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Mohottige D. Paving a Path to Equity in Cardiorenal Care. Semin Nephrol 2024:151519. [PMID: 38960842 DOI: 10.1016/j.semnephrol.2024.151519] [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: 07/05/2024]
Abstract
Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal. Semin Nephrol 36:x-xx © 20XX Elsevier Inc. All rights reserved.
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Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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Zong H, Hu Z, Li W, Wang M, Zhou Q, Li X, Liu H. Electronic cigarettes and cardiovascular disease: epidemiological and biological links. Pflugers Arch 2024; 476:875-888. [PMID: 38376568 PMCID: PMC11139732 DOI: 10.1007/s00424-024-02925-0] [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: 01/04/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
Electronic cigarettes (e-cigarettes), as alternative nicotine delivery methods, has rapidly increased among youth and adults in recent years. However, cardiovascular safety is an important consideration regarding e-cigarettes usage. e-cigarette emissions, including nicotine, propylene glycol, flavorings, nitrosamine, and metals, might have adverse effects on cardiovascular health. A large body of epidemiological evidence has indicated that e-cigarettes are considered an independent risk factor for increased rates of cardiovascular disease occurrence and death. The incidence and mortality of various types of cardiovascular disease, such as cardiac arrhythmia, hypertension, acute coronary syndromes, and heart failure, have a modest growth in vapers (users of e-cigarettes). Although the underlying biological mechanisms have not been fully understood, studies have validated that oxidative stress, inflammation, endothelial dysfunction, atherosclerosis, hemodynamic effects, and platelet function play important roles in which e-cigarettes work in the human body. This minireview consolidates and discusses the epidemiological and biological links between e-cigarettes and various types of cardiovascular disease.
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Affiliation(s)
- Huiqi Zong
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zhekai Hu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, 100053, China
| | - Weina Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, 100053, China
| | - Mina Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Qi Zhou
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Xiang Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
| | - Hongxu Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
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Martin E, Cook AG, Frost SM, Turner AW, Chen FK, McAllister IL, Nolde JM, Schlaich MP. Ocular biomarkers: useful incidental findings by deep learning algorithms in fundus photographs. Eye (Lond) 2024:10.1038/s41433-024-03085-2. [PMID: 38734746 DOI: 10.1038/s41433-024-03085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND/OBJECTIVES Artificial intelligence can assist with ocular image analysis for screening and diagnosis, but it is not yet capable of autonomous full-spectrum screening. Hypothetically, false-positive results may have unrealized screening potential arising from signals persisting despite training and/or ambiguous signals such as from biomarker overlap or high comorbidity. The study aimed to explore the potential to detect clinically useful incidental ocular biomarkers by screening fundus photographs of hypertensive adults using diabetic deep learning algorithms. SUBJECTS/METHODS Patients referred for treatment-resistant hypertension were imaged at a hospital unit in Perth, Australia, between 2016 and 2022. The same 45° colour fundus photograph selected for each of the 433 participants imaged was processed by three deep learning algorithms. Two expert retinal specialists graded all false-positive results for diabetic retinopathy in non-diabetic participants. RESULTS Of the 29 non-diabetic participants misclassified as positive for diabetic retinopathy, 28 (97%) had clinically useful retinal biomarkers. The models designed to screen for fewer diseases captured more incidental disease. All three algorithms showed a positive correlation between severity of hypertensive retinopathy and misclassified diabetic retinopathy. CONCLUSIONS The results suggest that diabetic deep learning models may be responsive to hypertensive and other clinically useful retinal biomarkers within an at-risk, hypertensive cohort. Observing that models trained for fewer diseases captured more incidental pathology increases confidence in signalling hypotheses aligned with using self-supervised learning to develop autonomous comprehensive screening. Meanwhile, non-referable and false-positive outputs of other deep learning screening models could be explored for immediate clinical use in other populations.
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Affiliation(s)
- Eve Martin
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Kensington, WA, Australia.
- School of Population and Global Health, The University of Western Australia, Crawley, Australia.
- Dobney Hypertension Centre - Royal Perth Hospital Unit, Medical School, The University of Western Australia, Perth, Australia.
- Australian e-Health Research Centre, Floreat, WA, Australia.
| | - Angus G Cook
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Shaun M Frost
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Kensington, WA, Australia
- Australian e-Health Research Centre, Floreat, WA, Australia
| | - Angus W Turner
- Lions Eye Institute, Nedlands, WA, Australia
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
| | - Fred K Chen
- Lions Eye Institute, Nedlands, WA, Australia
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, East Melbourne, VIC, Australia
- Ophthalmology Department, Royal Perth Hospital, Perth, Australia
| | - Ian L McAllister
- Lions Eye Institute, Nedlands, WA, Australia
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre - Royal Perth Hospital Unit, Medical School, The University of Western Australia, Perth, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre - Royal Perth Hospital Unit, Medical School, The University of Western Australia, Perth, Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
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Yuan R, Xu M, Hu C, Ma H, Meng F, Ren J, Wen J. Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients. Front Med (Lausanne) 2024; 11:1352918. [PMID: 38765256 PMCID: PMC11100417 DOI: 10.3389/fmed.2024.1352918] [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: 12/09/2023] [Accepted: 02/26/2024] [Indexed: 05/21/2024] Open
Abstract
Introduction The hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown. Methods In this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60-79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision. Results There were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p > 0.05), while significant differences were found in norepinephrine consumption between the two groups (p < 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 μg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 μg·kg-1·min-1) and Group A (0.06 ± 0.02 μg·kg-1·min-1) (p = 0.004). Conclusion Our study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=141081, ChiCTR2100053583.
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Affiliation(s)
- Ruimei Yuan
- Department of Anesthesiology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Min Xu
- Department of Endocrinology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chunhai Hu
- Department of Urology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Huailing Ma
- Department of Anesthesiology, Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Fanjun Meng
- Department of Anesthesiology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jie Ren
- Department of Anesthesiology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jing Wen
- Department of Urology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Hou HJ, Cong TZ, Cai Y, Ba YH, Chen ME, Yang JY, Luo ZH. Influencing factors of hospitalization cost of hypertension patients in traditional Chinese medicine hospitals. Front Public Health 2024; 12:1329768. [PMID: 38737867 PMCID: PMC11084283 DOI: 10.3389/fpubh.2024.1329768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/01/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives This study aimed to analyze the influencing factors of hospitalization cost of hypertensive patients in TCM (traditional Chinese medicine, TCM) hospitals, which can provide a scientific basis for hospitals to control the hospitalization cost of hypertension. Methods In this study, 3,595 hospitalized patients with a primary diagnosis of tertiary hypertension in Tianshui City Hospital of TCM, Gansu Province, China, from January 2017 to June 2022, were used as research subjects. Using univariate analysis to identify the relevant variables of hospitalization cost, followed by incorporating the statistically significant variables of univariate analysis as independent variables in multiple linear regression analysis, and establishing the path model based on the results of the multiple linear regression finally, to explore the factors influencing hospitalization cost comprehensively. Results The results showed that hospitalization cost of hypertension patients were mainly influenced by length of stay, age, admission pathways, payment methods of medical insurance, and visit times, with length of stay being the most critical factor. Conclusion The Chinese government should actively exert the characteristics and advantages of TCM in the treatment of chronic diseases such as hypertension, consistently optimize the treatment plans of TCM, effectively reduce the length of stay and steadily improve the health literacy level of patients, to alleviate the illnesses pain and reduce the economic burden of patients.
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Affiliation(s)
- Hao-jia Hou
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Tian-zhen Cong
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yu Cai
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Ya-hui Ba
- School of Business and Management, Gansu University of Chinese Medicine, Lanzhou, China
| | - Meng-en Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-yu Yang
- School of Business and Management, Gansu University of Chinese Medicine, Lanzhou, China
| | - Zhong-hua Luo
- School of Marxism Studies, Gansu University of Chinese Medicine, Lanzhou, China
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Li S, Hou L, Zhu S, Sun W, Cao J, Yi Q, Zhao D, Song P. Associations of serum uric acid with hypertension status, stages, phenotypes and progressions among Chinese middle-aged and elderly. Nutr Metab Cardiovasc Dis 2024; 34:988-997. [PMID: 38176957 DOI: 10.1016/j.numecd.2023.10.027] [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: 03/04/2023] [Revised: 09/15/2023] [Accepted: 10/21/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND AND AIMS No consensus has been reached on the association between serum uric acid (SUA) and hypertension. This study aimed to investigate the associations between SUA and hypertension, including its status, stages, phenotypes and progressions, among middle-aged and older Chinese. METHODS AND RESULTS Data were obtained from the China Health and Retirement Longitudinal Study 2011-2015. Binary logistic regression was used to evaluate the association between SUA and hypertension status. Multinomial logistic regression was used to explore the associations of SUA with hypertension stages, phenotypes and hypertension status progressions. Models were adjusted for potential confounders and stratified by sex. A total of 7931 individuals aged ≥45 years were included, with 39.16 % of hypertension. Significant associations were found of SUA with stage2 and above hypertension (quartile 4 [Q4] vs quartile 1 [Q1]: odds ratio 1.78, 95 % confidence interval 1.31-2.42, P < 0.001), and systolic diastolic hypertension (SDH) (Q4 vs Q1: 1.53, 1.14-2.06, P = 0.005). In sex stratification, significant associations were found between SUA and stage2 and above hypertension and SDH only for men. Moreover, higher quartiles of baseline SUA showed increased risks of maintained hypertension from 2011 to 2015 (Q3 vs Q1: 1.23, 1.03-1.48, P = 0.024; Q4 vs Q1: 1.73, 1.43-2.10, P < 0.001). CONCLUSION Higher SUA was associated with hypertension and maintained hypertension among Chinese middle-aged and elderly. Sex-specific associations of SUA with hypertension stages and phenotypes were observed. Regular measurement of SUA in clinical practice may indicate hypertension and its progression, particularly among men.
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Affiliation(s)
- Shuting Li
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Leying Hou
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siyu Zhu
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weidi Sun
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jin Cao
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Yi
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dong Zhao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Wu L, Zhang S, Zhang J, Xin Y, Niu P, Li J. Associations of heavy metal mixtures with blood pressure among U.S. adults in NHANES 2017-2018 by four statistical models. Chin Med J (Engl) 2024; 137:628-630. [PMID: 38282382 PMCID: PMC10932526 DOI: 10.1097/cm9.0000000000002956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Luli Wu
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Shixuan Zhang
- Department of Nutrition, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Junrou Zhang
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Ye Xin
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Piye Niu
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Jie Li
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
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Wang S, Dong Z, Wan X. Global, regional, and national burden of inflammatory bowel disease and its associated anemia, 1990 to 2019 and predictions to 2050: An analysis of the global burden of disease study 2019. Autoimmun Rev 2024; 23:103498. [PMID: 38052263 DOI: 10.1016/j.autrev.2023.103498] [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: 11/09/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
AIM Inflammatory bowel disease (IBD) exhibited a global increase in incidence over the past decade. Understanding global burden of IBD can offer valuable insights for shaping future management strategies. We aimed to provide a comprehensive assessment of global burden of IBD from 1990 to 2019 and predictions to 2050. METHODS Data on prevalence, incidence, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs) and IBD-attributable impairment factor (anemia) were extracted from the Global Burden of Diseases (GBD) 2019. Subgroup analyses were performed based on gender, geographical regions, and the Socio-Demographic Index (SDI). Joinpoint model, Bayesian age-period-cohort model and decomposition methodology were utilized to evaluate the temporal trends from 1990 to 2019, forecast the disease burden up to 2050 and decompose incidence, prevalence, YLDs and DALYs of IBD by population age structure, population growth and epidemiologic changes. RESULTS From 1990 to 2019, number of prevalence, DALYs, YLDs for IBD and number of prevalence for IBD-related-anemia increased significantly. Age-standardized rates of incidence, prevalence, DALYs, and YLDs showed declining trends, with this decline anticipated to continue until 2050 for both genders. The IBD burden remained high in countries with high and high-middle SDI. Besides, countries with low, low-middle, and middle SDI were experiencing an increasing burden. Number and ASR of prevalence and YLDs of IBD related anemia increased with SDI Decomposition analysis indicated that population growth was the primary contributing factor, followed by population aging. CONCLUSION Due to population growth and aging, the burden of IBD is projected to continue rising until 2050, which emphasizes the urgency of addressing the evolving public health challenge posed by IBD.
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Affiliation(s)
- Song Wang
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhixia Dong
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinjian Wan
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Li J, Tian A, Liu J, Ge J, Peng Y, Su X, Li J. Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China. CARDIOLOGY DISCOVERY 2024; 4:15-22. [PMID: 38505635 PMCID: PMC10947596 DOI: 10.1097/cd9.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024]
Abstract
Objective Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence. Methods This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment. Results A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11-1.72, P = 0.004). Conclusions HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients' misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.
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Affiliation(s)
- Jiaying Li
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jinzhuo Ge
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Xiaoming Su
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
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Liu L, Lin L, Ke J, Chen B, Xia Y, Wang C. Higher Nocturnal Blood Pressure and Blunted Nocturnal Dipping Are Associated With Decreased Daytime Urinary Sodium and Potassium Excretion in Patients With CKD. Kidney Int Rep 2024; 9:73-86. [PMID: 38312777 PMCID: PMC10831351 DOI: 10.1016/j.ekir.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/26/2023] [Accepted: 10/16/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Sodium homeostasis is intimately associated with blood pressure (BP) rhythm, and potassium excretion is closely associated with sodium excretion in the general population. However, the association between circadian sodium and potassium pattern excretion and nocturnal BP in patients with chronic kidney disease (CKD) is not elucidated. Methods We evaluated the correlation between the day-to-night ratio of urinary sodium and potassium excretion rate, nocturnal blood pressure, and nocturnal BP dipping in a CKD cohort. Results A total of 3152 (56.76% males, mean age 47.63 years) individuals with CKD were included in the study. Patients in quartile 1 (with the lowest ratio) exhibited a 12 mmHg or 9 mmHg higher nocturnal systolic blood pressure (SBP) and blunted SBP dipping than those in quartile 4 when urinary sodium or potassium excretion rate was divided into day-to-night ratios (both P < 0.001). In multivariate analyses, lower day-to-night ratio of urinary sodium was independently linked to higher nocturnal SBP and blunted SBP dipping (linear regression coefficient (95% confidence interval [CI]): -6.89 (-9.48 to -4.31), and -3.64 (-5.48 to -1.80), respectively; both P < 0.001). Similarly, compared with the highest quartile of day-to-night ratio of urinary potassium excretion rate, linear regression coefficient (95% CI) for the lowest quartile was -5.60 (-8.13 to -3.07) for nocturnal SBP, and -2.47 (-4.28 to -0.67) for SBP dipping (both P < 0.001). Moreover, urine flow rate and concentrates of sodium or potassium in the urine were positively associated with urinary sodium or potassium excretion during daytime (P < 0.001). Conclusion A higher nocturnal BP and a blunted nocturnal BP dipping were both independently linked to a lower excretion of sodium or potassium during the day in patients with CKD. Furthermore, a decreased urine flow rate and a diminished capacity to concentrate sodium or potassium in the urine appear to be the key contributors to a low day-to-night ratio of urinary sodium excretion or potassium rate.
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Affiliation(s)
- Lingling Liu
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Lin Lin
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Jianting Ke
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Binhuan Chen
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Yu Xia
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Cheng Wang
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
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Stanikzai MH, Wafa MH, Tawfiq E, Jafari M, Le CN, Wasiq AW, Rahimi BA, Baray AH, Ageru TA, Suwanbamrung C. Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan. PLoS One 2023; 18:e0295246. [PMID: 38150430 PMCID: PMC10752561 DOI: 10.1371/journal.pone.0295246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients. OBJECTIVES This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan. METHODS A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs. RESULTS We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29-3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63)], and presence of depressive symptoms [AOR 1.65 (1.14-2.38)]. CONCLUSION Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.
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Affiliation(s)
- Muhammad Haroon Stanikzai
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Hashim Wafa
- Faculty of Medicine, Neuropsychiatric and Behavioral science Department, Kandahar University, Kandahar, Afghanistan
| | - Essa Tawfiq
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Cua Ngoc Le
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
| | - Abdul Wahed Wasiq
- Faculty of Medicine, Department of Internal Medicine, Kandahar University, Kandahar, Afghanistan
| | - Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Ahmad Haroon Baray
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Temesgen Anjulo Ageru
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
| | - Charuai Suwanbamrung
- Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand
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Zhang Y, Feng Y, He M, Li Z. Association of blood trihalomethane concentrations with hypertension in US adults: A nationwide cross-sectional study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166712. [PMID: 37657551 DOI: 10.1016/j.scitotenv.2023.166712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
Trihalomethanes (THMs), as the most common species of disinfection byproducts in chlorinated water, have been associated with hypertensive disorders in pregnancy. However, there is sparse epidemiological evidence regarding the possible link between THMs exposure and hypertension in general adults. In the present study, we aimed to characterize the associations between THMs exposure and hypertension in general adults. We performed cross-sectional analyses of 15,135 adults from the 1999-2018 National Health and Nutrition Examination Survey. In the general US adults, the median blood concentrations of the chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform (TBM) were: 4.80 pg/mL, 0.71 pg/mL, 0.44 pg/mL and 0.71 pg/mL, respectively. And adults in the highest tertile of blood TBM and DBCM had odds ratios of 1.20 (95 % confidence intervals: 1.02, 1.42) and 1.15 (1.01, 1.30), respectively, for hypertension, compared with adults in the lowest tertile. Also, significant positive associations between blood brominated THM concentrations (sum of TBM, BDCM and DBCM) and prevalent hypertension were observed. In addition, significant interactions with BMI were demonstrated for Br-THMs (P for interaction = 0.017). Our study provides epidemiological evidence supporting a positive association between blood THMs and hypertension by using the nationally representative data, highlighting the need for further investigations to deepen our findings and elucidate the underlying mechanisms.
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Affiliation(s)
- Youyou Zhang
- Department of Geriatrics Neurology, The Second Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi 710004, China
| | - Yue Feng
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM 87131, United States
| | - Meian He
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhaoyang Li
- Department of Occupational and Environmental Health, School of Public Health, Xi' an Jiaotong University, Xi'an, Shaanxi 710061, China.
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13
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You S, Gao JW, Zhang HF, Xiong ZC, Hao QY, Han JJ, Wang JF, Zhang SL, Liu PM. Predictors of long-term absence of coronary artery calcium in individuals with high blood pressure: results from the MESA study. Ann Med 2023; 55:2209334. [PMID: 37155413 PMCID: PMC10167869 DOI: 10.1080/07853890.2023.2209334] [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: 01/11/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND & AIMS Individuals with high blood pressure (BP) have varying risks of cardiovascular events due to other coexisting factors. We aimed to identify the predictors of long-term absence of coronary artery calcium (CAC) in individuals with high BP, which is an indicator of healthy arterial aging and can guide preventive strategies. METHODS We analyzed data from participants with high BP (≥120/80 mm Hg) in the Multi-Ethnic Study of Atherosclerosis who had baseline CAC = 0 and underwent a second CAC scanning after 10 years. We used multivariable logistic regression to evaluate the association between various risk factors for atherosclerotic cardiovascular disease (ASCVD) and long-term CAC = 0. We also calculated the area under the receiver operating characteristic curve (AUC) to predict the phenotype of healthy arterial aging in this population. RESULTS We included 830 participants (37.6% male, mean ± SD age of 59.4 ± 8.7 years). During follow-up, 46.5% of participants (n = 386) had CAC = 0, and they were younger and had fewer metabolic syndrome components. Adding ASCVD risk factors to the demographic model (age, sex, and ethnicity) moderately increased the predictive value for long-term CAC = 0 (AUC: demographic model + ASCVD risk factors vs. demographic model alone, 0.653 vs. 0.597, p < .001; category net reclassification improvement = 0.104, p = .044; integrated discrimination improvement = 0.040, p < .001). CONCLUSION In individuals with high BP and initial CAC = 0, over 40% maintained CAC = 0 during a 10-year follow-up, which was associated with fewer ASCVD risk factors. These findings may have implications for preventive strategies in individuals with high BP.Clinical Trial registration number: The MESA was registered at clinical trials. gov as NCT00005487.KEY MESSAGESNearly half (46.5%) of individuals with high blood pressure (BP) maintained a long-term absence of coronary artery calcium (CAC) during a 10-year follow-up, and this was associated with a 66.6% lower risk of atherosclerotic cardiovascular disease (ASCVD) events compared to those who developed incident CAC.Individuals with high BP, who are usually assumed to have an increased risk of ASCVD, exhibit significant heterogeneity in their ASCVD risk; those who maintain CAC = 0 have a lower ASCVD risk.Adding overall ASCVD risk factors to demographic information resulted in a moderate improvement in predicting long-term CAC = 0.
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Affiliation(s)
- Si You
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai-Feng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuo-Chao Xiong
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qing-Yun Hao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Jin Han
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shao-Ling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Fotouhi F, Shahidi A, Hashemi H, Saffarpour M, Yekta A, Esmaieli R, Esteki T, Derakhshan HB, Khabazkhoob M. Hypertension prevalence in Iran's elderly according to new criteria: the Tehran Geriatric Eye Study. J Diabetes Metab Disord 2023; 22:1489-1498. [PMID: 37975137 PMCID: PMC10638178 DOI: 10.1007/s40200-023-01272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/27/2023] [Indexed: 11/19/2023]
Abstract
Purpose To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors. Methods A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications. Results Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension. Conclusion A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.
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Affiliation(s)
- Farid Fotouhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Shahidi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mahshid Saffarpour
- Department of Restorative Dentistry, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roghayeh Esmaieli
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Esteki
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoon Bana Derakhshan
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khonde Kumbu R, Matondo H, Labat A, Kianu B, Godin I, Kiyombo G, Coppieters Y. Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review. BMC Public Health 2023; 23:2316. [PMID: 37993815 PMCID: PMC10666436 DOI: 10.1186/s12889-023-17248-5] [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: 06/27/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Hypertension remains one of the leading risk factors for cardiovascular disease. Contrasting with the high-income countries where the rates of hypertension decline, it increases in Sub-Saharan African countries. The age group most affected by hypertension is the working population. Several studies carried out in Europe, North America, and Asia, underline the influence of job stress on the occurrence of hypertension. The objective of this review was to explore current knowledge about hypertension and job stress in Sub-Saharan Africa. METHODS We conducted a scoping review using Arksey and O'Malley's framework to synthesize findings. We searched in PubMed, Scopus, and ProQuest databases. The inclusion criteria were peer-reviewed manuscripts published on March 1, 2023, conducted among workers in Sub-Saharan Africa, reported hypertension and job stress, and using quantitative methodologies. Data were assessed independently by two researchers. RESULTS In total, 295 articles were identified from databases. Of these, only 12 articles met the inclusion criteria and were included in the review (9 cross-sectional studies and 3 case-control studies). These studies focused on sectors reported as stressful (health, banking, education, and industries). The prevalence of hypertension varied from 14.3% to 45.9%, with a high proportion of hypertensive participants (35.4%-70.6%) who were unaware that they had hypertension. Job stress was significantly associated with hypertension (OR = 2.4 [1.5-4.4]) and stress management was inversely associated with hypertension (r = -0.14, p < 0.05). However, no study reported an existing workplace health promotion program implemented, especially regarding cardiovascular disease risk factors. CONCLUSION Data available in the literature show that stressful working conditions may be associated with hypertension. We are faced with an increasing prevalence of hypertension among workers in Sub-Saharan Africa, where a large proportion of them are unaware that they have hypertension. Thus, there is a need to implement workplace prevention and health promotion strategies in Sub-Saharan Africa.
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Affiliation(s)
- Rodrigue Khonde Kumbu
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Hervé Matondo
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aline Labat
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bernard Kianu
- Unit of Cardiology, University Clinic of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Isabelle Godin
- Research Centre in Social Approaches to Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Guillaume Kiyombo
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yves Coppieters
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Canyolu BA, Şen N, Sadıç BÖ. Anthropometric indexes for predicting high blood pressure in Turkish adults. J Family Med Prim Care 2023; 12:2848-2854. [PMID: 38186827 PMCID: PMC10771201 DOI: 10.4103/jfmpc.jfmpc_460_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/21/2023] [Accepted: 08/23/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose It is controversial which anthropometric indexes are the best in predicting the risk of hypertension and how anthropometric measurements are related to blood pressure (BP). This study aimed to evaluate the relationship between BP and anthropometric indexes and to determine the best predictors for hypertension risk. Methods This cross-sectional study was conducted with 415 consecutive participants (161 men, mean age: 33.4 years) aged 18-88 years in Istanbul, Turkey. Weight, height, waist circumference (WC), and neck circumference (NC) and BP were measured by well-trained personnel. Waist-to-height ratio (WHtR) and body mass index (BMI) were calculated. Pearson correlation, linear regression, and multivariate analyses were used to assess the relationship between anthropometric measurements and SBP, DBP, using the Statistical Package for the Social Sciences version 23.0. Results The systolic BP (SBP) and diastolic BP (DBP) were related to weight, WC, NC, BMI, and WHtR (P < 0.05). Linear regression analyses showed BMI and WC as independent risk factors for SBP with an increase by 1.11 mmHg in men (P = 0.036) and 1.59 mmHg in women (P = 0.001) in SBP when BMI increased 1 unit, while SBP increases by 0.2 mmHg when WC increases by 1 unit regardless of gender (P = 0.013). Conclusion Our results showed that BMI and WC are related to BP and important predictors of hypertension risk. Therefore, the uses of BMI and WC are recommended as screening tools for the prediction of hypertension risk among Turkish adults.
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Affiliation(s)
- Burcu Aksoy Canyolu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nilüfer Şen
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Beste Özben Sadıç
- Department of Cardiology, School of Medicine, Marmara University, Istanbul, Turkey
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Fras Z, Jakše B, Kreft S, Malek Ž, Kamin T, Tavčar N, Fidler Mis N. The Activities of the Slovenian Strategic Council for Nutrition 2023/24 to Improve the Health of the Slovenian Population and the Sustainability of Food: A Narrative Review. Nutrients 2023; 15:4390. [PMID: 37892467 PMCID: PMC10610012 DOI: 10.3390/nu15204390] [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: 09/13/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
The health status of individuals in Slovenia across age groups is a matter of concern, as current unsustainable lifestyle choices are already leading to various chronic noncommunicable diseases (NCDs). Outdated national dietary guidelines, their inconsistent implementation, and a lack of structural changes represent obstacles to promoting healthy and sustainable nutrition. Limited access to and rising prices of healthy, sustainable foods, in addition to the high availability of low-priced, highly processed foods, increase the risk of NCDs. The lack of systematic health monitoring and early disease detection poses a challenge. Global and local environmental issues, resistance, and/or the inability to adopt healthier diets hinder individuals from changing their nutritional behaviours. In this narrative review, we provide an overview of the current situation in Slovenia as well as planned activities initiated by the Slovenian government and the Prime Minister's Strategic Council for Nutrition, aiming to make progress in supporting healthy and sustainable nutrition, limiting food waste, and increasing the availability of healthier foods for all. Improving the sustainability of the Slovenian food system can contribute to several Sustainable Development Goals (SDGs), ensuring Slovenia's commitment to internationally agreed-upon targets. This could lead Slovenia to take a role as a pilot country in testing and implementing the necessary systemic changes, which could be further applied in other countries.
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Affiliation(s)
- Zlatko Fras
- Division of Medicine, Centre for Preventive Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Samo Kreft
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Žiga Malek
- Institute for Environmental Studies (IVM), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Tanja Kamin
- Faculty of Social Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Nika Tavčar
- Umanotera, The Slovenian Foundation for Sustainable Development, 1000 Ljubljana, Slovenia;
| | - Nataša Fidler Mis
- Ministry of Health, 1000 Ljubljana, Slovenia
- Division of Paediatrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Arora A, Gola A, Loganathan V, Lakshminarayanan S, Kar SS. Hypertension Control Status Among Patients Receiving Treatment From Selected Primary Health Centres in Puducherry: A Cohort-Analysis Approach. Cureus 2023; 15:e45042. [PMID: 37829936 PMCID: PMC10566534 DOI: 10.7759/cureus.45042] [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: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND High blood pressure (hypertension) is a major risk factor contributing to 60% of premature deaths caused by non-communicable diseases. In India, a mere 15% of the hypertensive population achieves optimal blood pressure control. Effective monitoring of hypertension is crucial for mitigating the morbidity and mortality associated with cardiovascular diseases. OBJECTIVE This study employed a cohort analysis approach to determine the control status of hypertension and identify factors associated with hypertension among individuals seeking care at selected primary health centres (PHCs) in Puducherry from January 2019 to December 2022. METHODOLOGY We assessed treatment records of 1127 patients with hypertension registered at PHCs in both urban and rural areas between 2019 and 2022. Information on socio-demographic details and blood pressure readings was collected to assess the control status of hypertension on a quarterly and six-monthly basis. Additionally, 436 patients were interviewed to identify factors associated with uncontrolled hypertension. RESULTS Control rates of hypertension varied among PHCs on a quarterly and six-monthly basis. The rural PHC achieved the highest quarterly control rate of 80% in Q4 2020, while the urban PHC had the lowest rate of 44% in Q1 2020. Similarly, the highest six-monthly control rate of 78% was observed in Q3 2019 at both rural and urban PHCs, with the lowest rate of 44% in Q1 2020 at the urban PHC. Conclusion: Analysing data obtained from regular monitoring of hypertension control status allows healthcare providers to identify patterns, trends, and correlations. It assists providers in making informed decisions regarding treatment adjustments, medication choices, lifestyle recommendations, and policy changes. This approach is expected to improve control status for hypertension, leading to the ultimate goal of better health outcomes for patients.
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Affiliation(s)
- Aanchal Arora
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Anurag Gola
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Vignesh Loganathan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Subitha Lakshminarayanan
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Sitanshu Sekhar Kar
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
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Murray Horwitz ME, Tabani A, Brédy GS, Flynn DB, Edwards CV, Curran NJ, Parikh NI. The effect of postpartum lifestyle interventions on blood pressure: a systematic literature review. J Hypertens 2023; 41:1231-1238. [PMID: 37404053 DOI: 10.1097/hjh.0000000000003477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Postpartum lifestyle modification is recommended to hypertension risk. We conducted a systematic literature review to assess the evidence for postpartum lifestyle interventions to reduce blood pressure. We searched for relevant publications from 2010 through November 2022. Two authors independently conducted article screening and data extraction; a third resolved discrepancies. Ultimately, nine studies met inclusion criteria. Most were randomized controlled trials and had sample sizes <100. In all but one of the eight studies reporting race data, nearly all participants identified as White. None of the studies reported a significant intervention effect on blood pressure. However, most interventions were associated with improvements in other outcomes, such as physical activity. Overall, the evidence for postpartum lifestyle interventions to reduce blood pressure is limited to a handful of studies characterized by small sample sizes and a lack of racial diversity. Additional research with larger samples, more diverse populations, and intermediate outcomes is warranted.
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Affiliation(s)
- Mara E Murray Horwitz
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine
| | | | - G Saradjha Brédy
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine
| | - David B Flynn
- Boston University Chobanian & Avedisian School of Medicine
| | - Camille V Edwards
- Section of Hematology and Oncology, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Nadia J Curran
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
| | - Nisha I Parikh
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine
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Baray AH, Stanikzai MH, Wafa MH, Akbari K. High Prevalence of Uncontrolled Hypertension Among Afghan Hypertensive Patients: A Multicenter Cross-Sectional Study. Integr Blood Press Control 2023; 16:23-35. [PMID: 37426064 PMCID: PMC10329427 DOI: 10.2147/ibpc.s417205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023] Open
Abstract
Background Despite striking advances in the management of hypertension, blood pressure (BP) control remains suboptimal worldwide. Sustainable Development Goals (SDGs) call for 80% control rates by 2030, highlighting the urgency for improvements in hypertension control. Objective We aimed to determine the prevalence of uncontrolled hypertension (≥140/90 mmHg) and assess its associated factors in Afghan hypertensive patients. Methods We conducted this multicenter cross-sectional study at three Afghan public hospitals in Afghanistan. We recruited hypertensive patients (n=950) on antihypertensive medications (AHMs) from August to December 2022. We analyzed only complete datasets (853). We employed the 14-item Hill-Bone compliance scale to assess compliance with AHMs. We performed multivariable logistic regression analyses to determine factors associated with uncontrolled hypertension. Results The mean age (±SD) of the patients was 47.5 (± 9.5) years and males constituted 50.5% (431) of the study sample. The prevalence of uncontrolled hypertension in this study was 77.3% (95% CI: 74.2-79.9%). Factors associated with uncontrolled hypertension and their adjusted OR (95% CI) were physical inactivity: 3.45 (1.87-6.35), current smoking: 3.04 (1.50-6.15), high salt intake: 3.57 (1.9-6.7), presence of comorbid medical disease: 2.22 (1.20-4.08), higher BMI: 3.32 (1.12-9.88), poor compliance to AHMs: 8.50 (4.62-15.6), and presence of depressive symptoms: 1.99 (1.2-3.27). Conclusion The prevalence of uncontrolled hypertension was high in the present study. Factors associated with uncontrolled hypertension may epitomize potential targets for public/individual health interventions in Afghanistan.
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Affiliation(s)
- Ahmad Haroon Baray
- Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Mohammad Hashim Wafa
- Neuropsychiatric and Behavioral Science Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Khalid Akbari
- Internal Medicine Department, Faculty of Medicine, Paktia University, Paktia, Afghanistan
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Karam S, Cohen DL, Jaoude PA, Dionne J, Ding FL, Garg A, Tannor EK, Chanchlani R. Approach to Diagnosis and Management of Hypertension: A Comprehensive and Combined Pediatric and Adult Perspective. Semin Nephrol 2023; 43:151438. [PMID: 37951795 DOI: 10.1016/j.semnephrol.2023.151438] [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] [Indexed: 11/14/2023]
Abstract
The global prevalence of primary hypertension has been increasing both in children and in the adolescent and adult populations and can be attributed to changes in lifestyle factors with an obesity epidemic, increased salt consumption, and sedentary lifestyles. Childhood blood pressure is the strongest predictor of adult hypertension. Although hypertension in adults is associated strongly with an increased risk for cardiovascular disease, chronic kidney disease, and mortality, outcomes in children are defined less clearly. In adults, major guidelines agree on a threshold of less than 120/80 mm Hg as the optimal blood pressure (BP) and recommend a target of less than 130/80 mm Hg for treatment in most cases. In children, international pediatric guidelines recommend using thresholds based on the normative distribution of BP in healthy normal-weight children. Out-of-office BP assessment is extremely useful for confirming the diagnosis of hypertension and monitoring response to treatment. Lifestyle modifications are instrumental whether coupled or not with pharmacologic management. New agents such as nonsteroidal mineralocorticoid-receptor antagonists, aminopeptidase A inhibitors, aldosterone synthase inhibitors, and dual endothelin antagonists hold significant promise for resistant hypertension. The transition from pediatric to adult care can be challenging and requires careful planning and effective coordination within a multidisciplinary team that includes patients and their families, and pediatric and adult providers.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN.
| | - Debbie L Cohen
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pauline Abou Jaoude
- Division of Pediatric Nephrology, Hotel-Dieu de France-University Medical Center, Beirut, Lebanon
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - FangChao Linda Ding
- Division of Nephrology, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Anika Garg
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana; Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Kobalava Z, Kvasnikov B, Burtsev Y. Effectiveness and Tolerability of Bisoprolol/Perindopril Single-Pill Combination in Patients with Arterial Hypertension and a History of Myocardial Infarction: The PRIDE Observational Study. Adv Ther 2023; 40:2725-2740. [PMID: 37029871 PMCID: PMC10220120 DOI: 10.1007/s12325-023-02462-9] [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: 11/10/2022] [Accepted: 02/13/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION This study assessed the real-life effectiveness of a single-pill combination (SPC) of bisoprolol/perindopril for controlling blood pressure (BP) and symptoms of angina in patients with hypertension and a history of myocardial infarction (MI). METHODS Eligible patients with arterial hypertension and a history of MI were aged 18-79 years and had initiated bisoprolol/perindopril SPC within 3 months of study enrollment as part of routine Russian clinical practice. The primary endpoint was mean change in systolic and diastolic BP (SBP/DBP) at week 12 compared with baseline (data collected retrospectively). Secondary endpoints were assessed at weeks 4 and 12 and included mean change in resting heart rate (HR), proportion of patients reaching target level of resting HR, antianginal effectiveness of the SPC, and proportion of patients reaching target BP levels. RESULTS A total of 504 patients were enrolled, of whom 481 comprised the full analysis set (mean age 61.4 ± 8.9 years, 68% men). Mean baseline SBP/DBP and HR values were 148.9 ± 16.8/87.7 ± 11.0 mmHg and 77.4 ± 10.5 bpm, respectively. Mean durations of hypertension and CAD were 12.8 ± 8.4 and 6.1 ± 6.3 years, respectively, and time since MI was 3.8 ± 5.3 years. At week 12, SBP/DBP had decreased by 24.9/12.2 mmHg (P < 0.001 vs baseline). Target BP (< 140/90 mmHg) was achieved by 69.8% and 95.9% of patients at weeks 4 and 12, respectively, and target HR (55-60 bpm) by 17.3% and 34.5% at weeks 4 and 12 versus 3.1% at baseline (P < 0.001). Reductions in angina attacks, nitrate consumption, and improvements in HR were statistically significant. Treatment was well tolerated. CONCLUSION Treatment of symptomatic patients with CAD, hypertension, and a history of MI with a bisoprolol/perindopril SPC was associated with significant decreases in SBP/DBP and a high proportion of patients achieving BP treatment goals. This was accompanied by improvements in angina symptoms and reductions in HR in a broad patient population representative of those seen in everyday clinical practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04656847.
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Affiliation(s)
| | - Boris Kvasnikov
- Department of Medical Affairs, Servier Russia, Moscow, Russia
| | - Yuriy Burtsev
- Department of Medical Affairs, Servier Russia, Moscow, Russia
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Agabiti Rosei C, Del Pinto R, Grassi G, Muiesan ML, Ferri C. Prevalence of Cardiovascular Risk Factors and Related Medical and Lifestyle Interventions Among Italian Cardiovascular Specialists: A Proof-of-Concept Study. High Blood Press Cardiovasc Prev 2023; 30:255-264. [PMID: 37155127 PMCID: PMC10165575 DOI: 10.1007/s40292-023-00578-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Physicians and researchers in the cardiovascular field are constantly engaged in the promotion of guidelines-directed preventive measures, but whether they are themselves adherent to the same recommendations was only sporadically examined. AIM To assess awareness of self-exposure to cardiovascular risk factors and related management among cardiovascular specialists. METHODS During the National Conference of the Italian Society of Hypertension (October 2022), a pilot observational study on consecutive volunteer cardiovascular specialists was conducted. Participants underwent standard sitting and standing blood pressure (BP) measurements and answered a questionnaire regarding modifiable/non modifiable cardiovascular risk factors and related treatments. Based on self-declarations and actual measurements, BP was classified as optimal, normal, high-normal BP, and new hypertension in untreated participants, and as treated/untreated pre-existing hypertension. Controlled hypertension was defined as BP < 140/90 mmHg; age-adjusted lower targets were also applied, according to guidelines. RESULTS In total, 62 participants (30 F, mean age 43.2 ± 14.8 years) were enrolled; 79% reported regular physical activity; 53% of women and 38% of men were on a low-salt diet. After smoke (19.4%), dyslipidemia was the second most common risk factor (17.7%), often occurring with high BP (26.3%) and left untreated (36.7%). Pre-existing hypertension (11.3%) was often uncontrolled (57.1%) and associated with non-adherence to guidelines-directed lifestyle recommendations. About one in 12 participants was unaware of having high measured BP values. CONCLUSIONS Despite the specific professional exposure, a margin for improvement in self cardiovascular risk factors awareness and management remains in this exploratory sample of cardiovascular specialists. This pilot research anticipates forthcoming, larger studies during national and international conferences.
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Affiliation(s)
- Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, Clinica Medica, University of Brescia, Brescia, Italy
| | - Rita Del Pinto
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
- Internal Medicine and Nephrology Unit, ESH Excellence Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100, L'Aquila, Italy.
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, Clinica Medica, University of Brescia, Brescia, Italy
| | - Claudio Ferri
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Internal Medicine and Nephrology Unit, ESH Excellence Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, 67100, L'Aquila, Italy
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Rauf A, Joshi PB, Ahmad Z, Hemeg HA, Olatunde A, Naz S, Hafeez N, Simal-Gandara J. Edible mushrooms as potential functional foods in amelioration of hypertension. Phytother Res 2023. [PMID: 37157920 DOI: 10.1002/ptr.7865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
Edible mushrooms are popular functional foods attributed to their rich nutritional bioactive constituent profile influencing cardiovascular function. Edible mushrooms are omnipresent in various prescribed Dietary Approaches to Stop Hypertension, Mediterranean diet, and fortified meal plans as they are rich in amino acids, dietary fiber, proteins, sterols, vitamins, and minerals. However, without an understanding of the influence of mushroom bioactive constituents, mechanism of action on heart and allergenicity, it is difficult to fully comprehend the role of mushrooms as dietary interventions in alleviating hypertension and other cardiovascular malfunctions. To accomplish this endeavor, we chose to review edible mushrooms and their bioactive constituents in ameliorating hypertension. Hypertension and cardiovascular diseases are interrelated and if the former is managed by dietary changes, it is postulated that overall heart health could also be improved. With a concise note on different edible varieties of mushrooms, a particular focus is presented on the antihypertensive potential of mushroom bioactive constituents, mode of action, absorption kinetics and bioavailability. Ergosterol, lovastatin, cordycepin, tocopherols, chitosan, ergothioneine, γ-aminobutyric acid, quercetin, and eritadenine are described as essential bioactives with hypotensive effects. Finally, safety concerns on allergens and limitations of consuming edible mushrooms with special reference to chemical toxins and their postulated metabolites are highlighted. It is opined that the present review will redirect toxicologists to further investigate mushroom bioactives and allergens, thereby influencing dietary interventions for heart health.
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Affiliation(s)
- Abdur Rauf
- Department of Chemistry, University of Swabi, Swabi, Pakistan
- Department of Chemistry, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Payal B Joshi
- Operations and Method Development, Shefali Research Laboratories, Ambernath, India
| | - Zubair Ahmad
- Department of Chemistry, University of Swabi, Swabi, Pakistan
| | - Hassan A Hemeg
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Ahmed Olatunde
- Department of Medical Biochemistry, Abubakar Tafawa Balewa University, Bauchi, Nigeria
| | - Saima Naz
- Department of Biotechnology, Bacha Khan University, Khyber Pakhtunkhwa, Pakistan
| | - Nabia Hafeez
- Center of Biotechnology and Microbiology, University of Peshawar, Peshawar, Pakistan
| | - Jesus Simal-Gandara
- Nutrition and Bromatology Group, Analytical Chemistry and Food Science Department, Faculty of Science, Universidade de Vigo, Ourense, Spain
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Yihui C, Yanfeng G. Inflammatory markers in patients with hypertension. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 37235676 DOI: 10.12968/hmed.2022.0531] [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: 05/28/2023]
Abstract
Hypertension is a chronic disease with high levels of morbidity and disability. Elevated blood pressure can lead to many complications and is the main risk factor for stroke, heart failure and nephropathy. Factors associated with hypertension and inflammatory response differ from those associated with vascular inflammation. The immune system plays a vital role in the pathophysiology of hypertension. Inflammation is particularly relevant in the progression of cardiovascular diseases, which has led to extensive research on inflammatory markers and indicators.
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Affiliation(s)
- Chen Yihui
- Department of General Practice, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gong Yanfeng
- Department of General Practice, First Affiliated Hospital of Nanchang University, Nanchang, China
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Dzudie A, Barche B, Zomene F, Ebasone PV, Nkoke C, Mouliom S, Sidikatou D, Lade V, Ngote H, Njankouo YM, Mbatchou BH, Kamdem F, Njebet J, Kengne AP, Choukem SP. Real-World Effectiveness and Safety of Two-Drug Single Pill Combinations of Antihypertensive Medications for Blood Pressure Management: A Follow-Up on Daily Cardiology Practice in Douala, Cameroon. Adv Ther 2023; 40:2282-2295. [PMID: 36917430 PMCID: PMC10129918 DOI: 10.1007/s12325-023-02461-w] [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: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Hypertension is the leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Current guidelines recommend using two or more antihypertensive agents in single pill combinations (SPCs) to treat hypertension, but data from African patients that support these recommendations are lacking. We assessed the effectiveness and tolerance of three SPCs in lowering blood pressure (BP) amongst hypertensive patients in Douala. METHOD All patients included in the hypertension registry of the Douala General Hospital and the Douala Cardiovascular Center between January 2010 and May 2020, and receiving a two-drug SPCs (renin-angiotensin system inhibitors (RAASi) + diuretics (DIU), calcium channel blockers (CCB) + RAASi, or DIU + CCB) were tracked from baseline through 16 weeks. Our primary outcome was a decrease in systolic BP (SBP) from baseline up to 16 weeks after initiation of treatment. A mixed linear repeated model was used to evaluate the change of SBP from baseline to week 16, while controlling for age, gender, and baseline SBP. Statistical significance was set at p < 0.05. RESULTS Of 377 participants on two-drug SPCs, 123 were on CCB + DIU, 96 on RAASi + CCB, and 158 on RAASi + DIU. The mean age was 54.6 (± 11.2) years. At baseline, participants on RAASi + CCB presented with slightly higher SBP compared to the other two groups. Overall, the SBP decreased by 34.3 (± 14.2) mmHg from baseline values and this was comparable across the three groups of SPCs (p = 0.118). The control rate after 16 weeks of follow-up was 62.3% with no significant difference between groups. The occurrence of adverse events was 3.4% and was comparable among the three groups. CONCLUSION The three two-drug SPCs were highly effective in reducing and controlling BP with low and similar rates of adverse effects. Long-term data documenting safety and whether these agents exert a differential cardiovascular effect in addition to and independent of their BP-lowering effect are needed for SSA populations.
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Affiliation(s)
- Anastase Dzudie
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon.
- Lown Scholar Programs, Cardiovascular Health, Harvard T H Chan School of Public Health, Boston, USA.
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - Blaise Barche
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - Franck Zomene
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - Peter Vanes Ebasone
- Clinical Research Education Networking & Consultancy (CRENC), Douala, Cameroon
| | - Clovis Nkoke
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Sidick Mouliom
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Viche Lade
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon
| | - Henri Ngote
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon
| | - Yacouba Mapoure Njankouo
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Bertrand Hugo Mbatchou
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Felicite Kamdem
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive Parowvallei, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa
| | - Simeon Pierre Choukem
- Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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Onigbinde SO, Asaleye CM, Salako AA, Idowu BM, Onigbinde AO, Laoye A. The effect of systemic hypertension on prostatic artery resistive indices in patients with benign prostate enlargement. Prostate Int 2023; 11:46-50. [PMID: 36910898 PMCID: PMC9995693 DOI: 10.1016/j.prnil.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022] Open
Abstract
Background To investigate the effect of systemic hypertension on the prostatic artery resistive indices by a comparative ultrasonographic evaluation of the prostate gland in normotensive and hypertensive patients with benign prostatic enlargement (BPE). Materials and methods The participants had BPE and presented at the outpatient urologic clinic of a tertiary hospital. They were divided into normotensive and hypertensive groups. Each group had fifty patients. Calculation of international prostate symptom score, measurement of blood pressure, and transrectal ultrasonographic evaluation were done. Results The mean age for the normotensive and hypertensive groups were 66.9 ± 9.8 and 66.0 ± 10.7 years, respectively (P = 0.662). Patients with hypertensive BPE had a significantly higher mean transitional zone volume, transitional zone index, presumed circle area ratio, quality of life score, and prostatic arterial resistive indices than the age-matched normotensive BPE patients. Conclusion Patients with BPE and with hypertension had significantly higher prostate arteries resistive indices than normotensives with BPE. Even in patients with BPE and controlled hypertension, the prostatic artery resistance indices were still elevated than that of normotensive men with BPE.
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Affiliation(s)
- Stephen O Onigbinde
- Department of Anatomical Sciences, School of Medicine, St George's University, Grenada
| | - Christianah M Asaleye
- Department of Radiology, Obafemi Awolowo University and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Abdulkadir A Salako
- Department of Surgery, Obafemi Awolowo University and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Bukunmi M Idowu
- Department of Radiology, Union Diagnostics and Clinical Services Plc, Yaba, Lagos, Nigeria
| | - Abimbola O Onigbinde
- Department of Physiology, Neurology and Behavioral Sciences, School of Medicine, St George's University, Grenada
| | - Adeyinka Laoye
- Urology Department, Doncaster and Bassetlaw Teaching Hospitals NHS Found, South Yorkshire, United Kingdom
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Basu S, Malik M, Anand T, Singh A. Hypertension Control Cascade and Regional Performance in India: A Repeated Cross-Sectional Analysis (2015-2021). Cureus 2023; 15:e35449. [PMID: 36994270 PMCID: PMC10042544 DOI: 10.7759/cureus.35449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 02/27/2023] Open
Abstract
Background The weak control cascade of hypertension from the time of screening till the attainment of optimal blood pressure (BP) control is a public health challenge, particularly in resource-limited settings. The study objectives were to (1) estimate the change in the rate of prevalence of hypertension, the yield of newly diagnosed cases, initiation of treatment, and attainment of BP control in the age group 15 to 49 years; (2) ascertain the magnitude and predictors of undiagnosed hypertension, lack of initiation of treatment, and poor control of those on antihypertensive therapy; and (3) estimate the regional variation and state-level performance of the hypertension control cascade in India. Methodology We analyzed demographic and health surveillance (DHS) data from India's National Family Health Survey Fifth Series (NFHS-5), 2019-2021, and NFHS-4 (2015-2016). The NFHS-5 sample comprised 695,707 women and 93,267 men in the age group of 15 to 49 years. Multiple logistic regressions were performed to find the associated predictors, and respective adjusted odds ratios (aORs) were reported. Results The prevalence of hypertension (cumulative previously diagnosed and new cases) among individuals aged 15 to 49 years was 22.8% (22.6%, 23.1%; n = 172,532), out of which 52.06% were newly diagnosed cases. In contrast, in NFHS-4, the prevalence of hypertension among individuals aged 15 to 49 years was 20.4% (20.2%, 20.6%; n = 153,384), of which 41.65% were newly diagnosed cases. In NFHS-5, 40.7% (39.8% and 41.6%) of the previously diagnosed cases were on BP-lowering medications compared to 32.6% (31.8%, 33.6%) in NFHS-4. Furthermore, in NFHS-5, controlled BP was observed in 73.7% (72.7% and 74.7%) of the patients on BP-lowering medication compared to 80.8% (80.0%, 81.6%) in NFHS-4. Females compared to males (aOR = 0·72 and 0·007), residents of rural areas (aOR = 0·82 and 0·004), and those belonging to the socially disadvantaged groups were not initiated on treatment despite awareness of their hypertension status indicative of poor treatment-seeking behavior. Furthermore, increasing age (aOR = 0·49, P < 0·001), higher body mass index (aOR = 0·51, P < 0·001), and greater waist-to-hip ratio (aOR = 0·78, P = 0·047) were associated with uncontrolled hypertension in patients on antihypertensive drug therapy. Conclusions Hypertension control cascade in India is largely ineffectual although screening yield and initiation of antihypertensive treatment have improved in NFHS-5 compared to NFHS-4. Identification of high-risk groups for opportunistic screening, implementing community-based screening, strengthening primary care, and sensitizing associated practitioners are urgently warranted.
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Vischer AS, Rosania J, Socrates T, Burkard T. Reply to Hungerford, S.; Bart, N. Blood-Pressure-Monitoring Smartphone Applications: Ushering in a New Era of Wearable Cardiac Devices? Comment on "Vischer et al. Comparability of a Blood-Pressure-Monitoring Smartphone Application with Conventional Measurements-A Pilot Study. Diagnostics 2022, 12, 749". Diagnostics (Basel) 2023; 13:diagnostics13020291. [PMID: 36673102 PMCID: PMC9858185 DOI: 10.3390/diagnostics13020291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
We would like to thank Drs. Hungerford and Bart for their kind comment [...].
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Affiliation(s)
- Annina S. Vischer
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
- Correspondence:
| | - Jana Rosania
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Thenral Socrates
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
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30
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Nguyen TN, Kalia S, Hanlon P, Jani BD, Nicholl BI, Christie CD, Aliarzadeh B, Moineddin R, Harrison C, Chow C, Fortin M, Mair FS, Greiver M. Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada. J Prim Care Community Health 2023; 14:21501319231215025. [PMID: 38097504 PMCID: PMC10725138 DOI: 10.1177/21501319231215025] [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: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control. METHODS This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019. Uncontrolled BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. A list of 11 a priori selected chronic conditions was used to define multimorbidity. Multimorbidity was defined as having ≥1 long-term condition in addition to hypertension. Logistic regression models were used to estimate the association between multimorbidity (or individual long-term conditions) with uncontrolled BP. RESULTS A total of 67 385 patients with hypertension were included. They had a mean age of 70, 53.1% were female, 80.6% had multimorbidity, and 35.7% had uncontrolled BP. Patients with multimorbidity had lower odds of uncontrolled BP than those without multimorbidity (adjusted OR = 0.72, 95% CI 0.68-0.76). Among the long-term conditions, diabetes (aOR = 0.73, 95%CI 0.70-0.77), heart failure (aOR = 0.81, 95%CI 0.73-0.91), ischemic heart disease (aOR = 0.74, 95%CI 0.69-0.79), schizophrenia (aOR = 0.79, 95%CI 0.65-0.97), depression/anxiety (aOR = 0.91, 95%CI 0.86-0.95), dementia (aOR = 0.87, 95%CI 0.80-0.95), and osteoarthritis (aOR = 0.89, 95%CI 0.85-0.93) were associated with a lower likelihood of uncontrolled BP. CONCLUSION We found that multimorbidity was associated with better BP control. Several conditions were associated with better control, including diabetes, heart failure, ischemic heart disease, schizophrenia, depression/anxiety, dementia, and osteoarthritis.
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Affiliation(s)
- Tu N. Nguyen
- University of Sydney, Sydney, NSW, Australia
- University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | - Clara Chow
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Michelle Greiver
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
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Diabetes, Hypertension, and Comorbidity among Bangladeshi Adults: Associated Factors and Socio-Economic Inequalities. J Cardiovasc Dev Dis 2022; 10:jcdd10010007. [PMID: 36661902 PMCID: PMC9863699 DOI: 10.3390/jcdd10010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Diabetes, hypertension, and comorbidity are still crucial public health challenges that Bangladeshis face. Nonetheless, very few studies have been conducted to examine the associated factors, especially the socioeconomic inequalities in diabetes, hypertension, and comorbidity in Bangladesh. This study explored the prevalence of, factors connected with, and socioeconomic inequalities in diabetes, hypertension, and comorbidity among Bangladeshi adults. We used the Bangladesh Demographic and Health Survey (BDHS) data set of 2017−2018. A total of 12,136 (weighted) Bangladeshi adults with a mean age of 39.5 years (±16.2) participated in this study. Multilevel (mixed-effect) logistic regression analysis was employed to ascertain the determinants of diabetes, hypertension, and comorbidity, where clusters were considered as a level-2 factor. The concentration curve (CC) and concentration index (CIX) were utilized to investigate the inequalities in diabetes, hypertension, and comorbidity. The weighted prevalence of diabetes, hypertension, and comorbidity was 10.04%, 25.70%, and 4.47%, respectively. Age, body mass index, physical activity, household wealth status, and diverse administrative divisions were significantly associated with diabetes, hypertension, and comorbidity among the participants. Moreover, participants’ smoking statuses were associated with hypertension. Women were more prone to hypertension and comorbidity than men. Diabetes (CIX: 0.251, p < 0.001), hypertension (CIX: 0.071, p < 0.001), and comorbidity (CIX: 0.340, p < 0.001) were higher among high household wealth groups. A pro-wealth disparity in diabetes, hypertension, and comorbidity was found. These inequalities in diabetes, hypertension, and comorbidity emphasize the necessity of designing intervention schemes geared towards addressing the rising burden of these diseases.
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Singh RB, Nabavizadeh F, Fedacko J, Pella D, Vanova N, Jakabcin P, Fatima G, Horuichi R, Takahashi T, Mojto V, Juneja L, Watanabe S, Jakabcinova A. Dietary Approaches to Stop Hypertension via Indo-Mediterranean Foods, May Be Superior to DASH Diet Intervention. Nutrients 2022; 15:nu15010046. [PMID: 36615704 PMCID: PMC9824062 DOI: 10.3390/nu15010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Western-type diet with high salt and sugar, sedentary behavior, obesity, tobacco and alcoholism are important risk factors for hypertension. This review aims to highlight the role of western diet-induced oxidative stress and inflammation in the pathogenesis of hypertension and the role of various types of diets in its prevention with reference to dietary approaches to stop hypertension (DASH) diet. It seems that it is crucial to alter the western type of diet because such diets can also predispose all CVDs. Western diet-induced oxidative stress is characterized by excessive production of reactive oxygen species (ROS) with an altered oxidation-reduction (redox) state, leading to a marked increase in inflammation and vascular dysfunction. Apart from genetic and environmental factors, one important cause for differences in the prevalence of hypertension in various countries may be diet quality, deficiency in functional foods, and salt consumption. The role of the DASH diet has been established. However, there are gaps in knowledge about the role of some Indo-Mediterranean foods and Japanese foods, which have been found to decrease blood pressure (BP) by improving vascular function. The notable Indo-Mediterranean foods are pulses, porridge, spices, and millets; fruits such as guava and blackberry and vegetables, which may also decrease BPs. The Japanese diet consists of soya tofu, whole rice, in particular medical rice, vegetables and plenty of fish rich in fish oil, fish peptides and taurine that are known to decrease BPs. Epidemiological studies and randomized, controlled trials have demonstrated the role of these diets in the prevention of hypertension and metabolic diseases. Such evidence is still meager from Japan, although the prevalence of hypertension is lower (15-21%) compared to other developed countries, which may be due to the high quality of the Japanese diet. Interestingly, some foods, such as berries, guava, pumpkin seeds, carrots, soya beans, and spices, have been found to cause a decrease in BPs. Omega-3 fatty acids, fish peptide, taurine, dietary vitamin D, vitamin C, potassium, magnesium, flavonoids, nitrate and l-arginine are potential nutrients that can also decrease BPs. Larger cohort studies and controlled trials are necessary to confirm our views.
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Affiliation(s)
- Ram B. Singh
- Halberg Hospital and Research Institute, Moradabad 244001, India
| | - Fatemeh Nabavizadeh
- Department of Cardiology, Emirates Hospital, Dubai 999041, United Arab Emirates
| | - Jan Fedacko
- Department of Gerontology and Geriatric, PJ Safarik University and MEDIPARK—University Research Park, PJ Safarik University, 1, 041-90 Kosice, Slovakia
- Correspondence:
| | - Dominik Pella
- 1st Department of Cardiology, PJ Safarik University Faculty of Medicine and East Slovak Institute for Cardiovascular Disease, 040-11 Kosice, Slovakia
| | - Natalia Vanova
- Department of Internal Medicine, PJ Safarik University and Agel Hospital Kosice-Saca, 040-11 Kosice, Slovakia
| | - Patrik Jakabcin
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, 10000 Prague, Czech Republic
| | - Ghizal Fatima
- Era Medical College, Era University, Lucknow 226001, India
| | - Rie Horuichi
- Department of Food Sciences and Nutrition, Faculty of Human Environmental Sciences, Mukogawa Women’s University, Nishinomiya City 663-8558, Japan
| | - Toru Takahashi
- Department of Nutrition, Faculty of Nutrition, Kanazawa Gakuin University, Kanazawa City 920-1392, Japan
| | - Viliam Mojto
- Department of Internal Medicine, Comenius University, 813-72 Bratislava, Slovakia
| | - Lekh Juneja
- Executive Vice President, Kameda Seika Co., Ltd., Tokyo 160-0005, Japan
| | | | - Andrea Jakabcinova
- Department of Gerontology and Geriatric, Faculty of Medicine, PJ Safarik University and MEDIPARK—University Research Park, PJ Safarik University, 040-11 Kosice, Slovakia
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Nicolaou L, Underhill L, Hossen S, Simkovich S, Thangavel G, Rosa G, McCracken JP, Davila-Roman V, Fuentes LDL, Quinn AK, Clark M, Diaz A, Pillarisetti A, Steenland K, Waller LA, Jabbarzadeh S, Peel JL, Checkley W. Cross-sectional analysis of the association between personal exposure to household air pollution and blood pressure in adult women: Evidence from the multi-country Household Air Pollution Intervention Network (HAPIN) trial. ENVIRONMENTAL RESEARCH 2022; 214:114121. [PMID: 36029836 PMCID: PMC9492861 DOI: 10.1016/j.envres.2022.114121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 06/18/2023]
Abstract
Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP -fine particulate matter (PM2.5), carbon monoxide (CO), and black carbon (BC) - with BP measures in women aged 40-79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda. BP was obtained within a day of 24-h personal exposure measurements at baseline, when participants were using biomass for cooking. We used generalized additive models to characterize the shape of the association between BP and HAP, accounting for the interaction of personal exposures and age and adjusting for a priori identified confounders. A total of 418 women (mean age 52.2 ± 7.9 years) were included in this analysis. The interquartile range of exposures to PM2.5 was 42.9-139.5 μg/m3, BC was 6.4-16.1 μg/m3, and CO was 0.5-2.9 ppm. Both SBP and PP were positively associated with PM2.5 exposure in older aged women, achieving statistical significance around 60 years of age. The exact threshold varied by BP measure and PM2.5 exposures being compared. For example, SBP of women aged 65 years was on average 10.8 mm Hg (95% CI 1.0-20.6) higher at 232 μg/m3 of PM2.5 exposure (90th percentile) when compared to that of women of the same age with personal exposures of 10 μg/m3. PP in women aged 65 years was higher for exposures ≥90 μg/m3, with mean differences of 6.1 mm Hg (95% CI 1.8-10.5) and 9.2 mm Hg (95% CI 3.3-15.1) at 139 (75th percentile) and 232 μg/m3 (90th percentile) respectively, when compared to that of women of the same age with PM2.5 exposures of 10 μg/m3. Our findings suggest that reducing HAP exposures may help to reduce BP, particularly among older women.
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Affiliation(s)
- Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Lindsay Underhill
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Suzanne Simkovich
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, USA
| | - Gurusamy Thangavel
- Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London, UK
| | - John P McCracken
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala; Global Health Institute, Epidemiology and Biostatistics Department, University of Georgia, Athens, GA, USA
| | | | | | - Ashlinn K Quinn
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Maggie Clark
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Anaite Diaz
- Center for Health Studies, Universidad Del Valle de Guatemala, Guatemala City, Guatemala
| | - Ajay Pillarisetti
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Department of Environmental & Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
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Ivanova E, Ruzgienė D, Ažukaitis K, Jankauskienė A. Pharmacological Treatment of Arterial Hypertension in Children and Adolescents in Lithuania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13949. [PMID: 36360828 PMCID: PMC9655918 DOI: 10.3390/ijerph192113949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The global prevalence of arterial hypertension (AH) in the pediatric population is increasing, but therapeutic approaches and the choice of the most suitable antihypertensive medications remains challenging. The study aimed to estimate the prevalence, treatment rates, and pharmacological treatment patterns of children and adolescents with AH in Lithuania during 2019 using real-world data. The study population consisted of citizens of Lithuania aged 0 to 17 years, who were diagnosed with AH according to the International Classification of Diseases (ICD). The analysis of reimbursed antihypertensive medication prescriptions was performed according to AH etiology and age. The overall prevalence of AH by diagnostic ICD codes in 2019 was 0.29%:0.24% for primary and 0.05% for secondary. Treatment rates were 39.8% for primary AH and 66.3% for secondary AH. Angiotensin-converting enzyme inhibitors (ACEi) were the most popular medications irrespective of the etiology of AH or age. Beta-blockers were in the second place and used more often in older children. Calcium channel blockers were the third and angiotensin receptor blockers were the fourth most frequent choices. Enalapril was the most popular agent in the ACEi group and metoprolol in the beta-blocker group. Nearly forty percent of Lithuanian children with primary AH receive pharmacological therapy compared to two-thirds with secondary AH. Although ACEi are the predominant class of antihypertensive medications, discordances with available guidelines are evident, particularly in the overuse of beta-blockers and underuse of diuretics.
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Yang Y, Xu H, Liu X, Li J, Liew Z, Liu X, Huang C, Zhu J, Zhang J, Chen L, Hao Y, Qin G, Yu Y. Joint association of smoking and physical activity with mortality in elderly hypertensive patients: A Chinese population-based cohort study in 2007-2018. Front Public Health 2022; 10:1005260. [PMID: 36249230 PMCID: PMC9558130 DOI: 10.3389/fpubh.2022.1005260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/31/2022] [Indexed: 01/27/2023] Open
Abstract
Background Although associations of physical activity and smoking with mortality have been well-established, the joint impact of physical activity and smoking on premature mortality among elderly hypertensive population was still unclear. This study aimed to assess association of physical activity, smoking, and their interaction with all-cause and cardiovascular disease (CVD) mortality risk in elderly hypertensive patients. Methods We included 125,978 Chinese hypertensive patients aged 60-85 years [mean (SD) age, 70.5 (6.9) years] who had records in electronic health information system of Minhang District of Shanghai, China in 2007-2015. Cox regression was used to estimate individual and joint association of smoking and physical activity on all-cause and CVD mortality. Interactions were measured both additively and multiplicatively. Additive interaction was evaluated by relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). Results Among 125,978 elderly hypertensive patients (median age 70.1), 28,250 deaths from all causes and 13,164 deaths from CVD were observed during the follow-up up to 11 years. There was an additive interaction between smoking and physical inactivity [RERI: all-cause 0.19 (95% CI: 0.04-0.34), CVD 0.28 (0.06-0.50); AP: all-cause 0.09 (0.02-0.16), CVD 0.14 (0.04-0.23); S: all-cause 1.21 (1.04-1.42), CVD 1.36 (1.06-1.75)], while the concurrence of both risk factors was associated with more than 2-fold risk of death [hazard ratio (HR): all-cause 2.10 (1.99-2.21), CVD 2.19 (2.02-2.38)]. Conclusion Our study suggested that smoking and physical inactivity together may have amplified association on premature death compared to the sum of their individual associations, highlighting the importance of improving behavioral factors in combination and promoting a comprehensive healthy lifestyle in hypertensive elderly.
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Affiliation(s)
- Yating Yang
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China
| | - Xiaoqin Liu
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Jiong Li
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Xing Liu
- Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Chen Huang
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jingjing Zhu
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jinling Zhang
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China
| | - Linli Chen
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China,*Correspondence: Yuantao Hao
| | - Guoyou Qin
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China,Guoyou Qin
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China,Yongfu Yu
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The Effects of Foot Reflexology on Vital Signs: A Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4182420. [PMID: 36147645 PMCID: PMC9489354 DOI: 10.1155/2022/4182420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022]
Abstract
Introduction We evaluated the effects of foot reflexology on bodily vital signs. Methods Randomized controlled trials (RCTs) evaluating the effects of foot reflexology on vital signs were collected for a meta-analysis. Statistical analysis was conducted using RevMan5.4 software and pooled estimates of the effects were reported as mean differences (MDs) with 95% confidence intervals (CIs). Results Thirteen studies, including 819 patients, met our inclusion criteria. Our results showed that systolic blood pressure (SBP) (MD = -4.62, 95% CI: -5.58 to -3.66; P < 0.00001), diastolic blood pressure (DBP) (MD = -3.32, 95% CI: -4.48 to -2.17; P < 0.00001), heart rate (HR) (MD = -4.76, 95% CI: -6.49 to -3.04; P < 0.00001), respiratory rate (RR) (MD = -0.77, 95% CI: -1.50 to -0.48; P < 0.00001), and pulse oxygen saturation (SpO2) (MD = 0.95, 95% CI: 0.39 to 1.52; P = 0.0009) showed statistical significance in the foot reflexology group. Conclusions Short-term followup results showed that foot reflexology exerted positive effects on vital signs, reduced BP, HR, and RR and increased SpO2.
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Circulating short-chain fatty acids in hypertension: a reflection of various hypertensive phenotypes. J Hypertens 2022; 40:1589-1596. [PMID: 35881452 DOI: 10.1097/hjh.0000000000003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension is the most common chronic condition globally, contributing to an increased risk of cardiovascular disease and premature death. Despite advances in treatment options, approximately 10% of patients have resistant hypertension, characterized by elevated blood pressure that does not respond to treatment. The gut microbiome is now increasingly recognized to play a role in the development and pathogenesis of several diseases, including hypertension, although the exact mechanisms remain unclear. METHOD The aim of the present study was to investigate circulating levels of short-chain fatty acids, metabolites produced by gut bacteria, in essential ( n = 168) and resistant hypertensive ( n = 27) patients, compared with healthy controls ( n = 38). RESULTS Serum acetate was significantly lower in the resistant hypertensive population, compared with both the normotensive controls and those with essential hypertension (748 ± 89 versus 1335 ± 61 and 1171 ± 22 nmol/ml, P < 0.0001). Acetate was also significantly lower in treated versus untreated hypertensive patients or controls (1112 ± 27 versus 1228 ± 40 and 1327 ± 63 nmol/l, P < 0.01), with this finding more pronounced with increasing number of antihypertensive therapies. In contrast, propionate was lower and butyrate significantly higher in those with essential hypertension compared with controls (propionate: 25.2 ± 7.5 versus 58.6 ± 7.6 nmol/ml, P < 0.0001; butyrate: 46.5 ± 3.5 versus 14.7 ± 9.9 nmol/ml, P < 0.01). A novel and perhaps clinically relevant observation was the significant difference in acetate and propionate levels between patients taking ACE inhibitors or angiotensin-receptor blockers. CONCLUSION The present study has highlighted differences in circulating short-chain fatty acids in different hypertensive phenotypes and a possible influence of drug number and class. Although further research is necessary, this may represent a novel therapeutic target, particularly in patients with resistant hypertension.
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Risks’ Stratification of Metabolic Disorders and Arterial Hypertension Depending on the NOS3 (RS2070744) and GNB3 (RS5443) Genes’ Allelic State. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Early diagnosis of essential arterial hypertension (EAH), the search for risk factors for its occurrence and severity, which determine the metabolome and epigenetic structures activity, is an urgent task of modern medicine.
The objective: to assess the risks of metabolic disorders and the EAH occurrence, depending on the NOS3 (rs2070744) and GNB3 (rs5443) genes’ allelic state.
Materials and methods. 100 patients with EAH and 48 practically healthy (control group) were enrolled in the study. All participant underwent clinical and laboratory examinations. Metabolic changes were examined by blood glucose, total cholesterol (TC), triacylglycerol (TG), high and low density lipoprotein cholesterol (HDL-C, LDL-C), Atherogenicity index (AI). The NOS3 (rs2070744) and GNB3 (rs5443) genes were studied by real-time PCR. Risks, prognoses were determined by the clinical epidemiology method.
Results. The risk of metabolic disorders (dyslipidemia and hyperglycemia) in EAH patients does not depend on NOS3 gene polymorphism (rs2070744). However, the mutational T-allele of the GNB3 gene (825C>T) presence in the patients’ genotype increases the risk of hyperlipidemia due to atherogenic LDL-C 8.5 times [OR=8.45; OR 95%CI:0.99–72.70; p=0.05], with the CC-genotype protective role [OR=0.12; OR 95%CI:0.01–1.0; p=0.048].
The overall risk of EAH in the examined population increases with fasting hyperglycemia 9 times [OR 95%CI:2.86–27.08; p<0.001], with hypertriglyceridemia (>1.70 mmol/l) – 3 times [OR 95%CI:1.23–5.56; p=0.009] and with a decrease in HDL-C (<1.2 mmol/l) – more than 3.5 times [OR 95%CI:1.46–8.71; p=0.003], respectively.
Conclusion. The risk of metabolic disorders increases in EAH patients with the T-allele of the GNB3 gene (825C>T) 8.5 times with the lowest probability of such changes in the CC-genotype carriers [OR=0.12; p=0.048].
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Czerwińska K, Poręba M, Prokopowicz A, Januszewska L, Jaremków A, Markiewicz-Górka I, Martynowicz H, Mazur G, Poręba R, Pawlas K, Gać P. Association Between Serum Selenium Concentration and OPG/RANKL/RANK Axis in Patients with Arterial Hypertension. Cardiovasc Toxicol 2022; 22:620-630. [PMID: 35412194 DOI: 10.1007/s12012-022-09741-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/31/2022] [Indexed: 12/26/2022]
Abstract
The aim of the study was to determine the relationship between the serum selenium concentration (Se-S) and the blood concentrations of osteoprotegerin (OPG), receptor activator of nuclear factor kappa-Β ligand (RANKL) and the OPG/RANKL ratio in patients with arterial hypertension. The study group comprised 138 patients with arterial hypertension (age: 56.04 ± 11.59 years). Se-S was determined in all the subjects. Based on the Se-S, the following subgroups were distinguished: a subgroup of patients with a lower Se-S ("low-Se", Se-S < median) and a subgroup of patients with a higher Se-S ("high-Se", Se-S ≥ median). Moreover, the blood concentrations of the parameters of bone metabolism and extraskeletal calcification were assessed: OPG and RANKL. The OPG/RANKL ratio was calculated. In the "low-Se" subgroup, the RANKL concentration was statistically significantly lower, and the OPG/RANKL ratio was statistically significantly higher than in the patients in the "high-Se" subgroup. The correlation analysis showed the negative linear relationships between Se-S and OPG (r = - 0.25, p < 0.05) and between Se-S and OPG/RANKL (r = - 0.47, p < 0.05). Moreover, Se-S positively correlated with RANKL (r = 0.33, p < 0.05). In regression analysis, higher body mass index (BMI), smoking and lower Se-S were independently associated with a higher OPG/RANKL ratio, while lower BMI, use of diuretics, β-blockers and ACE inhibitors and lower OPG/RANKL ratio with effective blood pressure control. In summary, in the group of patients with arterial hypertension, lower Se-S is associated with an unfavourable prognostic panel of parameters of bone metabolism and extraskeletal calcification. Lower Se-S is an independent risk factor for a higher OPG/RANKL ratio, which is an independent prediction factor of ineffective blood pressure control in patients with hypertension.
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Affiliation(s)
- Karolina Czerwińska
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368, Wrocław, Poland
| | - Małgorzata Poręba
- Department of Paralympic Sports, Wroclaw University of Health and Sport Sciences, Witelona 25a, 51-617, Wrocław, Poland
| | - Adam Prokopowicz
- Institute of Occupational Medicine and Environmental Health in Sosnowiec, Kościelna 13, 41-200, Sosnowiec, Poland
| | - Lidia Januszewska
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368, Wrocław, Poland
| | - Aleksandra Jaremków
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368, Wrocław, Poland
| | - Iwona Markiewicz-Górka
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368, Wrocław, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Krystyna Pawlas
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368, Wrocław, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368, Wrocław, Poland.
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McGurgan IJ, Kelly PJ, Turan TN, Rothwell PM. Long-Term Secondary Prevention: Management of Blood Pressure After a Transient Ischemic Attack or Stroke. Stroke 2022; 53:1085-1103. [PMID: 35291823 DOI: 10.1161/strokeaha.121.035851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reducing blood pressure (BP) is a highly effective strategy for long-term stroke prevention. Despite overwhelmingly clear evidence from randomized trials that antihypertensive therapy substantially reduces the risk of stroke in primary prevention, uncertainty still surrounds the issue of BP lowering after cerebrovascular events, and the risk of recurrent stroke, coronary events, and vascular death remains significant. Important questions in a secondary prevention setting include should everyone be treated regardless of their poststroke BP, how soon after a stroke should BP-lowering treatment be commenced, how intensively should BP be lowered, what drugs are best, and how should long-term BP control be optimized and monitored. We review the evidence on BP control after a transient ischemic attack or stroke to address these unanswered questions and draw attention to some recent developments that hold promise to improve management of BP in current practice.
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Affiliation(s)
- Iain J McGurgan
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (I.J.M., P.M.R.)
| | - Peter J Kelly
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K.)
| | - Tanya N Turan
- Department of Neurology, Medical University of South Carolina, Charleston (T.N.T.)
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (I.J.M., P.M.R.)
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Liu G, Fang Q, Ji X, OuYang J, Zhu Y, Wang L, Wang X. Medical expenditure and its influencing factors of patients with hypertension in Shanxi Province, China: a study based on 'System of Health Accounts 2011' and multiple-layer perceptron neural network. BMJ Open 2022; 12:e048396. [PMID: 35241463 PMCID: PMC8895933 DOI: 10.1136/bmjopen-2020-048396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To study the medical expenditure and influencing factors of patients with hypertension in Shanxi Province, China. DESIGN A cross-sectional study. SETTING 1088 medical institutions, including general hospitals, traditional Chinese medicine hospitals, special hospitals, basic medical institutions and public health institutions. PARTICIPANTS 180 441 hypertensive outpatients and 14 763 inpatients from 1 January to 31 December 2017. PRIMARY AND SECONDARY OUTCOME MEASURES Curative care expenditure for hypertension (CCEht) was measured based on System of Health Accounts 2011. Influenced factors were analysed by univariate analysis and multiple layer perceptron neural network. RESULTS In 2017, CCEht was US$307.71 million, accounting for 3.63% of total CCE and 0.14% of gross domestic product (GDP) in Shanxi Province of China. CCE of hypertensive outpatients (CCEht-out) and inpatients (CCEht-in) accounted for 44.49% and 55.51% of CCEht. Drug fee accounted for 81.55% of CCEht-out and 22.50% of CCEht-in, respectively. The top three influencing factors were drug fee, surgical fee and hospitalisation days for inpatients, and drug fee, examination fee and test fee for outpatients. CONCLUSIONS The medical expenditure of hypertension is still heavy for individuals and society. The diagnosis and treatment capacities of primary healthcare system has been enhanced. New rural cooperation medical insurance and urban employee basic medical insurance have a trend of overusing, and the burden of family healthcare expenditure is still heavy. To ease the economic burden of patients with hypertension and improve the efficiency of social resources utilisation, policymakers should pay more attention to key groups, further increase support for primary healthcare system, standardise the treatment and reimbursement of hypertension and incline the reimbursement policy to outpatient service.
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Affiliation(s)
- Guojie Liu
- School of Forensic Medicine, China Medical University, Shenyang, China
| | - Quan Fang
- College of Health Management, China Medical University, Shenyang, China
| | - Xinyu Ji
- First Hospital of China Medical University, Shenyang, China
| | - Jing OuYang
- Humanity and Management College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yalan Zhu
- College of Health Management, China Medical University, Shenyang, China
| | - Leying Wang
- First Clinical Department, China Medical University, Shenyang, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, China
- School of Public Health, Xin Jiang Medical University, Urumqi, China
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Teshome DF, Balcha SA, Ayele TA, Atnafu A, Gelaye KA. Development and Psychometric Validation of the Hypertension Beliefs Assessment Tool Among Adult Population in Northwest Ethiopia. Patient Prefer Adherence 2021; 15:2659-2671. [PMID: 34858019 PMCID: PMC8630370 DOI: 10.2147/ppa.s335070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Ethiopia, the majority of hypertension cases remain undiagnosed, untreated, and uncontrolled. Beliefs about hypertension and its complications play an important role in hypertension management behaviors. Accurate assessment of individuals' beliefs towards the disease is of paramount importance in the design of hypertension education. This study aimed to develop and validate a hypertension belief assessment tool based on the Health Belief Model for the general population among rural adults in northwest Ethiopia. METHODS The study included item construction, face and content validation, factor analysis, and establishment of reliability and validity of the tool. A total of 308 rural adults participated in the study. Inter-item and item-to-total correlations were used to examine the items assessed with the same content on a scale. Principal component analysis with promax rotation was used to extract the factors. Internal consistency reliability was assessed using Cronbach's alpha coefficient. Convergent and discriminant validity were assessed using average variance extraction and maximum shared variance. RESULTS The median age of the participants was 41 (IQR: 31-55) years. Of the participants, 175 (56.8%) were female and 287 (93.2%) were farmers. Kaiser-Meyer-Olkin test value of 0.84 and significant Bartlett's test of sphericity (p=0.000) revealed that the data were suitable for exploratory factor analysis. The principal component analysis identified 6 factors, which explained 70.06% of the variation of the hypertension belief. Cronbach's alpha was 0.85 for the entire scale, ranging from 0.74 to 0.92 for the sub-domains. The average variance extracted was above 0.5 for all factors, indicating convergent validity. The maximum shared variance between the two constructs was lower than the average variance extracted from each factor, indicating that discriminating validity had been established. CONCLUSION The hypertension belief assessment tool was found to be valid and reliable, which can be used to measure the health beliefs on hypertension for the rural adult population.
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Affiliation(s)
- Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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