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Blair J, Kempf MC, Dionne JA, Causey-Pruitt Z, Wise JM, Jackson EA, Muntner P, Hanna DB, Kizer JR, Fischl MA, Ofotokun I, Ramirez C, Gange SJ, Brill IK, Levitan EB. Awareness, treatment, and control of hypertension among women at risk or living with HIV in the US South. AIDS 2024; 38:1703-1713. [PMID: 38905486 PMCID: PMC11293969 DOI: 10.1097/qad.0000000000003960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
OBJECTIVES Timely control of hypertension is vital to prevent comorbidities. We evaluated the association of race/ethnicity and HIV infection with incident hypertension outcomes, including awareness, treatment, and control. DESIGN We evaluated cisgender women living with HIV and sociodemographically matched women living without HIV recruited into four Southern sites of the Women's Interagency HIV Study (WIHS) (2013-2019). METHODS We calculated measurements of the time to four events or censoring: incident hypertension, hypertension awareness, hypertension treatment, and hypertension control. Hazard ratios for race/ethnicity and HIV status were calculated for each outcome using Cox proportional-hazards models adjusted for sociodemographic, behavioral, and clinical risk factors. RESULTS Among 712 women, 56% were hypertensive at baseline. Forty-five percentage of the remaining women who were normotensive at baseline developed incident hypertension during follow-up. Non-Hispanic white and Hispanic women had faster time to hypertension control compared with non-Hispanic black women ( P = 0.01). In fully adjusted models, women living with HIV who were normotensive at baseline had faster time to treatment compared with normotensive women living without HIV ( P = 0.04). CONCLUSION In our study of women in the US South, non-Hispanic black women became aware of their hypertension diagnosis more quickly than non-Hispanic white and Hispanic women but were slower to control their hypertension. Additionally, women living with HIV more quickly treated and controlled their hypertension compared with women living without HIV.
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Affiliation(s)
| | - Mirjam-Colette Kempf
- Department of Epidemiology
- Schools of Nursing, Public Health and Medicine
- Department of Medicine/Division of Infectious Diseases
| | | | | | | | - Elizabeth A Jackson
- School of Medicine/Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York City, New York
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Healthcare System, and Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, California
| | - Margaret A Fischl
- Department of Medicine/Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Igho Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Catalina Ramirez
- School of Medicine, University of North Carolina at Chapel Hill, North Carolina
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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2
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McLaughlin MM, Beatty AL. Disparities in awareness and treatment among women with hypertension: Insights from the American Heart Association Research Goes Red Registry. Am J Prev Cardiol 2024; 19:100703. [PMID: 39070020 PMCID: PMC11279261 DOI: 10.1016/j.ajpc.2024.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/07/2024] [Accepted: 06/23/2024] [Indexed: 07/30/2024] Open
Abstract
Hypertension is an important modifiable risk factor for cardiovascular disease and affects nearly one-third of women in the U.S. Prior research has demonstrated declining rates of blood pressure (BP) control nationally among women, and there are significant racial and ethnic disparities in both hypertension prevalence and outcomes among U.S. women. However, national-level data on attitudes and awareness of women with hypertension are limited. To address this gap, data were analyzed from participants with self-reported hypertension enrolled in the American Heart Association's Research Goes Red Registry. Of 6170 women who responded as of February 2023, 1835 (30 %) reported a history of hypertension. The top health concerns reported among women with hypertension were weight, healthcare access and costs, and hypertension. Health concerns varied significantly by age, race, and ethnicity; younger women and Black and Hispanic women were more likely to report hypertension as their top concern. Among women with self-reported hypertension, 77 % reported knowing their BP, and 90 % reported being on an anti-hypertensive. Black and Hispanic women were less likely to know their BP compared to White women. Younger women were less likely to be treated for hypertension, and there were also disparities in treatment by employment status and among uninsured women. In this national registry of women in the U.S., gaps and disparities exist in awareness and treatment of hypertension, highlighting targets for quality improvement in hypertension care for women.
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Affiliation(s)
- Megan M. McLaughlin
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, M1184A, San Francisco, CA 94117, USA
| | - Alexis L. Beatty
- Division of Cardiology, Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, M1184A, San Francisco, CA 94117, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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3
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Kapoor M, Holman B, Cohen C. Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study. JMIR Cardio 2024; 8:e57241. [PMID: 39102277 DOI: 10.2196/57241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/04/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors. OBJECTIVE This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension. METHODS The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 "Non-invasive Sphygmomanometers-Part 2: Clinical investigation of automated measurement type." This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app's BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app's PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values. RESULTS The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app's mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively. CONCLUSIONS A calibration-free, software-only medical device was independently tested against ISO 81060-2:2018/AMD 1:2020. The safety and performance demonstrated in this study suggest that this technique could be a potential solution for rapid and scalable screening and management of hypertension.
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Affiliation(s)
| | - Blair Holman
- Element Materials Technology Boulder, Louisville, CO, United States
| | - Carolyn Cohen
- Element Materials Technology Boulder, Louisville, CO, United States
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4
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Nguyen BA, Alexander MR, Harrison DG. Immune mechanisms in the pathophysiology of hypertension. Nat Rev Nephrol 2024; 20:530-540. [PMID: 38658669 DOI: 10.1038/s41581-024-00838-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
Hypertension is a leading risk factor for morbidity and mortality worldwide. Despite current anti-hypertensive therapies, most individuals with hypertension fail to achieve adequate blood pressure control. Moreover, even with adequate control, a residual risk of cardiovascular events and associated organ damage remains. These findings suggest that current treatment modalities are not addressing a key element of the underlying pathology. Emerging evidence implicates immune cells as key mediators in the development and progression of hypertension. In this Review, we discuss our current understanding of the diverse roles of innate and adaptive immune cells in hypertension, highlighting key findings from human and rodent studies. We explore mechanisms by which these immune cells promote hypertensive pathophysiology, shedding light on their multifaceted involvement. In addition, we highlight advances in our understanding of autoimmunity, HIV and immune checkpoints that provide valuable insight into mechanisms of chronic and dysregulated inflammation in hypertension.
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Affiliation(s)
- Bianca A Nguyen
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Matthew R Alexander
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN, USA
| | - David G Harrison
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA.
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN, USA.
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA.
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5
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Zhang J, Liu S, Ding W, Wan J, Qin JJ, Wang M. Resolution of inflammation, an active process to restore the immune microenvironment balance: A novel drug target for treating arterial hypertension. Ageing Res Rev 2024; 99:102352. [PMID: 38857706 DOI: 10.1016/j.arr.2024.102352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
The resolution of inflammation, the other side of the inflammatory response, is defined as an active and highly coordinated process that promotes the restoration of immune microenvironment balance and tissue repair. Inflammation resolution involves several key processes, including dampening proinflammatory signaling, specialized proresolving lipid mediator (SPM) production, nonlipid proresolving mediator production, efferocytosis and regulatory T-cell (Treg) induction. In recent years, increasing attention has been given to the effects of inflammation resolution on hypertension. Furthermore, our previous studies reported the antihypertensive effects of SPMs. Therefore, in this review, we aim to summarize and discuss the detailed association between arterial hypertension and inflammation resolution. Additional, the association between gut microbe-mediated immune and hypertension is discussed. This findings suggested that accelerating the resolution of inflammation can have beneficial effects on hypertension and its related organ damage. Exploring novel drug targets by focusing on various pathways involved in accelerating inflammation resolution will contribute to the treatment and control of hypertensive diseases in the future.
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Affiliation(s)
- Jishou Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Siqi Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Wen Ding
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China; Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China.
| | - Juan-Juan Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; Center for Healthy Aging, Wuhan University School of Nursing, Wuhan, China.
| | - Menglong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China.
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6
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Stabile E, Muiesan ML, Ribichini FL, Sangiorgi G, Taddei S, Versaci F, Villari B, Bacca A, Benedetto D, Fioretti V, Laurenzano E, Scapaticci M, Saia F, Tarantini G, Grassi G, Esposito G. Italian Society of Interventional Cardiology (GISE) and Italian Society of Arterial Hypertension (SIIA) Position Paper on the role of renal denervation in the management of the difficult-to-treat hypertension. Minerva Cardiol Angiol 2024; 72:313-328. [PMID: 38535984 DOI: 10.23736/s2724-5683.23.06433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Renal denervation (RDN) is a safe and effective strategy for the treatment of difficult to treat hypertension. The blood pressure (BP)-lowering efficacy of RDN is comparable to those of many single antihypertensive medications and it allows to consider the RDN as a valuable option for the treatment of difficult to treat hypertension together with lifestyle modifications and medical therapy. A multidisciplinary team is of pivotal importance from the selection of the patient candidate for the procedure to the post-procedural management. Further studies are needed to investigate the effect of RDN on clinical outcomes and to better identify the predictors of BP response to RDN in order to recognize the patients who are more likely to benefit from the procedure.
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Affiliation(s)
- Eugenio Stabile
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy
| | - Maria L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Flavio L Ribichini
- Division of Cardiovascular Medicine, Department of Medicine, University of Verona, Verona, Italy
| | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Bruno Villari
- Division of Cardiology, Sacro Cuore di Gesù Hospital, Benevento, Italy
| | - Alessandra Bacca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniela Benedetto
- Division of Cardiology, Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Fioretti
- Division of Cardiology, Cardiovascular Department, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy -
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7
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Schonberger RB. Preoperative Blood Pressures and the Physician Anesthesiologist. Anesthesiology 2024; 141:208-210. [PMID: 38980164 PMCID: PMC11239125 DOI: 10.1097/aln.0000000000005101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
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8
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Gnanenthiran SR, Barnhart M, Tan I, Zeng M, O'Hagan E, Gianacas C, Chow C, Schlaich M, Rodgers A, Schutte AE. Shop-to-Stop Hypertension: A multicenter cluster-randomized controlled trial protocol to improve screening and text message follow-up of adults with high blood pressure at health kiosks in hardware retail stores. Contemp Clin Trials 2024; 143:107610. [PMID: 38878995 DOI: 10.1016/j.cct.2024.107610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
High blood pressure (BP) is the leading preventable risk factor for death, but only one in three patients achieve target BP control. A key contributor to this problem is poor population awareness of high BP, as the majority of patients are asymptomatic. The Shop-To-Stop Hypertension study is a multicenter, cluster-randomized controlled trial to identify, refer and follow adults in need of hypertension care, whilst raising population-wide awareness. In participants with high BP measured by SiSU Health Stations located in major hardware chain stores across New South Wales, Australia, we will determine whether text message-based nudges will encourage repeat BP checks and visits to their doctor. Based on pilot data, we anticipate 65,340 participants will be screened over 12 months, of which 18% will have high BP. Thirty hardware stores will be randomized (1:1) to: (i) Intervention: participants detected with high BP (≥140/≥90 mmHg) will receive text message-based nudges to return for a repeat SiSU Health Station BP check and to visit their general practitioner (GP) to check and manage their BP; (ii) Control: participants with high BP will not receive text messages. The primary outcome is the difference in the proportion of participants with high BP having a repeat BP check at hardware Health Stations in the intervention vs. control group at 12 months. This novel setting for screening utilises a novel 'citizen science' approach inviting the general public to perform their own BP screening at health kiosks and foster behavioral change. This will allow screening in a low-stress environment.
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Affiliation(s)
- Sonali R Gnanenthiran
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia; Concord Repatriation General Hospital, Concord West, Sydney, NSW, Australia
| | - Molly Barnhart
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Isabella Tan
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Mingjuan Zeng
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Dept. of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Christopher Gianacas
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Clara Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Dept. of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Anthony Rodgers
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Aletta E Schutte
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Sydney, NSW, Australia.
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Lu Y, Arowojolu O, Qiu X, Liu Y, Curry LA, Krumholz HM. Barriers to Optimal Clinician Guideline Adherence in Management of Markedly Elevated Blood Pressure: A Qualitative Study. JAMA Netw Open 2024; 7:e2426135. [PMID: 39106065 PMCID: PMC11304113 DOI: 10.1001/jamanetworkopen.2024.26135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/09/2024] [Indexed: 08/07/2024] Open
Abstract
IMPORTANCE Hypertension poses a substantial public health challenge. Despite clinical practice guidelines for hypertension management, clinician adherence to these guidelines remains suboptimal. OBJECTIVE To develop a taxonomy of suboptimal adherence scenarios for severe hypertension and identify barriers to guideline adherence. DESIGN, SETTING, and PARTICIPANTS This qualitative content analysis using electronic health records (EHRs) of Yale New Haven Health System included participants who had at least 2 consecutive visits with markedly elevated blood pressure (BP; defined as at least 2 consecutive readings of systolic BP ≥160 mm Hg and diastolic BP ≥100 mm Hg) between January 1, 2013, and December 31, 2021, and no prescription for antihypertensive medication within a 90 days of the second BP measurement. Data analysis was conducted from January to December 2023. MAIN OUTCOMES AND MEASURES The primary outcome was scenarios and influencing factors contributing to clinician nonadherence to the guidelines for hypertension management. A thematic analysis of EHR data was conducted to generate a pragmatic taxonomy of scenarios of suboptimal clinician guideline adherence in the management of severe hypertension. RESULTS Of the 20 654 patients who met criteria, 200 were randomly selected and thematic saturation was reached after analyzing 100 patients (mean [SD] age at index visit, 66.5 [12.8] years; 50 female [50%]; 8 Black [8%]; 5 Hispanic or Latino [5%]; 85 White [85%]). Three content domains emerged: (1) clinician-related scenarios (defined as noninitiation or nonintensification of treatment due to issues relating to clinician intention, capability, or scope), which included 2 subcategories (did not address and diffusion of responsibility); (2) patient-related scenarios (defined as noninitiation or nonintensification of treatment due to patient behavioral considerations), which included 2 subcategories (patient nonadherence and patient preference); and (3) clinical complexity-related scenarios (defined as noninitiation or nonintensification of treatment due to clinical situational complexities), which included 3 subcategories (diagnostic uncertainty, maintenance of current intervention, and competing medical priorities). CONCLUSIONS AND RELEVANCE In this qualitative study of EHR data, a taxonomy of suboptimal adherence scenarios for severe hypertension was developed and barriers to guideline adherence were identified. This pragmatic taxonomy lays the foundation for developing targeted interventions to improve clinician adherence to guidelines and patient outcomes.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Oreoluwa Arowojolu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Xiaoliang Qiu
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Leslie A. Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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10
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Jiang J, Tan H, Xia Z, Li J, Zhou S, Huang T. Serum vitamin D concentrations and sleep disorders: insights from NHANES 2011-2016 and Mendelian Randomization analysis. Sleep Breath 2024; 28:1679-1690. [PMID: 38739211 PMCID: PMC11303418 DOI: 10.1007/s11325-024-03031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE This investigation seeks to examine the association between serum vitamin D concentrations and the prevalence of sleep disorders, additionally elucidating the causal relationship via Mendelian Randomization (MR) analysis. MATERIALS AND METHODS This research employed data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016, focusing on adults aged 20-50 years reporting sleep disorders. The research encompassed 4913 American adults. Weighted multivariable logistic regression models and cubic spline analyses were utilized to evaluate the association between serum vitamin D concentrations and the incidence of sleep disorders. Additionally, a two-sample Mendelian Randomization analysis was performed to evaluate the potential causal link between serum vitamin D concentrations and the risk of sleep disorders. RESULTS Within the 2011-2016 NHANES cohort of the U.S. population, a notable inverse association was detected between serum vitamin D concentrations and sleep disorders (β = - 3.81, 95% CI: - 6.10 to - 1.52, p = 0.003). After multivariate adjustments, a higher incidence of sleep disorders was associated with lower vitamin D Concentrations (OR 1.52, 95% CI 1.10-2.10, trend p = 0.014). Restricted cubic spline regression analysis indicated a linear association between serum vitamin D concentrations and sleep disorders(non-linearity p > 0.05). Lastly, the two-sample MR analysis yielded evidence supporting a potential causal connection between serum vitamin D concentrations and sleep disorders, with each unit increase in genetically predicted serum vitamin D reducing the odds ratio to 0.78 (95% CI 0.61-0.99, p = 0.044). CONCLUSIONS These results imply that lower vitamin D concentrations in the population might correlate with a heightened risk of sleep disorders, suggesting the importance of considering vitamin D supplementation when treating sleep disorders.
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Affiliation(s)
- Junjie Jiang
- Department of Otolaryngology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei Province, People's Republic of China
| | - Hanyu Tan
- Department of Otolaryngology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei Province, People's Republic of China
| | - Zhongfang Xia
- Department of Otolaryngology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei Province, People's Republic of China
| | - Jun Li
- Department of Otolaryngology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei Province, People's Republic of China
| | - Shuang Zhou
- Department of Otolaryngology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei Province, People's Republic of China
| | - Tao Huang
- Department of Otolaryngology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, Hubei Province, People's Republic of China.
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11
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Liang C, Zhao R, Du J, Zhao G, Zhang Y. The association between dietary selenium intake and telomere length in hypertension. J Clin Hypertens (Greenwich) 2024; 26:990-996. [PMID: 38967394 PMCID: PMC11301449 DOI: 10.1111/jch.14861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/29/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024]
Abstract
Telomere length is closely linked to biological aging, oxidative stress, and the development of cardiovascular diseases. This study aimed to assess the association between dietary selenium intake and telomere length in individuals with hypertension. Data on dietary selenium intake were captured through the National Health and Nutrition Examination Survey (NHANES) computer-assisted dietary interview system (CADI). Telomere length determination entailed selecting blood samples from all participants in the NHANES database. The analysis was performed using Analysis System software, with Empower stats utilized for data analysis. Results showed that there was a significant association between dietary selenium intake and telomere length in hypertension, particularly within the female group. In female hypertension cases, a 1 mcg increase in dietary selenium intake corresponded to a telomere length increase of 1.19 bp, even after adjusting for age, race, BMI, marital status, physical activity, energy intake, and stroke history. The relationship between dietary selenium intake and telomere length exhibited a linear pattern in female hypertension patients. This study identified a positive association between dietary selenium intake and telomere length in hypertension, particularly within the female group.
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Affiliation(s)
- Cui Liang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Ruixue Zhao
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Jiaqi Du
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Guojun Zhao
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yanzhou Zhang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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12
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Sims KD, Wei PC, Penko JM, Hennessy S, Coxson PG, Mukand NH, Bellows BK, Kazi DS, Zhang Y, Boylan R, Moran AE, Bibbins-Domingo K. Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults. Hypertension 2024; 81:1758-1765. [PMID: 38881463 PMCID: PMC11254541 DOI: 10.1161/hypertensionaha.124.22704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The 2017 American College of Cardiology/American Heart Association blood pressure guideline classified 31 million US adults as having stage 1 hypertension and recommended clinicians provide counseling on behavioral change to the low-risk portion of this group. However, nationwide reductions in cardiovascular disease (CVD) and associated health care expenditures achievable by nonpharmacologic therapy remain unquantified. METHODS We simulated interventions on a target population of US adults aged 35 to 64 years, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: that is, untreated systolic blood pressure 130 to 139 mm Hg with diastolic BP <90 mm Hg; no history of CVD, diabetes, or chronic kidney disease; and a low 10-year risk of CVD. We used meta-analyses and trials to estimate the effects of population-level behavior modification on systolic blood pressure. We assessed the extent to which restricting intervention to those in regular contact with clinicians might prevent the delivery of nonpharmacologic therapy. RESULTS Controlling systolic blood pressure to <130 mm Hg among the 8.8 million low-risk US adults with stage 1 hypertension could prevent 26 100 CVD events, avoid 2900 deaths, and save $1.7 billion in total direct health care costs over 10 years. Adoption of the Dietary Approaches to Stop Hypertension diet could prevent 28 000 CVD events. Other nonpharmacologic interventions could avert between 3800 and 19 500 CVD events. However, only 51% of men and 75% of women regularly interacted with clinicians for counseling opportunities. CONCLUSIONS Among low-risk adults with stage 1 hypertension, substantial benefits to cardiovascular health could be achieved through public policy that promotes the adoption of nonpharmacologic therapy.
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Affiliation(s)
- Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Pengxiao Carol Wei
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Joanne M. Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Susan Hennessy
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Pamela G. Coxson
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Nita H. Mukand
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Brandon K. Bellows
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts
| | - Yiyi Zhang
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ross Boylan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Andrew E. Moran
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
- Editorial Board, Journal of the American Medical Association, Chicago, Illinois
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13
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Metlock FE, Hinneh T, Benjasirisan C, Alharthi A, Ogungbe O, Turkson-Ocran RAN, Himmelfarb CR, Commodore-Mensah Y. Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review. Hypertension 2024; 81:1675-1700. [PMID: 38887955 DOI: 10.1161/hypertensionaha.123.22571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.
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Affiliation(s)
- Faith E Metlock
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | - Thomas Hinneh
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | | | | | - Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Research Section, Beth Israel Deaconess Medical Center, Boston, MA (R.-A.N.T.-O.)
- Harvard School of Medicine, Boston, MA (R.-A.N.T.-O.)
| | - Cheryl R Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins School of Medicine, Baltimore, MD (C.R.H.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
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14
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Oliveras A, Vázquez S, Vega MV, Camps C, Illana FJ, Armario P, Crespo M, de la Sierra A. Improvement of non-adherence and reduction of BP values in patients with difficult-to-treat hypertension: the ATHAN clinical trial. Hypertens Res 2024:10.1038/s41440-024-01748-x. [PMID: 39085464 DOI: 10.1038/s41440-024-01748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/21/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024]
Abstract
Hypertension treatment and blood pressure (BP) control reduce cardiovascular disease burden. However, prevalence of controlled BP is overall insufficient and lack of adherence to treatment is a suggested major contributor. This prospective, randomized clinical trial was designed to evaluate whether a specific 3-month (m) action plan to improve therapeutic adherence results in a decrease in BP. Patients with ambulatory 24 h-BP ≥ 130/80 mmHg despite receiving ≥2 antihypertensive drugs and with therapeutic non-compliance confirmed by antihypertensive drugs analyzed in urine were randomized (1:1) to receive a specific 3 m program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified and knowledge of non-adherence was only notified to patients randomized to the intervention group. Before randomization and at 3 m all patients underwent urinary screening for antihypertensive drugs and 24 h-ambulatory-BP monitoring. Forty-five patients (36% women, mean age: 58 ± 13 yr) were randomized. At 3 m, mean (95% CI) BP differences (INT vs. C) were 12.2 mmHg (4.3-20.8), adjusted-p = 0.032 and 8.7 mmHg (2.5-14.8), adjusted-p = 0.018 for 24 h-systolic and 24 h-diastolic BP, respectively. Differences (INT vs. C) for office SBP and DBP were 18.4 mmHg (6.8-30.1), adjusted-p = 0.005 and 15.7 mmHg (7.2-24.2), adjusted-p < 0.001. Non-detected antihypertensive drugs were median [IQR]: 40% [25-100] and 0% [0-20] at baseline and 3 m, respectively, in the INT group, and 33.3% [25-63.7] and 33.3% [23.8-57.9], in the C group (p < 0.001 for the 3-month between-group comparison). A combined action plan of notifying knowledge of non-adherence plus a 3-month specific nursing intervention to improve therapeutic adherence results in BP reduction in patients with inadequate therapeutic compliance.
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Affiliation(s)
- Anna Oliveras
- Hypertension Unit, Nephrology Dpt, Hospital del Mar, Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Spain.
| | - Susana Vázquez
- Hypertension Unit, Nephrology Dpt, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Carme Camps
- Hypertension Unit, Nephrology Dpt, Hospital del Mar, Barcelona, Spain
| | - Francisco J Illana
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Pedro Armario
- Cardiovascular Risk Area, Complex Hospitalari Universitari Moisès Broggi, University of Barcelona, Barcelona, Spain
| | - Marta Crespo
- IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Spain
- Nephrology Dpt, Hospital del Mar, Barcelona, Spain
| | - Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Terrassa, Spain
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15
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Krumholz HM, de Lemos JA, Sattar N, Linetzky B, Sharma P, Mast CJ, Ahmad NN, Bunck MC, Stefanski A. Tirzepatide and blood pressure reduction: stratified analyses of the SURMOUNT-1 randomised controlled trial. Heart 2024:heartjnl-2024-324170. [PMID: 39084707 DOI: 10.1136/heartjnl-2024-324170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Treating obesity may be a pathway to prevent and control hypertension. In the SURMOUNT-1 trial in people with obesity or overweight with weight-related complications, 72-week tirzepatide treatment led to clinically meaningful body weight and blood pressure reduction. Post hoc analyses were conducted to further explore the effects of tirzepatide on the pattern of blood pressure reduction and whether the effects were consistent across various subgroups. METHODS The mixed effect for repeated measure model was used to compare changes in overall blood pressure, across demographic and clinical subgroups, baseline blood pressure subgroups and hypertension categories between SURMOUNT-1 participants randomised to treatment with tirzepatide and placebo. The association between weight changes and blood pressure and adverse events associated with low blood pressure were also evaluated by mediation analysis. RESULTS Tirzepatide treatment was associated with a rapid decline in systolic and diastolic blood pressure over the first 24 weeks, followed by blood pressure stabilisation until the end of the observation period, resulting in a significant net reduction by 72 weeks of 6.8 mm Hg systolic and 4.2 mm Hg diastolic blood pressure versus placebo. Participants randomly assigned to any tirzepatide group were more likely than those assigned to placebo to have normal blood pressure at week 72 (58.0% vs 35.2%, respectively). The effects were broadly consistent across baseline blood pressure subgroups, shifting the blood pressure distribution curve to lower blood pressure levels. The mediation analysis indicated that weight loss explained 68% of the systolic and 71% of the diastolic blood pressure reduction. Low blood pressure adverse events were infrequent, but the rate was higher in the tirzepatide group. CONCLUSIONS In these post hoc analyses, in participants with obesity or overweight, tirzepatide was associated with reduced blood pressure consistently across participant groups primarily via weight loss, with relatively few blood pressure-related adverse events. TRIAL REGISTRATION NUMBER NCT04184622.
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Affiliation(s)
- Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - James A de Lemos
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland
| | | | | | - Casey J Mast
- Eli Lilly and Company, Indianapolis, Indiana, USA
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16
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Yao X, Zhou Z. Dietary intake of luteolin is negatively associated with all-cause and cardiovascular mortality in chronic kidney disease patients. BMC Public Health 2024; 24:2044. [PMID: 39080632 PMCID: PMC11290116 DOI: 10.1186/s12889-024-19458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Luteolin (Lut), a flavonoid present in the daily diet, exhibits potent anti-inflammatory and renoprotective effects. However, the association between Lut and chronic kidney disease (CKD) remains uncertain. The objective of this study is to explore the potential correlation. METHODS A total of 2,393 CKD patients were enrolled in a prospective cohort in the National Health and Nutrition Examination Survey (NHANES). A 24-h dietary recall was utilized to estimate the intake of dietary Lut based on the type and amount of food consumed. The National Death Index mortality data was utilized to ascertain all-cause and cardiac mortality (as of December 27, 2023). Cox proportional hazards model was used to estimate the relationship between Lut intake and mortality risk. RESULTS The median Lut intake was 0.305 mg/day, with interquartile range was 0.105-0.775 mg/day. During the follow-up period (median, 93 months), 682 all-cause deaths (217 cardiovascular disease [CVD] deaths) were recorded. Per unit increase in Lut intake reduced all-cause mortality by 27% (P < 0.001) and cardiac mortality by 34% (P = 0.01) in CKD patients. There was an inverse dose-response association between Lut intake (range: 0-8.945 mg/day) and mortality risk. Consistent results were also shown when stratified by age, sex, race, marital status, body mass index, CKD stage, urine protein creatinine ratio strata, CKD progression risk, hypertension, and CVD. CONCLUSION Dietary Lut intake is associated with a reduction in all-cause and cardiac mortality among CKD patients, potentially attributable to the anti-inflammatory characteristics of Lut.
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Affiliation(s)
- Xiaotian Yao
- The Division of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhengxi Zhou
- Department of Urology, Ningbo Mingzhou Hospital, Ningbo, Zhejiang, China.
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17
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Napoe GS, Kermah D, Mitchell NS, Norris K. Racial Disparities in Nocturia Persist Regardless of BMI Among American Women. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00256. [PMID: 39078291 DOI: 10.1097/spv.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
IMPORTANCE It is crucial to understand the racial and ethnic disparities that exist in nocturia prevalence to appropriately manage nocturia. OBJECTIVES Nocturia is associated with increased body mass index (BMI) and is most prevalent in Black and Hispanic women, who also have the highest and second highest prevalence of obesity, respectively. We sought to better understand the association of nocturia with BMI category by race and ethnicity in U.S. women. STUDY DESIGN This was a cross-sectional study using publicly available data from the National Health and Nutrition Examination Survey data from 2005 to 2018. We estimated the prevalence of moderate to severe nocturia (defined as 2 or more episodes of nighttime urination) by BMI category within each racial and ethnic (Black, White, Hispanic, and other) group of adult women. Logistic regression was performed to determine the odds ratio of nocturia by race. RESULTS The odds of nocturia was 2.25 (2.04-2.49) for Black women, 1.27 (1.15-1.4) for Hispanic women and 0.96 (0.82-1.13) for other women compared to White women. After accounting for BMI, socioeconomic status and comorbidities, the adjusted odds ratio was 1.76 (1.42-2.16) for Black women, 1.1 (.0.88-1.38) for Hispanic women, and 0.81 (0.5-1.29) for other women compared to White women. CONCLUSIONS Black women were nearly twice as likely to have nocturia than White women. The increased odds of nocturia, while not sustained for Hispanic women, persisted for Black women regardless of socioeconomic status, BMI, and comorbidities. Our study suggests that there are factors other than weight driving the prevalence of nocturia in Black women that require further investigation.
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Affiliation(s)
| | - Dulcie Kermah
- Clinical Research Center, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Nia S Mitchell
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Keith Norris
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA
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18
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Yin Z, Tan J, Huang H, Zhao J, Gong X, Li J, Chen C, Luo F, Huang X, Wang H, Lu H, Wu M, Yu R, Lei X, Zhang Q, Xu F, Li N, Jiang H, Fu J, Cheng R, Chen Y, Zhang Y. Trends in the antimicrobial susceptibility among Chinese neonates from 2012 to 2021: a multicenter study. Antimicrob Resist Infect Control 2024; 13:83. [PMID: 39080717 PMCID: PMC11290293 DOI: 10.1186/s13756-024-01440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Antibiotic resistance is a serious global public health issue. However, there are few reports on trends in antimicrobial susceptibility in Chinese neonates, and most of the existing evidence has been derived from adult studies. We aimed to assess the trends in antimicrobial susceptibility of common pathogens in full-term neonates with invasive bacterial infections (IBIs) in China. METHODS This cross-sectional survey study analyzed the antimicrobial susceptibility in Chinese neonates with IBIs from 17 hospitals, spanning from January 2012 to December 2021. Joinpoint regression model was applied to illustrate the trends and calculate the average annual percentage change (AAPC). Using Mantel-Haenszel linear-by-linear association chi-square test, we further compared the antibiotic minimum inhibitory concentrations (MICs) by pathogens between 2019 and 2021 to provide precise estimates of changes. RESULTS The proportion of Escherichia coli with extended-spectrum-beta-lactamase-negative strains increased from 0.0 to 88.5% (AAPC = 62.4%, 95% confidence interval (CI): 44.3%, 82.9%), with two breakpoints in 2014 and 2018 (p-trend < 0.001). The susceptibility of group B Streptococcus (GBS) to erythromycin and clindamycin increased by 66.7% and 42.8%, respectively (AAPC = 55.2%, 95% CI: 23.2%, 95.5%, p-trend = 0.002; AAPC = 54.8%, 95% CI: 9.6%, 118.6%, p-trend < 0.001), as did Staphylococcus aureus to penicillin (AAPC = 56.2%; 95% CI: 34.8%, 81.0%, p-trend < 0.001). However, the susceptibility of Enterococcus spp. to ampicillin declined from 100.0 to 25.0% (AAPC = - 11.7%, 95% CI: - 15.2%, - 8.1%, p-trend < 0.001), and no significant improvement was observed in the antibiotic susceptibility of Escherichia coli to ampicillin, gentamicin, and cephalosporin. Additionally, the proportion of GBS/Staphylococcus aureus with relatively low MIC values for relevant antibiotics also increased in 2021 compared to 2019. CONCLUSIONS Antimicrobial susceptibility of the most prevalent pathogens in full-term neonates seemed to have improved or remained stable over the last decade in China, implying the effectiveness of policies and practice of antibiotic stewardship had gradually emerged.
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Affiliation(s)
- Zhanghua Yin
- Department of Pediatrics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Jintong Tan
- Department of Pediatrics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Huafei Huang
- Department of Neonatology, Jiaxing University Affiliated Women and Children Hospital, 2468 Zhonghuan East Road, Nanhu District, Jiaxing, 314000, China
| | - Jianyuan Zhao
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, School of Medicine, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Li
- Department of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neonatology, Shanghai first maternity and infant hospital, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Fei Luo
- Department of Neonatology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaoyi Huang
- Department of Neonatology, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huaiyan Wang
- Department of Neonatology, Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Hongyan Lu
- Department of Neonatology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Mingfu Wu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Renqiang Yu
- Department of Neonatology, Affiliated Women's Hospital of Jiangnan University, Wuxi, China
| | - Xiaoping Lei
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qian Zhang
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengdan Xu
- Department of Neonatology, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Ning Li
- Department of Neonatology, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, China
| | - Hong Jiang
- Department of Neonatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianhua Fu
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Gulou District, Nanjing, 210008, China.
| | - Yan Chen
- Department of Pediatrics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.
| | - Yongjun Zhang
- Department of Pediatrics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.
- Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.
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Feng Z, Chen Q, Griffin P, Li J, Abedi V, Zand R. Care settings of transient ischemic attack in the United States: A cohort study from the TriNetX health research network. J Stroke Cerebrovasc Dis 2024; 33:107888. [PMID: 39067658 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Evaluation and hospitalization rates after a transient ischemic attack (TIA)-like presentation vary widely in clinical practice. This study aimed to examine variations in care settings at initial TIA diagnosis in the United States. METHODS We retrospectively analyzed an adult cohort with a first TIA principal diagnosis between January 1, 2015, and December 31, 2019, from TriNetX Diamond Network. Care settings at TIA diagnosis were defined as hospital care (including inpatient services and observation unit care without admission) and outpatient care (including any outpatient or emergency department visits). We estimated the distribution of care settings at TIA diagnosis and examined the associations of the hospital care setting with baseline age, sex, race, ethnicity, region, and stroke history. RESULTS Among the 554,315 included patients, 38.8% received hospital care at their initial TIA diagnosis. A higher percentage of hospital care was observed in the age group of 50-64 years (40.3%), Black (46.0%), Hispanic (41.2%), South (40.9%), and Midwest (43.0%) Regions, and with a history of stroke (39.6%). Multivariable logistic regression consistently showed patients who were aged 50-64 years (Odds Ratio=1.09, 95% CI: [1.07, 1.11]), Black (1.28, [1.24, 1.32]), Hispanic (1.13, [1.09, 1.18]), from South (1.20, [1.18, 1.22]) and Midwest Region (1.33, [1.30, 1.35]), and had a history of stroke (1.02, [1.00, 1.04]) to more likely receive hospital care. CONCLUSIONS Although there are TIA care disparities based on demographics, most patients with initial TIA received acute care in outpatient settings. It is imperative to ensure primary providers can risk-stratify TIA patients and provide rapid and proper management.
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Affiliation(s)
- Zixuan Feng
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, United States
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, United States
| | - Paul Griffin
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, United States
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, United States
| | - Vida Abedi
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, United States
| | - Ramin Zand
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, United States.
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20
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Blazek O, Bakris GL. A review of novel endothelin antagonists and overview of non-steroidal mineralocorticoid antagonists for treating resistant hypertension: An update. Eur J Pharmacol 2024; 979:176752. [PMID: 39047966 DOI: 10.1016/j.ejphar.2024.176752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/11/2024] [Accepted: 06/16/2024] [Indexed: 07/27/2024]
Abstract
Several agents are emerging from five different novel classes of antihypertensive medications. We will focus on endothelin antagonists and non-steroidal mineralocorticoid receptor antagonists. While several agents exist in this later class, only a couple have demonstrated superior efficacy in resistant hypertension management. Endothelin receptor antagonists are effective therapy for primary and resistant hypertension, but they are not widely used. This is due to side effects demonstrated in large clinical trials, specifically increased peripheral edema and worsening heart failure in some cases, as well as the availability of many alternative agents to manage blood pressure effectively. However, the relationship between endothelin and its close ties to hypertension is evolving. Recent pre-clinical work explores new applications of more selective endothelin receptor antagonists. They suggest that specific subtypes of hypertension may benefit more from endothelin receptor blockade than simply those with primary hypertension. We review this topic and other related data. Lastly, we also provide a brief overview of non-steroidal mineralocorticoid receptor antagonists as some in the class show promise as antihypertensive agents.
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Affiliation(s)
- Olivia Blazek
- Department of Medicine, Am Heart Assoc. Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA.
| | - George L Bakris
- Department of Medicine, Am Heart Assoc. Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA.
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21
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Wang Y, Lee JS, Pollack LM, Kumar A, Honeycutt S, Luo F. Health Care Expenditures and Use Associated with Hypertension Among U.S. Adults. Am J Prev Med 2024:S0749-3797(24)00228-9. [PMID: 39002890 DOI: 10.1016/j.amepre.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION This study seeks to estimate health care expenditures and use associated with hypertension, focusing on differences among racial and ethnic groups. METHODS Data were from the 2019 Medical Expenditure Panel Survey, analyzed in 2023. The study sample included noninstitutionalized U.S. adults aged ≥18 years. Outcome variables were health care expenditures and events. Hypertension was determined by a self-reported diagnosis or diagnosis codes. Race and ethnicity were self-reported. A 2-part model was used to estimate expenditures associated with hypertension. A zero-inflated negative binomial model was used to estimate events associated with hypertension. Sampling designs were applied to generate nationally representative estimates. RESULTS Hypertension was associated with $2,759 (95% confidence interval [CI]: $2,039, $3,479) in health care expenditures and 10.3 (95% CI: 9.3, 11.3) health care events, including prescriptions filled, in 2019 per person. Compared with non-Hispanic White adults, hypertension-associated health care expenditures were significantly lower among Hispanic adults (difference: -$1,877; 95% CI: -$3,389, -$364) and Asian adults (difference: -$2,452; 95% CI: -$4,093, -$811), and hypertension-associated health care events were significantly lower among Hispanic adults (difference: -3.8; 95% CI: -6.1, -1.6) and non-Hispanic Asian adults (difference: -4.1; 95% CI: -6.9, -1.2). Differences between non-Hispanic White adults and non-Hispanic Black adults were not statistically significant in health care expenditures (difference: -$954; 95% CI: -$2,849, $941) and events (difference: 0.3; 95% CI: -2.1, 2.8). CONCLUSIONS This study reveals differences in health care expenditures and use associated with hypertension among racial and ethnic groups. Future studies are needed to examine potential drivers of these differences.
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Affiliation(s)
- Yu Wang
- Division of Workforce Development, Public Health Infrastructure Center, Centers for Disease Control and Prevention, Atlanta, Georgia; Data Science and Evaluation Team, American Heart Association, Dallas, Texas
| | - Jun S Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa M Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashutosh Kumar
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Bizzell US, New Carrollton, Maryland
| | - Sally Honeycutt
- Data Science and Evaluation Team, American Heart Association, Dallas, Texas
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
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22
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Rojas-Saunero LP, Hughes TM, Mayeda ER, Jimenez MP. Racial and ethnic differences in the risk of dementia diagnosis under hypothetical blood pressure-lowering interventions: The Multi-Ethnic Study of Atherosclerosis. Alzheimers Dement 2024. [PMID: 38984649 DOI: 10.1002/alz.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Substantial racial and ethnic disparities in hypertension and dementia exist in the United States. We evaluated the effect of maintaining systolic blood pressure (SBP) below clinical thresholds on dementia incidence. METHODS We included 6806 Multi-Ethnic Study of Atherosclerosis participants (44 to 84 years old). We implemented the parametric g-formula to simulate the hypothetical interventions to reduce SBP below 120 and 140 mmHg over time, accounting for time-varying confounding. We estimated risk ratios (RRs) and risk differences for dementia incidence at 19 years. RESULTS The RRs (95% confidence intervals [CIs]) comparing an intervention reducing SBP below 120 mmHg to no intervention were 0.93 (0.87 to 0.99) for total sample, 0.95 (0.88 to 1.02) for White, 0.90 (0.79 to 1.02) for Black, 0.90 (0.78 to 1.05) for Latino, and 1.16 (0.83 to 1.55) for Chinese American participants. Results for lowering SBP below 140 mmHg and with death as competing event were attenuated. DISCUSSION The reduction of SBP below 120 mmHg over time has modest effects on reducing dementia incidence. More work is needed to understand the heterogeneity across racial and ethnic groups. HIGHLIGHTS There is a potential beneficial effect in lowering SBP to reduce the risk of dementia, which may vary by race and ethnicity. The percentage of participants who would need intervention on blood pressure to meet clinical thresholds is greater for Black and Latino communities. Results are sensitive to the way that death is specified in the research question and analysis.
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Affiliation(s)
- L Paloma Rojas-Saunero
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Marcia Pescador Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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23
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Chen X, Zheng J, Wang J, Wang H, Shi H, Jiang H, Shan P, Liu Q. Global burden and cross-country inequalities in stroke and subtypes attributable to diet from 1990 to 2019. BMC Public Health 2024; 24:1813. [PMID: 38978043 PMCID: PMC11229201 DOI: 10.1186/s12889-024-19337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
DATA SOURCES The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. BACKGROUND To describe burden, and to explore cross-country inequalities according to socio-demographic index (SDI) for stroke and subtypes attributable to diet. METHODS Death and years lived with disability (YLDs) data and corresponding estimated annual percentage changes (EAPCs) were estimated by year, age, gender, location and SDI. Pearson correlation analysis was performed to evaluate the connections between age-standardized rates (ASRs) of death, YLDs, their EAPCs and SDI. We used ARIMA model to predict the trend. Slope index of inequality (SII) and relative concentration index (RCI) were utilized to quantify the distributive inequalities in the burden of stroke. RESULTS A total of 1.74 million deaths (56.17% male) and 5.52 million YLDs (55.27% female) attributable to diet were included in the analysis in 2019.Between 1990 and 2019, the number of global stroke deaths and YLDs related to poor diet increased by 25.96% and 74.76% while ASRs for death and YLDs decreased by 42.29% and 11.34% respectively. The disease burden generally increased with age. The trends varied among stroke subtypes, with ischemic stroke (IS) being the primary cause of YLDs and intracerebral hemorrhage (ICH) being the leading cause of death. Mortality is inversely proportional to SDI (R = -0.45, p < 0.001). In terms of YLDs, countries with different SDIs exhibited no significant difference (p = 0.15), but the SII changed from 38.35 in 1990 to 45.18 in 2019 and the RCI showed 18.27 in 1990 and 24.98 in 2019 for stroke. The highest ASRs for death and YLDs appeared in Mongolia and Vanuatu while the lowest of them appeared in Israel and Belize, respectively. High sodium diets, high red meat consumption, and low fruit diets were the top three contributors to stroke YLDs in 2019. DISCUSSION The burden of diet-related stroke and subtypes varied significantly concerning year, age, gender, location and SDI. Countries with higher SDIs exhibited a disproportionately greater burden of stroke and its subtypes in terms of YLDs, and these disparities were found to intensify over time. To reduce disease burden, it is critical to enforce improved dietary practices, with a special emphasis on mortality drop in lower SDI countries and incidence decline in higher SDI countries.
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Affiliation(s)
- Xian Chen
- Department of Geriatric Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Jia Zheng
- Department of Geriatric Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Jianying Wang
- Department of Geriatric Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Hongping Wang
- Department of Geriatric Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Hui Shi
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongwei Jiang
- Department of Endocrinology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.
| | - Pengfei Shan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zhejiang University School of Medicine, Binjiang Institute of Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
| | - Qiang Liu
- Department of Geriatric Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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24
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Liberman AL, Razzak J, Lappin RI, Navi BB, Bruce SS, Liao V, Kaiser JH, Ng C, Segal AZ, Kamel H. Risk of Major Adverse Cardiovascular Events After Emergency Department Visits for Hypertensive Urgency. Hypertension 2024; 81:1592-1598. [PMID: 38660784 DOI: 10.1161/hypertensionaha.124.22885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Chronic hypertension is an established long-term risk factor for major adverse cardiovascular events (MACEs). However, little is known about short-term MACE risk after hypertensive urgency, defined as an episode of acute severe hypertension without evidence of target-organ damage. We sought to evaluate the short-term risk of MACE after an emergency department (ED) visit for hypertensive urgency resulting in discharge to home. METHODS We performed a case-crossover study using deidentified administrative claims data. Our case periods were 1-week intervals from 0 to 12 weeks before hospitalization for MACE. We compared ED visits for hypertensive urgency during these case periods versus equivalent control periods 1 year earlier. Hypertensive urgency and MACE components were all ascertained using previously validated International Classification of Diseases, Tenth Revision Clinical Modification codes. We used McNemar test for matched data to calculate risk ratios. RESULTS Among 2 225 722 patients with MACE, 1 893 401 (85.1%) had a prior diagnosis of hypertension. There were 4644 (0.2%) patients who had at least 1 ED visit for hypertensive urgency during the 12 weeks preceding their MACE hospitalization. An ED visit for hypertensive urgency was significantly more common in the first week before MACE compared with the same chronological week 1 year earlier (risk ratio, 3.5 [95% CI, 2.9-4.2]). The association between hypertensive urgency and MACE decreased in magnitude with increasing temporal distance from MACE and was no longer significant by 11 weeks before MACE (risk ratio, 1.2 [95% CI, 0.99-1.6]). CONCLUSIONS ED visits for hypertensive urgency were associated with a substantially increased short-term risk of subsequent MACE.
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Affiliation(s)
- Ava L Liberman
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.)
| | | | | | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.)
| | - Samuel S Bruce
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.)
| | - Vanessa Liao
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.)
| | - Jed H Kaiser
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.)
| | - Catherine Ng
- Information Technologies and Services Department, Weill Cornell Medicine, New York (C.N.)
| | - Alan Z Segal
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute (A.L.L., B.B.N., S.S.B., V.L., J.H.K., A.Z.S., H.K.)
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25
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Evbayekha E, Okorare O, Ishola Y, Eugene O, Chike A, Abraham S, Aneke AV, Green JT, Grace AE, Ibeson CE, Ohikhuai E, Okobi OE, Akande PO, Nwafor P, Bob-Manuel T. Sociodemographic predictors of hypertensive crisis in the hospitalized population in the United States. Curr Probl Cardiol 2024; 49:102610. [PMID: 38704130 DOI: 10.1016/j.cpcardiol.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Hypertensive crisis (HC) encompasses hypertensive emergencies (HE) and urgencies (HU). METHODS A retrospective analysis of the 2016-2020 National Inpatient Sample was conducted, and all hospitalizations for HC were identified with their ICD-10 codes. A probability estimation of outcomes was calculated by performing multivariable logistic regression analysis, which took confounders into account. Our primary outcomes were SDs of HC. Secondary outcomes were myocardial infarction (MI), stroke, acute kidney injury (AKI), and transient ischemic attack (TIA). RESULTS The minority populations were more likely than the Whites to be diagnosed with HCs: Black 2.7 (2.6-2.9), Hispanic 1.2 (1.2-1.3), and Asian population 1.4 (1.3-1.5), (p < 0.0001, all). Furthermore, being male 1.1 (1.09-1.2, p < 0.0001), those with 'self-pay' insurance 1.02 (1.01-1.03, p < 0.0001), and those in the <25th percentile of median household income 1.3 (1.2-1.3, p < 0.0001), were more likely to be diagnosed with HCs. The Black population had the highest likelihood of end-organ damage: MI 2.7 (2.6-2.9), Stroke 3.2 (3.1-3.4), AKI 2.4 (2.2-2.5), and TIA 2.8 (2.7-3.0), (p < 0.0001, all), compared to their Caucasian counterpart. CONCLUSIONS Being of a minority population, male sex, low-income status, and uninsured were associated with a higher likelihood of hypertensive crisis. The black population was the youngest and had the highest risk of hypertensive emergencies. Targeted interventions and healthcare policies should be implemented to address these disparities and enhance patient outcomes.
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Affiliation(s)
| | - Ovie Okorare
- Vassar Brothers Medical Center, Nuvance Health, NY, USA
| | - Yetunde Ishola
- Oba Okunade Sijuade College of Health Sciences Igbinedion University Okada, Nigeria
| | | | | | | | - Adaeze Vivian Aneke
- Enugu State University of Science and Technology College of Medicine, Enugu State, Nigeria
| | | | | | - Cece E Ibeson
- Department of Cardiology, HonorHealth Medical Group, Scottdale, USA
| | - Evidence Ohikhuai
- Department of Pharmacy, University of Health Science and Pharmacy, St. Louis, MO, USA
| | - Okelue E Okobi
- Larkin Community Hospital, Palms Spring Campus, Miami, FL
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26
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Fishkin T, Wang A, Frishman WH, Aronow WS. Healthcare Disparities in Cardiovascular Medicine. Cardiol Rev 2024; 32:328-333. [PMID: 36511638 DOI: 10.1097/crd.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are significant healthcare disparities in cardiovascular medicine that represent a challenge for cardiologists and healthcare policy-makers who wish to provide equitable care. Disparities exist in both the management and outcomes of hypertension, coronary artery disease and its sequelae, and heart failure. These disparities are present along the lines of race, gender, and socioeconomic status. Despite recent efforts to reduce disparity, there are knowledge and research gaps among cardiologists with regards to both the scope of the problem and how to solve it. Solutions include increasing awareness of disparities in cardiovascular health, increasing research for optimal treatment of underserved communities, and public policy changes that reduce disparities in social determinants of health.
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Affiliation(s)
- Tzvi Fishkin
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
| | - Andy Wang
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
| | - William H Frishman
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
| | - Wilbert S Aronow
- From the Departments of Medicine, and Cardiology, Westchester Medical Center and New York Medical College, Vaslhalla, NY
- Westchester Medical Center and New York Medical College, Vaslhalla, NY
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27
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Jones DW. A Pathway to Better Blood Pressure Control. JAMA Cardiol 2024:2820166. [PMID: 38888898 DOI: 10.1001/jamacardio.2024.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Daniel W Jones
- Department of Medicine, University of Mississippi Medical Center, Jackson
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28
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Alanaeme CJ, Ghazi L, Akinyelure OP, Wen Y, Christenson A, Poudel B, Dooley EE, Chen L, Hardy ST, Foti K, Bowling CB, Long MT, Colantonio LD, Muntner P. Trends in the Prevalence of Multiple Chronic Conditions Among US Adults With Hypertension From 1999-2000 Through 2017-2020. Am J Hypertens 2024; 37:493-502. [PMID: 38576398 DOI: 10.1093/ajh/hpae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The prevalence of many chronic conditions has increased among US adults. Many adults with hypertension have other chronic conditions. METHODS We estimated changes in the age-adjusted prevalence of multiple (≥3) chronic conditions, not including hypertension, using data from the National Health and Nutrition Examination Survey, from 1999-2000 to 2017-2020, among US adults with (n = 24,851) and without (n = 24,337 hypertension. Hypertension included systolic blood pressure (BP) ≥130 mm Hg, diastolic BP ≥80 mm Hg, or antihypertensive medication use. We studied 14 chronic conditions: arthritis, asthma, cancer, coronary heart disease, chronic kidney disease, depression, diabetes, dyslipidemia, hepatitis B, hepatitis C, heart failure, lung disease, obesity, and stroke. RESULTS From 1999-2000 to 2017-2020, the age-adjusted mean number of chronic conditions increased more among US adults with vs. without hypertension (2.2 to 2.8 vs. 1.7 to 2.0; P-interaction <0.001). Also, the age-adjusted prevalence of multiple chronic conditions increased from 39.0% to 52.0% among US adults with hypertension and from 26.0% to 30.0% among US adults without hypertension (P-interaction = 0.022). In 2017-2020, after age, gender, and race/ethnicity adjustment, US adults with hypertension were 1.94 (95% confidence interval: 1.72-2.18) times as likely to have multiple chronic conditions compared to those without hypertension. In 2017-2020, dyslipidemia, obesity, and arthritis were the most common 3 co-occurring chronic conditions among US adults with and without hypertension (age-adjusted prevalence 16.5% and 3.1%, respectively). CONCLUSIONS In 2017-2020, more than half of US adults with hypertension had ≥3 additional chronic conditions, a substantial increase from 20 years ago.
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Affiliation(s)
- Chibuike J Alanaeme
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lama Ghazi
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Oluwasegun P Akinyelure
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ying Wen
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashley Christenson
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bharat Poudel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin E Dooley
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ligong Chen
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shakia T Hardy
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn Foti
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - C Barrett Bowling
- Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Veterans Affairs, Durham Geriatric Research Education and Clinical Center, Durham, North Carolina, USA
| | - Michelle T Long
- Section of Gastroenterology, Department of Medicine, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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29
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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Moreno-Noguez M, Alcocer L, Álvarez-López H, Cardona-Muñoz EG, Chávez-Mendoza A, Díaz-Díaz E, Enciso-Muñoz JM, Galván-Oseguera H, Rosas-Peralta M. Patients Living With Arterial Hypertension in Mexico: First Insights of The Mexican Registry of Arterial Hypertension (RIHTA Study). Am J Hypertens 2024; 37:503-513. [PMID: 38466237 PMCID: PMC11176274 DOI: 10.1093/ajh/hpae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Arterial hypertension is a significant cause of morbidity and mortality in Mexico. However, there is limited evidence to understand blood pressure management and cardiometabolic profiles. Here, we aim to assess the prevalence of controlled and uncontrolled blood pressure, as well as the prevalence of cardiometabolic risk factors among patients from the Mexican Registry of Arterial Hypertension (RIHTA). METHODS We conducted a cross-sectional analysis of participants living with arterial hypertension registered on RIHTA between December 2021 and April 2023. We used both the 2017 ACC/AHA and 2018 ESC/ESH thresholds to define controlled and uncontrolled arterial hypertension. We considered eleven cardiometabolic risk factors, which include overweight, obesity, central obesity, insulin resistance, diabetes, hypercholesterolemia, hypertriglyceridemia, low HDL-C, high LDL-C, low-eGFR, and high cardiovascular disease (CVD) risk. RESULTS In a sample of 5,590 participants (female: 61%, n = 3,393; median age: 64 [IQR: 56-72] years), the prevalence of uncontrolled hypertension varied significantly, depending on the definition (2017 ACC/AHA: 59.9%, 95% CI: 58.6-61.2 and 2018 ESC/ESH: 20.1%, 95% CI: 19.0-21.2). In the sample, 40.43% exhibited at least 5-6 risk factors, and 32.4% had 3-4 risk factors, chiefly abdominal obesity (83.4%, 95% CI: 82.4-84.4), high LDL-C (59.6%, 95% CI: 58.3-60.9), high CVD risk (57.9%, 95% CI: 56.6-59.2), high triglycerides (56.2%, 95% CI: 54.9-57.5), and low HDL-C (42.2%, 95% CI: 40.9-43.5). CONCLUSIONS There is a high prevalence of uncontrolled hypertension interlinked with a high burden of cardiometabolic comorbidities in Mexican adults living with arterial hypertension, underscoring the urgent need for targeted interventions and better healthcare policies to reduce the burden of the disease in our country.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Instituto Mexicano del Seguro Social, Estado de México, Oriente, México
| | - Moises Moreno-Noguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar No. 55 Zumpango, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Estado de México, México
| | - Luis Alcocer
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Ángeles del Pedregal, Ciudad de México, México
| | - Humberto Álvarez-López
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital Puerta de Hierro Andares, Zapopan, Jalisco, México
| | - Ernesto G Cardona-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Adolfo Chávez-Mendoza
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Enrique Díaz-Díaz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Hospital General Zacatecas "Luz González Cosio", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Zacatecas, Zacatecas, México
- Asociación Nacional de Cardiólogos de México, Ciudad de México, México
| | - Héctor Galván-Oseguera
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Martín Rosas-Peralta
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Titular Academia Nacional de Medicina, Ciudad de México, México
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Elendu C, Amaechi DC, Elendu TC, Amaechi EC, Elendu ID. Dependable approaches to hypertension management: A review. Medicine (Baltimore) 2024; 103:e38560. [PMID: 38875433 PMCID: PMC11175961 DOI: 10.1097/md.0000000000038560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/16/2024] Open
Abstract
Hypertension, a prevalent chronic condition characterized by elevated blood pressure, is a significant global health burden, contributing to approximately 7.5 million premature deaths annually. While existing literature predominantly focuses on conventional treatment modalities, this paper offers unique insights into dependable approaches to hypertension management. Drawing upon epidemiological data, it highlights the increasing prevalence of hypertension across diverse populations, emphasizing demographic disparities and regional variations. This article underscores the need for tailored interventions considering individual risk profiles and socioeconomic determinants. Beyond conventional lifestyle modifications and pharmacological therapies, it explores emerging trends such as mindfulness-based interventions and integrative medicine in hypertension management. Additionally, it discusses the role of digital health technologies and telemedicine in enhancing patient engagement and remote monitoring, optimizing treatment outcomes. Furthermore, the paper addresses the evolving landscape of personalized medicine and genomic advancements in predicting individual responses to antihypertensive therapies, advocating for precision medicine approaches. This paper advocates for a holistic and patient-centered approach to hypertension management by offering a comprehensive overview of established and emerging strategies. It underscores the importance of interdisciplinary collaboration, continuous education, and innovative research endeavors to address the multifaceted challenges posed by hypertension and improve global cardiovascular health outcomes.
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Tam CC, Kerr WC, Cook WK, Li L. At-Risk Drinking in US Adults with Health Conditions: Differences by Gender, Race, and Ethnicity in the National Survey of Drug Use and Health, 2015-2019. J Racial Ethn Health Disparities 2024; 11:1444-1453. [PMID: 37219733 PMCID: PMC10729902 DOI: 10.1007/s40615-023-01621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023]
Abstract
Few studies in the US address alcohol consumption patterns in adults with chronic health conditions, and little is known about race and ethnicity differences. This study examined at-risk drinking prevalence rates among US adults with hypertension, diabetes, heart condition or cancer and assessed differences by gender and, among adults aged 50 and older, by race and ethnicity. We used data from the 2015-2019 National Survey on Drug Use and Health (N = 209,183) to estimate (1) prevalence rates and (2) multivariable logistic regression models predicting odds of at-risk drinking among adults with hypertension, diabetes, heart condition, or cancer, compared to adults with none of these conditions. To examine subgroup differences, analyses were stratified by gender (ages 18-49 and ages 50 +) and by gender and race and ethnicity for adults ages 50 + . Results showed that all adults with diabetes and women ages 50 + with heart conditions in the full sample had lower odds of at-risk drinking relative to their counterparts without any of the four conditions. Men ages 50 + with hypertension had greater odds. In race and ethnicity assessments among adults ages 50 + , only non-Hispanic White (NHW) men and women with diabetes and heart conditions had lower odds, and NHW men and women and Hispanic men with hypertension had greater odds of at-risk drinking. There were differential associations of at-risk drinking with demographic and lifestyle indicators across race and ethnicity groups. These findings underscore tailored efforts in community and clinical settings to reduce at-risk drinking in subgroups with health condition diagnoses.
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Affiliation(s)
- Christina C Tam
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA.
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
| | - Won Kim Cook
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
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Keiser T, Katz S, Robson SM, Greaney JL, Healy S, Malone SK, Farrahi V, Patterson F. Association between time-of-day for eating, exercise, and sleep with blood pressure in adults with elevated blood pressure or hypertension: a systematic review. J Hypertens 2024; 42:951-960. [PMID: 38647159 PMCID: PMC11062822 DOI: 10.1097/hjh.0000000000003732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The purpose of this review is to synthesize results from studies examining the association between time-of-day for eating, exercise, and sleep with blood pressure (BP) in adults with elevated BP or hypertension. Six databases were searched for relevant publications from which 789 were identified. Ten studies met inclusion criteria. Four studies examined time-of-day for eating, five examined time-of-day for exercise, and one examined time-of-day for sleep and their associations with BP. Results suggested that later time-of-day for eating ( n = 2/4) and later sleep mid-point ( n = 1/1) were significantly related to higher BP in multivariable models, whereas morning ( n = 3/5) and evening ( n = 4/5) exercise were associated with significantly lower BP. Although this small body of work is limited by a lack of prospective, randomized controlled study designs and underutilization of 24 h ambulatory BP assessment, these results provide preliminary, hypothesis-generating support for the independent role of time-of-day for eating, exercise, and sleep with lower BP.
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Affiliation(s)
- Thomas Keiser
- College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Sarah Katz
- Department of Library, Museums, and Press, University of Delaware, Newark, Delaware, USA
| | - Shannon M Robson
- College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Jody L Greaney
- College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Sean Healy
- Department of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
| | - Susan K Malone
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Vahid Farrahi
- Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Freda Patterson
- College of Health Sciences, University of Delaware, Newark, Delaware, USA
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Yévenes-Briones H, Caballero FF, Struijk EA, Estrada-deLeón DB, Rey-Martinez J, Rodríguez-Artalejo F, Banegas JR, Lopez-Garcia E. The Hearing Function and Ambulatory Blood Pressure in Older Adults. Otolaryngol Head Neck Surg 2024; 170:1712-1722. [PMID: 38494745 DOI: 10.1002/ohn.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To examine the association between hearing function, assessed with pure-tone average (PTA) of air conduction thresholds, and 24-hour ambulatory blood pressure (BP) in older adults. STUDY DESIGN Cross-sectional study. SETTING A total of 1404 community-dwelling individuals aged ≥65 years from the Seniors-ENRICA cohort were examined. METHODS Hearing loss was defined as PTA > 40-AudCal hearing loss decibels (dB-aHL) in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Circadian BP patterns were calculated as the percentage decline in systolic BP during the night, and participants were classified as dipper, nondipper, and riser. Ambulatory hypertension was defined as BP ≥ 130/80 mm Hg (24 hour), ≥135/85 (daytime), and ≥120/70 (nighttime) or on antihypertensive treatment. Analyses were performed with linear- and logistic-regression models adjusted for the main confounders. RESULTS In multivariable analyses, the PTA was associated with higher nighttime systolic BP [β coefficient per 20 dB-aHL increment standard frequency (95% confidence interval, CI): 2.41 mm Hg (0.87, 3.95); β (95% CI) per 20 dB-aHL increment speech frequency 2.17 mm Hg (0.70, 3.64)]. Among hypertensive patients, hearing loss at standard and high-frequency PTA was associated with the riser BP pattern [odds ratio: 2.01 (95% CI, 1.03-3.93) and 1.45 (1.00-2.09), respectively]; also, hearing loss at standard PTA was linked to uncontrolled nighttime BP [1.81 (1.01-3.24)]. CONCLUSION PTA was associated with higher nighttime BP, and hearing loss with a riser BP pattern and uncontrolled BP in older hypertensives.
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Affiliation(s)
- Humberto Yévenes-Briones
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Daniela B Estrada-deLeón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Jorge Rey-Martinez
- Osakidetza Basque Health Service, Biodonostia Health Research Institute, San Sebástian-Donostia, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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Krishnan J, Hennen EM, Ao M, Kirabo A, Ahmad T, de la Visitación N, Patrick DM. NETosis Drives Blood Pressure Elevation and Vascular Dysfunction in Hypertension. Circ Res 2024; 134:1483-1494. [PMID: 38666386 PMCID: PMC11116040 DOI: 10.1161/circresaha.123.323897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Neutrophil extracellular traps (NETs) are composed of DNA, enzymes, and citrullinated histones that are expelled by neutrophils in the process of NETosis. NETs accumulate in the aorta and kidneys in hypertension. PAD4 (protein-arginine deiminase-4) is a calcium-dependent enzyme that is essential for NETosis. TRPV4 (transient receptor potential cation channel subfamily V member 4) is a mechanosensitive calcium channel expressed in neutrophils. Thus, we hypothesize that NETosis contributes to hypertension via NET-mediated endothelial cell (EC) dysfunction. METHODS NETosis-deficient Padi4-/- mice were treated with Ang II (angiotensin II). Blood pressure was measured by radiotelemetry, and vascular reactivity was measured with wire myography. Neutrophils were cultured with or without ECs and exposed to normotensive or hypertensive uniaxial stretch. NETosis was measured by flow cytometry. ECs were treated with citrullinated histone H3, and gene expression was measured by quantitative reverse transcription PCR. Aortic rings were incubated with citrullinated histone H3, and wire myography was performed to evaluate EC function. Neutrophils were treated with the TRPV4 agonist GSK1016790A. Calcium influx was measured using Fluo-4 dye, and NETosis was measured by immunofluorescence. RESULTS Padi4-/- mice exhibited attenuated hypertension, reduced aortic inflammation, and improved EC-dependent vascular relaxation in response to Ang II. Coculture of neutrophils with ECs and exposure to hypertensive uniaxial stretch increased NETosis and accumulation of neutrophil citrullinated histone H3. Histone H3 and citrullinated histone H3 exposure attenuates EC-dependent vascular relaxation. Treatment of neutrophils with the TRPV4 agonist GSK1016790A increases intracellular calcium and NETosis. CONCLUSIONS These observations identify a role of NETosis in the pathogenesis of hypertension. Moreover, they define an important role of EC stretch and TRPV4 as initiators of NETosis. Finally, they define a role of citrullinated histones as drivers of EC dysfunction in hypertension.
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Affiliation(s)
- Jaya Krishnan
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
| | - Elizabeth M. Hennen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN (E.M.H.)
| | - Mingfang Ao
- Department of Anesthesiology (M.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Immunobiology (A.K.)
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN (A.K.)
- Vanderbilt Institute for Global Health, Nashville, TN (A.K.)
| | - Taseer Ahmad
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, Pakistan (T.A.)
| | - Néstor de la Visitación
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine (D.M.P.), Vanderbilt University Medical Center, Nashville, TN
| | - David M. Patrick
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Department of Veterans Affairs, Nashville, TN (D.M.P.)
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Li X, Zhou W, Hu G. The association between non-alcoholic fatty liver disease and urinary incontinence among adult females in the United States. BMC Public Health 2024; 24:1373. [PMID: 38778285 PMCID: PMC11110403 DOI: 10.1186/s12889-024-18578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) and urinary incontinence (UI) are both highly prevalent and age-related diseases. Nevertheless, the link between NAFLD and UI is unclear. Hence, the study was designed to evaluate the association between the NAFLD and UI (including UI types) in a nationally representative sample of United States (US) female adults. METHODS We conducted this study used data from U.S. female adults in the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 (pre-pandemic) cycles. The diagnosis of NAFLD is based on Vibration controlled transient elastography (VCTE) and absence of know liver diseases and significant alcohol consumption. The diagnosis and types of UI were assessment using a self-report questionnaire. Multivariable logistic regression models were used to analyze the association between NALFD and UI. Stratified analyses based on age, obesity, race, educational level, married status, PIR, and smoking status were conducted. RESULTS Of the 2149 participants, the mean (95% CI) age was 53.9 (52.7-55.0), 686 (61.1%) were Non-Hispanic White. UI was significantly more common in participants with NAFLD [490 (64.7%)] than those without NAFLD [552 (44.9%)]. Adjusted for age, race/ethnicity, marital status, educational level, family poverty income ratio (PIR) status, alanine aminotransferase (ALT), aspartate aminotransferase (AST), smoking status, obesity, type 2 diabetes mellitus (T2DM), hypertension and insulin resistance (IR) in a multivariable logistic regression model, NALFD were associated with UI [OR: 1.93, 95%CI 1.23-3.02, P = 0.01] and urge UI [OR: 1.55, 95%CI 1.03-2.33, P = 0.03], while patients with NAFLD did not show an increased odds in stress UI and mixed UI when compared with those without NAFLD subject (P > 0.05). In the subgroup analyses, NAFLD remained significantly associated with UI, particularly among those participants without obesity (OR: 2.69, 95% CI 1.84-4.00) and aged ≥ 60 years (OR: 2.20, 95% CI 1.38-3.51). CONCLUSIONS Among US female adults, NAFLD has a strong positive correlation with UI. Given that NAFLD is a modifiable disease, these results may help clinicians to target female patients with NAFLD for treatments and interventions that may help prevent the occurrence of UI and reduce the symptoms of UI.
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Affiliation(s)
- Xinyuan Li
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, 421001, People's Republic of China
| | - Weiwei Zhou
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, 421001, People's Republic of China.
| | - Guangsheng Hu
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, 421001, People's Republic of China.
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Hamaya R, Wang M, Juraschek SP, Mukamal KJ, Manson JE, Tobias DK, Sun Q, Curhan GC, Willett WC, Rimm EB, Cook NR. Prediction of 24-Hour Urinary Sodium Excretion Using Machine-Learning Algorithms. J Am Heart Assoc 2024; 13:e034310. [PMID: 38726910 PMCID: PMC11179835 DOI: 10.1161/jaha.123.034310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Accurate quantification of sodium intake based on self-reported dietary assessments has been a persistent challenge. We aimed to apply machine-learning (ML) algorithms to predict 24-hour urinary sodium excretion from self-reported questionnaire information. METHODS AND RESULTS We analyzed 3454 participants from the NHS (Nurses' Health Study), NHS-II (Nurses' Health Study II), and HPFS (Health Professionals Follow-Up Study), with repeated measures of 24-hour urinary sodium excretion over 1 year. We used an ensemble approach to predict averaged 24-hour urinary sodium excretion using 36 characteristics. The TOHP-I (Trial of Hypertension Prevention I) was used for the external validation. The final ML algorithms were applied to 167 920 nonhypertensive adults with 30-year follow-up to estimate confounder-adjusted hazard ratio (HR) of incident hypertension for predicted sodium. Averaged 24-hour urinary sodium excretion was better predicted and calibrated with ML compared with the food frequency questionnaire (Spearman correlation coefficient, 0.51 [95% CI, 0.49-0.54] with ML; 0.19 [95% CI, 0.16-0.23] with the food frequency questionnaire; 0.46 [95% CI, 0.42-0.50] in the TOHP-I). However, the prediction heavily depended on body size, and the prediction of energy-adjusted 24-hour sodium excretion was modestly better using ML. ML-predicted sodium was modestly more strongly associated than food frequency questionnaire-based sodium in the NHS-II (HR comparing Q5 versus Q1, 1.48 [95% CI, 1.40-1.56] with ML; 1.04 [95% CI, 0.99-1.08] with the food frequency questionnaire), but no material differences were observed in the NHS or HPFS. CONCLUSIONS The present ML algorithm improved prediction of participants' absolute 24-hour urinary sodium excretion. The present algorithms may be a generalizable approach for predicting absolute sodium intake but do not substantially reduce the bias stemming from measurement error in disease associations.
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Affiliation(s)
- Rikuta Hamaya
- Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA USA
- Division of Preventive Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Molin Wang
- Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA USA
- Department of Biostatistics Harvard T. H. Chan School of Public Health Boston MA USA
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - JoAnn E Manson
- Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA USA
- Division of Preventive Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Mary Horrigan Connors Center for Women's Health and Gender Biology Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Deirdre K Tobias
- Division of Preventive Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Department of Nutrition Harvard T. H. Chan School of Public Health Boston MA USA
| | - Qi Sun
- Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
- Department of Nutrition Harvard T. H. Chan School of Public Health Boston MA USA
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Renal Division, Department of Medicine Brigham and Women's Hospital Boston MA USA
| | - Walter C Willett
- Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA USA
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Department of Nutrition Harvard T. H. Chan School of Public Health Boston MA USA
| | - Eric B Rimm
- Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA USA
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Department of Nutrition Harvard T. H. Chan School of Public Health Boston MA USA
| | - Nancy R Cook
- Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA USA
- Division of Preventive Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA USA
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Akinyelure OP, Jaeger BC, Safford MM, Oparil S, Carson AP, Sims A, Hannon L, Howard G, Muntner P, Hardy ST. Social Determinants of Health and Incident Apparent Treatment-Resistant Hypertension Among White and Black US Adults: The REGARDS Study. J Am Heart Assoc 2024; 13:e031695. [PMID: 38752519 PMCID: PMC11179800 DOI: 10.1161/jaha.123.031695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND We examined the association of multilevel social determinants of health with incident apparent treatment-resistant hypertension (aTRH). METHODS AND RESULTS We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow-up visit. Over a median 9.5 years of follow-up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%). CONCLUSIONS Part of the association between race and incident aTRH risk was mediated by social determinants of health.
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Affiliation(s)
| | - Byron C. Jaeger
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNCUSA
| | | | - Suzanne Oparil
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - April P. Carson
- Departments of Medicine and Population Health ScienceUniversity of Mississippi Medical CenterJacksonMSUSA
| | - Andrew Sims
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamALUSA
| | - Lonnie Hannon
- Department of Health BehaviorUniversity of Alabama at BirminghamBirminghamALUSA
| | - George Howard
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamALUSA
| | - Paul Muntner
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Shakia T. Hardy
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Uddin J, Zhu S, Malla G, Levitan EB, Rolka DB, Carson AP, Long DL. Regional and rural-urban patterns in the prevalence of diagnosed hypertension among older U.S. adults with diabetes, 2005-2017. BMC Public Health 2024; 24:1326. [PMID: 38755548 PMCID: PMC11100106 DOI: 10.1186/s12889-024-18802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Hypertension prevalence among the overall US adult population has been relatively stable during the last two decades. However, whether this stabilization has occurred across rural-urban communities and across different geographic regions is unknown, particularly among older adults with diabetes who are likely to have concomitant cardiovascular risk factors. METHODS This serial cross-sectional analysis used the 5% national sample of Medicare administrative claims data (n = 3,516,541) to examine temporal trends (2005-2017) in diagnosed hypertension among older adults with diabetes, across urban-rural communities and US census regions (Northeast, Midwest, South, and West). Joinpoint regression was used to obtain annual percent change (APC) in hypertension prevalence across rural-urban communities and geographic regions, and multivariable adjusted regression was used to assess associations between rural-urban communities and hypertension prevalence. RESULTS The APC in the prevalence of hypertension was higher during 2005-2010, and there was a slowdown in the increase during 2011-2017 across all regions, with significant variations across rural-urban communities within each of the regions. In the regression analysis, in the adjusted model, older adults living in non-core (most rural) areas in the Midwest (PR = 0.988, 95% CI: 0.981-0.995) and West (PR = 0.935, 95% CI: 0.923-0.946) had lower hypertension prevalence than their regional counterparts living in large central metro areas. CONCLUSIONS Although the magnitudes of these associations are small, differences in hypertension prevalence across rural-urban areas and geographic regions may have implications for targeted interventions to improve chronic disease prevention and management.
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Affiliation(s)
- Jalal Uddin
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, Canada.
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA.
| | - Sha Zhu
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Gargya Malla
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Deborah B Rolka
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Georgia, USA
| | - April P Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - D Leann Long
- Department of Biostatistics and Data Science, Wake Forest University, Winston-Salem, USA
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Burke JF, Copeland LL, Sussman JB, Hayward RA, Gross AL, Briceño EM, Whitney R, Giordani BJ, Elkind MSV, Manly JJ, Gottesman RF, Gaskin DJ, Sidney S, Yaffe K, Sacco RL, Heckbert SR, Hughes TM, Galecki AT, Levine DA. Development and validation of the Michigan Chronic Disease Simulation Model (MICROSIM). PLoS One 2024; 19:e0300005. [PMID: 38753617 PMCID: PMC11098406 DOI: 10.1371/journal.pone.0300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/19/2024] [Indexed: 05/18/2024] Open
Abstract
Strategies to prevent or delay Alzheimer's disease and related dementias (AD/ADRD) are urgently needed, and blood pressure (BP) management is a promising strategy. Yet the effects of different BP control strategies across the life course on AD/ADRD are unknown. Randomized trials may be infeasible due to prolonged follow-up and large sample sizes. Simulation analysis is a practical approach to estimating these effects using the best available existing data. However, existing simulation frameworks cannot estimate the effects of BP control on both dementia and cardiovascular disease. This manuscript describes the design principles, implementation details, and population-level validation of a novel population-health microsimulation framework, the MIchigan ChROnic Disease SIMulation (MICROSIM), for The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG) study of the effect of BP levels over the life course on dementia and cardiovascular disease. MICROSIM is an agent-based Monte Carlo simulation designed using computer programming best practices. MICROSIM estimates annual vascular risk factor levels and transition probabilities in all-cause dementia, stroke, myocardial infarction, and mortality in a nationally representative sample of US adults 18+ using the National Health and Nutrition Examination Survey (NHANES). MICROSIM models changes in risk factors over time, cognition and dementia using changes from a pooled dataset of individual participant data from 6 US prospective cardiovascular cohort studies. Cardiovascular risks were estimated using a widely used risk model and BP treatment effects were derived from meta-analyses of randomized trials. MICROSIM is an extensible, open-source framework designed to estimate the population-level impact of different BP management strategies and reproduces US population-level estimates of BP and other vascular risk factors levels, their change over time, and incident all-cause dementia, stroke, myocardial infarction, and mortality.
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Affiliation(s)
- James F. Burke
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | | | - Jeremy B. Sussman
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, United States of America
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, United States of America
- Ann Arbor Veteran’s Affairs Hospital, Center for Clinical Management and Research, Ann Arbor, MI, United States of America
| | - Rodney A. Hayward
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, United States of America
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, United States of America
- Ann Arbor Veteran’s Affairs Hospital, Center for Clinical Management and Research, Ann Arbor, MI, United States of America
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, MD, United States of America
| | - Emily M. Briceño
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, United States of America
- Department of Physical Medicine and Rehabilitation, U-M, Ann Arbor, MI, United States of America
| | - Rachael Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, United States of America
| | - Bruno J. Giordani
- Department of Psychiatry & Michigan Alzheimer’s Disease Center, U-M, Ann Arbor, MI, United States of America
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Jennifer J. Manly
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, United States of America
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, United States of America
| | - Darrell J. Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States of America
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ralph L. Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Andrzej T. Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, United States of America
- Department of Biostatistics, U-M, Ann Arbor, MI, United States of America
| | - Deborah A. Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, United States of America
- Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, United States of America
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Brush JE, Lu Y, Liu Y, Asher JR, Li SX, Sawano M, Young P, Schulz WL, Anderson M, Burrows JS, Krumholz HM. Hypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records. J Am Heart Assoc 2024; 13:e033253. [PMID: 38686864 PMCID: PMC11179912 DOI: 10.1161/jaha.123.033253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/29/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The digital transformation of medical data enables health systems to leverage real-world data from electronic health records to gain actionable insights for improving hypertension care. METHODS AND RESULTS We performed a serial cross-sectional analysis of outpatients of a large regional health system from 2010 to 2021. Hypertension was defined by systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or recorded treatment with antihypertension medications. We evaluated 4 methods of using blood pressure measurements in the electronic health record to define hypertension. The primary outcomes were age-adjusted prevalence rates and age-adjusted control rates. Hypertension prevalence varied depending on the definition used, ranging from 36.5% to 50.9% initially and increasing over time by ≈5%, regardless of the definition used. Control rates ranged from 61.2% to 71.3% initially, increased during 2018 to 2019, and decreased during 2020 to 2021. The proportion of patients with a hypertension diagnosis ranged from 45.5% to 60.2% initially and improved during the study period. Non-Hispanic Black patients represented 25% of our regional population and consistently had higher prevalence rates, higher mean systolic and diastolic blood pressure, and lower control rates compared with other racial and ethnic groups. CONCLUSIONS In a large regional health system, we leveraged the electronic health record to provide real-world insights. The findings largely reflected national trends but showed distinctive regional demographics and findings, with prevalence increasing, one-quarter of the patients not controlled, and marked disparities. This approach could be emulated by regional health systems seeking to improve hypertension care.
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Affiliation(s)
- John E Brush
- Sentara Health Norfolk VA
- Eastern Virginia Medical School Norfolk VA
| | - Yuan Lu
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | | | - Shu-Xia Li
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Patrick Young
- Department of Laboratory Medicine Yale School of Medicine New Haven CT
| | - Wade L Schulz
- Department of Laboratory Medicine Yale School of Medicine New Haven CT
| | | | | | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
- Department of Health Policy and Management Yale School of Public Health New Haven CT
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Li J, Zhang J, Somers VK, Covassin N, Zhang L, Xu H. Trends and Disparities in Treatment and Control of Atherosclerotic Cardiovascular Disease in US Adults, 1999 to 2018. J Am Heart Assoc 2024; 13:e032527. [PMID: 38639366 PMCID: PMC11179884 DOI: 10.1161/jaha.123.032527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Although cardiovascular mortality continued declining from 2000 to 2019, the rate of this decrease decelerated. We aimed to assess the trends and disparities in risk factor control and treatment among US adults with atherosclerotic cardiovascular disease to find potential causes of the deceleration. METHODS AND RESULTS A total of 55 ,021 participants, aged ≥20 years, from the 1999 to 2018 National Health and Nutrition Examination Survey were included, of which 5717 were with atherosclerotic cardiovascular disease. Risk factor control was defined as hemoglobin A1c <7%, blood pressure <140/90 mm Hg, and non-high-density lipoprotein cholesterol <100 mg/dL. The prevalence of atherosclerotic cardiovascular disease oscillated between 7.3% and 8.9% from 1999 to 2018. A significant increasing trend was observed in the prevalence of diabetes, obesity, heavy alcohol consumption, and self-reported hypertension within the population with atherosclerotic cardiovascular disease (Ptrend≤0.001). Non-high-density lipoprotein cholesterol <100 mg/dL increased from 7.1% in 1999 to 2002 to 15.7% in 2003 to 2006, before plateauing. Blood pressure control (<140/90 mm Hg) increased until 2011 to 2014, but declined to 70.1% in 2015 to 2018 (Ptrend<0.001, Pjoinpoint=0.14). Similarly, the proportion of participants achieving hemoglobin A1c control began to decrease after 2006 (Pjoinpoint=0.05, Ptrend=0.001). The percentage of participants achieving all 3 targets increased significantly from 4.5% to 18.6% across 1999 to 2018 (Ptrend=0.02), but the increasing trend decelerated after 2005 to 2006 (Pjoinpoint<0.001). Striking disparities in risk factor control and medication use persisted between sexes, and between different racial and ethnic populations. CONCLUSIONS Worsened control of glycemia, blood pressure, obesity, and alcohol consumption, leveled lipid control, and persistent socioeconomic disparities may be contributing factors to the observed deceleration in decreasing cardiovascular mortality trends.
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Affiliation(s)
- Jingen Li
- Department of Cardiovascular MedicineDongzhimen Hospital, Beijing University of Chinese MedicineBeijingChina
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Cardiovascular Diseases CenterXiyuan Hospital, China Academy of Chinese Medical Sciences, National Clinical Research Center for Chinese Medicine CardiologyBeijingChina
| | - Jie Zhang
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China‐Japan Friendship HospitalBeijingChina
| | | | - Naima Covassin
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Lijing Zhang
- Department of Cardiovascular MedicineDongzhimen Hospital, Beijing University of Chinese MedicineBeijingChina
| | - Hao Xu
- Cardiovascular Diseases CenterXiyuan Hospital, China Academy of Chinese Medical Sciences, National Clinical Research Center for Chinese Medicine CardiologyBeijingChina
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Lin PD, Rifas‐Shiman S, Merriman J, Petimar J, Yu H, Daley MF, Janicke DM, Heerman WJ, Bailey LC, Maeztu C, Young J, Block JP. Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records. J Am Heart Assoc 2024; 13:e032197. [PMID: 38639340 PMCID: PMC11179868 DOI: 10.1161/jaha.123.032197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. METHODS AND RESULTS Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines (9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC 8 report (6% lower in 2018-2019 compared to 2010-2014). CONCLUSIONS Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.
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Affiliation(s)
- Pi‐I Debby Lin
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Sheryl Rifas‐Shiman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - John Merriman
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Joshua Petimar
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Han Yu
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente ColoradoAuroraCOUSA
| | - David M. Janicke
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFLUSA
| | - William J. Heerman
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - L. Charles Bailey
- Applied Clinical Research Center, Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Carlos Maeztu
- Department of Health Outcomes and Biomedical InformaticsUniversity of FloridaGainesvilleFLUSA
| | - Jessica Young
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMAUSA
| | - Jason P. Block
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMAUSA
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Parker M, Self‐Brown SR, Rahimi A, Fang X. Longitudinal Analysis of the Relationship Between Social Isolation and Hypertension in Early Middle Adulthood. J Am Heart Assoc 2024; 13:e030403. [PMID: 38619293 PMCID: PMC11179928 DOI: 10.1161/jaha.123.030403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Most studies have used cross-sectional or limited follow-up data to evaluate the relationship between social isolation (SI) and hypertension in older populations. The objective of this analysis was to examine the relationship between longitudinal SI and hypertension in a younger population. METHODS AND RESULTS The present analysis used data from waves I to V of the National Longitudinal Study of Adolescent to Adult Health (1994-2018) and logistic regression models to describe the association of timing, duration, and transitional patterns of SI with hypertension in early middle adulthood. Models were adjusted for demographic variables and adolescent socioeconomic and health-related confounders. SI was higher across life stages among individuals with hypertension (adolescence: 38% versus 35%, young adulthood: 52% versus 44%, and early middle adulthood: 61% versus 52%). Individuals who were socially isolated in young adulthood or early middle adulthood had greater odds of hypertension in early middle adulthood than those who were not (odds ratio [OR], 1.30 [95% CI, 1.07-1.56]; OR, 1.42 [95% CI, 1.15-1.76], respectively). Early middle adulthood hypertension was significantly associated with persistent SI across all life stages and for those who moved into persistent SI after adolescence (OR, 1.40 [95% CI, 1.02-1.93]; OR, 1.61 [95% CI, 1.18-2.19], respectively). CONCLUSIONS SI in young or early middle adulthood significantly increased the odds of hypertension, as did moving into SI and the accumulation of SI across life stages. Our analysis provides insights regarding timing for effective interventions to reduce hypertension earlier in the life course, which may prevent future adverse cardiovascular-related events.
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Affiliation(s)
- Marie Parker
- School of Public HealthGeorgia State UniversityAtlantaGA
| | | | | | - Xiangming Fang
- School of Public HealthGeorgia State UniversityAtlantaGA
- College of Economics and ManagementChina Agricultural UniversityBeijingChina
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Jieru P, Zhang S, Cai L, Long W, Wang Y, Zhang L, Dong Y, Zhang W, Liao J, Yang C. Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:59. [PMID: 38711145 DOI: 10.1186/s41043-024-00528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Choline, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S. METHODS This study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations. RESULTS In our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60-0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk. CONCLUSION Elevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.
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Affiliation(s)
- Peng Jieru
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Shanshan Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wencheng Long
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yueshan Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lu Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yao Dong
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wenqi Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juan Liao
- Department of Gastroenterology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Zhu J, Yang K, Liu W. Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre-frailty or frailty status. J Clin Hypertens (Greenwich) 2024; 26:514-524. [PMID: 38552135 PMCID: PMC11088431 DOI: 10.1111/jch.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 05/12/2024]
Abstract
In patients with hypertension and pre-frailty or frailty, the influence of systolic (SBP) and diastolic blood pressure (DBP) time in target range (TTR) on clinical outcomes is unclear. Thus, we conducted a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Classifying 4208 participants into frail and non-frail groups using a frailty index, the study calculated blood pressure time in target range (BP-TTR) for the first three months using the Rosendaal method. The primary endpoint included a composite of nonfatal myocardial infarction (MI), acute coronary syndromes, stroke, acute decompensated heart failure (ADHF), and cardiovascular death. Relationships between BP-TTR and outcomes were analyzed using Kaplan-Meier curves, Cox models, and restricted cubic spline curves, with subgroup analysis for further insights. In a median follow-up of 3.17 years, primary outcomes occurred in 6.7% of participants. Kaplan-Meier analysis showed that a lower systolic blood pressure time in target range (SBP-TTR) (0%-25%) correlated with an increased cumulative incidence of the primary outcome (p < .001), nonfatal MI (P = .021), stroke (P = .004), and cardiovascular death (P = .002). A higher SBP-TTR (75%-<100%) was linked to a reduced risk of these outcomes. The restricted cubic spline (RCS) curve revealed a linear association between SBP-TTR and the primary outcome (non-linear P = .704). Similar patterns were observed for diastolic blood pressure time in target range (DBP-TTR). Subgroup analysis showed that the protective effect of higher SBP-TTR was less pronounced at low DBP-TTR levels (P for interaction = .023). In conclusion, this study highlights the importance of maintaining BP within the target range to mitigate cardiovascular risks in this population.
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Affiliation(s)
- Jiajia Zhu
- Cardiac Intensive Care UnitBeijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Kun Yang
- Cardiac Intensive Care UnitBeijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Wenxian Liu
- Cardiac Intensive Care UnitBeijing Anzhen HospitalCapital Medical UniversityBeijingChina
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Lee JS, Bhatt A, Pollack LM, Jackson SL, Omeaku N, Beasley KL, Wilson C, Luo F, Roy K. Racial and Ethnic Differences in Hypertension-Related Telehealth and In-Person Outpatient Visits Before and During the COVID-19 Pandemic Among Medicaid Beneficiaries. Telemed J E Health 2024; 30:1262-1271. [PMID: 38241486 PMCID: PMC11065593 DOI: 10.1089/tmj.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Background: Little is known about the trends and costs of hypertension management through telehealth among individuals enrolled in Medicaid. Methods: Using MarketScan® Medicaid database, we examined outpatient visits among people with hypertension aged 18-64 years. We presented the numbers of hypertension-related telehealth and in-person outpatient visits per 100 individuals and the proportion of hypertension-related telehealth outpatient visits to total outpatient visits by month, overall, and by race and ethnicity. For the cost analysis, we presented total and patient out-of-pocket (OOP) costs per visit for telehealth and in-person visits in 2021. Results: Of the 229,562 individuals, 114,445 (49.9%) were non-Hispanic White, 80,692 (35.2%) were non-Hispanic Black, 3,924 (1.71%) were Hispanic. From February to April 2020, the number of hypertension-related telehealth outpatient visits per 100 persons increased from 0.01 to 6.13, the number of hypertension-related in-person visits decreased from 61.88 to 52.63, and the proportion of hypertension-related telehealth outpatient visits increased from 0.01% to 10.44%. During that same time, the proportion increased from 0.02% to 13.9% for non-Hispanic White adults, from 0.00% to 7.58% for non-Hispanic Black adults, and from 0.12% to 19.82% for Hispanic adults. The average total and patient OOP costs per visit in 2021 were $83.82 (95% confidence interval [CI], 82.66-85.05) and $0.55 (95% CI, 0.42-0.68) for telehealth and $264.48 (95% CI, 258.87-269.51) and $0.72 (95% CI, 0.65-0.79) for in-person visits, respectively. Conclusions: Hypertension management via telehealth increased among Medicaid recipients regardless of race and ethnicity, during the COVID-19 pandemic. These findings may inform telehealth policymakers and health care practitioners.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami Bhatt
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Omeaku
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Townsend RR, Ferdinand KC, Kandzari DE, Kario K, Mahfoud F, Weber MA, Schmieder RE, Pocock S, Tsioufis K, David S, Steigerwalt S, Walton A, Hopper I, Bertolet B, Sharif F, Fengler K, Fahy M, Hettrick DA, Brar S, Böhm M. Impact of Antihypertensive Medication Changes After Renal Denervation Among Different Patient Groups: SPYRAL HTN-ON MED. Hypertension 2024; 81:1095-1105. [PMID: 38314554 PMCID: PMC11025607 DOI: 10.1161/hypertensionaha.123.22251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND The SPYRAL HTN-ON MED (Global Clinical Study of Renal Denervation With the Symplicity Spyral Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications)trial showed significant office and nighttime systolic blood pressure (BP) reductions in patients with hypertension following renal denervation (RDN) compared with sham-control patients, despite similar 24-hour BP reductions. We compared antihypertensive medication and BP changes among prespecified subpopulations. METHODS The multicenter, randomized, sham-controlled, blinded SPYRAL HTN-ON MED trial (n=337) evaluated BP changes after RDN compared with a sham procedure in patients with hypertension prescribed 1 to 3 antihypertensive drugs. Most patients (n=187; 54%) were enrolled outside the United States, while 156 (46%) US patients were enrolled, including 60 (18%) Black Americans. RESULTS Changes in detected antihypertensive drugs were similar between RDN and sham group patients in the outside US cohort, while drug increases were significantly more common in the US sham group compared with the RDN group. Patients from outside the United States showed significant reductions in office and 24-hour mean systolic BP at 6 months compared with the sham group, whereas BP changes were similar between RDN and sham in the US cohort. Within the US patient cohort, Black Americans in the sham control group had significant increases in medication burden from baseline through 6 months (P=0.003) but not in the RDN group (P=0.44). CONCLUSIONS Patients enrolled outside the United States had minimal antihypertensive medication changes between treatment groups and had significant office and 24-hour BP reductions compared with the sham group. Increased antihypertensive drug burden in the US sham cohort, especially among Black Americans, may have diluted the treatment effect in the combined trial population. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02439775.
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Affiliation(s)
- Raymond R. Townsend
- Pereleman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.)
| | | | | | - Kazuomi Kario
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Felix Mahfoud
- Universitätsklinikum des Saarlandes, Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University, Homburg, Germany (F.M., M.B.)
| | | | | | - Stuart Pocock
- London School of Hygiene & Tropical Medicine, United Kingdom (S.P.)
| | | | - Shukri David
- Ascension Providence Hospital, Southfield, MI (S.D., S.S.)
| | | | - Antony Walton
- The Alfred Hospital, Melbourne, Australia (A.W., I.H.)
| | - Ingrid Hopper
- The Alfred Hospital, Melbourne, Australia (A.W., I.H.)
| | | | | | | | - Martin Fahy
- Medtronic, Santa Rosa, CA (M.F., D.A.H., S.B.)
| | | | | | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University, Homburg, Germany (F.M., M.B.)
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48
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Johnson KE, Li H, Zhang M, Springer MV, Galecki AT, Whitney RT, Gottesman RF, Hayward RA, Sidney S, Elkind MSV, Longstreth WT, Heckbert SR, Gerber Y, Sullivan KJ, Levine DA. Cumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity. JAMA Netw Open 2024; 7:e248502. [PMID: 38700866 PMCID: PMC11069082 DOI: 10.1001/jamanetworkopen.2024.8502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/28/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown. Objective To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types-ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)-and explore how these associations vary by race and ethnicity. Design, Setting, and Participants Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years. Exposure Time-dependent cumulative mean SBP. Main Outcomes and Measures The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH. Results Among 40 016 participants, 38 167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0% were women; 25.0% were Black, 8.9% were Hispanic of any race, and 66.2% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10-mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95% CI, 1.18-1.23]), IS (HR, 1.20 [95% CI, 1.17-1.22]), and ICH (HR, 1.31 [95% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95% CI, 0.99-1.29]; P = .06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95% CI, 1.09-1.33]) and ICH (HR, 1.67 [95% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident stroke and stroke type. Conclusions and Relevance The findings of this cohort study suggest that cumulative mean SBP was associated with incident stroke type, but the associations did not differ by race and ethnicity. Culturally informed stroke prevention programs should address modifiable risk factors such as SBP along with social determinants of health and structural inequities in society.
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Affiliation(s)
- Kimson E. Johnson
- Department of Health Management and Policy, University of Michigan, Ann Arbor
- Department of Sociology, University of Michigan, Ann Arbor
| | - Hanyu Li
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Min Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Andrzej T. Galecki
- Department of Biostatistics, University of Michigan, Ann Arbor
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | - Rachael T. Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Rodney A. Hayward
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - W. T. Longstreth
- Department of Epidemiology, University of Washington, Seattle
- Department of Neurology, University of Washington, Seattle
| | | | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lilian and Marcel Pollak Chair in Biological Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kevin J. Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Deborah A. Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
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49
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Khatib R, Glowacki N, Chang E, Lauffenburger J, Pletcher MJ, Siddiqi A. Disparities in Patient Portal Engagement Among Patients With Hypertension Treated in Primary Care. JAMA Netw Open 2024; 7:e2411649. [PMID: 38748420 PMCID: PMC11096988 DOI: 10.1001/jamanetworkopen.2024.11649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Patient portals are increasingly used for patient-clinician communication and to introduce interventions aimed at improving blood pressure control. Objective To characterize patient portal use among patients with hypertension managed in primary care. Design, Settings, and Participants This retrospective cohort study used electronic health records linked with patient portal log file data from a large, diverse Midwestern health care system. Patients with hypertension who had a primary care visit from January 1, 2021, to December 31, 2021, were included. The first visit in 2021 was considered the baseline visit; patient portal engagement was evaluated during the following year. Multivariate logistic regressions, presented as odds ratios (ORs) and 95% CIs, were used to evaluate associations between patient characteristics and patient portal engagement, adjusting for potential confounders. Exposures Primary exposures included 4 sociodemographic factors routinely collected in the electronic health record: race and ethnicity, insurance, preferred language, and smoking status. Main Outcomes and Measures Indicators of patient engagement with the patient portal included accessing the patient portal at least once, accessing the portal within 7 days of at least 50.0% of primary care physician (PCP) visits, frequent logins (<28 vs ≥28), messaging (<2 vs ≥2), and sharing home blood pressure readings. Results Among 366 871 patients (mean [SD], 63.5 [12.6] years), 52.8% were female, 3.4% were Asian, 7.8% were Hispanic, 19.7% were non-Hispanic Black, 66.9% were non-Hispanic White, and 2.3% were of other race or ethnicity. During the 1-year study period starting in 2021, 70.5% accessed the patient portal at least once, 60.2% accessed around the time of their PCP visits, 35.7% accessed the portal frequently, 28.9% engaged in messaging, and 8.7% shared home blood pressure readings. Compared with White patients, non-Hispanic Black and Hispanic patients had lower odds of any access (Black: OR, 0.53; 95% CI, 0.52-0.54; Hispanic: OR, 0.66; 95% CI, 0.64-0.68), access around PCP visit time (Black: OR, 0.49; 95% CI, 0.48-0.50; Hispanic: OR, 0.62; 95% CI, 0.60-0.64), frequent access (Black: OR, 0.56; 95% CI, 0.55-0.57; Hispanic: OR, 0.71; 95% CI, 0.69-0.73), and messaging (Black: OR, 0.63; 95% CI, 0.61-0.64); Hispanic: OR, 0.71; 95% CI, 0.69-0.73). Conclusions and Relevance This cohort study of patients with hypertension found clear sociodemographic disparities in patient portal engagement among those treated in primary care. Without special efforts to engage patients with portals, interventions that use patient portals to target hypertension may exacerbate disparities.
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Affiliation(s)
- Rasha Khatib
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Eva Chang
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Julie Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Health, Rolling Meadows, Illinois
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50
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Zhang Z, Li C, Hong J, Zhou X, Dai R, Shu Z, Han H, Ren Z. Secular trends of population-attributable fractions of obesity for hypertension among US population by sex and race/ethnicity: Analysis from NHANES 1999-2018. Prev Med Rep 2024; 41:102719. [PMID: 38623579 PMCID: PMC11017068 DOI: 10.1016/j.pmedr.2024.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/21/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024] Open
Abstract
Obesity is a major risk factor of hypertension, therefore quantifying the contribution of obesity to hypertension is necessary. The current study aimed to investigate the changes in population-attributable fractions (PAFs) of hypertension associated with general obesity and abdominal obesity over the recent 2 decades among the US population, as well as important sub-populations. This report was performed based on national-level cross-sectional data for 46,535 adults aged 18 years and older and 20,745 children aged 8-17 from the US National Health and Nutrition Examination Survey 1999-2018. The PAFs of hypertension due to general obesity and abdominal obesity were calculated by sex, race/ethnicity, and survey year. The linear regression analysis was used to evaluate the secular trends of PAFs over the years. The prevalence of general obesity and abdominal obesity presented significantly increasing trends during the past 2 decades in the US. The PAFs of hypertension due to general obesity increased steadily from 11.9 % to 15.1 % in women with a slope of 0.38 % (95 % CI: 0.31 - 0.45 %) and from 8.4 % to 13.4 % in men with a slope of 0.46 % (95 % CI: 0.36 - 0.56 %). Similar increasing trends were also observed for the PAFs due to abdominal obesity in both women and men. Additionally, there were significantly different trends of PAFs in various races/ethnicities. Over the past 2 decades, the contributions of obesity to hypertension were gradually rising among US population, which emphasizes the importance of controlling weight to further reduce the burden of hypertension.
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Affiliation(s)
- Zhichao Zhang
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
| | - Chen Li
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
| | - Jiakang Hong
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
| | - Xia Zhou
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
| | - Rongquan Dai
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
| | - Zhiqiang Shu
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
| | - Hui Han
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
| | - Zudong Ren
- Department of Neurosurgery, Maanshan Peopleˈs Hospital, Maˈanshan, Anhui Province, China
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