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Joseph G, Thanh Pham V, Kragh Andersen P, Louis Marott J, Møgelvang R, Biering-Sørensen T, Søgaard P, Nielsen G, Prescott E, Boje Jensen G, Eske Bruun N, Torp-Pedersen C. Cardiovascular events according to blood pressure thresholds recommended by ACC/AHA. Blood Press 2024; 33:2380346. [PMID: 39018201 DOI: 10.1080/08037051.2024.2380346] [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: 04/25/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
AIM The latest guidelines from ACC/AHA define hypertension at systolic blood pressure (SBP) 130-139 mmHg or diastolic blood pressure (DBP) 80-89 mmHg in contrast to guidelines from ESC/ESH defining hypertension at SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. The aim was to determine whether the ACC/AHA definition of hypertension identifies persons at elevated risk for future cardiovascular outcome. METHODS In a Danish prospective cardiovascular study, 19,721 white men and women aged 20-98 years were examined up to five occasions between 1976 and 2015. The population was followed until December 2018. The ACC/AHA definition of the BP levels were applied: Normal: SBP <120 mmHg and DBP <80 mmHg, Elevated: SBP 120-129 mmHg and DBP <80 mmHg, Stage 1: SBP 130-139 mmHg or DBP 80-89 mmHg, Stage 2: SBP ≥140 mmHg or DBP ≥90 mmHg. Absolute 10-year risk was calculated taking repeated examinations, covariates, and competing risk into account. RESULTS For all outcomes, the 10-year risk in stage 1 hypertension did not differ significantly from risk in subjects with normal BP: The 10-year risk of cardiovascular events in stage 1 hypertension was 14.1% [95% CI 13.2;15.0] and did not differ significantly from the risk in normal BP at 12.8% [95% CI 11.1;14.5] (p = 0.19). The risk was highest in stage 2 hypertension 19.4% [95% CI 18.9;20.0] and differed significantly from normal BP, elevated BP, and stage 1 hypertension (p < 0.001). The 10-year risk of cardiovascular death was 6.6% [95% CI 5.9;7.4] in stage 1 hypertension and did not differ significantly from the risk in normal BP at 5.7% [95% CI 4.1;7.3] (p = 0.33). CONCLUSIONS Stage 1 hypertension as defined by the ACC/AHA guidelines has the same risk for future cardiovascular events as normal BP. In contrast, the definition of hypertension as suggested by ESC/ESH identifies patients with elevated risk of cardiovascular events.
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Affiliation(s)
- Gowsini Joseph
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Vi Thanh Pham
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, Gentofte, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gitte Nielsen
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Eva Prescott
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Rojas-Solé C, Pinilla-González V, Lillo-Moya J, González-Fernández T, Saso L, Rodrigo R. Integrated approach to reducing polypharmacy in older people: exploring the role of oxidative stress and antioxidant potential therapy. Redox Rep 2024; 29:2289740. [PMID: 38108325 PMCID: PMC10732214 DOI: 10.1080/13510002.2023.2289740] [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] [Indexed: 12/19/2023] Open
Abstract
Increased life expectancy, attributed to improved access to healthcare and drug development, has led to an increase in multimorbidity, a key contributor to polypharmacy. Polypharmacy is characterised by its association with a variety of adverse events in the older persons. The mechanisms involved in the development of age-related chronic diseases are largely unknown; however, altered redox homeostasis due to ageing is one of the main theories. In this context, the present review explores the development and interaction between different age-related diseases, mainly linked by oxidative stress. In addition, drug interactions in the treatment of various diseases are described, emphasising that the holistic management of older people and their pathologies should prevail over the individual treatment of each condition.
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Affiliation(s)
- Catalina Rojas-Solé
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Víctor Pinilla-González
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - José Lillo-Moya
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Tommy González-Fernández
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luciano Saso
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Faculty of Pharmacy and Medicine, Sapienza University, Rome, Italy
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
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Carrillo-Larco RM. Cardiovascular predicted risk: A population-based comparison of the pooled cohorts equation and PREVENT. Int J Cardiol 2024; 414:132423. [PMID: 39102945 DOI: 10.1016/j.ijcard.2024.132423] [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: 06/04/2024] [Revised: 07/24/2024] [Accepted: 08/01/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND While the new cardiovascular risk score (PREVENT) has improvements, its implementation may lead to significant changes in the distribution of atherosclerotic cardiovascular diseases (ASCVD) in the United States. We aimed to quantify and characterize the distribution of the 10-year predicted absolute ASCVD risk using the Pooled Cohorts Equation (PCE) and PREVENT. METHODS We utilized the latest (2017-March 2020) round of the National Health and Nutrition Examination Survey (NHANES). Accounting for the complex survey design of the NHANES, we computed the mean predicted ASCVD risk overall and by sex, race, and education; similarly, we computed the prevalence of cardiovascular risk groups (<5%, 5%-7.4%, 7.5%-19.9%, and ≥ 20%). RESULTS The study included 3845 observations, representing 109,692,509 people. Using the PREVENT calculator resulted in a reduction of the mean 10-year ASCVD absolute risk by half compared to the PCE: 9.1% vs 4.7%. Under the PCE, the high-risk category accounted for 12.5% of the population, whereas under PREVENT it fell to 0.4%. Among those previously classified as high-risk under the PCE, 3.5% would remain in this category with PREVENT, while 93% would be reclassified as intermediate risk. CONCLUSIONS The adoption of the novel cardiovascular risk score, PREVENT, could lower the average predicted ASCVD risk and reduce the prevalence of high-risk individuals. While this shift might suggest improved cardiovascular health, it could also lead to complacency, potentially undermining ongoing public health efforts aimed at preventing cardiovascular disease.
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Nolde JM, Beaney T, Carnagarin R, Stergiou GS, Poulter NR, Schutte AE, Schlaich MP. Age-Related Blood Pressure Gradients Are Associated With Blood Pressure Control and Global Population Outcomes. Hypertension 2024; 81:2091-2100. [PMID: 39109449 DOI: 10.1161/hypertensionaha.124.23406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/22/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND The strong relationship between blood pressure (BP) and age is well known. Limited evidence suggests that a steeper age-BP slope may be associated with an increased risk of adverse outcomes. The May Measurement Month campaign enables an investigation of geographic, socioeconomic, and sex differences in age-related BP gradients and their association with public-health outcomes. METHODS Cross-sectional, annual global BP May Measurement Month screening data were analyzed. Average systolic BP and age-related BP slopes across different age groups were calculated to assess regional, socioeconomic, and sex-stratified variations. The association of BP slopes derived from adjusted linear regression models with country-level health metrics was investigated. RESULTS Age-related systolic BP gradients differed distinctly across global geographic regions, income levels, and between sexes. The steepest age gradients of BP were observed in populations from Africa and Europe. Women had lower BP levels than men at younger ages (20s and 30s) but subsequently experienced more pronounced age-related BP gradients. Geographically divergent age-related BP gradients were significantly associated with major national public health indicators. Globally, steeper age-related BP slopes were associated with poor BP control, increased disability-adjusted life years, and death rates. A steeper population age-BP slope of 1 mm Hg per 10 years was associated with a decrease in life expectancy of 3.3 years in this population (95% CI, -5.1 to -1.4; P=0.0007). CONCLUSIONS Age-related BP gradients vary considerably across global populations and are associated with variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of adverse BP gradients to improve health outcomes.
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Affiliation(s)
- Janis M Nolde
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital/Medical Research Foundation, University of Western Australia (J.M.N., R.C., M.P.S.)
- Department of Nephrology, University of Freiburg Medical Centre, Germany (J.M.N.)
| | - Thomas Beaney
- School of Public Health, Imperial College London, United Kingdom (T.B., N.R.P.)
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital/Medical Research Foundation, University of Western Australia (J.M.N., R.C., M.P.S.)
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, Greece (G.S.S.)
| | - Neil R Poulter
- School of Public Health, Imperial College London, United Kingdom (T.B., N.R.P.)
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Australia (A.E.S.)
- The George Institute for Global Health, Sydney, NSW, Australia (A.E.S.)
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital/Medical Research Foundation, University of Western Australia (J.M.N., R.C., M.P.S.)
- Departments of Cardiology and Nephrology (M.P.S.), Royal Perth Hospital, Australia
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.P.S.)
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Jing B, Liu X, Graham LA, Dave CV, Li Y, Fung K, Liu CK, Abdel Magid HS, Growdon ME, Deardorff WJ, Boscardin WJ, Lee SJ, Steinman MA, Odden MC. Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents. JAMA Intern Med 2024:2823919. [PMID: 39312220 PMCID: PMC11420821 DOI: 10.1001/jamainternmed.2024.4851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Importance Antihypertensive medication deprescribing is common among nursing home residents, yet its association with cognitive decline remains uncertain. Objective To investigate the association of deprescribing antihypertensive medication with changes in cognitive function in nursing home residents. Design, Setting, and Participants This cohort study using a target trial emulation approach included VA long-term care residents aged 65 years or older with stays of at least 12 weeks from 2006 to 2019. Residents who were not prescribed antihypertensive medication, with blood pressure greater than 160/90 mm Hg, or with heart failure were excluded. Eligible residents with stable medication use for 4 weeks were classified into deprescribing or stable user groups and followed for 2 years or until death or discharge for intention-to-treat (ITT) analysis. Participants switching treatment groups were censored in the per-protocol analysis. Cognitive function measurements during follow-up were analyzed using an ordinal generalized linear mixed model, adjusting for confounders with inverse probability of treatment weighting. Per-protocol analysis included inverse probability of censoring weighting. Data analyses were performed from May 1, 2023, and July 1, 2024. Exposures Deprescribing was defined as a reduction in the total number of antihypertensive medications or a decrease in medication dosage by 30%, sustained for a minimum of 2 weeks. Main Outcomes and Measures Cognitive Function Scale (CFS) was classified as cognitively intact (CFS = 1), mildly impaired (CFS = 2), moderately impaired (CFS = 3), and severely impaired (CFS = 4). Results Of 45 183 long-term care residents, 12 644 residents (mean [SD] age 77.7 [8.3] years; 329 [2.6%] females and 12 315 [97.4%] males) and 12 053 residents (mean [SD] age 77.7 [8.3] years; 314 [2.6%] females and 11 739 [97.4%] males) met eligibility for ITT and per-protocol analyses, respectively. At the end of the follow-up, 12.0% of residents had a worsened CFS (higher score) and 7.7% had an improved CFS (lower score) with 10.8% of the deprescribing group and 12.1% of the stable user group showing a worsened CFS score. In the per-protocol analysis, the deprescribing group had a 12% reduction in the odds of progressing to a worse CFS category per 12-week period (odds ratio, 0.88; 95% CI, 0.78-0.99) compared to the stable user group. Among residents with dementia, deprescribing was associated with 16% reduced odds of cognitive decline (odds ratio, 0.84; 95% CI, 0.72-0.98). These patterns remained consistent in the ITT analysis. Conclusions and Relevance This cohort study indicates that deprescribing is associated with less cognitive decline in nursing home residents, particularly those with dementia. More data are needed to understand the benefits and harms of antihypertensive deprescribing to inform patient-centered medication management in nursing homes.
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Affiliation(s)
- Bocheng Jing
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Northern California Institute for Research and Education, San Francisco
| | - Xiaojuan Liu
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Laura A Graham
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, California
| | - Chintan V Dave
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Rutgers University, New Brunswick, New Jersey
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, New Jersey
| | - Yongmei Li
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Kathy Fung
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Christine K Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University, School of Medicine, Stanford, California
- Geriatric Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Hoda S Abdel Magid
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Matthew E Growdon
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - W James Deardorff
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - W John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sei J Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michael A Steinman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
- Geriatric Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Pathak A, Weber MA, Poulos C, Cohen SA, DeBruin V, Kandzari DE. Impact of expected blood pressure reduction on patient preferences for pharmaceutical and renal denervation treatment. J Hypertens 2024:00004872-990000000-00547. [PMID: 39324951 DOI: 10.1097/hjh.0000000000003872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
BACKGROUND Effective patient-centered care requires an adequate understanding of patient preferences for different therapeutic options. We modelled patient preference for blood pressure (BP) management by pharmaceutical or interventional treatments such as renal denervation in patients with different profiles of uncontrolled hypertension. METHODS Modeling was based on the findings from a previously conducted quantitative discrete choice experiment (DCE). The likelihood of selecting either an interventional treatment option or additional antihypertensive medication option was calculated for three patient profiles that represent the range of patients with hypertension commonly encountered in clinical practice: treatment-naive, patients with uncontrolled BP while on one to three antihypertensive medications, and patients with drug-resistant hypertension. Variables in the preference model were treatment attributes from the DCE study: expected reduction in office SBP with each treatment, duration of treatment effect, risk of reversible drug side effects from drugs, and risk of temporary pain and/or bruising or vascular injury from interventions. Values of the variables were derived from published clinical studies or expert opinion. RESULTS The model predicted that the likelihood of choosing renal denervation over initiating pharmacotherapy was 17.2% for previously untreated patients, 23.7% for patients with moderate hypertension currently on pharmacotherapy, and 41.8% for patients with drug-resistant hypertension. The dominant variable driving preference in these models was the expected BP reduction. Patient preferences for intervention are greater when drug nonadherence or increased SBP reduction at 3 vs. 1 year are included in the model. Baseline BP, drug side effects, or risks of the procedure had little influence on decisions. CONCLUSION Modeling using patient preference weights predicts that a substantial minority of patients favor an interventional treatment such as renal denervation over initiation or escalation of medications. Awareness of a patient's interest in device-based versus pharmaceutical strategies should inform the shared decision-making process for hypertension treatment.
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Affiliation(s)
- Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monaco
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Flack JM, Bitner S, Buhnerkempe M. Evolving the Role of Black Race in Hypertension Therapeutics. Am J Hypertens 2024; 37:739-744. [PMID: 39022802 DOI: 10.1093/ajh/hpae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/30/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024] Open
Abstract
Black race has been used to guide antihypertensive drug selection for Black patients based on predominant between race (same drug) and intra-race (different drugs) blood pressure (BP) response patterns. Accordingly, thiazide diuretics and calcium antagonists have been recommended over renin-angiotensin system (RAS) inhibitors (angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors) and beta blockers for Black patients. Current antihypertensive drug prescribing reflects historical guidance as calcium antagonists and thiazide diuretics are prescribed more and RAS blockers less in Black than White patients. Hypertension control rates in Blacks, lag those for Whites despite their greater use of combination drug therapy and lesser use of monotherapy. This is also true across drug regimens containing any of the 4 recommended classes for initial therapy as well as for evidence-based combination drug therapy (calcium antagonist or thiazide diuretic + RAS blocker) regimens for which there is no known racial disparity in BP response. Current recommendations acknowledge the need for combination drug therapy in most, especially in Black patients. One exemplary comprehensive hypertension control program achieved >80% control rates in Black and White patients with minimal racial disparity while utilizing a race-agnostic therapeutic algorithm. Black patients manifest robust, if not outsized, BP responses to diet/lifestyle modifications. Importantly, race neither appears to be a necessary nor sufficient consideration for the selection of effective drug therapy. Accordingly, we urge the initiation of adequately intense race-agnostic drug therapy coupled with greater emphasis on diet/lifestyle modifications for Black patients as the cornerstone of a race-informed approach to hypertension therapeutics.
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Affiliation(s)
- John M Flack
- Hypertension Section, Division of General Internal Medicine, Department of Medicine, Southern Illinois University School of Medicine, Springfield IL, USA
| | - Stephanie Bitner
- Hypertension Section, Division of General Internal Medicine, Department of Medicine, Southern Illinois University School of Medicine, Springfield IL, USA
| | - Michael Buhnerkempe
- Department of Medicine, Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
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Loo YK, Wilkinson K, Harkness T, Howard G, Howard VJ, Judd SE, Zakai NA, Muntner P, Min L, Oparil S, Plante TB. Hypertension Severity as Quantified by Hypertension Daily Dose and Blood Pressure With Risk of Stroke in REGARDS. J Am Heart Assoc 2024; 13:e033401. [PMID: 39158538 DOI: 10.1161/jaha.123.033401] [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: 02/28/2024] [Accepted: 04/19/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND It is unknown how blood pressure (BP) relates to stroke risk across levels of hypertension daily dose (HDD)-quantified antihypertensive medication intensity. METHODS AND RESULTS The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study enrolled 30 239 participants from the 48 contiguous US states in 2003 to 2007 with in-person follow-up in 2013 to 2016 (Visit 2). We included those without prior stroke at Visit 2, treating this visit as T0. Biannual phone calls and medical record review ascertained incident stroke events. Cox proportional hazard models estimated the hazard ratio (HR) of incident stroke by treatment intensity defined by systolic BP stages and HDD groupings. There were 344 stroke events over a median 5.5 years. Relative to systolic BP <120 mm Hg and no antihypertensive medications, the stroke HR was 2.86 (95% CI, 1.68-4.85) for systolic BP 140 to 159 mm Hg and HDD tertile 2, 2.33 (1.37-3.97) for systolic BP 140 to 159 mm Hg and HDD tertile 3, 3.08 (1.20-7.88) for systolic BP ≥160 mm Hg and HDD tertile 2, and 3.66 (1.61-8.30) for systolic BP ≥160 mm Hg and HDD tertile 3. Stroke risk was similar across HDD levels for people with systolic BP <140 mm Hg. CONCLUSIONS Among adults without prior stroke, systolic BP ≥140 mm Hg and HDD tertile ≥2 was associated with greater stroke risk. For adults with BP <140 mm Hg, stroke risk was similar despite cumulative dose of antihypertensive medications used. These findings support the practice of BP-lowering medications to mitigate stroke risk.
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Affiliation(s)
- Ying K Loo
- The Robert Larner, M.D. College of Medicine at the University of Vermont Burlington VT USA
| | - Katherine Wilkinson
- The Robert Larner, M.D. College of Medicine at the University of Vermont Burlington VT USA
| | - Tyler Harkness
- The Robert Larner, M.D. College of Medicine at the University of Vermont Burlington VT USA
| | - George Howard
- Department of Biostatistics School of Public Health University of Alabama at Birmingham Birmingham AL USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health University of Alabama at Birmingham Birmingham AL USA
| | - Suzanne E Judd
- Department of Biostatistics School of Public Health University of Alabama at Birmingham Birmingham AL USA
| | - Neil A Zakai
- The Robert Larner, M.D. College of Medicine at the University of Vermont Burlington VT USA
| | - Paul Muntner
- Department of Epidemiology, School of Public Health University of Alabama at Birmingham Birmingham AL USA
| | - Lillian Min
- Department of Medicine University of Michigan Ann Arbor VA Medical Center Geriatric Research Education Clinical Center (GRECC) Ann Arbor MI USA
| | - Suzanne Oparil
- Department of Medicine University of Alabama at Birmingham Birmingham AL USA
| | - Timothy B Plante
- The Robert Larner, M.D. College of Medicine at the University of Vermont Burlington VT USA
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Muntner P, Jaeger BC, Foti K, Ghazi L, Bundy JD, Chen L, Safford MM. Predicted Cardiovascular Risk by the PREVENT Equations in US Adults With Stage 1 Hypertension. Hypertension 2024; 81:1976-1985. [PMID: 39005226 DOI: 10.1161/hypertensionaha.124.22998] [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: 03/06/2024] [Accepted: 05/06/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The 2017 American College of Cardiology/American Heart Association blood pressure guideline recommends initiation of antihypertensive medication for adults with stage 1 hypertension (systolic blood pressure, 130-139 mm Hg, or diastolic blood pressure, 80-89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10% estimated by the pooled cohort equations (PCEs). In 2023, the American Heart Association published the predicting risk of cardiovascular disease events (PREVENT) equations to estimate ASCVD and total cardiovascular disease risk. METHODS We analyzed US National Health and Nutrition Examination Survey data from 2013 to 2020 for 1703 adults aged 30 to 79 years without self-reported cardiovascular disease with stage 1 hypertension. We estimated 10-year ASCVD risk by the PCEs and 10-year ASCVD and total cardiovascular disease risk by the base PREVENT equations. Analyses were weighted to represent noninstitutionalized US adults with stage 1 hypertension. RESULTS Mean 10-year ASCVD risk was 5.4% (95% CI, 5.0%-5.9%) and 2.9% (95% CI, 2.7%-3.1%) using the PCEs and PREVENT equations, respectively. The proportion with 10-year ASCVD risk of 10% to <15% and ≥15% was 8.1% and 7.8% estimated by the PCEs, respectively, and 3.0% and 0.3% estimated by the PREVENT equations, respectively. No participants had a 10-year ASCVD risk ≥10% on the PREVENT equations and <10% on the PCEs, while 12.5% had a 10-year ASCVD risk ≥10% on the PCEs and <10% on the PREVENT equations. The mean 10-year total cardiovascular disease risk estimated by the PREVENT equations was lower than the mean 10-year ASCVD risk on the PCEs. CONCLUSIONS Among US adults with stage 1 hypertension, the 10-year predicted ASCVD risk estimated by the PREVENT equations was approximately half the risk estimated by the PCEs.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham (P.M., K.F., L.G., L.C.)
| | - Byron C Jaeger
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC (B.C.J.)
| | - Kathryn Foti
- Department of Epidemiology, University of Alabama at Birmingham (P.M., K.F., L.G., L.C.)
| | - Lama Ghazi
- Department of Epidemiology, University of Alabama at Birmingham (P.M., K.F., L.G., L.C.)
| | - Joshua D Bundy
- Department of Epidemiology, Tulane University, New Orleans, LA (J.D.B.)
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham (P.M., K.F., L.G., L.C.)
| | - Monika M Safford
- Department of Medicine, Weill Medical College of Cornell University, New York, NY (M.M.S.)
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Coates MM, Arah OA, Matthews TA, Sandler DP, Jackson CL, Li J. Multiple forms of perceived job discrimination and hypertension risk among employed women: Findings from the Sister Study. Am J Ind Med 2024; 67:844-856. [PMID: 38953171 PMCID: PMC11340861 DOI: 10.1002/ajim.23634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/16/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Hypertension has been linked to socially patterned stressors, including discrimination. Few studies have quantified the risk of hypertension associated with exposure to perceived job discrimination. METHODS We used prospective cohort data from the Sister Study (enrollment from 2003-2009) to estimate self-reported incident hypertension associated with perceived job discrimination based on race, gender, age, sexual orientation, or health status. Job discrimination in the prior 5 years was assessed in 2008-2012, and incident doctor-diagnosed hypertension was ascertained in previously hypertension-free participants. RESULTS Among the 16,770 eligible participants aged 37-78 years at the start of follow-up, 10.5% reported job discrimination in the past 5 years, and 19.2% (n = 3226) reported incident hypertension during a median follow-up of 9.7 years (interquartile range 8.2-11.0 years). Self-reported poor health or inclusion in minoritized groups based on race/ethnicity or sexual orientation were more frequent among those reporting job discrimination. In a Cox proportional hazards model adjusting for covariates, report of at least one type of job discrimination (compared to none) was associated with a 14% (hazard ratio = 1.14 [95% confidence: 1.02-1.27]) higher hypertension risk. Results from sensitivity analyses reinforced the findings. CONCLUSIONS Results suggest that interventions addressing job discrimination could have workplace equity and health benefits.
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Affiliation(s)
- Matthew M. Coates
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Onyebuchi A. Arah
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- Department of Statistics, Division of Physical Sciences, College of Letters and Science, University of California Los Angeles, Los Angeles, CA, United States
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Timothy A. Matthews
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- Department of Environmental and Occupational Health, California State University Northridge, Northridge, CA, United States
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, United States
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, United States
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Jian Li
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Gallagher BD, Windish DM. A Curriculum on Advanced Topics in Hypertension for Internal Medicine Residents. South Med J 2024; 117:556-561. [PMID: 39227050 DOI: 10.14423/smj.0000000000001732] [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: 09/05/2024]
Abstract
OBJECTIVES Hypertension (HTN) affects nearly half of US adults. Our multi-institutional survey revealed that Internal Medicine residents lack proficiency in advanced HTN topics. We developed a curriculum to address knowledge gaps in these topics and aimed to assess the effects of the curriculum on residents' confidence, desire for future training, and knowledge in advanced HTN topics. METHODS HTN experts taught four advanced topics in HTN: conducting a workup for secondary HTN, managing HTN in chronic kidney disease, managing HTN in patients who are or may become pregnant, and managing hypertensive urgency (severe asymptomatic HTN) in the outpatient setting. The setting of the curriculum was an ambulatory educational half-day, during which residents rotated through small-group sessions dedicated to each HTN topic. We developed pre-, immediate post-, and 8 weeks postcurriculum surveys assessing residents' confidence and desire for future training in the four topics (4-point Likert scales), and multiple-choice quizzes to assess changes in knowledge. We used repeated-measures analysis of variance to compare means between time points for surveys and quizzes. RESULTS A total of 112 Internal Medicine residents participated in the curriculum. The mean confidence scores for all four topics increased from 1.79 to 2.61 precurriculum to 2.90 to 3.45 immediately postcurriculum (all P < 0.001) and remained higher (2.53-3.18) than precurriculum at 8 weeks postcurriculum (all P < 0.02). The mean desire for future training scores decreased from 2.74 to 2.96 precurriculum to 2.06 to 2.36 immediately postcurriculum (all P < 0.001 except for managing HTN in patients who are or may become pregnant, which was P = 0.17) and remained lower (2.08-2.36) than precurriculum at 8 weeks postcurriculum (all P ≤ 0.003). The mean knowledge score increased from 48% precurriculum to 62% immediate postcurriculum (P < 0.001) and remained higher (55%) than precurriculum at 8 weeks postcurriculum (P = 0.015). CONCLUSIONS A curriculum on advanced HTN topics produced durable gains in confidence and knowledge and partially satisfied the desire for future learning among Internal Medicine residents.
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Affiliation(s)
- Benjamin D Gallagher
- From the Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Donna M Windish
- From the Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Shetty NS, Gaonkar M, Pampana A, Patel N, Irvin MR, Lin HJ, Guo X, Rich SS, Rotter JI, Budoff MJ, Li P, Arora G, Arora P. Genetic Risk and Coronary Artery Calcium in Personalizing Antihypertensive Treatment: A Pooled Cohort Analysis. Mayo Clin Proc 2024; 99:1422-1434. [PMID: 39115511 DOI: 10.1016/j.mayocp.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/29/2023] [Accepted: 12/27/2023] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To assess the role of the systolic blood pressure polygenic risk score (SBP-PRS) in antihypertensive treatment initiation and its comparative efficacy with coronary artery calcium (CAC) scores. PATIENTS AND METHODS This retrospective cohort study included participants with whole genome sequencing data who underwent CAC scanning between 1971 and 2008, were free of prevalent cardiovascular disease (CVD), and were not taking antihypertensive medications. The cohort was stratified by blood pressure (BP) treatment group and SBP-PRS (low/intermediate, first and second tertiles; high, third tertile) and CAC score (0 vs >0) subgroups. The primary outcome was the first occurence of adjudicated coronary heart disease, heart failure, or stroke during 10-year follow-up. The 10-year number needed to treat (NNT) to prevent 1 event of the primary outcome was estimated. A relative risk reduction of 25% for the primary outcome based on the treatment effect of intensive control (SBP <120 mm Hg) of hypertension in SPRINT (Systolic Blood Pressure Intervention Trial) was used for estimating the NNT. RESULTS Among the 5267 study participants, the median age was 59 years (interquartile range, 51-68 years); 2817 (53.5%) were women and 2880 (54.7%) were non-White individuals. Among 1317 individuals with elevated BP/low-risk stage 1 hypertension not recommended treatment, the 10-year incidence rate of the primary outcome was 5.6% for low/intermediate SBP-PRS and 6.3% for high SBP-PRS with NNTs of 63 and 59, respectively. Similarly, the 10-year incidence rate of the primary outcome was 2.9% for CAC score 0 and 9.7% for CAC score greater than 0, with NNTs of 117 and 37, respectively. CONCLUSION Including genetic information in risk estimation of individuals with elevated BP/low-risk stage 1 hypertension has modest value in the initiation of antihypertensive therapy. Genetic risk and CAC both have efficacy in personalizing antihypertensive therapy.
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Affiliation(s)
- Naman S Shetty
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham
| | - Mokshad Gaonkar
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham
| | - Akhil Pampana
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham
| | - Nirav Patel
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham
| | - Henry J Lin
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Stephen S Rich
- Center for Public Health, University of Virginia, Charlottesville
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Matthew J Budoff
- Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Peng Li
- School of Nursing, The University of Alabama at Birmingham, Birmingham
| | - Garima Arora
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham
| | - Pankaj Arora
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL.
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Ahmed Z, Chaudhary F, Agrawal DK. Epidemiology, Pathophysiology, and Current Treatment Strategies in Stroke. CARDIOLOGY AND CARDIOVASCULAR MEDICINE 2024; 8:389-404. [PMID: 39301121 PMCID: PMC11412115 DOI: 10.26502/fccm.92920399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Both ischemic and hemorrhagic strokes are critical health issues and the incidence is on the rise. The rapid neurological degeneration that can occur with either type of stroke warrants prompt medical attention. In the article, we critically reviewed the literature examining their incidence, pathophysiology, and present treatment strategies. Clinical trials show conflicting findings, with ischemic strokes accounting for 87% of all strokes. Brain injury following an ischemic stroke results in cell death and necrosis, immune cells being the primary actors in the process of neuroinflammation. In order to develop neuroprotective drugs against ischemic stroke, detailed investigation of glutamate production and metabolism as well as downstream pathways controlled by glutamate receptors provides significant information on the underlying mechanisms. The permeability of the blood-brain barrier and the degradation of glutamine synthase are two potential mechanisms by which peritoneal dialysis accelerates brain-to-blood glutamate clearance and thus reduces glutamate levels in the brain after a stroke. Oxidative stress in an ischemic stroke disturbs the oxidant-antioxidant balance, which is particularly problematic for brain cells that are high in polyunsaturated fatty acids. Because of demographic factors like age, sex, race/ethnicity, and socioeconomic status, the incidence and prevalence of stroke differ across people and regions. For rapid diagnosis and treatment decisions, diagnostic imaging tools such as vascular imaging, CT, and MRI are essential. To aid in the recovery and lessen neurological impairments following a stroke, novel avenues of research are under investigation on neuroprotective medications that target inflammation, oxidative stress, and neuronal death.
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Affiliation(s)
- Zubair Ahmed
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Fihr Chaudhary
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
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Lin GM, Tsai KZ, Chang YC, Liu PY, Sui X, Lavie CJ, Hsu PS. Substances use and risk of hypertension before midlife in military young adults: CHIEF cohort study, 2014-2020. Prog Cardiovasc Dis 2024:S0033-0620(24)00116-6. [PMID: 39209240 DOI: 10.1016/j.pcad.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The use of substances, e.g., tobacco and betel nut, are prevalent among military personnel in Taiwan, whereas some specific substances such as alcohol use are forbidden in military base. There were inconsistent findings for the incidence of hypertension with habitual substances use in diverse populations, while no studies were carried out in the military. METHODS A total of 2419 Taiwanese military personnel, aged 18-39 years, who were not taking any antihypertensive agents and did not have a baseline systolic blood pressure (SBP) ≥130 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg were followed for incidence of hypertension from baseline (2014) through the end of 2020. Alcohol, tobacco and betel nut use status (active vs. former/never) were self-reported by each participant at baseline. New-onset hypertension of each participant was defined by an average of two resting BP measurements in the annual health examinations (2015-2020). Multivariable Cox regression analysis with adjustments for baseline BP and other potential covariates were performed to determine the risk of incident hypertension with each substance use. Five-year absolute changes in BP level with specific substance use were compared using analysis of covariance (ANCOVA). RESULTS There were 867 active smokers (35.8 %), 237 active betel nut chewers (9.8 %) and 961 active alcohol consumers (39.7 %) at baseline. During a median follow-up of 5.8 years, 911 new-onset hypertension events (37.7 %) were observed. While compared to those without any substances use, merely active holiday alcohol users had a significantly lower risk of incident hypertension [hazard ratio (HR) and 95 % confidence interval: 0.72 (0.58-0.89)]. The 5-year diastolic BP increase (mmHg) was borderline significantly lower in active alcohol users on holidays as compared to former/never alcohol users (4.02 (standard deviation =9.01) and 4.76 (9.42), p = 0.07). The risk of incident hypertension was not significant in active smokers and active betel nut users, while the 5-year BP increase level was significantly greater in active smokers than former/never smokers (5.60 (9.96) vs. 4.42 (9.22), p = 0.03). CONCLUSION Our findings suggest that military young personnel consuming alcohol only allowed on holidays had a lower incidence of new-onset hypertension. On the contrary, the 5-year BP change may increase greater with habitual smoking, though the risk of new-onset hypertension was not affected.
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Affiliation(s)
- Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan; Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Zhe Tsai
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan; Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei, Taiwan; Departments of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yun-Chen Chang
- Nursing Department, China Medical University Hospital, Taichung, Taiwan; School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
| | - Pang-Yen Liu
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xuemei Sui
- Arnold School of Public Health, University of South Carolina, SC, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Po-Shun Hsu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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15
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Li J, Yao Y, Yin W, Feng S, Yan P, Wang L, Zhu X, Zhang K, Tian J, Wang Z, Yuan H. Association of periodontitis with cardiovascular and all-cause mortality in hypertensive individuals: insights from a NHANES cohort study. BMC Oral Health 2024; 24:950. [PMID: 39152381 PMCID: PMC11328503 DOI: 10.1186/s12903-024-04708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The objective of this research is to clarify the impact of periodontitis on overall and cardiovascular-related death rates among hypertensive individuals. METHOD A total of 5665 individuals with hypertension were included from the National Health and Nutrition Examination Survey (NHANES) data spanning 2001-2004 and 2009-2014. These individuals were divided into two groups based on the presence or absence of periodontitis and further stratified by the severity of periodontitis. We employed weighted multivariate Cox proportional hazards regression and Kaplan-Meier curves (log-rank test) to evaluate the impact of periodontitis on all-cause and cardiovascular mortality. Additional analyses, including adjustments for various covariates, subgroups, and sensitivity analyses, were conducted to ensure the robustness and reliability of our results. RESULT Over an average follow-up duration of 10.22 years, there were 1,122 all-cause and 297 cardiovascular deaths. Individuals with periodontitis exhibited an elevated risk of all-cause mortality (HR = 1.33, 95% CI 1.18-1.51; p < 0.0001) and cardiovascular mortality (HR = 1.48, 95% CI 1.15-1.89; p = 0.002). Moreover, we observed a progressive increase in both all-cause mortality and cardiovascular mortality (p for trend are both lower than 0.001) and correlating with the severity of periodontitis. These associations remained consistent across various subgroup and sensitivity analyses. CONCLUSION Our findings suggest a significant association between periodontitis and increased risks of all-cause and cardiovascular mortality among hypertensive individuals. Notably, the severity of periodontitis appears to be a critical factor, with moderate to severe cases exerting a more pronounced impact on all-cause mortality. Additionally, cardiovascular disease mortality significantlly increases in individuals with varying degrees of periodontitis.
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Affiliation(s)
- Jingru Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
- JiNan Key Laboratory of Cardiovascular Disease, Jinan, 250021, Shandong, P.R. China
| | - Yajun Yao
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Wenchao Yin
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, P.R. China
| | - Shuai Feng
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Pengcheng Yan
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, P.R. China
| | - Leiyan Wang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Xiao Zhu
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Kaiwen Zhang
- High school attached to shandong normal university, Jinan, 250014, Shandong, P.R. China
| | - Jingjing Tian
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Zhaoyang Wang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China.
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, P.R. China.
| | - Haitao Yuan
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China.
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, P.R. China.
- JiNan Key Laboratory of Cardiovascular Disease, Jinan, 250021, Shandong, P.R. China.
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Rojas‐Saunero LP, Hughes TM, Mayeda ER, Jimenez MP. Racial and ethnic differences in the risk of dementia diagnosis under hypothetical blood pressure-lowering interventions: The Multi-Ethnic Study of Atherosclerosis. Alzheimers Dement 2024; 20:5271-5280. [PMID: 38984649 PMCID: PMC11350054 DOI: 10.1002/alz.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Substantial racial and ethnic disparities in hypertension and dementia exist in the United States. We evaluated the effect of maintaining systolic blood pressure (SBP) below clinical thresholds on dementia incidence. METHODS We included 6806 Multi-Ethnic Study of Atherosclerosis participants (44 to 84 years old). We implemented the parametric g-formula to simulate the hypothetical interventions to reduce SBP below 120 and 140 mmHg over time, accounting for time-varying confounding. We estimated risk ratios (RRs) and risk differences for dementia incidence at 19 years. RESULTS The RRs (95% confidence intervals [CIs]) comparing an intervention reducing SBP below 120 mmHg to no intervention were 0.93 (0.87 to 0.99) for total sample, 0.95 (0.88 to 1.02) for White, 0.90 (0.79 to 1.02) for Black, 0.90 (0.78 to 1.05) for Latino, and 1.16 (0.83 to 1.55) for Chinese American participants. Results for lowering SBP below 140 mmHg and with death as competing event were attenuated. DISCUSSION The reduction of SBP below 120 mmHg over time has modest effects on reducing dementia incidence. More work is needed to understand the heterogeneity across racial and ethnic groups. HIGHLIGHTS There is a potential beneficial effect in lowering SBP to reduce the risk of dementia, which may vary by race and ethnicity. The percentage of participants who would need intervention on blood pressure to meet clinical thresholds is greater for Black and Latino communities. Results are sensitive to the way that death is specified in the research question and analysis.
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Affiliation(s)
| | - Timothy M. Hughes
- Department of Internal MedicineSection on Gerontology and Geriatric MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Elizabeth Rose Mayeda
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
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Heaton J, Imburgio S, Mararenko A, Udongwo N, Alshami A, Schoenfeld M, Apolito R, Selan J, Sealove B, Almendral J. Potential United States Population Impact of the 2023 PREVENT Risk Calculator on Hypertension Management. Hypertension 2024; 81:e88-e90. [PMID: 39018379 DOI: 10.1161/hypertensionaha.124.23013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Joseph Heaton
- Department of Medicine (J.H., S.I.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Steven Imburgio
- Department of Medicine (J.H., S.I.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Anton Mararenko
- Department of Cardiology (A.M., A.A., M.S., R.A., J.S., B.S., J.A.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Ndausung Udongwo
- Department of Cardiology, Morehouse School of Medicine, Atlanta, GA (N.U.)
| | - Abbas Alshami
- Department of Cardiology (A.M., A.A., M.S., R.A., J.S., B.S., J.A.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Matthew Schoenfeld
- Department of Cardiology (A.M., A.A., M.S., R.A., J.S., B.S., J.A.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Renato Apolito
- Department of Cardiology (A.M., A.A., M.S., R.A., J.S., B.S., J.A.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Jeffrey Selan
- Department of Cardiology (A.M., A.A., M.S., R.A., J.S., B.S., J.A.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Brett Sealove
- Department of Cardiology (A.M., A.A., M.S., R.A., J.S., B.S., J.A.), Jersey Shore University Medical Center, Neptune City, NJ
| | - Jesus Almendral
- Department of Cardiology (A.M., A.A., M.S., R.A., J.S., B.S., J.A.), Jersey Shore University Medical Center, Neptune City, NJ
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Salimi Z, Aminnezhad Kavkani B, Allahyari P, Askarpour SA, Mahmoudi Z, Torkaman M, Hoseini MSM, Mousavi Z, Tajadod S, Valisoltani N, Khoshdooz S, Doaei S, Kooshki A, Gholamalizadeh M. Branched-chain amino acids and the risk of hypertension; a persian cohort-based study. BMC Cardiovasc Disord 2024; 24:397. [PMID: 39085768 PMCID: PMC11290056 DOI: 10.1186/s12872-024-04045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The association of hypertension (HTN) and different types of dietary amino acids is not yet clear. The aim of the present study was to investigate the association of branch chain amino acids (BCAAs) and the prevention of HTN. METHODS This cross-sectional study was conducted on 4184 people aged 35 to 70 using data from the Sabzevar Persian cohort study in Sabzevar, Iran. Data on dietary intake of BCAAs including leucine, isoleucine, and valine were obtained using a validated Food Frequency Questionnaire (FFQ). Multivariable logistic regression analysis assessed the link between HTN and BCAAs. RESULTS The results showed that participants with HTN had a higher total protein and BCAAs intake than participants with normal BP (P < 0.01). A marginally significant association was found between the risk of HTN with the total intake of BCAAs (OR = 1.018, CI95%: 1.001-1.035, P = 0.04), leucine (OR = 1.040, CI95%:1.002-1.080, P = 0.03), isoleucine (OR = 1.068, CI95%:1.001-1.140, P = 0.04), and valine (OR = 1.060, CI95%:1.003-1.121, P = 0.04). However, the association disappeared after adjusting the total protein and calorie intake. CONCLUSIONS The results indicated that the dietary intake of BCAAs may be associated with the risk of HTN. Future longitudinal research is warranted.
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Affiliation(s)
- Zahra Salimi
- Student Research Committee, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Pooneh Allahyari
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Ali Askarpour
- Department of Environmental Health Engineering, Division in Food Safety and Hygiene, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mahmoudi
- Department of Nutrition, Science and Research Branch , Islamic Azad University, Tehran, Iran
| | - Mahdie Torkaman
- Department of Chemical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Zahra Mousavi
- Nursing and Midwifery school, Shahed University, Tehran, Iran
| | - Shirin Tajadod
- Department of Nutrition, School of Public Health, International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Valisoltani
- Department of Clinical Nutrition, School of Nutrition Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Khoshdooz
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeid Doaei
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Akram Kooshki
- Non-Communicable Diseases Research Center, Department of Nutrition & Biochemistry, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Maryam Gholamalizadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Masri D, Bar-Hai D, Masri-Iraqi H, Kahn A, Chaushu G, Chaushu L. Early Implant Failure in Patients Using Antihypertensive Medications: A Retrospective Cohort Study. Int Dent J 2024:S0020-6539(24)00138-2. [PMID: 39030096 DOI: 10.1016/j.identj.2024.05.003] [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: 02/13/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION AND AIMS Antihypertensive medications increase osteoblasts differentiation and bone mineral formation. Osseointegration of dental implants depends on new bone formation and remodelling. Consequently, improved osseointegration may be speculated in patients receiving antihypertensive drugs. Aim - Asses the effect of antihypertensive medications on osseointegration of dental implants. METHODS Retrospective cohort study. All individuals (792) who received at least one dental implant during a 6-year period at a single medical centre. The cohort was divided into three groups: normotensive (74.8% - 593) patients (NT group), hypertensive (23.4% - 185) patients using antihypertensive medications (HTN +med group), and hypertensive patients not using (1.8% - 14) antihypertensive medications (HTN -med group). Interventions-Installation of dental implants by experienced oral and maxillofacial surgeons with or without bone augmentation. Main measures - Early implant failure (EIF) (≤12 months from loading) reflects lack of new bone formation or excessive bone turnover during osseointegration. RESULTS The study included 792 individuals, 14 in the HTN-med group, 185 in the HTN +med group and 593 in the NT group. At the patient level, the HTN -med group were most likely (P = .041) to experience EIF 28.60% (4/14 patients). Due to the small sample of the HTN -med group, an additional analysis was carried out excluding this group. EIF of 9.70% (18/185 patients) in the HTN +med group was significantly (P = .047) lower than the NT group 14.50% (86/593 patients). 2971 implants were inserted in all study groups, 71.4% (2123) in the NT group, 26.4% (784) in the HTN +med group and 2.2% (64) in the HTN -med group. Collectively, EIF was recorded for 114 (3.84%) implants. In the HTN -med group, EIF of 6.25% (4 implants), was significantly (P < .001) higher than the two other groups. The EIF rate of the HTN +med group was 2.29% (18 implants) which was significantly less than that of the NT group 4.33% (92 implants). Controlling modifying parameters, using antihypertensive medication yielded lower EIF with marginal significance (P = .059) and OR = 0.618. CONCLUSION Based on statistically significant lower EIF rate found in the HTN +med group, antihypertensive medications may decrease the EIF rate of dental implants. CLINICAL RELEVANCE Clinicians should be encouraged to treat hypertensive patients with implant-supported prostheses, provided patient compliance regarding medications intake is good.
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Affiliation(s)
- Daya Masri
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqwa, Israel
| | - Dror Bar-Hai
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqwa, Israel
| | - Hiba Masri-Iraqi
- Department of Endocrinology, Rabin Medical Center, Campus Beilinson, Petah Tiqwa, Israel
| | - Adrian Kahn
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqwa, Israel.
| | - Liat Chaushu
- Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Navaneethabalakrishnan S, Goodlett B, Smith H, Montalvo R, Cardenas A, Mitchell B. Differential changes in end organ immune cells and inflammation in salt-sensitive hypertension: effects of increasing M2 macrophages. Clin Sci (Lond) 2024; 138:921-940. [PMID: 38949840 PMCID: PMC11250104 DOI: 10.1042/cs20240699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/02/2024]
Abstract
Salt-sensitive hypertension (SSHTN) is associated with M1 macrophage polarization and inflammatory responses, leading to inflammation-associated lymphangiogenesis and functional impairment across multiple organs, including kidneys and gonads. However, it remains unclear whether promoting M2 macrophage polarization can alleviate the hypertension, inflammation, and end organ damage in mice with salt sensitive hypertension (SSHTN). Male and female mice were made hypertensive by administering nitro-L-arginine methyl ester hydrochloride (L-NAME; 0.5 mg/ml) for 2 weeks in the drinking water, followed by a 2-week interval without any treatments, and a subsequent high salt diet for 3 weeks (SSHTN). AVE0991 (AVE) was intraperitoneally administered concurrently with the high salt diet. Control mice were provided standard diet and tap water. AVE treatment significantly attenuated BP and inflammation in mice with SSHTN. Notably, AVE promoted M2 macrophage polarization, decreased pro-inflammatory immune cell populations, and improved function in renal and gonadal tissues of mice with SSHTN. Additionally, AVE decreased lymphangiogenesis in the kidneys and testes of male SSHTN mice and the ovaries of female SSHTN mice. These findings highlight the effectiveness of AVE in mitigating SSHTN-induced elevated BP, inflammation, and end organ damage by promoting M2 macrophage polarization and suppressing pro-inflammatory immune responses. Targeting macrophage polarization emerges as a promising therapeutic approach for alleviating inflammation and organ damage in SSHTN. Further studies are warranted to elucidate the precise mechanisms underlying AVE-mediated effects and to assess its clinical potential in managing SSHTN.
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Affiliation(s)
| | - Bethany L. Goodlett
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX, U.S.A
| | - Hannah L. Smith
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX, U.S.A
| | - Robert A. Montalvo
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX, U.S.A
| | - Alyssa Cardenas
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX, U.S.A
| | - Brett M. Mitchell
- Department of Medical Physiology, Texas A&M University College of Medicine, Bryan, TX, U.S.A
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21
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Elias S, Wenzel J, Cooper LA, Perrin N, Commodore‐Mensah Y, Lewis KB, Koirala B, Slone S, Byiringiro S, Marsteller J, Himmelfarb CR. Multiethnic Perspectives of Shared Decision-Making in Hypertension: A Mixed-Methods Study. J Am Heart Assoc 2024; 13:e032568. [PMID: 38989822 PMCID: PMC11292762 DOI: 10.1161/jaha.123.032568] [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: 09/07/2023] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Shared decision-making (SDM) has the potential to improve hypertension care quality and equity. However, research lacks diverse representation and evidence about how race and ethnicity affect SDM. Therefore, this study aims to explore SDM in the context of hypertension management. METHODS AND RESULTS Explanatory sequential mixed-methods design was used. Quantitative data were sourced at baseline and 12-month follow up from RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) participants (n=1212) with hypertension. Qualitative data were collected from semistructured individual interviews, at 12-month follow-up, with participants (n=36) selected based on their SDM scores and blood pressure outcome. Patients were cross- categorized based on high or low SDM scores and systolic blood pressure reduction of ≥10 or <10 mm Hg. Multinomial logistic regression analysis showed that predictors of SDM scores and blood pressure outcome were race and ethnicity (relative risk ratio [RRR], 1.64; P=0.029), age (RRR, 1.03; P=0.002), educational level (RRR, 1.87; P=0.016), patient activation (RRR, 0.98; P<0.001; RRR, 0.99; P=0.039), and hypertension knowledge (RRR, 2.2; P<0.001; and RRR, 1.57; P=0.045). Qualitative and mixed-methods findings highlight that provider-patient communication and relationship influenced SDM, being emphasized both as facilitators and barriers. Other facilitators were patients' understanding of hypertension; clinicians' interest in the patient, and clinicians' personality and attitudes; and barriers included perceived lack of compassion, relationship hierarchy, and time constraints. CONCLUSIONS Participants with different SDM scores and blood pressure outcomes varied in determinants of decision and descriptions of contextual factors influencing SDM. Results provide actionable information, are novel, and expand our understanding of factors influencing SDM in hypertension.
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Affiliation(s)
| | - Jennifer Wenzel
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins School of MedicineBaltimoreMDUSA
| | - Lisa A. Cooper
- Johns Hopkins School of MedicineBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Yvonne Commodore‐Mensah
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | | | - Sarah Slone
- Johns Hopkins School of NursingBaltimoreMDUSA
| | | | - Jill Marsteller
- Johns Hopkins School of MedicineBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Cheryl R. Himmelfarb
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins School of MedicineBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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22
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Gallagher BD, Moreno JO. Can a Bedside Measure of Visceral Adiposity Predicts Progression of Prehypertension to Hypertension? Am J Hypertens 2024; 37:546-548. [PMID: 38708566 DOI: 10.1093/ajh/hpae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Benjamin D Gallagher
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jorge O Moreno
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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23
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Stoutenburg E, Sherman S, Bravo M, Howard V, Mukaz DK, Cushman M, Zakai NA, Judd S, Plante TB. Factor VIII and Incident Hypertension in Black and White Adults: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort. Am J Hypertens 2024; 37:580-587. [PMID: 38642910 DOI: 10.1093/ajh/hpae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Nearly half of all Americans have hypertension, and Black adults experience a disproportionate burden. Hypercoagulability may relate to hypertension risk, and higher levels of factor VIII increase thrombosis risk. Black adults have higher factor VIII and more hypertension than other groups. Whether higher factor VIII associates with incident hypertension is unknown. METHODS The Biomarkers as Mediators of Racial Disparities in Risk Factors (BioMedioR) study measured certain biomarkers in a sex-race stratified sample of 4,400 REGARDS participants who attended both visits. We included BioMedioR participants, excluding those with prevalent hypertension, missing factor VIII level, or covariates of interest. Modified Poisson regression estimated risk ratios (RR) for incident hypertension by higher log-transformed factor VIII level per SD (SD of log-transformed factor VIII, 0.33). Weighting was applied to take advantage of REGARDS sampling design. RESULTS Among the 1,814 participants included (55% female, 24% Black race), the median follow-up was 9.5 years and 35% (2,146/6,138) developed hypertension. Black participants had a higher median (IQR) factor VIII level (105.6%; 87.1%-126.9%) than White participants (95.6%; 79.8%-115.9%; P < 0.001). The age- and sex-adjusted Black-White hypertension RR was 1.45 (95% CI 1.28, 1.63). Higher factor VIII was not associated with more hypertension (final model RR 1.01; 95% CI 0.94, 1.07). CONCLUSIONS In a prospective study of Black and White adults without prevalent hypertension, factor VIII was not associated with greater hypertension risk.
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Affiliation(s)
- Eric Stoutenburg
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Sarah Sherman
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Maria Bravo
- Department of Biochemistry, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Virginia Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Science, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology and Laboratory Science, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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24
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Haberman D, Chitturi KR, Lupu L, Wermers JP, Waksman R. Overview of the 2023 FDA Circulatory System Devices Advisory Panel meeting on the Recor Paradise Ultrasound-Based Renal Denervation System. Catheter Cardiovasc Interv 2024; 104:34-43. [PMID: 38713867 DOI: 10.1002/ccd.31065] [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: 12/08/2023] [Revised: 03/07/2024] [Accepted: 04/17/2024] [Indexed: 05/09/2024]
Abstract
Hypertension continues to be a prominent, avoidable factor contributing to major vascular issues on a global scale. Even with lifestyle adjustments and more aggressive medical treatments, maintaining optimal blood pressure levels remains challenging. This challenge has driven the emergence of device-oriented approaches to address hypertension. To assess the safety and efficacy of the Recor Paradise Ultrasound Renal Denervation System, the Circulatory System Devices Panel was convened by the US Food and Drug Administration (FDA). This manuscript provides a condensed overview of the information put forth by the sponsor and the FDA, along with an account of the considerations and conversations that took place during the meeting.
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Affiliation(s)
- Dan Haberman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Kalyan R Chitturi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lior Lupu
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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25
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Lu Q, Xie H, Gao X. The Association of Blood Pressure Defined by the 2017 ACC/AHA Guidelines and Cardiovascular Disease Risk for Middle-Aged and Elderly People in China: A Cohort Study. Arq Bras Cardiol 2024; 121:e20230785. [PMID: 39194062 PMCID: PMC11341210 DOI: 10.36660/abc.20230785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/04/2024] [Accepted: 03/27/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a series of diseases affecting the heart or blood vessels. OBJECTIVES To assess the relationship between blood pressure (BP) levels defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline and CVD/atherosclerotic cardiovascular disease (ASCVD) risk for middle-aged and elderly people in China. METHODS A total of 6,644 middle-aged and elderly people from the China Health and Retirement Longitudinal Study (CHARLS) were finally included. According to the 2017 ACC/AHA guideline, all subjects were divided into four groups: normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension. The outcome of this study was considered as the risk of CVD and ASCVD. Univariate and multivariate COX regression models were adopted to examine the relationship of the 2017 ACC/AHA BP classification with the risk of CVD. Univariate and multivariate logistic regression models were used to investigate the association between BP levels and ASCVD risk. Subgroup analyses based on age, gender, and use of antihypertensive drugs were performed. P<0.05 was accepted as statistically significant. RESULTS After adjusting all covariates, compared to middle-aged and elderly patients with normal BP, we found that patients with stage 1/2 hypertension were associated with a higher risk of CVD, separately. Simultaneously, we also observed a positive association between individuals with elevated BP, stage 1 hypertension, stage 2 hypertension, and higher ASCVD risk in the fully adjusted model. The result of subgroup analyses implied that the relationship between stage 1/2 hypertension and CVD/ high ASCVD was robust in different ages and genders, and participants without using antihypertensive drugs. CONCLUSION BP classification under the 2017 ACC/AHA BP guidelines may apply to the Chinese population.
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Affiliation(s)
- Qingyang Lu
- Xicheng District Guangwai HospitalBeijingChinaXicheng District Guangwai Hospital - Cardiovascular Medicine, Beijing – China
| | - Haijing Xie
- Chongming Hospital Affiliated to ShanghaiUniversity of Medicine and Health SciencesShanghaiChinaChongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences - Oncology, Shanghai – China
| | - Xuefeng Gao
- Academician of the World Academy of Productivity SciencesChangchunChinaAcademician of the World Academy of Productivity Sciences, Changchun – China
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26
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Buis LR, Kim J, Sen A, Chen D, Dawood K, Kadri R, Muladore R, Plegue M, Richardson CR, Djuric Z, McNaughton C, Hutton D, Robert LP, Park SY, Levy P. The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e57863. [PMID: 38941601 PMCID: PMC11245662 DOI: 10.2196/57863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/12/2024] [Accepted: 04/30/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease-related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. OBJECTIVE We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. METHODS We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). RESULTS We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). CONCLUSIONS Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/12601.
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Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Junhan Kim
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Dongru Chen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katee Dawood
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rachelle Muladore
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Melissa Plegue
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Family Medicine, Brown University, Providence, RI, United States
| | - Zora Djuric
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Candace McNaughton
- Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - David Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lionel P Robert
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sun Young Park
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Phillip Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
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27
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Afifi RO, Mussa FF. Navigating clinical appropriateness: A review of management strategies for type B aortic dissection. Semin Vasc Surg 2024; 37:240-248. [PMID: 39152002 DOI: 10.1053/j.semvascsurg.2024.04.005] [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: 02/13/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 08/19/2024]
Abstract
Aortic dissection is a catastrophic, life-threatening event. Its management depends on the anatomic location of the intimal tear (type A v B) and the clinical presentation in type B aortic dissection. In this article, the current evidence supporting clinical practice, gaps in knowledge, and the need for more rigorous research and higher-quality studies are reviewed.
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Affiliation(s)
- Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, 6400 Fannin Street, Suite 2850, Houston, TX 77030.
| | - Firas F Mussa
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, 6400 Fannin Street, Suite 2850, Houston, TX 77030
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28
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Dave CV, Li Y, Steinman MA, Lee SJ, Liu X, Jing B, Graham LA, Marcum ZA, Fung KZ, Odden MC. Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents. JAMA Intern Med 2024; 184:661-669. [PMID: 38648065 PMCID: PMC11036308 DOI: 10.1001/jamainternmed.2024.0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 04/25/2024]
Abstract
Importance Limited evidence exists on the association between initiation of antihypertensive medication and risk of fractures in older long-term nursing home residents. Objective To assess the association between antihypertensive medication initiation and risk of fracture. Design, Setting, and Participants This was a retrospective cohort study using target trial emulation for data derived from 29 648 older long-term care nursing home residents in the Veterans Health Administration (VA) from January 1, 2006, to October 31, 2019. Data were analyzed from December 1, 2021, to November 11, 2023. Exposure Episodes of antihypertensive medication initiation were identified, and eligible initiation episodes were matched with comparable controls who did not initiate therapy. Main Outcome and Measures The primary outcome was nontraumatic fracture of the humerus, hip, pelvis, radius, or ulna within 30 days of antihypertensive medication initiation. Results were computed among subgroups of residents with dementia, across systolic and diastolic blood pressure thresholds of 140 and 80 mm Hg, respectively, and with use of prior antihypertensive therapies. Analyses were adjusted for more than 50 baseline covariates using 1:4 propensity score matching. Results Data from 29 648 individuals were included in this study (mean [SD] age, 78.0 [8.4] years; 28 952 [97.7%] male). In the propensity score-matched cohort of 64 710 residents (mean [SD] age, 77.9 [8.5] years), the incidence rate of fractures per 100 person-years in residents initiating antihypertensive medication was 5.4 compared with 2.2 in the control arm. This finding corresponded to an adjusted hazard ratio (HR) of 2.42 (95% CI, 1.43-4.08) and an adjusted excess risk per 100 person-years of 3.12 (95% CI, 0.95-6.78). Antihypertensive medication initiation was also associated with higher risk of severe falls requiring hospitalizations or emergency department visits (HR, 1.80 [95% CI, 1.53-2.13]) and syncope (HR, 1.69 [95% CI, 1.30-2.19]). The magnitude of fracture risk was numerically higher among subgroups of residents with dementia (HR, 3.28 [95% CI, 1.76-6.10]), systolic blood pressure of 140 mm Hg or higher (HR, 3.12 [95% CI, 1.71-5.69]), diastolic blood pressure of 80 mm Hg or higher (HR, 4.41 [95% CI, 1.67-11.68]), and no recent antihypertensive medication use (HR, 4.77 [95% CI, 1.49-15.32]). Conclusions and Relevance Findings indicated that initiation of antihypertensive medication was associated with elevated risks of fractures and falls. These risks were numerically higher among residents with dementia, higher baseline blood pressures values, and no recent antihypertensive medication use. Caution and additional monitoring are advised when initiating antihypertensive medication in this vulnerable population.
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Affiliation(s)
- Chintan V. Dave
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
- Department of Veterans Affairs-New Jersey Health Care System, East Orange
| | - Yongmei Li
- Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California
| | - Michael A. Steinman
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California
| | - Sei J. Lee
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California
| | - Xiaojuan Liu
- Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California
| | - Bocheng Jing
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California
| | - Laura A. Graham
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California
| | | | - Kathy Z. Fung
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California
| | - Michelle C. Odden
- Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California
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Houser A, Baconguis I. Structural Insights into Subunit-Dependent Functional Regulation in Epithelial Sodium Channels. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.28.595834. [PMID: 38853903 PMCID: PMC11160588 DOI: 10.1101/2024.05.28.595834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Epithelial sodium channels (ENaC) play a crucial role in Na + reabsorption in mammals. To date, four subunits have been identified-α, β, γ, and δ-believed to form different heteromeric complexes. Currently, only the structure of the αβγ complex is known. To understand how these channels form with varying subunit compositions and define the contribution of each subunit to distinct properties, we co-expressed human δ, β, and γ. Using single-particle cryo-electron microscopy, we observed three distinct ENaC complexes. The structures unveil a pattern in which β and γ positions are conserved among the different complexes while the α position in αβγ trimer is occupied by either δ or another β. The presence of δ induces structural rearrangements in the γ subunit explaining the differences in channel activity observed between αβγ and δβγ channels. These structures define the mechanism by which ENaC subunit composition tunes ENaC function.
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Krishnan J, Hennen EM, Ao M, Kirabo A, Ahmad T, de la Visitación N, Patrick DM. NETosis Drives Blood Pressure Elevation and Vascular Dysfunction in Hypertension. Circ Res 2024; 134:1483-1494. [PMID: 38666386 PMCID: PMC11116040 DOI: 10.1161/circresaha.123.323897] [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: 10/25/2023] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Neutrophil extracellular traps (NETs) are composed of DNA, enzymes, and citrullinated histones that are expelled by neutrophils in the process of NETosis. NETs accumulate in the aorta and kidneys in hypertension. PAD4 (protein-arginine deiminase-4) is a calcium-dependent enzyme that is essential for NETosis. TRPV4 (transient receptor potential cation channel subfamily V member 4) is a mechanosensitive calcium channel expressed in neutrophils. Thus, we hypothesize that NETosis contributes to hypertension via NET-mediated endothelial cell (EC) dysfunction. METHODS NETosis-deficient Padi4-/- mice were treated with Ang II (angiotensin II). Blood pressure was measured by radiotelemetry, and vascular reactivity was measured with wire myography. Neutrophils were cultured with or without ECs and exposed to normotensive or hypertensive uniaxial stretch. NETosis was measured by flow cytometry. ECs were treated with citrullinated histone H3, and gene expression was measured by quantitative reverse transcription PCR. Aortic rings were incubated with citrullinated histone H3, and wire myography was performed to evaluate EC function. Neutrophils were treated with the TRPV4 agonist GSK1016790A. Calcium influx was measured using Fluo-4 dye, and NETosis was measured by immunofluorescence. RESULTS Padi4-/- mice exhibited attenuated hypertension, reduced aortic inflammation, and improved EC-dependent vascular relaxation in response to Ang II. Coculture of neutrophils with ECs and exposure to hypertensive uniaxial stretch increased NETosis and accumulation of neutrophil citrullinated histone H3. Histone H3 and citrullinated histone H3 exposure attenuates EC-dependent vascular relaxation. Treatment of neutrophils with the TRPV4 agonist GSK1016790A increases intracellular calcium and NETosis. CONCLUSIONS These observations identify a role of NETosis in the pathogenesis of hypertension. Moreover, they define an important role of EC stretch and TRPV4 as initiators of NETosis. Finally, they define a role of citrullinated histones as drivers of EC dysfunction in hypertension.
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Affiliation(s)
- Jaya Krishnan
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
| | - Elizabeth M. Hennen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN (E.M.H.)
| | - Mingfang Ao
- Department of Anesthesiology (M.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Immunobiology (A.K.)
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN (A.K.)
- Vanderbilt Institute for Global Health, Nashville, TN (A.K.)
| | - Taseer Ahmad
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, Pakistan (T.A.)
| | - Néstor de la Visitación
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine (D.M.P.), Vanderbilt University Medical Center, Nashville, TN
| | - David M. Patrick
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Department of Veterans Affairs, Nashville, TN (D.M.P.)
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Hellem AK, Casetti A, Bowie K, Golbus JR, Merid B, Nallamothu BK, Dorsch MP, Newman MW, Skolarus L. A Community Participatory Approach to Creating Contextually Tailored mHealth Notifications: myBPmyLife Project. Health Promot Pract 2024; 25:417-427. [PMID: 36704967 PMCID: PMC11154014 DOI: 10.1177/15248399221141687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Just-in-time adaptive interventions (JITAIs) are a novel approach to mobile health (mHealth) interventions, sending contextually tailored behavior change notifications to participants when they are more likely to engage, determined by data from wearable devices. We describe a community participatory approach to JITAI notification development for the myBPmyLife Project, a JITAI focused on decreasing sodium consumption and increasing physical activity to reduce blood pressure. Eighty-six participants were interviewed, 50 at a federally qualified health center (FQHC) and 36 at a university clinic. Participants were asked to provide encouraging physical activity and low-sodium diet notifications and provided feedback on researcher-generated notifications to inform revisions. Participant notifications were thematically analyzed using an inductive approach. Participants noted challenging vocabulary, phrasing, and culturally incongruent suggestions in some of the researcher-generated notifications. Community-generated notifications were more direct, used colloquial language, and contained themes of grace. The FQHC participants' notifications expressed more compassion, religiosity, and addressed health-related social needs. University clinic participants' notifications frequently focused on office environments. In summary, our participatory approach to notification development embedded a distinctive community voice within our notifications. Our approach may be generalizable to other communities and serve as a model to create tailored mHealth notifications to their focus population.
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Affiliation(s)
| | | | | | | | - Beza Merid
- Arizona State University, Tempe, AZ, USA
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Maaliki D, Itani M, Jarrah H, El-Mallah C, Ismail D, El Atie YE, Obeid O, Jaffa MA, Itani HA. Dietary High Salt Intake Exacerbates SGK1-Mediated T Cell Pathogenicity in L-NAME/High Salt-Induced Hypertension. Int J Mol Sci 2024; 25:4402. [PMID: 38673987 PMCID: PMC11050194 DOI: 10.3390/ijms25084402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Sodium chloride (NaCl) activates Th17 and dendritic cells in hypertension by stimulating serum/glucocorticoid kinase 1 (SGK1), a sodium sensor. Memory T cells also play a role in hypertension by infiltrating target organs and releasing proinflammatory cytokines. We tested the hypothesis that the role of T cell SGK1 extends to memory T cells. We employed mice with a T cell deletion of SGK1, SGK1fl/fl × tgCD4cre mice, and used SGK1fl/fl mice as controls. We treated the mice with L-NAME (0.5 mg/mL) for 2 weeks and allowed a 2-week washout interval, followed by a 3-week high-salt (HS) diet (4% NaCl). L-NAME/HS significantly increased blood pressure and memory T cell accumulation in the kidneys and bone marrow of SGK1fl/fl mice compared to knockout mice on L-NAME/HS or groups on a normal diet (ND). SGK1fl/fl mice exhibited increased albuminuria, renal fibrosis, and interferon-γ levels after L-NAME/HS treatment. Myography demonstrated endothelial dysfunction in the mesenteric arterioles of SGK1fl/fl mice. Bone marrow memory T cells were adoptively transferred from either mouse strain after L-NAME/HS administration to recipient CD45.1 mice fed the HS diet for 3 weeks. Only the mice that received cells from SGK1fl/fl donors exhibited increased blood pressure and renal memory T cell infiltration. Our data suggest a new therapeutic target for decreasing hypertension-specific memory T cells and protecting against hypertension.
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Affiliation(s)
- Dina Maaliki
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon; (D.M.); (M.I.); (H.J.); (D.I.); (Y.E.E.A.)
| | - Maha Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon; (D.M.); (M.I.); (H.J.); (D.I.); (Y.E.E.A.)
| | - Hala Jarrah
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon; (D.M.); (M.I.); (H.J.); (D.I.); (Y.E.E.A.)
| | - Carla El-Mallah
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 1107, Lebanon; (C.E.-M.); (O.O.)
| | - Diana Ismail
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon; (D.M.); (M.I.); (H.J.); (D.I.); (Y.E.E.A.)
| | - Yara E. El Atie
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon; (D.M.); (M.I.); (H.J.); (D.I.); (Y.E.E.A.)
| | - Omar Obeid
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 1107, Lebanon; (C.E.-M.); (O.O.)
| | - Miran A. Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut 1107, Lebanon;
| | - Hana A. Itani
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut 1107, Lebanon; (D.M.); (M.I.); (H.J.); (D.I.); (Y.E.E.A.)
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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33
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Heaton J, Alshami A, Imburgio S, Mararenko A, Schoenfeld M, Sealove B, Asif A, Almendral J. Current Trends in Hypertension Identification and Management: Insights from the National Health and Nutrition Examination Survey (NHANES) Following the 2017 ACC/AHA High Blood Pressure Guidelines. J Am Heart Assoc 2024; 13:e034322. [PMID: 38563377 PMCID: PMC11262485 DOI: 10.1161/jaha.123.034322] [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: 01/05/2024] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hypertension is a global health issue associated with increased cardiovascular morbidity and mortality. This study aimed to investigate contemporary hypertension identification and management trends following the 2017 American College of Cardiology/American Heart Association guidelines. METHODS AND RESULTS Data from the National Health and Nutrition Examination Survey conducted from 2017 to 2020 were analyzed. Participants between 20 and 79 years of age were included. Participants were stratified into different treatment groups based on indication and guideline adherence. Descriptive statistics were used to compare medication use, diagnosis rates, and blood pressure control. A total of 265 402 026 people met the inclusion criteria, of which 19.0% (n=50 349 209) were undergoing guideline antihypertensive management. In the guideline antihypertensive management group, a single antihypertensive class was used to treat 45.7% of participants, and 55.2% had uncontrolled blood pressure. Participants not undergoing guideline antihypertensive management qualified for primary prevention in 11.5% (n=24 741 999) of cases and for secondary prevention in 2.4% (n=5 070 044) of cases; of these, 66.3% (n=19 774 007) did not know they may have hypertension and were not on antihypertensive medication. CONCLUSIONS Adherence to guidelines for antihypertensive management is suboptimal. Over half of patients undergoing guideline treatment had uncontrolled blood pressure. One-third of qualifying participants may not be receiving treatment. Education and medical management were missing for 2 in 3 qualifying participants. Addressing these deficiencies is crucial for improving blood pressure control and reducing cardiovascular event outcomes.
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Affiliation(s)
- Joseph Heaton
- Department of MedicineJersey Shore University Medical CenterNeptune CityNJ
| | - Abbas Alshami
- Division of CardiologyJersey Shore University Medical CenterNeptune CityNJ
| | - Steven Imburgio
- Department of MedicineJersey Shore University Medical CenterNeptune CityNJ
| | - Anton Mararenko
- Division of CardiologyJersey Shore University Medical CenterNeptune CityNJ
| | - Matthew Schoenfeld
- Division of CardiologyJersey Shore University Medical CenterNeptune CityNJ
| | - Brett Sealove
- Division of CardiologyJersey Shore University Medical CenterNeptune CityNJ
| | - Arif Asif
- Department of MedicineJersey Shore University Medical CenterNeptune CityNJ
| | - Jesus Almendral
- Division of CardiologyJersey Shore University Medical CenterNeptune CityNJ
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34
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Widyantoro B, Nailes JM, Sukonthasarn A, Soenarta AA. Ambulatory blood pressure monitoring profiles in Asia. J Clin Hypertens (Greenwich) 2024. [PMID: 38563647 DOI: 10.1111/jch.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.
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Affiliation(s)
- Bambang Widyantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Jennifer M Nailes
- Department of Preventive and Community Medicine, University of the East Ramon Magsaysay Memorial Medical Center Research Institute for Health Sciences, Manila, Philippines
| | - Apichard Sukonthasarn
- Cardiovascular Division, Department of Medicine, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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35
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Egan BM, Mattix-Kramer HJ, Basile JN, Sutherland SE. Managing Hypertension in Older Adults. Curr Hypertens Rep 2024; 26:157-167. [PMID: 38150080 PMCID: PMC10904451 DOI: 10.1007/s11906-023-01289-7] [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] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE OF REVIEW The population of older adults 60-79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease. RECENT FINDINGS Women live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women's health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60-79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60-79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets.
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Affiliation(s)
- Brent M Egan
- American Medical Association, Improving Health Outcomes, 2 West Washington Street, Suite 601, Greenville, SC, 29601, USA.
| | - Holly J Mattix-Kramer
- Department of Public Health Sciences and Medicine, Loyola University Chicago Loyola University Medical Center, Maywood, IL, USA
| | - Jan N Basile
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Susan E Sutherland
- American Medical Association, Improving Health Outcomes, 2 West Washington Street, Suite 601, Greenville, SC, 29601, USA
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Sotomayor Julio AD, Montana-Jimenez LP, Bernal Torres W, López Ponce de León JD, Zambrano Franco JA, Coca A, Camafort M, Vesga Reyes C. [Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review]. HIPERTENSION Y RIESGO VASCULAR 2024; 41:104-117. [PMID: 38480108 DOI: 10.1016/j.hipert.2024.01.001] [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: 10/30/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 04/14/2024]
Abstract
Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients' daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.
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Affiliation(s)
- A D Sotomayor Julio
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
| | - L P Montana-Jimenez
- Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - W Bernal Torres
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J D López Ponce de León
- Centro de Investigaciones Clínicas, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - J A Zambrano Franco
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - A Coca
- Universidad de Barcelona, Barcelona, España
| | - M Camafort
- Universidad de Barcelona, Barcelona, España
| | - C Vesga Reyes
- Departamento de Cardiología, Fundación Valle del Lili, Valle del Cauca, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
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Hirani MM, Gandhi R, Thakkar DG, Kateshiya N, Murugan Y. Investigating the Prevalence and Predictors of Uncontrolled Hypertension: A Cross-Sectional Study in Gujarat, India. Cureus 2024; 16:e59036. [PMID: 38800155 PMCID: PMC11128033 DOI: 10.7759/cureus.59036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Uncontrolled hypertension is a major public health concern that contributes significantly to cardiovascular morbidity and mortality. Treatment of hypertension prevents and reduces cardiovascular morbidity, notably a 40% reduction in risk of stroke and a 15% reduction in risk of myocardial infarction. Understanding the prevalence and predictors of uncontrolled hypertension is crucial for developing targeted interventions. OBJECTIVE This study aimed to determine the prevalence of uncontrolled hypertension and identify potential predictors among patients attending the Non-Communicable Disease (NCD) clinic of a tertiary care center in Gujarat, India. METHODS A cross-sectional study involving 732 adult patients with hypertension was conducted. Sociodemographic data, lifestyle factors, anthropometric measurements, and comorbidities were assessed. Blood pressure was measured using standardized protocols, and uncontrolled hypertension was defined as a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Univariate and multivariate logistic regression analyses were performed to identify predictors of uncontrolled hypertension. RESULTS The prevalence of uncontrolled hypertension was 60.2% (95% CI: 56.7%-63.7%). In the multivariate analysis, increasing age (adjusted OR: 1.21, 95% CI: 1.05-1.39), increased body mass index (adjusted OR: 1.49, 95% CI: 1.27-1.75), diabetes (adjusted OR: 1.68, 95% CI: 1.20-2.35), chronic kidney disease (adjusted OR: 2.11, 95% CI: 1.22-3.65), and current smoking status (adjusted OR: 1.83, 95% CI: 1.14-2.93) were identified as independent predictors of uncontrolled hypertension. CONCLUSION This study revealed a high prevalence of uncontrolled hypertension in this tertiary care setting. Age, obesity, diabetes, chronic kidney disease, and smoking were identified as significant predictors. Targeted interventions addressing these modifiable risk factors and comorbidities are crucial for improving blood pressure control and reducing the burden of hypertension-related complications.
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Affiliation(s)
- Mehjabin M Hirani
- General Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Rohankumar Gandhi
- Community and Family Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Dipenkumar G Thakkar
- Preventive and Social Medicine, Shri M P Shah Government Medical College, Jamnagar, IND
| | - Nilesh Kateshiya
- Internal Medicine, Guru Gobind Government Hospital, Jamnagar, IND
| | - Yogesh Murugan
- Family Medicine, Guru Gobind Government Hospital, Jamnagar, IND
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Bludorn J, Railey K. Hypertension Guidelines and Interventions. Prim Care 2024; 51:41-52. [PMID: 38278572 DOI: 10.1016/j.pop.2023.07.002] [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] [Indexed: 01/28/2024]
Abstract
Hypertension remains one of the most prevalent conditions encountered in the primary care setting and is a major contributor to cardiovascular disease in the United States. This reality underscores the importance for primary care clinicians to have an understanding of hypertension guidelines, interventions, and population-based considerations. This article provides a succinct overview of hypertension guidelines, reviews guideline-informed approaches to hypertension screening, diagnosis, and treatment, and concludes with a thoughtful discussion of population-based considerations.
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Affiliation(s)
- Janelle Bludorn
- Duke Physician Assistant Program, Department of Family Medicine and Community Health, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914 Durham, NC 27710, USA.
| | - Kenyon Railey
- Duke Physician Assistant Program, Department of Family Medicine and Community Health, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914 Durham, NC 27710, USA
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Ijaz N, Jamil Y, Brown CH, Krishnaswami A, Orkaby A, Stimmel MB, Gerstenblith G, Nanna MG, Damluji AA. Role of Cognitive Frailty in Older Adults With Cardiovascular Disease. J Am Heart Assoc 2024; 13:e033594. [PMID: 38353229 PMCID: PMC11010094 DOI: 10.1161/jaha.123.033594] [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: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024]
Abstract
As the older adult population expands, an increasing number of patients affected by geriatric syndromes are seen by cardiovascular clinicians. One such syndrome that has been associated with poor outcomes is cognitive frailty: the simultaneous presence of cognitive impairment, without evidence of dementia, and physical frailty, which results in decreased cognitive reserve. Driven by common pathophysiologic underpinnings (eg, inflammation and neurohormonal dysregulation), cardiovascular disease, cognitive impairment, and frailty also share the following risk factors: hypertension, diabetes, obesity, sedentary behavior, and tobacco use. Cardiovascular disease has been associated with the onset and progression of cognitive frailty, which may be reversible in early stages, making it essential for clinicians to diagnose the condition in a timely manner and prescribe appropriate interventions. Additional research is required to elucidate the mechanisms underlying the development of cognitive frailty, establish preventive and therapeutic strategies to address the needs of older patients with cardiovascular disease at risk for cognitive frailty, and ultimately facilitate targeted intervention studies.
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Affiliation(s)
- Naila Ijaz
- Thomas Jefferson University HospitalPhiladelphiaPAUSA
| | - Yasser Jamil
- Yale University School of MedicineNew HavenCTUSA
| | | | | | - Ariela Orkaby
- New England GRECC, VA Boston Healthcare SystemBostonMAUSA
- Division of AgingBrigham & Women’s Hospital, Harvard Medical SchoolBostonMAUSA
| | | | | | | | - Abdulla A. Damluji
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- The Inova Center of Outcomes ResearchInova Heart and Vascular InstituteFalls ChurchVAUSA
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Wu C, Zhao P, Xu P, Wan C, Singh S, Varthya SB, Luo SH. Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev 2024; 2:CD004184. [PMID: 38353289 PMCID: PMC10865448 DOI: 10.1002/14651858.cd004184.pub3] [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] [Indexed: 02/16/2024]
Abstract
BACKGROUND Variation in blood pressure levels display circadian rhythms. Complete 24-hour blood pressure control is the primary goal of antihypertensive treatment and reducing adverse cardiovascular outcomes is the ultimate aim. This is an update of the review first published in 2011. OBJECTIVES To evaluate the effectiveness of administration-time-related effects of once-daily evening versus conventional morning dosing antihypertensive drug therapy regimens on all-cause mortality, cardiovascular mortality and morbidity, total adverse events, withdrawals from treatment due to adverse effects, and reduction of systolic and diastolic blood pressure in people with primary hypertension. SEARCH METHODS We searched the Cochrane Hypertension Specialised Register via Cochrane Register of Studies (17 June 2022), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2022); MEDLINE, MEDLINE In-Process and MEDLINE Epub Ahead of Print (1 June 2022); Embase (1 June 2022); ClinicalTrials.gov (2 June 2022); Chinese Biomedical Literature Database (CBLD) (1978 to 2009); Chinese VIP (2009 to 7 August 2022); Chinese WANFANG DATA (2009 to 4 August 2022); China Academic Journal Network Publishing Database (CAJD) (2009 to 6 August 2022); Epistemonikos (3 September 2022) and the reference lists of relevant articles. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing the administration-time-related effects of evening with morning dosing monotherapy regimens in people with primary hypertension. We excluded people with known secondary hypertension, shift workers or people with white coat hypertension. DATA COLLECTION AND ANALYSIS Two to four review authors independently extracted data and assessed trial quality. We resolved disagreements by discussion or with another review author. We performed data synthesis and analyses using Review Manager Web for all-cause mortality, cardiovascular mortality and morbidity, serious adverse events, overall adverse events, withdrawals due to adverse events, change in 24-hour blood pressure and change in morning blood pressure. We assessed the certainty of the evidence using GRADE. We conducted random-effects meta-analysis, fixed-effect meta-analysis, subgroup analysis and sensitivity analysis. MAIN RESULTS We included 27 RCTs in this updated review, of which two RCTs were excluded from the meta-analyses for lack of data and number of groups not reported. The quantitative analysis included 25 RCTs with 3016 participants with primary hypertension. RCTs used angiotensin-converting enzyme inhibitors (six trials), calcium channel blockers (nine trials), angiotensin II receptor blockers (seven trials), diuretics (two trials), α-blockers (one trial), and β-blockers (one trial). Fifteen trials were parallel designed, and 10 trials were cross-over designed. Most participants were white, and only two RCTs were conducted in Asia (China) and one in Africa (South Africa). All trials excluded people with risk factors of myocardial infarction and strokes. Most trials had high risk or unclear risk of bias in at least two of several key criteria, which was most prominent in allocation concealment (selection bias) and selective reporting (reporting bias). Meta-analysis showed significant heterogeneity across trials. No RCTs reported on cardiovascular mortality and cardiovascular morbidity. There may be little to no differences in all-cause mortality (after 26 weeks of active treatment: RR 0.49, 95% CI 0.04 to 5.42; RD 0, 95% CI -0.01 to 0.01; very low-certainty evidence), serious adverse events (after 8 to 26 weeks of active treatment: RR 1.17, 95% CI 0.53 to 2.57; RD 0, 95% CI -0.02 to 0.03; very low-certainty evidence), overall adverse events (after 6 to 26 weeks of active treatment: RR 0.89, 95% CI 0.67 to 1.20; I² = 37%; RD -0.02, 95% CI -0.07 to 0.02; I² = 38%; very low-certainty evidence) and withdrawals due to adverse events (after 6 to 26 weeks active treatment: RR 0.76, 95% CI 0.47 to 1.23; I² = 0%; RD -0.01, 95% CI -0.03 to 0; I² = 0%; very low-certainty evidence), but the evidence was very uncertain. AUTHORS' CONCLUSIONS Due to the very limited data and the defects of the trials' designs, this systematic review did not find adequate evidence to determine which time dosing drug therapy regimen has more beneficial effects on cardiovascular outcomes or adverse events. We have very little confidence in the evidence showing that evening dosing of antihypertensive drugs is no more or less effective than morning administration to lower 24-hour blood pressure. The conclusions should not be assumed to apply to people receiving multiple antihypertensive drug regimens.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhao
- Medical Library, Sichuan University, Chengdu, China
| | - Ping Xu
- Medical Library, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Surjit Singh
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Pharmacology Department, All India Institute of Medical Sciences, Jodhpur, India
| | - Shuang-Hong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Belayachi S, Boukhari FZ, Essayagh F, Terkiba O, Marc I, Lambaki A, Zohoun A, Essayagh M, Essayagh T, Essayagh S. Uncontrolled blood pressure and its risk factors among hypertensive patients, Marrakech, Morocco. Sci Rep 2024; 14:2953. [PMID: 38316867 PMCID: PMC10844197 DOI: 10.1038/s41598-024-53115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/28/2024] [Indexed: 02/07/2024] Open
Abstract
Hypertension is a public health problem. Failure to control blood pressure figures is responsible for morbidity and premature mortality. This study aims to describe the characteristics of hypertensive patients followed at primary health care centers in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 922 hypertension patients attending primary health care centers in Marrakech was done. To gather socio-demographic, behavioral, and clinical data, as well as hypertension treatment features and the care-patient-physician triad, a face-to-face questionnaire was employed. To identify risk factors associated with uncontrolled blood pressure, multivariate logistic regression was used. Uncontrolled blood pressure was found in 73.5% of people. The patients' average age was 63.4 ± 9.4 years (mean ± standard deviation), and 524 (77.3%) were women. Tobacco consumption (Adjusted Odd Ratio of 4.34; 95% CI [1.58-11.9]); lack of self-monitoring of hypertension (AOR of 1.69; 95% CI [1.14-2.52]); a family history of hypertension (AOR of 1.58; 95% CI [1.12-2.22]); overweight or obesity (AOR of 1.73; 95% CI [1.15-2.58]); and nonadherence to antihypertensive medication (AOR of 1.58; 95% CI [1.05-2.38]) were identified as risk factors for uncontrolled blood pressure. In hypertensive individuals, the percentage of uncontrolled blood pressure is considerable. It is essential to provide therapeutic education classes for hypertension patients in order to strengthen their power and autonomy in managing their hypertension.
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Affiliation(s)
- Safae Belayachi
- Faculté des Sciences et Techniques, Laboratoire Agroalimentaire et Santé, Hassan First University of Settat, Settat, Morocco
| | - Fatima Zahra Boukhari
- Faculté des Sciences et Techniques, Laboratoire Agroalimentaire et Santé, Hassan First University of Settat, Settat, Morocco
| | - Firdaous Essayagh
- Faculté des Sciences Juridiques, Économiques et Sociales, Laboratoire Droit Privé et Enjeux de Développement, Université Sidi Mohamed Ben Abdellah, Fès, Morocco
| | - Othmane Terkiba
- Institut Supérieur des Sciences de la Santé, Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Settat, Morocco
| | - Ikram Marc
- Institut Supérieur des Sciences de la Santé, Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Settat, Morocco
| | - Abdellah Lambaki
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
| | - Alban Zohoun
- Unité d'enseignement et de Recherche en Hématologie, Faculté des Sciences de la Santé, Cotonou, Benin
| | - Meriem Essayagh
- Office National de Sécurité Sanitaire des Produits Alimentaires, Oriental, Morocco
| | - Touria Essayagh
- Institut Supérieur des Sciences de la Santé, Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Settat, Morocco
| | - Sanah Essayagh
- Faculté des Sciences et Techniques, Laboratoire Agroalimentaire et Santé, Hassan First University of Settat, Settat, Morocco
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Allgood KL, Fleischer NL, Morenoff J, Assari S, Needham BL. Do Police Encounters Increase the Risk for Cardiovascular Disease? Police Encounters and Framingham 30-Year Cardiovascular Risk Score. J Racial Ethn Health Disparities 2024; 11:348-363. [PMID: 36719543 DOI: 10.1007/s40615-023-01523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/23/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Despite increased attention to the societal consequences of aggressive policing, the focus on rarer instances of deaths/severe injuries fails to fully capture the day-to-day experiences that racially minoritized groups face during police encounters (PEs). We explored differential vulnerability by race/ethnicity in the relationship between PEs and cardiovascular disease (CVD) risk. METHODS Using data from the National Longitudinal Study of Adolescent to Adult Health, we regressed the Framingham 30-Year CVD risk score on a high number of lifetime PEs (6 + among men and 2 + among women). To explore differential vulnerability by race, we added an interaction between PEs and race/ethnicity. We also examined sex- and race and sex-stratified models. RESULTS We observed no association between PEs and CVD risk in the sample overall, but the interaction between PEs and race/ethnicity was statistically significant. In race stratified models, we found that higher PEs were associated with a lower CVD risk among Black respondents, whereas among White respondents there was no relationship. In the sex-stratified analysis, reporting higher PEs was associated with lower CVD risk among men, while among women there was no relationship. In sex- and race-stratified models, higher PEs was associated with lower CVD risk among Black men and higher CVD risk among White women, while there was no association among Black women and White men. CONCLUSION The association between PEs and CVD risk depends on race/ethnicity and sex. More work is needed to understand the counterintuitive finding that high PEs are associated with lower CVD risk among Black men.
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Affiliation(s)
- Kristi L Allgood
- Department of Epidemiology, Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI, 48109, USA.
| | - Nancy L Fleischer
- Department of Epidemiology, Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI, 48109, USA
| | - Jeffrey Morenoff
- Institute for Social Research, Population Health Studies, University of Michigan, Ann Arbor, MI, USA
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Shervin Assari
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Belinda L Needham
- Department of Epidemiology, Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, 2649A, SPH Tower, Ann Arbor, MI, 48109, USA
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Hellem A, Whitfield C, Mansour M, Curran Y, Dinh M, Warden K, Skolarus LE. Determinants of Bluetooth-Enabled Self-Measured Blood Pressure Monitoring in Federally Qualified Health Centers. J Prim Care Community Health 2024; 15:21501319241229921. [PMID: 38400549 PMCID: PMC10894531 DOI: 10.1177/21501319241229921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND In 2021, the Health Resources and Services Administration (HRSA) launched the National Hypertension Control Initiative (HTN Initiative) with the goal to enhance HTN control through Bluetooth-enabled self-measured blood pressure (BT-SMBP) monitoring and use this data to inform clinical decisions in Federally Qualified Health Centers (FQHCs) with a large proportion of their population with uncontrolled blood pressure (BP). We sought to understand the experience of Michigan-based FQHCs in implementing the HTN initiative. METHODS Staff from three Michigan-based FQHCs were invited to participate in semi-structured interviews from September to November 2022. Interviews were conducted in-person and were based on the Tailored Implementation in Chronic Diseases framework. Content analysis was performed by three coders. RESULTS Ten staff participated in interviews (FQHC 1: n = 6, FQHC 2: n = 1, FQHC 3: n = 3). The FQHCs differed in their stage of implementation and their approach. FQHC 1 created a large-scale, community health worker driven program, FQHC 2 created a small-scale, short term, BP device loan program, and FQHC 3 created a primarily outsourced, large-scale program through a contracted partner. Positive staff attitudes and outcome expectations, previous experience with SMBP grants, supportive clinic leadership, social support, and free BP cuff resources were identified as facilitators to implementation. Patients' high social needs, SMBP-related Technology, and insufficient workforce and staff capacity were identified as barriers. CONCLUSION BT-SMBP among FQHC patients is promising but challenges in integrating SMBP data into clinic workflow, workforce capacity to support the high social needs of participants, and to assist in reacting to the more frequent BP data remain to be overcome.
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Affiliation(s)
- Abby Hellem
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Candace Whitfield
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Maria Mansour
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yvonne Curran
- Davee Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Mackenzie Dinh
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Lesli E Skolarus
- Davee Department of Neurology, Northwestern University, Chicago, IL, USA
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Yamasaki S, Tokunou T, Maeda T, Horiuchi T. Night-Time Hot Spring Bathing Is Associated with a Lower Systolic Blood Pressure among Japanese Older Adults: A Single-Institution Retrospective Cohort Study. Geriatrics (Basel) 2023; 9:2. [PMID: 38392101 PMCID: PMC10888263 DOI: 10.3390/geriatrics9010002] [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: 08/30/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 02/24/2024] Open
Abstract
Hot spring bathing is practiced to help manage hypertension. We retrospectively investigated the effects of hot spring bathing on hypertension with the aim of identifying a novel approach to prevent and manage hypertension. The study cohort comprised 99 patients aged ≥65 years admitted to Kyushu University Beppu Hospital between 1 December 2021 and 30 November 2022 who could walk by themselves and who used hot springs for ≥3 days during their hospital stay. The changes in both systolic and diastolic blood pressure were significantly decreased in the night-time bathing group (n = 21) compared with the noontime (n = 26) and afternoon (n = 52) groups. Night-time hot spring bathing was significantly associated with reduced systolic blood pressure the next morning in older adults. Although prospective randomized controlled trials on night-time hot spring bathing as a hypertension treatment are warranted to investigate whether the practice can prevent hypertension among adults aged ≥65 years, we have initiated a single-center, phase II study on the relationship between sleep quality and quality of life in hypertensive patients after night-time hot spring bathing.
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Affiliation(s)
- Satoshi Yamasaki
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu 874-0838, Japan
- Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
| | - Tomotake Tokunou
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu 874-0838, Japan
- Division of Basic Medical Science and Fundamental Nursing, Department of Nursing, Fukuoka Nursing College, Fukuoka 814-0193, Japan
| | - Toyoki Maeda
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu 874-0838, Japan
| | - Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu 874-0838, Japan
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Qiu J, Kuang M, He S, Yu C, Wang C, Huang X, Sheng G, Zou Y. Gender perspective on the association between liver enzyme markers and non-alcoholic fatty liver disease: insights from the general population. Front Endocrinol (Lausanne) 2023; 14:1302322. [PMID: 38125795 PMCID: PMC10731038 DOI: 10.3389/fendo.2023.1302322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Objective Every distinct liver enzyme biomarker exhibits a strong correlation with non-alcoholic fatty liver disease (NAFLD). This study aims to comprehensively analyze and compare the associations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) with NAFLD from a gender perspective. Methods This study was conducted on 6,840 females and 7,411 males from the NAGALA cohort. Multivariable logistic regression analysis was used to compare the associations between liver enzyme markers and NAFLD in both genders, recording the corresponding adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of individual liver enzyme markers and different combinations of them in identifying NAFLD. Results Liver enzyme markers ALT, AST, and GGT were all independently associated with NAFLD and exhibited significant gender differences (All P-interaction<0.05). In both genders, ALT exhibited the most significant association with NAFLD, with adjusted standardized ORs of 2.19 (95% CI: 2.01-2.39) in males and 1.60 (95% CI: 1.35-1.89) in females. Additionally, ROC analysis showed that ALT had significantly higher accuracy in identifying NAFLD than AST and GGT in both genders (Delong P-value < 0.05), and the accuracy of ALT in identifying NAFLD in males was higher than that in females [Area under the ROC curve (AUC): male 0.79, female 0.77]. Furthermore, out of the various combinations of liver enzymes, ALT+GGT showed the highest accuracy in identifying NAFLD in both genders, with AUCs of 0.77 (95% CI: 0.75-0.79) in females and 0.79 (95% CI: 0.78-0.81) in males. Conclusion Our study revealed significant gender differences in the associations of the three commonly used liver enzyme markers with NAFLD. In both genders, the use of ALT alone may be the simplest and most effective tool for screening NAFLD, especially in males.
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Affiliation(s)
- Jiajun Qiu
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Maobin Kuang
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Shiming He
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Changhui Yu
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Chao Wang
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Xin Huang
- Department of Internal Medicine, Medical College of Nanchang University, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Zhou YF, Deng H, Wang GD, Chen S, Xing A, Wang Y, Zhao H, Gao J, Wu S. Cost-effectiveness of drug treatment for young and middle-aged stage 1 hypertensive patients with high risk. J Glob Health 2023; 13:04147. [PMID: 37997845 PMCID: PMC10668205 DOI: 10.7189/jogh.13.04147] [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: 11/25/2023] Open
Abstract
Background Drug treatment was recommended for stage 1 hypertensive patients (blood pressure of 130-139 / 80-89 millimetres of mercury (mmHg)) with high cardiovascular disease (CVD) risk in the 2017 Hypertension Clinical Practice Guidelines, 2018 Chinese guidelines and 2021 World Health Organization guidelines, but not in other guidelines. However, evidence on the cost-effectiveness of drug treatment among young and middle-aged patients remains scarce. This study aimed to compare the cost-effectiveness of drug treatment vs. non-drug treatment for stage 1 hypertensive patients aged <60 years with high CVD risk. Methods A microsimulation model projected quality-adjusted life years (QALYs), health care costs, and incremental cost-effectiveness ratios for drug treatment from a societal perspective. Transition probabilities were estimated from the Kailuan study with a sample size of 34 093 patients aged <60 years with high CVD risk. Costs and health utilities were obtained from the Kailuan study, national statistics reports and published literature. Results Over a 15-year time horizon, the model predicted that drug treatment generated QALY of 9.36 and was associated with expected costs of 3735 US dollars ($) compared with 9.07 and $3923 produced by non-drug treatment among stage 1 hypertensive patients, resulting in a cost-saving for drug treatment. At a willingness-to-pay threshold of $10439/QALY (one gross domestic product (GDP) per capita in 2020), drug treatment had a 99.99% probability of being cost-effective for 10 000 samples of probabilistic sensitivity analysis. Sensitivity analyses by different values of transition probability, cost, utility and discount rate did not appreciably change the results. Shortening the time horizon to the average follow-up period of eight years resulted in ICER of $189/QALY for drug treatment (<1 × GDP/QALY). Conclusions Our results suggested that drug treatment was a dominant strategy for stage 1 hypertensive patients aged <60 years with high CVD risk in China, which may provide evidence for policymakers and clinicians when weighing the pros and cons of drug treatment for young and middle-aged stage 1 hypertensive patients.
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Affiliation(s)
- Yan-Feng Zhou
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China
| | - Hua Deng
- Department of Nephrology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Guo-Dong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Aijun Xing
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yanxiu Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Haiyan Zhao
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jingli Gao
- Department of Intensive Care Unit, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
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Khonde Kumbu R, Matondo H, Labat A, Kianu B, Godin I, Kiyombo G, Coppieters Y. Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review. BMC Public Health 2023; 23:2316. [PMID: 37993815 PMCID: PMC10666436 DOI: 10.1186/s12889-023-17248-5] [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: 06/27/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Hypertension remains one of the leading risk factors for cardiovascular disease. Contrasting with the high-income countries where the rates of hypertension decline, it increases in Sub-Saharan African countries. The age group most affected by hypertension is the working population. Several studies carried out in Europe, North America, and Asia, underline the influence of job stress on the occurrence of hypertension. The objective of this review was to explore current knowledge about hypertension and job stress in Sub-Saharan Africa. METHODS We conducted a scoping review using Arksey and O'Malley's framework to synthesize findings. We searched in PubMed, Scopus, and ProQuest databases. The inclusion criteria were peer-reviewed manuscripts published on March 1, 2023, conducted among workers in Sub-Saharan Africa, reported hypertension and job stress, and using quantitative methodologies. Data were assessed independently by two researchers. RESULTS In total, 295 articles were identified from databases. Of these, only 12 articles met the inclusion criteria and were included in the review (9 cross-sectional studies and 3 case-control studies). These studies focused on sectors reported as stressful (health, banking, education, and industries). The prevalence of hypertension varied from 14.3% to 45.9%, with a high proportion of hypertensive participants (35.4%-70.6%) who were unaware that they had hypertension. Job stress was significantly associated with hypertension (OR = 2.4 [1.5-4.4]) and stress management was inversely associated with hypertension (r = -0.14, p < 0.05). However, no study reported an existing workplace health promotion program implemented, especially regarding cardiovascular disease risk factors. CONCLUSION Data available in the literature show that stressful working conditions may be associated with hypertension. We are faced with an increasing prevalence of hypertension among workers in Sub-Saharan Africa, where a large proportion of them are unaware that they have hypertension. Thus, there is a need to implement workplace prevention and health promotion strategies in Sub-Saharan Africa.
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Affiliation(s)
- Rodrigue Khonde Kumbu
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Hervé Matondo
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aline Labat
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bernard Kianu
- Unit of Cardiology, University Clinic of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Isabelle Godin
- Research Centre in Social Approaches to Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Guillaume Kiyombo
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yves Coppieters
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Hidalgo-Benites A, Senosain-Leon V, Carrillo-Larco RM, Ruiz-Alejos A, Gilman RH, Smeeth L, Miranda JJ, Bernabé-Ortiz A. Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study. F1000Res 2023; 10:1134. [PMID: 38046986 PMCID: PMC10690031 DOI: 10.12688/f1000research.73900.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%-18.4%) to 31.3% (95% CI 28.4%-34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4-4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.
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Affiliation(s)
| | | | - Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andrea Ruiz-Alejos
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
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Gardezi SKM, Aitken WW, Jilani MH. The Impact of Non-Adherence to Antihypertensive Drug Therapy. Healthcare (Basel) 2023; 11:2979. [PMID: 37998471 PMCID: PMC10671374 DOI: 10.3390/healthcare11222979] [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: 09/24/2023] [Revised: 10/28/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Medication non-adherence is a major healthcare barrier, especially among diseases that are largely asymptomatic, such as hypertension. The impact of poor medication adherence ranges from patient-specific adverse health outcomes to broader strains on health care system resources. The Centers for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database was used to retrieve Centers for Medicare and Medicaid Services' data pertaining to blood pressure (BP) medication adherence, socio-economic variables, and cardiovascular (CV) outcomes across the United States. Multivariable linear regression models were used to estimate the change in total CV deaths as a function of non-adherence to BP medications. For every percent increase in the non-adherence rate, the total number of CV deaths increased by 7.13 deaths per 100,000 adults (95% CI: 6.34-7.92), even after controlling for the percentage of residents with access to insurance, the percentage of residents who were eligible for Medicaid, the percentage of residents without a college education, median home value, income inequality, and the poverty rate (p < 0.001). There is a significant association between non-adherence to BP medications and total CV deaths. Even a one percent increase in the adherence rate in the United States could result in tens of thousands of preventable CV deaths. Based on recently published CDC data, this could also have a tremendous impact on health care costs. This provides compelling evidence for increased efforts to improve adherence.
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Affiliation(s)
| | - William W. Aitken
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Mohammad Hashim Jilani
- Division of Cardiovascular Health, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA;
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