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Bytnar JA, McGlynn KA, Kern SQ, Shriver CD, Zhu K. Incidence rates of bladder and kidney cancers among US military servicemen: comparison with the rates in the general US population. Eur J Cancer Prev 2024; 33:505-511. [PMID: 38568164 DOI: 10.1097/cej.0000000000000886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
OBJECTIVE The military population may differ from the general population in factors related to bladder and kidney cancers. However, incidence rates of these cancers have not been systematically compared between the two populations. This study compared incidence rates of bladder and kidney cancers between active-duty servicemen and men in the general US population. METHODS Data were obtained from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. Included were 18-59-year-old active-duty servicemen in ACTUR and men in SEER who were diagnosed with malignant bladder and kidney cancers from 1990 to 2013. Age-adjusted rates, incidence rate ratios (IRR) and their 95% confidence intervals (95% CI) were compared between the two populations by age, race, and cancer stage. RESULTS Incidence rates were lower in ACTUR than SEER for bladder cancer overall (IRR = 0.55, 95% CI, 0.48-0.62) and by age (except ages 50-59), race, and tumor stage. For ages 50-59, rates did not differ between the populations. Kidney cancer incidence rates were lower in the military for younger groups and Black men, but higher for ages 50-59. CONCLUSION Lower bladder and kidney cancer incidence in ACTUR, notably in younger men, may be primarily associated with better health and healthcare access. The lack of differences in bladder or kidney cancer incidence among 50-59-year-old men between the populations might result from multifactorial effects, such as the possible effects of cumulative military-related exposures offset by healthier status and better medical care.
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Affiliation(s)
- Julie A Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Sean Q Kern
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- Department of Surgery, Walter Reed National Military Medical Center
- Urology Services, Walter Reed National Military Medical Center
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- Department of Surgery, Walter Reed National Military Medical Center
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Byrne C, Kjærgaard J, Møller JE, Biering-Sørensen T, Borregaard B, Schmidt H, Hassager C. Relevance of age and hypertension for blood pressure targets in comatose survivors of cardiac arrest: a BOX-trial sub-study. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:663-669. [PMID: 39026044 DOI: 10.1093/ehjacc/zuae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/29/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
AIMS To assess whether the optimal mean arterial blood pressure (MAP) target after out-of-hospital cardiac arrest (OHCA) is influenced by age and a history of arterial hypertension. METHODS AND RESULTS A post hoc analysis of data from the Blood Pressure and Oxygenation Targets in Post Resuscitation Care trial. The trial included 789 comatose patients randomized to a MAP target of 63 or 77 mmHg. The primary outcome of this sub-study was 1-year all-cause mortality. Cox proportional hazards regression and restricted cubic splines were used to examine whether prevalent hypertension and age modified the effect of low vs. high MAP target on all-cause mortality. Of the 789 patients randomized, 393 were assigned to a high MAP target, and 396 to a low MAP target. Groups were well-balanced for mean age (high MAP target 63 ± 13 years vs. low 62 ± 14 years) and hypertension (45 vs. 47%, respectively). At 1 year, the primary outcome occurred in 143 patients (36%) with a high MAP target and 138 (35%) with a low MAP target. The risk of the primary outcome increased linearly with increasing age (P < 0.001). The effect of a high vs. low MAP target on the primary outcome was modified by age when tested continuously, potentially favouring a low MAP target in younger patients (P for interaction = 0.03). Prevalent hypertension did not modify the effect of a high vs. low MAP target on the primary outcome (P for interaction = 0.67). CONCLUSION Among patients resuscitated after OHCA, older patients and those with a history of hypertension did not benefit from a high MAP target.
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Affiliation(s)
- Christina Byrne
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Henrik Schmidt
- Department of Anesthesiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Hirooka K, Higashide T, Sakaguchi K, Udagawa S, Sugiyama K, Oki K, Kometani M, Yoneda T, Fukunaga K, Akita T, Baba T, Kiuchi Y. Prevalence of Normal-Tension Glaucoma in Patients With Primary Aldosteronism. Am J Ophthalmol 2024; 269:339-345. [PMID: 39284484 DOI: 10.1016/j.ajo.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE To investigate patients with primary aldosteronism (PA) and the prevalence of normal-tension glaucoma (NTG). DESIGN Cross-sectional study. METHODS Newly diagnosed PA patients were evaluated in this cross-sectional study, with ophthalmic examinations such as intraocular pressure measurements by a Goldmann applanation tonometer, central corneal thickness, slit-lamp biomicroscopic examination, gonioscopy, ophthalmoscopy, fundus photography, visual field test with a Humphrey Field Analyzer 24-2 SITA Standard program, and optical coherence tomography of the peripapillary retinal nerve fiber layer, performed in each of the subjects. Optic disc appearance, perimetric results, optical coherence tomography results, and other ocular findings were all used for determining the glaucoma diagnosis. The primary outcome was shown the prevalence of NTG in patients with PA. RESULTS NTG prevalence in the 212 PA patients was 11.8% (95% confidence interval [CI], 4.7%-20.7%). As compared to the hypertensive patients without PA, the hypertensive patients with PA exhibited a significantly increased NTG prevalence (odds ratio; 4.019, 95% CI, 1.223-13.205; P = .022). Increased NTG prevalence was associated with age, ranging from 8.8% (95% CI, 2.1%-15.6%) for those aged 40 to 49 years, to 37.5% (95% CI, 13.8%-61.2%) for those aged 70 years and older. In 72 hypertensive patients without PA, who were used as the controls, NTG prevalence was 5.2%, with a 95% CI ranging from 0.5% to 14.4%. CONCLUSIONS There was an 11.8% prevalence of NTG in PA patients, with these patients at an elevated risk of NTG, which was not mediated by blood pressure.
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Affiliation(s)
- Kazuyuki Hirooka
- From the Department of Ophthalmology and Visual Science, (K.H., T.B., Y.K.), Hiroshima University, Hiroshima, Japan.
| | - Tomomi Higashide
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kimikazu Sakaguchi
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Sachiko Udagawa
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology (T.H., K.S., S.U., K.S.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenji Oki
- Department of Molecular and Internal Medicine, (K.O.), Hiroshima University, Hiroshima, Japan
| | - Mitsuhiro Kometani
- Department of Health Promotion and Medicine of the Future (M.K., T.Y.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takashi Yoneda
- Department of Health Promotion and Medicine of the Future (M.K., T.Y.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kensaku Fukunaga
- Department of Endocrinology and Metabolism (K.F.), Kagawa University, Kagawa, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Diseases Control and Prevention (T.A.), Hiroshima University, Hiroshima, Japan
| | - Taro Baba
- From the Department of Ophthalmology and Visual Science, (K.H., T.B., Y.K.), Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- From the Department of Ophthalmology and Visual Science, (K.H., T.B., Y.K.), Hiroshima University, Hiroshima, Japan
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Castiglioni L, Gelosa P, Muluhie M, Mercuriali B, Rzemieniec J, Gotti M, Fiordaliso F, Busca G, Sironi L. Fenofibrate reduces cardiac remodeling by mitochondrial dynamics preservation in a renovascular model of cardiac hypertrophy. Eur J Pharmacol 2024; 978:176767. [PMID: 38909934 DOI: 10.1016/j.ejphar.2024.176767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
Fenofibrate, a PPAR-α agonist clinically used to lower serum lipid levels, reduces cardiac remodeling and improves cardiac function. However, its mechanism of action is not completely elucidated. In this study we examined the effect of fenofibrate on mitochondria in a rat model of renovascular hypertension, focusing on mediators controlling mitochondrial dynamics and autophagy. Rats with two-kidney one-clip (2K1C) hypertension were treated with fenofibrate 150 mg/kg/day (2K1C-FFB) or vehicle (2K1C-VEH) for 8 weeks. Systolic blood pressure and cardiac functional were in-vivo assessed, while cardiomyocyte size and protein expression of mediators of cardiac hypertrophy and mitochondrial dynamics were ex-vivo examined by histological and Western blot analyses. Fenofibrate treatment counteracted the development of hypertension and the increase of left ventricular mass, relative wall thickness and cross-sectional area of cardiomyocytes. Furthermore, fenofibrate re-balanced the expression Mfn2, Drp1 and Parkin, regulators of fusion, fission, mitophagy respectively. Regarding autophagy, the LC3-II/LC3-I ratio was increased in 2K1C-VEH and 2K1C-FFB, whereas the autophagy was increased only in 2K1C-FFB. In cultured H9C2 cardiomyoblasts, fenofibrate reversed the Ang II-induced mRNA up-regulation of hypertrophy markers Nppa and Myh7, accumulation of reactive oxygen species and depolarization of the mitochondrial membrane exerting protection mediated by up-regulation of the Uncoupling protein 2. Our results indicate that fenofibrate acts directly on cardiomyocytes and counteracts the pressure overload-induced cardiac maladaptive remodeling. This study reveals a so far hidden mechanism involving mitochondrial dynamics in the beneficial effects of fenofibrate, support its repurposing for the treatment of cardiac hypertrophy and provide new potential targets for its pharmacological function.
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Affiliation(s)
- Laura Castiglioni
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Paolo Gelosa
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Majeda Muluhie
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | | | - Joanna Rzemieniec
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Marco Gotti
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Fabio Fiordaliso
- Department of Molecular Biochemistry and Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Busca
- Azienda "Polo Veterinario di Lodi", University of Milan, Milan, Italy
| | - Luigi Sironi
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy.
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Williams JR, Cole MA, Pewowaruk RJ, Hein AJ, Korcarz CE, Raza F, Chesler NC, Eickhoff JC, Gepner AD. Using an in-office passive leg raise to identify older adults with suboptimal blood pressure control. J Hypertens 2024:00004872-990000000-00537. [PMID: 39248144 DOI: 10.1097/hjh.0000000000003858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
INTRODUCTION Passive leg raise (PLR) is a simple, dynamic maneuver that has been used to increase preload to the heart. We hypothesize that PLR may offer a new and efficient office-based tool for assessing blood pressure (BP) control in older adults. METHODS One hundred and three veterans (≥60 years old) without known cardiovascular disease and varying degrees of blood pressure control were included in this cross-sectional cohort study. Twenty-four hour ambulatory BP monitoring identified Veterans with optimal and suboptimal BP control (≥125/75 mmHg). Bioimpedance electrodes (Baxter Medical, Deerfield, Illinois, USA) and brachial BP were used to calculate hemodynamic parameter changes across PLR states [pre-PLR, active PLR (3 min), and post-PLR]. Multiple linear regression was used to assess associations between BP control status with changes in hemodynamic parameters between PLR states. RESULTS The 24-h ambulatory BP monitoring identified 43 (42%) older Veterans with optimal BP control (mean age of 70.5 ± 7.0 years) and 55 (54%) with suboptimal BP (mean age of 71.3 ± 8.7 years). Veterans with suboptimal BP control had significantly reduced change in total peripheral resistance (ΔTPR) (7.0 ± 156.0 vs. 127.3 ± 145.6 dynes s/cm5; P = 0.002) following PLR compared with Veterans with optimal BP control. Suboptimal BP control (β = -0.35, P = 0.004) had a significant association with reduced ΔTPR, even after adjusting for demographic variables. CONCLUSION Measuring PLR-induced hemodynamic changes in the office setting may represent an alternative way to identify older adults with suboptimal BP control when 24-h ambulatory BP monitoring is not available.
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Affiliation(s)
- Jeremy R Williams
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
- William S. Middleton Memorial Veterans Hospital
| | - Molly A Cole
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
- William S. Middleton Memorial Veterans Hospital
| | - Ryan J Pewowaruk
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
- William S. Middleton Memorial Veterans Hospital
| | - Amy J Hein
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
- William S. Middleton Memorial Veterans Hospital
| | - Claudia E Korcarz
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
- William S. Middleton Memorial Veterans Hospital
| | - Farhan Raza
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
| | - Naomi C Chesler
- Samueli School of Engineering, University of California-Irvine, Irvine, California, USA
| | - Jens C Eickhoff
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
| | - Adam D Gepner
- Department of Cardiovascular Medicine, University of Wisconsin-Madison
- William S. Middleton Memorial Veterans Hospital
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Alvarez L, April-Sanders A, Duran Luciano P, Lee UJ, Swett K, Herrera C, Collado D, Kaplan R, Gonzalez II F, Daviglus M, Garcia-Bedoya O, Elfassy T, Schneiderman N, Perreira K, Talavera GA, Corsino L, Rodriguez CJ. Hypertension Prevalence among Hispanics/Latinos of Dominican Background: A Transnational Comparison of HCHS/SOL and ENPREFAR-HAS-17. Glob Heart 2024; 19:71. [PMID: 39219850 PMCID: PMC11363888 DOI: 10.5334/gh.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
Background Hispanics/Latinos of Dominican background living in United States (US) have the highest hypertension prevalence compared with other Hispanic/Latino persons. Objective To understand cardiovascular health among Dominicans, we evaluated hypertension prevalence and risk factors among Dominicans from the US and Dominican Republic (DR) using data from Hispanic Community Health Study/ Study of Latinos [HCHS/SOL] and the Prevalencia de Hipertension Arterial y Factores de Riesgo Cardiovasculares en la República Dominicana al 2017 (ENPREFAR-HAS 17) study. Methods Hypertension was defined as blood pressure ≥140/90 mmHg, self-reported hypertension, or antihypertensive use. Exposures included sociodemographic/socioeconomic, clinical, and lifestyle/behavioral characteristics. Weighted generalized linear models were used to estimate associations between study characteristics and hypertension prevalence (PR = prevalence ratio), age-and-sex adjusted. HCHS/SOL (n = 1,473, US Dominicans; mean age 41 years, 60.4% female) was analyzed with survey procedures, while ENPREFAR-HAS 17 (n = 2,015 DR Dominicans; mean age 40 years, 50.3% female) was analyzed with statistical analyses for simple random sampling. Results Hypertension prevalence was 30.5% and 26.9% for DR and US Dominicans, respectively. Hypertension control was low in both cohorts (36.0% DR, 35.0% US). Alcohol use among DR Dominicans was inversely associated with hypertension prevalence (PRDR = 0.8) with no association among US Dominicans. In both settings, diabetes (PRDR = 1.4; PRUS = 1.4) and obesity (PRDR = 1.8; PRUS = 2.0) were associated with greater hypertension prevalence in Hispanics/Latinos of Dominican background. Physical activity was lower among US Dominicans (PR = 0.80) but higher among DR Dominicans (PR = 1.16); all p < 0.05. Conclusions Variations in social, lifestyle/behavioral, and clinical characteristics associated with hypertension among Dominicans in the US and DR were identified, suggesting that social context and cultural factors matter among immigrant populations.
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Affiliation(s)
- Luisa Alvarez
- Albert Einstein College of Medicine. Department of Cardiology. Clinical Cardiovascular Research Center. 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Ayana April-Sanders
- Rutgers School of Public Health. Department of Biostatistics & Epidemiology. 683 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Priscilla Duran Luciano
- Albert Einstein College of Medicine. Department of Cardiology. Clinical Cardiovascular Research Center. 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Un Jung Lee
- Northwell Health. Biostatistics Unit. 1111 Marcus Avenue Ste 107. New Hyde Park NY 11042, USA
| | - Katrina Swett
- Albert Einstein College of Medicine. Department of Cardiology. Clinical Cardiovascular Research Center. 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Cesar Herrera
- Advanced Medicine and Telemedicine Diagnostic Center [Centro de Diagnóstico y Medicina Avanzada y Telemedicina (CEDIMAT)]. Department of Cardiology. Pepillo Salcedo Street and Arturo Logroño Street, Ensanche La Fe, Santo Domingo, Dominican Republic
| | - Donaldo Collado
- Dominican Society of Cardiology [Sociedad Dominicana de Cardiología (SODOCARDIO)], 403 Santiago Street, Santo Domingo, Dominican Republic
| | - Robert Kaplan
- Albert Einstein College of Medicine. Department of Epidemiology & Population Health. 1300 Morris Park Avenue, Bronx, NY 10461, USA
- Fred Hutchinson Cancer Center. Public Health Sciences Division. 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Franklyn Gonzalez II
- University of North Carolina. Department of Biostatistics. 123 W. Franklin St., Suite 450, CB# 8030, Chapel Hill, NC 27516, USA
| | - Martha Daviglus
- University of Illinois at Chicago, College of Medicine. Institute for Minority Health Research. 835 S Wolcott Ave (Bldg 935). Mailbox #23 (M/C 769). Chicago, IL 60612, USA
| | - Olga Garcia-Bedoya
- University of Illinois at Chicago, College of Medicine. Institute for Minority Health Research. 835 S Wolcott Ave (Bldg 935). Mailbox #23 (M/C 769). Chicago, IL 60612, USA
| | - Tali Elfassy
- University of Miami, Miller School of Medicine. Department of Medicine. 1120 NW 14th St, Ste 822, Miami, FL 33136, USA
| | - Neil Schneiderman
- University of Miami, Miller School of Medicine. Department of Psychology. 1120 NW 14th St, Ste 822, Miami, FL 33136, USA
| | - Krista Perreira
- University of North Carolina. Department of Social Medicine. 123 W. Franklin St., CB#7240, Chapel Hill, NC 27516, USA
| | - Gregory A. Talavera
- San Diego State University. Department of Psychology. South Bay Latino Research Center. 780 Bay Blvd, Suite 200, Chula Vista, CA 91910, USA
| | - Leonor Corsino
- Duke University. Division of Endocrinology, Box 3451, Durham, NC 27710, USA
| | - Carlos J. Rodriguez
- Albert Einstein College of Medicine. Department of Cardiology. Clinical Cardiovascular Research Center. 1300 Morris Park Avenue, Bronx, NY 10461, USA
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Frame AA, Nist KM, Kim K, Puleo F, Moreira JD, Swaldi H, McKenna J, Wainford RD. Integrated renal and sympathetic mechanisms underlying the development of sex- and age-dependent hypertension and the salt sensitivity of blood pressure. GeroScience 2024:10.1007/s11357-024-01266-1. [PMID: 38976131 DOI: 10.1007/s11357-024-01266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Aging is a non-modifiable understudied risk factor for hypertension. We hypothesized that sympathetically mediated activation of renal sodium reabsorption drives age-dependent hypertension and the salt sensitivity of blood pressure (BP). Using 3-, 8-, and 16-month-old male and female Sprague-Dawley rats as a model of normal aging, we assessed BP, indices of sympathetic tone, and the physiological responses to acute and chronic sodium challenge including sodium chloride cotransporter (NCC) regulation. The effects of renal nerve ablation and NCC antagonism were assessed in hypertensive male rats. We observed sex-dependent impaired renal sodium handling (24 h sodium balance (meq), male 3-month 0.36 ± 0.1 vs. 16-month 0.84 ± 0.2; sodium load excreted during 5% bodyweight isotonic saline volume expansion (%) male 3-month 77 ± 5 vs. 16-month 22 ± 8), hypertension (MAP (mmHg) male 3-month 123 ± 4 vs. 16-month 148 ± 6), and the salt sensitivity of BP in aged male, but not female, rats. Attenuated sympathoinhibitory afferent renal nerve (ARN) responses contributed to increased sympathetic tone and hypertension in male rats. Increased sympathetic tone contributes to renal sodium retention, in part through increased NCC activity via a dysfunctional with-no-lysine kinase-(WNK) STE20/SPS1-related proline/alanine-rich kinase signaling pathway, to drive hypertension and the salt sensitivity of BP in aged male rats. NCC antagonism and renal nerve ablation, which reduced WNK dysfunction and decreased NCC activity, attenuated age-dependent hypertension in male Sprague-Dawley rats. The contribution of an impaired sympathoinhibitory ARN reflex to sex- and age-dependent hypertension in an NCC-dependent manner, via an impaired WNK1/WNK4 dynamic, suggests this pathway as a mechanism-based target for the treatment of age-dependent hypertension.
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Affiliation(s)
- Alissa A Frame
- Department of Pharmacology & Experimental Therapeutics and the Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kayla M Nist
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kiyoung Kim
- Department of Pharmacology & Experimental Therapeutics and the Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Franco Puleo
- Department of Pharmacology & Experimental Therapeutics and the Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jesse D Moreira
- Department of Health Sciences, Sargent College, Boston University, Boston, MA, USA
| | - Hailey Swaldi
- Division of Cardiology, Emory University School of Medicine, 1750 Haygood Drive, Atlanta, GA, N22030322, USA
| | - James McKenna
- Division of Cardiology, Emory University School of Medicine, 1750 Haygood Drive, Atlanta, GA, N22030322, USA
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Division of Cardiology, Emory University School of Medicine, 1750 Haygood Drive, Atlanta, GA, N22030322, USA.
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8
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Gao X, Guo J, Pan D, Gu Y. Treatment Strategies for Asymptomatic Carotid Stenosis: A Systematic Review and Bayesian Network Meta-Analysis. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01241. [PMID: 38967441 DOI: 10.1227/ons.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/23/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To compare the safety and efficacy of carotid endarterectomy (CEA), carotid stenting (CAS), and optimal medical therapy (OMT) in patients with asymptomatic carotid stenosis. METHODS Relevant randomized controlled trials were researched with PubMed, Web of Science, and the Cochrane Library databases. Fixed-effects model and random-effects model were used to estimate the relative risks and the hazard ratios (HRs). The results of the probabilistic analysis were reported as surfaces under the cumulative ranking curve. RESULTS Eight randomized controlled trials were included. Data from 10 348 patients (CEA: n = 4758; CAS: n = 3919; OMT: n = 1673) were evaluated. Compared with the previous OMT, CEA, CAS, and the current OMT (c-OMT) were all effective in reducing the risk of stroke (CEA: HR, 0.52; CI, 0.40-0.66; CAS: HR, 0.58; CI, 0.42-0.81; c-OMT: HR, 0.40; CI, 0.15-0.94); CEA and CAS reduced the risk of ipsilateral stroke (CEA: HR, 0.41; CI, 0.28-0.59; CAS: HR, 0.51; CI, 0.31-0.84), and the risk of fatal or disabling stroke (CEA: HR, 0.59; CI, 0.43-0.81; CAS: HR, 0.57; CI, 0.34-0.95). Regarding reducing the risk of stroke, only CEA was statistically significant in patients with any degree of stenosis compared with the previous medical treatment (<80%: HR, 0.48; CI, 0.33%-0.70%; 80%-99%: HR, 0.53; CI, 0.38-0.73). CONCLUSION In the treatment of asymptomatic carotid stenosis, the perioperative outcomes of CAS were similar to that of CEA; CEA, CAS, and c-OMT shared similar long-term outcomes; and CEA and CAS may be more effective in patients with high levels of asymptomatic stenosis.
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Affiliation(s)
- Xinyi Gao
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Hughes JP, Lee WY, Troxel AB, Heagerty PJ. Sample Size Calculations for Stepped Wedge Designs with Treatment Effects that May Change with the Duration of Time under Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:348-355. [PMID: 37728810 PMCID: PMC10950842 DOI: 10.1007/s11121-023-01587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
The stepped wedge design is often used to evaluate interventions as they are rolled out across schools, health clinics, communities, or other clusters. Most models used in the design and analysis of stepped wedge trials assume that the intervention effect is immediate and constant over time following implementation of the intervention (the "exposure time"). This is known as the IT (immediate treatment effect) assumption. However, recent research has shown that using methods based on the IT assumption when the treatment effect varies over exposure time can give extremely misleading results. In this manuscript, we discuss the need to carefully specify an appropriate measure of the treatment effect when the IT assumption is violated and we show how a stepped wedge trial can be powered when it is anticipated that the treatment effect will vary as a function of the exposure time. Specifically, we describe how to power a trial when the exposure time indicator (ETI) model of Kenny et al. (Statistics in Medicine, 41, 4311-4339, 2022) is used and the estimand of interest is a weighted average of the time-varying treatment effects. We apply these methods to the ADDRESS-BP trial, a type 3 hybrid implementation study designed to address racial disparities in health care by evaluating a practice-based implementation strategy to reduce hypertension in African American communities.
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Affiliation(s)
- James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA.
| | - Wen-Yu Lee
- Department of Population Health, Division of Biostatistics, New York University, New York, NY, USA
| | - Andrea B Troxel
- Department of Population Health, Division of Biostatistics, New York University, New York, NY, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
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10
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Mehta SJ, Volpp KG, Troxel AB, Teel J, Reitz CR, Purcell A, Shen H, McNelis K, Snider CK, Asch DA. Remote Blood Pressure Monitoring With Social Support for Patients With Hypertension: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2413515. [PMID: 38829618 PMCID: PMC11148689 DOI: 10.1001/jamanetworkopen.2024.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/25/2024] [Indexed: 06/05/2024] Open
Abstract
Importance Hypertension management has traditionally been based on office visits. Integrating remote monitoring into routine clinical practices and leveraging social support might improve blood pressure (BP) control. Objective To evaluate the effectiveness of a bidirectional text monitoring program focused on BP control and medication adherence with and without social support in adults with hypertension. Design, Setting, and Participants This randomized clinical trial included adults aged 18 to 75 treated at an academic family medicine practice in Philadelphia in 2018 and 2019. Patients had been seen at least twice in the prior 24 months and had at least 2 elevated BP measurements (>150/90 mm Hg or >140/90 mm Hg for patients aged 18-59 years or with diabetes or chronic kidney disease) during visits. All participants had a cell phone with text messaging, offered at least 1 support partner, and were taking maintenance medications to treat hypertension. Patients were randomized 2:2:1 to remote monitoring of BP and medication adherence (RM), remote monitoring of BP and medication adherence with feedback provided to a social support partner (SS), or usual care (UC). Data were analyzed on an intention-to-treat basis between October 14, 2019, and May 30, 2020, and were revisited from May 23 through June 2, 2023. Interventions The RM and SS groups received an automatic home BP monitor, 3 weekly texts requesting BP measurements, 1 weekly text inquiring about medication adherence, and a weekly text with feedback. In the SS arm, support partners received a weekly progress report. The UC group received UC through their primary care practice. Clinicians caring for the patients in the intervention groups received nudges via electronic health records to adjust medications when 3 of 10 reported BP measurements were elevated. Patients were followed up for 4 months. Main Outcomes and Measures The primary outcome was systolic BP at 4 months measured during the final follow-up visit. Secondary outcomes included achievement of normotension and diastolic BP. Results In all, 246 patients (mean [SD] age, 50.9 [11.4] years; 175 females [71.1%]; 223 Black individuals [90.7%] and 13 White individuals [5.3%]) were included in the intention-to-treat analysis: 100 patients in the RM arm, 97 in the SS arm, and 49 in the UC arm. Compared with the UC arm, there was no significant difference in systolic or diastolic BP at the 4-month follow-up visit in the RM arm (systolic BP adjusted mean difference, -5.25 [95% CI, -10.65 to 0.15] mm Hg; diastolic BP adjusted mean difference, -1.94 [95% CI, -5.14 to 1.27] mm Hg) or the SS arm (systolic BP adjusted mean difference, -0.91 [95% CI, -6.37 to 4.55] mm Hg; diastolic BP adjusted mean difference, -0.63 [95% CI, -3.77 to 2.51] mm Hg). Of the 206 patients with a final BP measurement at 4 months, BP was controlled in 49% (41 of 84) of patients in the RM arm, 31% (27 of 87) of patients in the SS arm, and 40% (14 of 35) of patients in the UC arm; these rates did not differ significantly between the intervention arms and the UC group. Conclusions and Relevance In this randomized clinical trial, neither remote BP monitoring nor remote BP monitoring with social support improved BP control compared with UC in adults with hypertension. Additional efforts are needed to examine whether interventions directed at helping patients remember to take their BP medications can lead to improved BP control. Trial Registration ClinicalTrials.gov Identifier: NCT03416283.
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Affiliation(s)
- Shivan J. Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia
| | - Andrea B. Troxel
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Joseph Teel
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Catherine R. Reitz
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Alison Purcell
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Humphrey Shen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kiernan McNelis
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - David A. Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia
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11
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Özkan G, Ulusoy Ş, Yılmaz R, Değer SM, Derici Ü, Arınsoy T, Erdem Y. How many blood pressure measurements should we take in the office? J Clin Hypertens (Greenwich) 2024; 26:708-713. [PMID: 38646917 PMCID: PMC11180697 DOI: 10.1111/jch.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 04/23/2024]
Abstract
No consensus has emerged among different guidelines concerning how many blood pressure (BP) measurements should be performed at office visits in the diagnosis of hypertension. The purpose of this study was to examine the compatibility of various multiple average office BP measurements and 24-h BP monitoring (ABPM) in patients followed up in the posthoc analysis of the Cappadocia hypertension cohort. A total 1158 office BP measurements by 207 patients were examined. The results were then classified as G1 (average of the 1st and 2nd BP), G2 (average of the 2nd and 3rd), G3 (average of the 2nd, 3rd, and 4th), G4 (average of the 2nd, 3rd, 4th, and 5th), and G5 (average of all five measurements). Compatibility between the average values in the groups and concomitant 24-h ABPM data was examined. While a significant difference was observed between daytime 24-h ABPM SBP and G1 (p = .002), no difference was found in the other groups. Office DBP approached the daytime 24-h ABPM values as the number of measurements in the five groups increased, although average office DBP data in all groups were higher than daytime 24-h ABPM DBP (p = .000 for all). In light of our study results, we recommend that three office BP measurements be performed and that the average of the 2nd and 3rd measurements be used for SBP, while in terms of DBP, we recommend that as many measurements as possible be taken without the 1st value being included in the average.
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Affiliation(s)
- Gülsüm Özkan
- Department of NephrologySchool of MedicineTekirdağ Namık Kemal UniversityTekirdağTürkiye
| | - Şükrü Ulusoy
- Department of NephrologySchool of MedicineKaradeniz Technical UniversityTrabzonTürkiye
| | - Rahmi Yılmaz
- Department of NephrologySchool of MedicineHacettepe UniversityAnkaraTürkiye
| | - Serpil Müge Değer
- Department of NephrologySchool of MedicineDokuz Eylül UniversityİzmirTürkiye
| | - Ülver Derici
- Department of NephrologySchool of MedicineGazi UniversityAnkaraTürkiye
| | - Turgay Arınsoy
- Department of NephrologySchool of MedicineGazi UniversityAnkaraTürkiye
| | - Yunus Erdem
- Department of NephrologySchool of MedicineHacettepe UniversityAnkaraTürkiye
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12
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Ferreira PD, Simoes JA, Velho DC. Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review. Cureus 2024; 16:e59532. [PMID: 38826951 PMCID: PMC11144025 DOI: 10.7759/cureus.59532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.
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Affiliation(s)
| | - Jose A Simoes
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, PRT
| | - Denise C Velho
- Family Medicine, ULS de Leiria, USF Santiago, Leiria, PRT
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13
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Diao P, Ning K, Wang S, He L. Physical exercise and hypertension: A retrospective study in southern Sichuan. Medicine (Baltimore) 2024; 103:e37675. [PMID: 38608078 PMCID: PMC11018173 DOI: 10.1097/md.0000000000037675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/29/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to scrutinize the relationship between physical exercise and hypertension, taking into account multiple variables such as age, body mass index (BMI), family history, smoking, and alcohol consumption in the Southern Sichuan population, China, using a retrospective approach based on hospital record data. This retrospective study analyzed data from 946 participants obtained from a hospital electronic medical record system. The data included information regarding participants' lifestyle factors, family history, and a clinical diagnosis of hypertension. Univariate and multivariate logistic regression models were employed to identify the association between lifestyle factors and hypertension. The study found a hypertension prevalence of 38.5% in the analyzed population. Multivariate analyses identified significant factors associated with hypertension as age (odds ratio [OR]: 1.045, 95% confidence interval [CI]: 1.036-1.054), BMI (OR: 1.107, 95% CI: 1.084-1.132), smoking (OR: 2.299, 95% CI: 1.674-3.157), alcohol consumption (OR: 0.644, 95% CI: 0.478-0.867), and physical exercise (OR: 0.682, 95% CI: 0.506-0.920). Findings from this hospital record-based retrospective study reinforce the multifactorial nature of hypertension. They highlight the significance of physical exercise, along with maintaining optimal BMI and encouraging healthy habits like nonsmoking and moderate alcohol consumption in hypertension prevention. Our findings also underscore the need for future prospective studies to establish causality and explore the generalizability of these results beyond the Southern Sichuan population.
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Affiliation(s)
- Pei Diao
- Department of Physical Education, Neijiang Normal University, Neijiang, Sichuan, China
| | - Kexue Ning
- College of Agroforestry and Health, The Open University of Sichuan, Chengdu, China
| | - Shaohua Wang
- Cytopathology Department, Department of Pathology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Lijuan He
- Department of Health Management Center, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
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14
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Pinto C, Chaves C, Duarte J, Raposo A, Zandonadi RP, Monteiro S, Teixeira-Lemos E. Exploring Lifestyle Factors and Treatment Adherence among Older Adults with Hypertension Attending a Mobile Health Unit (MHU) in a Rural Area of Central Portugal. Nutrients 2024; 16:1112. [PMID: 38674805 PMCID: PMC11055154 DOI: 10.3390/nu16081112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
This cross-sectional and analytical study aimed to characterize a sample of hypertensive older adults attending a Mobile Health Unit (MHU) in a rural area of central Portugal according to their lifestyle and to analyze the impact of lifestyles on treatment adherence. The sample comprised 235 Portuguese hypertense patients, mainly females (63.8%) with a mean age of 75 years (±8.14 years) and low level of education. The data collection was carried out through a questionnaire consisting of sociodemographic questions, dietary variables, an Alcohol Dependence Questionnaire, an International Physical Activity Questionnaire (Short Version), a Nutrition Health Determination Questionnaire, a Self-Care with Hypertension Scale, and an Adherence to Treatments Measurement Scale. Only 34.5% of the hypertensive patients have controlled blood pressure values (28.2% men and 38% women). However, more than half (56.2%) of the hypertensive patients are classified as adherent to therapeutic measures. The hypertensive individuals, who present higher levels of adherence to the treatment, do not present alcohol dependence, are frequent consumers of aromatic herbs, sporadically consume salt, present good nutritional health, and practice moderate physical activity. The predictor variables for treatment adherence are the self-care dimensions general dietary (p = 0.001), specific dietary (p = 0.034), physical activity (p = 0.031), and antihypertensive medication intake (p < 0.001). Hypertensive patients with healthier lifestyles present better levels of treatment adherence. Therefore, promoting physical activity and healthy dietary practices is necessary to improve treatment adherence and increase antihypertensive treatment's effectiveness.
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Affiliation(s)
- Cátia Pinto
- Câmara Municipal de Castro Daire, Rua Dr. Pio Figueiredo, No. 42, 3600-126 Castro Daire, Portugal;
| | - Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (C.C.); (J.D.)
| | - João Duarte
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (C.C.); (J.D.)
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
| | - Renata Puppin Zandonadi
- Nutrition Department, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Brasilia 70910-900, Brazil;
| | - Sara Monteiro
- Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Edite Teixeira-Lemos
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
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15
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Boston D, Hwang J, Lucas JA, Marino M, Larson Z, Sun E, Giebultowicz S, Crookes DM, Rodriguez CJ, Heintzman J. Latino-White Disparities in Identification and Control of Elevated Blood Pressure Among Adults With Hypertension. J Am Heart Assoc 2024; 13:e033151. [PMID: 38456400 PMCID: PMC11010015 DOI: 10.1161/jaha.123.033151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Studies analyzing blood pressure (BP) management using the hypertension control cascade have consistently shown disparities in hypertension awareness, treatment, and BP control between Latino patients and non-Latino White patients. We analyze this cascade using electronic health record data from a multistate network of community health centers. METHODS AND RESULTS Data from 790 clinics in 23 US states from 2012 to 2020, including 1 270 174 patients, were analyzed to compare BP documentation in the electronic health record, clinician acknowledgment (diagnosis or treatment) of incident hypertension (BP ≥140/90), medication prescription, and BP control between non-Latino White patients, English-preferring Latino patients, and Spanish-preferring Latino patients, adjusted for patient-level covariates, and clustered on patients' primary clinics. Among the 429 182 patients with elevated BP (≥140/90) during ambulatory visits from 2012 to 2020, we found that clinician acknowledgment of hypertension was more likely in Spanish-preferring and English-preferring Latino patients versus non-Latino White patients (adjusted odds ratio [aOR], 1.17 [95% CI, 1.11-1.24]; aOR, 1.07 [95% CI, 1.02-1.12], respectively). In addition, Spanish-preferring Latino patients were more likely to receive a medication versus non-Latino White patients (aOR, 1.21 [95% CI, 1.16-1.28]). Among those receiving medication, Latino patients were as likely as non-Latino White patients to have their BP controlled (<140/90). CONCLUSIONS In a large retrospective study of community health center patients with incident hypertension, the expected disparities in hypertension management between Spanish-preferring Latino, English-preferring Latino, and non-Latino White patients were not identified. These findings add to the hypertension control cascade by examining robust electronic health record data from community health centers and may provide clues to reducing disparities in hypertension management.
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Affiliation(s)
| | - Jun Hwang
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
| | - Jennifer A. Lucas
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
| | - Miguel Marino
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
| | | | | | | | | | | | - John Heintzman
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
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16
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Mundagowa PT, Zambezi P, Muchemwa-Munasirei P. The prevalence and determinants of blood pressure control among hypertension patients in eastern Zimbabwe: A cross-sectional study. PLoS One 2024; 19:e0293812. [PMID: 38451890 PMCID: PMC10919662 DOI: 10.1371/journal.pone.0293812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP), also known as hypertension, is a leading cause of morbidity and mortality globally. Lowering the elevated BP can significantly reduce one's risk for cardiovascular diseases. This study aimed to ascertain the determinants of BP control among hypertension patients. METHODS The data analyzed were from the exploratory survey of the Home Management of Hypertension (HoMHyper) project in eastern Zimbabwe. Hypertension patients were selected from the Chronic Disease Registers of five public health clinics using simple random sampling. A pretested interviewer-administered questionnaire was used to collect data, and the patient's BP was measured. The primary outcome, BP control, was used as a categorical variable (controlled vs. uncontrolled) to conduct a bivariate analysis. Variables significant at p<0.2 were included in the multivariable logistic regression analysis to control for confounding. Statistical significance in the final model was set at p<0.05. RESULTS Data from 321 hypertension patients were analyzed; their mean age was 62.3±11.9 years. The prevalence of controlled BP was 41.4% (95% Confidence interval-CI = 36.0%-46.9%). After adjusting for confounding, patients' residence and medication stocks were associated with BP control. Patients who resided in high-density suburbs had higher odds of uncontrolled BP than those who resided in middle- and low-density suburbs (Adjusted odds ratios-AOR = 2.5; 95% CI = 1.4-4.4; p<0.01). Hypertension patients who experienced medication stockouts over the last six months had higher odds of uncontrolled BP than patients who did not experience stockouts (AOR = 1.8; 95% CI = 1.1-2.9). CONCLUSION BP control among hypertension patients was suboptimal. Patient residence and antihypertensive medication stockouts were independent predictors of blood pressure control. We recommend exploring sustainable financing through private-public partnerships to ensure the availability of subsidized antihypertensive medication.
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Affiliation(s)
- Paddington Tinashe Mundagowa
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Pemberai Zambezi
- Africa University Clinical Research Center, Africa University, Mutare, Zimbabwe
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17
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Gupta A, Chouhdry H, Ellis SD, Young K, Mahnken J, Comfort B, Shanks D, McGreevy S, Rudy C, Zufer T, Mabry S, Woodward J, Wilson A, Anderson H, Loucks J, Chandaka S, Abu-El-Rub N, Mazzotti DR, Song X, Schmitz N, Conroy M, Supiano MA, Waitman LR, Burns JM. Design of a pragmatic randomized implementation effectiveness trial testing a health system wide hypertension program for older adults. Contemp Clin Trials 2024; 138:107466. [PMID: 38331381 DOI: 10.1016/j.cct.2024.107466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
Hypertension control remains poor. Multiple barriers at the level of patients, providers, and health systems interfere with implementation of hypertension guidelines and effective lowering of BP. Some strategies such as self-measured blood pressure (SMBP) and remote management by pharmacists are safe and effectively lower BP but have not been effectively implemented. In this study, we combine such evidence-based strategies to build a remote hypertension program and test its effectiveness and implementation in large health systems. This randomized, controlled, pragmatic type I hybrid implementation effectiveness trial will examine the virtual collaborative care clinic (vCCC), a hypertension program that integrates automated patient identification, SMBP, remote BP monitoring by trained health system pharmacists, and frequent patient-provider communication. We will randomize 1000 patients with uncontrolled hypertension from two large health systems in a 1:1 ratio to either vCCC or control (usual care with education) groups for a 2-year intervention. Outcome measures including BP measurements, cognitive function, and a symptom checklist will be completed during study visits. Other outcome measures of cardiovascular events, mortality, and health care utilization will be assessed using Medicare data. For the primary outcome of proportion achieving BP control (defined as systolic BP < 130 mmHg) in the two groups, we will use a generalized linear mixed model analysis. Implementation outcomes include acceptability and feasibility of the program. This study will guide implementation of a hypertension program within large health systems to effectively lower BP.
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Affiliation(s)
- Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States; Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States.
| | - Hira Chouhdry
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shellie D Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kate Young
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jonathan Mahnken
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Branden Comfort
- Division of General Internal Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Denton Shanks
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sheila McGreevy
- Division of General Internal Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Courtney Rudy
- Division of General Internal Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Tahira Zufer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sharissa Mabry
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jennifer Woodward
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Amber Wilson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Heidi Anderson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jennifer Loucks
- Department of Pharmacy, University of Kansas Health System, Kansas City, KS, United States
| | - Sravani Chandaka
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Noor Abu-El-Rub
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Xing Song
- Department of Biomedical Informatics, Biostatistics, and Medical Epidemiology, University of Missouri, Columbia, MO, United States
| | - Nolan Schmitz
- Department of Pharmacy, University of Kansas Health System, Kansas City, KS, United States
| | - Molly Conroy
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Mark A Supiano
- Geriatrics Division, Department of Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine and Center on Aging, University of Utah, Salt Lake City, UT, United States
| | - Lemuel R Waitman
- Department of Biomedical Informatics, Biostatistics, and Medical Epidemiology, University of Missouri, Columbia, MO, United States
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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Elijovich F, Kirabo A, Laffer CL. Salt Sensitivity of Blood Pressure in Black People: The Need to Sort Out Ancestry Versus Epigenetic Versus Social Determinants of Its Causation. Hypertension 2024; 81:456-467. [PMID: 37767696 PMCID: PMC10922075 DOI: 10.1161/hypertensionaha.123.17951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Race is a social construct, but self-identified Black people are known to have higher prevalence and worse outcomes of hypertension than White people. This may be partly due to the disproportionate incidence of salt sensitivity of blood pressure in Black people, a cardiovascular risk factor that is independent of blood pressure and has no proven therapy. We review the multiple physiological systems involved in regulation of blood pressure, discuss what, if anything is known about the differences between Black and White people in these systems and how they affect salt sensitivity of blood pressure. The contributions of genetics, epigenetics, environment, and social determinants of health are briefly touched on, with the hope of stimulating further work in the field.
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Affiliation(s)
- Fernando Elijovich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Jambarsang S, Soodejani MT, Tate R, Sefidkar R. How well do obesity indices predict undiagnosed hypertension in the Persian cohort (Shahedieh) adults community population of all ages? Health Sci Rep 2024; 7:e1897. [PMID: 38405171 PMCID: PMC10885643 DOI: 10.1002/hsr2.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Background and Aims Hypertension is the leading preventable risk factor for cardiovascular disease, chronic kidney disease and cognitive impairment, and mortality and disability worldwide. Since prevention, early detection, and treatment of blood pressure improve public health, the aim of present study was to determine the best obesity indices and estimate the optimal cut-off point for each one to predict the risk of elevated/stage 1 and undiagnosed hypertension in the population of center of Iran based on American ACC/AHA 2020 guidelines. Methods This cross-sectional study was performed on 9715 people who enrolled in 2018 in Persian Adult Cohort in Shahedieh area of Yazd, Iran in 2018. The anthropometric indices including body mass index (BMI) and waist circumference (WC), wrist circumference, hip circumference, waist-to-hip ratio, and waist-to height ratio of individuals, were extracted. The receiver operating characteristic curve was utilized to determine the optimum cut-off point of each anthropometric index to predict hypertension stages and compare their predictive power by age-sex categories. Statistical analysis was done using SPSS version 23.0. Results The results showed that BMI has the best predictive power to recognize the risk of elevated/stage 1 hypertension for female (area under the curve [AUC] = 0.72 and optimal cut-off = 30.10 kg/m2) and WC for male (AUC = 0.66 and optimal cut-off = 93.5 cm) in 35-45 age group. BMI had the best predictive power for the risk of undiagnosed hypertension for 35-45 years old male (AUC = 0.73 and optimal cut-off = 28.90 kg/m2) and female (AUC = 0.75 and optimal cut-off = 5.10 kg/m2), and hip circumference revealed similar predictive power for female as well (AUC = 0.75 and optimal cut-off = 112 cm). Conclusion Based on our findings, BMI and WC, which are simple, inexpensive, and noninvasive means, are the best markers to predict the risk of elevated/stage 1 and undiagnosed hypertension in young Iranians. It shows that the approach of reducing hypertension prevalence through primary prevention, early detection, and enhancing its treatment is achievable.
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Affiliation(s)
- Sara Jambarsang
- Center for Healthcare Data Modeling, Departments of Biostatistics and EpidemiologyShahid Sadoughi University of Medical SciencesYazdIran
| | - Moslem Taheri Soodejani
- Center for Healthcare Data Modeling, Departments of Biostatistics and EpidemiologyShahid Sadoughi University of Medical SciencesYazdIran
| | - Robert Tate
- Centre on AgingUniversity of ManitobaWinnipegCanada
- Department of Community Health Sciences, Max Rady College of MedicineUniversity of ManitobaWinnipegCanada
| | - Reyhane Sefidkar
- Center for Healthcare Data Modeling, Departments of Biostatistics and EpidemiologyShahid Sadoughi University of Medical SciencesYazdIran
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20
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Calixte R, Chahal K, Besson A, Kaplan MS. Access to routine health care and awareness of hypertension status among adults: Results from the National Health and Nutrition Examination Survey, 2011-2018. Prev Med 2024; 179:107843. [PMID: 38176445 DOI: 10.1016/j.ypmed.2023.107843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Hypertension is a growing pandemic affecting over 1 billion people worldwide; about 46% of people with hypertension are unaware. METHOD Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were analyzed to assess the relationship between access to a routine place of care and undiagnosed hypertension in adults aged 18 to 64 years old. We defined undiagnosed hypertension as those meeting the 2017 American Heart Association's guidelines for stage 1 or 2 hypertension who reported not being told by their healthcare provider that they had hypertension. We used a multivariable Poisson regression model to assess the relationship between access to a routine place of care and undiagnosed hypertension. RESULT The final analytic sample was 5345 hypertensive American adults, with 56% unaware of their status. The results indicate that lack of awareness of hypertension status was highest among those without a routine place of care [PR = 1.20, CI = (1.12-1.29), p < 0.001] compared to those with access to a routine place of care, after adjustment for sociodemographic and clinical characteristics. CONCLUSION Access to a routine place of care in a non-emergency department setting is essential to reduce the rate of undiagnosed hypertension among American adults. Policymakers should implement policies to address the shortage of primary care providers and increase access to a routine place of care.
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Affiliation(s)
- Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America.
| | - Kunika Chahal
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Ayanna Besson
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Mark S Kaplan
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States of America
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21
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Kiss PAJ, Uijl A, Betancur E, de Boer AR, Grobbee DE, Hollander M, Onland-Moret CN, Sturkenboom MCJM, Peters SAE. Sex Differences in the Primary Prevention of Cardiovascular Diseases in a Dutch Primary Care Setting. Glob Heart 2024; 19:6. [PMID: 38250702 PMCID: PMC10798167 DOI: 10.5334/gh.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Background Sex differences in the primary prevention of cardiovascular diseases (CVD) have been shown, but the evidence is mixed and fragmented. In this study, we assessed sex differences in cardiovascular risk factors assessment, risk factor levels, treatment, and meeting of treatment targets, within a Dutch primary care setting. Methods Data were obtained from individuals aged 40 to 70 years old, without prior CVD, registered during the entire year in 2018 at one of the 51 general practices participating in the Julius General Practitioner's Network (JGPN). History of CVD was defined based on the International Classification of Primary Care (ICPC). Linear and Poisson regressions were used to investigate sex differences in risk factor assessment, risk factor levels, treatment, and meeting of treatment targets. Results We included 83,903 individuals (50% women). With the exception of glycated hemoglobin (HbA1c), all risk factors for CVD were more often measured in women than in men. Lipid measurements and body mass index values were higher in women, while blood pressure (BP) and HbA1c levels were higher in men, along with estimated glomerular filtration rate (eGFR) levels. Among individuals with elevated BP or cholesterol levels, no sex difference was observed in the prescription of antihypertensive medications (RR 1.00, 95% CI: 0.94-1.06) but women were less likely than men to receive lipid-lowering medications (RR 0.87, 95% CI: 0.79-0.95). Among treated individuals, women were more likely than men to meet adequate levels of blood pressure (RR 1.17, 95% CI: 1.09-1.25) and less likely to meet target levels of cholesterol (RR 0.90, 95% CI: 0.83-0.98). Conclusion While women were more likely to have their CVD risk factors measured, they were less likely to be prescribed lipid-lowering medications and to meet target levels. When treated, men were less likely to achieve adequate blood pressure control.
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Affiliation(s)
- Pauline A. J. Kiss
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Alicia Uijl
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Estefania Betancur
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Annemarijn R. de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Charlotte N. Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Miriam C. J. M. Sturkenboom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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22
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Shokri Varniab Z, Saeedi Moghaddam S, Pourabhari Langroudi A, Shati M, Koolaji S, Ghanbari A, Mehdipour P, Barakati SH, Moghadam M, Shobeiri P, Esfahani Z, Sharifnejad Tehrani Y, Salahi S, Bagheri H, Mortazavi SS. The levels and trends of metabolic risk factors in the elderly population at the national and sub-national scale in Iran from 1990 to 2016. J Diabetes Metab Disord 2023; 22:1645-1655. [PMID: 37975131 PMCID: PMC10638250 DOI: 10.1007/s40200-023-01297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/03/2023] [Indexed: 11/19/2023]
Abstract
Purpose Describing the trends of metabolic risk factors (MRFs) in the elderly population. Methods We used modeled data from previous comprehensive systematic reviews for MRFs among adults aged ≥ 60 years. Two stages of age-specific Spatio-temporal modeling and Gaussian process regression were used to estimate the mean of MRFs. We used crosswalk modeling to estimate the prevalence of elevated and raised Total cholesterol (TC), overweight/obesity and obesity, hypertension, and diabetes. Estimates were analyzed based on combinations of sex, age, year, and province from 1990 to 2016. Results Comparing prevalence estimates from 2016 with those of 1990, in the elderly population, the age-standardized prevalence of overweight/obesity, obesity, diabetes, and hypertension increased, conversely, the prevalence of hypercholesteremia decreased. The prevalence of hypertension increased about 141.5% and 129.9% in men and women respectively. The age-standardized prevalence of diabetes increased about 109.5% in females, and 116.0% in males. Prevalence of elevated TC at the national level decreased to 67.4% (64.1-70.4) in women and to 51.1% (47.5-54.8) in men. These findings were almost shown across provinces. In general, the northern and western provinces had the highest prevalence of overweight/obesity in women in 2016. Conclusion The rising prevalence of most MRFs, as well as the greater prevalence and mean of all MRFs in women, necessitate effective public health policies to reduce the burden of non-communicable diseases and run preventive programs. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01297-z.
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Affiliation(s)
- Zahra Shokri Varniab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan Pourabhari Langroudi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Shati
- Mental Health Research Center, Department of Epidemiology, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sogol Koolaji
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Manije Moghadam
- Department of Older Adult Health, Health Deputy, Ministry of Health and Medical Education of Iran, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Sharifnejad Tehrani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Salahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanie Bagheri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyede Salehe Mortazavi
- Geriatric Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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23
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Ba DM, Zhang S, Nishita Y, Tange C, Qiu T, Gao X, Muscat J, Otsuka R. Mushroom consumption and hyperuricemia: results from the National Institute for Longevity Sciences-Longitudinal Study of Aging and the National Health and Nutrition Examination Survey (2007-2018). Nutr J 2023; 22:62. [PMID: 37990262 PMCID: PMC10664361 DOI: 10.1186/s12937-023-00887-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Prior study reported that mushroom consumption was associated with a lower incidence of hyperuricemia, but there is limited evidence on this association. We conducted a collaborative study to investigate the association between mushroom intake and hyperuricemia in middle-aged and older populations. METHODS We used data from the National Health and Nutrition Examination Survey (NHANES) in the U.S. (2007-2018) and the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan (1997-2012). Consumption of mushroom (g/day) were measured by one- or two-day dietary recall in NHANES and by 3-day dietary records in the NILS-LSA. Hyperuricemia was defined using uric acid levels as > 420 μmol/L and > 350 μmol/L in NHANES for men and women, respectively; in the NILS-LSA, serum uric acid was repeatedly measured at baseline and follow-up surveys. Hyperuricemia was defined as uric acid levels > 416.4 μmol/L for men and ≥ 356.9 μmol/L for women. Logistic regression models in NHANES (cross-sectionally) and Generalized Estimation Equations in NILS-LSA (longitudinally) were performed. RESULTS A total of 5,778 NHANES participants (mean (SD) age: 53.2 (9.6) years) and 1,738 NILS-LSA (mean (SD) age: 53.5 (11.2) years) were included. Mushrooms were consumed by 5.7% of participants in NHANES and 81.2% in NILS-LSA. We did not observe a significant association between mushroom intakes and hyperuricemia in the NHANES men and women. However, in the NILS-LSA, compared to non-consumers, a higher mushroom intake was associated with a lower risk of incident hyperuricemia in men under 65 years old. The adjusted odds ratio (95% CI) for non-consumers, participants with middle, and the highest consumption of mushrooms were 1.00 (Ref.), 0.77 (0.44, 1.36), and 0.55 (0.31, 0.99), respectively (P-trend = 0.036). No association was found in women in NILS-LSA. CONCLUSIONS Mushroom consumption was associated with a lower risk of incident hyperuricemia in Japanese men.
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Affiliation(s)
- Djibril M Ba
- Department Public Health Sciences, Penn State College Medicine, Hershey, USA.
| | - Shu Zhang
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yukiko Nishita
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Chikako Tange
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tian Qiu
- Department Public Health Sciences, Penn State College Medicine, Hershey, USA
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University Shanghai, Shanghai, China
| | - Joshua Muscat
- Department Public Health Sciences, Penn State College Medicine, Hershey, USA
| | - Rei Otsuka
- Department of Epidemiology of Aging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
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Zhang X, Wang X, Hu H, Qu H, Xu Y, Li Q. Prevalence and Trends of Thyroid Disease Among Adults, 1999-2018. Endocr Pract 2023; 29:875-880. [PMID: 37619827 DOI: 10.1016/j.eprac.2023.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/27/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Thyroid disease is a prominent endocrine disorder, yet the clinical epidemiology of this condition remains unclear. This study aims to describe the recent trends in the prevalence of thyroid disease in US adults from 1999-2018. METHODS This cross-sectional study used nationally representative data collected through the National Health and Nutrition Examination Survey (NHANES) from January 1, 1999 to December 31, 2018. Patients with thyroid disease were defined as patients who reported having a thyroid disease and were on thyroid-related treatment. Age-standardized prevalence of thyroid disease was calculated within 4-year survey periods (1999-2002, 2003-2006, 2007-2010, 2011-2014, and 2015-2018). RESULTS During the NHANES 1999-2018, a total of 57 540 participants were examined. The age-standardized prevalence of thyroid disease was 5.05% (95% CI, 4.55%-5.60%) from 2015-2018, signifying a significant increase from the 1999-2002 period (P <.0002). However, prevalent thyroid disease remained steady between 2003 and 2014. The highest prevalence of thyroid disease was observed in non-Hispanic Whites (8.1%; 95% CI, 7.3%-9.0%), individuals aged ≥60 years (15.4%; 95% CI, 13.3%-17.8%), and tended to be higher in women (7.6%; 95% CI, 6.8%-8.5%). Multiple regression analysis revealed that age, women sex, non-Hispanic White and Mexican American, body mass index, higher education and incomes were independently associated with increased risks of thyroid disease. CONCLUSION The age-standardized prevalence of thyroid disease among US adults increased from 1999-2003, remained stable between 2003 and 2014, and then saw an increase from 2014-2018, with the highest rate observed among elders, women, and non-Hispanic Whites.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Huanrong Hu
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Jiangxi, China; The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Yuying Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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25
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Alsubai AK, Ahmad M, Chang R, Asghar MA, Siddiqui A, Khan HN, Ashraf MH, Javaid MD, Kalwar A, Asad M, Memon K, Khan LA, Noorani A, Siddiqi AK. Effect of preterm birth on blood pressure in later life: A systematic review and meta-analysis. J Family Med Prim Care 2023; 12:2805-2826. [PMID: 38186804 PMCID: PMC10771170 DOI: 10.4103/jfmpc.jfmpc_684_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/16/2023] [Accepted: 07/21/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Preterm birth is linked to various complications in both infancy and adulthood. We assessed the association between preterm birth and hypertension in adulthood. Materials and Methods PubMed, EMBASE, and Cochrane CENTRAL Register were searched for randomized controlled trials (RCT) comparing systolic and diastolic blood pressures in individuals born preterm and those born full-term, from inception till April 11th, 2022. Data were extracted, pooled, and analyzed. Forest plots were created for a visual demonstration. Results Twenty-eight studies were included in our meta-analysis. SBP and DBP across all categories (Mean, Ambulatory, Daytime, and Nighttime) were higher in the preterm group compared to the term group. Mean SBP, mean ambulatory SBP, mean daytime SBP and mean nighttime SBP were 4.26 mmHg [95% CI: 3.09-5.43; P < 0.00001], 4.53 mmHg [95% CI: 1.82-7.24; P = 0.001], 4.51 mmHg [95% CI: 2.56-6.74; P < 0.00001], and 3.06 mmHg [95% CI: 1.32-4.80; P = 0.0006] higher in the preterm group, respectively. Mean DBP, mean ambulatory DBP, mean daytime DBP, and mean nighttime DBP were 2.32 mmHg [95% CI: 1.35-3.29; P < 0.00001], 1.54 mmHg [95% CI 0.68-2.39; P = 0.0004], 1.74 mmHg [95% CI: 0.92-2.56; P < 0.0001], and 1.58 mmHg [95% CI: 0.34-2.81; P = 0.01] higher in the preterm group, respectively. Conclusion Our observations suggest that individuals who were born preterm may have higher blood pressures as compared to those who were born full-term.
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Affiliation(s)
| | - Mushtaq Ahmad
- Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Rabia Chang
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mustafa A. Asghar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Amna Siddiqui
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Hamza N. Khan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad H. Ashraf
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Asifa Kalwar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mahnoor Asad
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Kainat Memon
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Laibah A. Khan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Amber Noorani
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Pirzada A, Cai J, Cordero C, Gallo LC, Isasi CR, Kunz J, Thyagaragan B, Wassertheil-Smoller S, Daviglus ML. Risk Factors for Cardiovascular Disease: Knowledge Gained from the Hispanic Community Health Study/Study of Latinos. Curr Atheroscler Rep 2023; 25:785-793. [PMID: 37773246 DOI: 10.1007/s11883-023-01152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE OF REVIEW The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) has made important contributions on the prevalence of and factors associated with cardiovascular disease (CVD) risk factors among diverse Hispanic/Latino adults in the US. This article summarizes the knowledge gained thus far on major CVD risk factors from this landmark study. RECENT FINDINGS HCHS/SOL demonstrated the sizeable burdens of CVD risk in all major Hispanic/Latino groups in the US, as well as the marked variations in prevalence of hypertension, hypercholesterolemia, diabetes, obesity, and smoking by sex and background. It also identified sociodemographic, lifestyle, and sociocultural characteristics associated with risk factors. HCHS/SOL has yielded an expanding body of literature on characteristics associated with adverse CVD risk factors in this population. Long-term follow-up of this cohort will shed further light on the observed heterogeneity in CVD risk across Hispanic/Latino groups and identify specific risk/protective factors driving these variations.
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Affiliation(s)
- Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, 1819 W. Polk Street, Suite 246, Chicago, IL, 60612, USA.
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John Kunz
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bharat Thyagaragan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | | | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, 1819 W. Polk Street, Suite 246, Chicago, IL, 60612, USA
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27
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Woodiwiss AJ, Orchard A, Mels CMC, Uys AS, Nkeh-Chungag BN, Kolkenbeck-Ruh A, Ware LJ, Yates S, Jones ESW, Peterson VR, Poulter NR. High prevalence but lack of awareness of hypertension in South Africa, particularly among men and young adults. J Hum Hypertens 2023:10.1038/s41371-023-00873-3. [PMID: 37880326 DOI: 10.1038/s41371-023-00873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of death in South Africa (SA) and high blood pressure (BP) is the primary risk factor. However, hypertension prevalence is high, BP control is poor and CV events occur at a younger age than in Europe or America. Increasing screening, raising awareness and improving management of hypertension are critical to prevent CVD in SA. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP. As part of the MMM campaign, in SA (2017, 2018, 2019 and 2021), BP measurements and a cross-sectional survey of volunteers aged ≥ 18years were performed. Of 11,320 individuals (age 36.6 ± 16.8years) screened, 29.7% had hypertension (systolic BP/diastolic BP ≥ 140/90 mmHg or antihypertensive medication use) and the prevalence was higher (p < 0.0001) in men (35.6%) than in women (26.3%). Of those with hypertension, only 54.3% were aware and 46.8% were receiving antihypertensive medication, and 53.7% of these had controlled BP. In men with hypertension, awareness (45.2%, treatment (38.2%) and controlled BP on antihypertensive medication (45.2%) were lower (p < 0.0001) than in women (awareness: 60.8%; treatment: 53.5%; controlled BP: 58.3%). In young participants (age < 40years), 15.6% had hypertension, 18.6% of these were on treatment but 76.0% were not aware, and only 57.7% had controlled BP. The high prevalence of hypertension, but low levels of awareness, treatment, and BP control in SA, especially in young adults and men, highlight the need for systematic BP screening programmes and improvements in education and management of hypertension.
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Affiliation(s)
- Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ane Orchard
- Clinical Pharmacy Division, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catharina M C Mels
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Aletta S Uys
- Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Benedicta N Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Science, Walter Sisulu University, Mthatha, South Africa
| | - Andrea Kolkenbeck-Ruh
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC-Wits Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J Ware
- SAMRC-Wits Developmental Pathways to Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samantha Yates
- Department of Life and Consumer Sciences, University of South Africa (UNISA), Science Campus, Roodepoort, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Vernice R Peterson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
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Shen S, Xiao Y. Association Between C-Reactive Protein and Albumin Ratios and Risk of Mortality in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:2289-2303. [PMID: 37873518 PMCID: PMC10590598 DOI: 10.2147/copd.s413912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/14/2023] [Indexed: 10/25/2023] Open
Abstract
Purpose This study was to evaluate the association between C-reactive protein (CRP) to albumin (ALB) ratio (CAR) and the risk of mortality in patients with chronic obstructive pulmonary disease (COPD). Methods In this retrospective cohort study, clinical data were extracted from the National Institutes of Health National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2010. Cox proportional hazard regressions were performed to assess the association between CAR and 5-year mortality in COPD patients. Subgroup analyses were applied to identify the consistency of the association based on the severity of COPD, gender, body mass index (BMI), smoking status, cardiovascular disease (CVD), and chronic kidney disease (CKD), and diabetes. The area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis was used to evaluate the predictive performance of CAR. Results A total of 1210 COPD patients were included, of which 110 COPD patients (9.09%) had 5-year mortality. The mean follow-up was 57.76 (0.33) months. A higher CAR was associated with an increased risk of 5-year mortality in COPD patients [hazard ratio (HR): 1.94, 95% confidence interval (CI): 1.07 to 3.50, P =0.029)]. Subgroup analysis showed that the association between CAR and mortality was especially suitable for COPD patients with mild COPD, in COPD patients who were still smoking, in COPD patients with BMI <=29.9 kg/m2, in COPD patients who were without CVD, in COPD patients who were without diabetes, and COPD patients who were without CKD. The AUCs of CAR for predicting 1-year, 3-year, and 5-year mortality in COPD patients were 0.735, 0.615, and 0.608, respectively. Conclusion CAR is strongly correlated with mortality in patients with COPD and CAR could be served as a prognostic biomarker for patients with COPD. This study may provide a promising prognostic biomarker for risk stratification and clinical management of patients with COPD.
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Affiliation(s)
- Shenghua Shen
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213004, People’s Republic of China
| | - Yuan Xiao
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, 213004, People’s Republic of China
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Wang J, Yang QY, Chai DJ, Su Y, Jin QZ, Wang JH. The relationship between obesity associated weight-adjusted waist index and the prevalence of hypertension in US adults aged ≥60 years: a brief report. Front Public Health 2023; 11:1210669. [PMID: 37869197 PMCID: PMC10587597 DOI: 10.3389/fpubh.2023.1210669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives The main objective was to examine the relationship between weight-adjusted waist index (WWI) and the prevalence of hypertension among individuals aged ≥60 years who participated in the NHANES between 2011 and 2018 years. Methods The data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. In this population-based study, we focused on participants who were over 60 years old. Data were collected from the aforementioned survey, and the variable of interest was WWI, which was calculated as waist (cm) divided by the square root of body weight (kg). Multivariable logistic regression model was applied to calculate adjusted ORs with 95% CIs in order to explore any possible correlation between WWI and the prevalence of hypertension. Subgroup analysis were used to verify the stability of the relationship between WWI and the prevalence of hypertension. The interaction tests were also conducted in this research. Results Results revealed that adults aged ≥60 years who were in the highest WWI quartile had significantly higher chances of developing hypertension when compared to those in the lowest quartile, after adjusting for covariates and potential confounders (p < 0.001). Conclusion These findings suggest that there is a strong correlation between elevated levels of WWI and the risk of developing hypertension among older adults. As such, WWI could serve as a unique and valuable biomarker for identifying hypertension risk at an earlier stage in the older adults population.
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Affiliation(s)
| | | | | | | | | | - Jin-Hua Wang
- Department of Cardiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, QuZhou, Zhejiang Province, China
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Romano S, Rigon G, Albrigi M, Tebaldi G, Sartorio A, Cristin L, Burrei G, Fava C, Minuz P. Hypertension, uncontrolled hypertension and resistant hypertension: prevalence, comorbidities and prescribed medications in 228,406 adults resident in urban areas. A population-based observational study. Intern Emerg Med 2023; 18:1951-1959. [PMID: 37530942 PMCID: PMC10543802 DOI: 10.1007/s11739-023-03376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
Although hypertension is the leading cause of cardiovascular disease and premature death worldwide, it remains difficult to control. The prevalence of uncontrolled and resistant hypertension (RH) may be underestimated and can reach up to 50% of all hypertensive patients. The aim of this observational study was to analyze the prevalence of hypertension, uncontrolled hypertension and RH, and their associations with risk factors or diseases in a large cohort of patients referred to primary care physician. In a population of 228406 adults, we only collected data from people with a diagnosis of arterial hypertension for a total of 43,526 patients. For this purpose, we used the MySQL database, run by Azalea.NET, built on the medical records of 150 General Practitioners (GPs). Patient data included sex, age, blood pressure (BP) values, number of antihypertensive drugs and presence of major cardiovascular comorbidities. We classified patients with RH as those treated with 3 different antihypertensive agents, with recorded BP ≥ 140/90 mmHg, or patients taking ≥ 4 medications. The prevalence of hypertension was 19.06%, that of resistant hypertension was 2.46% of the whole population and 20.85% of the hypertensive group. Thirteen thousand hundred, forty-six patients (30.20% of the hypertensive group) had uncontrolled BP (≥ 140/90 mmHg), whereas 16,577 patients did not have BP measurements done in the last 2 years (38.09% of the hypertensive group). Patients with uncontrolled BP were mainly female, used less drugs and showed a lower prevalence of all major cardiovascular comorbidities, except for diabetes. Instead, patients with RH had a significantly higher prevalence of all considered comorbidities compared to those without RH. Our results evidence that a broad number of patients with hypertension, especially those without comorbidities or with a low number of antihypertensive drugs, do not achieve adequate BP control. To improve the clinical management of these patients it is very important to increase the collaboration between GPs and clinical specialists of hypertension.
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Affiliation(s)
- Simone Romano
- Section of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy
| | | | | | | | - Andrea Sartorio
- Section of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Cristin
- Section of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy
| | - Giulia Burrei
- Section of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy
| | | | - Pietro Minuz
- Section of Internal Medicine C, Department of Medicine, University of Verona, Verona, Italy.
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31
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Ardissino M, Reddy RK, Slob EA, Griffiths J, Girling J, Ng FS. Maternal hypertensive traits and adverse outcome in pregnancy: a Mendelian randomization study. J Hypertens 2023; 41:1438-1445. [PMID: 37432894 PMCID: PMC10399932 DOI: 10.1097/hjh.0000000000003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/08/2023] [Accepted: 05/24/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy are associated with adverse feto-maternal outcomes. Existing evidence is mostly limited to observational studies, which are liable to confounding and bias. This study investigated the causal relevance of component hypertensive indices on multiple adverse pregnancy outcomes using Mendelian randomization. METHODS Uncorrelated ( r2 < 0.001) genome-wide significant ( P < 5 × 10 -8 ) single-nucleotide polymorphisms associated with SBP, DBP and pulse pressure (PP) were selected as instrumental variables. Genetic association estimates for outcomes of preeclampsia or eclampsia, preterm birth, placental abruption and hemorrhage in early pregnancy were extracted from summary statistics of genome-wide association studies in the FinnGen cohort. Two-sample, inverse-variance weighted Mendelian randomization formed the primary analysis method. Odds ratios (OR) are presented per-10 mmHg higher genetically predicted hypertensive index. RESULTS Higher genetically predicted SBP were associated with higher odds of preeclampsia or eclampsia [OR 1.81, 95% confidence interval (CI) 1.68-1.96, P = 5.45 × 10 -49 ], preterm birth (OR 1.09, 95% CI 1.03-1.16, P = 0.005) and placental abruption (OR 1.33, 95% CI 1.05-1.68, P = 0.016). Higher genetically-predicted DBP was associated with preeclampsia or eclampsia (OR 2.54, 95% CI 2.21-2.92, P = 5.35 × 10 -40 ). Higher genetically predicted PP was associated with preeclampsia or eclampsia (OR 1.68, 95% CI 1.47-1.92, P = 1.9 × 10 -14 ) and preterm birth (OR 1.18, 95% CI 1.06-1.30, P = 0.002). CONCLUSION This study provides genetic evidence to support causal associations of SBP, DBP and PP on multiple adverse outcomes of pregnancy. SBP and PP were associated with the broadest range of adverse outcomes, suggesting that optimized management of blood pressure, particularly SBP, is a key priority to improve feto-maternal health.
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Affiliation(s)
- Maddalena Ardissino
- National Heart and Lung Institute, Imperial College London, London
- Royal Papworth Hospital, Cambridge Biomedical Campus
| | - Rohin K. Reddy
- National Heart and Lung Institute, Imperial College London, London
| | - Eric A.W. Slob
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Applied Economics, Erasmus School of Economics
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jack Griffiths
- Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust
| | - Joanna Girling
- West Middlesex Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London
- West Middlesex Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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32
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Ebinger JE, Gluckman TJ, Magraner J, Chiu ST, Rider D, Thomas C, Das SR, Ho PM, Shreenivas S, Bradley S. Characterization of Individuals With Apparent Resistant Hypertension Using Contemporary Guidelines: Insights From CV-QUIC. Hypertension 2023; 80:1845-1855. [PMID: 37357771 PMCID: PMC10524942 DOI: 10.1161/hypertensionaha.123.20894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/09/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Apparent resistant hypertension (aRH) carries excess cardiovascular risk beyond nonresistant forms of hypertension; however, our understanding of this at-risk population, as defined by current US practice guidelines, is limited. Accordingly, we sought to evaluate the prevalence, clinical characteristics, and pharmacotherapeutic patterns of patients with aRH using contemporary blood pressure guidance. METHODS We classified patients at 3 large healthcare systems by hypertensive status using contemporary hypertension guidelines. We subsequently described the demographic and clinical characteristics of patients with aRH and compared these factors among hypertensive patients without aRH and between those with controlled and uncontrolled aRH. RESULTS A total of 2 420 468 patients were analyzed, of whom 1 343 489 (55.6%) were hypertensive according to contemporary guidelines. Among hypertensive patients, 11 992 (8.5%) met criteria for aRH, with nearly all assessed comorbid conditions, particularly diabetes and heart failure, being more common in those with aRH. When compared with patients with uncontrolled aRH, those with controlled aRH were more frequently prescribed a beta-blocker, diuretic, and nitrate, with the largest standardized difference observed for a mineralocorticoid receptor antagonist (35.4% versus 10.4%, Cohen D 0.62). Consistent findings were noted in sensitivity analyses using the blood pressure threshold of 140/90 mm Hg. CONCLUSIONS In an analysis of over 2.4 million individuals, a lower prevalence of aRH was observed than previously reported (12%-15%), but with a high burden of comorbidities. Identification of differences in pharmacotherapy between patients with controlled and uncontrolled aRH, particularly lower rates of mineralocorticoid receptor antagonist use, help define potential opportunities to improve care and lower cardiovascular risk.
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Affiliation(s)
- Joseph E. Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ty J Gluckman
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
| | - Jose Magraner
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shih Ting Chiu
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
| | - Deanna Rider
- Providence Research Network, Missoula, Montana, USA
| | | | - Sandeep R Das
- University of Texas Southwestern Medical Center and Center for Innovation and Value at Parkland, Dallas, Texas, USA
| | - P Michael Ho
- University of Colorado School of Medicine, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Satya Shreenivas
- Lindner Center for Research, The Christ Hospital, Cincinnati, Ohio, USA
| | - Steven Bradley
- Healthcare Delivery Innovation Center, Minneapolis Heart Institute, Minnesota, USA
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Egan BM, Cui MX. Characteristics of Adults With Apparent Treatment Resistant Hypertension: Six Factors Impacting Prevalence-Editorial Commentary. Hypertension 2023; 80:1856-1859. [PMID: 37585541 DOI: 10.1161/hypertensionaha.123.21494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Brent M Egan
- Improving Health Outcomes, American Medical Association, Greenville, SC (B.M.E.)
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Bruno RM, Varbiro S, Pucci G, Nemcsik J, Lønnebakken MT, Kublickiene K, Schluchter H, Park C, Mozos I, Guala A, Hametner B, Seeland U, Boutouyrie P. Vascular function in hypertension: does gender dimension matter? J Hum Hypertens 2023; 37:634-643. [PMID: 37061653 DOI: 10.1038/s41371-023-00826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023]
Abstract
Blood pressure and vascular ageing trajectories differ between men and women. These differences develop due to sex-related factors, attributable to sex chromosomes or sex hormones, and due to gender-related factors, mainly related to different sociocultural behaviors. The present review summarizes the relevant facts regarding gender-related differences in vascular function in hypertension. Among sex-related factors, endogenous 17ß-estradiol plays a key role in protecting pre-menopausal women from vascular ageing. However, as vascular ageing (preceding and inducing hypertension) has a steeper increase in women than in men starting already from the third decade, it is likely that gender-related factors play a prominent role, especially in the young. Among gender-related factors, psychological stress (including that one related to gender-based violence and discrimination), depression, some psychological traits, but also low socioeconomic status, are more common in women than men, and their impact on vascular ageing is likely to be greater in women. Men, on the contrary, are more exposed to the vascular adverse consequences of alcohol consumption, as well as of social deprivation, while "toxic masculinity" traits may result in lower adherence to lifestyle and preventive strategies. Unhealthy diet habits are more prevalent in men and smoking is equally prevalent in the two sexes, but have a disproportional negative effect on women's vascular health. In conclusion, given the major and complex role of gender-related factors in driving vascular alterations and blood pressure patterns, gender dimension should be systematically integrated into future research on vascular function and hypertension and to tailor cardiovascular prevention strategies.
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Affiliation(s)
- Rosa-Maria Bruno
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France.
| | - Szabolcs Varbiro
- Workgroup for Science Management, Doctoral School, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Giacomo Pucci
- Internal Medicine Unit, "Santa Maria" Terni Hospital and Department of Medicine and Surgery-University of Perugia, Perugia, Italy
| | - János Nemcsik
- Department of Family Medicine and Health Service of Zuglo (ZESZ), Semmelweis University, Budapest, Hungary
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Karolina Kublickiene
- Institution for Clinical Science, Intervention and Technology, Department of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Schluchter
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Bernhard Hametner
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna, Austria
| | - Ute Seeland
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pierre Boutouyrie
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Paris, France
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Kim SH, Choi SJ. Management of Hypertension in Fabry Disease. Electrolyte Blood Press 2023; 21:8-17. [PMID: 37434805 PMCID: PMC10329903 DOI: 10.5049/ebp.2023.21.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 07/13/2023] Open
Abstract
Fabry disease (FD), a rare X-linked lysosomal storage disorder that depletes alpha-galactosidase A (α-GalA), is caused by mutations in the GLA gene. Diminished α-GalA enzyme activity results in the accumulation of Gb3 and lyso-Gb3. The pathophysiology of hypertension in FD is complex and unclear. The storage of Gb3 in arterial endothelial cells and smooth muscle cells is known to produce vascular injury by increasing oxidative stress and inflammatory cytokines as a primary pathophysiological mechanism. In addition, Fabry nephropathy developed, resulting in a decrease in kidney function and contributing to hypertension. The prevalence of hypertension in patients with FD was between 28.4% and 56%, whereas hypertension in patients with chronic kidney disease ranged between 33% and 79%. A study using 24-hour ambulatory blood pressure monitoring (ABPM) to measure blood pressure (BP) indicated a high prevalence of uncontrolled hypertension in FD. Thus, 24-hour ABPM ought to be considered for FD hypertension assessments. Appropriate treatment of hypertension is believed to reduce mortality in patients with FD caused by kidney disease, cardiovascular disease, and cerebrovascular disease because hypertension significantly impacts organ damage. Up to 70% of FD patients have been reported to have kidney involvement, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribed for proteinuria are recommended as first-line therapy with antihypertensive drugs. In conclusion, hypertension should be controlled appropriately, given the different morbidity and mortality caused by significant organ involvement in FD patients.
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Affiliation(s)
- Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Soo Jeong Choi
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Ilori TO, Zhen A, Velani RN, Zhao R, Echouffo-Tcheugui J, Anderson CA, Waikar SS, Kengne AP. The impact of dietary and lifestyle interventions on blood pressure management in sub-Saharan Africa: a systematic review and metanalysis. J Hypertens 2023; 41:918-925. [PMID: 36928004 PMCID: PMC10158605 DOI: 10.1097/hjh.0000000000003411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Current literature is lacking a comprehensive review of data on dietary interventions in blood pressure (BP) management in sub-Saharan African countries. We assessed the association of dietary and other lifestyle interventions with BP-lowering effects in populations within sub-Saharan Africa. METHODS We performed a systematic review and random-effects meta-analysis to determine the impact of dietary and lifestyle interventions on SBP and DBP in sub-Saharan Africa. We searched the MEDLINE, EMBASE, and Web of Science databases. We included intervention studies that were randomized and nonrandomized conducted in Africans residing in sub-Saharan Africa investigating diet and other lifestyle, physical activity, weight loss, tobacco, and alcohol cessation modifications. We determined the effect of diet and other lifestyle interventions on SBP and DBP. We expressed effect size as weighted mean difference and 95% confidence interval (CI). MAIN RESULTS : We identified six studies with a total of 1412 individuals, 38% males, mean age of 52.8 years (SD = 11.5). The weighted mean difference of dietary and other lifestyle interventions on SBP and DBP was -7.33 mmHg, (95% CI: -9.90 to -4.76, P < 0.001) and -2.98 mmHg, (95% CI: -4.28 to -1.69, P < 0.001), respectively. In the metaregression analyses, the duration of the interventions did not have any effect on changes in SBP and DBP. PRINCIPAL CONCLUSION : Dietary modifications showed a beneficial overall improvement in SBP and DBP in Africans. However, aside from low-salt interventions, studies on dietary potassium, healthy dietary patterns, and lifestyle modifications have not been investigated extensively in Africans and are in critical need. In addition, researchers will need to consider the settings (rural, urban, or semiurban) and the predominant existing dietary habits while designing studies on dietary interventions in sub-Saharan Africa. PROSPERO REGISTRATION CRD42020207923.
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Affiliation(s)
- Titilayo O. Ilori
- Nephrology Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine
| | - Aileen Zhen
- Nephrology Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine
| | - Romie N. Velani
- School of Public Health, Boston University, Boston, Massachusetts
| | - Runqi Zhao
- Nephrology Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine
| | - Justin Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, John Hopkins University, Baltimore, Maryland
| | - Cheryl A.M. Anderson
- Department of Public Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sushrut S. Waikar
- Nephrology Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine
| | - Andre P. Kengne
- Noncommunicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Zhang X, Wang X, Wang M, Qu H, Hu B, Li Q. Prevalence, awareness, and treatment of isolated diastolic hypertension in the United States. Eur J Intern Med 2023; 112:93-99. [PMID: 37002149 DOI: 10.1016/j.ejim.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Isolated diastolic hypertension (IDH) is recognized as a risk factor for cardiovascular disease, yet its clinical epidemiology remains poorly understood due to insufficient recognition. This study aims to describe the trend in the prevalence, awareness, and treatment of IDH in the United States from 2001 to 2018. METHODS This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in nine consecutive two-year cycles from 2001-2002 to 2017-2018, comprising a sample of 48,742 adults aged over 18 years. IDH was defined as a diastolic blood pressure ≥ 80 mm Hg with a systolic BP < 130 mm Hg by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. RESULTS In the nationally representative dataset, 8.9% of participants had IDH in 2017-2018, a decreased of 3.6% (95% confidence interval [CI], -2.6% to -5.0%, P<0.0002) since 2001-2002. IDH prevalence was highest among Mexican American (10.5%), individuals aged 40-59 (12.3%), increased with body mass index (BMI) (11.2% among those BMI ≥30.0 kg/m2), and tended to be higher in men (12.3%). A multiple regression analysis showed that men, white race/ethnicity, young and middle-aged people (aged 18-59), and increasing BMI were independently associated with increased risks of IDH. Among IDH patients, there was a modest increase in awareness (P<0.0002), from 22.4% (95%CI, 18.4% to 27.1%) in 2001-2002 to 35.0% (95%CI, 28.2% to 42.5%) in 2017-2018, with the largest percentage increases among non-Hispanic white and men. IDH treatment increased by 7.6% (95%CI, 3.1% to 12.1%) between 2001-2002 and 2017-2018, with the greatest increases occurring in Mexican American and men. CONCLUSION IDH prevalence is decreasing from 2001-2002 to 2017-2018 in the United States. Despite the significantly increased in both awareness and treatment, they remain below 50%.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Miaoran Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China; China Academy of Chinese Medical Sciences, Beijing, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | | | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Bangi EF, Yousuf MH, Upadhyay S, Jain P, Jain R. Comprehensive Review of Hypertensive Disorders Related to Pregnancy. South Med J 2023; 116:482-489. [PMID: 37263611 DOI: 10.14423/smj.0000000000001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hypertensive disorder of pregnancy is a common complication during pregnancy that affects approximately 10% of pregnancies and is responsible for nearly 14% of maternal deaths worldwide. It affects the mother and the fetus simultaneously, sometimes putting the health of the mother and the fetus at odds with each other. It may present with only hypertension and proteinuria or with life-threatening complications in the mother such as eclampsia; stroke; acute pulmonary edema; acute renal failure; disseminated intravascular coagulation; placental abruption; hemolysis, elevated liver enzymes, and low platelet syndrome; pregnancy loss; and fetal growth restriction and prematurity resulting from the frequent need of delivering preterm in the fetus. In this review, we aimed to describe hypertensive disorders of pregnancy, mainly preeclampsia and chronic hypertension in pregnancy, by discussing the pathophysiology, the central role of abnormal placentation, the release of antiangiogenic factors in the circulation and immunological factors, the clinical outcome in the mother and the fetus, and the diagnostic criteria and principles of management of both the conditions. We also discuss possible screening methods and prevention of preeclampsia using low-dose aspirin and eclampsia prophylaxis.
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Affiliation(s)
- Eera Fatima Bangi
- From the Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | | | | | | | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Katsukunya JN, Soko ND, Naidoo J, Rayner B, Blom D, Sinxadi P, Chimusa ER, Dandara M, Dzobo K, Jones E, Dandara C. Pharmacogenomics of Hypertension in Africa: Paving the Way for a Pharmacogenetic-Based Approach for the Treatment of Hypertension in Africans. Int J Hypertens 2023; 2023:9919677. [PMID: 38633331 PMCID: PMC11022520 DOI: 10.1155/2023/9919677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 04/19/2024] Open
Abstract
In Africa, the burden of hypertension has been rising at an alarming rate for the last two decades and is a major cause for cardiovascular disease (CVD) mortality and morbidity. Hypertension is characterised by elevated blood pressure (BP) ≥ 140/90 mmHg. Current hypertension guidelines recommend the use of antihypertensives belonging to the following classes: calcium channel blockers (CCB), angiotensin converting inhibitors (ACEI), angiotensin receptor blockers (ARB), diuretics, β-blockers, and mineralocorticoid receptor antagonists (MRAs), to manage hypertension. Still, a considerable number of hypertensives in Africa have their BP uncontrolled due to poor drug response and remain at the risk of CVD events. Genetic factors are a major contributing factor, accounting for 20% to 80% of individual variability in therapy and poor response. Poor response to antihypertensive drug therapy is characterised by elevated BPs and occurrence of adverse drug reactions (ADRs). As a result, there have been numerous studies which have examined the role of genetic variation and its influence on antihypertensive drug response. These studies are predominantly carried out in non-African populations, including Europeans and Asians, with few or no Africans participating. It is important to note that the greatest genetic diversity is observed in African populations as well as the highest prevalence of hypertension. As a result, this warrants a need to focus on how genetic variation affects response to therapeutic interventions used to manage hypertension in African populations. In this paper, we discuss the implications of genetic diversity in CYP11B2, GRK4, NEDD4L, NPPA, SCNN1B, UMOD, CYP411, WNK, CYP3A4/5, ACE, ADBR1/2, GNB3, NOS3, B2, BEST3, SLC25A31, LRRC15 genes, and chromosome 12q loci on hypertension susceptibility and response to antihypertensive therapy. We show that African populations are poorly explored genetically, and for the few characterised genes, they exhibit qualitative and quantitative differences in the profile of pharmacogene variants when compared to other ethnic groups. We conclude by proposing prioritization of pharmacogenetics research in Africa and possible adoption of pharmacogenetic-guided therapies for hypertension in African patients. Finally, we outline the implications, challenges, and opportunities these studies present for populations of non-European descent.
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Affiliation(s)
- Jonathan N. Katsukunya
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Nyarai D. Soko
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Jashira Naidoo
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Brian Rayner
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dirk Blom
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Lipidology and Cape Heart Institute, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Phumla Sinxadi
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Clinical Pharmacology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile R. Chimusa
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle, Tyne and Wear NE1 8ST, UK
| | - Michelle Dandara
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Kevin Dzobo
- Medical Research Council-SA Wound Healing Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences University of Cape Town, Anzio Road Observatory, Cape Town 7925, South Africa
| | - Erika Jones
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
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Slagboom TNA, van Bunderen CC, De Vries R, Bisschop PH, Drent ML. Prevalence of clinical signs, symptoms and comorbidities at diagnosis of acromegaly: a systematic review in accordance with PRISMA guidelines. Pituitary 2023:10.1007/s11102-023-01322-7. [PMID: 37210433 PMCID: PMC10397145 DOI: 10.1007/s11102-023-01322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Diagnostic delay is high in acromegaly and leads to increased morbidity and mortality. The aim of this study is to systematically assess the most prevalent clinical signs, symptoms and comorbidities of acromegaly at time of diagnosis. DESIGN A literature search (in PubMed, Embase and Web of Science) was performed on November 18, 2021, in collaboration with a medical information specialist. METHODS Prevalence data on (presenting) clinical signs, symptoms and comorbidities at time of diagnosis were extracted and synthesized as weighted mean prevalence. The risk of bias was assessed for each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. RESULTS Risk of bias and heterogeneity was high in the 124 included articles. Clinical signs and symptoms with the highest weighted mean prevalence were: acral enlargement (90%), facial features (65%), oral changes (62%), headache (59%), fatigue/tiredness (53%; including daytime sleepiness: 48%), hyperhidrosis (47%), snoring (46%), skin changes (including oily skin: 37% and thicker skin: 35%), weight gain (36%) and arthralgia (34%). Concerning comorbidities, acromegaly patients more frequently had hypertension, left ventricle hypertrophy, dia/systolic dysfunction, cardiac arrhythmias, (pre)diabetes, dyslipidemia and intestinal polyps- and malignancy than age- and sex matched controls. Noteworthy, cardiovascular comorbidity was lower in more recent studies. Features that most often led to diagnosis of acromegaly were typical physical changes (acral enlargement, facial changes and prognatism), local tumor effects (headache and visual defect), diabetes, thyroid cancer and menstrual disorders. CONCLUSION Acromegaly manifests itself with typical physical changes but also leads to a wide variety of common comorbidities, emphasizing that recognition of a combination of these features is key to establishing the diagnosis.
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Affiliation(s)
- Tessa N A Slagboom
- Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
| | - Christa C van Bunderen
- Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ralph De Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Madeleine L Drent
- Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
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Sakboonyarat B, Poovieng J, Srisawat P, Hatthachote P, Mungthin M, Rangsin R, Jongcherdchootrakul K. Prevalence, awareness, and control of hypertension and associated factors among Royal Thai Army personnel in Thailand from 2017 to 2021. Sci Rep 2023; 13:6946. [PMID: 37117457 PMCID: PMC10141845 DOI: 10.1038/s41598-023-34023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/22/2023] [Indexed: 04/30/2023] Open
Abstract
Hypertension (HTN) is a potential risk factor for cardiovascular diseases. We aimed to determine the prevalence, awareness, and control of HTN among RTA personnel in Thailand. We conducted a series of cross-sectional studies from 2017 to 2021. HTN was defined by systolic blood pressure (BP) ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg from a physical health examination, a history of HTN diagnosed by medical personnel, or taking antihypertensive medication. A total of 504,484 participants were included in the present study. The overall HTN prevalence was 29.4%. The prevalence of HTN among males was 30.5%, while it was 17.1% among females. Of the RTA personnel with HTN, 35.9% were aware of their condition. The overall control of HTN among RTA personnel with HTN was 15.8% in 2017 and 17.6% in 2021. Behavioral factors associated with HTN were current smoking, alcohol consumption, and sedentary behavior. A higher BMI was associated with higher HTN prevalence and HTN awareness but less likely to have controllable HTN. Male participants, younger individuals, current alcohol use, and sedentary behavior were associated with a lower prevalence of HTN awareness and controlled HTN. Current tobacco use was also associated with a lower prevalence of HTN awareness.
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Affiliation(s)
- Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Jaturon Poovieng
- Department of Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Phutsapong Srisawat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Panadda Hatthachote
- Department of Physiology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Mathirut Mungthin
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Kanlaya Jongcherdchootrakul
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
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Gupta A, Ellis SD, Burkhardt C, Young K, Mazzotti DR, Mahnken J, Abu-el-rub N, Chandaka S, Comfort B, Shanks D, Woodward J, Unrein A, Anderson H, Loucks J, Song X, Waitman LR, Burns JM. Implementing a home-based virtual hypertension programme-a pilot feasibility study. Fam Pract 2023; 40:414-422. [PMID: 35994031 PMCID: PMC10047620 DOI: 10.1093/fampra/cmac084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Implementing a health system-based hypertension programme may lower blood pressure (BP). METHODS We performed a randomized, controlled pilot study to assess feasibility, acceptability, and safety of a home-based virtual hypertension programme integrating evidence-based strategies to overcome current barriers to BP control. Trained clinical pharmacists staffed the virtual collaborative care clinic (vCCC) to remotely manage hypertension using a BP dashboard and phone "visits" to monitor BP, adherence, side effects of medications, and prescribe anti-hypertensives. Patients with uncontrolled hypertension were identified via electronic health records. Enrolled patients were randomized to either vCCC or usual care for 3 months. We assessed patients' home BP monitoring behaviour, and patients', physicians', and pharmacists' perspectives on feasibility and acceptability of individual programme components. RESULTS Thirty-one patients (vCCC = 17, usual care = 14) from six physician clinics completed the pilot study. After 3 months, average BP decreased in the vCCC arm (P = 0.01), but not in the control arm (P = 0.45). The vCCC participants measured BP more (9.9 vs. 1.2 per week, P < 0.001). There were no intervention-related adverse events. Participating physicians (n = 6), pharmacists (n = 5), and patients (n = 31) rated all programme components with average scores of >4.0, a pre-specified benchmark. Nine adaptations in vCCC design and delivery were made based on potential barriers to implementing the programme and suggestions. CONCLUSION A home-based virtual hypertension programme using team-based care, technology, and a logical integration of evidence-based strategies is safe, acceptable, and feasible to intended users. These pilot data support studies to assess the effectiveness of this programme at a larger scale.
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Affiliation(s)
- Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- KU Alzheimer’s Disease Research Center, Kansas City, KS, United States
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shellie D Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Crystal Burkhardt
- Department of Pharmacy, University of Kansas, Lawrence, KS, United States
| | - Kate Young
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jonathan Mahnken
- KU Alzheimer’s Disease Research Center, Kansas City, KS, United States
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Noor Abu-el-rub
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sravani Chandaka
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Branden Comfort
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Denton Shanks
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jennifer Woodward
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Amber Unrein
- KU Alzheimer’s Disease Research Center, Kansas City, KS, United States
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Heidi Anderson
- KU Alzheimer’s Disease Research Center, Kansas City, KS, United States
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jennifer Loucks
- Department of Pharmacy, University of Kansas Health System, Kansas City, KS, United States
| | - Xing Song
- Health Management and Informatics, University of Missouri, Columbia, MO, United States
| | - Lemuel R Waitman
- Health Management and Informatics, University of Missouri, Columbia, MO, United States
| | - Jeffrey M Burns
- KU Alzheimer’s Disease Research Center, Kansas City, KS, United States
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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Minhas AS, Rooney MR, Fang M, Zhang S, Ndumele CE, Tang O, Schulman SP, Michos ED, McEvoy JW, Echouffo-Tcheugui JB, Christenson R, Selvin E. Prevalence and Correlates of Elevated NT-proBNP in Pregnant Women in the General U.S. Population. JACC. ADVANCES 2023; 2:100265. [PMID: 37168845 PMCID: PMC10168650 DOI: 10.1016/j.jacadv.2023.100265] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 01/19/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Physiologic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) across trimesters of pregnancy have not been well studied. OBJECTIVES The authors aimed to measure NT-proBNP in adult women, by pregnancy status and trimester, in a nationally representative sample from the National Health and Nutrition Examination Survey 1999 to 2004. METHODS We conducted a cross-sectional analysis of 2,134 women (546 pregnant) aged 20 to 40 years without a history of cardiovascular disease. RESULTS Among pregnant women in the first trimester, the prevalence of elevated NT-proBNP (>125 pg/mL) was 20.0% (SE, 6.6%) compared to 2.4% (SE, 0.8%) among women in the third trimester and 8.0% among nonpregnant women. After adjustment for demographics and cardiovascular risk factors, NT-proBNP was 44% higher (absolute difference 26.4 [95% CI: 11.2-41.6] pg/mL) in the first trimester of pregnancy compared to nonpregnant women. Among pregnant women only, adjusted NT-proBNP was 46% lower (absolute difference -22.2 [95% CI: -36.9 to -7.5] pg/mL) in women in the third trimester compared to women in the first trimester. NT-proBNP was inversely associated with body mass index and with systolic blood pressure. CONCLUSIONS Women in the first trimester of pregnancy had significantly higher NT-proBNP than those in the third trimester and compared to similarly aged nonpregnant women. The dynamic nature of NT-proBNP should be taken into consideration when ordering NT-proBNP lab tests in pregnant women.
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Affiliation(s)
- Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary R. Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Fang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sui Zhang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olive Tang
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Steven P. Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J. William McEvoy
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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The clinical impact of anti-hypertensive treatment drug-gene pairs in the asian population: a systematic review of publications in the past decade. J Hum Hypertens 2023; 37:170-180. [PMID: 36302845 DOI: 10.1038/s41371-022-00765-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/17/2022] [Accepted: 09/30/2022] [Indexed: 11/08/2022]
Abstract
Pharmacogenetics play an important role in determining the anti-hypertensive effects of blood pressure-lowering medications and have the potential to improve future patient care. Current literature on the topic, however, has a heavy focus on Caucasians and may not be generalisable to the Asian populations. Therefore, we have conducted this systematic review to summarise and evaluate the literature of the past decade. PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for relevant studies from 1 January 2011 to 23 July 2021. The outcome of interest was the response to anti-hypertensive treatment in Asians according to each genetic polymorphism. A total of 26 studies with a total of 8837 patients were included in our review, covering five classes of anti-hypertensive agents-namely, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), beta-blockers (BB), calcium channel blockers (CCB), and thiazide-like diuretics. Response to ACEI therapy was most susceptible to genotypic variations, while the efficacy of ARB and CCB were affected by pharmacogenetic differences to varying extent. For BB, only variations in the ADRB1 genotype significantly affects therapeutic response, while the therapeutic efficacy of thiazide-like diuretics was correlated with genotypic variations in the REN and ACE. This systematic review evaluated the impact of pharmacogenetic variations on the therapeutic efficacy of anti-hypertensive treatment in Asians and has described numerous drug-gene pairs that are potentially clinically important. Future prospective studies with larger sample sizes and longer follow-up periods are needed to better elucidate the impact of these drug-gene pairs.
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Wang W, Sa R, Dang S, Qiu L, Liu F. Prevalence, awareness, treatment, and control of hypertension and their risk factors in Shaanxi Province in 2004-18. Sci Rep 2023; 13:2548. [PMID: 36781890 PMCID: PMC9925732 DOI: 10.1038/s41598-023-28407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
To investigate trends in the prevalence, awareness, treatment and control of hypertension and their demographic determinants in Shaanxi Province. Six successive cross-sectional surveys on non-communicable chronic diseases and their risk factors were conducted between 2004 and 2018 in Shaanxi. Complex multistage stratified sampling was adopted to select participants. The information was collected through face-to-face interviews and on-site health examinations. Changes in hypertension prevalence and its management across survey years were estimated. Demographics associated with hypertension prevalence and its management was explored by multivariable logistic regression using pooled data from 2004 to 2018. The prevalence of hypertension increased from 16.71% in 2004 to 31.96% in 2018 with an estimated increase of 1.09% (95% CI 0.31-1.87) per year. However, the rate of awareness, treatment and control among these with hypertension was unexpectedly low and there were no significant change from 2004 to 2018. The corresponding changes were - 0.08% (95% CI - 0.85-0.69) per year for awareness, - 0.06% (95% CI - 1.11-1.00) per year for treatment, and - 0.23% (95% CI - 0.53-0.07) per year for control, respectively. Sensitivity analysis showed the same trend. Adults who were old, male, divorced/Widowed/Separated, retired were more likely to develop hypertension. Among these with hypertension, those who were more educated and retired were more likely to manage their hypertension compared with their counterparts. The overall hypertension prevalence from 2004 to 2018 increased rapidly, while awareness, treatment and control of hypertension remained unexpectedly low. This suggested urgent intervention should be implemented to improve hypertension control in Shaanxi Province.
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Affiliation(s)
- Weihua Wang
- Shaanxi Provincial Center for Disease Control and Prevention, No.3, Jiandong Road, Xi'an, Shaanxi, People's Republic of China
| | - Rina Sa
- Shaanxi Provincial Center for Disease Control and Prevention, No.3, Jiandong Road, Xi'an, Shaanxi, People's Republic of China
| | - Shaonong Dang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, People's Republic of China
| | - Lin Qiu
- Shaanxi Provincial Center for Disease Control and Prevention, No.3, Jiandong Road, Xi'an, Shaanxi, People's Republic of China.
| | - Feng Liu
- Shaanxi Provincial Center for Disease Control and Prevention, No.3, Jiandong Road, Xi'an, Shaanxi, People's Republic of China.
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Parra-Gómez LA, Galeano L, Chacón-Manosalva M, Camacho P. [Barriers to knowledge, treatment, and control of hypertension in Latin America: a scoping reviewBarreiras ao conhecimento, tratamento e controle da hipertensão arterial na América Latina: uma revisão de escopo]. Rev Panam Salud Publica 2023; 47:e26. [PMID: 36788962 PMCID: PMC9910558 DOI: 10.26633/rpsp.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/26/2022] [Indexed: 02/11/2023] Open
Abstract
Objective Group the barriers to knowledge, treatment, and control of hypertension in patients in Latin America through a scoping review. Methods A scoping review was conducted in accordance with the Arksey and O'Malley methodological framework and the PRISMA guidelines for systematic reviews and meta-analyses. Searches were carried out in the PubMed, Virtual Health Library, and Scopus databases. Blind and independent selection was conducted in the RAYYAN QCRI application. Finally, the results of the selected studies were addressed narratively. Results Eight qualitative and quantitative studies that fit the research question were included. The most frequently described barriers are systemic barriers that hinder comprehensive and equitable access to health care and medication, as well as a lack of educational programs, personalized interventions to improve adherence to treatments, and lifestyle changes. Economic factors are critical in Latin America, hindering access to the health system and changes to lifestyles due to the costs of transportation, medical appointments, and medicines. Conclusions The detected barriers affect all dimensions of adherence to treatment; among the most important barriers are decision makers who lack education and positioning with respect to care of hypertension.
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Affiliation(s)
- Laura Alejandra Parra-Gómez
- Subdirección de Investigación, Innovación y EducaciónClínica FOSCALFloridablancaColombiaSubdirección de Investigación, Innovación y Educación, Clínica FOSCAL, Floridablanca, Colombia.
| | - Luis Galeano
- Subdirección de Investigación, Innovación y EducaciónClínica FOSCALFloridablancaColombiaSubdirección de Investigación, Innovación y Educación, Clínica FOSCAL, Floridablanca, Colombia.
| | - María Chacón-Manosalva
- Subdirección de Investigación, Innovación y EducaciónClínica FOSCALFloridablancaColombiaSubdirección de Investigación, Innovación y Educación, Clínica FOSCAL, Floridablanca, Colombia.
| | - Paul Camacho
- Subdirección de Investigación, Innovación y EducaciónClínica FOSCALFloridablancaColombiaSubdirección de Investigación, Innovación y Educación, Clínica FOSCAL, Floridablanca, Colombia.
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Serum lactate dehydrogenase is associated with impaired lung function: NHANES 2011-2012. PLoS One 2023; 18:e0281203. [PMID: 36730242 PMCID: PMC9894433 DOI: 10.1371/journal.pone.0281203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Serum lactate dehydrogenase levels reflect disease status in a variety of organs, but its role in indicating pulmonary function is not yet clear. Therefore, this study explored the correlation between pulmonary function and serum lactate dehydrogenase, and investigated thresholds for changes in pulmonary function indicators in the total population as well as in different strata of the population. METHODS Based on data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 (n = 3453), univariate and stratified analyses were performed to investigate factors associated with pulmonary function, and multiple regression analysis was used to further investigate the specific relationship with serum lactate dehydrogenase. Smoothed curve fitting, threshold effect and saturation effect analysis were used to explore the threshold level of serum lactate dehydrogenase at the onset of changes in pulmonary function indicators. RESULTS Adjusted smoothed curve fit plots showed a linear relationship between serum lactate dehydrogenase levels and forced vital capacity and forced expiratory volume in one second: for each 1 U/L increase in serum lactate dehydrogenase levels, forced vital capacity decreased by 1.24 mL (95% CI = -2.05, -0.42, P = 0.0030) and forced expiratory volume in one second by 1.11 mL (95% CI = -1.82, -0.39, P = 0.0025). CONCLUSIONS Serum lactate dehydrogenase was negatively and linearly correlated with pulmonary function indices in the total population analyzed. Based on the total population and different population stratifications, this study determined the threshold values of serum lactate dehydrogenase at the onset of decline of pulmonary function in different populations. This provides a new serological monitoring indicator for patients suffering from respiratory diseases and has implications for patients with possible clinical impairment of pulmonary function. However, our cross-sectional study was not able to determine a causal relationship between these two factors, and further research is needed.
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Bo Y, Yu T, Guo C, Chang LY, Huang J, Wong MCS, Tam T, Lao XQ. Isolated systolic or diastolic hypertension and mortality risk in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline: a longitudinal cohort study. J Hypertens 2023; 41:271-279. [PMID: 36583352 DOI: 10.1097/hjh.0000000000003325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is known regarding the health effects of different hypertension phenotypes including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH) defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline among young adults. We conducted this longitudinal study using time-varying analyses to evaluate the relationship between cardiovascular/all-natural mortality risk and different hypertension phenotypes in young adults. METHODS A total of 284 597 young adults (aged 18-39 years) were recruited between 1996 and 2016. Participants were classified into eight mutually exclusive BP groups: normal blood pressure (BP), elevated BP, stage 1 IDH, stage 1 ISH, stage 1 SDH, stage 2 IDH, stage 2 ISH, and stage 2 SDH. The outcomes were cardiovascular and all-natural mortality. RESULTS After a median follow-up of 15.8 years, 2341 all-natural deaths with 442 cardiovascular deaths were observed. When compared with individuals with normal BP, the multivariable adjusted hazard ratios (95% confidence interval) of cardiovascular mortality was 1.39 (1.01-1.93) for elevated BP, 2.00 (1.45-2.77) for stage 1 IDH, 1.66 (1.08-2.56) for stage 1 ISH, 3.08 (2.13-4.45) for stage 1 SDH, 2.85 (1.76-4.62) for stage 2 IDH, 4.30 (2.96-6.25) for stage 2 ISH, and 6.93 (4.99-9.61) for stage 2 SDH, respectively. In consideration to all-natural mortality, similar results were observed for stage 1 SDH, stage 2 ISH, and stage 2 SDH; but not for elevated BP, stage 1 IDH, stage 1 ISH, and stage 2 IDH. CONCLUSION Young adults with stage 1 or stage 2 ISH, IDH, and SDH are at increased risk of cardiovascular death than those with normal BP. Regardless of BP stage, SDH was associated with a higher cardiovascular mortality risk than IDH and ISH.
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Affiliation(s)
- Yacong Bo
- School of Public Health, Zhengzhou University, Henan, China
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | - Cui Guo
- Department of Urban Planning and Design, University of Hong Kong, Hong Kong
| | | | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong
| | - Tony Tam
- Department of Sociology, The Chinese University of Hong Kong
| | - Xiang Qian Lao
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong
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Anceschi U, Mormando M, Flammia RS, Fiori C, Zappalà O, De Concilio B, Brassetti A, Carrara A, Ferriero MC, Tuderti G, Misuraca L, Prata F, Tufano A, Bove AM, Mastroianni R, Appetecchia M, Tirone G, Porpiglia F, Celia A, Simone G. The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series. J Clin Med 2023; 12:997. [PMID: 36769646 PMCID: PMC9917842 DOI: 10.3390/jcm12030997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. METHODS Between 2011 and 2022, a four-center adrenalectomy dataset was queried for "unilateral adrenal mass" and "UPA" (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan-Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. RESULTS At a median follow-up of 42 months (IQR 27-54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan-Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11-0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1-1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32-6.1; p = 0.007) was the only independent predictor of absent clinical success. CONCLUSIONS TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery.
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Affiliation(s)
- Umberto Anceschi
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Marilda Mormando
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Rocco Simone Flammia
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Cristian Fiori
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Orazio Zappalà
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Bernardino De Concilio
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Aldo Brassetti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Alessandro Carrara
- APSS, Santa Maria del Carmine Hospital, Department of General Surgery, Corso Verona, 38068 Rovereto, Italy
| | - Maria Consiglia Ferriero
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Gabriele Tuderti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Leonardo Misuraca
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Francesco Prata
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Antonio Tufano
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Alfredo Maria Bove
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Marialuisa Appetecchia
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Giuseppe Tirone
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Francesco Porpiglia
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Antonio Celia
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
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Zhang Z, Zhao L, Zhou X, Meng X, Zhou X. Role of inflammation, immunity, and oxidative stress in hypertension: New insights and potential therapeutic targets. Front Immunol 2023; 13:1098725. [PMID: 36703963 PMCID: PMC9871625 DOI: 10.3389/fimmu.2022.1098725] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Hypertension is regarded as the most prominent risk factor for cardiovascular diseases, which have become a primary cause of death, and recent research has demonstrated that chronic inflammation is involved in the pathogenesis of hypertension. Both innate and adaptive immunity are now known to promote the elevation of blood pressure by triggering vascular inflammation and microvascular remodeling. For example, as an important part of innate immune system, classically activated macrophages (M1), neutrophils, and dendritic cells contribute to hypertension by secreting inflammatory cy3tokines. In particular, interferon-gamma (IFN-γ) and interleukin-17 (IL-17) produced by activated T lymphocytes contribute to hypertension by inducing oxidative stress injury and endothelial dysfunction. However, the regulatory T cells and alternatively activated macrophages (M2) may have a protective role in hypertension. Although inflammation is related to hypertension, the exact mechanisms are complex and unclear. The present review aims to reveal the roles of inflammation, immunity, and oxidative stress in the initiation and evolution of hypertension. We envisage that the review will strengthen public understanding of the pathophysiological mechanisms of hypertension and may provide new insights and potential therapeutic strategies for hypertension.
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Affiliation(s)
| | | | | | - Xu Meng
- *Correspondence: Xianliang Zhou, ; Xu Meng,
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