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Zhong L, Liu S, Yang Y, Xie T, Liu J, Zhao H, Tan G. Metabolic syndrome and risk of subclinical hypothyroidism: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1399236. [PMID: 38982986 PMCID: PMC11231392 DOI: 10.3389/fendo.2024.1399236] [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: 03/11/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Abstract
Background Subclinical hypothyroidism (SCH) is a common endocrine subclinical disorder, the main adverse consequences of which are the development of clinical hypothyroidism and the promotion of ischemic heart disease. Metabolic syndrome (MetS) is a collection of metabolic problems. The goal of this meta-analysis was to evaluate the relationship between MetS and SCH. Methods Suitable publications were identified using PubMed, Embase, and the Cochrane Library. The meta-analysis included only studies in English that reported odds ratio (OR) data for MetS and SCH. Two researchers combined data using a random-effects model. OR and 95% confidence intervals (CIs) were used to present the results. Results MetS was associated with an elevated risk of developing SCH (OR 2.56, 95% CI 1.44-4.55). However, the individual components of MetS were not associated with the risk of SCH. Subgroup analysis revealed that different definitions of MetS had varying effects on SCH. Sensitivity analysis confirmed that our results were robust. Conclusions This meta-analysis indicates that patients with MetS have an increased risk of SCH, while there is no significant association between the five individual components of MetS and the risk of SCH. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023454415.
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Affiliation(s)
- Lei Zhong
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuo Liu
- Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yao Yang
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Tong Xie
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Jifeng Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Huahui Zhao
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Guang Tan
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Cai P, Lin Q, Lv D, Zhang J, Wang Y, Wang X. Establishment of a scoring model for the differential diagnosis of white coat hypertension and sustained hypertension. Blood Press Monit 2023; 28:185-192. [PMID: 37115849 PMCID: PMC10309104 DOI: 10.1097/mbp.0000000000000646] [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: 10/01/2022] [Accepted: 03/19/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES This study aimed to establish a scoring model for the differential diagnosis of white coat hypertension (WCH) and sustained hypertension (SHT). METHODS This study comprised 553 adults with elevated office blood pressure, normal renal function, and no antihypertensive medications. Through questionnaire investigation and biochemical detection, 17 parameters, such as gender and age, were acquired. WCH and SHT were distinguished by 24 h ambulatory blood pressure monitoring. The participants were randomly divided into a training set (445 cases) and a validation set (108 cases). The above parameters were screened using least absolute shrinkage and selection operator regression and univariate logistic regression analysis in the training set. Afterward, a scoring model was constructed through multivariate logistic regression analysis. RESULTS Finally, six parameters were selected, including isolated systolic hypertension, office systolic blood pressure, office diastolic blood pressure, triglyceride, serum creatinine, and cardiovascular and cerebrovascular diseases. Multivariate logistic regression was used to establish a scoring model. The R2 and area under the ROC curve (AUC) of the scoring model in the training set were 0.163 and 0.705, respectively. In the validation set, the R2 of the scoring model was 0.206, and AUC was 0.718. The calibration test results revealed that the scoring model had good stability in both the training and validation sets (mean square error = 0.001, mean absolute error = 0.014; mean square error = 0.001, mean absolute error = 0.025). CONCLUSION A stable scoring model for distinguishing WCH was established, which can assist clinicians in identifying WCH at the first diagnosis.
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Affiliation(s)
- Peng Cai
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Qingshu Lin
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Dan Lv
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Jing Zhang
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Yan Wang
- Department of Pharmacy, Key Laboratory of Basic Pharmacology of Ministry of Education Joint International Research Laboratory of Ministry Education, Zunyi Medical University, Zunyi
| | - Xukai Wang
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
- Department of Cardiology, Chongqing Hygeia Hospital, Chongqing, China
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3
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Eyyupkoca F, Kocak A, Yildirim O, Altintas MS, Ercan K, Sabanoglu C, Okutucu S. Is there a relationship between heart rate recovery and blood pressure in white coat hypertension? KARDIOLOGIIA 2022; 62:55-63. [PMID: 35569164 DOI: 10.18087/cardio.2022.4.n1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/14/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Aim Increasing evidence suggests that autonomic dysfunction may be involved in the etiology of white coat hypertension (WCH). The aim of this study was to evaluate cardiac autonomic function by using heart rate recovery (HRR) indices in patients with WCH classified according to their circadian rhythm type of blood pressure (BP).Material and methods This cross-sectional study included 120 participants over the age of 18 yrs, including 50 patients diagnosed with WCH and 70 healthy controls with normal in- and out-of-office BP and without any known disease. Circadian rhythm types, i.e., dippers and non-dippers, were identified using ambulatory BP monitoring. The HRR indices were calculated by subtracting the 1st-minute (HRR1), 2nd-minute (HRR2), and 3rd-minute (HRR3) heart rates from the maximal heart rate recorded during stress testing.Results The lesser decline in nighttime BP (6.4±2.14 and 13.3±2.2 mmHg, respectively; p<0.001) and the smaller mean HRR1 (25.5±3.0 and 30.3±3.1 beats / min, respectively; p<0.001) were evident in WCH non-dippers compared to WCH dippers. Linear regression analysis showed that HRR1 (β±SE=0.43±0.11; p<0.001) and diastolic BP at maximum exercise (β±SE=0.14±0.07; p=0.040) are independent risk factors for the blunted decline in nighttime BP.Conclusion Delayed recovery of heart rate after an exercise stress test is associated with non-dipper type of circadian rhythm of BP. This was more pronounced in WCH patients, and these patients are at risk of autonomic dysfunction.
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Zheng Z, Shen Y, Xia L, Xiao L, Sun Y, Wang H, Chen Z, Wu Y, Shi H, He J, Feng Y, Yin S. Thyroid-Related Hormone Levels in Clinical Patients With Moderately Severe-to-Profound Sudden Sensorineural Hearing Loss: A Prospective Study. Front Neurol 2021; 12:753270. [PMID: 34777223 PMCID: PMC8581239 DOI: 10.3389/fneur.2021.753270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: Sudden sensorineural hearing loss (SSNHL) is a common otological emergency, causing a measure of hearing loss and affecting the quality of life. This study aims to investigate the association of thyroid-related hormone levels with moderately severe-to-profound SSNHL. Methods: The study included 70 patients with moderately severe-to-profound SSNHL and 100 age- and sex-matched healthy controls. Peripheral venous blood samples were taken from the participants, and their thyroid-related hormone levels were measured at admission and 1 week after treatment. Results: In moderately severe-to-profound SSNaHL patients, the concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) (all P < 0.05) were significantly lower than in the control group. The TT3, TT4, FT3, and TSH levels were significantly higher in the effective group than in the ineffective group (all P < 0.05). Linear correlation analysis revealed that TSH level (R = 0.707, P < 0.05) elevation after treatment successfully predicted a favorable outcome of hearing recovery. Logistic regression analyses suggested low FT3 and TSH levels to be independent occurrence predictors, while the increase of TSH level may be an independent favorable outcome predictor. Conclusions: The results suggest that low FT3 and TSH levels are risk factors for moderately severe-to-profound SSNHL. By discovering the positive association between TSH elevation and hearing recovery, along with the potential novel predictors of FT3 and TSH, our study may contribute valuable insights to the research and treatment of moderately severe-to-profound SSNHL.
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Affiliation(s)
- Zhong Zheng
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Ying Shen
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Liang Xia
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Lili Xiao
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yuanyuan Sun
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hui Wang
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yaqin Wu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Haibo Shi
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jingchun He
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Xinhua Hospital, Shanghai, China
| | - Yanmei Feng
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Wang X, Wang H, Yan L, Yang L, Xue Y, Yang J, Yao Y, Tang X, Tong N, Wang G, Zhang J, Wang Y, Ba J, Chen B, Du J, He L, Lai X, Li Y, Yan Z, Liao E, Liu C, Liu L, Qin G, Qin Y, Quan H, Shi B, Sun H, Ye Z, Zhang Q, Zhang L, Zhu J, Zhu M, Li Y, Teng W, Shan Z. The Positive Association between Subclinical Hypothyroidism and Newly-Diagnosed Hypertension Is More Explicit in Female Individuals Younger than 65. Endocrinol Metab (Seoul) 2021; 36:778-789. [PMID: 34372624 PMCID: PMC8419610 DOI: 10.3803/enm.2021.1101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. METHODS Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. RESULTS The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. CONCLUSION The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.
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Affiliation(s)
- Xichang Wang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang,
China
| | - Haoyu Wang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang,
China
| | - Li Yan
- Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou,
China
| | - Lihui Yang
- Department of Endocrinology and Metabolism, People’s Hospital of the Tibet Autonomous Region, Lhasa, Tibet,
China
| | - Yuanming Xue
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming,
China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan,
China
| | - Yongli Yao
- Department of Endocrinology, Qinghai Provincial People’s Hospital, Xining,
China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou,
China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu,
China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun,
China
| | - Jinan Zhang
- Department of Endocrinology, Health Science Affiliated Zhoupu Hosipital, Shanghai University of Medicine, Shanghai,
China
| | - Youmin Wang
- Department of Endocrinology, The First Hospital of An Hui Medical University, Hefei,
China
| | - Jianming Ba
- Department of Endocrinology, Chinese PLA General Hospital, Beijing,
China
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing,
China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian,
China
| | - Lanjie He
- Department of Endocrinology, Cardiovascular and Cerebrovascular Disease Hospital of Ningxia Medical University, Yinchuan,
China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang,
China
| | - Yanbo Li
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin,
China
| | - Zhaoli Yan
- Department of Endocrinology, The Affiliated Hospital of Inner Mongolia Medical University. Hohhot,
China
| | - Eryuan Liao
- Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, Changsha,
China
| | - Chao Liu
- Research Center of Endocrine and Metabolic Diseases, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing,
China
| | - Libin Liu
- Department of Endocrinology and Metabolism, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou,
China
| | - Guijun Qin
- Division of Endocrinology, Department of Internal Medicine, The First Affiliated Hospital, Zhengzhou University, Zhengzhou,
China
| | - Yingfen Qin
- Department of Endocrine, First Affiliated Hospital of Guangxi Medical University, Nanning,
China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Haikou,
China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an,
China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan,
China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou,
China
| | - Qiao Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Guiyang Medical University, Guiyang,
China
| | - Lihui Zhang
- Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang,
China
| | - Jun Zhu
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi,
China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin,
China
| | - Yongze Li
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang,
China
| | - Weiping Teng
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang,
China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang,
China
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Cai P, Peng Y, Chen Y, Wang Y, Wang X. Blood pressure characteristics of subclinical hypothyroidism: an observation study combined with office blood pressure and 24-h ambulatory blood pressure. J Hypertens 2021; 39:453-460. [PMID: 32941202 PMCID: PMC7928215 DOI: 10.1097/hjh.0000000000002655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the characteristics of blood pressure in subclinical hypothyroidism by combining office blood pressure and 24-h ambulatory blood pressure. METHODS A total of 3078 adults voluntarily participants were enrolled in this study between December 2017 and November 2019. Among 1431 of them who did not fit exclusion criteria, 104 patients were with subclinical hypothyroidism (S-HYPO group), and 1327 were euthyroid participants (euthyroid group). Office blood pressure measurement and 24-h ambulatory blood pressure monitoring were carried out to analyze the characteristics of blood pressure in subclinical hypothyroidism. RESULTS There was no statistical difference in office SBP and DBP between the S-HYPO group and the euthyroid group (P > 0.05). On the ambulatory blood pressure level, the daytime SBP, night-time SBP, night-time SBP, 24-h SBP and DBP in the S-HYPO group were significantly higher than those in the euthyroid group (P = 0.048, P = 0.002, P = 0.003, P = 0. 014, P = 0. 046, respectively), and the proportion of nondipper blood pressure in the S-HYPO group was higher than that in the euthyroid group. Comprehensive analysis of blood pressure inside and outside the joint clinic revealed that the S-HYPO group was independently related to sustained hypertension and masked hypertension but not to white-coat hypertension (P = 0.004, P = 0.002, P = 0.886, respectively). After adjusting for age, sex, BMI, and other confounding factors, the above differences were still statistically significant (P < 0.05). CONCLUSION The characteristics of blood pressure in subclinical hypothyroidism can be more accurately understood by combining office blood pressure and ambulatory blood pressure.
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Affiliation(s)
- Peng Cai
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
| | - Yan Peng
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
| | - YuXi Chen
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
| | - Yan Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education Joint International Research Laboratory of Ministry Education, Zunyi Medical University, Zunyi, China
| | - Xukai Wang
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
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Karnjanapiboonwong A, Anothaisintawee T, Chaikledkaew U, Dejthevaporn C, Attia J, Thakkinstian A. Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:491. [PMID: 33225900 PMCID: PMC7681982 DOI: 10.1186/s12872-020-01736-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Clinic blood pressure measurement (CBPM) is currently the most commonly used form of screening for hypertension, however it might have a problem detecting white coat hypertension (WCHT) and masked hypertension (MHT). Home blood pressure measurement (HBPM) may be an alternative, but its diagnostic performance is inconclusive relative to CBPM. Therefore, this systematic review aimed to estimate the performance of CBPM and HBPM compared with ambulatory blood pressure measurement(ABPM) and to pool prevalence of WCHT and MHT. METHODS Medline, Scopus, Cochrane Central Register of Controlled Trials and WHO's International Clinical Trials Registry Platform databases were searched up to 23rd January 2020. Studies having diagnostic tests as CBPM or HBPM with reference standard as ABPM, reporting sensitivity and specificity of both tests and/or proportion of WCHT or MHT were eligible. Diagnostic performance of CBPM and HBPM were pooled using bivariate mixed-effect regression model. Random effect model was applied to pool prevalence of WCHT and MHT. RESULTS Fifty-eight studies were eligible. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of CBPM, when using 24-h ABPM as the reference standard, were 74% (95% CI: 65-82%), 79% (95% CI: 69%, 87%), and 11.11 (95% CI: 6.82, 14.20), respectively. Pooled prevalence of WCHT and MHT were 0.24 (95% CI 0.19, 0.29) and 0.29 (95% CI 0.20, 0.38). Pooled sensitivity, specificity, and DOR of HBPM were 71% (95% CI 61%, 80%), 82% (95% CI 77%, 87%), and 11.60 (95% CI 8.98, 15.13), respectively. CONCLUSIONS Diagnostic performances of HBPM were slightly higher than CBPM. However, the prevalence of MHT was high in negative CBPM and some persons with normal HBPM had elevated BP from 24-h ABPM. Therefore, ABPM is still necessary for confirming the diagnosis of HT.
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Affiliation(s)
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathevi, Bangkok, 10400 Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Charungthai Dejthevaporn
- Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - John Attia
- School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kotanidou EP, Giza S, Tsinopoulou VR, Vogiatzi M, Galli-Tsinopoulou A. Diagnosis and Management of Endocrine Hypertension in Children and Adolescents. Curr Pharm Des 2020; 26:5591-5608. [PMID: 33185153 DOI: 10.2174/1381612826666201113103614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Hypertension in childhood and adolescence has increased in prevalence. Interest in the disease was raised after the 2017 clinical practice guidelines of the American Academy of Paediatrics on the definition and classification of paediatric hypertension. Among the secondary causes of paediatric hypertension, endocrine causes are relatively rare but important due to their unique treatment options. Excess of catecholamine, glucocorticoids and mineralocorticoids, congenital adrenal hyperplasia, hyperaldosteronism, hyperthyroidism and other rare syndromes with specific genetic defects are endocrine disorders leading to paediatric and adolescent hypertension. Adipose tissue is currently considered the major endocrine gland. Obesity-related hypertension constitutes a distinct clinical entity leading to an endocrine disorder. The dramatic increase in the rates of obesity during childhood has resulted in a rise in obesity-related hypertension among children, leading to increased cardiovascular risk and associated increased morbidity and mortality. This review presents an overview of pathophysiology and diagnosis of hypertension resulting from hormonal excess, as well as obesity-related hypertension during childhood and adolescence, with a special focus on management.
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Affiliation(s)
- Eleni P Kotanidou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Styliani Giza
- Fourth Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki-Regina Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Vogiatzi
- Division of Endocrinology and Diabetes, Children' s Hospital of Philadelphia, PA 19104, United States
| | - Assimina Galli-Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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9
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Cai P, Zhong W, Wang Y, Wang X. Effects of white-coat, masked and sustained hypertension on coronary artery stenosis and cardiac arrhythmia. Hypertens Res 2020; 43:121-131. [PMID: 31624353 PMCID: PMC8076024 DOI: 10.1038/s41440-019-0342-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate whether hypertension phenotypes such as white-coat hypertension (WCHT), diagnosed with the addition of nighttime blood pressure (BP) criteria, are related to coronary artery stenosis (CAS) and cardiac arrhythmia. In this cross-sectional observational study, 844 participants who did not use antihypertensive, lipid-lowering, and antiplatelet drugs were selected. The subjects were divided into normotensive (NT), WCHT, masked hypertension (MHT), and sustained hypertension (SHT) groups based on the results of clinic BP measurement and ambulatory BP monitoring. Coronary angiography and ambulatory electrocardiography were performed to determine the participants' CAS and cardiac arrhythmia status. Coronary angiography revealed 556 patients with CAS and 288 participants with normal coronary arteries. The chi-squared test showed that the incidence of CAS was higher in the MHT and SHT groups than in the NT group, while no significant change was found in the WCHT group (P = 0.003, P < 0.001, P = 0.119). The logarithm of the Gensini score was used to compare the degree of CAS between the groups. Multiple linear regression analysis showed that the degree of CAS was higher in the WCHT, MHT, and SHT groups than in the NT group (P < 0.05). The incidences of frequent atrial premature beats, atrial tachycardia, and ventricular cardiac arrhythmia were significantly higher in the WCHT and SHT groups than in the NT group, while only ventricular cardiac arrhythmia changes were observed in the MHT group. This study found that hypertension phenotypes such as WCHT were closely associated with CAS and cardiac arrhythmia.
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Affiliation(s)
- Peng Cai
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Weitian Zhong
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China.
| | - Xukai Wang
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China.
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