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Zhang W, Xu R, Cai Z, Zheng X, Zheng M, Ni C. Association between physical activity and resistant hypertension in treated hypertension patients: analysis of the national health and nutrition examination survey. BMC Cardiovasc Disord 2023; 23:289. [PMID: 37286953 DOI: 10.1186/s12872-023-03303-x] [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: 06/20/2022] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Current guidelines suggest that regular aerobic training might lower blood pressure in hypertensive individuals. However, evidence linking resistant hypertension (RH) with total daily physical activity (PA), including work-, transport-, and recreation-related PA, is limited. Therefore, this study assessed the association between daily PA and RH. METHOD A cross-sectional study was conducted using data acquired from a nationwide survey in the US (the National Health and Nutrition Examination Survey, NHANES). The weighted prevalence of RH was calculated, and moderate and vigorous daily PA was assessed using the Global Physical Activity Questionnaire (GPAQ). A multivariate logistic regression model determined the association between daily PA and RH. RESULTS A total of 8,496 treated hypertension patients were identified, including 959 RH cases. The unweighted prevalence of RH among treated hypertension cases was 11.28%, while the weighted prevalence was 9.81%. Participants with RH had a low rate of recommended PA levels (39.83%), and daily PA and RH were significantly associated. PA exhibited significant dose-dependent trends with a low probability of RH (p-trends < 0.05). Additionally, participants with sufficient daily PA had a 14% lower probability of RH than those with insufficient PA [fully adjusted odds ratio (OR) = 0.86; 95% confidence interval (CI) = 0.74-0.99). CONCLUSION The present study revealed that RH has an incidence of up to 9.81% in treated hypertension patients. Hypertensive patients tended to be physically inactive, and insufficient PA and RH were significantly associated. Sufficient daily PA should be recommended to reduce the RH probability among treated hypertension patients.
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Affiliation(s)
- Weidai Zhang
- Department of Cardiology, Shantou Central Hospital, No. 114 Waima Road Shantou, Guangdong, 515000, China
| | - Ronghe Xu
- Department of Cardiology, Shantou Central Hospital, No. 114 Waima Road Shantou, Guangdong, 515000, China
| | - Zhixiong Cai
- Department of Cardiology, Shantou Central Hospital, No. 114 Waima Road Shantou, Guangdong, 515000, China
| | - Xiaodong Zheng
- Department of Cardiology, Shantou Central Hospital, No. 114 Waima Road Shantou, Guangdong, 515000, China
| | - Meiyi Zheng
- Department of Cardiology, Shantou Central Hospital, No. 114 Waima Road Shantou, Guangdong, 515000, China
| | - Chumin Ni
- Department of Cardiology, Shantou Central Hospital, No. 114 Waima Road Shantou, Guangdong, 515000, China.
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Joo HJ, Yum Y, Kim YH, Son JW, Kim SH, Choi S, Han S, Shin MS, Jeong JO, Kim EJ. Gender Difference of Blood Pressure Control Rate and Clinical Prognosis in Patients With Resistant Hypertension: Real-World Observation Study. J Korean Med Sci 2023; 38:e124. [PMID: 37096308 PMCID: PMC10125792 DOI: 10.3346/jkms.2023.38.e124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/05/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND There are several differences in the clinical course of hypertension due to the biological and social differences between men and women. Resistant hypertension is an advanced disease state, and significant gender difference could be expected, but much has not been revealed yet. The purpose of this study was to compare gender differences on the current status of blood pressure (BP) control and clinical prognosis in patients with resistant hypertension. METHODS This is a multicenter, retrospective cohort study using common data model databases of 3 tertiary hospitals in Korea. Total 4,926 patients with resistant hypertension were selected from January 2017 to December 2018. Occurrence of dialysis, heart failure (HF) hospitalization, myocardial infarction, stroke, dementia or all-cause mortality was followed up for 3 years. RESULTS Male patients with resistant hypertension were younger but had a higher cardiovascular risk than female patients. Prevalence of left ventricular hypertrophy and proteinuria was higher in men than in women. On-treatment diastolic BP was lower in women than in men and target BP achievement rate was higher in women than in men. During 3 years, the incidence of dialysis and myocardial infarction was higher in men, and the incidence of stroke and dementia was higher in women. After adjustment, male sex was an independent risk factor for HF hospitalization, myocardial infarction, and all-cause death. CONCLUSION In resistant hypertension, men were younger than women, but end-organ damage was more common and the risk of cardiovascular event was higher. More intensive cardiovascular prevention strategies may be required in male patients with resistant hypertension.
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Affiliation(s)
- Hyung Joon Joo
- Department of Medical Informatics, Korea University College of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yunjin Yum
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Yong Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jung-Woo Son
- Department of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Hea Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seongwoo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
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Hong Z, Jiang Y, Liu P, Zhang L. Association of microalbuminuria and adverse outcomes in hypertensive patients: a meta-analysis. Int Urol Nephrol 2021; 53:2311-2319. [PMID: 33674949 DOI: 10.1007/s11255-021-02795-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Studies on the association of microalbuminuria with adverse outcomes in patients with hypertension remain controversial. This meta-analysis aimed to assess the predictive value of microalbuminuria in hypertensive patients. METHODS PubMed and Embase databases were comprehensively searched for studies that published from their inceptions to July 10, 2020. Observational studies reporting the association of microalbuminuria (defined as urinary albumin excretion 30 and 300 mg/24 h urine or albumin/creatinine ratio 30-300 mg/g from a spot urine or equivalent value) with all-cause mortality or major adverse cardiovascular events (MACEs) in hypertensive patients were selected. RESULTS Nine studies with a total of 19,893 hypertensive patients were included. When compared with those without microalbuminuria, hypertensive patients with microalbuminuria had an increased risk of all-cause mortality (risk ratio [RR] 1.68; 95% confidence interval [CI] 1.46-1.93) and MACEs (RR 1.40; 95% CI 1.22-1.62), respectively. Gender-specific analysis indicated that microalbuminuria was significantly associated with an increased risk of all-cause mortality (RR 1.61; 95% CI 1.17-2.21) in men but not in women (RR 1.18; 95% CI 0.78-1.80). CONCLUSION This meta-analysis suggests that microalbuminuria is independently associated with higher risk of MACEs and all-cause mortality in hypertensive patients. Determination of microalbuminuria has potential to improve the risk classification of hypertension.
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Affiliation(s)
- Zhibin Hong
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China.
| | - Yabao Jiang
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China
| | - Peijun Liu
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China
| | - Li Zhang
- Department of Second Cardiovascular Medicine, The First People's Hospital of Tianshui, No. 105 Jianshe Road, Qinzhou District, Tianshui, 741000, GansuProvince, China
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Wang X, Luo Q, Wang M, Hu J, Zhang D, Zhang W, Wang G, Li N. Long-term impact of spironolactone compliance on microalbuminuria in patients with primary aldosteronism. Hypertens Res 2020; 44:426-434. [PMID: 33299114 DOI: 10.1038/s41440-020-00589-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/30/2020] [Accepted: 09/11/2020] [Indexed: 11/09/2022]
Abstract
Patients with primary aldosteronism (PA) have a high prevalence of microalbuminuria (MAU), which leads to more severe systemic vascular damage. However, the primary recommended drug treatment for PA, spironolactone (SPL), has had poor patient compliance owing to its adverse effects, and the effect of SPL compliance on MAU has not been fully evaluated in patients with PA. We analyzed the effect of SPL compliance on endothelial dysfunction by assessing MAU in patients with PA. The study included 145 confirmed PA patients who received long-term medical treatment (mean, 5 years). As expected, compliance with SPL treatment improved patients' blood pressure and serum potassium levels. Patients with PA who complied fully with SPL treatment had a lower rate of MAU than noncompliant patients (13.73% versus 34.88%, respectively; P = 0.004). Multivariate logistic regression analyses adjusted for age and sex showed that continuous SPL treatment was associated with a lower presence of MAU (odds ratio, 0.319; 95% confidence interval, 0.135-0.750; P = 0.009). This association remained significant after further adjusting for other major risk factors. However, in the subgroup analysis, the protective effect against MAU was limited in compliant patients treated with ≥40 mg/day SPL compared with noncompliant patients (9.62% versus 34.88%, respectively; P < 0.05). Our findings demonstrated that in addition to improving high blood pressure and hypokalemia, full compliance with the appropriate dose of SPL may benefit endothelial function, as reflected by a lower prevalence of MAU in patients with PA.
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Affiliation(s)
- Xiaotong Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China
| | - Qin Luo
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China
| | - Menghui Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China
| | - Junli Hu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China
| | - Delian Zhang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China
| | - Weiwei Zhang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China
| | - Guoliang Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China.
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Yugar-Toledo JC, Moreno Júnior H, Gus M, Rosito GBA, Scala LCN, Muxfeldt ES, Alessi A, Brandão AA, Moreira Filho O, Feitosa ADDM, Passarelli Júnior O, Souza DDSMD, Amodeo C, Barroso WKS, Gomes MAM, Paiva AMGD, Barbosa ECD, Miranda RD, Vilela-Martin JF, Nadruz Júnior W, Rodrigues CIS, Drager LF, Bortolotto LA, Consolim-Colombo FM, Sousa MGD, Borelli FADO, Kaiser SE, Salles GF, Azevedo MDFD, Magalhães LBNC, Póvoa RMDS, Malachias MVB, Nogueira ADR, Jardim PCBV, Jardim TDSV. Brazilian Position Statement on Resistant Hypertension - 2020. Arq Bras Cardiol 2020; 114:576-596. [PMID: 32267335 PMCID: PMC7792719 DOI: 10.36660/abc.20200198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Heitor Moreno Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Miguel Gus
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | | | - Elizabeth Silaid Muxfeldt
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Wilson Nadruz Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde Pontifícia Universidade Católica de são Paulo, São Paulo, SP - Brasil
| | - Luciano Ferreira Drager
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | | | | | | | | | - Gil Fernando Salles
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Huang R, Chen X. Increased Spot Urine Albumin-to-Creatinine Ratio and Stroke Incidence: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 28:104260. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/27/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022] Open
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Muxfeldt ES, Chedier B, Rodrigues CIS. Resistant and refractory hypertension: two sides of the same disease? ACTA ACUST UNITED AC 2018; 41:266-274. [PMID: 30525180 PMCID: PMC6699444 DOI: 10.1590/2175-8239-jbn-2018-0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension
(RH), being considered an uncontrolled blood pressure besides the use of 5 or
more antihypertensive medications, including a long-acting thiazide diuretic and
a mineralocorticoid antagonist. RH is common, with 10-20% of the general
hypertensives, and its associated with renin angiotensin aldosterone system
hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems
to be influenced by increased sympathetic activity. RH patients are older and
more obese than general hypertensives. It is strongly associated with diabetes,
obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in
women, younger patients and Afro-americans compared to RFs. Both are associated
with increased albuminuria, left ventricular hypertrophy, chronic kidney
diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat
effect seems to be higher among RH patients. Intensification of diuretic therapy
is indicated in RH, while in RfH, therapy failure imposes new treatment
alternatives such as the use of sympatholytic therapies. In conclusion, both RH
and RfH constitute challenges in clinical practice and should be addressed as
distinct clinical entities by trained professionals who are capable to identify
comorbidities and provide specific, diversified, and individualized
treatment.
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Affiliation(s)
- Elizabeth Silaid Muxfeldt
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil.,Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Bernardo Chedier
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil.,Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Departamento de Medicina, Sorocaba, SP, Brasil
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