings.

Background: The talonavicular joint is a rare site of dislocation. Its etiology varies and can be the result of either acute trauma or a chronic degenerative process that most commonly occurs in patients with rheumatoid arthritis or Charcot arthropathy. Our aim is to highlight the relationship between the underlying pathology of talonavicular dislocations and the final outcome in the case of operative management. Methods: We present three cases of talonavicular dislocation with the dislocation itself as the only common denominator, and a completely different etiology, natural history, treatment, and prognosis among them. Results: There was one case of a traumatic talocalcaneonavicular dislocation in a healthy individual, one case in a rheumatoid arthritis patient, and one case in a patient with diabetes mellitus. All patients were treated surgically. The outcomes were excellent, fair, and poor, respectively. Conclusions: Among many factors that influence prognosis, it is equally critical to evaluate the overall background in which the dislocation occurs so as to apply the suitable treatment. The surgeon not only needs to treat the local incident but also appreciate the general medical condition to provide the best final outcome to the patient.