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Prevalence, awareness, treatment, and control of hypertension and their determinants: Results from the first cohort of non-communicable diseases in a Kurdish settlement. Sci Rep 2019; 9:12409. [PMID: 31455810 PMCID: PMC6711962 DOI: 10.1038/s41598-019-48232-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/25/2019] [Indexed: 12/21/2022] Open
Abstract
Hypertension is a public health issue in Iran. The study aimed to estimate the prevalence, awareness, treatment, and control of hypertension, and to explore their determinants among 10,040 Kurdish adults from Ravansar Non-Communicable Disease (RaNCD) cohort study in Iran. Univariate, and multivariate analyses were used for statistical analysis. Prevalence of hypertension was 15.7%. Among hypertensive patients, awareness, treatment, and control of hypertension were 80.7%, 73.2%, and 53.3%, respectively. In multivariate analysis, significant associations were found between awareness and female sex, older age, being married rather than being single, literacy, living in rural areas, having family history, and comorbidities, with a higher probability for those who had both diabetes and dyslipidemia. Being married, living in rural areas, being ex-smokers, having less physical activity and individuals who had diabetes and dyslipidemia had higher odds of receiving treatment. Being female had a statistically significant association with the control of hypertension. The Kurdish population had higher awareness, with a greater proportion of treated, and controlled patients compared to populations included in previous studies for the last 20 years in Iran. With the continuing health promotion programs in Iran, it is expected to observe a lower prevalence of hypertension, higher awareness and greater number of treated individuals with controlled hypertension.
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202
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Tomitaka S, Kawasaki Y, Ide K, Akutagawa M, Ono Y, Furukawa TA. Distribution of psychological distress is stable in recent decades and follows an exponential pattern in the US population. Sci Rep 2019; 9:11982. [PMID: 31427587 PMCID: PMC6700099 DOI: 10.1038/s41598-019-47322-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/15/2019] [Indexed: 01/13/2023] Open
Abstract
The prevalence of psychological distress is fairly stable in industrialised countries in recent decades, but the reasons for this stability remain unknown. To investigate the mechanisms underlying stability of psychological distress in the general population of the United States, we analysed the mathematical patterns of the distribution of psychological distress in recent decades. The present study utilised the Kessler psychological distress scale (K6) data from the 1997‒2017 United States National Health Interview Survey. We used overlap coefficients and graphical analysis to investigate the stability and mathematical patterns of the K6 distribution. Overlap coefficients and graphical analysis demonstrated that the distribution of K6 total scores was stable in the United States over the past two decades. Furthermore, the distributions of K6 total scores exhibited an exponential pattern, with the exception of the lower end of the distribution. These findings suggest that the lack of change in the prevalence of psychological distress over several decades is due to the stability of psychological distress distribution itself. Furthermore, the stability of the distribution of psychological distress over time may be linked to the exponential pattern of psychological distress distribution.
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Affiliation(s)
- Shinichiro Tomitaka
- Department of Mental Health, Panasonic Health Center, Tokyo, Japan. .,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kazuki Ide
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.,Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Maiko Akutagawa
- Department of Drug Evaluation and Informatics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yutaka Ono
- Center for the Development of Cognitive Behavior Therapy Training, Tokyo, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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203
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Broxterman RM, La Salle DT, Zhao J, Reese VR, Richardson RS, Trinity JD. Influence of dietary inorganic nitrate on blood pressure and vascular function in hypertension: prospective implications for adjunctive treatment. J Appl Physiol (1985) 2019; 127:1085-1094. [PMID: 31414959 DOI: 10.1152/japplphysiol.00371.2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Dietary inorganic nitrate (nitrate) is a promising adjunctive treatment to reduce blood pressure and improve vascular function in hypertension. However, it remains unknown if the efficacy of nitrate is dependent upon an elevated blood pressure or altered by medication in patients with hypertension. Therefore, blood pressure and vascular function, measured by passive leg movement (PLM) and flow-mediated dilation (FMD), were assessed following 3 days of placebo (nitrate-free beetroot juice) and nitrate (nitrate-rich beetroot juice) administration in 13 patients (age: 53 ± 12 yr) with hypertension taking antihypertensive medications (study 1) and in 14 patients (49 ± 13 yr) with hypertension not taking antihypertensive medications (study 2). In study 1, plasma nitrite concentration was greater for nitrate than placebo (341 ± 118 vs. 308 ± 123 nmol/L, P < 0.05), yet blood pressure and vascular function were unaltered. In study 2, plasma nitrite concentration was greater for nitrate than placebo (340 ± 102 vs. 295 ± 93 nmol/L, P < 0.01). Systolic (136 ± 16 vs. 141 ± 19 mmHg), diastolic (84 ± 13 vs. 88 ± 12 mmHg), and mean (101 ± 12 vs. 106 ± 13 mmHg) blood pressures were lower (P < 0.05), whereas the PLM change in leg vascular conductance (6.0 ± 3.0 vs. 5.1 ± 2.6 mL·min-1·mmHg-1) and FMD (6.1 ± 2.4% vs. 4.1 ± 2.7%) were greater (P < 0.05) for nitrate than placebo. The changes in systolic blood pressure (r = -0.60) and FMD (r = -0.48) induced by nitrate were inversely correlated (P < 0.05) to the respective baseline values obtained in the placebo condition. Thus, the efficacy of nitrate to improve blood pressure and vascular function in hypertension appears to be dependent on the degree of blood pressure elevation and vascular dysfunction and not antihypertensive medication status, per se.NEW & NOTEWORTHY Dietary nitrate (nitrate) is a promising intervention to improve blood pressure and vascular function in hypertension. We demonstrate that these beneficial effects of nitrate are inversely related to the baseline value in a continuous manner with no distinction between antihypertensive medication status. Thus, the efficacy of nitrate to improve blood pressure and vascular function in hypertension appears to be dependent on the degree of blood pressure elevation and vascular dysfunction and not antihypertensive mediation status.
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Affiliation(s)
- Ryan M Broxterman
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - D Taylor La Salle
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Jia Zhao
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Van R Reese
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah.,Center on Aging, University of Utah, Salt Lake City, Utah
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah.,Center on Aging, University of Utah, Salt Lake City, Utah
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204
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Freedman VA, Kasper JD, Spillman BC, Plassman BL. Short-Term Changes in the Prevalence of Probable Dementia: An Analysis of the 2011-2015 National Health and Aging Trends Study. J Gerontol B Psychol Sci Soc Sci 2019; 73:S48-S56. [PMID: 29669099 DOI: 10.1093/geronb/gbx144] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 01/13/2023] Open
Abstract
Objectives Studies have reported decreasing dementia prevalence in recent decades in the United States. We explore with a new national data source whether declines have occurred since 2011, whether trends are attributable to shifts in dementia incidence or mortality, and whether trends are related to shifts in population composition or subgroup prevalence. Methods We use the 2011-2015 National Health and Aging Trends Study (N = 27,547) to examine prevalence of probable dementia among the 70 and older population. To minimize the influence of potential learning effects on prevalence rates, we require individuals to meet probable dementia criteria at two consecutive rounds. Results Prevalence of probable dementia declines over this period by 1.4% to 2.6% per year. Declines are concentrated among women, non-Hispanic white and black groups, and those with no vascular conditions or risk factors. The latter group also has experienced declines in dementia incidence. Declines in prevalence are largely attributable to age- and education-related shifts in population composition. Discussion Given the role of age and educational composition in short-term declines, the United States is likely to continue to experience short-term declines in dementia prevalence. However, persistently high rates among minority groups, especially of Hispanic origin, are concerning, and, barring new treatments, long-run trends may reverse course.
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Affiliation(s)
- Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Judith D Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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205
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Vable AM, Nguyen TT, Rehkopf D, Glymour MM, Hamad R. Differential associations between state-level educational quality and cardiovascular health by race: Early-life exposures and late-life health. SSM Popul Health 2019; 8:100418. [PMID: 31249857 PMCID: PMC6586990 DOI: 10.1016/j.ssmph.2019.100418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 01/13/2023] Open
Abstract
Cardiovascular diseases (CVD) are patterned by educational attainment but educational quality is rarely examined. Educational quality differences may help explain racial disparities. Health and Retirement Study respondent data (1992-2014; born 1900-1951) were linked to state- and year-specific educational quality measures when the respondent was 6 years old. State-level educational quality was a composite of state-level school term length, student-to-teacher ratio, and per-pupil expenditure. CVD-related outcomes were self-reported (N = 24,339) obesity, heart disease, stroke, ever-smoking, high blood pressure, diabetes and objectively measured (N = 10,704) uncontrolled blood pressure, uncontrolled blood sugar, total cholesterol, high-density lipoprotein cholesterol (HDL), and C-reactive protein. Race/ethnicity was classified as White, Black, or Latino. Cox models fit for dichotomous time-to-event outcomes and generalized estimating equations for continuous outcomes were adjusted for individual and state-level confounders. Heterogeneities by race were evaluated using state-level educational quality by race interaction terms; race-pooled, race by educational quality interaction, and race-specific estimates were calculated. In race-pooled analyses, higher state-level educational quality was protective for obesity (HR = 0.92; 95%CI(0.87,0.98)). In race-specific estimates for White Americans, state-level educational quality was protective for high blood pressure (HR = 0.95; 95%CI(0.91,0.99). Differential relationships among Black compared to White Americans were observed for obesity, heart disease, stroke, smoking, high blood pressure, and HDL cholesterol. In race-specific estimates for Black Americans, higher state-level educational quality was protective for obesity (HR = 0.88; 95%CI(0.84,0.93)), but predictive of heart disease (HR = 1.07; 95%CI(1.01,1.12)), stroke (HR = 1.20; 95%CI(1.08,1.32)), and smoking (HR = 1.05; 95%CI(1.02,1.08)). Race-specific hazard ratios for Latino and Black Americans were similar for obesity, stroke, and smoking. Better state-level educational quality had differential associations with CVD by race. Among minorities, better state-level educational quality was predominately associated with poorer CVD outcomes. Results evaluate the 1900-1951 birth cohorts; secular changes in the racial integration of schools since the 1950s, means results may not generalize to younger cohorts.
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Affiliation(s)
- Anusha M. Vable
- Department of Family and Community Medicine, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Thu T. Nguyen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - David Rehkopf
- Center for Population Health Sciences, Stanford University, USA
- Department of Medicine, Division of Primary Care and Population Health, Stanford University, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Social and Behavioral Health, Harvard T.H. Chan School of Public Health, Harvard University, USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
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206
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Pan L, Li G, Wan S, Yihuo W, Yang F, Li Z, Shan G. The association between high-sensitivity C-reactive protein and blood pressure in Yi people. BMC Public Health 2019; 19:991. [PMID: 31340788 PMCID: PMC6657064 DOI: 10.1186/s12889-019-7324-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/16/2019] [Indexed: 02/08/2023] Open
Abstract
Background High-sensitivity C-reactive protein (hs-CRP) is a common risk factor for developing cardiovascular disease. However, there has been no study reporting the relationship between hs-CRP and blood pressure in Yi adults. The aim of this study is to investigate the association between hs-CRP and blood pressure in Yi adults. Methods In this cross-sectional study, included subjects were 2916 Yi migrants or farmers aged 20–80 years, recruited by using a stratified cluster sampling method from Liangshan Yi Autonomous Prefecture of Sichuan Province in 2014. The directed acyclic graphs(DAG) was used to select a minimal sufficient adjustment sets of variables which would identification the unconfounded effect of hs-CRP and hypertension. Multiple linear and multinomial logit analysis were used to estimate the effect of hs-CRP on SBP/DBP/MAP/PP and the prevalence of prehypertension/hypertension after adjustment for the relevant confounders. Results The median level of hs-CRP was 1.20 (0.50–3.06)mg/L in Yi migrants, and 0.84(0.36–2.52) mg/L in Yi farmers, and the prevalence of high hs-CRP was 23.25%. For hs-CRP > 3 mg/L group, the adjusted PP tended to have lower values (β = − 1.49, 95%CI: − 2.49--0.49, P = 0.0034) compared with < 1 mg/L group. After adjusting for confounders, there were no significant association between hs-CRP and prehypertension/hypertension (P > 0.05). Conclusions Our results suggest that high hs-CRP is prevalent in Yi people, and this study does not support hs-CRP as a risk factor of prehypertension or hypertension.
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Affiliation(s)
- Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Guoju Li
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao, 266011, Shandong, China
| | | | - WuLi Yihuo
- Department for Chronic Noncommunicable Diseases Control, Puge County Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Fang Yang
- Xichang Municipal Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Zheng Li
- Xichang Municipal Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
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207
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Zhang YX, Wang SR. Profiles of body mass index and blood pressure among young adults categorised by waist-to-height ratio cut-offs in Shandong, China. Ann Hum Biol 2019; 46:409-414. [PMID: 31304787 DOI: 10.1080/03014460.2019.1640792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Waist-to-height ratio (WHtR) is proposed as a valid measure of abdominal obesity and health risks in practice. The present study examined the profiles of weight status and blood pressure (BP) among young adults categorised by WHtR cut-offs.Methods: A total of 4226 college students (2107 males and 2119 females) aged 19-22 years participated in the study. The body mass index (BMI) cut-offs recommended by the Working Group on Obesity in China (WGOC) were used to define underweight, normal weight, overweight and obesity. The BMI and BP profiles within each WHtR category were examined.Results: For both males and females, 'the high WHtR group' (WHtR ≥ 0.5) had the highest, and 'the low WHtR group' (WHtR < 0.4) had the lowest BMI and BP levels. In the WHtR = 0.30-0.34 sub-group, 66.10% of males and 66.67% of females were underweight; in the WHtR ≥ 0.55 sub-group, 91.49% of males and 83.33% of females were obese; in the WHtR = 0.40-0.44 sub-group, 88.88% of males and 89.85% of females were normal weight. The prevalence of high BP in the WHtR < 0.5 group was 9.99% in males and 2.19% in females; the corresponding figures were 28.92% (males) and 14.06% (females) in the WHtR ≥ 0.5 group; the latter is significantly higher than the former (p < 0.01).Conclusion: Individuals with low WHtR were underweight and those with high WHtR were obese with high BP. Results from this study support WHtR as a simple and effective screening tool for abdominal obesity and high BP in practice.
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Affiliation(s)
- Ying-Xiu Zhang
- Shandong Center for Disease Control and Prevention, Shandong University Institute of Preventive Medicine, Shandong,PR China
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208
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Vedanthan R, Lee DJ, Kamano JH, Herasme OI, Kiptoo P, Tulienge D, Kimaiyo S, Balasubramanian H, Fuster V. Hypertension management in rural western Kenya: a needs-based health workforce estimation model. HUMAN RESOURCES FOR HEALTH 2019; 17:57. [PMID: 31311561 PMCID: PMC6636021 DOI: 10.1186/s12960-019-0389-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Elevated blood pressure is the leading risk for mortality in the world. Task redistribution has been shown to be efficacious for hypertension management in low- and middle-income countries. However, the workforce requirements for such a task redistribution strategy are largely unknown. Therefore, we developed a needs-based workforce estimation model for hypertension management in western Kenya, using need and capacity as inputs. METHODS Key informant interviews, focus group discussions, a Delphi exercise, and time-motion studies were conducted among administrative leadership, clinicians, patients, community leaders, and experts in hypertension management. These results were triangulated to generate the best estimates for the inputs into the health workforce model. The local hypertension clinical protocol was used to derive a schedule of encounters with different levels of clinician and health facility staff. A Microsoft Excel-based spreadsheet was developed to enter the inputs and generate the full-time equivalent workforce requirement estimates over 3 years. RESULTS Two different scenarios were modeled: (1) "ramp-up" (increasing growth of patients each year) and (2) "steady state" (constant rate of patient enrollment each month). The ramp-up scenario estimated cumulative enrollment of 7000 patients by year 3, and an average clinical encounter time of 8.9 min, yielding nurse full-time equivalent requirements of 4.8, 13.5, and 30.2 in years 1, 2, and 3, respectively. In contrast, the steady-state scenario assumed a constant monthly enrollment of 100 patients and yielded nurse full-time equivalent requirements of 5.8, 10.5, and 14.3 over the same time period. CONCLUSIONS A needs-based workforce estimation model yielded health worker full-time equivalent estimates required for hypertension management in western Kenya. The model is able to provide workforce projections that are useful for program planning, human resource allocation, and policy formulation. This approach can serve as a benchmark for chronic disease management programs in low-resource settings worldwide.
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Affiliation(s)
- Rajesh Vedanthan
- New York University School of Medicine, 180 Madison Avenue, 8th Floor, New York, NY 10016 USA
| | - Danielle J. Lee
- Temple University School of Medicine, 3500 N Broad St, Philadelphia, PA 19140 USA
| | - Jemima H. Kamano
- Department of Medicine, School of Medicine, Moi University College of Health Sciences, Nandi Rd, Eldoret, Kenya
| | - Omarys I. Herasme
- Icahn School of Medicine at Weill Cornell, 1 Gustave L. Levy Pl, New York, NY 10029 USA
- Weill Cornell Medicine, 413 East 69th Street, New York, NY 10021 USA
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Deborah Tulienge
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | - Sylvester Kimaiyo
- Department of Medicine, School of Medicine, Moi University College of Health Sciences, Nandi Rd, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, Eldoret, 30100 Kenya
| | | | - Valentin Fuster
- Icahn School of Medicine at Weill Cornell, 1 Gustave L. Levy Pl, New York, NY 10029 USA
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209
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Benetos A, Aviv A. Ancestry, Telomere Length, and Atherosclerosis Risk. ACTA ACUST UNITED AC 2019; 10:CIRCGENETICS.117.001718. [PMID: 28615296 DOI: 10.1161/circgenetics.117.001718] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Athanase Benetos
- From the Département de Médecine Gériatrique, CHRU de Nancy, The Institut national de la santé et de la recherche médicale, Université de Lorraine, France (A.B.); and Center of Human Development and Aging, New Jersey Medical School, Rutgers University, Newark (A.A.).
| | - Abraham Aviv
- From the Département de Médecine Gériatrique, CHRU de Nancy, The Institut national de la santé et de la recherche médicale, Université de Lorraine, France (A.B.); and Center of Human Development and Aging, New Jersey Medical School, Rutgers University, Newark (A.A.)
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210
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Silveira LCJ, Aliti GB, Da Silva EM, Pimentel RP, Gus M, Rabelo-Silva ER. Effect of motivational interviewing in hypertensive patients (MIdNIgHT): study protocol for a randomized controlled trial. Trials 2019; 20:414. [PMID: 31288854 PMCID: PMC6617897 DOI: 10.1186/s13063-019-3486-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/30/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Only one-third of hypertensive patients achieve and maintain blood-pressure control. This is attributed to low treatment adherence and has a negative impact on clinical outcomes. Adherence is multidimensional and involves aspects both related to patient characteristics and to the chronic nature of the disease. In this context, motivational interviewing has been proposed as an approach to foster patients' motivations to change their behavior for the benefit of their own health, thus providing more lasting behavioral changes. DESIGN AND METHODS Single-center, parallel, randomized controlled trial with outcome-assessor blinding. This study will select adult patients (n = 120) diagnosed with hypertension who receive regular follow-up in a specialized outpatient clinic. Patients will be randomly allocated across two groups: the intervention group will have appointments focused on motivational interviewing, while the control group will have traditional appointments. Patients will be monitored face-to-face, once monthly for six months. The primary outcomes will be a reduction of at least 8 mmHg in systolic blood pressure and changes in mean blood pressure measured by 24-h ambulatory blood pressure monitoring. Secondary outcomes include improvement of adherence to a low-sodium diet, adherence to self-care behaviors, regular use of antihypertensive medications, increase or maintenance of physical activity, weight reduction, evaluation of changes in daytime sleepiness, and cessation of smoking. DISCUSSION This study shows an intervention strategy that will be tested and, if effective, warrant replication in monitoring of other chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov, NCT02892929 . Registered on 24 August 2016.
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Affiliation(s)
- Luana Claudia Jacoby Silveira
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Graziella Badin Aliti
- Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Elisabeth Meyer Da Silva
- Graduate Program, Instituto de Cardiologia - Fundação Universitária de Cardiologia, Rua Princesa Isabel, 395, Porto Alegre, RS, 90620-001, Brazil
| | - Ravi Pereira Pimentel
- Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil
| | - Miguel Gus
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil. .,Nursing School, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, Porto Alegre, RS, 90620-110, Brazil. .,Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2060, Porto Alegre, RS, 90035-903, Brazil.
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211
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Abstract
PURPOSE OF REVIEW Interventional cardiology and in particular the field of renal denervation is subject to constant change. This review provides an up to date overview of renal denervation trials and an outlook on what to expect in the future. RECENT FINDINGS After the sham-controlled SYMPLICITY HTN-3 trial dampened the euphoria following early renal denervation trials, the recently published results of the sham-controlled SPYRAL HTN and RADIANCE HTN trials provided proof-of-principle for the blood pressure-lowering efficacy of renal denervation. However, these studies underline the major issue of patients' non-adherence to antihypertensive medication as well as the need for reliable patient- and procedure-related predictors of response. The second generation of sham-controlled renal denervation trials provided proof of principle for the blood pressure-lowering efficacy of RDN. However, larger trials have to assess long-term safety and efficacy.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany.
| | - Milan A Wolf
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Sean S Scholz
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
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212
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Shin JY. Trends in the prevalence and management of diabetes in Korea: 2007-2017. Epidemiol Health 2019; 41:e2019029. [PMID: 31319658 PMCID: PMC6702122 DOI: 10.4178/epih.e2019029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study analyzed Korea National Health and Nutrition Examination Survey data from 2007 to 2017 to assess trends in the prevalence, treatment, and control of diabetes in Korean adults ≥30 years of age. METHODS Prevalent diabetes was defined as a fasting plasma glucose level ≥126 mg/dL, self-reported use of anti-diabetic treatment (insulin or oral anti-diabetic drugs), or diabetes diagnosis by a physician. Target levels were defined as glycosylated hemoglobin <6.5% or <7.0%, blood pressure <130/80 mmHg, and total cholesterol <200 mg/dL. All survey waves were age-standardized to the 2005 Korean census population. RESULTS Diabetes prevalence increased from 9.6% in 2007-2009 to 10.8% in 2016-2017 (p<0.001). Impaired fasting glucose prevalence significantly increased in both genders and almost every age group. Diabetes awareness and glycemic control did not show an increasing trend; however, the treatment rate and proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved from 57.2% to 63.5% (p=0.008), from 41.1% to 53.2% (p<0.001), and from 65.0% to 78.0% (p<0.001), respectively. CONCLUSIONS From 2007 to 2017, the prevalence of diabetes increased moderately in Korea, whereas the diabetes treatment rate and the proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved. However, awareness of diabetes and glycemic control require significant improvements. A national-level action plan is required to raise awareness about diabetes and prediabetes, with the goal of improving glycemic control and minimizing the occurrence of adverse health outcomes.
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Affiliation(s)
- Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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213
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Moraes NC, Aprahamian I, Yassuda MS. Executive function in systemic arterial hypertension: A systematic review. Dement Neuropsychol 2019; 13:284-292. [PMID: 31555400 PMCID: PMC6753903 DOI: 10.1590/1980-57642018dn13-030004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/01/2019] [Indexed: 12/21/2022] Open
Abstract
Systemic arterial hypertension (SAH) may be associated with worse cognitive performance, especially in tasks that evaluate the executive functions (EF). OBJECTIVE we aimed to review the evidence regarding which components of executive functions are most affected in adults with SAH. METHODS this systematic review used the PRISMA statement for searching Pubmed, Scielo and Lilacs databases with the keywords "executive function OR executive functioning AND hypertension". RESULTS EF tasks were divided into shifting, inhibitory control and updating. A total of 9 cross-sectional and 3 longitudinal studies were selected. Only 3 studies did not report worse performance among SAH patients on EF tasks when compared to normotensive controls. The measures of shifting and inhibitory control were the most frequently investigated and reported as altered among SAH individuals, assessed mainly by the Stroop Test and Trail-Making Test part B, respectively. CONCLUSION inhibitory control and shifting are the EF components most influenced by SAH. The results of this review may contribute to the devising of hypotheses about mechanisms underlying these cognitive impairments.
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Affiliation(s)
- Natália Cristina Moraes
- University of São PauloDepartment of NeurologySPBrazilDepartment of Neurology, University of São Paulo, SP, Brazil.
| | - Ivan Aprahamian
- Faculty of Medicine of JundiaíDepartment of Internal MedicineDivision of Geriatrics and GerontologySPBrazilDivision of Geriatrics and Gerontology, Department of Internal Medicine, Faculty of Medicine of Jundiaí, SP, Brazil.
| | - Mônica Sanches Yassuda
- University of São PauloDepartment of NeurologySPBrazilDepartment of Neurology, University of São Paulo, SP, Brazil.
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214
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Kim SJ, Kwon OD, Cho B, Oh SW, Lee CM, Choi HC. Effects of combination drugs on antihypertensive medication adherence in a real-world setting: a Korean Nationwide Study. BMJ Open 2019; 9:e029862. [PMID: 31230034 PMCID: PMC6596965 DOI: 10.1136/bmjopen-2019-029862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/23/2019] [Accepted: 05/24/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES We tried to clarify, by using representative national data in a real-world setting, whether single-pill combinations (SPCs) of antihypertensives actually improve medication adherence. DESIGN A nationwide population-based study. SETTING We used a 2.2% cohort (n=1 048 061) of the total population (n=46 605 433) that was randomly extracted by National Health Insurance of Korea from 2008 to 2013. PARTICIPANTS We included patients (n=116 677) who were prescribed with the same antihypertensive drugs for at least 1 year and divided them into groups of angiotensin II receptor blocker (ARB)-only, calcium channel blocker (CCB)-only, multiple-pill combinations (MPCs) and SPCs of ARB/CCB. PRIMARY OUTCOME MEASURES Medication possession ratio (MPR), a frequently used indirect measurement method of medication adherence. RESULTS Adjusted MPR was higher in combination therapy (89.7% in SPC, 87.2% in MPC) than monotherapy (81.6% in ARB, 79.7% in CCB), and MPR of SPC (89.7%, 95% CI 89.3 to 90.0) was higher than MPR of MPC (87.2%, 95% CI 86.7 to 87.7) (p<0.05). In subgroup analysis, adherence of SPC and MPC was 92.3% (95% CI 91.5 to 93.0) vs 88.1% (95% CI 87.1 to 89.0) in those aged 65-74 years and 89.3% (95% CI 88.0 to 90.7) vs 84.8% (95% CI 83.3 to 92.0) in those ≥75 years (p<0.05). According to total pill numbers, adherence of SPC and MPC was 90.9% (CI 89.8 to 92.0) vs 85.3% (95% CI 84.1 to 86.5) in seven to eight pills and 91.2% (95% CI 89.3 to 93.1) vs 82.5% (95% CI 80.6 to 84.4) in nine or more (p<0.05). The adherence difference between SPC and MPC started to increase at five to six pills and at age 50-64 years (p<0.05). When analysed according to elderly status, the adherence difference started to increase at three to four pills in the elderly (≥65 years) and at five to six in the non-elderly group (20-64 years) (p<0.05). These differences all widened further with increasing age and the total medications. CONCLUSION SPC regimens demonstrated higher adherence than MPC, and this tendency is more pronounced with increasing age and the total number of medications.
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Affiliation(s)
- Seung Jae Kim
- Department of Family Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Oh Deog Kwon
- Navy Medical Office, ROK Submarine Force Command, Changwon, Korea
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ho-Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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215
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Qvarnström M, Kahan T, Kieler H, Brandt L, Hasselström J, Wettermark B. Medication persistence to antihypertensive drug treatment – a cross-sectional study of attitudes towards hypertension and medication in persistent and non-persistent patients. Blood Press 2019; 28:309-316. [DOI: 10.1080/08037051.2019.1627858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Miriam Qvarnström
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hasselström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Björn Wettermark
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
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216
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Sahakian Y, Bylykbashi B, Rahman A. Prescribing Patterns of Antihypertensive Medications in US Ambulatory Care Settings. PHARMACY 2019; 7:E64. [PMID: 31207894 PMCID: PMC6630790 DOI: 10.3390/pharmacy7020064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022] Open
Abstract
Over 70 million Americans are diagnosed with hypertension. Adherence to current AHA/ACC 2017 hypertension guidelines and appropriate antihypertensive therapy is important for optimal treatment outcomes. This study investigates prescribing patterns for ambulatory care patients with hypertension and adherence to these guidelines. Data from the 2015 National Ambulatory Medical Care Survey (NAMCS) were used in the study. Patients with primary diagnoses of essential hypertension were extracted from the data using ICD-9 code "401". A total of 595 patients were identified. Correlation among demographic variables, source of payment and prescriber specialty were examined. Chi-square and descriptive analysis were performed. 51.4% of the prescriptions were non-first-line medications. Primary care physicians and cardiologists adhered to the guidelines more, when compared to the other specialties. There was a significant difference between various geographic regions, as it relates to guidelines adherence. This study concluded that prescribers do not always adhere to the AHA/ACC 2017 hypertension guidelines. It is recommended to adhere to the guidelines if there are no contraindications. The study's findings were limited to the ambulatory patients visiting providers in 2015 and by the operational definitions of the study.
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Affiliation(s)
- Yelena Sahakian
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.
| | - Brisilda Bylykbashi
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.
| | - Ateequr Rahman
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.
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217
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Cho SMJ, Lee H, Pyun WB, Kim HC. Differential Control Rate of Systolic and Diastolic Blood Pressure among Korean Adults with Hypertension: the Sixth Korean National Health and Nutrition Examination Survey, 2013-2015 (KNHANES VI). Korean Circ J 2019; 49:1035-1048. [PMID: 31190479 PMCID: PMC6813160 DOI: 10.4070/kcj.2019.0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/27/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives Discrepancy in blood pressure (BP) control rate may be owed to different risk factors associated with elevated systolic and diastolic BP (SBP and DBP). Methods In a nationally representative survey of Korean population with BP measurements, a total of 5,100 participants with hypertension was included in the analyses. Three separate types of control rates were calculated: SBP, DBP, and (combined) S&DBP among all participants with hypertension and participants with treated hypertension, separately. Control rates were compared across sex and age groups. Multivariable logistic regression was used to identify demographic factors associated with SBP, DBP, and S&DBP control rates, separately. Results In total, SBP, DBP, and S&DBP control rates were 63.0%, 63.7%, and 42.5% among all hypertension patients, and 77.5%, 87.4%, and 71.6% among treated hypertension patients. Men aged 40–49 years with hypertension and 30–39 years treated for hypertension had the highest SBP control rate (74.6% and 96.2%), which decreased by older age. Inversely, DBP control rate progressively increased with older age. SBP control rate among women with hypertension was the highest in 40–49 years (67.0%) but without linear trend by age group. Interestingly, both combined and DBP control rates were noticeably low among women aged 50–59 years. Women with body mass index ≥25 were at higher odds of having controlled SBP. Lower DBP control rate was observed in men with lower education level, higher household income, and heavy drinkers. Conclusions Separate examination of control rates demonstrated different sex- and age-differential trends, which would have been overlooked in combined control rates.
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Affiliation(s)
- So Mi Jemma Cho
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.
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218
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Odutayo A, Gill P, Shepherd S, Akingbade A, Hopewell S, Tennankore K, Hunn BH, Emdin CA. Income Disparities in Absolute Cardiovascular Risk and Cardiovascular Risk Factors in the United States, 1999-2014. JAMA Cardiol 2019; 2:782-790. [PMID: 28593301 DOI: 10.1001/jamacardio.2017.1658] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Large improvements in the control of risk factors for cardiovascular disease have been achieved in the United States, but it remains unclear whether adults in all socioeconomic strata have benefited equally. Objective To assess temporal trends in 10-year predicted absolute cardiovascular risk and cardiovascular risk factors among US adults in different socioeconomic strata. Design, Setting, and Participants A cross-sectional analysis was conducted using data on adults 40 to 79 years of age without established cardiovascular disease from the 1999 to 2014 National Health and Nutrition Examination Survey. Exposures Socioeconomic status was based on the family income to poverty ratio and participants were divided into the following 3 groups: high income (family income to poverty ratio, ≥4), middle income (>1 and <4), or at or below the federal poverty level (≤1). Main Outcomes and Measures We assessed predicted absolute cardiovascular risk using the pooled cohort equation. We assessed the following 4 risk factors: systolic blood pressure, smoking status, diabetes, and total cholesterol. Results Of the 17 199 adults whose data were included in the study (8828 women and 8371 men; mean age, 54.4 years), from 1999-2014, trends in the percentage of adults with predicted absolute cardiovascular risk of 20% or more, mean systolic blood pressure, and the percentage of current smokers varied by income strata (P ≤ .02 for interaction). For adults with incomes at or below the federal poverty level, there was little evidence of a change in any of these outcomes across survey years (cardiovascular risk ≥20%, 14.9% [95% CI, 12.9%-16.8%] in 1999-2004; 16.5% [95% CI, 13.7%-19.2%] in 2011-2014; P = .41; mean systolic blood pressure, 127.6 [95% CI, 126.1-129.0] mm Hg in 1999-2004; 126.8 [95% CI, 125.2-128.5] mm Hg in 2011-2014; P = .44; and smoking, 36.5% [95% CI, 32.1%-41.0%] in 1999-2004; 36.0% [95% CI, 31.1%-40.8%] in 2011-2014; P = .87). For adults in the high-income stratum, these variables decreased across survey years (cardiovascular risk ≥20%, 12.0% [95% CI, 10.7%-13.3%] in 1999-2004; 9.5% [95% CI, 8.2%-10.7%] in 2011-2014; P = .003; systolic blood pressure, 126.0 [95% CI, 125.0-126.9] mm Hg in 1999-2004; 122.3 [95% CI, 121.3-123.3] mm Hg in 2011-2014; P < .001; and smoking, 14.1% [95% CI, 12.0%-16.2%] in 1999-2004; 8.8% [95% CI, 6.6%-11.0%] in 2011-2014; P = .001). Trends in the percentage of adults with diabetes and the mean total cholesterol level did not vary by income. Conclusions and Relevance Adults in each socioeconomic stratum have not benefited equally from efforts to control cardiovascular risk factors.
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Affiliation(s)
- Ayodele Odutayo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada2Centre for Statistics in Medicine, University of Oxford, Oxford, England
| | - Peter Gill
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Shaun Shepherd
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Aquila Akingbade
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Sally Hopewell
- Centre for Statistics in Medicine, University of Oxford, Oxford, England
| | - Karthik Tennankore
- Division of Nephrology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Benjamin H Hunn
- Department of Medicine, School of Medicine, University of Tasmania, Hobart, Australia5Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, England
| | - Connor A Emdin
- St John's College, University of Oxford, Oxford, England
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219
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Lambert EA, Esler MD, Schlaich MP, Dixon J, Eikelis N, Lambert GW. Obesity-Associated Organ Damage and Sympathetic Nervous Activity. Hypertension 2019; 73:1150-1159. [DOI: 10.1161/hypertensionaha.118.11676] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elisabeth A. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Murray D. Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine–Royal Perth Hospital Unit, University of Western Australia (M.P.S.)
| | - John Dixon
- Clinical Obesity Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.D.)
| | - Nina Eikelis
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
| | - Gavin W. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
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220
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Cheng Y, Yin H, Zheng H, Yin D, Yin G, Ying S, Li X, Dai H, Zhao L, Shen C, Shen Z, Gu L. Time trend of cardiometabolic risk factors over a 10-year period in the office-working population in China. BMJ Open 2019; 9:e025915. [PMID: 31154304 PMCID: PMC6549710 DOI: 10.1136/bmjopen-2018-025915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Recent dramatic increases in cardiovascular disease mortality in China can be mostly explained by adverse changes in hypertension, dyslipidaemia, diabetes and obesity, known as cardiometabolic risk factors. Our study aimed to assess the trend of these four signatures by a 10-year lag in Nanjing, China. METHODS 8017 subjects attended the routine health examination in 2008, and 9379 subjects in 2017, from multiple work units of Nanjing, were included in the present study. The prevalence and trend of four cardiometabolic risk factors: hypertension, dyslipidaemia, diabetes and obesity were analysed. RESULTS From 2008 to 2017, the prevalence of hypertension declined, while the prevalence of dyslipidaemia, diabetes and obesity increased. Besides, the population in 2008 and 2017 had an average of 0.66 and 0.78 risk factors, respectively. CONCLUSION Cardiometabolic risk factors are common for the staff in administrative agencies and institutions of Nanjing, China. Effective screening and interventions against these risk factors should be adopted in high-risk populations such as the office-working population in China.
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Affiliation(s)
- Yang Cheng
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Hongli Yin
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Zheng
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Donghua Yin
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yin
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Shanping Ying
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohong Li
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Dai
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Lvkun Zhao
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Chong Shen
- Division of Clinical Epidemiology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhixiang Shen
- Center for Health Management, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Liubao Gu
- Division of Clinical Epidemiology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
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221
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Kim S, Chang Y, Kang J, Cho A, Cho J, Hong YS, Zhao D, Ahn J, Shin H, Guallar E, Ryu S, Sung KC. Relationship of the Blood Pressure Categories, as Defined by the ACC/AHA 2017 Blood Pressure Guidelines, and the Risk of Development of Cardiovascular Disease in Low-Risk Young Adults: Insights From a Retrospective Cohort of Young Adults. J Am Heart Assoc 2019; 8:e011946. [PMID: 31140347 PMCID: PMC6585354 DOI: 10.1161/jaha.119.011946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There are limited outcome studies of hypertension among young adults, especially using the new blood pressure (BP) categories from the American College of Cardiology and the American Heart Association. We examined associations between the new BP categories and the risk of incident cardiovascular disease (CVD) in low‐risk and young adults. Methods and Results A cohort study was performed in 244 837 Korean adults (mean age, 39.0 years; SD, 8.9 years) who underwent a comprehensive health examination at Kangbuk Samsung Hospital from January 1, 2011, to December 31, 2016; they were followed up for incident CVD via linkage to the Health Insurance and Review Agency database until the end of 2016, with a median follow‐up of 4.3 years. BP was categorized according to the new American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines. During 924 420.7 person‐years, 1435 participants developed new‐onset CVD (incidence rate of 16.0 per 104 person‐years). The multivariable‐adjusted hazard ratios (95% CIs ) for CVD comparing elevated BP, stage 1 hypertension, stage 2 hypertension, treated and strictly controlled (systolic BP/diastolic BP <130/80 mm Hg with antihypertensive use), treated and controlled (systolic BP 130–139 and diastolic BP 80 to 89 mm Hg with antihypertensive use), treated uncontrolled, and untreated hypertension to normal BP were 1.37 (1.11–1.68), 1.45 (1.26–1.68), 2.12 (1.74–2.58), 1.41 (1.12–1.78), 1.97 (1.52–2.56), 2.29 (1.56–3.37) and 1.93 (1.53–2.45), respectively. Conclusions In this large cohort of low‐risk and young adults, all categories of higher BP were independently associated with an increased risk of CVD compared with normal BP, underscoring the importance of BP management even in these low‐risk populations.
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Affiliation(s)
- Seolhye Kim
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Yoosoo Chang
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,2 Department of Occupational and Environmental Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea
| | - Jeonggyu Kang
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Ara Cho
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Juhee Cho
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea.,4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Yun Soo Hong
- 4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Di Zhao
- 4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Jiin Ahn
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hocheol Shin
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,5 Department of Family Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul South Korea.,6 Division of Cardiology Department of Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Eliseo Guallar
- 3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea.,4 Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Seungho Ryu
- 1 Center for Cohort Studies Total Healthcare Center Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,2 Department of Occupational and Environmental Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea.,3 Department of Clinical Research Design and Evaluation Samsung Advanced Institute for Health Sciences and Technology Sungkyunkwan University Seoul Republic of Korea
| | - Ki-Chul Sung
- 6 Division of Cardiology Department of Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Schoenthaler A, Fei K, Ramos MA, Richardson LD, Ogedegbe G, Horowitz CR. Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans. J Clin Hypertens (Greenwich) 2019; 21:794-803. [PMID: 31125186 DOI: 10.1111/jch.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 12/25/2022]
Abstract
This paper describes the multilevel factors that contribute to hypertension disparities in 2052 hypertensive African Americans (mean age 52.9 ± 9.9 years; 66.3% female) who participated in a clinical trial. At the family level, participants reported average levels of life chaos and high social support. However, at the individual level, participants exhibited several adverse clinical and behavioral factors including poor blood pressure control (45% of population), obesity (61%), medication non-adherence (48%), smoking (32%), physical inactivity (45%), and poor diet (71%). While participants rated their provider as trustworthy, they reported high levels of discrimination in the health care system. Finally, community-level data indicate that participants reside in areas characterized by poor socio-economic and neighborhood conditions (eg, segregation). In the context of our trial, hypertensive African Americans exhibited several adverse risks and protective factors at multiple levels of influence. Future research should evaluate the impact of these factors on cardiovascular outcomes using a longitudinal design.
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Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Kezhen Fei
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle A Ramos
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne D Richardson
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Carol R Horowitz
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
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223
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Kelley EF, Olson TP, Curry TB, Sprissler R, Snyder EM. The Effect of Genetically Guided Mathematical Prediction and the Blood Pressure Response to Pharmacotherapy in Hypertension Patients. Clin Med Insights Cardiol 2019; 13:1179546819845883. [PMID: 31105432 PMCID: PMC6501483 DOI: 10.1177/1179546819845883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/03/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose: The purpose of this study was to determine the effectiveness of a simple algorithm to mathematically predict a patients’ response to blood pressure (BP) therapy using functional genes in the 3 major organ systems involved in hypertension. Methods: Eighty-six patients with controlled hypertension completed 1 study visit consisting of a buccal swab collection, measurement of office BP, and a medical chart review for BP history. Genes in the analysis included 14 functional alleles in 11 genes. These genotypes were mathematically summed per organ system to determine whether a patient would likely respond to target therapy. Results: Patients recommended to and taking a diuretic had significantly higher rates of control (<120/<80) than patients recommended but not taking this drug class (0.2 ± 0.1 and 0.03 ± 0.03, respectively). Furthermore, there was a difference between patients genetically recommended and taking an angiotensin receptor blocker (ARB) vs patients recommended but not taking an ARB for the lowest diastolic blood pressure (DBP) and mean arterial pressure (MAP) recorded in the past 2 years (DBP = 66.2 ± 2.9 and 75.3 ± 1.7, MAP = 82.3 ± 2.8 and 89.3 ± 1.5, respectively). In addition, there was a nonsignificant trend for greater reductions in ΔSBP, ΔDBP, and ΔMAP in patients on recommended drug class for beta-blockers, diuretics, and angiotensin II receptor blockers vs patients not on these classes. Conclusion: The present study suggests that simple mathematical weighting of functional genotypes known to control BP may be ineffective in predicting control. This study demonstrates the need for a more complex, weighted, multigene algorithm to more accurately predict BP therapy response.
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Affiliation(s)
- Eli F Kelley
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Thomas P Olson
- Geneticure, Inc, Rochester, MN, USA.,College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Timothy B Curry
- Geneticure, Inc, Rochester, MN, USA.,College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Ryan Sprissler
- Geneticure, Inc, Rochester, MN, USA.,Department of Genetics, University of Arizona Genomics Core, Tucson, AZ, USA
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224
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Ahmadi S, Sajjadi H, Nosrati Nejad F, Ahmadi N, Karimi SE, Yoosefi M, Rafiey H. Lifestyle modification strategies for controlling hypertension: How are these strategies recommended by physicians in Iran? Med J Islam Repub Iran 2019; 33:43. [PMID: 31456967 PMCID: PMC6708116 DOI: 10.34171/mjiri.33.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background: This study aimed to evaluate lifestyle changes and their impact on hypertension control and why and how lifestyle modifications are recommended for patients with hypertension. Four non pharmacological strategies have been recommended by physicians for hypertension control for hypertensive patients in Iran: healthier diet, smoking cessation, physical activity, and weight loss.
Methods: Among participants of Iran STEPS Non-communicable Disease Risk Factors Survey (STEPs), 7879 hypertensive patients aged ≥25 years were selected. All statistical analyses were calculated using STATA software version 14. Means, proportions, and multiple binary logistic regression models were used. Two-tailed p values of <0.05 were considered statistically significant.
Results: The results of this study showed that about three quarters of people with high blood pressure had been recommended lifestyle strategies by their physician for blood pressure control. Of the participants, 41% reported that they had been recommended only lifestyle modification for their blood pressure (BP), while 35% reported that they were recommended both lifestyle changes and medications as part of their treatment. Healthier diet, 71.9% (70.8-72.9), and smoking cessation, 23.8% (21.4-25.6), were the most and least frequently recommended strategies, respectively. Also, the rates of recommendations on smoking cessation, weight loss, increased physical activity, and healthier diet were more among women, married, and illiterate individuals, respectively.
Conclusion: Because of the changes and transitions in the lifestyle and dietary habits in the modern world, policies and training programs should be developed to improve the recommendations on lifestyle modification. Also, educational programs should be developed to increase patient’s acceptance of lifestyle modifications and physical activity.
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Affiliation(s)
- Sina Ahmadi
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Homeira Sajjadi
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farhad Nosrati Nejad
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Moein Yoosefi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Rafiey
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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225
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Sonawane K, Zhu Y, Balkrishnan R, Suk R, Sharrief A, Deshmukh AA, Aguilar D. Antihypertensive drug use and blood pressure control among stroke survivors in the United States: NHANES 2003-2014. J Clin Hypertens (Greenwich) 2019; 21:766-773. [PMID: 31099465 DOI: 10.1111/jch.13553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/02/2019] [Accepted: 04/21/2019] [Indexed: 01/13/2023]
Abstract
Understanding the patterns of antihypertensive drug use and blood pressure (BP) control among stroke survivors in the "real-world" setting is important to identify gaps in treatment and control, if any. The objective of our study was to assess trends and patterns in antihypertensive drug use and BP control among stroke survivors in the United States. We performed a retrospective cross-sectional analysis of the 2003-2014 National Health and Nutrition Examination Survey (NHANES). Stroke and hypertension diagnoses were self-reported. Information regarding the use of antihypertensive drugs was collected during an in-person interview. Measurement of BP was performed by trained medical professionals in mobile examination centers. A total 1244 adult stroke survivors (equating to 6 232 215 stroke survivors nationwide) were identified, of which 956 had hypertension. Antihypertensive drug use increased from 2003 (79.5%) to 2014 (92.2%; P for trend < 0.001). The prevalence of drug use was lower (52%) among survivors aged 20-39 years compared with older age groups. Use of ≥2 antihypertensive drugs was prevalent (63.8%), but diuretics alone or in combination with angiotensin-converting enzyme inhibitors were underutilized (22.4%). More than one-third of the survivors were not at BP goal (ie, BP < 140/90 mm Hg). Males were more likely to attain BP goal than female stroke survivors (odds ratio [OR] = 2.02; 95% CI: 1.34-3.05). Our findings suggest that despite improvements in antihypertensive drug use in the recent years, BP is not adequately controlled in a significant proportion of stroke survivors. Further research focusing on understanding the reasons for unmet BP goal in stroke survivors is needed.
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Affiliation(s)
- Kalyani Sonawane
- Department of Management, Center for Healthcare Data, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.,Department of Management, Center for Health Services Research, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Yenan Zhu
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Rajesh Balkrishnan
- Section on Population Health and Prevention Research, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ryan Suk
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Anjail Sharrief
- Department of Neurology, UTHealth Medical School at Houston, Houston, Texas
| | - Ashish A Deshmukh
- Department of Management, Center for Health Services Research, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - David Aguilar
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas.,Department of Medicine, Division of Cardiology, UTHealth Medical School at Houston, Houston, Texas
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226
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Soni M, Rodriguez VJ, Babayigit S, Jones DL, Kumar M. Blood Pressure, HIV, and Cocaine Use Among Ethnically and Racially Diverse Individuals. South Med J 2019; 111:643-648. [PMID: 30391997 DOI: 10.14423/smj.0000000000000893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Racial minorities are at greater risk of cardiovascular disease (CVD), and CVD is the primary cause of mortality among human immunodeficiency virus (HIV)-infected individuals. Cocaine use also has been associated with hypertension. This study examined the contribution of lifestyle factors to systolic, diastolic, and mean arterial pressure (MAP) among people living with HIV and cocaine users from racially and ethnically diverse backgrounds. METHODS Participants (N = 401: 213 men, 188 women) aged 18 to 50 years with no history of CVD were recruited from South Florida. A total of 200 participants were HIV-cocaine-infected, 100 were HIV-infected individuals with no history of cocaine use, and 101 were HIV-uninfected individuals with cocaine abuse or dependence. Carotid intima-media thickness and plaque, blood pressure (BP), and lifestyle risk were assessed. RESULTS Mean age was 36 years (standard deviation 9.33); the majority (62%) were African American. Carotid plaques were identified in 23% of participants; 42% were obese, 68% engaged in ≥150 minutes of weekly exercise, and 68% were smokers. Sex, body mass index (BMI), and diet were associated with systolic BP. Age, BMI, cannabis use, and diet were associated with diastolic BP and MAP. CONCLUSIONS Age, BMI, cannabis use, and diet were associated with increased diastolic BP and MAP. Cocaine did not emerge as a significant predictor of CVD after controlling for cannabis dependence. Cocaine and HIV lacked significant association with CVD, possibly because the majority of the sample was younger than age 40. Lifestyle modifications and substance abuse counseling may be important in preventing CVD among those without a history of CVD.
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Affiliation(s)
- Manasi Soni
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Violeta J Rodriguez
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Suat Babayigit
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Deborah L Jones
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mahendra Kumar
- From the Departments of Medicine and Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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227
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Abstract
PURPOSE OF REVIEW To provide an overview of the different guidelines for hypertension management from around the world. RECENT FINDINGS The guidelines discussed include those from the United States (US), Europe, Canada, and Latin America. All guidelines except the US define hypertension as > 140/90 mmHg, and the US defines it as > 130/80 mmHg. In general, all guidelines except those from the US emphasize lifestyle modification as the cornerstone of initial therapy given blood pressure levels < 140/90 mmHg. The US emphasizes lifestyle modification at all BP levels starting at 130/80 mmHg. Additionally, all guidelines emphasize the need to assess cardiovascular risk with the Canadian guidelines indicating that a high cardiovascular risk person should have a goal of < 130/80 mmHg. All agree on the proper method of blood pressure measurement techniques and importance of home blood pressure. All support use combination therapy with the European guideline emphasizing initial therapy should be a combination pill. All guidelines stress the importance of patient adherence to maintain blood pressure control. All guidelines emphasize lifestyle modification, need for home blood pressure measurement, as well as use of proper techniques to measure blood pressure. The fundamental difference between US and all other guidelines is the definition of hypertension, > 130/80 mmHg in US and > 140/90 mmHg in the rest of the world.
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228
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Smith JD, Colville D, Lyttle N, Lamoureux E, Savige J. Increased microvascular disease in X-linked and autosomal recessive Alport syndrome: a case control cross sectional observational study. Ophthalmic Genet 2019; 40:129-134. [PMID: 30985254 DOI: 10.1080/13816810.2019.1589528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Retinal microvascular disease reflects, in part, poor blood pressure control and systemic microvascular disease contributes to renal failure progression. This study examined the retinal microvasculature in Alport syndrome. MATERIALS AND METHODS Retinal images from 28 males and 28 females with X-linked Alport syndrome, and 13 individuals with autosomal recessive disease were reviewed retrospectively for microvascular/ hypertensive retinopathy (Wong and Mitchell classification), and small vessel calibre (using a computerised semiautomated method and revised Knudtson formula). Data were compared with age and gender-matched individuals with normal blood pressure and renal function. RESULTS Microvascular/hypertensive retinopathy was more common in males and females with X-linked Alport syndrome than age- and gender-matched controls (23, 82% and 10, 36%, p < 0.01; and 21, 75% and 13, 48%, p = 0.05, respectively), and in individuals with autosomal recessive disease compared with controls (12, 92% and 16, 43%, p < 0.01). Moderate microvascular/hypertensive changes were present in males and females with X-linked or autosomal recessive disease but not controls. Arteriolar calibre was reduced in males with X-linked disease (142.5 ± 18.7 µm, and 150.7 ± 10.1 µm, p = 0.046) and in autosomal recessive disease (133.5 ± 11.10 µm and 149.1 ± 10.6 µm, p < 0.0001). Microvascular/hypertensive retinopathy and arteriolar narrowing in males with X-linked disease were not different after renal transplantation and before (p NS). CONCLUSIONS Microvascular/hypertensive retinopathy was more common and more severe in Alport syndrome than normotensive controls. Improved BP levels may further slow the rate of renal functional decline in Alport syndrome.
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Affiliation(s)
- James D Smith
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
| | - Deb Colville
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
| | - Nicolette Lyttle
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
| | - Ecosse Lamoureux
- b Singapore Eye Research Institute, Yong Loo Lin School of Medicine , National University of Singapore , Singapore.,c Department of Ophthalmology, Centre for Eye Research Australia , The University of Melbourne , Melbourne , Australia.,d Duke-NUS Graduate Medical School, National University of Singapore , Singapore
| | - Judy Savige
- a Department of Medicine , Royal Melbourne Hospital, The University of Melbourne , Parkville , Australia
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229
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Oso AA, Adefurin A, Benneman MM, Oso OO, Taiwo MA, Adebiyi OO, Oluwole O. Health insurance status affects hypertension control in a hospital based internal medicine clinic. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2019; 1:100003. [PMID: 33447737 PMCID: PMC7803069 DOI: 10.1016/j.ijchy.2019.100003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/22/2019] [Indexed: 01/13/2023]
Abstract
Hypertension is a worldwide disorder that contributes significantly to morbidity, mortality, and healthcare costs in both developed and developing communities. A retrospective cohort study of hypertensive patients attending the Internal Medicine continuity clinic at Nashville General Hospital (NGH) between January and December 2007 was conducted. Given the easy access to health care at NGH and affordable Blood pressure (BP) medications, we explored the ability to achieve optimal BP control <140/90 mmHg and evaluated which factors are associated. Of the 199 subjects, 59% achieved BP goal <140/90 mmHg. The mean BP was 139/80 mmHg. Health insurance status was associated with SBP and DBP (All P < 0.046). Patients with health insurance had a 2.2 fold increased odds of achieving BP control compared to patients without health insurance (P = 0.025). Furthermore, the number of BP medications used was significantly associated with SBP and DBP (All P < 0.003). Patients taking more than three BP medications had a 58% reduced odds of achieving optimal BP control compared to patients taking one medication (P = 0.039). Ethnicity was not associated with achieving BP control. Our study revealed the number of BP medications used and health insurance status, are factors associated with achieving BP control.
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Affiliation(s)
- Ayodeji A. Oso
- Meharry Medical College, 1005 DB Todd Blvd., Nashville, TN 37208, USA
- Nashville General Hospital, 1818 Albion St, Nashville, TN 37208, USA
| | - Abiodun Adefurin
- Meharry Medical College, 1005 DB Todd Blvd., Nashville, TN 37208, USA
- Corresponding author. Meharry Medical College, Department of Internal Medicine, 1005 DB Todd Blvd, Nashville, TN 37208, USA.
| | - Monique M. Benneman
- Meharry Medical College, 1005 DB Todd Blvd., Nashville, TN 37208, USA
- Nashville General Hospital, 1818 Albion St, Nashville, TN 37208, USA
| | - Olatunde O. Oso
- Meharry Medical College, 1005 DB Todd Blvd., Nashville, TN 37208, USA
| | - Muinat A. Taiwo
- Meharry Medical College, 1005 DB Todd Blvd., Nashville, TN 37208, USA
| | - Oluwafisayo O. Adebiyi
- Meharry Medical College, 1005 DB Todd Blvd., Nashville, TN 37208, USA
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Olorunkemi Oluwole
- Meharry Medical College, 1005 DB Todd Blvd., Nashville, TN 37208, USA
- Medical University of South Carolina, Charleston, SC 29425, USA
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Hypertension and Diabetes Mellitus among Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Int J Chronic Dis 2019; 2019:2509242. [PMID: 31080806 PMCID: PMC6476026 DOI: 10.1155/2019/2509242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 01/03/2023] Open
Abstract
Background The burden of noncommunicable disease (NCD) in Africa is on a remarkable rise exacerbating the poor public health status affected by the existing but yet unsolved communicable disease. In Ethiopia, there is a paucity of evidence regarding prevalence and risk factors to NCD. Objective This study sought to determine the prevalence of risk factors of NCDs, prevalence of DM and HTN, and risk factors associated with diabetes mellitus (DM) and hypertension (HTN). Method This is an institution based cross-sectional study conducted on a sample of 411 clients attending a university-based comprehensive specialized hospital in Southern Ethiopia. The data was collected by using a pretested interviewer-administered questionnaire and observational checklist. Frequency, proportions, bivariate and multivariate logistic regression analysis was conducted using SPSS software version 20. Result We identified 64.2% of the clients had at least one of the risk factors to the NCDs. One-third (33.3%) had physical inactivity, whereas 20.2% had a BMI of ≥ 25%. The prevalence of DM and HTN was 12.2% and 10.5%, respectively. The multivariate analysis demonstrated that age ≥ 60 years, physical inactivity, higher BMI, and cigarette smoking were risk factors for at least one of the NCDs. Conclusion The prevalence of DM and prevalence of HTN were high. The magnitudes of risk factors to NCDs among the study population were substantial. Higher BMI, physical inactivity, low fruit and vegetable consumption, alcohol use, khat chewing, and cigarette smoking were among the prevailing risk factors identified.
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231
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Chandler J, Sox L, Kellam K, Feder L, Nemeth L, Treiber F. Impact of a Culturally Tailored mHealth Medication Regimen Self-Management Program upon Blood Pressure among Hypertensive Hispanic Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071226. [PMID: 30959858 PMCID: PMC6479738 DOI: 10.3390/ijerph16071226] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 01/11/2023]
Abstract
Background: Uncontrolled hypertension (HTN) and medication nonadherence are more prominent among Hispanics compared to non-Hispanic whites and African Americans. Advances in wireless health technology enable real-time monitoring of medication adherence (MA) and blood pressure (BP), facilitating timely patient–provider communication including tailored reinforcement/motivational feedback to patients and quicker titration changes by providers. The purpose of the current study was to conduct a 9-month smartphone-enabled efficacy trial addressing MA and BP control among Hispanic adults with uncontrolled HTN and poor MA. Methods: The research design was a 9-month, two-arm efficacy trial including an experimental (Smartphone Med Adherence Stops Hypertension, SMASH) group and an enhanced standard care (ESC) group. SMASH participants utilized a SMASH app which interfaced with a Bluetooth-enabled BP monitor for BP self-monitoring and an electronic medication tray. The ESC participants received text messages including links to PDFs and brief video clips containing healthy lifestyle tips for attention control. Results: Participants were 54 Hispanic adults (mean age: 46.5 years) with uncontrolled HTN. They were randomly assigned to either the SMASH (n = 26) or ESC group (n = 28). At baseline, no participants had controlled systolic BP (SBP). Baseline group averages for SBP between the SC and SMASH groups did not differ (150.7 and 152.3 mmHg, respectively; p = 0.53). At the 1, 3, 6, and 9-month time points, SBP averages were significantly lower in the SMASH versus SC groups (month 1: 125.3 vs. 140.6; month 3: 120.4 vs. 137.5, month 6: 121.2 vs. 145.7 mmHg; month 9: 121.8 vs. 145.7, respectively; all p-values <0.01). At months 3, 6, and 9 there was a significant difference between the percentage of participants meeting the 7th Joint National Committee cutoffs for SBP control in the SC and SMASH groups (month 3: 62.5 vs. 92.0%; month 6: 57.9 and 94.4%, month 9: 27.8 and 92.3%, respectively; all p-values ≤0.01). Average medical regimen adherence, as indicated by timestamped medication intake and BP monitoring for the SMASH group, ranged from 89.1 to 95.2% across the 9-month trial. Conclusion: Our findings indicate that our culturally tailored smartphone-enabled medical regimen self-management program may be an effective solution for the promotion of MA, resulting in statistically and clinically significant reductions in SBP among Hispanic adults with uncontrolled HTN.
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Affiliation(s)
- Jessica Chandler
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Luke Sox
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Kinsey Kellam
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Lauren Feder
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Lynne Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Frank Treiber
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
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Dieter BP, Daratha KB, McPherson SM, Short R, Alicic RZ, Tuttle KR. Association of Acute Kidney Injury with Cardiovascular Events and Death in Systolic Blood Pressure Intervention Trial. Am J Nephrol 2019; 49:359-367. [PMID: 30939480 PMCID: PMC7765707 DOI: 10.1159/000499574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/27/2019] [Indexed: 01/13/2023]
Abstract
RATIONALE AND OBJECTIVE In the Systolic Blood Pressure Intervention Trial, the possible relationships between acute kidney injury (AKI) and risk of major cardiovascular events and death are not known. STUDY DESIGN Post hoc analysis of a multicenter, randomized, controlled, open-label clinical trial. SETTING AND PARTICIPANTS Hypertensive adults without diabetes who were ≥50 years of age with prior cardiovascular disease, chronic kidney disease (CKD), 10-year Framingham risk score > 15%, or age > 75 years were assigned to a systolic blood pressure target of < 120 mm Hg (intensive) or < 140 mm Hg (standard). PREDICTOR AKI episodes. OUTCOMES The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or cardiovascular death. The secondary outcome was death from any cause. Analytical Approach: AKI was defined using the Kidney Disease: Improving Global Outcomes modified criteria based solely upon serum creatinine. AKI episodes were identified by serious adverse events or emergency room visits. Cox proportional hazards models assessed the risk for the primary and secondary outcomes by AKI status. RESULTS Participants were 68 ± 9 years of age, 36% women (3,332/9,361), and 30% Black race (2,802/9,361), and 17% (1,562/9,361) with cardiovascular disease. Systolic blood pressure was 140 ± 16 mm Hg at study entry. AKI occurred in 4.4% (204/4,678) and 2.6% (120/4,683) in the intensive and standard treatment groups respectively (p < 0.001). Those who experienced AKI had higher risk of cardiovascular events (hazard ratio [HR] 1.52, 95% CI 1.05-2.20, p = 0.026) and death from any cause (HR 2.33, 95% CI 1.56-3.48, p < 0.001) controlling for age, sex, race, baseline systolic blood pressure, body mass index, number of antihypertensive medications, cardiovascular disease and CKD status, hypotensive episodes, and treatment assignment. LIMITATIONS The study was not prospectively designed to determine relationships between AKI, cardiovascular events, and death. CONCLUSIONS Among older adults with hypertension at high cardiovascular risk, intensive treatment of blood pressure independently increased risk of AKI, which substantially raised risks of major cardiovascular events and death.
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Affiliation(s)
- Brad P Dieter
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA,
| | - Kenn B Daratha
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Sterling M McPherson
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Department of Medicine, Psychiatry and Behavioral Sciences, Spokane, Washington, USA
| | - Robert Short
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Medicine, Psychiatry and Behavioral Sciences, Spokane, Washington, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Medicine, Psychiatry and Behavioral Sciences, Spokane, Washington, USA
- Division of Nephrology, Kidney Research Institute, Institute of Translational Health Sciences, University of Washington, Spokane, Washington, USA
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Taylor KA, Wiles JD, Coleman DA, Leeson P, Sharma R, O'Driscoll JM. Neurohumoral and ambulatory haemodynamic adaptations following isometric exercise training in unmedicated hypertensive patients. J Hypertens 2019; 37:827-836. [PMID: 30817465 DOI: 10.1097/hjh.0000000000001922] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Hypertension remains the leading modifiable risk factor for cardiovascular disease. Isometric exercise training (IET) has been shown to be a useful nonpharmacological intervention for reducing resting blood pressure (BP). This study aimed to measure alterations in office BP, ambulatory BP, cardiac autonomic modulation and inflammatory and vascular biomarkers following a programme of IET in unmedicated hypertensive patients. METHODS Twenty-four unmedicated stage 1 hypertensive patients (age 43.8 ± 7.3 years; height, 178.1 ± 7 cm; weight 89.7 ± 12.8 kg) were randomly assigned in a cross-over study design, to 4-weeks of home-based IET and control period, separated by a 3-week washout period. Office and ambulatory BP, cardiac autonomic modulation, and inflammatory and vascular biomarkers were recorded pre and post-IET and control periods. RESULTS Clinic and 24-h ambulatory BP significantly reduced following IET by 12.4/6.2 and 11.8/5.6 mmHg in SBP/DBP, respectively (P < 0.001 for both), compared with the control. The BP adaptations were associated with a significant (P = 0.018) reduction in the average real variability of 24-h ambulatory BP following IET, compared with control. Cardiac autonomic modulation improved by 11% (P < 0.001), baroreceptor reflex sensitivity improved by 47% (P < 0.001), and IL-6 and asymmetric dimethylarginine reduced by 10% (P = 0.022) and 19% (P = 0.023), respectively, which differed significantly to the control period. CONCLUSION This is the first evidence of durable BP reduction and wider cardiovascular disease risk benefits of IET in a relevant patient population. Our findings support the role of IET as a safe and viable therapeutic and preventive intervention in the treatment of hypertension.
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Affiliation(s)
- Katrina A Taylor
- School of Human and Life Sciences, Canterbury Christ Church University, Kent
| | - Jonathan D Wiles
- School of Human and Life Sciences, Canterbury Christ Church University, Kent
| | - Damian A Coleman
- School of Human and Life Sciences, Canterbury Christ Church University, Kent
| | - Paul Leeson
- Department of Cardiovascular Medicine, Oxford Clinical Cardiovascular Research Facility, University of Oxford, Oxford
| | - Rajan Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jamie M O'Driscoll
- School of Human and Life Sciences, Canterbury Christ Church University, Kent
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
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234
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Momma H, Sawada SS, Sloan RA, Gando Y, Kawakami R, Miyachi M, Fukunaka Y, Okamoto T, Tsukamoto K, Nagatomi R, Blair SN. Frequency of achieving a 'fit' cardiorespiratory fitness level and hypertension: a cohort study. J Hypertens 2019; 37:820-826. [PMID: 30817464 DOI: 10.1097/hjh.0000000000001935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Although maintaining cardiorespiratory fitness is encouraged to reduce the risk of hypertension, the level at, and length of time for which, individuals need to maintain fitness remains unclear. We examined the association between the frequency of achieving the recommended fitness levels of the 'Physical Activity Reference for Health Promotion 2013' and the risk of hypertension among Japanese men. METHODS This cohort study was conducted in 6653 men without hypertension enrolled in 1986. Whether the participants' fitness level was equal to or exceeded the reference value (fit) or not (unfit) was determined. The frequency of achieving the recommended fitness level was calculated by counting the number of times the fitness level was achieved in 1980 through 1986. Incident hypertension was defined as the first visit with a SBP/DBP of at least 140/90 mmHg or self-reported antihypertensive medication use and was evaluated during annual health examinations from 1986 until 2009. RESULTS During the follow-up period, 3630 men developed hypertension. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing men with fit versus unfit at baseline was 0.79 (0.74-0.85). Moreover, the frequency of achieving the recommended fitness level was inversely associated with the incidence of hypertension. The risk of hypertension was lower among those who achieved three or more of the recommended levels (0.72 for three times to 0.62 for seven times). CONCLUSION Achieving the fitness level recommended in the Japanese guideline three or more times during a 6-year period can be beneficial for the risk reduction of hypertension.
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Affiliation(s)
- Haruki Momma
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Aoba-ku, Sendai, Miyagi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo
| | - Susumu S Sawada
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo
| | - Robert A Sloan
- Department of Psychosomatic Internal Medicine, Graduate Medical and Dental School, Kagoshima University, Kagoshima, Kagoshima
| | - Yuko Gando
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo
| | - Ryoko Kawakami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku, Tokyo
| | | | | | | | - Ryoichi Nagatomi
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Aoba-ku, Sendai, Miyagi
| | - Steven N Blair
- Department of Epidemiology and Biostatistics
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
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Gümüştakım RŞ, Ozkara A, Kahveci R, Döner Güner P, Ayhan Başer D, Dede F. Awareness, Treatment and Control Rates of Hypertensive Patients in Ankara. EURASIAN JOURNAL OF FAMILY MEDICINE 2019. [DOI: 10.33880/ejfm.2019080103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: It was aimed to evaluate the awareness levels of patients about hypertension, treatment and control rates.
Methods: The descriptive study included 203 patients between ages of 35–80 with a previous diagnosis of hypertension to the primary care outpatient clinic of Ankara Numune Training and Research Hospital in September 2011-January 2012. A 42-item questionnaire was used and 19 questions were used to determine the level of awareness among them. Nine measurements were in the office by the researcher and 12 measurements at home by the patient.
Results: 25.6% of the patients were males and 74.4% were females. The median age was 59 years (IQR=13). The section for scoring the awareness levels revealed following: 27.1% of patients were non-aware, 58.6% had a low level of awareness and 14.3% had a high level of awareness. 72.9% of the patients were aware, 93.1% were taking antihypertensive treatment, while 42.4% measured blood pressures both at home and at office are under control. Awareness level is related to diet, exercise, education, salt usage, blood pressure measurement frequency, doctor referral frequency, education and knowledge level about hypertension, blood pressure monitoring branch, antihypertensive treatment status, hypertension duration, number of antihypertensive drugs and regular usage rates; but hypertension control was only associated with salt use, antihypertensive treatment and number of antihypertensive drugs.
Conclusion: Hypertension is a common problem in our country and as we have seen in our studies, awareness rates are insufficient. Although the treatment rates are high, the control rates are not sufficient. This suggests that patients' compliance with treatment is not at the desired level. The most important thing to do in this regard is to raise awareness by increasing public awareness about hypertension. In this respect, primary care physicians have a great responsibility.
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Affiliation(s)
| | - Adem Ozkara
- Department of Family Medicine, Ankara Numune Training and Research Hospital
| | - Rabia Kahveci
- Department of Family Medicine, Ankara Numune Training and Research Hospital
| | | | - Duygu Ayhan Başer
- Department of Family Medicine, Hacettepe University School of Medicine
| | - Fatih Dede
- Department of Internal Medicine, Ankara Numune Training and Research Hospital
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Affiliation(s)
- Athanase Benetos
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, France (A.B.)
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, and Ghent University, Belgium (M.P.)
| | - Timo Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland (T.S.)
- Center for Life Course Health Research, University of Oulu, Finland (T.S.)
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Bakris G. Similarities and Differences Between the ACC/AHA and ESH/ESC Guidelines for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Circ Res 2019; 124:969-971. [PMID: 30920926 DOI: 10.1161/circresaha.118.314664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- George Bakris
- From the Department of Medicine, AHA Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, IL
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238
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Physician Trust and Home Remedy Use Among Low-Income Blacks and Whites with Hypertension: Findings from the TRUST Study. J Racial Ethn Health Disparities 2019; 6:830-835. [PMID: 30915684 DOI: 10.1007/s40615-019-00582-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/25/2019] [Accepted: 03/12/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Home remedies are used for the treatment of hypertension despite unsubstantiated claims of their effectiveness. Home remedy use is often attributed to mistrust towards healthcare providers. Few studies examine the relationship between home remedy use and physician trust. The objective of this study was to examine and compare the association between home remedy use and trust in physicians in a cohort of low-income Blacks and Whites with hypertension living in an inner city in Alabama. METHODS A cross-sectional examination was conducted among 925 Black and White patients receiving care at an urban hospital. Data was collected from in-person surveys. Trust in physicians was self-reported using the Hall General Trust Scale which included questions about honesty, confidentiality, and trust. Home remedy use was self-reported using the Brown and Segal scale which included questions about home remedy use and types of home remedies used. Covariates included demographic factors such as age, race, gender, and health outcomes. Data were analyzed using linear regression. RESULTS Twenty-eight percent of Black and 15% of White participants reported home remedy use (p = 0.001). Black home remedy users (38.9) and non-users (39.3) had similar trust scores (p = 0.582). Whites home remedy users (32.9) reported lower trust in physicians than White non-users (37.7) (p = 0.026). CONCLUSIONS Black home remedy users, non-users, and White non-users reported similar trust scores; the lowest trust scores were found among White home remedy users. Home remedy use was higher among Black participants. Future studies should examine the context of mistrust and home remedy use among Whites.
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Wang D, Hatahet M, Wang Y, Liang H, Bazikian Y, Bray CL. Multivariate analysis of hypertension in general US adults based on the 2017 ACC/AHA guideline: data from the national health and nutrition examination survey 1999 to 2016. Blood Press 2019; 28:191-198. [DOI: 10.1080/08037051.2019.1593042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Dong Wang
- Department of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Mohamad Hatahet
- Department of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Yanning Wang
- Department of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Hong Liang
- Department of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Yvette Bazikian
- Department of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Christopher L. Bray
- Department of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
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240
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Wahl L, Tubbs RS. A review of the clinical anatomy of hypertension. Clin Anat 2019; 32:678-681. [PMID: 30873636 DOI: 10.1002/ca.23369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 01/13/2023]
Abstract
Hypertension is defined as the persistent elevation of blood pressure above normal limits. It can be classified according to whether the contributing factors are genetics and environmental (primary hypertension) or underlying medical conditions and medications (secondary hypertension). The goal of this review is to increase recognition of the various anatomical etiologies of hypertension. Clin. Anat. 32:678-681, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lauren Wahl
- Seattle Science Foundation, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Ali F, Tacey M, Lykopandis N, Colville D, Lamoureux E, Wong TY, Vangaal W, Hutchinson A, Savige J. Microvascular narrowing and BP monitoring: A single centre observational study. PLoS One 2019; 14:e0210625. [PMID: 30870422 PMCID: PMC6417722 DOI: 10.1371/journal.pone.0210625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/28/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction Half of all hypertensive individuals have inadequately-controlled BP because monitoring methods are ineffective. This single centre study examined consecutive subjects undergoing 24 hour BP measurements for clinic and ambulatory BP levels, and for end-organ damage (retinal microvascular abnormalities and left ventricular hypertrophy, LVH, > 1.1 cm). Retinal images were graded for microvascular retinopathy (Wong and Mitchell classification), and vessel calibre using a semiautomated method. Features were compared using chi-squared, Fisher’s exact or the student’s t test. Methods One hundred and thirty-one individuals (59 male, 45.0%, mean age 61.7 ± 14.5 years) were studied. Ninety-nine (76.2%) had a clinic BP ≥ 140/90 mm Hg, 84 (64.6%) had a mean awake systolic BP ≥ 135 mm Hg, 100 (76.9%) had a mean sleeping systolic BP ≥ 120 mm Hg, and 100 (76.2%) had abnormal nocturnal BP dipping patterns. Sixty-nine individuals had undergone echocardiography and 23 (33.3%) had LVH. Results All participants had a mild (88.5%) or moderate (11.5%) microvascular retinopathy. Moderate microvascular retinopathy was found in 86.7% of those with a mean awake systolic BP ≥135 mm Hg (p = 0.058) but was not associated with other abnormal BP measurements, abnormal dipping patterns or LVH. However retinal arteriole calibre was reduced in subjects with a mean 24 hour awake systolic BP ≥ 135 mm Hg (p = 0.05). Retinal arteriole calibre was smaller in subjects with LVH (128.1 ± 13.5 μm compared with 137.6 ± 14.1 μm in normals, p = 0.014). Venular calibre was also less in subjects with LVH (185.4 ± 24.6 μm compared with 203.0 ± 27.2 μm in normals, p = 0.016). Arteriole narrowing predicted an increased risk of LVH (AUC 0.69, 95%CI 0.55 to 0.83) that was comparable with 24 hour systolic BP ≥130 mm Hg (AUC 0.68, 95%CI 0.53 to 0.82) and mean awake systolic BP ≥135 mm Hg (AUC 0.68, 95%CI 0.54 to 0.83). Conclusions This study suggests that retinal arteriole narrowing may be equally accurate in predicting LVH as any clinic or ambulatory BP measurement. The convenience and accuracy of microvascular calibre measurement mean that it should be investigated further for a role in routine hypertension assessment and monitoring.
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Affiliation(s)
- Fariya Ali
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Mark Tacey
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Nick Lykopandis
- Department of Cardiology, Northern Health, Epping, Victoria, Australia
| | - Deb Colville
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Tien Y. Wong
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - William Vangaal
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
- Department of Cardiology, Northern Health, Epping, Victoria, Australia
| | - Anastasia Hutchinson
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Judy Savige
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
- * E-mail:
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Komnenov D, Levanovich PE, Rossi NF. Hypertension Associated with Fructose and High Salt: Renal and Sympathetic Mechanisms. Nutrients 2019; 11:nu11030569. [PMID: 30866441 PMCID: PMC6472002 DOI: 10.3390/nu11030569] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023] Open
Abstract
Hypertension is a leading cause of cardiovascular and chronic renal disease. Despite multiple important strides that have been made in our understanding of the etiology of hypertension, the mechanisms remain complex due to multiple factors, including the environment, heredity and diet. This review focuses on dietary contributions, providing evidence for the involvement of elevated fructose and salt consumption that parallels the increased incidence of hypertension worldwide. High fructose loads potentiate salt reabsorption by the kidney, leading to elevation in blood pressure. Several transporters, such as NHE3 and PAT1 are modulated in this milieu and play a crucial role in salt-sensitivity. High fructose ingestion also modulates the renin-angiotensin-aldosterone system. Recent attention has been shifted towards the contribution of the sympathetic nervous system, as clinical trials demonstrated significant reductions in blood pressure following renal sympathetic nerve ablation. New preclinical data demonstrates the activation of the renal sympathetic nerves in fructose-induced salt-sensitive hypertension, and reductions of blood pressure after renal nerve ablation. This review further demonstrates the interplay between sodium handling by the kidney, the renin-angiotensin-aldosterone system, and activation of the renal sympathetic nerves as important mechanisms in fructose and salt-induced hypertension.
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Affiliation(s)
- Dragana Komnenov
- Department of Physiology, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
- Department of Internal Medicine, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
| | - Peter E Levanovich
- Department of Physiology, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
| | - Noreen F Rossi
- Department of Physiology, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
- Department of Internal Medicine, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
- John D. Dingell VA Medical Center, 4646 John R Street, Detroit, MI 48201, USA.
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Health-related quality of life among rural men and women with hypertension: assessment by the EQ-5D-5L in Jiangsu, China. Qual Life Res 2019; 28:2069-2080. [PMID: 30830645 DOI: 10.1007/s11136-019-02139-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Hypertension is a major global public health problem, including rural China. However, studies examining health-related quality of life (HRQoL) for patients with hypertension have been mostly conducted in urban populations. This study aimed to use the EuroQol five-dimensional-five-level (EQ-5D-5L) and its recently developed Chinese value set to analyze HRQoL and its influencing factors among hypertensive population in rural China. METHODS This is a cross-sectional population-based survey. Standard interview of participants was conducted from July to September 2016 in Donghai County's 334 villages of Jiangsu Province, China. Data collection included the EQ-5D-5L, along with sociodemographic characteristics and disease-related factors such as duration of hypertension, antihypertensive treatment and comorbid conditions. The Tobit regression model was employed to analyze potential influencing factors on HRQoL. RESULTS A total of 16,596 adults (18 years and older) with hypertension participated in this study. 62.4% were women. The mean utility score was 0.85 (standard deviation [SD] = 0.23). The proportion of participants reporting pain/discomfort problems was highest, while least patients reported problems in self-care dimension. Females, elderly, illiterate patients, ex-smokers and patients with longer duration of hypertension or comorbidities scored lower on HRQoL than others. Stroke, heart failure and coronary heart disease were associated with a larger negative impact on HRQoL among all comorbidities. CONCLUSIONS The HRQoL was lower in this rural hypertensive population than previously reported urban counterparts. To improve the HRQoL of hypertensive patients in rural areas, it is important to control hypertension and prevent its associated co-morbidities. More attention needs to be directed to elderly female patients with less education who scored much lower HRQoL than their male counterparts.
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Abstract
UNLABELLED ABSTRACTBackground:Both elevated blood pressure and/or depression increase the risk of cardiovascular disease and mortality. This study in treated elderly hypertensive patients explored the incidence of depression, its association (pre-existing and incident) with mortality and predictors of incident depression. METHODS Data from 6,083 hypertensive patients aged ≥65 years enrolled in the Second Australian National Blood Pressure study were used. Participants were followed for a median of 10.8 years (including 4.1 years in-trial) and classified into: "no depression," "pre-existing" and "incident" depression groups based on either being "diagnosed with depressive disorders" and/or "treated with an anti-depressant drug" at baseline or during in-trial period. Further, we redefined "depression" restricted to presence of both conditions for sensitivity analyses. For the current study, end-points were all-cause and any cardiovascular mortality. RESULTS 313 (5%) participants had pre-existing depression and a further 916 (15%) participants developed depression during the trial period (incidence 4% per annum). Increased (hazard-ratio, 95% confidence-interval) all-cause mortality was observed among those with either pre-existing (1.23, 1.01-1.50; p = 0.03) or incident (1.26, 1.12-1.41; p < 0.001) depression compared to those without. For cardiovascular mortality, a 24% increased risk (1.24, 1.05-1.47; p = 0.01) was observed among those with incident depression. The sensitivity analyses, using the restricted depression definition showed similar associations. Incident depression was associated with being female, aged ≥75 years, being an active smoker at study entry, and developing new diabetes during the study period. CONCLUSIONS This elderly cohort had a high incidence of depression irrespective of their randomised antihypertensive regimen. Both pre-existing and incident depression were associated with increased mortality.
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Kang J, Chang Y, Kim S, Sung KC, Shin H, Ryu S. Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults. Atherosclerosis 2019; 282:188-195. [DOI: 10.1016/j.atherosclerosis.2018.11.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/14/2018] [Accepted: 11/22/2018] [Indexed: 12/13/2022]
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Phelps PK, Kelley EF, Walla DM, Ross JK, Simmons JJ, Bulock EK, Ayres A, Akre MK, Sprissler R, Olson TP, Snyder EM. Relationship between a Weighted Multi-Gene Algorithm and Blood Pressure Control in Hypertension. J Clin Med 2019; 8:jcm8030289. [PMID: 30823438 PMCID: PMC6463118 DOI: 10.3390/jcm8030289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/16/2019] [Accepted: 02/25/2019] [Indexed: 01/01/2023] Open
Abstract
Hypertension (HTN) is a complex disease with interactions among multiple organ systems, including the heart, vasculature, and kidney with a strong heritable component. Despite the multifactorial nature of HTN, no clinical guidelines utilize a multi-gene approach to guide blood pressure (BP) therapy. Non-smokers with a family history of HTN were included in the analysis (n = 384; age = 61.0 ± 0.9, 11% non-white). A total of 17 functional genotypes were weighted according to the previous effect size in the literature and entered into an algorithm. Pharmacotherapy was ranked from 1–4 as most to least likely to respond based on the algorithmic assessment of individual patient’s genotypes. Three-years of data were assessed at six-month intervals for BP and medication history. There was no difference in BP at diagnosis between groups matching the top drug recommendation using the multi-gene weighted algorithm (n = 92) vs. those who did not match (n = 292). However, from diagnosis to nadir, patients who matched the primary recommendation had a significantly greater drop in BP when compared to patients who did not. Further, the difference between diagnosis to current 1-year average BP was lower in the group that matched the top recommendation. These data suggest an association between a weighted multi-gene algorithm on the BP response to pharmacotherapy.
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Affiliation(s)
- Pamela K Phelps
- Medical Center, University of Minnesota, Fairview, Minneapolis, MN 55455, USA.
| | - Eli F Kelley
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Danielle M Walla
- Medical Center, University of Minnesota, Fairview, Minneapolis, MN 55455, USA.
| | - Jennifer K Ross
- Medical Center, University of Minnesota, Fairview, Minneapolis, MN 55455, USA.
| | - Jerad J Simmons
- Medical Center, University of Minnesota, Fairview, Minneapolis, MN 55455, USA.
| | - Emma K Bulock
- Medical Center, University of Minnesota, Fairview, Minneapolis, MN 55455, USA.
| | - Audrie Ayres
- Medical Center, University of Minnesota, Fairview, Minneapolis, MN 55455, USA.
| | | | - Ryan Sprissler
- Geneticure, Inc., Rochester, MN 55902, USA.
- University of Arizona Genomics Core, University of Arizona, Tucson, AZ 85705, USA.
| | - Thomas P Olson
- Geneticure, Inc., Rochester, MN 55902, USA.
- College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Peters SA, Muntner P, Woodward M. Sex Differences in the Prevalence of, and Trends in, Cardiovascular Risk Factors, Treatment, and Control in the United States, 2001 to 2016. Circulation 2019; 139:1025-1035. [DOI: 10.1161/circulationaha.118.035550] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Sanne A.E. Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK (S.A.E.P., M.W.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands (S.A.E.P.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham (P.M.)
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK (S.A.E.P., M.W.)
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.W.)
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
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Role of Bioactive Peptides in Reducing the Severity of Hypertension with the Inhibition of ACE. Int J Pept Res Ther 2019. [DOI: 10.1007/s10989-018-09806-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
PURPOSE OF REVIEW To review data supporting the use of home blood pressure monitoring (HBPM) and provide practical guidance to clinicians wishing to incorporate HBPM into their practice. RECENT FINDINGS HBPM more accurately reflects the risk of cardiovascular events than office blood pressure measurement. In addition, there is high-quality evidence that HBPM combined with clinical support improves blood pressure control. Therefore, HBPM is increasingly recommended by guidelines to confirm the diagnosis of hypertension and evaluate the efficacy of blood pressure-lowering medications. Nevertheless, HBPM use remains low due to barriers from the patient, clinician, and healthcare system level. Understanding these barriers is crucial for developing strategies to effectively implement HBPM into routine clinical practice. HBPM is a valuable adjunct to office blood pressure measurement for diagnosing hypertension and guiding antihypertensive therapy. Following recommended best practices can facilitate the successful implementation of HBPM and impact how hypertension is managed in the primary care setting.
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