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Zhang Y, Kong X, Song K, He M, Xian Y, Xie X, Cheng J, Bai R, Ren Y. Long-Term Protective Effects and Mechanisms of Gastric Bypass Surgery on the Kidneys in Hypertensive Obese Rat. Obes Surg 2024; 34:1257-1266. [PMID: 38396260 DOI: 10.1007/s11695-024-07108-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Investigate the long-term protective effects of gastric bypass surgery on the kidneys of hypertensive obese rats to better understand the role of gastric bypass surgery in preventing renal injury in humans with hypertension and obesity. METHODS Compare 6-week-old spontaneously hypertensive rats, including 30 Roux-en-Y gastric bypass (RYGB) and 30 sham operations. Body weight and blood pressure were monitored before and up to 12 months after the operation. Blood lipids, blood creatinine, and blood urea nitrogen were measured. Kidney pathology was assessed using HE staining, while renal fibrosis was observed via Masson staining. Inflammatory indicators were examined by ELISA. The expression of the NLRP3 gene in the kidney was measured using immunofluorescence and western blot, and the changes in key pathways including ASC/IL-1β protein were verified. RESULTS RYGB reduced the body weight of hypertensive obese rats and had a protective effect on blood pressure. Additionally, the bypass effectively mitigated renal inflammation and fibrosis. Moreover, RYGB modulated the expression of NLRP3 and prevented kidney damage via the ASC/IL-1 pathway. CONCLUSION This study validates that RYGB effectively attains sustained blood pressure control in hypertensive obese rats and has a potential kidney-protective mechanism via the NLRP3-ASC/IL-1β pathway.
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Affiliation(s)
- Yuan Zhang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong City, 637000, Sichuan Province, China
- Institute of Hepatobiliary, Pancreatic and Gastroenterology, North Sichuan Medical College, Nanchong, 637000, China
| | - Xiangxin Kong
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong City, 637000, Sichuan Province, China
- Institute of Hepatobiliary, Pancreatic and Gastroenterology, North Sichuan Medical College, Nanchong, 637000, China
| | - Ke Song
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong City, 637000, Sichuan Province, China
- Institute of Hepatobiliary, Pancreatic and Gastroenterology, North Sichuan Medical College, Nanchong, 637000, China
| | - Ming He
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong City, 637000, Sichuan Province, China
| | - Yin Xian
- Nanchong Psychosomatic Hospital, Nanchong, 637000, China
| | - Xing Xie
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong City, 637000, Sichuan Province, China
| | - Junming Cheng
- People's Hospital of Dazhu County, Dazhou, 635100, Sichuan Province, China
| | - Rubing Bai
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong City, 637000, Sichuan Province, China
| | - Yixing Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong City, 637000, Sichuan Province, China.
- General Surgery, Xinhua Hospital, Chengdu, 610000, China.
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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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Fink JT, Magnan EM, Johnson HM, Bednarz LM, Allen GO, Greenlee RT, Bolt DM, Smith MA. Blood Pressure Control and Other Quality of Care Metrics for Patients with Obesity and Diabetes: A Population-Based Cohort Study. High Blood Press Cardiovasc Prev 2018; 25:391-399. [PMID: 30328045 PMCID: PMC6400223 DOI: 10.1007/s40292-018-0284-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION There are no population-level estimates in the United States for achievement of blood pressure goals in patients with diabetes and hypertension by obesity weight class. AIM We sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. METHODS We conducted an observational population-based cohort study of electronic health data of three large health systems from 2010-2012 in rural, urban and suburban settings of 51,229 adults with diabetes. Outcomes were achievement of diabetes quality of care metrics: blood pressure, A1c, and LDL control, and A1c and LDL testing. Two blood pressure goals were examined given the recommendation for adults with diabetes of 130/80 mmHg from JNC7 and the recommendation of 140/90 mmHg from JNC8 in 2014. RESULTS Patients in obesity classes I, II, and III with diagnosed hypertension were less likely to achieve blood pressure control at both the 140/90 mmHg and 130/80 mmHg control levels. The patients from obesity class III had the lowest likelihood of achieving control at the 130/80 mmHg goal, and control was markedly worse for the 130/80 mmHg threshold in all weight classes. There were minimal to no differences by weight class in LDL and A1c control and LDL and A1c testing. CONCLUSIONS Although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, we found that patients with obesity are even further behind in achieving blood pressure control.
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Affiliation(s)
- Jennifer T Fink
- Department of Health Informatics and Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI, USA
| | - Elizabeth M Magnan
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA
| | - Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lauren M Bednarz
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Dr., Suite 210-31, Madison, WI, 53705, USA
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glenn O Allen
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert T Greenlee
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin School of Education, Madison, WI, USA
| | - Maureen A Smith
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Dr., Suite 210-31, Madison, WI, 53705, USA.
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Animut Y, Assefa AT, Lemma DG. Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study. Integr Blood Press Control 2018; 11:37-46. [PMID: 29720880 PMCID: PMC5918628 DOI: 10.2147/ibpc.s150628] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Large segments of the hypertensive population in the world are either untreated or inadequately treated. The incidence of heart failure and mortality from cardiovascular complications of hypertension is high among patients with uncontrolled blood pressure (BP). But BP control status of hypertensive patients has not been investigated in the study area. The study aimed to assess BP control status and determinant factors among adult hypertensive patients on antihypertensive medication attending outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia. Methods An institution-based retrospective follow-up study was conducted from September 2015 to April 2016. Data were collected using a structured and pretested questionnaire adopted from the World Health Organization STEPwise approach. BP records of 6 months were used, and patients were classified as having controlled BP if their BP readings were <140/90 mmHg for all adults ≥18 years of age and <150/90 mmHg for adults aged ≥60 years. A generalized estimating equation was fitted, and the odds ratio with a 95% confidence level was used to determine the effect of covariates on BP control status. Results Among 395 participants, 50.4% (95% CI: 45–55) of them controlled their BP in the last 6 months of the survey. Physical activity (adjusted odds ratio [AOR]=1.95, 95% CI: 1.41–2.68), duration on antihypertensive drugs of 2–4 years (AOR=1.70, 95% CI: 1.13–2.56) and 5 years or more (AOR=1.96, 95% CI: 1.32–2.92), and high adherence (AOR=2.18, 95% CI: 1.14–4.15) to antihypertensive drugs were positively associated with BP control, while salt intake (AOR=0.67, 95% CI: 0.49–0.93), overweight (AOR=0.50, 95% CI: 0.36–0.68), and obesity (AOR=0.56, 95% CI: 0.36–0.87) were inversely associated with BP control. Conclusion In this study, only half of the hypertensive patients controlled their BP. Thus, health care providers need to be made aware about the importance of counseling hypertensive patients on drug adherence, moderate physical activity, and salt restriction to improve BP control.
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Affiliation(s)
- Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemu Takele Assefa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereseh Gezie Lemma
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Supriya R, Yung BY, Yu AP, Lee PH, Lai CW, Cheng KK, Yau SY, Chan LWC, Sheridan S, Siu PM. Adipokine Profiling in Adult Women With Central Obesity and Hypertension. Front Physiol 2018; 9:294. [PMID: 29636702 PMCID: PMC5881161 DOI: 10.3389/fphys.2018.00294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Central obesity and hypertension are common risk factors for the metabolic syndrome, cardiovascular and renal diseases. Studies have shown that it is more difficult to control blood pressure and prevent end-organ damage in obese individuals with hypertension compared to their non-obese counterparts, especially among women. Obese females have a 6 times higher risk of developing hypertension than non-obese females while obese males are at a 1.5 times higher risk of developing hypertension, compared to their non-obese counterparts. Indeed, the inter-relationship between obesity and hypertension is unclear. Adipokines have been proposed to play a mediating role in the relationship between obesity and hypertension and are involved in the pathogenesis of metabolic diseases. Therefore, this study sought to determine the role of adipokines (adiponectin, plasminogen activator inhibitor-1, leptin, and tumor necrosis factor-α) in hypertensive Hong Kong Chinese women with central obesity. A total of 387 women aged 58 ± 11 years who were examined with a 2 × 2 factorial design for central obesity (waist circumference ≥ 80 cm) and hypertension (blood pressure ≥ 140/90 mmHg), were recruited from a pool of 1,492 Hong Kong Chinese adults who were previously screened for metabolic syndrome. Subjects with hyperglycemia, hypertriglyceridemia, and dyslipidemia were excluded to eliminate confounding effects. Our findings revealed that hypertensive women with central obesity had a lower anti-inflammatory status (adiponectin) and a higher pro-inflammatory status (TNF-α) than obese alone or hypertensive alone women. Also, women with central obesity had higher circulatory PAI-1 and leptin concentrations than their non-obese counterparts. We conclude that obesity may shift toward a more pro-inflammatory state and may become more severe in the presence of hypertension or vice versa.
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Affiliation(s)
- Rashmi Supriya
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Benjamin Y Yung
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Angus P Yu
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Paul H Lee
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Christopher W Lai
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kenneth K Cheng
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Suk Y Yau
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Lawrence W C Chan
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sinead Sheridan
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Parco M Siu
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
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