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Zhang T, Yang S, Liu W, Bai Q, Gao S. Tai Chi training as a primary care plan for the prevention and management of hypertension: an opinion and positioning article. Ann Med 2024; 56:2320863. [PMID: 38373214 PMCID: PMC10878327 DOI: 10.1080/07853890.2024.2320863] [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: 10/19/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
Hypertension is a prevalent chronic condition worldwide that can impact patients' quality of life. Oral antihypertensive drugs are widely used to manage high blood pressure, primarily by regulating the renin-angiotensin-aldosterone system. Nevertheless, limited efficacy and low compliance represent significant obstacles, arising primarily from dose, duration, and medication type restrictions. Furthermore, the prolonged use of antihypertensive medication may result in dependence and adverse effects, without any substantial improvement in achieving targeted blood pressure leves. As a result, research has focused on using exercise therapy to treat hypertension. Tai Chi, a widely-practiced Chinese health exercise, has evolved into a form of exercise therapy that might help alleviate the risk associated with hypertension. Therefore, this article aims to outline the role of Tai Chi in preventing and managing hypertension.
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Affiliation(s)
- Ting Zhang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- University Hospital, Zhejiang Normal University, Jinhua, China
| | - Shuman Yang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Wei Liu
- Physical Education College, Guangxi University of Science and Technology, Liuzhou, China
| | - Qingping Bai
- Physical Education College, Guangxi University of Science and Technology, Liuzhou, China
| | - Song Gao
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
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2
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Wong ELY, Xu RH, Cheung AWL. Health-related quality of life among patients with hypertension: population-based survey using EQ-5D-5L in Hong Kong SAR, China. BMJ Open 2019; 9:e032544. [PMID: 31562165 PMCID: PMC6773333 DOI: 10.1136/bmjopen-2019-032544] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To evaluate the effect of hypertension and related comorbidities on the health-related quality of life (HRQoL) using EuroQol 5-dimensions instrument with five-level scale (EQ-5D-5L) Hong Kong (HK) version. DESIGN Data were analysed by a secondary data analysis based on a cross-sectional study assessing experience on public specialist outpatient service. SETTING A representative sample was recruited from 26 specialist outpatient clinics in HK. PARTICIPANTS A total of 4528 patients with hypertension aged 18 or above who responded to the survey. INTERVENTION EQ-5D-5L HK was applied to assess the HRQoL. The five-dimension descriptive system and the utility index of EQ-5D-5L were treated as the dependent variable in the current study. Regression modelling was applied to estimate the effect of hypertension and related comorbidities on health-related quality of life. RESULTS More respondents were women (53.9%), aged ≥65 years old (60.1%), and with primary educational attainment or below (52.3%). A total of 1466 respondents (32.4%) also reported suffering from diabetes, heart disease (20.8%), vision problem (1.7%) and cancer (1.5%). In the ordinal least squares model, utility decreased most when patients reported having physical disability associated with hypertension (beta=-0.395, SE=0.047), and 0.128, 0.064, 0.05 and 0.048 for mental problem, cancer, vision problem and heart problem. In the Tobit model, the utility reduced most for comorbidity of physical disability, and then mental problem, cancer, vision problem, heart problem and diabetes. For first part of two-part model, respondents coliving with mental problem were 10% less likely to report a full health. For the second part of two-part model, the respondents with physical disability had 0.294 lower in utility. CONCLUSIONS Respondents with hypertension reported a low EQ-5D utility score. Respondents were women, with a high education, fully employed and living with families reported better HRQoL. There is a significant effect of comorbidity influence on the decreased HRQoL, particularly those with physical disability and mental problem.
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Affiliation(s)
- Eliza Lai Yi Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Richard Huan Xu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Annie Wai Ling Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Cao J, Eshak ES, Liu K, Gero K, Liu Z, Yu C. Age-Period-Cohort Analysis of Stroke Mortality Attributable to High Sodium Intake in China and Japan. Stroke 2019; 50:1648-1654. [PMID: 31195942 PMCID: PMC6594775 DOI: 10.1161/strokeaha.118.024617] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Purpose- The aim of this study is to assess the long-term trends in stroke mortality attributable to high sodium intake in China and Japan during the period 1990 to 2016. Methods- The mortality data were obtained from the GBD study (Global Burden of Disease) 2016 and were analyzed using an age-period-cohort method. Results- The age-standardized mortality rates showed declining trends for high sodium intake-related stroke mortality. The overall net drifts per year were -3.1% for Chinese men and -5.0% for Chinese women; and -4.6% for Japanese men and -5.7% for Japanese women. The local drift values were below zero in all age groups for both sexes in both countries, and all local drift values of female participants were below their counterparts of male participants. The longitudinal age curves of high sodium intake-attributable stroke mortality increased rapidly for both sexes in China, whereas those of Japanese were slowly rising. The period and cohort rate ratios were found to have similar downward patterns for both sexes in both countries, with a quicker decline for women than for men (significantly with P<0.05 for all). Conclusions- The age-standardized mortality rates, the period effect and the cohort effect of stroke mortality attributable to high sodium intake in China and Japan have been declining in both sexes and all age groups from 1990 to 2016. Consequently, sodium-reduction strategies are of low cost and effective for the prevention of stroke. It is necessary to educate the nation with the correct knowledge on healthy diet and techniques to reduce salt consumption.
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Affiliation(s)
- Jinhong Cao
- From the Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, China (J.C. and C.Y.)
| | - Ehab S Eshak
- Department of Public Health, Community and Preventive Medicine, Faculty of Medicine, Minia University, Egypt (E.S.E).,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Japan (E.S.E., K.L.)
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Japan (E.S.E., K.L.)
| | - Krisztina Gero
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (K.G.)
| | | | - Chuanhua Yu
- From the Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, China (J.C. and C.Y.)
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Ayalasomayajula S, Langenickel T, Pal P, Boggarapu S, Sunkara G. Clinical Pharmacokinetics of Sacubitril/Valsartan (LCZ696): A Novel Angiotensin Receptor-Neprilysin Inhibitor. Clin Pharmacokinet 2018; 56:1461-1478. [PMID: 28417439 DOI: 10.1007/s40262-017-0543-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sacubitril/valsartan (LCZ696) is indicated for the treatment of heart failure with reduced ejection fraction. Absorption of sacubitril/valsartan and conversion of sacubitril (prodrug) to sacubitrilat (neprilysin inhibitor) was rapid with maximum plasma concentrations of sacubitril, sacubitrilat, and valsartan (angiotensin receptor blocker) reaching within 0.5, 1.5-2.0, and 2.0-3.0 h, respectively. With a two-fold increase in dose, an increase in the area under the plasma concentration-time curve was proportional for sacubitril, ~1.9-fold for sacubitrilat, and ~1.7-fold for valsartan in healthy subjects. Following multiple twice-daily administration, steady-state maximum plasma concentration was reached within 3 days, showing no accumulation for sacubitril and valsartan, while ~1.6-fold accumulation for sacubitrilat. Sacubitril is eliminated predominantly as sacubitrilat through the kidney; valsartan is eliminated mainly by biliary route. Drug-drug interactions of sacubitril/valsartan were evaluated with medications commonly used in patients with heart failure including furosemide, warfarin, digoxin, carvedilol, levonorgestrel/ethinyl estradiol combination, amlodipine, omeprazole, hydrochlorothiazide, intravenous nitrates, metformin, statins, and sildenafil. Co-administration with sacubitril/valsartan increased the maximum plasma concentration (~2.0-fold) and area under the plasma concentration-time curve (1.3-fold) of atorvastatin; however, it did not affect the pharmacokinetics of simvastatin. Age, sex, or ethnicity did not affect the pharmacokinetics of sacubitril/valsartan. In patients with heart failure vs. healthy subjects, area under the plasma concentration-time curves of sacubitril, sacubitrilat, and valsartan were higher by approximately 1.6-, 2.1-, and 2.3-fold, respectively. Renal impairment had no significant impact on sacubitril and valsartan area under the plasma concentration-time curves, while the area under the plasma concentration-time curve of sacubitrilat correlated with degree of renal function (1.3-, 2.3-, 2.9-, and 3.3-fold with mild, moderate, and severe renal impairment, and end-stage renal disease, respectively). Moderate hepatic impairment increased the area under the plasma concentration-time curves of valsartan and sacubitrilat ~2.1-fold.
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Affiliation(s)
- Surya Ayalasomayajula
- Clinical Pharmacology, Allergan PLC, Suite 1900, Harborside V, 185 Hudson Street, Jersey, NJ, 07311, USA.
| | - Thomas Langenickel
- Novartis Institutes for Biomedical Research, Translational Medicine, Novartis Pharma AG, Basel, Switzerland
| | - Parasar Pal
- Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | | | - Gangadhar Sunkara
- Clinical Pharmacology, Allergan PLC, Suite 1900, Harborside V, 185 Hudson Street, Jersey, NJ, 07311, USA
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Ayalasomayajula S, Langenickel T, Pal P, Boggarapu S, Sunkara G. Erratum to: Clinical Pharmacokinetics of Sacubitril/Valsartan (LCZ696): A Novel Angiotensin Receptor-Neprilysin Inhibitor. Clin Pharmacokinet 2017; 57:105-123. [PMID: 28527109 DOI: 10.1007/s40262-017-0558-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sacubitril/valsartan (LCZ696) is indicated for the treatment of heart failure with reduced ejection fraction. Absorption of sacubitril/valsartan and conversion of sacubitril (prodrug) to sacubitrilat (neprilysin inhibitor) was rapid with maximum plasma concentrations of sacubitril, sacubitrilat, and valsartan (angiotensin receptor blocker) reaching within 0.5, 1.5-2.0, and 2.0-3.0 h, respectively. With a twofold increase in dose, an increase in the area under the plasma concentration-time curve was proportional for sacubitril, ~1.9-fold for sacubitrilat, and ~1.7-fold for valsartan in healthy subjects. Following multiple twice-daily administration, steady-state maximum plasma concentration was reached within 3 days, showing no accumulation for sacubitril and valsartan, while ~1.6-fold accumulation for sacubitrilat. Sacubitril is eliminated predominantly as sacubitrilat through the kidney; valsartan is eliminated mainly by biliary route. Drug-drug interactions of sacubitril/valsartan were evaluated with medications commonly used in patients with heart failure including furosemide, warfarin, digoxin, carvedilol, levonorgestrel/ethinyl estradiol combination, amlodipine, omeprazole, hydrochlorothiazide, intravenous nitrates, metformin, statins, and sildenafil. Co-administration with sacubitril/valsartan increased the maximum plasma concentration (~2.0-fold) and area under the plasma concentration-time curve (1.3-fold) of atorvastatin; however, it did not affect the pharmacokinetics of simvastatin. Age, sex, or ethnicity did not affect the pharmacokinetics of sacubitril/valsartan. In patients with heart failure vs. healthy subjects, area under the plasma concentration-time curves of sacubitril, sacubitrilat, and valsartan were higher by approximately 1.6-, 2.1-, and 2.3-fold, respectively. Renal impairment had no significant impact on sacubitril and valsartan area under the plasma concentration-time curves, while the area under the plasma concentration-time curve of sacubitrilat correlated with degree of renal function (1.3-, 2.3-, 2.9-, and 3.3-fold with mild, moderate, and severe renal impairment, and end-stage renal disease, respectively). Moderate hepatic impairment increased the area under the plasma concentration-time curves of valsartan and sacubitrilat ~2.1-fold.
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Affiliation(s)
| | - Thomas Langenickel
- Novartis Institutes for Biomedical Research, Translational Medicine, Novartis Pharma AG, Basel, Switzerland
| | - Parasar Pal
- Novartis Healthcare Private Limited, Hyderabad, India
| | | | - Gangadhar Sunkara
- Novartis Institutes for Biomedical Research, Clinical PKPD, East Hanover, NJ, USA
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6
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Efficacy and safety of sacubitril/valsartan (LCZ696) add-on to amlodipine in Asian patients with systolic hypertension uncontrolled with amlodipine monotherapy. J Hypertens 2017; 35:877-885. [DOI: 10.1097/hjh.0000000000001219] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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7
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Tran KC, Leung AA, Tang KL, Quan H, Khan NA. Efficacy of Calcium Channel Blockers on Major Cardiovascular Outcomes for the Treatment of Hypertension in Asian Populations: A Meta-analysis. Can J Cardiol 2017; 33:635-643. [PMID: 28377067 DOI: 10.1016/j.cjca.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Whether calcium channel blockers exert a greater effect on cardiovascular risk reduction in Asian populations than other antihypertensive agents is unclear. We conducted a meta-analysis of hypertension trials of dihydropyridine calcium channel blockers in Asian populations to clarify this association. METHODS EMBASE, MEDLINE, and Cochrane databases were searched (from inception to August 2016) for randomized controlled trials on cardiovascular death, major adverse cardiovascular events, stroke, congestive heart failure, and coronary revascularization in Asian persons with hypertension. We identified 9 trials that reported data specific to Asian populations (N = 29,643). These trials included 1 placebo-controlled trial and 8 active comparator trials; of these, 5 had angiotensin receptor blockers as the active comparator. RESULTS One placebo-controlled trial (n = 9711) showed significantly reduced cardiovascular mortality, major adverse cardiovascular events, and stroke with calcium channel blockers. Among 8 active comparator trials (n = 19,932), there were no significant differences in mortality (relative risk [RR], 1.10; 95% confidence interval [CI], 0.72-1.67; I2 = 0.0%), major adverse cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I2 = 0.0%), stroke (RR, 0.97; 95% CI, 0.80-1.17; I2 = 0.0%), congestive heart failure (RR, 1.01; 95% CI, 0.51-2.00; I2 = 53.7), or coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25; I2 = 0.0%) in the calcium channel blocker group compared with other antihypertensive agents. When restricting the meta-analysis to angiotensin receptor blocker comparators (n = 10,384), there were no significant differences in cardiovascular outcomes. CONCLUSIONS There is no evidence that dihydropyridine calcium channel blockers are superior to other antihypertensive agents in Asian populations for the treatment of hypertension.
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Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nadia A Khan
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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8
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Shen Y, Peng X, Wang M, Zheng X, Xu G, Lü L, Xu K, Burstrom B, Burstrom K, Wang J. Family member-based supervision of patients with hypertension: a cluster randomized trial in rural China. J Hum Hypertens 2017; 31:29-36. [PMID: 26911532 PMCID: PMC5144121 DOI: 10.1038/jhh.2016.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
Empirical evidence has suggested that social support from family can help patients take their medicines correctly. This study aims to evaluate the role of a family member-based supervision package in the management of hypertension using a cluster randomized trial in rural China. We recruited patients with hypertension from four villages in Yangzhong and randomly allocated them to the control group (n=288) and the intervention group (n=266). A family member-based supervision package was applied to the intervention group, while the usual service was applied to the controls. Patients were followed for 12 months and completed face-to-face interviews at the end of 6 and 12 months. The primary outcomes were patients' medication adherence and frequency of blood pressure measurement. Secondary outcomes included changes in blood pressure, altered risk behaviours and occurrence of hypertension-related complications. To control for the effects of cluster randomization, multilevel mixed-effects regression models were used to compare group changes. We observed that the intervention improved patients' blood pressure measurement frequency (OR: 9.00, 95% CI: 4.52-17.91) and adherence to antihypertensive treatment (OR: 1.74, 95% CI: 0.91-3.32). Its effect on the blood pressure control rate was significant at the mid-term investigation (OR: 0.67, 95% CI: 0.40-0.93), but the long-term effect was not significant (OR: 0.89, 95% CI: 0.64-1.26). After 6 months of intervention, either systolic or diastolic blood pressure was significantly decreased in the intervention group. However, this difference was not significant at the final investigation. Findings from this study revealed that the family member-based supervised therapy may have positive effects on patients' adherence to blood monitoring and hypertensive medications.
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Affiliation(s)
- Y Shen
- Department of Gastrointestinal Surgery, Aoyoung Hospital, Zhangjiagang, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Peng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - M Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Zheng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - G Xu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - L Lü
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - K Xu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - B Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - K Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - J Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- The Innovation Center for Social Risk Governance in Health, School of Public Health, Nanjing Medical University, Nanjing, China
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An S, Bao M, Wang Y, Li Z, Zhang W, Chen S, Li J, Yang X, Wu S, Cai J. Relationship between cardiovascular health score and year-to-year blood pressure variability in China: a prospective cohort study. BMJ Open 2015; 5:e008730. [PMID: 26503389 PMCID: PMC4636657 DOI: 10.1136/bmjopen-2015-008730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES On the basis of cardiovascular health factors and behaviours, the American Heart Association proposed the Cardiovascular Health Score (CHS). It has been widely used to estimate the cardiovascular health status of individuals. The aim of this study was to investigate the relationship between CHS and year-to-year blood pressure variability (BPV). DESIGN Prospective cohort study. SETTINGS We stratified participants into two groups by gender: first group, female group; second group, male group. The relationship between CHS and year-to-year blood pressure variability were analysed. PARTICIPANTS A total of 41,613 individuals met the inclusion criteria (no history of stroke, transient ischaemic attack, myocardial infarction, malignant tumour or atrial fibrillation) and had complete blood pressure data. RESULTS The coefficient of the variation of systolic blood pressure (SCV) was 8.33% in the total population and 8.68% and 8.22% in female and male groups, respectively (p<0.05). Multivariable linear regression analysis revealed that higher CHS was inversely associated with increasing year-to-year BPV, which persisted after adjusting for baseline systolic blood pressure and other risk factors. Each SD increase in CHS could lead to a 0.016SD decrease in SCV (p<0.05). CONCLUSIONS In summary, CHS was inversely related to year-to-year BPV, which suggested that a healthy lifestyle may contribute to better blood pressure management.
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Affiliation(s)
- Shasha An
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Minghui Bao
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Zhifang Li
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Wenyan Zhang
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Junjuan Li
- Department of Nephrology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Xinchun Yang
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Jun Cai
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
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10
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Park JB, Kario K, Wang JG. Systolic hypertension: an increasing clinical challenge in Asia. Hypertens Res 2015; 38:227-36. [PMID: 25503845 PMCID: PMC4396396 DOI: 10.1038/hr.2014.169] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 12/21/2022]
Abstract
Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.
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Affiliation(s)
- Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Huang S, Chen Y, Zhou J, Wang J. Use of family member-based supervision in the management of patients with hypertension in rural China. Patient Prefer Adherence 2014; 8:1035-42. [PMID: 25114514 PMCID: PMC4125371 DOI: 10.2147/ppa.s66777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Medication nonadherence is a major problem in the management of hypertension. The aim of this study was to develop a family member-based supportive therapy for patients with hypertension to provide an affordable way to access essential health services and to ensure adequate control of blood pressure. This study applied a mixed methods approach using qualitative and quantitative study designs in Yangzhong County, a rural area in the People's Republic of China. Findings from indepth interviews demonstrated that the limited effects of traditional health education, a lack of professional advice regarding antihypertensive treatment, and age were related to a patient's adherence with regular blood pressure measurement and taking medication. We also performed a quantitative study, selecting two villages in Yangzhong County as study sites. A total of 188 patients with hypertension were invited to participate in a 6-month family member-based intervention trial. The primary outcomes were the acceptability and feasibility of the intervention strategy. Secondary outcomes included medication adherence and changes in blood pressure. More than 75% of patients expressed a wish for external reminders, and 93.5% responded that they would accept the family member-based supervision. The patients preferred their spouse or a child as the supervisor. After the 6-month intervention, the proportion of patients with uncontrolled blood pressure decreased from 87.2% to 45.7%. This pilot study shows that external supervision by family members is acceptable and feasible for patients with hypertension; it also shows favorable effects with regard to improved treatment adherence and blood pressure control. Future randomized controlled trials with modified intervention measures are needed to validate this finding.
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Affiliation(s)
- Susan Huang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Ye Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jing Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jianming Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China
- Correspondence: Jianming Wang, Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, People’s Republic of China, Email
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