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Edwards JJ, Coleman DA, Ritti-Dias RM, Farah BQ, Stensel DJ, Lucas SJE, Millar PJ, Gordon BDH, Cornelissen V, Smart NA, Carlson DJ, McGowan C, Swaine I, Pescatello LS, Howden R, Bruce-Low S, Farmer CKT, Leeson P, Sharma R, O'Driscoll JM. Isometric Exercise Training and Arterial Hypertension: An Updated Review. Sports Med 2024:10.1007/s40279-024-02036-x. [PMID: 38762832 DOI: 10.1007/s40279-024-02036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/20/2024]
Abstract
Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Damian A Coleman
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK
| | - Raphael M Ritti-Dias
- Graduate Program in Rehabilitation Sciences, University Nove de Julho, São Paulo, Brazil
| | - Breno Q Farah
- Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Sam J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Philip J Millar
- Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, College of Biological Sciences, University of Guelph, Guelph, ON, Canada
| | - Ben D H Gordon
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Debra J Carlson
- School of Health, Medical and Applied Sciences, CQ University, North Rockhampton, QLD, Australia
| | - Cheri McGowan
- Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Ian Swaine
- Sport Science, University of Greenwich, London, UK
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, 06269, USA
| | - Reuben Howden
- Department of Applied Physiology, Health and Clinical Sciences, UNC Charlotte, Charlotte, NC, 28223, USA
| | - Stewart Bruce-Low
- Department of Applied Sport and Exercise Science, University of East London, London, UK
| | | | - Paul Leeson
- Oxford Clinical Cardiovascular Research Facility, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Rajan Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, CT1 1QU, UK.
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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Andishgar A, Bazmi S, Tabrizi R, Rismani M, Keshavarzian O, Pezeshki B, Ahmadizar F. Machine learning-based models to predict the conversion of normal blood pressure to hypertension within 5-year follow-up. PLoS One 2024; 19:e0300201. [PMID: 38483860 PMCID: PMC10939282 DOI: 10.1371/journal.pone.0300201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Factors contributing to the development of hypertension exhibit significant variations across countries and regions. Our objective was to predict individuals at risk of developing hypertension within a 5-year period in a rural Middle Eastern area. METHODS This longitudinal study utilized data from the Fasa Adults Cohort Study (FACS). The study initially included 10,118 participants aged 35-70 years in rural districts of Fasa, Iran, with a follow-up of 3,000 participants after 5 years using random sampling. A total of 160 variables were included in the machine learning (ML) models, and feature scaling and one-hot encoding were employed for data processing. Ten supervised ML algorithms were utilized, namely logistic regression (LR), support vector machine (SVM), random forest (RF), Gaussian naive Bayes (GNB), linear discriminant analysis (LDA), k-nearest neighbors (KNN), gradient boosting machine (GBM), extreme gradient boosting (XGB), cat boost (CAT), and light gradient boosting machine (LGBM). Hyperparameter tuning was performed using various combinations of hyperparameters to identify the optimal model. Synthetic Minority Over-sampling Technology (SMOTE) was used to balance the training data, and feature selection was conducted using SHapley Additive exPlanations (SHAP). RESULTS Out of 2,288 participants who met the criteria, 251 individuals (10.9%) were diagnosed with new hypertension. The LGBM model (determined to be the optimal model) with the top 30 features achieved an AUC of 0.67, an f1-score of 0.23, and an AUC-PR of 0.26. The top three predictors of hypertension were baseline systolic blood pressure (SBP), gender, and waist-to-hip ratio (WHR), with AUCs of 0.66, 0.58, and 0.63, respectively. Hematuria in urine tests and family history of hypertension ranked fourth and fifth. CONCLUSION ML models have the potential to be valuable decision-making tools in evaluating the need for early lifestyle modification or medical intervention in individuals at risk of developing hypertension.
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Affiliation(s)
- Aref Andishgar
- USERN Office, Fasa University of Medical Sciences, Fasa, Iran
| | - Sina Bazmi
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Reza Tabrizi
- Noncommunicable Diseases Research Center, Fasa University of Medical Science, Fasa, Iran
| | - Maziyar Rismani
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Omid Keshavarzian
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Pezeshki
- Clinical Research Development Unit, Valiasr Hospital, Fasa University of Medical Sciences, Fasa, Iran
| | - Fariba Ahmadizar
- Department of Data Science and Biostatistics, Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands
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3
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Jeoung B. The relationship between blood pressure and functional fitness of older adults in Korea. J Exerc Rehabil 2024; 20:11-16. [PMID: 38433856 PMCID: PMC10902697 DOI: 10.12965/jer.2346596.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 03/05/2024] Open
Abstract
Hypertension, also known as high blood pressure (BP), is a critical health issue that can cause cardiovascular disease. It is observed more frequently in older adults. Thus, this study aimed to identify the functional fitness and body composition factors that significantly influence both systolic and diastolic BPs in older adults. Data from 155,266 older adults (51,751 men [33.3%] and 103,505 women [66.7%]) who underwent functional fitness tests between 2013 and 2018 were analyzed. The following seven functional fitness tests were conducted: (a) aerobic endurance (2-min step), (b) upper body muscle strength (hand grip strength), (c) lower body muscle endurance (chair sit-and-stand), (d) flexibility (sit-and-reach), (e) agility (Timed Up and Go), and (f) body composition (body mass index [BMI] and body fat percentage). Systolic and diastolic BPs were used as outcome variables. In examining the proposed relationships, the regression analysis revealed that BMI, body fat percentage, sit-and-reach, 2-min step, hand grip, chair sit-and-stand, and Timed Up and Go were significantly associated with reduced systolic and diastolic body pressures.
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Affiliation(s)
- Bogja Jeoung
- Department of Exercise Rehabilitation & Welfare, College of Health Science, Gachon University, Incheon,
Korea
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Ross SM, Wang A, Anthony L, Persell SD, Yu J, Kho AN. Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices. J Hum Hypertens 2023; 37:1007-1014. [PMID: 36949284 PMCID: PMC10514225 DOI: 10.1038/s41371-023-00813-1] [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: 04/12/2022] [Revised: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 03/24/2023]
Abstract
Interventions for blood pressure (BP) control have positive effects on outcomes for patients with hypertension. Research on these effects in small- and medium-sized practices is limited. Our retrospective analysis used data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016-2018 as part of the Agency for Healthcare Research and Quality's EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. Thirty-eight H3 practices met inclusion criteria and were assigned to an implementer group (high or low) based on the number of interventions implemented with the support of a practice facilitator during the study. Practices in the high-implementer group implemented a mean of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had greater improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were greater for the high-implementer group. These outcomes show that implementing additional interventions had a positive association with measures of BP control, though clinical significance was unknown or limited. Future research is needed to understand the impact of interventions for BP control in small- and medium-sized practices, including the interactions among intervention implementation, practice facilitation, and practice and patient characteristics.
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Affiliation(s)
- Samuel M Ross
- Center for Health Information Partnerships, Institute for Public Health & Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Andrew Wang
- Center for Health Information Partnerships, Institute for Public Health & Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Health Services and Outcomes Research, Institute for Public Health & Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Stephen D Persell
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jingzhi Yu
- Center for Health Information Partnerships, Institute for Public Health & Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Abel N Kho
- Center for Health Information Partnerships, Institute for Public Health & Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Edwards JJ, Deenmamode AHP, Griffiths M, Arnold O, Cooper NJ, Wiles JD, O'Driscoll JM. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Br J Sports Med 2023; 57:1317-1326. [PMID: 37491419 DOI: 10.1136/bjsports-2022-106503] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices. DESIGN Systematic review and network meta-analysis. DATA SOURCES PubMed (Medline), the Cochrane library and Web of Science were systematically searched. ELIGIBILITY CRITERIA Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included. RESULTS 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (-4.49/-2.53 mm Hg, p<0.001), dynamic resistance training (-4.55/-3.04 mm Hg, p<0.001), combined training (-6.04/-2.54 mm Hg, p<0.001), high-intensity interval training (-4.08/-2.50 mm Hg, p<0.001) and isometric exercise training (-8.24/-4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively. CONCLUSION Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Algis H P Deenmamode
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Megan Griffiths
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Oliver Arnold
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jonathan D Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
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Zamandi M, Daroudi R, Sari AA. Direct Costs of Hypertension Treatment in Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1973-1983. [PMID: 38033845 PMCID: PMC10682570 DOI: 10.18502/ijph.v52i9.13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2023]
Abstract
Background Hypertension is a common public health problem with potentially serious consequences. We aimed to explore the direct costs of hypertension treatment in Iran. Methods Literature review and STEPS survey were used to estimate the incidence and prevalence of hypertension for Iranian males and females and the proportion of its treatment coverage in 2020. A standard national protocol for hypertension treatment was used to estimate the required medical services including visits, medications, and lab tests. The cost of each service and the total cost of the disease were identified using the national reference costs. Results About 23.39 million people suffer from moderate systolic blood pressure (BP of 120 to 139 mm/Hg) and a further 14.6 million people had severe BP (≥140 mm/Hg). Nearby 39.8% of these patients, receive BP treatment. The direct costs of hypertension treatment were 19,006.08 billion IR Rials (USD 87.54 million), of which 16.60% and 83.40% of the costs were related to new and prior cases, respectively. The costs of patient visits, medications, and lab tests were 56%, 35.51%, and 8.49% of the total costs, respectively. Conclusion The prevalence and economic burden of hypertension are relatively high in Iran. Early detection and treatment of hypertension might have a significant effect on reducing its complications and costs.
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Affiliation(s)
- Mahmoud Zamandi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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7
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Nakagami H. Challenges in the development of novel therapies, vaccines and siRNAs for the treatment of hypertension. Hypertens Res 2023; 46:1812-1815. [PMID: 37169884 DOI: 10.1038/s41440-023-01302-1] [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] [Received: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Hironori Nakagami
- Department of Health Development and Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, Japan.
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8
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Addison ML, Ranasinghe P, Webb DJ. Emerging insights and future prospects for therapeutic application of siRNA targeting angiotensinogen in hypertension. Expert Rev Clin Pharmacol 2023; 16:1025-1033. [PMID: 37897397 DOI: 10.1080/17512433.2023.2277330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/26/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Hypertension is the main global risk factor for cardiovascular disease. Despite this, less than half of treated hypertensive patients are controlled. One reason for this is nonadherence, a major unmet need in hypertension pharmacotherapy. Small interfering RNA (small interfering ribonucleic acid) therapies inhibit protein translation, and, when linked to N-acetylgalactosamine, allow liver-specific targeting, and durability over several months. Targeted knockdown of hepatic angiotensinogen, the source of all angiotensins, offers a precision medicine approach. AREAS COVERED This article describes the molecular basis for durability over months and the 24-h tonic target inhibition observed after one administration. We present an analysis of the published phase I trials using zilebesiran, a siRNA targeting hepatic angiotensinogen, which reduces blood pressure (BP) by up to 20 mmHg, lasting 24 weeks. Finally, we examine data evaluating reversibility of angiotensinogen knockdown and its relevance to the future clinical utility of zilebesiran. EXPERT OPINION Further studies should assess safety, efficacy, and outcomes in larger, more broadly representative groups. An advantage of zilebesiran is the potential for bi-annual dosing, thereby reducing nonadherence and improving control rates. It may also reduce nighttime BP due to 24-h tonic control. The provision of adherence assessment services will maximize the clinical value of zilebesiran.
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Affiliation(s)
- Melisande L Addison
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Priyanga Ranasinghe
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - David J Webb
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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9
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Nghiem N, Atkinson J, Nguyen BP, Tran-Duy A, Wilson N. Predicting high health-cost users among people with cardiovascular disease using machine learning and nationwide linked social administrative datasets. HEALTH ECONOMICS REVIEW 2023; 13:9. [PMID: 36738348 PMCID: PMC9898915 DOI: 10.1186/s13561-023-00422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To optimise planning of public health services, the impact of high-cost users needs to be considered. However, most of the existing statistical models for costs do not include many clinical and social variables from administrative data that are associated with elevated health care resource use, and are increasingly available. This study aimed to use machine learning approaches and big data to predict high-cost users among people with cardiovascular disease (CVD). METHODS We used nationally representative linked datasets in New Zealand to predict CVD prevalent cases with the most expensive cost belonging to the top quintiles by cost. We compared the performance of four popular machine learning models (L1-regularised logistic regression, classification trees, k-nearest neighbourhood (KNN) and random forest) with the traditional regression models. RESULTS The machine learning models had far better accuracy in predicting high health-cost users compared with the logistic models. The harmony score F1 (combining sensitivity and positive predictive value) of the machine learning models ranged from 30.6% to 41.2% (compared with 8.6-9.1% for the logistic models). Previous health costs, income, age, chronic health conditions, deprivation, and receiving a social security benefit were among the most important predictors of the CVD high-cost users. CONCLUSIONS This study provides additional evidence that machine learning can be used as a tool together with big data in health economics for identification of new risk factors and prediction of high-cost users with CVD. As such, machine learning may potentially assist with health services planning and preventive measures to improve population health while potentially saving healthcare costs.
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Affiliation(s)
- Nhung Nghiem
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Binh P Nguyen
- School of Mathematics and Statistics, Victoria University of Wellington, Wellington, New Zealand
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Koh WY, Lim XX, Teoh ESW, Kobun R, Rasti B. The Effects of Gamma-Aminobuytric Acid (GABA) Enrichment on Nutritional, Physical, Shelf-Life, and Sensorial Properties of Dark Chocolate. Foods 2023; 12:foods12010213. [PMID: 36613430 PMCID: PMC9818575 DOI: 10.3390/foods12010213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
Hypertension is the leading cause of cardiovascular disease and premature death worldwide. Gamma-aminobutyric acid (GABA) has potential in regulating hypertension. Cocoa beans are rich in GABA, but GABA is being destroyed during roasting of cocoa beans and chocolate production. This study aimed to develop GABA-enriched dark chocolate by partially replacing sugar syrup with pure GABA powder at concentrations of 0.05 (F1), 0.10 (F2), and 0.15% (F3). The chocolate samples were incorporated with GABA after the heating and melting process of cocoa butter to maintain the viability and functionality of the GABA in the final product. The effects of GABA enrichment on the quality of chocolate in terms of nutritional, physical, shelf-life, and sensorial properties were studied. The inclusion of 0.15% GABA significantly increased the GABA content and angiotensin-converting-enzyme (ACE) inhibitory effect of chocolate. The nutritional compositions of the control and GABA-enriched chocolates were almost similar. The addition of GABA significantly increased the hardness but did not affect the apparent viscosity and melting properties of chocolate. Accelerated shelf-life test results showed that all the chocolates stored at 20 and 30 °C were microbiologically safe for consumption for at least 21 days. Among the GABA-enriched chocolates, panellists preferred F2 the most followed by F3 and F1, owing to the glossiness and sweetness of F2. F3 with the highest GABA content (21.09 mg/100 g) and ACE inhibitory effect (79.54%) was identified as the best GABA-enriched dark chocolate.
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Affiliation(s)
- Wee Yin Koh
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
- Correspondence:
| | - Xiao Xian Lim
- Food Technology Division, School of Industrial Technology, Universiti Sains Malaysia, Minden 11800, Pulau Pinang, Malaysia
| | - Eva Sheue Wen Teoh
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Rovina Kobun
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Babak Rasti
- Australasian Nanoscience and Nanotechnology Initiative, 8054 Monash University LPO, Clayton, VIC 3168, Australia
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11
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Tan PPS, Sandhu RS, Zain SM, Hall D, Tan NC, Lim HM, Daud F, Pung YF. Health motivations and perceived barriers are determinants of self-care behaviour for the prevention of hypertension in a Malaysian community. PLoS One 2022; 17:e0278761. [PMID: 36477162 PMCID: PMC9728916 DOI: 10.1371/journal.pone.0278761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Self-care behaviour is fundamental in preventing hypertension in the general population. According to the Health Belief Model, health beliefs and perceptions influence the success in adopting disease prevention strategies. While factors influencing hypertension self-care behaviour have been examined previously in patient populations, they have not been assessed in the general community. METHODS This was a cross-sectional study conducted between 12 June 2020 to 26 July 2021. An online survey was administered via email and social media to Malaysians in the Selangor and Kuala Lumpur communities. Respondents were over 18 years old, without a formal diagnosis of hypertension. The survey evaluated hypertension knowledge, Health Belief Model constructs, self-care behaviour frequency, and motivators and barriers to self-care behaviour. Multiple linear regression was performed to determine the main predictors of self-care behaviour, and descriptive statistics were used to characterise motivators and barriers of each self-care behaviour. RESULTS Only health motivations (β = 0.217, p < 0.001) and perceived barriers (β = 0.571, p < 0.001) significantly influenced self-care behaviour. Maintaining a healthy diet, regular physical activity and blood pressure checks need to be improved in the community, particularly in reducing salt and calorie intake. Lack of time, limited choices and laziness are the biggest challenges that need to be tackled in adopting a healthy diet and an active lifestyle in the community. Many are ignorant towards their health status, therefore, do not prioritize blood pressure screenings, suggesting a need to enhance community blood pressure checks for early diagnosis of hypertension. CONCLUSION AND IMPLICATIONS Motivations and barriers were the main determinants of self-care behaviour in the Selangor and Kuala Lumpur community. Targeting these aspects of self-care behaviour should be considered when developing interventions and education programmes tailored to local cultural, environmental and personal factors, to more effectively reduce the hypertension prevalence and burden.
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Affiliation(s)
- Paulina Pei Suu Tan
- School of Pharmacy, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Ryand Singh Sandhu
- School of Pharmacy, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Shamsul Mohd Zain
- Department of Pharmacology, University Malaya, Kuala Lumpur, Malaysia
| | - Deborah Hall
- Department of Psychology, Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
| | - Hooi Min Lim
- Department of Primary Care Medicine, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Faiz Daud
- Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yuh-Fen Pung
- School of Pharmacy, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
- * E-mail:
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12
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Ranasinghe P, Addison ML, Webb DJ. Small Interfering RNA Therapeutics in Hypertension: A Viewpoint on Vasopressor and Vasopressor-Sparing Strategies for Counteracting Blood Pressure Lowering by Angiotensinogen-Targeting Small Interfering RNA. J Am Heart Assoc 2022; 11:e027694. [PMID: 36216481 DOI: 10.1161/jaha.122.027694] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Priyanga Ranasinghe
- Faculty of Medicine, Department of Pharmacology University of Colombo Colombo Sri Lanka.,University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom
| | - Melisande L Addison
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom
| | - David J Webb
- University/British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom
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13
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Ghose SM, Reid MP, Dautovich ND, Dzierzewski JM. Sleep and Social Wellness: Does Current Subjective and Objective Sleep Inform Future Social Well-Being? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11668. [PMID: 36141945 PMCID: PMC9517259 DOI: 10.3390/ijerph191811668] [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: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The present study aimed to investigate the link between sleep and broader social well-being. Specifically, the current study evaluated whether subjective and objective sleep indices were associated with subsequent social well-being. METHODS The archival data from the Midlife in the United States Study (MIDUS II and III, Project 1 and 4) were utilized for the current investigation. The participants completed cross-sectional surveys as part of their involvement in both study waves, 10 years apart. They were 213 adults, 59.6% female-identifying, with an average age of 56 years, who completed 8 days of sleep measurement via wrist actigraphy, sleep diary, as well as the PSQI. The participants also completed the measures of depressive symptoms and social well-being. RESULTS The actigraphic total sleep time, the diary-reported sleep quality, and the global sleep quality measured by the PSQI emerged as the significant predictors of social well-being over a 10-year period. CONCLUSIONS The present study is an initial step in providing evidence for the importance of sleep for social functioning. Future research should attend to the association between past sleep behaviors and social functioning, specifically the mechanisms by which sleep is associated with social well-being as well as the temporal associations in an adult sample.
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Affiliation(s)
- Sarah M. Ghose
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
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14
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Ismail SNA, Nayan NA, Jaafar R, May Z. Recent Advances in Non-Invasive Blood Pressure Monitoring and Prediction Using a Machine Learning Approach. SENSORS (BASEL, SWITZERLAND) 2022; 22:6195. [PMID: 36015956 PMCID: PMC9412312 DOI: 10.3390/s22166195] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
Blood pressure (BP) monitoring can be performed either invasively via arterial catheterization or non-invasively through a cuff sphygmomanometer. However, for conscious individuals, traditional cuff-based BP monitoring devices are often uncomfortable, intermittent, and impractical for frequent measurements. Continuous and non-invasive BP (NIBP) monitoring is currently gaining attention in the human health monitoring area due to its promising potentials in assessing the health status of an individual, enabled by machine learning (ML), for various purposes such as early prediction of disease and intervention treatment. This review presents the development of a non-invasive BP measuring tool called sphygmomanometer in brief, summarizes state-of-the-art NIBP sensors, and identifies extended works on continuous NIBP monitoring using commercial devices. Moreover, the NIBP predictive techniques including pulse arrival time, pulse transit time, pulse wave velocity, and ML are elaborated on the basis of bio-signals acquisition from these sensors. Additionally, the different BP values (systolic BP, diastolic BP, mean arterial pressure) of the various ML models adopted in several reported studies are compared in terms of the international validation standards developed by the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) for clinically-approved BP monitors. Finally, several challenges and possible solutions for the implementation and realization of continuous NIBP technology are addressed.
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Affiliation(s)
- Siti Nor Ashikin Ismail
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Selangor, Malaysia
| | - Nazrul Anuar Nayan
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Selangor, Malaysia
- Institute Islam Hadhari, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Selangor, Malaysia
| | - Rosmina Jaafar
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Selangor, Malaysia
| | - Zazilah May
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, UKM Bangi 43600, Selangor, Malaysia
- Electrical and Electronic Engineering Department, Universiti Teknologi Petronas, Seri Iskandar 32610, Perak, Malaysia
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15
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Gore R. Policy by Pilot? Learning From Demonstration Projects for Integrated Care Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study". Int J Health Policy Manag 2022; 12:7152. [PMID: 35942955 PMCID: PMC10125225 DOI: 10.34172/ijhpm.2022.7152] [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: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
Analysis of policy implementation for chronic disease in Belgium highlights the difficulties of launching experiments for integrated care in a health system with fragmented governance. It also entreats us to consider the inherent challenges of piloting integrated care for chronic disease. Sociomedical characteristics of chronic disease -political, social, and economic aspects of improving outcomes - pose distinct problems for pilot projects, particularly because addressing health inequity requires collaboration across health and social sectors and a long-term, life-course perspective on health. Drawing on recent US experience with demonstration projects for health service delivery reform and on chronic disease research, I discuss constraints of and lessons from pilot projects. The policy learning from pilots lies beyond their technical evaluative yield. Pilot projects can evince political and social challenges to achieving integrated chronic disease care, and can illuminate overlooked perspectives, such as those of community-based organizations (CBOs), thereby potentially extending the terms of policy debate.
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Affiliation(s)
- Radhika Gore
- Family Health Centers at NYU Langone, Brooklyn, NY, USA
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16
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MacLeod KE, Ye Z, Donald B, Wang G. A Literature Review of Productivity Loss Associated with Hypertension in the United States. Popul Health Manag 2022; 25:297-308. [PMID: 35119298 PMCID: PMC9536345 DOI: 10.1089/pop.2021.0201] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A literature review of peer-reviewed articles published 2000-2019 was conducted to determine the types and extent of hypertension-associated productivity loss among adults in the United States. All monetary outcomes were standardized to 2019 $ by using the Employment Cost Index. Twenty-seven articles met the inclusion criteria. Nearly half of the articles (12 articles) presented monetary outcomes of productivity loss. Absenteeism (14 articles) and presenteeism (8 articles) were most frequently assessed. Annual absenteeism was estimated to cost more than $11 billion, nationally controlling for sociodemographic characteristics. The annual additional costs per person were estimated at $63 for short-term disability, $72-$330 for absenteeism, and $53-$156 for presenteeism, controlling for participant characteristics; and may be as high as $2362 for absenteeism and presenteeism when considered in combination. The annual additional time loss per person was estimated as 1.3 days for absenteeism, controlling for common hypertension comorbidities, including stroke and diabetes; and 15.6 days for work and home productivity loss combined, controlling for sociodemographic characteristics. The loss from absenteeism alone might be more than 20% of the total medical expenditure of hypertension. Although the differences in estimation methods and study populations make it challenging to synthesize the costs across the studies, this review provides detailed information on the various types of productivity loss. In addition, the ways in which methods could be standardized for future research are discussed. Accounting for the costs from productivity loss can help public health officials, health insurers, employers, and researchers better understand the economic burden of hypertension.
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Affiliation(s)
- Kara E. MacLeod
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - Zhiqiu Ye
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Bruce Donald
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
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17
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The Modulation of Arachidonic Acid Metabolism and Blood Pressure-Lowering Effect of Honokiol in Spontaneously Hypertensive Rats. Molecules 2022; 27:molecules27113396. [PMID: 35684335 PMCID: PMC9182499 DOI: 10.3390/molecules27113396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiovascular diseases have consistently been the leading cause of death in the United States over the last two decades, with 30% of the adult American population having hypertension. The metabolites of arachidonic acid (AA) in the kidney play an important role in blood pressure regulation. The present study investigates the antihypertensive effect of honokiol (HON), a naturally occurring polyphenol, and examines its correlation to the modulation of AA metabolism. Methods: Spontaneously hypertensive rats (SHR) were randomly divided into four groups. Treatment groups were administered HON intraperitoneally at concentrations of 5, 20, and 50 mg/kg. Blood pressure was monitored at seven-day intervals. After a total of 3 weeks of treatment, the rats were euthanized and the kidney tissues were collected to examine the activity of the two major enzymes involved in AA metabolism in the kidney, namely cytochrome P450 (CYP)4A and soluble epoxide hydrolase (sEH). Results: Rats treated with HON did not experience the rise in blood pressure observed in the untreated SHR. High-dose HON significantly reduced blood pressure and inhibited the activity and protein expression of the CYP4A enzyme in the rat kidney. The activity of the sEH enzyme in renal cytosol was significantly inhibited by medium and high doses of HON. Conclusion: Our data demonstrate the antihypertensive effect of HON and provide a novel mechanism for its underlying cardioprotective properties.
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18
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Nalbant G, Hassanein ZM, Lewis S, Chattopadhyay K. Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Public Health 2022; 10:846231. [PMID: 35419342 PMCID: PMC8995771 DOI: 10.3389/fpubh.2022.846231] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/28/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives This systematic review aimed to synthesize the content, structure, and delivery characteristics of effective yoga interventions used for managing hypertension and to compare these characteristics with ineffective interventions. Design and Method The JBI and the PRISMA guidelines were followed in this systematic review. RCTs conducted among hypertensive adults were included. RCTs reporting at least one of the major components of yoga (i.e., asana, pranayama, and dhyana and relaxation practices) and comparing them with no intervention or any intervention were eligible. Sixteen databases were searched for published and unpublished studies without any date and language restrictions till March 15, 2021. Results The literature search yielded 13,130 records. 34 RCTs (evaluating 38 yoga interventions) met the inclusion criteria. Overall, included studies had low methodological quality mostly due to inadequate reporting. Yoga reduced SBP and DBP compared to a control intervention (MD -6.49 and -2.78; 95CI% -8.94- -4.04 and -4.11- -1.45, respectively). Eighteen, 14 and 20 interventions were effective in improving SBP, DBP, or either, respectively. 13 out of 20 effective interventions incorporated all the 3 major components of yoga and allocated similar durations to each component whereas ineffective interventions were more focused on the asana and duration of asana practice was longer. The most common duration and frequency of effective interventions were 45 min/session (in 5 interventions), 7 days/week (in 5 interventions), and 12 weeks (in 11 interventions) whereas the most common session frequency was 2 days a week (in 7 interventions) in ineffective interventions. Effective interventions were mostly center-based (in 15 interventions) and supervised (in 16 interventions) and this was similar with ineffective interventions. Conclusion Despite the low quality and heterogeneity of included studies, our findings suggest yoga interventions may effectively manage hypertension. The differences between the effective and ineffective interventions suggest that effective yoga interventions mostly incorporated asana, pranayama, and dhyana and relaxation practices and they had a balance between these three components and included regular practice. They were mostly delivered in a center and under supervision. Future studies should consider developing and evaluating an intervention for managing hypertension using the synthesized findings of the effective interventions in this review. Systematic Review Registration [PROSPERO], identifier [CRD42019139404].
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Affiliation(s)
- Gamze Nalbant
- Lifespan and Population Health Academic Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,The Nottingham Centre for Evidence-Based Healthcare, A JBI Centre of Excellence, Nottingham, United Kingdom
| | - Zeinab M Hassanein
- Lifespan and Population Health Academic Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,The Nottingham Centre for Evidence-Based Healthcare, A JBI Centre of Excellence, Nottingham, United Kingdom
| | - Sarah Lewis
- Lifespan and Population Health Academic Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kaushik Chattopadhyay
- Lifespan and Population Health Academic Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,The Nottingham Centre for Evidence-Based Healthcare, A JBI Centre of Excellence, Nottingham, United Kingdom
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19
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Paczkowska-Walendowska M, Sip S, Staszewski R, Cielecka-Piontek J. Single-Pill Combination to Improve Hypertension Treatment: Pharmaceutical Industry Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074156. [PMID: 35409840 PMCID: PMC8999086 DOI: 10.3390/ijerph19074156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022]
Abstract
Multiple illness is an increasingly common phenomenon. Its consequence is the need for polytherapy, which is particularly common among people suffering from arterial hypertension. The development of combined preparations (containing at least two API-active pharmaceutical ingredients) dedicated to the treatment of hypertension is a response to increased compliance, especially in elderly patients. In our work, we describe in particular the possibilities of using β-adrenergic receptors blockers and angiotensin-converting enzyme inhibitors in combinations. The combinations of APIs are used as single pills in patients with arterial hypertension with concomitant diseases such as hyperlipidemia; blood coagulation problems and diabetes mellitus were also discussed successively. Pharmacoeconomic analysis for the API combinations shown is also presented. As a final conclusion, numerous benefits of using the combined preparations should be indicated, especially by the elderly and/or in patients with coexistence of other diseases.
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Affiliation(s)
| | - Szymon Sip
- Department of Pharmacognosy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (M.P.-W.); (S.S.)
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznań, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (M.P.-W.); (S.S.)
- Correspondence:
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20
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Edwards J, De Caux A, Donaldson J, Wiles J, O'Driscoll J. Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis. Br J Sports Med 2021; 56:506-514. [PMID: 34911677 DOI: 10.1136/bjsports-2021-104642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We aimed to compare the efficacy of isometric exercise training (IET) versus high-intensity interval training (HIIT) in the management of resting blood pressure (BP). DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed (MEDLINE), the Cochrane library and SPORTDiscus were systematically searched. ELIGIBILITY CRITERIA Randomised controlled trials published between 1 January 2000 and 1 September 2020. Research trials reporting the effects of IET or HIIT on resting BP following a short-term intervention (2-12 weeks). RESULTS 38 studies were analysed (18 IET and 20 HIIT), including 1583 (672 IET and 911 HIIT) participants, of which 612 (268 IET and 344 HIIT) were controls.IET produced significantly greater reductions in resting BP compared with HIIT with systolic, diastolic and mean BP effect sizes of 8.50 mm Hg vs 2.86 mm Hg (Q=17.10, p<0.001), 4.07 mm Hg vs 2.48 mm Hg (Q=4.71, p=0.03) and 6.46 mm Hg vs 3.15 mm Hg (Q=4.21, p=0.04) respectively. However, HIIT reduced resting heart rate significantly more than IET (3.17bpm vs 1.34bpm, Q=7.63, p=0.006). CONCLUSION While both modes are efficacious, IET appears to be the superior mode of exercise in the management of resting BP. However, HIIT may achieve wider physiological benefits, with greater reductions in resting heart rate.
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Affiliation(s)
- Jamie Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Anthony De Caux
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - James Donaldson
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK.,Department of Sport Science, Nottingham Trent University, Nottingham, UK
| | - Jonathan Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Jamie O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
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21
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Using Digital Storytelling to Reduce Unplanned Health Care Encounters: A Feasibility Study. J Nurs Care Qual 2021; 36:269-273. [PMID: 33009171 DOI: 10.1097/ncq.0000000000000515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a growing body of literature establishing digital storytelling as an efficacious strategy to improve hypertension outcomes. The purpose of this nurse-led project was to explore the use of digital storytelling to reduce unplanned health care encounters and to determine whether the approach was feasible. PROBLEM Half of adults in the United States have hypertension. However, only 1 in 4 has his or her condition under control. In addition, the annual economic burden is more than $51 billion. APPROACH Digital storytelling was employed with residents in northeast Louisiana. Videos of individuals with well-managed hypertension shared success stories with less well-managed individuals over a 16-month long program. OUTCOMES The study found that 55 (93%) of listeners had no unplanned provider visits, 57 (94.9%) had no emergency department room visits, and 57 (94.9%) were not hospitalized over the study period. CONCLUSIONS Digital storytelling reduced unplanned encounters, and the program was deemed feasible.
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22
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Siddiqui N, Daya R, Seedat F, Bulbulia S, Bayat Z. Secondary hypertension: An update on the diagnosis and localisation of a pheochromocytoma or paraganglioma. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 34342483 PMCID: PMC8377944 DOI: 10.4102/safp.v63i1.5277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Most cases of hypertension are because of essential hypertension, however 5% – 15% of cases can be a result of a secondary cause. In this article, we focus on the endocrine causes of secondary hypertension with a particular focus on pheochromocytomas (PCCs) and paragangliomas (PGLs). Around 15 endocrine disorders can initially present with hypertension. Amongst those PCCs and PGLs are rare but potentially life-threatening causes. An early diagnosis and timely referral can be life-saving. Herein, we present an approach for screening and diagnosis of these patients and focus on the importance of genetic testing.
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Affiliation(s)
- Nida Siddiqui
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Faculty of Health Sciences, Helen Joseph Hospital, Johannesburg.
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23
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Bilger M, Koong AYL, Phoon IKY, Tan NC, Bahadin J, Bairavi J, Batcagan-Abueg APM, Finkelstein EA. Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27496. [PMID: 34106085 PMCID: PMC8262550 DOI: 10.2196/27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID) DERR1-10.2196/27496
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Affiliation(s)
- Marcel Bilger
- Health Economics and Policy, Vienna University of Economics and Business, Vienna, Austria, Austria
| | | | | | | | - Juliana Bahadin
- Saudara Clinic by A+J General Physicians, Singapore, Singapore
| | - Joann Bairavi
- Heath Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Eric A Finkelstein
- Heath Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, United States
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24
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Philip R, Beaney T, Appelbaum N, Gonzalvez CR, Koldeweij C, Golestaneh AK, Poulter N, Clarke JM. Variation in hypertension clinical practice guidelines: a global comparison. BMC Med 2021; 19:117. [PMID: 33975593 PMCID: PMC8114719 DOI: 10.1186/s12916-021-01963-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension is the largest single contributor to the global burden of disease, affecting an estimated 1.39 billion people worldwide. Clinical practice guidelines (CPGs) can aid in the effective management of this common condition, however, inconsistencies exist between CPGs, and the extent of this is unknown. Understanding the differences in CPG recommendations across income settings may provide an important means of understanding some of the global variations in clinical outcomes related to hypertension. AIMS This study aims to analyse the variation between hypertension CPGs globally. It aims to assess the variation in three areas: diagnostic threshold and staging, treatment and target blood pressure (BP) recommendations in hypertension. METHODS A search was conducted on the MEDLINE repository to identify national and international hypertension CPGs from 2010 to May 2020. An additional country-specific grey-literature search was conducted for all countries and territories of the world as identified by the World Bank. Data describing the diagnosis, staging, treatment and target blood pressure were extracted from CPGs, and variations between CPGs for these domains were analysed. RESULTS Forty-eight CPGs from across all World Bank income settings were selected for analysis. Ninety-six per cent of guidelines defined hypertension as a clinic-based BP of ≥140/90 mmHg, and 87% of guidelines recommended a target BP of < 140/90 mmHg. In the pharmacological treatment of hypertension, eight different first-step, 17 different second-step and six different third-step drug recommendations were observed. Low-income countries preferentially recommended diuretics (63%) in the first-step treatment, whilst high-income countries offered more choice between antihypertensive classes. Forty-four per cent of guidelines, of which 71% were from higher-income contexts recommended initiating treatment with dual-drug therapy at BP 160/100 mmHg or higher. CONCLUSION This study found that CPGs remained largely consistent in the definition, staging and target BP recommendations for hypertension. Extensive variation was observed in treatment recommendations, particularly for second-line therapy. Variation existed between income settings; low-income countries prescribed cheaper drugs, offered less clinician choice in medications and initiated dual therapy at later stages than higher-income countries. Future research exploring the underlying drivers of this variation may improve outcomes for hypertensive patients across clinical contexts.
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Affiliation(s)
- Richu Philip
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nick Appelbaum
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Carmen Rodriguez Gonzalvez
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Charlotte Koldeweij
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jonathan M Clarke
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
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25
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Hong D, Shan W. Improvement in Hypertension Management with Pharmacological and Non- Pharmacological Approaches: Current Perspectives. Curr Pharm Des 2021; 27:548-555. [PMID: 32962608 DOI: 10.2174/1381612826666200922153045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Improving hypertension management is still one of the biggest challenges in public health worldwide. Existing guidelines do not reach a consensus on the optimal Blood Pressure (BP) target. Therefore, how to effectively manage hypertension based on individual characteristics of patients, combined with the pharmacological and non-pharmacological approach, has become a problem to be urgently considered. METHODS Reports published in PubMed that covered Pharmacological and Non-Pharmacological Approaches in subjects taking hypertension management were reviewed by the group independently and collectively. Practical recommendations for hypertension management were established by the panel. RESULTS Pharmacological mechanism, action characteristics, and main adverse reactions varied across different pharmacological agents, and patients with hypertension often require a combination of antihypertensive medications to achieve the target BP range. Non-pharmacological treatment provides an additional effective method for improving therapy adherence and long-term BP control, thus reducing the risk of cardiovascular diseases, and slowing down the progression of the disease. CONCLUSION This review summarizes the available literature on the most convincing guideline principles, pharmacological treatment, biotechnology interference, interventional surgical treatment, managing hypertension with technical means of big data, Artificial Intelligence and Behavioral Intervention, as well as providing future directions, for facilitating Current and Developing knowledge into clinical implementation.
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Affiliation(s)
- Dongsheng Hong
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wenya Shan
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Edwards JJ, Taylor KA, Cottam C, Jalaludeen N, Coleman DA, Wiles JD, Sharma R, O'Driscoll JM. Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study. J Hypertens 2021; 39:341-348. [PMID: 33031171 DOI: 10.1097/hjh.0000000000002630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hypertension remains the leading cause of cardiovascular disease and premature mortality globally. Although high-intensity interval training (HIIT) is an effective nonpharmacological intervention for the reduction of clinic blood pressure (BP), very little research exists regarding its effects on ambulatory BP. The aim of this study was to measure alterations in ambulatory and clinic BP following HIIT in physically inactive adults. METHODS Forty-one participants (22.8 ± 2.7 years) were randomly assigned to a 4-week HIIT intervention or control group. The HIIT protocol was performed on a cycle ergometer set against a resistance of 7.5% bodyweight and consisted of 3 × 30-s maximal sprints separated with 2-min active recovery. Clinic and ambulatory BP was recorded pre and post the control period and HIIT intervention. RESULTS Following the HIIT intervention, 24-h ambulatory BP significantly decreased by 5.1 mmHg in sBP and 2.3 mmHg in dBP (P = 0.011 and 0.012, respectively), compared with the control group. In addition, clinic sBP significantly decreased by 6.6 mmHg compared with the control group (P = 0.021), with no significant changes in dBP and mean BP (mBP). Finally, 24-h ambulatory diastolic, daytime sBP, mBP and dBP, and night-time sBP and mBP variability significantly decreased post-HIIT compared with the control group. CONCLUSION HIIT remains an effective intervention for the management of BP. Our findings support enduring BP reduction and improved BP variability, which are important independent risk factors for cardiovascular disease.
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Affiliation(s)
- Jamie J Edwards
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Katrina A Taylor
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Christian Cottam
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Navazh Jalaludeen
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Damian A Coleman
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Jonathan D Wiles
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Rajan Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - Jamie M O'Driscoll
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
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Levy RV, Brathwaite KE, Sarathy H, Reidy K, Kaskel FJ, Melamed ML. Analysis of Active and Passive Tobacco Exposures and Blood Pressure in US Children and Adolescents. JAMA Netw Open 2021; 4:e2037936. [PMID: 33620445 PMCID: PMC7903259 DOI: 10.1001/jamanetworkopen.2020.37936] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/30/2020] [Indexed: 12/28/2022] Open
Abstract
Importance Hypertension is a leading cause of cardiovascular disease in adults; preclinical associations between hypertension and cardiovascular disease are seen in childhood. Nicotine is a known toxin, but its association with pediatric hypertension is unclear. Objective To test the hypothesis that tobacco exposure is associated with the presence of elevated blood pressure in US children and adolescents and that this association is dose dependent. Design, Setting, and Participants This cross-sectional study used data from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative sample of US children and adolescents. Children were eligible if they were aged 8 to 19 years at the time of participation in the main NHANES study. Exclusion criteria included those of the main NHANES study, inability to complete testing, or missing questionnaires. Of the 10 143 participants in NHANES aged 8 to 19 during the study years, 8520 were included in the analysis. Analysis was conducted from October 12, 2019, to July 9, 2020. Exposures Tobacco exposure, defined as serum cotinine levels greater than 0.05 µg/L, or reporting living with a smoker or smoking themselves. Main Outcomes and Measures Elevated blood pressure, classified as greater than 90% for a child's age, sex, and height according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. The a priori hypothesis that there is a positive association between tobacco exposure and elevated blood pressure in the study population was tested. Analysis included logistic regression with adjustment for possible confounders. Subgroup and sensitivity analyses were conducted. Results A total of 8520 children were included in the analysis, representing 41 million US children. The mean (SD) age of the participants was 13.1 (0.05) years, 51% (95% CI, 49%-52%) were male, and 58% (95% CI, 54%-62%) were non-Hispanic White individuals. Participants with any tobacco smoke exposure were more likely than those without exposure to be older (mean [SD] age, 13.3 [0.07] years vs 12.8 [0.06] years), male (53% [95% CI, 51%-55%] vs 49% [95% CI, 47%-50%]), and non-Hispanic Black individuals (19% [95% CI, 16%-22%] vs 10% [95% CI, 8%-12%]). The odds of having elevated blood pressure was 1.31 (95% CI, 1.06-1.61) for any tobacco exposure after adjustment; odds were similar across subgroups and remained significant in multiple sensitivity analyses. Conclusions and Relevance This study suggests that tobacco exposure is associated with elevated blood pressure in US children and adolescents. This modifiable risk factor represents a target for further research into reducing hypertension in children and adolescents.
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Affiliation(s)
- Rebecca V. Levy
- Division of Pediatric Nephrology, Department of Pediatrics, Montefiore Medical Center, Bronx, New York
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Kaye E. Brathwaite
- Division of Pediatric Nephrology, Department of Pediatrics, Montefiore Medical Center, Bronx, New York
| | - Harini Sarathy
- Division of Nephrology, Department of Medicine, University of California, San Francisco
| | - Kimberly Reidy
- Division of Pediatric Nephrology, Department of Pediatrics, Montefiore Medical Center, Bronx, New York
| | - Frederick J. Kaskel
- Division of Pediatric Nephrology, Department of Pediatrics, Montefiore Medical Center, Bronx, New York
| | - Michal L. Melamed
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Quantifying direct effects of social determinants of health on systolic blood pressure in United States adult immigrants. J Behav Med 2021; 44:345-354. [PMID: 33515173 DOI: 10.1007/s10865-020-00199-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
Identify the pathway by which social determinants of health (SDoH) variables impact systolic blood pressure (SBP) in immigrants. Latent variables were used to assess the relationship between SDoH and SBP. Latent variables were identified using confirmatory factor analysis (CFA) for (1) global socioeconomic status (SES) (education, income, number of hours worked per week), (2) stressors of immigration (life-course SES, immigration stress, immigration demand), (3) adaptation to immigration (perceived discrimination, perceived stress, health literacy), and (4) burden of disease (disability, comorbidities, chronic pain). Structural equation modeling (SEM) was used to investigate the relationship between immigrant specific latent variables and SBP. The study included 181 adult immigrants. The initial model (chi2 (77, n = 181) = 302.40, p < 0.001, RMSEA = 0.086, CFI = 0.84, TLI = 0.78, CD = 0.91) showed that stressors of immigration had a direct relationship with SBP (-0.35, p = 0.033); global (SES) had a direct relationship with burden of disease (-0.70, p = 0.007) and an indirect relationship with SBP by way of burden of disease (0.24, p = 0.015). The final model (chi2 (69, n = 181) = 149.98, p < 0.001, RMSEA = 0.054, CFI = 0.94, TLI = 0.91, CD = 0.96) maintained that global SES had a direct relationship with burden of disease (-0.40, p < 0.001) and an indirect relationship with SBP by way burden of disease (0.34, p < 0.001). This study suggests a direct relationship between burden of disease and SBP, and an indirect relationship between SES and SBP. Development of interventions should take burden of disease into account as a direct driver of blood pressure in immigrants, and address factors related to SES.
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Ghantous CM, Kamareddine L, Farhat R, Zouein FA, Mondello S, Kobeissy F, Zeidan A. Advances in Cardiovascular Biomarker Discovery. Biomedicines 2020; 8:biomedicines8120552. [PMID: 33265898 PMCID: PMC7759775 DOI: 10.3390/biomedicines8120552] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases are the leading causes of mortality worldwide. Among them, hypertension and its pathological complications pose a major risk for the development of other cardiovascular diseases, including heart failure and stroke. Identifying novel and early stage biomarkers of hypertension and other cardiovascular diseases is of paramount importance in predicting and preventing the major morbidity and mortality associated with these diseases. Biomarkers of such diseases or predisposition to their development are identified by changes in a specific indicator’s expression between healthy individuals and patients. These include changes in protein and microRNA (miRNA) levels. Protein profiling using mass spectrometry and miRNA screening utilizing microarray and sequencing have facilitated the discovery of proteins and miRNA as biomarker candidates. In this review, we summarized some of the different, promising early stage protein and miRNA biomarker candidates as well as the currently used biomarkers for hypertension and other cardiovascular diseases. Although a number of promising markers have been identified, it is unlikely that a single biomarker will unambiguously aid in the classification of these diseases. A multi-marker panel-strategy appears useful and promising for classifying and refining risk stratification among patients with cardiovascular disease.
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Affiliation(s)
- Crystal M. Ghantous
- Department of Nursing and Health Sciences, Faculty of Nursing and Health Sciences, Notre Dame University-Louaize, Keserwan 72, Lebanon;
| | - Layla Kamareddine
- Biomedical Sciences Department, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar;
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
| | - Rima Farhat
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon;
| | - Fouad A. Zouein
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon;
| | - Stefania Mondello
- Oasi Research Institute-IRCCS, 94018 Troina, Italy;
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, 98125 Messina, Italy
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon;
| | - Asad Zeidan
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
- Department of Basic Medical Science, Faculty of Medicine, QU Health, Qatar University, Doha 2713, Qatar
- Correspondence: ; Tel.: +97-431-309-19
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AlKaabi LA, Ahmed LS, Al Attiyah MF, Abdel-Rahman ME. Predicting hypertension using machine learning: Findings from Qatar Biobank Study. PLoS One 2020; 15:e0240370. [PMID: 33064740 PMCID: PMC7567367 DOI: 10.1371/journal.pone.0240370] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background and objective Hypertension, a global burden, is associated with several risk factors and can be treated by lifestyle modifications and medications. Prediction and early diagnosis is important to prevent related health complications. The objective is to construct and compare predictive models to identify individuals at high risk of developing hypertension without the need of invasive clinical procedures. Methods This is a cross-sectional study using 987 records of Qataris and long-term residents aged 18+ years from Qatar Biobank. Percentages were used to summarize data and chi-square tests to assess associations. Predictive models of hypertension were constructed and compared using three supervised machine learning algorithms: decision tree, random forest, and logistics regression using 5-fold cross-validation. The performance of algorithms was assessed using accuracy, positive predictive value (PPV), sensitivity, F-measure, and area under the receiver operating characteristic curve (AUC). Stata and Weka were used for analysis. Results Age, gender, education level, employment, tobacco use, physical activity, adequate consumption of fruits and vegetables, abdominal obesity, history of diabetes, history of high cholesterol, and mother’s history high blood pressure were important predictors of hypertension. All algorithms showed more or less similar performances: Random forest (accuracy = 82.1%, PPV = 81.4%, sensitivity = 82.1%), logistic regression (accuracy = 81.1%, PPV = 80.1%, sensitivity = 81.1%) and decision tree (accuracy = 82.1%, PPV = 81.2%, sensitivity = 82.1%. In terms of AUC, compared to logistic regression, while random forest performed similarly, decision tree had a significantly lower discrimination ability (p-value<0.05) with AUC’s equal to 85.0, 86.9, and 79.9, respectively. Conclusions Machine learning provides the chance of having a rapid predictive model using non-invasive predictors to screen for hypertension. Future research should consider improving the predictive accuracy of models in larger general populations, including more important predictors and using a variety of algorithms.
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Affiliation(s)
- Latifa A. AlKaabi
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
| | - Lina S. Ahmed
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
| | - Maryam F. Al Attiyah
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
| | - Manar E. Abdel-Rahman
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
- * E-mail:
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Liao CT, Wu PC, Shih JC, Cheng TJ, Wu WS. Higher hypertension prevalence, lower incidence, and aggressive treatment with decreasing mortality, cardiovascular, and cerebrovascular incidence in Taiwan from 2005 to 2010: A 2 population-based cohorts study. Medicine (Baltimore) 2020; 99:e22437. [PMID: 32991480 PMCID: PMC7523812 DOI: 10.1097/md.0000000000022437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hypertension continues to be an important public health concern because of its associated morbidity, mortality, and economic impact on society. The aims of this study are to compare the secular changes in age-stratified hypertension prevalence, incidence, co-morbidity, and 3 years of cardiovascular outcome in Taiwan in the years 2005 and 2010.We enrolled hypertensive individuals from the datasets of the Longitudinal Health Insurance Database (LHID) in 2005 and 2010 in Taiwan separately. We analyzed the hypertension prevalence, incidence, medication treatment, and associated morbidities. The risks of cardiovascular and cerebrovascular events and all-causes mortalities among the hypertensive individuals were evaluated in 3 years of follow-up.There was an increased prevalence of hypertension but decreased incidence of hypertension in those over 65 from 2005 to 2010. Dyslipidemia was the highest rate of co-morbidity in 2005 and 2010. The most frequent categories of anti-hypertensive agents prescribed was 1 or 2 for both 2005 and 2010. Calcium channel blockers were the most common anti-hypertensive agents prescribed, followed by Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers. After 3 years of follow-up, the risks of coronary artery disease (CAD), cerebrovascular diseases (CVD) as well as death were less in 2010 than in 2005 in Taiwan.Our study showed that hypertension individuals had an increased prevalence, younger age, decreased incidence, increased medication treatment associated with decreased the CAD, CVD, and mortalities in 2010 compared to 2005 in Taiwan.
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Affiliation(s)
- Chia-Te Liao
- Division of Cardiovascular Medicine, Chi-Mei Medical Center
- Department of Public Health of Medicine, College of Medicine, National Cheng Kung University
| | - Pei-Chih Wu
- Department of Green Energy and Environmental Resources
- Department of Occupational Safety and Health, Chang Jung Christian University
| | - Jung-Chang Shih
- Division of Cardiovascular Medicine, Chiali branch of Chi-Mei Hospital
| | - Tain-Junn Cheng
- Departments of Neurology and Occupational Medicine, Chi-Mei Medical Center
| | - Wen-Shiann Wu
- Division of Cardiovascular Medicine, Chi-Mei Medical Center
- Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
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The Story of the Silent Killer : A History of Hypertension: Its Discovery, Diagnosis, Treatment, and Debates. Curr Hypertens Rep 2020; 22:72. [PMID: 32852612 DOI: 10.1007/s11906-020-01077-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hypertension is the leading risk factor for death and disability-adjusted life-years lost globally. Despite this tremendous impact on health, blood pressure measurement and treatment are relatively new to medical practice, with widespread measurement beginning just over 100 years ago. How, in such a short time, did blood pressure become such an integral measurement in medical practice that it is now considered one of the vital signs? Key revelations through Stephen Hales and his horse experiment, Riva-Rocci's modern blood pressure cuff, Korotkoff sounds, and President Roosevelt's death set the stage for discovery. Landmark trials such as the VA Cooperative studies of the 1960s through the recent Systolic Blood Pressure Intervention Trial and Prevention with Mediterranean Diet trials provide the foundation for modern clinical practice. An understanding of the history of hypertension can directly affect current clinical practice and offers unique insights into how the medical community has approached the management of one of the deadliest medical conditions in history.
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Balanova YA, Kontsevaya AV, Myrzamatova AO, Mukaneeva DK, Khudyakov MB, Drapkina OM. Economic Burden of Hypertension in the Russian Federation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-05-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yu. A. Balanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. O. Myrzamatova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. K. Mukaneeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. B. Khudyakov
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Endomba FT, Wafeu GS, Efon-Ekangouo A, Djune-Yemeli L, Donfo-Azafack C, Nana-Djeunga HC, Kamgno J. Support for families of isolated or deceased COVID-19 patients in sub-Saharan Africa. Health Psychol Open 2020; 7:2055102920975293. [PMID: 33282330 PMCID: PMC7691915 DOI: 10.1177/2055102920975293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aside the direct effect of the COVID-19 on infected patients, this infectious disease outbreak has various psychological consequences. These mental health repercussions pertain to the general population of uninfected individuals, and particularly families of isolated or deceased COVID-19 patients. This aspect is of substantial interest amid sub-Saharan African communities, considering the key place and cultural significance of mourning and funerals in these settings. In this commentary, we discuss on the issue of psychological and social support of COVID-19 patients' families, by taking into account some sub-Saharan African cultural considerations.
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Affiliation(s)
- Francky Teddy Endomba
- Health Economics & Policy
Research and Evaluation for Development Results Group (HEREG),
Cameroon
- Psychiatry Internship Program,
University of Bourgogne, Dijon, France
| | - Guy Sadeu Wafeu
- Centre for Research on Filariasis
and other Tropical Diseases (CRFilMT), Cameroon
| | | | - Linda Djune-Yemeli
- Centre for Research on Filariasis
and other Tropical Diseases (CRFilMT), Cameroon
| | | | | | - Joseph Kamgno
- Centre for Research on Filariasis
and other Tropical Diseases (CRFilMT), Cameroon
- Faculty of Medicine and Biomedical
Sciences, University of Yaoundé I, Cameroon
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Herholt A, Galinski S, Geyer PE, Rossner MJ, Wehr MC. Multiparametric Assays for Accelerating Early Drug Discovery. Trends Pharmacol Sci 2020; 41:318-335. [PMID: 32223968 DOI: 10.1016/j.tips.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
Drug discovery campaigns are hampered by substantial attrition rates largely due to a lack of efficacy and safety reasons associated with candidate drugs. This is true in particular for genetically complex diseases, where insufficient knowledge of the modulatory actions of candidate drugs on targets and entire target pathways further adds to the problem of attrition. To better profile compound actions on targets, potential off-targets, and disease-linked pathways, new innovative technologies need to be developed that can elucidate the complex cellular signaling networks in health and disease. Here, we discuss progress in genetically encoded multiparametric assays and mass spectrometry (MS)-based proteomics, which both represent promising toolkits to profile multifactorial actions of drug candidates in disease-relevant cellular systems to promote drug discovery and personalized medicine.
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Affiliation(s)
- Alexander Herholt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 7, 80336 Munich, Germany; Systasy Bioscience GmbH, Balanstr. 6, 81669, Munich, Germany
| | - Sabrina Galinski
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 7, 80336 Munich, Germany; Systasy Bioscience GmbH, Balanstr. 6, 81669, Munich, Germany
| | - Philipp E Geyer
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Am Klopferspitz 18, 82152 Planegg, Germany; NNF Center for Protein Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; OmicEra Diagnostics GmbH, Am Klopferspitz 19, 82152, Planegg, Germany
| | - Moritz J Rossner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 7, 80336 Munich, Germany
| | - Michael C Wehr
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 7, 80336 Munich, Germany; Systasy Bioscience GmbH, Balanstr. 6, 81669, Munich, Germany.
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Adane E, Atnafu A, Aschalew AY. The Cost of Illness of Hypertension and Associated Factors at the University of Gondar Comprehensive Specialized Hospital Northwest Ethiopia, 2018. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:133-140. [PMID: 32184636 PMCID: PMC7064277 DOI: 10.2147/ceor.s234674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Non-communicable diseases impose a significant social, economic and health burden. Hypertension, the leading contributor to the global burden of disease and a growing public health problem worldwide, is one of the most serious non-communicable diseases. In Ethiopia, empirical evidence on the economic burden of hypertension is limited. Therefore, this study aimed to measure the cost of hypertension and associated factors at the University of Gondar comprehensive specialized hospital, northwest Ethiopia. PATIENTS AND METHODS An institution-based cross-sectional study was conducted on 442 adult hypertensive patients using a semi-structured questionnaire to estimate the direct and indirect costs of hypertension. The human capital approach was used to calculate indirect costs. A generalized linear model was fitted to identify factors associated with the cost of hypertension at a 95% confidence level and <0.05 p-value. RESULTS A total of 442, 56.3% female and 64.3% stage one hypertension patients were included. The total cost of hypertension was ETB 2510.32 ($91.72) ± 2152.80 (78.65) per patient per year; The direct medical and non-medical cost constituted 60.81% and 12.17% of the total cost of hypertension, respectively. Hospitalized (exp(b)=1.87, p<0.001), using multidrug (exp(b)=1.32, p<0.000), high socioeconomic status (exp(b)=1.41,p<0.000), college and above education(exp(b)= 1.35, p<0.016), government employment (exp(b)= 1.30, p<0.012), retirement (exp(b)= 0.71, p< 0.001) and co-morbidity (exp(b)= 1.20, p<0.004) were factors significantly associated with the cost of hypertension. CONCLUSION The total cost of illness of hypertension is high, and direct medical cost has the highest component of the total cost of illness. Hospitalization, using multidrug, co-morbidity, attending college and above education, highest socioeconomic status and government employment were factors significantly associated with the high cost of hypertension. Therefore, prevention and early detection of complications and co-morbidity are essential to reduce hospitalization and the number of drugs to reduce the direct medical and indirect costs.
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Affiliation(s)
- Elsabet Adane
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Andualem Yalew Aschalew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Wilson OWA, Kamara K, Papalia Z, Bopp M, Bopp CM. Changes in Hypertension Diagnostic Criteria Enhance Early Identification of at Risk College Students. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2020. [DOI: 10.1249/tjx.0000000000000114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kamara K, Wilson OWA, Papalia Z, Bopp M, Bopp CM. Comparison of College Student Hypertension Prevalence between the JNC7 and ACC/AHA Diagnostic Criteria. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2019; 12:898-903. [PMID: 31523347 PMCID: PMC6719808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hypertension is highly prevalent and associated with non-communicable diseases and increased premature mortality risk. However, the impact of the new hypertension diagnostic criteria on the prevalence of hypertension diagnoses has yet to be examined among college students. The purpose of this study was to compare the prevalence of hypertension between the JNC7 and the ACC/AHA hypertension diagnostic criteria among college students. The blood pressure of 5,945 college students was assessed, and chi-square tests for independence examined differences between JNC7 and ACC/AHA criteria. The mean age of participants was 21.30 ± 1.05 years, and the majority identified as men (60.5%). Men were found to have significantly higher systolic (p < .001, η 2 = .10) and diastolic (p < .001, η 2 = .04) blood pressure, so all analyses were separated by sex. Hypertension guideline changes resulted in significant changes in hypertension categorization of both men, χ 2 = 7,178, p < .001, Φ c = .816 and women, χ 2 = 4,670, p < .001, Φ c = .816. Under the JNC7 guidelines, 292 (8.2%) men and 67 (2.8%) women were hypertensive. Using the ACC/AHA guidelines, 1455 (40.5%) men and 521 (22.3%) women were hypertensive. Hypertension guideline changes resulted in a significant increase in the prevalence of hypertension among college students, highlighting the potential demand for targeted prevention programs focused on fostering healthy lifestyle behaviors, i.e. physical activity and healthy eating, among students.
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Affiliation(s)
- Kadiatu Kamara
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Oliver W A Wilson
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Zack Papalia
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Melissa Bopp
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Christopher M Bopp
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
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Grosse SD, Krueger KV, Pike J. Estimated annual and lifetime labor productivity in the United States, 2016: implications for economic evaluations. J Med Econ 2019; 22:501-508. [PMID: 30384792 PMCID: PMC6688510 DOI: 10.1080/13696998.2018.1542520] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Human-capital based lifetime productivity estimates are frequently used in cost-of-illness (COI) analyses and, less commonly, in cost-effectiveness analyses (CEAs). Previous US estimates assumed that labor productivity and real earnings both grow by 1% per year. Objectives: This study presents estimates of annual and lifetime productivity for 2016 using data from the American Community Survey, the American Time Use Survey, and the Current Population Survey, and with varying assumptions about real earnings growth. Methods: The sum of market productivity (gross annual personal labor earnings adjusted for employer-paid benefits) and the imputed value of non-market time spent in household, caring, and volunteer services was estimated. The present value of lifetime productivity at various ages was calculated for synthetic cohorts using annual productivity estimates, life tables, discount rates, and assumptions about future earnings growth rates. Results: Mean annual productivity was $57,324 for US adults in 2016, including $36,935 in market and $20,389 in non-market productivity. Lifetime productivity at birth, using a 3% discount rate, is roughly $1.5 million if earnings grow by 1% per year and $1.2 million if future earnings growth averages 0.5% per year. Conclusions: Inclusion of avoidable productivity losses in societal-perspective CEAs of health interventions is recommended in new US cost-effectiveness guidelines. However, estimates vary depending on whether analysts choose to estimate total productivity or just market productivity, and on assumptions made about growth in future productivity and earnings.
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Affiliation(s)
- Scott D Grosse
- a National Center on Birth Defects and Developmental Disabilities , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | | | - Jamison Pike
- c Immunization Services Division , National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Hird TR, Zomer E, Owen AJ, Magliano DJ, Liew D, Ademi Z. Productivity Burden of Hypertension in Australia. Hypertension 2019; 73:777-784. [DOI: 10.1161/hypertensionaha.118.12606] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Thomas R. Hird
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (T.R.H., D.J.M.)
| | - Ella Zomer
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
| | - Alice J. Owen
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
| | - Dianna J. Magliano
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (T.R.H., D.J.M.)
| | - Danny Liew
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
| | - Zanfina Ademi
- From the Division of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (T.R.H., E.Z., A.J.O., D.J.M., D.L., Z.A.)
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Nawata K, Sugano H, Kimura M. An Analysis of the Effects of Blood Pressure and Antihypertensive Drugs on Heart Disease. Health (London) 2019. [DOI: 10.4236/health.2019.116064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Pike J, Grosse SD. Friction Cost Estimates of Productivity Costs in Cost-of-Illness Studies in Comparison with Human Capital Estimates: A Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:765-778. [PMID: 30094591 PMCID: PMC6467569 DOI: 10.1007/s40258-018-0416-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Cost-of-illness (COI) studies often include the 'indirect' cost of lost production resulting from disease, disability, and premature death, which is an important component of the economic burden of chronic conditions assessed from the societal perspective. In most COI studies, productivity costs are estimated primarily as the economic value of production forgone associated with loss of paid employment (foregone gross earnings); some studies include the imputed value of lost unpaid work as well. This approach is commonly but imprecisely referred to as the human capital approach (HCA). However, there is a lack of consensus among health economists as to how to quantify loss of economic productivity. Some experts argue that the HCA overstates productivity losses and propose use of the friction cost approach (FCA) that estimates societal productivity loss as the short-term costs incurred by employers in replacing a lost worker. This review sought to identify COI studies published during 1995-2017 that used the FCA, with or without comparison to the HCA, and to compare FCA and HCA estimates from those studies that used both approaches. We identified 80 full COI studies (of which 75% focused on chronic conditions), roughly 5-8% of all COI studies. The majority of those studies came from three countries, Canada, Germany, and the Netherlands, that have officially endorsed use of the FCA. The FCA results in smaller productivity loss estimates than the HCA, although the differential varied widely across studies. Lack of standardization of HCA and FCA methods makes productivity cost estimates difficult to compare across studies.
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Affiliation(s)
- Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road NE, MS A-19, Atlanta, GA, 30329-4027, USA.
| | - Scott D Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
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Sackner MA, Patel S, Adams JA. Changes of blood pressure following initiation of physical inactivity and after external addition of pulses to circulation. Eur J Appl Physiol 2018; 119:201-211. [PMID: 30350153 PMCID: PMC6342894 DOI: 10.1007/s00421-018-4016-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine whether an innovative, motorized, wellness device that effortlessly produces physical activity (JD) can mitigate the hypertensive effects of prolonged sitting or lying down. METHODS Twenty-two normotensive and hypertensive adults of both genders gave informed consent to participate in a randomized controlled crossover study of a passive simulated jogging device (JD) in both supine and seated postures. Each study participant was monitored with a continuous non-invasive arterial pressure monitoring device (CNAP) over 60 min. The initial 10 min served as baseline for each posture. The subjects were randomized to begin with either JD or SHAM control for 30 min, and monitoring was continued for an additional 10 min in one posture; three days later posture and order of JD or SHAM were changed. RESULTS In both seated and supine postures, SHAM was associated with a significant rise in blood pressure (BP) which was observed within 5-10 min; it continued to rise or remain elevated for over a 40-min observation period. In contrast, JD produced a significant decrease in both systolic and diastolic blood pressure in both postures. During recovery in seated posture JD decreased systolic and diastolic BP by - 8.1 and - 7.6 mmHg, respectively. In supine posture, a similar decrease in BP occurred. CONCLUSIONS There is rapid onset of increase in systolic and diastolic BP with physical inactivity in both supine and seated postures. Administration of JD significantly decreased BP in both postures. Further studies are needed to assess long-term effectiveness.
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Affiliation(s)
- Marvin A Sackner
- Emeritus Director of Medical Services, Mt Sinai Medical Center of Greater Miami, Miami Beach, FL, USA
| | | | - Jose A Adams
- Division Neonatology, Mt Sinai Medical Center of Greater Miami, Miami Beach, FL, USA.
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Nawata K, Kimura M. Does High Systolic Blood Pressure Truly Increase Medical Expenditure?—An Empirical Analysis of the New 2017 ACC/AHA Hypertension Guideline. Health (London) 2018. [DOI: 10.4236/health.2018.108079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Grosse SD. How Economic Findings Can Inform Prevention Research in Cardiovascular Disease. Am J Prev Med 2017; 53:S118-S120. [PMID: 29153112 PMCID: PMC6033324 DOI: 10.1016/j.amepre.2017.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
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