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Kreutz R, Azizi M, Grassi G, Januszewicz A, Kahan T, Lurbe E, Polonia J, Tsioufis K, Weber T, Williams B, Mancia G. Why were the 2023 Guidelines of the European Society of Hypertension not developed as Joint Guidelines together with the European Society of Cardiology? Blood Press 2024; 33:2317263. [PMID: 38404242 DOI: 10.1080/08037051.2024.2317263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Reinhold Kreutz
- Charite - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Michel Azizi
- Universite Paris Cite, Paris, France; AP-HP Hopital Europeen Georges-Pompidou, Hypertension Department and DMU CARTE
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Thomas Kahan
- Karolinska Institutet, Departement of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Empar Lurbe
- Consorcio Hospital General Universitario de Valencia, Valencia, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, University of Valencia, Valencia, Spain
| | | | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London (UCL), National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK
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Ashraf T, Aamir KF, Nadeem A, Hassan MU, Raza H, Rauf MA, Din JU, Shah S, Khan F, Akram Z, Ishaque M, Hanif B. Impact of educational intervention on hypertension management by primary care physician: A randomized control trial. PEC INNOVATION 2024; 4:100285. [PMID: 38737890 PMCID: PMC11087987 DOI: 10.1016/j.pecinn.2024.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/14/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
Objective The current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. Methods This randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. Results A total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. Conclusion After the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. Innovation The study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.
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Affiliation(s)
- Tariq Ashraf
- Karachi Institute of Heart Disease, Karachi, Pakistan
| | | | - Asif Nadeem
- Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Haseeb Raza
- Mukhtar A. Sheikh Hospital, Multan, Pakistan
| | | | - Jalal Ud Din
- Bolan Medical Complex Hospital, Quetta, Pakistan
| | | | - Fayza Khan
- Health Icon Medical Centre, Karachi, Pakistan
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de la Sierra A, Staplin N, Ruilope LM, Gorostidi M, Vinyoles E, Segura J, Baigent C, Williams B. A blunted nocturnal blood pressure decline is associated with all-cause and cardiovascular mortality. J Hypertens 2024; 42:1197-1202. [PMID: 38477142 DOI: 10.1097/hjh.0000000000003712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE It has been suggested that a blunted nocturnal blood pressure (BP) decline is associated with a poor prognosis. Nevertheless, it remains unclear if an abnormal dipping is deleterious per se or it merely reflects an elevated BP during sleep. We aimed to assess the prognostic value of nocturnal BP decline, with or without concomitant elevated nocturnal BP. METHODS Vital status and cause of death were obtained from death certificates in 59 124 patients, enrolled in the Spanish ABPM Registry between 2004 and 2014 (median follow-up: 10 years). The association between night-to-day ratio (NDR) and dipping patterns (extreme dippers, dippers, reduced dippers, and risers) with all-cause and cardiovascular mortality were evaluated by Cox-proportional models adjusted for clinical confounders and 24 h blood pressure. RESULTS NDR was associated with all-cause mortality [hazard ratio for 1SD change: 1.15; 95% confidence interval (CI) 1.13-1.17]. Reduced dippers (1.13; 1.06-1.20) and risers (1.41; 1.32-1.51) were associated with an increased risk of all-cause death, whereas extreme dippers (0.90; 0.79-1.02) were not. Elevated NDR (≥0.9) in the absence of elevated night SBP (<120 mmHg) was associated with an increased risk of death (1.13; 1.04-1.22), as well as elevated night SBP but normal NDR (1.38; 1.26-1.50), and the combination of both abnormalities (1.56; 1.46-1.66). Similar results were obtained for cardiovascular mortality. CONCLUSION Abnormalities in the circadian pattern are associated with an increased risk of all-cause and cardiovascular mortality. This is maintained even in the absence of nocturnal BP elevation.
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Affiliation(s)
- Alejandro de la Sierra
- Department of Internal Medicine. Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Natalie Staplin
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid
| | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo
| | - Ernest Vinyoles
- Primary Care Centre 'La Mina', IDIAP Jordi Gol, University of Barcelona, Barcelona, Spain
| | - Julián Segura
- Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid
| | - Colin Baigent
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bryan Williams
- University College London (UCL) Institute of Cardiovascular Science and National Institute for Health Research (NIHR) UCL Hospitals Biomedical Research Centre, London, UK
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Liu R, Wang L, Zhong W, Xu L, Li L, He C, Wei Q. Triglyceride glucose index combined with body mass index and its 4-year change with the risk of hypertension in middle-aged and older Chinese: A prospective cohort study. Nutr Metab Cardiovasc Dis 2024; 34:1381-1388. [PMID: 38494367 DOI: 10.1016/j.numecd.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND AIM To explore the association of triglyceride glucose index-body mass index (TyG-BMI) and its dynamic changes with the risk of hypertension among middle-aged and older Chinese adults based on a large-sample prospective cohort study. METHODS AND RESULTS Participants over 45 years old and without a history of hypertension were included from the China Health and Retirement Longitudinal Study registry. Data were collected in 2011 and followed up in 2015. TyG index and TyG-BMI were calculated as ln (triglyceride∗glucose/2) and TyG index∗BMI, respectively. We performed multivariate logistic regression analysis to identify the relationship between the TyG index, TyG-BMI and their dynamic change and the risk of hypertension. In the analyses, 3885 participants were included. After 4 years of follow-up, 1705 (43.89 %) patients developed hypertension. Logistic regression analysis revealed that after adjustments for all potential confounding factors, the highest tertile of baseline TyG index, baseline TyG-BMI, and the dynamic change in TyG-BMI were each associated with higher hypertension incidence than the lowest tertile: OR,1.38, 95 % CI, 1.17-1.63, OR,1.28, 95 % CI, 1.06-1.56, and OR, 1.26, 95 % CI, 1.07-1.48, respectively, whereas TyG index change was not. Moreover, the risk of hypertension increased with increasing levels of baseline TyG index (P for trend < 0.001), baseline TyG-BMI (P for trend = 0.013), and the dynamic change in TyG-BMI (P for trend = 0.006). CONCLUSIONS The baseline TyG index, baseline TyG-BMI, and the dynamic changes in TyG-BMI were significantly and positively associated with the risk of hypertension in Chinese adults older than 45 years.
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Affiliation(s)
- Rui Liu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Lu Wang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Wen Zhong
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Lin Xu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Lijuan Li
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Chengqi He
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Quan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China.
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Grassi G. Thirty-five years of the European Society of Hypertension: from past to future. J Hypertens 2024:00004872-990000000-00477. [PMID: 38780171 DOI: 10.1097/hjh.0000000000003778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The European Society of Hypertension (ESH) was established 35 years ago. Since then, it promoted and coordinated a number of activities which include educational projects, epidemiological surveys and research investigations whose main focus includes different clinical and therapeutic aspects of the hypertensive disease. This article, which is based on data presented during the Presidential lecture held during the 33rd ESH Meeting in Berlin, will provide an overview of the main organization and structure of the ESH. Emphasis will be given to the relevance of the different society bodies, with a particular focus on the educational and research activities, such as the 15 working groups and the more than 120 excellence centers located in European and extra-European countries. Other main activities of the Society refer to the ESH Hypertension Specialist Program, the ESH Summer School, the ESH Young Fellow Program and the Annual Scientific Meeting of the Society. A special emphasis will be given to the central role of the Society in the organization of the various research projects and in the development and dissemination of the ESH Guideline document on hypertension diagnosis and treatment. Finally, the future perspectives of the ESH in the context of the European scientific framework will be highlighted.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Boukhari FZ, Belayachi S, Essayagh F, Terkiba O, Naji AA, Amine M, Lambaki A, Essayagh M, Essayagh S, Essayagh T. Self-reported depression and its risk factors among hypertensive patients, Morocco: a cross-sectional study. Sci Rep 2024; 14:11196. [PMID: 38755268 PMCID: PMC11099232 DOI: 10.1038/s41598-024-61390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Hypertensive patients are at an elevated risk of developing mental diseases such as depression, which can impair their quality of life. The purpose of this study is to measure the prevalence of self-reported depression among hypertensive patients treated at primary health care facilities in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 1053 hypertensive patients attending primary health care facilities in Marrakech was conducted. A face-to-face questionnaire was used to collect socio-demographic, behavioral, and clinical data, as well as hypertension treatment characteristics and the care-patient-physician triad. The Patient Health Questionnaire-9 was used to assess self-reported depression. To identify self-reported depression risk factors, multivariate logistic regression was used. Depressive symptoms were reported by 56.1% of hypertensive patients. The patients' average age was 63.2 ± 9.5 years, and 508 (85.9%) were female. Female sex, stress, a low-salt diet, pain and physical discomfort, an urban living environment, a lack of self-monitoring of hypertension, an unsatisfactory relationship with the healthcare system, a family history of hypertension, and the perception of adverse effects of the antihypertensive drug were all associated with self-reported depression. Self-reported depression is prevalent among hypertensive patients in Marrakech. The mental health component should be emphasized while addressing hypertensive patients in primary health care facilities.
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Affiliation(s)
- Fatima Zahra Boukhari
- Faculté des sciences et techniques, Laboratoire agroalimentaire et santé, Hassan First University of Settat, Settat, Morocco
| | - Safae Belayachi
- Faculté des sciences et techniques, Laboratoire agroalimentaire et santé, Hassan First University of Settat, Settat, Morocco
| | - Firdaous Essayagh
- Faculté des sciences juridiques, économiques et sociales, Laboratoire droit privé et enjeux de développement, Université Sidi Mohamed Ben Abdellah, Fès, Morocco
| | - Othmane Terkiba
- Institut supérieur des sciences de la santé, Laboratoire sciences et technologies de la santé, Hassan First University of Settat, Settat, Morocco
| | - Ahmed Anouar Naji
- Faculté des sciences juridiques, économiques et sociales, Laboratoire droit privé et enjeux de développement, Université Sidi Mohamed Ben Abdellah, Fès, Morocco
| | - Mohammed Amine
- Faculty of medicine and pharmacy, Clinical research service, Mohammed VI university hospital center, Department of public health, epidemiology and community medicine, Laboratory of biosciences and health, Cadi Ayyad University, Marrakech, Morocco
| | - Abdellah Lambaki
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
| | - Meriem Essayagh
- Office national de sécurité sanitaire des produits alimentaires, Oriental, Morocco
| | - Sanah Essayagh
- Faculté des sciences et techniques, Laboratoire agroalimentaire et santé, Hassan First University of Settat, Settat, Morocco
| | - Touria Essayagh
- Institut supérieur des sciences de la santé, Laboratoire sciences et technologies de la santé, Hassan First University of Settat, Settat, Morocco
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Qin H, Shen L, Xu D. Association of composite dietary antioxidant index with mortality in adults with hypertension: evidence from NHANES. Front Nutr 2024; 11:1371928. [PMID: 38807639 PMCID: PMC11132182 DOI: 10.3389/fnut.2024.1371928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/17/2024] [Indexed: 05/30/2024] Open
Abstract
Objective The objective of this study is to assess the correlation between composite dietary antioxidant index (CDAI) with all-cause mortality and cause-specific mortality in adults with hypertension. Methods The cohort study comprised adult participants with hypertension from the NHANES database, spanning 9 cycles from 2001 to 2018. Follow-up was conducted until December 31, 2019. Multi-variable Cox regression analysis was utilized to ascertain hazard ratios (HR) and their corresponding 95% confidence intervals, evaluating the relationship between CDAI and the risks of all-cause and cause-specific mortality. To further investigate the association between CDAI and mortality rates in adults with hypertension, Kaplan-Meier survival curves, restricted cubic splines (RCS), subgroup analyses and sensitivity analyses were employed. Results The analysis included 16,713 adults with hypertension (mean age 56.93 ± 0.23 years, 8,327 [49.61%] male). During the mean follow-up time 102.11 ± 1.22 months, with 3,908 (18.08%) all-cause mortality occurred, 1,082 (4.84%) cardiovascular mortality and 833 (3.80%) cancer mortality. Compared to the lowest quartile of CDAI, the weighted multivariate hazard ratios of participants in the highest quartile was 0.77 (95% CI, 0.68-0.87) for all-cause mortality, 0.83 (95% CI, 0.67-1.04) for cardiovascular mortality, and 0.64 (95% CI, 0.50-0.82) for cancer mortality. RCS analysis demonstrated a nonlinear association of CDAI with all-cause and cancer mortality, and a linear association between CDAI and cardiovascular mortality. The results were robust in subgroup analyses and sensitivity analyses. Conclusion Higher CDAI is associated with reduced all-cause mortality, cardiovascular mortality, and cancer mortality in hypertensive adults. Our findings highlight the importance of an antioxidant diet in improving outcomes in adults with hypertension.
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Affiliation(s)
| | - Li Shen
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Danyan Xu
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
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Bentzel S, Ljungman C, Hjerpe P, Schiöler L, Manhem K, Bengtsson Boström K, Kahan T, Mourtzinis G. Long-term secondary prevention and outcome following acute coronary syndrome: real-world results from the Swedish Primary Care Cardiovascular Database. Eur J Prev Cardiol 2024; 31:812-821. [PMID: 38135289 DOI: 10.1093/eurjpc/zwad389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
AIMS Most studies of treatment adherence after acute coronary syndrome (ACS) are based on prescribed drugs and lack long-term follow-up or consecutive data on risk factor control. We studied the long-term treatment adherence, risk factor control, and its association to recurrent ACS and death. METHODS AND RESULTS We retrospectively included 3765 patients (mean age 75 years, 40% women) with incident ACS from 1 January 2006 until 31 December 2010 from the Swedish Primary Care Cardiovascular Database of Skaraborg. All patients were followed until 31 December 2014 or death. We recorded blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), recurrent ACS, and death. We used data on dispensed drugs to calculate the proportion of days covered for secondary prevention medications. Cox regressions were used to analyse the association of achieved BP and LDL-C to recurrent ACS and death. The median follow-up time was 4.8 years. The proportion of patients that reached BP of <140/90 mm Hg was 58% at Year 1 and 66% at Year 8. 65% of the patients reached LDL-C of <2.5 mmol/L at Year 1 and 56% at Year 8; however, adherence to statins varied from 43% to 60%. Only 62% of the patients had yearly measured BP, and only 28% yearly measured LDL-C. Systolic BP was not associated with a higher risk of recurrent ACS or death. Low-density lipoprotein cholesterol of 3.0 mmol/L was associated with a higher risk of recurrent ACS {hazard ratio [HR] 1.19 [95% confidence interval (CI) 1.00-1.40]} and death HR [1.26 (95% CI 1.08-1.47)] compared with an LDL-C of 1.8 mmol/L. CONCLUSION This observational long-term real-world study demonstrates low drug adherence and potential for improvement of risk factors after ACS. Furthermore, the study confirms that uncontrolled LDL-C is associated with adverse outcome even in this older population.
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Affiliation(s)
- Sara Bentzel
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 3, 413 46, Gothenburg, Sweden
| | - Charlotta Ljungman
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 3, 413 46, Gothenburg, Sweden
| | - Per Hjerpe
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Bengtsson Boström
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Mourtzinis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Medicine and Emergency Mölndal, Sahlgrenska University Hospital, Mölndal, Sweden
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Pan P, Yang Y, He S, Zhao G, Chen XP. The effects of initial and subsequent overweight or obesity on hypertension in the middle age. J Clin Hypertens (Greenwich) 2024; 26:525-531. [PMID: 38552194 PMCID: PMC11088430 DOI: 10.1111/jch.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
The aims of our study were to examine whether initial or subsequent adiposity status had a greater effect on hypertension. We collected data in 1992 and again in 2007 from the same group of 597 individuals in the middle age. The subjects were classified into four groups: individuals with a normal body mass index (BMI) in 1992 and 2007 were in Group I; those with a normal BMI in 1992, but became overweight or obese in 2007 were in Group II; those who were overweight or obese in 1992, but had a normal BMI in 2007 were in Group III; and those who were overweight or obese in 1992 and 2007 were in Group IV. Their demographic data were recorded. The relationship between adiposity status and hypertension was analyzed using logistic regression model. The cumulative incidence of hypertension was 35.5%, 56.3%, 50.0%, and 65.1% for Group I to IV, respectively. Compared with Group I, after adjusted factors, the hazard ratio (HR) was 1.80 for Group II (P = .001), 1.40 for Group III (P = .150), and 2.31 for Group IV (P < .001). Adiposity status in 2007 could predict hypertension (OR = 2.5, P < .001), as opposed to the initial adiposity status (P = .148). Subsequently adiposity status could have major effects on hypertension. Our society is very short of public health resources, particularly in developing countries, we should pay more attention to current adiposity status and encourage middle-aged people to lose weight.
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Affiliation(s)
- Pei Pan
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yang
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Sen He
- Department of Cardiovascular, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Zhao
- Department of Cardiovascular, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Ping Chen
- Department of Cardiovascular, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Martínez-Ibáñez P, Marco-Moreno I, García-Sempere A, Peiró S, Martínez-Ibáñez L, Barreira-Franch I, Bellot-Pujalte L, Avelino-Hidalgo E, Escrig-Veses M, Bóveda-García M, Calleja-del-Ser M, Robles-Cabaniñas C, Hurtado I, Rodríguez-Bernal CL, Giménez-Loreiro M, Sanfélix-Gimeno G, Sanfélix-Genovés J. Long-Term Effect of Home Blood Pressure Self-Monitoring Plus Medication Self-Titration for Patients With Hypertension: A Secondary Analysis of the ADAMPA Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2410063. [PMID: 38728033 PMCID: PMC11087839 DOI: 10.1001/jamanetworkopen.2024.10063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Patient empowerment through pharmacologic self-management is a common strategy for some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure (BP). Several trials have shown its potential for reducing BP in the short term, but evidence in the longer term is scarce. Objective To evaluate the longer-term effectiveness of BP self-monitoring plus self-titration of antihypertensive medication vs usual care for patients with poorly controlled hypertension, with passive follow-up and primary-care nursing involvement. Design, Setting, and Participants The ADAMPA (Impact of Self-Monitoring of Blood Pressure and Self-Titration of Medication in the Control of Hypertension) study was a randomized, unblinded clinical trial with 2 parallel arms conducted in Valencia, Spain. Included participants were patients 40 years or older, with systolic BP (SBP) over 145 mm Hg and/or diastolic BP (DBP) over 90 mm Hg, recruited from July 21, 2017, to June 30, 2018 (study completion, August 25, 2020). Statistical analysis was conducted on an intention-to-treat basis from August 2022 to February 2024. Interventions Participants were randomized 1:1 to usual care vs an individualized, prearranged plan based on BP self-monitoring plus medication self-titration. Main Outcomes and Measures The main outome was the adjusted mean difference (AMD) in SBP between groups at 24 months of follow-up. Secondary outcomes were the AMD in DBP between groups at 24 months of follow-up, proportion of patients reaching the BP target (SBP <140 mm Hg and DBP <90 mm Hg), change in behaviors, quality of life, health service use, and adverse events. Results Among 312 patients included in main trial, data on BP measurements at 24 months were available for 219 patients (111 in the intervention group and 108 in the control group). The mean (SD) age was 64.3 (10.1) years, and 120 patients (54.8%) were female; the mean (SD) SBP was 155.6 (13.1) mm Hg, and the mean (SD) diastolic BP was 90.8 (7.7) mm Hg. The median follow-up was 23.8 months (IQR, 19.8-24.5 months). The AMD in SBP at the end of follow-up was -3.4 mm Hg (95% CI, -4.7 to -2.1 mm Hg; P < .001), and the AMD in DBP was -2.5 mm Hg (95% CI, -3.5 to -1.6 mm Hg; P < .001). Subgroup analysis for the main outcome showed consistent results. Sensitivity analyses confirmed the robustness of the main findings. No differences were observed between groups in behaviors, quality of life, use of health services, or adverse events. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, BP self-monitoring plus self-titration of antihypertensive medication based on an individualized prearranged plan used in primary care reduced BP in the longer term with passive follow-up compared with usual care, without increasing health care use or adverse events. These results suggest that simple, inexpensive, and easy-to-implement self-management interventions have the potential to improve the long-term control of hypertension in routine clinical practice. Trial Registration ClinicalTrials.gov Identifier: NCT03242785.
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Affiliation(s)
- Patricia Martínez-Ibáñez
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Irene Marco-Moreno
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Aníbal García-Sempere
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Salvador Peiró
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | | | | | | | | | | | | | | | - Celia Robles-Cabaniñas
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Isabel Hurtado
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Clara L. Rodríguez-Bernal
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | | | - Gabriel Sanfélix-Gimeno
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - José Sanfélix-Genovés
- Health Services Research & Pharmacoepidemiology Unit, Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- INCLIVA Health Research Institute, Valencia, Spain
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de la Sierra A, Williams B, Bursztyn M, Parati G, Stergiou GS, Vinyoles E, Segura J, Gorostidi M, Ruilope LM. Prognostic Relevance of Short-Term Blood Pressure Variability. The Spanish ABPM Registry. Hypertension 2024; 81:1125-1131. [PMID: 38506051 DOI: 10.1161/hypertensionaha.124.22716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, with all-cause and cardiovascular mortality in a large cohort of patients with hypertension. METHODS We selected 59 124 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry from 2004 to 2014 (median follow-up: 9.7 years). Systolic and diastolic BP SD and coefficient of variation from daytime and nighttime, weighted SD, weighted coefficient of variation, average real variability (mean of differences between consecutive readings), and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through baseline 24-hour ambulatory BP monitoring. Association with all-cause and cardiovascular mortality were assessed by Cox regression models adjusted for clinical confounders and BP. RESULTS Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In adjusted models systolic and diastolic daytime and weighted SD and coefficient of variation, average real variability, as well as systolic nighttime SD and BP variability ratio were all significantly associated with all-cause and cardiovascular mortality. Hazard ratios for 1-SD increase in the systolic components ranged from 1.05 to 1.12 for all-cause mortality and from 1.07 to 1.17 for cardiovascular mortality. A daytime SD≥13 mm Hg, a nighttime and a weighted SD≥12 mm Hg, and an average real variability ≥10 mm Hg, all systolic, were independently associated with mortality. CONCLUSIONS Short-term blood pressure variability shows a relatively weak but significant association with all-cause and cardiovascular mortality in patients with hypertension.
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Affiliation(s)
- Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.S.)
| | - Bryan Williams
- University College London (UCL), Institute of Cardiovascular Science and National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.)
| | - Michael Bursztyn
- Hypertension Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Mount-Scopus, and Faculty of Medicine, Hadassah Hebrew University School of Medicine, Jerusalem, Israel (M.B.)
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Cardiology Unit and Department of Cardiovascular, Neural, and Metabolic Sciences, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.)
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.)
| | | | - Julián Segura
- Hypertension Unit and Cardiorenal Translational Laboratory, Madrid, Spain (J.S., L.M.R.)
| | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain (M.G.)
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Madrid, Spain (J.S., L.M.R.)
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12
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Okamura K, Shimada H, Imazato K, Sako H, Udo A, Taniguchi K, Morisaki S, Imamura I, Urata H, Arima H, Miura SI. Impact of renal denervation on quality of life (How does renal denervation contribute to improving hypertension treatment affected by poor medication adherence?). Hypertens Res 2024:10.1038/s41440-024-01679-7. [PMID: 38605140 DOI: 10.1038/s41440-024-01679-7] [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: 02/27/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
The US Food and Drug Administration has approved renal denervation (RDN) as a new treatment option for hypertension (HT) because it not only has antihypertensive effects but also improves the quality of blood pressure (BP) reduction. RDN is expected to be increasingly used in clinical practice in the future. This review summarizes the impact of RDN on quality of life (QOL). Although the treatment of HT aims to improve life prognosis, the use of antihypertensive agents can impair QOL because of adverse effects and lifestyle changes associated with long-term medication use. Consequently, poor adherence to antihypertensive agents is a common problem and may be the most important issue affecting patient QOL. In RDN trials in patients taking antihypertensive agents, approximately 40% of patients had poor adherence to the drugs. Poor adherence is often the cause of resistant hypertension. Therefore, RDN should be well suited to treating HT and improving QOL. Studies have shown that approximately 30% of HT patients prefer RDN to drug treatment. Patients who prefer RDN are typically male and younger and have high BP, poor adherence, and a history of adverse effects of antihypertensive agents. We hope that RDN will improve not only life prognosis but also QOL in HT patients because of its benefits for adherence. Furthermore, we expect that in the future, RDN will be used in other sympathetic nervous system-related diseases, such as heart failure, atrial fibrillation, and sleep apnea syndrome.
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Affiliation(s)
- Keisuke Okamura
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan.
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Fukuoka, Japan.
| | - Hideaki Shimada
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Keisuke Imazato
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Hideto Sako
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Akihiro Udo
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Kenichiro Taniguchi
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Shogo Morisaki
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Ichiro Imamura
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Fukuoka, Japan
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Yuenyongchaiwat K, Sermsinsathong N, Songsorn P, Charususin N, Buranapuntalug S, Buekban C, Thanawattano C. Development and feasibility assessment of a virtual reality-based aerobic exercise program with real-time pulse rate monitoring on hemodynamic and arterial stiffness in healthy people: a pilot study. Front Digit Health 2024; 6:1356837. [PMID: 38650665 PMCID: PMC11034385 DOI: 10.3389/fdgth.2024.1356837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Virtual reality (VR) exercises are reportedly beneficial as a physical activity tool for health promotion and rehabilitation, and can also help individuals exercise under professional supervision. We developed and investigated the potential feasibility of a VR-based aerobic exercise program using the XBOX ONE console and Kinect sensor with real-time pulse rate monitoring. The VR setting consisted of two-dimensional (2D) environments via computer, laptop, or television screens. In addition, the study investigated the potential feasibility of the VR-based exercise program on hemodynamic response and arterial stiffness in healthy participants of various ages. Methods Healthy participants (n = 30) aged > 18 years were enrolled in the VR exercise-based program. All participants were required to wear a polar heart rate (HR) monitor set for moderate-intensity exercise, targeting 40%-59% of their HR reserve. Hemodynamic and arterial stiffness (pulse wave velocity) were noninvasively measured. The Borg scale rate of perceived exertion (RPE) was also assessed. Results Following a VR-guided exercise routine, all participants performed moderate-intensity exercise with no adverse health outcomes during or after the exercise. The effects of VR-based aerobic exercise extended beyond enhanced central hemodynamic and arterial stiffness. However, neither hemodynamic nor arterial stiffness showed significant differences before and after the VR exercise, except for a higher RPE response following the exercise program. Conclusion VR-based aerobic exercise with pulse rate monitoring is a promising physical activity tool to induce physiological changes and impact dyspnea scales and is also feasible for administration to healthy populations.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Natsinee Sermsinsathong
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Preeyaphorn Songsorn
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Noppawan Charususin
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Sasipa Buranapuntalug
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Chatchai Buekban
- Biomedical Electronics and Systems Research Team Assistive Technology and Medical Devices Research Group, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand
| | - Chusak Thanawattano
- Biomedical Electronics and Systems Research Team Assistive Technology and Medical Devices Research Group, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand
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14
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De Ciuceis C, Rosei CA, Malerba P, Rossini C, Nardin M, Chiarini G, Famà F, Lemoli M, Baresi M, Petelca A, Bortoluzzi C, Porteri E, Salvetti M, Muiesan ML, Rosei EA, Rizzoni D. Prognostic significance of the wall to lumen ratio of retinal arterioles evaluated by adaptive optics. Eur J Intern Med 2024; 122:86-92. [PMID: 37914655 DOI: 10.1016/j.ejim.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Microvascular structural alterations may be considered an important form of hypertension-mediated organ damage. An increased media-to-lumen ratio of subcutaneous small arteries evaluated with locally invasive techniques (micromyography) predicts the development of cardiovascular (CV) events. However, it is not known whether retinal arteriole structural alterations evaluated with a noninvasive approach (Adaptive Optics) may have a prognostic significance. DESIGN AND METHODS Two-hundred and thirty-seven subjects (mean age 58.7 ± 16.1 years, age range 13-89 years; 116 males) were included in the study: 65 normotensive subjects (27.4 %) and 172 patients with essential hypertension or primary aldosteronism (72.6 %). All subjects underwent a non-invasive evaluation of retinal arteriolar wall-to-lumen ratio (WLR) by Adaptive Optics. Subjects were re-evaluated after an average follow-up time of 4.55 years in order to assess the occurrence of clinical events (non CV and/or CV death or events). RESULTS Fifty-four events occurred in the study population:26 were cardio-cerebrovascular events (ischemic or hemorragic stroke, atrial fibrillation, heart failure, coronary artery disease, peripheral artery disease, cardiac valvular disease) while the remaining were deaths for any cause, or neoplastic diseases. Subjects with events were older and had a WLR of retinal arterioles significantly greater than those without events. The event-free survival was significantly worse in those with a baseline WLR above the median value of the population (0.28) according to Kaplan-Mayer survival curves and multivariate analysis (Cox's proportional hazard model). The evidence was confirmed after restricting the analysis to CV events. CONCLUSIONS Structural alterations of retinal arterioles evaluated by Adaptive Optics may predict total and CV events.
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Affiliation(s)
- Carolina De Ciuceis
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy.
| | - Claudia Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Paolo Malerba
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Claudia Rossini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Matteo Nardin
- Third Division of Medicine, ASST Spedali Civili di Brescia, Italy
| | - Giulia Chiarini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Francesca Famà
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Matteo Lemoli
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Mattia Baresi
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Alina Petelca
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Chiara Bortoluzzi
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Enzo Porteri
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Massimo Salvetti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Enrico Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy; Division of Medicine, ASST Spedali Civili di Brescia, Montichiari, Brescia, Italy
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15
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Son JJ, Arif Y, Oludipe D, Weyrich L, Killanin AD, Wiesman AI, Okelberry HJ, Willett MP, Johnson HJ, Wilson TW. Multispectral brain connectivity during visual attention distinguishes controlled from uncontrolled hypertension. J Physiol 2024; 602:1775-1790. [PMID: 38516712 PMCID: PMC11150863 DOI: 10.1113/jp285568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Hypertension-related changes in brain function place individuals at higher risk for cognitive impairment and Alzheimer's disease. The existing functional neuroimaging literature has identified important neural and behavioural differences between normotensive and hypertensive individuals. However, previously-used methods (i.e. magnetic resonance imaging, functional near-infrared spectroscopy) rely on neurovascular coupling, which is a useful but indirect measure of neuronal activity. Furthermore, most studies fail to distinguish between controlled and uncontrolled hypertensive individuals, who exhibit significant behavioural and clinical differences. To partially remedy this gap in the literature, we used magnetoencephalography (MEG) to directly examine neuronal activity that is invariant to neurovascular coupling changes induced by hypertension. Our study included 52 participants (19 healthy controls, 15 controlled hypertensives, 18 uncontrolled hypertensives) who completed a modified flanker attention task during MEG. We identified significant oscillatory neural responses in two frequencies (alpha: 8-14 Hz, gamma: 48-60 Hz) for imaging and used grand-averaged images to determine seeds for whole-brain connectivity analysis. We then conducted Fisher-z tests for each pair of groups, using the relationship between the neural connectivity and behavioural attention effects. This highlighted a distributed network of regions associated with cognitive control and selective attention, including frontal-occipital and interhemispheric occipital connections. Importantly, the inferior frontal cortex exhibited a unique neurobehavioural relationship that distinguished the uncontrolled hypertensive group from the controlled hypertensive and normotensive groups. This is the first investigation of hypertension using MEG and identifies critical whole-brain connectivity differences based on hypertension profiles. KEY POINTS: Structural and functional changes in brain circuitry scale with hypertension severity and increase the risk of cognitive impairment and Alzheimer's disease. We harness the excellent spatiotemporal precision of magnetoencephalography (MEG) to directly quantify dynamic functional connectivity in healthy control, controlled hypertensive and uncontrolled hypertensive groups during a flanker task. In the first MEG study of hypertension, we show that there are neurobehavioural relationships that distinguish the uncontrolled hypertensive group from healthy and controlled hypertensive group in the prefrontal cortex. These results provide novel insights into the differential impact of hypertension on brain dynamics underlying selective attention.
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Affiliation(s)
- Jake J Son
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yasra Arif
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Davina Oludipe
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Lucas Weyrich
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Abraham D Killanin
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alex I Wiesman
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Hannah J Okelberry
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Madelyn P Willett
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Hallie J Johnson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
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Abdelrehim AB, Ahmed AAH, Elgendi SS, Ibrahim WH. Study of Respiratory Variations of Mitral Valve Diastolic Flow in Hemodialysis Patients. Angiology 2024; 75:359-366. [PMID: 36746780 DOI: 10.1177/00033197231155509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The respiratory variations in mitral valve (MV) Doppler flow in hemodialysis (HD) patients have not been investigated and the normal echocardiographic value is used as a reference for HD patients. The present study evaluated the respiratory variation in MV Doppler flow in HD patients to determine if it has a unique pattern. In this prospective cohort study, echocardiography was performed before and 6 h after dialysis. The transmitral spectral Doppler E wave was measured during inspiratory and expiratory phases. The percent changes in the E wave were calculated pre- and post-dialysis. The means of the percent variation in the MV inspiratory and expiratory E wave pre- and post-dialysis were 56 ± 7% and 44 ± 1.1%, respectively, with a significant reduction after dialysis (P = .000). There was a significant positive correlation between post-dialysis ∆E wave % change and post-dialysis % change in weight (r = .318; P = .000). The respiratory changes in the MV E wave in HD patients were higher than the normal reference values. This marked variation could be explained by fluid overloading in HD patients.
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Affiliation(s)
- Ahmad B Abdelrehim
- Department of Internal Medicine, Cardiology and Critical Care Unit, Assiut University Hospital, Assiut, Egypt
| | - Ahmed Abdel Haleem Ahmed
- Department of Internal Medicine, resident in Internal Medicine Department, Assiut University Hospital, Assiut, Egypt
| | - Salwa Salah Elgendi
- Department of Internal Medicine, Rheumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Walaa H Ibrahim
- Department of Internal Medicine, Nephrology Unit, Assiut University Hospital, Assiut, Egypt
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Gupta A, Whiteley WN, Godec T, Rostamian S, Ariti C, Mackay J, Whitehouse A, Janani L, Poulter NR, Sever PS. Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial. Eur Heart J 2024; 45:1159-1169. [PMID: 38291599 PMCID: PMC10984564 DOI: 10.1093/eurheartj/ehad814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND AND AIMS Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment. METHODS Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes. RESULTS Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10-1.17], P < .001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18-1.26), P < .001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72-0.93), P = .003], total CV events [HR 0.93 (95% CI 0.88-0.98), P = .008], total coronary events [HR 0.92 (95% CI 0.86-0.99), P = .024], and atrial fibrillation [HR 0.91 (95% CI 0.83-0.99), P = .030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82-1.01), P = .073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality. CONCLUSIONS Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period.
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Affiliation(s)
- Ajay Gupta
- William Harvey Research Institute, Queen Mary University of London, UK
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | | | - Thomas Godec
- William Harvey Research Institute, Queen Mary University of London, UK
| | - Somayeh Rostamian
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Cono Ariti
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Judith Mackay
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Andrew Whitehouse
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
| | - Leila Janani
- Clinical Trials Unit, Imperial College London, UK
| | | | - Peter S Sever
- National Heart & Lung Institute, Imperial College London, Room 333, ICTEM Building, Du Cane Road, London W12 0NN, UK
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18
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Zhang W, Li X, Li W, Zhang Y, Cai J, Feng S, Sun Z. Clinical diagnosis of pheochromocytoma and paraganglioma-induced secondary hypertension through UPLC-MS/MS analysis of plasma catecholamines and their metabolites. J Clin Hypertens (Greenwich) 2024; 26:416-424. [PMID: 38459755 PMCID: PMC11007807 DOI: 10.1111/jch.14779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 03/10/2024]
Abstract
This study aimed to elucidate the clinical diagnostic value of plasma catecholamines and their metabolites for pheochromocytoma and paraganglioma (PPGL)-induced secondary hypertension using ultraperformance liquid chromatography-mass spectrometry (UPLC-MS/MS). The study population included 155 patients with PPGL that were divided into the PPGL with hypertension (n = 79) and a PPGL without hypertension (n = 76) groups, and 90 healthy volunteers and 90 patients with primary hypertension as the control groups. UPLC-MS/MS was performed to detect plasma levels of catecholamines and their metabolites, including dopamine, vanillylmandelic acid (VMA), norepinephrine, metanephrine, and normetanephrine. Receiver operating characteristic curves were generated to analyze the diagnostic value of the plasma levels of catecholamines and their metabolites in PPGL-induced secondary hypertension. Patients in the primary hypertension and PPGL without hypertension groups had higher levels of dopamine, VMA, norepinephrine, metanephrine, and normetanephrine than patients in the normal group (all p < .05). On the other hand, patients in the PPGL with hypertension group had higher levels of dopamine, VMA, norepinephrine, metanephrine, and normetanephrine than patients in the normal, primary hypertension, and PPGL without hypertension groups (all p < .05). Collectively, our findings showed that dopamine, VMA, norepinephrine, metanephrine, and normetanephrine are all effective biomarkers for the diagnosis of PPGL and PPGL-induced secondary hypertension.
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Affiliation(s)
- Weiyun Zhang
- Department of Laboratory MedicineGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Xiao Li
- Department of Laboratory MedicineGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Wanqin Li
- Department of Laboratory MedicineGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Yanmei Zhang
- Department of Laboratory MedicineGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Jiajia Cai
- Department of Laboratory MedicineGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Shiyu Feng
- Department of Laboratory MedicineGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Zhaohui Sun
- Department of Laboratory MedicineGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
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19
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Galceran JM. Is proteinuria an important fact concerning the nephroprotective effect of renin-angiotensin system inhibitors? HIPERTENSION Y RIESGO VASCULAR 2024; 41:75-77. [PMID: 38508876 DOI: 10.1016/j.hipert.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Affiliation(s)
- J M Galceran
- Department of Nephrology, Althaia Foundation, Manresa, Barcelona, Spain.
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20
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Romero-Secin AA, Díez-Espino J, Prieto-Díaz MA, Pallares-Carratala V, Barquilla-García A, Micó-Pérez RM, Polo-García J, Velilla-Zancada SM, Martín-Sanchez V, Segura-Fragoso A, Ginel-Mendoza L, Arce-Vazquez VM, Cinza-Sanjurjo S. Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients. Semergen 2024; 50:102220. [PMID: 38554607 DOI: 10.1016/j.semerg.2024.102220] [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: 12/19/2023] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.
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Affiliation(s)
- A A Romero-Secin
- Specialist in Family and Community Medicine, Colloto Health Clinic, Principality of Asturias Health Service, Asturias, Spain; Fundacion redGEDAPS, Spain
| | - J Díez-Espino
- Fundacion redGEDAPS, Spain; Specialist in Family and Community Medicine, Tafalla Health Center, Tafalla, Navarrese Health Service, Navarra, Spain
| | - M A Prieto-Díaz
- Specialist in Family and Community Medicine, Vallobín-La Florida Health Center, Principality of Asturias Health Service, Asturias, Spain
| | | | - A Barquilla-García
- Specialist in Family and Community Medicine, Trujillo Health Center, Extremadura Health Service, Cáceres, Spain
| | - R M Micó-Pérez
- Specialist in Family and Community Medicine, Fontanars dels Alforins Health Center, Xàtiva-Ontinyent Department of Health, Valencia, Spain
| | - J Polo-García
- Specialist in Family and Community Medicine, Casar de Cáceres Health Center, Extremadura Health Service, Cáceres, Spain
| | - S M Velilla-Zancada
- Specialist in Family and Community Medicine, Joaquin Elizalde Health Center, Rioja Health Service, Logroño, La Rioja, Spain
| | - V Martín-Sanchez
- Institute of Biomedicine (IBIOMED), University of León, Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), León, Spain
| | | | - L Ginel-Mendoza
- Specialist in Family and Community Medicine, Ciudad Jardín Health Center, Málaga, Spain
| | - V M Arce-Vazquez
- Centro de investigación en medicina molecular y enfermedades crónicas (CIMUS), Universidad de Santiago de Compostela, Galicia, Spain
| | - S Cinza-Sanjurjo
- Specialist in Family and Community Medicine, Milladoiro Health Centre, Health Area of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain; Networking Biomedical Research, Centre-Cardiovascular Diseases (CIBERCV), Santiago de Compostela, Spain
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21
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Cui L, Liu X, Li Y, Jing T, Liu D, Ren C, Yin T, Wang Y, Zhao Z, Wang J, Han X, Wang L. Chinese patent medicine combined with calcium channel blockers in the treatment of essential hypertension:a Bayes network meta-analysis and systematic review. Front Pharmacol 2024; 15:1321405. [PMID: 38560355 PMCID: PMC10978809 DOI: 10.3389/fphar.2024.1321405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Backgroud: The co-administration of Chinese patent medicine with calcium channel blockers (CCBs) is a prevalent practice in China for treating essential hypertension (EH). However, robust evidence supporting the efficacy and safety of tailored combinations of different Chinese patent medicines with CCBs, according to individual patient conditions, is still limited. This study sought to elucidate the efficacy and safety of these combinations using a systematic review and network meta-analysis. Materials and methods: Relevant studies were sourced from established databases, incorporating randomized controlled trials published up to 1 February 2023. The ROB2 tool from the Cochrane Collaborative Network was employed to independently assess and cross-verify the quality of the included literature. A network meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 and PRISMA-Network Meta-Analyses (PRISMA-NMA) guidelines. A Bayesian network meta-analysis was utilized to gauge the efficacy and safety of distinct integrations of Chinese patent medicine and CCBs. Primary outcomes were interpreted using a paired fixed-effect meta-analysis. Publication bias was appraised through Egger's test and represented with funnel plots. All statistical analyses were executed within the R statistical framework. Results: Following rigorous selection, data extraction, and bias evaluation, 36 articles were incorporated. Tianma Gouteng Granule, when combined with CCBs, displayed superior efficacy in reducing systolic blood pressure (SBP). In terms of diastolic blood pressure (DBP) reduction, Songling Xuemaikang Capsule combined with CCBs emerged as the most effective. Regarding enhancement of antihypertensive effective rates, Qinggan Jiangya Capsule paired with CCBs demonstrated optimal results. For diminishing Traditional Chinese Medicine syndrome scores, the Qiangli Dingxuan Tablet and CCBs combination proved most beneficial. When aiming to reduce total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) levels, Tianma Gouteng Granule and CCBs showcased superior results. In contrast, the combination of Songling Xuemaikang Capsule and CCBs was more effective in reducing LDL-C, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6). Conclusion: This study underscores variability in outcomes from combining Chinese patent medicine and CCBs for hypertension, emphasizing the importance of personalized medicinal combinations, especially Tianma Gouteng Granule and Songling Xuemaikang Capsule. The results offer robust evidence to inform clinical guidelines for essential hypertention and significantly aid clinician in seleting appropriate Chinese patent medicines for treatment.
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Affiliation(s)
- Liangyu Cui
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xingfang Liu
- Research Department, Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
| | - Yukun Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tianyue Jing
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dasheng Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Cong Ren
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tong Yin
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhiwei Zhao
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaheng Wang
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Xuejie Han
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liying Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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22
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Pakhan AA, Jawade S, Boob MA, Somaiya KJ. Impact of Pulsed Electromagnetic Field Therapy and Aerobic Exercise on Patients Suffering With Hypertension: A Systematic Review. Cureus 2024; 16:e56414. [PMID: 38638759 PMCID: PMC11024783 DOI: 10.7759/cureus.56414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Hypertension is a major preventable risk factor for cardiovascular disease. This review evaluates the effects of pulsed electromagnetic field (PEMF) therapy and aerobic exercise on blood pressure (BP) levels in hypertensive patients. This study incorporated research conducted between 2012 and 2020 that was found through a systematic literature search. The measures used to estimate the improvement in BP include the BP measurements, quality-of-life (QOL) scale, and plasma nitric oxide (NO) level. The examination of the review comprised eight studies. These encompassed studies involving individuals with a systolic BP (SBP) above 140 mmHg and a diastolic BP (DBP) above 90 mmHg; those falling within the age range of 40 to 60 years, including both genders; and patients on antihypertensive medications. The review of selected articles concluded that PEMF therapy and aerobic exercise positively impact BP among individuals with hypertension. Aerobic exercises of moderate intensity including brisk walking, jogging, and cycling type of aerobic exercises help reduce BP and maintain patients' physical fitness. PEMF therapy is a complementary approach that affects the biological system and potential health, positively impacting BP. Results indicate that PEMF therapy can be a nonpharmacological method to manage BP in clinical populations. More thorough research is necessary to understand the best dosage, long-term effects, and comparison between PEMF therapy and aerobic exercise.
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Affiliation(s)
- Arjavi A Pakhan
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manali A Boob
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamya J Somaiya
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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23
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Marzano L, Ronco C. Clinical and biochemical outcomes after adrenalectomy for primary aldosteronism in tertiary and quaternary referral centers: data from SOPRANO study. Hypertens Res 2024; 47:721-734. [PMID: 38182902 DOI: 10.1038/s41440-023-01554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/04/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024]
Abstract
Hypertension cure following adrenalectomy in unilateral primary aldosteronism (PA) remains uncertain. Previous meta-analyses have shown highly variable surgical outcomes. Our study aimed to determine the unknown proportion of complete clinical and biochemical success in tertiary and quaternary referral centers. We conducted a systematic review and meta-analysis of studies reporting surgical outcomes of unilateral PA patients within the Surgical Outcome of PRimary Aldosteronism progNostic mOdels (SOPRANO) study. From 27 publications we identified 32 eligible studies, of which 22 were judged to be at low risk of bias. Eighteen were single-center studies, while fourteen were multi-center studies, with patients recruited from 132 referral centers worldwide. Adrenalectomy was performed on 5887 patients, with 4861 (83%) included in the final analysis. The pooled estimates of complete clinical and biochemical success for all studies were 39% (95% CI: 34-44%) and 99% (95% CI: 96-99%), respectively, similar to that found for studies at low risk of bias. Multivariate meta-regression analyses for all studies and low-bias risk studies revealed that BMI (P < 0.01), recruitment time period (P < 0.01), and hypertension duration (P < 0.05) inversely correlated with complete clinical success, while BMI (P < 0.05) and the number of enrolled centers (P < 0.05) inversely correlated with complete biochemical success. In summary, our findings offer robust estimates of complete clinical and biochemical success rates following adrenalectomy for unilateral PA in tertiary and quaternary referral centers and identify new potential effect modifiers that can help clinicians to inform and counsel patients about post-surgery expectations, guaranteeing effective treatment and ultimately enhancing outcomes.
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Affiliation(s)
- Luigi Marzano
- Centro per lo Studio e la Cura dell'Ipertensione Arteriosa, Internal Medicine Unit, San Bortolo Hospital, U.L.S.S. 8 Berica, Vicenza, Italy.
- Internal Medicine Unit, San Bortolo Hospital, U.L.S.S. 8 Berica, 36100, Vicenza, Italy.
| | - Claudio Ronco
- Department of Medicine (DIMED), University of Padova, 35128, Padova, Italy
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, 36100, Vicenza, Italy
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24
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Lee CJ, Kang WC, Ihm SH, Sohn IS, Woo JS, Kim JW, Hong SJ, Choi JH, Suh J, Seo J, Doh J, Son J, Park J, Lee J, Hong YJ, Heo JH, Shin J, Kang S. Efficacy and safety of combination therapy with telmisartan, rosuvastatin, and ezetimibe in patients with dyslipidemia and hypertension: A randomized, double-blind, multicenter, therapeutic confirmatory, phase III clinical trial. J Clin Hypertens (Greenwich) 2024; 26:262-273. [PMID: 38319595 PMCID: PMC10918710 DOI: 10.1111/jch.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/14/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
This study aimed to compare and evaluate the efficacy of the blood pressure (BP) control and cholesterol-lowering effects and safety of combination therapy with telmisartan, rosuvastatin, and ezetimibe versus rosuvastatin and ezetimibe double therapy or telmisartan single therapy in dyslipidemia patients with hypertension. After a wash-out/therapeutic lifestyle change period of ≥4 weeks, a total of 100 eligible patients were randomized and received one of three treatments for 8 weeks: (1) telmisartan 80 mg/rosuvastatin 20 mg/ezetimibe 10 mg (TRE), (2) rosuvastatin 20 mg/ezetimibe 10 mg (RE), or (3) telmisartan 80 mg (T). The primary endpoint was the efficacy evaluation of TRE by comparing changes in mean sitting systolic blood pressure (msSBP) and mean percentage change in low-density lipoprotein-C (LDL-C) from baseline after 8 weeks of treatment. The least square (LS) mean (SE) changes in msSBP at 8 weeks compared with baseline were -23.02 (3.04) versus -7.18 (3.09) mmHg in the TRE and RE groups, respectively (p < .0001), and -25.80 (2.74) versus -14.92 (2.65) mmHg in the TRE and T groups, respectively (p = .0005). The percentage changes in the mean (SD) LDL-C at 8 weeks compared with baseline were -54.97% (3.49%) versus -0.17% (3.23%) in the TRE and T groups, respectively (p < .0001). No serious adverse events occurred, and no statistically significant differences in the incidence of overall AEs and adverse drug reactions occurred among the three groups. TRE therapy significantly decreased msSBP and LDL-C compared to RE or T therapy with comparable safety and tolerability profiles.
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Affiliation(s)
- Chan Joo Lee
- Division of CardiologyDepartment of Internal MedicineSeverance HospitalYonsei University College of MedicineSeoulSouth Korea
| | - Woong Chol Kang
- Department of CardiologyGil HospitalGachon UniversityIncheonSouth Korea
| | - Sang Hyun Ihm
- Division of CardiologyDepartment of Internal MedicineBucheon St. Mary's HospitalThe Catholic University of KoreaSeoulSouth Korea
| | - Il Suk Sohn
- Department of CardiologyKyung Hee University Hospital at GangdongSeoulSouth Korea
| | - Jong Shin Woo
- Department of Internal MedicineKyung Hee University College of MedicineKyung Hee University Medical CenterSeoulSouth Korea
| | - Jin Won Kim
- Division of Interventional CardiologyCardiovascular CenterKorea University Guro HospitalSeoulSouth Korea
| | - Soon Jun Hong
- Division of CardiologyDepartment of Internal MedicineKorea University Anam HospitalSeoulSouth Korea
| | - Jung Hyun Choi
- Division of CardiologyDepartment of Internal MedicinePusan National University School of MedicineBusanSouth Korea
| | - Jung‐Won Suh
- Division of CardiologyDepartment of Internal MedicineSeoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jae‐Bin Seo
- Division of CardiologyDepartment of Internal MedicineBoramae Medical CenterSeoul National University College of MedicineSeoulSouth Korea
| | - Joon‐Hyung Doh
- Division of CardiologyDepartment of MedicineInje University Ilsan Paik HospitalGoyangSouth Korea
| | - Jung‐Woo Son
- Division of CardiologyDepartment of Internal MedicineWonju Severance Christian HospitalYonsei University Wonju College of MedicineWonjuSouth Korea
| | - Jae‐Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University HospitalSchool of Medicine, Chungnam National UniversityDaejeonSouth Korea
| | - Ju‐Hee Lee
- Division of CardiologyDepartment of Internal MedicineChungbuk National University HospitalChungbuk National University College of MedicineCheongjuSouth Korea
| | - Young Joon Hong
- Division of CardiologyChonnam National University Medical SchoolChonnam National University HopitalGwangjuSouth Korea
| | - Jung Ho Heo
- Division of CardiologyDepartment of Internal MedicineKosin University Gospel HospitalBusanSouth Korea
| | - Jinho Shin
- Division of CardiologyDepartment of Internal MedicineHanyang University Seoul HospitalHanyang University College of MedicineSeoulSouth Korea
| | - Seok‐Min Kang
- Division of CardiologyDepartment of Internal MedicineSeverance HospitalYonsei University College of MedicineSeoulSouth Korea
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Adejumo OA, Mutagaywa R, Akumiah FK, Akintunde AA. Task Sharing and Task Shifting (TSTS) in the Management of Africans with Hypertension: A Call For Action-Possibilities and Its Challenges. Glob Heart 2024; 19:22. [PMID: 38404613 PMCID: PMC10885825 DOI: 10.5334/gh.1301] [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: 10/04/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Hypertension is a leading cause of mortality globally and one of the most common risk factors for cardiovascular disease. Diagnosis, awareness, and optimal treatment rates are suboptimal, especially in low- and middle-income countries, with attendant high health consequences and grave socioeconomic impact. There is an enormous gap between disease burden and physician-patient ratios that needs to be bridged. Task sharing and task shifting (TSTS) provide a viable temporary solution. However, sociocultural, demographic, and economic factors influence the effective uptake of such interventions. This review discusses the dynamics of TSTS in the African context looking at challenges, feasibility, and approach to adopt it in the management of hypertension in Africa.
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Affiliation(s)
| | - Reuben Mutagaywa
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
- Muhimbili Orthopedic Institute, Tanzania
| | - Florence Koryo Akumiah
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Ghana
- National Cardiothoracic Centre, Korle Bu, Ghana
| | - Adeseye Abiodun Akintunde
- Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology and LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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26
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Fernandes LM, Lorigo M, Cairrao E. Relationship between Androgens and Vascular and Placental Function during Pre-eclampsia. Curr Issues Mol Biol 2024; 46:1668-1693. [PMID: 38534724 DOI: 10.3390/cimb46030108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Hypertensive disorders of pregnancy (HDP) represent a substantial risk to maternal and fetal health. Emerging evidence suggests an association between testosterone and pre-eclampsia (PE), potentially mediated through androgen receptors (AR). Nevertheless, the mechanism driving this association is yet to be elucidated. On the other hand, reports of transgender men's pregnancies offer a limited and insightful opportunity to understand the role of high androgen levels in the development of HDP. In this sense, a literature review was performed from a little over 2 decades (1998-2022) to address the association of testosterone levels with the development of HDP. Furthermore, this review addresses the case of transgender men for the first time. The main in vitro outcomes reveal placenta samples with greater AR mRNA expression. Moreover, ex vivo studies show that testosterone-induced vasorelaxation impairment promotes hypertension. Epidemiological data point to greater testosterone levels in blood samples during PE. Studies with transgender men allow us to infer that exogenous testosterone administration can be considered a risk factor for PE and that the administration of testosterone does not affect fetal development. Overall, all studies analyzed suggested that high testosterone levels are associated with PE.
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Affiliation(s)
- Lara M Fernandes
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Margarida Lorigo
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Elisa Cairrao
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
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Pang L, Kottu L, Guo Z, Ma M, Wang H, Zhao Y, Tang M, Shi Y, Liu W, Wu X, Song J, Sun M, Merkus D, Ferdous MM, He L, Duo L. A tryst of 'blood pressure control- sex- comorbidities': the odyssey of basic public health services in Yunnan in quest for truth. BMC Public Health 2024; 24:490. [PMID: 38365657 PMCID: PMC10870683 DOI: 10.1186/s12889-023-17157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/04/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-"Hypertension" (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern. METHODS We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities. RESULTS Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276-4.570), three or more (OR = 5.500, 95%CI: 1.174-25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430-3.289) and (OR = 2.785, 95%CI: 1.242-6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women. CONCLUSIONS Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding "management of hypertensive comorbidities". This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.
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Affiliation(s)
- Linhong Pang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Lakshme Kottu
- Division of Experimental Cardiology, Erasmus university medical center, 3015GD, Rotterdam, The Netherlands
| | - Zihong Guo
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Min Ma
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Huadan Wang
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Yajing Zhao
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Mingjing Tang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Yi Shi
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Wei Liu
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Xia Wu
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Junjie Song
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Manli Sun
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Daphne Merkus
- Division of Experimental Cardiology, Erasmus university medical center, 3015GD, Rotterdam, The Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), LMU, 81377, Munich, Germany
| | - Md Misbahul Ferdous
- The Third People's Hospital of Longgang District, 518083, Shenzhen, China.
- Lepu Medical Technology (Beijing) Co., Ltd, 102200, Beijing, China.
| | - Liping He
- School of Public Health, Kunming Medical University, 650500, Kunming, China.
| | - Lin Duo
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China.
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Huang Z, Wang F, Xiao X, Liu D, Deng Z. Non-linear relationship between pulse pressure and the risk of prediabetes: a 5-year cohort study in Chinese adults. Sci Rep 2024; 14:3824. [PMID: 38360859 PMCID: PMC10869682 DOI: 10.1038/s41598-024-52136-x] [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: 10/20/2023] [Accepted: 01/14/2024] [Indexed: 02/17/2024] Open
Abstract
Previous research has established a strong link between pulse pressure (PP) and diabetes, but there is limited investigation into the connection between PP and prediabetes. This study aims to explore the potential association between PP and prediabetes. A retrospective cohort study encompassed 202,320 Chinese adults who underwent health check-ups between 2010 and 2016. Prediabetes was defined in accordance with the World Health Organization criteria, indicating impaired fasting glucose, with fasting blood glucose levels ranging from 6.1 to 6.9 mmol/L. To assess the PP-prediabetes relationship, we employed Cox regression analysis, sensitivity analysis, and subgroup analysis. Cox proportional hazards regression, coupled with cubic spline functions and smooth curve fitting, helped elucidate the non-linear PP-prediabetes relationship. Upon adjusting for confounding factors, we observed a positive association between PP and prediabetes (HR 1.15, 95% CI 1.11-1.18, P < 0.0001). Participants in the fourth quartile (PP ≥ 51 mmHg) had a 73% higher likelihood of developing prediabetes compared to those in the first quartile (PP < 36 mmHg) (HR 1.73, 95% CI 1.52-1.97, P < 0.0001). Moreover, the relationship between PP and prediabetes was non-linear. A two-piece Cox proportional hazards regression model identified an inflection point at 40 mmHg for PP (P for log-likelihood ratio test = 0.047). Sensitivity and subgroup analyses corroborated the robustness of our findings. Our study reveals a non-linear correlation between PP and prediabetes, signifying an increased risk of prediabetes when PP levels exceed 40 mmHg. This discovery has significant clinical implications for early prediabetes prevention and intervention, ultimately contributing to improved patient outcomes and quality of life.
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Affiliation(s)
- Zhenhua Huang
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, 518037, Guangdong, China
| | - Fangxi Wang
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, 518037, Guangdong, China
| | - Xiaoyong Xiao
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, 518037, Guangdong, China
| | - Dehong Liu
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, 518037, Guangdong, China.
| | - Zhe Deng
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, 518037, Guangdong, China.
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Wu C, Zhao P, Xu P, Wan C, Singh S, Varthya SB, Luo SH. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev 2024; 2:CD004184. [PMID: 38353289 PMCID: PMC10865448 DOI: 10.1002/14651858.cd004184.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Variation in blood pressure levels display circadian rhythms. Complete 24-hour blood pressure control is the primary goal of antihypertensive treatment and reducing adverse cardiovascular outcomes is the ultimate aim. This is an update of the review first published in 2011. OBJECTIVES To evaluate the effectiveness of administration-time-related effects of once-daily evening versus conventional morning dosing antihypertensive drug therapy regimens on all-cause mortality, cardiovascular mortality and morbidity, total adverse events, withdrawals from treatment due to adverse effects, and reduction of systolic and diastolic blood pressure in people with primary hypertension. SEARCH METHODS We searched the Cochrane Hypertension Specialised Register via Cochrane Register of Studies (17 June 2022), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2022); MEDLINE, MEDLINE In-Process and MEDLINE Epub Ahead of Print (1 June 2022); Embase (1 June 2022); ClinicalTrials.gov (2 June 2022); Chinese Biomedical Literature Database (CBLD) (1978 to 2009); Chinese VIP (2009 to 7 August 2022); Chinese WANFANG DATA (2009 to 4 August 2022); China Academic Journal Network Publishing Database (CAJD) (2009 to 6 August 2022); Epistemonikos (3 September 2022) and the reference lists of relevant articles. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing the administration-time-related effects of evening with morning dosing monotherapy regimens in people with primary hypertension. We excluded people with known secondary hypertension, shift workers or people with white coat hypertension. DATA COLLECTION AND ANALYSIS Two to four review authors independently extracted data and assessed trial quality. We resolved disagreements by discussion or with another review author. We performed data synthesis and analyses using Review Manager Web for all-cause mortality, cardiovascular mortality and morbidity, serious adverse events, overall adverse events, withdrawals due to adverse events, change in 24-hour blood pressure and change in morning blood pressure. We assessed the certainty of the evidence using GRADE. We conducted random-effects meta-analysis, fixed-effect meta-analysis, subgroup analysis and sensitivity analysis. MAIN RESULTS We included 27 RCTs in this updated review, of which two RCTs were excluded from the meta-analyses for lack of data and number of groups not reported. The quantitative analysis included 25 RCTs with 3016 participants with primary hypertension. RCTs used angiotensin-converting enzyme inhibitors (six trials), calcium channel blockers (nine trials), angiotensin II receptor blockers (seven trials), diuretics (two trials), α-blockers (one trial), and β-blockers (one trial). Fifteen trials were parallel designed, and 10 trials were cross-over designed. Most participants were white, and only two RCTs were conducted in Asia (China) and one in Africa (South Africa). All trials excluded people with risk factors of myocardial infarction and strokes. Most trials had high risk or unclear risk of bias in at least two of several key criteria, which was most prominent in allocation concealment (selection bias) and selective reporting (reporting bias). Meta-analysis showed significant heterogeneity across trials. No RCTs reported on cardiovascular mortality and cardiovascular morbidity. There may be little to no differences in all-cause mortality (after 26 weeks of active treatment: RR 0.49, 95% CI 0.04 to 5.42; RD 0, 95% CI -0.01 to 0.01; very low-certainty evidence), serious adverse events (after 8 to 26 weeks of active treatment: RR 1.17, 95% CI 0.53 to 2.57; RD 0, 95% CI -0.02 to 0.03; very low-certainty evidence), overall adverse events (after 6 to 26 weeks of active treatment: RR 0.89, 95% CI 0.67 to 1.20; I² = 37%; RD -0.02, 95% CI -0.07 to 0.02; I² = 38%; very low-certainty evidence) and withdrawals due to adverse events (after 6 to 26 weeks active treatment: RR 0.76, 95% CI 0.47 to 1.23; I² = 0%; RD -0.01, 95% CI -0.03 to 0; I² = 0%; very low-certainty evidence), but the evidence was very uncertain. AUTHORS' CONCLUSIONS Due to the very limited data and the defects of the trials' designs, this systematic review did not find adequate evidence to determine which time dosing drug therapy regimen has more beneficial effects on cardiovascular outcomes or adverse events. We have very little confidence in the evidence showing that evening dosing of antihypertensive drugs is no more or less effective than morning administration to lower 24-hour blood pressure. The conclusions should not be assumed to apply to people receiving multiple antihypertensive drug regimens.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhao
- Medical Library, Sichuan University, Chengdu, China
| | - Ping Xu
- Medical Library, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Surjit Singh
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shuang-Hong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Belayachi S, Boukhari FZ, Essayagh F, Terkiba O, Marc I, Lambaki A, Zohoun A, Essayagh M, Essayagh T, Essayagh S. Uncontrolled blood pressure and its risk factors among hypertensive patients, Marrakech, Morocco. Sci Rep 2024; 14:2953. [PMID: 38316867 PMCID: PMC10844197 DOI: 10.1038/s41598-024-53115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/28/2024] [Indexed: 02/07/2024] Open
Abstract
Hypertension is a public health problem. Failure to control blood pressure figures is responsible for morbidity and premature mortality. This study aims to describe the characteristics of hypertensive patients followed at primary health care centers in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 922 hypertension patients attending primary health care centers in Marrakech was done. To gather socio-demographic, behavioral, and clinical data, as well as hypertension treatment features and the care-patient-physician triad, a face-to-face questionnaire was employed. To identify risk factors associated with uncontrolled blood pressure, multivariate logistic regression was used. Uncontrolled blood pressure was found in 73.5% of people. The patients' average age was 63.4 ± 9.4 years (mean ± standard deviation), and 524 (77.3%) were women. Tobacco consumption (Adjusted Odd Ratio of 4.34; 95% CI [1.58-11.9]); lack of self-monitoring of hypertension (AOR of 1.69; 95% CI [1.14-2.52]); a family history of hypertension (AOR of 1.58; 95% CI [1.12-2.22]); overweight or obesity (AOR of 1.73; 95% CI [1.15-2.58]); and nonadherence to antihypertensive medication (AOR of 1.58; 95% CI [1.05-2.38]) were identified as risk factors for uncontrolled blood pressure. In hypertensive individuals, the percentage of uncontrolled blood pressure is considerable. It is essential to provide therapeutic education classes for hypertension patients in order to strengthen their power and autonomy in managing their hypertension.
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Affiliation(s)
- Safae Belayachi
- Faculté des Sciences et Techniques, Laboratoire Agroalimentaire et Santé, Hassan First University of Settat, Settat, Morocco
| | - Fatima Zahra Boukhari
- Faculté des Sciences et Techniques, Laboratoire Agroalimentaire et Santé, Hassan First University of Settat, Settat, Morocco
| | - Firdaous Essayagh
- Faculté des Sciences Juridiques, Économiques et Sociales, Laboratoire Droit Privé et Enjeux de Développement, Université Sidi Mohamed Ben Abdellah, Fès, Morocco
| | - Othmane Terkiba
- Institut Supérieur des Sciences de la Santé, Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Settat, Morocco
| | - Ikram Marc
- Institut Supérieur des Sciences de la Santé, Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Settat, Morocco
| | - Abdellah Lambaki
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
| | - Alban Zohoun
- Unité d'enseignement et de Recherche en Hématologie, Faculté des Sciences de la Santé, Cotonou, Benin
| | - Meriem Essayagh
- Office National de Sécurité Sanitaire des Produits Alimentaires, Oriental, Morocco
| | - Touria Essayagh
- Institut Supérieur des Sciences de la Santé, Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Settat, Morocco
| | - Sanah Essayagh
- Faculté des Sciences et Techniques, Laboratoire Agroalimentaire et Santé, Hassan First University of Settat, Settat, Morocco
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de la Sierra A, Ruilope LM, Martínez-Camblor P, Vinyoles E, Gorostidi M, Segura J, Williams B. Impact of timing of antihypertensive treatment on mortality: an observational study from the Spanish Ambulatory Blood Pressure Monitoring Registry. J Hypertens 2024; 42:260-266. [PMID: 37796235 DOI: 10.1097/hjh.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIMS Whether bedtime versus morning administration of antihypertensive therapy is beneficial on outcomes is controversial. We evaluated the risk of total and cardiovascular mortality in a very large observational cohort of treated hypertensive patients, according to the timing of their usual treatment administration (morning versus evening). METHODS Vital status and cause of death were obtained from death certificates of 28 406 treated hypertensive patients (mean age 62 years, 53% male individuals), enrolled in the Spanish Ambulatory Blood Pressure Monitoring (ABPM) Registry between 2004 and 2014. Among the 28 406 patients, most (86%) received their medication exclusively in the morning; whilst 13% were treated exclusively in the evening or at bedtime. Follow-up was for a median of 9.7 years and 4345 deaths occurred, of which 1478 were cardiovascular deaths. RESULTS Using Cox-models adjusted for clinical confounders and 24-h SBP, and compared with patients treated in the morning (reference group), all-cause mortality [hazard ratio 1.01; 95% CI 0.93-1.09) and cardiovascular mortality (hazard ratio 1.04; 95% CI 0.91-1.19) was not significantly different in those receiving evening medication dosing. The results were consistent in all the subgroups of patients analysed. CONCLUSION In this very large observational study, morning versus bedtime dosing of antihypertensive medication made no difference to the subsequent risk of all-cause or cardiovascular mortality. These findings are in accordance with results from a recent randomized controlled trial and do not support the hypothesis of a specific beneficial effect of night-time antihypertensive treatment dosing on risk of all-cause or cardiovascular death.
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Affiliation(s)
| | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid, Spain
| | - Pablo Martínez-Camblor
- Departments of Anesthesiology and Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Faculty of Health Sciences, Universidad Autónoma de Chile, Chile
| | - Ernest Vinyoles
- Primary Care Centre 'La Mina', IDIAP Jordi Gol, University of Barcelona, Barcelona
| | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo
| | - Julián Segura
- Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid, Spain
| | - Bryan Williams
- University College London (UCL) Institute of Cardiovascular Science and National Institute for Health Research (NIHR) UCL Hospitals Biomedical Research Centre, London, UK
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Kasprzyk P, Undrunas A, Dziadziuszko K, Dziedzic R, Kuziemski K, Szurowska E, Rzyman W, Zdrojewski T. Evaluation of Conventional Cardiovascular Risk Factors and Ordinal Coronary Artery Calcium Scoring in a Lung Cancer Screening Cohort. J Cardiovasc Dev Dis 2024; 11:16. [PMID: 38248886 PMCID: PMC10816916 DOI: 10.3390/jcdd11010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50-79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.
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Affiliation(s)
- Piotr Kasprzyk
- First Department of Cardiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
| | - Aleksandra Undrunas
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
| | - Katarzyna Dziadziuszko
- II Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.D.); (E.S.)
| | - Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland (W.R.)
| | - Krzysztof Kuziemski
- Department of Allergology and Pneumonology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Edyta Szurowska
- II Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (K.D.); (E.S.)
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland (W.R.)
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.U.); (T.Z.)
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Gao Q, Li L, Bai J, Fan L, Tan J, Wu S, Cai J. Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults. Chin Med J (Engl) 2024; 137:63-72. [PMID: 37319412 PMCID: PMC10766249 DOI: 10.1097/cm9.0000000000002669] [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: 08/06/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population. METHODS Participants with stage 1 hypertension ( n = 69,509) or normal BP ( n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis. RESULTS During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13-1.25) for primary outcome, 1.24 (95% CI, 1.05-1.46) for MI, 1.45 (95% CI, 1.33-1.59) for stroke, and 1.11 (95% CI, 1.04-1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85-0.96). CONCLUSIONS Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.
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Affiliation(s)
- Qiannan Gao
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Liuxin Li
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jingjing Bai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Luyun Fan
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Jiangshan Tan
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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Okur NÜ, Çağlar EŞ, Kaynak MS, Diril M, Özcan S, Karasulu HY. Enhancing Oral Bioavailability of Domperidone Maleate: Formulation, In vitro Permeability Evaluation In-caco-2 Cell Monolayers and In situ Rat Intestinal Permeability Studies. Curr Drug Deliv 2024; 21:1010-1023. [PMID: 36786136 PMCID: PMC11092562 DOI: 10.2174/1567201820666230214091509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/03/2023] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The domperidone maleate, a lipophilic agent classified as a Biopharmaceutical Classification System Class II substance with weak water solubility. Self- Emulsifying Drug Delivery System is a novel approach to improve water solubility and, ultimately bioavailability of drugs. OBJECTIVE This study aimed to develop and characterize new domperidone-loaded self-emulsifying drug delivery systems as an alternative formulation and to evaluate the permeability of domperidone-loaded self-emulsifying drug delivery systems by using Caco-2 cells and via single-pass intestinal perfusion method. METHODS Three self-emulsifying drug delivery systems were prepared and characterized in terms of pH, viscosity, droplet size, zeta potential, polydispersity index, conductivity, etc. Each formulation underwent 10, 100, 200, and 500 times dilution in intestinal buffer pH 6.8 and stomach buffer pH 1.2, respectively. Female Sprague Dawley rats were employed for in situ single-pass intestinal perfusion investigations. RESULTS Results of the study revealed that the ideal self-emulsifying drug delivery systems formulation showed narrow droplet size, ideal zeta potential, and no conductivity. Additionally, as compared to the control groups, the optimum formulation had better apparent permeability (12.74 ± 0.02×10-4) from Caco-2 cell monolayer permeability experiments. The study also revealed greater Peff values (2.122 ± 0.892×10-4 cm/s) for the optimal formulation from in situ intestinal perfusion analyses in comparison to control groups (Domperidone; 0.802 ± 0.418×10-4 cm/s). CONCLUSION To conclude, prepared formulations can be a promising way of oral administration of Biopharmaceutical Classification System Class II drugs.
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Affiliation(s)
- Neslihan Üstündağ Okur
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Emre Şefik Çağlar
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Sinan Kaynak
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Anadolu University, Eskişehir, Turkey
| | - Mine Diril
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Ege University, Izmir, Turkey
| | - Saniye Özcan
- Department of Analytical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir, Turkey
| | - Hatice Yeşim Karasulu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Ege University, Izmir, Turkey
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Delolmo-Romero S, Correa-Rodríguez M, Sánchez-Martínez MC, Gil-Gutiérrez R, Ortego-Centeno N, Rueda-Medina B. Social Health and Its Influence on Metabolic Health Among a Rural Population: A Cross-Sectional Study. Clin Nurs Res 2024; 33:9-18. [PMID: 37382362 DOI: 10.1177/10547738231184935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) in a Spanish rural population and assess differences in prevalence according to loneliness level, social isolation, and social support. This is a cross-sectional study of 310 patients. MetS was defined by National Cholesterol Education Program-Third Adult Treatment Panel. The UCLA (University of California, Los Angeles) Loneliness Scale, Multidimensional Scale of Social Support, and Lubben Social Network Scale were used to assess loneliness, perceived social support, and social isolation. Almost half of the participants fulfilled MetS diagnosis criteria. Subjects with MetS showed significantly higher levels of loneliness, less social support, and greater social isolation. Systolic blood pressure was significantly higher in socially isolated rural adults. Environmental factors may play a key role in the prevalence of MetS, so specific screening and prevention programs could help health professionals prevent the increasing rates of MetS in rural populations under these socially specific conditions of vulnerability.
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Affiliation(s)
- Sara Delolmo-Romero
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
| | - María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
| | | | - Rocío Gil-Gutiérrez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
| | - Norberto Ortego-Centeno
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Department of Medicine, Faculty of Medicine, University of Granada, Spain
| | - Blanca Rueda-Medina
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
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Tao Z, Qu Q, Li J, Li X. Factors influencing blood pressure variability in postmenopausal women: evidence from the China Health and Nutrition Survey. Clin Exp Hypertens 2023; 45:2181356. [PMID: 36842972 DOI: 10.1080/10641963.2023.2181356] [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: 02/28/2023]
Abstract
BACKGROUND The aim is to identify the factors influencing blood pressure variability in postmenopausal women based on the China Health and Nutrition Survey (CHNS). MATERIAL AND METHODS The data on postmenopausal women between 1993 and 2015 were extracted from the CHNS. Group-based trajectory modeling was used to analyze the development track of blood pressure changes, based on which the subjects were separately divided into two groups for systolic blood pressure (SBP) and diastolic blood pressure (DBP). Univariate and multivariate analyzes were performed to analyze the factors influencing SBP and DBP. RESULTS A total of 346 women were eligible for the study. Group-based trajectory modeling showed two different trajectories of blood pressure, including the low-level, slowly developed type and the high-level, rapidly developed, stable type of SBP, as well as the low-level, slowly developed type and the high-level, slowly developed type of DBP. In multivariate analysis, age (odds ratio [OR]: 1.118, 95% confidence interval [CI]: 1.082-1.156), body mass index (BMI) (OR: 2.239, 95%CI: 1.010-4.964), antihypertensive agents (OR: 7.293, 95%CI: 2.191-24.275), hip circumference (OR: 1.069, 95%CI: 1.014-1.128) and marital status (OR: 3.103, 95%CI: 1.028-9.361) were found to be the significant factors influencing SBP; age (OR: 1.067, 95%CI: 1.039-1.096), alcohol consumption (OR: 2.741, 95%CI: 1.169-6.429), antihypertensive agents (OR: 4.577, 95%CI: 1.553-13.492), hip circumference (OR: 1.093, 95%CI: 1.049-1.138), and marital status (OR: 3.615, 95%CI: 1.228-10.644) were the predominant factors influencing DBP. CONCLUSIONS In postmenopausal women, age, BMI, antihypertensive agents, hip circumference, and marital status are associated with SBP changes, while age, alcohol consumption, antihypertensive agents, hip circumference, and marital status with DBP variability. MESH KEYWORDS postmenopausal women, blood pressure, development track, influencing factors, CHNS.
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Affiliation(s)
- Zhonge Tao
- Department of Gynecology, Tianjin First Center Hospital, Tianjin, P.R. China
| | - Quanxin Qu
- Department of Gynecology, Tianjin First Center Hospital, Tianjin, P.R. China
| | - Jing Li
- Department of Gynecology, Tianjin First Center Hospital, Tianjin, P.R. China
| | - Xiaolin Li
- Department of Gynecology, Tianjin First Center Hospital, Tianjin, P.R. China
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Khan I, Berge CA, Eskerud I, Larsen TH, Pedersen ER, Lønnebakken MT. Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease. IJC HEART & VASCULATURE 2023; 49:101240. [PMID: 38173787 PMCID: PMC10761305 DOI: 10.1016/j.ijcha.2023.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 01/05/2024]
Abstract
Background Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Whether increased EAT volume is associated with coronary plaque vulnerability and demand myocardial ischemia in patients with non-obstructive coronary artery disease (CAD) is less explored. Methods In 125 patients (median age 63[58, 69] years and 58% women) with chest pain and non-obstructive CAD, EAT volume was quantified on non-contrast cardiac CT images. EAT volume in the highest tertile (>125 ml) was defined as high EAT volume. Total coronary plaque volume and plaque vulnerability were quantified by coronary CT angiography (CCTA). Demand myocardial ischemia was detected by contrast dobutamine stress echocardiography. Results High EAT volume was more common in men and associated with higher BMI, hypertension, increased left ventricular mass index (LVMi), C-reactive protein (CRP) and positive remodelling (all p < 0.05). There was no difference in age, coronary calcium score, total and non-calcified plaque volume or presence of demand myocardial ischemia between groups (all p ≥ 0.34). In a multivariable model, obesity (p = 0.006), hypertension (p = 0.007) and LVMi (p = 0.016) were independently associated with high EAT volume. Including plaque vulnerability in an alternative model, positive remodelling (p = 0.038) was independently associated with high EAT volume. Conclusion In non-obstructive CAD, high EAT volume was associated with cardiometabolic risk factors, inflammation and plaque vulnerability, while there was no association with demand myocardial ischemia or coronary plaque volume. Following our results, the role of EAT volume as a biomarker in non-obstructive CAD remains unclear.
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Affiliation(s)
- Ingela Khan
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Caroline A. Berge
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
| | - Ingeborg Eskerud
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
- Institute of Biomedicine, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway
| | - Eva R. Pedersen
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
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Zhang X, Zhao Q, Wang T, Long Q, Sun Y, Jiao L, Gullerova M. DNA damage response, a double-edged sword for vascular aging. Ageing Res Rev 2023; 92:102137. [PMID: 38007046 DOI: 10.1016/j.arr.2023.102137] [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: 04/14/2023] [Revised: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Vascular aging is a major risk factor for age-related cardiovascular diseases, which have high rates of morbidity and mortality. It is characterized by changes in the blood vessels, such as macroscopically increased vascular diameter and intima-medial thickness, chronic inflammation, vascular calcification, arterial stiffening, and atherosclerosis. DNA damage and the subsequent various DNA damage response (DDR) pathways are important causative factors of vascular aging. Deficient DDR, which may result in the accumulation of unrepaired damaged DNA or mutations, can lead to vascular aging. On the other hand, over-activation of some DDR proteins, such as poly (ADP ribose) polymerase (PARP) and ataxia telangiectasia mutated (ATM), also can enhance the process of vascular aging, suggesting that DDR can have both positive and negative effects on vascular aging. Despite the evidence reviewed in this paper, the role of DDR in vascular aging and potential therapeutic targets remain poorly understood and require further investigation.
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Affiliation(s)
- Xiao Zhang
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; China International Neuroscience Institute (China-INI), Beijing 100053, China
| | - Qing Zhao
- M.D. Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; China International Neuroscience Institute (China-INI), Beijing 100053, China
| | - Qilin Long
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom
| | - Yixin Sun
- First Hospital, Peking University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; China International Neuroscience Institute (China-INI), Beijing 100053, China; Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
| | - Monika Gullerova
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom.
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Du M, Wang Y, Hu G, Wang D, Man Z, Chu C, Liao Y, Chen C, Ma Q, Yan Y, Jia H, Sun Y, Zhang X, Luo W, Chang M, Mu J. Association of high-normal albuminuria and vascular aging: Hanzhong adolescent hypertension study. J Clin Hypertens (Greenwich) 2023; 25:1096-1104. [PMID: 37966821 PMCID: PMC10710548 DOI: 10.1111/jch.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
Normoalbuminuria has recently been associated with increased cardiovascular risk, and vascular aging is proposed as the early manifestation of cardiovascular disease. Here, the authors aimed to examine the association of high-normal albuminuria and vascular aging in a Chinese cohort. From our previously established cohort, 1942 participants with estimated glomerular filtration rate ≥60 mL/min/1.73 m2 or urinary albumin-creatinine ratio (UACR) <30 mg/g were enrolled. Brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s and/or carotid intima-media thickness (CIMT) ≥0.9 mm were used as indicators of vascular aging. Multivariate regression and receiving operating characteristic curve analysis were performed to examine the relationship between continuous and categorical UACR with vascular aging. We found an average UACR value of 8.08 (5.45-12.52) mg/g in this study. BaPWV and CIMT demonstrated positive correlations with lg-UACR (p < .05). High-normal albuminuria (10-29 mg/g) was significantly associated with the presence of vascular aging after adjusting for multiple cardiovascular confounders (OR = 1.540, 95% CI = 1.203-1.972, p = .001). In addition, a lg-UACR cutoff point of 0.918 lg(mg/g) (equal to UACR of 8.285 mg/g) was significantly associated with the presence of vascular aging and its components for all participants and those without hypertension or diabetes and without medication (p < .05). Briefly, high-normal albuminuria was significantly associated with vascular aging in this sample of Chinese adults. These findings implied the warning of elevated UACR even within normal range in clinical practice and the importance of UACR screening in normoalbuminuria for early detection and prevention of cardiovascular disease in otherwise healthy participants.
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Affiliation(s)
- Ming‐Fei Du
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yang Wang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Gui‐Lin Hu
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Dan Wang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Zi‐Yue Man
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Chao Chu
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yue‐Yuan Liao
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Chen Chen
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Qiong Ma
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yu Yan
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Hao Jia
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Yue Sun
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Xi Zhang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
| | - Wen‐Jing Luo
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ming‐Ke Chang
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Jian‐Jun Mu
- Department of Cardiovascular MedicineFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Key Laboratory of Molecular Cardiology of Shaanxi ProvinceXi'anChina
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University)Ministry of EducationXi'anChina
- International Joint Research Center for Cardiovascular Precision Medicine of Shaanxi ProvinceXi'anChina
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Stoner L, Higgins S, Paterson C. The 24-h activity cycle and cardiovascular outcomes: establishing biological plausibility using arterial stiffness as an intermediate outcome. Am J Physiol Heart Circ Physiol 2023; 325:H1243-H1263. [PMID: 37737729 DOI: 10.1152/ajpheart.00258.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
This review proposes a biologically plausible working model for the relationship between the 24-h activity cycle (24-HAC) and cardiovascular disease. The 24-HAC encompasses moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior (SB), and sleep. MVPA confers the greatest relative cardioprotective effect, when considering MVPA represents just 2% of the day if physical activity guidelines (30 min/day) are met. While we have well-established guidelines for MVPA, those for the remaining activity behaviors are vague. The vague guidelines are attributable to our limited mechanistic understanding of the independent and additive effects of these behaviors on the cardiovascular system. Our proposed biological model places arterial stiffness, a measure of vascular aging, as the key intermediate outcome. Starting with prolonged exposure to SB or static standing, we propose that the reported transient increases in arterial stiffness are driven by a cascade of negative hemodynamic effects following venous pooling. The subsequent autonomic, metabolic, and hormonal changes further impair vascular function. Vascular dysfunction can be offset by using mechanistic-informed interruption strategies and by engaging in protective behaviors throughout the day. Physical activity, especially MVPA, can confer protection by chronically improving endothelial function and associated protective mechanisms. Conversely, poor sleep, especially in duration and quality, negatively affects hormonal, metabolic, autonomic, and hemodynamic variables that can confound the physiological responses to next-day activity behaviors. Our hope is that the proposed biologically plausible working model will assist in furthering our understanding of the effects of these complex, interrelated activity behaviors on the cardiovascular system.
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Affiliation(s)
- Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Simon Higgins
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Craig Paterson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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Yan X, Gong J, Wang Z, Wang F, Qi C. Association of lipoprotein(a) with left ventricular hypertrophy assessed by electrocardiogram in adults: a large cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1260050. [PMID: 38098866 PMCID: PMC10720892 DOI: 10.3389/fendo.2023.1260050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023] Open
Abstract
Background and aims Increasing evidence supports a causal relationship between lipoprotein(a) [Lp(a)] and atherosclerotic cardiovascular disease, yet its association with left ventricular hypertrophy (LVH) assessed by electrocardiogram (ECG) remains unknown. The aim of this study was to explore the relationship between Lp(a) and LVH assessed by ECG in general population. Methods and results In this cross-sectional study, we screened 4,052 adults from the participants of the third National Health and Nutrition Examination Survey for analysis. Lp(a) was regarded as an exposure variable. LVH defined by the left ventricular mass index estimated from ECG was considered as an outcome variable. Multivariate logistic regression and restricted cubic spline (RCS) were used to assess the relationship between Lp(a) and LVH. Individuals with LVH had higher Lp(a) compared to individuals without LVH (P< 0.001). In the fully adjusted model, Lp(a) was strongly associated with LVH when as a continuous variable (per 1-unit increment, OR: 1.366, 95% CI: 1.043-1.789, P = 0.024), and higher Lp(a) remained independently associated with a higher risk of LVH when participants were divided into four groups according to quartiles of Lp(a) (Q4 vs Q1, OR: 1.508, 95% CI: 1.185-1.918, P = 0.001). And in subgroup analysis, this association remained significant among participants< 60 years, ≥ 60 years, male, with body mass index< 30 kg/m2, with hypertension and without diabetes (P< 0.05). In addition, we did not observe a nonlinear and threshold effect of Lp(a) with LVH in the RCS analysis (P for nonlinearity = 0.113). Conclusion Lp(a) was closely associated with LVH assessed by ECG in general population.
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Affiliation(s)
- Xuejiao Yan
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jing Gong
- Department of Geriatrics, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenwei Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Wang
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Chunjian Qi
- Medical Research Center, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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Zhao J, Wang M, Li N, Luo Q, Yao L, Cai X, Yue N, Ren Y, Wang G. Development and Validation of a Novel Model for Predicting Coronary Heart Disease in Snoring Hypertensive Patients with Hyperhomocysteinemia. Int Heart J 2023; 64:970-978. [PMID: 37967976 DOI: 10.1536/ihj.23-384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Hypertensive patients with snoring and elevated plasma homocysteine levels are common. When these factors are combined, the risk of coronary heart disease (CHD) is high. Herein, we developed and validated an easy-to-use nomogram to predict high-risk CHD in snoring hypertensive patients with elevated plasma homocysteine.Snoring patients (n = 1,962) with hyperhomocysteinemia and hypertension were divided into training (n = 1,373, 70%) and validation (n = 589, 30%) sets. We extracted CHD predictors using multivariate Cox regression analysis, then constructed a nomogram model. Internal validation using 1,000 bootstrap resampling was performed to assess the consistency and discrimination of the predictive model using the area under the receiver operating characteristic curve (AUC) and calibration plots.We constructed a nomogram model with the extracted predictors, including age, waist-height ratio, smoking, and low-density lipoprotein cholesterol levels. The AUCs of the training and validation cohorts at 80 months were 0.735 (95% CI: 0.678-0.792) and 0.646 (95% CI: 0.547-0.746), respectively. The consistency between the observed CHD survival and the probability of CHD survival in the training and validation sets was acceptable based on the calibration plots. A total of more than 151 points in the nomogram can be used in the identification of high-risk patients for CHD among snoring hypertensive patients with elevated plasma homocysteine.We developed a CHD risk prediction model for snoring hypertension patients with hyperhomocysteinemia. Our findings provide a useful clinical tool for the rapid identification of high-risk CHD at an early stage.
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Affiliation(s)
- Jianwen Zhao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Menghui Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Qin Luo
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Ling Yao
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Xintian Cai
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Na Yue
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Yingli Ren
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
| | - Guoliang Wang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region
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Bordier V, Teysseire F, Drewe J, Madörin P, Bieri O, Schmidt-Trucksäss A, Hanssen H, Beglinger C, Meyer-Gerspach AC, Wölnerhanssen BK. Effects of a 5-week intake of erythritol and xylitol on vascular function, abdominal fat and glucose tolerance in humans with obesity: a pilot trial. BMJ Nutr Prev Health 2023; 6:264-272. [PMID: 38618550 PMCID: PMC11009538 DOI: 10.1136/bmjnph-2023-000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/25/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Previous studies in humans and rats suggest that erythritol might positively affect vascular function, xylitol decrease visceral fat mass and both substances improve glycaemic control. The objective of this study was to investigate the impact of a 5-week intake of erythritol and xylitol on vascular function, abdominal fat and blood lipids, glucose tolerance, uric acid, hepatic enzymes, creatinine, gastrointestinal tolerance and dietary patterns in humans with obesity. Methods Forty-two participants were randomised to consume either 36 g erythritol, 24 g xylitol, or no substance daily for 5 weeks. Before and after the intervention, arterial stiffness (pulse wave velocity, arteriolar-to-venular diameter ratio), abdominal fat (liver volume, liver fat percentage, visceral and subcutaneous adipose tissue, blood lipids), glucose tolerance (glucose and insulin concentrations), uric acid, hepatic enzymes, creatinine, gastrointestinal tolerance and dietary patterns were assessed. Data were analysed by linear mixed effect model. Results The 5-week intake of erythritol and xylitol showed no statistically significant effect on vascular function. Neither the time nor the treatment effects were significantly different for pulse wave velocity (time effect: p=0.079, Cohen's D (95% CI) -0.14 (-0.54-0.25); treatment effect: p=0.792, Cohen's D (95% CI) control versus xylitol: -0.11 (-0.61-0.35), control versus erythritol: 0.05 (0.44-0.54), erythritol versus xylitol: 0.07 (-0.41-0.54)). There was no statistically significant effect on abdominal fat, glucose tolerance, uric acid, hepatic enzymes and creatinine. Gastrointestinal tolerance was good except for a few diarrhoea-related symptoms. Participants of all groups reduced their consumption of sweetened beverages and sweets compared with preintervention. Conclusions The 5-week intake of erythritol and xylitol showed no statistically significant effects on vascular function, abdominal fat, or glucose tolerance in people with obesity. Clinical trial registration NCT02821923.
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Affiliation(s)
- Valentine Bordier
- Metabolic Research Group, St. Clara Research Ltd, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Fabienne Teysseire
- Metabolic Research Group, St. Clara Research Ltd, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jürgen Drewe
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland
| | - Philipp Madörin
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Oliver Bieri
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Henner Hanssen
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christoph Beglinger
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne Christin Meyer-Gerspach
- Metabolic Research Group, St. Clara Research Ltd, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Bettina K Wölnerhanssen
- Metabolic Research Group, St. Clara Research Ltd, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University of Basel, Basel, Switzerland
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Moreira-Rosário A, Ismael S, Barreiros-Mota I, Morais J, Rodrigues C, Castela I, Mendes IC, Soares MI, da Costa LS, Oliveira CB, Henriques T, Pinto P, Pita D, de Oliveira CM, Maciel J, Serafim T, Araújo J, Rocha JC, Pestana D, Silvestre MP, Marques C, Faria A, Polonia J, Calhau C. Empowerment-based nutrition interventions on blood pressure: a randomized comparative effectiveness trial. Front Public Health 2023; 11:1277355. [PMID: 38026295 PMCID: PMC10679749 DOI: 10.3389/fpubh.2023.1277355] [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: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Empowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program. Methods Three hundred and eleven adults (median age of 44 years, IQR 34-54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na+) and potassium (K+) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference. Results There were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of -2.5 mm Hg in SBP (95% CI, -4.1 to -0.8) and - 2.7 mm Hg in DBP (95% CI, -3.8 to -1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was -2.1 mm Hg in SBP (95% CI, -3.7 to -0.5) and - 2.3 mm Hg in DBP (95% CI, -3.4 to -1.1). This effect increases in subjects with high-normal BP or hypertension [SBP - 7.9 mm Hg (95% CI, -12.5 to -3.3); DBP - 7.3 mm Hg (95% CI, -10.2 to -4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of -1.5 mm Hg (95% CI, -2.6 to -0.4) in ITT analysis and - 1.4 mm Hg (95% CI, -2.4 to -0.3) in CC analysis, relative to baseline]. Overall, improvements in Na+/K+ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na+/K+ ratio. Conclusion Salt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.
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Affiliation(s)
- André Moreira-Rosário
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Shámila Ismael
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Barreiros-Mota
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Juliana Morais
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Catarina Rodrigues
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inês Castela
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | | | | | - Patrícia Pinto
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Débora Pita
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | | | - Janaína Maciel
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Thaina Serafim
- CUF Academic and Research Medical Center, Lisbon, Portugal
| | - João Araújo
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Júlio César Rocha
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Diogo Pestana
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marta P. Silvestre
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Cláudia Marques
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Faria
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Polonia
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
- Hypertension and Cardiovascular Risk Unit, Unidade Local de Saúde Matosinhos, Matosinhos, Portugal
| | - Conceição Calhau
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- CINTESIS@RISE, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
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Huang Y, Wang Y, Xiao Z, Yao S, Tang Y, Zhou L, Wang Q, Xie Y, Zhang L, Zhou Y, Lu Y, Zhu W, Chen M. The association between metabolic dysfunction-associated steatotic liver disease, cardiovascular and cerebrovascular diseases and the thickness of carotid plaque. BMC Cardiovasc Disord 2023; 23:554. [PMID: 37951879 PMCID: PMC10640732 DOI: 10.1186/s12872-023-03580-6] [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: 08/27/2022] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and atherosclerosis has been controversial, which has become a hit of recent research. The study aimed to explore the association between MASLD, cardiovascular and cerebrovascular diseases (CCVD), and the thickness of carotid plaque which was assessed by ultrasound. METHODS From September 2018 to June 2019, 3543 patients were enrolled. We asked participants to complete questionnaires to obtain information. All patients underwent liver ultrasound and bilateral carotid ultrasound to obtain carotid intima-media thickness (IMT) and maximum carotid plaque thickness (CPT). Hepatic steatosis was quantified during examination according to Hamaguchi's ultrasonographic score, from 0 to 6 points. A score < 2 was defined as without fatty liver, and a score ≥ 2 was defined as fatty liver. Information about blood lipids was collected based on the medical records. RESULTS We found common risk factors for CCVD events, MASLD, and atherosclerosis. There was a significant correlation between MASLD and carotid plaque, but not with CPT. No association was found between MASLD and CCVD events. CPT and IMT were thicker in CCVD patients than in non-CCVD patients. No significant difference was found between IMT and CPT in MASLD patients and non-MASLD patients. CCVD was independently and consistently associated with higher IMT, and free fatty acid (FFA). CONCLUSIONS According to our results, we recommend carotid ultrasound examination of the patients when FFA is increased, regardless of the presence of risk factors and MASLD. Due to the distribution of CPT of both CCVD and MASLD patients in the CPT 2-4 mm group, contrast-enhanced ultrasound is necessary to assess the vulnerability of the plaque when CPT ≥ 2 mm. Timely treatment of vulnerable plaques may reduce the incidence of future CCVD events.
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Affiliation(s)
- Yunqian Huang
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqun Wang
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengguang Xiao
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengqi Yao
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhua Tang
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linjun Zhou
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Wang
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanchun Xie
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixia Zhang
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Lu
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqian Zhu
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Man Chen
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Yılmaz BK, Baykan A, Kardaş F, Kendirci M. Evaluation of the effect of obesity, dietary glycemic index and metabolic profiles on the cardiovascular risk in children with classical phenylketonuria. Mol Genet Metab 2023; 140:107677. [PMID: 37544048 DOI: 10.1016/j.ymgme.2023.107677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To compare the glycemic index(GI),obesity,echocardiographic,and arterial stiffness measurements with the healthy control group to evaluate the cardiovascular risk of pediatric classical phenylketonuria(PKU). METHODS The study was a prospective observational,involving 104 pediatric volunteers between 2019 and 2020.Two groups were formed:the PKU patient group and the healthy control group.These two groups were further divided into three subgroups:obese,overweight,and normal weight.The patients' anthropometric measurements,body fat analysis,biochemical analysis, GI and glycemic load(GL),arterial stiffness measurements,and echocardiographic findings were recorded. RESULTS The PKU patient group's glucose,total cholesterol,LDL,and HDL values were significantly lower than the healthy control group(p = 0.010 for glucose and p = 0.001 for total cholesterol,LDL and HDL).Triglyceride levels were higher in the PKU patient group than in the healthy controls(109.6 vs. 76.7 mg/dl,p = 0.001). GI and GL were significantly lower in the PKU patient group than in the healthy control group(GI 453 vs. 392.9,p = 0.017 and GL 101.1 vs. 85.5,p = 0.036).Left ventricular mass(LVM)-z-score and LVM index were significantly higher in the PKU group than in the healthy control group(LVM z-score 0.9 vs. 0.5,p = 0.014 and LVM index 38.9 vs. 32.7 g/m2.7,p = 0.001). A moderately statistically significant positive correlation was found between the mean phenylalanine(phe) value and pulse wave velocity(PWV) among the PKU patient groups(R: 0.477,p < 0.001).A moderately statistically significant positive correlation was also found between waist circumference and PWV in the PKU patient group(R:0.541, p < 0.001). CONCLUSIONS Our study found that close follow-up of phe levels and PWV is more critical than obesity, GI, and GL in the cardiovascular evaluation of classical PKU patients.A large number of multicenter pediatric studies are needed in this area.
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Affiliation(s)
- Banu Kadıoğlu Yılmaz
- Department of Pediatric Metabolism, Konya City Hospital, University of Health Sciences, Konya, Turkey.
| | - Ali Baykan
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - Fatih Kardaş
- Department of Pediatric Metabolism, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - Mustafa Kendirci
- Department of Pediatric Endocrinology and Metabolism, Bağcılar Medipol Mega University Hospital, İstanbul, Turkey
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Nuhn EM, Wallbach M, Elger F, Koziolek MJ. Successful baroreflex activation therapy in a case of therapy-resistant renovascular hypertension. Clin Res Cardiol 2023; 112:1710-1712. [PMID: 36547755 PMCID: PMC10584732 DOI: 10.1007/s00392-022-02137-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Eva Maria Nuhn
- Department of Nephrology and Rheumatology, University Medical Centre, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, University Medical Centre, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 30, 37075, Göttingen, Germany
| | - Florian Elger
- Department of Cardiac, Thoracic and Vascular Surgery, University Medical Centre, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Michael Johann Koziolek
- Department of Nephrology and Rheumatology, University Medical Centre, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 30, 37075, Göttingen, Germany.
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Vogiatzi G, Lazaros G, Oikonomou E, Kostakis M, Kypritidou Z, Christoforatou E, Theofilis P, Argyraki A, Thomaidis N, Tousoulis D. Impact of drinking water hardness on carotid atherosclerosis and arterial stiffness: Insights from the "Corinthia" study. Hellenic J Cardiol 2023; 74:32-38. [PMID: 37121519 DOI: 10.1016/j.hjc.2023.04.006] [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: 12/01/2022] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Several investigations have highlighted the role of water quality in cardiovascular health. In the present study, we have investigated the effects of drinking water hardness on atherosclerotic burden in carotid arteries and arterial stiffness. METHODS "Corinthia" study was conducted in the homonym region in Greece from 2015 to 2017. Carotid atherosclerosis was assessed by intima-media thickness (IMT). Pulse wave velocity (PWV) was used to evaluate arterial stiffness. Tap-water samples were collected from the study area and analyzed for a variety of elements, as well as pH and total hardness. RESULTS Individuals living in lower drinking water hardness areas (Area 1) versus individuals living in higher water hardness areas (Area 2) had lower max IMT (p = 0.004) and were less susceptible to carotid plaque formation (p = 0.004). Interestingly, individuals over 65 years from Area 1 had lower mean IMT, max IMT, and less plaque formation (p < 0.001 for all). The mean value of PWV in the overall study population was below the 10 m/s cutoff, which defines arterial stiffness (9.15 ± 2.79 m/s). Nevertheless, a marginally higher rate of vascular stiffening was noted in Area 2 vs. Area 1 (16.2% and 12.8%, respectively, p = 0.048). CONCLUSIONS According to this cross-sectional study's findings, a positive association between extra hard water and carotid atherosclerotic burden was found. However, the association with arterial stiffness is unclear and should be investigated further.
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Affiliation(s)
- Georgia Vogiatzi
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - George Lazaros
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Oikonomou
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Marios Kostakis
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Zacharenia Kypritidou
- Section of Economic Geology and Geochemistry, Department of Geology and Geoenvironment, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Christoforatou
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Theofilis
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ariadne Argyraki
- Section of Economic Geology and Geochemistry, Department of Geology and Geoenvironment, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Thomaidis
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Luque del Moral R, Gastelurrutia MA, Martinez-Martinez F, Jacomé JA, Dago A, Suarez B, Fikri-Benbrahim N, Martí M, Nuñez C, Sierra-Alarcón S, Fernandez-Gomez FJ. Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study. J Pers Med 2023; 13:1484. [PMID: 37888095 PMCID: PMC10608270 DOI: 10.3390/jpm13101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically. METHODS A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy. RESULTS The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems. CONCLUSIONS Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.
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Affiliation(s)
- Raúl Luque del Moral
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
- Council of Official Associations of Pharmaceutics of Castilla-La Mancha, 45005 Toledo, Spain
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
| | - Miguel A. Gastelurrutia
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Julio A. Jacomé
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Ana Dago
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Blanca Suarez
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
- Council of Official Associations of Pharmaceutics of Castilla-La Mancha, 45005 Toledo, Spain
| | - Narjis Fikri-Benbrahim
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Mercé Martí
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Cristina Nuñez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
| | - Sandra Sierra-Alarcón
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
| | - Francisco-José Fernandez-Gomez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
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Nagai M, Hoshide S, Kario K. Evening home blood pressure and pulse rate: age-specific associations with nocturia severity. J Hum Hypertens 2023; 37:913-918. [PMID: 36693950 DOI: 10.1038/s41371-023-00803-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/16/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
Previous studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology associated with pulse rate (PR) remains unclear. In the Japan Morning Surge-Home Blood Pressure Study, a self-administered nocturia questionnaire and evening home blood pressure (BP) and PR measurements (taken on a mean of 11.2 days) were performed on 4310 patients with one or more cardiovascular risk factors (mean: 64.9 years old; 47% male). According to the number of nighttime voids, the study population was divided into three groups (no voids: n = 2382; 1 void: n = 847; ≥2 voids per night: n = 1082). In the multinomial logistic regression analysis adjusted for confounders, diuretic use (OR, 1.23; 95%CI, 1.01-1.50; p < 0.05) was significantly associated with one nocturnal void, whereas evening home systolic BP (SBP) (OR per 1 SD, 1.14; 95%CI, 1.05-1.24; p < 0.01) and evening home PR (OR per 1 SD, 1.12; 95%CI: 1.02-1.24; p < 0.05) were significantly associated with multiple nocturnal voids. In the younger group (<65 years), only evening home PR was significantly related to multiple nighttime voids (p < 0.01), whereas in the older group (≥65 years), only evening home SBP was significantly related to multiple nighttime voids (p = 0.02). In this study, both higher evening home PR and higher evening home SBP were associated with multiple nighttime voids, with the former playing a greater role in the younger participants, and the latter more often associating the older group. An age-stratified approach to reduce the burden of BP or PR might be important to improve sleep quality.
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Affiliation(s)
- Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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