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Haji Aghajani M, Taherpour N, Parsa Mahjoob M, Kachoueian N, Alipour M, Ghorbani S. Is the prevalence of risk factors, clinical presentations and severity of coronary artery diseases (CAD) in patients with very early and premature CAD are different from mature CAD patients?: A registry- based cross-sectional study. GLOBAL EPIDEMIOLOGY 2024; 8:100148. [PMID: 38983952 PMCID: PMC11231720 DOI: 10.1016/j.gloepi.2024.100148] [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: 03/03/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction The present study aims to compare the risk factors, clinical presentation, and severity of coronary artery involvement in young compared to elderly CAD patients to assess the cardiovascular health status for better disease management and control of these specific patients. Methods This registry-based cross-sectional study was conducted using Coronary Angiography and Angioplasty Registry (CAAR) patients in east of Tehran, Iran. The data were extracted from 330 patients with confirmed CAD recorded by the CAAR during July 2021 to August 2023. Results The majority of patients in MCAD (68.2%) and VECAD (80%) were male, while the majority of PCAD patients were female (51.8%). Among PCAD patients, the prevalence of diabetes (38.1%) was higher than in other groups. The presence of IHD history in the father (38.1%) and mother (26.3%) was higher in the VECAD group. The mean total cholesterol, LDL, and LDL/HDL ratio were higher in the VECAD group. Among MCAD group (75.4%) compared to PCAD (58.1%) and VECAD (47.2%) groups, the multi-vessel disease was more common.MCAD patients had the highest median Gensini score compared to PCAD and VECAD patients. Also, in male compared to female the mean Gensini score was higher by 8 units (ß = 8.26, 95%CI = 0.24, 16.28). Conclusion Modifiable risk factors in young CAD patients are common. High LDL-C levels and smoking were the common modifiable CVD risk factors in young patients, indicating the significant role of these traditional risk factors in early atherosclerosis development alongside inheritable risk-factors such as positive family history that were more common in young CAD patients. While, the severity of coronary artery involvement in individuals with MCAD was higher, but the priority of involvement based on the type of vessel was almost the same in all CAD groups.
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Affiliation(s)
- Mohammad Haji Aghajani
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Taherpour
- Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Parsa Mahjoob
- Department of Cardiology, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser Kachoueian
- Department of Cardiac Surgery, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Alipour
- Department of Medicine, Islamic Azad University of Tehran Medical Sciences, Tehran, Iran
| | - Saman Ghorbani
- Department of Cardiology, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mthethwa WS, Mampofu ZM, Mokwena MA, Ramoshaba NE. The relationship between mid-upper arm circumference and blood pressure in Walter Sisulu University community. Blood Press 2024; 33:2296904. [PMID: 38254330 DOI: 10.1080/08037051.2023.2296904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
Prevalence of hypertension is increasing to higher levels in South Africa. Anthropometric measures for obesity are well known to predict the development of hypertension. However, the relationship between mid-upper arm circumference (MUAC) and blood pressure (BP) is scant in South African communities such as universities. Therefore, this study was aimed at investigating the correlation between MUAC and BP among the community of Walter Sisulu University (WSU). A total of 230 participants from WSU (students and staff members), 113 females and 117 males aged ≥ 18 years participated in this cross-sectional study. MUAC, systolic BP (SBP) and diastolic BP (DBP) were measured using standard procedures. In a Pearson's correlation analysis, MUAC was positively correlated with SBP and DBP in both women (SBP; r = 0.53, P< 0.001; DBP; r = 0.45 P < 0.001) and men (SBP; r = 0.29 P = 0.001; DBP; r = 0.25 P = 0.007). Furthermore, in the multivariable-adjusted regression analysis, MUAC was positively associated with SBP in women only (adjusted R2 = 0.489, β = 0.29 (95% CI = 0.16; 2.08)), P =0.023) after adjusted for age, body fat percentage, waist-to-height ratio, smoking and alcohol. MUAC is positively correlated with BP in women, not in men of WSU community. MUAC, as a simple and low-cost quantifiable parameter, could be employed as a risk indicator in the early detection and prevention of cardiovascular diseases (CVDs) in women.
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Affiliation(s)
- Wenzile S Mthethwa
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Zuqaqambe M Mampofu
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Madigoahle A Mokwena
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
| | - Nthai E Ramoshaba
- Department of Human Biology, Walter Sisulu University, Nelson Mandela Drive, Mthatha5117, South Africa
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Elsahoryi NA, Subih HS, Hammouh F, Hammad FJ. Stage of Change of Transtheoretical Model for Nine Health-Related Behaviors Among Hypertensive Patients: Cross-Sectional Study. Patient Prefer Adherence 2024; 18:1691-1711. [PMID: 39161802 PMCID: PMC11330744 DOI: 10.2147/ppa.s442291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 08/21/2024] Open
Abstract
Aim This study aimed to determine the current stage of change (SOG) toward seven healthy eating behaviors and two healthy lifestyle behaviors related to blood pressure (BP) control. The lifestyle behaviors included smoking Behavior and practicing regular exercise, while the dietary behaviors included the DASH diet guidelines. Methods A total of 1109 outpatients participated in this cross-sectional study that was conducted between 2021 and 2022 in Jordan. A staging algorithm assessed SOG for several BP control-related behaviors for diagnosed hypertension patients. Data were collected by a structured interview-based questionnaire. Results There was a high degree of maintenance toward consuming diets with high grains, fruit, vegetables, meat, and poultry, less saturated fat, and more low-fat dairy products. More than half of the participants were in the pre-action stage for quitting smoking, practicing physical exercise, and consuming sweets and added sugars. Significant associations were observed between the degree of maintenance for several behaviors (p < 0.01). Age, income, education level, disease duration, and nutrition consultation availability were the most related factors to the SOG of the studied behaviors (p < 0.01). Conclusion Patients with hypertension in Jordan are still in the pre-action stages for quitting smoking, practicing physical exercise, and consuming 5 servings of refined sweets and added sugars weekly. The current outcome suggests a need for nutritional counseling, education, and interventions to raise awareness of lifestyle factors influencing BP among hypertension patients.
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Affiliation(s)
- Nour Amin Elsahoryi
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, The University of Petra, Jordan
| | - Hadil Shafee Subih
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, IrbidJordan
| | - Fadwa Hammouh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, American University of Madaba, Madaba, Jordan
| | - Fwziah Jammal Hammad
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, IrbidJordan
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Nsor OO, Alabi BA, Badejo JA, Afolabi F, Nku-Ekpang OA, Iwalewa EO. Soursop leaf extract and fractions protects against L-NAME-induced hypertension and hyperlipidemia. Front Nutr 2024; 11:1437101. [PMID: 39171117 PMCID: PMC11337232 DOI: 10.3389/fnut.2024.1437101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/16/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction Despite the high phenolic content of Annona muricata, little is known about its anti-hypertensive and antihyperlipidemic properties. This study evaluated the anti-hypertensive and antihyperlipidemic potential of A. muricata leaf extracts. Materials and methods Forty-two male Wistar rats were divided into seven groups of six animals each. N-nitro-L-arginine methyl ester (L-NAME) was used to induce hypertension and hyperlipidemia. Results Phytochemical screening of Annona muricata leaf extracts (AMLE) revealed the presence of saponins, alkaloids, flavonoids, tannins, coumarins, steroids, terpenoids, and phenols. Comparing the methanol extract with the ethyl acetate fraction, quantification revealed that the methanol extract contained more phenolics, flavonoids, and alkaloids. The AMLE rats significantly reduced triglycerides, total cholesterol, LDL, VLDL, atherogenic index, coronary risk index, and blood pressure. The significant decrease in GSH, catalase, SOD, GST, and oxidative stress markers (MDA, nitrites, and MPO) was reversed by AMLE in a dose-dependent manner. Also, the elevated serum levels of TNF-α and IL-1β in the hypertensive rats were attenuated in the treatment groups. Discussion This study suggests the potential ameliorative effects of Annona muricata leaf extracts against L-NAME-induced hypertension in rats. Notably, the study showed the antioxidant and anti-inflammatory properties of A. muricata leaf extracts, which is seen in its ability to attenuate oxidative stress and inflammatory cytokines in L-NAME-induced hypertensive rats. A. muricata extracts also decreased atherogenic risk and improved lipid profiles.
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Affiliation(s)
- Okim Okim Nsor
- Neuropharmacology Unit, Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babatunde Adebola Alabi
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, Bowen University, Iwo, Nigeria
- Department of Pharmacology and Therapeutics, Faculty of Medicine and Pharmacy, Kampala International University in Tanzania, Dar es Salaam, Tanzania
| | - Joseph Ayo Badejo
- Neuropharmacology Unit, Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Faith Afolabi
- Neuropharmacology Unit, Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Okot-Asi Nku-Ekpang
- Department of Physiology, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ezekiel Olugbenga Iwalewa
- Neuropharmacology Unit, Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Taha Z, Elhag H, Hassan AA, Adam I. Association Between Hemoglobin Level, Anemia, and Hypertension Among Adults in Northern Sudan: A Community-Based Cross-Sectional Study. Vasc Health Risk Manag 2024; 20:323-331. [PMID: 39070218 PMCID: PMC11277984 DOI: 10.2147/vhrm.s472480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024] Open
Abstract
Background Hypertension and anemia are major health problems globally. However, data regarding the association between hypertension and hemoglobin/anemia among adults are few and controversial. Therefore, the current study aimed to investigate the associations between hemoglobin/anemia and hypertension among Sudanese adults. Methods A community-based cross-sectional study was conducted in Northern Sudan from September to December 2022. The participants' sociodemographic characteristics were assessed using a questionnaire. Standardized procedures measured participants' weight, height, body mass index (BMI), hemoglobin, and hypertension. Multivariate regression analysis was performed to determine the association between anemia and hypertension. Results Three hundred eighty-four adults were enrolled; 195 (50.8%) and 189 (49.2%) were males and females, respectively. The median interquartile age of the enrolled adults of age, BMI, and hemoglobin level was 45.0 (33.0‒55.8) years, 26.6 (22.6‒30.6) kg/m2, and 13.4 (12.4‒14.4) g/dl, respectively. Of 384 adults, 216 (56.3%) had hypertension, and 148 (38.5%) were newly diagnosed hypertensive. Eighty-six adults (22.4%) had anemia. In univariate analysis, while increasing age, being female, being unmarried, having a positive family history of hypertension, and increasing BMI were positively associated with hypertension, anemia was inversely associated with hypertension. Education, occupation, cigarette smoking, and alcohol consumption were not associated with hypertension. In multivariate analysis, age (adjusted odd ratio [AOR] = 1.05, 95% confidence interval [CI] = 1.03‒1.07), BMI (AOR= 1.07, 95% CI = 1.03‒1.12) were inversely associated with hypertension, being female (AOR = 2.92, 95% CI = 1.43‒5.94), positive family history of hypertension (AOR= 1.73, 95% CI = 1.09‒2.75), and hemoglobin level (AOR= 1.34, 95% CI = 1.12‒1.61) were associated with hypertension. Anemia (AOR = 0.58, 95% CI = 0.34‒0.99) was inversely associated with hypertension. Conclusion Both anemia and hypertension are major public health problems in Northern Sudan. Anemia is associated with hypertension. Further research is needed to explore the complex association between hemoglobin/anemia and hypertension.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| | - Hiba Elhag
- Department of Public Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahmed Ali Hassan
- Department of Public Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Alemayehu E, Mohammed O, Debash H, Belete MA, Weldehanna DG, Tilahun M, Gedefie A, Ebrahim H. Hematological parameters of hypertensive patients in northeast Ethiopia: A comparative cross-sectional study. Heliyon 2024; 10:e34069. [PMID: 39071591 PMCID: PMC11283052 DOI: 10.1016/j.heliyon.2024.e34069] [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: 11/22/2023] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Hypertension has emerged as a significant public health concern, ranking among the leading causes of mortality in low- and middle-income countries. Moreover, it is closely associated with structural and functional alterations in hematopoietic cells. Therefore, this study aimed to evaluate the hematological parameters of hypertensive patients in Northeast Ethiopia. Methods A comparative cross-sectional study was conducted from January to March 2023, involving 248 participants. This included 124 hypertensive patients and 124 apparently healthy controls selected using a systematic random sampling technique. Socio-demographic and clinical data were collected through a structured questionnaire, and anthropometric measurements were obtained following established guidelines. Ethical approval was obtained from the Ethical Review Committee of the College of Medicine and Health Sciences at Wollo University. After obtaining informed consent, approximately 5 ml of venous blood was drawn from each participant for complete blood count and fasting blood glucose analysis, performed using the Mindray BC-3000 Plus hematology analyzer and the DIRUI CS-T240 automated clinical chemistry analyzer, respectively. Data analysis involved independent t-tests, Mann-Whitney U-tests, correlation tests, and logistic regression. A p-value of <0.05 was considered statistically significant. Results The study found that white blood cell count, platelet count, platelet distribution width, red cell distribution width, and mean platelet volume were significantly higher in hypertensive patients compared to the control group (p < 0.05). Conversely, red blood cell count, hematocrit, and hemoglobin levels were significantly higher in the control group than in hypertensive patients (p < 0.05). Additionally, white blood cells and platelets exhibited a positive correlation with systolic and diastolic blood pressure (p < 0.05), while red blood cell count, hematocrit, and hemoglobin demonstrated a negative correlation with blood pressure indices and body mass index. Anemia was observed in 20.2 % of hypertensive patients. Notably, an abnormal body mass index (AOR: 3.5, 95 % CI: 1.3-9.6, p = 0.011) and high systolic blood pressure (AOR: 4.6, 95 % CI: 1.3-15.5, p = 0.013) were significantly associated with anemia among hypertensive patients. Conclusion This study identified significant differences in various hematological parameters between hypertensive patients and the control group. Routine assessments of hematological parameters should be considered to effectively manage hypertension-related complications in hypertensive patients.
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Affiliation(s)
- Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik Weldehanna
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Awolope A, El-Sabrout H, Chattopadhyay A, Richmond S, Hessler-Jones D, Hahn M, Gottlieb L, Razon N. The Construction and Meaning of Race Within Hypertension Guidelines: A Systematic Scoping Review. J Gen Intern Med 2024:10.1007/s11606-024-08874-9. [PMID: 38954319 DOI: 10.1007/s11606-024-08874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Professional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. Amid increased recognition of the role racism plays in shaping inequitable healthcare delivery, many researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. Critiques highlight how racism influences the evidence that guidelines are based on and its interpretation. However, few have used a systematic methodology to examine race-based recommendations. This review examines hypertension guidelines, a condition affecting nearly half of all adults in the United States (US), to understand how guidelines reference and develop recommendations related to race. METHODS A systematic scoping review of all professional guidelines on the management of essential hypertension published between 1977 and 2022 to examine the use and meaning of race categories. RESULTS Of the 37 guidelines that met the inclusion criteria, we identified a total of 990 mentions of race categories. Black and African/African American were the predominant race categories referred to in guidelines (n = 409). Guideline authors used race in five key domains: describing the prevalence or etiology of hypertension; characterizing prior hypertension studies; describing hypertension interventions; social risk and social determinants of health; the complexity of race. Guideline authors largely used race categories as biological rather than social constructions. None of the guidelines discussed racism and the role it plays in perpetuating hypertension inequities. DISCUSSION Hypertension guidelines largely refer to race as a distinct and natural category rather than confront the longstanding history of racism within and beyond the medical system. Normalizing race as a biological rather than social construct fails to address racism as a key determinant driving inequities in cardiovascular health. These changes are necessary to produce meaningful structural solutions that advance equity in hypertension education, research, and care delivery.
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Affiliation(s)
- Anna Awolope
- School of Medicine, University of California, Davis (UC Davis), Sacramento, CA, USA
| | - Hannah El-Sabrout
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- School of Public Health, Joint Medical Program, University of California, Berkeley, CA, USA
| | | | - Stephen Richmond
- Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Danielle Hessler-Jones
- Department of Family and Community Medicine, UCSF, San Francisco, CA, USA
- Department of Family and Community Medicine and Social Interventions Research and Evaluation Network (SIREN), UCSF, San Francisco, CA, USA
| | - Monica Hahn
- Department of Family and Community Medicine, UCSF, San Francisco, CA, USA
| | - Laura Gottlieb
- Department of Family and Community Medicine, UCSF, San Francisco, CA, USA
- Department of Family and Community Medicine and Social Interventions Research and Evaluation Network (SIREN), UCSF, San Francisco, CA, USA
| | - Na'amah Razon
- Department of Family & Community Medicine, UC Davis, Sacramento, CA, USA.
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HUA Q, FAN L, WANG ZW, LI J. 2023 Guideline for the management of hypertension in the elderly population in China. J Geriatr Cardiol 2024; 21:589-630. [PMID: 38973827 PMCID: PMC11224653 DOI: 10.26599/1671-5411.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Affiliation(s)
| | - Qi HUA
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li FAN
- Chinese PLA General Hospital, Beijing, China
| | - Zeng-Wu WANG
- Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing LI
- Xuanwu Hospital, Capital Medical University, Beijing, China
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Bakris G, Chen C, Campbell AK, Ashton V, Haskell L, Singhal M. Real-World Impact of Blood Pressure Control in Patients With Apparent Treatment-Resistant or Difficult-to-Control Hypertension and Stages 3 and 4 Chronic Kidney Disease. Am J Hypertens 2024; 37:438-446. [PMID: 38436491 PMCID: PMC11094384 DOI: 10.1093/ajh/hpae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common comorbidity in patients with apparent treatment-resistant hypertension (aTRH). We assessed clinical outcomes, healthcare resource utilization events, and costs in patients with aTRH or difficult-to-control hypertension and stage 3-4 CKD with uncontrolled vs. controlled BP. METHODS This retrospective cohort study used linked IQVIA Ambulatory EMR-US and IQVIA PharMetrics Plus claims databases. Adult patients had claims for ≥3 antihypertensive medication classes within 30 days between 01/01/2015 and 06/30/2021, 2 office BP measures recorded 1-90 days apart, ≥1 claim with ICD-9/10-CM diagnosis codes for CKD 3/4, and ≥1 year of continuous enrollment. Baseline BP was defined as uncontrolled (≥130/80 mm Hg) or controlled (<130/80 mm Hg) BP. Outcomes included risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure hospitalization), end-stage renal disease (ESRD), healthcare resource utilization events, and costs during follow-up. RESULTS Of 3,966 patients with stage 3-4 CKD using ≥3 antihypertensive medications, 2,479 had uncontrolled BP and 1,487 had controlled BP. After adjusting for baseline differences, patients with uncontrolled vs. controlled BP had a higher risk of MACE+ (HR [95% CI]: 1.18 [1.03-1.36]), ESRD (1.85 [1.44-2.39]), inpatient hospitalization (rate ratio [95% CI]: 1.35 [1.28-1.43]), and outpatient visits (1.12 [1.11-1.12]) and incurred higher total medical and pharmacy costs (mean difference [95% CI]: $10,055 [$6,741-$13,646] per patient per year). CONCLUSIONS Patients with aTRH and stage 3-4 CKD and uncontrolled BP despite treatment with ≥3 antihypertensive classes had an increased risk of MACE+ and ESRD and incurred greater healthcare resource utilization and medical expenditures compared with patients taking ≥3 antihypertensive classes with controlled BP.
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Affiliation(s)
- George Bakris
- University of Chicago Medicine, Chicago, Illinois, USA
| | - Cindy Chen
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | | | - Veronica Ashton
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Lloyd Haskell
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
| | - Mukul Singhal
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
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Bakris G, Lin P(P, Xu C, Chen C, Ashton V, Singhal M. Prediction of cardiovascular and renal risk among patients with apparent treatment-resistant hypertension in the United States using machine learning methods. J Clin Hypertens (Greenwich) 2024; 26:500-513. [PMID: 38523465 PMCID: PMC11088433 DOI: 10.1111/jch.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/26/2024]
Abstract
Apparent treatment-resistant hypertension (aTRH), defined as blood pressure (BP) that remains uncontrolled despite unconfirmed concurrent treatment with three antihypertensives, is associated with an increased risk of developing cardiovascular and renal complications compared with controlled hypertension. We aimed to identify the characteristics of aTRH patients with an elevated risk of major adverse cardiovascular events plus (MACE+; defined as stroke, myocardial infarction, or heart failure hospitalization) and end stage renal disease (ESRD). This retrospective cohort study included aTRH patients (BP ≥140/90 mmHg and taking ≥3 antihypertensives) from the United States-based Optum® de-identified Electronic Health Record dataset and used machine learning models to identify risk factors of MACE+ or ESRD. Patients had claims for ≥3 antihypertensive classes within 30 days between January 1, 2015 and June 30, 2021, and two office BP measures recorded 1-90 days apart within 30 days to 11 months after the index regimen date. Of a total 18 797 070 patients identified with any hypertension, 71 100 patients had aTRH. During the study period (mean 25.5 months), 4944 (7.0%) patients had a MACE+ and 2403 (3.4%) developed ESRD. In total, 22 risk factors were included in the MACE+ model and 16 in the ESRD model, and most were significantly associated with study outcomes. The risk factors with the largest impact on MACE+ risk were congestive heart failure, stages 4 and 5 chronic kidney disease (CKD), age ≥80 years, and living in the Southern region of the United States. The risk factors with the largest impact on ESRD risk, other than pre-existing CKD, were anemia, congestive heart failure, and type 2 diabetes. The overall study cohort had a 5-year predicted MACE+ risk of 13.4%; this risk was increased in those in the top 50% and 25% high-risk groups (21.2% and 29.5%, respectively). The overall study cohort had a predicted 5-year risk of ESRD of 6.8%, which was increased in the top 50% and 25% high-risk groups (10.9% and 17.1%, respectively). We conclude that risk models developed in our study can reliably identify patients with aTRH at risk of MACE+ and ESRD based on information available in electronic health records; such models may be used to identify aTRH patients at high risk of adverse outcomes who may benefit from novel treatment interventions.
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Affiliation(s)
| | | | - Chang Xu
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | - Cindy Chen
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | | | - Mukul Singhal
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
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Hezam AAM, Shaghdar HBM, Chen L. The connection between hypertension and diabetes and their role in heart and kidney disease development. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:22. [PMID: 38855561 PMCID: PMC11162087 DOI: 10.4103/jrms.jrms_470_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/24/2023] [Accepted: 01/25/2024] [Indexed: 06/11/2024]
Abstract
Hypertension and diabetes are two common metabolic disorders that often coexist in the same individual. Their concurrence increases the risk of cardiovascular disease, renal dysfunction, and other complications. Cardiovascular disease is the primary cause of morbidity and mortality in individuals with diabetes, and hypertension further aggravates this condition. Interestingly, hypertension and diabetes share several common pathophysiological mechanisms including insulin resistance, vascular inflammation, endothelial dysfunction, obesity, and oxidative stress suggesting a cross-talk between these two conditions that could potentially contribute to the development of other human diseases. Effective management of diabetes should include a multifaceted approach that addresses not only glycemic control but also blood pressure (BP) and lipid control. Treatment plans should be individualized to each patient's needs and should involve a combination of lifestyle modifications and medications to achieve optimal control. With the availability of newer antidiabetic medications such as SGLT inhibitors and GLP1 receptor agonists, it is crucial to consider their potential to reduce BP, enhance kidney function, and lower the risk of cardiovascular diseases when initiating treatment for glycemic control. A more profound comprehension of the shared underlying mechanisms between these conditions could pave the way for the development of innovative therapeutic approaches to tackle them. Our review offers an in-depth analysis of the literature, providing a holistic view of the mechanisms underlying diabetes-hypertension comorbidity and its implications on heart and kidney diseases. The present article concludes by discussing current approaches for managing hypertensive diabetic patients to create a set of comprehensive individualized recommendations.
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Affiliation(s)
- Ali Ahmed Mohammed Hezam
- Department of General Practice, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | | | - Liying Chen
- School of Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Guo J, Jiang Z, Xia Y, Wang H, Tang Q, Meng B. The association between statin use and diabetic nephropathy in US adults: data from NHANES 2005 - 2018. Front Endocrinol (Lausanne) 2024; 15:1381746. [PMID: 38726340 PMCID: PMC11079199 DOI: 10.3389/fendo.2024.1381746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Background A serious consequence of diabetes is diabetic nephropathy (DN), which is commonly treated by statins. Studies evaluating the effects of statin medication have yielded inconsistent results regarding the potential association with diabetic nephropathy. To manage diabetic nephropathy's onset and improve the quality of life of patients, it is imperative to gain a comprehensive understanding of its contributing factors. Data and methods Our study was conducted using the National Health and Nutrition Examination Survey (NHANES) as well as weighted multivariate logistic regression models to determine the odds ratio (OR) and 95% confidence intervals (95%CI) for diabetic nephropathy. We conducted stratified analyses to examine the impact of statins and the duration of their usage on diabetic nephropathy in different subgroups. A nomogram model and the receiver operating characteristic (ROC) curve were also developed to predict DN risk. Results Statin use significantly increased the incidence of DN (OR=1.405, 95%CI (1.199,1.647), p<0.001). Individuals who used statins for 5 to 7 years were more likely to develop diabetic nephropathy (OR=1.472, 95%CI (1.057,2.048), p=0.022) compared to those who used statins for 1-3 years (OR=1.334, 95%CI (1.058,1.682), p=0.015) or <1 year (OR=1.266, 95%CI (1.054,1.522), p = 0.012). Simvastatin has a greater incidence of diabetic nephropathy (OR=1.448, 95%CI(1.177, 1.78), P < 0.001). Conclusion Taking statins long-term increases the risk of DN. Statin use is associated with an increased risk of DN. Caution should be exercised when prescribing atorvastatin and simvastatin for long-term statin therapy.
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Affiliation(s)
| | | | | | | | - Qun Tang
- Medical School, Hunan University of Chinese Medicine, Changsha, Hunan, China
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Bashir AO, Elimam MA, Elimam MA, Adam I. Snoring is associated with hypertension and diabetes mellitus among adults in north Sudan: a cross-sectional study. BMC Public Health 2024; 24:974. [PMID: 38584276 PMCID: PMC11000284 DOI: 10.1186/s12889-024-18505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/02/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Different levels of association between snoring, hypertension, and diabetes mellitus (DM) are reported. There are few published studies on this topic in African countries, and no investigation was conducted in Sudan. This study aimed to assess the prevalence and factors associated with snoring and the association between snoring, hypertension, and type 2 DM (T2DM) in northern Sudan. METHODS A community-based cross-sectional study using a multistage sampling technique was conducted in four villages in the River Nile state of northern Sudan from July to September 2021. Sociodemographic characteristics were collected using a questionnaire. Body mass index (BMI) was measured using standard methods, and a multivariate analysis was conducted using the Statistical Package for the Social Sciences® (SPSS®) for Windows, version 22.0. RESULTS Of the 384 adults, 193 (50.3%) were males and 191 (49.7%) were females. Of the adults, 38 (9.9%) were underweight, 121 (31.5%) had average weight, 113 (29.4%) were overweight, and 112 (29.2%) were obese. One hundred and six (27.6%) adults were snorers. Multivariate analysis showed that increasing age (adjusted odds ratio [AOR] = 1.02, 95% confidence interval [CI] = 1.01‒1.04), increasing BMI (AOR = 1.04, 95 CI = 1.01‒1.08), obesity (AOR = 2.0, 95% CI = 1.10‒3.69), and alcohol consumption (AOR = 2.32, 95% CI = 1.14‒4.74) were positively associated with snoring. Of the 384 adults, 215 (56.0%) had hypertension. Multivariate analysis showed that increasing age (AOR = 1.04, 95% CI = 1.02‒1.06), increasing BMI (AOR = 1.08, 95% CI = 1.04‒1.13), female sex (AOR = 1.7, 95% CI = 1.08‒2.73), and snoring (AOR = 1.69, 95% CI = 1.02‒2.82) were positively associated with hypertension. One hundred and six (27.6%) adults had T2DM. Multivariate analysis showed that increasing age (AOR = 1.03, 95% CI = 1.01‒1.05) and snoring (AOR = 1.78, 95% CI = 1.09‒2.91) were associated with T2DM. CONCLUSION Around one-fourth of the adults in Northern Sudan are snorers. Snoring is more common among obese adults. Snoring is associated with increased odds of hypertension and T2DM. Adults who snore must pay close attention to their blood pressure and blood glucose levels to prevent hypertension and DM.
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Affiliation(s)
- Amal O Bashir
- Faculty of Public Health and Health Informatics, University of Umm Al Qura, Mekkah, Saudi Arabia
| | - Mousab A Elimam
- Faculty of Medicine, Alzaiem Alazhari University, Khartoum North, Sudan
| | - Mohamed A Elimam
- Faculty of Medicine, Alzaiem Alazhari University, Khartoum North, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
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Pang L, Kottu L, Guo Z, Ma M, Wang H, Zhao Y, Tang M, Shi Y, Liu W, Wu X, Song J, Sun M, Merkus D, Ferdous MM, He L, Duo L. A tryst of 'blood pressure control- sex- comorbidities': the odyssey of basic public health services in Yunnan in quest for truth. BMC Public Health 2024; 24:490. [PMID: 38365657 PMCID: PMC10870683 DOI: 10.1186/s12889-023-17157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/04/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-"Hypertension" (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern. METHODS We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities. RESULTS Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276-4.570), three or more (OR = 5.500, 95%CI: 1.174-25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430-3.289) and (OR = 2.785, 95%CI: 1.242-6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women. CONCLUSIONS Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding "management of hypertensive comorbidities". This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.
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Affiliation(s)
- Linhong Pang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Lakshme Kottu
- Division of Experimental Cardiology, Erasmus university medical center, 3015GD, Rotterdam, The Netherlands
| | - Zihong Guo
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Min Ma
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Huadan Wang
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Yajing Zhao
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Mingjing Tang
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Yi Shi
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Wei Liu
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Xia Wu
- School of Public Health, Kunming Medical University, 650500, Kunming, China
| | - Junjie Song
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Manli Sun
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China
| | - Daphne Merkus
- Division of Experimental Cardiology, Erasmus university medical center, 3015GD, Rotterdam, The Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), LMU, 81377, Munich, Germany
| | - Md Misbahul Ferdous
- The Third People's Hospital of Longgang District, 518083, Shenzhen, China.
- Lepu Medical Technology (Beijing) Co., Ltd, 102200, Beijing, China.
| | - Liping He
- School of Public Health, Kunming Medical University, 650500, Kunming, China.
| | - Lin Duo
- Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, 650221, Kunming, China.
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15
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Eslami H, Halimi Milani F, Salehnia F, Kourehpaz N, Katebi K. Relationship between sublingual varices and hypertension: a systematic review and meta-analysis. BMC Oral Health 2024; 24:240. [PMID: 38360643 PMCID: PMC10868067 DOI: 10.1186/s12903-024-03982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Previous research has investigated the connection between sublingual varices (SV) and cardiovascular disease, aging, and smoking. However, it is still unclear whether arterial hypertension affects the presence of SV. This meta-analysis aimed to investigate the relationship between hypertension and the presence of SV. METHODS The literature search was performed using PubMed, Web of Science, Scopus, Google Scholar, and Embase for cross-sectional studies until July 2023. PRISMA guidelines were used for article selection. A meta-analysis using standardized mean differences by a random effects model was conducted to pool studies. RESULTS A total of 568 articles were retrieved, of which twelve were included in the meta-analysis. Cumulatively, 2543 samples in the case group (1185 with hypertension) and 3897 samples (821 with hypertension) were studied in the control group. Using the random effects model, the pooled odds ratio (OR) revealed a significant association between hypertension and sublingual varices (OR = 2.66; 95% CI: 1.69-4.18). CONCLUSION The meta-analysis showed a significant and positive association between sublingual varices and hypertension. SV's presence could be used by dentists as a non-invasive indicator of hypertension screening.
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Affiliation(s)
- Hosein Eslami
- Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Salehnia
- Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negar Kourehpaz
- Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Katayoun Katebi
- Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
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Feitosa ADDM, Barroso WKS, Mion Junior D, Nobre F, Mota-Gomes MA, Jardim PCBV, Amodeo C, Oliveira AC, Alessi A, Sousa ALL, Brandão AA, Pio-Abreu A, Sposito AC, Pierin AMG, Paiva AMGD, Spinelli ACDS, Machado CA, Poli-de-Figueiredo CE, Rodrigues CIS, Forjaz CLDM, Sampaio DPS, Barbosa ECD, Freitas EVD, Cestario EDES, Muxfeldt ES, Lima Júnior E, Campana EMG, Feitosa FGAM, Consolim-Colombo FM, Almeida FAD, Silva GVD, Moreno Júnior H, Finimundi HC, Guimarães ICB, Gemelli JR, Barreto-Filho JAS, Vilela-Martin JF, Ribeiro JM, Yugar-Toledo JC, Magalhães LBNC, Drager LF, Bortolotto LA, Alves MADM, Malachias MVB, Neves MFT, Santos MC, Dinamarco N, Moreira Filho O, Passarelli Júnior O, Vitorino PVDO, Miranda RD, Bezerra R, Pedrosa RP, Paula RBD, Okawa RTP, Póvoa RMDS, Fuchs SC, Lima SGD, Inuzuka S, Ferreira-Filho SR, Fillho SHDP, Jardim TDSV, Guimarães Neto VDS, Koch VHK, Gusmão WDP, Oigman W, Nadruz Junior W. Brazilian Guidelines for In-office and Out-of-office Blood Pressure Measurement - 2023. Arq Bras Cardiol 2024; 121:e20240113. [PMID: 38695411 DOI: 10.36660/abc.20240113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2024] Open
Affiliation(s)
- Audes Diogenes de Magalhães Feitosa
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Instituto de Assistência, Pesquisa e Ensino em Saúde (IAPES), Recife, PE - Brasil
| | | | - Decio Mion Junior
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Fernando Nobre
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Marco Antonio Mota-Gomes
- Centro Universitário CESMAC, Maceió, AL - Brasil
- Hospital do Coração de Alagoas, Maceió, AL - Brasil
- Centro de Pesquisas Clínicas Dr. Marco Mota, Maceió, AL - Brasil
| | | | - Celso Amodeo
- Hcor, Associação Beneficente Síria, São Paulo, SP - Brasil
| | | | | | - Ana Luiza Lima Sousa
- Faculdade de Enfermagem da Universidade Federal de Goiás (UFG), Goiânia, GO - Brasil
| | | | - Andrea Pio-Abreu
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Andrei C Sposito
- Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo - Brasil
| | | | | | | | | | | | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde,Sorocaba, SP - Brasil
| | | | | | | | | | | | - Elizabeth Silaid Muxfeldt
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho - Programa de Hipertensão Arterial Resistente (ProHArt), Rio de Janeiro, RJ - Brasil
- Instituto de Educação Médica (IDOMED) - Universidade Estácio de Sá, Rio de Janeiro, RJ - Brasil
| | | | | | - Fabiana Gomes Aragão Magalhães Feitosa
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE - Brasil
| | | | - Fernando Antônio de Almeida
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde,Sorocaba, SP - Brasil
| | - Giovanio Vieira da Silva
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Marcio Ribeiro
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | | | - Luciano F Drager
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | - Marcus Vinícius Bolívar Malachias
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Fundação Educacional Lucas Machado (FELUMA), Belo Horizonte, MG - Brasil
| | | | - Mayara Cedrim Santos
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Instituto de Assistência, Pesquisa e Ensino em Saúde (IAPES), Recife, PE - Brasil
| | - Nelson Dinamarco
- Colegiado de Medicina - Universidade Estadual de Santa Cruz (UESC), Ilhéus, BA - Brasil
| | | | | | | | | | - Rodrigo Bezerra
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Laboratório de Imunopatologia Keizo Asami da Universidade Federal de Pernambuco, Recife, PE - Brasil
| | | | | | | | | | - Sandra C Fuchs
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Sayuri Inuzuka
- Unidade de Hipertensão Arterial - NIPEE - LHA/UFG, Goiânia, GO - Brasil
| | | | | | | | | | - Vera Hermina Kalika Koch
- Instituto da Criança e do adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Waléria Dantas Pereira Gusmão
- Centro Universitário CESMAC, Maceió, AL - Brasil
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL - Brasil
| | - Wille Oigman
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
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Dzampe AK, Takahashi S. Financial incentives and health provider behaviour: Evidence from a capitation policy in Ghana. HEALTH ECONOMICS 2024; 33:333-344. [PMID: 37905938 DOI: 10.1002/hec.4773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
The capitation payment model has been used as a supply-side cost-containment tool in controlling physician behaviour. However, little is known regarding its effectiveness in controlling costs and discouraging use of low-value care. This study seeks to examine whether financial incentives in capitation influence provider behaviour, and if so, whether such behaviour compromises outcomes for inpatients with hypertension. To this end, we evaluate the effect on outpatient visits and inpatient outcomes of the introduction of capitation into a mixed payment system involving diagnosis-related groups and fee-for-service in the Ashanti region of Ghana. We use difference-in-differences with fixed effects and event study analysis of claims data over 48 months (2016-2019). We found that providers responded to financial incentives in capitation; outpatient visits were approximately 35% lower. However, we found no significant impact of capitation on inpatient outcomes; that is, the in-hospital death rate did not increase, and the length of hospital stay (which may be a rough indicator of the severity of illness) also did not increase. These findings indicate that patient health outcomes did not deteriorate. Evidence suggests that the observed reduction in outpatient visits may be in unnecessary or low-value visits, especially at lower levels of the healthcare system.
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Affiliation(s)
- Adolf Kwadzo Dzampe
- Graduate School for International Development and Cooperation, Hiroshima University, Higashihiroshima, Japan
- Claims Processing Centre, National Health Insurance Authority, PMB Ministries, Accra, Ghana
| | - Shingo Takahashi
- Graduate School for International Development and Cooperation, Hiroshima University, Higashihiroshima, Japan
- School of Economics and Management, University of Hyogo, Hyogo, Japan
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Musa IR, Hassan AA, Adam I. Multimorbidity and its associated risk factors among adults in northern Sudan: a community-based cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:13. [PMID: 38281058 PMCID: PMC10822146 DOI: 10.1186/s41043-024-00513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/25/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Multimorbidity (having two or more coexisting long-term conditions) is a growing global challenge. However, data on multimorbidity among adults in Africa, including Sudan, are scarce. Thus, this study aimed to investigate the prevalence of multimorbidity and its associated risk factors among adults in Sudan. METHODS A community-based cross-sectional study was conducted in northern Sudan from March 2022 to May 2022. Participants' sociodemographic characteristics were assessed using a questionnaire. Multimorbidity was defined as having two or more coexisting long-term conditions, including diabetes mellitus (DM), hypertension, obesity, anaemia and depression-anxiety. Multivariate logistic regression analyses were performed to determine the associated factors. RESULTS The participants included 250 adults: 119 (47.6%) males and 131(52.4%) females. The median interquartile range (IQR) of the enrolled adults of the age was 43.0 (30.0‒55.0) years. Of the 250 adults, 82(32.8%), 17(6.8%), 84(33.6%), and 67(26.8%) were normal weight, underweight, overweight, and obese, respectively; 148(59.2%), 72(28.8%), 63(25.2%), 67(26.8%), and 98(39.2%) had hypertension, DM, anaemia, obesity, and depression-anxiety, respectively. A total of 154 adults (61.6%) had multimorbidity: 97(38.8%), 49(19.6%), and 8(3.2%) had two, three, and four morbidities, respectively. The remaining 21 (8.4%), and 75 (30.0%) adults had no morbidity, and one morbidity, respectively. In amultivariate logistic regression analysis, increasing age (adjusted odd ratio [AOR] = 1.03, 95% CI = 1.01‒1.05), and female sex (AOR = 2.17, 95% CI = 1.16‒4.06) were associated with multimorbidity. CONCLUSIONS The high prevalence of multimorbidity revealed in this study uncovers a major public health problem among Sudanese adults. Our results show that increasing age and female sex are associated with multimorbidity. Additional extensive studies are necessary to evaluate the magnitude of multimorbidity for improved future planning and establishing effective health systems.
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Affiliation(s)
- Imad R Musa
- Royal Commission Hospital at AL Jubail Industrial City, Al Jubail, Kingdom of Saudi Arabia
| | | | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, 51911, Unaizah, Kingdom of Saudi Arabia
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Fallahzadeh A, Mehraban S, Mahmoodi T, Sheikhy A, Naderian M, Afsaneh Aein P, Rafiee H, Mehrani M, Tajdini M, Masoud‐kabir F, Sadeghian S, Hosseini K. Risk factor profile and outcomes of premature acute coronary syndrome after percutaneous coronary intervention: A 1-year prospective design. Clin Cardiol 2024; 47:e24170. [PMID: 37818995 PMCID: PMC10766129 DOI: 10.1002/clc.24170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The prevalence of acute coronary syndrome (ACS) among young adults (premature ACS) has dramatically increased in recent years, especially in developing countries. Yet, the data on these patients' attributed risk factors and outcomes are inconsistent. In this study, we aimed to investigate these data in a cohort of premature ACS cases who underwent percutaneous coronary intervention (PCI) compared to older patients. HYPOTHESIS We hypothesize that premature ACS patients undergoing PCI will exhibit different risk factor profiles and outcomes compared to non-premature patients. specifically, we anticipate that premature patients do not necessarily have better outcomes than non-premature. METHODS Overall, 3142 and 10 399 patients were included in premature and non-premature groups, respectively. Patients' pre-operative, post-operative, and follow-up data were retrieved retrospectively from the Tehran Heart Center PCI databank. RESULTS The mean age of premature and non-premature cohorts was 48.39 and 67 years, respectively. Patients were predominantly male in both groups. Family history of coronary artery disease (CAD), dyslipidemia, smoking, and opium addiction were more prevalent among the younger cohort. After adjustment, in-hospital mortality in younger patients was considerably higher, with all-cause mortality and major cardiovascular and cerebrovascular events (MACCE) exhibiting no noticeable difference among the two groups. CONCLUSIONS Risk factor profile is different in young patients, and traditional cardiovascular risk factors, such as hypertension and diabetes mellitus, are more prevalent among older adults. Younger age is not equivalent to a better prognosis; hence, similar or even more caution should be taken into consideration regarding secondary prevention for these patients.
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Affiliation(s)
- Aida Fallahzadeh
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Saghar Mehraban
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Tara Mahmoodi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Sheikhy
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | | | - Phd Afsaneh Aein
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Hamed Rafiee
- School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Farzad Masoud‐kabir
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran University of Medical SciencesTehranIran
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20
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Kaya T, Demir N. Evaluation of Patients Diagnosed with Essential Hypertension in Terms of Mental and Personality Disorders. ALPHA PSYCHIATRY 2024; 25:54-62. [PMID: 38799485 PMCID: PMC11114208 DOI: 10.5152/alphapsychiatry.2024.231363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/18/2023] [Indexed: 05/29/2024]
Abstract
Objective Recent studies have suggested a link between hypertension and psychiatric disorders. However, the relationship between hypertension and mental health conditions remains unclear. So in this study, it was aimed to compare the prevalence of psychiatric diseases seen in hypertension patients with the healthy group. Methods Psychiatric interviews were conducted with 104 patients in the hypertension group and 102 participants in the control group. The Sociodemographic and Clinical Data Form, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Disorders, Structured Clinical Interview for DSM-5-Clinician Version, and DSM-5 Structured Clinical Interview for Personality Disorders were implemented for participants. Results Patients with hypertension were found to have a significantly higher number of psychiatric disorders compared to the control group (χ 2 = 29.389; P = .001). Statistically significant difference in the diagnosis of severe depression, chronic depression disorder, and specific phobia was discovered between the 2 groups (P < .05). The HAM-A and HAM-D scores were also significantly higher in the hypertension group (P < .001). No statistically significant difference was found between the patient and control groups in terms of the frequency of personality disorders. (χ 2 = 0.045; P = .833). Conclusion The fact that depression and anxiety symptoms are more common in hypertension patients stands out as a subject that needs further investigation in terms of both the pathophysiology of hypertension. In this regard, since essential hypertension is a serious risky disease for mortality and morbidity on its own, it is critical to conduct psychiatric screening and develop new additional treatments to provide patients with supportive care.
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Affiliation(s)
- Tanju Kaya
- Department of Psychiatry, Karabük University, Faculty of Medicine, Karabük, Turkey
| | - Nefise Demir
- Department of Psychiatry, Karabük University, Faculty of Medicine, Karabük, Turkey
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21
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Gladwell LR, Ahiarah C, Rasheed S, Rahman SM, Choudhury M. Traditional Therapeutics and Potential Epidrugs for CVD: Why Not Both? Life (Basel) 2023; 14:23. [PMID: 38255639 PMCID: PMC10820772 DOI: 10.3390/life14010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide. In addition to the high mortality rate, people suffering from CVD often endure difficulties with physical activities and productivity that significantly affect their quality of life. The high prevalence of debilitating risk factors such as obesity, type 2 diabetes mellitus, smoking, hypertension, and hyperlipidemia only predicts a bleak future. Current traditional CVD interventions offer temporary respite; however, they compound the severe economic strain of health-related expenditures. Furthermore, these therapeutics can be prescribed indefinitely. Recent advances in the field of epigenetics have generated new treatment options by confronting CVD at an epigenetic level. This involves modulating gene expression by altering the organization of our genome rather than altering the DNA sequence itself. Epigenetic changes are heritable, reversible, and influenced by environmental factors such as medications. As CVD is physiologically and pathologically diverse in nature, epigenetic interventions can offer a ray of hope to replace or be combined with traditional therapeutics to provide the prospect of addressing more than just the symptoms of CVD. This review discusses various risk factors contributing to CVD, perspectives of current traditional medications in practice, and a focus on potential epigenetic therapeutics to be used as alternatives.
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Affiliation(s)
- Lauren Rae Gladwell
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
| | - Chidinma Ahiarah
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
| | - Shireen Rasheed
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
| | - Shaikh Mizanoor Rahman
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat Al-Mouz, Nizwa 616, Oman
| | - Mahua Choudhury
- Department of Pharmaceutical Sciences, Texas A&M Irma Lerma Rangel College of Pharmacy, 1114 TAMU, College Station, TX 77843, USA
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22
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Sheikhy A, Fallahzadeh A, Jameie M, Aein A, Masoudkabir F, Maghsoudi M, Tajdini M, Salarifar M, Jenab Y, Pourhosseini H, Mehrani M, Alidoosti M, Vasheghani-Farahani A, Hosseini K. In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis. Front Cardiovasc Med 2023; 10:1235667. [PMID: 38173819 PMCID: PMC10761535 DOI: 10.3389/fcvm.2023.1235667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Aim A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established. Methods This retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions. Results Approximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99-12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91-2.65, P:0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, P: 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, P: 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92-6.21, P < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, P: 0.008) than SMuRF+ women. Conclusions Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality.
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Affiliation(s)
- Ali Sheikhy
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Fallahzadeh
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Aein
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Maghsoudi
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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23
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Hassan AA, Musa SM, Omer HEO, Adam I. The association between red cell distribution width and newly diagnosed hypertension among adults in Northern Sudan: a case-control study. Libyan J Med 2023; 18:2254502. [PMID: 37665970 PMCID: PMC10478621 DOI: 10.1080/19932820.2023.2254502] [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: 05/12/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
The existing data have shown inconsistency about the association between red cell distribution width (RDW) and hypertension. Thus, the aim of the present study was to investigate the association between RDW and newly diagnosed hypertension among adults in Sudan. This was a case-control study conducted in Northern Sudan from July to September 2022. The cases were patients with newly diagnosed hypertension (n = 78), and the controls were healthy participants (n = 78). A questionnaire was used to collect the participants' sociodemographic, and clinical data. RDW was measured using an automated hematology analyzer. A logistic regression analysis was performed. The univariate analysis revealed no association between sex, educational level, occupational level, RDW, and newly diagnosed hypertension. In the multivariate analysis, increasing age (adjusted odds ratio [AOR], 1.05; 95% confidence interval [CI], 1.02‒1.08) and body mass index (AOR, 1.12; 95% CI, 1.05‒1.19) were associated with newly diagnosed hypertension. No association was found between RDW and newly diagnosed hypertension. No correlation was found between RDW and systolic (r = 0.045, P = 0.577) or diastolic blood pressure (r = 0.023, P = 0.772). In conclusion, no association in RDW was found between the patients with newly diagnosed hypertension and the healthy controls.
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Affiliation(s)
- Ahmed A. Hassan
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Shaza M. Musa
- Adjunct instructor- Biology, Tarrant County College Northwest Campus, Fort Worth, TX, USA
| | - Husam-Eldin O. Omer
- Department of Pathology, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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24
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Yang R, Tang J, Kuang M, Liu H. Analysis of prescription status of antihypertensive drugs in Chinese patients with hypertension based on real-world study. Ann Med 2023; 55:276-284. [PMID: 36594446 PMCID: PMC9815216 DOI: 10.1080/07853890.2022.2162113] [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] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Globally, the prevalence of hypertension and the accompanying burden of cardiovascular disease are increasing. Through drug utilization research, we can understand the prescription status of hypertension patients and promote rational drug use. The purpose of this retrospective study was to describe the current prescription pattern of antihypertensive drugs in Chinese patients and determine the compliance level of treatment guidelines. MATERIALS AND METHODS Around 11.1 million patients who received a prescription for antihypertensive therapy between January 2021 to December 2021 were obtained from a database of Hangzhou Kang Sheng Health Consulting CO., Ltd. RESULTS The mean age of hypertensive patients was 54.75 ± 12.98 years. About 6.7 million (60.30%) were males. About 46.07% of patients had comorbidities. The most common classes of antihypertensive medications used were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs). Around 78.33% of participants were on monotherapy. Diuretics + ARBs and Diuretics + CCBs + ARBs were the most commonly prescribed pattern in two-drug combination therapy and three-drug combination therapy, respectively. CONCLUSIONS CCBs and ARBs were the two most frequently prescribed for patients with hypertension. The prescription pattern of antihypertensive medications in the study largely complied with recommended Chinese hypertension guidelines.Key messagesCardiovascular disease is the most common complication of hypertension.Calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) are the two most commonly used drugs for hypertension patients in China.The proportion of combination prescription pattern in Chinese hypertensive patients is low.
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Affiliation(s)
- Renren Yang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
| | - Jia Tang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
| | - Ming Kuang
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
| | - Hongying Liu
- Medical Affairs, Hangzhou Kang Sheng Health Consulting CO., Ltd, Hangzhou, China
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25
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Cardoso AM, Aneli NM, Lammers M, Mânica A, Zanini D, Maciel SFVDO, Sévigny J, Corralo VDS, De Sá CA. Resistance training reduces platelet activation in hypertensive women: the role of purinergic signaling. J Hypertens 2023; 41:1745-1752. [PMID: 37796209 DOI: 10.1097/hjh.0000000000003529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND AIM Essential arterial hypertension is a risk factor for stroke, myocardial infarction, heart failure, and arterial aneurysm, which are related to the activation of platelets. Purinergic signaling has a central role in platelet aggregation. Although ATP and ADP can act as a proaggregant agent, adenosine inhibits platelet aggregation and reduces vascular injury. Physical exercise exhibits antiaggregant properties and can modulate purinergic system. The aim of this study was to evaluate the effect of 6 months of resistance training on purinergic system components in platelets and on platelet activation, hemodynamic and anthropometric parameters in hypertensive woman. METHOD A total of 31 hypertensive and 28 normotensive middle-aged sedentary women were submitted to 6 months of resistance training. Purinergic enzymes activities were assessed in platelets; ATP and Tromboxane B2 (TXB2) levels were measured in serum. Blood pressure (BP), BMI, and body fat were also measured. All variables were statistically analyzed, considering P value less than 0.05. RESULTS Six months of resistance training was able to significantly reduce BP, ATP, and TXB2 levels as well as NTPDase, ecto-5'nucleotidase, and ADA activities in hypertensive group. After 6 months of resistance training, purinergic system components and TXB2 of hypertensive group were similar to normotensive group in platelets, demonstrating that resistance training was able to modulate platelet activation. A positive correlation was found between BP, enzyme activities, and levels of ATP and TXB2. CONCLUSION Our findings demonstrated the relationship between purinergic signaling and platelet activation in hypertension and suggests that resistance training serve as tool to reduce platelet aggregation in hypertensive woman by modulating purinergic system.
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Affiliation(s)
| | | | | | - Aline Mânica
- Health Sciences Postgraduate Program, Community University of Chapecó Region, Chapecó, SC, Brazil
| | | | | | - Jean Sévigny
- Département de microbiologie-infectiologie et d'immunologie, Faculté de Médecine and Centre de recherché du CHU de Québec, Université Laval, Québec City, Québec, Canada
| | - Vanessa da Silva Corralo
- Health Sciences Postgraduate Program, Community University of Chapecó Region, Chapecó, SC, Brazil
| | - Clodoaldo Antônio De Sá
- Health Sciences Postgraduate Program, Community University of Chapecó Region, Chapecó, SC, Brazil
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26
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Birla S, Angural A, Madathumchalil A, Shende RV, Shastry SV, Mahadevappa M, Shambhu SK, Vishwanath P, Prashant A. Redefining the polypill: pros and cons in cardiovascular precision medicine. Front Pharmacol 2023; 14:1268119. [PMID: 37799963 PMCID: PMC10549989 DOI: 10.3389/fphar.2023.1268119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Polypill is a multi-drug formulation in a single pill intended to simplify the drug regimen and reduce medication-induced adverse effects. The most common multidrug combinations in a polypill are used to treat cardiovascular diseases and are targeted against key modifiable risk factors such as hypertension and hyperlipidemia. These contain blood-pressure lowering agents, statins, and anti-platelet agents usually in a fixed dose. Polypills can be an affordable therapeutic intervention for treating high-risk patients, as these are proven to increase patients' adherence to medication and improve clinical outcomes. Over the previous years, randomized clinical trials of several polypills have yielded contradictory findings, raising skepticism regarding their widespread use in primary disease prevention. Here, we have reviewed the concept of polypills, the evidence-based strengths, the limitations of this polypharmacy intervention strategy, and discussed future directions for their use in the primary and secondary preventive management of cardiovascular diseases and associated risk factors.
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Affiliation(s)
- Siddharth Birla
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Arshia Angural
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Arya Madathumchalil
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Ritika V. Shende
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Sharvani V. Shastry
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Manjappa Mahadevappa
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Sunil Kumar Shambhu
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Prashant Vishwanath
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
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27
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Almeida GDO, de Oliveira IS, Arantes EC, Sampaio SV. Snake venom disintegrins update: insights about new findings. J Venom Anim Toxins Incl Trop Dis 2023; 29:e20230039. [PMID: 37818211 PMCID: PMC10561651 DOI: 10.1590/1678-9199-jvatitd-2023-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/25/2023] [Indexed: 10/12/2023] Open
Abstract
Snake venom disintegrins are low molecular weight, non-enzymatic proteins rich in cysteine, present in the venom of snakes from the families Viperidae, Crotalidae, Atractaspididae, Elapidae, and Colubridae. This family of proteins originated in venom through the proteolytic processing of metalloproteinases (SVMPs), which, in turn, evolved from a gene encoding an A Disintegrin And Metalloprotease (ADAM) molecule. Disintegrins have a recognition motif for integrins in their structure, allowing interaction with these transmembrane adhesion receptors and preventing their binding to proteins in the extracellular matrix and other cells. This interaction gives disintegrins their wide range of biological functions, including inhibition of platelet aggregation and antitumor activity. As a result, many studies have been conducted in an attempt to use these natural compounds as a basis for developing therapies for the treatment of various diseases. Furthermore, the FDA has approved Tirofiban and Eptifibatide as antiplatelet compounds, and they are synthesized from the structure of echistatin and barbourin, respectively. In this review, we discuss some of the main functional and structural characteristics of this class of proteins and their potential for therapeutic use.
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Affiliation(s)
- Gabriela de Oliveira Almeida
- Department of Clinical Analysis, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Isadora Sousa de Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Eliane Candiani Arantes
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Suely Vilela Sampaio
- Department of Clinical Analysis, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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28
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Shahbazi F, Najafi F, Shojaei L, Farzaei MH, Shokoohinia Y, Pasdar Y, Hamzeh B, Tahvilian R, Rahimi W, Shakiba E, Karim H, Dobson A, Bhatt N, Moradinazar M. Hypertension medication from guidelines to practice: A cohort study in western Iran. Pharmacoepidemiol Drug Saf 2023; 32:951-960. [PMID: 36974582 DOI: 10.1002/pds.5626] [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: 07/25/2022] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Hypertension (HTN) is one of the most common risk factors for non-communicable chronic diseases. The aim of the current study is to evaluate the prescribing patterns of antihypertensive medications in Kermanshah Province, west of Iran. METHODS The Ravansar Non-Communicable Diseases (RaNCD) cohort study is the first Kurdish community-based study; subjects' age ranged from 35 to 65 years. In order to examine the use of medications to control blood pressure, participants were asked to bring all prescribed medications to the study center. Treatments were compared with 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines for the management of arterial HTN. RESULTS From a total of 10 040 participants in RaNCD cohort, 1575 (15.7%) individuals were hypertensive, of whom, 1271 (80.7%) people were aware of their condition. From 1153 (73.20%) people under treatment, 840 (72.8%) had their HTN properly controlled. The most common medications used to treat HTN were losartan (27.5%), metoprolol (14.3%), and captopril (11.9%). Regardless of type of treatment, 49.3% of all patients have received the medication for l 6 ≥ years. The most commonly used drugs were β-blockers and angiotension receptor blockers as 620 (31.0%) and 612 (30.6%), respectively. Multivariable analysis showed that female gender, those receive ≥3 antihypertensive agents, and using preferred combinations were associated with a better blood pressure control. In addition, the probability of hypertension control was less likely with increasing duration of treatment (i.e >6 years) and in obese patients with ≥35 kg/m2 . CONCLUSIONS Even though adherence to the international guidelines was acceptable, improvements can be made for better control of HTN. Therefore, it is imperative to educate healthcare professionals on improving their selection of antihypertensive medications and combination therapy for hypertensive patients.
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Affiliation(s)
- Foroud Shahbazi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lida Shojaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yalda Shokoohinia
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Pharmacognosy & Biotechnology, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Nutritional Sciences Department School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Tahvilian
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Werya Rahimi
- Research Center of Oils and fats, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Karim
- Kermanshah Cardiovascular Research Center, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Annette Dobson
- Centre for Longitudinal and Life Course Research (CLLR), School of Population Health, University of Queensland, Queensland, Australia
| | - Neha Bhatt
- Ric Scalzo Institute for Botanical Sciences, Sonoran University of Health Sciences, Tempe, Arizona, USA
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Jiao T, Platt RW, Douros A, Filion KB. Use of a Statistical Adaptive Treatment Strategy Approach for Emulating Randomized Controlled Trials Using Observational Data: The Example of Blood-Pressure Control Strategies for the Prevention of Cardiovascular Events Among Individuals With Hypertension at High Cardiovascular Risk. Am J Epidemiol 2023; 192:1576-1591. [PMID: 37073411 DOI: 10.1093/aje/kwad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 10/12/2022] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
Statistical approaches to adaptive treatment strategies (ATS) can be used to mimic the sequential decision-making inherently found in clinical practice. To illustrate the use of a statistical ATS approach, we emulated a target trial of different blood pressure (BP) control plans for the prevention of cardiovascular events among individuals with hypertension at high cardiovascular risk, inspired by the Systolic Blood Pressure Intervention Trial (SPRINT). We included 103,708 patients with hypertension and a "QRISK3" estimated 10-year risk of cardiovascular disease of ≥20% who initiated an antihypertensive drug between 1998 and 2018. Dynamic marginal structural models estimated the comparative effects of treating patients with intensive (target BP: 130/80 mm Hg), standard (140/90 mm Hg), and conservative (150/90 mm Hg) BP control strategies. The adjusted hazard ratios (HRs) for the intensive versus standard strategy were 0.96 (95% confidence interval (CI): 0.92, 1.00) for major adverse cardiovascular events and 0.93 (95% CI: 0.88, 0.97) for death from cardiovascular causes. For the conservative versus standard strategy, they were 1.06 (95% CI: 1.02, 1.10) and 1.08 (95% CI: 1.03, 1.13), respectively. These results are largely compatible with SPRINT. ATS can be used to emulate randomized controlled trials of complex treatment strategies in an observational setting and represents an alternative approach for situations where randomized controlled trials are not feasible.
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Lee V, Zheng Q, Toh DF, Pua CJ, Bryant JA, Lee CH, Cook SA, Butler J, Díez J, Richards AM, Le TT, Chin CWL. Sacubitril/valsartan versus valsartan in regressing myocardial fibrosis in hypertension: a prospective, randomized, open-label, blinded endpoint clinical trial protocol. Front Cardiovasc Med 2023; 10:1248468. [PMID: 37674806 PMCID: PMC10478086 DOI: 10.3389/fcvm.2023.1248468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
Background Diffuse interstitial myocardial fibrosis is a key common pathological manifestation in hypertensive heart disease (HHD) progressing to heart failure (HF). Angiotensin receptor-neprilysin inhibitors (ARNi), now a front-line treatment for HF, confer benefits independent of blood pressure, signifying a multifactorial mode of action beyond hemodynamic regulation. We aim to test the hypothesis that compared with angiotensin II receptor blockade (ARB) alone, ARNi is more effective in regressing diffuse interstitial myocardial fibrosis in HHD. Methods Role of ARNi in Ventricular Remodeling in Hypertensive LVH (REVERSE-LVH) is a prospective, randomized, open-label, blinded endpoint (PROBE) clinical trial. Adults with hypertension and left ventricular hypertrophy (LVH) according to Asian sex- and age-specific thresholds on cardiovascular magnetic resonance (CMR) imaging are randomized to treatment with either sacubitril/valsartan (an ARNi) or valsartan (an ARB) in 1:1 ratio for a duration of 52 weeks, at the end of which a repeat CMR is performed to assess differential changes from baseline between the two groups. The primary endpoint is the change in CMR-derived diffuse interstitial fibrosis volume. Secondary endpoints include changes in CMR-derived left ventricular mass, volumes, and functional parameters. Serum samples are collected and stored to assess the effects of ARNi, compared with ARB, on circulating biomarkers of cardiac remodeling. The endpoints will be analyzed with reference to the corresponding baseline parameters to evaluate the therapeutic effect of sacubitril/valsartan vs. valsartan. Discussion REVERSE-LVH will examine the anti-fibrotic potential of sacubitril/valsartan and will offer mechanistic insights into the clinical benefits of sacubitril/valsartan in hypertension in relation to cardiac remodeling. Advancing the knowledge of the pathophysiology of HHD will consolidate effective risk stratification and personalized treatment through a multimodal manner integrating complementary CMR and biomarkers into the conventional care approach.Clinical Trial Registration: ClinicalTrials.gov, identifier, NCT03553810.
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Affiliation(s)
- Vivian Lee
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
| | | | - Desiree-Faye Toh
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
| | - Chee Jian Pua
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
| | - Jennifer A. Bryant
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Stuart A. Cook
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, United States
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, United States
| | - Javier Díez
- Centre for Applied Medical Research (CIMA), and School of Medicine, University of Navarra, Pamplona, Spain
- Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain
| | - A. Mark Richards
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Thu-Thao Le
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular Academic Clinical Program (ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Calvin W. L. Chin
- National Heart Research Institute Singapore (NHRIS), National Heart Centre Singapore, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular Academic Clinical Program (ACP), Duke-NUS Medical School, Singapore, Singapore
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Hassan AA, Abdelbagi O, Osman OE, Adam I. Association between serum 25-hydroxyvitamin D concentrations and hypertension among adults in North Sudan: a community-based cross-sectional study. BMC Cardiovasc Disord 2023; 23:402. [PMID: 37592222 PMCID: PMC10433536 DOI: 10.1186/s12872-023-03432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Globally, hypertension represents a major public health problem. The association between 25-hydroxyvitamin D (25[OH]D) levels and hypertension remains unclear. The current study aimed to investigate the association between serum 25(OH)D levels and hypertension among adults in Sudan. METHODS A community-based cross-sectional study was conducted among adults in North Sudan. Sociodemographic and clinical data were collected using a questionnaire and face-to-face interviews. Serum 25(OH)D was measured using an enzyme-linked immunosorbent assay. Multivariate logistic regression and multiple linear regression analyses were performed. RESULTS Of the total of 391 participants, 202 (51.7%) were females. The median (interquartile range [IQR]) of participants' ages was 45(32-55) years. Of the total, 219(56.0%) had hypertension. The median (IQR) of serum25(OH)D was 13.3(9.9-19.7) ng/mL, and 295 (75.4%) participants had vitamin D deficiency (< 20 ng/mL). In multivariable logistic regression, the adjusted odds ratio (AOR) for age = 1.05, 95% confidence interval (CI)1.03‒1.061, the AOR for being female = 2.02, 95% CI, 1.12‒3.66, and body mass index was AOR = 1.09, 95% CI, 1.05‒1.14, all of which were significantly associated with hypertension. However, serum 25(OH)D levels were not associated with hypertension (AOR = 1.01, 95% CI 0.99‒1.05, P = 0.317). In multiple linear regression, while systolic blood pressure was negatively associated with 25(OH)D (coefficient = - 0.28, P = 0.017), there was no significant association between serum 25(OH)D level and diastolic blood pressure (coefficient = - 0.10, P = 0.272) or mean blood pressure (coefficient =-0.03, P = 0.686). CONCLUSION The current study revealed a negative association between vitamin D and systolic blood pressure. The mechanism of such an association needs further study.
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Affiliation(s)
- Ahmed A. Hassan
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Omer Abdelbagi
- Department of Pathology, AlQunfudhah Faculty of Medicine, Umm Al-Qura University, Al Qunfudhah, Saudi Arabia
| | - Osman E. Osman
- Faculty of Medicine, Alneelain University, Khartoum, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Bakris G, Chen C, Campbell AK, Ashton V, Haskell L, Singhal M. Association of uncontrolled blood pressure in apparent treatment-resistant hypertension with increased risk of major adverse cardiovascular events plus. J Clin Hypertens (Greenwich) 2023; 25:737-747. [PMID: 37461262 PMCID: PMC10423765 DOI: 10.1111/jch.14701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
Patients with apparent treatment-resistant hypertension (aTRH) are at increased risk of end-organ damage and cardiovascular events. Little is known about the effects of blood pressure (BP) control in this population. Using a national claims database integrated with electronic medical records, the authors evaluated the relationships between uncontrolled BP (UBP; ≥130/80 mmHg) or controlled BP (CBP; <130/80 mmHg) and risk of major adverse cardiovascular events plus (MACE+; stroke, myocardial infarction, heart failure requiring hospitalization) and end-stage renal disease (ESRD) in adult patients with aTRH (taking ≥3 antihypertensive medication classes concurrently within 30 days between January 1, 2015 and June 30, 2021). MACE+ components were also evaluated separately. Multivariable regression models were used to adjust for baseline differences in demographic and clinical characteristics, and sensitivity analyses using CBP <140/90 mmHg were conducted. Patients with UBP (n = 22 333) were younger and had fewer comorbidities at baseline than those with CBP (n = 11 427). In the primary analysis, which adjusted for these baseline differences, UBP versus CBP patients were at an 8% increased risk of MACE+ (driven by a 31% increased risk of stroke) and a 53% increased risk of ESRD after 2.7 years of follow-up. Greater MACE+ (22%) and ESRD (98%) risk increases with UBP versus CBP were seen in the sensitivity analysis. These real-world data showed an association between suboptimal BP control in patients with aTRH and higher incidence of MACE+ and ESRD linked with UBP despite the use of multidrug regimens. Thus, there remains a need for improved aTRH management.
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Affiliation(s)
| | - Cindy Chen
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
| | | | | | - Lloyd Haskell
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Mukul Singhal
- Janssen Scientific Affairs, LLCTitusvilleNew JerseyUSA
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Sithole N, Castle A, Nxumalo S, Mazibuko L, Manyaapelo T, Abrahams-Gessel S, Dlamini S, Gareta D, Orne-Gliemann J, Baisley K, Bachmann M, Magula N, Gaziano TA, Siedner MJ. Protocol: Implementation evaluation of a combination intervention for sustainable blood pressure control in rural KwaZulu-Natal, South Africa (IMPACT BP): A three-arm, unblinded, parallel group individually randomized clinical trial. Contemp Clin Trials 2023; 131:107258. [PMID: 37308076 PMCID: PMC10527603 DOI: 10.1016/j.cct.2023.107258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hypertension is the primary risk factor for stroke and heart disease, which are leading causes of death in South Africa. Despite the availability of treatments, there is an implementation gap in how best to deliver hypertension care in this resource-limited region. METHODS We describe a three-arm parallel group individually randomized control trial to evaluate the effectiveness and implementation of a technology-supported, community-based intervention to improve blood pressure control among people with hypertension in rural KwaZulu-Natal. The study will compare three strategies: 1) standard of care (SOC arm) clinic-based management, 2) home-based blood pressure management supported by community blood pressure monitors (CBPM arm) and a mobile health application to record blood pressure readings and enable clinic-based nurses to remotely manage care, and 3) an identical strategy to the CBPM arm, except that participants will use a cellular blood pressure cuff, which automatically transmits completed readings over cellular networks directly to clinic-based nurses (eCBPM+ arm). The primary effectiveness outcome is change in blood pressure from enrollment to 6 months. The secondary effectiveness outcome is the proportion of participants with blood pressure control at 6 months. Acceptability, fidelity, sustainability, and cost-effectiveness of the interventions will also be assessed. CONCLUSIONS In this protocol, we report the development of interventions in partnership with the South Africa Department of Health, a description of the technology-enhanced interventions, and details of the study design so that our intervention and evaluation can inform similar efforts in rural, resource-limited settings. PROTOCOL Version 3 November 9th, 2022. CLINICALTRIALS gov Trial Registration: NCT05492955 SAHPRA Trial Number: N20211201. SANCTR Number: DOH-27-112,022-4895.
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Affiliation(s)
- Nsika Sithole
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
| | - Alison Castle
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | | | | | | | | | | | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Joanna Orne-Gliemann
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nombulelo Magula
- Division of Internal Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Thomas A Gaziano
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Division of Internal Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Rezaee M, Fallahzadeh A, Sheikhy A, Ajam A, Sadeghian S, Bsc MP, Shirzad M, Mansourian S, Bagheri J, Hosseini K. The prognostic role of the low and very low baseline LDL-C level in outcomes of patients with cardiac revascularization; comparative registry-based cohort design. J Cardiothorac Surg 2023; 18:240. [PMID: 37507734 PMCID: PMC10386279 DOI: 10.1186/s13019-023-02333-y] [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: 11/05/2022] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Although low-density lipoprotein-cholesterol (LDL-C) level is considered one of the main prognostic factors in patients with coronary artery bypass grafting (CABG), the question about "the lower the better" is still unanswered. We aimed to evaluate and compare the outcomes of patients with CABG and low or very low baseline LDL-C, regardless of statin usage. METHODS In this registry-based cohort study, 10,218 patients with low/very low (70-100 and ≤ 70 mg/dL) baseline LDL-C who underwent isolated and the first-time CABG without known previous history of cardio-cerebrovascular events, were included and compared. The median follow-up was 73.33 (72.15-74.51) months. Primary outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACCE) (consisted of all-cause mortality, acute coronary syndrome, stroke or transient ischemic attack, and the need for repeat revascularization [percutaneous coronary intervention or redo-CABG]). Cox regression analyses before and after the propensity score matching (PSM) model were applied to evaluate and compare outcomes. RESULTS The mean age of the study population was 66.17 ± 9.98 years old and 2506 (24.5%) were women. Diabetes mellitus and a history of cigarette smoking were significantly higher in the very low LDL group (P-value ≤ 0.001). In Cox regression analyses before applying PSM model, both all-cause mortality (14.2% vs. 11.9%, P-value = 0.004 and MACCE (26.0% vs. 23.6%, P-value = 0.006) were significantly higher in the very low LDL group compared to low LDL. However, these results were no longer significant after applying the PSM model (all-cause mortality HR: 1.115 [95% CI: 0.986-1.262], P = 0.083 and MACCE HR: 1.077 [95%CI: 0.984-1.177], P = 0.095). The sensitivity analysis to remove the statin effect demonstrated that very low LDL-C level was correlated to higher risk of all-cause mortality in both unmatched and PSM analyses. CONCLUSION Very low serum LDL-C levels (≤ 70 mg/dl) could increase long-term all-cause mortality and cardiovascular events in patients who have undergone isolated CABG.
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Affiliation(s)
- Malihe Rezaee
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
| | - Aida Fallahzadeh
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
| | - Ali Sheikhy
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
| | - Ali Ajam
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
| | - Saeed Sadeghian
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
- Department of Cardiac Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang Bsc
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
| | - Mahmoud Shirzad
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
- Department of Cardiac Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mansourian
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
- Department of Cardiac Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran
- Department of Cardiac Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Karegar Ave, P.O. Box: 1411713138, Tehran, Iran.
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Englert I, Egert S, Hoffmann L, Kohlenberg-Müller K. Concept of an Intervention for Sustainable Weight Loss in Postmenopausal Women with Overweight-Secondary Analysis of a Randomized Dietary Intervention Study. Nutrients 2023; 15:3250. [PMID: 37513668 PMCID: PMC10383994 DOI: 10.3390/nu15143250] [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: 06/12/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The approach of an individual diet has great potential for sustainable weight reduction. Social support, participation and empowerment are also key factors for high motivation and compliance. So, the impact of an individual diet in combination with group sessions on weight loss in postmenopausal women with overweight was investigated. METHODS In this reanalysis of a controlled intervention study, postmenopausal women (n = 54; BMI 30.9 ± 3.4 kg/m2; 59 ± 7 years) were recruited receiving an energy restricted diet for 12 weeks, followed by a six-month follow-up phase. The women received 51 individual meal plans based on their habits and were trained in four group sessions. RESULTS Forty-six women completed the intervention phase, and 29 completed the follow-up. Average weight loss was -5.8 ± 3.0 kg (p < 0.001) after 12 weeks and was still significant at follow-up (-4.9 ± 5.4 kg, p < 0.001). Also, decreases in fat-free mass (-1.1 ± 1.2 kg, p < 0.001) and resting energy expenditure (-1096 ± 439 kJ/24 h, p < 0.001) were observed. CONCLUSIONS The individual nutrition approach with a focus on nutritype in combination with group sessions was effective for long-lasting weight loss in postmenopausal women. An important factor is close individual and group support.
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Affiliation(s)
- Isabell Englert
- Department of Nutritional, Food and Consumer Sciences, University of Applied Sciences, 36037 Fulda, Germany
| | - Sarah Egert
- Department of Nutrition and Food Science, Nutritional Physiology, University of Bonn, 53113 Bonn, Germany
| | - Laura Hoffmann
- Department of Nutritional, Food and Consumer Sciences, University of Applied Sciences, 36037 Fulda, Germany
| | - Kathrin Kohlenberg-Müller
- Department of Nutritional, Food and Consumer Sciences, University of Applied Sciences, 36037 Fulda, Germany
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Baye T, Girmaw F, Ashagrie G, Kassaw AT. Drug Therapy Problems and Associated Factors Among Hypertensive Patients in North Wollo Public Hospitals, Northeast Ethiopia: Institutional-Based Cross-Sectional Study. Integr Blood Press Control 2023; 16:47-57. [PMID: 37492163 PMCID: PMC10364825 DOI: 10.2147/ibpc.s416585] [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: 04/10/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
Background Drug therapy problems (DTPs) are common in people with hypertension and may threaten the effective management of the disease. The purpose of this study was to determine the prevalence and predictors for DTPs in hypertensive people in North Wollo public hospitals. Methods On patients with hypertension, a cross-sectional study based in a health institution was carried out using an interviewer-administered structured questionnaire and medical record review from 6 November 2022 to 18 January 2023. All hypertensive patients, ages 18 and older, who underwent regular follow-ups for at least 12 months were included in the study using a simple random sampling method. Multivariate logistic regression analysis was used to establish the association between independent variables and the occurrence of DTPs. Unnecessary drug therapy, the need for additional drug therapy, ineffective drugs, dosage too low, dosage too high, adverse drug reactions, and noncompliance were the outcome variables. Results The study included 376 hypertensive patients. Of the total participants, 258 (68.6%) were female. The mean number of drug therapy problems per patient was 1.55 ± 0.307, with 298 participants (79.3%) reporting having at least one such problem. This study found that the need for additional drug therapy was the most prevalent problem (149, 39.66%). Polypharmacy (AOR = 2.487, 95% CI = 1.375-4.499, p = 0.003), presence of comorbidity (AOR = 1.886, 95% CI = 1.035-3.439, p = 0.038), and uncontrolled BP (AOR = 2.961, 95% CI = 1.669-5.254, p = <0.001) predicts the development of drug therapy problems. Conclusion Patients with hypertension who are on follow-up experience drug therapy problems frequently. Promoting the involvement of clinical pharmacists in designing, implementing, and monitoring therapeutic plans is recommended to decrease the occurrence of drug therapy problems.
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Affiliation(s)
- Tenaw Baye
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Fentaw Girmaw
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Getachew Ashagrie
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Health Science, Woldia University, Woldia, Ethiopia
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Barega B, Seifu L, Melkie A, Abebe S, Taye M. Blood Pressure Control among Adults with Hypertension at a Tertiary Hospital in Ethiopia. Ethiop J Health Sci 2023; 33:563-570. [PMID: 38784211 PMCID: PMC11111181 DOI: 10.4314/ejhs.v33i4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2024] Open
Abstract
Background Uncontrolled hypertension is a leading modifiable risk factor for cardiovascular disease morbidity and mortality. Despite the availability of several effective blood pressure lowering drugs, hypertension control rates remain poor globally. This study aimed to define the level of blood pressure control and to determine the factors associated with poor hypertension control. Methods A hospital-based cross-sectional study was conducted from January to March 2019 at Tikur Anbessa Specialized Hospital among randomly selected 369 patients with hypertension. Data were collected using a pre-tested structured questionnaire. Multivariate binary logistic regression was used to identify determinants of blood pressure control. Results The mean (SD) age of the study participants was 55.5 (13.2) years; 188 (50.9%) were males and 28 (7.6%) were active smokers. More than half of the patients (56.0%) were overweight or obese. The most commonly identified comorbidities were diabetes mellitus (48.0%), dyslipidemia (50.9%), and chronic kidney disease (56.1%). The mean (SD) systolic blood pressure was 140.6 (22) mmHg, and diastolic blood pressure was 85.8 (14) mmHg. About two-thirds of the patients (60.2%) had uncontrolled blood pressure. The factors associated with poor blood pressure control with an AOR (95% CI) were increasing age: 1.05 (1.00-1.11), increasing household income: 1.25 (1.04-1.49), being physically inactive: 7.64 (1.14-51.13), chronic kidney disease: 5.36 (1.14-5.16), and use of home blood pressure monitoring: 0.31 (0.102-0.94). Conclusion The rate of blood pressure control in patients with hypertension was suboptimal. Age, household income, level of physical activity, chronic kidney disease, and use of home blood pressure monitoring were independent predictors of blood pressure control. It is important to optimize the treatment of hypertension in this high-risk group by implementing effective strategies.
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Affiliation(s)
- Binyam Barega
- Department of Internal Medicine, Ras Desta Hospital, Addis Ababa, Ethiopia
| | - Lissane Seifu
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Addisu Melkie
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sintayehu Abebe
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melaku Taye
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ahmad H, Khan H, Haque S, Ahmad S, Srivastava N, Khan A. Angiotensin-Converting Enzyme and Hypertension: A Systemic Analysis of Various ACE Inhibitors, Their Side Effects, and Bioactive Peptides as a Putative Therapy for Hypertension. J Renin Angiotensin Aldosterone Syst 2023; 2023:7890188. [PMID: 37389408 PMCID: PMC10307051 DOI: 10.1155/2023/7890188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 07/01/2023] Open
Abstract
Hypertension is a major risk factor for heart attack, produce atherosclerosis (hardening of the arteries), congestive heart failure, stroke, kidney infection, blindness, end-stage renal infection, and cardiovascular diseases. Many mechanisms are involved in causing hypertension, i.e., via calcium channels, alpha and beta receptors, and the renin-angiotensin system (RAS). RAS has an important role in blood pressure control and is also involved in the metabolism of glucose, homeostasis, and balance of electrolytes in the body. The components of RAS that are involved in the regulation of blood pressure are angiotensinogen, Ang I (angiotensin I), Ang II (angiotensin II), ACE (angiotensin-converting enzyme), and ACE 2 (angiotensin-converting enzyme 2). These components provide for relevant therapeutic targets for the treatment of hypertension, and various drugs are commercially available that target individual components of RAS. Angiotensin receptor blockers (ARBs) and ACE inhibitors are the most popular among these drugs. ACE is chosen in this review as it makes an important target for blood pressure control because it converts Ang I into Ang II and also acts on the vasodilator, bradykinin, to degrade it into inactive peptides. This review highlights various aspects of blood pressure regulation in the body with a focus on ACE, drugs targeting the components involved in regulation, their associated side effects, and a need to shift to alternative therapy for putative hypertension treatment in the form of bioactive peptides from food.
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Affiliation(s)
- Hafiz Ahmad
- RAK College of Medical Sciences, RAK Medical & Health Sciences University, Ras al Khaimah, UAE
- Microbiology and Molecular Division-RAK Hospital, Ras al Khaimah, UAE
| | - Huma Khan
- Faculty of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, India
| | - Shabirul Haque
- The Feinstein Institute of Medical Research, Northwell Health, Manhasset, NY, USA
| | - Shameem Ahmad
- Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India
| | - Namita Srivastava
- Faculty of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, India
| | - Azhar Khan
- Faculty of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, India
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Solomon M, Negussie YM, Bekele NT, Getahun MS, Gurara AM. Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study. BMC Cardiovasc Disord 2023; 23:258. [PMID: 37198582 DOI: 10.1186/s12872-023-03290-z] [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: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Uncontrolled blood pressure is an important medical and public health problem in developing countries like Ethiopia. Improving the management of hypertension requires a better comprehension of the factors influencing blood pressure control and the application of interventions. But in clinical practice, blood pressure is still not adequately controlled. Thus, this study aimed to assess uncontrolled blood pressure and associated among adult hypertensive patients on follow-up at public health facility ambulatory clinics in Bishoftu, Ethiopia. METHODS A hospital-based cross-sectional study was conducted among 398 adult hypertensive patients who were on treatment and follow-up from April to May 31, 2022. Systematic random sampling was used to select study participants. Data were collected using an interviewer-administered, semi-structured questionnaire and chart review. The Eighth Joint National Committee (JNC 8) criteria was applied to define blood pressure control status. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association. Finally, at a p-value < 0.05, statistical significance was proclaimed. RESULT Of the total study participants, 249(62.6%) were male. The mean age was 62.26 ± 11.55 years. The overall proportion of uncontrolled blood pressure was 58.8% (95% CI: 54-64). Salt intake (AOR = 2.51; 95% CI: 1.49-4.24), lack of physical activity (AOR = 1.40; 95% CI: 1.10-2.62), habitual coffee consumption (AOR = 4.52; 95% CI: 2.67-7.64), higher BMI (AOR = 2.08; 95% CI: 1.24-3.49), and non-adherence to antihypertensive medications (AOR = 2.31; 95% CI: 1.3-3.89) were independent predictors of uncontrolled blood pressure. CONCLUSION More than half of the hypertensive patients in this study had uncontrolled blood pressure. Healthcare providers and other accountable stakeholders should urge patients to follow salt restriction, physical activity, and antihypertensive medication regimes. Reduced coffee consumption and weight maintenance are other crucial blood pressure control measures.
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Affiliation(s)
- Menawork Solomon
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
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Jo W, Koh ES, Chung S. Therapeutic roles of thiazides and loop diuretics in blood pressure control and renal protection against chronic kidney disease. Clin Hypertens 2023; 29:14. [PMID: 37183259 PMCID: PMC10184374 DOI: 10.1186/s40885-023-00238-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/17/2023] [Indexed: 05/16/2023] Open
Abstract
Fluid overload secondary to loss of functional nephron mass can elevate blood pressure, which is characteristic of hypertension shown in chronic kidney disease (CKD). Therefore, it is logical to use diuretics at appropriate dose to lower blood pressure in patients with CKD and hypertension. Despite the theoretical background on the use of diuretics in CKD, there have been no definitive data on the effectiveness or safety of diuretics as first-line therapy for the management of hypertension in patients with CKD. Results from some clinical trials have demonstrated that diuretics would not lower blood pressure. They could even worsen electrolyte imbalance and kidney function when they are administered in patients with CKD. Major clinical practice guidelines on management of blood pressure or CKD have stated that evidence for benefits of thiazide diuretics is not conclusive yet in patients with advanced CKD, although loop diuretics are often effective for volume control at lower glomerular filtration rate. Recently, evidence for diuretics as effective blood pressure lowering agents in patients with advanced CKD is increasing. Renoprotective effect of thiazide or loop diuretics might represent a consequence of their influence on blood pressure or their ability to potentiate the effect of renin-angiotensin system blockade by making intraglomerular pressure more renin-angiotensin system-dependent, although their direct benefit on renal function remains controversial. This review summarizes recent data on the possible role of diuretics in lowering blood pressure, slowing the progression of kidney disease, and reducing cardiovascular risk in CKD patients.
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Affiliation(s)
- Wonji Jo
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Sil Koh
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungjin Chung
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Souza PDO, de Oliveira JMP, Januário LH. Influence of Arm Fat on the Indirect Measurement of Blood Pressure: A Statistical and Machine Learning Approach. Arq Bras Cardiol 2023; 120:e20220484. [PMID: 37194829 PMCID: PMC10348388 DOI: 10.36660/abc.20220484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/16/2022] [Accepted: 02/15/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The indirect measurement of blood pressure (BP) is known to be influenced by many factors such as the technique, observer, and equipment; however, the influence of arm composition has not been investigated yet. OBJECTIVE To identify the influence of arm fat on the indirect measurement of blood pressure using statistical inference and machine learning models. METHODS Cross-sectional study, with 489 healthy young adults aged from 18 to 29 years old. Measurements of arm length (AL), arm circumference (AC) and arm fat index (AFI) were taken. BP was measured in both arms simultaneously. Data were processed using Python 3.0 and its specific packages for descriptive analysis, regression and cluster analysis. Significance levels: 5% for all calculations. RESULTS BP and anthropometric measurements were different between the hemi-bodies. In the right arm, systolic blood pressure (SBP), AL and AFI were higher, while AC was similar compared with the left arm. AL and AC showed positive correlation with SBP. According to the regression model, for a fixed value of AC and AL, SBP readings could be reduced by a mean of 1.80 mmHg in the right arm, and 1.62 mmHg in the left arm for every 10% increase in AFI. Clustering analysis corroborated the regression results. CONCLUSION There was a significant influence of AFI on BP readings. SBP had a positive correlation with AL and AC, and a negative correlation with AFI, suggesting the need for further investigations on the relationship between BP and percentages of arm muscle and fat.
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Affiliation(s)
- Paôla de Oliveira Souza
- Instituto Federal de Minas GeraisIbiritéMGBrasilInstituto Federal de Minas Gerais, Ibirité, MG – Brasil
| | - José Maria Parente de Oliveira
- Instituto Tecnológico de AeronáuticaSão José dos CamposSPBrasilInstituto Tecnológico de Aeronáutica, São José dos Campos, SP – Brasil
| | - Letícia Helena Januário
- Universidade Federal de São João del-ReiDivinópolisSPBrasilUniversidade Federal de São João del-Rei, Divinópolis, SP – Brasil
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Chrysant SG. The debate over the optimal blood pressure treatment target of less than 130/80 mmHg. Postgrad Med 2023; 135:208-213. [PMID: 35285378 DOI: 10.1080/00325481.2022.2052516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to analyze the controversy regarding the optimal blood pressure (BP) target of <130/80 mmHg as proposed by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) across all age groups. Hypertension is a major risk factor for cardiovascular disease (CVD), stroke, and chronic kidney disease (CKD), and its optimal control is associated with lessening or preventing these complications. A recent study has argued that this BP level is universally accepted as an optimal and safe BP level. However, this argument is not accepted by other investigators, arguing that higher BP levels are as effective and safe. METHODS In order to investigate the current status of this level of BP control, a Medline search of the English literature was conducted between 2017 and February 2022, and 25 pertinent papers were selected. RESULTS The analysis of data from these studies indicates that these BP are effective in lowering the BP and preventing cardiovascular disease, heart failure, and chronic kidney disease, and they are indeed universally accepted. CONCLUSION Based on the current evidence, the current proposed by the 2017 ACC/AHA treatment guidelines are effective in lowering the BP and decreasing its cardiovascular complications and should followed, till perhaps, new data come out to the contrary.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Zhang Z, Chen Y, Wang Q, Xie L, Shan Y, Yang N, Wu W. Influence of fasting plasma glucose-lowering rate on BNP levels in type 2 diabetes mellitus patients with coronary microcirculation dysfunction. Hormones (Athens) 2023; 22:33-43. [PMID: 36369625 DOI: 10.1007/s42000-022-00404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/06/2022] [Indexed: 11/13/2022]
Abstract
AIM The aim was to analyze the influence of fasting plasma glucose-lowering rate (FPGLR) on plasma BNP levels in type 2 diabetes mellitus (T2DM) patients with coronary microcirculation dysfunction (CMD) and to determine the optimal FPGLR for these patients. METHODS A total of 170 T2DM patients who received intensive glucose-lowering therapy during hospitalization in the First Affiliated Hospital of Harbin Medical University were enrolled. Ninety-two patients with CMD and 78 patients without CMD were assigned to a study and a control group, respectively. The study group was stratified as S1 (4.1 ~ 6.0 mmol·L-1·day-1), S2 (2.1 ~ 4.0 mmol·L-1·day-1), and S3 (≤ 2.0 mmol·L-1·day-1) by different FPGLR, and the same in the control group (C1, C2, and C3). The plasma BNP levels with the same FPGLR were compared between the study and the control group, and patients with a different FPGLR in the study group were also compared. RESULTS In the study and the control group, the BNP level in S1 was significantly higher than that in C1 (87 vs. 12 pg/ml, P < 0.001), although there was no significant difference between S2 and C2, S3 and C3. In the study group, the BNP level in S1 was significantly higher than that in S2 (87 vs. 22 pg/ml, P < 0.001) and S3 (87 vs. 15 pg/ml, P < 0.001), but there was no significant difference between S2 and S3. CONCLUSION Rapid intensive glucose-lowering may lead to increased plasma BNP levels in T2DM patients with CMD. Optimal FPGLR for these patients was determined to be no more than 4.0 mmol·L-1·day-1.
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Affiliation(s)
- Ziying Zhang
- Department of Endocrinology, The Third Affiliated Hospital of Shenzhen University, Shenzhen, 518000, People's Republic of China
| | - Yangwen Chen
- The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Qian Wang
- The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Lingli Xie
- Department of Endocrinology, The Third Affiliated Hospital of Shenzhen University, Shenzhen, 518000, People's Republic of China
| | - Yongyan Shan
- The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Ning Yang
- The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China.
| | - Weihua Wu
- Department of Endocrinology, The Third Affiliated Hospital of Shenzhen University, Shenzhen, 518000, People's Republic of China.
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Tebelu DT, Tadesse TA, Getahun MS, Negussie YM, Gurara AM. Hypertension self-care practice and its associated factors in Bale Zone, Southeast Ethiopia: A multi-center cross-sectional study. J Pharm Policy Pract 2023; 16:20. [PMID: 36732868 PMCID: PMC9893557 DOI: 10.1186/s40545-022-00508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hypertension is a serious threat to public health globally owing to its high prevalence and related complications. It is the main risk factor for cardiovascular disease, kidney disease, eye problems, and death. Self-care practices have been emphasized as a major element in reducing and preventing complications from hypertension. Thus, this study aimed to assess hypertension self-care practices and associated factors in Bale Zone, Southeast Ethiopia. METHODS A health facility-based cross-sectional study was conducted at three public hospitals from April 1 to May 31, 2021. Data were entered into Epi-Data version 4.6 and exported to Statistical Package for the Social Sciences (SPSS) version 25.0 for analysis. The study participants were characterized using descriptive statistics. The associations between self-care practice and independent variables were modeled using binary logistic regression analysis. Adjusted odds ratios with a 95% confidence interval were used to estimate the association between self-care practice and independent variables. The statistical significance of the association was declared at p < 0.05. RESULTS This study involved 405 hypertensive patients, with a response rate of 96.7%. The overall level of good self-care practice was 33.1% (95% CI: 28.6, 37.5). The multivariable logistic regression model showed that age under 65 years (AOR = 3.77, 95% CI: 1.60-8.89), good knowledge of hypertension self-care practice (AOR = 6.36, 95% CI: 2.07-19.56), absence of a depression (AOR = 6.08, 95% CI: 1.24-29.73) and good self-efficacy (AOR = 3.33, 95% CI: 1.12-9.87) were independent predictors of good self-care practice. CONCLUSION The level of good hypertension self-care practice in the study area was low. Hence, it is crucial to expand non-communicable disease control programs and implement public health interventions on self-care for hypertension. Moreover, to enhance hypertension self-care practices, patient-centered interventions are essential.
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Ammann EM, O’Brien ES, Milentijevic D, Kharat AA, Talbot DA, Canovatchel W, Haskell L, Andrawis NS. Characteristics, management, and blood pressure control in patients with apparent resistant hypertension in the US. Heliyon 2023; 9:e13258. [PMID: 36846680 PMCID: PMC9950828 DOI: 10.1016/j.heliyon.2023.e13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Background Per treatment guidelines, resistant hypertension is defined as uncontrolled blood pressure (BP) while taking 3 concomitant antihypertensives (AHTs) or controlled BP while taking ≥4 AHTs. Characteristics, AHT therapy use, and BP control were analyzed in US patients with hypertension who were prescribed ≥3 classes of AHT medications. Methods This retrospective analysis of the Optum® Electronic Health Record Database evaluated patients ≥18 years of age with a diagnosis of hypertension classified based on the number of prescribed AHT medication classes (3, 4, or ≥5). For the primary analysis, uncontrolled hypertension was defined as systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg. For secondary analyses, uncontrolled hypertension was defined as SBP ≥130 mmHg or DBP ≥80 mmHg. Results 207,705 patients with hypertension and concurrent use of ≥3 AHT medication classes were included. Diuretics, beta blockers, ACE inhibitors and/or ARBs, and CCBs were the most prescribed classes; thiazides and thiazide-like agents were the most prescribed diuretics. Among patients who were prescribed 3, 4, or ≥5 AHT medication classes, approximately 70% achieved a BP goal of <140/90 mmHg; approximately 40% achieved BP <130/80 mmHg. After ≥1 year of follow-up, the number of concurrent AHT medication classes was unchanged from baseline in the majority of patients and the prevalence of uncontrolled hypertension (≥140/90 mmHg) was similar. Conclusions This study illustrates suboptimal BP control in many patients with apparent resistant hypertension despite the use of multidrug regimens and suggests a need for new drug classes and regimens that effectively manage resistant hypertension.
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Affiliation(s)
| | - Ellen S. O’Brien
- Janssen Global Services, LLC, Horsham, PA, USA
- Corresponding author. Janssen Global Services, LLC, 800 Ridgeview Drive, Horsham, PA, USA.
| | | | | | | | | | - Lloyd Haskell
- Janssen Research & Development, LLC, Raritan, NJ, USA
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Mohammed SAD, Hanxing L, Fang L, Algradi AM, Alradhi M, Safi M, Shumin L. Integrated Chinese herbal medicine with Western Medicine versus Western Medicine in the effectiveness of primary hypertension treatment: A systematic review and meta-analysis of randomized controlled trials. JOURNAL OF ETHNOPHARMACOLOGY 2023; 300:115703. [PMID: 36096347 DOI: 10.1016/j.jep.2022.115703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/30/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Integrated Chinese herbal medicine (CHM) and Western Medicine (WM) treatments have been used for primary hypertension (PHTN) patients in China. Currently, there are many randomized control trials (RCTs) published regarding the effect of CHM and WM on PHTN, which indicated that combining Chinese with WM was effective and safe for PHTN when compared with WM alone, but the quality of evidence was insufficient, and there is no clear information and summary are available for these RCTs assessing the effectiveness of CHM with WM versus WM in patients with PHTN. OBJECTIVES This systematic study and meta-analysis aimed to evaluate the effectiveness and safety of CHM combined with WM in comparison with WM in reducing systolic and diastolic blood pressure for patients with PHTN. METHODS The information of this study was searched from electronic databases (PubMed, COCHRANE, EMBASE, Ovid, CNKI, VIP, Wanfang, and CBM). The markedly effective and effective terms were according to Guiding Principles for Clinical Research of New Chinese Medicines. Two investigators independently reviewed each trial. The Cochrane risk of bias assessment tool was used for quality assessment, and RevMan 5.4 was used for meta-analysis. RESULTS In this study, a total of 29 studies that included 2623 patients were recorded. The study results displayed that the clinical effectiveness in the treatment of hypertension patients from the integrated medicines was considerably higher than that with WM alone, clinical effective (RR 1.23, 95% CI [1.17, 1.30], P < 0.00001), and markedly effective (ME) in the patients (RR 1.66, 95% CI [1.52, 1.80], and P < 0.00001). Random effect in SBP (MD 7.91 mmHg,[6.00, 983], P < 0.00001) and DBP (MD 5.46 mmHg, [3.88, 6.43], P < 0.00001), a subgroup analysis was carried out based on the type of intervention, duration of treatment, and CHM formulas that showed significance. Furthermore, no severe side effects were reported, and no patients stopped treatment or withdrawal due to any severe adverse events. CONCLUSION Compared to WM alone, the therapeutic effectiveness of CHM combined with WM is significantly improved in the treatment of hypertension. Additionally, CHM with WM may safely and efficiently lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in individuals with PHTN. However, rigorous randomized controlled trials with a large sample, high quality, long duration of treatment, and follow-up are recommended to strengthen this clinical evidence.
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Affiliation(s)
- Shadi A D Mohammed
- Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China; School of Pharmacy, Lebanese International University, 18644, Sana'a, Yemen
| | - Liu Hanxing
- Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Lu Fang
- Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Adnan Mohammed Algradi
- Key Laboratory of Chinese Materia Medica, Ministry of Education of Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China
| | - Mohammed Alradhi
- Department of Urology, Affiliated Hospital of Qingdao Binhai University, Qingdao, Shandong, China
| | - Mohammed Safi
- Department of Respiratory Diseases, Shandong Second Provincial General Hospital, Shandong University, Shandong, China
| | - Liu Shumin
- Heilongjiang University of Chinese Medicine, Harbin, 150040, Heilongjiang, China.
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Song X, Liu Y, Wang S, Zhang H, Qiao A, Wang X. Non-invasive hemodynamic diagnosis based on non-linear pulse wave theory applied to four limbs. Front Bioeng Biotechnol 2023; 11:1081447. [PMID: 36970627 PMCID: PMC10033961 DOI: 10.3389/fbioe.2023.1081447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction: Hemodynamic diagnosis indexes (HDIs) can comprehensively evaluate the health status of the cardiovascular system (CVS), particularly for people older than 50 years and prone to cardiovascular disease (CVDs). However, the accuracy of non-invasive detection remains unsatisfactory. We propose a non-invasive HDIs model based on the non-linear pulse wave theory (NonPWT) applied to four limbs. Methods: This algorithm establishes mathematical models, including pulse wave velocity and pressure information of the brachial and ankle arteries, pressure gradient, and blood flow. Blood flow is key to calculating HDIs. Herein, we derive blood flow equation for different times of the cardiac cycle considering the four different distributions of blood pressure and pulse wave of four limbs, then obtain the average blood flow in a cardiac cycle, and finally calculate the HDIs. Results: The results of the blood flow calculations reveal that the average blood flow in the upper extremity arteries is 10.78 ml/s (clinically: 2.5-12.67 ml/s), and the blood flow in the lower extremity arteries is higher than that in the upper extremity. To verify model accuracy, the consistency between the clinical and calculated values is verified with no statistically significant differences (p < 0.05). Model IV or higher-order fitting is the closest. To verify the model generalizability, considering the risk factors of cardiovascular diseases, the HDIs are recalculated using model IV, and thus, consistency is verified (p < 0.05 and Bland-Altman plot). Conclusion: We conclude our proposed algorithmic model based on NonPWT can facilitate the non-invasive hemodynamic diagnosis with simpler operational procedures and reduced medical costs.
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Affiliation(s)
- Xiaorui Song
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
| | - Yi Liu
- Department of Ultrasound, Taian Maternity and Child Health Care Hospital, Tai’an, China
| | - Sirui Wang
- Graduate School of Engineering, Chiba University, Chiba, Japan
| | - Honghui Zhang
- College of Engineering, Inner Mongolia Minzu University, Tongliao, China
| | - Aike Qiao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Xuezheng Wang
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
- Department of Medical Image, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
- *Correspondence: Xuezheng Wang,
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Hypertension and cardiomyopathy associated with chronic kidney disease: epidemiology, pathogenesis and treatment considerations. J Hum Hypertens 2023; 37:1-19. [PMID: 36138105 PMCID: PMC9831930 DOI: 10.1038/s41371-022-00751-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Chronic kidney disease (CKD) is a complex condition with a prevalence of 10-15% worldwide. An inverse-graded relationship exists between cardiovascular events and mortality with kidney function which is independent of age, sex, and other risk factors. The proportion of deaths due to heart failure and sudden cardiac death increase with progression of chronic kidney disease with relatively fewer deaths from atheromatous, vasculo-occlusive processes. This phenomenon can largely be explained by the increased prevalence of CKD-associated cardiomyopathy with worsening kidney function. The key features of CKD-associated cardiomyopathy are increased left ventricular mass and left ventricular hypertrophy, diastolic and systolic left ventricular dysfunction, and profound cardiac fibrosis on histology. While these features have predominantly been described in patients with advanced kidney disease on dialysis treatment, patients with only mild to moderate renal impairment already exhibit structural and functional changes consistent with CKD-associated cardiomyopathy. In this review we discuss the key drivers of CKD-associated cardiomyopathy and the key role of hypertension in its pathogenesis. We also evaluate existing, as well as developing therapies in the treatment of CKD-associated cardiomyopathy.
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Ramoshaba NE, Fihla MQ, Mthethwa WS, Tshangela L, Mampofu ZM. Neck Circumference and Blood Pressure Measurements among Walter Sisulu University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15235. [PMID: 36429953 PMCID: PMC9690920 DOI: 10.3390/ijerph192215235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Hypertension is a public health problem in South Africa. Increases in subcutaneous fat, presented by the neck circumference (NC) value, contribute to and predict the development of hypertension. However, to date, there has been no study done to investigate the relationship between the NC and blood pressure (BP) among historically disadvantaged university students. Therefore, the aim of the study was to investigate the relationship between the NC and BP among Walter Sisulu University students. This cross-sectional study was conducted in Walter Sisulu University. All 127 students were aged 18 years and above and underwent NC and clinical BP measurements using standard procedures. In a Pearson's correlation analysis, the NC positively correlated with both the systolic blood pressure (SBP) (r = 0.5; p < 0.001) and diastolic blood pressure (DBP) (r = 0.3; p < 0.001). Furthermore, in the multivariable-adjusted regression analysis, the NC was positively associated with both the SBP (adjusted R2 = 0.3, β = 2.0 (95% CI = 1.1; 2.9), p < 0.001) and DBP (adjusted R2 = 0.1 β = 0.950 (95% CI = 0.3; 1.6), p = 0.008) adjusted for age, gender, body mass index, waist-to-height ratio, alcohol, and smoking. The NC is related to BP among historically disadvantaged university students.
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