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Khan A, Cheema MF, Fatima R, Cheema SS, Butt Z, Gillani S, Ahmad A, Subhan Ullah M, Jalal U, Cheema S. Prevalence of Chronic Kidney Disease in a High-Risk Population in Urban Lahore, Pakistan: A Cross-sectional Study. Cureus 2024; 16:e63296. [PMID: 39077231 PMCID: PMC11284504 DOI: 10.7759/cureus.63296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
Background Chronic kidney disease (CKD) is a globally increasing health concern, and there is a growing focus on early screening and prevention efforts. However, the availability of data on CKD prevalence in Pakistan, particularly in the urban area of Lahore district, is limited. The objective of the Kidney Early Evaluation Program (KEEP) Lahore was to assess the prevalence of CKD in a high-risk population residing in the urban area of Lahore, Pakistan. Methods A cross-sectional study was conducted involving 254 participants, who were over 18 years old and belonged to a high-risk population according to the pre-defined operational definitions. The participants were randomly selected from various towns in Lahore. Screening camps were set up to measure serum creatinine levels and urinary albumin to creatinine ratio (UACR), and then the estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration 2021 (CKD EPI) equation. Results Out of the total 254 participants, a diagnosis of CKD was made in 62 (24.2%) individuals. Significant associations were found between CKD and risk factors including hypertension, diabetes, family history of CKD, ischemic heart disease (IHD) or congestive heart failure (CHF), intake of painkillers, and herbal medicines. However, no association was found between obesity (BMI ≥ 30) and CKD. Participants diagnosed with CKD had a mean age of 49.9 years and a mean serum creatinine level of 1.2 mg/dL, while non-CKD participants had a mean age of 43.7 years and a mean serum creatinine level of 0.7 mg/dL. Conclusion Our study revealed that CKD was prevalent in about one-fourth of the participants from the high-risk population of Lahore, indicating a high prevalence of the disease within society. Moreover, hypertension, diabetes, family history of CKD, heart disease, painkillers, and the use of herbal medicines were all significantly linked to CKD in the surveyed sample population.
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Affiliation(s)
- Afifa Khan
- Department of Nephrology, Jinnah Hospital, Lahore, PAK
| | - Manal F Cheema
- College of Medicine, CMH (Combined Military Hospital) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Rida Fatima
- Department of Internal Medicine, Jinnah Hospital, Lahore, PAK
| | - Sidra S Cheema
- Department of Pathology, CMH (Combined Military Hospital) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Zeeshan Butt
- Department of Internal Medicine, Baystate Medical Center, Springfield, USA
| | - Samreen Gillani
- Department of Internal Medicine, Fatima Memorial Hospital, Lahore, PAK
| | - Ayesha Ahmad
- Department of Internal Medicine, Jinnah Hospital, Lahore, PAK
| | | | - Urba Jalal
- Department of Internal Medicine, Jinnah Hospital, Lahore, PAK
| | - Shafiq Cheema
- Department of Nephrology, Jinnah Hospital, Lahore, PAK
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Tsuro U, Oladimeji KE, Pulido-Estrada GA, Apalata TR. Risk Factors Attributable to Hypertension among HIV-Infected Patients on Antiretroviral Therapy in Selected Rural Districts of the Eastern Cape Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11196. [PMID: 36141463 PMCID: PMC9517599 DOI: 10.3390/ijerph191811196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Antiretroviral therapy has improved HIV patients' quality of life and life expectancy. However, complications have emerged in the form of hypertension. In the rural Eastern Cape, there is minimal information about HIV-infected people. The current study intended to evaluate the factors associated with hypertension in HIV-infected individuals receiving antiretroviral therapy in rural areas of South Africa's Eastern Cape. METHODS For this cohort study, HIV-positive people taking antiretroviral therapy aged 15 and up were recruited at random from several rural locations in the Eastern Cape. Using Cox univariate and multivariate analyses, the key predictors of hypertension were found. RESULTS Of the total participants (n = 361), 53% of individuals had hypertension. In the Cox multivariate model, patients that had hypertension heredity, BMI ≥ 25 kg/m2, eGFR < 60 mL/min/1.73 m2, advanced and severe CD4 counts, 1TFE and 1T3E regimens, and the male gender were found to be at greater risk of hypertension. CONCLUSIONS The findings of this study indicate that hypertension is a prevalent concern among HIV patients receiving antiretroviral therapy. HIV patients should have their blood pressure checked regularly, and they should be screened for high blood pressure and given treatment for it.
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Affiliation(s)
- Urgent Tsuro
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
| | - Kelechi E. Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
- College of Graduate Studies, University of South Africa, Pretoria 0001, South Africa
| | | | - Teke R. Apalata
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
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3
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Advances in the Treatment Strategies in Hypertension: Present and Future. J Cardiovasc Dev Dis 2022; 9:jcdd9030072. [PMID: 35323620 PMCID: PMC8949859 DOI: 10.3390/jcdd9030072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/11/2022] Open
Abstract
Hypertension is the most frequent chronic and non-communicable disease all over the world, with about 1.5 billion affected individuals worldwide. Its impact is currently growing, particularly in low-income countries. Even in high-income countries, hypertension remains largely underdiagnosed and undertreated, with consequent low rates of blood pressure (BP) control. Notwithstanding the large number of clinical observational studies and randomized trials over the past four decades, it is sad to note that in the last few years there has been an impressive paucity of innovative studies. Research focused on BP mechanisms and novel antihypertensive drugs is slowing dramatically. The present review discusses some advances in the management of hypertensive patients, and could play a clinical role in the years to come. First, digital/health technology is expected to be increasingly used, although some crucial points remain (development of non-intrusive and clinically validated devices for ambulatory BP measurement, robust storing systems enabling rapid analysis of accrued data, physician-patient interactions, etc.). Second, several areas should be better outlined with regard to BP diagnosis and treatment targets. Third, from a therapeutic standpoint, existing antihypertensive drugs, which are generally effective and well tolerated, should be better used by exploiting available and novel free and fixed combinations. In particular, spironolactone and other mineral-corticoid receptor antagonists should be used more frequently to improve BP control. In particular, some drugs initially developed for conditions different from hypertension including heart failure and diabetes have demonstrated to lower BP significantly and should therefore be considered. Finally, renal artery denervation is another procedure that has proven effective in the management of hypertension.
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4
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Manandhar K, Risal A, Koju R, Linde M, Steiner TJ. If headache has any association with hypertension, it is negative. Evidence from a population-based study in Nepal. Cephalalgia 2021; 41:1310-1317. [PMID: 34148406 DOI: 10.1177/03331024211020398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hypertension and headache disorders are major contributors to public ill health, linked by a long-standing but questionable belief that hypertension is a conspicuous cause of headache. In Nepal, where hypertension is common and often untreated, we assessed the substance of this belief, hypothesising that, should hypertension be a significant cause of headache, a clear positive association between these disorders would exist. METHODS In a cross-sectional, nationwide study, trained health workers conducted face-to-face structured interviews, during unannounced home visits, with a representative sample of the Nepalese adult population (18-65 years). They applied standard diagnostic criteria for headache disorders and measured blood pressure digitally. Hypertension was defined as systolic pressure ≥140 and/or diastolic ≥90 mm Hg. RESULTS Of 2,100 participants (59.0% female, mean age 36.4 ± 12.8 years), 317 (15.1%) had hypertension (41.0% female) and 1,794 (85.4%) had headache (61.6% female; 728 migraine, 863 tension-type headache, 161 headache on ≥15 days/month [mutually exclusive diagnoses]; 42 unclassified headaches).All headache collectively was less prevalent among hypertension cases (78.9%) than non-cases (86.6%; p = 0.001). A negative association between hypertension and all headache was demonstrated in bivariate analysis (odds ratio: 0.6 [95% Confidence interval: 0.4-0.8]; p < 0.001), but did not maintain significance in multivariate regression analysis (adjusted odds ratio: 0.8 [95% Confidence interval: 0.5-1.1]; p = 0.09). The findings were reflected, without significance, in each headache type. CONCLUSIONS If any association exists between hypertension and headache disorders, it is negative. From the public-health perspective, headache disorders and hypertension are unrelated entities: they need distinct policies and programs for prevention, control and management.
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Affiliation(s)
- Kedar Manandhar
- 375889Dhulikhel Hospital, 375889Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,92962Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Ajay Risal
- 375889Dhulikhel Hospital, 375889Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,92962Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Rajendra Koju
- 375889Dhulikhel Hospital, 375889Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,92962Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, 8018Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, 8018Norwegian University of Science and Technology, Trondheim, Norway.,Division of Brain Sciences, 4615Imperial College London, London, UK
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5
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Lubega G, Mayanja B, Lutaakome J, Abaasa A, Thomson R, Lindan C. Prevalence and factors associated with hypertension among people living with HIV/AIDS on antiretroviral therapy in Uganda. Pan Afr Med J 2021; 38:216. [PMID: 34046122 PMCID: PMC8140674 DOI: 10.11604/pamj.2021.38.216.28034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/10/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction antiretroviral therapy (ART) has improved survival of People Living with HIV (PLWH); however, this has resulted in an increasingly high prevalence of non-communicable diseases (NCD) like hypertension. Hypertension is a major risk factor for cardiovascular and cerebral vascular disease, which are both associated with high morbidity and mortality rates. We studied the prevalence and factors associated with hypertension among PLWH on ART. Methods we conducted a retrospective data analysis of PLWH on ART enrolled between 2011 and 2014 into a randomized double-blinded placebo-controlled trial investigating the safety of discontinuing cotrimoxazole prophylaxis (COSTOP) among PLWH in Central Uganda. We used the mean blood pressure (BP) measurements of the first four monthly clinic visits to define hypertension. Patients were categorised as: having normal BP (≤120/80mmHg), elevated BP (systolic >120-129, and diastolic ≤80), Stage 1 hypertension (systolic 130-139, or diastolic >80-89) and Stage 2 hypertension (systolic ≥140 or diastolic ≥90). Multiple logistic regression was used to evaluate factors associated with hypertension. Results data from 2026 COSTOP trial study participants were analysed, 74.1% were women and 77.2% were aged 35 years and above. The overall prevalence of hypertension was 29%, of whom 19.5% had Stage 1 hypertension and 9.5% had Stage 2 hypertension. About 21.4% were overweight or obese. Factors independently associated with hypertension among PLWH on ART included increasing age (p≤0.001) and high body mass index (p≤0.001). Efavirenz (p≤0.001) and lopinavir/ritonavir (p=0.036) based regimen had lower odds of hypertension than Nevirapine based regimens. Conclusion PLWH on ART have a high prevalence of hypertension, which rises with increasing age and body mass index (BMI) and among those on nevirapine-based ART. Implementation of hypertension prevention measures among PLWH on ART and integration of NCD and HIV care to improve patients’ management outcomes are required.
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Affiliation(s)
- Gloria Lubega
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Billy Mayanja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Joseph Lutaakome
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Andrew Abaasa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Rebecca Thomson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christina Lindan
- School of Medicine, University of California at San Francisco, San Francisco, United States of America
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Warda HM, Elshorbagy AK, Habib A, Wagdi A, Mihailidou AS, Warda M. Blood pressure measurement protocol determines hypertension phenotypes in a Middle Eastern population. J Clin Hypertens (Greenwich) 2020; 22:1995-2003. [PMID: 32941678 DOI: 10.1111/jch.14048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
Clinic blood pressure (BP) measurement remains a crucial step in managing hypertension. While the number of measures recorded in different settings varies, with typically 1-3 measures, there has been no prior justification for the actual number of measures required. We investigated the pattern of BP variability over 5 consecutive automated readings (R1-R5) and the influence of patient characteristics on this pattern to identify the phenotype of hypertension in a Middle Eastern population. There were 1389 outpatients (51% men, 49% women), age range (18-87 y) who had 5 unattended automated consecutive BP measurements with one-minute intervals using the validated Datascope Mindray Passport V Monitor with the patient blinded from the results. Mean (±SEM) SBP for R1 (136.0 ± 2 mm Hg) was similar to R2 (136.2 ± 2 mm Hg). Thereafter SBP progressively declined till R5 by total of 5.5 mm Hg. The SBP decline was less (4.2 mm Hg) in older (>50 years) vs younger participants (8.1 mm Hg; P < .001) and was blunted in diabetic and hypertensive participants. Overall, 43% of participants had R2 > R1, and 24% additionally had R5 > R1. Age was a strong independent predictor of having both R2 > R1 and R5 > R1, as well as diabetes. Diastolic blood pressure (DBP) decreased by average 2.8 mm Hg from R1 to R5. Females had a 5-fold greater total decline in DBP vs males (P < .001). Using the mean of 5 BP measures resulted in fewer participants being classified as hypertensive (36% of the population) compared to using one measurement (46%), or established BP guidelines which use different combinations of R1-R3 (37%-42%). Our findings in a Middle Eastern population highlight the importance of the BP measurement protocol in combination with patient characteristics in determining whether a patient is diagnosed with hypertension. Protocols that rely on different combinations of only 3 measures (R1-3) will classify more participants as hypertensive, compared to using 5 measures or disregarding a high R2.
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Affiliation(s)
- Hazem M Warda
- Alhyatt Heart and Vascular Center, Alexandria, Egypt.,Department of Cardiology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
| | - Amany K Elshorbagy
- Department of Physiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amira Habib
- Alhyatt Heart and Vascular Center, Alexandria, Egypt
| | - Ahmed Wagdi
- Alhyatt Heart and Vascular Center, Alexandria, Egypt.,Institute of Cardiovascular Physiology, University Medical Center Goettingen, Goettingen, Germany
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mamdouh Warda
- Alhyatt Heart and Vascular Center, Alexandria, Egypt.,Department of Cardiology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
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7
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Curi ACC, Maior Alves AS, Silva JG. Cardiac autonomic response after cranial technique of the fourth ventricle (cv4) compression in systemic hypertensive subjects. J Bodyw Mov Ther 2018; 22:666-672. [PMID: 30100295 DOI: 10.1016/j.jbmt.2017.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/18/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare blood pressure (BP) behavior and heart rate variability (HRV) among hypertensive stage I and normotensive individuals who were submitted to the cranial technique of the 4th ventricle compression (CV4), an osteopathic technique. METHODS In this experimental controlled study, thirty men between 40 and 60 years old were evaluated and divided into two groups: normotensive (NT) and hypertensive (HT). The CV4 maneuver was applied in both groups and BP was measured at 5 (five) different stages: pre and post-intervention, 5, 10 and 15min after technique. Time-frequency parameters were obtained from measurements of RR intervals. Data were analyzed using an ANOVA two-way for analysis of the condition factor (NT and HT) and times with p-value ≤ .05. RESULTS There was a reduction in the BP of the HT group. A significant intergroup difference (p = .01) was noticed, with respect to the standard deviation of successive normal R-R intervals (SDNN) values, mainly between pre-intervention and 15min stages. Concerning root mean square of the mean squared differences (RNSSD) values, the highlights were differences between pre-intervention and 10min (p = .01) only in the NT group. There was an increase in high frequencies (HF) values and a low frequencies (LF) attenuation in both groups at all different stages. CONCLUSION The data showed a BP reduction in the HT group in pre-intervention/15min and an increase in parasympathetic activity and decreased sympathetic activity in both groups. This suggests a change in the sympathetic-vagal balance. However, further studies are needed to elucidate the data on BP reduction mechanisms with CV4.
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Affiliation(s)
| | - Alex Souto Maior Alves
- Rehabilitation Science at UNISUAM (Centro Universitário Augusto Motta), Rio de Janeiro, RJ, Brazil
| | - Julio Guilherme Silva
- Rehabilitation Science at UNISUAM (Centro Universitário Augusto Motta), Brazil; Department of Physical Therapy - UFRJ [Universidade Federal do Rio de Janeiro], Brazil.
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8
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Baptiste D, Hamilton JB, Foronda C, Sloand E, Fahlberg B, Pfaff T, Delva S, Davidson PM. Hypertension among adults living in Haiti: An integrative review. J Clin Nurs 2018; 27:2536-2545. [DOI: 10.1111/jocn.14320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Diana‐Lyn Baptiste
- Department of Acute and Chronic Care Johns Hopkins University School of Nursing Baltimore MD USA
| | - Jill B. Hamilton
- Office of Academic Advancement Nell Hodgson Woodruff School of Nursing at Emory University Atlanta GA USA
| | - Cynthia Foronda
- Schwartz Center Nursing/HS University of Miami Coral Gables FL USA
| | - Elizabeth Sloand
- Department of Acute and Chronic Care Johns Hopkins University School of Nursing Baltimore MD USA
| | - Beth Fahlberg
- Division of Continuing Studies University of Wisconsin‐Madison Madison WI USA
| | - Teresa Pfaff
- Center for Global Initiatives‐Department of Community and Public Health Johns Hopkins University School of Nursing Baltimore MD USA
| | - Sabianca Delva
- Department of Acute and Chronic Care Johns Hopkins University School of Nursing Baltimore MD USA
| | - Patricia M. Davidson
- Department of Acute and Chronic Care Johns Hopkins University School of Nursing Baltimore MD USA
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9
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Modesti PA, Marzotti I. Epidemiology of hypertension and survey protocols: how to count counts. Hypertens Res 2017; 40:432-433. [DOI: 10.1038/hr.2017.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Home blood pressure and treatment decisions: caveat emptor. J Hypertens 2016; 34:1494-6. [PMID: 27355997 DOI: 10.1097/hjh.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Angeli F, Reboldi G, Verdecchia P. The 2014 hypertension guidelines: implications for patients and practitioners in Asia. HEART ASIA 2015; 7:21-5. [PMID: 27326216 DOI: 10.1136/heartasia-2015-010639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 01/20/2023]
Abstract
Hypertension is a global public health issue and a major cause of morbidity and mortality. Because of population growth and ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly 1 billion in 2008. Furthermore, the number of adults with hypertension in 2025 has also been predicted to increase by about 60% to a total of 1.56 billion. The prevalence of hypertension in most Asian countries has increased over the last 30 years and more dramatically in the last 10 years. Several factors contributed to such changes in Asia, but acculturation to Western lifestyle, modernisation and urbanisation are considered key contributing factors. There are some unique features in regards to cardiovascular risk in Asia. Specifically, Asian regions have disproportionately higher mortality and morbidity from stroke compared with Western countries. Furthermore, the relationship between blood pressure level and risk of stroke is stronger in Asia than in Western regions. Although evidence-based and qualified guidelines for hypertension diagnosis and management have been released recently from Europe and North America, the unique features of Asian patients with hypertension raise concerns in regards to the real clinical applicability of Western guidelines in Asian populations. Specifically, it is not yet clear to what extent the new blood pressure target proposed by Western guidelines for high risk and elderly hypertensive individuals apply to Asian populations.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology , Hospital 'S.M. della Misericordia' , Perugia , Italy
| | | | - Paolo Verdecchia
- Department of Internal Medicine , Hospital of Assisi , Assisi , Italy
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12
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Angeli F, Verdecchia P, Poltronieri C, Bartolini C, de Filippo V, D'Ambrosio C, Reboldi G. Ambulatory blood pressure monitoring in the elderly: features and perspectives. Nutr Metab Cardiovasc Dis 2014; 24:1052-1056. [PMID: 24932538 DOI: 10.1016/j.numecd.2014.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/30/2014] [Accepted: 04/07/2014] [Indexed: 11/22/2022]
Abstract
Aging leads to a multitude of changes in the cardiovascular system that include a rise in blood pressure. Age-related changes in blood pressure are mainly attributable to an increase in systolic blood pressure, generally associated with a slight decrease diastolic blood pressure. This leads to a widening in pulse pressure. Ambulatory blood pressure monitoring is a useful tool to understand these processes and to refine cardiovascular risk assessment. In the light of emerging data in this area, we reviewed the main features of ambulatory blood pressure in elderly and discussed the evidence showing that ambulatory blood pressure is superior to clinic blood pressure to reflect the true pattern of blood pressure over time. Furthermore, we discussed the role of weight control obtained by fitness programs to prevent an excessive rise in blood pressure with age. A thorough understanding of these concepts is of paramount importance and has therapeutic implications in the growing population of elderly subjects with increased blood pressure.
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Affiliation(s)
- F Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, University Hospital of Perugia, Perugia, Italy.
| | - P Verdecchia
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | - C Poltronieri
- Division of Cardiology and Cardiovascular Pathophysiology, University Hospital of Perugia, Perugia, Italy
| | - C Bartolini
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | - V de Filippo
- Department of Internal Medicine, Hospital of Assisi, Assisi, Italy
| | - C D'Ambrosio
- Department of Internal Medicine, Hospital of Città della Pieve, Italy
| | - G Reboldi
- Department of Internal Medicine, University of Perugia, Italy
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13
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Is systolic blood pressure below 150 mm Hg an appropriate goal for primary prevention of cardiovascular events among elderly population? ACTA ACUST UNITED AC 2014; 8:491-7. [PMID: 25064771 DOI: 10.1016/j.jash.2014.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/19/2014] [Accepted: 04/29/2014] [Indexed: 11/23/2022]
Abstract
Recently, Joint National Committee has changed the optimal therapeutic goal of systolic blood pressure (SBP) up to 150 mm Hg for elderly population. We aimed to investigate impact of different blood pressure (BP) categories on risk of developing cardiovascular disease (CVD) and mortality among elderly. The present study included 1845 participants, aged ≥60 years (mean age = 65 years), free of CVD at baseline, who had undergone health examinations between January 1999 and 2001, and were followed up until March 2010. Cox proportional hazard regression was performed to assess the hazard ratios (HRs) of BP categories for CVD and mortality events, considering those with optimal BP (SBP <120 mm Hg and diastolic BP [DBP] <80 mm Hg) as reference. During a median of 10 years follow-up, 380 cases of first CVD and 260 cases of mortality events occurred. In multivariable adjusted model, prehypertensive group (SBP between 120-129 mm Hg or DBP between 80-85 mm Hg) could not predict CVD (HR, 0.87 [0.61-1.24]) nor mortality events (HR, 0.86 [0.58-1.34]). Those with SBP between 140 mm Hg and 150 mm Hg (group 3) were at higher risk for developing CVD (HR, 1.79 [1.17-2.74]), but there were no significant risk for total mortality (HR, 1.13 [0.65-1.97]). Hypertensive group (SBP ≥150 mm Hg or DBP ≥90 mm Hg or taking antihypertensive drugs) was associated with increased risk of both CVD (HR, 1.73 [1.24-2.42]) and mortality events (HR, 1.49 [1.00-2.23]).However, Joint National Committee 8 suggested no more benefit with lowering SBP <150 mm Hg, but the results of this study imply that those with SBP between 150 mm Hg and 140 mm Hg are still at elevated risk for CVD/coronary heart disease events.
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