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Younis J, Wang L, Zhang K, Jebril M, Jiang H, Fan Y, Li Z, Ma M, Ma L, Hui Z, Ma M, Zhang W. Prevalence of hypertension and its associated factors among healthcare workers in the Gaza Strip, Palestine: a cross-sectional study. BMJ Open 2024; 14:e076577. [PMID: 39653574 PMCID: PMC11628958 DOI: 10.1136/bmjopen-2023-076577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/30/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertension (HTN) is one of the leading risk factors of cardiovascular diseases and accounts for substantial morbidity and mortality worldwide. We aimed to estimate the prevalence of HTN and its associated factors among healthcare workers (HCWs) at the Gaza Strip's governmental hospitals and primary healthcare centres (PHCs). DESIGN Cross-sectional study. SETTINGS, PARTICIPANTS AND METHODS The study with multistage stratified random sampling was conducted in 10 hospitals and 15 PHCs of the Ministry of Health in Palestine from February to May 2020. Self-administered face-to-face interview questionnaires were used to collect information on sociodemographics, lifestyles, health profiles and health-related risk factors. The anthropometric parameters were measured, including height, weight, waist circumference (WC), hip circumference (HC), and systolic and diastolic blood pressure. HTN was diagnosed by taking any antihypertensive medication, or the mean blood pressure ≥140/90 mm Hg. The SPSS V.26.0 software was used for data analyses. RESULTS A total of 1850 participants, with a mean (SD) age of 36.6 (7.9) years, including 12.2% physicians, 65.3% nurses, 18.1% paramedics and 4.4% non-medical personnel, were included in this study. The prevalence of HTN among HCWs was 8.4%. The associated modifiable factors of HTN were body mass index (BMI), smoking, coffee intake and physical activity (p<0.05). The anthropometric parameters were considerably higher in HTN than in non-HTN (p<0.05). In adjusted models, age, BMI, WC, HC, type of work, workplace, working experience, smoking, coffee intake, physical activity and family history of HTN showed statistically significant associations with HTN (p<0.05). CONCLUSIONS The modifiable factors, including smoking, coffee intake, physical activity and BMI, were associated with the risk of HTN. These findings indicate that effective efforts in maintaining a healthy lifestyle are needed to prevent HTN among HCWs.
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Affiliation(s)
- Joma Younis
- General Practice Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Ministry of Health, Gaza, Palestine
| | - Lina Wang
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kejing Zhang
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | | | - Hong Jiang
- General Practice Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yahui Fan
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhaofang Li
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Mei Ma
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Le Ma
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhaozhao Hui
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Mao Ma
- General Practice Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wei Zhang
- General Practice Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Ma LH, Xiu JY, Ma LX, Zhang QY, Wang XY, Sun TY, Qian X, Chen MY, He JL. Effect of transcutaneous electrical acupoint stimulation at different frequencies on mild hypertension: A randomized controlled trial. Complement Ther Med 2024; 87:103103. [PMID: 39454736 DOI: 10.1016/j.ctim.2024.103103] [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: 08/17/2024] [Revised: 10/17/2024] [Accepted: 10/18/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Transcutaneous electrical acupoint stimulation (TEAS) may contribute to blood pressure (BP) control, but the evidence remains insufficient. Our objectives were to evaluate the impact of TEAS on hypertension and determine the optimal frequency. METHODS A total of 120 hypertensive patients were randomly allocated to the TEAS-2Hz group, TEAS-10Hz group, or usual care control group in a 1:1:1 ratio. All patients were advised to continue their usual antihypertensive regimen. Additionally, patients in the TEAS groups received TEAS therapy 3 times per week for 4 weeks, with a 4-week follow-up. RESULTS The primary outcome was the change in systolic BP (SBP) from baseline to week 4. Secondary outcomes included changes in diastolic BP (DBP), mean arterial pressure (MAP), heart rate (HR), heart rate variability (HRV), and 12-item health survey (SF-12) at different time points. Both TEAS groups showed reductions in SBP relative to control (TEAS-2Hz group vs. control, -4.70 mmHg [95 % CI, -7.00 to -2.40 mmHg]; P < 0.001; TEAS-10Hz group vs. control, -8.66 mmHg [95 % CI, -10.97 to -6.36 mmHg]; P < 0.001). TEAS-10Hz provided a significant decrease in SBP than TEAS-2Hz (-3.96 mmHg [95 % CI, -1.66 to -6.26 mmHg]; P< 0.001). TEAS groups also exhibited reductions in DBP, MAP, HR, LF/HF ratio(LF/HF), very low frequency (VLF), and normalized low frequency (LF norm), and an increase in normalized high frequency (HF norm) than control. No differences were observed among groups in low frequency (LF), high frequency (HF), total power (TP), very low frequency (VLF), and SF-12. CONCLUSION TEAS might be a promising adjunctive therapy for hypertension, and the recommended frequency is 10 Hz, which should be confirmed in larger trials.
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Affiliation(s)
- Ling-Hui Ma
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Yun Xiu
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Liang-Xiao Ma
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China; The Key Unit of State Administration of Traditional Chines Medicine, Evaluation of Characteristic Acupuncture Therapy, Beijing, China.
| | - Qin-Yong Zhang
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiu-Yan Wang
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Tian-Yi Sun
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Qian
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Meng-Yu Chen
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jia-Ling He
- School of Acupuncture-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Batta A, Singhania A, Sharma S, Gautam S, Singla A, Kalsi H, Mahendru D, Singh S, Goyal I, Ghosh H, Uppal A, Dhand N, Bansal N, Chaudhary A, Wander GS, Ramakrishnan S, Mohan B. Current practices and knowledge of home blood pressure monitoring among people with hypertension: Insights from a Multicentric study from North India. Indian Heart J 2024; 76:398-404. [PMID: 39579976 DOI: 10.1016/j.ihj.2024.11.249] [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: 09/28/2024] [Revised: 11/14/2024] [Accepted: 11/21/2024] [Indexed: 11/25/2024] Open
Abstract
OBJECTIVES Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregivers in the Indian context. METHODS The current study was conducted across three North Indian centres to evaluate the prevalence, training and technique of HBPM among people with HTN and their caregivers. People with diagnosed HTN (>3 months duration) and their caregivers, were screened and their HBPM use was evaluated. HBPM practices were assessed by observing participants measuring BP using a pre-validated, structured 16-point observational checklist. HBPM knowledge was assessed using a 19-point self-administered questionnaire based on the most recent AHA guidelines. Responses were graded and classified based on quartiles. RESULTS A total of 2750 participants were screened, of which 2588 (2070 from urban and 518 from rural areas) were included. A total of 468 (18.1 %) were using HBPM. The proportion of respondents using HBPM was 20.5 % (424/2070) in urban, and 8.5 % (44/518) in rural areas. Only 24.7 % (n = 116) of the 468 participants (236 patients and 232 caregivers) using HBPM at home recalled ever receiving training from any healthcare workers. The majority (75.2 %, 352/468) of participants reported learning HBPM themselves through observation, videos, and reading. In HBPM practice assessment, 15.9 % of people with HTN (37/232) vs 5.9 % caregivers (14/236) scored excellent (score >75 %). In HPBM knowledge assessment, 0.4 % of people with HTN (1/232) vs no caregivers scored excellent. HPBM practices were better than knowledge, with mean scores of 62.3 ± 13.1 % and 40.1 ± 16.2 % respectively. Higher education level was associated with improved patient knowledge (p = 0.041), but not practices (p = 0.225). CONCLUSIONS There is need for more robust training on HBPM to enable people from all backgrounds to better manage their HTN, especially in rural areas. Education is not a barrier to learning good HBPM technique.
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Affiliation(s)
- Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India.
| | - Anusha Singhania
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Sarit Sharma
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Singal Gautam
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Ankur Singla
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Harsimran Kalsi
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Diksha Mahendru
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Samneet Singh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Ishaan Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Hiyanoor Ghosh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Aditya Uppal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Nishma Dhand
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Namita Bansal
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Anurag Chaudhary
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Gurpreet Singh Wander
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | | | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India.
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Nilsson PM, Pikkemaat M, Schutte AE. Sustainable hypertension care - a new strategy for an expanding problem. J Hypertens 2024; 42:1891-1894. [PMID: 39360762 DOI: 10.1097/hjh.0000000000003842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 08/04/2024] [Indexed: 10/09/2024]
Affiliation(s)
- Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital
| | - Miriam Pikkemaat
- Center for Primary Healthcare Research, Department of Clinical Sciences, Malmö, Lund University, Malmö
- University Clinic Primary Care Skåne, Region Skåne, Sweden
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
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Tan MY, Mo CY, Zhao Q. The Association between Magnesium Depletion Score and Hypertension in US Adults: Evidence from the National Health and Nutrition Examination Survey (2007-2018). Biol Trace Elem Res 2024; 202:4418-4430. [PMID: 38147232 DOI: 10.1007/s12011-023-04034-y] [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: 09/10/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
The magnesium depletion score (MDS) emerges as a new valuable predictor of the body's magnesium status index. This study aims to explore the link between MDS and hypertension (HTN) using the National Health and Nutrition Examination Survey (NHANES) data. A total of 9708 participants from NHANES (2007-2018) were enrolled to investigate MDS's connection with HTN. HTN was defined based on clinical guidelines. MDS classification (low, 0-1; middle, 2; high, 3-5) relied on alcohol consumption, diuretic use, proton-pump inhibitor (PPI) usage, and kidney disease. Multivariable logistic regression assessed MDS-HTN association. Subsequent analyses included interaction tests, subgroups, and sensitivity analysis. Each unit increase in MDS correlated with an 87% higher HTN risk (OR, 1.87; 95% CI, 1.64-2.13) after adjusting for confounders. High MDS participants exhibited significantly elevated HTN risk compared to low MDS counterparts (OR, 8.31; 95% CI, 4.81-14.36), with a significant trend across MDS groups (p < 0.001). Subgroup analyses supported a consistent positive correlation. Sensitivity analysis confirmed a robust association. The results indicated a positive correlation between MDS and the risk of developing HTN in US adults.
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Affiliation(s)
- Mo-Yao Tan
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chao-Yue Mo
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qian Zhao
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, Sichuan, China.
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ZHANG YJ, SONG JJ, ZHAN JH, ZHOU CL, LI A, WANG MQ, LI BJ, DING CC, ZHANG YW, TAN ZH, CHENG ZH, HUANG X. Alcohol drinking triggered decrease of oxidative balance score is associated with high all-cause and cardiovascular mortality in hypertensive individuals: findings from NHANES 1999-2014. J Geriatr Cardiol 2024; 21:779-790. [PMID: 39308501 PMCID: PMC11411262 DOI: 10.26599/1671-5411.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Oxidative stress is closely associated with hypertensive outcomes. The oxidative balance score (OBS) measures oxidative stress exposure from dietary and lifestyle elements. The objective of this study was to investigate the association between OBS and mortality in hypertensive patients. METHODS This study included 7823 hypertensive patients from the National Health and Nutrition Examination Survey (NHANES) 1999-2014. Several models, including Cox regression, restricted cubic splines (RCS), Kaplan‒Meier survival analysis, subgroup, and sensitivity analyses, were exploited to investigate the relationship between OBS and the risk of mortality. RESULTS Controlling for all potential confounders, a significantly inverse association was observed between elevated OBS and all-cause [hazard ratio (HR) = 0.90, 95% CI: 0.85-0.95] and cardiovascular mortality (HR = 0.85, 95% CI: 0.75-0.95). With adjustment for covariates, significant associations between lifestyle OBS and mortality risks diminished, whereas associations between dietary OBS and these mortality risks remained robust (all-cause mortality: HR = 0.91, 95% CI: 0.86-0.96; cardiovascular mortality: HR = 0.85, 95% CI: 0.76-0.96). RCS demonstrated a linear relationship between OBS and all-cause and cardiovascular mortality risk (P nonlinear = 0.088 and P nonlinear = 0.447, respectively). Kaplan‒Meier curves demonstrated that the mortality rate was lower with a high OBS (P < 0.001). The consistency of the association was demonstrated in subgroup and sensitivity analyses. RCS after stratification showed that among current drinkers, those with higher OBS had a lower risk of mortality compared with former or never drinkers. CONCLUSIONS In hypertensive individuals, there was a negative association between OBS and all-cause and cardiovascular mortality. Encouraging hypertensive individuals, especially those currently drinking, to maintain high levels of OBS may be beneficial in improving their prognosis.
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Affiliation(s)
- Yu-Jun ZHANG
- Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Huankui Academy, Nanchang University, Nanchang, China
| | - Jing-Jing SONG
- Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- School of Ophthalmology and Optometry of Nanchang University, Nanchang, China
| | - Jian-Hao ZHAN
- Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Huankui Academy, Nanchang University, Nanchang, China
| | - Chu-Lin ZHOU
- The Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Ao LI
- Queen Mary School, Nanchang University, Nanchang, China
| | - Mao-Qi WANG
- The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Ben-Jie LI
- Queen Mary School, Nanchang University, Nanchang, China
| | - Cong-Cong DING
- Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yi-Wei ZHANG
- Queen Mary School, Nanchang University, Nanchang, China
| | - Zi-Heng TAN
- Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Cardiovascular Medicine, Huzhou First People’s Hospital, Zhejiang, China
| | - Zai-Hua CHENG
- Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xiao HUANG
- Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Chen C, Zhu Y, Liu L, Ke J, Yu W, Song Q, Li M, Tang Y, Wang C. Associations of 24-Hour Central Systolic Blood Pressure With Multiorgan Damage in Nondialysis Patients With Chronic Kidney Disease. J Am Heart Assoc 2024; 13:e034469. [PMID: 39158576 DOI: 10.1161/jaha.124.034469] [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: 01/14/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Multiple target-organ damages (TODs) in the same patient are common and further increase the risk of cardiovascular disease. However, the relationship between ambulatory central systolic blood pressure (SBP) and multiple TODs has yet to be explored. METHODS AND RESULTS MobilO-Graph PWA was used to monitor the participants' ambulatory blood pressure, and the presence of left ventricular hypertrophy, carotid hypertrophy, and kidney injury were used to define TOD. Logistic regression analyses and receiver operating characteristic analyses were used to explore the correlation between SBP and TOD. Overall, 2018 nondialysis patients with chronic kidney disease were included and 580 (28.74%) had multiple TODs. Twenty-four-hour central SBP with c2 calibration exhibited a stronger correlation with the increasing number of TOD compared with 24-hour brachial SBP in ordinal logistic regression analyses. In the multivariable analyses with the presence of multiple TODs, the odds ratios were 1.786 (95% CI, 1.474-2.165; P<0.001) for 24-hour brachial SBP and 1.949 (95% CI, 1.605-2.366; P<0.001) for 24-hour central SBP with c2 calibration. The receiver operating characteristic analyses also showed that 24-hour central SBP with c2 calibration had higher discrimination than 24-hour brachial SBP regarding multiple TODs (P<0.001). In addition, using 130/135 mm Hg as the threshold for 24-hour brachial SBP/central SBP with c2 calibration to cross-classify, the prevalence of multiple TODs was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension, with no difference between the latter 2 conditions. CONCLUSIONS Twenty-four-hour central SBP with c2 calibration was more associated with the presence of multiple TODs compared with 24-hour brachial SBP and was helpful in risk classification of multiple TODs among nondialysis patients with chronic kidney disease.
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Affiliation(s)
- Cheng Chen
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Ye Zhu
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Lingling Liu
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Jianting Ke
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Wenjuan Yu
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Qirong Song
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Ying Tang
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Cheng Wang
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
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Norrman A, Hasselström J, Ljunggren G, Wachtler C, Eriksson J, Kahan T, Wändell P, Gudjonsdottir H, Lindblom S, Ruge T, Rosenblad A, Brynedal B, Carlsson AC. Predicting new cases of hypertension in Swedish primary care with a machine learning tool. Prev Med Rep 2024; 44:102806. [PMID: 39091569 PMCID: PMC11292513 DOI: 10.1016/j.pmedr.2024.102806] [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: 03/08/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Background Many individuals with hypertension remain undiagnosed. We aimed to develop a predictive model for hypertension using diagnostic codes from prevailing electronic medical records in Swedish primary care. Methods This sex- and age-matched case-control (1:5) study included patients aged 30-65 years living in the Stockholm Region, Sweden, with a newly recorded diagnosis of hypertension during 2010-19 (cases) and individuals without a recorded hypertension diagnosis during 2010-19 (controls), in total 507,618 individuals. Patients with diagnoses of cardiovascular diseases or diabetes were excluded. A stochastic gradient boosting machine learning model was constructed using the 1,309 most registered ICD-10 codes from primary care for three years prior the hypertension diagnosis. Results The model showed an area under the curve (95 % confidence interval) of 0.748 (0.742-0.753) for females and 0.745 (0.740-0.751) for males for predicting diagnosis of hypertension within three years. The sensitivity was 63 % and 68 %, and the specificity 76 % and 73 %, for females and males, respectively. The 25 diagnoses that contributed the most to the model for females and males all exhibited a normalized relative influence >1 %. The codes contributing most to the model, all with an odds ratio of marginal effects >1 for both sexes, were dyslipidaemia, obesity, and encountering health services in other circumstances. Conclusions This machine learning model, using prevailing recorded diagnoses within primary health care, may contribute to the identification of patients at risk of unrecognized hypertension. The added value of this predictive model beyond information of blood pressure warrants further study.
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Affiliation(s)
- Anders Norrman
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Jan Hasselström
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Gunnar Ljunggren
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Caroline Wachtler
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Julia Eriksson
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Hrafnhildur Gudjonsdottir
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Womeńs Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Toralph Ruge
- Department of Clinical Sciences Malmö, Lund University & Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Andreas Rosenblad
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Regional Cancer Centre Stockholm-Gotland, Region Stockholm, Stockholm, Sweden
- Department of Medical Sciences, Division of Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Boel Brynedal
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Axel C. Carlsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
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Coca A, Whelton SP, Camafort M, López-López JP, Yang E. Single-pill combination for treatment of hypertension: Just a matter of practicality or is there a real clinical benefit? Eur J Intern Med 2024; 126:16-25. [PMID: 38653633 DOI: 10.1016/j.ejim.2024.04.011] [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: 02/11/2024] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
Elevated blood pressure (BP) is the largest contributor to the incident cardiovascular disease worldwide. Despite explicit guideline recommendations for the diagnosis and management of hypertension, a large proportion of patients remain undiagnosed, untreated, or treated but uncontrolled. Inadequate BP control is associated with many complex factors including patient preference, physician's inertia, health systems disparities, and poor adherence to prescribed antihypertensive drug treatment. The primary driver for reduced cardiovascular morbidity and mortality is lowering of BP ''per se'' and not class effects of specific pharmacotherapies. The recent ESH guidelines recommend the use of four major classes of drugs including renin-angiotensin-aldosterone system (RAS) blockers (angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEi)), calcium channel blockers (CCB), thiazide and thiazide-like diuretics, and betablockers. Initiation of treatment for hypertension with a two-drug regimen, preferably in a single pill combination (SPC), is recommended for most patients. Preferred combinations should comprise a RAS blocker (either an ACEi or an ARB) with a CCB or thiazide/thiazide-like diuretic. These strategies are supported by robust evidence that combination therapy produces greater BP reductions than monotherapy, reduces side effects of the individual components, improves therapeutic adherence and long-term persistence on treatment, and permits achievement of earlier BP control.
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Affiliation(s)
- A Coca
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - S P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Camafort
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic (IDIBAPS, CIBER-OBN). University of Barcelona, Barcelona, Spain
| | - J P López-López
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia
| | - E Yang
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
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Desideri G, Pegoraro V, Cipelli R, Ripellino C, Miroddi M, Meto S, Gori M, Fabrizzi P. Extemporaneous combination therapy with nebivolol/ramipril for the treatment of hypertension: a real-world evidence study in Europe. Curr Med Res Opin 2024; 40:1093-1102. [PMID: 38832726 DOI: 10.1080/03007995.2024.2362276] [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: 02/22/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To describe the clinical characteristics and treatment adherence in European adult hypertensive patients starting treatment with the extemporaneous combination of nebivolol and ramipril (NR-EXC). METHODS Retrospective database analysis of patients receiving NR-EXC treatment across five European countries (Italy, Germany, France, Poland, Hungary) over a period ranging from 3 to 9 years (until 30 June 2020) according to data availability for the different data sources. Patient demographics, comorbidities, and treatment adherence were evaluated. RESULTS We identified 592,472 patients starting NR-EXC. Most of them were over 60 years of age, with ramipril most commonly prescribed at 5 mg (from 30.0 to 57.2% of patients across the databases). Notable comorbidities included diabetes (19.2%) and dyslipidemia (18.2%). The study population was also highly subjected to polytherapy with antithrombotics, lipid-lowering agents, and other lowering blood pressure agents as the most co-prescribed medications, as resulted from Italian database. Up to 59% of the patients did not request a cardiologic visit during the study period. Adherence to therapy was low in 56.3% of the patients, and it was high only in 11.1% of them. CONCLUSIONS The combination of nebivolol and ramipril is frequently prescribed in Europe, but adherence to treatment is suboptimal. The transition to a single pill combination could enhance treatment adherence and streamline regimens, potentially leading to significant benefits. Improved adherence not only correlates with better blood pressure control but also reduces the risk of cardiovascular events, underscoring the importance of this development.
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Affiliation(s)
- Giovambattista Desideri
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Marco Miroddi
- A. Menarini Farmaceutica Internazionale S.r.l., Florence, Italy
| | - Suada Meto
- A. Menarini Industrie Farmaceutiche Riunite S.r.l., Florence, Italy
| | | | - Paolo Fabrizzi
- A. Menarini Industrie Farmaceutiche Riunite S.r.l., Florence, Italy
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Chen Y, Hou X, Zhong J, Liu K. Association between red cell distribution width and hypertension: Results from NHANES 1999-2018. PLoS One 2024; 19:e0303279. [PMID: 38768100 PMCID: PMC11104644 DOI: 10.1371/journal.pone.0303279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
The relationship between red cell distribution width (RDW) and hypertension remains a contentious topic, with a lack of large-scale studies focusing on the adults in the United States. This study aimed to investigate the association between RDW and hypertension among US adults from 1999 to 2018. METHODS Data were derived from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. RDW values were obtained from the Laboratory Data's Complete Blood Count with 5-part Differential-Whole Blood module. Hypertension data were obtained through hypertension questionnaires and blood pressure measurements. Multivariable weighted logistic regression analyses were conducted to assess the association between RDW and hypertension, followed by subgroup and smooth curve analyses. RESULTS Compared to the non-hypertensive group, the hypertensive group exhibited higher RDW values (13.33±1.38 vs. 12.95±1.27, P <0.001). After adjusting for covariates, weighted multivariable logistic regression analysis revealed a positive correlation between RDW and hypertension prevalence (OR: 1.17, 95% CI 1.13, 1.21, P <0.001). When RDW was included as a categorical variable, participants in the fourth quartile had the highest risk of hypertension (OR: 1.86, 95% CI 1.70, 2.03, P <0.001). Subgroup analysis showed that, except for age, BMI and weak/failing kidneys, gender, race, education level, smoking, alcohol use, congestive heart failure, and stroke did not significantly influence this correlation (all P-values for interaction >0.05).Smooth curve fitting analysis revealed a reverse J-shaped relationship between RDW and hypertension prevalence, with an inflection point at 12.93%. CONCLUSION We first explored the relationship between RDW and hypertension among US adults and discovered a reverse J-shaped association, providing further insights into the relationship between blood cell counts and hypertension and offering a new foundation for hypertension prevention and control.
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Affiliation(s)
- Ying Chen
- Medical Laboratory Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, 570311, China
| | - Xiaoxiao Hou
- Department of Cardiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, 570311, China
| | - Jiaxin Zhong
- Geriatric Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, 570311, China
| | - Kai Liu
- Geriatric Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, 570311, China
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Wang L, Gao J, Liu B, Fu Y, Yao Z, Guo S, Song Z, Zhang Z, He J, Wang C, Ma W, Wu F. The association between lymphocyte-to-monocyte ratio and all-cause mortality in obese hypertensive patients with diabetes and without diabetes: results from the cohort study of NHANES 2001-2018. Front Endocrinol (Lausanne) 2024; 15:1387272. [PMID: 38686205 PMCID: PMC11056572 DOI: 10.3389/fendo.2024.1387272] [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: 02/17/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Objective Obesity, hypertension and diabetes are high prevalent that are often associated with poor outcomes. They have become major global health concern. Little research has been done on the impact of lymphocyte-to-monocyte ratio (LMR) on outcomes in these patients. Thus, we aimed to explore the association between LMR and all-cause mortality in obese hypertensive patients with diabetes and without diabetes. Methods The researchers analyzed data from the National Health and Nutrition Examination Survey (2001-2018), which included 4,706 participants. Kaplan-Meier analysis was employed to compare survival rate between different groups. Multivariate Cox proportional hazards regression models with trend tests and restricted cubic splines (RCS) analysis and were used to investigate the relationship between the LMR and all-cause mortality. Subgroup analysis was performed to assess whether there was an interaction between the variables. Results The study included a total of 4706 participants with obese hypertension (48.78% male), of whom 960 cases (20.40%) died during follow-up (median follow-up of 90 months). Kaplan-Meier curves suggested a remarkable decrease in all-cause mortality with increasing LMR value in patients with diabetes and non-diabetes (P for log-rank test < 0.001). Moreover, multivariable Cox models demonstrated that the risk of mortality was considerably higher in the lowest quartile of the LMR and no linear trend was observed (P > 0.05). Furthermore, the RCS analysis indicated a non-linear decline in the risk of death as LMR values increased (P for nonlinearity < 0.001). Conclusions Increased LMR is independently related with reduced all-cause mortality in patients with obese hypertension, regardless of whether they have combined diabetes.
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Affiliation(s)
- Lixia Wang
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Jie Gao
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Bing Liu
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Youliang Fu
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Zhihui Yao
- Department of Cardiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Shanshan Guo
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Ziwei Song
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Zhaoyuan Zhang
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Jiaojiao He
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
| | - Congxia Wang
- Department of Cardiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Weidong Ma
- Department of Cardiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Feng Wu
- Department of Cardiology, Xi’an International Medical Center Hospital, Xi’an, Shaanxi, China
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Sagara K, Goto K, Maeda M, Murata F, Fukuda H. Medication adherence and associated factors in newly diagnosed hypertensive patients in Japan: the LIFE study. J Hypertens 2024; 42:718-726. [PMID: 38230627 DOI: 10.1097/hjh.0000000000003661] [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: 01/18/2024]
Abstract
Hypertension is the leading cardiovascular risk factor worldwide. However, in Japan, only 30% of patients have their blood pressure controlled under 140/90 mmHg, and nonadherence to antihypertensives is thought to be a reason for the poor control of hypertension. We therefore sought to assess the adherence to hypertension treatment and to evaluate factors influencing patients' adherence in a large, representative sample of the Japanese population. To this end, we analyzed claims data from the LIFE Study database, which includes 112 506 Japanese adults with newly diagnosed hypertension. Medication adherence was measured for a year postdiagnosis using the proportion of days covered (PDC) method. Factors associated with adherence to antihypertensives were also assessed. Among the total 112 506 hypertensive patients, the nonadherence rate (PDC ≤ 80%) for antihypertensives during the first year after initiation of the treatment was 26.2%. Younger age [31-35 years: odds ratio (OR), 0.15; 95% confidence interval (95% CI), 0.12-0.19 compared with 71-74-year-old patients], male gender, monotherapy, and diuretics use [OR, 0.87; 95% CI, 0.82-0.91 compared with angiotensin II receptor blockers (ARBs)] were associated with poor adherence in the present study. Cancer comorbidity (OR, 0.84; 95% CI, 0.79-0.91 compared with no comorbidity), prescription at a hospital, and living in a medium-sized to regional city were also associated with poor adherence. Our present findings showing the current status of adherence to antihypertensive medications and its associated factors using claims data in Japan should help to improve adherence to antihypertensives and blood pressure control.
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Affiliation(s)
- Kumi Sagara
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka City
| | - Kenichi Goto
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka City
| | - Megumi Maeda
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University Fukuoka City, Fukuoka, Japan
| | - Fumiko Murata
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University Fukuoka City, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University Fukuoka City, Fukuoka, Japan
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Cuspidi C, Faggiano A, Mancia G, Grassi G. Echocardiographic Phenotypes of Subclinical Organ Damage: Clinical and Prognostic Value in the General Population. Findings from the Pamela Study. High Blood Press Cardiovasc Prev 2023; 30:497-511. [PMID: 38032423 DOI: 10.1007/s40292-023-00610-4] [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: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Subclinical alterations in cardiac structure and function include a variety of abnormal phenotypes of established adverse prognostic significance such as left ventricular hypertrophy (LVH), alterations of LV geometry, left atrial (LA) enlargement, and aortic root (AR) dilatation. The excess cardiovascular (CV) risk associated with these phenotypes has been consistently demonstrated in different clinical settings such in patients with systemic hypertension, coronary heart disease, diabetes mellitus, chronic kidney disease, heart failure and in geneal population samples. The Pressioni Monitorate e Loro Associazioni (PAMELA), a longitudinal population-based study originally designed to assess the normality values, prognostic significance of office, home and 24-hour blood pressure, including among the many clinical and laboratory variables the collection of echocardiographic data, allowed to gather important information on the clinical prognostic significance of subclinical cardiac damage during a long follow-up period. This article summarizes the original findings provided by the PAMELA study on the clinical correlates and prognostic significance of echocardiographic markers of subclinical organa damage namely LVH, left atrial enlargement (LA) and AR dilatation at the community level.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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