Tag Archives: improves

Antihypertensives Crossing Blood-Brain Barrier Improves Memory

Antihypertensive medications that cross the blood-brain barrier (BBB) may be linked with less memory decline, compared with other drugs for high blood pressure, suggest the findings of a meta-analysis.

Over a 3-year period, cognitively normal older adults taking BBB-crossing antihypertensives demonstrated superior verbal memory, compared with similar individuals receiving non–BBB-crossing antihypertensives, reported lead author Jean K. Ho, PhD, of the Institute for Memory Impairments and Neurological Disorders at the University of California, Irvine, and colleagues.

According to the investigators, the findings add color to a known link between hypertension and neurologic degeneration, and may aid the search for new therapeutic targets.

“Hypertension is a well-established risk factor for cognitive decline and dementia, possibly through its effects on both cerebrovascular disease and Alzheimer’s disease,” Ho and colleagues wrote in Hypertension. “Studies of antihypertensive treatments have reported possible salutary effects on cognition and cerebrovascular disease, as well as Alzheimer’s disease neuropathology.”

In a previous study, individuals younger than 75 years exposed to antihypertensives had an 8% decreased risk of dementia per year of use, while another trial showed that intensive blood pressure–lowering therapy reduced mild cognitive impairment by 19%.

“Despite these encouraging findings…larger meta-analytic studies have been hampered by the fact that pharmacokinetic properties are typically not considered in existing studies or routine clinical practice,” wrote Ho and colleagues. “The present study sought to fill this gap [in that it was] a large and longitudinal meta-analytic study of existing data recoded to assess the effects of BBB-crossing potential in renin-angiotensin system [RAS] treatments among hypertensive adults.”

Methods and Results

The meta-analysis included randomized clinical trials, prospective cohort studies, and retrospective observational studies. The researchers assessed data on 12,849 individuals from 14 cohorts that received either BBB-crossing or non–BBB-crossing antihypertensives. Cognition was assessed via the following seven domains: executive function, attention, verbal memory learning, language, mental status, recall, and processing speed.

Compared with individuals taking non–BBB-crossing antihypertensives, those taking BBB-crossing agents had significantly superior verbal memory (recall), with a maximum effect size of 0.07 (P = .03).

According to the investigators, this finding was particularly noteworthy, as the BBB-crossing group had relatively higher vascular risk burden and lower mean education level.

“These differences make it all the more remarkable that the BBB-crossing group displayed better memory ability over time despite these cognitive disadvantages,” the investigators wrote.

Still, not all the findings favored BBB-crossing agents. Individuals in the BBB-crossing group had relatively inferior attention ability, with a minimum effect size of –0.17 (P = .02).

The other cognitive measures were not significantly different between groups.

Clinicians May Consider Findings After Accounting for Other Factors

Principal investigator Daniel A. Nation, PhD, associate professor of psychological science and a faculty member of the Institute for Memory Impairments and Neurological Disorders at the University of California, Irvine, suggested that the small difference in verbal memory between groups could be clinically significant over a longer period of time.

“Although the overall effect size was pretty small, if you look at how long it would take for someone [with dementia] to progress over many years of decline, it would actually end up being a pretty big effect,” Nation said in an interview. “Small effect sizes could actually end up preventing a lot of cases of dementia,” he added.

The conflicting results in the BBB-crossing group — better verbal memory but worse attention ability — were “surprising,” he noted.

“I sort of didn’t believe it at first,” Nation said, “because the memory finding is sort of replication — we’d observed the same exact effect on memory in a smaller sample in another study…The attention [finding], going another way, was a new thing.”

Nation suggested that the intergroup differences in attention ability may stem from idiosyncrasies of the tests used to measure that domain, which can be impacted by cardiovascular or brain vascular disease. Or it could be caused by something else entirely, he said, noting that further investigation is needed.

He added that the improvements in verbal memory within the BBB-crossing group could be caused by direct effects on the brain. He pointed out that certain ACE polymorphisms have been linked with Alzheimer’s disease risk, and those same polymorphisms, in animal models, lead to neurodegeneration, with reversal possible through administration of ACE inhibitors.

“It could be that what we’re observing has nothing really to do with blood pressure,” Nation explained. “This could be a neuronal effect on learning memory systems.”

He went on to suggest that clinicians may consider these findings when selecting antihypertensive agents for their patients, with the caveat that all other prescribing factors have already been taking to account.

“In the event that you’re going to give an ACE inhibitor or an angiotensin receptor blocker anyway, and it ends up being a somewhat arbitrary decision in terms of which specific drug you’re going to give, then perhaps this is a piece of information you would take into account – that one gets in the brain and one doesn’t – in somebody at risk for cognitive decline,” Nation said.

Exact Mechanisms of Action Unknown

Hélène Girouard, PhD, assistant professor of pharmacology and physiology at the University of Montreal, said in an interview that the findings are “of considerable importance, knowing that brain alterations could begin as much as 30 years before manifestation of dementia.”

Since 2003, Girouard has been studying the cognitive effects of antihypertensive medications. She noted that previous studies involving rodents “have shown beneficial effects [of BBB-crossing antihypertensive drugs] on cognition independent of their effects on blood pressure.”

The drugs’ exact mechanisms of action, however, remain elusive, according to Girouard, who offered several possible explanations, including amelioration of BBB disruption, brain inflammation, cerebral blood flow dysregulation, cholinergic dysfunction, and neurologic deficits. “Whether these mechanisms may explain Ho and colleagues’ observations remains to be established,” she added.

Andrea L. Schneider, MD, PhD, assistant professor of neurology at the University of Pennsylvania, Philadelphia, applauded the study, but ultimately suggested that more research is needed to impact clinical decision-making.

“The results of this important and well-done study suggest that further investigation into targeted mechanism-based approaches to selecting hypertension treatment agents, with a specific focus on cognitive outcomes, is warranted,” Schneider said in an interview. “Before changing clinical practice, further work is necessary to disentangle contributions of medication mechanism, comorbid vascular risk factors, and achieved blood pressure reduction, among others.”

The investigators disclosed support from the National Institutes of Health, the Alzheimer’s Association, the Waksman Foundation of Japan, and others. The interviewees reported no relevant conflicts of interest.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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This post originally appeared on Medscape Medical News Headlines

Oil prices rally towards $70 as demand outlook improves

Author: RT
This post originally appeared on RT Business News

Crude oil prices got a major boost this week thanks to optimistic expectations about demand from OPEC+ and rebalancing fuel inventories in the United States.

Brent jumped to over $ 68 per barrel, and West Texas Intermediate neared $ 65 per barrel by the middle of the week and could rise even further unless headwinds appear.

Earlier in the week, OPEC+ forecast that oil demand this year would increase by 5.95 million barrels per day (bpd). This was an upward revision of 70,000 bpd from an earlier projection, and this fact injected optimism in traders, as did OPEC+’s decision to forego a meeting this week and keep producing at previously agreed rates.

Meanwhile, the US Energy Information Administration reported on Wednesday that crude oil inventories are within the five-year average for the season—for the first time in months—and that middle distillate inventories were down by a sizeable 3.3 million barrels last week.

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Middle distillates, mainly diesel, have been a headache for refiners during the pandemic as inventories reached excessive levels due to the slowdown in various activities involving freight transport. Now, businesses are returning to normal operation, according to the data, and demand for diesel is picking up.

“Between planting season and online truck deliveries, you have a nice number in the diesel,” Bob Yawger, energy futures director at Mizuho, said as quoted by Reuters. “Planting season is doing wonders for the distillate market.”

It seems the latest fuel demand developments in the United States were enough to eclipse earlier worry about Indian fuel demand amid a resurgence of infections there.

“There’s a lot of green shoots in demand,” according to Matt Sallee, portfolio manager at asset manager TortoiseEcofin, as quoted by Bloomberg. According to him, the situation in India is “clearly a headwind, but looking at what’s going on in the US, it’s a completely different story.”

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“The market expects a major revitalization for global oil demand from this summer onwards,” Rystad Energy’s head of oil markets Bjornar Tonhaugen told Bloomberg. “As vaccination campaigns progress and as lockdowns are set to soon be lifted in Europe and other recovering economies, the need for road and jet fuels will increase and the result will be felt.”

Indeed, optimism appears to be on the rise. Goldman Sachs, which has been particularly bullish on oil, has stuck to its forecast that Brent could hit $ 80 a barrel in the second half of this year. The investment bank also said in a new note that it expected global oil demand to book its strongest rebound ever over the next six months.

At 5.2 million bpd, according to Goldman, the demand jump will be the result of accelerating vaccinations in Europe, which would, in turn, lead to greater demand for travel. This will also lead to an uptick in jet fuel demand—the worst hit segment of the fuel industry—to the tune of 1.5 million bpd, according to the investment bank. 

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If the rally continues as forecast, it will provide a much-needed breathing space for the Persian Gulf’s oil-dependent economies, most of which need Brent to trade much higher than current prices to avoid another budget deficit. A price of $ 70 per barrel of the most traded benchmark may be high enough for some, such as Saudi Arabia. Still, others, notably Bahrain, need oil at $ 100 per barrel to make their budget ends meet.

At the same time, however, it would undermine calls for a green recovery from the pandemic. The IEA has already warned that emissions are once again on the rise after last year’s lull because of lockdowns. The rebound in oil demand that banks and analysts expect appears to be proof that the transition to all-electric transport might be more challenging than some hope.

This article was originally published on Oilprice.com

Xbox Series X and S update improves console's best feature: Quick Resume gets an upgrade

Xbox Series X and Series S consoles are about to receive a big new system update.

The next major firmware update is currently being tested by early access preview members.

And according to Xbox engineering lead Eden Marie, the new update makes big changes to one of the console’s best features.

In a series of tweets previewing the update, Marie points out that you can now group your games by titles that support Quick Resume.

Likewise, the upcoming update will let you know if the game you’re currently running supports the feature in the first place.

“Alpha and Alpha Skip Ahead Insiders: in case you were wondering why I shared that tip on reordering groups!” reads an Eden Marie tweet.

“See what’s stored in Quick Resume from your groups list (Guide, Home and My games & apps) and see if your running game supports Quick Resume in the Guide.”

In a follow-up tweet, the Xbox engineer confirms that fans can delete Quick Resume games that are no longer required.

“Also, delete your Quick Resume save for games you don’t care about anymore.”

Quick Resume is one of the Xbox Series X and S console’s best new features. It lets you instantly rejoin upwards of six previously played games.

However, as I pointed out in my Xbox Series X review, not all games support the feature. Furthermore, there’s no way of knowing which games support the feature or not, other than trial and error.

The upcoming Xbox update improves Quick Resume functionality by removing any doubt.

In other Xbox news, Microsoft has started sending out invites to the next stage in its Xbox Cloud Gaming beta program.

Starting from today (April 20), select Xbox Game Pass Ultimate subscribers will be selected to join the beta.

The beta makes it possible to stream Xbox games in the cloud on iPhones, iPads and Windows 10 PCs.

If you want to get an invite and try the service for yourself, then you’ll need to live in one of the 22 supported countries.

This includes the United Kingdom, USA, Canada, France, Germany, Ireland, Italy and Spain. The full list of supported countries can be found by visiting the Microsoft website.

As Microsoft points out in the official announcement, you’ll also need to subscribe to Xbox Game Pass Ultimate.

Microsoft explains more: “Starting tomorrow, we’ll begin sending out invites to select Xbox Game Pass Ultimate members to start testing the Xbox Cloud Gaming limited beta for Windows 10 PCs and Apple phones and tablets via web browsers.

This article originally appeared on Daily Express :: Gaming Feed

IMF improves Russia’s economic growth outlook for this year

The International Monetary Fund (IMF) has upgraded its forecast for economic growth in Russia for the second time this year, and now expects GDP to gain as much as 3.8% in 2021.

In its April report, the IMF raised its projections for Russia’s GDP by 0.8% compared to its January outlook, and by 1.5% compared to its October forecast.

While the outlook for Russia’s economic performance in 2021 has been raised for the second time, next year’s growth could be slightly slower than previously thought. The IMF expects Russia’s GDP to grow at the same pace as this year in 2022, by 3.8%, which is 0.1% lower than it predicted in January.
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The upward revision for Russia came as the IMF revealed a more optimistic forecast for the global economy amid vaccine rollouts. The fund now expects it to expand by 6% in 2021.

The fund said that Russia’s fiscal policy was countercyclical in 2020. It also revised the figures for the crisis year, when Russia, like most countries, implemented lockdowns to prevent the spread of the coronavirus. According to its latest estimates, the Russian economy shrank 3.1%, not the previously reported 3.6%.

“There will be some degree of consolidation in 2021 in line with economic recovery, and the deficit is likely to come back to the fiscal rule’s limit in 2022,” the IMF said.
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After the new economic outlook was released, IMF Executive Director for Russia Aleksei Mozhin said he expects the Russian economy to outpace its pre-crisis pace of growth in 2021 and 2022. He explained the growth potential by the rather slow development of the Russian economy before the pandemic hit, along with an expected rebound after the recent downturn.

The IMF improved projections for the Russian economy shortly after the World Bank did the same. However, the World Bank is less optimistic, projecting the country’s GDP to grow by 3.3% this year and 3.4% next year.

For more stories on economy & finance visit RT’s business section

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