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Rijal A, Adhikari TB, Dhakal S, Maagaard M, Piri R, Nielsen EE, Neupane D, Jakobsen JC, Olsen MH. Effects of adding exercise to usual care on blood pressure in patients with hypertension, type 2 diabetes, or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. J Hypertens 2024; 42:10-22. [PMID: 37796224 DOI: 10.1097/hjh.0000000000003589] [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
INTRODUCTION Exercise is the most recommended lifestyle intervention in managing hypertension, type 2 diabetes, and/or cardiovascular disease; however, evidence in lowering blood pressure is still inconsistent and often underpowered. METHOD We conducted a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials adding any form of trialist defined exercise to usual care versus usual care and its effect on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in participants with hypertension, type 2 diabetes, or cardiovascular disease searched in different databases from inception to July 2020. Our methodology was based on PRISMA and Cochrane Risk of Bias-version1. Five independent reviewers extracted data and assessed risk of bias in pairs. RESULTS Two hundred sixty-nine trials randomizing 15 023 participants reported our predefined outcomes. The majority of exercise reported in the review was dynamic aerobic exercise (61%), dynamic resistance (11%), and combined aerobic and resistance exercise (15%). The trials included participants with hypertension (33%), type 2 diabetes (28%), or cardiovascular disease (37%). Meta-analyses and trial sequential analyses reported that adding exercise to usual care reduced SBP [mean difference (MD) MD: -4.1 mmHg; 95% confidence interval (95% CI) -4.99 to -3.14; P < 0.01; I2 = 95.3%] and DBP (MD: -2.6 mmHg; 95% CI -3.22 to -2.07, P < 0.01; I2 = 94%). Test of interaction showed that the reduction of SBP and DBP was almost two times higher among trials from low-and middle-income countries (LMICs) as compared to high-income countries (HICs). The exercise induced SBP reduction was also higher among participants with hypertension and type 2 diabetes compared to participants with cardiovascular disease. The very low certainty of evidence warrants a cautious interpretation of the present results. CONCLUSION Adding any type of exercise to usual care may be a potential complementary strategy for optimal management of blood pressure for patients with hypertension, type 2 diabetes, or cardiovascular disease, especially, in LMICs.PROSPERO registration number CRD42019142313.
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Affiliation(s)
- Anupa Rijal
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark
| | - Tara Ballav Adhikari
- Department of Public Health, Research Unit for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | - Sarmila Dhakal
- Center for Research on Environment, Health and Population Activities (CREPHA), Kusunti, Lalitpur, Nepal
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koge
| | - Reza Piri
- Department of Clinical Research, University of Southern Denmark
- Department of Nuclear Medicine, Odense University Hospital
- Department of Cardiology, Odense University Hospital, Odense Denmark
| | - Emil Eik Nielsen
- Department of Regional Health Research, University of Southern Denmark
- Department of Cardiology, Odense University Hospital, Odense Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University Baltimore, Mayland, USA
| | - Janus Christian Jakobsen
- Department of Regional Health Research, University of Southern Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark
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Krishnamoorthy Y, Nagarajan R, Murali S. Effectiveness of multiple combined lifestyle interventions in reducing blood pressure among patients with prehypertension and hypertension: a network meta-analysis. J Public Health (Oxf) 2022:6535708. [PMID: 35211753 DOI: 10.1093/pubmed/fdac027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Different combinations of lifestyle interventions have been studied with varying results on hypertension control. Hence, this review was done to compare multiple combined lifestyle intervention in reducing blood pressure (BP) among patients with prehypertension or hypertension. METHODS We conducted systematic search in the following databases: MEDLINE, PubMed Central, CENTRAL, ScienceDirect, Google Scholar from 1964 until November 2020. Estimates of comparative intervention effect from network meta-analyses (random-effects model) were represented as mean difference (MD) with 95% confidence interval. RESULTS In total, 14 studies with 2451 participants were included. Almost all the studies had high risk of bias. Healthy diet (HD) and physical activity (PA) combination showed highest mean reduction in systolic BP (-9.88 mmHg) and diastolic BP (-6.28 mmHg) followed by HD + PA + smoking cessation + alcohol restriction combination (systolic BP = -6.58 mmHg, diastolic BP = -4.09 mmHg) compared with usual care. HD and PA combination had the highest probability of being the best intervention (82.8% for SBP and 81.7% for DBP). CONCLUSION We found that HD and PA are the most important combination of lifestyle modifications for prehypertensive and hypertensive patients. Hence, a coordinated approach is required from the clinicians by integrating beneficial effect of these modifications through education, counselling and support. SUMMARY BOX
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Affiliation(s)
| | - Ramya Nagarajan
- Scientist-B, Indian Council of Medical Research- National Institute of Epidemiology, Chennai 600077, India
| | - Sharan Murali
- Scientist-B, Indian Council of Medical Research- National Institute of Epidemiology, Chennai 600077, India
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Collins D, Inglin L, Laatikainen T, Shoismatuloeva M, Sultonova D, Jonova B, Faromuzova K, Abdullaeva M, Otambekova M, Farrington JL. Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan. BMC Health Serv Res 2021; 21:472. [PMID: 34006266 PMCID: PMC8132349 DOI: 10.1186/s12913-021-06490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary healthcare in Tajikistan. Methods The study protocol was published a priori. A pragmatic, sequential, mixed methods explanatory design was piloted. The quantitative strand is reported here. All primary health care facilities that met inclusion criteria in Shahrinav district were included and computer randomized to either usual care or intervention. The intervention consisted of: adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes, a two-day training of doctors and nurses, supportive supervision visits, clinical decision support tools, and quality improvement support. Data were collected from paper-based clinical records at baseline and 12 months follow-up. The primary outcome was blood pressure control among patients with hypertension, in addition to several secondary process indicators along the care pathway. Age and sex adjusted logistic regression models were used for intervention and control clinics to determine changes between baseline and follow-up and to assess interactions between allocation group and time. For continuous variables, multivariate linear regression models were used. Results 19 primary health care centres were included of which ten were randomized to intervention and nine to control. 120 clinicians received training. The records of all registered hypertensive patients were reviewed at baseline and follow-up for a total of 1,085 patient records. Blood pressure control significantly improved in the intervention clinics (OR 3.556, 95 % CI 2.219, 5.696) but not the control clinics (OR 0.644, 95 % CI 0.370, 1.121) (p < 0.001 for interaction). Smoking assessment, statin prescribing, triple therapy prescribing, and blood pressure measurement significantly improved in intervention clinics relative to control, whereas cholesterol and glucose testing, and aspirin prescribing did not. Conclusions It is feasible to use routine, paper-based, clinical records to evaluate essential CVD interventions in primary health care in Tajikistan. Adapted WHO PEN/HEARTS guidelines in the context of a complex intervention significantly improved blood pressure control after 12 months.
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Affiliation(s)
| | - Laura Inglin
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint municipal authority for North Karelia Health and Social Services, Joensuu, Finland
| | | | - Dilorom Sultonova
- Service of State Supervision for Medical Activities and Social Protection of the Population of the Republic of Tajikistan, Dushanbe, Tajikistan
| | - Bunafsha Jonova
- Republican Clinical and Training Centre of Family Medicine, Dushanbe, Tajikistan
| | - Katoyon Faromuzova
- Department of Epidemiology and Health Economics of the Faculty of Medicine, Tajik State University, Dushanbe, Tajikistan.,Public Health, Faculty of Medicine, Social Hygiene and Health Organization, Tajik State University, Dushanbe, Tajikistan
| | | | | | - Jill L Farrington
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, Niebauer J, Tiberi M, Abreu A, Solberg EE, Pescatello L, Brguljan J, Coca A, Leeson P. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol 2021; 29:205-215. [PMID: 33758927 DOI: 10.1093/eurjpc/zwaa141] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
Treatment of hypertension and its complications remains a major ongoing health care challenge. Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of the population will have hypertension. Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality. Hence, current international guidelines on cardiovascular disease prevention provide generic advice to increase aerobic activity, but physiological responses differ with blood pressure (BP) level, and greater reductions in BP across a population may be achievable with more personalized advice. We performed a systematic review of meta-analyses to determine whether there was sufficient evidence for a scientific Consensus Document reporting how exercise prescription could be personalized for BP control. The document discusses the findings of 34 meta-analyses on BP-lowering effects of aerobic endurance training, dynamic resistance training as well as isometric resistance training in patients with hypertension, high-normal, and individuals with normal BP. As a main finding, there was sufficient evidence from the meta-review, based on the estimated range of exercise-induced BP reduction, the number of randomized controlled trials, and the quality score, to propose that type of exercise can be prescribed according to initial BP level, although considerable research gaps remain. Therefore, this evidence-based Consensus Document proposes further work to encourage and develop more frequent use of personalized exercise prescription to optimize lifestyle interventions for the prevention and treatment of hypertension.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Arne Deiseroth
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Nicolle Kränkel
- Charité, University Medicine Berlin, Department of Cardiology, Campus Benjamin-Franklin (CBF), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1 Pesaro, Italy
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Portugal.,Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa, Portugal
| | | | - Linda Pescatello
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, USA
| | - Jana Brguljan
- Universitiy Medical Centre Ljubljana, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic, University of Barcelona, Spain
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Bhandari B, Narasimhan P, Vaidya A, Jayasuriya R. Theory-based mobile phone text messaging intervention for blood pressure control (TEXT4BP) among hypertensive patients in Nepal: study protocol for a feasibility randomised controlled trial. BMJ Open 2020; 10:e040799. [PMID: 32873686 PMCID: PMC7467528 DOI: 10.1136/bmjopen-2020-040799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Uncontrolled blood pressure is one of the main risk factors for cardiovascular disease and death in Low-income and middle-income countries. Improvements to medication adherence and lifestyle changes can be assisted by using mobile phone text messaging interventions. This study aims to test the feasibility and acceptability of a text messaging intervention for blood pressure control '(TEXT4BP)', developed based on behavioural change theory to improve treatment adherence and lifestyle change among hypertensive patients in Nepal. METHODS AND ANALYSIS The TEXT4BP intervention will be tested using a two-arm parallel-group, unblinded, individually randomised controlled trial. This feasibility study would recruit 200 clinically diagnosed hypertensive patients aged 18-69 years, currently receiving blood pressure-lowering medication for more than 3 months, visiting a tertiary healthcare facility in Kathmandu, Nepal. A nested qualitative study will assess the acceptability of the short message service intervention. The intervention group will receive text messages containing information on hypertension, diet, medication and physical activity three times a week for 3 months. The control group will receive standard care. At baseline and 3 months, measures of medication adherence, salt intake, physical activity and blood pressure will be collected. Feasibility measures, such as differential rates of recruitment and attrition rates, will be calculated. Acceptability of text message interventions will be studied using usability measures and in-depth interviews among intervention group participants. This pilot study is not funded. ETHICS AND DISSEMINATION This study has received ethics approval from the University of New South Wales Human Research Ethics Committee B (HC190357), Nepal Health Research Council (302/2019) and Institutional Review Committee of Kathmandu Medical College and Teaching Hospital Kathmandu, Nepal (030520192). The findings of the study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619001213134.
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Affiliation(s)
- Buna Bhandari
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Central Department of Public Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Padmanesan Narasimhan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Rohan Jayasuriya
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Woodham NS, Taneepanichskul S, Somrongthong R, Kitsanapun A, Sompakdee B. Effectiveness of a Multidisciplinary Approach Intervention to Improve Blood Pressure Control Among Elderly Hypertensive Patients in Rural Thailand: A Quasi-Experimental Study. J Multidiscip Healthc 2020; 13:571-580. [PMID: 32694916 PMCID: PMC7340360 DOI: 10.2147/jmdh.s254286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Uncontrolled blood pressure among Thai elderly hypertensive patients is a significant public health issue in primary health care facilities under the Universal Health Coverage Scheme in Thailand. This study examines the effectiveness of a multidisciplinary approach intervention to improve blood pressure control among elderly persons in rural Thailand. Patients and Methods This was quasi-experimental study conducted on 200 elderly persons who receive care for hypertension at primary health care facility in rural areas of Thailand. Participants were assigned to either the intervention or control groups. The intervention group was subjected to a multidisciplinary approach intervention program. This program included community-based care for hypertension, family-supportive care for hypertension, antihypertension medication adherence education program, the use of a reminder electronic pill box, and monthly pill counts and blood pressure measurements. The intervention continued for three months. The control group received care for hypertension at the hypertension clinic of the health center. Three measurements were taken at baseline, one month, and three months after the intervention. Data analysis included descriptive statistics and independent sample t-tests. Repeated-measure analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were used to compare the differences between the two groups. Results At one month and three months after the intervention, the multidisciplinary approach intervention controlled blood pressure more effectively compared with the control group. Furthermore, the intervention group had lower systolic and diastolic blood pressure compared with the control group (P-value < 0.001). Conclusion These results suggest that the multidisciplinary approach intervention can be effective in controlling blood pressure in elderly hypertensive patients. Future studies should investigate a cost-effective means of integrating multidisciplinary approach interventions in routine hypertension care for elderly hypertensive patients.
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Affiliation(s)
| | | | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Tian ZX, Liu CZ, Qi YS, Tu JF, Lin Y, Wang Y, Yang JW, Shi GX, Liu JH, Wang LQ. Transcutaneous electrical acupoint stimulation for stage 1 hypertension: protocol for a randomized controlled pilot trial. Trials 2020; 21:558. [PMID: 32571411 PMCID: PMC7310085 DOI: 10.1186/s13063-020-04493-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
Background Hypertension is a major pathogenic factor of cardiovascular diseases. Insufficient blood pressure control rate and sub-optimal medication adherence remain challenges for effective management of hypertension. Transcutaneous electrical acupoint stimulation (TEAS) has been used to treat various diseases, including hypertension, but the scientific evidence for its benefit remains insufficient. Therefore, we will perform a randomized, controlled clinical trial in patients with stage 1 hypertension to evaluate the effect of TEAS. Methods/design The study will be a two-arm parallel, randomized controlled trial. Sixty patients with stage 1 hypertension will be randomly assigned to the TEAS group and the control group in a 1:1 ratio. The participants in the TEAS group will receive non-invasive acupoint electrical stimulation for 30 min at four acupoints in the upper and lower extremities at home, 4 times weekly for 12 weeks for a total of 48 sessions. Participants in the control group will not receive any form of acupoint stimulation. All participants in both groups will receive lifestyle education on how to control high blood pressure, including diet, weight control, and exercise. The primary outcome measure will be the change of the mean systolic blood pressure from baseline to 12 weeks. Secondary outcomes include the change of mean diastolic blood pressure, quality of life, body mass index, and physical activity level. Discussion This pilot, randomized, controlled trial will explore the feasibility of TEAS. It will also provide potential clinical evidence for the efficacy and safety of TEAS in the treatment of patients with stage 1 hypertension. The results of this study will be published in peer-reviewed journals. Furthermore, this pilot trial as the precursor of a large scale randomized controlled trial will inform the sample size of the subsequent trial. Trial registration Chinese clinical trial registry, ChiCTR1900025042, Registered on 8 August 2019 (http://www.chictr.org.cn/showproj.aspx?proj=41496).
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Affiliation(s)
- Zhong-Xue Tian
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Cun-Zhi Liu
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - You-Sheng Qi
- Nanyuan Community Health Service Center, Fengtai District, Beijing, China
| | - Jian-Feng Tu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Dongcheng District, Beijing, China
| | - Ying Lin
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Yu Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Dongcheng District, Beijing, China
| | - Jing-Wen Yang
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Guang-Xia Shi
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Jun-Hong Liu
- Nanyuan Community Health Service Center, Fengtai District, Beijing, China
| | - Li-Qiong Wang
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
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Saarinen AIL, Keltikangas-Järvinen L, Hintsa T, Pulkki-Råback L, Ravaja N, Lehtimäki T, Raitakari O, Hintsanen M. Does Compassion Predict Blood Pressure and Hypertension? The Modifying Role of Familial Risk for Hypertension. Int J Behav Med 2020; 27:527-538. [PMID: 32347444 PMCID: PMC7497423 DOI: 10.1007/s12529-020-09886-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background This study investigated (i) whether compassion is associated with blood pressure or hypertension in adulthood and (ii) whether familial risk for hypertension modifies these associations. Method The participants (N = 1112–1293) came from the prospective Young Finns Study. Parental hypertension was assessed in 1983–2007; participants’ blood pressure in 2001, 2007, and 2011; hypertension in 2007 and 2011 (participants were aged 30–49 years in 2007–2011); and compassion in 2001. Results High compassion predicted lower levels of diastolic and systolic blood pressure in adulthood. Additionally, high compassion was related to lower risk for hypertension in adulthood among individuals with no familial risk for hypertension (independently of age, sex, participants’ and their parents’ socioeconomic factors, and participants’ health behaviors). Compassion was not related to hypertension in adulthood among individuals with familial risk for hypertension. Conclusion High compassion predicts lower diastolic and systolic blood pressure in adulthood. Moreover, high compassion may protect against hypertension among individuals without familial risk for hypertension. As our sample consisted of comparatively young participants, our findings provide novel implications for especially early-onset hypertension. Electronic supplementary material The online version of this article (10.1007/s12529-020-09886-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aino I L Saarinen
- Research Unit of Psychology, University of Oulu, P.O. Box 2000 (Erkki Koiso-Kanttilan katu 1), 90014, Oulu, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Taina Hintsa
- Department of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Niklas Ravaja
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Mirka Hintsanen
- Research Unit of Psychology, University of Oulu, P.O. Box 2000 (Erkki Koiso-Kanttilan katu 1), 90014, Oulu, Finland.
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Cherfan M, Vallée A, Kab S, Salameh P, Goldberg M, Zins M, Blacher J. Unhealthy behaviors and risk of uncontrolled hypertension among treated individuals-The CONSTANCES population-based study. Sci Rep 2020; 10:1925. [PMID: 32024888 PMCID: PMC7002708 DOI: 10.1038/s41598-020-58685-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/19/2019] [Indexed: 11/09/2022] Open
Abstract
From an epidemiological standpoint, quantifying the individual and the combined effect of lifestyle factors on uncontrolled blood pressure (BP) deserves further evaluation. We aimed to examine the individual and combined associations between unhealthy behaviors and uncontrolled hypertension among treated hypertensive adults. Cross-sectional analysis was conducted using data from CONSTANCES, an ongoing French population-based cohort study. Uncontrolled BP was defined as mean systolic BP ≥140 mmHg and/or mean diastolic BP ≥90 mmHg. Unhealthy behaviors were considered as heavy alcohol consumption, low or medium adherence to dietary recommendations, sedentary physical activity level, and overweight. A total of 10,710 hypertensive treated volunteer participants were included and 56.1% had uncontrolled hypertension; of them, 2.0%, 24.5%, 54.0% and 19.5% exhibited 0, 1, 2 or ≥3 unhealthy behaviors respectively. In men, there was an increased odds of uncontrolled hypertension with heavy alcohol drinking compared to light-or-never (adjusted odds ratio 1.34, 95% CI 1.10-1.63), with low as well as with medium adherence to dietary recommendations compared to high (p < 0.05 for both), and with overweight or obesity compared to a normal body mass index (p ≤ 0.001 for both). In addition, men reporting a combination of ≥3 unhealthy behaviors compared to none, had an increased odds of hypertension of 1.67 (95% CI 1.09-2.53). Unhealthy behaviors described as, heavy alcohol consumption, non-adherence to dietary recommendations and overweight are associated with uncontrolled hypertension, at the individual and combined level, and particularly in men. Improvement of modifiable lifestyle factors could offer considerable benefits in the management of hypertension.
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Affiliation(s)
- Michelle Cherfan
- Nutritional Epidemiology Research Unit (EREN), Inserm U1153, Inra U1125, Cnam, Crnh, Paris 13 University Sorbonne Paris Cite, Bobigny, France
- Faculty of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Alexandre Vallée
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital; AP-HP, Paris, France
| | - Sofiane Kab
- Population-based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Pascale Salameh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Marcel Goldberg
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Population-based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Marie Zins
- Faculty of Medicine, Paris-Descartes University, Paris, France
- Population-based Epidemiological Cohorts Unit, Inserm, UMS011, Villejuif, France
| | - Jacques Blacher
- Nutritional Epidemiology Research Unit (EREN), Inserm U1153, Inra U1125, Cnam, Crnh, Paris 13 University Sorbonne Paris Cite, Bobigny, France.
- Faculty of Medicine, Paris-Descartes University, Paris, France.
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital; AP-HP, Paris, France.
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Kim HS, Suh Y, Kim MS, Yoo BN, Lee EJ, Lee EW, Park JH. Effects of Community-Based Primary Care Management on Patients With Hypertension and Diabetes. Asia Pac J Public Health 2019; 31:522-535. [DOI: 10.1177/1010539519867797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As the prevalence of chronic diseases is continuously increasing, the socioeconomic cost of those conditions in Korea is also rising. In order to effectively manage chronic diseases, the “Community-Based Primary Care Project” was implemented from 2014 to 2016 and focused on primary medical care and physician-led chronic disease management. The purpose of this study is evaluating the effects of the project through the DID (difference in difference) model. The project’s database and the National Health Insurance claims database were both used to compare the project and control groups (n = 6092 vs 24 368). Results of the analysis show that medication adherence was increased more in the project group compared with the control group. Hospitalization days, outpatient days, and number of primary medical clinic visits increased more in the participant group than the control group. As the project showed an improvement in treatment persistence, it will be necessary to monitor for a longer period of time.
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Affiliation(s)
- Hee-Sun Kim
- National Evidence-Based Collaborating Agency, Seoul, Republic of Korea
| | - Youshin Suh
- National Evidence-Based Collaborating Agency, Seoul, Republic of Korea
| | - Mi-Sook Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Bit-Na Yoo
- National Evidence-Based Collaborating Agency, Seoul, Republic of Korea
| | - Eun-Ji Lee
- National Evidence-Based Collaborating Agency, Seoul, Republic of Korea
| | - Eun-Whan Lee
- Gyeonggi Research Institute, Gyeonggi-do, Republic of Korea
| | - Jae-Hyun Park
- Sungkyunkwan University, Gyeonggi-do, Republic of Korea
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12
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Freire MAM, Santana LNS, Bittencourt LO, Nascimento PC, Fernandes RM, Leão LKR, Fernandes LMP, Silva MCF, Amado LL, Gomes-Leal W, Crespo-Lopez ME, Maia CDSF, Lima RR. Methylmercury intoxication and cortical ischemia: Pre-clinical study of their comorbidity. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 174:557-565. [PMID: 30865911 DOI: 10.1016/j.ecoenv.2019.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
Stroke is one of the main causes of human disability worldwide. Ischemic stroke is mostly characterized by metabolic collapse and fast tissue damage, followed by secondary damage in adjacent regions not previously affected. Heavy metals intoxication can be associated with stroke incidence, because of their damaging action in the vascular system. Mercury, in particular, possesses a high tropism by metabolically active regions, such as the brain. In the present study we sought to evaluate whether methylmercury (MeHg) intoxication can aggravate the tissue damage caused by an ischemic stroke induced by microinjections of endothelin-1 (ET-1) into the motor cortex of adult rats. Following MeHg intoxication by gavage (0.04 mg/kg/day) during 60 days, the animals were injected with ET-1 (1 μl, 40 pmol/μl) or vehicle (1 μl). After 7 days, all animals were submitted to behavioral tests and then their brains were processed to biochemical and immunohistochemical analyses. We observed that long-term MeHg intoxication promoted a significant Hg deposits in the motor cortex, with concomitant increase of microglial response, followed by reduction of the neuronal population following ischemia and MeHg intoxication, as well as disturbance in the antioxidant defense mechanisms by misbalance of oxidative biochemistry with increase of both lipid peroxidation and nitrite levels, associated to behavioral deficits. MeHg exposure and cortical ischemia demonstrated that both injuries are able of causing significant neurobehavioural impairments in motor coordination and learning accompanied of an exacerbated microglial activation, oxidative stress and neuronal loss in the motor cortex, indicating that MeHg as a source of metabolic disturbance can act as an important increasing factor of ischemic events in the brain.
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Affiliation(s)
| | - Luana Nazaré S Santana
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Leonardo Oliveira Bittencourt
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Priscila Cunha Nascimento
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Rafael Monteiro Fernandes
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Luana Ketlen R Leão
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Luanna Melo P Fernandes
- Laboratory of Pharmacology of Inflammation and Behavior, Institute of Health Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Marcia Cristina F Silva
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Lílian Lund Amado
- Laboratory of Ecotoxicology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Walace Gomes-Leal
- Laboratory of Experimental Neuroprotection and Neuroregeneration, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Maria Elena Crespo-Lopez
- Laboratory of Molecular Pharmacology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Cristiane do Socorro F Maia
- Laboratory of Pharmacology of Inflammation and Behavior, Institute of Health Sciences, Federal University of Pará, Belém, PA, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil.
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13
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Shirinzadeh M, Afshin-Pour B, Angeles R, Gaber J, Agarwal G. The effect of community-based programs on diabetes prevention in low- and middle-income countries: a systematic review and meta-analysis. Global Health 2019; 15:10. [PMID: 30709362 PMCID: PMC6359819 DOI: 10.1186/s12992-019-0451-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/10/2019] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND The increasing prevalence of type 2 diabetes mellitus (T2DM) can have a substantial impact in low- and middle-income countries (LMICs). Community-based programs addressing diet, physical activity, and health behaviors have shown significant benefits on the prevention and management of T2DM, mainly in high-income countries. However, their effects on preventing T2DM in the at-risk population of LMICs have not been thoroughly evaluated. METHODS The Cochrane Library (CENTRAL), MEDLINE, EMBASE and two clinical trial registries were searched to identify eligible studies. We applied a 10 years limit (from 01 Jan 2008 to 06 Mar 2018) on English language literature. We included randomized controlled trials (RCTs) with programs focused on lifestyle changes such as weight loss and/or physical activity increase, without pharmacological treatments, which aimed to alter incidence of diabetes or one of the T2DM risk factors, of at least 6 months duration based on follow-up, conducted in LMICs. RESULTS Six RCTs randomizing 2574 people were included. The risk of developing diabetes in the intervention groups reduced more than 40%, RR (0.57 [0.30, 1.06]), for 1921 participants (moderate quality evidence), though it was not statistically significant. Significant differences were observed in weight, body mass index, and waist circumference change in favor of community-based programs from baseline, (MD [95% CI]; - 2.30 [- 3.40, - 1.19], p < 0.01, I2 = 87%), (MD [95% CI]; - 1.27 [- 2.10, - 0.44], p < 0.01, I2 = 96%), and (MD [95% CI]; - 1.66 [- 3.17, - 0.15], p = 0.03, I2 = 95%), respectively. The pooled effect showed a significant reduction in fasting blood glucose and HbA1C measurements in favor of the intervention (MD [95% CI]; - 4.94 [- 8.33, - 1.55], p < 0.01, I2 = 62%), (MD [95% CI]; - 1.17 [- 1.51, - 0.82], p < 0.01, I2 = 46%), respectively. No significant difference was observed in 2-h blood glucose values, systolic or diastolic blood pressure change between the two groups. CONCLUSION Based on available literature, evidence suggests that community-based interventions may reduce the incidence rate of T2DM and may positively affect anthropometric indices and HbA1C. Due to the heterogeneity observed between trials we recommend more well-designed RCTs with longer follow-up durations be executed, to confirm whether community-based interventions lead to reduced T2DM events in the at-risk population of LMIC settings.
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Affiliation(s)
- Maryam Shirinzadeh
- Department of Health Research Methodology, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8 Canada
| | | | - Ricardo Angeles
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8 Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8 Canada
| | - Gina Agarwal
- Department of Family Medicine, and Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8 Canada
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Kimani S, Mirie W, Chege M, Okube OT, Muniu S. Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study. BMJ Open 2019; 9:e023995. [PMID: 30782721 PMCID: PMC6340423 DOI: 10.1136/bmjopen-2018-023995] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya. DESIGN Descriptive, cross-sectional. SETTING Medical wards and outpatient clinic of a national referral hospital. PARTICIPANTS Patients (n=229) diagnosed with primary hypertension for at least 6 months. PRIMARY OUTCOMES Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjusted for age, gender and education; antihypertensive adherence; views on prevention of hypertension and adequacy of hypertension information. RESULTS Ageing was associated with elevated diastolic blood pressure (BP) (p<0.05), heart rate (HR) and cholesterol. Females had higher body mass index (BMI). More males reported drinking alcohol and smoking (p<0.001), especially the highly educated. Higher BPs were observed in smokers and drinkers (p<0.05). Daily vegetables and fruits intake were linked to lower BP, HR and BMI (p<0.05). Intake of foods high in saturated fat and cholesterol were associated with raised HR (p<0.05). Respondents on antihypertensive medication, those engaged in healthy lifestyle and took their prescribed medications had lower mean BPs than those on medication only (138/85 vs 140/90). Few respondents (30.8%) considered hypertension as preventable, mainly the single and highly educated (p<0.05). Respondents (53.6%) believed they should stop taking their antihypertensive medication once hypertension is controlled. CONCLUSION Missed targets for BP control and hypertension-related risks are associated with ageing, female gender, fast food and animal fat intake. Alcohol and smoking is common in males associated with poor BP control. Daily vegetables and fruits intake are associated with better BP control and overall hypertension risk reduction. Observed suboptimal BP control despite pharmacological adherence suggests lifestyle modification is needed besides antihypertensive medication. Interventions should address modifiable risk factors aggravated by age and adverse lifestyles through adopting combined lifestyle modification, pharmacological adherence and tailored expert delivered hypertension-related information.
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Affiliation(s)
- Samuel Kimani
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Waithira Mirie
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Margaret Chege
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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15
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Maslakpak MH, Rezaei B, Parizad N. Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1537063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Masumeh Hemmati Maslakpak
- Department of Medical Surgical Nursing, Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Behrooz Rezaei
- Department of Medical Surgical Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Department of Medical-Surgical Nursing, Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, Iran
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16
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Non-pharmacological management of hypertension: in the light of current research. Ir J Med Sci 2018; 188:437-452. [DOI: 10.1007/s11845-018-1889-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/16/2018] [Indexed: 02/07/2023]
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17
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Brotons Cuixart C, Alemán Sánchez JJ, Banegas Banegas JR, Fondón León C, Lobos-Bejarano JM, Martín Rioboó E, Navarro Pérez J, Orozco-Beltrán D, Villar Álvarez F. Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2018. Aten Primaria 2018; 50 Suppl 1:4-28. [PMID: 29866357 PMCID: PMC6836998 DOI: 10.1016/s0212-6567(18)30360-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Carlos Brotons Cuixart
- Especialista en Medicina Familiar y Comunitaria, Equipo de Atención Primaria Sardenya, Barcelona
| | - José Juan Alemán Sánchez
- Especialista en Medicina Familiar y Comunitaria, Dirección General de Salud Pública, Servicio Canario de la Salud
| | - José Ramón Banegas Banegas
- Especialista en Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid
| | - Carlos Fondón León
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Colmenar de Oreja, Madrid
| | | | | | - Jorge Navarro Pérez
- Especialista en Medicina Familiar y Comunitaria, Hospital Clínico Universitario, Valencia
| | - Domingo Orozco-Beltrán
- Especialista en Medicina Familiar y Comunitaria, Unidad de Investigación CS Cabo Huertas, Departamento San Juan de Alicante, Alicante
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18
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Abshire DA, Mudd-Martin G, Moser DK, Lennie TA. Comparing measures of general and abdominal adiposity as predictors of blood pressure in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:51-60. [PMID: 28820677 DOI: 10.1080/07448481.2017.1369092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare anthropometric measures of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and sagittal abdominal diameter (SAD) as predictors of blood pressure in college students. PARTICIPANTS Students (N = 116) were recruited from November 2012 to May 2014 at an urban university and rural community colleges. METHODS Students underwent a brief physical examination during which anthropometric measures were obtained and blood pressure was measured. Covariates were measured using self-reported questionnaires. Hierarchical multiple linear regressions were used for the data analysis. RESULTS All anthropometric measures were predictive of systolic (SBP) and diastolic blood pressure (DBP). WC was the strongest predictor of SBP (β = .582, p < .01) explaining an additional 3-4% of the variance than BMI, WHtR, or SAD. The measures were similar in predicting DBP. WC predicted SBP independent of BMI. CONCLUSIONS Clinicians should consider using WC to assess the risk for hypertension in college students.
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Affiliation(s)
- Demetrius A Abshire
- a University of South Carolina College of Nursing , Columbia , South Carolina, USA
| | - Gia Mudd-Martin
- b University of Kentucky College of Nursing , Lexington , Kentucky, USA
| | - Debra K Moser
- b University of Kentucky College of Nursing , Lexington , Kentucky, USA
| | - Terry A Lennie
- b University of Kentucky College of Nursing , Lexington , Kentucky, USA
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19
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Riddell MA, Edwards N, Thompson SR, Bernabe-Ortiz A, Praveen D, Johnson C, Kengne AP, Liu P, McCready T, Ng E, Nieuwlaat R, Ovbiagele B, Owolabi M, Peiris D, Thrift AG, Tobe S, Yusoff K. Developing consensus measures for global programs: lessons from the Global Alliance for Chronic Diseases Hypertension research program. Global Health 2017; 13:17. [PMID: 28298233 PMCID: PMC5353794 DOI: 10.1186/s12992-017-0242-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/23/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams' data collection plans. One year later all teams were asked which consensus measures had been implemented. RESULTS Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. CONCLUSIONS Deriving consensus measures across diverse research projects and contexts was challenging. The major barrier to their implementation was related to the time taken to develop and present these measures. Inclusion of consensus measures into future funding announcements would facilitate researchers integrating these measures within application protocols. We suggest that adoption of consensus measures developed here, across the field of hypertension, would help advance the science in this area, allowing for more comparable data sets and generalizable inferences.
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Affiliation(s)
- Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Nancy Edwards
- School of Nursing, Faculty of Health Science, University of Ottawa, Ottawa, Canada
| | | | | | | | - Claire Johnson
- The George Institute for Global Health - Sydney, Sydney, Australia
| | - Andre P Kengne
- South African Medical Research Council, Cape Town, South Africa
| | - Peter Liu
- University of Ottawa Heart Institute, Toronto, Canada
| | - Tara McCready
- Population Health Research Institute, Hamilton, Canada
| | - Eleanor Ng
- Population Health Research Institute, Hamilton, Canada
| | | | | | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - David Peiris
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Sheldon Tobe
- Sunnybrook Health Sciences Center, Toronto, Canada
| | - Khalid Yusoff
- UniversitiTeknologi MARA, Selangor, Malaysia.,UCSI University, Selangor, Malaysia
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20
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Makovac E, Thayer JF, Ottaviani C. A meta-analysis of non-invasive brain stimulation and autonomic functioning: Implications for brain-heart pathways to cardiovascular disease. Neurosci Biobehav Rev 2017; 74:330-341. [DOI: 10.1016/j.neubiorev.2016.05.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/24/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
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21
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Vamvakis A, Gkaliagkousi E, Triantafyllou A, Gavriilaki E, Douma S. Beneficial effects of nonpharmacological interventions in the management of essential hypertension. JRSM Cardiovasc Dis 2017; 6:2048004016683891. [PMID: 28228940 PMCID: PMC5308526 DOI: 10.1177/2048004016683891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/14/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022] Open
Abstract
Essential hypertension is a major health problem causing excess cardiovascular morbidity and mortality. Management of essential hypertension consists of pharmacological and nonpharmacological interventions. In order to prevent and/or treat hypertension, parameters like nutrition, body weight, and physical exercise should be evaluated and taken under consideration for improvement. A large body of evidence clearly support that the role of salt, alcohol, fruits, and vegetables is important for high blood pressure. Furthermore, maintaining a normal body weight should be succeeded along with physical activity few times per week if not daily. Nonpharmacological intervention is rather a dynamic procedure that takes a multilevel approach with repeated training of the hypertensives by a team of expert physicians, rather than a single based guidance. Additionally, it should be based on a profile customization and personalized approach. Intensive interventions aiming at lifestyle changes through educational meetings are considered more effective in lowering high blood pressure. This consists of a lifestyle modification with a permanent basis for patient’s daily schedule and eventually should become a philosophy for a better quality of life through improvement of nutritional and exercise behavior. Further studies are needed so intervention guideline models can be even more effective for patients with essential hypertension.
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Affiliation(s)
- Anastasios Vamvakis
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
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22
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Theodotou M, Fokianos K, Mouzouridou A, Konstantinou C, Aristotelous A, Prodromou D, Chrysikou A. The effect of resveratrol on hypertension: A clinical trial. Exp Ther Med 2017; 13:295-301. [PMID: 28123505 PMCID: PMC5245087 DOI: 10.3892/etm.2016.3958] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/27/2016] [Indexed: 12/25/2022] Open
Abstract
The aim of this clinical trial was to investigate the effects of Evelor, a micronized formulation of resveratrol (RESV; 3,5,4'-trihydroxy-trans-stilbene), in patients with primary hypertension. RESV is a stilbenoid and phytoalexin produced by several plants in response to injury or attack by pathogens, such as bacteria and fungi. Patients included in the clinical trial were split into the following two groups, based on the severity of their disease: Group A (n=46), stage I hypertension [systolic blood pressure (SBP), 140-159 mmHg; diastolic blood pressure (DBP), 90-99 mmHg] and Group B (n=51), stage II hypertension (SBP, 160-179 mmHg; DBP, 100-109 mmHg). Each group was divided into two subgroups: A1 and B1, patients treated with standard antihypertensive therapy (A1, 10 mg Dapril; B1, 20 mg Dapril), and A2 and B2, patients treated with antihypertensive therapy (Dapril) plus Evelor. The present study aimed to determine the effects of Evelor, in addition to the standard hypertension treatment, and its effect on the hepatic enzymes serum glutamate-pyruvate transaminase (SGPT) and gamma-glutamyl transferase (gamma-GT). Following the trial, which lasted two years (October 2010 to October 2012), the mean blood pressure of both groups lay within the normal range, indicating that blood pressure was efficiently controlled. The results of the present study demonstrate that the addition of RESV to standard antihypertensive therapy is sufficient to reduce blood pressure to normal levels, without the need for additional antihypertensive drugs. In addition, statistical analysis of the results identified a significant reduction in plasma concentration levels of SGPT (P<0.001) and gamma-GT (P<0.001) with the addition of RESV, indicating that RESV prevents liver damage.
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Affiliation(s)
- Marios Theodotou
- Riegler, Ltd., Institute of Medical Clinical Trials, Limassol 3020, Cyprus
| | - Konstantinos Fokianos
- Department of Mathematics and Statistics, University of Cyprus, Nicosia 20537, Cyprus
| | | | | | | | - Dafni Prodromou
- Agios Efrem, Advanced Medical Diagnostic Center, Limassol 3020, Cyprus
| | - Asimina Chrysikou
- Riegler, Ltd., Institute of Medical Clinical Trials, Limassol 3020, Cyprus
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Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple Risk Factor Interventions for Primary Prevention of CVD in LMIC: A Cochrane Review. Glob Heart 2016; 12:199-208.e8. [PMID: 27452771 DOI: 10.1016/j.gheart.2016.03.639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022] Open
Abstract
This study sought to determine the effectiveness of multiple risk factor interventions aimed at modifying major cardiovascular risk factors for the primary prevention of cardiovascular disease in low- and middle-income countries (LMIC). We searched electronic databases for randomized controlled trials of health promotion interventions to achieve behavior change. The pooled effect indicated a reduction in systolic blood pressure (-6.72 mm Hg; 95% confidence interval [CI]: -9.82 to -3.61; I2 = 91%), diastolic blood pressure (-4.40 mm Hg; 95% CI: -6.47 to -2.34; I2 = 92%), body mass index (-0.76 kg/m2; 95% CI: -1.29 to -0.22; I2 = 80%), and waist circumference (-3.31 cm; 95% CI: -4.77 to -1.86; I2 = 55%) in favor of multiple risk factor interventions. There is some evidence that multiple risk factor interventions may lower blood pressure levels and anthropometrics in populations in LMIC settings at high risk of hypertension and diabetes.
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Affiliation(s)
- Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, The University of Warwick, Warwick, United Kingdom.
| | - Louise Hartley
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Fiona Taylor
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shah Ebrahim
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Nulu S. Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor. Glob Public Health 2016; 12:396-415. [PMID: 26948138 DOI: 10.1080/17441692.2016.1154584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behaviour, risk and disease, which implicitly locates 'risk' within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with 'alternative' environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralise health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralising health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualising strategies that may address both behavioural and structural determinants of health.
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Affiliation(s)
- Shanti Nulu
- a Department of Medicine , Yale University , New Haven , CT , USA
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Bobrow K, Farmer AJ, Springer D, Shanyinde M, Yu LM, Brennan T, Rayner B, Namane M, Steyn K, Tarassenko L, Levitt N. Mobile Phone Text Messages to Support Treatment Adherence in Adults With High Blood Pressure (SMS-Text Adherence Support [StAR]): A Single-Blind, Randomized Trial. Circulation 2016; 133:592-600. [PMID: 26769742 DOI: 10.1161/circulationaha.115.017530] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 12/23/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND We assessed the effect of automated treatment adherence support delivered via mobile phone short message system (SMS) text messages on blood pressure. METHODS AND RESULTS In this pragmatic, single-blind, 3-arm, randomized trial (SMS-Text Adherence Support [StAR]) undertaken in South Africa, patients treated for high blood pressure were randomly allocated in a 1:1:1 ratio to information only, interactive SMS text messaging, or usual care. The primary outcome was change in systolic blood pressure at 12 months from baseline measured with a validated oscillometric device. All trial staff were masked to treatment allocation. Analyses were intention to treat. Between June 26, 2012, and November 23, 2012, 1372 participants were randomized to receive information-only SMS text messages (n=457), interactive SMS text messages (n=458), or usual care (n=457). Primary outcome data were available for 1256 participants (92%). At 12 months, the mean adjusted change in systolic blood pressure compared with usual care was -2.2 mm Hg (95% confidence interval, -4.4 to -0.04) with information-only SMS and -1.6 mm Hg (95% confidence interval, -3.7 to 0.6) with interactive SMS. Odds ratios for the proportion of participants with a blood pressure <140/90 mm Hg were 1.42 (95% confidence interval, 1.03-1.95) for information-only messaging and 1.41 (95% confidence interval, 1.02-1.95) for interactive messaging compared with usual care. CONCLUSIONS In this randomized trial of an automated adherence support program delivered by SMS text message in a general outpatient population of adults with high blood pressure, we found a small reduction in systolic blood pressure control compared with usual care at 12 months. There was no evidence that an interactive intervention increased this effect. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02019823. South African National Clinical Trials Register, number SANCTR DOH-27-1212-386; Pan Africa Trial Register, number PACTR201411000724141.
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Affiliation(s)
- Kirsten Bobrow
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Andrew J Farmer
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.).
| | - David Springer
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Milensu Shanyinde
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Ly-Mee Yu
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Thomas Brennan
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Brian Rayner
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Mosedi Namane
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Krisela Steyn
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Lionel Tarassenko
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
| | - Naomi Levitt
- From Institute of Biomedical Engineering, Department of Engineering Science (K.B., D.S., T.B., L.T.) and Nuffield Department of Primary Care Health Sciences (K.B., A.J.F., M.S., L.-M.Y.), University of Oxford, UK; Chronic Disease Initiative for Africa, Cape Town, South Africa (K.B., K.S., N.L.); Division of Nephrology and Hypertension, Groote Schuur Hospital, Cape Town, South Africa (B.R.); University of Cape Town, South Africa (B.R.); Western Cape Province Department of Health, Cape Town, South Africa (M.N.); and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, South Africa (N.L., K.B.)
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Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries. Cochrane Database Syst Rev 2015; 2015:CD011163. [PMID: 26272648 PMCID: PMC6999125 DOI: 10.1002/14651858.cd011163.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In many low- and middle-income countries (LMICs) morbidity and mortality associated with cardiovascular diseases (CVDs) have grown exponentially over recent years. It is estimated that about 80% of CVD deaths occur in LMICs. People in LMICs are more exposed to cardiovascular risk factors such as tobacco, and often do not have access to effective and equitable healthcare services (including early detection services). Evidence from high-income countries indicates that multiple risk factor intervention programmes do not result in reductions in CVD events. Given the increasing incidence of CVDs and lower CVD health awareness in LMICs it is possible that such programmes may have beneficial effects. OBJECTIVES To determine the effectiveness of multiple risk factor interventions (with or without pharmacological treatment) aimed at modifying major cardiovascular risk factors for the primary prevention of CVD in LMICs. SEARCH METHODS We searched (from inception to 27 June 2014) the Cochrane Library (CENTRAL, HTA, DARE, EED), MEDLINE, EMBASE, Global Health and three other databases on 27 June 2014. We also searched two clinical trial registers and conducted reference checking to identify additional studies. We applied no language limits. SELECTION CRITERIA We included randomised controlled trials (RCTs) of health promotion interventions to achieve behaviour change (i.e. smoking cessation, dietary advice, increasing activity levels) with or without pharmacological treatments, which aim to alter more than one cardiovascular risk factor (i.e. diet, reduce blood pressure, smoking, total blood cholesterol or increase physical activity) of at least six months duration of follow-up conducted in LMICs. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias, and extracted data. We combined dichotomous data using risk ratios (RRs) and continuous data using mean differences (MDs), and presented all results with a 95% confidence interval (CI). The primary outcome was combined fatal and non-fatal cardiovascular disease events. MAIN RESULTS Thirteen trials met the inclusion criteria and are included in the review. All studies had at least one domain with unclear risk of bias. Some studies were at high risk of bias for random sequence generation (two trials), allocation concealment (two trials), blinding of outcome assessors (one trial) and incomplete outcome data (one trial). Duration and content of multiple risk factor interventions varied across the trials. Two trials recruited healthy participants and the other 11 trials recruited people with varying risks of CVD, such as participants with known hypertension and type 2 diabetes. Only one study reported CVD outcomes and multiple risk factor interventions did not reduce the incidence of cardiovascular events (RR 0.57, 95% CI 0.11 to 3.07, 232 participants, low-quality evidence); the result is imprecise (a wide confidence interval and small sample size) and makes it difficult to draw a reliable conclusion. None of the included trials reported all-cause mortality. The pooled effect indicated a reduction in systolic blood pressure (MD -6.72 mmHg, 95% CI -9.82 to -3.61, I² = 91%, 4868 participants, low-quality evidence), diastolic blood pressure (MD -4.40 mmHg, 95% CI -6.47 to -2.34, I² = 92%, 4701 participants, low-quality evidence), body mass index (MD -0.76 kg/m², 95% CI -1.29 to -0.22, I² = 80%, 2984 participants, low-quality evidence) and waist circumference (MD -3.31, 95% CI -4.77 to -1.86, I² = 55%, 393 participants, moderate-quality evidence) in favour of multiple risk factor interventions, but there was substantial heterogeneity. There was insufficient evidence to determine the effect of these interventions on consumption of fruit or vegetables, smoking cessation, glycated haemoglobin, fasting blood sugar, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and total cholesterol. None of the included trials reported on adverse events. AUTHORS' CONCLUSIONS Due to the limited evidence currently available, we can draw no conclusions as to the effectiveness of multiple risk factor interventions on combined CVD events and mortality. There is some evidence that multiple risk factor interventions may lower blood pressure levels, body mass index and waist circumference in populations in LMIC settings at high risk of hypertension and diabetes. There was considerable heterogeneity between the trials, the trials were small, and at some risk of bias. Larger studies with longer follow-up periods are required to confirm whether multiple risk factor interventions lead to reduced CVD events and mortality in LMIC settings.
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Affiliation(s)
- Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, The University of WarwickWarwick Centre for Applied Health Research and Delivery (WCAHRD)WarwickUK
| | - Louise Hartley
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
| | - Fiona Taylor
- London School of Hygiene & Tropical MedicineDepartment of Non‐communicable Disease EpidemiologyKeppel StreetLondonUKWC1E 7HT
| | - Shah Ebrahim
- London School of Hygiene & Tropical MedicineDepartment of Non‐communicable Disease EpidemiologyKeppel StreetLondonUKWC1E 7HT
| | - Aileen Clarke
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryWarwickshireUKCV4 7AL
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Li Y, Ley SH, VanderWeele TJ, Curhan GC, Rich-Edwards JW, Willett WC, Forman JP, Hu FB, Qi L. Joint association between birth weight at term and later life adherence to a healthy lifestyle with risk of hypertension: a prospective cohort study. BMC Med 2015; 13:175. [PMID: 26228391 PMCID: PMC4521367 DOI: 10.1186/s12916-015-0409-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/25/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Low birth weight and unhealthy lifestyles in adulthood have been independently associated with an elevated risk of hypertension. However, no study has examined the joint effects of these factors on incidence of hypertension. METHODS We followed 52,114 women from the Nurses' Health Study II without hypercholesterolemia, diabetes, cardiovascular disease, cancer, prehypertension, and hypertension at baseline (1991-2011). Women born preterm, of a multiple pregnancy, or who were missing birth weight data were excluded. Unhealthy adulthood lifestyle was defined by compiling status scores of body mass index, physical activity, alcohol consumption, the Dietary Approaches to Stop Hypertension diet, and the use of non-narcotic analgesics. RESULTS We documented 12,588 incident cases of hypertension during 20 years of follow-up. The risk of hypertension associated with a combination of low birth weight at term and unhealthy lifestyle factors (RR, 1.95; 95 % CI, 1.83-2.07) was more than the addition of the risk associated with each individual factor, indicating a significant interaction on an additive scale (P interaction <0.001). The proportions of the association attributable to lower term birth weight alone, unhealthy lifestyle alone, and their joint effect were 23.9 % (95 % CI, 16.6-31.2), 63.7 % (95 % CI, 60.4-66.9), and 12.5 % (95 % CI, 9.87-15.0), respectively. The population-attributable-risk for the combined adulthood unhealthy lifestyle and low birth weight at term was 66.3 % (95 % CI, 56.9-74.0). CONCLUSION The majority of cases of hypertension could be prevented by the adoption of a healthier lifestyle, though some cases may depend on simultaneous improvement of both prenatal and postnatal factors.
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Affiliation(s)
- Yanping Li
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - Sylvia H Ley
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. .,Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
| | - Gary C Curhan
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 665 Huntington Ave, Boston, MA, 02115, USA. .,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. .,The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Walter C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. .,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 665 Huntington Ave, Boston, MA, 02115, USA.
| | - John P Forman
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Frank B Hu
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. .,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 665 Huntington Ave, Boston, MA, 02115, USA.
| | - Lu Qi
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 665 Huntington Ave, Boston, MA, 02115, USA.
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