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Mitsnefes MM, Maltenfort M, Denburg MR, Flynn JT, Schuchard J, Dixon BP, Patel HP, Claes D, Dickinson K, Chen Y, Gluck C, Leonard M, Verghese PS, Forrest CB. Derivation of paediatric blood pressure percentiles from electronic health records. EBioMedicine 2023; 98:104885. [PMID: 37988770 PMCID: PMC10679476 DOI: 10.1016/j.ebiom.2023.104885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Identification of abnormal blood pressure (BP) in children requires normative data. We sought to examine the feasibility of using "real-world" office BP data obtained from electronic health records (EHR) to generate age-, sex- and height-specific BP percentiles for children. METHODS Using data collected 01/01/2009-8/31/2021 from eight large children's healthcare organisations in PEDSnet, we applied a mixed-effects polynomial regression model with random slopes to generate Z-scores and BP percentiles and compared them with currently used normative BP distributions published in the 2017 American Academy of Paediatrics (AAP) Clinical Practise Guidelines (CPG). FINDINGS We identified a study sample of 292,412 children (1,085,083 BP measurements), ages 3-17 years (53% female), with no chronic medical conditions, who were not overweight/obese and who were primarily seen for general paediatric care in outpatient settings. Approximately 45,000-75,000 children contributed data to each age category. The PEDSnet systolic BP percentile values were 1-4 mmHg higher than AAP CPG BP values across age-sex-height groups, with larger differences observed in younger children. Diastolic BP values were also higher in younger children; starting with age 7 years, diastolic BP percentile values were 1-3 mmHg lower than AAP CPG values. Cohen's Kappa was 0.90 for systolic BP, 0.66 for diastolic BP, and 0.80 overall indicating excellent agreement between PEDSnet and 2017 AAP CPG data for systolic BP and substantial agreement for diastolic BP. INTERPRETATION Our analysis indicates that real-word EHR data can be used to generate BP percentiles consistent with current clinical practise on BP management in children. FUNDING Funding for this work was provided by the Preserving Kidney Function in Children with Chronic Kidney Disease (PRESERVE) study; Patient-Centred Outcomes Research Institute (PCORI) RD-2020C2020338 (Principal Investigator: Dr. Forrest; Co-Principal Investigator: Dr. Denburg).
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Affiliation(s)
- Mark M Mitsnefes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, OH, USA.
| | - Mitchell Maltenfort
- Children's Hospital of Philadelphia, Applied Clinical Research Center, Philadelphia, PA, USA
| | - Michelle R Denburg
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania: Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Julia Schuchard
- Children's Hospital of Philadelphia, Applied Clinical Research Center, Philadelphia, PA, USA
| | - Bradley P Dixon
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Donna Claes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, OH, USA
| | - Kimberley Dickinson
- Children's Hospital of Philadelphia, Applied Clinical Research Center, Philadelphia, PA, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline Gluck
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | | | - Priya S Verghese
- Ann & Robert H Lurie Children's Hospital, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher B Forrest
- Children's Hospital of Philadelphia, Applied Clinical Research Center, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania: Philadelphia, PA, USA
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Kamińska MS, Schneider-Matyka D, Rachubińska K, Panczyk M, Grochans E, Cybulska AM. Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. J Clin Med 2023; 12:7058. [PMID: 38002671 PMCID: PMC10672665 DOI: 10.3390/jcm12227058] [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: 10/10/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Menopause is an important event in women's lives, possibly contributing to the development of CVD, which is associated with changes in the cardiovascular risk profile, markers of metabolic health, and subclinical atherosclerosis. The aim of this study was to assess the association of menopause with CVD risk factors and subclinical markers of cardiometabolic disease. (2) Methods: The study involved 235 women from the general population at different stages of menopause. The methods used in this study were: diagnostic survey, anthropometric measurement (WC, height, BMI, WHtR), blood pressure measurement, biochemical analysis of venous blood (lipid profile, glucose, insulin, HbA1c), and CVD risk assessment (ASCVD Risk Calculator, POL-SCORE, SCORE-2). (3) Results: The vast majority of respondents had low cardiovascular risk, irrespective of the scale used for measuring the risk of CVD. The age at menopause was not an independent risk factor for CVD. In Model 1, the age at menopause and the time since menopause were found to be factors that increased CVD risk (OR = 1.186 and 1.267, respectively). In Models 2 and 3, the severity of menopausal symptoms was not a risk factor for CVD. Models 3 and 4 demonstrated that women with metabolic syndrome (MetS) were at a significantly higher risk of CVD. In model 5, the odds ratio of CVD with MetS as a standalone factor was 13.812. (4) Conclusions: Menopause predisposes women to an increased risk and MetS to a significantly higher risk of CVD.
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Affiliation(s)
- Magdalena Sylwia Kamińska
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Daria Schneider-Matyka
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Kamila Rachubińska
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-518 Warsaw, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Anna Maria Cybulska
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
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Mosepele M, Bennett K, Gaolathe T, Makhema JM, Mmalane M, Holme MP, Lebelonyane R, Ometoruwa O, Mills LA, Powis KM, Leidner J, Jarvis JN, Tapela NM, Masupe T, Mokgatlhe L, Triant VA, Wirth KE, Moshomo T, Lockman S. Prevalence and control of hypertension in a high HIV-prevalence setting, insights from a population based study in Botswana. Sci Rep 2023; 13:17814. [PMID: 37857692 PMCID: PMC10587125 DOI: 10.1038/s41598-023-44499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
In a population-based representative sample of adults residing in 22 communities in Botswana, a southern African country with high HIV prevalence, 1 in 4 individuals had high blood pressure. High blood pressure was less prevalent in adults with HIV than without HIV. Sixty percent of persons with high blood pressure had not previously been diagnosed. Among individuals with a prior diagnosis of high blood pressure who reported being prescribed anti-hypertension medications, almost half had elevated blood pressure, irrespective of HIV-status. One-third of adults in this setting (mainly men) declined free non-invasive blood pressure assessments in their households. In conclusion, our study highlights alarmingly high hypertension rates in the community, with low levels of awareness and control, emphasizing the urgent need for community level BP screening and active management to reach recommended targets.
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Affiliation(s)
- Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Sir Ketumile Masire Teaching Hospital, Department of Internal Medicine, Faculty of Medicine, University of Botswana, 3rd Floor, Block F, Room F4069, Gaborone, Botswana.
| | - Kara Bennett
- Bennett Statistical Consulting Inc, Ballston Lake, New York, USA
| | - Tendani Gaolathe
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Mompati Mmalane
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Molly Pretorius Holme
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Omolola Ometoruwa
- Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, USA
| | - Lisa A Mills
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Kathleen M Powis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Joseph N Jarvis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Neo M Tapela
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Ministry of Health & Wellness, Gaborone, Botswana
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Tiny Masupe
- Department of Family Medicine & Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Lucky Mokgatlhe
- Department of Biostatistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Virginia A Triant
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen E Wirth
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Thato Moshomo
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, USA
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French SA, Kunin-Batson AS, Sherwood NE, Berge JM, Shanley R. NET-Works paediatric obesity prevention trial: 66 month outcomes. Pediatr Obes 2023; 18:e13055. [PMID: 37171137 PMCID: PMC10462385 DOI: 10.1111/ijpo.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/28/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The NET-Works trial (2012-2018) randomized 534 children ages 2-4 years at baseline and their caregivers to either a 3-year multicomponent obesity prevention intervention or a control group. This research examined treatment effects on body mass index and other outcomes at 66 months. METHODS Parent-child dyads (n = 338) who agreed to participate in a 66 month measurement visit were measured for child BMI, physical activity, diet, and cardiometabolic risk factor variables. RESULTS At 66 months, no significant treatment effects were observed on BMI (Effect = -0.38; 95% CI = -1.13, 0.37). Subgroup results were consistent with the NET-Works 36 month results. Children with overweight at baseline in the intervention group gained significantly less BMI versus children with overweight in the control group (Effect = -1.28; 95% CI = -2.48, -0.07). Among Hispanic children, those in the intervention gained significantly less BMI than those in the control group (Effect = -1.04; 95% CI = -1.97, -0.11). CONCLUSIONS Evidence suggests that early intervention with children at highest risk for obesity, using community-based, multicomponent, multisetting interventions, may be effective in reducing excess weight gain and obesity among certain subgroups of children. The intervention appeared to be effective in slowing BMI gain 66 months after randomization among children who were already overweight at ages 2-4 years and among children of Hispanic ethnicity.
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Affiliation(s)
- Simone A French
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Alicia S Kunin-Batson
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nancy E Sherwood
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ryan Shanley
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis Minnesota
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Kamińska MS, Lubkowska A, Panczyk M, Walaszek I, Grochans S, Grochans E, Cybulska AM. Relationships of Body Mass Index, Relative Fat Mass Index, and Waist Circumference with Serum Concentrations of Parameters of Chronic Inflammation. Nutrients 2023; 15:2789. [PMID: 37375693 DOI: 10.3390/nu15122789] [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: 05/19/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Obesity in the perimenopausal period is associated with hormonal changes, lifestyle, and environment. In obesity, elevated levels of IL-6 and TNF-α and reduced levels of adiponectin are observed, and the associated chronic inflammation favors the development of cardiometabolic diseases. Therefore, the aim of our study was to assess the relationship between selected measures of obesity (BMI, WC, RFM, VAI, WHtR) and parameters of chronic inflammation (CRP, TNF-α, IL-6) in perimenopausal women. (2) Methods: The study involved 172 perimenopausal women. The methods used in this study were diagnostic surveys, anthropometric measurements, blood pressure measurements, and venous blood sampling. (3) Results: Preliminary multivariate linear regression analysis showed that CRP moderately positively correlated with IL-6 (β = 0.25; p = 0.001) and weakly negatively correlated with adiponectin (β = -0.23; p = 0.002). Similar associations were noted in preliminary multivariate linear regression analysis adjusted for age, menopausal status, and smoking status. Preliminary multivariate linear regression analysis also showed that BMI positively correlated with IL-6 (β = 0.16; p = 0.033). VAI weakly positively correlated with CRP (β = 0.25; p = 0.001) and negatively correlated with adiponectin (β = -0.43; p = 0.000). (4) BMI, WC, RFM, VAI, and WHtR are clearly related to selected parameters of chronic inflammation. Our study suggests that each of the anthropometric variables provides distinct information on metabolic processes associated with inflammatory parameters.
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Affiliation(s)
- Magdalena Sylwia Kamińska
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Anna Lubkowska
- Department of Functional Diagnostics and Physical Medicine, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 54 Żołnierska St., 71-210 Szczecin, Poland
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-518 Warsaw, Poland
| | - Ireneusz Walaszek
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, 1 Unii Lubelskiej St., 72-252 Szczecin, Poland
| | - Szymon Grochans
- Department of Specialised Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
| | - Anna Maria Cybulska
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 48 Żołnierska St., 71-210 Szczecin, Poland
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Prado JP, Galdino G. Effect of a cardiac telerehabilitation program during COVID-19 associated social isolation. SPORTS MEDICINE AND HEALTH SCIENCE 2023. [DOI: 10.1016/j.smhs.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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The Levels of Bioelements in Postmenopausal Women with Metabolic Syndrome. Nutrients 2022; 14:nu14194102. [PMID: 36235758 PMCID: PMC9572475 DOI: 10.3390/nu14194102] [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: 08/24/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Metabolic syndrome is a set of factors that considerably increase the risk of developing atherosclerosis, type 2 diabetes, and their cardiovascular complications. Studies show that menopause and the levels of elements may be significantly associated with increased risk of MetS. The present study evaluated the relationship between element levels (Ca, P, Na, K, Fe, Mg, Cu, Zn, Sr) and the incidence of MetS and concomitant metabolic disorders in peri-menopausal women. (2) The study involved 170 perimenopausal women. The methods used were: survey, anthropometric measurement (WC, height, BMI, WHtR), blood pressure measurement, and biochemical analysis of venous blood (lipid profile, glucose, insulin, HbA1C). (3) The study demonstrated statistically significantly higher WC, WHtR, SBP, and DBP values in women with pre-Mets than in those with Mets and the control group. Significantly higher FPG, TG, LDL, HbA1C, insulin, TG/HDL ratio, and TC/HDL ratio were recorded in the MetS group compared to the rest of respondents. In addition, post hoc analysis revealed statistically significant differences in mean K concentrations between pre-MetS and MetS women. (4) Low blood K levels in perimenopausal women are associated with an increased risk of MetS. Significantly higher Cu levels were observed in overweight women. The concentration of Cu negatively correlates with the values of TC, LDL, and SBP.
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McMahon J, Thompson DR, Brazil K, Ski CF. An eHealth intervention (ManGuard) to reduce cardiovascular disease risk in male taxi drivers: protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2022; 8:209. [PMID: 36104740 PMCID: PMC9472349 DOI: 10.1186/s40814-022-01163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Men are at higher risk then women of developing cardiovascular disease (CVD), and male taxi drivers are a particularly high-risk group because of their typically unhealthy behaviours, such as poor eating habits, smoking and sedentary lifestyle. However, only two studies of behavioural interventions targeting taxi drivers have been identified, one of which reported a high attrition rate. Therefore, an eHealth intervention co-designed by taxi drivers may prove more acceptable and effective. The aim of this study is to assess the feasibility an eHealth intervention (ManGuard) to reduce CVD risk in male taxi drivers. Methods A randomised wait-list controlled trial will be conducted with a sample of 30 male taxi drivers to establish feasibility, including recruitment, engagement, and retention rates. Program usability and participant satisfaction will be assessed by a survey completed by all participants at 3 months after allocation. Additionally, an in-depth qualitative process evaluation to explore acceptability of the intervention will be conducted with a subset of participants by semi-structured telephone interviews. Preliminary efficacy of ManGuard for improving key CVD-related outcomes will be assessed, including biomarkers (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and total/HDL cholesterol ratio), blood pressure, anthropometry (body mass index, body fat percentage, and waist circumference), physical activity (accelerometery, and self-report) and psychosocial status (health-related quality of life, self-efficacy, and social support). Outcomes will be assessed at baseline, 7 weeks, and 3 months after group allocation. The wait-list control group will be offered access to the intervention at the completion of data collection. Discussion eHealth interventions show potential for promoting behaviour change and reducing CVD risk in men, yet there remains a paucity of robust evidence pertaining to male taxi drivers, classified as a high-risk group. This study uses a randomised controlled trial to assess the feasibility of ManGuard for reducing CVD risk in male taxi drivers. It is envisaged that this study will inform a fully powered trial that will determine the effectiveness of eHealth interventions for this high risk and underserved population. Trial registration This trial has been registered prospectively on the ISRCTN registry on 5 January 2022, registration number ISRCTN29693943 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01163-4.
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The Effect of Whole Blood Lead (Pb-B) Levels on Changes in Peripheral Blood Morphology and Selected Biochemical Parameters, and the Severity of Depression in Peri-Menopausal Women at Risk of Metabolic Syndrome or with Metabolic Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145033. [PMID: 32668760 PMCID: PMC7400500 DOI: 10.3390/ijerph17145033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023]
Abstract
The aim of our study was to assess the impact of whole blood lead (Pb-B) levels on changes in peripheral blood morphology and selected biochemical parameters, and the severity of depression in peri-menopausal women at risk of metabolic syndrome (pre-MetS) or with metabolic syndrome (MetS). The study involved 233 women from the general population of the West Pomeranian Province (Poland) aged 44–65 years. The intensity of menopausal symptoms and the severity of depression was examined using the Blatt–Kupperman Index (KI) and the Beck Depression Inventory (BDI). C-reactive protein (CRP), insulin, glucose, glycated hemoglobin (HbA1C), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglyceride levels (TG), cortisol, morphology of blood cells and homeostasis model assessment for insulin resistance (HOMA-IR) and Pb-B was measured. Women with MetS had higher levels of glucose, HbA1C, HDL, LDL, TG, cortisol, insulin and higher HOMA-IR. No significant differences in Pb-B were observed between pre-MetS and the control group, and between pre-MetS and the MetS group. A significant correlation was noticed between Pb-B vs. the percentage of monocytes in blood, and blood cortisol levels in women with MetS; Pb-B vs. lymphocyte count and HbA1C in the pre-MetS group, as well as in the BDI scores between the MetS and pre-MetS group. We cannot clearly state that exposure to Pb is an environmental factor that can be considered as a risk factor for MetS in this studied group.
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Association Between HDL Cholesterol and QTc Interval: A Population-Based Epidemiological Study. J Clin Med 2019; 8:jcm8101527. [PMID: 31547597 PMCID: PMC6832837 DOI: 10.3390/jcm8101527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 01/06/2023] Open
Abstract
Previous experimental studies showed that increasing high-density lipoprotein cholesterol (HDL) cholesterol shortens cardiac ventricular repolarization and the QT interval corrected for heart rate (QTc). However, little is known about the epidemiological relationship between HDL and QTc. The potential antiarrhythmic effect of HDL cholesterol remains a speculative hypothesis. In this cross-sectional population based study in adults living in the Italian-speaking part of Switzerland, we aimed to explore the association between HDL cholesterol and the QTc interval in the general population. A total of 1202 subjects were screened. electrocardiogram (ECG) recordings, measurements of lipid parameters and other laboratory tests were performed. QTc was corrected using Bazett’s (QTcBaz) and Framingham (QTcFram) formulas. HDL was categorized according to percentile distributions: <25th (HDL-1; ≤1.39 mmol/L); 25th–<50th (HDL-2; 1.40–1.69 mmol/L); 50th–<75th (HDL-3; 1.69–1.99 mmol/L); and ≥75th (HDL-4; ≥2.0 mmol/L). After exclusion procedures, data of 1085 subjects were analyzed. Compared with the HDL reference group (HDL-1), HDL-2 and HDL-3 were associated with a reduction of QTcBaz and QTcFram duration in crude (HDL-2, QTcBaz/QTcFram: β-11.306/–10.186, SE 4.625/4.016; p = 0.016/0.012; HDL-3, β-12.347/–12.048, SE 4.875/4.233, p = 0.012/<0.001) and adjusted (HDL-2: β-11.697/–10.908, SE 4.333/4.151, p < 0.001/0.010; HDL-3 β-11.786/–11.002, SE 4.719/4.521, p = 0.014/0.016) linear regression models in women. In adjusted logistic regression models higher HDL, were also associated with lower risk of prolonged QTcBaz/QTcFram (HDL-2: OR 0.16/0.17, CI 0.03–0.83/0.47–0.65; HDL-3: OR 0.10/0.14, CI 0.10–0.64/0.03–0.63) in women. Restricted cubic spline analysis confirmed a non linear association (p < 0.001). The present findings indicate an epidemiological association between HDL cholesterol and QTc duration. To draw firm conclusions, further investigations in other populations and with a prospective cohort design are needed.
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The effect of high evening blood pressure on obstructive sleep apnea-related morning blood pressure elevation: does sex modify this interaction effect? Sleep Breath 2019; 23:1255-1263. [PMID: 31183742 DOI: 10.1007/s11325-019-01869-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/28/2019] [Accepted: 05/24/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) can lead to increased morning blood pressure (BP). We hypothesized that high evening BP may aggravate OSA-related morning BP elevation. Additionally, this interactional effect may be modified by sex. METHODS This retrospective, cross-sectional study included newly diagnosed OSA patients with an apnea-hypopnea index (AHI) ≥ 5 per hour on a full-night polysomnography. An analysis of covariance (ANCOVA) was used to determine whether severe OSA (AHI ≥ 30) was associated with higher morning BP than mild-to-moderate OSA (5 ≤ AHI < 30) and whether there was an interaction between apnea severity and evening BP on morning BP. To identify the sex effects, analyses were performed separately in each sex group. RESULTS A total of 1445 patients with an average age of 51.9 years (SD 11.7) (male 77.9% vs. female 22.1%; high evening BP group 22.4% vs. normal evening BP group 59.6%) were included in the study. Based on the ANCOVA, patients with severe OSA had significantly higher morning systolic BP (SBP) (p = 0.003), diastolic BP (DBP) (p < 0.001), and mean BP (MBP) (p < 0.001) than the mild-to-moderate group in male subjects. A significant interaction between apnea severity and evening BP was identified on morning DBP and MBP in male subjects. However, there were no differences in morning BP between severe and mild-to-moderate OSA groups in female subjects. CONCLUSIONS In male subjects, severe OSA contributed to higher morning BP than mild-to-moderate OSA. OSA-associated morning BP elevation was more prominent in the high evening BP group than in the normal BP group. Such relations were not found in female subjects.
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The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2019; 14:e0211032. [PMID: 30726242 PMCID: PMC6364898 DOI: 10.1371/journal.pone.0211032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/07/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Management of hypertension in chronic kidney disease (CKD) remains a major challenge. We conducted a systematic review to assess whether exercise is an effective strategy for lowering blood pressure in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We searched MEDLINE, EMBASE, the Cochrane Library, CINAHL and Web of Science for randomized controlled trials (RCTs) that examined the effect of exercise on blood pressure in adults with non-dialysis CKD, stages 3-5. Outcomes were non-ambulatory systolic blood pressure (primary), other blood pressure parameters, 24-hour ambulatory blood pressure, pulse-wave velocity, and flow-mediated dilatation. Results were summarized using random effects models. RESULTS Twelve studies with 505 participants were included. Ten trials (335 participants) reporting non-ambulatory systolic blood pressure were meta-analysed. All included studies were a high risk of bias. Using the last available time point, exercise was not associated with an effect on systolic blood pressure (mean difference, MD -4.33 mmHg, 95% confidence interval, CI -9.04, 0.38). The MD after 12-16 and 24-26 weeks of exercise was significant (-4.93 mmHg, 95% CI -8.83, -1.03 and -10.94 mmHg, 95% CI -15.83, -6.05, respectively) but not at 48-52 weeks (1.07 mmHg, 95% CI -6.62, 8.77). Overall, exercise did not have an effect on 24-hour ambulatory blood pressure (-5.40 mmHg, 95% CI -12.67, 1.87) or after 48-52 weeks (-7.50 mmHg 95% CI -20.21, 5.21) while an effect was seen at 24 weeks (-18.00 mmHg, 95% CI -29.92, -6.08). Exercise did not have a significant effect on measures of arterial stiffness or endothelial function. CONCLUSION Limited evidence from shorter term studies suggests that exercise is a potential strategy to lower blood pressure in CKD. However, to recommend exercise for blood pressure control in this population, high quality, longer term studies specifically designed to evaluate hypertension are needed.
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Muntner P, Einhorn PT, Cushman WC, Whelton PK, Bello NA, Drawz PE, Green BB, Jones DW, Juraschek SP, Margolis KL, Miller ER, Navar AM, Ostchega Y, Rakotz MK, Rosner B, Schwartz JE, Shimbo D, Stergiou GS, Townsend RR, Williamson JD, Wright JT, Appel LJ. Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 73:317-335. [PMID: 30678763 PMCID: PMC6573014 DOI: 10.1016/j.jacc.2018.10.069] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 11/21/2022]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Paula T Einhorn
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland
| | - William C Cushman
- Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Paul E Drawz
- Division of Renal Diseases & Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Daniel W Jones
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Edgar R Miller
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Yechiam Ostchega
- National Center for Health Statistics of the Centers for Disease Control and Prevention, Hyattsville, Maryland
| | | | - Bernard Rosner
- Department of Medicine, Brigham's and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Joseph E Schwartz
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York
| | - Daichi Shimbo
- The Hypertension Center, Columbia University Medical Center, New York, New York
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Raymond R Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeff D Williamson
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jackson T Wright
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Rabeya R, Zaman S, Chowdhury A, Nabi M, Hawlader M. Magnitude and Determinants of Hypothyroidism among Dyslipidemic Patients in Bangladesh: A Hospital-Based Cross-Sectional Study. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000499379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Dyslipidemia is one of the most commonly experienced metabolic disorders, and it is strongly related to atherosclerotic cardiovascular disease. Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid hormones. Several studies from developed countries provide evidence that the rate of hypothyroidism in dyslipidemic patients is higher, but there is a scarcity of data from Bangladesh. <b><i>Objectives:</i></b> The aim of this study was to evaluate the prevalence and determinants of hypothyroidism in the adult dyslipidemic Bangladeshi population. <b><i>Method:</i></b> We examined the thyroid function of outpatients who were advised for fasting lipid profile and who were found to be dyslipidemic at a tertiary care hospital in Savar, Bangladesh, by a cross-sectional study conducted from July 2016 to June 2017. A total of 200 outpatients aged 20–65 years were enrolled in this study. A standard questionnaire was used to take record of sociodemographic, socioeconomic, and behavioral features. Body mass index (BMI) and blood pressure were examined with standard procedures. Biochemical parameters, such as fasting lipid profile and thyroid function markers, thyroid-stimulating hormone (TSH) and free thyroxine (fT4), were determined using standard assay methods. A <i>p</i> value < 0.05 was considered to be statistically significant. <b><i>Results:</i></b> Among the participants, 56% were male and 44% were female. 11.5% of the dyslipidemic subjects had hypothyroidism, among which 9.5% had subclinical hypothyroidism and only 2% had overt hypothyroidism. We also found that serum mean ± SD levels of TSH were significantly higher in the obese group of patients (<i>p</i> = 0.02). There was a significantly positive association of BMI and diastolic blood pressure with serum levels of TSH (<i>p</i> < 0.01) and fT4 (<i>p</i> = 0.02), respectively. <b><i>Conclusion:</i></b> Dyslipidemic patients should have more regular checkups. The findings of this study might be helpful in setting up the clinical management of dyslipidemias with or without normal thyroid function.
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Blood Pressure Measurement Training Program and Adherence of Public Health Nurses to BP Measurement Guidelines. ACTA ACUST UNITED AC 2017; 51:351-359. [PMID: 33986553 DOI: 10.47895/amp.v51i4.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To compare the level of adherence of public health nurses to BP measurement guidelines based on their knowledge if the guidelines and skills in BP measurement before and after Blood Pressure Measurement Training Program (BPMTP). Methods An experimental pre- and post-test design using two-staged cluster randomization was conducted. 118 PHNs (mean age ± 38.45 years, mean years of experience ± 13.45 years; 84.1% women) from six districts in Manila were equally assigned to either the BPMTP group or control group. Structured instruments were used. Results Demographic characteristics, current BP measurement practices, and level of adherence to BP measurement guidelines based on knowledge of the guidelines and skills in BP measurement were equivalent in both groups at baseline. Nurses in the BPMTP group showed improved adherence (p=<0.05) compared to nurses in the control group. Both groups did not show significant change in their skill on recording, interpretation, and referral (p=1.000). Conclusion This study showed that Blood Pressure Measurement Training Package is feasible in improving adherence of nurses based on their increased knowledge of the BP measurement guidelines and skills in BP measurement. A larger-scale study is warranted to show that BPMTP can potentially improve clinical management of hypertension in public health clinics globally.
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