151
|
Korhonen PE, Palmu S, Kautiainen H, Eriksson JG. Blood pressure load per body surface area is higher in women than in men. J Hum Hypertens 2020; 35:371-377. [PMID: 32366928 DOI: 10.1038/s41371-020-0339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 04/02/2020] [Indexed: 11/09/2022]
Abstract
Many unexplained sex differences have been observed in blood pressure (BP) related morbidity. However, there has been little research about the most obvious difference between men and women-body size. Given that blood vessels are organs of tubular shape, we hypothesized that correction of BP for body surface area (BSA), a two-dimensional measurement of body size, would allow comparison of BP load between men and women. We assessed the relationship of 24-h ambulatory BP measurements and BSA in 534 participants (mean age 61 ± 3 years, 51% women) from the Helsinki Birth Cohort Study. The study subjects had no previous medication affecting vasculature or BP. When BP values were adjusted for age, smoking, physical activity, and body fat percentage, males had higher ambulatory daytime mean systolic BP (131 mmHg vs. 127 mmHg, p < 0.001), diastolic BP (83 mmHg vs. 78 mmHg, p < 0.001), and mean arterial pressure (100 mmHg vs. 96 mmHg, p < 0.001) than females. However, all BP components per unit of BSA were significantly lower in males: daytime mean systolic BP (65 mmHg vs. 71 mmHg, p < 0.001), diastolic BP (41 mmHg vs. 44 mmHg, p < 0.001), pulse pressure (24 mmHg vs. 28 mmHg, p = 0.013), and mean arterial pressure (49 mmHg vs. 54 mmHg, p < 0.001). The same phenomenon was observed in night-time BP values. BP load per BSA is higher in women than in men, which may explain many reported sex differences in cardiovascular morbidity. Relatively small-sized individuals might benefit from a more aggressive therapeutic strategy.
Collapse
Affiliation(s)
- Päivi E Korhonen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland.
| | - Samuel Palmu
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
152
|
Leung AA, Williams JV, McAlister FA, Campbell NR, Padwal RS, Tran K, Tsuyuki R, McAlister FA, Campbell NR, Khan N, Padwal R, Quan H, Leung AA. Worsening Hypertension Awareness, Treatment, and Control Rates in Canadian Women Between 2007 and 2017. Can J Cardiol 2020; 36:732-739. [DOI: 10.1016/j.cjca.2020.02.092] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 01/13/2023] Open
|
153
|
Income-based inequalities in hypertension and in undiagnosed hypertension: analysis of Health Survey for England data. J Hypertens 2020; 38:912-924. [DOI: 10.1097/hjh.0000000000002350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
154
|
Derington CG, Cohen JB, Bress AP. Restoring the upward trend in blood pressure control rates in the United States: a focus on fixed-dose combinations. J Hum Hypertens 2020; 34:617-623. [PMID: 32332921 DOI: 10.1038/s41371-020-0340-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Catherine G Derington
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Jordana B Cohen
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
155
|
Lora CM, Ricardo AC, Chen J, Franceschini N, Kramer HJ, Melamed ML, Raij L, Rosas SE, Schneiderman N, Daviglus M, Lash JP. Prevalence, Awareness, and Treatment of Hypertension in Hispanics/Latinos With CKD in the Hispanic Community Health Study/Study of Latinos. Kidney Med 2020; 2:332-340. [PMID: 32734253 PMCID: PMC7380346 DOI: 10.1016/j.xkme.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Rationale & Objective Lower rates of hypertension awareness, treatment, and control have been observed in Hispanics/Latinos compared with non-Hispanic whites. These factors have not been studied in Hispanics/Latinos with chronic kidney disease (CKD). We sought to describe the prevalence, awareness, treatment, and control of hypertension in Hispanic/Latino adults with CKD. Study Design Cross-sectional cohort. Setting & Participants US.Hispanics/Latinos aged 18 to 74 years enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) with CKD. Comparisons were made with the National Health and Nutrition Examination Survey (NHANES) 2007 to 2010. Exposure CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or urinry albumin-creatinine ratio ≥ 30 mg/g creatinine. Outcomes Hypertension was defined as systolic blood pressure (BP) ≥ 140 or diastolic BP ≥ 90 mm Hg or use of antihypertensives. For hypertension control, 2 thresholds were examined: <140/90 and <130/80 mm Hg. Results The prevalence of hypertension was 51.5%; among those with hypertension, hypertension awareness and treatment were present in 78.1% and 70.4%, respectively. A low prevalence of BP control was observed (32.6% with BP < 140/90 mm Hg; 17.9% with BP < 130/80 mm Hg). Health insurance coverage was associated with higher odds of BP < 140/90 mm Hg (OR, 1.98; 95% CI, 1.15-3.43). Compared with non-Hispanic whites with CKD in NHANES, HCHS/SOL participants with CKD had a lower prevalence of hypertension but a lower rate of BP control (32.6% vs 48.6% for BP < 140/90 mm Hg). Limitations Use of a single measurement of creatinine, cystatin C, and urinary albumin excretion to define CKD. Single-visit measurement of BP. Conclusions Hispanics/Latinos with CKD residing in the United States have very low rates of BP control. The association of health insurance coverage with hypertension control suggests that improved access to health care may improve outcomes for this growing population.
Collapse
|
156
|
Secular Trends of the Impact of Overweight and Obesity on Hypertension in Yi People: Yi Migrant Study, 1996-2015. Int J Hypertens 2020; 2020:5368357. [PMID: 32292597 PMCID: PMC7146090 DOI: 10.1155/2020/5368357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/10/2020] [Indexed: 01/13/2023] Open
Abstract
Background Rising hypertension prevalence, coupled with increasing overweight and obesity rates, has been observed in Yi people. Moreover, the growing blood pressure level among Yi people was mostly attributable to the continuous increase of body mass index (BMI). However, little is known about the trend of association between them. Methods Consequently, we investigated the impact of overweight/obesity on hypertension over three periods (1996, 2007-2008, 2015) using data from Yi Migrant Study (n = 8749). The Yi Migrant Study incorporated three successive cross-sectional studies which were implemented by the same team with consistent protocols. Results Compared with period 1 (1996), the influence of overweight/obesity on hypertension risk significantly increased in period 2 (2007-2008) and period 3 (2015); relative excess risk due to interaction (RERI) was 1.59 (95% CI: 0.12, 3.05) and 1.41 (95% CI: 0.30, 2.78), respectively. Meanwhile, the overweight/obese population in period 3 did not show hypertension risk higher than that in period 2 (RERI = 0.15; 95% CI: -0.76, 1.07). Additionally, we observed a continuously growing trend of hypertension risk among normal weight Yi people. Conclusions During the past two decades, there was a significant increase in the association between overweight/obesity and hypertension in Yi people, whereas the increasing trend has leveled off in more recent years. These findings suggest that overweight/obesity and hypertension are becoming more epidemic comorbidity over time. Interventions to prevent hypertension should focus not only on the overweight/obese population, but also on those with normal weight.
Collapse
|
157
|
Yamazaki M, Munetsuna E, Yamada H, Ando Y, Mizuno G, Fujii R, Nouchi Y, Kageyama I, Teshigawara A, Ishikawa H, Suzuki K, Shimono Y, Hashimoto S, Ohashi K. Maternal fructose consumption down-regulates Lxra expression via miR-206-mediated regulation. J Nutr Biochem 2020; 82:108386. [PMID: 32388164 DOI: 10.1016/j.jnutbio.2020.108386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022]
Abstract
Maternal fructose consumption affects the metabolic functions of offspring later in life. However, the molecular mechanism remains poorly understood. Differences of microRNA expression profile and DNA methylation status are a candidate mechanism to explain the developmental programming that contributes to the development of a metabolic disorder. This study examined the transgenerational effect of maternal fructose consumption from the perspective of epigenetic modification. To do this, we collected serum and liver tissues from male offspring rats that were exposed to maternal distilled water or 20% fructose water during gestation and lactation. A decreased serum high-density lipoprotein cholesterol (HDL-C) level was observed in the offspring of fructose-fed dams at postnatal day (PD) 160. Given research indicating a role of liver X receptor alpha (LXRA) in cholesterol metabolism, we analyzed Lxra expression. Real-time polymerase chain reaction analysis demonstrated that offspring that were delivered from fructose-fed dams exhibited decreased Lxra gene expression in their liver tissue. There is a well-established association between Lxra expression and the level of DNA methylation and miR-206 expression. Pyrosequencing assays revealed no differences in the level of DNA methylation in the Lxra promoter region, whereas miR-206 expression was increased in the liver at PD 60 and 160. Our data indicate that early-life exposure to maternal fructose results in changing of miR-206 expression level in the liver that suppresses the expression of Lxra. This phenomenon may be associated with the decreased serum HDL-C level in offspring.
Collapse
Affiliation(s)
- Mirai Yamazaki
- Department of Clinical Biochemistry, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan; Department of Medical Technology, Kagawa Prefectural University of Health Sciences, 761-0123, Takamatsu, Japan
| | - Eiji Munetsuna
- Department of Biochemistry, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - Hiroya Yamada
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan.
| | - Yoshitaka Ando
- Department of Clinical Biochemistry, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| | - Genki Mizuno
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan; Deparment of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - Ryosuke Fujii
- Department of Preventive Medical Sciences, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| | - Yuki Nouchi
- Department of Clinical Biochemistry, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| | - Itsuki Kageyama
- Department of Clinical Biochemistry, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| | - Atsushi Teshigawara
- Department of Clinical Biochemistry, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| | - Hiroaki Ishikawa
- Department of Clinical Biochemistry, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| | - Koji Suzuki
- Department of Preventive Medical Sciences, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| | - Yohei Shimono
- Department of Biochemistry, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - Koji Ohashi
- Department of Clinical Biochemistry, Fujita Health University School of Health Sciences, Toyoake, 470-1192, Japan
| |
Collapse
|
158
|
Álvarez-Aliaga A, Frómeta-Guerra A, Suárez-Quesada A, Del Llano-Sosa D, Berdú-Saumell J, Lago-Santiesteban YA. Prognostic model of the adaptive changes from hypertensive cardiopathy: from mild diastolic dysfunction to depressed systolic function. Medwave 2020; 20:e7873. [PMID: 32469849 DOI: 10.5867/medwave.2020.03.7873] [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: 11/04/2019] [Accepted: 03/18/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction By definition, hypertensive cardiopathy is a series of complex and variable effects responsible for the chronic elevation of blood pressure in the heart. It stands out within a broad spectrum of cardiovascular diseases associated with hypertension. Objective To evaluate the capacity to predict the development of adaptive changes to hypertensive cardiopathy within ten years following diagnosis of the condition, using a model based on prognostic factors. Methods A prospective cohort study was conducted in hypertensive patients. The patients were followed at the specialized hypertension physicians office of the specialty policlinic attached to Carlos Manuel de Céspedes University Hospital, in the Bayamo Municipality, Granma Province, Cuba, from 1 January 2008 to 31 December 2018. Results Coxs proportional regression model showed a significant statistical relationship between most of the factors and the development of the adaptive changes in hypertensive cardiopathy within ten years of follow-up after the diagnosis of this condition. The lack of blood pressure control (Hazard ratio: 2.090; confidence interval 95%: 1.688 to 2.588; p: 0.000) followed by stage 2 of hypertension (hazard ratio: 1.987; confidence interval 95%: 1.584 to 2.491; p: 0.000) were the main factors. Internal validation of the model, discriminant capacity (C- statistic: 0.897) and calibration Hosmer-Lemeshow (χ2: 5.384; p: 0.716), was acceptable. Conclusions We develop a model to predict the progression of hypertensive cardiopathy from grade I to grade IV with adequate discriminatory capacity. The model is based on prognostic factors, among which characteristic effects of arterial hypertension, diabetes mellitus, and chronic kidney disease stood out.
Collapse
Affiliation(s)
- Alexis Álvarez-Aliaga
- Hospital General Universitario Carlos Manuel de Céspedes, Bayamo, Granma, Cuba. Universidad de Ciencias Médicas de Granma, Bayamo, Cuba. . ORCID: 0000-0002-4706-3821
| | - Adonis Frómeta-Guerra
- Hospital General Universitario Carlos Manuel de Céspedes, Bayamo, Granma, Cuba. Universidad de Ciencias Médicas de Granma, Bayamo, Cuba. ORCID: 0000-0003-0436-5974
| | - Alexis Suárez-Quesada
- Hospital General Universitario Carlos Manuel de Céspedes, Bayamo, Granma, Cuba. Universidad de Ciencias Médicas de Granma, Bayamo, Cuba. ORCID: 0000-0002-7672-5601
| | - David Del Llano-Sosa
- Hospital General Universitario Carlos Manuel de Céspedes, Bayamo, Granma, Cuba. Universidad de Ciencias Médicas de Granma, Bayamo, Cuba. ORCID: 0000-0002-0104-1715
| | - Joel Berdú-Saumell
- Hospital General Universitario Carlos Manuel de Céspedes, Bayamo, Granma, Cuba. Universidad de Ciencias Médicas de Granma, Bayamo, Cuba. ORCID: 0000-0002-8818-2704
| | - Yasel Alberto Lago-Santiesteban
- Hospital General Universitario Carlos Manuel de Céspedes, Bayamo, Granma, Cuba. Universidad de Ciencias Médicas de Granma, Bayamo, Cuba. ORCID: 0000-0003-2933-0663
| |
Collapse
|
159
|
Du X, Patel A, Anderson CS, Dong J, Ma C. Epidemiology of Cardiovascular Disease in China and Opportunities for Improvement: JACC International. J Am Coll Cardiol 2020; 73:3135-3147. [PMID: 31221263 DOI: 10.1016/j.jacc.2019.04.036] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 12/24/2022]
Abstract
The burden of cardiovascular (CV) disease is very high in China, due to highly prevalent and poorly controlled risk factors resulting from changing sociodemographic structure and lifestyles in its large population. Rapid economic development and urbanization have been accompanied by changing patterns, expression, and management of CV disease. However, the health care system in China lacks a hierarchical structure, with a focus on treating acute diseases in hospital while ignoring long-term management, and primary health care is too weak to effectively control CV risk factors. To address these challenges, the Chinese central government has ensured health is a national priority and has introduced reforms that include implementing policies for a healthy environment, strengthening primary care, and improving affordability and accessibility within the health system. Turning the inverted pyramid of the health care system is essential in the ongoing battle against CV disease.
Collapse
Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; The George Institute for Global Health China at Peking University Health Science Center, Beijing, China
| | - Jianzeng Dong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
160
|
Heimberger S, Mueller A, Ratnaparkhi R, Perdigao JL, Rana S. Angiogenic factor abnormalities and risk of peripartum complications and prematurity among urban predominantly obese parturients with chronic hypertension. Pregnancy Hypertens 2020; 20:124-130. [PMID: 32299059 DOI: 10.1016/j.preghy.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/04/2020] [Accepted: 04/05/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare characteristics and outcomes of women with chronic hypertension (cHTN) between those with normal and abnormal plasma angiogenic profiles. STUDY DESIGN This secondary analysis explored associations between angiogenic markers soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) drawn prior to delivery among women with history of cHTN who were enrolled between 22 and 41 weeks. Patients were divided into two groups based on sFlt1/PlGF ratio, namely low sFlt1/PlGF (<85) and high sFlt1/PlGF (≥85) ratio. RESULTS Of the 115 patients, 76% were African American. Compared to women with low sFlt1/PlGF (n = 78), patients with high sFlt1/PlGF (n = 37) had higher median antenatal blood pressures (systolic mmHg 179 vs 155; diastolic 106 vs 91), lower gestational age at delivery (34.7 vs 38.2 weeks), lower birthweight (1940 vs 3103 g), and a higher prevalence of preterm delivery <34 (40.5% vs 7.7%) and <37 weeks (64.9% vs 20.5%), all p < 0.001. Importantly, more women with high sFlt1/PlGF had a diagnosis of superimposed preeclampsia (62.2% vs 26.9%, p = 0.003), preeclampsia with severe features (59.5% vs 20.5%, p < 0.0001), maternal adverse outcomes (24.3% vs 3.9%, p = 0.002), neonatal intensive care unit admissions (71.9% vs 40.8%; p = 0.003), severe postpartum hypertension (67.6% vs 38.5%, p = 0.01) and longer hospital stays (median 6.0 vs 4.5 days, p = 0.003). DISCUSSION In contrast to patients with a low ratio, high sFlt1/PlGF is characterized by an increased risk of maternal adverse outcomes and prematurity. Incorporation of angiogenic biomarkers while managing cHTN may improve accuracy of early identification of adverse outcomes to improve outcomes.
Collapse
Affiliation(s)
- Sarah Heimberger
- University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Ariel Mueller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rubina Ratnaparkhi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Joana Lopes Perdigao
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Pennsylvania, PA, United States
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States.
| |
Collapse
|
161
|
Gerber Y, Gibbons RJ, Weston SA, Fabbri M, Herrmann J, Manemann SM, Frye RL, Asleh R, Greason K, Killian JM, Roger VL. Coronary Disease Surveillance in the Community: Angiography and Revascularization. J Am Heart Assoc 2020; 9:e015231. [PMID: 32237975 PMCID: PMC7428619 DOI: 10.1161/jaha.119.015231] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Temporal declines in cardiac stress tests results, coronary revascularization, and cardiovascular mortality have suggested a decline in the population burden of coronary disease until the 2000s. However, recent data indicate these favorable trends could be ending. We aimed to assess the evolution of the population burden of coronary disease in the community by examining trends in angiography and revascularization. Methods and Results We analyzed age- and sex-adjusted trends from all coronary angiographic diagnostic procedures and revascularizations performed in Olmsted County, MN from 2000 to 2018. A total of 12 981 invasive angiograms were performed among 9049 individuals (64% men; 55% aged ≥65 years). Adjusted angiography rates decreased by 30% (95% CI, 25%-34%) between 2000 and 2009 and leveled off thereafter. Including computed tomography, angiography uncovered an increase in angiography use in recent years (risk ratio=1.15 [95% CI, 1.07-1.23] for 2018 versus 2014) and a decline in the prevalence of anatomic CAD from 2000 to 2018. CAD severity declined substantially from 2000 to 2009, followed by a plateau. Among 6570 revascularizations (72% men; 57% aged ≥65 years), 77% were percutaneous coronary interventions and 23% coronary artery bypass graft surgeries. The adjusted revascularization rates declined by 34% (95% CI, 27%-39%) from 2000 to 2009, followed by a plateau (risk ratio=1.10 [95% CI, 1.00-1.22]). Conclusions Between 2000 and 2018 in the community, coronary angiography use declined initially, leveled off, and then increased. Trends in CAD severity and revascularization use decreased then plateaued. The most recent trends are concerning as they suggest the burden of coronary disease is no longer declining. This warrants reinvigorated primary prevention and population surveillance.
Collapse
Affiliation(s)
- Yariv Gerber
- Department of Health Sciences Research Mayo Clinic Rochester MN.,Department of Epidemiology and Preventive Medicine School of Public Health Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | | | - Susan A Weston
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Matteo Fabbri
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Joerg Herrmann
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Robert L Frye
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Rabea Asleh
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Kevin Greason
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Jill M Killian
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Véronique L Roger
- Department of Health Sciences Research Mayo Clinic Rochester MN.,Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| |
Collapse
|
162
|
McDoom MM, Cooper LA, Hsu YJ, Singh A, Perin J, Thornton RLJ. Neighborhood Environment Characteristics and Control of Hypertension and Diabetes in a Primary Care Patient Sample. J Gen Intern Med 2020; 35:1189-1198. [PMID: 32043258 PMCID: PMC7174485 DOI: 10.1007/s11606-020-05671-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hypertension control and diabetes control are important for reducing cardiovascular disease burden. A growing body of research suggests an association between neighborhood environment and hypertension or diabetes control among patients engaged in clinical care. OBJECTIVE To investigate whether neighborhood conditions (i.e., healthy food availability, socioeconomic status (SES), and crime) were associated with hypertension and diabetes control. DESIGN Cross-sectional analyses using electronic medical record (EMR) data, U.S. Census data, and secondary data characterizing neighborhood food environments. Multivariate logistic regression analyses adjusted for potential confounders. Analyses were conducted in 2017. PARTICIPANTS Five thousand nine hundred seventy adults receiving primary care at three Baltimore City clinics in 2010-2011. MAIN MEASURES Census tract-level neighborhood healthy food availability, neighborhood SES, and neighborhood crime. Hypertension control defined as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. Diabetes control defined as HgbA1c < 7. KEY RESULTS Among patients with hypertension, neighborhood conditions were not associated with lower odds of blood pressure control after accounting for patient and physician characteristics. However, among patients with diabetes, in fully adjusted models accounting for patient and physician characteristics, we found that patients residing in neighborhoods with low and moderate SES had reduced odds of diabetes control (OR = 0.74 (95% CI = 0.57-0.97) and OR = 0.75 (95% CI = 0.57-0.98), respectively) compared to those living in high-SES neighborhoods. CONCLUSIONS Neighborhood disadvantage may contribute to poor diabetes control among patients in clinical care. Community-based chronic disease care management strategies to improve diabetes control may be optimally effective if they also address neighborhood SES among patients engaged in care.
Collapse
Affiliation(s)
- M Maya McDoom
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Lisa A Cooper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Center for Health Equity, 5200 Eastern Avenue, Suite 4200, Baltimore, MD, 21224, USA
| | - Yea-Jen Hsu
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Abhay Singh
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jamie Perin
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Rachel L J Thornton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Center for Health Equity, 5200 Eastern Avenue, Suite 4200, Baltimore, MD, 21224, USA.
| |
Collapse
|
163
|
Carvajal CA, Tapia-Castillo A, Vecchiola A, Baudrand R, Fardella CE. Classic and Nonclassic Apparent Mineralocorticoid Excess Syndrome. J Clin Endocrinol Metab 2020; 105:5691192. [PMID: 31909799 DOI: 10.1210/clinem/dgz315] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/28/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Arterial hypertension (AHT) is one of the most frequent pathologies in the general population. Subtypes of essential hypertension characterized by low renin levels allowed the identification of 2 different clinical entities: aldosterone-mediated mineralocorticoid receptor (MR) activation and cortisol-mediated MR activation. EVIDENCE ACQUISITION This review is based upon a search of Pubmed and Google Scholar databases, up to August 2019, for all publications relating to endocrine hypertension, apparent mineralocorticoid excess (AME) and cortisol (F) to cortisone (E) metabolism. EVIDENCE SYNTHESIS The spectrum of cortisol-mediated MR activation includes the classic AME syndrome to milder (nonclassic) forms of AME, the latter with a much higher prevalence (7.1%) than classic AME but different phenotype and genotype. Nonclassic AME (NC-AME) is mainly related to partial 11βHSD2 deficiency associated with genetic variations and epigenetic modifications (first hit) and potential additive actions of endogenous or exogenous inhibitors (ie, glycyrrhetinic acid-like factors [GALFS]) and other factors (ie, age, high sodium intake) (second hit). Subjects with NC-AME are characterized by a high F/E ratio, low E levels, normal to elevated blood pressure, low plasma renin and increased urinary potassium excretion. NC-AME condition should benefit from low-sodium and potassium diet recommendations and monotherapy with MR antagonists. CONCLUSION NC-AME has a higher prevalence and a milder phenotypical spectrum than AME. NC-AME etiology is associated to a first hit (gene and epigene level) and an additive second hit. NC-AME subjects are candidates to be treated with MR antagonists aimed to improve blood pressure, end-organ damage, and modulate the renin levels.
Collapse
Affiliation(s)
- Cristian A Carvajal
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN), Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Alejandra Tapia-Castillo
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN), Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Andrea Vecchiola
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN), Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rene Baudrand
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN), Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN), Pontificia Universidad Catolica de Chile, Santiago, Chile
| |
Collapse
|
164
|
Chowdhury EK, Nelson MR, Ernst ME, Margolis KL, Beilin LJ, Johnston CI, Woods RL, Murray AM, Wolfe R, Storey E, Shah RC, Lockery JE, Tonkin AM, Newman AB, Williamson JD, Abhayaratna WP, Stocks NP, Fitzgerald SM, Orchard SG, Trevaks RE, Donnan GA, Grimm R, McNeil JJ, Reid CM. Factors Associated With Treatment and Control of Hypertension in a Healthy Elderly Population Free of Cardiovascular Disease: A Cross-sectional Study. Am J Hypertens 2020; 33:350-361. [PMID: 31807750 DOI: 10.1093/ajh/hpz192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/01/2019] [Accepted: 12/04/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Despite readily available treatments, control of blood pressure (BP) with population aging remains suboptimal. Further, there are gaps in the understanding of the management of high BP in the aged. We explored antihypertensive treatment and control among elderly hypertensive participants free from overt cardiovascular disease (CVD), and identified factors related to both "untreated" and "treated but uncontrolled" high BP. METHODS We analyzed baseline data from 19,114 individuals aged ≥65 years enrolled from Australia and United States (US) in the ASPirin in Reducing Events in the Elderly study. Hypertension was defined as an average systolic/diastolic BP ≥140/90 mm Hg and/or the use of any BP lowering medication. "Controlled hypertension" was defined if participants were receiving antihypertensive medication and BP <140 and 90 mm Hg. Descriptive analyses were used to summarize hypertension control rates; logistic regression was used to investigate relationships with treatment and BP control. RESULTS Overall, 74% (14,213/19,114) of participants were hypertensive; and of these 29% (4,151/14,213) were untreated. Among those treated participants, 53% (5,330/10,062) had BP ≥140/90 mm Hg. Participants who were untreated were more likely to be men, have higher educational status, and be in good physical health, and less likely to have significant comorbidities. The factors related to "treated but uncontrolled" BP included older age, male, Black race (vs. White), using antihypertensive monotherapy (vs. multiple) and residing in Australia (vs. US). CONCLUSIONS High levels of "untreated" and "treated but uncontrolled" BP occur in healthy elderly people without CVD, suggesting there are opportunities for better BP control in the primary prevention of CVD in this population. CLINICAL TRIALS REGISTRATION NCT01038583.
Collapse
Affiliation(s)
- Enayet K Chowdhury
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Mark R Nelson
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City , IA, USA
| | | | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, WA, Australia
| | | | - Robyn L Woods
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute (HHRI), Hennepin Healthcare, Minneapolis, MN, USA
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | - Rory Wolfe
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elsdon Storey
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jessica E Lockery
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew M Tonkin
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeff D Williamson
- Sticht Center on Healthy Aging and Alzheimer’s Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Walter P Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
| | - Sharyn M Fitzgerald
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne G Orchard
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ruth E Trevaks
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Richard Grimm
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | - John J McNeil
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher M Reid
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | | |
Collapse
|
165
|
Derington CG, King JB, Herrick JS, Shimbo D, Kronish IM, Saseen JJ, Muntner P, Moran AE, Bress AP. Trends in Antihypertensive Medication Monotherapy and Combination Use Among US Adults, National Health and Nutrition Examination Survey 2005-2016. Hypertension 2020; 75:973-981. [PMID: 32148129 PMCID: PMC7398637 DOI: 10.1161/hypertensionaha.119.14360] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Blood pressure (BP) control rates among US adults taking antihypertensive medication have not increased over the past decade. Many adults require 2 or more classes of antihypertensive medication to achieve guideline-recommended BP goals, but the proportion of US adults taking antihypertensive medication monotherapy, versus combination therapy, has not been quantified using contemporary data. We analyzed data from 2005 to 2008, 2009 to 2012, and 2013 to 2016 National Health and Nutrition Examination Surveys to determine trends in monotherapy and combinations of antihypertensive medication classes among US adults age ≥20 years with hypertension taking antihypertensive medication (n=7837). The proportion of US adults taking antihypertensive medication with uncontrolled BP (ie, systolic BP ≥140 or diastolic BP ≥90 mm Hg) was 32.3%, 30.2%, and 31.0% in 2005 to 2008, 2009 to 2012, and 2013 to 2016, respectively (Ptrend=0.37). Between 2005 to 2008 and 2013 to 2016, there was no evidence of changes in the proportions of US adults taking antihypertensive monotherapy (39.5%-40.4%, Ptrend=0.67), dual-therapy (37.9%-38.3%, Ptrend=0.75), triple-therapy (17.6%-16.5%, Ptrend=0.36), or quadruple-therapy (4.4%-4.3%, Ptrend=0.93). Between 2005 to 2008 and 2013 to 2016, there was no evidence of changes in the proportions of US adults with uncontrolled BP taking antihypertensive monotherapy (39.3%-40.6%, Ptrend=0.78). A high proportion of US adults with hypertension, including those with uncontrolled BP, are taking one antihypertensive medication class. Increasing the use of dual- and triple-therapy antihypertensive medication regimens may restore the upward trend in BP control rates among US adults.
Collapse
Affiliation(s)
- Catherine G Derington
- From the Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO (C.G.D., J.B.K.)
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO (C.G.D., J.J.S.)
| | - Jordan B King
- From the Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO (C.G.D., J.B.K.)
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT (J.B.K., J.S.H., A.P.B.)
| | - Jennifer S Herrick
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT (J.B.K., J.S.H., A.P.B.)
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (D.S., I.M.K., A.E.M.)
| | - Ian M Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (D.S., I.M.K., A.E.M.)
| | - Joseph J Saseen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO (C.G.D., J.J.S.)
- Department of Family Medicine, University of Colorado, School of Medicine, Aurora, CO (J.J.S.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (P.M.)
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (D.S., I.M.K., A.E.M.)
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT (J.B.K., J.S.H., A.P.B.)
| |
Collapse
|
166
|
Wen Y, Crowley SD. Connecting cytokines and cellular signals in the nephron during CKD and hypertension. Kidney Int 2020; 97:651-653. [PMID: 32200858 DOI: 10.1016/j.kint.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
Chronic kidney disease features chronic inflammation and fibrosis, both of which contribute to and are exacerbated by arterial hypertension. The contribution of immune responses to renal sodium retention has received intense scrutiny. In this regard, the article by Furusho et al. details a mechanism wherein intrarenal TNFα augments salt-sensitive hypertension during CKD via activation of the WNK1-SPAKNCC phosphorylation cascade.
Collapse
Affiliation(s)
- Yi Wen
- Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, USA; Department of Medicine, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Steven D Crowley
- Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, USA; Department of Medicine, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
| |
Collapse
|
167
|
Heimberger S, Perdigao JL, Mueller A, Shahul S, Naseem H, Minhas R, Chintala S, Rana S. Effect of blood pressure control in early pregnancy and clinical outcomes in African American women with chronic hypertension. Pregnancy Hypertens 2020; 20:102-107. [PMID: 32229425 DOI: 10.1016/j.preghy.2020.03.008] [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: 01/12/2020] [Revised: 03/05/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Chronic hypertension (cHTN) affects 3-5% of all pregnancies and is twice as prevalent in African American (AA) women. AA women develop more severe HTN at an earlier onset and have higher rates of adverse pregnancy outcomes. Blood pressure control during pregnancy is controversial. STUDY DESIGN This retrospective cohort included AA women with cHTN and singleton pregnancies delivering between January 2013 and December 2016. Patients were classified as not receiving antihypertensives in the first 20 weeks (Group A), on antihypertensives in the first 20 weeks but with an average BP <140/90 during pregnancy (Group B) and on antihypertensives in the first 20 weeks but with average BP during pregnancy ≥140/90 (Group C). Adverse outcomes including severe HTN and preterm delivery <35 weeks was compared between groups. RESULTS Of the 198 patients included, 68 received at least one AHT before 20 weeks including 45 patients with average BP <140/90 and 23 with average BP ≥140/90 during pregnancy. The incidence of superimposed PE and preterm birth was significantly higher among women with elevated BPs on AHT (39.1% vs 8.9% vs 17.7%, p = 0.01; preterm birth 52.2%, 8.9% and 9.2%, p < 0.001 for Groups C, B and A, respectively). A significantly higher proportion of adverse neonatal outcomes were observed in Group C (78.3%) as opposed to those in Group B (53.3%) or Group A (50.0%; p = 0.04). CONCLUSIONS Among AA women with cHTN, use of antihypertensives prior to 20 weeks and lower antenatal BP was associated with a decreased risk of adverse maternal and neonatal outcomes.
Collapse
Affiliation(s)
- Sarah Heimberger
- University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Joana Lopes Perdigao
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Pennsylvania, PA, United States
| | - Ariel Mueller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sana Shahul
- University of Chicago, Chicago, IL, United States
| | - Heba Naseem
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Ruby Minhas
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Sireesha Chintala
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, IL, United States.
| |
Collapse
|
168
|
Blood pressure targets in chronic kidney disease: an update on the evidence. Curr Opin Nephrol Hypertens 2020; 29:327-332. [PMID: 32167996 DOI: 10.1097/mnh.0000000000000601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Hypertension is the leading modifiable cause of cardiovascular events and of mortality and is generally considered as a direct cause of chronic kidney disease. Defining optimal blood pressure targets in patients with chronic kidney disease is therefore of critical importance. RECENT FINDINGS Over the recent years, results and post-hoc analyses of several important trials comparing blood pressure targets which included patients with chronic kidney disease have been published. Although these results provide important means to understand the consequences of high blood pressure and to improve the management of hypertension in chronic kidney disease, they led to remarkably different interpretations and recommendations in the current guidelines. SUMMARY The present review summarizes the current evidence and areas of controversy for the definition of blood pressure targets in patients with chronic kidney disease.
Collapse
|
169
|
Ali WE, Bakris GL. Fear of Lowering Cardiovascular Risk by Achieving Blood Pressure Goals: The Irrationality of Combination Therapy Avoidance. Hypertension 2020; 75:943-944. [PMID: 32148130 DOI: 10.1161/hypertensionaha.119.14528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Waleed E Ali
- From the Department of Medicine, Am. Heart Assoc. Comprehensive Hypertension Center, University of Chicago Medicine, IL
| | - George L Bakris
- From the Department of Medicine, Am. Heart Assoc. Comprehensive Hypertension Center, University of Chicago Medicine, IL
| |
Collapse
|
170
|
Ni Z, Atluri N, Shaw RJ, Tan J, Khan K, Merk H, Ge Y, Shrestha S, Shrestha A, Vasudevan L, Karmacharya B, Yan LL. Evaluating the Feasibility and Acceptability of a Mobile Health-Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e15419. [PMID: 32149712 PMCID: PMC7091025 DOI: 10.2196/15419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/29/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension is a major modifiable risk factor for cardiovascular disease, the world's leading cause of death. The prevalence of hypertension is disproportionately higher in South Asian countries than in other regions of the world. Screening for hypertension in primary care settings remains a challenge in many South Asian countries, including Nepal. Nepal is located in the Himalayan Mountains region, posing significant geographical challenges for its rural citizens to access primary health care and service delivery. This barrier increases the costs and inconvenience for rural Nepalis to access hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4%-38.6%. Nepal's Ministry of Health and Population relies on female community health volunteers to link health centers and communities to provide basic health services. Over 50,000 of these volunteers in Nepal have received basic health care training and are assigned to take care of maternal and child health. Due to limited health care resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the role of female community health volunteers to include hypertension management through blood pressure monitoring and home-based education. OBJECTIVE The goal of this study was to assess if a mobile health-based female community health volunteer approach of combining the traditional community health volunteer program with digital technologies would be feasible and acceptable in rural Nepal. METHODS In this study, we recruited 17 female community health volunteers and extended their role from maternal and child health to hypertension management through screening blood pressures. RESULTS All 17 female community health volunteers successfully measured 1113 rural Nepalis' blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 70% of them had a mobile phone, and 92% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 84% preferred voice calls, and 7% and 1% preferred texting and apps, respectively. CONCLUSIONS Results from this study indicate that a digital health intervention that leverages feature-phones combined with female community health volunteers may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal.
Collapse
Affiliation(s)
- Zhao Ni
- Duke University, Durham, NC, United States
| | | | | | | | - Kinza Khan
- Duke University, Durham, NC, United States
| | | | - Yunfan Ge
- Duke Kunshan University, Kunshan, China
| | | | | | | | | | | |
Collapse
|
171
|
Abstract
PURPOSE OF REVIEW To provide an overview of the available data on the prevalence of hypertension (HTN) in various groups and segments of the Hispanic population; prevalence of awareness, treatment and control of HTN among Hispanics; and HTN-related disparities, through disproportionate effects on the Hispanic elderly, women, and young adults. RECENT FINDINGS Data on HTN in Hispanics has been lacking or aggregated and frequently not inclusive of certain groups of Hispanics but the available data do show a pattern of more prevalent HTN and HTN disparities among Hispanics compared with non-Hispanic whites. Hispanic adults have some of the highest prevalence of poorly controlled blood pressure compared with any other race-ethnic group in the United States. Further, the impact of the most recent iteration of the HTN guidelines among all segments of the Hispanic population has not been well studied. SUMMARY The most recent HTN guidelines will likely only further illuminate worsening HTN-related disparities among Hispanics. These findings suggest significant screening and treatment disparities must be addressed to reduce HTN risk among the Hispanic population.
Collapse
|
172
|
Loutradis C, Sarafidis P. Pharmacotherapy of hypertension in patients with pre-dialysis chronic kidney disease. Expert Opin Pharmacother 2020; 21:1201-1217. [PMID: 32073319 DOI: 10.1080/14656566.2020.1726318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hypertension is the most common co-morbidity in patients with chronic kidney disease (CKD), with prevalence gradually increasing across CKD Stages to the extent that about 90% of end-stage renal disease (ESRD) patients are hypertensives. Several factors contribute to blood pressure (BP) elevation and guide the therapeutic interventions that should be employed in these patients. AREAS COVERED This review summarizes the existing data for the management of hypertension, regarding optimal BP targets and the use of major antihypertensive classes in patients with CKD. EXPERT OPINION Management of hypertension in CKD requires both lowering BP levels and reducing proteinuria to minimize the risk of both CKD progression and cardiovascular disease. In this respect, aggressive control of office BP to levels <130/80 mmHg has long been proposed for patients with proteinuric nephropathies. Following evidence from recent studies that confirmed significant reductions in renal and cardiovascular outcomes with strict BP control, most, but not all, of international guidelines, suggest such BP goals for all hypertensive patients, including those with CKD. Use of renin-angiotensin system (RAS) blockers is the treatment of choice for patients with proteinuric nephropathies, while, in most patients with CKD, combination treatment with two, three, or more antihypertensive agents is often required to control BP.
Collapse
Affiliation(s)
- Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| |
Collapse
|
173
|
Wu XQ, Satmary W, Peng J, Hui KK. Women's preconception health patterns in traditional Chinese medicine as a predictor of fertility outcomes. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:222-228. [PMID: 32008985 DOI: 10.1016/j.joim.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/30/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association between traditional Chinese medicine (TCM), preconception health patterns and fertility outcomes. METHODS A community-based prospective cohort study was conducted in China. A total of 3012 newly married women who were willing to conceive within 2 years were enrolled in the study and took National Free Prepregnancy Checkups (NFPC). A reliably structured self-rating scale was used to measure the TCM preconception health patterns of the enrolled women. A 3-year follow-up was conducted to obtain the fertility outcomes, including pregnancy rate, time to pregnancy, spontaneous miscarriage and newborn status. Statistical analyses were conducted using Chi-square or Fisher's exact tests, logistic regression models, general linear models and the Cox proportional hazard model. RESULTS The fertility outcomes showed no statistic correlations to the terms of NFPC in this population. Approximately a half of the women (46.66%) had unhealthy patterns. Women with qi & blood-deficiency (odds ratio [OR] = 35.19, 95% confidence interval [CI] = 1.55-801.15) or qi-stagnation (OR = 4.55, 95% CI = 0.90-23.06) pattern took a longer time to get pregnant, and those with qi-stagnation (OR = 2.05, 95% CI = 1.1-3.82) or yang-deficiency (OR = 1.91, 95% CI = 1.12-3.25) pattern had a higher risk of spontaneous miscarriage. CONCLUSION Three unhealthy TCM patterns during the preconception period might be risk factors for low fecundity or poor pregnancy outcomes. The TCM preconception pattern identification may provide a convenient and effective way to screen for potential pregnancy risks beyond the NFPC. Further, appropriate interventions based on the TCM preconception health patterns are needed to improve quality in women's fecundability and birth outcomes.
Collapse
Affiliation(s)
- Xia-Qiu Wu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China; Center for East-West Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.
| | - Wendy Satmary
- Department of Obstetrics & Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Jin Peng
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Ka-Kit Hui
- Center for East-West Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| |
Collapse
|
174
|
Bacon E. Racial/ethnic differences in treatment recommendations: lifestyle changes and medication prescriptions for high cholesterol. ETHNICITY & HEALTH 2020; 25:273-288. [PMID: 29092619 PMCID: PMC5932286 DOI: 10.1080/13557858.2017.1398315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
Objective: High cholesterol is a common condition in the United States, affecting nearly one third of adults, and is a leading precursor to coronary heart disease. This study investigates race/ethnic differences in treatment recommendations for patients with high cholesterol, including prescription medication and lifestyle changes such as eating less fat, losing weight, or exercising more.Design: Data were obtained from the 2005 to 2010 National Health and Nutrition Examination Survey (N = 4846), a representative sample of adults in the United States, and the 2005-2010 National Ambulatory Medical Care Survey (N = 12,113), a representative sample of patient visits in the United States. Logistic regression analyses were used to assess whether health professionals recommended lifestyle changes or medication prescriptions differently by patient race/ethnicity and age. Models adjusted for demographic characteristics, socioeconomic status, health behaviors, health care access/utilization, and comorbidities.Results: Non-Hispanic Black and Hispanic patients with high cholesterol were significantly and substantially more likely to receive recommendations for lifestyle changes compared to non-Hispanic White patients. These differences were exacerbated at younger ages and largely diminished for adults over the age of 65. These patterns were reflected in both datasets. However, non-Hispanic Black patients from the NHANES analysis were less likely than non-Hispanic White patients to receive medication prescriptions for high cholesterol, particularly at younger ages. There were no race/ethnic differences in odds of medication prescriptions for Hispanic patients compared to White patients.Conclusions: Results suggest widespread and pervasive race/ethnic differences in recommending lifestyle changes for patients with high cholesterol. Although lifestyle changes may lower cholesterol they are often less effective than prescription medication. Because differences in lifestyle recommendations were not reflected in prescription practices, results may indicate a form of discrimination within physician-patient interactions that could be addressed by increased provider education about most effective treatment practices.
Collapse
Affiliation(s)
- Emily Bacon
- Department of Sociology and Population Program, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| |
Collapse
|
175
|
Zhao D, Post WS, Blasco-Colmenares E, Cheng A, Zhang Y, Deo R, Pastor-Barriuso R, Michos ED, Sotoodehnia N, Guallar E. Racial Differences in Sudden Cardiac Death. Circulation 2020; 139:1688-1697. [PMID: 30712378 DOI: 10.1161/circulationaha.118.036553] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Blacks have a higher incidence of out-of-hospital sudden cardiac death (SCD) in comparison with whites. However, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale community-based cohorts. The objective of this study is to compare the lifetime cumulative risk of SCD among blacks and whites, and to evaluate the risk factors that may explain racial differences in SCD risk in the general population. METHODS This is a cohort study of 3832 blacks and 11 237 whites participating in the Atherosclerosis Risk in Communities Study (ARIC). Race was self-reported. SCD was defined as a sudden pulseless condition from a cardiac cause in a previously stable individual, and SCD cases were adjudicated by an expert committee. Cumulative incidence was computed using competing risk models. Potential mediators included demographic and socioeconomic factors, cardiovascular risk factors, presence of coronary heart disease, and electrocardiographic parameters as time-varying factors. RESULTS The mean (SD) age was 53.6 (5.8) years for blacks and 54.4 (5.7) years for whites. During 27.4 years of follow-up, 215 blacks and 332 whites experienced SCD. The lifetime cumulative incidence of SCD at age 85 years was 9.6, 6.6, 6.5, and 2.3% for black men, black women, white men, and white women, respectively. The sex-adjusted hazard ratio for SCD comparing blacks with whites was 2.12 (95% CI, 1.79-2.51). The association was attenuated but still statistically significant in fully adjusted models (hazard ratio, 1.38; 95% CI, 1.11-1.71). In mediation analysis, known factors explained 65.3% (95% CI 37.9-92.8%) of the excess risk of SCD in blacks in comparison with whites. The single most important factor explaining this difference was income (50.5%), followed by education (19.1%), hypertension (22.1%), and diabetes mellitus (19.6%). Racial differences were evident in both genders but stronger in women than in men. CONCLUSIONS Blacks had a much higher risk for SCD in comparison with whites, particularly among women. Income, education, and traditional risk factors explained ≈65% of the race difference in SCD. The high burden of SCD and the racial-gender disparities observed in our study represent a major public health and clinical problem.
Collapse
Affiliation(s)
- Di Zhao
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
| | - Wendy S Post
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.).,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.)
| | - Elena Blasco-Colmenares
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
| | - Alan Cheng
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.).,Medtronic Inc, Minneapolis, MN (A.C.)
| | - Yiyi Zhang
- Division of General Medicine, Department of Medicine, Columbia University, New York, NY (Y.Z.)
| | - Rajat Deo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia (R.D.)
| | - Roberto Pastor-Barriuso
- National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.)
| | - Erin D Michos
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.).,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.)
| | - Nona Sotoodehnia
- Division of Cardiology, Cardiovascular Health Research Unit, University of Washington, Seattle (N.S.)
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
| |
Collapse
|
176
|
Eghbali-Babadi M, Feizi A, Khosravi A, Nouri F, Taheri M, Sarrafzadegan N. Development and evaluation of the psychometric properties of a hypertension self-care questionnaire. ARYA ATHEROSCLEROSIS 2020; 15:241-249. [PMID: 31949451 PMCID: PMC6954361 DOI: 10.22122/arya.v15i5.1835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are a number of tools to assess self-care in hypertension (HTN), but they do not cover all the dimensions of self-care and do not have a good reliability and validity. This study was conducted to develop and evaluate the psychometric properties of a tool for self-care assessment in HTN. METHODS This cross-sectional, methodological study was conducted in Isfahan, Iran. An expert panel was held to assess the qualitative face validity of the tool. The content validity ratio (CVR) and content validity index (CVI) were measured. The questionnaire was distributed among 20 patients to measure its internal reliability. After 14 days, it was re-distributed among the same patients, as a measure of external reliability. The questionnaire was completed by 203 patients with HTN and an exploratory factor analysis was performed in order to assess the construct validity of the tool. RESULTS The items of the self-care tool were confirmed with a CVR ≥ 0.5, Kappa ≥ 0.71, I-CVI = 0.69, and intraclass correlation coefficient (ICC) = 0.952. The factor analysis showed that the 16-item questionnaire has 5 dimensions, including follow-up [3 items; factor loadings (FL) = 0.619 to 0.869, and Cronbach's alpha (α) = 0.737], healthy lifestyle (5 items; FL = 0.709 to 0.846, α = 0.703), promoting qualifications (4 items; FL = 0.610 to 0.791, α = 0.594), medication therapy (2 items; FL = 0.699 and 0.740, α = 0.717), and following recommendations (2 items, FL = 0.577 and 0.744, α = 0.701). These 5 dimensions explained 62.686% of the variance. The Cronbach's alpha coefficient of the final self-care assessment questionnaire was 0.833. CONCLUSION The developed questionnaire proved to have appropriate psychometric properties for measuring self-care in patients with HTN.
Collapse
Affiliation(s)
- Maryam Eghbali-Babadi
- Assistant Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute AND Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- PhD Candidate, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- PhD Candidate, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
177
|
Abstract
Hypertension is still the number one global killer. No matter what causes are, lowering blood pressure can significantly reduce cardiovascular complications, cardiovascular death, and total death. Unfortunately, some hypertensive individuals simply do not know having hypertension. Some knew it but either not being treated or treated but blood pressure does not achieve goal. The reasons for inadequate control of blood pressure are many. One important reason is that we are not very familiar with antihypertensive agents and less attention has been paid to comorbidities, complications as well as the hypertension-modified target organ damage in patients with hypertension. The right antihypertensive drug was not given to the right hypertensive patients at right time. This reviewer studied comprehensively the literature, hopefully that the review will help improve antihypertensive drug selection and antihypertensive therapy.
Collapse
Affiliation(s)
- Rutai Hui
- Chinese Academy of Medical Sciences FUWAI Hospital Hypertension Division, 167 Beilishilu West City District, 100037, Beijing People's Republic of China, China.
| |
Collapse
|
178
|
Locke JE, Reed RD, Kumar V, Berry B, Hendricks D, Carter A, Shelton BA, Mustian MN, MacLennan PA, Qu H, Hannon L, Yates C, Hanaway MJ. Enhanced Advocacy and Health Systems Training Through Patient Navigation Increases Access to Living-donor Kidney Transplantation. Transplantation 2020; 104:122-129. [PMID: 30946213 PMCID: PMC6773517 DOI: 10.1097/tp.0000000000002732] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND To date, no living donation program has simultaneously addressed the needs of both transplant candidates and living donors by separating the advocacy role from the candidate and improving potential donor comfort with the evaluation process. We hypothesized that the development of a novel program designed to promote both advocacy and systems training among transplant candidates and their potential living kidney donors would result in sustained increases in living-donor kidney transplantation (LDKT). To this end, we developed and implemented a Living Donor Navigator (LDN) Program at the University of Alabama at Birmingham. METHODS We included adult patients awaiting kidney-only transplant in a retrospective cohort analysis. Using time-varying Cox proportional hazards regression, we explored likelihood of living donor screening and approval by participation in the LDN program. RESULTS There were 56 LDN participants and 1948 nonparticipants (standard of care). LDN was associated with a 9-fold increased likelihood of living donor screenings (adjusted hazard ratio, 9.27; 95% confidence interval, 5.97-14.41, P < 0.001) and a 7-fold increased likelihood of having an approved living donor (adjusted hazard ratio, 7.74; 95% confidence interval, 3.54-16.93; P < 0.001) compared with the standard of care. Analyses by participant race demonstrated higher likelihood of screened donors and a similar likelihood of having an approved donor among African Americans compared with Caucasians. CONCLUSIONS These data suggest that both advocacy and systems training are needed to increase actual LDKT rates, and that LDN programs may mitigate existing racial disparities in access to LDKT.
Collapse
Affiliation(s)
- Jayme E. Locke
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Rhiannon D Reed
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Vineeta Kumar
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Beverly Berry
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Daagye Hendricks
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Alexis Carter
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Brittany A Shelton
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | | | - Paul A MacLennan
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Haiyan Qu
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Lonnie Hannon
- Tuskegee University Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
| | - Clayton Yates
- Tuskegee University Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
| | - Michael J Hanaway
- University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| |
Collapse
|
179
|
Trends in cardiometabolic risk factors in the Americas between 1980 and 2014: a pooled analysis of population-based surveys. Lancet Glob Health 2020; 8:e123-e133. [PMID: 31839128 PMCID: PMC7025323 DOI: 10.1016/s2214-109x(19)30484-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/30/2019] [Accepted: 10/24/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Describing the prevalence and trends of cardiometabolic risk factors that are associated with non-communicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014. METHODS We did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7·0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas. FINDINGS 389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3·9% (95% CI 2·2-6·3) in 1980, to 18·6% (14·3-23·3) in 2014, in men; and from 12·2% (8·2-17·0) in 1980, to 30·5% (25·7-35·5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5·2% (2·1-10·4) in men and 6·4% (2·6-10·4) in women in 1980, to 11·1% (6·4-17·3) in men and 13·6% (8·2-21·0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27·6% (22·3-33·2) in men and 19·9% (15·8-24·4) in women in 1980, to 15·5% (11·1-20·9) in men and 10·7% (7·7-14·5) in women in 2014. INTERPRETATION Despite the generally high prevalence of cardiometabolic risk factors across the Americas, estimates also showed a high level of heterogeneity in the transition between countries. The increasing prevalence of obesity and diabetes observed over time requires appropriate measures to deal with these public health challenges. Our results support a diversification of health interventions across subregions and countries. FUNDING Wellcome Trust.
Collapse
|
180
|
Foti K, Wang D, Appel LJ, Selvin E. Hypertension Awareness, Treatment, and Control in US Adults: Trends in the Hypertension Control Cascade by Population Subgroup (National Health and Nutrition Examination Survey, 1999-2016). Am J Epidemiol 2019; 188:2165-2174. [PMID: 31504121 DOI: 10.1093/aje/kwz177] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/26/2019] [Accepted: 08/07/2019] [Indexed: 12/12/2022] Open
Abstract
Examination of changes in hypertension awareness, treatment, and control (i.e., the hypertension control cascade) by population subgroup can inform targeted efforts to improve hypertension control and reduce disparities. We analyzed 1999-2016 data from the National Health and Nutrition Examination Survey and examined trends across 6-year periods in hypertension awareness, treatment, and control by age, sex, and race/ethnicity. We included 39,589 participants (16,141 with hypertension). Hypertension awareness, treatment, and control increased from 1999 to 2016 among all age groups. However, there were few changes after 2010. Across all time periods, awareness, treatment, and control were higher among younger women (ages 25-44 years) than among younger men, while control was higher among older men (ages ≥65 years) than among older women. Hypertension control was persistently lower for blacks than for whites of all ages, and awareness, treatment, and control were lower among younger Hispanics. There have been few changes in hypertension awareness, treatment, and control since 2010. Disparities in hypertension control by sex highlight the need for effective interventions among younger men and older women. Concerted efforts are also needed to reduce persistent racial/ethnic disparities, particularly to improve treatment control among blacks and to further address gaps at all stages among younger Hispanics.
Collapse
|
181
|
Abstract
Hypertension is the most common cardiovascular risk factor and underlies heart failure, coronary artery disease, stroke, and chronic kidney disease. Hypertensive heart disease can manifest as cardiac arrhythmias. Supraventricular and ventricular arrhythmias may occur in the hypertensive patients. Atrial fibrillation and hypertension contribute to an increased risk of stroke. Some antihypertensive drugs predispose to electrolyte abnormalities, which may result in atrial and ventricular arrhythmias. A multipronged strategy involving appropriate screening, aggressive lifestyle modifications, and optimal pharmacotherapy can result in improved blood pressure control and prevent the onset or delay progression of heart failure, coronary artery disease, and cardiac arrhythmias.
Collapse
Affiliation(s)
- Muhammad R Afzal
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Salvatore Savona
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Omar Mohamed
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Aayah Mohamed-Osman
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA.
| |
Collapse
|
182
|
Nag K, Karmakar N, Ghosh B, Datta A. An Epidemiological Study on the Assessment of Cardiovascular Health Status among Adults in an Urban Area of Teliamura Municipality Area, Khowai, Tripura. Indian J Community Med 2019; 44:332-336. [PMID: 31802795 PMCID: PMC6881879 DOI: 10.4103/ijcm.ijcm_386_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: In India, cardiovascular disease (CVD) is the largest cause of mortality and morbidity in all regions of the country. Now, to reduce the burden of CVD in our country, we first need to assess cardiovascular health status of the adult population. Objective: The aim of this study is to assess cardiovascular health status among adults and to find the influence of sociodemographic factors on it. Methodology: In a cross-sectional study, cardiovascular health status of 100 sampled adult population of urban area of Teliamura Municipality area, Tripura, was assessed using a pre-designed and pre-tested semi-structured schedule from July 2017 to August 2017. Samples were taken from the adult population by simple random sampling. Collected data were compiled and analyzed using the Statistical Package for the Social Sciences (SPSS 16.0.). The Chi-square and Fisher's exact test were applied to find association. Results: The mean age of the study participants was 44.89 (±13.76) years, comprised 52.0% males and 48% females. Hypertension was seen among 58% of the study population and 77% had ideal (<100 mg/dl) level of fasting blood sugar (FBS). The present study showed obesity, hypertension, high level of total cholesterol, high level of FBS was mostly prevalent among 42–61 years age group. Married people were more obese, hypertensive compared to unmarried. Conclusion: Middle age group population were worst affected by high blood pressure, high blood sugar, poor body mass index, and poor level of cholesterol. Healthy lifestyle measures might reduce the burden of CVD which could be evaluated in future research.
Collapse
Affiliation(s)
- Kaushik Nag
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Nabarun Karmakar
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Bivek Ghosh
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| | - Anjan Datta
- Departments of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
| |
Collapse
|
183
|
Consistency of Blood Pressure Control: a Useful Tool of Hypertension Assessment in a Vulnerable Population. J Gen Intern Med 2019; 34:2711-2713. [PMID: 31515738 PMCID: PMC6854129 DOI: 10.1007/s11606-019-05299-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
184
|
Siddiqui E, Shah A, Para A, Baredes S, Park RCW. Risk assessment of hypertension in carotid body surgeries: A NSQIP analysis. Laryngoscope 2019; 130:2008-2012. [DOI: 10.1002/lary.28373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/26/2019] [Accepted: 09/23/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Emaad Siddiqui
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Aakash Shah
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Ashok Para
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology–Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey U.S.A
| |
Collapse
|
185
|
Abstract
Supplemental Digital Content is available in the text. Evidence about the target blood pressure (BP) in patients with resistant hypertension is limited. The present study aimed to assess the efficacy of intensive BP treatment (systolic BP target, <120 mm Hg) versus standard BP treatment (systolic BP target, <140 mm Hg) in patients with resistant hypertension. This is a secondary analysis using data from SPRINT (Systolic Blood Pressure Intervention Trial). This study included 1397 patients with resistant hypertension and 7698 without resistant hypertension. Using the Cox proportional hazards model, we compared time to first occurrence of a major adverse cardiovascular event (cardiovascular death, myocardial infarction, and stroke) between the intensive and standard BP treatment groups. Mean follow-up was 3.1 years; major adverse cardiovascular events was confirmed in 381 patients. Risk of major adverse cardiovascular events was significantly lower in the intensive treatment group than in the standard treatment group (hazard ratio, 0.62; 95% CI, 0.40–0.96; P=0.03). Risks of all-cause and cardiovascular death in patients with resistant hypertension were also significantly lower in the intensive treatment group than in the standard treatment group (hazard ratio for all-cause death: 0.60; 95% CI, 0.38–0.97; P=0.03; hazard ratio for cardiovascular death: 0.34; 95% CI, 0.15–0.81; P=0.01). Similar associations were observed in various subgroups. Intensive BP treatment was significantly associated with a decreased risk of major adverse cardiovascular events in patients with resistant hypertension.
Collapse
Affiliation(s)
- Tetsuro Tsujimoto
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kajio
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
186
|
Aggarwal R, Petrie B, Bala W, Chiu N. Mortality Outcomes With Intensive Blood Pressure Targets in Chronic Kidney Disease Patients. Hypertension 2019; 73:1275-1282. [PMID: 31067189 DOI: 10.1161/hypertensionaha.119.12697] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hypertension is highly prevalent and morbid in the chronic kidney disease population, and blood pressure (BP) targets for this population are unclear. We aimed to compare all-cause mortality outcomes with intensively targeting systolic BP to <130 mm Hg versus a standard of <140 mm Hg. Individual patient data from 4983 chronic kidney disease patients with hypertension were pooled from 4 multicenter randomized control trials-AASK (African American Study of Kidney Disease and Hypertension), ACCORD (Action to Control Cardiovascular Risk in Diabetes), MDRD (Modification of Diet in Renal Disease), and the SPRINT (Systolic Blood Pressure Intervention Trial). Patients were assigned their trial-assigned randomized intervention group-standard (n=2474) versus intensive (n=2509) BP targets. Additional analyses included excluding patients with a glomerular filtration rate ≥60 mL/min per 1.73 m2 along with those undergoing intensive glycemic control. The primary outcome was all-cause mortality. Average achieved BP was 125.0 mm Hg in the intensive group and 136.9 mm Hg in the standard group. In the primary analysis, the all-cause mortality rate trended towards improved outcomes with intensive treatment but was not statistically significant (hazard ratio: 0.87 [0.69-1.08]; P=0.21). One hundred seventy-three of 2474 patients (1.95% per year) in the standard group and 153 of 2509 patients (1.71% per year) in the intensive group died. After excluding patients with higher glomerular filtration rate values and those undergoing intensive glycemic control, there was a statistically significant decrease in all-cause mortality rate (hazard ratio: 0.79 [0.63-1.00]; P=0.048). An intensive BP target of <130 mm Hg decreases all-cause mortality when compared with a standard target of <140 mm Hg in patients with chronic kidney disease stage 3 or greater who are not undergoing intensive glycemic therapy.
Collapse
Affiliation(s)
| | | | - Wasif Bala
- From the Boston University School of Medicine, MA
| | | |
Collapse
|
187
|
Tsujimoto T, Kajio H. Thiazide Use and Cardiovascular Events in Type 2 Diabetic Patients With Well-Controlled Blood Pressure. Hypertension 2019; 74:1541-1550. [PMID: 31679424 PMCID: PMC7069392 DOI: 10.1161/hypertensionaha.119.13886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Evidence regarding the efficacy and safety of thiazides in patients with well-controlled and relatively low blood pressure (BP) is lacking. This study aimed to assess whether thiazide use is effective and safe in type 2 diabetic patients with well-controlled BP and whether intensive BP control leads to decreased risk of cardiovascular events depending on thiazide use. We performed an observational cohort study using data from the ACCORD study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was major adverse cardiovascular events (MACE), which was a composite end point including cardiovascular death, myocardial infarction, and stroke. Hazard ratios for primary and secondary outcomes with 95% CIs were calculated using Cox proportional hazards models. We included 10 011 type 2 diabetic patients. The overall mean follow-up period was 7.7 years, and 1776 patients experienced MACE. Mean systolic BP at baseline in patients taking and not taking thiazides was 137.2 and 135.7 mm Hg, respectively. Thiazide use was associated with increased risk of MACE, particularly stroke (hazard ratio, 1.49 [95% CI, 1.18-1.88]). In addition, thiazide use was significantly associated with higher risks of MACE and stroke in patients receiving intensive BP control but not in those receiving standard BP control. Similar associations were observed in analyses using propensity score matching. Intensive BP control reduced the risks of MACE and stroke in patients not taking thiazides but not in patients taking thiazides. Thiazide use may be harmful in type 2 diabetic patients with relatively low BP.
Collapse
Affiliation(s)
- Tetsuro Tsujimoto
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kajio
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
188
|
Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial. J Gen Intern Med 2019; 34:2397-2404. [PMID: 31396815 PMCID: PMC6848522 DOI: 10.1007/s11606-019-05241-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/30/2019] [Accepted: 07/17/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown. OBJECTIVE To evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control. DESIGN Three-arm pragmatic randomized controlled trial. PATIENTS One hundred forty-nine primary care patients aged 18-75 with hypertension and text messaging capabilities who were seen at least twice in the prior 12 months with at least two out-of-range blood pressure (BP) measurements, including the most recent visit. INTERVENTIONS Patients were randomized in a 1:2:2 ratio to receive (1) usual care, (2) electronic pill bottles for medication adherence monitoring (pill bottle), and (3) bidirectional text messaging for medication adherence monitoring (bidirectional text). MAIN MEASURES Change in systolic BP during the final 4-month visit compared with baseline. KEY RESULTS At the 4-month follow-up visit, mean (SD) change values in systolic blood pressure were - 4.7 (23.4) mmHg in usual care, - 4.3 (21.5) mmHg in the pill bottle arm, and - 4.6 (19.8) mmHg in the text arm. There was no significant change in systolic blood pressure between control and the pill bottle arm (p = 0.94) or the text messaging arm (p = 1.00), and the two intervention arms did not differ from each other (p = 0.93). CONCLUSIONS Despite good measured adherence, neither feedback with electronic pill bottles nor bidirectional text messaging about medication adherence improved blood pressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control. TRIAL REGISTRATION clinicaltrials.gov (NCT02778542).
Collapse
|
189
|
Zhang Y, Ying Y, Zhou L, Fu J, Shen Y, Ke C. Exposure to Chinese famine in early life modifies the association between hyperglycaemia and cardiovascular disease. Nutr Metab Cardiovasc Dis 2019; 29:1230-1236. [PMID: 31427048 DOI: 10.1016/j.numecd.2019.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS The Great Leap Forward Famine during 1959-1961 was the world's largest famine, and its adverse long-term effects might be more apparent in the coming decade with ageing of the exposed populations. The aim of this study was to examine whether the Chinese Famine modified the effect of hyperglycaemia on cardiovascular disease (CVD). METHODS AND RESULTS We used data of 4337 adults born between 1952 and 1964 collected from the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression was used to estimate the odds ratios (ORs) and confidence intervals (CIs) between hyperglycaemia and CVD. The prevalence of CVD showed significant difference among different famine exposure cohorts (P = 0.0156). After multivariable adjustment, the ORs (95% CIs) were as follows: 1.46 (0.94, 2.26) for late childhood, 1.76 (1.06, 2.90) for mid childhood, 1.40 (0.86, 2.27) for early childhood, 2.55 (1.30, 5.02) for the foetal cohort and 1.10 (0.63, 1.95) for the non-exposed cohort. There was a significant interaction between hyperglycaemia and famine exposure for CVD (P = 0.0374). In addition, the subgroup analyses showed that the effect of hyperglycaemia on CVD in the foetal exposure cohort was significantly higher than those in any of the other famine-exposed cohorts, especially in those who lived in rural areas (OR: 4.67, 95% CI: 1.70-12.84), those who lived in severe famine areas (OR: 5.01, 95% CI: 1.22-20.66) and those who were men (OR: 3.66, 95% CI: 1.01-13.33). CONCLUSION Exposure to the Chinese Famine, especially during the foetal stage of life, aggravated the association between hyperglycaemia and CVD.
Collapse
Affiliation(s)
- Yuxia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, PR China
| | - Yaoyu Ying
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, PR China
| | - Liang Zhou
- Liyang Center for Disease Control and Prevention, 55 Nanhuan Road, Liyang, 213371, PR China
| | - Jiaojiao Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, PR China
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, PR China.
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, PR China.
| |
Collapse
|
190
|
Prevalence, Characteristics, and Association of Obstructive Sleep Apnea with Blood Pressure Control in Patients with Resistant Hypertension. Ann Am Thorac Soc 2019; 16:1414-1421. [DOI: 10.1513/annalsats.201901-053oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
191
|
Rohacek M, Burkard T. [Heart Failure in Africa]. PRAXIS 2019; 108:983-990. [PMID: 31771489 DOI: 10.1024/1661-8157/a003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Heart Failure in Africa Abstract. In Africa, mortality due to heart failure is twice as high as in other low- to middle-income countries and five times as high as in high-income countries. Arterial hypertension is by far the most common cause of heart failure, followed by cardiomyopathies and rheumatic heart diseases. At diagnosis, most patients suffer already from an advanced disease stage. Only a few patients are aware of arterial hypertension, and few are treated and have their hypertension well controlled. Only a minority of patients have a well-controlled hypertension. The neglect of chronic non-communicable diseases on the health agenda leads to poor awareness, poor diagnostic resources, preventions strategies and treatment options. International guidelines cannot be properly followed in these circumstances. Information at community level and in healthcare facilities is urgently needed as well as training of healthcare staff, implementation of improved diagnostics and treatment of arterial hypertension and heart failure.
Collapse
Affiliation(s)
- Martin Rohacek
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Schweizerisches Tropen- und Public Health-Institut (Swiss TPH)
- Universität Basel, Basel
| | - Thilo Burkard
- Universität Basel, Basel
- Kardiologie, Universitätsspital, Basel
- Medical Outpatient Department and Hypertension Clinic, Universitätsspital, Basel
| |
Collapse
|
192
|
Mitchell UA, Ailshire JA, Kim JK, Crimmins EM. Black-White Differences in 20-year Trends in Cardiovascular Risk in the United States, 1990-2010. Ethn Dis 2019; 29:587-598. [PMID: 31641326 DOI: 10.18865/ed.29.4.587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective Improvements in the Black-White difference in life expectancy have been attributed to improved diagnosis and treatment of cardiovascular diseases and declines in cardiovascular disease mortality. However, it is unclear whether race differences in total cardiovascular risk and the prevalence of cardiovascular risk factors have improved in the United States since the 1990s. Design Serial cross-sectional design. Setting Data from the 1988-1994, 1999-2002, and 2009-2012 National Health and Nutrition Examination Survey (NHANES). Methods We estimated total cardiovascular risk levels, the prevalence of high-risk cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs among US Black and White men and women to determine whether differential changes occurred from 1990-2010. Results Total cardiovascular risk declined for all races from 1990-2010. The Black-White difference was only significant in 2000 and sex-specific analyses showed that trends seen in the total population were driven by changes among women. Black and White men did not differ in risk at any time during this period. Conversely, Black women had significantly higher risk than White women in 1990 and 2000; this difference was eliminated by 2010. Improved diagnosis and treatment of high blood pressure and high cholesterol reduced risk in the total population; improved blood pressure and lipid profiles among Black women and increasing obesity prevalence among White women specifically contributed to the narrowing of the Black-White difference in risk among women. Conclusion Cardiovascular risk and racial disparities in risk declined among US Whites and Blacks due to greater use and effectiveness of lipid-lowering and antihypertensive medications.
Collapse
Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Jennifer A Ailshire
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Jung Ki Kim
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Eileen M Crimmins
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| |
Collapse
|
193
|
Vorselaars WMCM, van Beek DJ, Postma EL, Spiering W, Borel Rinkes IHM, Valk GD, Vriens MR. Validation of the Aldosteronoma Resolution Score Within Current Clinical Practice. World J Surg 2019; 43:2459-2468. [PMID: 31270571 DOI: 10.1007/s00268-019-05074-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Complete resolution of hypertension after adrenalectomy for primary aldosteronism is far from a certainty. This stresses the importance of adequate preoperative patient counseling. The aldosteronoma resolution score (ARS) is a simple and easy to use prediction model only including four variables: ≤ 2 antihypertensive medications, body mass index ≤ 25 kg/m2, duration of hypertension ≤ 6 years and female sex. However, because the model was developed and validated within the USA over a decade ago, the applicability in modern practice and outside of the USA is questionable. Therefore, we aimed to validate the ARS in current clinical practice within an international cohort. MATERIALS AND METHOD Patients who underwent unilateral adrenalectomy, between 2010 and 2016, in 16 medical centers from the USA, Europe (EU), Canada (CA) and Australia (AU) were included. Resolution of hypertension was defined as normotension without antihypertensive medications. RESULTS In total, 514 patients underwent adrenalectomy and 435 (85%) patients were eligible. Resolution of hypertension was achieved in 27% patients within the total cohort and in 22%, 30%, 40% and 38% of patients within USA, EU, CA and AU, respectively (p = 0.015). The area under the curve (AUC) for the complete cohort was 0.751. Geographic validation displayed a AUC within the USA, EU, CA and AU of 0.782, 0.681, 0.811 and 0.667, respectively. DISCUSSION The ARS is an easy to use prediction model with a moderate to good predictive performance within current clinical practice. The model showed the highest predictive performance within North America but potentially has less predictive performance in EU and AU.
Collapse
Affiliation(s)
- Wessel M C M Vorselaars
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Room G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Dirk-Jan van Beek
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Room G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Emily L Postma
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Room G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Room G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Room G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| |
Collapse
|
194
|
Large body mass index and waist circumference are associated with high blood pressure and impaired fasting glucose in young Chinese men. Blood Press Monit 2019; 24:289-293. [PMID: 31567186 DOI: 10.1097/mbp.0000000000000404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Obesity is closely related to many chronic diseases and metabolic risk factors. The present study examined the relationship of obesity-related indices to blood pressure (BP) and fasting plasma glucose (FPG) among young Chinese men. METHODS A total of 1193 male college students aged 18-22 years participated in the study. Height, weight, waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and FPG were measured. High BP was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg. Impaired fasting glucose (IFG) was defined as FPG ≥5.6 mmol/L. RESULTS BMI, WC and WHtR were positively correlated with BP and FPG (rBMI-SBP = 0.455, rBMI-DBP = 0.367, rBMI-FPG = 0.113, rWC-SBP = 0.445, rWC-DBP = 0.382, rWC-FPG = 0.115, rWHtR-SBP = 0.396, rWHtR-DBP = 0.302, rWHtR-FPG = 0.106, P all < 0.01). When categorized by BMI (underweight, normal weight, overweight and obesity), the mean values of SBP, DBP, FPG and the prevalence of high BP and IFG increased with BMI, significant differences were observed among the four groups (P < 0.01). When categorized by WC and WHtR, similar differences were observed, with subjects in the large WC/WHtR group had a higher BP and FPG than their counterparts in the low WC/WHtR group (P < 0.01). CONCLUSION Large BMI and WC/WHtR are associated with high BP and IFG. Our results suggested that prevention of obesity in youth may be an effective approach for preventing the development of diabetes and hypertension in the future.
Collapse
|
195
|
Graham N, Ward J, Mackay D, Pell JP, Cavanagh J, Padmanabhan S, Smith DJ. Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank. BMJ Open 2019; 9:e024433. [PMID: 31575565 PMCID: PMC6797415 DOI: 10.1136/bmjopen-2018-024433] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To assess whether a history of major depressive disorder (MDD) in middle-aged individuals with hypertension influences first-onset cardiovascular disease outcomes. DESIGN Prospective cohort survival analysis using Cox proportional hazards regression with a median follow-up of 63 months (702 902 person-years). Four mutually exclusive groups were compared: hypertension only (n=56 035), MDD only (n=15 098), comorbid hypertension plus MDD (n=12 929) and an unaffected (no hypertension, no MDD) comparison group (n=50 798). SETTING UK Biobank. PARTICIPANTS UK Biobank participants without cardiovascular disease aged 39-70 who completed psychiatric questions relating International Classification of Diseases-10 Revision (ICD-10) diagnostic criteria on a touchscreen questionnaire at baseline interview in 2006-2010 (n=134 860). PRIMARY AND SECONDARY OUTCOME MEASURES First-onset adverse cardiovascular outcomes leading to hospital admission or death (ICD-10 codes I20-I259, I60-69 and G45-G46), adjusted in a stepwise manner for sociodemographic, health and lifestyle features. Secondary analyses were performed looking specifically at stroke outcomes (ICD-10 codes I60-69 and G45-G46) and in gender-separated models. RESULTS Relative to controls, adjusted HRs for adverse cardiovascular outcomes were increased for the hypertension only group (HR 1.36, 95% CI 1.22 to 1.52) and were higher still for the comorbid hypertension plus MDD group (HR 1.66, 95% CI 1.45 to 1.9). HRs for the comorbid hypertension plus MDD group were significantly raised compared with hypertension alone (HR 1.22, 95% CI 1.1 to 1.35). Interaction measured using relative excess risk due to interaction (RERI) and likelihood ratios (LRs) were identified at baseline (RERI 0.563, 95% CI 0.189 to 0.938; LR p=0.0116) but not maintained during the follow-up. LIMITATIONS Possible selection bias in UK Biobank and inability to assess for levels of medication adherence. CONCLUSIONS Comorbid hypertension and MDD conferred greater hazard than hypertension alone for adverse cardiovascular outcomes, although evidence of interaction between hypertension and MDD was inconsistent over time. Future cardiovascular risk prediction tools may benefit from the inclusion of questions about prior history of depressive disorders.
Collapse
Affiliation(s)
- Nicholas Graham
- Gartnavel Royal Hopsital, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Joey Ward
- Gartnavel Royal Hopsital, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Daniel Mackay
- 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jonathan Cavanagh
- 1 Lilybank Gardens, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
196
|
Udoko AN, Graff J, Ransone S, Coday M, Gatwood JD, Bailey JE. Characteristics of Health-related Text Messages Preferred by Medically Underserved African-American Patients with Diabetes. Cureus 2019; 11:e5743. [PMID: 31723504 PMCID: PMC6825447 DOI: 10.7759/cureus.5743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction Text messaging (TM) is increasingly used by the U.S. medical practices and healthcare delivery systems, but little is known about preferences of medically underserved minority patients for TM supporting improved self-care decisions. We sought to determine the characteristics of text messages and TM programs preferred by African-American patients with diabetes in medically underserved areas. Methods This convergent mixed methods study employed a self-administered survey and focus group interviews. Quantitative and qualitative data were collected simultaneously, analyzed separately, and merged to provide a holistic view of the TM characteristics patients preferred. Participants (N = 36) were recruited from a medically underserved area in Memphis, Tennessee. Focus group data were uploaded into the NVivo qualitative data analysis software program, and main themes were identified. Standard frequencies were calculated for survey responses. Results Participants ranged in the age of 22-74 years (M = 54.1; SD = 14.6) were predominantly female (77.8%), African-Americans (88.9%), and had at least a high school education (91.7%). A majority used mobile phones for sending (69.4%) and receiving (72.2%) text messages. Participants wanted to receive daily (44.4%) or weekly (47.2%) text messages from their healthcare provider (61.1%), or a motivational message program (33.3%). They preferred actionable messages with a positive tone and wanted options to customize message type, content, and frequency according to their preferences, goals, and needs. Discussion Medically underserved African-American diabetes patients want customized text messages that are practical, actionable, encouraging, and from their doctor. Healthcare providers seeking to develop patient-centered TM programs for medically underserved minority patients should personalize and tailor messages according to patient preferences, health goals, and self-care needs.
Collapse
Affiliation(s)
- Aniekan N Udoko
- Pediatrics, University of Tennessee Health Science Center, Memphis, USA
| | - Joyce Graff
- Pediatrics, University of Tennessee Health Science Center, Memphis, USA
| | | | - Mace Coday
- Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Justin D Gatwood
- Pharmacy, University of Tennessee Health Science Center, Nashville, USA
| | - James E Bailey
- Internal Medicine, University of Tennessee Health Science Center, Memphis, USA
| |
Collapse
|
197
|
Kang SJ, Ahn CH. The effects of home-based stair and normal walking exercises on lower extremity functional ability, fall risk factors, and cardiovascular health risk factors in middle-aged older women. J Exerc Rehabil 2019; 15:584-591. [PMID: 31523681 PMCID: PMC6732555 DOI: 10.12965/jer.1938362.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/04/2019] [Indexed: 01/13/2023] Open
Abstract
The purpose of this study was to exam 12 weeks of stair and normal walking effects on lower extremity functional ability and cardiovascular health risk factors in middle-aged older women. Twenty-four subjects were assigned either to the stair walking group (SWG, 57.40±6.11 years, n=10) or the normal walking group (NWG, 57.28±16.83 years, n= 14). They performed exercises 3 times per week, 60 min per day for 12 weeks. Lower extremity functional ability (lower extremity muscular strength, walking speed, active and static balance ability, and agility) and cardiovascular health risk factors were compared by time and groups using a two-way repeated analysis of variance and mean values were compared within group using paired t-test. As results, significant time differences were found in lower extremity muscular strength, walking speed and active balance; no time and group interactions were found. Also, significant time differences were found in systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, fasting glucose. Significant time and group interactions were found in body fat. In addition, significant time differences within the groups were found in lower extremity muscular strength, walking speed, active balance in SWG and NWG; systolic blood pressure in SWG; systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, and fasting glucose in NWG. These results indicated that home-based stair and normal walking exercises can be utilized to improve lower extremity functional ability and cardiovascular health risk factors in middle-aged and older women.
Collapse
Affiliation(s)
- Suh-Jung Kang
- Department of Sport & Health Care, College of Art & Culture, Sangmyung University, Seoul, Korea
| | - Chang-Hyun Ahn
- Department of Sport & Health Care, College of Art & Culture, Sangmyung University, Seoul, Korea
| |
Collapse
|
198
|
Mbouemboue OP, Ngoufack TJO. High Blood Pressure Prevalence, Awareness, Control, and Associated Factors in a Low-Resource African Setting. Front Cardiovasc Med 2019; 6:119. [PMID: 31544107 PMCID: PMC6728810 DOI: 10.3389/fcvm.2019.00119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/05/2019] [Indexed: 01/13/2023] Open
Abstract
Background and Objectives: Recent and contextualized data are needed to improve hypertension management known as a major cardiovascular disease risk factor regardless of the geographical area. This study aimed at assessing the prevalence of hypertension, awareness of hypertensive status, treatment, and control of hypertension as well as assessing the factors associated with risk of hypertension and awareness of hypertensive status in the population of Ngaoundere. Methods: This was a community based cross sectional study carried out from February to December 2016. A three-stage sampling method was used for recruitment of participants. Demographic, clinical, and biological data were collected and analyzed using Statistical Package for Social Sciences version 20.0. Statistical significance was set at P < 0.05. Results: In total, 948 participants were included in the study. The overall prevalence of hypertension was 46.94% (n = 445). Fraction of hypertensive participants who were aware of their status was 36.85% (n = 164). Among them, 39 (23.78%) were getting treatment and the control rate of treated hypertensives was 30.56%. Age, marital status, family history of hypertension, overweight, and high serum triglyceride level were identified as independent predicting factors of hypertension, whereas female gender, age, personal history of stroke or diabetes, family history of hypertension or heart failure, overweight, and abdominal obesity were those of hypertension awareness. Conclusion: The present study revealed high prevalence, extremely low awareness, treatment, and control rates of hypertension in Ngaoundere community setting.
Collapse
Affiliation(s)
- Olivier Pancha Mbouemboue
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Ngaoundere, Cameroon
- General Medicine Service, Ngaoundere Regional Hospital, Ngaoundere, Cameroon
| | - Tsougmo Jacques Olivier Ngoufack
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Ngaoundere, Cameroon
- Hypertension and Diabetes Unit, Ngaoundere Regional Hospital, Ngaoundere, Cameroon
| |
Collapse
|
199
|
Prevalence, awareness, treatment, and control of hypertension and their determinants: Results from the first cohort of non-communicable diseases in a Kurdish settlement. Sci Rep 2019; 9:12409. [PMID: 31455810 PMCID: PMC6711962 DOI: 10.1038/s41598-019-48232-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/25/2019] [Indexed: 12/21/2022] Open
Abstract
Hypertension is a public health issue in Iran. The study aimed to estimate the prevalence, awareness, treatment, and control of hypertension, and to explore their determinants among 10,040 Kurdish adults from Ravansar Non-Communicable Disease (RaNCD) cohort study in Iran. Univariate, and multivariate analyses were used for statistical analysis. Prevalence of hypertension was 15.7%. Among hypertensive patients, awareness, treatment, and control of hypertension were 80.7%, 73.2%, and 53.3%, respectively. In multivariate analysis, significant associations were found between awareness and female sex, older age, being married rather than being single, literacy, living in rural areas, having family history, and comorbidities, with a higher probability for those who had both diabetes and dyslipidemia. Being married, living in rural areas, being ex-smokers, having less physical activity and individuals who had diabetes and dyslipidemia had higher odds of receiving treatment. Being female had a statistically significant association with the control of hypertension. The Kurdish population had higher awareness, with a greater proportion of treated, and controlled patients compared to populations included in previous studies for the last 20 years in Iran. With the continuing health promotion programs in Iran, it is expected to observe a lower prevalence of hypertension, higher awareness and greater number of treated individuals with controlled hypertension.
Collapse
|
200
|
Tomitaka S, Kawasaki Y, Ide K, Akutagawa M, Ono Y, Furukawa TA. Distribution of psychological distress is stable in recent decades and follows an exponential pattern in the US population. Sci Rep 2019; 9:11982. [PMID: 31427587 PMCID: PMC6700099 DOI: 10.1038/s41598-019-47322-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/15/2019] [Indexed: 01/13/2023] Open
Abstract
The prevalence of psychological distress is fairly stable in industrialised countries in recent decades, but the reasons for this stability remain unknown. To investigate the mechanisms underlying stability of psychological distress in the general population of the United States, we analysed the mathematical patterns of the distribution of psychological distress in recent decades. The present study utilised the Kessler psychological distress scale (K6) data from the 1997‒2017 United States National Health Interview Survey. We used overlap coefficients and graphical analysis to investigate the stability and mathematical patterns of the K6 distribution. Overlap coefficients and graphical analysis demonstrated that the distribution of K6 total scores was stable in the United States over the past two decades. Furthermore, the distributions of K6 total scores exhibited an exponential pattern, with the exception of the lower end of the distribution. These findings suggest that the lack of change in the prevalence of psychological distress over several decades is due to the stability of psychological distress distribution itself. Furthermore, the stability of the distribution of psychological distress over time may be linked to the exponential pattern of psychological distress distribution.
Collapse
Affiliation(s)
- Shinichiro Tomitaka
- Department of Mental Health, Panasonic Health Center, Tokyo, Japan. .,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kazuki Ide
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.,Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Maiko Akutagawa
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yutaka Ono
- Center for the Development of Cognitive Behavior Therapy Training, Tokyo, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| |
Collapse
|