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Stephens BY, Young BE, Nandadeva D, Skow RJ, Greaney JL, Brothers RM, Fadel PJ. Sympathetic transduction at rest and during cold pressor test in young healthy non-Hispanic Black and White women. Am J Physiol Regul Integr Comp Physiol 2023; 325:R682-R691. [PMID: 37781734 PMCID: PMC11178294 DOI: 10.1152/ajpregu.00073.2023] [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: 03/23/2023] [Revised: 09/01/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Non-Hispanic Black (BL) individuals have the highest prevalence of hypertension and cardiovascular disease (CVD) compared with all other racial/ethnic groups. Previous work focused on racial disparities in sympathetic control and blood pressure (BP) regulation between young BL and White (WH) adults, have mainly included men. Herein, we hypothesized that BL women would exhibit augmented resting sympathetic vascular transduction and greater sympathetic and BP reactivity to cold pressor test (CPT) compared with WH women. Twenty-eight young healthy women (BL: n = 14, 22 [Formula: see text] 4 yr; WH: n = 14, 22 [Formula: see text] 4 yr) participated. Beat-to-beat BP (Finometer), common femoral artery blood flow (duplex Doppler ultrasound), and muscle sympathetic nerve activity (MSNA; microneurography) were continuously recorded. In a subset (BL n = 10, WH n = 11), MSNA and BP were recorded at rest and during a 2-min CPT. Resting sympathetic vascular transduction was quantified as changes in leg vascular conductance (LVC) and mean arterial pressure (MAP) following spontaneous bursts of MSNA using signal averaging. Sympathetic and BP reactivity were quantified as changes in MSNA and MAP during the last minute of CPT. There were no differences in nadir LVC following resting MSNA bursts between BL (-8.70 ± 3.43%) and WH women (-7.30 ± 3.74%; P = 0.394). Likewise, peak increases in MAP following MSNA bursts were not different between groups (BL: +2.80 ± 1.42 mmHg; vs. WH: +2.99 ± 1.15 mmHg; P = 0.683). During CPT, increases in MSNA and MAP were also not different between BL and WH women, with similar transduction estimates between groups (ΔMAP/ΔMSNA; P = 0.182). These findings indicate that young, healthy BL women do not exhibit exaggerated sympathetic transduction or augmented sympathetic and BP reactivity during CPT.NEW & NOTEWORTHY This study was the first to comprehensively investigate sympathetic vascular transduction and sympathetic and BP reactivity during a cold pressor test in young, healthy BL women. We demonstrated that young BL women do not exhibit exaggerated resting sympathetic vascular transduction and do not have augmented sympathetic or BP reactivity during cold stress compared with their WH counterparts. Collectively, these findings suggest that alterations in sympathetic transduction and reactivity are not apparent in young, healthy BL women.
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Affiliation(s)
- Brandi Y Stephens
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Benjamin E Young
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Damsara Nandadeva
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rachel J Skow
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Jody L Greaney
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - R Matthew Brothers
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, United States
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Woods SB, Udezi V, Roberson PNE, Arnold EM, Nesbitt S, Hiefner A. "A cuff is not enough": A community-based participatory research approach to soliciting perspectives of African Americans with hypertension and their family members on self-management intervention features. FAMILY PROCESS 2023:10.1111/famp.12935. [PMID: 37718711 PMCID: PMC10947536 DOI: 10.1111/famp.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Abstract
We aimed to solicit the perspectives of African Americans with hypertension and their family members on the desired features of a behavioral hypertension self-management intervention. Using a community-based participatory approach to intervention design, we conducted four dyadic focus groups, including African American community members with hypertension (n = 23) and their family members (n = 23), recruited from African American-serving Christian churches in a large, southern metropolitan area. We used open-ended questions to elicit participants' perspectives regarding program features they would recommend, intervention delivery, and barriers necessary to address. Our grounded theory analysis identified themes reflecting participants' recommendations for hypertension self-management interventions to enhance health literacy and provide communication training via an accessible, population-tailored, family-based approach, which they believed has the potential to create family-level impact on health across generations. Participants also recommended intervention researchers engage in advocacy (i.e., via physician education and policy change) as part of a broader impact on structural inequities driving worse hypertension and health outcomes for African Americans. The perceptions and recommendations of African Americans with a lived experience of hypertension, as well as their family members, aid in shaping acceptable and efficacious behavioral interventions aiming to promote hypertension self-management behavior while leveraging the unique power of family relationships to create sustained behavior change.
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Affiliation(s)
- Sarah B. Woods
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | - Victoria Udezi
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | | | - Elizabeth Mayfield Arnold
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | - Shawna Nesbitt
- University of Texas Southwestern Medical Center, Departments of Internal Medicine and Cardiology, Dallas TX, USA
| | - Angela Hiefner
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
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Urhoghide E, Onyechi NP, Okobi OE, Odoma VA, Okunromade O, Moevi AA, Louise-Oluwasanmi O, Ojo S, Harry NM, Awoyemi E, Sike CG, Nwatamole BC, Agbama JA, Evbayekha EO. A Cross-Sectional Study of the Trends in Cardiovascular Mortality Among African Americans With Hypertension. Cureus 2023; 15:e40437. [PMID: 37456481 PMCID: PMC10349209 DOI: 10.7759/cureus.40437] [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] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Background and Objective In the United States, hypertension remains a significant cause of cardiovascular disease mortality and morbidity, affecting various racial and ethnic groups. High blood pressure is a common health concern, given its high frequency among all populations and racial groups in the United States; nevertheless, the condition remains untreated in most individuals. It affects a significant number of individuals in the African American community and contributes to a notable proportion of deaths. Arguably more prevalent, severe, and tends to occur earlier in African Americans compared to some other races. This lack of blood pressure control may contribute to the increasing mortality rates associated with hypertension-related cardiovascular diseases in the United States, while notable race and sex disparities persist. This study aims to compare the number of deaths caused by each cardiovascular disease (hypertension) in African Americans to those of people of other races. Methodology To understand the impact of hypertension on mortality rates among different racial groups, this study utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) dataset, which includes death certificates filed in the United States. The research focused on individuals aged 25 years or older with a mention of hypertension and cardiovascular disease as the underlying cause of death between 1999 and 2019. The study analyzed hypertension-associated deaths by different cardiovascular disease subtypes, such as ischemic heart disease, heart failure (HF), and cerebrovascular diseases that include acute ischemic attacks, which are the most frequent in the United States, with specific assessments for African Americans, White, and other races' decedents. Results The study findings indicated that African American males had higher mortality rates from cardiovascular diseases compared to African American females. The prevalence of hypertension was also higher among African Americans (87.47%) compared to Whites (30.33%), Asian/Pacific Islanders (40.26%), and American Indians/Alaska Natives (61.18%). Additionally, the study identified regional variations in mortality rates, with states like Arizona, California, Texas, Florida, and Washington having higher rates, while Vermont, North Dakota, and Wyoming had lower rates. The northwest region had lower mortality compared to the western and southwestern regions. Conclusions Within the studied period, there was an increase in the prevalence of mortality due to hypertension amongst African Americans when compared to other races. These findings underscore the pressing need to address the increasing prevalence of hypertension and mortality rates among African American. More efforts should focus on prevention of CVD and hypertension and the associated risk factors based on the World Health Organization (WHO) recommendations, which include the promotion of healthy lifestyle behaviors, improvement of access to quality healthcare, and implementation of culturally sensitive interventions tailored for African American communities.
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Affiliation(s)
| | | | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Victor A Odoma
- Cardiology/Oncology, Indiana University (IU) Health, Bloomington, USA
| | - Omolola Okunromade
- Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Savannah, USA
| | - Adole A Moevi
- Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | | | - Soji Ojo
- Psychiatry, University of Texas Health Science Center at Houston, Dallas, USA
| | - Nkechinyere M Harry
- Internal Medicine, National Pirogov Memorial Medical University, Vinnytsia, UKR
| | - Eyitope Awoyemi
- Family Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, NGA
| | - Cherechi G Sike
- General Practice, Windsor University School of Medicine, Cayon, KNA
| | - Bright C Nwatamole
- Cardiology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield , GBR
| | - Joseph A Agbama
- Internal Medicine, University of Calabar Teaching Hospital, Calabar, NGA
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Hidayani WR, Dewi SU, Adriani P, Sormin REM, Kanan M, A'yun SQ, Andarwulan S. Development model of integrated development post for non-communicable diseases in West Java of Indonesia. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY = JOURNAL DE LA THERAPEUTIQUE DES POPULATIONS ET DE LA PHARMACOLOGIE CLINIQUE 2022; 29:e177-e187. [PMID: 36473729 DOI: 10.47750/jptcp.2022.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
Data from the West Java Health Office in 2013 stated that the prevalence of non-communicable diseases (NCD), one of which is diabetes Mellitus, was 4.2% with pre-diabetes at 7.8% and 144 cases in the work area of the Singaparna Puskesmas.1 Empowerment of Posbindu cadres with NCD (PTM) ) to reduce cases of PTM. The purpose of this research is to develop a model of empowerment of Posbindu PTM by increasing the role and skills of the Posbindu PTM cadres. This study uses a combined or collaborative method approach, namely qualitative and quantitative. Sampling by stratified random sampling from August to November 2019 consisted of four government stakeholders as research informants, and 16 Posbindu PTM cadres. Collecting data using questionnaires, in-depth interviews, and Focus Group Discussions (FGD). Analysis using thematic content analysis and Wilcoxon Test. Results shows in qualitative research that cadres have knowledge about the role of cadres, but do not yet know the main tasks and functions of cadres and do not have cadre skills. The quantitative analysis showed that there were differences in the knowledge and skills of cadres after training compared to before training p = 0.000 (p < 0.05). In conclusion, Cadres know the role of cadres through training. There were differences in the knowledge and skills of cadres after training compared to before training.
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Affiliation(s)
| | - Siti Utami Dewi
- Sekolah Tinggi Ilmu Kesehatan Fatmawati, DKI Jakarta, Indonesia
| | | | | | - Maria Kanan
- Universitas Tompotika, Central Sulawesi, Indonesia
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Krousel-Wood M, Peacock E, Bradford WD, Mohundro B, Craig LS, O'Connell S, Bazzano L, Shi L, Ford M. Time Preference for Immediate Gratification: Associations With Low Medication Adherence and Uncontrolled Blood Pressure. Am J Hypertens 2022; 35:256-263. [PMID: 34788786 DOI: 10.1093/ajh/hpab175] [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: 06/30/2021] [Revised: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In search of innovative approaches to the challenge of uncontrolled hypertension, we assessed the association between preference for immediate gratification (i.e., high discounting rate), low medication adherence, and uncontrolled blood pressure (BP) in adults with hypertension. METHODS Using a probability discounting model and the Collier-Williams hypothetical discount rate framework, participants in this cross-sectional study reported their preference for a smaller amount of money available immediately (high discount rate; immediate gratification preference) vs. a larger amount available 1 year later (low discount rate; delayed gratification preference). Multivariable Poisson regression was used to test the association of high discounting rates with low antihypertensive medication adherence using the validated 4-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4 score ≥1). Mediation of the association between high discounting rate and uncontrolled BP (systolic/diastolic BP ≥ 130/80 mm Hg) by low adherence was tested using the counterfactual approach. RESULTS Among 235 participants (mean age 63.7 ± 6.7 years; 51.1% women; 41.9% Black), 50.6% had a high 1-year discount rate, 51.9% had low K-Wood-MAS-4 adherence, and 59.6% had uncontrolled BP. High discounting rates were associated with low adherence (adjusted prevalence ratio 1.58, 95% confidence interval (CI) 1.18, 2.12). Forty-three percent (95% CI 40.9%, 45.8%) of the total effect of high discount rate on uncontrolled BP was mediated by low adherence. CONCLUSIONS Adults with preference for immediate gratification had worse adherence; low adherence partially mediated the association of high discount rate with uncontrolled BP. These results support preference for immediate gratification as an innovative factor underlying low medication adherence and uncontrolled BP.
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Affiliation(s)
- Marie Krousel-Wood
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - Erin Peacock
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - W David Bradford
- Department of Public Administration and Policy, University of Georgia School of Public and International Affairs, Athens, Georgia, USA
| | - Brice Mohundro
- Blue Cross Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
| | - Leslie S Craig
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Samantha O'Connell
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Milam Ford
- Blue Cross Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
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Vincent-Doe A, Sneed R, Jordan T, Key K, Bailey RS, Jefferson BB, Sanders RPE, Brewer A, Scott JB, Calvin K, Summers M, Farmer B, Johnson-Lawrence V. Exploring the Readiness of African-American Churches to Engage in a Community-Engaged Blood Pressure Reduction Research Study: Lessons Learned from the Church Challenge. JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP 2022; 14:10. [PMID: 35734421 PMCID: PMC9207767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction The Transtheoretical Model (TTM) has been used to assess individual readiness for health behavior change. We describe our use of the TTM to assess organizational readiness of African-American churches to participate in the Church Challenge (CC) in Flint, Michigan; the processes of change that moved churches toward readiness for change; and lessons learned. Methods The CC was a faith-based, multilevel intervention to reduce chronic disease risk. A community-based participatory approach was used to engage and recruit churches. We used the TTM to capture church readiness for change and track church progress through the five stages. Results We engaged with 70 churches: 35 remained in Stage 1 (precontemplation), 10 remained in Stage 2 (contemplation), 3 remained in Stage 3 (preparation), 5 made it to Stage 4 (action), and 17 finished within Stage 5 (maintenance). Churches engaged in several processes of change as they moved through the various stages of change. Lessons Learned Utilizing processes of change, establishing rapport, and having previous participants share success stories helped move churches from stage-to-stage. However, certain barriers prevented progression, such as burnout/trauma from the Flint Water Crisis and scheduling conflicts. Discussion Faith-based organizational readiness greatly impacted participation in the CC. Researchers should utilize established social capital, build rapport, and remain flexible when working with African-American churches. Conclusion Although traditionally used at the individual level, the TTM works well at the organizational level to assess and monitor church readiness to participate in community-engaged research and health programming to improve health in an African-American faith community.
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Affiliation(s)
| | - Rodlescia Sneed
- Division of Public Health, Michigan State University, Flint, MI
| | - Tamara Jordan
- Division of Public Health, Michigan State University, Flint, MI
| | - Kent Key
- Division of Public Health, Michigan State University, Flint, MI,Community Based Organization Partners, Flint, MI
| | - Rev. Sarah Bailey
- Bridges to the Future, Flint, MI,Community Based Organization Partners, Flint, MI
| | | | | | - Allysoon Brewer
- Division of Public Health, Michigan State University, Flint, MI
| | - Jamil B. Scott
- Division of Public Health, Michigan State University, Flint, MI,National Human Genome Research Institute, National Institute of Health
| | - Kahlil Calvin
- Division of Public Health, Michigan State University, Flint, MI
| | - Monicia Summers
- Division of Public Health, Michigan State University, Flint, MI
| | - Bridget Farmer
- Division of Public Health, Michigan State University, Flint, MI
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Firibastat: a Novel Treatment for Hypertension. Curr Hypertens Rep 2021; 23:46. [PMID: 34950965 DOI: 10.1007/s11906-021-01163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the unique mechanism of firibastat, a new antihypertension medication. Hypertension continues to be a highly prevalent public health issue. RECENT FINDINGS Firibastat is a novel agent developed to treat hypertension. As the first member in the class of centrally acting agents to target the brain renin angiotensin system, firibastat offers new pathways to consider and enhances the regimen of agents currently available to treat hypertension. Recent clinical trials have demonstrated effectiveness and safety in mild hypertension as well as resistant hypertension. This review introduces firibastat as a new therapeutic class of treatment for hypertension focused on the renin angiotensin system in the brain. Early studies have shown a significant reduction in blood pressure with minimal side effects particularly in patients who are difficult to treat.
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SCHNEIDER RH, GRIM C, KOTCHEN T, MARWAHA K, KOTCHEN J, SALERNO JW, KING CG, NIDICH S, ALEXANDER CN. Randomized controlled trial of stress reduction with meditation and health education in black men and women with high normal and normal blood pressure. Am J Prev Cardiol 2021; 8:100279. [PMID: 34729544 PMCID: PMC8546372 DOI: 10.1016/j.ajpc.2021.100279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/20/2021] [Accepted: 10/01/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Black men and women suffer from disparities in morbidity and mortality from hypertension, cardiovascular disease, and currently, COVID-19. These conditions are associated with social determinants of health and psychosocial stress. While previous trials demonstrated that stress reduction with meditation lowered BP in the grade I range in Black adults, there is a paucity of evidence for high normal and normal BP. OBJECTIVE This randomized controlled trial was conducted to evaluate the effect of stress reduction with the Transcendental Meditation (TM) technique in Black adults with high normal BP and normal BP using international classifications. METHODS A total of 304 Black men and women with high normal (130-139/85-89 mm Hg) and normal BP (120-129/80-84 mm Hg) were randomized to either TM or health education (HE) groups. BP was recorded at 3, 6, 9, 12, 24, 30 and 36 months after baseline. Linear mixed model analysis was conducted to compare the BP change between TM and HE participants in the high-normal BP and normal-BP groups. Survival analysis for hypertensive events was conducted. RESULTS After an average of 19.9 ± 11.1 months follow-up, TM participants in the high-normal BP group showed significantly lower posttest SBP (-3.33 mm Hg, p = 0.045). There was no difference in DBP (-0.785 mm Hg, p = 0.367) compared to HE participants. In the normal BP group, the SBP and DBP were not different between the TM and HE participants. The hazard ratio for hypertensive events was 0.52 (p = 0.15) in the high normal BP group (7 TM vs 13 HE) with no difference in the normal BP group. CONCLUSION This RCT found that meditation lowered systolic BP in Black men and women with high normal BP but not in normal BP participants. These results may be relevant to reducing health disparities in CVD and related co-morbidities.
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Affiliation(s)
- Robert H. SCHNEIDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Clarence GRIM
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Theodore KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Komal MARWAHA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Jane KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John W. SALERNO
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Carolyn Gaylord KING
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Sanford NIDICH
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Charles N. ALEXANDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
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Elkholi MH, Alrais ZF, Algouhary AR, Al-Taie MS, Sawwan AA, Khalafalla AA, Beniamein MM, Alkhouly AE, Shoaib MI, Alkholy HE, Abdel Hadi AM, Abu Alkhair AT. Acute kidney injury in ventilated patients with coronavirus disease-2019 pneumonia: A single-center retrospective study. Int J Crit Illn Inj Sci 2021; 11:123-133. [PMID: 34760658 PMCID: PMC8547683 DOI: 10.4103/ijciis.ijciis_194_20] [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: 12/19/2020] [Revised: 02/02/2021] [Accepted: 06/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Acute kidney injury (AKI) is repeatedly observed in ventilated critically ill patients with coronavirus disease-2019 (COVID-19) pneumonia. This study aimed to determine the incidence, risk factors, and consequences of AKI in the ventilated critically ill adult patients with COVID-19 pneumonia. Methods: This retrospective study included all the ventilated critically ill adult patients with COVID-19 pneumonia from March 1, 2020, to June 1, 2020. Data were collected from the electronic medical system. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice definition. Patients were followed 90 days from the intensive care unit (ICU) admission time or to the date when they were discharged from the hospital. Results: AKI occurred in 65.1% of patients, with 26.6% of these started on continuous renal replacement therapy (CRRT). Patients with AKI had higher comorbidity and illness severity scores (P < 0.001). Age and the vasopressor requirements were predictors of AKI (P= 0.016 and P = 0.041) and hypertension predicted AKI (P = 0.099) and its progression (P = 0.05). The renal recovery rate was 86.7% and was associated with the mean arterial pressure on ICU admission in the no-CRRT group (P = 0.014) and the hypoxic index in the CRRT group (P = 0.019). AKI was associated with higher mortality (P = 0.017) and significantly longer ICU length-of-stay (P = 0.001). Additionally, AKI patients were more often discharged to a long-term skilled nursing facility (P = 0.005). Conclusion: COVID-19-associated AKI was common and associated with poor outcome, with the specific mechanisms being the main driving factors.
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Loh YC, Chan SY, Oo CW, Yam MF. Discovery of trans-3,4,4'-trihydroxystilbene as new lead vasorelaxant agent for antihypertensive drug development. Life Sci 2021; 278:119560. [PMID: 33915131 DOI: 10.1016/j.lfs.2021.119560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
AIMS The structure-vasorelaxant activity relationships (SARs) assessment in previous study has found that trans-3,4,4'-trihydroxystilbene (344OH) could potentially act as a vasorelaxing agent with demonstration of over 2-fold maximal relaxation (Rmax) compared to its analogue, resveratrol. The present study focuses on the mechanism of actions and pathways employed by 344OH and compared to its analogue to further speculate the SAR of stilbenoids towards vasorelaxation. MATERIALS AND METHODS The 344OH employed in present study was synthesized based on the protocol in previous study. The vascular responses towards the cumulative addition of 344OH were evaluated using in vitro rat aortic rings assays. KEY FINDINGS The pEC50 and Rmax values were found to be 4.33 ± 0.05 and 106 ± 3.99%, respectively. Results showed that the vasorelaxation of 344OH were predominated by G-protein-coupled muscarinic- (M3) and β2-adrenergic receptors, followed by PGI2/AC/cAMP- and NO/sGC/cGMP-dependent pathways. It was also identified that 344OH employed voltage-activated- (Kv), calcium-activated- (Kca) and inwardly-rectifying (Kir) potassium channels and act as an antagonist for both VOCC and IP3R while regulating the action potential in the vasculature. SIGNIFICANCE The different position of hydroxyl substituent located in A-ring of the stilbenoid backbone in 344OH compared to resveratrol resulted in a significant difference in mechanistic actions that lead to 344OH's fast-acting and less time-dependent vasorelaxation behaviour. This has substantially increased the potential of 344OH to be developed as an effective antihypertensive drug in future. Present findings further strengthen our inferences where the SARs study approach should be carried out as the mainstream methodology in future drug development research.
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Affiliation(s)
- Yean Chun Loh
- Department of Organic Chemistry, School of Chemical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Sock Ying Chan
- Department of Organic Chemistry, School of Chemical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Chuan Wei Oo
- Department of Organic Chemistry, School of Chemical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | - Mun Fei Yam
- Department of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia; College of Pharmacy, Fujian University of Traditional Chinese Medicine, 1 Qiuyanng Road, Shangjie, Minhou, Fuzhou 350122, Fujian, China.
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11
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Ferdinand KC. Uncontrolled hypertension in sub-Saharan Africa: Now is the time to address a looming crisis. J Clin Hypertens (Greenwich) 2020; 22:2111-2113. [PMID: 32951284 PMCID: PMC8030060 DOI: 10.1111/jch.14046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Keith C. Ferdinand
- Tulane Heart and Vascular InstituteTulane University School of MedicineNew OrleansLouisianaUSA
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