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Liu Z, Jin P, Liu Y, Zhang Z, Wu X, Weng M, Cao S, Wang Y, Zeng C, Yang R, Liu C, Sun P, Tian C, Li N, Zeng Q. A comprehensive approach to lifestyle intervention based on a calorie-restricted diet ameliorates liver fat in overweight/obese patients with NAFLD: a multicenter randomized controlled trial in China. Nutr J 2024; 23:64. [PMID: 38872173 PMCID: PMC11170812 DOI: 10.1186/s12937-024-00968-8] [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: 10/26/2023] [Accepted: 06/06/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a globally increasing health epidemic. Lifestyle intervention is recommended as the main therapy for NAFLD. However, the optimal approach is still unclear. This study aimed to evaluate the effects of a comprehensive approach of intensive lifestyle intervention (ILI) concerning enhanced control of calorie-restricted diet (CRD), exercise, and personalized nutrition counseling on liver steatosis and extrahepatic metabolic status in Chinese overweight and obese patients with NAFLD. METHODS This study was a multicenter randomized controlled trial (RCT) conducted across seven hospitals in China. It involved 226 participants with a body mass index (BMI) above 25. These participants were randomly assigned to two groups: the ILI group, which followed a low carbohydrate, high protein CRD combined with exercise and intensive counseling from a dietitian, and a control group, which adhered to a balanced CRD along with exercise and standard counseling. The main measure of the study was the change in the fat attenuation parameter (FAP) from the start of the study to week 12, analyzed within the per-protocol set. Secondary measures included changes in BMI, liver stiffness measurement (LSM), and the improvement of various metabolic indexes. Additionally, predetermined subgroup analyses of the FAP were conducted based on variables like gender, age, BMI, ethnicity, hyperlipidemia, and hypertension. RESULTS A total of 167 participants completed the whole study. Compared to the control group, ILI participants achieved a significant reduction in FAP (LS mean difference, 16.07 [95% CI: 8.90-23.25] dB/m) and BMI (LS mean difference, 1.46 [95% CI: 1.09-1.82] kg/m2) but not in LSM improvement (LS mean difference, 0.20 [95% CI: -0.19-0.59] kPa). The ILI also substantially improved other secondary outcomes (including ALT, AST, GGT, body fat mass, muscle mass and skeletal muscle mass, triglyceride, fasting blood glucose, fasting insulin, HbA1c, HOMA-IR, HOMA-β, blood pressure, and homocysteine). Further subgroup analyses showed that ILI, rather than control intervention, led to more significant FAP reduction, especially in patients with concurrent hypertension (p < 0.001). CONCLUSION In this RCT, a 12-week intensive lifestyle intervention program led to significant improvements in liver steatosis and other metabolic indicators in overweight and obese Chinese patients suffering from nonalcoholic fatty liver disease. Further research is required to confirm the long-term advantages and practicality of this approach. TRIAL REGISTRATION This clinical trial was registered on ClinicalTrials.gov (registration number: NCT03972631) in June 2019.
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Affiliation(s)
- Zhong Liu
- Health Management Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Piaopiao Jin
- Health Management Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yuping Liu
- Department of Health Management, Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Zhimian Zhang
- Health Management Center, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xiangming Wu
- Zhejiang Nutriease Health Technology Company Limited, Hangzhou, 311121, China
| | - Min Weng
- Department of Nutrition, The First Affiliated Hospital, Kunming Medical University, Kunming, 650034, China
| | - Suyan Cao
- Health Management Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yan Wang
- Health Management Center, Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Chang Zeng
- Health Management Center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Rui Yang
- Healthcare Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chenbing Liu
- Health Management Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ping Sun
- Department of Health Management, Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Cuihuan Tian
- Health Management Center, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Nan Li
- Health Management Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Qiang Zeng
- Health Management Institute, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100039, China.
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Wan Y, Ma D, Shang Q, Xu H. Association between dietary flavonoid intake and hypertension among U.S. adults. Front Immunol 2024; 15:1380493. [PMID: 38680497 PMCID: PMC11046732 DOI: 10.3389/fimmu.2024.1380493] [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: 02/01/2024] [Accepted: 03/22/2024] [Indexed: 05/01/2024] Open
Abstract
Background Hypertension is one of the major risk factors for cardiovascular disease. Dietary flavonoids have been reported to reduce inflammation, protect against oxidative stress, protect the vascular endothelium, and improve vascular health. However, the relationship between dietary flavonoid intake and the prevalence of hypertension remains controversial. Methods This study included 8010 adults from the 2007-2010 and 2017-2018 National Health and Nutrition Examination Surveys (NHANES). The relationship between dietary flavonoid intake and the prevalence of hypertension was explored by weighted logistic regression and weighted restricted cubic spline. Results We found an inverse relationship between total anthocyanin intake and the prevalence of hypertension in the fourth quartile compared with the first quartile [0.81(0.66,0.99), p = 0.04]. Moreover, the prevalence of hypertension tended to decrease with increasing total anthocyanin intake in participants over 60 years of age. In addition, we found a U-shaped relationship between the prevalence of hypertension and total flavan-3-ol intake. Total flavan-3-ol intake was inversely associated with hypertension prevalence in the third quartile compared with the first quartile [0.79 (0.63,0.99), p = 0.04]. Moreover, there was a significant negative association between the prevalence of hypertension and total flavan-3-ol intake when total flavan-3-ol intake was below 48.26 mg/day. Conclusion Our study found a negative association between the prevalence of hypertension and moderate total anthocyanins intake and total flavan-3-ols intake. Our study provides evidence from a population-based study for a negative association between dietary flavonoid intake and the prevalence of hypertension.
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Affiliation(s)
- Yingying Wan
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dan Ma
- China Academy of Chinese Medical Sciences, Xiyuan Hospital Suzhou Hospital, Suzhou, China
| | - Qinghua Shang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Xu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Tian X, Feng J, Chen S, Zhang Y, Zhang X, Xu Q, Wang P, Wu S, Wang A. Baseline and longitudinal cardiovascular health using Life's Essential 8 metrics with the risk of incident hypertension. Clin Exp Hypertens 2023; 45:2271190. [PMID: 37983187 DOI: 10.1080/10641963.2023.2271190] [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: 07/03/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE The quantification of cardiovascular health (CVH) was updated by the American Heart Association recently by using the "Life's Essential 8" (LE8) score. We aimed to investigate the associations of baseline and longitudinal CVH status measured by the new LE8 score (except for blood pressure) with the risk of hypertension. METHODS A total of 52 990 participants with complete data on LE8 metrics and without hypertension were enrolled from the Kailuan study, Tangshan, China. The associations of incident hypertension with the overall baseline, time-updated, and time-varying CVH score (ranging 0 [lowest] to 100 [highest]), and each component of LE8, were assessed by Cox regressions. RESULTS During a median follow-up of 10.73 years 28 380 cases of incident hypertension were identified. The risk of hypertension attenuated with increased CVH score (Ptrend < 0.0001), the hazard ratios (HRs) in high CVH versus low CVH group was 0.54 (95% confidence interval [CI], 0.51-0.57) for baseline CVH, 0.47 (95% CI, 0.45-0.50) for time-updated CVH, and 0.59 (95% CI, 0.55-0.63) for time-varying CVH. The predictive value of CVH in predicting hypertension improved by using LE8 than using Life's Simple 7 metrics. Among LE8 components, body mass index score was the strongest risk factor for hypertension. Subgroup analyses showed that the benefit of a higher CVH score on hypertension was more prominent in young adults and in women (Pinteraction < 0.05). CONCLUSIONS A higher CVH score assessed by new LE8 is associated with a lower risk of subsequent hypertension, especially young adults and women.
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Affiliation(s)
- Xue Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jingxuan Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Penglian Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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Cross-sectional comparisons of dietary indexes underlying nutrition labels: nutri-score, Canadian 'high in' labels and Diabetes Canada Clinical Practices (DCCP). Eur J Nutr 2023; 62:261-274. [PMID: 35960367 DOI: 10.1007/s00394-022-02978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the cross-sectional association between dietary indexes (DI) that underlie, respectively, the Nutri-score (NS), the proposed Canadian 'High In' Symbol (CHIL) and the Diabetes Canada Clinical Practice Guidelines (DCCP) with food consumption, nutrient intakes and metabolic markers. METHODS 1836 adults (18-74 years) participating in the representative ESTEBAN study, conducted in mainland France in 2014-2016, were included in the analysis. Food consumption was assessed with three repeated 24 h dietary recalls. Anthropometric measurements and biomarkers of metabolic risk (cholesterol-total, LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein)-triglycerides, glucose) were obtained through a clinical examination and fasting blood draw. The DI were assessed for their association with food consumption, dietary intakes and metabolic biomarkers as quintiles and continuous variables using multi-adjusted linear regression. Heathier diets were assigned to lower scores. RESULTS Correlations between scores ranged from + 0.62 between CHIL-DI and NS-DI to + 0.75 between NS-DI and DCCP-DI. All DIs discriminated individuals according to the nutritional quality of their diets through food consumption and nutrient intakes (healthier diets were associated with lower intakes of energy, added sugars and saturated fat; and with higher intakes of fiber, vitamins and minerals). NS-DI was associated with blood glucose (adjusted mean in Q1 = 5 vs. Q5 = 5.46 mmol/dl, ptrend = 0.001) and DCCP-DI was associated with BMI (Q1 = 24.8 kg/m2 vs. Q5 = 25.8 kg/m2, ptrend = 0.025), while CHIL showed no significant association with any anthropometric measures or biomarkers. CONCLUSIONS This study provides elements supporting the validity of the nutrient profiling systems underlying front-of-package nutrition labellings (FOPLs) to characterize the healthiness of diets.
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Attahiru M, Simon PL, Mutalub YB, Akangoziri MD, Grema BA. Predictors of blood pressure control amongst primary care patients of a teaching hospital in Bauchi, North-Eastern Nigeria. Niger Postgrad Med J 2023; 30:46-52. [PMID: 36814163 DOI: 10.4103/npmj.npmj_256_22] [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: 02/10/2023]
Abstract
Background Poorly managed hypertension is still a serious global public health issue, despite medication. It is unclear what is causing treated hypertensive patients to have trouble achieving their target blood pressure (BP). Aim The goal of this study was to determine the predictors of BP control amongst hypertensive patients attending a teaching hospital in North-eastern Nigeria. Materials and Methods A cross-sectional study was conducted on 277 hypertensive patients from a tertiary healthcare institution. Data were analysed using version 20 of the Statistical Package for the Social Sciences (SPSS). Frequency and percentages were used to summarise data while Chi-square test was used to test for associations. To identify the factors linked to BP control, logistic regression was employed. At P < 0.05, predictors of BP control were found using adjusted odds ratios (AORs) with a 95% confidence interval (CI). Results The respondents' average age was 53.1 ± 14.6 years, of which 67.5% were female. The level of optimal BP control was 40.8%. Factors associated with reduced BP control include not currently married (AOR = 0.29 [95% CI: 0.16-0.53], P ≤ 0.0001), imperfect adherence (AOR = 0.37 [95% CI: 0.22-0.64], P ≤ 0.0001), taking more than two drugs (AOR = 0.3 [95% CI: 0.14-0.64], P = 0.001) and body mass index (BMI) ≥25 kg/m2 (AOR = 0.40 [95% CI: 0.22-0.72], P = 0.002). Conclusion The optimal BP control is alarmingly low in this setting. Marital status, medication adherence, increased pill burden and BMI ≥25 kg/m2 negatively affect the attainment of BP control.
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Affiliation(s)
- Muhammad Attahiru
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Pitmang Labo Simon
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Yahkub Babatunde Mutalub
- Department of Clinical Pharmacology and Therapeutics/Department of Family Medicine, Abubakar Tafawa Balewa University/Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Mark Divine Akangoziri
- Department of Family Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Bukar Alhaji Grema
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
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Wu Z, Wu Y, Rao J, Hu H, Wang C, Wu J, Shi Y, Fu Y, Cheng X, Li P. Associations among vitamin D, tobacco smoke, and hypertension: A cross-sectional study of the NHANES 2001-2016. Hypertens Res 2022; 45:1986-1996. [PMID: 36202982 DOI: 10.1038/s41440-022-01023-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022]
Abstract
The interrelationships among vitamin D, tobacco smoking, and hypertension are currently unknown. This study was conducted to determine the relationship between vitamin D levels and hypertension and the effect of tobacco smoke exposure levels on this relationship among US adults. We performed a cross-sectional analysis of adult participants from the 2001-2016 National Health and Nutrition Examination Survey (NHANES). Serum 25-hydroxyvitamin D concentration was used as a biomarker of vitamin D status, and tobacco smoke exposure levels were objectively evaluated by serum cotinine levels. Among 22,875 eligible adults who were not receiving antihypertensive medications, the prevalence of hypertension, vitamin D deficiency (<50 mmol/L), and cotinine ≥3 ng/mL was 13.9%, 34.9%, and 29.4%, respectively. Serum cotinine and vitamin D levels were independently associated with hypertension risk after controlling for confounders (P < 0.05). When stratified by the cotinine group (<0.05, 0.05-3 and ≥3 ng/mL), we found that the risk of hypertension associated with vitamin D deficiency was higher among subjects with cotinine levels ≥3 ng/mL compared with the other strata [OR (95% CI) 1.30 (1.09, 1.54) vs. 1.53 (1.19, 1.96) vs. 1.64 (1.30, 2.06); P for heterogeneity test <0.05]. Furthermore, serum cotinine levels were negatively correlated with vitamin D levels. These findings suggested that the increased risk of hypertension could be partly attributed to low vitamin D levels induced by tobacco smoke exposure, in addition to the effects of tobacco smoke exposure and vitamin D deficiency themselves.
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Affiliation(s)
- Zuxiang Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Yingxing Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Jingan Rao
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Huan Hu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Chenxi Wang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Ji Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Yumeng Shi
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Yang Fu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
| | - Xiaoshu Cheng
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ping Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. .,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China. .,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Umemoto S, Onaka U, Kawano R, Kawamura A, Motoi S, Honda N, Kanazashi H, Mitarai M. Effects of a Japanese Cuisine-Based Antihypertensive Diet and Fish Oil on Blood Pressure and Its Variability in Participants with Untreated Normal High Blood Pressure or Stage I Hypertension: A Feasibility Randomized Controlled Study. J Atheroscler Thromb 2022; 29:152-173. [PMID: 33298663 PMCID: PMC8803568 DOI: 10.5551/jat.57802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/09/2020] [Indexed: 11/11/2022] Open
Abstract
AIM The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for lowering blood pressure (BP). Our previous single-arm trial revealed that the Japanese cuisine-based DASH (J-DASH) diet (supplying NaCl 8.0 g per day) reduced BP and improved cardiometabolic biomarkers. The present study's primary objective was to test the feasibility of the J-DASH diet based on its effects on the BP and BP variability of subjects with untreated high-normal BP or stage 1 hypertension. METHODS The 6-month study period was held from December 2015 to August 2016. The participants were recruited through advertisements in local newspapers and our website and from among randomized participants at Yamaguchi University Hospital. The 2-month treatments included the following: the J-DASH-1 diet 1×/day or the J-DASH-2 diet providing a fish hamburger-patty 2×/day (5 days/week respectively). The control group consumed their usual diets. For the subsequent 4 months, all participants consumed their usual diets. The main outcome measure was the feasibility of the J-DASH diet. We also collected the data of clinic BP and home BP (by automatic BP monitor), cardiometabolic biomarkers, and lifestyle and psychosocial parameters during the intervention phase. We examined behavior changes throughout the study period, and the diets' safety. RESULTS Fifty-one participants were recruited; following screening, 48 met the inclusion criteria and were randomized by central allocation. Eight participants were eliminated based on exclusion criteria, and the 40 participants were randomly allocated to the J-DASH 1 and J-DASH 2 groups ( n=13 each) and the usual-diet group (n=14). The participants' mean age was 50 years, and 44% were women. The three groups' clinic BP values were not significantly different, but the home BP values were lower in the J-DASH 1 group and lowest in the J-DASH 2 group compared to the usual-diet group and differed significantly among the three groups throughout the study period (p<0.0001). The home BP variability was significantly lower in the J-DASH groups compared to the usual-diet group throughout the study period ( p<0.01). The other indices including fish oil showed little differences among the groups throughout the study period. CONCLUSIONS The J-DASH diet was feasible to improve home BP and stabilize its variability, and it did so more effectively than the participants' usual diets.
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Affiliation(s)
- Seiji Umemoto
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Reo Kawano
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
| | - Atsuko Kawamura
- Department of Community/Gerontological Nursing, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Nunes PRP, Silva TRGB, Carneiro MAS, Martins FM, Souza AP, Orsatti FL. Functional high-intensity interval training is not equivalent when compared to combined training for blood pressure improvements in postmenopausal women: a randomized controlled trial. Clin Exp Hypertens 2021; 44:127-133. [PMID: 34749549 DOI: 10.1080/10641963.2021.2001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Low-volume functional high-intensity interval training (F-HIIT) improves cardiorespiratory fitness, body composition, and physical function similarly to combined training (CT, gold standard protocol), however no previous studies have compared the F-HIIT equivalence with CT in reducing blood pressure in older people, particularly in postmenopausal women (PW). Therefore, the aim of this study (trial registration: NCT03200639) was designed to test whether F-HIIT of low volume is an equivalent strategy to CT for improving blood pressure (BP) in PW. MATERIAL AND METHOD Forty-nine PW were divided into two groups: F-HIIT and CT. The F-HIIT protocol was composed of 10 sets of 60 seconds of high-intensity exercises interspersed with 60 seconds of low-intensity exercises for recovery. The CT protocol was composed of 30 minutes of moderate-intensity walking, followed by five total body resistance exercises. Both protocols were performed 3-times-a-week for 12 weeks. The BP from rest condition (before exercise) was measured before and after 12 weeks of intervention in both groups, using an automatic blood pressure monitor. The boundaries values for equivalence for systolic and diastolic BP was set at 5.14 and 2.92 mmHg, respectively. RESULTS There was only a significant reduction (P < .05) in systolic BP in CT group from baseline (-3.2 (95% CI, -6.2 to -0.2) mmHg). The difference of systolic BP between F-HIIT and CT was 5.8 (95% CI, 1.3-10.4) mmHg, showing non-equivalence (inferiority) for F-HIIT. CONCLUSION Thus, these results suggest that low-volume F-HIIT protocol is not an equivalent strategy when compared to CT for BP improvements in PW.
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Affiliation(s)
- Paulo R P Nunes
- Exercise Biology Laboratory (BioEx), Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil.,Department of Physical Education, Minas Gerais State University (UEMG), Minas Gerais, Brazil
| | - Thalles R G B Silva
- Exercise Biology Laboratory (BioEx), Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil
| | - Marcelo A S Carneiro
- Exercise Biology Laboratory (BioEx), Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil
| | - Fernanda M Martins
- Exercise Biology Laboratory (BioEx), Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil
| | - Aletéia P Souza
- Exercise Biology Laboratory (BioEx), Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil
| | - Fábio L Orsatti
- Exercise Biology Laboratory (BioEx), Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil.,Department of Sport Sciences, Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil
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How Does Being Overweight Moderate Associations between Diet and Blood Pressure in Male Adolescents? Nutrients 2021; 13:nu13062054. [PMID: 34203997 PMCID: PMC8232677 DOI: 10.3390/nu13062054] [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: 04/23/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Diet is one of the strongest modifiable risk factors for hypertension. In this study, we described the associations between dietary factors and blood pressure; and explored how weight status moderated these associations in a sample of New Zealand male adolescents. We collected demographics information, anthropometric, blood pressure, and dietary data from 108 male adolescents (15–17 years old). Mixed effects and logistic regression models were used to estimate relationships between dietary variables, blood pressure, and hypertension. Moderation effects of overweight status on the relationship between hypertension and diet were explored through forest plots. One-third (36%) of the sample was classified as hypertensive. Fruit intake was related to significantly lower systolic (−2.4 mmHg, p = 0.005) and diastolic blood pressure (−3.9 mmHg, p = 0.001). Vegetable and milk intake was related to significantly lower diastolic blood pressure (−1.4 mmHg, p = 0.047) and (−2.2 mmHg, p = 0.003), respectively. In overweight participants, greater vegetable and milk, and lower meat intake appeared to reduce the odds of hypertension. Certain dietary factors may have more prominent effects on blood pressure depending on weight status.
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Crea F. Interaction between predisposing genes and environmental risk factors in cardiovascular disease: how prevention can counteract this salty combination. Eur Heart J 2021; 41:3287-3291. [PMID: 33216876 DOI: 10.1093/eurheartj/ehaa781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Di Daniele N, Marrone G, Di Lauro M, Di Daniele F, Palazzetti D, Guerriero C, Noce A. Effects of Caloric Restriction Diet on Arterial Hypertension and Endothelial Dysfunction. Nutrients 2021; 13:nu13010274. [PMID: 33477912 PMCID: PMC7833363 DOI: 10.3390/nu13010274] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
The most common manifestation of cardiovascular (CV) diseases is the presence of arterial hypertension (AH), which impacts on endothelial dysfunction. CV risk is associated with high values of systolic and diastolic blood pressure and depends on the presence of risk factors, both modifiable and not modifiable, such as overweight, obesity, physical exercise, smoking, age, family history, and gender. The main target organs affected by AH are the heart, brain, vessels, kidneys, and eye retina. AH onset can be counteracted or delayed by adopting a proper diet, characterized by a low saturated fat and sodium intake, a high fruit and vegetable intake, a moderate alcohol consumption, and achieving and maintaining over time the ideal body weight. In this review, we analyzed how a new nutritional approach, named caloric restriction diet (CRD), can provide a significant reduction in blood pressure values and an improvement of the endothelial dysfunction. In fact, CRD is able to counteract aging and delay the onset of CV and neurodegenerative diseases through the reduction of body fat mass, systolic and diastolic values, free radicals production, and oxidative stress. Currently, there are few studies on CRD effects in the long term, and it would be advisable to perform observational studies with longer follow-up.
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Affiliation(s)
- Nicola Di Daniele
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (F.D.D.); (D.P.); (C.G.); (A.N.)
- Correspondence: ; Tel.: +39-062090-2982; Fax: +39-062090-3362
| | - Giulia Marrone
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (F.D.D.); (D.P.); (C.G.); (A.N.)
- School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Manuela Di Lauro
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (F.D.D.); (D.P.); (C.G.); (A.N.)
| | - Francesca Di Daniele
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (F.D.D.); (D.P.); (C.G.); (A.N.)
- School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Daniela Palazzetti
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (F.D.D.); (D.P.); (C.G.); (A.N.)
| | - Cristina Guerriero
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (F.D.D.); (D.P.); (C.G.); (A.N.)
| | - Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (G.M.); (M.D.L.); (F.D.D.); (D.P.); (C.G.); (A.N.)
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Vrettos I, Voukelatou P, Pappa E, Beletsioti C, Papadopoulos A, Niakas D. Increased Body Mass Index and Hypertension: An Unbreakable Bond. Int J Prev Med 2020; 11:155. [PMID: 33209225 PMCID: PMC7643575 DOI: 10.4103/ijpvm.ijpvm_218_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/17/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Adherence with lifestyle recommendations is low among hypertensive patients. The main objective of this study was to assess the prevalence of diagnosed hypertension among the Greek urban population and to examine how lifestyle and sociodemographic characteristics differ between already known hypertensive and the rest of the population. METHODS In this cross-sectional survey, data were collected from 1,060 participants (mean age 47.1 ± 16.9 (mean ± 1standard deviation), 52.7% females). Sociodemographic characteristics, health risk factors, and medical history were involved. Body mass index (BMI) (kg/m2) was calculated, according to reported height and weight. Parametric tests and multiple logistic regression analysis were applied to identify whether socio-demographic characteristics and health risk factors differed between known hypertensive and the rest of the population. RESULTS Already known hypertensives were 179 (101 females-78 males). The prevalence of known hypertension was 16.9% (18.1% in females and 15.6% in males). In multivariate analysis, known hypertensives were more likely to have advanced age (P < 0,001, OR = 1.101, 95%CI 1.081-1.121) and increased BMI (P < 0,001, OR = 1.138, 95%CI 1.085-1.194). Moreover, they had a higher probability of suffering from other cardiovascular diseases or sharing other risk factors for cardiovascular diseases. CONCLUSIONS Among Greek urban population, almost one to six adults knows to suffer from hypertension. In spite the recommendations, patients who were aware of their illness have increased BMI compared with the rest of the population.
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Affiliation(s)
- Ioannis Vrettos
- Department of Internal Medicine, General and Oncology Hospital of Kifissia “AgioiAnargyroi”, Athens, Greece
| | - Panagiota Voukelatou
- Department of Internal Medicine, General and Oncology Hospital of Kifissia “AgioiAnargyroi”, Athens, Greece
| | - Evelina Pappa
- Faculty of Social Sciences, Hellenic Open University, Patra, Greece
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Impact of Intensive Lifestyle Treatment (Diet Plus Exercise) on Endothelial and Vascular Function, Arterial Stiffness and Blood Pressure in Stage 1 Hypertension: Results of the HINTreat Randomized Controlled Trial. Nutrients 2020; 12:nu12051326. [PMID: 32392715 PMCID: PMC7284619 DOI: 10.3390/nu12051326] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022] Open
Abstract
Lifestyle modification is an important component of essential hypertension (EH) therapy. The aim of the Hypertension Intensive Nutrition Treatment (HINTreat) parallel, randomized controlled trial was to examine the effect of a 6-month intensive lifestyle treatment (ILT) (diet plus exercise with monthly visits) compared to the usual care. A total of 76 adults with stage 1 EH were randomized (38 in each group). Dietary analysis, anthropometry, physical activity, biochemical and urine profile, blood pressure (BP), asymmetric dimethylarginine (ADMA), central hemodynamics, β-stiffness index and carotid intima media-thickness were evaluated. The dietary inflammatory index (DII) was calculated for each participant from the intake of 29 nutrients/food components. At the end of the trial, participants in the ILT group reduced their 24h urinary Na excretion (p ≤ 0.001), daytime systolic BP (p ≤ 0.048) and mean carotid β-stiffness index (p ≤ 0.005) and ameliorated their lipidemic profile compared to the standard care. Univariate analysis for the total sample showed a strong association between DII and ADMA levels (β = 0.089, p ≤ 0.01). ILT is effective in improving the inflammatory components of the diet and selected cardiometabolic parameters, including arterial stiffness.
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Prevalence of potential modifiable factors of hypertension in patients with difficult-to-control hypertension. J Hypertens 2020; 37:398-405. [PMID: 30074565 DOI: 10.1097/hjh.0000000000001885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND A comprehensive diagnostic evaluation of potential modifiable factors of difficult-to-control hypertension would enable clinicians to target-specific amendable causes. Therefore, we assessed the prevalence of underlying medical conditions, lifestyle factors, and concomitant medication use in an integrated diagnostic evaluation in patients with difficult-to-control hypertension, referred to a tertiary center. METHODS The study population consisted of 653 patients referred between 2006 and 2016 for difficult-to-control hypertension to the University Medical Center Utrecht. Difficult-to-control hypertension was defined by not reaching blood pressure (BP) goals despite BP-lowering drug use, or high office BP (>160/100 mmHg) without BP-lowering drug use. Patients were evaluated according to a highly standardized protocol including 24-h ambulatory blood measurements after cessation of BP-lowering drugs, 24-h urine sample, and a isotonic (0.9%) saline infusion test. RESULTS In 621 patients (95%) one or more modifiable factors related to hypertension were identified (mean 2.1, SD 1.1). Obesity-related insulin resistance was the most common underlying medical condition which was diagnosed in 130 patients (20%). Primary aldosteronism was diagnosed in 40 patients (6%) and obstructive sleep apnea in 17 patients (3%). Sodium intake was deemed to high (urinary excretion of >6 g/day) in 433 patients (66%). In total, 283 patients (43%) were physical inactive (<30 min/day, during 5 days/week). Oral contraceptive-related hypertension was diagnosed in 10 women (3% of women). CONCLUSION In patients with difficult-to-control hypertension there is a high prevalence of potential modifiable factors related to hypertension, highlighting the importance for an integrated diagnostic evaluation.
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Mandini S, Conconi F, Mori E, Caruso L, Grazzi G, Mazzoni G. Guided walking reduces blood pressure in hypertensive sedentary subjects including those with resistant hypertension. J Hum Hypertens 2020; 35:226-231. [PMID: 32152454 DOI: 10.1038/s41371-020-0324-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 11/09/2022]
Abstract
Hypertension poorly responsive to medications is defined resistant hypertension. We have previously shown that 1-year of guided walking is followed by highly significant reduction of systolic blood pressure in hypertensive subjects. Aim of this study was to assess the effect of a 1-year of guided walking on the blood pressure of sedentary hypertensive subjects including patients with resistant hypertension. Two hundred and fifty-nine sedentary subjects with systolic pressure ≥130 mmHg were subdivided in a group without blood pressure medications and in a group taking three or more antihypertensive drugs, including diuretics. Blood pressure, body weight, body mass index, waist circumference, and walking speed were determined at enrollment and after 1-year of walking, supervised by exercise physiologists. At baseline, systolic pressure was significantly higher in the subjects under therapy (144.6 ± 12.2 vs. 140.2 ± 10.7). Two hundred and three subjects (124 without and 79 with therapy) completed the program. During the 1-year program each subject walked ~220 h. After 1-year a significant decrease (P < 0.0001) of systolic pressure was observed in both groups. The decrease was significantly higher (P < 0.0001) in the subjects under therapy. The decrease of systolic pressure was directly proportional to baseline values. Diastolic blood pressure decreased significantly in both groups. In conclusion, habitual walking may lead to clinically significant reductions of blood pressure in therapy resistant hypertensive subjects.
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Affiliation(s)
- Simona Mandini
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.
| | - Francesco Conconi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Elisa Mori
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL, Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL, Ferrara, Italy
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Adherence to the Dietary Approaches to Stop Hypertension (DASH) and hypertension risk: results of the Longitudinal Study of Adult Health (ELSA-Brasil). Br J Nutr 2020; 123:1068-1077. [PMID: 31959262 DOI: 10.1017/s0007114520000124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We investigated whether high adherence to the Dietary Approaches to Stop Hypertension (DASH) diet was independently associated with lower risk of incident hypertension. Participants included 5632 adults, without hypertension at the baseline (2008-2010) of the Longitudinal Study of Adult Health, who took part in the second follow-up visit (2012-2014). Adherence to the DASH diet was estimated at baseline using a score based on eight food items (final scores from 8 to 40 points) and was categorised as high adherence (≥30 points, or ≥75 %) and low adherence (<75 %; reference). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg, or use of antihypertensive drugs. The association between adherence to the DASH diet and the risk of incident hypertension was estimated using Cox regression models adjusted by covariates. In total, 780 new cases of hypertension (13·8 %) were identified in about 3·8-year follow-up. Participants with high adherence to the DASH diet had 26 % lower risk of hypertension (hazard ratio (HR) 0·74; 95 % CI 0·57, 0·95) after adjustment for socio-demographic characteristics, health-related behaviours, diabetes and family history of hypertension. The HR reduced to 0·81 (95 % CI 0·63, 1·04) and was of borderline statistical significance after adjustment for BMI, suggesting that lower body weight explains about 10 % of the association between high adherence to the DASH diet and hypertension risk reduction. The results indicate that high adherence to the DASH diet lowered the risk of hypertension by one-fourth over a relatively short follow-up period.
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Chen YJ, Chang J, Yang SY. Psychometric Evaluation of Chinese Version of Adherence to Refills and Medications Scale (ARMS) and Blood-Pressure Control Among Elderly with Hypertension. Patient Prefer Adherence 2020; 14:213-220. [PMID: 32103905 PMCID: PMC7020932 DOI: 10.2147/ppa.s236268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/25/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to develop the ARMS-C and test its psychometric properties in hypertensive patients, to assess the level of medication adherence and to identify associated predictors for medication adherence and blood-pressure control among Chinese hypertensive patients. METHODS Hypertensive elderly who met inclusion criteria were recruited from an aged-care facility in Henan Province between January 2019 and July 2019. The patients completed the adapted ARMS-C. The scale's factor structure, internal consistency, and construct validity were tested. RESULTS Good internal consistency (Cronbach's α=0.89) and test-retest reliability (r=0.86, p<0.01) were obtained. Item-total correlation coefficients for the ten-item ARMS-C were 0.505-0.801. Factor analysis of construct validity identified two factors, explaining a total variance of 63.3%. Binary regression showed that patients with scores at level 2 (≤20 ARMS-10 scores <30) were six times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20, OR 6.6, 95% CI 1.7-25.1; p=0.006), and patients with scores at level 3 (ARMS-10 scores >30) were 115 times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20,OR 115, 95% CI 9-1,470; p=0). CONCLUSION The ten-item ARMS-C is a reliable and valid self-reporting screening tool for adherence to medication and refills in elderly hypertensive Chinese patients.
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Affiliation(s)
- Yi-Jing Chen
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Henan, People’s Republic of China
| | - Jing Chang
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Correspondence: Jing Chang Email
| | - Si-Yu Yang
- Xiangya Medical School, Central South University, Changsha, People’s Republic of China
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Sanchez A, Chung SC, Mejia A, Ramirez FE, Shavlik GW, Bivens RL, Brown-Fraser S, Gallant RD. Multiple lifestyle interventions reverses hypertension. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1636534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Albert Sanchez
- NEWSTART Program, Weimar Institute, Weimar, CA, USA
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - S. Christine Chung
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - Alfredo Mejia
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - Francisco E. Ramirez
- NEWSTART Program, Weimar Institute, Weimar, CA, USA
- Research, Nedley Clinic, Weimar, CA, USA
| | | | | | - Sherine Brown-Fraser
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
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Consumption of Aged White Wine under a Veil of Flor Reduces Blood Pressure-Increasing Plasma Nitric Oxide in Men at High Cardiovascular Risk. Nutrients 2019; 11:nu11061266. [PMID: 31167421 PMCID: PMC6627822 DOI: 10.3390/nu11061266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Hypertension remains the largest attributable risk factor of cardiovascular disease (CVD), and a reduction of cardiovascular events is linked to diminished elevated blood pressure (BP) values. High alcohol intake is a common cause of hypertension, but some studies have suggested that moderate wine consumption may reduce BP and increase plasma nitric oxide (NO) due to its polyphenol content. Objective: The aim of the present study was to compare the effects of Andalusian aged white wine (AWW) under a veil of flor, an alcoholic beverage with a moderate polyphenol content, with those of gin, an alcoholic beverage without polyphenols, on BP and plasma NO in men at high cardiovascular risk. Methods: This study was designed as an open, randomized crossover-controlled trial in which 38 high-risk male volunteers, aged 55 to 80, received 30 g of ethanol daily in the form of AWW or gin. This was carried out over the course of three weeks, after a two-week washout period. At baseline and after each intervention period, BP, anthropometric parameters, and plasma NO were measured; food intake was also recorded, and physical activity was monitored. Results: Compared to gin, AWW significantly reduced systolic and diastolic BP (p ≤ 0.033; both) and increased plasma NO levels (p = 0.013). Additionally, changes in BP values observed after AWW significantly correlated with increases in plasma NO. No changes in food intake, physical activity, body weight, or waist were observed between the two intervention periods. Conclusions: Moderate daily consumption of AWW may be useful to reduce elevated BP due to an increase of NO synthesis. This effect could be attributed to grape-derived compounds in AWW, such as polyphenols, which are not present in gin.
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Roth I, Casas R, Medina-Remón A, Lamuela-Raventós RM, Estruch R. Consumption of aged white wine modulates cardiovascular risk factors via circulating endothelial progenitor cells and inflammatory biomarkers. Clin Nutr 2019; 38:1036-1044. [DOI: 10.1016/j.clnu.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 01/12/2023]
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Zaidi Touis L, Bolbrinker J, Riemer TG, Kreutz R. Moderation of alcohol consumption as a recommendation in European hypertension management guidelines: a survey on awareness, screening and implementation among European physicians. BMJ Open 2018; 8:e022026. [PMID: 30344170 PMCID: PMC6196817 DOI: 10.1136/bmjopen-2018-022026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Moderation of alcohol consumption is included as a class I, level of evidence A recommendation in the current European guidelines for the management of hypertension. We investigated its awareness and self-reported implementation among European physicians across different specialties and workplaces. DESIGN AND SETTING A cross-sectional survey study conducted in two annual German meetings (German Society of Cardiology and the German Society of Internal Medicine) and two annual European meetings (European Society of Hypertension and European Society Cardiology) in 2015. PARTICIPANTS 1064 physicians attending the European meetings were interviewed including 52.1% cardiologists, 29.2% internists and 8.8% general practitioners. MAIN OUTCOME MEASURES Physician screening of alcohol consumption, awareness and self-implementation of the recommendation of the current European guidelines about moderation of alcohol consumption for the management of hypertension. RESULTS Overall, 81.9% of physicians reported to generally quantify alcohol consumption in patients with hypertension. However, only 28.6% and 14.5% of participants reported screening alcohol consumption in their patients with newly detected or treatment-resistant hypertension. Physicians recommended a maximum alcohol intake of 13.1±11.7 g/day for women (95% CI 12.3 to 13.8) and 19.9±15.6 g/day for men (95% CI 18.8 to 20.9). In case of moderate to high alcohol consumption, 10.3% would manage only hypertension without addressing alcohol consumption, while 3.7% of the physicians would do so in case of alcohol dependence (p<0.001). CONCLUSIONS The average amount of alcohol intake per day recommended by European physicians in this survey was in agreement with the guidelines. The low number of physicians that screen for alcohol consumption in patients with newly detected and with treatment-resistant hypertension indicates an important deficit in the management of hypertension.
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Affiliation(s)
- Laila Zaidi Touis
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Juliane Bolbrinker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Thomas Günther Riemer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut fur Klinische Pharmakologie und Toxikologie, Berlin, Germany
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Mandini S, Conconi F, Mori E, Myers J, Grazzi G, Mazzoni G. Walking and hypertension: greater reductions in subjects with higher baseline systolic blood pressure following six months of guided walking. PeerJ 2018; 6:e5471. [PMID: 30186685 PMCID: PMC6119598 DOI: 10.7717/peerj.5471] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/28/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of the study was to assess the effects of walking on the blood pressure in sedentary adults with differing degrees of systolic blood pressure (SBP). METHODS A total of 529 subjects with SBP above 120 mmHg were enrolled. Blood pressure, body weight, body mass index, waist circumference and walking speed were determined at enrolment and after six months. Walking sessions were supervised by exercise physiologists. RESULTS The weekly walking time of the subjects completing the project was uniform and reached 300 minutes by the second month. 56% of participants completed the 6 months intervention (182 women 59.6 ± 9.0 years, and 114 men, 65.4 ± 8.6 years) 27 had a baseline SBP >160 mm Hg, 35 between 150-159, 70 between 140-149, 89 between 130-139 and 75 between 120-129 mmHg. Following six months of supervised walking, SBP was significantly reduced in all subgroups (p < 0.001), with the greatest reduction (-21.3 mmHg) occurring in subjects with baseline SBP >160 and the smallest reduction (-2.6 mmHg) occurring in subjects with baseline SBP of 120-129 mmHg. Diastolic blood pressure, body weight, body mass index and waist circumference were also significantly reduced following the walking intervention (p < 0.001). These reductions were nearly identical within the various groups. DISCUSSION In a large group of sedentary adults with varying degrees of SBP, 6 months of supervised walking elicited a marked reduction in systolic blood pressure with the largest reductions in pressure occurring in individuals with higher baseline SBP.
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Affiliation(s)
- Simona Mandini
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Francesco Conconi
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
| | - Elisa Mori
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Health Care System Cardiology, VA Palo Alto Health Care System Cardiology, Palo Alto, CA, USA
- School of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Giovanni Grazzi
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Gianni Mazzoni
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
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Imbeault B, Vallée M. Single-Pill Combinations in the Treatment of Hypertension in Adults: Beyond Convenience. Can J Diabetes 2018; 42:205-208. [PMID: 29602409 DOI: 10.1016/j.jcjd.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/24/2018] [Indexed: 01/13/2023]
Abstract
Adequate blood pressure control in patients with hypertension remains the pillar of cardiovascular-event prevention. Smoking cessation, reduced dietary salt intake, physical exercise and weight loss contribute to better blood pressure control and reduced cardiovascular morbidity, but alone, they are often insufficient in doing so, and their success is highly dependent on individual patient motivation. Pharmacologic therapy, thus, remains necessary for most patients, and our conception of the optimal way of approaching this therapy has evolved over the past decade. Traditionally, monotherapy using a first-line drug was initiated and uptitrated, with the addition of other antihypertensive agents as needed. The latest Hypertension Canada guidelines, however, now recommend first-line treatment with single-pill combinations in patients without compelling indications for treatment. In this review, we discuss the evidence behind this recommendation and how single-pill combinations can improve patient care.
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Affiliation(s)
- Benoit Imbeault
- Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Michel Vallée
- Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada.
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Comparison Among Recommendations for the Management of Arterial Hypertension Issued by Last US, Canadian, British and European Guidelines. High Blood Press Cardiovasc Prev 2017; 25:9-16. [PMID: 29094260 DOI: 10.1007/s40292-017-0236-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/17/2017] [Indexed: 12/23/2022] Open
Abstract
Guidelines for the management of hypertension have been issued by different hypertension societies or organizations. Despite many similarities one can identify major differences in the diagnosis, management and treatment of the hypertensive patients among ESH/ESC, NICE, Canadian and NJC8 guidelines. Differences that can be identified are in the definition of hypertension in the elderly population, the optimal blood pressure targets in different hypertensive populations such as patients with diabetes and chronic kidney disease patients and the choose of the initial and appropriate antihypertensive agent depending on comorbidities of the treated population. Everyday clinical praxis physicians are confused by these differences and these incongruities contribute to doctor and patient inertia to reduce blood pressure levels at an optimal level. Community physicians cannot easily distinguish what recommendations are the best to be used for their patients. The critical view of these differences can also help the guidelines committees to make appropriate changes and finally to agree to a global view of recommendations for the management and treatment of hypertension.
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García-Tejedor A, Manzanares P, Castelló-Ruiz M, Moscardó A, Marcos JF, Salom JB. Vasoactive properties of antihypertensive lactoferrin-derived peptides in resistance vessels: Effects in small mesenteric arteries from SHR rats. Life Sci 2017; 186:118-124. [DOI: 10.1016/j.lfs.2017.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
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Clegg DJ, Cody M, Palmer BF. Challenges in Treating Cardiovascular Disease: Restricting Sodium and Managing Hyperkalemia. Mayo Clin Proc 2017; 92:1248-1260. [PMID: 28778258 DOI: 10.1016/j.mayocp.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 02/02/2023]
Abstract
High sodium intake, whether via diet or drugs, augments cardiorenal risk. Regardless of its source, high sodium intake can both lead to hypertension and reduce the efficacy of renin-angiotensin-aldosterone system inhibitors, which are currently guideline-recommended treatments for hypertension, chronic kidney disease, and heart failure. Reducing sodium intake is therefore recommended to reduce the risk of adverse cardiorenal outcomes. An inverse relationship exists between sodium and potassium, with foods high in sodium being lower in potassium. Diets high in potassium have been associated with reducing hypertension and heart failure; however, optimal renin-angiotensin-aldosterone system inhibitor dosing is often limited by hyperkalemia, which can lead to life-threatening cardiac arrhythmias and increased mortality. Potassium binders are effective at reducing potassium levels. Although some use sodium as the potassium exchange ion, thus increasing sodium intake, a new potassium binder uses another exchange ion and therefore does not increase sodium intake. When treatment options require agents that may precipitate hyperkalemia, particularly in patients at high cardiorenal risk, drugs that do not add to the sodium load may be preferred. A literature search was conducted using PubMed; search terms included potassium, sodium, hyperkalemia, potassium binders, and the literature search focused on manuscripts published more recently since 2000.
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Affiliation(s)
- Deborah J Clegg
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Michael Cody
- Medical Affairs, Relypsa, Inc. (a Vifor Pharma Group Company), Redwood City, CA
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Malachias MVB, Andrea Araujo Brandão AA, Kaiser S, Moreira O. 7th Brazilian Guideline of Arterial Hypertension: Chapter 5 - Therapeutic Decision and Targets. Arq Bras Cardiol 2017; 107:25-29. [PMID: 27819384 PMCID: PMC5319458 DOI: 10.5935/abc.20160155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Bolbrinker J, Zaidi Touis L, Gohlke H, Weisser B, Kreutz R. European guidelines on lifestyle changes for management of hypertension : Awareness and implementation of recommendations among German and European physicians. Herz 2017; 43:352-358. [PMID: 28534177 DOI: 10.1007/s00059-017-4575-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the 2013 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines for the management of arterial hypertension, six lifestyle changes for treatment are recommended for the first time with class I, level of evidence A. We initiated a survey among physicians to explore their awareness and consideration of lifestyle changes in hypertension management. METHODS The survey included questions regarding demographics as well as awareness and implementation of the recommended lifestyle changes. It was conducted at two German and two European scientific meetings in 2015. RESULTS In all, 1064 (37.4% female) physicians participated (806 at the European and 258 at the German meetings). Of the six recommended lifestyle changes, self-reported awareness was highest for regular exercise (85.8%) followed by reduction of weight (66.2%). The least frequently self-reported lifestyle changes were the advice to quit smoking (47.3%) and moderation of alcohol consumption (36.3%). Similar frequencies were observed for the lifestyle changes implemented by physicians in their care of patients. CONCLUSION A close correlation between awareness of guideline recommendations and their implementation into clinical management was observed. European physicians place a stronger emphasis on regular exercise and weight reduction than on the other recommended lifestyle changes. Moderation of alcohol consumption is the least emphasized lifestyle change.
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Affiliation(s)
- J Bolbrinker
- Institut für Klinische Pharmakologie und Toxikologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - L Zaidi Touis
- Institut für Klinische Pharmakologie und Toxikologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - H Gohlke
- , Neue Kirchstr. 22, 79282, Ballrechten-Dottingen, Germany
| | - B Weisser
- Institut für Sportwissenschaft, Arbeitsbereich Sportmedizin, Christian-Albrechts-Universität zu Kiel, Olshausenstraße 74, 24098, Kiel, Germany
| | - R Kreutz
- Institut für Klinische Pharmakologie und Toxikologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Talaei M, Pan A, Yuan JM, Koh WP. Dairy Food Intake Is Inversely Associated with Risk of Hypertension: The Singapore Chinese Health Study. J Nutr 2017; 147:235-241. [PMID: 27974606 PMCID: PMC5265692 DOI: 10.3945/jn.116.238485] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/28/2016] [Accepted: 11/22/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Epidemiological evidence from Western populations suggests that dairy food intake may reduce the risk of hypertension, probably through its calcium content. However, there are no epidemiological studies among Asian populations with generally lower dairy and calcium consumption. OBJECTIVE The relation between dairy or calcium intake and risk of hypertension was evaluated in a Chinese population in Singapore. METHODS The analysis included 37,124 Chinese men and women aged 45-74 y who participated in the Singapore Chinese Health Study in 1993-1998. The subjects included in the present study had no history of cancer, hypertension, or cardiovascular disease at baseline and completed ≥1 follow-up interview. Diet at baseline was assessed by using a validated 165-item semiquantitative food-frequency questionnaire. The occurrence of new, physician-diagnosed hypertension was ascertained through follow-up interviews during 1999-2004 and 2006-2010. The Cox proportional hazard regression method was used to compute HRs and 95% CIs with adjustment for potential confounders. RESULTS Dairy food intake was inversely associated with the risk of hypertension in a dose-dependent manner: HRs across quartiles were 1.00 (lowest quartile, reference), 0.97 (95% CI: 0.92, 1.02), 0.98 (95% CI: 0.92, 1.03), and 0.93 (95% CI: 0.88, 0.98) (P-trend = 0.01). Milk accounted for ∼80% of all dairy products consumed in this population. Daily milk drinkers had a lower risk of hypertension (HR: 0.94; 95% CI: 0.89, 0.99) than did nondrinkers. Nondairy calcium intake contributed 80% of total calcium intake. Although dairy calcium intake was associated with a lower risk of hypertension (HR comparing extreme quartiles: 0.88; 95% CI: 0.83, 0.94; P-trend < 0.001), there was no association for nondairy calcium intake (HR: 1.02; 95% CI: 0.94, 1.10; P-trend = 0.58). CONCLUSIONS Baseline dairy food intake, and specifically that of milk, may reduce the risk of developing hypertension in Chinese adults, and this may not be associated with the calcium component.
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Affiliation(s)
- Mohammad Talaei
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore;
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA;,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; and
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; .,Duke-NUS Medical School Singapore, Singapore
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Khayyat SM, Khayyat SMS, Hyat Alhazmi RS, Mohamed MMA, Abdul Hadi M. Predictors of Medication Adherence and Blood Pressure Control among Saudi Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study. PLoS One 2017; 12:e0171255. [PMID: 28135324 PMCID: PMC5279800 DOI: 10.1371/journal.pone.0171255] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/17/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess the level of medication adherence and to investigate predictors of medication adherence and blood pressure control among hypertensive patients attending primary healthcare clinics in Makkah, Saudi Arabia. PATIENTS AND METHODS Hypertensive patients meeting the eligibility criteria were recruited from eight primary care clinics between January and May 2016 for this study. The patients completed Arabic version of Morisky Medication Adherence Scale (MMAS-8), an eight-item validated, self-reported measure to assess medication adherence. A structured data collection form was used to record patients' sociodemographic, medical and medication data. RESULTS Two hundred and four patients, of which 71.6% were females, participated in the study. Patients' mean age was 59.1 (SD 12.2). The mean number of medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the patients were non-adherent to their medications (MMAS score < 6). Binary regression analysis showed that highly adherent patients (MMAS score = 8) were about five times (OR 4.91 [95%CI: 1.85-12.93; P = 0.01]) more likely to have controlled blood pressure compared to low adherent patients. Female gender (OR 0.40 [95% CI: 0.20-0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0-4.2; P = 0.04]), and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04]) were found to be independent predictors of medication adherence. CONCLUSION Medication adherence is alarmingly low among hypertensive patients attending primary care clinics in Saudi Arabia which may partly explain observed poor blood pressure control. There is a clear need to educate patients about the importance of medication adherence and its impact on improving clinical outcomes. Future research should identify barriers to medication adherence among Saudi hypertensive patients.
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Affiliation(s)
- Sarah M. Khayyat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Mahmoud M. A. Mohamed
- Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
- Pharmaceutical Research Center, Deanship of Scientific Research, Umm Al-Qura University, Makkah, Saudi Arabia
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Bhatnagar A, Tripathi Y, Kumar A. Change in Oxidative Stress of Normotensive Elderly Subjects Following Lifestyle Modifications. J Clin Diagn Res 2016; 10:CC09-CC13. [PMID: 27790427 DOI: 10.7860/jcdr/2016/20184.8469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Oxidative stress is associated with aging, which ultimately causes deterioration of muscles. Antioxidant defense system deteriorates while enhancing accumulations of Reactive Oxygen Species (ROS) due to lipid peroxidation and altered enzyme activities in old age. Regular practice of yoga can maintain the antioxidants level of the body, even in stressful conditions. AIM The present study was designed to assess the effects of lifestyle technique on oxidative stress and lipid profile in normotensive elderly subjects. MATERIALS AND METHODS Seventy four healthy elderly subjects (43 males and 31 females) 60 to 80 years of age were selected from the Santosh Medical College, Ghaziabad Uttar Pradesh, India, for three months lifestyle modification program which included morning walk, Nadi shodan pranayama, dietary restrictions and increased intake of water. Blood pressure and oxidative stress markers Glutathione (GSH), Super Oxide Dismutase (SOD) and Malondialdehyde (MDA) were recorded twice, one at baseline and another after three months of lifestyle modifications. RESULTS Post lifestyle modifications technique values revealed a significant increase in GSH (88.03±9.58 ng/ml vs 93.12±9.17 ng/ml, p < 0.0001) and SOD (78.22±11.97 ng/ml vs 85.22±11.08 ng/ml, p < 0.0001), and a decline in MDA (5.28±0.52 m mol/ml vs 4.48± 0.69 m mol/ml, p < 0.0001) levels. Further, there was significant reduction in the systolic blood pressure (p <0.0001) and diastolic blood pressure (p<0.0002); besides all fasting lipids decreased significantly except High Density Lipids (HDL). CONCLUSION The findings of the present study show that lifestyle modification is helpful in reducing cardiovascular disease risk but also assuring for good health by decreasing oxidative stress level along with lipid profile. Further, all these modifications are easy to follow. However, more studies are required to make a generalized lifestyle modification program in normotensive elderly subjects.
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Affiliation(s)
- Anubhav Bhatnagar
- PhD Scholar, Department of Physiology, Santosh Medical College , Ghaziabad, Uttar Pradesh, India
| | - Yogesh Tripathi
- Dean and Professor, Department of Physiology, Santosh Medical College , Ghaziabad, Uttar Pradesh, India
| | - Anoop Kumar
- PhD Scholar, Department of Biochemistry, Santosh Medical College , Ghaziabad, Uttar Pradesh, India
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Kaddumukasa MN, Katabira E, Sajatovic M, Pundik S, Kaddumukasa M, Goldstein LB. Influence of sodium consumption and associated knowledge on poststroke hypertension in Uganda. Neurology 2016; 87:1198-205. [PMID: 27558374 DOI: 10.1212/wnl.0000000000003117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/04/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed 24-hour urine sodium levels as an index of dietary salt consumption and its association with dietary salt knowledge and hypertension among poststroke patients with and without a history of hypertension in Uganda. METHODS A case-control study in which poststroke patients with a history of hypertension (cases, n = 123) were compared to poststroke patients without known hypertension (controls, n = 112). Dietary salt intake was assessed by 24-hour urine sodium, a valid measure of dietary salt consumption. Dietary salt knowledge was determined by questionnaire. The independent relationships among salt knowledge, 24-hour urine sodium, and blood pressure control were assessed using multiple regression analysis. RESULTS High 24-hour urine sodium (≥8.5 g/d) was 2 times more prevalent among hypertensive poststroke patients than controls (p = 0.002). Patients with minimal poststroke disability who had a choice in determining their diets had higher urine sodium than their more disabled counterparts. Only 43% of the study population had basic dietary salt knowledge, 39% had adequate diet-disease-related knowledge, and 37% had procedural knowledge (report of specific steps being taken to reduce salt consumption). Dietary salt knowledge was similarly poor among cases and controls (p = 0.488) and was not related to education level (p = 0.205). CONCLUSIONS High urine sodium and high salt-diet preferences were more frequent among poststroke hypertensive patients in Uganda than in their nonhypertensive counterparts. There was, however, no difference in dietary salt knowledge between these groups. The development of educational strategies that include salt-diet preferences may lead to better blood pressure control in this high-risk population.
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Affiliation(s)
- Martin N Kaddumukasa
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington.
| | - Elly Katabira
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Martha Sajatovic
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Svetlana Pundik
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Mark Kaddumukasa
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
| | - Larry B Goldstein
- From the Department of Internal Medicine (M.N.K., E.K., M.K.), Makerere University, College of Health Sciences, Kampala, Uganda; Neurological and Behavioral Outcomes Center (M.S.), University Hospitals Case Medical Center, Cleveland; School of Medicine (S.P.), Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH; and Department of Neurology (L.B.G.), University of Kentucky, Lexington
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Tamosiunas A, Klumbiene J, Petkeviciene J, Radisauskas R, Vikhireva O, Luksiene D, Virviciute D. Trends in major risk factors and mortality from main non-communicable diseases in Lithuania, 1985-2013. BMC Public Health 2016; 16:717. [PMID: 27492379 PMCID: PMC4972981 DOI: 10.1186/s12889-016-3387-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022] Open
Abstract
Background This study aimed to assess the trends in the prevalence and levels of risk factors and mortality from main non-communicable diseases in the Lithuanian population aged 45–64 years during 1985 to 2013. Methods Data from four general population surveys conducted between 1985 and 2008 were used. All these surveys were carried out in Kaunas city and five randomly selected municipalities of Lithuania. Risk factors measured at each survey included regular smoking, overweight, obesity, arterial hypertension, and high levels of blood lipids. In total, data of 10,719 subjects (4,965 men and 5,754 women) aged 45–64 were analysed. Trends in standardized all-cause mortality and mortality from cardiovascular disease (CVD), coronary heart disease (CHD), and malignant neoplasms were estimated for both sexes by joinpoint regression analysis. Results In 1985–2013, some favourable trends were observed in the age-standardized mean levels and prevalence of risk factors and mortality from main non-communicable diseases in the Lithuanian middle-aged population. The mean values of blood lipids (with the exception of triglycerides) and the prevalence of dyslipidemias declined. In women, mean levels of systolic blood pressure and body mass index decreased, while in men, the levels of these factors increased. The prevalence of arterial hypertension and obesity increased in men. The proportion of obese women decreased. Smoking prevalence increased in both men and women. From 2007 to 2008, significant downward trends, which were steeper in women than in men, were observed in all-cause, CVD, and CHD mortality. Conclusions Despite the favourable changes in some risk factors and mortality rates, the prevalence of risk factors and mortality from main non-communicable diseases in Lithuania are still high. This indicates the importance of the ongoing primary and secondary prevention and optimal treatment of these diseases.
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Affiliation(s)
- Abdonas Tamosiunas
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania. .,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Jurate Klumbiene
- Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Janina Petkeviciene
- Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Olga Vikhireva
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Dalia Luksiene
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Virviciute
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Rautiainen S, Wang L, Lee IM, Manson JE, Gaziano JM, Buring JE, Sesso HD. Multivitamin use and the risk of hypertension in a prospective cohort study of women. J Hypertens 2016; 34:1513-9. [PMID: 27327440 PMCID: PMC4927371 DOI: 10.1097/hjh.0000000000000973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Despite the widespread use of multivitamin supplements, little is known regarding their effects on blood pressure (BP) and the development of hypertension. We, therefore, sought to prospectively investigate how multivitamin use was associated with incident hypertension among middle-aged and older women. METHODS We studied 28 157 women from the Women's Health Study aged at least 45 years and free of cardiovascular disease, cancer, and hypertension at baseline. Women reported information on a wide range of lifestyle, clinical, and dietary factors, including multivitamin and other supplement use at baseline. Hypertension was identified on baseline and annual follow-up questionnaires. Incident hypertension was defined as either a new diagnosis of hypertension by a physician, initiation of antihypertensive medication, newly reported SBP at least 140 mmHg, or DBP at least 90 mmHg during follow-up. RESULTS During a mean follow-up of 11.5 years, we identified 16 316 cases of incident hypertension. We found that neither baseline (hazard ratio = 1.03, 95% confidence interval: 1.00, 1.07) nor time-varying multivitamin use (hazard ratio = 0.97, 95% confidence interval: 0.94-1.00) were associated with the risk of incident hypertension in multivariable-adjusted models. When we investigated the duration of multivitamin use reported at baseline, we also observed no association with the risk of hypertension. CONCLUSION The results from this prospective study of middle-aged and older women suggest that neither baseline multivitamin use nor time-varying multivitamin use is associated with the risk of developing hypertension.
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Affiliation(s)
- Susanne Rautiainen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Lu Wang
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA USA (IML, JEM, JEB, and HDS)
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA USA (IML, JEM, JEB, and HDS)
| | - J. Michael Gaziano
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- VA Boston Healthcare System, Boston, MA USA
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Julie E. Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA USA (IML, JEM, JEB, and HDS)
| | - Howard D. Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA USA (IML, JEM, JEB, and HDS)
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
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Perl S, Niederl E, Kos C, Mrak P, Ederer H, Rakovac I, Beck P, Kraler E, Stoff I, Klima G, Pieske BM, Pieber TR, Zweiker R. Randomized Evaluation of the Effectiveness of a Structured Educational Program for Patients With Essential Hypertension. Am J Hypertens 2016; 29:866-72. [PMID: 26643687 DOI: 10.1093/ajh/hpv186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/05/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adherence to medication and lifestyle interventions are essential keys for the management of hypertension. In this respect, a structured educational program for hypertensive patients has got remarkable merits (herz.leben). In order to determine the isolated effect of participation in the educational program, neglecting the possible impact of more intense care, this prospective multicenter randomized controlled study was designed (NCT00453037). METHODS A total of 256 patients in 13 centers were enrolled and randomly assigned to 2 groups (G). G-I (n = 137) underwent the educational program immediately (T-0), G-II (n = 119) after 6 months (T-6). Follow-up visits were done after 6 (T-6) and 12 (T-12) months. Primary endpoint was a difference in office blood pressure (BP) at T-6, when only G-I had undergone the educational program. RESULTS Patients' baseline characteristics were comparable. At T-6, systolic office and home BP were significantly lower in G-I compared to G-II: office BP systolic 139 (134-150) mm Hg vs. 150 (135-165) mm Hg (P < 0.01); diastolic 80 (76-85) mm Hg vs. 84 (75-90) mm Hg (ns); home BP systolic 133 (130-140) mm Hg vs. 142 (132-150) mm Hg (P < 0.01); diastolic 80 (75-85) mm Hg vs. 80 (76-89) mm Hg (ns)). At T-12, when all patients had undergone the educational program differences in BP disappeared. CONCLUSION The results of this multicenter randomized controlled study provide significant evidence for benefit by participation in a structured educational program. Positive effects seem to be mediated by better adherence and life style changes due to higher levels of information and patient empowerment. Therefore, educational strategies should be considered as standard of care for hypertensive patients.
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Affiliation(s)
- Sabine Perl
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria;
| | - Ella Niederl
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Cornelia Kos
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Ivo Rakovac
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Peter Beck
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Elisabeth Kraler
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ingrid Stoff
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gert Klima
- Public Health Fund Styria, Graz, Austria
| | - Burkert M Pieske
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria; Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Zweiker
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Thirty-year risk of cardiovascular disease in senior medical students - based on the StudHeart study. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:172-7. [PMID: 27516798 PMCID: PMC4971280 DOI: 10.5114/kitp.2016.61059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/21/2016] [Indexed: 11/17/2022]
Abstract
Introduction Long-term risk functions highlight the need of prophylaxis in youth before the first symptoms of cardiovascular disease (CVD) occur. Aim On the basis of data obtained in the StudHeart study, the aim of this report was to evaluate the 30-year risk of CVD based on the risk scale developed by the Framingham Heart Study (FHS). Material and methods Seven hundred and one students aged 22–27 (mean age: 24 ±1.42) from the 5th and 6th year of the medical faculties of the Medical University of Lodz were included in the study. The StudHeart study was based on an anonymous survey comprising 12 questions. Based on the answers the authors evaluated the 30-year risk of CVD in each respondent using an on-line calculator that allows one to evaluate: general CVD risk including coronary death, myocardial infarction, coronary insufficiency, angina, ischemic stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery disease, heart failure and hard CVD risk including coronary death, myocardial infarction and stroke. Results Elevated general 30-year CVD risk occurred in 23.18% of students, while hard CVD risk was elevated in 16.91% of respondents. In both cases elevated risk occurred more often in men (general CVD risk: 43.46% male vs. 8.93% female, p < 0.001 and hard CVD risk: 29.33% male vs. 8.19% female, p < 0.001). Elevation of the risk was mainly caused by overweight, obesity and smoking cigarettes. Conclusions Based on FHS 30-Year CVD risk, elevated risk occurred in almost one-fourth of students. Prophylactic actions should be performed, especially in men.
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Kelishadi R, Qorbani M, Motlagh ME, Heshmat R, Ardalan G, Bahreynian M. Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study. J Pediatr (Rio J) 2016; 92:156-67. [PMID: 26804012 DOI: 10.1016/j.jped.2015.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/12/2015] [Accepted: 05/27/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES This study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents. METHODS This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6-18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. RESULTS Eating more frequently (≥ 6 vs. ≤ 3) was found among students who were at younger age (11.91 vs. 13.29 years) (p<0.001). Students who reported an EF of 4 (OR: 0.67, CI: 0.57-0.79), 5 (OR: 0.74, CI: 0.62-0.87), and 6 (OR: 0.54, CI: 0.44-0.65) had lower odds of being obese compared to those who had EF ≤ 3. Having EF of 4 (OR: 0.82, CI: 0.71-0.94), 5 (OR: 0.86, CI: 0.74-0.99), and ≥ 6 (OR: 0.73, CI: 0.63-0.85) was related to lower prevalence of abdominal adiposity. CONCLUSION Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group.
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Affiliation(s)
- Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran; Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Bahreynian
- Department of Nutrition, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Kelishadi R, Qorbani M, Motlagh ME, Heshmat R, Ardalan G, Bahreynian M. Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN‐IV Study. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fang J, Moore L, Loustalot F, Yang Q, Ayala C. Reporting of adherence to healthy lifestyle behaviors among hypertensive adults in the 50 states and the District of Columbia, 2013. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2016; 10:252-262.e3. [PMID: 26851000 PMCID: PMC4992982 DOI: 10.1016/j.jash.2016.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Achieving and maintaining a healthy lifestyle is an important part of hypertension management. The purpose of this study was to assess US state-level prevalence of adherence to healthy lifestyle behaviors among those with self-reported hypertension. Using 2013 data from the Behavioral Risk Factor Surveillance System, a state-based telephone survey, we examined the adherence to five healthy lifestyle behaviors related to hypertension management: having a "normal" weight, not smoking, avoiding or limiting alcohol intake, consuming the recommended amount of fruits and vegetables, and engaging in the recommended amount of physical activity. We estimated age-standardized percentages of each healthy lifestyle behavior overall and by state, as well as prevalence of all five healthy lifestyle behaviors. Overall, the prevalence of healthy lifestyle behaviors varied widely among those with self-reported hypertension: 20.5% had a normal weight, 82.3% did not smoke, 94.1% reported no or limited alcohol intake, 14.1% consumed the recommended amounts of fruits or vegetables, and 46.6% engaged in the recommended amount of physical activity. Overall, only 1.7% of adults with self-reported hypertension reported all five healthy lifestyle behaviors, with significant variation by state. Age-standardized prevalence of individuals reporting all five healthy lifestyle behaviors ranged from 0.3% in Louisiana to 3.8% in the District of Columbia. In conclusion, adherence to healthy lifestyle behaviors varied among those with hypertension; fewer than 2% reported meeting current recommendations and standards when assessed collectively. Disparities were observed by demographic and descriptive characteristics, including geography.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Latetia Moore
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carma Ayala
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Jankowska-Polańska B, Uchmanowicz I, Dudek K, Mazur G. Relationship between patients' knowledge and medication adherence among patients with hypertension. Patient Prefer Adherence 2016; 10:2437-2447. [PMID: 27994443 PMCID: PMC5153315 DOI: 10.2147/ppa.s117269] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between knowledge on arterial hypertension (AH) and its management, and adherence to pharmaceutical treatment. METHODS The study included 233 patients diagnosed with AH and treated with hypotensive drugs for at least 1 year. The 8-item © Morisky Medication Adherence Scale (MMAS-8) and the Hypertension Knowledge-Level Scale (HK-LS) were used. RESULTS Sixty-three percent of the patients had a low level of knowledge on AH, with the smallest proportion of correct answers provided for items related to non-pharmaceutical treatment, diet, hypertension definition, and drug adherence. When compared to patients with a high level of knowledge, those with a low knowledge had lower scores in the MMAS (6.45±1.45 vs 7.08±1.04; P=0.038). Multiple-factor analysis showed that statistically significant independent determinants of good adherence included a high level of knowledge (β=0.208; P=0.001), non-pharmaceutical treatment (β=0.182; P=0.006), and frequent blood pressure measurements (β=0.183; P=0.004). The most significant factor in MMAS was knowledge in the "drug adherence" domain (ρ=0.303; P<0.001). CONCLUSION Patients' knowledge on hypertension is a significant independent determinant of good adherence. Other independent determinants include non-pharmaceutical treatment and regular blood pressure measurements. IMPLICATION FOR PRACTICE The identification of knowledge deficits as a factor contributing to lack of adherence and poor hypertension control remains a key challenge for multidisciplinary team caring for patients with hypertension.
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Affiliation(s)
- Beata Jankowska-Polańska
- Department of Clinical Nursing, Wroclaw Medical University
- Correspondence: Beata Jankowska-Polańska, Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 27 Wyspianski Street, 50-370 Wroclaw, Poland, Tel +48 71 784 1824, Fax +48 71 345 9324, Email
| | | | - Krzysztof Dudek
- Department of Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology
| | - Grzegorz Mazur
- Department and Clinic of Internal and Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
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Lava SAG, Bianchetti MG, Simonetti GD. Salt intake in children and its consequences on blood pressure. Pediatr Nephrol 2015; 30:1389-96. [PMID: 25127918 DOI: 10.1007/s00467-014-2931-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 02/07/2023]
Abstract
Sodium is the most abundant extracellular cation and therefore pivotal in determining fluid balance. At the beginning of life, a positive sodium balance is needed to grow. Newborns and preterm infants tend to lose sodium via their kidneys and therefore need adequate sodium intake. Among older children and adults, however, excessive salt intake leads to volume expansion and arterial hypertension. Children who are overweight, born preterm, or small for gestational age and African American children are at increased risk of developing high blood pressure due to a high salt intake because they are more likely to be salt sensitive. In the developed world, salt intake is generally above the recommended intake also among children. Although a positive sodium balance is needed for growth during the first year of life, in older children, a sodium-poor diet seems to have the same cardiovascular protective effects as among adults. This is relevant, since: (1) a blood pressure tracking phenomenon was recognized; (2) the development of taste preferences is important during childhood; and (3) salt intake is often associated with the consumption of sugar-sweetened beverages (predisposing children to weight gain).
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Affiliation(s)
- Sebastiano A G Lava
- Division of Pediatric Nephrology, University Children's Hospital Bern, Bern, Switzerland
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Rimoldi SF, Messerli FH, Bangalore S, Scherrer U. Resistant hypertension: what the cardiologist needs to know. Eur Heart J 2015; 36:2686-95. [PMID: 26261296 DOI: 10.1093/eurheartj/ehv392] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/27/2015] [Indexed: 12/23/2022] Open
Abstract
Treatment-resistant hypertension (TRH) affects between 3 and 30% of hypertensive patients, and its presence is associated with increased cardiovascular morbidity and mortality. Until recently, the interest on these patients has been limited, because providing care for them is difficult and often frustrating. However, the arrival of new treatment options [i.e. catheter-based renal denervation (RDN) and baroreceptor stimulation] has revitalized the interest in this topic. The very promising results of the initial uncontrolled studies on the blood pressure (BP)-lowering effect of RDN in TRH seemed to suggest that this intervention might represent an easy solution for a complex problem. However, subsequently, data from controlled studies have tempered the enthusiasm of the medical community (and the industry). Conversely, these new studies emphasized some seminal aspects on this topic: (i) the key role of 24 h ambulatory BP and arterial stiffness measurement to identify 'true' resistant patients; (ii) the high prevalence of secondary hypertension among this population; and (iii) the difficulty to identify those patients who may profit from device-based interventions. Accordingly, for those patients with documented TRH, the guidelines suggest to refer them to a hypertension specialist/centre in order to perform adequate work-up and treatment strategies. The aim of this review is to provide guidance for the cardiologist on how to identify patients with TRH and elucidate the prevailing underlying pathophysiological mechanism(s), to define a strategy for the identification of patients with TRH who may benefit from device-based interventions and discuss results and limitations of these interventions, and finally to briefly summarize the different drug-based treatment strategies.
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Affiliation(s)
- Stefano F Rimoldi
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
| | - Franz H Messerli
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland Division of Cardiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Sripal Bangalore
- Division of Cardiology, St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Urs Scherrer
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile
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Rubio-Ruiz ME, Pérez-Torres I, Soto ME, Pastelín G, Guarner-Lans V. Aging in blood vessels. Medicinal agents FOR systemic arterial hypertension in the elderly. Ageing Res Rev 2014; 18:132-47. [PMID: 25311590 DOI: 10.1016/j.arr.2014.10.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 12/12/2022]
Abstract
Aging impairs blood vessel function and leads to cardiovascular disease. The mechanisms underlying the age-related endothelial, smooth muscle and extracellular matrix vascular dysfunction are discussed. Vascular dysfunction is caused by: (1) Oxidative stress enhancement. (2) Reduction of nitric oxide (NO) bioavailability, by diminished NO synthesis and/or augmented NO scavenging. (3) Production of vasoconstrictor/vasodilator factor imbalances. (4) Low-grade pro-inflammatory environment. (5) Impaired angiogenesis. (6) Endothelial cell senescence. The aging process in vascular smooth muscle is characterized by: (1) Altered replicating potential. (2) Change in cellular phenotype. (3) Changes in responsiveness to contracting and relaxing mediators. (4) Changes in intracellular signaling functions. Systemic arterial hypertension is an age-dependent disorder, and almost half of the elderly human population is hypertensive. The influence of hypertension on the aging cardiovascular system has been studied in models of hypertensive rats. Treatment for hypertension is recommended in the elderly. Lifestyle modifications, natural compounds and hormone therapies are useful for initial stages and as supporting treatment with medication but evidence from clinical trials in this population is needed. Since all antihypertensive agents can lower blood pressure in the elderly, therapy should be based on its potential side effects and drug interactions.
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Affiliation(s)
- María Esther Rubio-Ruiz
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", México, DF, Mexico
| | - Israel Pérez-Torres
- Department of Pathology, Instituto Nacional de Cardiología "Ignacio Chávez", México, DF, Mexico
| | - María Elena Soto
- Department of Immunology, Instituto Nacional de Cardiología "Ignacio Chávez", México, DF, Mexico
| | - Gustavo Pastelín
- Department of Pharmacology, Instituto Nacional de Cardiología "Ignacio Chávez", México, DF, Mexico
| | - Verónica Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", México, DF, Mexico.
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Petkeviciene J, Klumbiene J, Simonyte S, Ceponiene I, Jureniene K, Kriaucioniene V, Raskiliene A, Smalinskiene A, Lesauskaite V. Physical, behavioural and genetic predictors of adult hypertension: the findings of the Kaunas Cardiovascular Risk Cohort study. PLoS One 2014; 9:e109974. [PMID: 25313554 PMCID: PMC4196949 DOI: 10.1371/journal.pone.0109974] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/08/2014] [Indexed: 02/07/2023] Open
Abstract
Background The roots of adult hypertension go back to childhood. This study aimed to examine the independent effects of physical, behavioural and genetic factors identified in childhood and mid-adulthood for prediction of adult hypertension. Methods The study subjects were participants of the Kaunas Cardiovascular Risk Cohort study started in 1977 (n = 1082, age 12–13 years). In 2012, a total of 507 individuals (63.9% of eligible sample) participated in the 35-year follow-up survey. Health examination involved measurements of blood pressure (BP), anthropometric parameters, and interview about health behaviours. Subjects were genotyped for AGT (M235T), ACE (I/D, rs4340), ADM (rs7129220), and CACNB2 (rs12258967) genes polymorphisms. A genetic risk score was calculated as the sum of the number of risk alleles at each of four single nucleotide polymorphisms. Results AGT TT genotype male carriers had the highest mean values of systolic BP in childhood. In females, ADM genotype AA was associated with the highest values of systolic and diastolic BP, while CACNB2 genotype CC carriers had the highest values of diastolic BP in childhood. Systolic and diastolic BP in childhood, gain in BMI from childhood to adulthood, and risky alcohol consumption predicted hypertension in middle-aged men. In women, genetic risk score together with diastolic BP in childhood and gain in BMI were significant predictors of adult hypertension. The comparison of four nested logistic regression models showed that the prediction of hypertension improved significantly after the addition of BMI gain. Genetic risk score had a relatively weak effect on the improvement of the model performance in women. Conclusions BP in childhood and the gain in BMI from childhood to adulthood were significant predictors of adult hypertension in both genders. Genetic risk score in women and risky alcohol consumption in men were independently related with the risk of adult hypertension.
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Affiliation(s)
- Janina Petkeviciene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- * E-mail:
| | - Jurate Klumbiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sandrita Simonyte
- Institute of Microbiology and Virology, Veterinary Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Indre Ceponiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Jureniene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vilma Kriaucioniene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Asta Raskiliene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alina Smalinskiene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vaiva Lesauskaite
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Rational approaches to the treatment of hypertension: modification of lifestyle measures. Kidney Int Suppl (2011) 2014; 3:346-348. [PMID: 25019019 PMCID: PMC4089571 DOI: 10.1038/kisup.2013.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hypertension is an important health problem. Informative counseling is required for patients to completely understand the importance of non-pharmacologic treatments. Lifestyle changes such as restriction of salt intake, exercise, restriction of alcohol intake, diet, and weight loss are included in all hypertension treatment guidelines. However, serious motivation is required from the patient and the physician to succeed in this. Although the decrease in blood pressure may be limited with these measures, lifestyle modifications should be continued.
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Eating frequency is inversely associated with blood pressure and hypertension in Korean adults: analysis of the Third Korean National Health and Nutrition Examination Survey. Eur J Clin Nutr 2014; 68:481-9. [PMID: 24518746 DOI: 10.1038/ejcn.2014.9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 12/01/2013] [Accepted: 12/24/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES A lower eating frequency (EF) has been suggested to be important in the development of cardiovascular risk factors such as obesity and hyperlipidemia. However, the association between EF and blood pressure (BP) remains unclear. SUBJECTS/METHODS The aim of this study was to explore the association of EF with BP and hypertension after adjusting for confounding variables, including body mass index (BMI) and waist circumference (WC). This cross-sectional study used data from the Third Korean National Health and Nutrition Examination Survey. A total of 4625 subjects aged ≥ 19 years were included. To explore the association of EF with BP and hypertension, we performed multiple linear regression analyses and multiple logistic regression analyses for survey design, respectively. RESULTS EF was inversely associated with systolic BP (SBP) and diastolic BP (DBP). As EF increased from ≤ 2 to 3, 4 and ≥ 5 times per day, estimated adjusted means of both SBP and DBP decreased, showing a significant linear trend independent of obesity (SBP: 120.66, 120.23, 119.18 and 117.92 mm Hg, respectively; P<0.001; DBP: 78.36, 77.78, 77.25 and 76.50 mm Hg, respectively; P=0.004). The inverse association between EF and hypertension was gradually attenuated and significant after adjustment for confounding variables including BMI and WC (P=0.040). CONCLUSIONS This study suggests that lower EF is significantly associated with higher BP, which may be partially mediated by the effect of central obesity. Further prospective studies are needed to verify this causal relationship.
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2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2014; 31:1281-357. [PMID: 23817082 DOI: 10.1097/01.hjh.0000431740.32696.cc] [Citation(s) in RCA: 3284] [Impact Index Per Article: 328.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Caffeine as an analgesic adiuvant has been discussed for many years. In a recent Cochrane review based on 19 studies with a total of 7238 patients, caffeine enhanced the efficacy of paracetamol, ibuprofen or aspirin with a number needed to treat (NNT) of about 16, comparable to the effect of doubling the dose of the primary analgesic, reported by other authors. Analgesia by caffeine is best explained by antagonism at adenosine receptors. Recent studies confirmed a favourable tolerability profile of caffeine when consumed in "normal" quantities (e.g. 300 mg or about 3 cups of coffee per day), including possible cardiovascular risks, effects on bone density, and exposure in pregnancy. Beneficial effects are known,e.g.,in Parkinson's disease and liver cirrhosis and fibrosis. Caffeine remains an analgesic adiuvant with a favourable risk-benefit balance.
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Droste DW, Iliescu C, Vaillant M, Gantenbein M, De Bremaeker N, Lieunard C, Velez T, Meyer M, Guth T, Kuemmerle A, Chioti A. A daily glass of red wine and lifestyle changes do not affect arterial blood pressure and heart rate in patients with carotid arteriosclerosis after 4 and 20 weeks. Cerebrovasc Dis Extra 2013; 3:121-9. [PMID: 24403903 PMCID: PMC3884179 DOI: 10.1159/000354847] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Regular consumption of small amounts of red wine improves blood lipids. However, there is concern whether this beneficial effect might be counterbalanced by an increase in blood pressure (BP) and heart rate (HR), which are risk factors for cerebro-cardiovascular disease. In particular, we studied whether regular consumption of red wine with and without lifestyle changes (LC; healthy diet and physical activity advice) results in an increase in BP and HR. METHODS A prospective, unblinded randomized trial was performed in 108 patients (67% men) with carotid atherosclerosis documented by ultrasound, a mean BP of 122/79 mm Hg and a mean HR of 71 bpm at inclusion in the study. Sixty-eight percent were known and treated hypertensives. The mean 24-hour BP at baseline was 122/79 mm Hg. Half of the study participants, the control group, was seen by a nurse at baseline, after 4 and after 20 weeks, and was instructed not to change their eating and physical activity habits. In the other half, a dietician performed five sessions of 30 min each (at baseline, after 1 week and after 2, 3 and 4 weeks) giving advice on healthy eating based on a Mediterranean diet and physical exercise. The recommendations given were the following: 5 portions of fruit/vegetables per day, a diet low in absolute fat, a preference of vegetable oil (olive or rapeseed oil), whole-grain products, poultry, low-fat dairy products, 1 fat and 1 lean fish meal per week, reduced consumption of red meat, and avoidance of pork, ready-made meals, sugar and excessive salt intake. In addition, regular consumption of 1 bar of dark chocolate (25 g, >70% of cacao), 1-2 tomatoes, and 3-5 walnuts as well as at least 30 min of moderate daily physical activity were recommended. Within these two groups, half of the patients were randomized either to avoid alcohol completely or to drink 100 ml (women) or 200 ml of red wine (men) daily. RESULTS Neither LC nor red wine had an effect on the mean systolic and diastolic 24-hour BP and HR after 4 and 20 weeks, as analyzed by general linear modeling. No difference was found for diurnal and nocturnal values. CONCLUSIONS The possible beneficial effect of regular consumption of small amounts of red wine is not counterbalanced in the long term by an increase in the mean BP or HR in mainly normotensive and well-treated hypertensive patients with carotid atherosclerosis, neither in the patients given healthy lifestyle advice nor in those with a standard lifestyle. Yet, we remain cautious about actively advice patients to drink alcohol regularly given the well-known risks.
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Affiliation(s)
- Dirk W Droste
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg, Luxemburg
| | | | | | | | | | | | - Telma Velez
- Clinical and Epidemiological Investigation Centre, Luxemburg
| | - Michèle Meyer
- Clinical and Epidemiological Investigation Centre, Luxemburg
| | - Tessy Guth
- Methodology and Statistical Competence Centre, Luxemburg
| | - Andrea Kuemmerle
- Centre of Health Studies, Centre de Recherche Public-Santé, Strassen, Luxemburg
| | - Anna Chioti
- Clinical and Epidemiological Investigation Centre, Luxemburg
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