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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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Rossi GP, Bagordo D, Rossi FB, Pintus G, Rossitto G, Seccia TM. 'Essential' arterial hypertension: time for a paradigm change. J Hypertens 2024; 42:1298-1304. [PMID: 38748508 PMCID: PMC11216381 DOI: 10.1097/hjh.0000000000003767] [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: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/21/2024]
Abstract
The exclusion of causes of hypertension is not systematically exploited in clinical practice. Therefore, essential hypertension is consistently presented as the most prevalent 'cause'. The paradox of a condition with unknown causes being described as a common cause of hypertension translates into a diagnosis of essential hypertension in most patients, which precludes the detection of a curable cause of hypertension. The aim of this review is to investigate how the notion of essential hypertension has developed and whether scientific evidence still support the notion of its high prevalence by examining the most recent studies. These studies provided solid scientific evidence that, when systematically sought for, secondary hypertension is quite common and that secondary hypertension is highly prevalent. The increased awareness should lead to a systematic search for, with the goal of curing or achieving a better control of high blood pressure, and ultimately improving patients' quality of life.
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Affiliation(s)
| | - Domenico Bagordo
- Specialized Hypertension Center
- ARHYVAB, International PhD Program in Arterial Hypertension and Vascular Biology, Department of Medicine – DIMED and Department of Biomedical Sciences, University of Padova, Padova
| | - Federico B. Rossi
- Specialized Hypertension Center
- ARHYVAB, International PhD Program in Arterial Hypertension and Vascular Biology, Department of Medicine – DIMED and Department of Biomedical Sciences, University of Padova, Padova
| | - Giovanni Pintus
- Specialized Hypertension Center
- ARHYVAB, International PhD Program in Arterial Hypertension and Vascular Biology, Department of Medicine – DIMED and Department of Biomedical Sciences, University of Padova, Padova
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Giacomo Rossitto
- Internal & Emergency Medicine
- Specialized Hypertension Center
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
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Rodríguez-Lescure Á, Gallego J, Garcia-Alfonso P, Massuti B, Márquez R, Calvo L, Sánchez-Rovira P, Antón A, Chacón JI, Ciruelos E, Ponce JJ, Santaballa A, Valladares-Ayerbes M, Dueñas MR, Alonso V, Aparicio J, Encinas S, Robles L, Escudero MJ, Caballero R, Bezares S, de la Haba-Rodriguez J. Hypertension as predictive factor for bevacizumab-containing first-line therapy in metastatic breast and colorectal cancer in BRECOL (GEICAM/2011-04) study. Clin Transl Oncol 2024; 26:1896-1907. [PMID: 38578537 PMCID: PMC11249439 DOI: 10.1007/s12094-024-03411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Retrospective data suggest an association between bevacizumab efficacy and the incidence of arterial hypertension (AHT). Additionally, epigenetic mechanisms have been related to AHT. METHODS This prospective observational study conducted by GEICAM Spanish Breast Cancer Research Group included metastatic breast (MBC) or colorectal (mCRC) cancer patients treated with bevacizumab-containing chemotherapy as first-line treatment. Blood pressure (BP) levels were measured (conventional and 24-h Holter monitoring) at baseline and up to cycle 3. Primary endpoint assessed BP levels increase as predictive factor for progression-free survival (PFS). Germline DNA methylation profile was explored in pre-treatment blood samples; principal component analysis was used to define an epigenetic predictive score for increased BP levels. RESULTS From Oct-2012 to Jul-2016, 143 (78 MBC and 65 mCRC) patients were included. The incidence of AHT according to guidelines was neither predictive of PFS nor of best overall tumor response (BOR). No statistically significant association was observed with systolic BP nor diastolic BP increment for PFS or BOR. Grade 3 and 4 adverse events were observed in 37 and 5% of patients, respectively. We identified 27 sites which baseline methylation status was significantly associated to BP levels increase secondary to bevacizumab-containing chemotherapy. CONCLUSIONS Neither the frequency of AHT nor the increase of BP levels were predictive of efficacy in MBC and mCRC patients treated with bevacizumab-containing chemotherapy. CLINICAL TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT01733628.
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Affiliation(s)
- Álvaro Rodríguez-Lescure
- Medical Oncology Department, Hospital General Universitario de Elche, Carrer Almazara, 11, 03203, Elche, Alicante, Spain.
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Carrer Almazara, 11, 03203, Elche, Alicante, Spain
| | - Pilar Garcia-Alfonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina de la Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Bartomeu Massuti
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Raúl Márquez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Lourdes Calvo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Pedro Sánchez-Rovira
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario de Jaén, Jaén, Spain
| | - Antonio Antón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IISA), Hospital Universitario Miguel Servet, Universidad de Zaragoza, Saragossa, Spain
| | - José Ignacio Chacón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario de Toledo, Toledo, Spain
| | - Eva Ciruelos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Jose Juan Ponce
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Ana Santaballa
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Valladares-Ayerbes
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Vicente Alonso
- Instituto de Investigación Sanitaria de Aragón (IISA), Hospital Universitario Miguel Servet, Universidad de Zaragoza, Saragossa, Spain
| | - Jorge Aparicio
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Luis Robles
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | | | | | - Juan de la Haba-Rodriguez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Instituto Maimónides de Investigación Biomédica (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
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Elahi T, Ahmed S, Mubarak M, Ahmed E. Clinicopathological characteristics and renal outcomes of adult patients with pauci-immune necrotizing glomerulonephritis according to ANCA status. Clin Rheumatol 2024; 43:2669-2678. [PMID: 38954279 DOI: 10.1007/s10067-024-07047-7] [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: 04/25/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Pauci-immune necrotizing glomerulonephritis (PING) is commonly associated with the presence of antineutrophilic cytoplasmic antibodies (ANCAs) but a significant number of patients do not have these antibodies. The significance of ANCA-negativity in the context of Berden's classification of PING is not known. METHODS A retrospective analysis was conducted on all patients with histopathological diagnosis of idiopathic PING irrespective of ANCA status diagnosed between January 1998 to December 2018 and followed up at renal clinic for > 12 months. All biopsies were reclassified by Berden's classification. Clinicopathological characteristics and renal outcomes of ANCA-positive and ANCA-negative patients were compared. RESULTS Out of 134 patients, 66 (49.5%) were ANCA-negative. The mean age was 34.76 ± 13.3 years. Compared with the ANCA-positive patients, ANCA-negative patients had significantly greater prevalence of nephrotic-range proteinuria (74.23% Vs 57.9%, P = 0.036) with less extra-renal manifestations (P < 0.05)). On histology, focal and crescentic classes dominated with less number of globally sclerosed glomeruli (2.7% Vs 5.07%, P = 0.02) and more mesangial proliferation (22.7% Vs 4.41%, P = 0.002) in the ANCA-negative group, whereas sclerotic was predominant in the ANCA-positive group (P = 0.05). More patients achieved complete and partial recovery in ANCA-negative patients (42.4% Vs 20.5%, P < 0.05) with better renal survival (27.27% Vs 16.17%, log-rank test: P = 0.03) and less patient mortality (13.63% vs 30.8%, log-rank test: P = 0.04) at 2 years. CONCLUSION Our study confirms high prevalence of ANCA negativity among our cohort and this group presents with isolated renal involvement with better renal and patient survival. The ANCA-positive group showed significantly more patients in the sclerotic class, lower 2-year renal survival, and higher 2-year mortality as compared to the ANCA-negative group. However, the complete and partial responses to treatment were significantly better in the ANCA-negative group. Key Points • This study shows a high prevalence of ANCA negativity in cases of PING in Pakistani population, as almost half of patients in this study did not have these antibodies. • This negativity is more prevalent in the Asian populations but its significance in the context of Berden's classification of PING is unknown. • ANCA-negative group exhibited less severe phenotype and better outcomes compared with ANCA-positive group.
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Affiliation(s)
- Tabassum Elahi
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road Near Civil Hospital, Karachi, 74200, Pakistan.
| | - Saima Ahmed
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road Near Civil Hospital, Karachi, 74200, Pakistan
| | - Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road near Civil Hospital, Karachi, 74200, Pakistan
| | - Ejaz Ahmed
- Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road Near Civil Hospital, Karachi, 74200, 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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Cancho B, Alvarez Lopez A, Valladares J, Rodriguez Sabillon JA, Lopez Gomez J, Robles NR. [Prognostic Value of Isolated High Serum Cystatin C Levels Without Glomerular Filtration Rate Reduction]. Med Clin (Barc) 2024; 162:511-515. [PMID: 38388320 DOI: 10.1016/j.medcli.2023.12.015] [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: 10/02/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Cystatin C is increasingly used as a marker of renal function as a complement to serum creatinine and glomerular filtration rate (GFR). We have assessed its efficacy as a predictor of mortality in a group of patients with increased cystatin C but GFR> 60mL/min. DESIGN AND METHODS We included 608 patients, 65.9% male, 34.6% had diabetes mellitus. The mean age was 58.5±14.5 years and a mean GFR of 64.1±33.5mL/min. Patients were divided into 3 groups: CONTROL (normal cystatin C and GFR> 60mL/min, age 53.3±12.8years, GFR 96.6±22.4mL/min,n=193), INCREASED CYSTATIN (cystatin C>1.03mg/l and GFR>60mL/min, age 58.9±13,1years, GFR 72.2±10.4mL/min, n=40) and CKD (chronic kidney disease, increased cystatin C and GFR <60mL/min, age 61.4±14.8years, GFR 36.0±12.7mL/min, n=160). The relationship with overall mortality was analyzed using the Kaplan-Meier method. RESULTS Mean cystatin C was 0.75±0.13 versus 1.79±0.54 in CKD group and 1.14±0.14mg/l, p <0.001). In CONTROL group survival was 93.9% at 5y, compared to 78.8% in the ERC group and 82.3% in the INCREASED CYSTATIN group (p <0.001) Five-year survival before renal replacement therapy was also different for the ERC group (73%, p <0.001 Log Rank) but not between the other two groups (CONTROL 99.0%, INCREASED CYSTATIN 94.3% p=0.08). CONCLUSIONS Increased plasmatic levels of cystatin C in patients with GFR> 60mL/min was a predictor of increased mortality but not of progression to end-stage renal failure. These results confirm the interest of routinely measuring cystatin C.
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Affiliation(s)
- Barbara Cancho
- Servicio de Nefrología. Hospital Universitario de Badajoz. Universidad de Extremadura, Badajoz, España
| | - Alvaro Alvarez Lopez
- Servicio de Nefrología. Hospital Universitario de Badajoz. Universidad de Extremadura, Badajoz, España
| | - Julian Valladares
- Servicio de Nefrología. Hospital Universitario de Badajoz. Universidad de Extremadura, Badajoz, España
| | | | - Juan Lopez Gomez
- Servicio de Bioquímica Clínica. Hospital Universitario de Badajoz. Universidad de Extremadura, Badajoz, España
| | - Nicolas Roberto Robles
- Servicio de Nefrología. Hospital Universitario de Badajoz. Universidad de Extremadura, Badajoz, España.
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Zhao S, Xie Y, Ding X, Zheng C, Chen J, Zhao N, Ji Y, Wang Q, Liu Y, Cheng C. Exploring the causal relationship between antihypertensive drugs and glioblastoma by combining drug target Mendelian randomization study, eQTL colocalization, and single-cell RNA sequencing. ENVIRONMENTAL TOXICOLOGY 2024; 39:3425-3433. [PMID: 38450887 DOI: 10.1002/tox.24210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
Recent reports indicate a potential oncogenic role of antihypertensive drugs in common cancers. However, it remains uncertain whether this phenomenon influences the risk of glioblastoma multiforme (GBM). This study aimed to assess the potential causal effects of blood pressure (BP) and antihypertensive drugs on GBM. Genome-wide association study (GWAS) summary statistics for systolic blood pressure (SBP), diastolic blood pressure (DBP), and GBM in Europeans were downloaded. To represent the effects of antihypertensive drugs, we utilized single nucleotide polymorphisms (SNPs) associated with SBP/DBP adjacent to the coding regions of different antihypertensive drugs as instrumental variables to model five antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, β-receptor blockers (BBs), and thiazide diuretics. Positive control studies were performed using GWAS data in chronic heart failure. The primary method for causality estimation was the inverse-variance-weighted method. Mendelian randomization analysis showed that BBs with the β1-adrenergic receptor (ADRB1) as a therapeutic target could significantly reduce the risk of GBM by mediating DBP (OR = 0.431, 95% CI: 0.267-0.697, p < .001) and that they could also significantly reduce the risk of GBM by mediating SBP (OR = 0.595, 95% CI: 0.422-0.837, p = .003). Sensitivity analysis and colocalization analysis reinforced the robustness of these findings. Finally, the low expression of the ADRB1 gene in malignant gliomas was found by GBM data from TCGA and single-cell RNA sequencing, which most likely contributed to the poor prognosis of GBM patients. In summary, our study provides preliminary evidence of some causal relationship between ADRB1-targeted BBs and glioblastoma development. However, more studies are needed to validate these findings and further reveal the complex relationship between BP and GBM.
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Affiliation(s)
- Songyun Zhao
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yi Xie
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xu Ding
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Chuanhua Zheng
- Department of Neurosurgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Jiaxing Chen
- Department of Neurosurgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Ning Zhao
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yi Ji
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Qi Wang
- Department of Gastroenterology, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuankun Liu
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Chao Cheng
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
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Gustafsson B, Rovio SP, Ruohonen S, Hutri-Kähönen N, Kähönen M, Viikari JSA, Pahkala K, Raitakari OT. Determinants of echocardiographic epicardial adipose tissue in a general middle-aged population - The Cardiovascular Risk in Young Finns Study. Sci Rep 2024; 14:11982. [PMID: 38796541 PMCID: PMC11127977 DOI: 10.1038/s41598-024-61727-7] [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: 11/28/2023] [Accepted: 05/08/2024] [Indexed: 05/28/2024] Open
Abstract
Epicardial adipose tissue (EAT) is the cardiac visceral fat depot proposed to play a role in the etiology of various cardiovascular disease outcomes. Little is known about EAT determinants in a general population. We examined cardiometabolic, dietary, lifestyle and socioeconomic determinants of echocardiograpghically measured EAT in early adulthood. Data on cardiometabolic, dietary, lifestyle and socioeconomic factors were collected from participants of the Cardiovascular Risk in Young Finns Study (YFS; N = 1667; age 34-49 years). EAT thickness was measured from parasternal long axis echocardiograms. Multivariable regression analysis was used to study potential EAT determinants. Possible effect modification of sex was addressed. Mean EAT thickness was 4.07 mm (95% CI 4.00-4.17). Multivariable analysis [β indicating percentage of change in EAT(mm) per one unit increase in determinant variable] indicated female sex (β = 11.0, P < 0.0001), type 2 diabetes (β = 14.0, P = 0.02), waist circumference (cm) (β = 0.38, P < 0.0001), systolic blood pressure (mmHg) (β = 0.18, P = 0.02) and red meat intake (g/day) (β = 0.02, P = 0.05) as EAT determinants. Sex-specific analysis revealed age (year) (β = 0.59, P = 0.01), alcohol intake (drinks/day) (β = 4.69, P = 0.006), heavy drinking (yes/no) (β = 30.4, P < 0.0001) as EAT determinants in women and fruit intake (g/day) (β = -1.0, P = 0.04) in men. In the YFS cohort, waist circumference, systolic blood pressure and red meat intake were directly associated with EAT among all participants. In women, age, alcohol intake, heavy drinking and type 2 diabetes associated directly with EAT, while an inverse association was observed between fruit intake and EAT in men.
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Affiliation(s)
- Behnoush Gustafsson
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
- Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
| | - Suvi P Rovio
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Saku Ruohonen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Orion Pharma, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Katja Pahkala
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre, Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Center for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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9
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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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10
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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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11
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Sun L, Chang YF, Wang YF, Xie QX, Ran XZ, Hu CY, Luo B, Ning B. Effect of Continuous Positive Airway Pressure on Blood Pressure in Patients with Resistant Hypertension and Obstructive Sleep Apnea: An Updated Meta-analysis. Curr Hypertens Rep 2024; 26:201-211. [PMID: 38460066 DOI: 10.1007/s11906-024-01294-4] [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] [Accepted: 12/26/2023] [Indexed: 03/11/2024]
Abstract
PURPOSE OF REVIEW The effect of continuous positive airway pressure (CPAP) on resistant hypertension in patients at high risk with obstructive sleep apnea (OSA) needs further investigation. We aimed to determine the effect of CPAP on blood pressure in patients with resistant hypertension and OSA. Databases including PubMed, EMBASE, MEDLINE, the Cochrane Library, and CMB were searched. Data were pooled using a random-effects or fixed-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals (CIs). RECENT FINDINGS A total of 12 trials and 718 participants were included. Compared with control, CPAP significantly reduced 24-h systolic blood pressure (SBP) (WMD: - 5.92 mmHg [ - 8.72, - 3.11]; P<0.001), 24-h diastolic blood pressure (DBP) (WMD: - 4.44 mmHg [- 6.26 , - 2.62]; P <0.001), daytime SBP (WMD: - 5.76 mmHg [ - 9.16, - 2.36]; P <0.001), daytime DBP (WMD: - 3.92 mmHg [- 5.55, - 2.30]; nighttime SBP (WMD: - 4.87 mmHg [ - 7.96 , - 1.78]; P = 0.002), and nighttime DBP (WMD: - 2.05 mmHg [- 2.99, - 1.11]; P<0.001) in patients with resistant hypertension and OSA. CPAP improved the blood pressure both in the short (<3 months) and long term (≥ 3 months). No significant impact on mean heart rate was noted (WMD: -2.76 beats per min [- 7.50, 1.97]; P = 0.25). CPAP treatment was associated with BP reduction in patients with resistant hypertension and OSA.
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Affiliation(s)
- Ling Sun
- Fuyang Tumor Hospital, Fuyang, China
| | - Ya-Fei Chang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Yun-Fei Wang
- The 90th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei, Chine
| | | | | | - Chun-Yang Hu
- Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Bin Luo
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
| | - Bin Ning
- Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China.
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12
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Jobe M, Mactaggart I, Hydara A, Kim MJ, Bell S, Kotanmi GB, Badjie O, Prentice AM, Burton MJ. Blood pressure and the hypertension care cascade in The Gambia: Findings from a nationwide survey. J Clin Hypertens (Greenwich) 2024; 26:563-572. [PMID: 38563710 PMCID: PMC11088434 DOI: 10.1111/jch.14806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
Community treatment of hypertension in sub-Saharan Africa is hampered by gaps at several stages of the care cascade. We compared blood pressure (BP) levels (systolic, diastolic and pulse pressures) in four groups of participants by hypertension and treatment status. We conducted a nationally representative survey of adults 35 years and older using a multistage sampling strategy based on the 2013 Gambia Population and Housing Census. The BP measurements were taken in triplicate 5 min apart, and the average of the last two measurements was used for analysis. Systolic and diastolic BP levels and pulse pressure were compared by hypertension status using mean and 95% confidence intervals (CI). 53.1% of the sample were normotensive with mean systolic BP (SBP) of 119.2 mmHg (95% CI, 118.7-119.6) and diastolic BP (DBP) of 78.1 mmHg (77.8-78.3). Among individuals with hypertension, mean SBP was 148.7 mmHg (147.7-149.7) among those unaware of their hypertension, 152.2 mmHg (151.0-153.5) among treated individuals and was highest in untreated individuals at 159.3 mmHg (157.3-161.2). The findings were similar for DBP levels, being 93.9 mmHg (93.4-94.4) among the unaware, 95.1 mmHg (94.4-95.8) among the treated and highest at 99.1 mmHg (98.1-100.2) in untreated participants. SBP and DBP were higher in men, and SBP was as expected higher in those aged ≥55 years. BP level was similar in urban and rural areas. Our data shows high BP levels among participants with hypertension including those receiving treatment. Efforts to reduce the health burden of hypertension will require inputs at all levels of the care cascade.
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Affiliation(s)
- Modou Jobe
- Medical Research Council Unit The GambiaLondon School of Hygiene and Tropical MedicineFajaraThe Gambia
| | - Islay Mactaggart
- International Centre for Eye HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care CentreBanjulThe Gambia
| | - Min J. Kim
- International Statistics and Epidemiology GroupDepartment of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation TrustLondonUK
| | - Gaetan Brezesky Kotanmi
- Medical Research Council Unit The GambiaLondon School of Hygiene and Tropical MedicineFajaraThe Gambia
| | - Omar Badjie
- Health Promotion & EducationMinistry of HealthBanjulThe Gambia
| | - Andrew M. Prentice
- Medical Research Council Unit The GambiaLondon School of Hygiene and Tropical MedicineFajaraThe Gambia
| | - Matthew J. Burton
- International Centre for Eye HealthLondon School of Hygiene & Tropical MedicineLondonUK
- National Institute for Health Research Biomedical Research Centre for OphthalmologyMoorfields Eye Hospital NHS Foundation TrustLondonUK
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13
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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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14
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Şahin M, Kazaz SN, Kartaler F, Kodal B, Altuntaş S, Yüce E, Turan OE, Kutlu M. Arterial Stiffness May Predict Subsequent Cancer Therapy-Related Cardiac Dysfunction in Breast Cancer Patients. Cardiovasc Toxicol 2024; 24:375-384. [PMID: 38457021 PMCID: PMC10998812 DOI: 10.1007/s12012-024-09841-w] [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: 10/11/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Cancer therapy-related cardiac dysfunction (CTRCD) is still a serious problem. Existing risk scores are insufficient for risk classification, especially in low and medium-risk patients. This study aims to evaluate if arterial stiffness (AS) measurement, which is associated with most of the known risk factors, can be a useful parameter for predicting subsequent CTRCD in patients with breast cancer (BC). Patients with BC were included in the study. All patients' AS parameters such as pulse wave velocity (PWV), augmentation index (AIx), augmentation pressure (AP), and echocardiographic parameters were obtained before treatment. During treatment, echocardiographic follow-up with routine parameters and left ventricle global longitudinal strain (LVGLS) were measured. Patients were evaluated on whether CTRCD occurred or not. A total of 67 patients were analyzed. The mean age of the study population was 54.9 ± 11 years. Baseline characteristics were similar except for age. No CTRCD diagnosis was obtained according to left ventricle ejection fraction (LVEF) reduction, but 18 patients (26.8%) developed CTRCD regarding the decline in LVGLS. Left ventricle hypertrophy and diastolic dysfunction were more frequent in patients with CTRCD (p = 0.016 and p = 0.015, respectively). PWV, AIx, and AP as AS parameters were significantly higher in patients with CTRCD, but Alx@75 were not (p = 0.005, p = 0.034, p = 0.008, p = 0.077, respectively). A positive correlation between PWV and a decreased percent in LVGS (R = 0.607, p < 0.001) was observed. ROC curve analyses revealed an AUC of 0.747 (p = 0.02, 95% CI 0.632-0.832) for PWV. A PWV value of 9.2 m/s predicted CTRCD with 94% sensitivity and 73% specificity. AS measurement may be useful for predicting CTRCD in patients with low to medium-risk BC.
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Affiliation(s)
- Mürsel Şahin
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey.
| | - Seher Nazlı Kazaz
- Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | | | - Burcu Kodal
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey
| | - Seda Altuntaş
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey
| | - Elif Yüce
- Department of Medical Oncology, Karaman Training and Research Hospital, Karaman, Turkey
| | - Oğuzhan Ekrem Turan
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Merih Kutlu
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey
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15
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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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16
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Rao S, Basu S, Nandi K, Singh MM, Lalwani H, Maheshwari V, Borle A, Sharma N. Metabolic syndrome burden, determinants and treatment status in an urban slum resettlement colony in Delhi, India. Int Health 2024:ihae024. [PMID: 38517308 DOI: 10.1093/inthealth/ihae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/10/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) in low-resource settings contributes to accentuated risk of cardiovascular disease, including stroke. The study objective was to estimate the prevalence, determinants and treatment status of MetS in an urban slum resettlement population in Delhi, India. METHODS This study was conducted from February to May 2023. Multiphase sampling was conducted with 1910 individuals screened for abdominal obesity (AO), with 996 detected as having AO, of which, 400 were selected by simple random sampling and further evaluated for triglycerides (TGs), high-density lipoprotein (HDL) and fasting glucose levels. RESULTS Among the 400 participants detected as having AO, 211 had evidence of MetS (52.75% [95% confidence interval 47.83 to 57.62]). The most prevalent combination of MetS clustering was for all five components (AO, diabetes mellitus [DM], hypertension [HTN], low HDL and high TGs; 14.69%), followed by AO, DM and HTN (12.32%). On adjusted analysis, the odds of having MetS was found to be independently associated with increasing age (≥40 y) but not sex. CONCLUSIONS A high burden of MetS and suboptimal treatment status is prevalent in urban slum populations. Screening of individuals with AO, especially in those >40 y of age, can be an effective programmatic strategy for early diagnosis and management of MetS and its underlying components.
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Affiliation(s)
- Shivani Rao
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Saurav Basu
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, Haryana 122102, India
| | - Kajal Nandi
- Department of Biochemistry, Maulana Azad Medical College, New Delhi 110002, India
| | - M M Singh
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Heena Lalwani
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Vansh Maheshwari
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, Haryana 122102, India
| | - Amod Borle
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
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17
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Al Ashmar S, Anwardeen NR, Anlar GG, Pedersen S, Elrayess MA, Zeidan A. Metabolomic profiling reveals key metabolites associated with hypertension progression. Front Cardiovasc Med 2024; 11:1284114. [PMID: 38390445 PMCID: PMC10881871 DOI: 10.3389/fcvm.2024.1284114] [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: 08/28/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Pre-hypertension is a prevalent condition among the adult population worldwide. It is characterized by asymptomatic elevations in blood pressure beyond normal levels but not yet reaching the threshold for hypertension. If left uncontrolled, pre-hypertension can progress to hypertension, thereby increasing the risk of serious complications such as heart disease, stroke, kidney damage, and others. Objective The precise mechanisms driving the progression of hypertension remain unknown. Thus, identifying the metabolic changes associated with this condition can provide valuable insights into potential markers or pathways implicated in the development of hypertension. Methods In this study, we utilized untargeted metabolomics profiling, which examines over 1,000 metabolites to identify novel metabolites contributing to the progression from pre-hypertension to hypertension. Data were collected from 323 participants through Qatar Biobank. Results By comparing metabolic profiles between pre-hypertensive, hypertensive and normotensive individuals, six metabolites including stearidonate, hexadecadienoate, N6-carbamoylthreonyladenosine, 9 and 13-S-hydroxyoctadecadienoic acid (HODE), 2,3-dihydroxy-5-methylthio- 4-pentenoate (DMTPA), and linolenate were found to be associated with increased risk of hypertension, in both discovery and validation cohorts. Moreover, these metabolites showed a significant diagnostic performance with area under curve >0.7. Conclusion These findings suggest possible biomarkers that can predict the risk of progression from pre-hypertension to hypertension. This will aid in early detection, diagnosis, and management of this disease as well as its associated complications.
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Affiliation(s)
- Sarah Al Ashmar
- Department of Basic Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Gulsen Guliz Anlar
- Department of Basic Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Shona Pedersen
- Department of Basic Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Mohamed A Elrayess
- Department of Basic Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Asad Zeidan
- Department of Basic Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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18
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Yu L, Xu G, Zhou Q, Ouyang M, Gao L, Zeng S. Biomechanical properties of the ascending aorta in patients with arterial hypertension by velocity vector imaging. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:397-405. [PMID: 37991691 DOI: 10.1007/s10554-023-03003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023]
Abstract
Aortic stiffness is an important risk factor for cardiovascular events and morbidity. Increased aortic stiffness is associated with an increase in cardiac and vascular hypertension-related organ damage. To evaluate the biomechanical properties of the ascending aorta (AA) in patients with arterial hypertension (AH) by velocity vector imaging (VVI). Ninety-five patients with AH and 53 normal healthy control participants were prospectively enrolled. AA biomechanical properties, i.e., ascending aortic global longitudinal strain (ALS), ascending aortic global circumferential strain (ACS), and fractional area change (FAC), were evaluated by VVI. Relative wall thickness (RWT) and left ventricular mass (LVM) were calculated. Pulsed Doppler early transmitral peak flow velocity (E), early diastolic mitral annular velocity (e'), left ventricular global longitudinal strain (GLS), distensibility (D) and stiffness index (SI) of AA were also obtained. The ALS, ACS and FAC were significantly lower in the AH patients, especially in those with ascending aorta dilatation (AAD), than in the normal healthy control subjects. The patients with AAD had a higher E/e' ratio, RWT, LVM and SI and a lower GLS and D than patients without AAD and normal healthy volunteers (p < 0.05). There were significant associations between biomechanical properties and D, SI, E/e' and GLS (ALS and D: r = 0.606, ALS and SI: r = - 0.645, ALS and E/e': r = - 0.489, ALS and GLS: r = 0.466, ACS and D: r = 0.564, ACS and SI: r = - 0.567, ACS and E/e': r = - 0.313, ACS and GLS: r = 0.320, FAC and D: r = 0.649, FAC and SI: r = - 0.601, FAC and E/e': r = - 0.504, FAC and GLS: r = 0.524, respectively, p < 0.05). The biomechanical properties of AA were impaired in patients with AH, especially patients with ascending aorta dilatation. Hypertension is associated with a high prevalence of diastolic and systolic dysfunction and increased arterial stiffness. Further study is needed to evaluate the clinical application of AA biomechanical properties by VVI.
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Affiliation(s)
- Li Yu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Ganqiong Xu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Mingzhi Ouyang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Lei Gao
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, 410000, China.
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19
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Sorbie GG, Williams AK, Carter SE, Campbell AK, Glen J, Lavallee D, Sculthorpe N, Murray A, Beaumont AJ. Improved Physical Health in Middle-Older Aged Golf Caddies Following 24 Weeks of High-Volume Physical Activity. J Phys Act Health 2024; 21:134-145. [PMID: 37939701 DOI: 10.1123/jpah.2023-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The physical demands of golf caddying, including walking while carrying a golf bag, may potentially affect body composition, and markers of metabolic, cardiovascular, and musculoskeletal health. Therefore, this study examined the impact of 24 weeks of caddying on physical health in middle-older aged males. METHODS Eleven full-time experienced male caddies (age: 59 [8] y; caddying experience: 14 [12] y) were recruited from a local golf course. The following were assessed at preseason and after 24 weeks of caddying (March-September 2022): body composition, heart rate, blood pressure, blood lipids, and performance tests (static and dynamic balance, strength, and submaximal fitness). Physical activity (PA) levels were assessed at preseason and at the mid-point of the caddying season. Across the caddying season, participants completed a monthly average of 24.0 (3.8) rounds. RESULTS Following the caddying season, improvements in static balance (Δ = 13.5 s), dynamic balance (Δ = -1.8 s), and lower back absolute strength (Δ = 112.8 N), and muscle quality (Δ = 2.0 N·kg-1) were observed (all P < .05). Additionally, blood lipids, including total cholesterol (Δ = -0.6 mmol·L-1), high-density lipoprotein cholesterol (Δ = 0.1 mmol·L-1), low-density lipoprotein cholesterol (Δ = -0.6 mmol·L-1) (all P < .05), and body composition, including body mass (Δ = -2.7 kg), fat mass (Δ = -1.9 kg), fat percentage (Δ = -1.4%), fat-to-muscle ratio (Δ = -0.03), and body mass index (Δ = -0.9 kg·m-2) (all P < .05) improved. Caddying did not offer beneficial changes to cardiovascular variables or cardiorespiratory fitness (P > .05), while coronary heart disease risk score decreased (Δ = -3.3%) (P < .05). In relation to PA, light- (Δ = 145 min) and moderate-intensity (Δ = 71 min) PA, moderate to vigorous PA (Δ = 73 min), and total PA (Δ = 218 min) between preseason and the mid-point of the caddying season increased, while sedentary time (Δ = -172 min) decreased (all P < .05). CONCLUSION Golf caddying can provide several physical health benefits such as improvements in various markers of cardiometabolic health, lower back absolute strength, and static and dynamic balance. The physical health improvements that caddying offers is likely contributed to by increased PA volume and intensity through walking on the golf course. Therefore, caddying may represent a feasible model for increasing PA volume and intensity and achieve physical health-related benefits.
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Affiliation(s)
- Graeme G Sorbie
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Ashley K Williams
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Sophie E Carter
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Amy K Campbell
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Jonathan Glen
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - David Lavallee
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Lanarkshire, United Kingdom
| | - Andrew Murray
- Medical and Scientific Department, The R&A, St Andrews, United Kingdom
- Sport and Exercise, University of Edinburgh, Edinburgh, United Kingdom
| | - Alexander J Beaumont
- School of Science, Technology and Health, York St John University, York, United Kingdom
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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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21
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Wadström K, Jacobsson LTH, Mohammad AJ, Warrington KJ, Matteson EL, Turesson C. Apolipoproteins and the risk of giant cell arteritis-a nested case-control study. Arthritis Res Ther 2024; 26:37. [PMID: 38281009 PMCID: PMC10821258 DOI: 10.1186/s13075-024-03273-1] [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: 09/19/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The etiology of giant cell arteritis (GCA) and its predictors are incompletely understood. Previous studies have indicated reduced risk of future development of GCA in individuals with obesity and/or diabetes mellitus. There is limited information on blood lipids before the onset of GCA. The objective of the study was to investigate the relation between apolipoprotein levels and future diagnosis of GCA in a nested case-control analysis. METHODS Individuals who developed GCA after inclusion in a population-based health survey (the Malmö Diet Cancer Study; N = 30,447) were identified by linking the health survey database to the local patient administrative register and the national patient register. A structured review of medical records was performed. Four controls for every validated case, matched for sex, year of birth, and year of screening, were selected from the database. Anthropometric measures, self-reported physical activity, based on a comprehensive, validated questionnaire, and non-fasting blood samples had been obtained at health survey screening. Concentrations of apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) in stored serum were measured using an immunonephelometric assay. Potential predictors of GCA were examined in conditional logistic regression models. RESULTS There were 100 cases with a confirmed clinical diagnosis of GCA (81% female; mean age at diagnosis 73.6 years). The median time from screening to diagnosis was 12 years (range 0.3-19.1). The cases had significantly higher ApoA-I at baseline screening compared to controls (mean 168.7 vs 160.9 mg/dL, odds ratio [OR] 1.57 per standard deviation (SD); 95% confidence interval [CI] 1.18-2.10) (SD 25.5 mg/dL). ApoB levels were similar between cases and controls (mean 109.3 vs 110.4 mg/dL, OR 0.99 per SD; 95% CI 0.74-1.32) (SD 27.1 mg/dL). The ApoB/ApoA1 ratio tended to be lower in cases than in controls, but the difference did not reach significance. The association between ApoA-I and GCA development remained significant in analysis adjusted for body mass index and physical activity (OR 1.48 per SD; 95% CI 1.09-1.99). CONCLUSION Subsequent development of GCA was associated with significantly higher levels of ApoA-I. These findings suggest that a metabolic profile associated with lower risk of cardiovascular disease may predispose to GCA.
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Affiliation(s)
- Karin Wadström
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, 205 02, Sweden
- Center for Rheumatology, Academic Specialist Center, Stockholm, Region Stockholm, Sweden
| | - Lennart T H Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, 205 02, Sweden
- Department of Rheumatology & Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aladdin J Mohammad
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, 205 02, Sweden.
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
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Shafer BM, Kogan SA, McHill AW. Pressure Building Against the Clock: The Impact of Circadian Misalignment on Blood Pressure. Curr Hypertens Rep 2024; 26:31-42. [PMID: 37837518 PMCID: PMC10916535 DOI: 10.1007/s11906-023-01274-0] [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] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW Misalignment between the endogenous biological timing system and behavioral activities (i.e., sleep/wake, eating, activity) contributes to adverse cardiovascular health. In this review, we discuss the effects of recurring circadian misalignment on blood pressure regulation and the implications for hypertension development. Additionally, we highlight emerging therapeutic approaches designed to mitigate the negative cardiovascular consequences elicited by circadian disruption. RECENT FINDINGS Circadian misalignment elicited by work schedules that require individuals to be awake during the biological night (i.e., shift work) alters 24-h blood pressure rhythms. Mechanistically, circadian misalignment appears to alter blood pressure via changes in autonomic nervous system balance, variations to sodium retention, dysregulation of endothelial vasodilatory responsiveness, and activation of proinflammatory mechanisms. Recurring circadian misalignment produced by a mismatch in sleep timing on free days vs. work days (i.e., social jetlag) appears to have no direct effects on prevailing blood pressure levels in healthy adults; though, circadian disruptions resulting from social jetlag may increase the risk of hypertension through enhanced sympathetic activation and/or obesity. Furthermore, social jetlag assessment may be a useful metric in shift work populations where the magnitude of circadian misalignment may be greater than in the general population. Circadian misalignment promotes unfavorable changes to 24-h blood pressure rhythms, most notably in shift working populations. While light therapy, melatonin supplementation, and the timing of drug administration may improve cardiovascular outcomes, interventions designed to target the effects of circadian misalignment on blood pressure regulation are warranted.
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Affiliation(s)
- Brooke M Shafer
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Sophia A Kogan
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Andrew W McHill
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA.
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Filchenko I, Korostovtseva L, Bochkarev M, Tsoy U, Sviryaev Y. Cardiovascular remodeling in active and controlled acromegaly: association with sleep-disordered breathing. Sleep Breath 2023; 27:2305-2314. [PMID: 37148385 DOI: 10.1007/s11325-023-02838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE We hypothesized that an unfavorable cardiovascular profile in acromegaly is associated with sleep-disordered breathing (SDB), while acromegaly control improves both respiratory sleep characteristics and the cardiovascular profile. METHODS The patients underwent the assessment of breathing during sleep and cardiovascular profile assessment at the start of the study including arterial stiffness, blood pressure, echocardiography, nocturnal heart rate variability (HRV). The assessment was repeated in patients with acromegaly at 1 year after transsphenoidal adenectomy (TSA). RESULTS A total of 47 patients with acromegaly and 55 control subjects were enrolled. At one year after TSA, 22 patients with acromegaly were reassessed. Multiple linear regression analysis with adjustment for age, sex and body mass index (BMI) showed the associations of insulin growth-like factor 1 (IGF-1) with obstructive apnea index (OAI: β=0.035/h, p<0.001), but not with cardiovascular parameters, in patients with acromegaly. The analysis of combined acromegaly and control dataset with adjustment for age, sex and BMI showed the association the presence of acromegaly with diastolic blood pressure (DBP; β=17.99 mmHg, p<0.001), ejection fraction (EF; β=6.23%, p=0.009), left heart remodeling (left ventricle posterior wall: β=0.81 mm, p=0.045) and the association of the presence of SDB (apnea-hypopnea index≥15/h) with left ventricular function (EF: -4.12%, p=0.040; end systolic volume: 10.12 ml, p=0.004). Control of acromegaly was accompanied by the decrease in OAI (5.9 [0.8, 14.5]/h and 1.7 [0.2, 5.1]/h, p=0.004) and nocturnal heart rate (66.1 [59.2, 69.8] bpm and 61.7 [54.0, 67.2] bpm, p=0.025) and by the increase in blood pressure (DBP: 78.0 [70.3, 86.0] mm Hg and 80.0 [80.0, 90.0] mm Hg, p=0.012). CONCLUSION The comorbidities of acromegaly, including sleep-disordered breathing, appear to have a long-term effect on cardiovascular remodeling in active acromegaly. Future studies should investigate the applicability of the treatment of SDB for the reduction of cardiovascular risk in acromegaly.
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Affiliation(s)
- Irina Filchenko
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341.
| | - Lyudmila Korostovtseva
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Mikhail Bochkarev
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Uliana Tsoy
- Almazov National Medical Research Center, Laboratory of Endocrinology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Yuri Sviryaev
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
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Ma Q, Song S, Xu G. Inverse association between caffeine intake and albuminuria in US adults: an analysis of NHANES 2005-2016. Acta Clin Belg 2023; 78:438-445. [PMID: 37278165 DOI: 10.1080/17843286.2023.2222243] [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: 03/15/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Albuminuria is a significant biomarker of various kidney diseases and is associated with renal outcome. Recently, caffeine intake has shown potential renoprotective effects. However, the relationship between caffeine intake and albuminuria remains profoundly elusive. METHODS We conducted a cross-sectional study aimed to explore the association between caffeine intake and albuminuria in the American adult population using the data acquired from the National Health and Nutrition Examination Survey (NHANES) 2005-2016. Caffeine intake was assessed by 24-h dietary recalls, and albuminuria was assessed by albumin-to-creatinine ratio. Multivariate logistic regression was performed to explore the independent association between caffeine intake and albuminuria. Subgroup analysis and interaction tests were also conducted. RESULTS Among 23,060 participants, 11.8% of the individuals exhibited albuminuria, and the prevalence of albuminuria decreased with higher caffeine intake tertiles (Tertile 1: 13%; Tertile 2: 11.9%; Tertile 3: 10.5%; P < 0.001). After adjusted potential confounders, the results of logistic regression indicated that a higher caffeine intake was associated with a decreased risk of albuminuria (OR = 0.903; 95% CI: 0.84, 0.97; P = 0.007), especially in females and the participants aged <60 years and chronic kidney disease stage II. CONCLUSION The present study first indicated an inverse correlation between caffeine intake and albuminuria, which further confirmed the potentially protective effects of caffeine on the kidney.
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Affiliation(s)
- Qiqi Ma
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuaihua Song
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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25
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Lallemand A, Verrue C, Santi A, Delhaye N, Willaert M, Attipoe A, Tomas M, Philippe G. Evaluation of community pharmacist follow-up supported by the use of healthcare technology for type 2 diabetes patients. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100330. [PMID: 37743852 PMCID: PMC10514548 DOI: 10.1016/j.rcsop.2023.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Prevalence of type 2 diabetes is high in Belgium (estimated at over 10%, 1 patient out of 3 being unaware of their diagnosis). Management based on a change of lifestyle and the adoption of health-promoting behaviors, supplemented when needed with drug treatment, prevents complications, improves the patient's quality of life and reduces mortality. Multidisciplinary patient support is essential. In this, pharmacists have a key role, e.g. through therapeutic patient education activities, in which they are increasingly involved. Moreover, research suggests that the use of mobile technologies can be a useful tool for helping patients with their daily life and disease management. Objectives This study aims at exploring the benefits of community pharmacist follow-up supported by the use of mobile technologies in the monitoring of individuals with type 2 diabetes. The presented intervention aimed to reinforce the patients' willingness to actively participate in the management of their disease and to adopt favorable health behaviors, in order to increase their level of medication adherence. Methods A quantitative quasi-experimental study was conducted in community pharmacies throughout Belgium over a 6-month period with 3 data collection periods (before, during and after the intervention). Primary outcomes, related to the level of medication adherence, and secondary outcomes, considered as markers of the patient's overall health, were analyzed. In addition, qualitative data concerning participants' opinions on their experience were collected. Results 66 patients participated in the study, with 50 remaining after 3 months and 46 completing the entire study. Statistical analyses did not show an improvement in the level of medication adherence. This parameter was high from the beginning, reflecting patients with controlled diabetes. However, statistically significant results were observed for systolic blood pressure and waist circumference (both improved), while other outcomes showed a positive trend or remained stable. Patient follow-up by the pharmacist was a positive experience for both parties which noted their interest and satisfaction for the project. Conclusions Although clinical results are not conclusive, patients were motivated and the attrition rate was low. Participants showed their interest in participating in this kind of project, opening up opportunities for further studies in the community pharmacy setting. As front-line health professionals, community pharmacists certainly have a key-role to play in therapeutic patient education and mobile technologies could be additional tools in this process.
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Affiliation(s)
- A. Lallemand
- Center for Interdisciplinary Research on Medicines, Faculty of Medicine, University of Liege, Liege, Belgium
| | | | - A. Santi
- Multipharma SC, Brussels, Belgium
| | | | | | | | - M. Tomas
- Comunicare Solutions SA, Liege, Belgium
| | - G. Philippe
- Center for Interdisciplinary Research on Medicines, Faculty of Medicine, University of Liege, Liege, Belgium
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Shin J, Wang JG, Chia YC, Kario K, Chen CH, Cheng HM, Fujiwara T, Hoshide S, Huynh MV, Li Y, Nagai M, Nailes J, Park S, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Teo BW, Tomitani N, Tsoi K, Turana Y, Verma N, Wang TD, Zhang Y. The HOPE Asia Network consensus on blood pressure measurements corresponding to office measurements: Automated office, home, and ambulatory blood pressures. J Clin Hypertens (Greenwich) 2023. [PMID: 37878534 DOI: 10.1111/jch.14729] [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: 04/06/2023] [Revised: 07/28/2023] [Accepted: 09/06/2023] [Indexed: 10/27/2023]
Abstract
For adopting recently introduced hypertension phenotypes categorized using office and out of office blood pressure (BP) for the diagnosis of hypertension and antihypertension drug therapy, it is mandatory to define the corresponding out of office BP with the specific target BP recommended by the major guidelines. Such conditions include white-coat hypertension (WCH), masked hypertension (MH), white-coat uncontrolled hypertension (WUCH), and masked uncontrolled hypertension (MUCH). Here, the authors review the relevant literature and discuss the related issue to facilitate the use of corresponding BPs for proper diagnosis of WCH, MH, WUCH, and MUCH in the setting of standard target BP as well as intensive target BP. The methodology of deriving the corresponding BP has evolved from statistical methods such as standard deviation, percentile value, and regression to an outcome-based approach using pooled international cohort study data and comparative analysis in randomized clinical trials for target BPs such as the SPRINT and STEP studies. Corresponding BPs to 140/90 and 130/80 mm Hg in office BP is important for safe and strict achievement of intensive BP targets. The corresponding home, daytime, and 24-h BPs to 130/80 mm Hg in office BP are 130/80, 130/80, and 125/75 mm Hg, respectively. However, researchers have found some discrepancies among the home corresponding BPs. As tentative criterion for de-escalation of antihypertensive therapy as shown in European guidelines was 120 mm Hg in office BP, corresponding home, daytime, and 24-h systolic BPs to 120 mm Hg in office systolic BP are 120, 120, and 115 mm Hg, respectively.
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Affiliation(s)
- Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Minh Van Huynh
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, ., Vietnam
| | - Yan Li
- Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michiaki Nagai
- Department of Internal Medicine, General Medicine and Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc., Quezon City, Philippines
| | - Sungha Park
- Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, South Korea
| | | | - Jorge Sison
- Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
| | - Guru Prasad Sogunuru
- Fortis Hospitals, Chennai, Tamil Nadu, India
- College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Boon Wee Teo
- Division of Nephrology Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kelvin Tsoi
- JC School of Public Health and Primary Care, JC Institute of Ageing, SH Big Data Decision Analytics Research Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yuda Turana
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Narsingh Verma
- Indian Society of Hypertension, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tzung-Dau Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yuqing Zhang
- Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Song Y, Gu Y, Guo H, Yang H, Wang X, Wu H, Wang A, Wang H, Zhang Q, Zhang Q, Liu L, Meng G, Liu B, Niu K. Association Between Neutrophil-to-Lymphocyte Ratio and Benign Prostatic Hyperplasia: Results from the TCLSIH Cohort Study. J Inflamm Res 2023; 16:4857-4866. [PMID: 37904787 PMCID: PMC10613407 DOI: 10.2147/jir.s431049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023] Open
Abstract
Purpose The prevalence of benign prostatic hyperplasia (BPH) in the general Chinese adult male population has risen sharply over the past few decades. Increasing evidence suggests that inflammation plays an important role in the pathogenesis of BPH. To better understand the role of inflammation in the pathogenesis of BPH, we can use the neutrophil-to-lymphocyte ratio (NLR) because it is a simple and effective marker of inflammation and immunity. This study aims to prospectively investigate the association between NLR levels and the prevalence of BPH in a general Chinese adult male population. Patients and Methods This study included a total of 15,783 male participants free from BPH at baseline. NLR was measured according to the complete blood count. BPH was defined as total prostate volume (TPV) ≥30 mL, and TPV was determined by transabdominal ultrasonography. Multivariable Cox proportional hazards models were fitted to calculate hazards ratios (HRs) and corresponding 95% confidence intervals (CIs) for BPH risk with NLR levels. Results During a median follow-up of 2.7 years, 5078 BPH cases were documented. After adjusting for age, body mass index, smoking, alcohol, education, occupation, income, physical activity, total energy intake, personal and family history of disease, and inflammation markers, the multivariable-adjusted HRs of BPH were 1.00 (reference), 1.08 (95% CIs 0.99, 1.17), 1.10 (95% CIs1.02, 1.19), and 1.12 (95% CIs1.03, 1.21), respectively, for participants with NLR in the first, second, third, and fourth quartiles (P for trend <0.01). Conclusion Higher NLR levels were associated with a higher risk of BPH in Chinese adult male population. Our findings support the notion that NLR levels may be an important target for BPH prevention and intervention.
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Affiliation(s)
- Yanqi Song
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Yeqing Gu
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People’s Republic of China
| | - Honglei Guo
- School of Graduate, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Honghao Yang
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Xuena Wang
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Hongmei Wu
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Aidi Wang
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Haijin Wang
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Quan Zhang
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Ge Meng
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Baoshan Liu
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Kaijun Niu
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, People’s Republic of China
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Shibata M, Hosoi M, Anno K, Hirabayashi N, Hirakawa Y, Kawata H, Iwaki R, Sawamoto R, Sudo N, Ninomiya T. Inadequate care and excessive overprotection during childhood are associated with the presence of diabetes mellitus in adulthood in a general Japanese population: a cross-sectional analysis from the Hisayama Study. BMC Endocr Disord 2023; 23:222. [PMID: 37821847 PMCID: PMC10568832 DOI: 10.1186/s12902-023-01474-4] [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: 10/02/2022] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To investigate associations between parenting styles during childhood and diabetes in adulthood in a Japanese community. METHODS In 2011, 710 community-dwelling Japanese residents aged ≥ 40 years were assessed for the presence of diabetes and for their perceptions of the parenting style of their parents, as measured using the "care" and "overprotection" scales of the Parental Bonding Instrument. Care and overprotection scores for each parent were dichotomized by age-specific median values. Diabetes mellitus was defined as a fasting plasma glucose level of ≥ 7.0 mmol/L, a 2-h post-loaded glucose level of ≥ 11.1 mmol/L, HbA1c ≥ 6.5%, and/or the current use of insulin or oral glucose-lowering agents. The odds ratios (ORs) for prevalent diabetes were calculated using a logistic regression model. RESULTS The prevalence of diabetes was 14.9%. Subjects with a high paternal overprotection score had a significantly greater likelihood of prevalent diabetes than those with a low paternal overprotection score after adjusting for confounders (OR 1.71, 95% confidence interval [CI] 1.06-2.77), while there was no significant association between paternal care and diabetes. Additionally, the multivariable-adjusted ORs for the presence of diabetes were significantly higher in subjects with a low maternal care score (OR 1.61, 95%CI 1.00-2.60) or in subjects with a high maternal overprotection score (OR 1.73, 95%CI 1.08-2.80). Moreover, the subjects with a low care score and high overprotection score for both their father and mother had a significantly higher multivariable-adjusted OR of diabetes than those with a high care score and low overprotection score for both parents (OR 2,12, 95%CI 1.14-3.95). CONCLUSIONS This study suggests that inadequate care and excessive overprotection during childhood may contribute to the development of diabetes in adulthood.
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Grants
- JSPS KAKENHI Grant Number JP19H03752, JP19H03752, JP21H03200, JP21K07522, JP21K11725, JP21K10448, JP22K07421, JP22K17396, JP23K09692, JP23K09717, JP23K16330, JP23K06787, and JP23K09060 Ministry of Education, Culture, Sports, Science and Technology of Japan
- JSPS KAKENHI Grant Number JP19H03752, JP19H03752, JP21H03200, JP21K07522, JP21K11725, JP21K10448, JP22K07421, JP22K17396, JP23K09692, JP23K09717, JP23K16330, JP23K06787, and JP23K09060 Ministry of Education, Culture, Sports, Science and Technology of Japan
- JSPS KAKENHI Grant Number JP19H03752, JP19H03752, JP21H03200, JP21K07522, JP21K11725, JP21K10448, JP22K07421, JP22K17396, JP23K09692, JP23K09717, JP23K16330, JP23K06787, and JP23K09060 Ministry of Education, Culture, Sports, Science and Technology of Japan
- JPMH23FA1006, and JPMH23FA1022 Health and Labour Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan
- JP23dk0207053, JP23km0405209 Japan Agency for Medical Research and Development
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Affiliation(s)
- Mao Shibata
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan.
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
- Division of Research Management, Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kozo Anno
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Naoki Hirabayashi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Kawata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rie Iwaki
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ryoko Sawamoto
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Division of Research Management, Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abuelazm M, Saleh O, Albarakat MM, Katamesh B, Abdalshafy H, Mahmoud A, Abdelazeem B. The effect of bedtime versus morning dosing of antihypertensive drugs on the cardiovascular outcomes: a systematic review and meta-analysis of randomized controlled trials. J Hypertens 2023; 41:1595-1605. [PMID: 37642592 DOI: 10.1097/hjh.0000000000003508] [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: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVE Antihypertensive drugs are one of the most effective strategies to prevent disability and mortality; however, there have been contradictory findings about the best dosing time for antihypertensive drugs. Therefore, we aim to evaluate the effect of bedtime versus morning dosing of antihypertensive drugs on cardiovascular outcomes. METHODS We synthesized randomized controlled studies (RCTs) from the Web of Science, SCOPUS, EMBASE, PubMed, and CENTRAL until 13 October 2022. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42022368612. RESULTS Five RCTs with 59 200 participants were included. Bedtime dosing was significantly associated with less incidence of myocardial infarction (MI) [RR: 0.80 with 95% CI (0.70-0.91), P = 0.0007] compared with morning dosing; however, there was no statistically significant difference between bedtime and morning dosing, regarding all-cause mortality [RR: 0.77 with 95% CI (0.51-1.16), P = 0.21], cardiovascular mortality [RR: 0.65 with 95% CI (0.35-1.21), P = 0.17], major adverse cardiac events (MACE) [RR: 0.79 with 95% CI (0.56-1.10), P = 0.16], heart failure [RR: 0.68 with 95% CI (0.42-1.09), P = 0.11], cerebrovascular accidents [RR: 0.80 with 95% CI (0.53-1.22), P = 0.30], coronary revascularization [RR: 0.79 with 95% CI (0.50-1.24), P = 0.30}, and angina [RR: 0.91 with 95% CI (0.55-1.50), P = 0.70]. CONCLUSION Evidence about the comparative efficacy of bedtime versus morning dosing of antihypertensives is still uncertain. However, bedtime dosing significantly reduced MI, which warrants more robust RCTs to validate.
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Affiliation(s)
| | - Othman Saleh
- Faculty of Medicine, The Hashemite University, Zarqa
| | - Majd M Albarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Healthcare, Flint
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
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Obajed Al-Ali N, Tóth SR, Váróczy L, Pinczés LI, Soltész P, Szekanecz Z, Kerekes G. One Step Back from Bedside to the Bench-How Do Different Arterial Stiffness Parameters Behave in Relation to Peripheral Resistance? Diagnostics (Basel) 2023; 13:2897. [PMID: 37761264 PMCID: PMC10528548 DOI: 10.3390/diagnostics13182897] [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: 07/20/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The investigation of arterial stiffening is a promising approach to estimating cardiovascular risk. Despite the widespread use of different methods, the dynamic nature of measured and calculated stiffness parameters is marginally investigated. We aimed to determine the stability of large artery elasticity parameters assessed via commonly used, ultrasound-based and oscillometric methods in relation to peripheral resistance modulation. A human experimental environment was composed, and fifteen young males were investigated at rest after extremity heating and external compression. Functional vascular parameters were monitored in each session, and several arterial stiffness parameters were analysed. The distensibility coefficient (DC) did not show significant changes during heat provocation and extremity compression, while DC's stability seemed to be acceptable. The same stability of carotid-femoral pulse wave velocity (PWV) was detected with ultrasound measurement (5.43 ± 0.79, 5.32 ± 0.86 and 5.28 ± 0.77, with p = 0.38, p = 0.27 and p = 0.76, respectively) with excellent intersession variability (intraclass correlation coefficient of 0.90, 0.88 and 0.91, respectively). However, the oscillometric PWV (oPWV) did change significantly between the heating and outer compression phase of the study (7.46 ± 1.37, 7.10 ± 1.18 and 7.60 ± 1.21, with p = 0.05, p = 0.68 and p < 0.001, respectively), the alteration of which is closely related to wave reflection, represented by the changes in reflection time. Our results indicate the good stability of directly measured elastic parameters such as DC and PWV, despite the extreme modulation of peripheral resistance. However, the oscillometric, indirectly detected PWV might be altered by physical interventions, which depend on wave reflection. The effective modulation of wave reflection was characterized by changes in the augmentation index, detected using both oscillometry and applanation tonometry. Thus, the environment during oscillometric measurement should be rigorously standardized. Furthermore, our results suggest the dynamic nature of the reflection point, rather than being a fixed anatomical point, proposed previously as aortic bifurcation.
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Affiliation(s)
- Nóra Obajed Al-Ali
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.V.); (L.I.P.)
| | - Sára Rebeka Tóth
- Department of Cardiology, Medical Centre, Hungarian Defence Forces, 1134 Budapest, Hungary;
| | - László Váróczy
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.V.); (L.I.P.)
| | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.V.); (L.I.P.)
| | - Pál Soltész
- Division of Angiology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - György Kerekes
- Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
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Treciokiene I, Peceliuniene J, Wettermark B, Gulbinovic J, Taxis K. Hypertension management and drug-related problems. A case report of the 23-year history of Mr. Jonas. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100313. [PMID: 37601158 PMCID: PMC10433230 DOI: 10.1016/j.rcsop.2023.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Arterial hypertension is a lifelong disease, which management is recognized as the most effective way to reduce cardiovascular mortality. Even though there is extensive evidence on the benefits of lifestyle modification and antihypertensive treatment, many patients with hypertension do not reach blood pressure targets. This paper aims to review the history of antihypertensive treatment of one patient and identify the drug related problems that occurred over the study period. In this case report, the patient's health record was studied, guidelines checked and a semi-structured interview conducted. Drug related problems were identified and possible pharmacist interventions were introduced. Drug related problems that could have contributed to the lack of hypertension control were adherence, side effects and disease-drug interaction. Identified pharmacists' interventions ranged from managing self-medication, to collaboration with general practitioner to change prescribing, and counselling the patient on medication use, including adherence. Even though the drug related problems were not that serious in the studied case, the patient could have valued from pharmacist intervention.
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Affiliation(s)
- Indre Treciokiene
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Jurate Peceliuniene
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Bjorn Wettermark
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
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32
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Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, Sanner B. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. J Intern Med 2023; 294:251-268. [PMID: 37401044 DOI: 10.1111/joim.13678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
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Affiliation(s)
- G Mancia
- University of Milano-Bicocca, Milan, Italy
| | - F P Cappuccio
- University of Warwick, Warwick Medical School, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - M Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - C Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - R Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - B Sanner
- Department of Internal Medicine, Agaplesion Bethesda, Wuppertal, Germany
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Cesana G, Fermi F, Andreasi V, Bonaldi M, Uccelli M, Oldani A, Zanoni A, Olmi S. Could Glycated Hemoglobin be Leakage Predictor in Sleeve Gastrectomy? A Retrospective Observational Study on 4233 Patients. Obes Surg 2023; 33:2851-2858. [PMID: 37468702 DOI: 10.1007/s11695-023-06754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Diabetes increases the risks related to surgery. At the same time, bariatric surgery improves diabetes. Glycated hemoglobin (A1C) is an index of diabetes severity. The purpose of this study is to evaluate A1C as a possible predictor of postoperative complications after Sleeve Gastrectomy (SG), focusing on leakage. MATERIALS AND METHODS Monocentric retrospective study considering all consecutive patients with obesity, with or without diabetes, who underwent bariatric surgical procedures, from January 2018 to December 2021. All patients had preoperative A1C values. RESULTS 4233 patients were considered. 522 patients (12.33%) were diabetics (A1C ≥ 6.5%). Of these, 260 patients (6.14%) had A1C ≥ 7% and 59 (1.39%) A1C ≥ 8%. 1718 patients (40.58%) were in a pre-diabetic range (A1C 5.7%-6.5%). Higher A1C values were associated with older age, male gender, higher BMI and increased rate of comorbidities. A longer operative time was observed for patients with A1C ≥ 7%, p = 0.027 (53 ± 20 vs 51 ± 18 min). The frequency of leakage was significantly higher when A1C ≥ 7% (3.8% vs 2.0%, p = 0.026). The frequency of leakage further increased when A1C ≥ 8% (5.1%), although this difference did not reach statistical significance. CONCLUSION Patients with obesity and A1C ≥ 7% need to be referred to a diabetologist to treat diabetes before surgery and consequently decrease the risk of leakage.
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Affiliation(s)
- Giovanni Cesana
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy.
| | - Francesca Fermi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
- Olmi is an Associated Professor. Fermi and Andreasi are Residents in the General Surgery Program, Università Vita-Salute San Raffaele, Milan, Italy
| | - Valentina Andreasi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
- Olmi is an Associated Professor. Fermi and Andreasi are Residents in the General Surgery Program, Università Vita-Salute San Raffaele, Milan, Italy
| | - Marta Bonaldi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Matteo Uccelli
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Alberto Oldani
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Adelinda Zanoni
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
| | - Stefano Olmi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Zingonia, BG, Italy
- Olmi is an Associated Professor. Fermi and Andreasi are Residents in the General Surgery Program, Università Vita-Salute San Raffaele, Milan, Italy
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AlGhibiwi HK, Sarawi WS, Alosaimi ME, Alhusaini AM, Assiri MA, Algarzae NK. The Association between Cardiovascular Risk Factors and Carotid Intima-Media Thickness in 42,726 Adults in UK Biobank: A Cross-Sectional Study. J Cardiovasc Dev Dis 2023; 10:358. [PMID: 37754787 PMCID: PMC10532383 DOI: 10.3390/jcdd10090358] [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: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Traditional modifiable cardiovascular risk factors, such as high blood pressure, have long been positively correlated with high carotid intima-media thickness (cIMT). However, traditional cardiovascular risk factors made a minor contribution to cIMT variance, meaning that other markers may be regarded as independent markers for increasing cIMT. AIMS To investigate the simple demographic patterns of carotid intima-media thickness (cIMT) in the UK Biobank and to identify which upstream cardiovascular disease (CVD) risk factors are independently associated with cIMT. METHODS AND RESULTS A cross-sectional-based study of healthy middle-aged people recruited in the UK between 2006 and 2010 (n = 42,726). RESULTS This study showed that the cardiovascular risk profile generally worsened across the cIMT quantiles from lowest to highest. The lowest cIMT quartile was defined as having a mean cIMT < 588 µm, while the highest cIMT quartile was defined as having a mean cIMT > 748 µm. Specifically, the highest cIMT quantile group had a worse CVD risk factors profile compared to the lowest cIMT quantile group. It was found that, for every one SD increase in age and systolic blood pressure, the mean cIMT increased by 0.357 SD and 0.115 SD, respectively. CONCLUSION Systolic blood pressure and age were the strongest independent risk factors for a high cIMT value compared to other risk factors.
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Affiliation(s)
- Hanan K. AlGhibiwi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia; (W.S.S.); (A.M.A.); (M.A.A.)
| | - Wedad S. Sarawi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia; (W.S.S.); (A.M.A.); (M.A.A.)
| | - Manal E. Alosaimi
- Department of Basic Health Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Ahlam M. Alhusaini
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia; (W.S.S.); (A.M.A.); (M.A.A.)
| | - Mohammed A. Assiri
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia; (W.S.S.); (A.M.A.); (M.A.A.)
| | - Norah K. Algarzae
- Department of Physiology, College of Medicine, King Saud University, Riyadh 11149, Saudi Arabia;
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35
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Song Y, Gu Y, Guo H, Yang H, Wang X, Wu H, Wang A, Wang M, Wang H, Zhang Q, Liu L, Meng G, Liu B, Niu K. Association Between Mean Platelet Volume and Benign Prostatic Hyperplasia: A Population Study from the TCLSIH Cohort Study. J Inflamm Res 2023; 16:3259-3269. [PMID: 37564954 PMCID: PMC10411514 DOI: 10.2147/jir.s416404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose This study aimed to prospectively investigate the association between mean platelet volume (MPV) levels and risk of benign prostatic hyperplasia (BPH) in a general Chinese adult male population, and assessed this association in metabolic syndrome (MetS) patients. Patients and methods This study included a total of 14,923 male participants free from BPH at baseline. MPV was measured by the method of laser-based flow cytometric impedance according to the complete blood sample. BPH was defined as total prostate volume (TPV) ≥ 30 mL, TPV was determined by transabdominal ultrasonography. Multivariable Cox proportional hazards models were fitted to calculate hazards ratios (HRs) and corresponding 95% confidence intervals (CIs) for BPH risk with NLR levels. Results During a median follow-up of 2.7 years, 4848 BPH cases were documented in total male participants, and 1787 BPH cases were documented in MetS participants. After adjusting for age, body mass index, smoking, alcohol and personal and family history of disease, the multivariable-adjusted HRs of BPH were 1.00 (reference), 1.03 (95% CIs 0.96, 1.11), 1.00 (95% CIs 0.92, 1.08) and 0.98 (95% CIs 0.90, 1.06), respectively, for participants with MPV in the 1st, 2nd, 3rd and 4th quartiles (P for trend = 0.47). In MetS patients, the multivariable-adjusted HRs of BPH were 1.00 (reference), 1.03 (95% CIs 0.90, 1.16), 0.99 (95% CIs 0.87, 1.14) and 1.01 (95% CIs 0.89, 1.15) (P for trend= 0.98), respectively. Conclusion A non-significant association was observed between MPV levels and risk of BPH, and no association in this association in MetS patients. Our findings support the notion that MPV levels may not be a target for BPH prevention and intervention.
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Grants
- This study was supported by grants from the Study of Diet and Nutrition Assessment and Intervention Technology (No. 2020YFC2006300) from Active Health and Aging Technologic Solutions Major Project of National Key R&D Program——Study on Intervention Strategies of Main Nutrition Problems in China (No. 2020YFC2006305), National Natural Science Foundation of China (Nos. 81941024, 81872611, 82103837, 81903315 and 8197141228), Tianjin Major Public Health Science and Technology Project (No. 21ZXGWSY00090), National Health Commission of China (No. SPSYYC 2020015), Food Science and Technology Foundation of Chinese Institute of Food Science and Technology (No. 2019-12), 2014 and 2016 Chinese Nutrition Society (CNS) Nutrition Research Foundation—DSM Research Fund (Nos. 2016-046, 2014-071 and 2016-023), China
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Affiliation(s)
- Yanqi Song
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Yeqing Gu
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People’s Republic of China
| | - Honglei Guo
- Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
| | - Honghao Yang
- School of Public Health of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Xuena Wang
- School of Public Health of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Hongmei Wu
- School of Public Health of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Aidi Wang
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Mengxiao Wang
- Binzhou Hospital of Chinese Medicine, Shandong, People’s Republic of China
| | - Haijin Wang
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People’s Republic of China
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Baoshan Liu
- Department of Traditional Chinese Medicine, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Kaijun Niu
- School of Public Health of Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, People’s Republic of China
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
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Ahmad H, Khan H, Haque S, Ahmad S, Srivastava N, Khan A. Angiotensin-Converting Enzyme and Hypertension: A Systemic Analysis of Various ACE Inhibitors, Their Side Effects, and Bioactive Peptides as a Putative Therapy for Hypertension. J Renin Angiotensin Aldosterone Syst 2023; 2023:7890188. [PMID: 37389408 PMCID: PMC10307051 DOI: 10.1155/2023/7890188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 07/01/2023] Open
Abstract
Hypertension is a major risk factor for heart attack, produce atherosclerosis (hardening of the arteries), congestive heart failure, stroke, kidney infection, blindness, end-stage renal infection, and cardiovascular diseases. Many mechanisms are involved in causing hypertension, i.e., via calcium channels, alpha and beta receptors, and the renin-angiotensin system (RAS). RAS has an important role in blood pressure control and is also involved in the metabolism of glucose, homeostasis, and balance of electrolytes in the body. The components of RAS that are involved in the regulation of blood pressure are angiotensinogen, Ang I (angiotensin I), Ang II (angiotensin II), ACE (angiotensin-converting enzyme), and ACE 2 (angiotensin-converting enzyme 2). These components provide for relevant therapeutic targets for the treatment of hypertension, and various drugs are commercially available that target individual components of RAS. Angiotensin receptor blockers (ARBs) and ACE inhibitors are the most popular among these drugs. ACE is chosen in this review as it makes an important target for blood pressure control because it converts Ang I into Ang II and also acts on the vasodilator, bradykinin, to degrade it into inactive peptides. This review highlights various aspects of blood pressure regulation in the body with a focus on ACE, drugs targeting the components involved in regulation, their associated side effects, and a need to shift to alternative therapy for putative hypertension treatment in the form of bioactive peptides from food.
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Affiliation(s)
- Hafiz Ahmad
- RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah, UAE
- Microbiology and Molecular Division-RAK Hospital, Ras al Khaimah, UAE
| | - Huma Khan
- Faculty of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, India
| | - Shabirul Haque
- The Feinstein Institute of Medical Research, Northwell Health, Manhasset, NY, USA
| | - Shameem Ahmad
- Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India
| | - Namita Srivastava
- Faculty of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, India
| | - Azhar Khan
- Faculty of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, India
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Elendu C, Elendu RC, Enyong JM, Ibhiedu JO, Ishola IV, Egbunu EO, Meribole ES, Lawal SO, Okenwa CJ, Okafor GC, Umeh ED, Mutalib OO, Opashola KA, Fatoye JO, Awotoye TI, Tobih-Ojeanelo JI, Ramon-Yusuf HI, Olanrewaju A, Afuh RN, Adenikinju J, Amosu O, Yusuf A. Comprehensive review of current management guidelines of chronic kidney disease. Medicine (Baltimore) 2023; 102:e33984. [PMID: PMID: 37335639 PMCID: PMC10256423 DOI: 10.1097/md.0000000000033984] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Chronic kidney disease (CKD) is a prevalent and progressive condition affecting millions worldwide. It is a long-term condition characterized by gradual loss of kidney function over time. The management of CKD is complex and requires a multidisciplinary approach. This review aims to outline the current management guidelines for CKD. The study included a comprehensive search of various PubMed, Embase, and the Cochrane Library databases for articles published between 2010 and 2023. The search terms used were "chronic kidney disease," "management," and "guidelines." The inclusion criteria were articles that provided management guidelines for patients with CKD. A total of 23 articles were included in the review. Most articles were based on the Kidney Disease Improving Global Outcomes guidelines, the most widely recognized and used guidelines for managing CKD. The study found that the guidelines emphasize the importance of early detection and management of CKD and the need for an approach that involves multiple disciplines in its management. The guidelines recommend several interventions to slow the progression of CKD, including blood pressure control, glycemic control in diabetic patients, and reduce proteinuria. Other interventions include lifestyle modifications such as dietary changes, physical activity, and smoking cessation. The guidelines also recommend regular monitoring of kidney function and referral to a nephrologist for patients with advanced CKD or other complications. Overall, the current management guidelines for CKD emphasize the importance of early detection and a multidisciplinary approach to its management.
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Affiliation(s)
| | - Rhoda C Elendu
- van Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | | | | | | | | | | | | | - Chinazo J Okenwa
- Windsor University School of Medicine, Cayon, St Kitts and Nevis
| | | | | | | | | | - John O Fatoye
- University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | | | | | | | - Opeyemi Amosu
- Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
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Ioannidou E, Shabnam S, Abner S, Kaur N, Zaccardi F, Ray KK, Seidu S, Davies MJ, Khunti K, Gillies CL. Effect of more versus less intensive blood pressure control on cardiovascular, renal and mortality outcomes in people with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Syndr 2023; 17:102782. [PMID: 37257222 DOI: 10.1016/j.dsx.2023.102782] [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: 01/18/2023] [Revised: 04/22/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Currently, there is uncertainty as to whether blood pressure control in patients with type 2 diabetes should be treated to standard recommended levels or more intensively. METHODS Medline, EMBASE, CENTRAL, and Clinicaltrials.gov were searched between January 1, 2000 and April 20th, 2023. Outcomes considered were all-cause mortality, stroke, heart failure, cardiovascular disease, albuminuria, coronary heart disease, and renal outcomes. Random-effects meta-analyses estimated pooled relative risks and mean differences. RESULTS Nine trials enrolling 11,005 participants with type 2 diabetes were included. The pooled mean difference between the intensive and standard treatment groups at follow-up were -7.98 mmHg (95% CI: 12.19 to -3.76) in systolic blood pressure, and -5.08 mmHg (-7.00 to -3.17) in diastolic blood pressure; although between study heterogeneity was high for both meta-analyses (I2>85%). Intensive blood pressure lowering resulted in a reduction in risk of stroke (risk ratio 0.64; 0.52 to 0.79), and macro-albuminuria (0.77; 0.63 to 0.93). More intensive blood pressure control did not result in a statistically significant reduction in risk of all-cause mortality, heart failure, cardiovascular death, cardiovascular events, renal outcomes, and micro-albuminuria; although the direction of estimated effect was beneficial for all outcomes. CONCLUSIONS The use of intensive compared with standard blood pressure targets resulted in a significant reduction in blood pressure, stroke, and macro-albuminuria in patients with type 2 diabetes. The post-treatment blood pressure level in the intensive group was 125/73 mmHg, suggesting the current recommendations of 130/80 mmHg blood pressure or lower if tolerated, could be reduced further.
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Affiliation(s)
- Ekaterini Ioannidou
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester, LE5 4PW, UK
| | - Sharmin Shabnam
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Sophia Abner
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Navjot Kaur
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Kausik K Ray
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Sam Seidu
- National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Melanie J Davies
- National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Kamlesh Khunti
- Professor of Primary Care Diabetes and Vascular Medicine, National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester, LE5 4PW, UK.
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester, LE5 4PW, UK
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39
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Wu S, Tian X, Chen S, Zhang Y, Zhang X, Xu Q, Wang A. Arterial stiffness and blood pressure in treated hypertension: a longitudinal study. J Hypertens 2023; 41:768-774. [PMID: 36883462 DOI: 10.1097/hjh.0000000000003400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVES It has been reported that an increase in arterial stiffness precedes an increase in blood pressure (BP) in the general population. Whether BP lowering results from of reducing arterial wall or vice versa in antihypertensive treatment is unclear. This study aimed to investigate the association between arterial stiffness and BP in patients with treated hypertension. METHODS This study included 3277 participants who were treated with antihypertensive agents and with repeated measurements of branchial-ankle pulse wave velocity (baPWV) and BP during 2010-2016 from the Kailuan study. Temporal relation between baPWV and BP was assessed by cross-lagged path analyses. RESULTS After adjustment for potential confounders, the standard regression coefficient from baseline baPWV to follow-up SBP was 0.14 [95% confidence interval (95% CI), 0.10-0.18], which was significantly greater than that from baseline SBP to follow-up baPWV (0.05; 95% CI, 0.02-0.08) ( P < 0.0001 for difference). Similar results were observed for the cross-lagged analysis with changes of baPWV and mean arterial pressure. Further analysis showed that the yearly rate of change in SBP during the follow-up period significantly varied across increasing quartiles of baseline baPWV ( P < 0.0001), whereas the yearly rate of change in baPWV showed a nonsignificantly varied trend across quartiles of baseline SBP ( P = 0.2443). CONCLUSION These findings provided strong evidence that reduction in arterial stiffness through antihypertensive treatment could precede BP lowering.
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Affiliation(s)
- Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan
| | - Xue Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital
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Rodrigues MP, Ferreira CB, Santos KAMD, Merello PN, Rossato SL, Fuchs SC, Moreira LB. Efficacy of an Educational Intervention for Sodium Restriction in Patients with Hypertension: A Randomized Controlled Trial. Nutrients 2023; 15:2159. [PMID: 37432286 DOI: 10.3390/nu15092159] [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: 03/03/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 07/12/2023] Open
Abstract
There is sound evidence showing the efficacy of non-pharmacological interventions in lowering blood pressure (BP); however, adherence is usually poor. Interventions to induce behavioral changes aim to improve the ability to read labels, choose foods, and eat low-sodium meals, reinforcing adherence to sodium restriction. In this randomized parallel-controlled trial, we assessed the effectiveness of an educational intervention using the Dietary Sodium Restriction Questionnaire (DSRQ) scores. A follow-up period of 6 months was conducted. Participants were randomized into (1) an educational intervention provided by a registered dietitian on individual visits and dietary planning; (2) a control group with the usual care and dietary recommendations. Patients underwent 24-h ambulatory BP monitoring, 12-h fasting blood tests, spot urine collection, and assessment using DSRQ. We randomized 120 participants (67.5% women and 68.3% Caucasians), and 25 participants were lost to follow-up. The 24-h sodium urinary excretion changed in the control (Δ -1610 mg/day; 95% confidence interval [CI] -1800 to -1410) and intervention groups (Δ -1670 mg/day; 95% CI -1800 to -1450) over time. There was no significant difference in the 24-h estimated sodium between groups. In hypertensive patients, DSRQ-based educational intervention is effective for improving the ability to detect and overcome obstacles to a low-sodium restriction diet but is as effective as dietary recommendations for lowering sodium.
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Affiliation(s)
- Marcela P Rodrigues
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil
| | - Carolina B Ferreira
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil
| | | | - Paula N Merello
- Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil
| | - Sinara L Rossato
- Graduation Course in Collective Health, Institute of Geography, Universidade Federal de Uberlandia (UFU), Uberlandia 38400-902, Brazil
| | - Sandra C Fuchs
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
| | - Leila B Moreira
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
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Saito T, Shibata M, Hirabayashi N, Honda T, Morisaki Y, Anno K, Sudo N, Hosoi M, Ninomiya T. Family dysfunction is associated with chronic pain in a community-dwelling Japanese population: The Hisayama study. Eur J Pain 2023; 27:518-529. [PMID: 36585949 DOI: 10.1002/ejp.2076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Poor family functioning has been reported to be associated with the severity of chronic pain in outpatients, but the association has not been fully addressed in general populations. The present study aimed to examine the association between family dysfunction levels and the presence of chronic pain in a community-dwelling Japanese population. METHODS A total of 2598 participants aged ≥40 years were classified as having healthy, borderline or unhealthy family functioning. Chronic pain was defined as subjective pain for three months or longer, and further classified by pain intensity, the number of chronic pain sites, pain duration and the extent of pain spread. A logistic regression model was used to compute the odds ratios (ORs) for chronic pain outcomes. RESULTS The prevalence of chronic pain was 49%. The age- and sex-adjusted prevalence of total and severe chronic pain were increased significantly with increasing family dysfunction levels (all p for trend <0.01). After adjusting for sociodemographic, physical, social and family structure factors, the ORs (95% confidence intervals [CI]) for having chronic pain among borderline and unhealthy groups were 1.20 (1.01-1.44) and 1.43 (1.15-1.79), respectively, as compared with a healthy family function group. The association was stronger among people who were employed and those who were living with their children. In addition, the ORs for severe chronic pain increased significantly with increasing levels of family dysfunction. CONCLUSIONS The family dysfunction level was positively associated with the presence as well as the severity of chronic pain in a community-dwelling population. SIGNIFICANCE A biopsychosocial burden due to family relationships could worsen the clinical presentation of pain. Social support or family therapy for dysfunctional families would be a potential initiative for the prevention or management of chronic pain.
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Affiliation(s)
- Takafumi Saito
- Faculty of Rehabilitation, School of Physical Therapy, Reiwa Health Sciences University, Fukuoka, Japan
| | - Mao Shibata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Hirabayashi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Honda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukiko Morisaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kozo Anno
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Kuate Defo A, Daskalopoulou SS. Alterations in Vessel Hemodynamics Across Uncomplicated Pregnancy. Am J Hypertens 2023; 36:183-191. [PMID: 36638267 DOI: 10.1093/ajh/hpac132] [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: 05/27/2022] [Revised: 12/03/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Pregnancy is marked by the onset of rapid hemodynamic alterations in order to accommodate the needs of the developing fetus. Arterial stiffness is an independent predictor of cardiovascular events and mortality, and its measurement in clinical practice has been recommended. It follows a U-shaped curve in uncomplicated pregnancy, decreasing to a nadir in mid-pregnancy and rising at term. Systemic vasodilation occurs due to elevated nitric oxide, prostacyclin, endothelium-derived hyperpolarizing factor, estrogen, progesterone, and relaxin. Vascular resistance decreases to a nadir in mid-pregnancy, while endothelial function is enhanced starting in the first trimester. Plasma volume increases by about 50%, and total red blood cell mass increases by up to 40%. Cardiac output increases by up to 45%, at first due primarily to elevated stroke volume, then mainly due to increased heart rate. Along with echocardiography, cardiac magnetic resonance imaging is safe for use in pregnancy. It may assess cardiac function more accurately than echocardiography, and may be indicated in specific clinical cases. Moreover, blood pressure decreases to a nadir in mid-pregnancy and rises to near preconception values postpartum. An appreciation of the vascular changes occurring in healthy pregnancy can aid in the prediction and diagnosis of pregnancy complications, such as preeclampsia and other hypertensive disorders of pregnancy, and inform treatment. In particular, noninvasive arterial stiffness/hemodynamics assessment provides unique clinical information beyond blood pressure and traditional maternal characteristics, and can signal a need for further testing, or be used in combination with other tests to predict or diagnose complications of pregnancy.
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Affiliation(s)
- Alvin Kuate Defo
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Gaeini Z, Bahadoran Z, Mirmiran P, Feyzi Z, Azizi F. High-Fat Dairy Products May Decrease the Risk of Chronic Kidney Disease Incidence: A Long-Term Prospective Cohort Study. J Ren Nutr 2023; 33:307-315. [PMID: 36270480 DOI: 10.1053/j.jrn.2022.10.003] [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: 02/27/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The association between consumption of dairy products and risk of chronic kidney disease (CKD) is under debate. We aimed to determine the potential effects of total and subtypes of dairy intake on the occurrence of CKD. METHODS This study was conducted within the Tehran Lipid and Glucose Study (TLGS) on 2416 CKD-free adults. At baseline, consumption of dairy products was estimated using a validated 168-items semiquantitative food frequency questionnaire. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of CKD were calculated in tertile categories of dairy products. Also, the CKD risk was estimated with multivariable Cox regression to substitute total dairy with other dietary protein sources. RESULTS During 8.4 years of follow-up, the incidence rate of CKD was 21%. The participants' mean (±SD) age was 38 (±13) years and 46% were men. Dietary intakes of total dairy, low-fat dairy, and fermented dairy were not associated with CKD risk. There were significant lower risks of CKD in the highest compared to the lowest tertiles of high-fat dairy (HR = 0.76, 95% CI = 0.60-0.95) and high-fat milk (HR = 0.75, 95% CI = 0.59-0.96). However, no significant associations were found between other categories of dairy products and CKD incidence. Substitutions of total dairy with other dietary protein sources were not associated with CKD risk. CONCLUSIONS In this study, higher intakes of high-fat dairy and high-fat milk were associated with lower risks of CKD. No significant associations were found between other dairy products and CKD. More prospective and clinical trials are needed to clarify the issue.
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Affiliation(s)
- Zahra Gaeini
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Feyzi
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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He Z, Yang P, Lin Q, Thio CHL, Zhang F, Wang R, Wang Y, Snieder H, Zhang Q. Blood biomarkers for new-onset hypertension in midlife women: a nested case-control study. Menopause 2023; 30:156-164. [PMID: 36696640 DOI: 10.1097/gme.0000000000002100] [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: 01/26/2023]
Abstract
OBJECTIVE Midlife in women is associated with an increase in prevalence of hypertension. Little is known on the risk factors of new-onset hypertension among middle-aged women. METHODS In this nested case-control study, 1,430 women aged 40 to 60 years with repeated physical examinations between 2009 and 2019 were recruited. Data included age, body mass index, blood pressure (BP), and a series of blood biomarkers. Participants with hypertension were divided into two case-control samples: 388 cases with episodic new-onset hypertension (ie, one normal BP at the first visit and one abnormal BP during follow-up) each with two age-matched controls (n = 776) and 151 cases with regular new-onset hypertension (ie, normal BP at the first two visits and abnormal BP at two or more follow-up visits) each with three age-matched controls (n = 453). Multivariable-adjusted logistic regression was used to analyze the data. RESULTS Our data showed very consistent results for episodic and regular new-onset hypertension, respectively, and verified known associations (odds ratio [95% confidence interval], per SD increase) with obesity (body mass index, 1.72 [1.49-1.98] and 1.81 [1.45-2.26]), inflammation (white blood cell count, 1.39 [1.23-1.58] and 1.38 [1.13-1.69]), and metabolic dysregulation (triglycerides, 1.25 [1.09-1.44] and 1.31 [1.08-1.58]; glucose, 1.46 [1.23-1.73] and 1.27 [1.05-1.54]) but, more surprisingly, also revealed positive associations with red blood cell count (1.27 [1.11-1.44] and 1.38 [1.14-1.68]), hemoglobin (1.18 [1.03-1.35] and 1.31 [1.05-1.64]), and platelet count (1.39 [1.20-1.61] and 1.33 [1.09-1.63]). CONCLUSIONS In addition to obesity and metabolic dysregulation, increased hemoglobin and counts of platelets, and red and white blood cells are associated with hypertension in this period. Future study may verify whether these associations are causal in nature and whether these variables are useful in risk stratification.
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Affiliation(s)
| | - Peixuan Yang
- Department of Physical Examination, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Qiuqiang Lin
- Department of Internal Medicine, Chenghai People's Hospital, Shantou, China
| | - Chris H L Thio
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Ruifeng Wang
- Department of Physical Examination, Chenghai People's Hospital, Shantou, China
| | - Yue Wang
- From the Department of Public Health and Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Qingying Zhang
- From the Department of Public Health and Preventive Medicine, Shantou University Medical College, Shantou, China
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Avelino DC, da Silva A, Chaves LO, Carraro JCC, de Carvalho Vidigal F, Bressan J. Triglyceride-glucose index is associated with poor sleep quality in apparently healthy subjects: A cross-sectional study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:73-91. [PMID: 36155123 PMCID: PMC9983794 DOI: 10.20945/2359-3997000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective We aimed to evaluate the association between the triglyceride glucose index (TyG index) and sleep quality and to establish a cut-off value for the TyG index based on the prevalence of subjects with insulin resistance (IR). Methods This cross-sectional study involved Brazilian health professionals (20-59 years). A total of 138 subjects answered the Pittsburgh Sleep Quality questionnaire to evaluate sleep quality. They were categorized into two groups: good sleep quality (global score ≤ 5 points) and poor sleep quality (global score ≥ 6 points). Also, we classified the subjects as having a high (>8.08 or >4.38) or low TyG index (≤ 8.08 or ≤4.38). Results The majority of the subjects (70%) with high TyG index values (>8.08 or >4.38) reported poor sleep quality (p ≤ 0.001). Those with poor sleep quality had a 1.44-fold higher prevalence of IR (TyG index >8.08 or >4.38) compared to those with good sleep quality, regardless of sex, total cholesterol, LDL/HDL ratio, insulin, complement C3, CRP, and adiponectin (p ≤ 0.001). Conclusion Our data showed a positive and significant association between the TyG index and poor sleep quality. Thus, these findings support the association between poor sleep quality and IR.
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Affiliation(s)
| | - Alessandra da Silva
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, MG, Brasil
| | | | | | | | - Josefina Bressan
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, MG, Brasil
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[Retinal alterations detected by non-mydriatic retinal camera screening and referral to ophthalmology in a population with high cardiovascular risk]. Semergen 2023; 49:101921. [PMID: 36645935 DOI: 10.1016/j.semerg.2022.101921] [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: 10/04/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the main retinal alterations detected by non-mydriatic retinal camera screening and to evaluate factors related to referral to ophthalmology in a population at high cardiovascular risk in Palmira, Colombia. MATERIALS AND METHODS Cross-sectional observational study, which included 11,983 photographic imaging records of patients with hypertension and diabetes mellitus from Gesencro's S.A.S. comprehensive chronic disease care program between 2018 and 2020. Risk factors associated to referral to ophthalmology were evaluated with logistic regression, and crude and adjusted ORs (odds ratios) were obtained. RESULTS A total of 11,880 records were analyzed; 67.7±12years old, and 69.5% were women. Among the retinal alterations were patients with diabetic retinopathy classified as more than mild in 10% and gradeI hypertensive retinopathy in 54.9% right eye, 51.9% left eye. Macular edema was also identified. Only 2069 patients (17.4%) required referral to ophthalmology, and for imaging control 82.6%. In the multivariate analysis, the risk factors associated with the probability of being referred were male gender, age 60years and older, glycosylated hemoglobin out-of-target, advanced chronic kidney disease and the microalbumin-to-creatinine ratio moderate to severely elevated. CONCLUSION This study makes it possible to determine the importance of screening with a non-mydriatic retinal camera in patients at high cardiovascular risk to detect retinal abnormalities and assess risk factors associated with referral to ophthalmology. Early documentation of ocular compromise in these patients could prevent and avoid visual impairment and blindness.
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Forcada P, Vilela-Martin JF. Evaluation of Central Hemodynamics in the Diagnosis and Treatment of Hypertension. Curr Cardiol Rev 2023; 19:1-4. [PMID: 37171002 PMCID: PMC10636802 DOI: 10.2174/1573403x19666230511145035] [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: 06/23/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Affiliation(s)
- Pedro Forcada
- Department of Cardiology, Universidad Austral, Pilar, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
| | - Jose F. Vilela-Martin
- Adjunct Professor at the State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Paulo,Brazil
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Niranjan PK, Bahadur S. Recent Developments in Drug Targets and Combination Therapy for the Clinical Management of Hypertension. Cardiovasc Hematol Disord Drug Targets 2023; 23:226-245. [PMID: 38038000 DOI: 10.2174/011871529x278907231120053559] [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: 09/27/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
Raised blood pressure is the most common complication worldwide that may lead to atherosclerosis and ischemic heart disease. Unhealthy lifestyles, smoking, alcohol consumption, junk food, and genetic disorders are some of the causes of hypertension. To treat this condition, numerous antihypertensive medications are available, either alone or in combination, that work via various mechanisms of action. Combinational therapy provides a certain advantage over monotherapy in the sense that it acts in multi mechanism mode and minimal drug amount is required to elicit the desired therapeutic effect. Such therapy is given to patients with systolic blood pressure greater than 20 mmHg and/or diastolic blood pressure exceeding 10 mmHg beyond the normal range, as well as those suffering from severe cardiovascular disease. The selection of antihypertensive medications, such as calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and low-dose diuretics, hinges on their ability to manage blood pressure effectively and reduce cardiovascular disease risks. This review provides insights into the diverse monotherapy and combination therapy approaches used for elevated blood pressure management. In addition, it offers an analysis of combination therapy versus monotherapy and discusses the current status of these therapies, from researchbased findings to clinical trials.
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Affiliation(s)
| | - Shiv Bahadur
- Institute of Pharmaceutical Research, GLA University, Mathura, Uttar Pradesh, India
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50
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Lee KJ, Ryu JK, Cho YH, Shin WY, Kim JS, Yoon YW, Jang JY, Kim WH, Beom JW, Kang SM. Effectiveness and Safety of a Fixed-Dose Combination of Valsartan and Rosuvastatin (Rovatitan ® Tablet) in Patients with Concomitant Hypertension and Hyperlipidemia: An Observational Study. Drug Des Devel Ther 2023; 17:1047-1062. [PMID: 37051292 PMCID: PMC10084874 DOI: 10.2147/dddt.s391288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/23/2023] [Indexed: 04/14/2023] Open
Abstract
Purpose This study aimed to assess the effectiveness and safety of a fixed-dose combination of rosuvastatin and valsartan (Rovatitan®) in Korean patients with concomitant hypertension and hyperlipidemia. Patients and Methods A total of 1008 eligible patients with concomitant hypertension and hyperlipidemia were enrolled and treated for 12 weeks. Both upward and downward drug dose titrations were allowed based on the investigator's discretion. This study evaluated the effectiveness of the study drug, defined by the percentage of patients achieving the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) treatment targets. Additionally, regression analyses were conducted to evaluate the factors associated with the effectiveness and safety of the study drug. Of the 1008 patients enrolled in the study, 911 were analyzed for clinical effectiveness. Results At 12 weeks, 84.6% and 75.9% of patients treated with the study drug achieved their BP and LDL-C targets, respectively, and 64.8% of patients achieved both targets simultaneously. Furthermore, the percentage of patients who achieved their BP and LDL-C treatment targets demonstrated a trend across the respective risk groups; the higher the risk group, the lower the success of attaining the respective target. This trend was also observed regardless of the prior antihypertensive and/or lipid-lowering treatments. According to regression analysis, poor metabolic profiles, including a higher body mass index (BMI) and higher BP and LDL-C levels at baseline, were significantly associated with treatment failure for BP. Among the 1005 patients included in the safety analysis, 17 patients (1.7%) experienced serious adverse events; however, none were considered related to the study drug. Conclusion The study drug used for the treatment of concomitant hypertension and hyperlipidemia in a real-world setting was effective and was well tolerated. Therefore, the study drug is suggested as a good alternative to increase patient convenience and compliance, particularly in those taking multiple medications.
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Affiliation(s)
- Kwang Je Lee
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jae-Kean Ryu
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | | | - Won Yong Shin
- Department of Cardiology, Soon Chun Hyang University Hospital Cheonan, Cheonan, Korea
| | - Jeong Su Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Won Yoon
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yong Jang
- Department of Cardiology, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
| | - Won Ho Kim
- Eulji University School of Medicine, Daejeon, Korea
| | - Jong Wook Beom
- Department of Cardiology, Jeju National University Hospital, Jeju, Korea
| | - Seok-Min Kang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Correspondence: Seok-Min Kang, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea, Tel +82 2-2647-3225, Email
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