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Yeh PT, Rhee DK, Kennedy CE, Zera CA, Lucido B, Tunçalp Ö, Gomez Ponce de Leon R, Narasimhan M. Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review. BMC Pregnancy Childbirth 2022; 22:454. [PMID: 35641913 PMCID: PMC9152837 DOI: 10.1186/s12884-022-04751-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes. METHODS We searched for publications that compared SMBP with clinic-based monitoring during antenatal care. We included studies measuring any of the following outcomes: maternal mortality, pre-eclampsia, long-term risk and complications, autonomy, HELLP syndrome, C-section, antenatal hospital admission, adverse pregnancy outcomes, device-related issues, follow-up care with appropriate management, mental health and well-being, social harms, stillbirth or perinatal death, birthweight/size for gestational age, and Apgar score. After abstract screening and full-text review, we extracted data using standardized forms and summarized findings. We also reviewed studies assessing values and preferences as well as costs of SMBP. RESULTS We identified 6 studies meeting inclusion criteria for the effectiveness of SMBP, 6 studies on values and preferences, and 1 study on costs. All were from high-income countries. Overall, when comparing SMBP with clinic-monitoring, there was no difference in the risks for most of the outcomes for which data were available, though there was some evidence of increased risk of C-section among pregnant women with chronic hypertension. Most end-users and providers supported SMBP, motivated by ease of use, convenience, self-empowerment and reduced anxiety. One study found SMBP would lower health sector costs. CONCLUSION Limited evidence suggests that SMBP during pregnancy is feasible and acceptable, and generally associated with maternal and neonatal health outcomes similar to clinic-based monitoring. However, more research is needed in resource-limited settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021233839 .
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Affiliation(s)
- Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dong Keun Rhee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Elizabeth Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chloe A Zera
- Department of Obstetrics and Gynecology, Harvard Medical Faculty Physicians, Boston, MA, USA
| | - Briana Lucido
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | | | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
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Dube SR, Dube M, Damle S, Patil A. Ambulatory Blood Pressure Monitoring: Our Experience in Routine Clinical Practice. Cureus 2021; 13:e17390. [PMID: 34584800 PMCID: PMC8457258 DOI: 10.7759/cureus.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To evaluate feasibility and usefulness of ambulatory blood pressure monitoring (ABPM) in outpatient setting. Material and methods: In this prospective study, data of 58 patients who were evaluated with ABPM for diagnosis or therapeutic efficacy purpose were collected from their records. Demographic details of these were recorded. Patients were categorized into different categories based on 24 hours BP pattern. Dipping pattern was compared based on the gender, age, and presence of diabetes or hypertension. Number of patients diagnosed as hypertensive with ABPM reports was compared with office and home BP measurement. Results: Fifty-eight patients (mean age 57.8 years; 70.69% males) were included of whom 22 (37.93%) underwent ABPM for diagnostic purposes. There was gender-wise significant difference in terms of purpose of performing ABPM (p=0.040). Diabetes was present in 22 (37.93%) patients. Out of 36 known hypertensive patients, 17 (47.22%) patients were receiving dual therapy. Out of 45 patients whose records for active BP variability were available, 26 (57.78%) had high variability. The number and percentage of dippers, extreme dippers and reverse dippers as 23 (42.79%), three (5.56%), and six (11.11%), respectively. Depending on the age, there was significant difference in the dipping pattern (p=0.013). On office blood pressure measurement, 35 (64.81%) patients were found to have hypertension. ABPM revealed hypertension in 32 (59.26%). Masked hypertension and white-coat hypertension was observed in nine (16.17%) and 12 (22.22%) patients, respectively. Conclusion: ABPM is feasible and useful in routine outpatient clinical practice for diagnosis of essential hypertension, pattern of dipping, masked hypertension, and white-coat hypertension and also for the therapeutic evaluation of patients in clinical practice.
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Affiliation(s)
- Sunil R Dube
- Medicine, DY Patil deemed to be University School of Medicine, Navi Mumbai, IND
| | - Manjree Dube
- Family Physician, Shyamlata Clinic, Chembur, Mumbai, IND
| | - Sayali Damle
- Geriatrics, DY Patil deemed to be University School of Medicine, Navi Mumbai, IND
| | - Anant Patil
- Pharmacology, DY Patil deemed to be University School of Medicine, Navi Mumbai, IND
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Paula DP, Lopes LJ, Mill JG, Fonseca MJM, Griep RH. Identifying patterns of diurnal blood pressure variation among ELSA-Brasil participants. J Clin Hypertens (Greenwich) 2020; 22:2315-2324. [PMID: 33017521 DOI: 10.1111/jch.14066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is the gold standard method for the diagnosis of hypertension. ABPM provides a set of repeated measurements for blood pressure (BP), usually over 24 h. Traditional approaches characterize diurnal BP variation by single ABPM parameters such as average and standard deviation, regardless of the temporal nature of the data. In this way, information about the pattern of diurnal BP variation and relationship between parameters is lost. The objective of this study was to identify and characterize daily BP patterns considering the set of repeated measures from 24-h ABPM. A total of 859 adult participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) performed a 24-h ABPM record. Hypertension, sex, age, race/color, education, marital status, smoking, alcohol, physical activity, and BMI were the covariables analyzed. Techniques for longitudinal clustering, multinomial models, and models with mixed effects were used. Three daily BP patterns were identified. Daily BP patterns with high BP presented higher standard deviation and morning surge and lower nocturnal dipping. They showed greater systolic BP variability and faster rise than fall in diastolic BP during sleep. Hypertensive, "pardos," and men had greater odds to present these patterns. Daily BP patterns with high BP presented the worst profile concerning ABPM parameters associated with cardiovascular risk. The daily BP patterns identified contribute to the characterization of diurnal BP variation.
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Affiliation(s)
- Daniela P Paula
- National School of Statistical Sciences, Brazilian Institute of Geography and Statistics, Rio de Janeiro, Brazil
| | - Leidjaira J Lopes
- Department of Nutrition and Health, Federal University of Viçosa, Minas Gerais, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Maria J M Fonseca
- Department of Epidemiology, National School of Public Health (ENSP/Fiocruz), Rio de Janeiro, Brazil
| | - Rosane H Griep
- Health and Environmental Education Laboratory, Oswaldo Cruz Institute (IOC/Fiocruz), Rio de Janeiro, Brazil
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Vasquez EC, Aires R, Ton AMM, Amorim FG. New Insights on the Beneficial Effects of the Probiotic Kefir on Vascular Dysfunction in Cardiovascular and Neurodegenerative Diseases. Curr Pharm Des 2020; 26:3700-3710. [DOI: 10.2174/1381612826666200304145224] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Abstract
The mechanisms responsible for cardiovascular and neurodegenerative diseases have been the focus of
experimental and clinical studies for decades. The relationship between the gut microbiota and the organs and
system tissues represents the research field that has generated the highest number of publications. Homeostasis of
the gut microbiota is important to the host because it promotes maturation of the autoimmune system, harmonic
integrative functions of the brain, and the normal function of organs related to cardiovascular and metabolic systems.
On the other hand, when a gut microbiota dysbiosis occurs, the target organs become vulnerable to the
onset or aggravation of complex chronic conditions, such as cardiovascular (e.g., arterial hypertension) and neurodegenerative
(e.g., dementia) diseases. In the present brief review, we discuss the main mechanisms involved in
those disturbances and the promising beneficial effects that have been revealed using functional food (nutraceuticals),
such as the traditional probiotic Kefir. Here, we highlight the current scientific advances, concerns, and
limitations about the use of this nutraceutical. The focus of our discussion is the endothelial dysfunction that
accompanies hypertension and the neurovascular dysfunction that characterizes ageing-related dementia in patients
suffering from Alzheimer's disease.
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Affiliation(s)
- Elisardo C. Vasquez
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
| | - Rafaela Aires
- Physiological Sciences Graduate Program, Federal University of Espirito Santo (UFES), Vitoria, ES, Brazil
| | - Alyne M. M. Ton
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
| | - Fernanda G. Amorim
- Pharmaceutical Sciences Graduate Program, Vila Velha University (UVV), Vila Velha, ES, Brazil
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Sánchez RA, Boggia J, Peñaherrera E, Barroso WS, Barbosa E, Villar R, Cobos L, Hernández Hernández R, Lopez J, Octavio JA, Parra Carrillo JZ, Ramírez AJ, Parati G. Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper-accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020. J Clin Hypertens (Greenwich) 2020; 22:527-543. [PMID: 32049441 PMCID: PMC8030035 DOI: 10.1111/jch.13816] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.
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Affiliation(s)
- Ramiro A. Sánchez
- Arterial Hypertension and Metabolic UnitUniversity Hospital, Favaloro, FoundationBuenos AiresArgentina
| | - José Boggia
- Unidad de HipertensiónCentro de NefrologíaHospital Dr. Manuel QuintelaUniversidad de la RepúblicaMontevideoUruguay
| | | | | | - Eduardo Barbosa
- Hypertension League Hospital San FranciscoComplexo Ermandade Santa Casa de Porto AlegrePorto AlegreBrazil
| | | | | | - Rafael Hernández Hernández
- Hypertension and Cardiovascular Risk Factors ClinicSchool of MedicineUniversidad Centro Occidental Lisandro AlvaradoBarquisimetoVenezuela
| | - Jesús Lopez
- Unidad de Hipertension ArterialHospital Universitario Dr. Jose M. VargasSan CristobalTachiraVenezuela
| | - José Andrés Octavio
- Department of Experimental CardiologyTropical Medicine InstituteUniversidad Central de VenezuelaCaracasVenezuela
| | | | - Agustín J. Ramírez
- Arterial Hypertension and Metabolic UnitUniversity Hospital, Favaloro, FoundationBuenos AiresArgentina
| | - Gianfranco Parati
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
- Cardiology UnitIstituto Auxologico ItalianoIRCCSSan Luca HospitalMilanItaly
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Li N, Ma R, Wang S, Zhao Y, Wang P, Yang Z, Jin L, Zhang P, Ding H, Bai F, Yu J. The potential role of testosterone in hypertension and target organ damage in hypertensive postmenopausal women. Clin Interv Aging 2019; 14:743-752. [PMID: 31118595 PMCID: PMC6501555 DOI: 10.2147/cia.s195498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/27/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: The aim of this study was to confirm the potential role of testosterone in hypertension and target organ damage (TOD) in hypertensive postmenopausal women. Methods: A matched group study was conducted. One hundred sixty-one hypertensive postmenopausal women between 45 and 65 years of age were enrolled as group 1. Another 161 age-matched hypertensive men were enrolled as group 2. Ambulatory blood pressure monitoring, echocardiographic imaging, vascular function, sex hormones and clinical characteristics were evaluated. Quantitative data were analyzed using independent Student’s t-test and multiple regression analysis. Results: The mean and load level of blood pressure were lower in women than in men (P<0.05), except for the mean level and load of the nocturnal systolic blood pressure (SBP) (123.77±15.72 mmHg vs 126.35±15.64 mmHg, and 50.43±30.31% vs 55.35±28.51%, P>0.05). However, the carotid-femoral pulse wave velocity (cf-PWV) in women was higher than that in men (9.68±2.23 m/s vs 8.03±2.82 m/s, P<0.05). The ratio of the early diastolic mitral peak flow velocity to early diastolic mitral annular velocity (E/Em) was obviously impaired (13.06±3.53 vs 12.05±3.68, P<0.05) in women. Furthermore, in women, a positive correlation was found between testosterone and cf-PWV (γ=0.157, P=0.046), and Cf-PWV was positively related to the mean level of nighttime SBP (γ=0.210, P=0.008). Moreover, nocturnal SBP was a risk factor for E/Em (γ=0.156, P=0.048, P<0.05). Conclusion: Testosterone may play a role in the correlation between hypertension and TOD in hypertensive postmenopausal women. Clinical Trial number: This research study was registered under the ClinicalTrials.gov PRS Website (NCT03451747).
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Affiliation(s)
- Ningyin Li
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Ruixin Ma
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Shixiong Wang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Yang Zhao
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Ping Wang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Zhitao Yang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Lingling Jin
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Panpan Zhang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Hong Ding
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Feng Bai
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Jing Yu
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
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Khanra D, Duggal B. Pseudo-resistant, resistant, and refractory hypertension: The good, the bad, and the ugly. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2019. [DOI: 10.4103/jpcs.jpcs_31_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Giglio BM, Fernandes RC, Marini AB, Mota JF, Pimentel GD. High out-of-clinic blood pressure is associated with adiposity indicators in leisure physical activity practitioners in Midwest Brazil. Clin Hypertens 2018; 24:8. [PMID: 29713495 PMCID: PMC5911962 DOI: 10.1186/s40885-018-0093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/05/2018] [Indexed: 11/29/2022] Open
Abstract
Background Several diseases, such as obesity, hypertension and type 2 diabetes are frequently associated with metabolic abnormalities, high costs of healthcare and morbi-mortality; thus the aim of this study was to investigate the relationship between out-of-clinic high blood pressure and chronic disease-associated adiposity indicators in practitioners of leisure physical activity. Methods A cross-sectional study with 414 subjects of both genders aged 24–65 years. Data were collected by trained interviewers in five public parks. Body Mass Index (BMI), triceps skinfold and waist circumference (WC) were evaluated. Exercise training, smoking status, alcohol consumption and hypertension diagnosis were self-reported. Casual glycemia concentrations were collected and blood pressure was measured out-of-clinic once during the study. Participants with systolic ≥140 mmHg and diastolic ≥90 mmHg blood pressures were classified as high blood pressure. All analyses were adjusted for age and sex. Results High-blood pressure was diagnosed in 31.4% (n = 130), but 34 (8.3%) from patients took medication anti-hypertensive and were previously hypertension diagnosed. Participants with high blood pressure had a higher BMI (25.66 vs. 26.87 kg/m2; p = 0.012), WC (90.92 vs. 95.02 cm; p = 0.001), and systolic and diastolic blood pressure (p < 0.0001) when compared to subjects with normal blood pressure. Logistic regression analysis revealed that overweight status assessed by BMI, triceps skinfold and WC increases the high blood pressure probability by approximately 1.61 (95 CI%: 1.06–2.45), 1.02 (95%CI: 1.01–1.05) and 1.61 (95%CI: 1.06–2.45), respectively. Conclusions Adiposity indicators are associated with high out-of-clinic blood pressure measured in practitioners of leisure physical activity.
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Affiliation(s)
- Bruna M Giglio
- 1Clinical and Sports Nutrition Research Laboratory (Labince), Nutrition Faculty (FANUT) Federal University of Goias (UFG), Goiânia, GO Brazil
| | - Renata C Fernandes
- 1Clinical and Sports Nutrition Research Laboratory (Labince), Nutrition Faculty (FANUT) Federal University of Goias (UFG), Goiânia, GO Brazil
| | - Ana B Marini
- 1Clinical and Sports Nutrition Research Laboratory (Labince), Nutrition Faculty (FANUT) Federal University of Goias (UFG), Goiânia, GO Brazil
| | - João F Mota
- 1Clinical and Sports Nutrition Research Laboratory (Labince), Nutrition Faculty (FANUT) Federal University of Goias (UFG), Goiânia, GO Brazil
| | - Gustavo D Pimentel
- 2Gabinete 10, Faculdade de Nutrição (FANUT) Universidade Federal de Goiás (UFG), Rua 227, Quadra 68 s/n°, Setor Leste Universitário, CEP: 74605-080, Goiânia, GO Brazil
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