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Tuzimek A, Dziedzic EA, Beck J, Kochman W. Correlations Between Acute Coronary Syndrome and Novel Inflammatory Markers (Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and Aggregate Index of Systemic Inflammation) in Patients with and without Diabetes or Prediabetes. J Inflamm Res 2024; 17:2623-2632. [PMID: 38707954 PMCID: PMC11067916 DOI: 10.2147/jir.s454117] [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] [Received: 12/09/2023] [Accepted: 03/20/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Type 2 diabetes mellitus (DM) is a recognized independent risk factor for both chronic coronary syndrome (CCS) and its complication, acute coronary syndrome (ACS). Patients with DM and prediabetes (preDM) face an increased ACS risk. Inflammation plays a significant role in the pathogenesis of both CCS and ACS. This study delves into novel inflammatory markers, such as the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI, also known as SIIRI or PIV), to explore their relationship with ACS and CCS in patients that have been or have not been diagnosed with DM or preDM. Patients and Methods This study included data of 493 patients with chest pain undergoing coronary angiography. They were categorized into four groups: 1) without DM/preDM and with CCS; 2) with both DM/preDM and CCS; 3) without DM/preDM and with ACS, 4) with both DM/preDM and ACS. Standard methods of statistical analysis were used to reveal possible differences between groups and to find the most influential ACS risk factors in groups with DM/preDM and without DM/preDM. Results The analysis showed no significant differences in SII, SIRI, or AISI between the respective patient groups. A logistic regression analysis generated a model incorporating SII, high-density lipoprotein, and low-density lipoprotein levels as the influential ACS risk factors for patients with DM/preDM. The model demonstrated 71.0% accuracy, 37.0% sensitivity, and 89.4% specificity. Conclusion The findings suggest that the aforementioned inflammatory markers may have potential for distinguishing DM/preDM patients at higher risk of ACS at a low financial cost. However, further comprehensive and well-designed research is required to validate their clinical utility.
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Affiliation(s)
- Agnieszka Tuzimek
- Cardiovascular Clinic, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland
| | - Ewelina A Dziedzic
- Cardiovascular Clinic, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland
| | - Joanna Beck
- Bioimaging Research Center, Institute of Physiology and Pathology of Hearing, Warsaw, 02-042, Poland
- Medical Faculty, Lazarski University, Warsaw, 02-662, Poland
| | - Wacław Kochman
- Cardiovascular Clinic, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland
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152
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Van Der Arend BWH, Van Veelen N, De Ruijter JET, Olsen MH, MaassenVanDenBrink A, Terwindt GM. Safety considerations in the treatment with anti-CGRP(R) monoclonal antibodies in patients with migraine. Front Neurol 2024; 15:1387044. [PMID: 38742048 PMCID: PMC11089895 DOI: 10.3389/fneur.2024.1387044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Background Anti-CGRP-(receptor-)monoclonal antibodies (anti-CGRP(R)-mAbs) represent a novel class of drugs for migraine treatment, but their long-term cerebrovascular and cardiovascular (CV) safety warrants further examination. Methods In this observational cohort study we assessed the CV safety for erenumab and fremanezumab in a real-world setting during a follow-up period of at least 1 year. Patients with hypertension or CV history were excluded. We conducted ECGs and collected clinical data at treatment initiation and thereafter every 3 months, including liver and kidney function, lipid-, electrolyte-and glucose levels. Results Among patients receiving erenumab (n = 101) or fremanezumab (n = 92), 3.1% (6/193) developed abnormal ECGs or CV adverse events. Of these, three (1.6%) experienced moderate to severe CV adverse events (cerebellar stroke, spontaneous coronary artery dissection, and pericarditis) and discontinued treatment. The remaining three (1.6%) developed non-threatening ECG abnormalities without physical complaints. No significant changes were observed in liver and kidney function, lipid-, electrolyte-, or glucose levels. Discussion We observed CV events in 1.6% of patients with 1.5-year follow-up of anti-CGRP(R)-mAbs treatment. We advise awareness regarding CV events in patients with migraine undergoing CGRP-targeted treatment, not as a confirmation of increased risk but as a proactive measure to address potential multifactorial influences.
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Affiliation(s)
- Britt W. H. Van Der Arend
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nancy Van Veelen
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Michael H. Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbæk, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Gisela M. Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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153
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Castillo Velarde E, Roca-Sánchez-Moreno J, Núñez Muñoz A, Guillen Rivera A, Hidalgo Babilonia M, García Meneses J, Mamani Turpo L, Cepeda Horna W. The Effect of Clothes on Blood Pressure Measurement in Normotensive and Hypertensive Subjects in a Real-Life Setting. Kidney Blood Press Res 2024; 49:295-301. [PMID: 38643750 DOI: 10.1159/000538164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/10/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION The effect of clothing on the recording of blood pressure in a normotensive and hypertensive population remains essential to diagnosing and managing. METHODS This is a cross-sectional study to measure blood pressure using a validated oscillometric sphygmomanometer in two populations. The records were made over the thicker sleeve arm and non-sleeved arm (either on bare arm or indicating the removal of the outermost garment). Clothing was categorized according to how patients attended the outpatient clinic based on the real world. RESULTS A total of 75 patients were included with a diagnosis of hypertension whose mean age was 67.1 years (SD ± 16.3). The group of normotension included 63 patients whose mean age was 21.1 years (SD ± 2.2). There was not variability related to technique or inherent to the condition of the subject on the first and second measurements of blood pressure. In the comparative analysis, the group with normotension did not report a significant difference in systolic or diastolic blood pressure due to the effect of clothing during the first or second measurement (p > 0.05). In the group with hypertension, a significant difference was observed in the first measurement, between the group over-the-sleeve and non-sleeved arm (systolic blood pressure, p: 0.021 and diastolic, p: 0.001). However, when the variable order of measurement was analyzed by randomizing the initial registry with or without clothing was not found a statistical difference. CONCLUSION Clothing does not a significant difference in the measure of blood pressure in a normotensive or hypertensive population.
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Affiliation(s)
- Edwin Castillo Velarde
- INICIB, Instituto de Investigaciones de Ciencias Biomédicas de la Facultad de Medicina de la Universidad Ricardo Palma, Lima, Peru
- Nephrology Department, Hospital Guillermo Almenara, Lima, Peru
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154
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Zhang C, Wang Y, Xie W, Zhang J, Tian T, Zhu Q, Fang X, Sui J, Pan D, Xia H, Wang S, Sun G, Dai Y. Sex differences and dietary patterns in the association of air pollutants and hypertension. BMC Public Health 2024; 24:1134. [PMID: 38654317 PMCID: PMC11040935 DOI: 10.1186/s12889-024-18620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Hypertension is one of the major public health problems in China. Limited evidence exists regarding sex differences in the association between hypertension and air pollutants, as well as the impact of dietary factors on the relationship between air pollutants and hypertension. The aim of this study was to investigate the sex-specific effects of dietary patterns on the association between fine particulate matter (PM2.5), ozone(O3) and hypertension in adults residing in Jiangsu Province of China. METHODS A total of 3189 adults from the 2015 China Adult Chronic Disease and Nutrition Surveillance in Jiangsu Province were included in this study. PM2.5 and O3 concentrations were estimated using satellite space-time models and assigned to each participant. Dietary patterns were determined by reduced rank regression (RRR), and multivariate logistic regression was used to assess the associations of the obtained dietary patterns with air pollutants and hypertension risk. RESULTS After adjusting for confounding variables, we found that males were more sensitive to long-term exposure to PM2.5 (Odds ratio (OR) = 1.42 95%CI:1.08,1.87), and females were more sensitive to long-term exposure to O3 (OR = 1.61 95%CI:1.15,2.23). Traditional southern pattern identified through RRR exhibited a protective effect against hypertension in males (OR = 0.73 95%CI: 0.56,1.00). The results of the interaction between dietary pattern score and PM2.5 revealed that adherence to traditional southern pattern was significantly associated with a decreased risk of hypertension in males (P < 0.05), while no significant association was observed among females. CONCLUSIONS Our findings suggested that sex differences existed in the association between dietary patterns, air pollutants and hypertension. Furthermore, we found that adherence to traditional southern pattern may mitigate the risk of long-term PM2.5 exposure-induced hypertension in males.
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Affiliation(s)
- Chen Zhang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China
| | - Yuanyuan Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China
| | - Wei Xie
- Institute of Food Safety and Assessment, Jiangsu Provincial Center for Disease Control and Prevention, 210009, Nanjing, China
| | - Jingxian Zhang
- Institute of Food Safety and Assessment, Jiangsu Provincial Center for Disease Control and Prevention, 210009, Nanjing, China
| | - Ting Tian
- Institute of Food Safety and Assessment, Jiangsu Provincial Center for Disease Control and Prevention, 210009, Nanjing, China
| | - Qianrang Zhu
- Institute of Food Safety and Assessment, Jiangsu Provincial Center for Disease Control and Prevention, 210009, Nanjing, China
| | - Xinyu Fang
- Institute of Food Safety and Assessment, Jiangsu Provincial Center for Disease Control and Prevention, 210009, Nanjing, China
| | - Jing Sui
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China
- Research Institute for Environment and Health, Nanjing University of Information Science and Technology, 211544, Nanjing, China
| | - Da Pan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China
| | - Hui Xia
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China.
| | - Yue Dai
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 210009, Nanjing, China.
- Institute of Food Safety and Assessment, Jiangsu Provincial Center for Disease Control and Prevention, 210009, Nanjing, China.
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Lee HS, Lim HI, Moon TJ, Lee SY, Lee JH. Trajectories of atherosclerotic cardiovascular disease risk scores as a predictor for incident chronic kidney disease. BMC Nephrol 2024; 25:141. [PMID: 38649847 PMCID: PMC11036697 DOI: 10.1186/s12882-024-03583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The relationship between atherosclerosis and renal function is well established. Atherosclerotic cardiovascular disease (ASCVD) risk scores reflect atherosclerotic burden, which changes over time. We investigated the association between ASCVD risk trajectories and incident chronic kidney disease (CKD) using data from a large community-based Korean cohort with up to 16 years of follow-up. METHODS We analyzed data from 5032 participants without CKD from the baseline survey of the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Participants were categorized into stable or increasing ASCVD risk groups based on the revised ASCVD risk pooled cohort equation over a median period of exposure of 5.8 years. Incident CKD was defined as two consecutive events of an estimated glomerular filtration rate < 60 mL/min/1.73 m2. RESULTS During a median 9.9 years of event accrual period, 449 (8.92%) new-onset CKD cases were identified. Multiple Cox proportional regression analyses showed that the hazard ratio (95% confidence interval) for incident CKD in the increasing group, compared to the stable group, was 2.13 (1.74-2.62) in the unadjusted model and 1.35 (1.02-1.78) in the fully-adjusted model. Significant relationships were maintained in subgroups of individuals in their 50s, without diabetes mellitus or hypertension. The prevalence of proteinuria was consistently higher in the increasing group than that in the stable group. CONCLUSIONS An increasing trend in ASCVD risk scores independently predicted adverse renal outcomes in patients without diabetes mellitus or hypertension. Continuous monitoring of ASCVD risk is not only important for predicting cardiovascular disease but also for predicting CKD.
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Affiliation(s)
- Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, 03277, Republic of Korea
| | - Hong Il Lim
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea
| | - Tae Ju Moon
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea
| | - So Young Lee
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea
| | - Jun-Hyuk Lee
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, 01830, Republic of Korea.
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Li R, Shao J, Hu C, Xu T, Zhou J, Zhang J, Liu Q, Han M, Ning N, Fan X, Zhou W, Huang R, Ma Y, Jin L. Metabolic risks remain a serious threat to cardiovascular disease: findings from the Global Burden of Disease Study 2019. Intern Emerg Med 2024:10.1007/s11739-024-03605-8. [PMID: 38642311 DOI: 10.1007/s11739-024-03605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
Metabolic factors are major and controllable risk factors for cardiovascular diseases (CVD), and few studies have described this burden. We aim to assess it from 1990 to 2019 and predict the trends through 2034. Global Burden of Disease (GBD) provides data on sex, age, and socio-demographic index (SDI) levels. Numbers, age-standardized death rates (ASDR) and estimated annual percentage change (EAPC) were used. Future trends were estimated by NORDPRED model. The deaths cases of metabolic-related CVD increased from 8.61 million (95% UI: 7.91-9.29) to 13.71 million (95% UI: 12.24-14.94) globally. The ASDR continued to decline globally (EAPC = -1.36). The burden was heavier in male and middle-aged people and elderly people. CVD-related ASDR caused by high systolic blood pressure (SBP) had a downward trend globally (EAPC = -1.45), while trends of high body mass index (BMI) (EAPC = 1.29, 1.97, 0.92) and fasting plasma glucose (FPG) (EAPC = 0.95, 1.08, 0.46) were increasing in the middle, low-middle, and low SDI regions, respectively. Compared to 2015-2019, cumulative deaths will increase by 27.85% from 2030 to 2034, while ASDR will decrease 10.47%. The metabolic-related CVD burden remained high globally and deaths will continue to rise in the future. Men, middle-aged and elderly people were focus of concern. High SBP was globally well-managed over the past 30 years, but the CVD burden due to high BMI and FPG remained high. Exceptional initiatives are needed to regarding interventions targeting high BMI and FPG in middle and lower SDI regions.
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Affiliation(s)
- Runhong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Jinang Shao
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Chengxiang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Tong Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Jin Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Jiaqi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Qitong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Mengying Han
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Ning Ning
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Xiaoting Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Wenhui Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Rong Huang
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Yanan Ma
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China.
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin, China.
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Marinescu SC(N, Apetroaei MM, Nedea MI(I, Arsene AL, Velescu BȘ, Hîncu S, Stancu E, Pop AL, Drăgănescu D, Udeanu DI. Dietary Influence on Drug Efficacy: A Comprehensive Review of Ketogenic Diet-Pharmacotherapy Interactions. Nutrients 2024; 16:1213. [PMID: 38674903 PMCID: PMC11054576 DOI: 10.3390/nu16081213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
It is widely acknowledged that the ketogenic diet (KD) has positive physiological effects as well as therapeutic benefits, particularly in the treatment of chronic diseases. Maintaining nutritional ketosis is of utmost importance in the KD, as it provides numerous health advantages such as an enhanced lipid profile, heightened insulin sensitivity, decreased blood glucose levels, and the modulation of diverse neurotransmitters. Nevertheless, the integration of the KD with pharmacotherapeutic regimens necessitates careful consideration. Due to changes in their absorption, distribution, metabolism, or elimination, the KD can impact the pharmacokinetics of various medications, including anti-diabetic, anti-epileptic, and cardiovascular drugs. Furthermore, the KD, which is characterised by the intake of meals rich in fats, has the potential to impact the pharmacokinetics of specific medications with high lipophilicity, hence enhancing their absorption and bioavailability. However, the pharmacodynamic aspects of the KD, in conjunction with various pharmaceutical interventions, can provide either advantageous or detrimental synergistic outcomes. Therefore, it is important to consider the pharmacokinetic and pharmacodynamic interactions that may arise between the KD and various drugs. This assessment is essential not only for ensuring patients' compliance with treatment but also for optimising the overall therapeutic outcome, particularly by mitigating adverse reactions. This highlights the significance and necessity of tailoring pharmacological and dietetic therapies in order to enhance the effectiveness and safety of this comprehensive approach to managing chronic diseases.
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Affiliation(s)
- Simona Cristina (Nicolescu) Marinescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
- Amethyst Radiotherapy Center, 42, Drumul Odăi, 075100 Otopeni, Romania
| | - Miruna-Maria Apetroaei
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
| | - Marina Ionela (Ilie) Nedea
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
| | - Andreea Letiția Arsene
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
- Marius Nasta Institute of Pneumophthiology, 90, Viilor Street, 050159 Bucharest, Romania
| | - Bruno Ștefan Velescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
| | - Sorina Hîncu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
- Fundeni Clinical Institute, 258, Fundeni Street, 022328 Bucharest, Romania
| | - Emilia Stancu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
| | - Anca Lucia Pop
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
| | - Doina Drăgănescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
| | - Denisa Ioana Udeanu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6, Traian Vuia Street, 020956 Bucharest, Romania (A.L.A.); (B.Ș.V.); (S.H.); (E.S.); (A.L.P.); (D.D.); (D.I.U.)
- Marius Nasta Institute of Pneumophthiology, 90, Viilor Street, 050159 Bucharest, Romania
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Figueroa-Salcido OG, Arámburo-Gálvez JG, Mora-Melgem JA, Camacho-Cervantes DL, Gracia-Valenzuela MH, Cuevas-Rodríguez EO, Ontiveros N. Alcalase-Based Chickpea ( Cicer arietinum L.) Protein Hydrolysates Efficiently Reduce Systolic Blood Pressure in Spontaneously Hypertensive Rats. Foods 2024; 13:1216. [PMID: 38672889 PMCID: PMC11049421 DOI: 10.3390/foods13081216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Studies on antihypertensive chickpea protein hydrolysates have rarely performed in vivo evaluations, limiting the entry of such hydrolysates into functional food development and clinical trials. Thus, our aim was to optimize the hydrolysis conditions to produce an alcalase-based chickpea hydrolysate with a hypotensive effect in vivo at convenient oral doses. The hydrolysis reaction time, temperature, and alcalase/substrate concentration were optimized using a response surface analysis (RSA). ACE-I inhibition was the response variable. The optimized hydrolysis conditions were time = 0.5 h, temperature = 40 °C, and E/S concentration = 0.254 (U/g). The IC50 of the optimized hydrolysate (OCPH) was 0.358 mg/mL. Five hydrolysates from the RSA worksheet (one of them obtained after 5 min of hydrolysis (CPH15)) had an ACE-I inhibitory potential similar to that of OCPH (p > 0.05). At 50 mg/kg doses, OCPH and CPH15 promoted a clinically relevant hypotensive effect in spontaneously hypertensive rats, up to -47.35 mmHg and -28.95 mmHg, respectively (p < 0.05 vs. negative control). Furthermore, the hypotensive effect was sustained for at least 7 h post-supplementation. Overall, OCPH and CPH15 are promising ingredients for functional food development and as test materials for clinical trials.
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Affiliation(s)
- Oscar Gerardo Figueroa-Salcido
- Integral Postgraduate Program in Biotechnology, Faculty of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan 80010, Sinaloa, Mexico;
| | - Jesús Gilberto Arámburo-Gálvez
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80019, Sinaloa, Mexico; (J.G.A.-G.); (J.A.M.-M.); (D.L.C.-C.)
| | - José Antonio Mora-Melgem
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80019, Sinaloa, Mexico; (J.G.A.-G.); (J.A.M.-M.); (D.L.C.-C.)
| | - Diana Laura Camacho-Cervantes
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80019, Sinaloa, Mexico; (J.G.A.-G.); (J.A.M.-M.); (D.L.C.-C.)
| | | | - Edith Oliva Cuevas-Rodríguez
- Integral Postgraduate Program in Biotechnology, Faculty of Chemical and Biological Sciences, Autonomous University of Sinaloa, Ciudad Universitaria, Culiacan 80010, Sinaloa, Mexico;
| | - Noé Ontiveros
- Nutrition Sciences Postgraduate Program, Faculty of Nutrition Sciences, Autonomous University of Sinaloa, Culiacan 80019, Sinaloa, Mexico; (J.G.A.-G.); (J.A.M.-M.); (D.L.C.-C.)
- Clinical and Research Laboratory (LACIUS, C.N.), Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Faculty of Biological and Health Sciences, University of Sonora, Navojoa 85880, Sonora, Mexico
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Leung LYL, Tam HL, Leung ISH, Chan ASW, Yin Y, Zhang X, Mao A, Cheong PL. Perceived Well-Being among Adults with Diabetes and Hypertension: A National Study. Healthcare (Basel) 2024; 12:844. [PMID: 38667606 PMCID: PMC11049827 DOI: 10.3390/healthcare12080844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Perceived health and distresses are associated with the practice of lifestyle modifications, which increases the risk of diabetes and hypertension-related complications. This study aimed to define the characteristics and distribution of perceived health and distresses across the states between people with diabetes and hypertension. Data were derived from a national survey of US adults aged ≥18 years who were interviewed via phone call. Perceived health and distresses were assessed through corresponding questions. An amount of 333,316 respondents (43,911 with diabetes and 130,960 with hypertension) were included in the analysis; 61.8% of people with diabetes and 74.5% of people with hypertension reported having good or better health, while residents in the Southwest region perceived poor health statuses and more distresses. Education level (diabetes: odds ratio [OR] = 0.47-0.79, hypertension: OR = 0.42-0.76), employment status level (diabetes: OR = 1.40-2.22, hypertension: OR = 1.56-2.49), and household income (diabetes: OR = 0.22-0.65, hypertension: OR = 0.15-0.78) were significant factors associated with poorly perceived health among people with diabetes and hypertension, and the use of technology and strategies for policymakers are suggested to improve the perceived health status in this regard.
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Affiliation(s)
- Leona Yuen-Ling Leung
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China;
| | - Hon-Lon Tam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Isaac Sze-Him Leung
- Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China;
| | - Alex Siu-Wing Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University of Hong Kong, Hong Kong SAR, China;
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, Nanjing 210029, China;
| | - Xiubin Zhang
- School of Public Health, National Heart and Lung Institute, Imperial College London, London W12 7RQ, UK;
| | - Aimei Mao
- Department of Education, Kiang Wu Nursing College of Macau, Macau SAR, China; (A.M.); (P.-L.C.)
| | - Pak-Leng Cheong
- Department of Education, Kiang Wu Nursing College of Macau, Macau SAR, China; (A.M.); (P.-L.C.)
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160
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Zhang Z, Du C, Zhong X, Wang R, Tang L, Liu X. The secondary prevention of coronary heart disease in US adults 75 Years and older in daily practice: Results from the National Health and Nutrition Examination Survey 1999-2018 survey. Heliyon 2024; 10:e28239. [PMID: 38571641 PMCID: PMC10987917 DOI: 10.1016/j.heliyon.2024.e28239] [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] [Received: 11/11/2022] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Background Pharmacologic therapies, risk factor control, and lifestyle alterations were independently proven to reduce long-term cardiovascular events. However, comprehensive research examining the extent to which individuals aged 75 and above in the United States adhere to national guidelines for the secondary prevention of coronary heart disease is limited. Therefore, the primary objective of this study was to examine the current state of secondary prevention of coronary heart disease in persons 75 years of age and older in the United States and to examine the factors that contribute to inadequate drug utilization and poor control of numerous risk factors. Methods We identified patients over 75 years of age with coronary heart disease based on the National Health and Nutrition Examination Survey from 1999 to 2018 and analyzed the adequacy of risk factor control and adherence to lifestyle and medication recommendations to assess the effectiveness of coronary heart disease management. Logistic regression analysis was used to identify factors associated with uncontrolled risk factors or noncompliance with recommended medications. Results We collected information from 1566 known coronary heart disease patients aged ≥75 years of age. The majority were at target goals for blood pressure (58.88%), low-density lipoprotein cholesterol (66.85%), and glycated hemoglobin (76.12%). Only 27.8% and 36.06% were at targets for body mass index and waist circumference, respectively. 91.95% reported smoking cessation, 85.98% followed recommended alcohol consumption, whereas only 10.34% reported sufficient physical activity. For β blockers, angiotensin -converting enzyme inhibitors/angiotensin receptor blockers, statins, and antiplatelet drugs, the utilization of indicated therapy was 54.41%, 49.36%, 54.79%, and 19.03%, respectively (6.26% for all 4 medications). The results of the logistic regression analysis demonstrated that diabetes mellitus and metabolic syndrome were critical markers of numerous uncontrolled risk variables as well as noncompliance with medication regimens. Conclusions A vast majority of coronary heart disease patients ≥75 years in the USA exhibited suboptimal overall control of critical coronary heart disease risk factors. For this patient population, more knowledge is necessary to enable patients to receive continuous support, guidance, and counseling.
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Affiliation(s)
- Zhi Zhang
- Department of Cardiology, First People's Hospital of Linping District, Hangzhou, Zhejiang 311199, PR China
| | - Changqing Du
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Xin Zhong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Ruilin Wang
- Department of Radiology, Zhejiang Hospital, Hangzhou, Zhejiang, 310013, PR China
| | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
| | - Xiaowei Liu
- Department of Cardiology, Zhejiang Hospital, Hangzhou, Zhejiang 310013, PR China
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161
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Fadl Elmula FEM, Mariampillai JE, Heimark S, Kjeldsen SE, Burnier M. Medical Measures in Hypertensives Considered Resistant. Am J Hypertens 2024; 37:307-317. [PMID: 38124494 PMCID: PMC11016838 DOI: 10.1093/ajh/hpad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. METHODS All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. RESULTS Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. CONCLUSIONS Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
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Affiliation(s)
- Fadl Elmula M Fadl Elmula
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | | | - Sondre Heimark
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Ullevaal University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Rocha Neto HG, Lessa JLM, Koiller LM, Pereira AM, Gomes BMDS, Veloso Filho CL, Casado Telleria CH, Cavalcanti MT, Telles-Correia D. Operational criteria application does not change clinicians' opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study. Front Psychiatry 2024; 15:1303007. [PMID: 38686124 PMCID: PMC11056870 DOI: 10.3389/fpsyt.2024.1303007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/13/2024] [Indexed: 05/02/2024] Open
Abstract
Objective Our objective was to check if the ICD-10 operational criteria application changes non-operational, prototype-based diagnoses obtained in a real-life scenario. Methods Psychiatry residents applied the diagnostic criteria of the ICD-10 as a "diagnostic test" to five outpatient patients they were already following who had a prototype-based diagnosis. Tests were used to ascertain whether changes in opinion were significant and if any of the diagnostic groups were more prone to change than others. The present paper is part of the study with UTN U1111-1260-1212. Results Seventeen residents reviewed their last five case files, retrieving 85 diagnostic pairs of non-operational-based vs. operational-based diagnoses. The Stuart-Maxwell test did not indicate a significant opinion change (χ2 = 5.25, p = 0.39; power = 0.94) besides 30% of diagnostic changes. Despite not being statistically significant, 20.2% of all evaluations resulted in a change that would affect treatment choices. Using ICD-10 operational criteria slightly increased the number of observed diagnoses, but probably without clinical relevance. None of the non-operational diagnoses have a higher tendency to change with operational criteria application (χ2 = 11.6, p = 0.07). The female gender was associated with a higher diagnostic change tendency. Conclusion Applying ICD-10 operational criteria as a diagnostic test does not induce a statistically significant diagnostic opinion change in residents and no diagnostic group seems more sensible to diagnostic change. Gender-related differences in diagnostic opinion changes might be evidence of sunk cost bias. Although not statistically significant, using operational criteria after diagnostic elaboration might help to deal with subjects without adequate treatment response.
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Affiliation(s)
- Helio G Rocha Neto
- Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
- Programa de Doutoramento do Centro Acadêmico de Medicina da Universidade de Lisboa (PhD CAML), Lisbon, Portugal
| | - José Luiz Martins Lessa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luisa Mendez Koiller
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Amanda Machado Pereira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Carlos Linhares Veloso Filho
- Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Carlos Henrique Casado Telleria
- Medicine Faculty, Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maria T Cavalcanti
- Programa de Pós Graduação em Psiquiatria e Saúde Mental (PROPSAM), Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
- Medicine Faculty, Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Diogo Telles-Correia
- Programa de Doutoramento do Centro Acadêmico de Medicina da Universidade de Lisboa (PhD CAML), Lisbon, Portugal
- Clinica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Chirilă CN, Mărginean C, Ghiga DV, Voidăzan S, Chirilă PM, Gliga ML. A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk. CHILDREN (BASEL, SWITZERLAND) 2024; 11:468. [PMID: 38671685 PMCID: PMC11049313 DOI: 10.3390/children11040468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of
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Affiliation(s)
- Cristian Nicolae Chirilă
- Department of Internal Medicine-Nephrology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (C.N.C.); (M.L.G.)
- Department of Nephrology, Mures Clinical County Hospital, 540103 Târgu Mureș, Romania
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology 2, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania
- Department of Obstetrics and Gynecology, Mures Clinical County Hospital, 540057 Târgu Mureș, Romania
| | - Dana Valentina Ghiga
- Department of Scientific Medical Research Methodology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Septimiu Voidăzan
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Paula Maria Chirilă
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania;
- Department of Endocrinology, Mures Clinical County Hospital, 540142 Târgu Mureș, Romania
| | - Mirela Liana Gliga
- Department of Internal Medicine-Nephrology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (C.N.C.); (M.L.G.)
- Department of Nephrology, Mures Clinical County Hospital, 540103 Târgu Mureș, Romania
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164
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Angeli F, Verdecchia P, Reboldi G. Prognostic impact of hypertension grading. Eur J Intern Med 2024:S0953-6205(24)00166-3. [PMID: 38616483 DOI: 10.1016/j.ejim.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Most Hypertension Guidelines grade hypertension according to various cut-off values. We sought to investigate the prognostic impact of Grades 1 (140-159 and/or 90-99 mmHg), 2 (160-179 and/or 100-109 mmHg) and 3 (≥180 and/or ≥110 mmHg). METHODS We followed for an average of 10 years a cohort of 3,150 initially untreated hypertensive patients (mean age 50 years, 44 % women) with no previous cardiovascular disease at entry. All patients underwent diagnostic tests including 24-hour ambulatory blood pressure (BP) monitoring. RESULTS At entry, average clinic BP was 156/97 mmHg and average 24-hour BP was 137/87 mmHg. During follow-up, 314 patients experienced a first major cardiovascular event (composite of non-fatal myocardial infarction or stroke, cardiovascular death, or hospitalization for heart failure). Event rate was not formally dissimilar between Grade 1 and Grade 2 (0.73 vs 0.95 per 100 patient-years, respectively; p = 0.06). It was higher in Grade 3 (1.93 per 100 patient-years; p < 0.01 vs Grade 1 and Grade 2). After adjustment for a robust set of covariables, the hazard ratio was not dissimilar between Grade 1 and Grade 2 (p = 0.27), and higher in Grade 3 than in Grade 1 (p < 0.01), but the excess risk in Grade 3 was no longer significant (hazard ratio: 1.25, 95 % CI 0.87-1.78; p = 0.22) after adjustment for 24-hour ambulatory systolic BP. CONCLUSIONS We were unable to find a significant difference in the relative hazard of cardiovascular events tied to hypertension Grades 1 and 2. Conversely, Grade 3 (clinic BP ≥180/110 mmHg) portends a higher cardiovascular risk, which is associated with higher levels of 24-hour ambulatory BP.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, Varese, and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy.
| | - Gianpaolo Reboldi
- Department of Medicine and Surgery, University of Perugia, Perugia and Division of Nephrology, Hospital S. Maria della Misericordia, Perugia, Italy
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165
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Guo L, Du X, Wu H, Xia S, Du J, Kong X, Yang X, Wang C, Dong J, Ma C, Engineer L. Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system. Front Public Health 2024; 12:1326272. [PMID: 38680927 PMCID: PMC11047042 DOI: 10.3389/fpubh.2024.1326272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions. Methods Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same. Results Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose. Conclusion Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.
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Affiliation(s)
- Lizhu Guo
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Xin Du
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huanqi Wu
- Data Science Academy, Capital University of Economics and Business, Beijing, China
| | - Shijun Xia
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Du
- Beijing Centre for Disease Prevention and Control, Beijing, China
| | - Xiangrong Kong
- Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Xiaohui Yang
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chi Wang
- Heart Health Research Centre, Beijing, China
| | - Jianzeng Dong
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lilly Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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166
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Ortiz-Saavedra B, Montes-Madariaga ES, Moreno-Loaiza O, Toro-Huamanchumo CJ. Hypertension subtypes at high altitude in Peru: Analysis of the Demographic and Family Health Survey 2016-2019. PLoS One 2024; 19:e0300457. [PMID: 38608222 PMCID: PMC11014732 DOI: 10.1371/journal.pone.0300457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The prevalence of hypertension in Peru has increased over the years. Approximately one third of the Peruvian population lives at high altitudes. This population presents particular physiological, genetic and environmental characteristics that could be related to the prevalence of hypertension and its subtypes. OBJECTIVE To assess the association between altitude and hypertension in the Peruvian population through an analysis of a nationally representative survey. METHODS We conducted a cross-sectional analysis of the Demographic and Family Health Survey for the period 2016-2019. We included 122,336 individuals aged 18 years and older. Hypertension was defined according to the JNC-7 guidelines. High-altitude location was defined as a residential cluster located above 2,500 meters above sea level. We utilized generalized linear models from the Poisson family with a log-link function to assess the magnitude of the association between high altitude and hypertension. Additionally, we employed multinomial regression models to analyze the association between high altitude and subtypes of hypertension, including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). RESULTS In the adjusted Poisson regression model, we found that the prevalence of hypertension among participants living at high altitudes was lower compared to those living at low altitudes (aPR: 0.89; 95% CI: 0.86-0.93). In the adjusted multinomial regression model, we observed a lower prevalence rate of ISH among participants residing at high altitudes (aRPR: 0.68; 95% CI: 0.61-0.73) and a higher prevalence rate of IDH among participants residing at high altitudes (aRPR: 1.60; 95% CI: 1.32-1.94). CONCLUSIONS Residents at high altitudes in Peru have a lower prevalence rate of ISH and a higher prevalence rate of IDH compared to those living at low altitudes. Further studies are needed to determine the influence of other biological, environmental, and healthcare access factors on this relationship.
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Affiliation(s)
| | | | - Oscar Moreno-Loaiza
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru
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Lai C, Li R, Tang W, Liu J, Duan XDXF, Bao D, Liu H, Fu S. Metabolic Syndrome and Tendon Disease: A Comprehensive Review. Diabetes Metab Syndr Obes 2024; 17:1597-1609. [PMID: 38616994 PMCID: PMC11015851 DOI: 10.2147/dmso.s459060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Metabolic syndrome (MS) is a multifaceted pathological condition characterized by the atypical accumulation of various metabolic components such as central obesity or excess weight, hyperlipidemia, low-density lipoprotein (LDL), hypertension, and insulin resistance. Recently, MS has been recognized as a notable contributor to heart and circulatory diseases. In addition, with increasing research, the impact of MS on tendon repair and disease has gradually emerged. Recent studies have investigated the relationship between tendon healing and diseases such as diabetes, dyslipidemia, obesity, and other metabolic disorders. However, diabetes mellitus (DM), hypercholesterolemia, obesity, and various metabolic disorders often coexist and together constitute MS. At present, insulin resistance is considered the major pathological mechanism underlying MS, central obesity is regarded as the predominant factor responsible for it, and dyslipidemia and other metabolic diseases are known as secondary contributors to MS. This review aims to evaluate the current literature regarding the impact of various pathological conditions in MS on tendon recovery and illness, and to present a comprehensive overview of the effects of MS on tendon recovery and diseases, along with the accompanying molecular mechanisms.
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Affiliation(s)
- Canhao Lai
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Ruichen Li
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Weili Tang
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Jinyu Liu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Xinfang D X F Duan
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Dingsu Bao
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
- Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Huan Liu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Shijie Fu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
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Lin JJ, Dai PY, Zhang J, Guan YQ, Gong WW, Yu M, Fang L, Hu RY, He QF, Li N, Wang LX, Liang MB, Zhong JM. Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults. Front Endocrinol (Lausanne) 2024; 15:1341546. [PMID: 38654930 PMCID: PMC11036864 DOI: 10.3389/fendo.2024.1341546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study aimed to quantify the severity of metabolic syndrome(MetS) and investigate its association with cardiovascular disease(CVD) risk on Chinese adults. Methods 13,500 participants from the Zhejiang Adult Chronic Disease Study were followed up between 2010 and 2021. A continuous MetS severity score derived from the five components of MetS was used to quantify MetS severity, and the association between MetS severity and the risk of incident CVD was assessed using Cox proportional hazard and restricted cubic spline regression. Results Both the presence and severity of MetS were strongly associated with CVD risk. MetS was related to an increased risk of CVD (hazard ratio(HR):1.700, 95% confidence interval(CI): 1.380-2.094). Compared with the hazard ratio for CVD in the lowest quartile of the MetS severity score, that in the second, third, and highest quartiles were 1.812 (1.329-2.470), 1.746 (1.265-2.410), and 2.817 (2.015-3.938), respectively. A linear and positive dose-response relationship was observed between the MetS severity and CVD risk (P for non-linearity = 0.437). Similar results were found in various sensitivity analyses. Conclusion The MetS severity score was significantly associated with CVD risk. Assessing MetS severity and further ensuring intervention measures according to the different severities of MetS may be more useful in preventing CVD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jie-ming Zhong
- Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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de Souza Rocha B, Silva JSD, Pedreira JGB, Montagnoli TL, Barreiro EJ, Zapata-Sudo G. Antihypertensive Effect of New Agonist of Adenosine Receptor in Spontaneously Hypertensive Rats. Arq Bras Cardiol 2024; 121:e20230405. [PMID: 38597541 DOI: 10.36660/abc.20230405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/14/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Systemic arterial hypertension is a risk factor for cardiac, renal, and metabolic dysfunction. The search for new strategies to prevent and treat cardiovascular diseases led to the synthesis of new N-acylhydrazones to produce antihypertensive effect. Adenosine receptors are an alternative target to reduce blood pressure because of their vasodilatory action and antioxidant properties, which may reduce oxidative stress characteristic of systemic arterial hypertension. OBJECTIVE To evaluate the antihypertensive profile of novel selenium-containing compounds designed to improve their interaction with adenosine receptors. METHODS Vascular reactivity was evaluated by recording the isometric tension of pre-contracted thoracic aorta of male Wistar rats after exposure to increasing concentrations of each derivative (0.1 to 100 μM). To investigate the antihypertensive effect in spontaneously hypertensive rats, systolic, diastolic, and mean arterial pressure and heart rate were determined after intravenous administration of 10 and 30 μmol/kg of the selected compound LASSBio-2062. RESULTS Compounds named LASSBio-2062, LASSBio-2063, LASSBio-2075, LASSBio-2076, LASSBio-2084, LASSBio-430, LASSBio-2092, and LASSBio-2093 promoted vasodilation with mean effective concentrations of 15.5 ± 6.5; 14.6 ± 2.9; 18.7 ± 9.6; 6.7 ± 4.1; > 100; 6.0 ± 3.6; 37.8 ± 11.8; and 15.9 ± 5.7 μM, respectively. LASSBio-2062 (30 μmol/kg) reduced mean arterial pressure in spontaneously hypertensive rats from 124.6 ± 8.6 to 72.0 ± 12.3 mmHg (p < 0.05). Activation of adenosine receptor subtype A3 and potassium channels seem to be involved in the antihypertensive effect of LASSBio-2062. CONCLUSIONS The new agonist of adenosine receptor and activator of potassium channels is a potential therapeutic agent to treat systemic arterial hypertension.
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170
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Henderson M, Fidler S, Foster C. Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps. Trop Med Infect Dis 2024; 9:74. [PMID: 38668535 PMCID: PMC11053933 DOI: 10.3390/tropicalmed9040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
In resourced settings, adults living with perinatally acquired HIV are approaching the 5th decade of life. Their clinical and psychological outcomes highlight potential future issues for the much larger number of adolescents growing up with HIV in sub-Saharan Africa, and will inform the development of appropriate healthcare services. Lifelong exposure to HIV, and increasingly to antiretroviral therapy throughout growth and development, contrasts with adults acquiring HIV in later life. This review describes the clinical outcomes for adults living with perinatally acquired HIV including post transition mortality, morbidity and retention in care. Rates of viral suppression, drug resistance and immunological function are explored. Co-morbidities focus on metabolic, cardiovascular, respiratory and bone health with quality-of-life data including neurocognitive functioning and mental health. Sexual and reproductive health including vaccine-preventable disease and the prevention of onward transmission to partners and infants are considered. The data gaps and future research questions to optimise outcomes for this emerging adult cohort are highlighted.
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Affiliation(s)
- Merle Henderson
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Sarah Fidler
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Caroline Foster
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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171
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Widyantoro B, Nailes JM, Sukonthasarn A, Soenarta AA. Ambulatory blood pressure monitoring profiles in Asia. J Clin Hypertens (Greenwich) 2024. [PMID: 38563647 DOI: 10.1111/jch.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.
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Affiliation(s)
- Bambang Widyantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Jennifer M Nailes
- Department of Preventive and Community Medicine, University of the East Ramon Magsaysay Memorial Medical Center Research Institute for Health Sciences, Manila, Philippines
| | - Apichard Sukonthasarn
- Cardiovascular Division, Department of Medicine, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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172
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Chi JH, Lee BJ. Association of relative hand grip strength with myocardial infarction and angina pectoris in the Korean population: a large-scale cross-sectional study. BMC Public Health 2024; 24:941. [PMID: 38566101 PMCID: PMC10986018 DOI: 10.1186/s12889-024-18409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Low hand grip strength (HGS) is associated with the risk of cardiovascular diseases, but the association between HGS and myocardial infarction/angina pectoris (MIAP) is unclear. Furthermore, there have been no studies examining the associations of MIAP with anthropometric indices, absolute HGS indices, and relative HGS indices calculated by dividing absolute HGS values by body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), or weight values. Therefore, the objective of this study was to examine the associations of MIAP with absolute and relative HGS combined with several anthropometric indices. METHODS In this large-scale cross-sectional study, a total of 12,963 subjects from the National Health and Nutrition Examination Survey were included. Odds ratios and 95% confidence intervals for the associations of MIAP with anthropometric indices, absolute HGS indices, and relative HGS indices were computed from binary logistic regression models. We built 3 models: a crude model, a model that was adjusted for age (Model 1), and a model that was adjusted for other relevant covariates (Model 2). RESULTS For men, the average age was 61.55 ± 0.16 years in the MIAP group and 66.49 ± 0.61 years in the non-MIAP group. For women, the average age was 61.99 ± 0.14 years in the MIAP group and 70.48 ± 0.61 years in the non-MIAP group. For both sexes, the MIAP group had lower diastolic blood pressure, shorter stature, greater WC, and a greater WHtR than did the non-MIAP group, and women tended to have greater systolic blood pressure, weight, and BMI than in men. HGS was strongly associated with the risk of MIAP in the Korean population. In men, relative HGS indices combined with WC and the WHtR had greater associations with MIAP than did the anthropometric indices and absolute HGS indices. However, in women, anthropometric indices, including weight, BMI, WC, and WHtR, were more strongly associated with MIAP than were absolute and relative HGS indices, unlike in men. When comparing absolute and relative HGS indices in women, relative HGS indices combined with BMI and weight was more strongly related to MIAP than was absolute HGS indices. CONCLUSIONS MIAP might be better identified by relative HGS than absolute HGS in both sexes. The overall magnitudes of the associations of MIAP with absolute and relative HGS are greater in men than in women.
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Affiliation(s)
- Jeong Hee Chi
- Department of Computer Science and Engineering, Konkuk University, Seoul, Republic of Korea
| | - Bum Ju Lee
- Digital Health Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, 34054, Daejeon, Republic of Korea.
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173
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Du J, Pan Y, Jiang J, Liu Y, Lam BCP, Schutte AE, Tsang IW, Sachdev PS, Wen W. Association of Blood Pressure With Brain Ages: A Cohort Study of Gray and White Matter Aging Discrepancy in Mid-to-Older Adults From UK Biobank. Hypertension 2024; 81:906-916. [PMID: 38465593 DOI: 10.1161/hypertensionaha.123.22176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/11/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Gray matter (GM) and white matter (WM) impairments are both associated with raised blood pressure (BP), although whether elevated BP is differentially associated with the GM and WM aging process remains inadequately examined. METHODS We included 37 327 participants with diffusion-weighted imaging (DWI) and 39 630 participants with T1-weighted scans from UK Biobank. BP was classified into 4 categories: normal BP, high-normal BP, grade 1, and grade 2 hypertension. Brain age gaps (BAGs) for GM (BAGGM) and WM (BAGWM) were derived from diffusion-weighted imaging and T1 scans separately using 3-dimensional-convolutional neural network deep learning techniques. RESULTS There was an increase in both BAGGM and BAGWM with raised BP (P<0.05). BAGWM was significantly larger than BAGGM at high-normal BP (0.195 years older; P=0.006), grade 1 hypertension (0.174 years older; P=0.004), and grade 2 hypertension (0.510 years older; P<0.001), but not for normal BP. Mediation analysis revealed that the association between hypertension and cognitive decline was primarily mediated by WM impairment. Mendelian randomization analysis suggested a causal relationship between hypertension and WM aging acceleration (unstandardized B, 1.780; P=0.016) but not for GM (P>0.05). Sliding-window analysis indicated the association between hypertension and brain aging acceleration was moderated by chronological age, showing stronger correlations in midlife but weaker associations in the older age. CONCLUSIONS Compared with GM, WM was more vulnerable to raised BP. Our study provided compelling evidence that concerted efforts should be directed towards WM damage in individuals with hypertension in clinical practice.
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Affiliation(s)
- Jing Du
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Sydney, Australia (J.D., J.J., B.C.P.L., P.S.S., W.W.)
| | - Yuangang Pan
- Centre for Frontier AI Research, A*STAR, Singapore (Y.P., I.W.T.)
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Sydney, Australia (J.D., J.J., B.C.P.L., P.S.S., W.W.)
| | - Yue Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L.)
| | - Ben C P Lam
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Sydney, Australia (J.D., J.J., B.C.P.L., P.S.S., W.W.)
| | - Aletta E Schutte
- School of Population Health, UNSW Medicine & Health, UNSW Sydney, NSW, Australia (A.E.S.)
- The George Institute for Global Health, Sydney, NSW, Australia (A.E.S.)
| | - Ivor W Tsang
- Centre for Frontier AI Research, A*STAR, Singapore (Y.P., I.W.T.)
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Sydney, Australia (J.D., J.J., B.C.P.L., P.S.S., W.W.)
- Neuropsychiatric Institute, Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia (P.S.S., W.W.)
| | - Wei Wen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales (UNSW), Sydney, Australia (J.D., J.J., B.C.P.L., P.S.S., W.W.)
- Neuropsychiatric Institute, Euroa Centre, Prince of Wales Hospital, Randwick, NSW, Australia (P.S.S., W.W.)
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Bratteteig M, Rueegg CS, Raastad T, Grydeland M, Torsvik IK, Schindera C, Ruud E, Anderssen SA. Physical Activity, Fitness, and Cardiovascular Disease Risk in Adolescent Childhood Cancer Survivors Compared to Controls: The Physical Activity in Childhood Cancer Survivors Study. J Adolesc Young Adult Oncol 2024; 13:338-346. [PMID: 37703544 DOI: 10.1089/jayao.2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Purpose: Childhood cancer survivors have increased risk of cardiac late effects that can be potentially mitigated by physical activity and fitness. We aimed to (1) compare cardiovascular disease (CVD) risk between survivors and controls, and (2) examine whether the associations of moderate-to-vigorous physical activity (MVPA), cardiorespiratory fitness (CRF), and musculoskeletal fitness (MSF) with CVD risk factors differed between survivors and controls. Methods: Within the Physical Activity in Childhood Cancer Survivors (PACCS) study, we assessed CVD risk factors (android fat mass, systolic blood pressure [SBP], total cholesterol/high-density lipoprotein [HDL]-cholesterol, and glycosylated hemoglobin) in 157 childhood cancer survivors and 113 age- and sex-matched controls aged 9-18 years. We used multivariable mixed linear regression models to compare CVD risk factors between survivors and controls, and assess associations of MVPA, CRF, and MSF with CVD risk factors. Results: Compared with controls, survivors had more android fat mass (861 vs. 648 g, p = 0.001) and lower SBP (114 vs. 118 mmHg, p = 0.002). MVPA, CRF, and MSF were associated with lower levels of android fat mass and total cholesterol/HDL-cholesterol, and higher SBP in survivors. Associations of MVPA, CRF, and MSF with CVD risk factors were similar in survivors and controls (Pinteraction > 0.05), except the associations of CRF and MSF with android fat mass, which were stronger in survivors than in controls (Pinteraction ≤ 0.001). Conclusion: Owing to higher levels of android fat mass and its stronger association with physical fitness in childhood cancer survivors compared with controls, survivors should get targeted interventions to increase fitness to reduce future risk of CVD.
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Affiliation(s)
- Mari Bratteteig
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Truls Raastad
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - May Grydeland
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Christina Schindera
- Paediatric Oncology/Haematology, University Children's Hospital Basel, Basel, Switzerland
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ellen Ruud
- Division for Paediatric- and Adolescence Medicine, Department of Paediatric Haematology and Oncology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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175
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Memon SS, Srivastava P, Karlekar M, Thakkar H, Bandgar T. Ambulatory blood pressure monitoring in pheochromocytoma - paraganglioma: A single center experience. J Postgrad Med 2024; 70:84-90. [PMID: 37555422 PMCID: PMC11160991 DOI: 10.4103/jpgm.jpgm_208_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Accepted: 05/02/2023] [Indexed: 08/10/2023] Open
Abstract
CONTEXT/AIMS Pheochromocytoma and paraganglioma (PPGL) are rare tumors, and data on ambulatory blood pressure monitoring (ABPM) in these patients and the effect of blocking on ABPM parameters is limited. We aimed to describe ABPM parameters in a cohort of PPGL at our center in western India. METHODS Retrospective study of patients with PPGL whose ABPM data was available. Demographic details, secretory status, and ABPM data were retrieved. Coefficient of variability (CV) was calculated as standard deviation/mean in percentage. RESULTS In the 39 included patients, mean age at presentation was 39.3 ± 14.2 yr; 20 (51.3%) were males, 25 (64.1%) hypertensive, and mean tumor diameter was 5.3 cm. In 18 patients whose baseline ABPM was done without medications, those with nocturnal blood pressure dipping (6/18, 33%) had higher serum metanephrines (median 313.2 vs. 34.7 pg/ml, P = 0.028). Despite normal office blood pressure (BP), 8.9% of systolic BP readings were >140 mmHg, and 1.2% were >160 mmHg. Among 29 patients with both pre and post-block ABPM, mean BP (systolic 121.6 vs. 132.5 mmHg, P = 0.014; diastolic 68.9 vs. 76.4 mmHg, P = 0.005) and percentage of BP readings above 140 mmHg (median 9.4% vs. 24.4%, P = 0.016) were significantly lowered after the preoperative blockade in hypertensive ( n = 19) patients, whereas CV was similar. The post-blockade ABPM characteristics were similar in patients blocked with amlodipine or prazosin. CONCLUSION ABPM provides additional information about BP characteristics in PPGL. The preoperative blocking decreases the magnitude of BP excursions but does not affect BP variability.
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Affiliation(s)
- SS Memon
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - P Srivastava
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - M Karlekar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H Thakkar
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - T Bandgar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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176
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Sotomayor Julio AD, Montana-Jimenez LP, Bernal Torres W, López Ponce de León JD, Zambrano Franco JA, Coca A, Camafort M, Vesga Reyes C. [Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review]. HIPERTENSION Y RIESGO VASCULAR 2024; 41:104-117. [PMID: 38480108 DOI: 10.1016/j.hipert.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 04/14/2024]
Abstract
Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients' daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.
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Affiliation(s)
- A D Sotomayor Julio
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
| | - L P Montana-Jimenez
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - W Bernal Torres
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J D López Ponce de León
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J A Zambrano Franco
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - A Coca
- Universidad de Barcelona, Barcelona, España
| | - M Camafort
- Universidad de Barcelona, Barcelona, España
| | - C Vesga Reyes
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
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177
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Serra MO, de Macedo LR, Silva M, Lautner RQ. Effect of Vitamin D supplementation on blood pressure in hypertensive individuals with hypovitaminosis D: a systematic review and meta-analysis. J Hypertens 2024; 42:594-604. [PMID: 38164948 DOI: 10.1097/hjh.0000000000003646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
In the present study, we aimed to conduct a literature review and meta-analysis to assess the effect of Vitamin D supplementation on SBP and DBP levels in individuals with hypertension and hypovitaminosis D. PubMed, Scopus, Web of Science, and SciELO were systematically searched for relevant publications until January 2023. The review has been registered at PROSPERO (CRD42023400035). To compare the effects of vitamin D with placebo, the mean differences with 95% confidence intervals (95% CIs) were pooled based on the random-effects model. Subgroup analyses were performed to identify the source of heterogeneity, and assessment of study quality was conducted using the GRADE approach. Publication bias was evaluated using funnel plots and Egger's tests. In total, 14 randomized controlled trials (RCTs) were included in this systematic review, and 11 trials were selected for meta-analysis. The data showed that Vitamin D significantly decreased SBP levels; however, it did not affect DBP levels. In subgroup analysis, Vitamin D supplementation significantly decreased in SBP in studies involving individuals over 60 years of age, with a dose greater than 400 000 IU, duration greater than 8 weeks, frequency of weekly supplementation in studies conducted in Asia. In addition, subgroup analysis revealed a significant reduction in DBP in the weekly frequency subgroups and in the studies carried out in Asia. This meta-analysis indicated that Vitamin D significantly reduced the SBP in individuals with hypertension and hypovitaminosis D. Further, well designed trials are necessary to validate these results.
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Affiliation(s)
| | | | - Maísa Silva
- Department of Basic Life Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Brazil
| | - Roberto Queiroga Lautner
- Department of Basic Life Sciences, Universidade Federal de Juiz de Fora, Governador Valadares, Brazil
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178
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Park CH, Kim HW, Joo YS, Park JT, Chang TI, Yoo TH, Park SK, Kim YH, Sung S, Hyun YY, Oh KH, Kang SW, Han SH. Findings from the KNOW-CKD Study indicate that higher systolic blood pressure time in target range is associated with a lower risk of chronic kidney disease progression. Kidney Int 2024; 105:835-843. [PMID: 38159679 DOI: 10.1016/j.kint.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
Time-in-target range (TTR) of systolic blood pressure (SBP) is determined by the proportion of time during which SBP remains within a defined optimal range. TTR has emerged as a useful metric for assessing SBP control over time. However, it is uncertain if SBP-TTR can predict the progression of chronic kidney disease (CKD). Here, we investigated the association between SBP-TTR during the first year of enrollment and CKD progression among 1758 participants from the KNOW-CKD (KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease). Baseline median estimated glomerular filtration rate (eGFR) was 51.7 ml/min per 1.73 m2. Participants were categorized into four SBP-TTR groups (0%, 1-50%, 51-99%, and 100%). The primary outcome was CKD progression defined as 50% or more decline in eGFR from baseline measurement or the initiation of kidney replacement therapy. During the follow-up period (9212 person-years over a median 5.4 years), the composite outcome occurred in 710 participants. In the multivariate cause-specific hazard model, a one-standard deviation increase in SBP-TTR was associated with an 11% lower risk of the composite outcome with hazard ratio, 0.89 (95% confidence interval, 0.82-0.97). Additionally, compared to patients with SBP-TTR 0%, the respective hazard ratios for those with SBP-TTR 1-50%, 51-99%, and 100% were 0.85 (0.68-1.07), 0.76 (0.60-0.96), and 0.72 (0.55-0.94), and the respective corresponding slopes of eGFR decline were -3.17 (-3.66 to -2.69), -3.02 (-3.35 to -2.68), -2.62 (-2.89 to - 2.36), and -2.33 (-2.62 to -2.04) ml/min/1.73 m2. Thus, higher SBP-TTR was associated with a decreased risk of CKD progression in patients with CKD.
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Affiliation(s)
- Cheol Ho Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Young Su Joo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea; Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Sue Kyung Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Suah Sung
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Kidney Research Institute, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
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Rotz SJ, Bhatt NS, Hamilton BK, Duncan C, Aljurf M, Atsuta Y, Beebe K, Buchbinder D, Burkhard P, Carpenter PA, Chaudhri N, Elemary M, Elsawy M, Guilcher GM, Hamad N, Karduss A, Peric Z, Purtill D, Rizzo D, Rodrigues M, Ostriz MBR, Salooja N, Schoemans H, Seber A, Sharma A, Srivastava A, Stewart SK, Baker KS, Majhail NS, Phelan R. International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update. Transplant Cell Ther 2024; 30:349-385. [PMID: 38413247 PMCID: PMC11181337 DOI: 10.1016/j.jtct.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 02/29/2024]
Abstract
As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the number of HCTs performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pretransplantation, peritransplantation, and post-transplantation exposures and other underlying risk factors. Guidelines for screening and preventive practices for HCT survivors were originally published in 2006 and then updated in 2012. An international group of experts was convened to review the contemporary literature and update the recommendations while considering the changing practices of HCT and cellular therapy. This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed, but cGVHD management is not covered in detail. These guidelines emphasize the special needs of patients with distinct underlying HCT indications or comorbidities (eg, hemoglobinopathies, older adults) but do not replace more detailed group-, disease-, or condition-specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.
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Affiliation(s)
- Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Neel S Bhatt
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christine Duncan
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Harvard University, Boston, Massachusetts
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Yoshiko Atsuta
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
| | - Kristen Beebe
- Phoenix Children's Hospital and Mayo Clinic Arizona, Phoenix, Arizona
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California
| | | | | | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Elemary
- Hematology and BMT, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mahmoud Elsawy
- Division of Hematology, Dalhousie University, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Gregory Mt Guilcher
- Section of Pediatric Oncology/Transplant and Cellular Therapy, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, St Vincent's Clinical School Sydney, University of New South Wales, School of Medicine Sydney, University of Notre Dame Australia, Australia
| | - Amado Karduss
- Bone Marrow Transplant Program, Clinica las Americas, Medellin, Colombia
| | - Zinaida Peric
- BMT Unit, Department of Hematology, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Duncan Purtill
- Fiona Stanley Hospital, Murdoch, PathWest Laboratory Medicine WA, Australia
| | - Douglas Rizzo
- Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Maria Belén Rosales Ostriz
- Division of hematology and bone marrow transplantation, Instituto de trasplante y alta complejidad (ITAC), Buenos Aires, Argentina
| | - Nina Salooja
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven, Department of Public Health and Primary Care, ACCENT VV, KU Leuven, University of Leuven, Leuven, Belgium
| | | | - Akshay Sharma
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | | | | | - Navneet S Majhail
- Sarah Cannon Transplant and Cellular Therapy Network, Nashville, Tennessee
| | - Rachel Phelan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Gupta A, Whiteley WN, Godec T, Rostamian S, Ariti C, Mackay J, Whitehouse A, Janani L, Poulter NR, Sever PS. Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial. Eur Heart J 2024; 45:1159-1169. [PMID: 38291599 PMCID: PMC10984564 DOI: 10.1093/eurheartj/ehad814] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND AND AIMS Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment. METHODS Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes. RESULTS Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10-1.17], P < .001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18-1.26), P < .001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72-0.93), P = .003], total CV events [HR 0.93 (95% CI 0.88-0.98), P = .008], total coronary events [HR 0.92 (95% CI 0.86-0.99), P = .024], and atrial fibrillation [HR 0.91 (95% CI 0.83-0.99), P = .030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82-1.01), P = .073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality. CONCLUSIONS Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period.
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Affiliation(s)
- Ajay Gupta
- William Harvey Research Institute, Queen Mary University of London, UK
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | | | - Thomas Godec
- William Harvey Research Institute, Queen Mary University of London, UK
| | - Somayeh Rostamian
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Cono Ariti
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Judith Mackay
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Andrew Whitehouse
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Leila Janani
- Clinical Trials Unit, Imperial College London, UK
| | | | - Peter S Sever
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
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181
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Li SR, Phillips AR, Reitz KM, Mikati N, Brown JB, Tzeng E, Makaroun MS, Guyette FX, Liang NL. Hypertension during transfer is associated with poor outcomes in unstable patients with ruptured abdominal aortic aneurysm. J Vasc Surg 2024; 79:755-762. [PMID: 38040202 PMCID: PMC11129779 DOI: 10.1016/j.jvs.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/09/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Limited data exist for optimal blood pressure (BP) management during transfer of patients with ruptured abdominal aortic aneurysm (rAAA). This study evaluates the effects of hypertension and severe hypotension during interhospital transfers in a cohort of patients with rAAA in hemorrhagic shock. METHODS We performed a retrospective, single-institution review of patients with rAAA transferred via air ambulance to a quaternary referral center for repair (2003-2019). Vitals were recorded every 5 minutes in transit. Hypertension was defined as a systolic BP of ≥140 mm Hg. The primary cohort included patients with rAAA with hemorrhagic shock (≥1 episode of a systolic BP of <90 mm Hg) during transfer. The primary analysis compared those who experienced any hypertensive episode to those who did not. A secondary analysis evaluated those with either hypertension or severe hypotension <70 mm Hg. The primary outcome was 30-day mortality. RESULTS Detailed BP data were available for 271 patients, of which 125 (46.1%) had evidence of hemorrhagic shock. The mean age was 74.2 ± 9.1 years, 93 (74.4%) were male, and the median total transport time from helicopter dispatch to arrival at the treatment facility was 65 minutes (interquartile range, 46-79 minutes). Among the cohort with shock, 26.4% (n = 33) had at least one episode of hypertension. There were no significant differences in age, sex, comorbidities, AAA repair type, AAA anatomic location, fluid resuscitation volume, blood transfusion volume, or vasopressor administration between the hypertensive and nonhypertensive groups. Patients with hypertension more frequently received prehospital antihypertensives (15% vs 2%; P = .01) and pain medication (64% vs 24%; P < .001), and had longer transit times (36.3 minutes vs 26.0 minutes; P = .006). Episodes of hypertension were associated with significantly increased 30-day mortality on multivariable logistic regression (adjusted odds ratio [aOR], 4.71; 95% confidence interval [CI], 1.54-14.39; P = .007; 59.4% [n = 19] vs 40.2% [n = 37]; P = .01). Severe hypotension (46%; n = 57) was also associated with higher 30-day mortality (aOR, 2.82; 95% CI, 1.27-6.28; P = .01; 60% [n = 34] vs 32% [n = 22]; P = .01). Those with either hypertension or severe hypotension (54%; n = 66) also had an increased odds of mortality (aOR, 2.95; 95% CI, 1.08-8.11; P = .04; 58% [n = 38] vs 31% [n = 18]; P < .01). Level of hypertension, BP fluctuation, and timing of hypertension were not significantly associated with mortality. CONCLUSIONS Hypertensive and severely hypotensive episodes during interhospital transfer were independently associated with increased 30-day mortality in patients with rAAA with shock. Hypertension should be avoided in these patients, but permissive hypotension approaches should also maintain systolic BPs above 70 mm Hg whenever possible.
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Affiliation(s)
- Shimena R Li
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Katherine M Reitz
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Nancy Mikati
- Department of Emergency Medicine, University of Iowa Health Care, Iowa City, IA
| | - Joshua B Brown
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Trauma and General Surgery, Pittsburgh Trauma Research Center, University of Pittsburgh, Pittsburgh, PA
| | - Edith Tzeng
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Michel S Makaroun
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nathan L Liang
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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John D, Johnson AR, Fathima FN, Mundackal R. Diabetes, hypertension, and other cardiovascular disease risk factors among adults in an urban underprivileged community in Bangalore city, India. J Family Med Prim Care 2024; 13:1440-1447. [PMID: 38827696 PMCID: PMC11141983 DOI: 10.4103/jfmpc.jfmpc_1256_23] [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] [Received: 08/01/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 06/04/2024] Open
Abstract
Aim Diabetes and hypertension are major risk factors of cardiovascular disease, which is known to be the leading cause of global mortality in the world today. Studies have shown that the prevalence of these risk factors is on the rise, with the burden of diabetes alone increasing by 80% in the last two decades. Complications of diabetes and hypertension result in huge public health challenges for the country and catastrophic medical expenditures for families among the urban poor. Our study aims to estimate the prevalence of diabetes, hypertension, and other cardiovascular risk factors among adults in an urban underprivileged community of Bengaluru city. Objectives and Methods A cross-sectional study was conducted over a period of 6 months where 2245 individuals aged 30 or older were interviewed using a structured interviewer-administered questionnaire used to capture sociodemographic details that assessed modifiable risk factors for diabetes and hypertension. Inclusion criteria for diabetes were considered if the random blood sugar reading was ≥200 mg/dL, whereas a diagnosis of hypertension was taken into consideration if the systolic blood pressure reading was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg. Results Among the 2245 participants that took part in the study, 15.5% were diabetics and 17.2% were hypertensive. There was a strong association of diabetes among consumers of alcohol, with more than one-third having a high prevalence of the disease (odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.1-3.9). More than half the population were consumers of junk food; the prevalence of diabetes in this group was 1.35 times higher than that in their counterparts (OR: 1.35, 95% CI: 1.0-1.8). A significant association of diabetes was also seen among those identified with central obesity (OR: 1.83, 95% CI: 1.4-2.5). One-third of the population who consumed alcohol were found to be diagnosed with hypertension (OR: 3.08, 95% CI: 1.6-5.9), and one-fifth of individuals who were regular consumers of junk food had a higher prevalence of hypertension (OR: 1.41, 95% CI: 1.1-1.8). A higher prevalence of hypertension was also seen among individuals with central obesity or a body mass index (BMI) of >30 (OR: 1.59, 95% CI: 1.2-2.1; OR: 1.92, 95% CI: 1.4-2.6). Conclusion The findings from our study conducted in an urban underprivileged area of Bengaluru city shed light on the significant associations between diabetes and hypertension and various demographic and lifestyle factors. Specifically, male gender and lower educational status were found to have a significant association with diabetes, whereas being unmarried and having a high BMI status were strongly linked to hypertension. In addition, the study revealed that elderly individuals, alcohol consumers, junk food eaters, and those with central obesity demonstrated an increased risk for both diabetes and hypertension. By identifying these risk factors, targeted interventions can be developed to address the unique challenges faced by this vulnerable section of society. Strategies can be designed to raise awareness, encourage healthier lifestyle choices, and improve access to healthcare services to effectively prevent and manage diabetes and hypertension in this community.
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Affiliation(s)
- David John
- Department of General Surgery, Basingstoke and North Hampshire Hosptial, United Kingdom
| | - Avita R. Johnson
- Department of Community Medicine, St Johns National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Farah N. Fathima
- Department of Community Medicine, St Johns National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Rose Mundackal
- Department of Community Medicine, St Johns National Academy of Health Sciences, Bangalore, Karnataka, India
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Zhu A, Ostbye T, Naheed A, de Silva HA, Jehan I, Gandhi M, Chakma N, Kasturiratne A, Samad Z, Jafar TH. Ambulatory blood pressure levels in individuals with uncontrolled clinic hypertension across Bangladesh, Pakistan, and Sri Lanka. J Clin Hypertens (Greenwich) 2024; 26:391-404. [PMID: 38450866 PMCID: PMC11007786 DOI: 10.1111/jch.14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
Hypertension is a leading risk factor for cardiovascular disease in South Asia. The authors aimed to assess the cross-country differences in 24-h ambulatory, daytime, and nighttime systolic blood pressure (SBP) among rural population with uncontrolled clinic hypertension in Bangladesh, Pakistan, and Sri Lanka. The authors studied patients with uncontrolled clinic hypertension (clinic BP ≥ 140/90 mmHg) who underwent ambulatory blood pressure monitoring (ABPM) during the baseline assessment as part of a community-based trial. The authors compared the distribution of ABPM profiles of patients across the three countries, specifically evaluating ambulatory SBP levels with multivariable models that adjusted for patient characteristics. Among the 382 patients (mean age, 58.3 years; 64.7% women), 56.5% exhibited ambulatory hypertension (24-h ambulatory BP ≥ 130/80 mmHg), with wide variation across countries: 72.6% (Bangladesh), 50.0% (Pakistan), and 51.0% (Sri Lanka; P < .05). Compared to Sri Lanka, adjusted mean 24-h ambulatory, daytime, and nighttime SBP were higher by 12.24 mmHg (95% CI 4.28-20.20), 11.96 mmHg (3.87-20.06), and 12.76 mmHg (4.51-21.01) in Bangladesh, separately. However, no significant differences were observed between Pakistan and Sri Lanka (P > .05). Additionally, clinic SBP was significantly associated with 24-h ambulatory (mean 0.38, 95% CI 0.28-0.47), daytime (0.37, 0.27-0.47), and nighttime SBP (0.40, 0.29-0.50) per 1 mmHg increase. The authors observed substantial cross-country differences in the distribution of ABPM profiles among patients with uncontrolled clinic hypertension in rural South Asia. The authors findings indicated the need to incorporate 24-h BP monitoring to mitigate cardiovascular risk, particularly in Bangladesh.
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Affiliation(s)
- Anqi Zhu
- Program in Health Services & Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Truls Ostbye
- Duke University Department of Family Medicine and Community HealthDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Aliya Naheed
- Health Systems and Population Studies DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | - H Asita de Silva
- Department of PharmacologyFaculty of MedicineUniversity of KelaniyaRagamaSri Lanka
| | - Imtiaz Jehan
- Department of Community Health ScienceAga Khan UniversityKarachiPakistan
| | - Mihir Gandhi
- BiostatisticsSingapore Clinical Research InstituteSingaporeSingapore
- Centre of Quantitative MedicineDuke‐NUS Medical SchoolSingaporeSingapore
- Tampere Center for Child Health ResearchTampere UniversityTampereFinland
| | - Nantu Chakma
- Health Systems and Population Studies DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | | | - Zainab Samad
- Department of MedicineMedical CollegeAga Khan UniversityKarachiPakistan
| | - Tazeen Hasan Jafar
- Program in Health Services & Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
- Duke Global Health InstituteDurhamNorth CarolinaUSA
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Wu L, Gao J, Zhuang J, Wu M, Chen S, Wang G, Hong L, Wu S, Hong J. Hypertension combined with atherosclerosis increases the risk of heart failure in patients with diabetes. Hypertens Res 2024; 47:921-933. [PMID: 38102214 DOI: 10.1038/s41440-023-01529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
The increase in heart failure risk in the diabetic population when hypertension and atherosclerosis are both present is still inconclusive. The aim of this study was to explore the effects of hypertension combined with atherosclerosis in diabetic population on the risk of heart failure. We selected 10,711 patients with diabetes who participated in the Kailuan study and completed brachial-ankle pulse wave velocity (baPWV) testing for statistical analysis. The subjects were divided into the non-hypertensive non-atherosclerotic, hypertensive, atherosclerotic, and hypertensive atherosclerotic groups based on their history of hypertension and atherosclerosis. At a median follow-up of 4.15 years, 227 cases of heart failure occurred. Compared with the non-hypertensive non-atherosclerotic group, the multifactorial Cox proportional risk regression model showed that the hazard ratio (HR) for heart failure in the hypertensive atherosclerotic group was 3.08 (95% confidence interval [CI]: 1.32-7.16), whereas the HR decreased to 2.38 (95% CI: 1.01-5.63) after gradual correction of lipid-lowering, glucose-lowering, and antihypertensive drugs. The subgroup analysis and sensitivity analysis were consistent with that of total population. In conclusion, patients with diabetes exposed to both hypertension and atherosclerosis had an increased heart failure risk, which was attenuated by the use of lipid-lowering, glucose-lowering, and antihypertensive drugs.
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Affiliation(s)
- Lili Wu
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Jingli Gao
- Department of Intensive Care Unit, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Jinqiang Zhuang
- Emergency Intensive Care Unit, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Meimei Wu
- Department of Emergency and Critical Care Medicine, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China
| | - Linge Hong
- West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China.
| | - Jiang Hong
- Department of Emergency and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Rotshild V, Matok I. Authors Reply to Comment on Rotshild et al's "The Risk for Prostate Cancer With Calcium Channel Blockers". Ann Pharmacother 2024; 58:443. [PMID: 37614020 DOI: 10.1177/10600280231185784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
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186
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Chagnac A, Friedman AN. Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio. Kidney Med 2024; 6:100804. [PMID: 38576526 PMCID: PMC10993191 DOI: 10.1016/j.xkme.2024.100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
An increased urinary albumin excretion rate is an important early risk factor for chronic kidney disease and other major outcomes and is usually measured using the urinary albumin-creatinine ratio (ACR). Obesity is highly prevalent in the general and chronic kidney disease populations and is an independent risk factor for moderately increased albuminuria (henceforth, moderate albuminuria). In this review, we describe how the ACR was developed and used to define moderate albuminuria. We then investigate how biases related to urinary creatinine excretion are introduced into the ACR measurement and how the use of the 30-mg/g threshold decreases the performance of the test in populations with higher muscle mass, with a primary focus on why and how this occurs in the obese population. The discussion then raises several strategies that can be used to mitigate such bias. This review provides a comprehensive overview of the medical literature on the uses and limitations of ACR in individuals with obesity and critically assesses related issues. It also raises into question the widely accepted 30-mg/g threshold as universally adequate for the diagnosis of moderate albuminuria. The implications of our review are relevant for clinicians, epidemiologists, and clinical trialists.
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Affiliation(s)
- Avry Chagnac
- Maccabi Healthcare Services, Ramat Hasharon Medical Center, Israel
| | - Allon N. Friedman
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN
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187
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Rai P, Sahadevan P, Mensegere AL, Issac TG, Muniz‐Terrera G, Sundarakumar JS. Rural-urban disparities in the diagnosis and treatment of hypertension and diabetes among aging Indians. Alzheimers Dement 2024; 20:2943-2951. [PMID: 38460118 PMCID: PMC11032561 DOI: 10.1002/alz.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Hypertension and diabetes are modifiable risk factors for dementia. We aimed to assess rural-urban disparities in the diagnosis and treatment of these conditions among aging Indians. METHODS Participants (n = 6316) were from two parallel, prospective aging cohorts in rural and urban India. Using self-report and clinical/biochemical assessments, we subdivided participants with diabetes and hypertension into undiagnosed and untreated groups. Logistic regression and Fairlie decomposition analysis were the statistical methods utilized. RESULTS There was a significant rural-urban disparity in undiagnosed hypertension (25.14%), untreated hypertension (11.75%), undiagnosed diabetes (16.94%), and untreated diabetes (11.62%). Further, sociodemographic and lifestyle factors, such as age and tobacco use were the common contributors to the disparities in both undiagnosed hypertension and undiagnosed diabetes, whereas education and body mass index (BMI) were significant contributors to the disparity in untreated hypertension. DISCUSSION Rural Indians face significant healthcare disadvantages as compared to their urban counterparts, which prompts the urgent need for strategies for equitable healthcare.
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Affiliation(s)
- Pooja Rai
- Centre for Brain ResearchIndian Institute of ScienceBangaloreIndia
| | - Pravin Sahadevan
- Centre for Brain ResearchIndian Institute of ScienceBangaloreIndia
| | | | - Thomas G. Issac
- Centre for Brain ResearchIndian Institute of ScienceBangaloreIndia
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia PreventionUniversity of EdinburghEdinburghUK
- Heritage College of Osteopathic MedicineOhio UniversityAthensOhioUSA
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Gao X, Li X, Chen L, Chen S, Hou G, Lin L, Wang Q, Qu J, Liu S. A biomarker panel of secondary hypertension is simultaneously quantified by coupling of magnetic solid-phase extraction and liquid chromatography-tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2024; 38:e9703. [PMID: 38356091 DOI: 10.1002/rcm.9703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/07/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Abstract
RATIONALE Secondary hypertension is often caused by activation of complex multi-organ endocrine systems, while renin activity indicated by angiotensins (Angs), aldosterone (ALD) and cortisol (COR) in such systems are generally accepted as its diagnostic markers. As antibody-based methods cannot offer comparable quantification for these biomarkers, a liquid chromatography (LC)-tandem mass spectrometry (MS/MS)-based approach was developed to quantify them simultaneously and accurately. METHODS Five different beads for magnetic solid-phase extraction (MSPE) were evaluated towards their enrichment efficiency for these biomarkers. An LC system with optimized elution gradient and a triple-quadrupole MS with tuned parameters were coupled to quantitatively monitor the extracted analytes. The method performance was further examined such as linearity, precision, stability, recovery rate and matrix effect. Based on the developed method, the abundance of Ang II, ALD and COR in plasma was measured and the quantification was compared with that derived from commercial ELISA kits. RESULTS As compared with other MSPEs, Angs, ALD and COR were highly enriched by the HLB magnetic beads with satisfactory recoveries. These analytes were simultaneously quantified by LC/MS/MS and all the method parameters for quantification were well matched with the requirements of clinical testing. Comparison of the quantitative results derived from ELISA and LC/MS/MS exhibited that the two methods offered basically comparable values with Pearson r values at 0.896, 0.895 and 0.835, respectively. The stability test for plasma Angs at room temperature indicated that the abundance of Ang II was relatively stable within 3 h, whereas that of Ang I and Ang 1-7 was time-dependently changed. CONCLUSIONS Coupling of HLB beads and LC/MS/MS thus enables simultaneous quantification of a set of biomarkers related to secondary hypertension.
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Affiliation(s)
- Xi Gao
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
- BGI Genomics, Shenzhen, China
| | - Xiaoyong Li
- Department of Clinical Laboratory, Shenzhen Third People's Hospital, National Clinical Research Center for Infectious Diseases, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | | | - Shuyan Chen
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | | | | | | | - Jiuxin Qu
- Department of Clinical Laboratory, Shenzhen Third People's Hospital, National Clinical Research Center for Infectious Diseases, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Siqi Liu
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
- BGI Genomics, Shenzhen, China
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Diallo AO, Marcus ME, Flood D, Theilmann M, Rahim NE, Kinlaw A, Franceschini N, Stürmer T, Tien DV, Abbasi-Kangevari M, Agoudavi K, Andall-Brereton G, Aryal K, Bahendeka S, Bicaba B, Bovet P, Dorobantu M, Farzadfar F, Ghamari SH, Gathecha G, Guwatudde D, Gurung M, Houehanou C, Houinato D, Hwalla N, Jorgensen J, Kagaruki G, Karki K, Martins J, Mayige M, McClure RW, Moghaddam SS, Mwalim O, Mwangi KJ, Norov B, Quesnel-Crooks S, Sibai A, Sturua L, Tsabedze L, Wesseh C, Geldsetzer P, Atun R, Vollmer S, Bärnighausen T, Davies J, Ali MK, Seiglie JA, Gower EW, Manne-Goehler J. Multiple cardiovascular risk factor care in 55 low- and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003019. [PMID: 38536787 PMCID: PMC10971750 DOI: 10.1371/journal.pgph.0003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009-2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40-69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8-66.4]) than those with hypertension only (47.4% [45.3-49.6]) or diabetes only (46.7% [44.1-49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8-41.8] using antihypertensive and 42.3% [95% CI: 39.4-45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1-27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4-18.8]), followed by diabetes (13.3% [10.7-15.8]) and hypertension-diabetes (6.6% [5.4-7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors.
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Affiliation(s)
- Alpha Oumar Diallo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Maja E. Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - David Flood
- University of Michigan, Ann Arbor, Michigan, United States of America
| | - Michaela Theilmann
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nicholas E. Rahim
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Alan Kinlaw
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina School of Pharmacy at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Dessie V. Tien
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Krishna Aryal
- Nepal Health Sector Programme 3, Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal
| | | | - Brice Bicaba
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- Ministry of Health, Victoria, Seychelles
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Maria Dorobantu
- Department of Cardiology, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mongal Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Nahla Hwalla
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jutta Jorgensen
- Dept of Public Health and Epidemiology, Institute of Global Health, Copenhagen University, Copenhagen, Denmark
| | - Gibson Kagaruki
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Khem Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Joao Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa’e, Dili, Timor-Leste
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Roy Wong McClure
- Office of Epidemiology and Surveillance, Costa Rican Social Security Fund, San José, Costa Rica
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | | | - Abla Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Pascal Geldsetzer
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Division of Primary Care and Population Health, Stanford University, Stanford, California, United States of America
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Till Bärnighausen
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Africa Health Research Institute, Somkhele, South Africa
| | - Justine Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Emily W. Gower
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jennifer Manne-Goehler
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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190
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Moosa AS, Oka P, Ng CJ. Exploring primary care physicians' challenges in using home blood pressure monitoring to manage hypertension in Singapore: a qualitative study. Front Med (Lausanne) 2024; 11:1343387. [PMID: 38590317 PMCID: PMC10999538 DOI: 10.3389/fmed.2024.1343387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Objective Hypertension guidelines recommend using home blood pressure (HBP) to diagnose, treat and monitor hypertension. This study aimed to explore the challenges primary care physicians (PCPs) face in using HBP to manage patients with hypertension. Method A qualitative study was conducted in 2022 at five primary care clinics in Singapore. An experienced qualitative researcher conducted individual in-depth interviews with 17 PCPs using a semi-structured interview guide. PCPs were purposively recruited based on their clinical roles and seniority until data saturation. The interviews were audio-recorded, transcribed verbatim and managed using NVivo qualitative data management software. Analysis was performed using thematic analysis. Results PCPs identified variations in patients' HBP monitoring practices and inconsistencies in recording them. Access to HBP records relied on patients bringing their records to the clinic visit. A lack of seamless transfer of HBP records to the EMR resulted in an inconsistency in documentation and additional workload for PCPs. PCPs struggled to interpret the HBP readings, especially when there were BP fluctuations; this made treatment decisions difficult. Conclusion Despite strong recommendations to use HBP to inform hypertension management, PCPs still faced challenges accessing and interpreting HBP readings; this makes clinical decision-making difficult. Future research should explore effective ways to enhance patient self-efficacy in HBP monitoring and support healthcare providers in documenting and interpreting HBP.
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Affiliation(s)
- Aminath Shiwaza Moosa
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Prawira Oka
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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191
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Sosa F, Shaban M, Lopez J, Duarte GJ, Jain S, Khizar A, Vittorio T, Mishra R, Rodriguez Guerra M. Impact of Hyperuricemia and Urate-Lowering Agents on Cardiovascular Diseases. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2024; 18:11795468241239542. [PMID: 38529322 PMCID: PMC10962038 DOI: 10.1177/11795468241239542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
The association between hyperuricemia and cardiovascular diseases has been studied for many years. Research has shown a link between high uric acid levels and increased risk of including coronary artery disease hypertension and other cardiovascular conditions. Urate-lowering therapy, particularly with xanthine oxidase inhibitors like allopurinol, has shown promising results in reducing blood pressure in individuals with hyperuricemia and hypertension. Clinical trials and studies have demonstrated significant reductions in both systolic and diastolic blood pressure with urate-lowering treatment. Urate-lowering treatment has shown a favorable effect on reducing systolic blood pressure and major adverse cardiovascular events in patients with previous cardiovascular disease. In terms of cardiovascular safety, clinical trials have indicated that xanthine oxidase inhibitors such as febuxostat are non-inferior to allopurinol and do not increase the risk of death or serious adverse events. Overall, these findings highlight the importance of managing hyperuricemia and utilizing urate-lowering therapy to mitigate the adverse cardiovascular effects associated with elevated uric acid levels.
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Affiliation(s)
- Franklin Sosa
- BronxCare Health System, Icahn School of Medicine, Bronx, NY, USA
| | - Mohammed Shaban
- BronxCare Health System, Icahn School of Medicine, Bronx, NY, USA
| | - Jose Lopez
- Division of Cardiovascular Disease, University of Miami Miller School of Medicine/JFK Hospital, Atlantis, FL, USA
| | - Gustavo J. Duarte
- Division of Cardiology, Cleveland Clinic Florida, Fort Lauderdale, FL, USA
| | - Swati Jain
- Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, USA
| | - Asma Khizar
- Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, USA
| | - Timothy Vittorio
- BronxCare Health System, Icahn School of Medicine, Bronx, NY, USA
| | - Rishabh Mishra
- Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, USA
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192
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Kaur P, Sakthivel M, Venkatasamy V, Jogewar P, Gill SS, Kunwar A, Sharma M, Pathni AK, Durgad K, Sahoo SK, Wankhede A, Kumar N, Bharadwaj V, Das B, Chavan T, Khedkar S, Sarode L, Bangar SD, Krishna A, Shivashankar R, Ganeshkumar P, Pragya P, Bhargava B. India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022. Glob Heart 2024; 19:30. [PMID: 38524909 PMCID: PMC10959138 DOI: 10.5334/gh.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/05/2024] [Indexed: 03/26/2024] Open
Abstract
Background Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented. Methods We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment. Results Of 281,209 patients initiated on amlodipine 5 mg, 159,292 continued on protocol drugs and came for a follow-up visit during the first quarter of 2022. Of 33,450 individuals who came for the follow-up in Punjab and 125,842 in Maharashtra, 70% and 76% had controlled BP, respectively, at the first step with amlodipine 5 mg. In Punjab, at the second step with amlodipine 10 mg, the cumulative BP control increased to 75%. A similar 5% (76%-81%) increase was seen in the second step after adding telmisartan 40 mg in Maharashtra. Overall, the mean (SD) systolic blood pressure (SBP) decreased by 16 mmHg from 148 (15) mmHg at the baseline in Punjab. In Maharashtra, the decline in the mean (SD) SBP was about 15 mmHg from the 144 (18) mmHg baseline. Conclusion Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.
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Affiliation(s)
- Prabhdeep Kaur
- ICMR - National Institute of Epidemiology Author Institution is Unverified Chennai, IN
| | | | | | - Padmaja Jogewar
- State NCD Cell, Directorate of Health and Family Welfare, Government of Maharashtra, Mumbai, IN
| | - Sandeep S. Gill
- State NCD Cell, Directorate of Health and Family Welfare, Government of Punjab, Chandigarh, IN
| | - Abhishek Kunwar
- Division of Noncommunicable Diseases, WHO Country Office for India, New Delhi, IN
| | - Meenakshi Sharma
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | | | - Kiran Durgad
- IHCI project, WHO Country Office for India, New Delhi, IN
| | | | - Amol Wankhede
- IHCI project, WHO Country Office for India, New Delhi, IN
| | - Navneet Kumar
- IHCI project, State NCD Cell, Chandigarh (Punjab), WHO, IN
| | | | - Bidisha Das
- IHCI project, District NCD Cell, Bhatinda (Punjab), WHO, IN
| | | | - Suhas Khedkar
- IHCI project, District NCD Cell, Satara (Maharashtra), WHO, IN
| | - Lalit Sarode
- IHCI project, District NCD Cell, Nashik (Maharashtra), WHO, IN
| | - Sampada D. Bangar
- Division of Epidemiology and biostatistics, ICMR-National AIDS Research Institute, Pune, IN
| | | | - Roopa Shivashankar
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | | | - Pragati Pragya
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | - Balram Bhargava
- Department of Health Research, MoHFW, Indian Council of Medical Research (ICMR), New Delhi, IN
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193
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Cardoso AM. Microbial influence on blood pressure: unraveling the complex relationship for health insights. MICROBIOME RESEARCH REPORTS 2024; 3:22. [PMID: 38841410 PMCID: PMC11149090 DOI: 10.20517/mrr.2023.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 06/07/2024]
Abstract
Hypertension, a critical global health concern, is characterized by persistent high blood pressure and is a major cause of cardiovascular events. This perspective explores the multifaceted implications of hypertension, its association with cardiovascular diseases, and the emerging role of the gut microbiota. The gut microbiota, a dynamic community in the gastrointestinal tract, plays a pivotal role in hypertension by influencing blood pressure through the generation of antioxidant, anti-inflammatory, and short-chain fatty acids metabolites, and the conversion of nitrates into nitric oxide. Antihypertensive medications interact with the gut microbiota, impacting drug pharmacokinetics and efficacy. Prebiotics and probiotics present promising avenues for hypertension management, with prebiotics modulating blood pressure through lipid and cholesterol modulation, and probiotics exhibiting a general beneficial effect. Personalized choices based on individual factors are crucial for optimizing prebiotic and probiotic interventions. In conclusion, the gut microbiota's intricate influence on blood pressure regulation offers innovative perspectives in hypertension therapeutics, with targeted strategies proving valuable for holistic blood pressure management and health promotion.
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194
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Felício J, Moraes L, Lemos G, Souza Í, Vieira G, Silva L, Queiroz N, Souza AC, Melo F, Neto JFA, Britto H, Lemos M, Santos M, Figueiredo P, Motta AR, Reis M, Caldeira G, Leal V, Piani P, Aquino V, Felício K. High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy. Sci Rep 2024; 14:6374. [PMID: 38493259 PMCID: PMC10944468 DOI: 10.1038/s41598-024-56934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.
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Affiliation(s)
- João Felício
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil.
| | - Lorena Moraes
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Gabriela Lemos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Ícaro Souza
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Giovana Vieira
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Lilian Silva
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Natércia Queiroz
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Ana Carolina Souza
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Franciane Melo
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - João Felício Abrahão Neto
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Hana Britto
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Manuela Lemos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Márcia Santos
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Priscila Figueiredo
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Ana Regina Motta
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Melissa Reis
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Gisele Caldeira
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Valéria Leal
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Pedro Piani
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Vitória Aquino
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
| | - Karem Felício
- Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, 4487, Guamá, Belém, Pará, 66073-000, Brazil
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195
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Lin H, Zhou C, Li J, Ma X, Yang Y, Zhu T. A risk prediction nomogram for resistant hypertension in patients with obstructive sleep apnea. Sci Rep 2024; 14:6127. [PMID: 38480770 PMCID: PMC10937983 DOI: 10.1038/s41598-024-56629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) are liable to have resistant hypertension (RH) associated with unfavorable cardiovascular events. It is of necessity to predict OSA patients who are susceptible to resistant hypertension. Hence, we conducted a retrospective study based on the clinical records of OSA patients admitted to Yixing Hospital Affiliated to Jiangsu University from January 2018 to December 2022. According to different time periods, patients diagnosed between January 2018 and December 2021 were included in the training set (n = 539) for modeling, and those diagnosed between January 2022 and December 2022 were enrolled into the validation set (n = 259) for further assessment. The incidence of RH in the training set and external validation set was comparable (P = 0.396). The related clinical data of patients enrolled were collected and analyzed through univariate analysis and least absolute shrinkage and selection operator (LASSO) logistic regression analysis to identify independent risk factors and construct a nomogram. Finally, five variables were confirmed as independent risk factors for OSA patients with RH, including smoking, heart disease, neck circumference, AHI and T90. The nomogram established on the basis of variables above was shown to have good discrimination and calibration in both the training set and validation set. Decision curve analysis indicated that the nomogram was useful for a majority of OSA patients. Therefore, our nomogram might be useful to identify OSA patients at high risk of developing RH and facilitate the individualized management of OSA patients in clinical practice.
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Affiliation(s)
- Hongze Lin
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Chen Zhou
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Jiaying Li
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Xiuqin Ma
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Yan Yang
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China.
| | - Taofeng Zhu
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China.
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China.
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196
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Gumilang RA, Fan YC, Wu SH, Bai CH. Adiposity indices and their higher predictive value for new-onset hypertension in metabolically healthy young women: findings from a population-based prospective cohort study. BMC Cardiovasc Disord 2024; 24:150. [PMID: 38475731 DOI: 10.1186/s12872-024-03817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND AND AIMS The present study aimed to investigate the predictive ability of selected adiposity indices, such as body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC), and waist-to-height ratio (WHtR), for new-onset hypertension in metabolically healthy Taiwanese adults. The study also sought to establish sex-specific cutoff points for these indices and to analyze the risk of new-onset hypertension, taking into account sex and age. METHODS This prospective cohort study utilized the Taiwan Biobank database to examine metabolically healthy participants aged between 20 and 65 at baseline. Four adiposity indices, namely BMI, WHR, WC, and WHtR, were calculated and used to predict new-onset hypertension over 4 years. Receiver operating characteristics (ROCs) and areas under the curve (AUCs) were used to evaluate the effectiveness of the parameters in predicting new-onset hypertension over 4 years. Sex-specific cutoff points were identified and used to assess the risk of new-onset hypertension. RESULTS This study analyzed 13,375 participants over 4.28 years. The incidence of new-onset hypertension was 17.65%. The new-onset rate of hypertension was 34.39% in men and 65.61% in women. Adiposity indices effectively predict new-onset hypertension, with WHtR having the highest predictive value (i.e., AUC) for both sexes. The classification of participants into low and high categories for each adiposity index was based on sex-specific cutoff points, and the risk of new-onset hypertension was assessed according to sex and age. This study found that high adiposity indices predicted a significantly higher risk of new-onset hypertension in metabolically healthy adults. The risk was equal for both sexes. Young women had a higher risk of new-onset hypertension than middle-aged women when they were further categorized. All risk ratios of the indices in young women were over two-fold and significant. CONCLUSION According to the sex-specific cutoff point, high adiposity indices had a higher predictive value for new-onset hypertension in metabolically healthy Taiwanese young women.
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Affiliation(s)
- Rizki Amalia Gumilang
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Faculty of Medicine, Public Health, and Nursing/Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yen-Chun Fan
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shang-Hao Wu
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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197
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Mundagowa PT, Zambezi P, Muchemwa-Munasirei P. The prevalence and determinants of blood pressure control among hypertension patients in eastern Zimbabwe: A cross-sectional study. PLoS One 2024; 19:e0293812. [PMID: 38451890 PMCID: PMC10919662 DOI: 10.1371/journal.pone.0293812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP), also known as hypertension, is a leading cause of morbidity and mortality globally. Lowering the elevated BP can significantly reduce one's risk for cardiovascular diseases. This study aimed to ascertain the determinants of BP control among hypertension patients. METHODS The data analyzed were from the exploratory survey of the Home Management of Hypertension (HoMHyper) project in eastern Zimbabwe. Hypertension patients were selected from the Chronic Disease Registers of five public health clinics using simple random sampling. A pretested interviewer-administered questionnaire was used to collect data, and the patient's BP was measured. The primary outcome, BP control, was used as a categorical variable (controlled vs. uncontrolled) to conduct a bivariate analysis. Variables significant at p<0.2 were included in the multivariable logistic regression analysis to control for confounding. Statistical significance in the final model was set at p<0.05. RESULTS Data from 321 hypertension patients were analyzed; their mean age was 62.3±11.9 years. The prevalence of controlled BP was 41.4% (95% Confidence interval-CI = 36.0%-46.9%). After adjusting for confounding, patients' residence and medication stocks were associated with BP control. Patients who resided in high-density suburbs had higher odds of uncontrolled BP than those who resided in middle- and low-density suburbs (Adjusted odds ratios-AOR = 2.5; 95% CI = 1.4-4.4; p<0.01). Hypertension patients who experienced medication stockouts over the last six months had higher odds of uncontrolled BP than patients who did not experience stockouts (AOR = 1.8; 95% CI = 1.1-2.9). CONCLUSION BP control among hypertension patients was suboptimal. Patient residence and antihypertensive medication stockouts were independent predictors of blood pressure control. We recommend exploring sustainable financing through private-public partnerships to ensure the availability of subsidized antihypertensive medication.
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Affiliation(s)
- Paddington Tinashe Mundagowa
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Pemberai Zambezi
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
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198
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Vendeville N, Lepage MA, Festa MC, Mavrakanas TA. Clinical Outcomes of Renin-Angiotensin-Aldosterone Blockade in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-analysis. Can J Cardiol 2024:S0828-282X(24)00192-2. [PMID: 38458564 DOI: 10.1016/j.cjca.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The cardiovascular and renal benefits of renin-angiotensin aldosterone system (RAAS) blockade are not well established in patients with advanced chronic kidney disease (CKD). We conducted a systematic review and meta-analysis to identify potential risks and benefits from RAAS blockade in patients with CKD stage 4-5. METHODS A Medline search from inception to November 2022 was conducted to identify randomised controlled trials (RCTs) in patients with CKD stage 4-5 (estimated glomerular filtration rate ≤ 30 mL/min/1.73 m2) comparing RAAS blockade vs placebo or alternative antihypertensive therapy. Different intervention strategies were assessed (RAAS use vs nonuse, initiation vs placebo/alternative therapy, or discontinuation vs continuation). The primary outcome was progression to end-stage kidney disease (ESKD). Secondary outcomes were all-cause mortality and major adverse cardiovascular events (MACE). The risk ratio (RR) was estimated with the use of a random-effects model. RESULTS Nine RCTs (1150 patients) were included. RAAS blockade was associated with a significant reduction in progression to ESKD: RR 0.84 (95% confidence interval [CI] 0.74-0.96; P = 0.01). There was no benefit from RAAS blockade on all-cause mortality or MACE: RR 1.02 (95% CI 0.63-1.65; P = 0.93) and RR 0.87 (95% CI 0.49-1.57; P = 0.65), respectively. CONCLUSIONS RAAS blockade may be considered in selected patients with CKD stage 4-5 to delay progression to ESKD.
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Affiliation(s)
- Nicolas Vendeville
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.
| | - Marc-Antoine Lepage
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - M Carolina Festa
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Thomas A Mavrakanas
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada; Research Institute, McGill University Health Centre, Montréal, Québec, Canada
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Gao J, Li Y, Zhang Y, Zhan X, Tian X, Li J, Wang R, He Y, Wang A, Wu S. Severity and Remission of Metabolic Dysfunction-Associated Fatty/Steatotic Liver Disease With Chronic Kidney Disease Occurrence. J Am Heart Assoc 2024; 13:e032604. [PMID: 38390843 PMCID: PMC10944048 DOI: 10.1161/jaha.123.032604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The association of the severity of hepatic steatosis in metabolic dysfunction-associated fatty liver disease (MAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) and the remission of MAFLD/MASLD with CKD occurrence is unclear. METHODS AND RESULTS The study enrolled 79 540 participants from the Kailuan cohort. Hepatic steatosis was diagnosed by ultrasound. MAFLD/MASLD was defined as hepatic steatosis combined with metabolic dysfunction and MASLD further excluded alcohol or other causes of liver disease. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate<60 mL/min per 1.73 m2 or positive proteinuria (≥1+). Hazard ratio (HR) was calculated by Cox regression models. After a median follow-up of 12.9 years, CKD occurred in 20 465 participants. After adjusting for potential confounders, MAFLD was associated with a higher risk of CKD compared with non-MAFLD (HR, 1.12 [95% CI, 1.09-1.16]), and this risk increased with increasing severity of hepatic steatosis (P-trend<0.001). Consistent findings were observed when MASLD was used as the exposure. Compared with persistent non-MAFLD, no statistical difference was found in the risk of CKD in MAFLD remission (HR, 1.04 [95% CI, 0.95-1.15]); however, MASLD remission still had a higher risk of CKD compared with persistent non-MASLD (HR, 1.15 [95% CI, 1.03-1.27]). When grouped according to the prior severity of hepatic steatosis, there was no statistically significant difference in risk of CKD in mild-MAFLD/MASLD remission compared with persistent non-MAFLD/MASLD, but moderated/severe-MAFLD/MASLD remission still had a higher risk. CONCLUSIONS The risk of CKD in patients with MAFLD/MASLD increased with the severity of hepatic steatosis. Even after remission of the disease, patients with MAFLD/MASLD with prior moderate to severe hepatic steatosis still had a higher risk of CKD.
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Affiliation(s)
- Jingli Gao
- Department of Intensive Care UnitKailuan General HospitalTangshanChina
| | - Yuhao Li
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Yijun Zhang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Clinical Epidemiology and Clinical TrialCapital Medical UniversityBeijingChina
| | - Xin Zhan
- School of Public HealthThe University of SydneySydneyAustralia
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Junjuan Li
- Department of CardiologyKailuan General HospitalTangshanChina
| | - Ru Wang
- Department of CardiologyKailuan General HospitalTangshanChina
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Anxin Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Clinical Epidemiology and Clinical TrialCapital Medical UniversityBeijingChina
| | - Shouling Wu
- Department of CardiologyKailuan General HospitalTangshanChina
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Gonçalves R, Gaillard R, Cecil C, Defina S, Steegers EAP, Jaddoe VWV. Arterial Health Markers in Relation to Behavior and Cognitive Outcomes at School Age. J Am Heart Assoc 2024; 13:e029771. [PMID: 38420836 PMCID: PMC10944063 DOI: 10.1161/jaha.123.029771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Impaired arterial health is associated with a decline in cognitive function and psychopathology in adults. We hypothesized that these associations originate in early life. We examined the associations of blood pressure, common carotid artery intima media thickness, and carotid distensibility with behavior and cognitive outcomes during adolescence. METHODS AND RESULTS This study was embedded in the Dutch Generation R Study, a population-based prospective cohort study from early fetal life onwards. Blood pressure, carotid intima media thickness, and carotid distensibility were measured at the age of 10 years. At the age of 13 years, total, internalizing and externalizing problems and attention-deficit hyperactivity disorder symptoms were measured using the parent-reported Child Behavior Checklist (CBCL/6-18), autistic traits were assessed by the Social Responsiveness Scale, and IQ was assessed using the Wechsler Intelligence Scale for Children-Fifth Edition. A 1-SD score higher mean arterial pressure was associated with lower odds of internalizing problems (odds ratio [OR], 0.92 [95% CI, 0.85-0.99]). However, this association was nonsignificant after correction for multiple testing. Carotid intima media thickness and carotid distensibility were not associated with behavior and cognitive outcomes at 13 years old. CONCLUSIONS From our results, we cannot conclude that the associations of blood pressure, carotid intima media thickness, and carotid distensibility at age 10 years with behavior and cognitive outcomes are present in early adolescence. Further follow-up studies are needed to identify the critical ages for arterial health in relation to behavior and cognitive outcomes at older ages.
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Affiliation(s)
- Romy Gonçalves
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of Pediatrics, Sophia’s Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
| | - Romy Gaillard
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of Pediatrics, Sophia’s Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
| | - Charlotte Cecil
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of Child and Adolescent Psychiatry/PsychologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Serena Defina
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of Child and Adolescent Psychiatry/PsychologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Eric. A. P. Steegers
- Department of Obstetrics and Gynecology, Sophia’s Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of Pediatrics, Sophia’s Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
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