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Zhang H, Zhang X, Jiang X, Dai R, Zhao N, Pan W, Guo J, Fan J, Bao S. Mindfulness-based intervention for hypertension patients with depression and/or anxiety in the community: a randomized controlled trial. Trials 2024; 25:299. [PMID: 38698436 DOI: 10.1186/s13063-024-08139-0] [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: 09/28/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To evaluate mindfulness-based intervention for hypertension with depression and/or anxiety. METHODS 10-week mindfulness-based intervention, including health education for hypertension, exclusively for the control group, was administered to the intervention group to assist sixty hypertension patients with depression/anxiety. Among them, the intervention group comprised 8 men and 22 women, with a mean age of 60.02 years and a mean duration of hypertension of 6.29 years. The control group consisted of 14 men and 16 women with a mean age of 57.68 years and a mean duration of hypertension of 6.32 years. The severity of depressive and/or anxiety symptoms was assessed using the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder scale (GAD-7), along with blood pressure (BP) measurements taken twice daily. The study utilized a self-made self-efficacy scale and awareness of physical and mental health to evaluate mental health and state. RESULTS The depression PHQ-9 or GAD-7 scores reduced by 21.1% or 17.8% in the mindfulness-based intervention group, compared to the control (Z = -2.040, P = 0.041) post 10-week period, suggesting significant reduction in anxiety/stress. These results were consistent with a reduction in systolic BP of 12.24 mm Hg (t = 6.041, P = 0.000). The self-efficacy score of the mindfulness intervention group significantly improved compared to the control (t = 7.818, P < 0.001), while the awareness of physical and mental health in the mindfulness intervention group significantly improved compared to the control (χ2 = 5.781, P = 0.016). CONCLUSION Mindfulness-based, short-term focused interventions provide modest relief for depression and/or anxiety and are effective in lowering blood pressure and improving self-efficacy scores. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900028258. Registered 16 December 2019, https://www.chictr.org.cn/showproj.html?proj=43627 .
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Affiliation(s)
- Hailiang Zhang
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, 730101, Gansu, China
- Collaborative Innovation Center for Traditional Chinese Medicine Prevention and, Control of Environmental and Nutrition-Related Diseases in Northwest China, Lanzhou, 730101, Gansu, China
- Department of Mental Health, Gansu Provincial Centre for Disease Control and Prevention, Lanzhou, 730030, Gansu, China
| | - Xiangrong Zhang
- Department of Chinese Medicine, Center of Hekou Town, Xigu District, Lanzhou, 730094, Gansu, China
| | - Xiaomei Jiang
- Department of Psychosomatic and Sleep Medicine, Gansu Gem Flower Hospital, Xigu District, Lanzhou, 730060, Gansu, China
| | - Runjing Dai
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, 730101, Gansu, China
| | - Na Zhao
- Department of Hospital Infection-Control, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, 730020, Gansu, China
| | - Weimin Pan
- Department of Mental Health, Gansu Provincial Centre for Disease Control and Prevention, Lanzhou, 730030, Gansu, China
| | - Jiaohong Guo
- Department of Vasculo-Cardiology, Pingliang Second People's Hospital, Kongtong District, Pingliang, 744000, Gansu, China.
| | - Jingchun Fan
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, 730101, Gansu, China.
- Collaborative Innovation Center for Traditional Chinese Medicine Prevention and, Control of Environmental and Nutrition-Related Diseases in Northwest China, Lanzhou, 730101, Gansu, China.
| | - Shisan Bao
- Center for Laboratory and Simulation Training, School of Public Health, Center for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, 730101, Gansu, China.
- Collaborative Innovation Center for Traditional Chinese Medicine Prevention and, Control of Environmental and Nutrition-Related Diseases in Northwest China, Lanzhou, 730101, Gansu, China.
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Rahman ARA, Magno JDA, Cai J, Han M, Lee HY, Nair T, Narayan O, Panyapat J, Van Minh H, Khurana R. Management of Hypertension in the Asia-Pacific Region: A Structured Review. Am J Cardiovasc Drugs 2024; 24:141-170. [PMID: 38332411 PMCID: PMC10973088 DOI: 10.1007/s40256-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.
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Affiliation(s)
- Abdul R A Rahman
- An Nur Specialist Hospital, Jalan Gerbang Wawasan 1, Seksyen 15, 43650, Bandar Baru Bangi, Selangor, Malaysia.
| | - Jose Donato A Magno
- Division of Cardiovascular Medicine, Philippine General Hospital, Cardiovascular Institute, University of the Philippines College of Medicine, Angeles University Foundation Medical Center, Angeles, Philippines
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, Beijing, People's Republic of China
| | - Myint Han
- Grand Hantha International Hospital, Yangon, Myanmar
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Chongno-gu, Seoul, 03080, South Korea
| | - Tiny Nair
- PRS Hospital, Trivandrum, Kerala, India
| | - Om Narayan
- The Northern Hospital, 185 Cooper St., Epping, VIC, 3122, Australia
| | - Jiampo Panyapat
- Bhumibol Adulyadej Hospital, 171 Paholyothin Road, Saimai, Bangkok, 10220, Thailand
| | - Huynh Van Minh
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue, 530000, Vietnam
| | - Rohit Khurana
- The Harley Street Heart and Vascular Center, Gleneagles Hospital, Singapore, 258500, Singapore
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Elbarbary M, Shoeib O, El-Saied SB, Atlm RM, Alkassas A. Prevalence and determinants of resistant hypertension in the delta region of Egypt: A prospective observational study. Health Sci Rep 2023; 6:e1441. [PMID: 37701356 PMCID: PMC10494290 DOI: 10.1002/hsr2.1441] [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: 03/08/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023] Open
Abstract
Background and Aims Hypertension (HTN) is a leading cause of morbidity and mortality affecting about 30%-40% of the adult population in developed countries. Fewer data were published about the prevalence, sociodemographics, and clinical characteristics of the resistant hypertensive population in Egypt. Hence, our aim is to focus the attention on these determinants especially in the delta region of Egypt. Methods Data belonging to patients visiting our HTN clinic in the Cardiovascular Department, Tanta University Hospital, Gharbeyah Governorate, Egypt, were collected over 12 months, between January 1, 2022, and 31 December 31, 2022, and then carefully analyzed. Results We found that the prevalence of resistant hypertension (RHTN) in the delta region of Egypt was 18%. We noted more RHTN cases in older age, that is, mean ± Std. was 51.5 ± 13.24 and 62.1 ± 7.56 for non-RHTN and RHTN, respectively. Also, the prevalence was higher in women representing about 54.4% of cases. Sixty-two percent of the patients with RH were obese (mean ± Std. of body mass index was 30.7 ± 5.36 in HTN and 47.7 ± 30.3 in RHTN groups with p value <0.001). We found a significant relationship between chronic kidney disease, diabetes, and RHTN. Conclusion Control of HTN among the Egyptian population in the delta region was unsatisfactory and higher than rates published globally. RH was more obvious in women, elderly, obese population, and diabetic and chronic kidney disease patients. Excessive use of nonsteroidal anti-inflammatory drugs, smoking, and high salt intake were clearly observed.
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Affiliation(s)
- Mohammed Elbarbary
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Osama Shoeib
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Shaimaa B El-Saied
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Ramy M Atlm
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Amr Alkassas
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
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Khalfallah M, Elsheikh A, Eissa A, Elnagar B. Prevalence, Predictors, and Outcomes of Resistant Hypertension in Egyptian Population. Glob Heart 2023; 18:31. [PMID: 37334401 PMCID: PMC10275134 DOI: 10.5334/gh.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background Hypertension is a leading problem; it affects around thirty million adult Egyptians, according to the last national registry. The exact prevalence of resistant hypertension (RH) in Egypt wasn't spotted before. The purpose of this study was to determine the prevalence, predictors, and impact on adverse cardiovascular outcomes among adult Egyptians with RH. Methods The present study examined a cohort of 990 hypertensive patients who were divided into two groups based on their blood pressure control; group I (n = 842) patients who achieved blood pressure control and group II (n = 148) patients who met the RH definition criteria. All patients underwent a close follow-up for one year to evaluate the major cardiovascular events. Results The prevalence of RH was 14.9%. The main predictors impacting the cardiovascular outcomes of RH were advanced age (≥65 years), the presence of chronic kidney diseases, a BMI ≥ 30 kg/m2, and NSAID use. After one year of follow-up, the RH group displayed noticeably higher rates of major cardiovascular events, including new-onset atrial fibrillation (6.8% vs. 2.5%, P = 0.006), cerebral stroke (4.1% vs. 1.2%, P = 0.011), myocardial infarction (4.7% vs. 1.3%, P = 0.004), and acute heart failure (4.7% vs. 1.8%, P = 0.025). Conclusion The prevalence of RH in Egypt is moderately high. Patients with RH have a far higher risk of cardiovascular events than those whose blood pressure is within control.
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Affiliation(s)
- Mohamed Khalfallah
- Assistant professor of cardiovascular medicine, cardiovascular department, faculty of Medicine, Tanta University, EG
| | - Ayman Elsheikh
- Assistant professor of cardiovascular medicine, cardiovascular department, faculty of Medicine, Tanta University, EG
| | - Ahmad Eissa
- Lecturer of endocrinology, internal medicine department, faculty of Medicine, Tanta University, EG
| | - Basma Elnagar
- Lecturer of cardiovascular medicine, cardiovascular department, faculty of Medicine, Tanta University, EG
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Ahmed AM, Nur SM, Xiaochen Y. Association between obstructive sleep apnea and resistant hypertension: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1200952. [PMID: 37332747 PMCID: PMC10272746 DOI: 10.3389/fmed.2023.1200952] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Obstructive sleep apnea syndrome (OSAS) is a chronic disorder characterized by recurring episode obstruction and collapse of upper airways during sleep, leading to hypoxia and sleep disruption. OSAS is commonly associated with an increased prevalence of hypertension. The underlying mechanism in OSA with hypertension is related to intermittent hypoxia. This hypoxia induces endothelial dysfunction, overactivity of sympathetic effects, oxidative stress, and systemic inflammation. Hypoxemia triggers the sympathetic process's overactivity, leading to the development of resistant hypertension in OSA. Thus, we hypothesize to evaluate the association between resistant hypertension and OSA. Methods The PubMed, ClinicalTrails.gov, CINAHL, Google Scholar, Cochrane Library, and Science Direct databases were searched from 2000 to January 2022 for studies demonstrating the association between resistant hypertension and OSA. The eligible articles underwent quality appraisal, meta-analysis, and heterogeneity assessment. Results This study comprises seven studies, including 2,541 patients ranged from 20 to 70 years. The pooled analysis of six studies demonstrated that OSAS patients with a history of increased age, gender, obesity, and smoking status are at an increased risk for resistant hypertension (OR: 4.16 [3.07, 5.64], I2:0%) than the non-OSAS patients. Similarly, the pooled effect demonstrated that patients with OSAS were at an increased risk of resistant hypertension (OR: 3.34 [2.44, 4.58]; I2:0%) than the non-OSAS patients when all associated risk factors were adjusted using multivariate analysis. Conclusion This study concludes that OSAS patients with or without related risk factors demonstrated increased risk for resistant hypertension.
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Affiliation(s)
- Abass Mahamoud Ahmed
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Salman Mohamud Nur
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Yuan Xiaochen
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China
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Lu D, Gao Y, Qi X, Li A, Zhang J. The COVID-19 vaccination hesitancy among Chinese individuals with diabetes and the impact on glycemic control of vaccination: a questionnaire study. BMC Endocr Disord 2022; 22:329. [PMID: 36550448 PMCID: PMC9780090 DOI: 10.1186/s12902-022-01201-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The study aimed to investigate the attitudes of people with diabetes mellitus (DM) on COVID-19 vaccination and its influence on the glycemic control. METHODS Data were collected from a consecutive series of adults (age > 18 years) with type 2 diabetes under regular follow-ups in the Integrated Care Diabetes Outpatient Clinic of Peking University First Hospital from December 1st to December 31st 2021. An online interview questionnaire was conducted, and demographic data including age, sex category, history of drug allergy, history of hypertension, the duration of diabetes, reasons for vaccine hesitancy (VH) and adverse reactions after each injection of vaccines was collected. Glucose levels were collected from medical records. RESULTS Thirty-nine (22.9%) subjects experienced VH and 131 (77.1%) people living with diabetes received inactivated vaccine against COVID-19. Hesitant individuals had a higher proportion of female gender (vaccinated group vs. VH group, 62/131 vs. 26/39, p = 0.044), higher baseline glycosylated hemoglobin A1c (HbA1c) (vaccinated group vs. VH group, 6.56 ± 0.95% vs. 7.54 ± 2.01%, p < 0.001) and elevated baseline postprandial blood glucose (PBG) (vaccinated group vs. VH group, 8.32 ± 1.97 mmol/L vs. 9.44 ± 2.94 mmol/L, p = 0.015). Subjects of male gender (p = 0.025) and history of hypertension (p = 0.021) were likely to get vaccinated, while higher HbA1c was negatively associated with an elevated propensity to receive anti-COVID-19 vaccine (p = 0.003). Most common reasons for hesitating to receive COVID-19 vaccination were worrying about the possibility of leading to other diseases (30.8%), followed by fearing of glucose variation (17.9%). Systemic adverse reactions were reported in 30.5% individuals after the first injection of inactivated vaccines, and resolved within 3 days in medium. Fasting blood glucose (FBG) decreased significantly after the third injection compared with FBG after the second dose (second vs. third, 6.78 ± 1.24 mmol/L vs. 6.41 ± 1.30 mmol/L, p = 0.027). HbA1c reduced significantly from 6.56% before vaccination to 6.35% after the second injection (p = 0.012). CONCLUSIONS Our study demonstrated that vaccine hesitancy was lower among male subjects and people with hypertension, while vaccine confidence was reduced in people with poor glycemic control. HbA1c level was lower along with vaccination.
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Affiliation(s)
- Difei Lu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Ying Gao
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | | | - Ang Li
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
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Ram CVS, Dalal J, Kahali D, Mohanan PP, Das MK, Guha S, Nair T, Narasimhan C, Roy DG, Abdullakutty J, Ray S, Fulwani M, Mohan JC, Gupta R, Abhyankar M, Revankar S. Management of American Heart Association/American College of Cardiology-Defined Stage 2 Hypertension by Cardiologists in India. Am J Cardiol 2022; 167:62-67. [PMID: 35034692 DOI: 10.1016/j.amjcard.2021.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/01/2022]
Abstract
Uncontrolled hypertension is an important cardiovascular risk factor and therefore requires effective approaches to patient management. This study assessed approaches to the management of patients with Stage 2 hypertension by cardiologists in India. This was a retrospective, multicenter, observational, case-based questionnaire study. Data on demographic characteristics, risk factors associated with Stage 2 hypertension, use of antihypertensive medications, side effects, and approaches to education for 2,540 patients were extracted from questionnaire responses provided by 508 cardiologists. The study population of patients with Stage 2 hypertension had a mean age of 55.0 years. Most of the patients (62.6%) were aged 30 to 60 years and diabetes mellitus was the most prevalent comorbidity (48.9%). Triple antihypertensive therapy was being used by 760 patients, and 634 and 1,146 patients were receiving 4 and 5 different antihypertensive medications, respectively. Telmisartan, amlodipine, chlorthalidone, hydrochlorothiazide, spironolactone, metoprolol, and prazosin were the commonly prescribed drugs. Ankle edema (27.7%) was the most frequent side effect of therapy. Pharmacotherapy was supported by patient education and lifestyle modifications for better blood pressure control. The standardized approach to the collection and assessment of these contemporary data provides useful insights into the characteristics and treatment of patients with Stage 2 hypertension in India.
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Brant LCC, Passaglia LG, Pinto-Filho MM, de Castilho FM, Ribeiro ALP, Nascimento BR. The Burden of Resistant Hypertension Across the World. Curr Hypertens Rep 2022; 24:55-66. [PMID: 35118612 DOI: 10.1007/s11906-022-01173-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Resistant hypertension (R-HTN) is related to worse cardiovascular, renal outcomes, and death compared to non R-HTN. We aimed to review the burden of R-HTN across the world, focusing on its prevalence, associated factors and outcomes, and the impact of treatment. RECENT FINDINGS R-HTN prevalence among hypertensive individuals varies around 10-20%, depending on the population and definition applied. R-HTN consistently relates to older age, chronic kidney disease, obesity, and obstructive sleep apnea - which are increasing in prevalence with global population aging. As such, R-HTN prevalence is also expected to rise. Infrequent use of ambulatory blood pressure monitoring to identify at higher risk individuals and poor adherence to treatment are still barriers in the approach of R-HTN. Available evidence suggests that 10-20% of patients with hypertension have R-HTN. However, the prevalence of true R-HTN using contemporaneous standardized definitions is still unknown. Novel strategies to address clinicians, patients and health system barriers to treatment inertia and adherence are fundamental to reduce the burden of R-HTN.
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Affiliation(s)
- Luisa Campos Caldeira Brant
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.
| | - Luiz Guilherme Passaglia
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Marcelo Martins Pinto-Filho
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Fabio Morato de Castilho
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil
| | - Bruno Ramos Nascimento
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil. .,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Santa Efigênia, 30130-100, Belo Horizonte, MG, Brazil.
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Qin F, Li J, Dai YF, Zhong XG, Pan YJ. Renal denervation inhibits the renin-angiotensin-aldosterone system in spontaneously hypertensive rats. Clin Exp Hypertens 2021; 44:83-92. [PMID: 34818958 DOI: 10.1080/10641963.2021.1996587] [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] [Indexed: 01/13/2023]
Abstract
This study was conducted to explore the effect of renal denervation (RDN) on the renin-angiotensin-aldosterone system (RAAS) in spontaneously hypertensive rats (SHRs). Our experimental rats were randomly divided into the RDN group conducted by painting 10% phenol on the bilateral renal nerves (RDNX), the shamoperation group simply painting with saline (Sham), and the normotension control group (WKY) following all the animal blood and tissues of kidney, hypothalamus, and adrenal gland collected and examined 2 weeks after RDN operation. We found that the aldosterone (ALD) levels in serum and tissues all decreased in the RDNX group compared with the Sham group (p < .05). Meantime, the expression of angiotensin II type1 receptor (AT1R) mRNA also exhibited significantly reduced by 2.22-fold in the RDNX group compared to the Sham group identical to the expression of AT1R protein in the renal cortex and outer stripe of the outer medulla (OSOM) subjected to denervation surgery, which manifested the lower ATIR protein expression than the Sham group (p < .05). Besides, the expression of angiotensin II (Ang II) protein in the cortex , OSOM, and inner stripe of the outer medulla were all attenuated by RDN in comparison with the Sham group (p < .05). RDN reduced intrarenal RAAS and circulating RAAS to lower blood pressure and repair renal function.
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Affiliation(s)
- Fei Qin
- Department of Hypertension, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China
| | - Jianling Li
- Department of Hypertension, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China.,Department of Graduate School, Post-doctoral Stations of Guangxi Medical University, Nanning, Guangxi, China
| | - Yong-Fa Dai
- Department of Hypertension, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China
| | - Xiao-Ge Zhong
- Department of Hypertension, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China
| | - Ya-Jin Pan
- Department of Hypertension, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China
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Medication Adherence and Treatment-Resistant Hypertension in Newly Treated Hypertensive Patients in the United Arab Emirates. J Clin Med 2021; 10:jcm10215036. [PMID: 34768553 PMCID: PMC8584664 DOI: 10.3390/jcm10215036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022] Open
Abstract
(1) Background: The present study aimed to analyze medication adherence and its effect on blood pressure (BP) control and assess the prevalence of treatment-resistant hypertension (TRH) among newly treated hypertensive patients in the United Arab Emirates (UAE); (2) Methods: A retrospective chart review was conducted to evaluate 5308 naïve hypertensive adults registered for the treatment across Abu Dhabi Health Services (SEHA) clinics in Abu Dhabi in 2017. After collecting data regarding basic details and BP measurements, patients were followed up for six months. Patients who did not reach BP targets despite taking three or more antihypertensive medications were defined as TRH; (3) Results: The overall adherence to antihypertensive treatment was 42%. At 6-month, a significant reduction in BP was observed in patients adherent to medications (systolic: -4.5 mm Hg and diastolic: -5.9 mm Hg) than those who were nonadherent to antihypertensive therapy (1.15 mm Hg and 3.59 mm Hg). Among 189 patients using three or more antihypertensive medications for six months, only 34% (n = 64) were adherent to the treatment, and only 13.7% (n = 26) reached the BP target. The prevalence of TRH was 20.1%; (4) Conclusions: Medication adherence and BP control among the participants were suboptimal. The study shows a high prevalence of TRH among newly treated hypertensives in the UAE. More extraordinary efforts toward improving adherence to antihypertensive therapy and more focus toward BP control and TRH are urgently needed.
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Mahapatra R, Kaliyappan A, Chinnakali P, Hanumanthappa N, Govindarajalou R, Bammigatti C. Prevalence and Risk Factors for Resistant Hypertension: Cross-Sectional Study From a Tertiary Care Referral Hospital in South India. Cureus 2021; 13:e18779. [PMID: 34796068 PMCID: PMC8590471 DOI: 10.7759/cureus.18779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Around 10% patients with hypertension have resistant hypertension (RH). Older age, Black race, obesity, diabetes mellitus (DM) and chronic kidney disease (CKD) are the common risk factors for RH. The present study was done to find out the prevalence and factors associated with RH. Methods This cross-sectional study was done between December 2018 and February 2020. Adult patients registered with the hypertension clinic and on care for more than three months were included in the study. History was noted and blood pressure (BP) was measured using standard precautions. The patients were divided into two groups - resistant and non-resistant hypertension. Chi-square test was done to check the significance of the differences between the two groups. Binary logistic regression was done for the risk factors with a p-value < 0.2 in the Chi-square test. Results A total of 275 patients were included. The mean age was 56 ± 10 years and 61% were females. The mean duration of hypertension was 7 ± 5 years; 77% of patients were overweight or obese. A family history of hypertension was present in 30% and 18% had diabetes mellitus. History suggestive of secondary hypertension was present in 13%. BP was controlled (<130/80 mm of hg) in 145 (53%), uncontrolled in 130 (47%) and resistant hypertension was seen in 31 [(11%) 95% CI 8-16%] patients. Duration of hypertension, obesity, and elevated fasting blood sugar were significantly associated with RH. Conclusions RH was found in 11% of hypertensive patients. Longer duration of hypertension, obesity, and higher fasting blood glucose were associated with RH.
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Affiliation(s)
- Rima Mahapatra
- Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Anupriya Kaliyappan
- Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Palanivel Chinnakali
- Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Nandeesha Hanumanthappa
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ramkumar Govindarajalou
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Beshel JA, Palacios J, Beshel FN, Nku CO, Owu DU, Nwokocha M, Bórquez J, Simirgiotis MJ, Nwokocha CR. Blood pressure-reducing activity of Gongronema latifolium Benth. (Apocynaeceae) and the identification of its main phytochemicals by UHPLC Q-Orbitrap mass spectrometry. J Basic Clin Physiol Pharmacol 2019; 31:jbcpp-2018-0178. [PMID: 32037779 DOI: 10.1515/jbcpp-2018-0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/25/2019] [Indexed: 01/15/2023]
Abstract
Background Gongronema latifolium Benth. (family Apocynaceae) leaves (GL) has interesting medicinal properties. The effects of extracts from G. latifolium on blood pressure (BP) and the possible mechanisms of action were also investigated. Methods The ultrahigh resolution liquid chromatography orbitrap MS analysis was used to identify the phytochemicals present. Normotensive Wistar rats were anesthetized with sodium pentobarbitone (40 mg/kg) intraperitoneally, and the jugular vein was cannulated for infusion of drugs while the carotid artery was cannulated for direct BP measurement. GL extract (5-20 mg) alone or with nifedipine (10 mg/kg), atropine (2 mg/kg), L-NAME (5 mg/kg), methyl blue (3 mg/kg) and propranolol (1 mg/kg) were administered intravenously to Wistar rats and direct BP measurements were carried out. Results Systolic and diastolic BP levels (128/90 mm Hg; MAP 103 ± 3 mm Hg) and heart rates were all significantly (p < 0.01) decreased after GL administration. Raised mean arterial pressure (MAP) and heart rate by atropine, L-NAME and methyl blue were significantly (p < 0.01) reduced after GL administration, while propranolol significantly (p < 0.01) inhibited hypotension caused by GL. Infusion of GL reduced MAP (95 ± 3 mm Hg) comparable with nifedipine (93 ± 2 mm Hg), a calcium channel blocker. The phytochemicals identified were 34 compounds, including oleanolic acid derivatives, flavonoids, antioxidant fatty acids, 2 coumarins and 2 iridoids. Conclusions These results suggest that G. latifolium has hypotensive properties mediated by the synergistic activity of the compounds, probably via the β-adrenergic blockade mechanism.
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Affiliation(s)
- Justin Atiang Beshel
- Department of Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Javier Palacios
- Facultad de Ciencias de la Salud, Instituto de EtnoFarmacología (IDE), Universidad Arturo Prat., Iquique, Chile
| | - Favour Nyoh Beshel
- Department of Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Clement Oshie Nku
- Department of Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Daniel U Owu
- Department of Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria, Phone: +234 8093243446
| | - Magdalene Nwokocha
- Department of Pathology, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - Jorge Bórquez
- Laboratorio de Productos Naturales, Departamento de Química, Facultad de Ciencias Básicas, Universidad de Antofagasta, Antofagasta, Chile
| | - Mario J Simirgiotis
- Instituto de Farmacia, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - Chukwuemeka R Nwokocha
- Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
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Wang MH, Lu TH, Huang WN, Yeh YT. Intelligent prescription system combined with a national pharmacloud for geriatrics care. Expert Rev Pharmacoecon Outcomes Res 2018; 18:559-564. [PMID: 29939812 DOI: 10.1080/14737167.2018.1492912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The elderly are high risk for chronic diseases and multiple drug use - two problems that make geriatric medication use more complex; as a result, the possibility of duplicate prescriptions and drug interactions increase, affecting patient safety. The objective of this study was to develop an Intelligent Prescription System Combined with a National PharmaCloud for Geriatrics Care (IPSPcG) that can reduce the occurrence of duplicate prescriptions. METHODS The system was implemented in a teaching hospital in Taiwan. The IPSPcG consists of two major components: (1) the collection module and (2) Intelligent Knowledge-base Module. Data on medication prescription behaviors and medication-blocking rates were gathered from January 2015 to December 2017. RESULTS Overall, during the study period, the IPSPcG system included 39,678 prescriptions. Antihypertensive medications were included at the highest proportion (8962, 22.6%). The system changed physician's prescription behavior (p < .001) and decreased potential duplicate prescription times (14%). CONCLUSION The results of this study show that integrating appropriate recommendations from drug messages can reduce repeated drug prescriptions. Due to the diversity of diseases, the diversity and accuracy of medical advice must improve. The results of the 'Comprehensive Prescription Information' provided by this system can serve as a reference for future research.
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Affiliation(s)
- Mei-Hua Wang
- a Graduate Institute of Biomedical Informatics, College of Medical Science and Technology , Taipei Medical University , Taipei City , Taiwan
| | - Tzu-Hsuan Lu
- b Medical Quality Department, Shuang Ho Hospital , Taipei Medical University , New Taipei City , Taiwan
| | - Wei-Ni Huang
- c Information Technology Office, Shuang Ho Hospital , Taipei Medical University , New Taipei City , Taiwan
| | - Yu-Ting Yeh
- a Graduate Institute of Biomedical Informatics, College of Medical Science and Technology , Taipei Medical University , Taipei City , Taiwan.,c Information Technology Office, Shuang Ho Hospital , Taipei Medical University , New Taipei City , Taiwan
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