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Ophey MJ, Westerweel A, van Oort M, van den Berg R, Kerkhoffs GMMJ, Tak IJR. Impaired hemodynamics of the patella in patients with patellofemoral pain: A case-control study. J Exp Orthop 2024; 11:e12009. [PMID: 38455453 PMCID: PMC10900186 DOI: 10.1002/jeo2.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose According to the homeostasis model, patellofemoral pain (PFP) arises as a consequence of disturbed homeostasis of anterior structures of the knee due to vascular insufficiency. Near-infrared spectroscopy (NIRS) allows to measure changes of concentrations (µmol/cm2) of (de)-oxygenated hemoglobine (HHb and O2Hb). The aim was to study differences in patellar hemodynamics between patients and healthy controls. Methods Hemodynamics of patients (n = 30 [female = 20, age = 21.5, BMI = 22.9]) and controls (n = 30 (female = 18, age = 21.4, BMI = 22.4]) were evaluated for two activities ('Prolonged Sitting' and 'Stair Descent'). Blinding for health status was implemented. Results During 'Prolonged Sitting', PFP patients exhibited smaller decreases in mean changes for HHb (PFP [M = -1.5 to -1.9], healthy controls [M = -2.0 to -2.3]) and O2Hb (PFP [M = -2.0 to -3.2], healthy controls [M = -3.4 to -4.1]). However, these differences were statistically non-significant (p = 0.14-0.82 and p = 0.056-0.18, respectively). Conversely, for 'Stair Descent', PFP patients showed statistically significant smaller decreases in mean changes for HHb (PFP [M = -1.9, SD = 1.8], healthy controls [M = -2.5, SD = 1.7], p = 0.043) and O2Hb (PFP [M = -3.2, SD = 3.2], healthy controls [M = -4.9, SD = 2.7], p = 0.004). Conclusions The differences suggest potential impairment in patellar hemodynamics in PFP patients, providing support for the homeostasis model. Evidence-based treatment strategies targeting patellar hemodynamics should be further refined and subjected to evaluation in clinical trials. Level of Evidence Level III.
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Affiliation(s)
- Martin J. Ophey
- IJsveldFysio—Private Physical Therapy ClinicNijmegenThe Netherlands
- Department of Orthopaedic Surgery and Sports MedicineAmsterdam UMC, AMC locationAmsterdamThe Netherlands
- ESP Science and EducationViennaAustria
| | - Anne Westerweel
- Master Biomedical SciencesRU—Radboud UniversityNijmegenThe Netherlands
| | - Maxime van Oort
- Master Biomedical SciencesRU—Radboud UniversityNijmegenThe Netherlands
| | - Robert van den Berg
- ESP Science and EducationViennaAustria
- Physical Therapy DepartmentFH Burgenland—University of Applied SciencePinkafeldAustria
- AIM—Austrian Institute of ManagementAdvanced Physiotherapy & ManagementEisenstadtAustria
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery and Sports MedicineAmsterdam UMC, AMC locationAmsterdamThe Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS)IOC Research CenterAmsterdamThe Netherlands
- Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands
| | - Igor J. R. Tak
- ESP Science and EducationViennaAustria
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS)IOC Research CenterAmsterdamThe Netherlands
- Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands
- Physiotherapy Utrecht Oost—Sports Rehabilitation and Manual TherapyUtrechtThe Netherlands
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Green BB, Anderson ML, McClure JB, Ehrlich K, Hall YN, Hansell L, Hsu C, Margolis KL, Munson SA, Thompson MJ. Is Hypertension Diagnostic Testing and Diagnosis Associated With Psychological Distress? Am J Hypertens 2024; 37:69-76. [PMID: 37688515 DOI: 10.1093/ajh/hpad083] [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: 05/26/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Psychological impacts of hypertension diagnostic testing and new hypertension diagnoses are unclear. METHODS BP-CHECK was a randomized diagnostic study conducted in 2017-2019 in an integrated healthcare system. Participants with no hypertension diagnosis or medications and elevated blood pressure (BP) were randomized to one of three diagnostic regimens: (i) Clinic, (ii) Home, or (iii) Kiosk. Participants completed questionnaires at baseline, after completion of the diagnostic regimens, and at 6 months. Outcomes included changes from baseline in health-related quality of life (HRQOL), BP-related worry, and thoughts about having a stroke or heart attack. RESULTS Participants (n = 482) were mostly over age 50 (77.0%), and White race (80.3%). HRQOL did not significantly change from baseline to 3 weeks or 6 months. Among all participants, BP-related worry and concerns about having a heart attack or stroke increased significantly from baseline to 3 weeks, with heart attack and stroke concerns significantly higher in the Kiosk compared Clinic and Home groups. At 6 months, thoughts about having a heart attack or stroke returned to baseline overall and in the Kiosk group, however BP-related worry was significantly higher among those with, compared to those without, a new hypertension diagnosis. CONCLUSIONS The hypertension diagnostic process did not lead to short-term or intermediate-term changes in self-reported HRQOL. However, BP-related worry increased short-term and persisted at 6 months among individuals with a new hypertension diagnosis. Results warrant validation in more representative populations and additional exploration of the impacts of this worry on psychological well-being and hypertension control. CLINICALTRIALS.GOV IDENTIFIER NCT03130257.
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Affiliation(s)
- B B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Washington Permanente Medical Group, Seattle, Washington, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - M L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - J B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - K Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Y N Hall
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - L Hansell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - C Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - K L Margolis
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | - S A Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, Washington, USA
| | - M J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Ophey MJ, Westerweel A, van Oort M, van den Berg R, Kerkhoffs GMMJ, Tak IJR. Near-Infrared Spectroscopy measurements are reliable for studying patellar bone hemodynamics and affected by venous occlusion, but not by skin compression. J Exp Orthop 2023; 10:124. [PMID: 38017345 PMCID: PMC10684445 DOI: 10.1186/s40634-023-00709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE According to the homeostasis model, patellofemoral pain (PFP) results from disturbed homeostasis due to vascular insufficiency in the anterior knee. Near-Infrared Spectroscopy (NIRS) measures relative changes in concentrations (in µmol/cm2) of (de-)oxygenated hemoglobine (HHb and O2Hb). The aims were to: 1) investigate the characteristics of the NIRS signal derived from the patella during experiments affecting hemodynamics in healthy controls, and 2) determine the test-retest reliability of NIRS in positions clinically relevant for PFP patients. METHODS Two experiments were conducted on 10 healthy controls and analysed using Student's t-test. Reliability (ICC2,1) was evaluated for two activities ('Prolonged Sitting' and 'Stair Descent') in five PFP patients and 15 healthy controls, performed twice within five days. RESULTS The NIRS signal (HHb and O2Hb) showed a statistically significant increase (p < .001 - .002) on all optodes (30, 35, 40 mm) during 'Venous Occlusion' (M = 1.0 - 2.0), while it showed no statistically significant change (p = .075 - .61) during 'Skin Compression' (M = -0.9 - 0.9) on the 30 and 35 mm optode. Reliability of NIRS (HHb and O2Hb) ranged from moderate to almost perfect (ICC2,1 = .47 - .95) on the 30 mm optode for 'Prolonged Sitting', and from moderate to substantial (ICC2,1 = .50 - .68) on the 35 mm optode for 'Stair Descent'. CONCLUSIONS Patella NIRS measurements are affected by venous occlusion, but not by skin compression, and are sufficiently reliable as research application to compare real-time patellar bone hemodynamics. These insights may assist to improve effectiveness of evidence-based treatment strategies for PFP. TRIAL REGISTRATION ISRCTN Trial Registration under number: 90377123.
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Affiliation(s)
- Martin J Ophey
- IJsveldFysio - Private Physical Therapy Clinic, Nijmegen, The Netherlands.
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- ESP Science and Education, Vienna, Austria.
| | - Anne Westerweel
- RU - Radboud University, Biomedical Sciences, Nijmegen, The Netherlands
| | - Maxime van Oort
- RU - Radboud University, Biomedical Sciences, Nijmegen, The Netherlands
| | - Robert van den Berg
- ESP Science and Education, Vienna, Austria
- FH Burgenland, Physical Therapy Department, University of Applied Science, Pinkafeld, Austria
- AIM - Austrian Institute of Management, Advanced Physiotherapy & Management, Eisenstadt, Austria
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Collaboration On Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Igor J R Tak
- ESP Science and Education, Vienna, Austria
- Amsterdam Collaboration On Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, The Netherlands
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Burrell C. A quasi-experimental study on adult weight loss using a multidimensional approach among a rural population. SAGE Open Med 2023; 11:20503121231187746. [PMID: 37492649 PMCID: PMC10363867 DOI: 10.1177/20503121231187746] [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: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objectives The study aimed to investigate the effectiveness of a yearlong digital multidimensional weight-loss intervention among residents in a southern rural community. The intervention utilized a quasi-experimental design to assess weight loss and lifestyle habit changes in volunteer individuals living in a rural community in western North Carolina. Methods The quasi-experimental design featured pre- and post-in-person health assessments, including anthropometric measures such as body composition, blood pressure, and lifestyle habits, through a health risk questionnaire. Upon completion of the in-person pre-assessment, participants received digital health education and challenges via email and challenge runner for 1 year. Following 12 months, participants were asked to complete the post-assessment to review their results. The multidimensional weight-loss intervention was communicated via newspaper and social media to promote participation among community members, utilizing a volunteer sample. Univariate analyses were conducted to determine age, weight, BMI, and body fat percentage. A paired sample t-test was conducted on pre- and post-weight as well as pre- and post-health scores. The health score was derived from the health risk questionnaire. A bivariate Pearson correlation was conducted for post-weight and post-health score analyses. Results The average participant was female in their mid-40s (N = 67). Results showed insignificant statistical mean differences between pre- and post-weight and pre- and post-health scores. A Pearson correlation indicated a moderate correlation r = -0.36, p = 0.003) between post-weight and post-health score. The negative correlation indicates changes in health behavior reflected in the health score improving as weight decreased. Conclusion The weight-loss intervention proved unsuccessful in clinical weight loss but demonstrated an association between healthy behavior changes and weight loss. However, further research is needed to solidify the current findings, as there were limitations identified in COVID-19.
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Affiliation(s)
- Chelsea Burrell
- Chelsea Burrell, School of Health Sciences, Western Carolina University, 4121 Little Savannah Road, Cullowhee, NC 28723, USA.
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Thompson MJ, Anderson ML, Cook AJ, Ehrlich K, Hall YN, Hsu C, Margolis KL, McClure JB, Munson SA, Green BB. Acceptability and Adherence to Home, Kiosk, and Clinic Blood Pressure Measurement Compared to 24-H Ambulatory Monitoring. J Gen Intern Med 2023; 38:1854-1861. [PMID: 36650328 PMCID: PMC9845022 DOI: 10.1007/s11606-023-08036-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The US Preventive Services Task Force recommends measuring blood pressure (BP) outside of clinic/office settings. While various options are available, including home devices, BP kiosks, and 24-h ambulatory BP monitoring (ABPM), understanding patient acceptability and adherence is a critical factor for implementation. OBJECTIVE To compare the acceptability and adherence of clinic, home, kiosk, and ABPM measurement. DESIGN Comparative diagnostic accuracy study which randomized adults to one of three BP measurement arms: clinic, home, and kiosk. ABPM was conducted on all participants. PARTICIPANTS Adults (18-85 years) receiving care at 12 Kaiser Permanente Washington primary care clinics (Washington State, USA) with a high BP (≥ 138 mmHg systolic or ≥ 88 mmHg diastolic) in the electronic health record with no hypertension diagnosis and on no hypertensive medications and with high BP at a research screening visit. MEASURES Patient acceptability was measured using a validated survey which was used to calculate an overall acceptability score (range 1-7) at baseline, after completing their assigned BP measurement intervention, and after completing ABPM. Adherence was defined based on the pre-specified number of BP measurements completed. KEY RESULTS Five hundred ten participants were randomized (mean age 59 years), with mean BP of 150/88. Overall acceptability score was highest (i.e. most acceptable) for Home BP (mean 6.2, SD 0.7) and lowest (least acceptable) for ABPM (mean 5.0, SD 1.0); scores were intermediate for Clinic (5.5, SD 1.1) and Kiosk (5.4, SD 1.0). Adherence was higher for Home (154/170, 90.6%) and Clinic (150/172, 87.2%) than for Kiosk (114/168, 67.9%)). The majority of participants (467/510, 91.6%) were adherent to ABPM. CONCLUSIONS Participants found home BP measurement most acceptable followed by clinic, BP kiosks, and ABPM. Our findings, coupled with recent evidence regarding the accuracy of home BP measurement, further support the routine use of home-based BP measurement in primary care practice in the US. TRIAL REGISTRATION ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257.
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Affiliation(s)
- Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | - Yoshio N Hall
- Division of Nephrology, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
| | | | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Sean A Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA.
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
- Washington Permanente Medical Group, Seattle, WA, USA.
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Green BB, Anderson ML, Cook AJ, Ehrlich K, Hall YN, Hsu C, Joseph D, Klasnja P, Margolis KL, McClure JB, Munson SA, Thompson MJ. Clinic, Home, and Kiosk Blood Pressure Measurements for Diagnosing Hypertension: a Randomized Diagnostic Study. J Gen Intern Med 2022; 37:2948-2956. [PMID: 35239109 PMCID: PMC9485334 DOI: 10.1007/s11606-022-07400-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The US Preventive Services Task Force recommends blood pressure (BP) measurements using 24-h ambulatory monitoring (ABPM) or home BP monitoring before making a new hypertension diagnosis. OBJECTIVE Compare clinic-, home-, and kiosk-based BP measurement to ABPM for diagnosing hypertension. DESIGN, SETTING, AND PARTICIPANTS Diagnostic study in 12 Washington State primary care centers, with participants aged 18-85 years without diagnosed hypertension or prescribed antihypertensive medications, with elevated BP in clinic. INTERVENTIONS Randomization into one of three diagnostic regimens: (1) clinic (usual care follow-up BPs); (2) home (duplicate BPs twice daily for 5 days); or (3) kiosk (triplicate BPs on 3 days). All participants completed ABPM at 3 weeks. MAIN MEASURES Primary outcome was difference between ABPM daytime and clinic, home, and kiosk mean systolic BP. Differences in diastolic BP, sensitivity, and specificity were secondary outcomes. KEY RESULTS Five hundred ten participants (mean age 58.7 years, 80.2% white) with 434 (85.1%) included in primary analyses. Compared to daytime ABPM, adjusted mean differences in systolic BP were clinic (-4.7mmHg [95% confidence interval -7.3, -2.2]; P<.001); home (-0.1mmHg [-1.6, 1.5];P=.92); and kiosk (9.5mmHg [7.5, 11.6];P<.001). Differences for diastolic BP were clinic (-7.2mmHg [-8.8, -5.5]; P<.001); home (-0.4mmHg [-1.4, 0.7];P=.52); and kiosk (5.0mmHg [3.8, 6.2]; P<.001). Sensitivities for clinic, home, and kiosk compared to ABPM were 31.1% (95% confidence interval, 22.9, 40.6), 82.2% (73.8, 88.4), and 96.0% (90.0, 98.5), and specificities 79.5% (64.0, 89.4), 53.3% (38.9, 67.2), and 28.2% (16.4, 44.1), respectively. LIMITATIONS Single health care organization and limited race/ethnicity representation. CONCLUSIONS Compared to ABPM, mean BP was significantly lower for clinic, significantly higher for kiosk, and without significant differences for home. Clinic BP measurements had low sensitivity for detecting hypertension. Findings support utility of home BP monitoring for making a new diagnosis of hypertension. TRIAL REGISTRATION ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257.
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Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA. .,Washington Permanente Medical Group, Seattle, WA, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Yoshio N Hall
- Kidney Research Institute, University of Washington Department of Medicine, Seattle, WA, USA
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Dwayne Joseph
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Predrag Klasnja
- University of Michigan, School of Information, Ann Arbor, MI, USA
| | | | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sean A Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA
| | - Mathew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Walther LM, von Känel R, Heimgartner N, Zuccarella-Hackl C, Stirnimann G, Wirtz PH. Alpha-Adrenergic Mechanisms in the Cardiovascular Hyperreactivity to Norepinephrine-Infusion in Essential Hypertension. Front Endocrinol (Lausanne) 2022; 13:824616. [PMID: 35937820 PMCID: PMC9355707 DOI: 10.3389/fendo.2022.824616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS Essential hypertension (EHT) is characterized by cardiovascular hyperreactivity to stress but underlying mechanism are not fully understood. Here, we investigated the role of α-adrenergic receptors (α-AR) in the cardiovascular reactivity to a norepinephrine (NE)-stress reactivity-mimicking NE-infusion in essential hypertensive individuals (HT) as compared to normotensive individuals (NT). METHODS 24 male HT and 24 male NT participated in three experimental trials on three separate days with a 1-min infusion followed by a 15-min infusion. Trials varied in infusion-substances: placebo saline (Sal)-infusions (trial-1:Sal+Sal), NE-infusion without (trial-2:Sal+NE) or with non-selective α-AR blockade by phentolamine (PHE) (trial-3:PHE+NE). NE-infusion dosage (5µg/ml/min) and duration were chosen to mimic duration and physiological effects of NE-release in reaction to established stress induction protocols. We repeatedly measured systolic (SBP) and diastolic blood pressure (DBP) as well as heart rate before, during, and after infusions. RESULTS SBP and DBP reactivity to the three infusion-trials differed between HT and NT (p's≤.014). HT exhibited greater BP reactivity to NE-infusion alone compared to NT (trial-2-vs-trial-1: p's≤.033). Group differences in DBP reactivity to NE disappeared with prior PHE blockade (trial-3: p=.26), while SBP reactivity differences remained (trial-3: p=.016). Heart rate reactivity to infusion-trials did not differ between HT and NT (p=.73). CONCLUSION Our findings suggest a mediating role of α-AR in DBP hyperreactivity to NE-infusion in EHT. However, in SBP hyperreactivity to NE-infusion in EHT, the functioning of α-AR seems impaired suggesting that the SBP hyperreactivity in hypertension is not mediated by α-AR.
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Affiliation(s)
- Lisa-Marie Walther
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nadja Heimgartner
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Guido Stirnimann
- Department of Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Petra H. Wirtz
- Biological Work and Health Psychology, University of Konstanz, Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
- *Correspondence: Petra H. Wirtz,
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Al-Ghamdi NS, Shaheen AAM. Reference values and regression equations for predicting the 6-minute walk distance in Saudi adults aged 50-80 years: A cross- sectional study. J Back Musculoskelet Rehabil 2021; 34:783-793. [PMID: 33896811 DOI: 10.3233/bmr-200240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The 6-minute walk test (6-MWT) is commonly used to measure functional capacity in clinical and research settings. The reference equations for predicting the 6-minute walk distance (6-MWD) in different populations have been established; however, there is a lack of information regarding healthy Saudi individuals over 50 years old. OBJECTIVES This study aimed to establish the reference values of 6-MWD in a sample of healthy Saudi adults aged 50-80 years, develop regression equations for the established 6-MWD, and compare the measured 6-MWD in the present study with the predicted 6-MWD derived from the previously published regression equations. METHODS In total, 210 healthy Saudi volunteers aged 50-80 years participated in this cross-sectional study. The 6-MWT was performed according to the American Thoracic Society (ATS) guidelines. Lung function, physical activity, blood pressure, heart rate, oxygen saturation, exertion level of leg fatigue, and sensation of dyspnea were measured. RESULTS The mean 6-MWD was 396.2 ± 69.4 m. It was significantly correlated with age, sex, height, body mass index (BMI), and physical activity. The predictors of 6-MWD were age and BMI for men, while they were age, BMI, and height for women. They accounted for 25% and 35% of the total variance of 6-MWD for men and women, respectively. The measured 6-MWD was significantly shorter than the predicted 6-MWD. CONCLUSION Saudi populations have significantly shorter 6-MWDs than those reported in other ethnic groups. The sex-specific equations developed in this study are expected to provide a useful measure of 6-MWT for Saudi adults. However, further investigation is required to validate the application of these equations to individuals living in different regions of Saudi Arabia.
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Affiliation(s)
- Nawal S Al-Ghamdi
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Physical Medicine and Rehabilitations, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
| | - Afaf A M Shaheen
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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9
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Jofré-Saldía E, Villalobos-Gorigoitía Á, Gea-García G. Effects of multicomponent exercise program with progressive phases on functional capacity, fitness, quality of life, dual-task and physiological variables in older adults: Randomized controlled trial protocol. Rev Esp Geriatr Gerontol 2021; 56:272-278. [PMID: 34112535 DOI: 10.1016/j.regg.2021.04.006] [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: 02/16/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The multicomponent exercise program must be carried out in phases, due to the low tolerance of the old adults to prolonged efforts, since their functional reserve is reduced. The aim of study is investigate the effects of Multicomponent on Progressive Phases Program on functional capacity, fitness, quality of life, dual-task and physiological variables in the elderly. METHODS This is a randomized controlled trial protocol with blind examiners. The protocol was registered at clinictrials.gov (protocol number: NCT04118478). The experimental group will participate in a progressive multi-component program of 27 weeks divided into 3 phases of 9 weeks each of them. Primary outcomes will be determined by evaluating functional capacity using the Short Physical Performance Battery (SPPB), gait speed, and Time up and Go test. Fitness will be determined by the handgrip, 2-min step test, chair sit and reach test, and back scratch test. Quality of life will appear with the SF-36 questionnaire and dual-task with the walking-while-talking test. The physiological variables evaluated will be heart rate and blood pressure at rest, autonomic balance and forced spirometry. Secondary outcomes are determined by measuring the level of physical activity, motivation for exercise, and anthropometric variables. DISCUSSION The results derived from this research will increase the knowledge about the effects of a program of this type. The possible discoveries could serve as a guide to encourage future researchers to develop similar protocols. The purpose of the program is to serve as a practical and viable tool for the benefit of older people. Clinical trial registry protocol: NCT04118478.
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Affiliation(s)
- Emilio Jofré-Saldía
- Instituto del Deporte de Universidad de las Américas, Escuela Licenciatura en Ciencias de la Actividad Física, Chile.
| | - Álvaro Villalobos-Gorigoitía
- Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Chile
| | - Gemma Gea-García
- Department of Sport Science, Faculty of Sport Sciences, Catholic University of Murcia, Spain; Health, Physical Activity, Fitness and Motor Control Performance Research Group (GISAFFCOM), Spain
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Albuquerque NS, Padwal R, Araujo TL. Brazilian health professionals' perceptions and knowledge about automated blood pressure monitors. J Hum Hypertens 2021; 36:681-688. [PMID: 34091596 DOI: 10.1038/s41371-021-00556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
Obtaining accurate blood pressure readings is vital. However, students and health professionals do not always receive adequate training on blood pressure measurement, especially regarding new technologies, leading to insufficient knowledge. Therefore, the aim of this study is to analyze Brazilian health professionals' perceptions and knowledge about automated blood pressure monitors. This cross-sectional study involved 1734 Brazilian nurses, nursing technicians, and doctors who reported having some experience of using automated monitors. Perceptions about differences between readings obtained through the auscultatory and oscillometric methods, influence of small differences in clinical decision-making, confidence in automated monitors, and knowledge about contraindications for the use of these devices were assessed. Most medical and nursing professionals considered differences of up to 5 mmHg (40.94%) between auscultatory and oscillometric measurements acceptable. Of these, 69.02% reported that even small differences can influence clinical decisions. Confidence in readings obtained using automated blood pressure monitors was reported by 53.92%. Among the motivations for making these devices available in health services, the most frequent was the saving of time (48.85%) and the least frequent, the perception that the use of this technology requires less training (9.40%). Arrhythmia was the most recognized contraindication for the use of automated monitors (28.49%), followed by obesity (28.14%) and blood pressure readings above 160 × 100 mmHg. In conclusion, there is a lack of knowledge about the functionalities and indications of blood pressure monitors and a low tolerance for measurements different from those obtained through manual mercury sphygmomanometers or aneroids.
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Affiliation(s)
- Nila S Albuquerque
- Department of Nursing, Federal University of Ceara, Fortaleza, Ceara, Brazil.
| | - Raj Padwal
- Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Thelma L Araujo
- Department of Nursing, Federal University of Ceara, Fortaleza, Ceara, Brazil
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11
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Craveiro V, Ramos E, Araújo J. Metabolically healthy overweight in young adulthood: is it a matter of duration and degree of overweight? Nutr Metab Cardiovasc Dis 2021; 31:455-463. [PMID: 33229201 DOI: 10.1016/j.numecd.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Given the controversy regarding metabolically healthy obesity, we studied the association between duration and degree of body mass index (BMI) from adolescence to early adulthood and metabolic status of both overweight/obese and under/normal weight subjects. METHODS AND RESULTS Participants of the EPITeen cohort were evaluated at 13, 17, 21 and 24 years (n = 1040). Duration and degree of BMI in the 11-year period was summarized through the area under the curve of BMI (BMIAUC). Metabolic health at 24 y was defined as optimal levels of lipids, blood pressure and glucose. The association between BMIAUC per year and metabolic health was estimated through binary logistic regression models, adjusted for confounders and stratified by BMI. The proportion of metabolically healthy overweight/obesity at 24 y was 13.4%. After adjustment for sociodemographic and behavioural factors, the increase of one kg/m2 in BMI on average per year during the period between 13 and 24 y was associated with 14% lower odds of being metabolically healthy among under/normal weight participants (OR = 0.86, 95% CI 0.78-0.94); and 8% lower odds of metabolic health among obese/overweight participants (OR = 0.92, 95% CI 0.85-1.00). After additional adjustment for waist circumference, the association was attenuated, especially in the obese/overweight group (OR = 1.03, 95% CI 0.93-1.14). About 20% of the metabolically healthy obese/overweight at 13 y transitioned to metabolically unhealthy obesity/overweight at 24 y. CONCLUSION The results support the hypothesis that the healthy obesity phenotype could be explained by a lower exposure to adiposity, either by shorter time or lower quantity, and a more favourable body fat distribution.
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Affiliation(s)
- Vanda Craveiro
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas nº 135, 4050-600, Porto, Portugal
| | - Elisabete Ramos
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas nº 135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Joana Araújo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas nº 135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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12
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Gurdasani D, Carstensen T, Fatumo S, Chen G, Franklin CS, Prado-Martinez J, Bouman H, Abascal F, Haber M, Tachmazidou I, Mathieson I, Ekoru K, DeGorter MK, Nsubuga RN, Finan C, Wheeler E, Chen L, Cooper DN, Schiffels S, Chen Y, Ritchie GRS, Pollard MO, Fortune MD, Mentzer AJ, Garrison E, Bergström A, Hatzikotoulas K, Adeyemo A, Doumatey A, Elding H, Wain LV, Ehret G, Auer PL, Kooperberg CL, Reiner AP, Franceschini N, Maher D, Montgomery SB, Kadie C, Widmer C, Xue Y, Seeley J, Asiki G, Kamali A, Young EH, Pomilla C, Soranzo N, Zeggini E, Pirie F, Morris AP, Heckerman D, Tyler-Smith C, Motala AA, Rotimi C, Kaleebu P, Barroso I, Sandhu MS. Uganda Genome Resource Enables Insights into Population History and Genomic Discovery in Africa. Cell 2020; 179:984-1002.e36. [PMID: 31675503 DOI: 10.1016/j.cell.2019.10.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/03/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022]
Abstract
Genomic studies in African populations provide unique opportunities to understand disease etiology, human diversity, and population history. In the largest study of its kind, comprising genome-wide data from 6,400 individuals and whole-genome sequences from 1,978 individuals from rural Uganda, we find evidence of geographically correlated fine-scale population substructure. Historically, the ancestry of modern Ugandans was best represented by a mixture of ancient East African pastoralists. We demonstrate the value of the largest sequence panel from Africa to date as an imputation resource. Examining 34 cardiometabolic traits, we show systematic differences in trait heritability between European and African populations, probably reflecting the differential impact of genes and environment. In a multi-trait pan-African GWAS of up to 14,126 individuals, we identify novel loci associated with anthropometric, hematological, lipid, and glycemic traits. We find that several functionally important signals are driven by Africa-specific variants, highlighting the value of studying diverse populations across the region.
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Affiliation(s)
- Deepti Gurdasani
- William Harvey Research Institute, Queen Mary's University of London, London, UK
| | | | - Segun Fatumo
- London School of Hygiene and Tropical Medicine, London, UK; Uganda Medical Informatics Centre (UMIC), MRC/UVRI and LSHTM (Uganda Research Unit), Entebbe, Uganda; H3Africa Bioinformatics Network (H3ABioNet) Node, Center for Genomics Research and Innovation (CGRI)/National Biotechnology Development Agency CGRI/NABDA, Abuja, Nigeria
| | - Guanjie Chen
- Center for Research on Genomics and Global Health, National Institute of Health, Bethesda, MD, USA
| | | | | | | | | | - Marc Haber
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | - Ioanna Tachmazidou
- GSK Medicines Research Centre, Gunnels Wood Road, Stevenage Hertfordshire SG1 2NY, UK
| | - Iain Mathieson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth Ekoru
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene & Tropical Medicine Uganda Research Unit on AIDS, Entebbe, Uganda; Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marianne K DeGorter
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rebecca N Nsubuga
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene & Tropical Medicine Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Chris Finan
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | - Eleanor Wheeler
- Wellcome Sanger Institute, Hinxton, Cambridge, UK; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Li Chen
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephan Schiffels
- Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
| | - Yuan Chen
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | | | | | | | - Alex J Mentzer
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | | | - Konstantinos Hatzikotoulas
- Wellcome Sanger Institute, Hinxton, Cambridge, UK; Institute of Translational Genomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Institute of Health, Bethesda, MD, USA
| | - Ayo Doumatey
- Center for Research on Genomics and Global Health, National Institute of Health, Bethesda, MD, USA
| | | | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Georg Ehret
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Paul L Auer
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Charles L Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Dermot Maher
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene & Tropical Medicine Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Stephen B Montgomery
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Yali Xue
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK; Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene & Tropical Medicine Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene & Tropical Medicine Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Anatoli Kamali
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene & Tropical Medicine Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Elizabeth H Young
- Wellcome Sanger Institute, Hinxton, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK
| | - Cristina Pomilla
- Wellcome Sanger Institute, Hinxton, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK
| | - Nicole Soranzo
- Wellcome Sanger Institute, Hinxton, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge, UK; The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Fraser Pirie
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew P Morris
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK; Department of Biostatistics, University of Liverpool, Liverpool, UK
| | | | | | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, National Institute of Health, Bethesda, MD, USA.
| | - Pontiano Kaleebu
- London School of Hygiene and Tropical Medicine, London, UK; Uganda Medical Informatics Centre (UMIC), MRC/UVRI and LSHTM (Uganda Research Unit), Entebbe, Uganda; Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene & Tropical Medicine Uganda Research Unit on AIDS, Entebbe, Uganda.
| | - Inês Barroso
- Wellcome Sanger Institute, Hinxton, Cambridge, UK; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Manj S Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK.
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Reproducibility of the European Society of Hypertension - International Protocol for validation of blood pressure measuring devices in obese patients. J Hypertens 2019; 37:1832-1837. [PMID: 31246893 DOI: 10.1097/hjh.0000000000002106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electronic devices for blood pressure (BP) measurements need to go through independent clinical validation as recommended by different authorities, both in general and special populations. Reproducibility of such validation protocols is unknown. OBJECTIVE The aim of this study was to assess the inter-centre reproducibility of the European Society of Hypertension-International protocol (ESH-IP) in patients with large arm circumference at least 32 cm or obesity. METHODS Two independent validation studies were performed in parallel according to the ESH-IP protocol in two centres (Serbia and Armenia). The two studies were performed blindly and independently. The ESH-IP criteria were applied for the analysis. The OMRON RS7 wrist oscillometric devices were used in both studies. RESULTS The distribution of the mean differences values of 5 or less, 10 or less and 15 mmHg or less between the observers and the device were for the Serbia team: 74, 95 and 98 for SBP and 78, 95 and 99 for DBP; and for the Armenia team: 86, 95 and 99 for SBP and 90, 99 and 99 for DBP. The mean differences (SD) of BP values between the observers and the device were for the Serbia team of 1.7 ± 4.8 mmHg for SBP and 1.2 ± 4.6 mmHg for DBP and for the Armenia team of -1.1 ± 4.2 mmHg for SBP and -0.3 ± 3.5 mmHg for DBP. CONCLUSION This study showed that the ESH-IP validation protocol presents a good inter-centre reproducibility. The OMRON RS7 device showed similar results, fulfilling the validation criteria in two independent studies in patients with arm circumference at least 32 cm.
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14
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Green BB, Anderson ML, Campbell J, Cook AJ, Ehrlich K, Evers S, Hall YN, Hsu C, Joseph D, Klasnja P, Margolis KL, McClure JB, Munson SA, Thompson MJ. Blood pressure checks and diagnosing hypertension (BP-CHECK): Design and methods of a randomized controlled diagnostic study comparing clinic, home, kiosk, and 24-hour ambulatory BP monitoring. Contemp Clin Trials 2019; 79:1-13. [PMID: 30634036 PMCID: PMC7067555 DOI: 10.1016/j.cct.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/14/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The US Preventive Services Task Force recommends out-of-office blood pressure (BPs) before making a new diagnosis of hypertension, using 24-h ambulatory (ABPM) or home BP monitoring (HBPM), however this is not common in routine clinical practice. Blood Pressure Checks and Diagnosing Hypertension (BP-CHECK) is a randomized controlled diagnostic study assessing the comparability and acceptability of clinic, home, and kiosk-based BP monitoring to ABPM for diagnosing hypertension. Stakeholders including patients, providers, policy makers, and researchers informed the study design and protocols. METHODS Adults aged 18-85 without diagnosed hypertension and on no hypertension medication with elevated BPs in clinic and at the baseline research visit are randomized to one of 3 regimens for diagnosing hypertension: (1) clinic BPs, (2) home BPs, or (3) kiosk BPs; all participants subsequently complete ABPM. The primary outcomes are the comparability (with daytime ABPM mean systolic and diastolic BP as the reference standard) and acceptability (e.g., adherence to, patient-reported outcomes) of each method compared to ABPM. Longer-term outcomes are assessed at 6-months including: patient-reported outcomes, primary care providers' diagnosis of hypertension; and BP control. We report challenges experienced and our response to these. RESULTS Enrollment began in May of 2017 with a target of randomizing 510 participants. BP thresholds for diagnosing hypertension in the US changed after the trial started. We discuss the stakeholder process used to assess and respond to these changes. CONCLUSION AND PUBLIC HEALTH IMPACT BP-CHECK will inform which hypertension diagnostic methods are most accurate, acceptable, and feasible to implement in primary care.
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Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington Health Research Institute, United States; Kaiser Permanente Washington Medical Group, United States.
| | | | - Jerry Campbell
- Kaiser Permanente Washington Health Research Institute, United States
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, United States
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, United States
| | - Sarah Evers
- Kaiser Permanente Washington Health Research Institute, United States
| | - Yoshio N Hall
- Kidney Research Institute, University of Washington Department of Medicine, United States
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, United States
| | - Dwayne Joseph
- Kaiser Permanente Washington Health Research Institute, United States
| | - Predrag Klasnja
- Kaiser Permanente Washington Health Research Institute, United States
| | | | | | - Sean A Munson
- University of Washington, Department of Human Centered Design and Engineering, United States
| | - Mathew J Thompson
- University of Washington, Department of Family Medicine, United States
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Araújo J, Severo M, Santos S, Ramos E. Life course path analysis of total and central adiposity throughout adolescence on adult blood pressure and insulin resistance. Nutr Metab Cardiovasc Dis 2017; 27:360-365. [PMID: 28216283 DOI: 10.1016/j.numecd.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM We aimed to study whether the effect of adolescent adiposity on adult blood pressure and insulin resistance was mediated by adult adiposity. METHODS AND RESULTS Data from the EPITeen cohort at 13, 17 and 21 years was used (n = 2211). Sex- and age-specific body mass index z-scores (BMIz) and waist-to-hip ratio (WHR) were used as indicators of total and central adiposity, respectively. Systolic blood pressure (SBP), glucose and insulin were assessed at 21 years and the homeostasis model assessment (HOMA-IR) was used as a marker of insulin resistance. Path analysis was applied to evaluate direct and indirect effects of adiposity (13, 17 and 21y) on adult SBP and HOMA-IR, separately for total and central adiposity and for each outcome. Results are presented as standardized regression coefficients [β (95%CI)]. The total effect of BMIz at 13 years on SBP at 21 years was 0.211 (0.178; 0.244), totally mediated by adult BMIz. Total effect of BMIz 13y on HOMA-IR was 0.248 (0.196; 0.299). Although this effect was mostly mediated by BMIz 21y, an additional direct effect from BMIz 17y was found [β = -0.240 (-0.315; -0.164)]. Central adiposity was also positively associated with SBP and HOMA-IR at 21 years, and the effect of adolescent WHR was totally mediated by adult WHR for both outcomes. CONCLUSIONS The effect of adolescent adiposity on adult SBP and HOMA-IR was mostly mediated by adult adiposity. However, for HOMA-IR an additional direct effect from total adiposity at 17 years was found.
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Affiliation(s)
- J Araújo
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
| | - M Severo
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - S Santos
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - E Ramos
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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Azaki A, Diab R, Harb A, Asmar R, Chahine MN. Questionable accuracy of home blood pressure measurements in the obese population - Validation of the Microlife WatchBP O3 ® and Omron RS6 ® devices according to the European Society of Hypertension-International Protocol. Vasc Health Risk Manag 2017; 13:61-69. [PMID: 28280348 PMCID: PMC5338962 DOI: 10.2147/vhrm.s126285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Two oscillometric devices, the Microlife WatchBP O3® and the Omron RS6®, designed for self-blood pressure measurement were evaluated according to the European Society of Hypertension (ESH)-International Protocol (IP) Revision 2010 in the obese population. METHODS The Microlife WatchBP O3 measures blood pressure (BP) at the brachial level and the Omron RS6 measures BP at the wrist level. The ESH-IP revision 2010 includes a total of 33 subjects. The difference between observers' and device BP values was calculated for each measure. A total of 99 pairs of BP differences were classified into three categories (≤5, ≤10, and ≤15 mmHg). The protocol procedures were followed precisely in each of the two studies. RESULTS Microlife WatchBP O3 and Omron RS6 failed to fulfill the criteria of the ESH-IP. The mean differences between the device and the mercury readings were: 0.3±7.8 mmHg and -1.9±6.4 mmHg for systolic BP and diastolic BP, respectively, for Microlife WatchBP O3, and 2.7±9.9 mmHg for SBP and 3.5±11.1 mmHg for diastolic BP for Omron RS6. CONCLUSION Microlife WatchBP O3 and Omron RS6 readings differing from the mercury standard by more than 5, 10, and 15 mmHg failed to fulfill the ESH-IP revision 2010 requirements in obese subjects. Therefore, the two devices cannot be recommended for use in obese subjects.
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Affiliation(s)
- Alaa Azaki
- Faculty of Medical Sciences, Lebanese University, Hadath
| | - Reem Diab
- Faculty of Medical Sciences, Lebanese University, Hadath
| | - Aya Harb
- Faculty of Medical Sciences, Lebanese University, Hadath
| | - Roland Asmar
- Faculty of Medical Sciences, Lebanese University, Hadath
- Foundation-Medical Research Institutes (F-MRI®), Beirut, Lebanon
| | - Mirna N Chahine
- Faculty of Medical Sciences, Lebanese University, Hadath
- Foundation-Medical Research Institutes (F-MRI®), Beirut, Lebanon
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Validation of the Omron MIT Elite blood pressure device in a pregnant population with large arm circumference. Blood Press Monit 2017; 22:109-111. [PMID: 28151753 DOI: 10.1097/mbp.0000000000000239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy of the Omron MIT Elite automated device in pregnant women with an arm circumference of or above 32 cm, using the British Hypertension Society validation protocol. METHODS Blood pressure was measured sequentially in 46 women of any gestation requiring the use of a large cuff (arm circumference ≥32 cm) alternating between the mercury sphygmomanometer and the Omron MIT Elite device. RESULTS The Omron MIT Elite achieved an overall D/D grade with a mean of the device-observer difference being 7.17±6.67 and 9.31±6.59 for systolic and diastolic blood pressure respectively. Interobserver accuracy was 94.6% for systolic and 95% for diastolic readings within 5 mmHg. CONCLUSION The Omron MIT Elite overestimates blood pressure and has failed the British Hypertension Society protocol requirements. Therefore, it cannot be recommended for use in pregnant women with an arm circumference of or above 32 cm.
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18
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Ezejimofor MC, Uthman OA, Maduka O, Ezeabasili AC, Onwuchekwa AC, Ezejimofor BC, Asuquo E, Chen YF, Stranges S, Kandala NB. The Burden of Hypertension in an Oil- and Gas-Polluted Environment: A Comparative Cross-Sectional Study. Am J Hypertens 2016; 29:925-33. [PMID: 26884135 DOI: 10.1093/ajh/hpw009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/18/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence of positive association between traffic-related air pollution and elevated blood pressure has been published widely. However, the risk of hypertension and prolonged exposure to crude oil pollution and gas flares remains unexplored. METHODS We recruited 2,028 residents (aged 18-80) in a cross-sectional survey of both oil/gas polluted and nonpolluted communities in the Niger Delta region of Nigeria. Prevalence and risk of hypertension, anthropometric indices, lifestyle and sociodemographic factors, and cardiovascular comorbidities were examined and compared between the 2 groups. Hypertension was defined as blood pressure ≥140/90mm Hg or on antihypertensive medication. Both univariate and multivariate logistic regression models were used to examine factors associated with hypertension. Model fits statistics were used to assess the parsimonious model and predictive power. RESULTS More than one-third of participants were hypertensive (37.4%). Half of the participants were from oil-polluted areas (51%). Only 15% of participants reported family history of hypertension. In the adjusted model, participants living in oil-polluted areas were almost 5 times as likely to have developed hypertension (adjusted odds ratio (aOR) = 4.85, 95% confidence interval (CI): 1.84-12.82) compared to participants in unpolluted areas. Age modifies the association between pollution status and risk of hypertension. For every 10 years increase in the age of the participants, the odds of developing hypertension increased by 108% (aOR = 2.08, 95% CI: 1.77-2.43). CONCLUSION The results suggested that exposure to oil/gas pollution may be associated with an increased risk of hypertension. Our findings need to be further investigated in longitudinal studies.
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Affiliation(s)
| | | | - Omosivie Maduka
- Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Nigeria
| | | | - Arthur C Onwuchekwa
- Department of Internal Medicine, University of Port Harcourt, Port Harcourt, Nigeria
| | | | - Eme Asuquo
- Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Nigeria
| | - Yen-Fu Chen
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK; Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Saverio Stranges
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK; Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Ngianga-Bakwin Kandala
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK; Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Mathematics and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
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Vrachimis A, Hadjicharalambous M, Tyler C. The Effect of Circuit Training on Resting Heart Rate Variability, Cardiovascular Disease Risk Factors and Physical Fitness in Healthy Untrained Adults. Health (London) 2016. [DOI: 10.4236/health.2016.82017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Odunaiya NA, Louw QA, Grimmer KA. Are lifestyle cardiovascular disease risk factors associated with pre-hypertension in 15-18 years rural Nigerian youth? A cross sectional study. BMC Cardiovasc Disord 2015; 15:144. [PMID: 26537355 PMCID: PMC4632346 DOI: 10.1186/s12872-015-0134-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/25/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a public health concern worldwide. Hypertensive heart disease is predominant in Nigeria. To effectively reduce CVD in Nigeria, the prevalence of, and factors associated with, pre-hypertension in Nigerian youth first need to be established. METHODS A locally-validated CVD risk factor survey was completed by 15-18 year olds in a rural setting in south-west Nigeria. Body Mass Index (BMI), waist-hip ratio and systolic and diastolic blood pressure was measured. Putative risk factors were tested in gender-specific hypothesized causal pathways for overweight/obesity, and for pre-hypertension. RESULTS Of 1079 participants, prevalence of systolic pre-hypertension was 33.2 %, diastolic pre-hypertension prevalence approximated 5 %, and hypertension occurred in less than 10 % sample. There were no gender differences in prevalence of pre- hypertension, and significant predictors of systolic pre-hypertension (high BMI and older age) were identified. Considering high BMI, older age was a risk for both genders, whilst fried food preference was female-only risk, and low breakfast cereal intake was a male-only risk. CONCLUSION Rural Nigerian adolescents are at-risk of future CVD because of lifestyle factors, and high prevalence of systolic pre-hypertension. Relevant interventions can now be proposed to reduce BMI and thus ameliorate future rural adult Nigerian CVD.
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Affiliation(s)
- N A Odunaiya
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
- Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria.
| | - Q A Louw
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
| | - K A Grimmer
- Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
- International Center for Allied Health Evidence, University of South Australia, Adelaide, Australia.
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Centra JC, Roberts G, Opie G, Cheong J, Doyle LW. Masked hypertension in extremely preterm adolescents. J Paediatr Child Health 2015; 51:1060-5. [PMID: 26040929 DOI: 10.1111/jpc.12928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
AIM Extremely preterm (EPT, born <28 weeks gestation) or extremely low birthweight (ELBW, birthweight <1000 g) individuals are at increased risk of high blood pressure (BP) and cardiovascular disease. We compared office BP measurements with 24-h ambulatory BP measurement (ABP) in EPT/ELBW individuals at age 18 years and term controls, and determined the sensitivity and specificity of office BP in predicting masked hypertension (24-h ABP measurements > 130/80). METHODS All EPT/ELBW individuals and matched term control adolescents born in Victoria, Australia, between 1991 and 1992 were recruited. A subset of this cohort was seen at 18 years, and researchers blinded to birth status measured office BP and ABP. We established the office BP thresholds that had the highest sensitivity and specificity in predicting masked hypertension. RESULTS EPT/ELBW (N = 120) individuals had higher mean BP measurements at 18 years, compared with controls (N = 71). Although there were no significant differences in rates of high BP between groups, high proportions of both EPT/ELBW (43.3%) and term control (36.6%) participants met criteria for masked systolic hypertension. In EPT/ELBW individuals, office systolic BP measurement of ≥122.5 mmHg predicted masked systolic hypertension (sensitivity 79%, specificity 74%). Office diastolic BP measurement of ≥75.5 mmHg predicted masked diastolic hypertension (sensitivity 77%, specificity, 77%). CONCLUSIONS At age 18 years, EPT/ELBW individuals have higher systolic and diastolic BP, compared with controls. Office BP may be an adequate screen for masked hypertension in EPT/ELBW survivors, but further research is needed to identify accurate ABP thresholds for masked hypertension for young Australians.
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Affiliation(s)
- Johanna C Centra
- Department of Paediatrics, Barwon Health, Geelong, Victoria, Australia
| | - Gehan Roberts
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Gillian Opie
- Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Jeanie Cheong
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
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Supiyev A, Kossumov A, Utepova L, Nurgozhin T, Zhumadilov Z, Bobak M. Prevalence, awareness, treatment and control of arterial hypertension in Astana, Kazakhstan. A cross-sectional study. Public Health 2015; 129:948-53. [PMID: 25818013 DOI: 10.1016/j.puhe.2015.02.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Very little is known about prevalence of common cardiovascular risk factors in Central Asia. The aim of the study was to assess the prevalence, awareness, treatment and control of arterial hypertension, and factors associated with these indices in a population sample of Astana, the new capital city of Kazakhstan. DESIGN Cross-sectional study of subjects registered in eight outpatient policlinics in Astana. METHODS A total of 497 adults (response rate 56%) aged 50-75 years randomly selected from registers of the policlinics were examined. Hypertension was defined as a mean systolic and/or diastolic blood pressure of ≥140/90 mm Hg and/or antihypertensive medication use during the last two weeks. Awareness and treatment were based on self-report. Hypertension control was defined as blood pressure <140/90 mm Hg among hypertensive subjects. RESULTS The overall prevalence of hypertension was 70%. Among hypertensive subjects, 91% were aware of their condition, 77% took antihypertensive medications, and 34% had blood pressure controlled (<140/90 mm Hg). The prevalence of hypertension and its awareness, treatment and control was more common in women, among persons aged 60 years or more and (except control) among those with high body mass index. None of several available socio-economic or lifestyle measures was associated with any of hypertension indices. CONCLUSIONS The levels of awareness, treatment and control of hypertension were higher than in most Eastern European and Central Asian populations with available data, most likely reflecting high education and large proportion of civil servants in the new capital city. However, even in this privileged population the rates of successful control of hypertension were modest.
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Affiliation(s)
- A Supiyev
- Department of Epidemiology and Public Health, University College London, London, UK; Center for Life Sciences, Nazarbayev University, Astana, Kazakhstan
| | - A Kossumov
- Center for Life Sciences, Nazarbayev University, Astana, Kazakhstan
| | - L Utepova
- Center for Life Sciences, Nazarbayev University, Astana, Kazakhstan
| | - T Nurgozhin
- Center for Life Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Z Zhumadilov
- Center for Life Sciences, Nazarbayev University, Astana, Kazakhstan
| | - M Bobak
- Department of Epidemiology and Public Health, University College London, London, UK.
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Dean SC, Kerry SM, Khong TK, Kerry SR, Oakeshott P. Evaluation of a specialist nurse-led hypertension clinic with consultant backup in two inner city general practices: randomized controlled trial. Fam Pract 2014; 31:172-9. [PMID: 24356073 DOI: 10.1093/fampra/cmt074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although practice nurses are increasingly involved in hypertension management, there is little robust evidence of effectiveness. OBJECTIVE To evaluate the effect of a specialist nurse-led hypertension clinic with consultant backup on change in systolic blood pressure. DESIGN Randomized trial. SETTING Two inner city general practices. Participants. Three hundred and fifty-three patients, mean age 62 years (range 18-99), with last recorded blood pressure ≥ British Hypertension Society audit standard were randomly allocated to the nurse-led clinic or usual care. Intervention. Patients received a letter informing them that their last blood pressure was over target and inviting them to the clinic. After assessment at the clinic, the nurse discussed any changes in anti-hypertensive treatment with a visiting consultant and the patient's GP, and followed up the patient over 6 months until blood pressure targets were achieved. MAIN OUTCOME MEASURE Reduction in systolic blood pressure, assessed using two audits of the practices' computerized records where blood pressure was measured independently by practice staff before and after the intervention period. RESULTS Follow-up was 89% (313/353). There was greater reduction in systolic blood pressure in the clinic group (n = 144) than usual care group (n = 169, adjusted difference 4.4 mmHg; 95% CI 0.7 to 8.2). Of 167 patients randomly selected for the clinic, 91 (55%) attended, 49 had blood pressure above target when measured according to protocol and 26 had their anti-hypertensive treatment intensified by their GP. CONCLUSION Invitation to a specialist nurse-led hypertension clinic with consultant back up was associated with reduced systolic blood pressure.
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Affiliation(s)
- Sally C Dean
- Population Health Sciences and Education, St George's, University of London, London, UK
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Pagonas N, Schmidt S, Eysel J, Compton F, Hoffmann C, Seibert F, Hilpert J, Tschöpe C, Zidek W, Westhoff TH. Impact of Atrial Fibrillation on the Accuracy of Oscillometric Blood Pressure Monitoring. Hypertension 2013; 62:579-84. [DOI: 10.1161/hypertensionaha.113.01426] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of automated oscillometric blood pressure monitors was the basis for today’s widespread use of blood pressure self-measurement. However, in atrial fibrillation, there is a controversial debate on the use of oscillometry because there is a high variability of heart rate and stroke volume. To date, the accuracy of oscillometric blood pressure monitoring in atrial fibrillation has only been investigated using auscultatory sphygmomanometry as reference method, which may be biased by arrhythmia as well. We performed a cross-sectional study in 102 patients (52 sinus rhythm, 50 atrial fibrillation) assessing the accuracy of an automated and validated oscillometric upper arm (M5 Professional, Omron) and wrist device (R5 Professional, Omron) to invasively assessed arterial pressure. Blood pressure values were calculated as the mean of 3 consecutive measurements. Systolic and diastolic blood pressure did not significantly differ in patients with sinus rhythm and atrial fibrillation, independent of the method of measurement (
P
>0.05 each). The within-subject variability of the oscillometric measurements was higher in patients with atrial fibrillation compared with sinus rhythm (
P
<0.01 each). The biases of systolic and diastolic blood pressure, however, did not significantly differ in presence or absence of atrial fibrillation in Bland-Altmann analysis (
P
>0.05 each). In conclusion, atrial fibrillation did not significantly affect the accuracy of oscillometric measurements, if 3 repeated measurements were performed.
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Affiliation(s)
- Nikolaos Pagonas
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Sven Schmidt
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Jörg Eysel
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Friederike Compton
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Clemens Hoffmann
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Felix Seibert
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Justus Hilpert
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Carsten Tschöpe
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Walter Zidek
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Timm H. Westhoff
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
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Vancampfort D, Probst M, Scheewe T, De Herdt A, Sweers K, Knapen J, van Winkel R, De Hert M. Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia. Psychiatry Res 2013; 207:25-32. [PMID: 23051886 DOI: 10.1016/j.psychres.2012.09.026] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/01/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
Low physical fitness has been recognised as a prominent behavioural risk factor for cardiovascular diseases (CVD) and metabolic syndrome (MetS), and as an independent risk factor for all-cause mortality. No studies have systematically assessed physical fitness compared with a matched health control group in patients with schizophrenia. Eighty patients with schizophrenia and 40 age-, gender- and body mass index (BMI)-matched healthy volunteers were included. All participants performed an Eurofit test battery and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms. Patients with schizophrenia demonstrated significant differences from controls in whole body balance, explosive leg muscle strength, abdominal muscular endurance, and running speed. Inactive patients scored worse on most Eurofit items than patients walking for at least 30min per day. Low physical fitness was associated with illness duration, smoking, the presence of MetS and more severe negative, depressive and cognitive symptoms. Less physically active patients who smoke and suffer from high levels of negative, depressive and/or cognitive symptoms might benefit from specific rehabilitation interventions aimed at increasing physical fitness.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium.
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Sabater-Hernández D, De La Sierra A, Sánchez-Villegas P, Santana-Pérez FM, Merino-Barber L, Faus MJ. Agreement Between Community Pharmacy and Ambulatory and Home Blood Pressure Measurement Methods to Assess the Effectiveness of Antihypertensive Treatment: The MEPAFAR Study. J Clin Hypertens (Greenwich) 2012; 14:236-44. [DOI: 10.1111/j.1751-7176.2012.00598.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Magnitude of the white-coat effect in the community pharmacy setting: the MEPAFAR study. Am J Hypertens 2011; 24:887-92. [PMID: 21509052 DOI: 10.1038/ajh.2011.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is little information regarding the community pharmacy blood pressure (CPBP) measurement method and their differences with home (HBP) or ambulatory BP (ABP). The aim of this study was to measure such differences and their variation over successive visits. METHOD Cross-sectional study carried out in eight pharmacies in Gran Canaria (Spain). The study included 169 treated hypertensive patients. BP was measured at the pharmacy (four visits), at HBP (4 days) and 24-h ABP monitoring. We defined pharmacy white-coat effect (PWCE) as differences between CPBP and HBP (home PWCE) or daytime ABP (ambulatory PWCE). RESULTS The overall (pooled values for all visits) ambulatory PWCE was not significantly different from zero for systolic BP (SBP) (-0.4 mm Hg (95% confidence interval (CI): -1.8 to 1.1)), but greater than zero for diastolic BP (DBP) (3.4 mm Hg (95% CI: 2.3 to 4.6)). The overall home PWCE was not significantly different from zero, both for SBP (1.2 mm Hg (95% CI: -0.1 to 2.6)) and DBP (0.1 mm Hg (95% CI: -0.7 to 1.0)). The ambulatory and home PWCE on the first visit were greater than zero (P < 0.001) (SBP/DBP): 3.5/4.8 and 1.9/1.5 mm Hg, respectively; but showed important reductions at the second visit and became not significantly different from zero, except the ambulatory PWCE in DBP, which persisted until the last visit. CONCLUSION The trend in the PWCE decreased over the successive visits to the pharmacy. Only the ambulatory PWCE in DBP proved to be statistically greater than zero after the second visit. Repeated CPBP measurements could be a useful alternative to assess the response to antihypertensive treatment.
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Vancampfort D, Probst M, Sweers K, Maurissen K, Knapen J, De Hert M. Reliability, minimal detectable changes, practice effects and correlates of the 6-min walk test in patients with schizophrenia. Psychiatry Res 2011; 187:62-7. [PMID: 21185084 DOI: 10.1016/j.psychres.2010.11.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/24/2010] [Accepted: 11/29/2010] [Indexed: 11/18/2022]
Abstract
We examined the reproducibility of the 6-min walk test (6 MWT) in patients with schizophrenia. Secondary aims were to assess minimal detectable changes and practice effects of the 6 MWT and the presence of clinical conditions that might interfere. From 71 patients with schizophrenia two trials of the 6 MWT, administered within 3 days, were analysed. The intraclass correlation coefficient between the two tests was 0.96. The minimal detectable change was 56.2m for men and 50.2m for women. Body mass index, daily antipsychotic dose, negative and depressive symptoms, resting heart rate, age, smoking behavior and different musculoskeletal complaints were all significantly associated with the distance walked. The 6 MWT can be recommended for evaluating the functional exercise capacity in patients with schizophrenia. Some practice effect could however not be excluded.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium.
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Sabater-Hernández D, Sánchez-Villegas P, García-Corpas JP, Amariles P, Sendra-Lillo J, Faus MJ. Predictors of the community pharmacy white-coat effect in treated hypertensive patients. The MEPAFAR study. Int J Clin Pharm 2011; 33:582-9. [DOI: 10.1007/s11096-011-9514-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
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Fall CHD, Borja JB, Osmond C, Richter L, Bhargava SK, Martorell R, Stein AD, Barros FC, Victora CG. Infant-feeding patterns and cardiovascular risk factors in young adulthood: data from five cohorts in low- and middle-income countries. Int J Epidemiol 2011; 40:47-62. [PMID: 20852257 PMCID: PMC3043278 DOI: 10.1093/ije/dyq155] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Infant-feeding patterns may influence lifelong health. This study tested the hypothesis that longer duration of breastfeeding and later introduction of complementary foods in infancy are associated with reduced adult cardiovascular risk. METHODS Data were pooled from 10 912 subjects in the age range of 15-41 years from five prospective birth-cohort studies in low-/middle-income countries (Brazil, Guatemala, India, Philippines and South Africa). Associations were examined between infant feeding (duration of breastfeeding and age at introduction of complementary foods) and adult blood pressure (BP), plasma glucose concentration and adiposity (skinfolds, waist circumference, percentage body fat and overweight/obesity). Analyses were adjusted for maternal socio-economic status, education, age, smoking, race and urban/rural residence and infant birth weight. RESULTS There were no differences in outcomes between adults who were ever breastfed compared with those who were never breastfed. Duration of breastfeeding was not associated with adult diabetes prevalence or adiposity. There were U-shaped associations between duration of breastfeeding and systolic BP and hypertension; however, these were weak and inconsistent among the cohorts. Later introduction of complementary foods was associated with lower adult adiposity. Body mass index changed by -0.19 kg/m(2) [95% confidence interval (CI) -0.37 to -0.01] and waist circumference by -0.45 cm (95% CI -0.88 to -0.02) per 3-month increase in age at introduction of complementary foods. CONCLUSIONS There was no evidence that longer duration of breastfeeding is protective against adult hypertension, diabetes or overweight/adiposity in these low-/middle-income populations. Further research is required to determine whether 'exclusive' breastfeeding may be protective. Delaying complementary foods until 6 months, as recommended by the World Health Organization, may reduce the risk of adult overweight/adiposity, but the effect is likely to be small.
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Affiliation(s)
- Caroline HD Fall
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Judith B Borja
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Clive Osmond
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Linda Richter
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Santosh K Bhargava
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Reynaldo Martorell
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aryeh D Stein
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK, Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines, Human Sciences Research Council, University of Witwatersrand, South Africa, Sunder Lal Jain Hospital, New Delhi, India, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA, Postgraduate Programme in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Brazil and Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
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Abstract
BACKGROUND The possibility that daily sessions of music-guided slow breathing may reduce 24-h ambulatory blood pressure (ABP), and predictors of efficacy were explored in a randomized, placebo-controlled trial with parallel design. METHODS Age-matched and sex-matched hypertensive patients were randomized to music-guided slow breathing exercises (4-6 breaths/min; 1: 2 ratio of inspiration: expiration duration) (Intervention; n = 29) or to control groups who were thought to relax while either listening to slow music (Control-M; n = 26) or reading a book (Control-R; n = 31). At baseline and at follow-up visits (1 week and 1, 3 and 6 months), ABP monitoring was performed. RESULTS At mixed model analysis, intervention was associated with a significant reduction of 24-h (P = 0.001) and night-time (0100-0600 h) (P < 0.0001) systolic ABP. The average reduction of systolic 24-h ABP at 6 months was 4.6 mmHg [confidence limits at 95% 1.93-7.35] and 4.1 mmHg (95% confidence limits 1.59-6.67) vs. Control-M and Control-R groups, respectively, (P < 0.001 for both). Antihypertensive treatment was selected as negative predictor of BP reduction at multivariate stepwise analysis. When antihypertensive treatment was inserted as covariate in a generalized linear model, psychological subscales assessed at baseline by the Mental Health Inventory questionnaire were found to affect systolic blood pressure reduction at 6-month follow-up (general positive affect P < 0.001; emotional ties, P < 0.001; loss of behavioral control, P = 0.035). In particular, a level of general positive affect higher than the 75th percentiles was found to be significantly associated with low treatment efficacy (odds ratio 0.09; 95% confidence limits 0.01-0.93). CONCLUSION Daily sessions of voluntary music-guided slow breathing significantly reduce 24-h systolic ABP, and psychological predictors of efficacy can be identified.
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European Society of Hypertension International Protocol for the validation of blood pressure monitors: a critical review of its application and rationale for revision. Blood Press Monit 2010; 15:39-48. [PMID: 20087174 DOI: 10.1097/mbp.0b013e3283360eaf] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To perform a systematic review of validation studies of blood pressure measuring devices done using the European Society of Hypertension International Protocol (ESH-IP) since its publication in 2002. METHODS Major aspects of ESH-IP studies are described. A review of the ESH-IP performance, problems and violations in its application, and the effect of applying several more stringent validation criteria in an ESH-IP revision is carried out. RESULTS From January 2002 to June 2009, 104 validation studies had been conducted using the ESH-IP, 36 using the British Hypertension Society protocol and 28 using the US Association for the Advancement of Medical Instrumentation protocol. Among 78 studies reported up to June 2008, in 66 (85%) the tested device has passed the ESH-IP. In 19 validations a modification of the ESH-IP was performed to adapt for specific study needs (population or device). Protocol violations of the ESH-IP were identified in 23 studies (eight major violations). A test of several arbitrarily chosen changes in the ESH-IP validation criteria applied in the published studies showed the phase 2.1 criterion (BP differences < or =15 mmHg) and the phase 2.2 criteria to be the more stringent. CONCLUSION The ESH-IP has succeeded in expanding the validation procedure worldwide by three to four-fold compared with the period before its publication. There is a need for protocol revision aiming to address issues that appeared in published studies, prevent protocol violations, and ensure complete data reporting. Standardization of the ESH-IP validation studies' report and application of more stringent criteria should be considered.
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Evaluation of the Omron MX3 Plus monitor for blood pressure measurement in adolescents. Eur J Pediatr 2009; 168:1349-54. [PMID: 19221789 DOI: 10.1007/s00431-009-0936-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
Abstract
This study analyzed the accuracy/agreement of the Omron MX3 monitor on 165 adolescents. Blood pressure was measured by the automatic monitor connected in Y with the mercury column (three consecutive and simultaneous measures). The independent measures were analyzed, and the mean differences between systolic and diastolic measures for both methods were calculated and compared with British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation (AAMI) criteria. The automatic monitor received the highest degree of BHS recommendations for systolic and diastolic blood pressures according to the BHS. The median (25th and 75th) difference between the observer and the monitor measurements was -2 (-6 and 1) mmHg for systolic and 0 (-3 and 1) mmHg for diastolic pressures. The monitor also satisfies the AAMI standard for the studied population. In conclusion, the Omron MX3 Plus monitor can be considered reliable and valid for clinical practice and is in accordance with BHS and AAMI criteria.
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A food-based dietary strategy lowers blood pressure in a low socio-economic setting: a randomised study in South Africa. Public Health Nutr 2008; 11:1397-406. [DOI: 10.1017/s136898000800342x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo assess the impact of a food-based intervention on blood pressure (BP) in free-living South African men and women aged 50–75 years, with drug-treated mild-to-moderate hypertension.MethodsA double-blind controlled trial was undertaken in eighty drug-treated mild-to-moderate hypertensive subjects randomised to an intervention (n40) or control (n40) arm. The intervention was 8-week provision of six food items with a modified cation content (salt replacement (SOLO™), bread, margarine, stock cubes, soup mix and a flavour enhancer) and 500 ml of maas (fermented milk)/d. The control diet provided the same quantities of the targeted foods but of standard commercial composition and 500 ml/d of artificially sweetened cooldrink.FindingsThe intervention effect estimated as the contrast of the within-diet group changes in BP from baseline to post-intervention was a significant reduction of 6·2 mmHg (95 % CI 0·9, 11·4) for systolic BP. The largest intervention effect in 24 h BP was for wake systolic BP with a reduction of 5·1 mmHg (95 % CI 0·4, 9·9). For wake diastolic BP the reduction was 2·7 mmHg (95 % CI −0·2, 5·6).ConclusionsModification of the cation content of a limited number of commonly consumed foods lowers BP by a clinically significant magnitude in treated South African hypertensive patients of low socio-economic status. The magnitude of BP reduction provides motivation for a public health strategy that could be adopted through lobbying of the food industry by consumer and health agencies.
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Abstract
INTRODUCTION Little is known about how and why patients use home blood pressure monitoring (HBPM). We investigated from where patients obtain their monitor, their reasons for using HBPM, and their frequency of performing blood pressure (BP) measurements. We also examined whether those using HBPM provide written reports of measurements to their doctor and whether they have ever had their monitor checked. METHODS We conducted a cross-sectional mail survey of adult patients with hypertension enrolled in a practice-based research network of 24 primary care practices throughout the state of North Carolina. We analyzed results using descriptive statistics. RESULTS We received 530 returned questionnaires (76% response rate). Of the 43% (n=226) who reported performing HBPM, 68% purchased their monitor from a pharmacy or department store; the remaining purchased their monitor elsewhere or received it as a gift. Approximately 19% [95% confidence interval (CI): 13.6-23.9] check their BP every day or almost every day; 26% (95% CI: 20.5-32.2) check their BP a few times per week; and 29% (95% CI: 3.0-35.0) check their BP a few times per month. For nearly one-third, their primary reason for using HBPM was because their doctor recommended it. Over one-half said they used HBPM because they were 'just interested in knowing' their BP. The majority (70%; 95% CI: 64.4-76.4) indicated that they did not provide a written report of BP readings to their doctor. Less than one-third (29%, 95% CI: 22.9-34.9) has had their monitor checked by a doctor or nurse. CONCLUSION Most patients with hypertension using HBPM do so because of a doctor's recommendation or a simple desire to know their BP. The majority of those performing home measurements do so at least a few times per month. Most do not provide their doctor with a written report of measurements, and most have not had their monitor checked.
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