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Hughes AD, Davey Smith G, Howe LD, Lawlor D, Jones S, Park CM, Chaturvedi N. Differences between brachial and aortic blood pressure in adolescence and their implications for diagnosis of hypertension. J Hypertens 2024; 42:1382-1389. [PMID: 38660719 PMCID: PMC11216383 DOI: 10.1097/hjh.0000000000003743] [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: 01/15/2024] [Revised: 03/06/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Blood pressure (BP) is the leading global cause of mortality, and its prevalence is increasing in children and adolescents. Aortic BP is lower than brachial BP in adults. We aimed to assess the extent of this difference and its impact on the diagnosis of hypertension among adolescents. METHODS We used data from 3850 participants from a UK cohort of births in the early 1990s in the Southwest of England, who attended their ∼17-year follow-up and had valid measures of brachial and aortic BP at that clinic [mean (SD) age 17.8 (0.4) years, 66% female individuals]. Data are presented as mean differences [95% prediction intervals] for both sexes. RESULTS Aortic systolic BP (SBP) was lower than brachial SBP [male, -22.3 (-31.2, -13.3) mmHg; female, -17.8 (-25.5, -10.0) mmHg]. Differences between aortic and brachial diastolic BP (DBP) were minimal. Based on brachial BP measurements, 101 male individuals (6%) and 22 female individuals (1%) were classified as hypertensive. In contrast, only nine male individuals (<1%) and 14 female individuals (<1%) met the criteria for hypertension based on aortic BP, and the predictive value of brachial BP for aortic hypertension was poor (positive-predictive value = 13.8%). Participants with aortic hypertension had a higher left ventricular mass index than those with brachial hypertension. CONCLUSION Brachial BP substantially overestimates aortic BP in adolescents because of marked aortic-to-brachial pulse pressure amplification. The use of brachial BP measurement may result in an overdiagnosis of hypertension during screening in adolescence.
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Affiliation(s)
- Alun D. Hughes
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Laura D. Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Deborah Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Siana Jones
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
| | - Chloe M. Park
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
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Borie YA, Tamiso A, Gutema K, Jisso M, Deribe B, Fikre R, Defar S, Ayalew M, Abera W. Psychological distress and its associated factors among people with specific chronic conditions (diabetes and/or hypertension) in the Sidama region of southern Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0303196. [PMID: 38985813 PMCID: PMC11236106 DOI: 10.1371/journal.pone.0303196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/17/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The majority of people with long-term, non-communicable medical conditions experience significant psychological anguish. Poor mental health or psychological distress influences low lifestyle decisions that result in obesity, inactivity, and cigarette use as well as poor health literacy and limited access to health promotion activities. OBJECTIVES The study's purpose was to measure the prevalence of psychological distress and it's predictors in patients with chronic non-communicable diseases who were being treated in selected hospitals in the Sidama region of southern Ethiopia in 2022. METHODOLOGY Institutional based cross-sectional study was carried out using a sample of 844 patients receiving medication for either high blood pressure or diabetes mellitus or both between May1 and August 31, 2022. To gauge psychiatric distress, the Amharic translation and Ethiopian validation of the Kessler 6 scale (K-6) was employed. The analysis was done using binary logistic regression and an odds ratio with the corresponding 95% confidence interval was estimated to measure the strength of the association. P value <0.05 was considered to declare the significance. RESULT Patients with diabetic mellitus, hypertension or both had a 49.6% prevalence of psychological distress at selected Sidama hospitals. Age, drug side effects, history medical complications following diabetic mellitus/hypertension, and body mass index of the patient were all significantly linked with psychological distress (P<0.05). CONCLUSION According to the results of this study, psychological distress is far more prevalent than it was in past studies in Ethiopia and other African countries. To lessen the problem, all stakeholders must cooperate, but health agencies, policymakers, and NGOs particularly need to put in extra effort. The study also showed a significant association between body mass index, patient age, drug side effects, and history of medical complications following diabetic mellitus /hypertension.
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Affiliation(s)
- Yacob Abraham Borie
- Department of Psychiatry, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Alemu Tamiso
- School of Public Health, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Keneni Gutema
- School of Public Health, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Meskerem Jisso
- School of Public Health, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Bedilu Deribe
- School of Public Health, College of Medicine and Health Science, Hawassa University, Ethiopia
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Rekiku Fikre
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Semira Defar
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Mohammed Ayalew
- Department of Psychiatry, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Wondwossen Abera
- School of Medical Laboratory, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Mehmood S, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Impact of the diagnosis of gestational diabetes on maternal physical activity after pregnancy. Diabetes Obes Metab 2024; 26:1207-1215. [PMID: 38116699 DOI: 10.1111/dom.15415] [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: 11/09/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
AIM The diagnosis of gestational diabetes (GDM) identifies women who are at future risk of developing type 2 diabetes. However, it is unclear if diagnosing GDM thus motivates women to increase physical activity after pregnancy or if this medicalization has the opposite effect of decreasing activity, possibly reflecting assumption of a sick role. We thus sought to evaluate the impact of diagnosing GDM on changes in maternal physical activity after pregnancy. METHODS In this prospective cohort study, physical activity patterns were assessed by the Baecke questionnaire for the year before pregnancy and the first year postpartum in 405 white women comprising the following three gestational glucose tolerance groups: (a) those who did not have GDM (non-GDM; n = 247), (b) women with undiagnosed GDM (n = 46) and (c) those diagnosed with GDM (n = 112). RESULTS In the year before pregnancy, mean adjusted total physical activity progressively decreased from non-GDM to undiagnosed GDM to diagnosed GDM (p = .067). Conversely, at 1 year postpartum, total physical activity was highest in those who had been diagnosed with GDM (p = .02). Compared with non-GDM, diagnosed GDM predicted an increase in total physical activity from pre-pregnancy to 1 year postpartum (t = 2.3, p = .02) whereas undiagnosed GDM predicted a concurrent decrease in leisure-time activity (t = -2.74, p = .006). Accordingly, the mean adjusted increase in body mass index from pre-pregnancy to 1 year postpartum was lowest in those with diagnosed GDM (0.26 ± 0.25 kg/m2 ), highest in undiagnosed GDM (1.23 ± 0.38 kg/m2 ) and intermediate in non-GDM (0.89 ± 0.22 kg/m2 ) (overall p = .04). CONCLUSION Diagnosis of GDM leads to increased physical activity after pregnancy that may partially attenuate postpartum weight retention.
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Affiliation(s)
- Sadia Mehmood
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Chang Ye
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Anthony J Hanley
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Philip W Connelly
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Mathew Sermer
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Canada
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
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Xu Z, Wu X, Xiao C, Zhang W, Yan P, Yang C, Zhang L, Cui H, Tang M, Wang Y, Chen L, Liu Y, Zou Y, Qu Y, Xiao C, Zhang L, Yang C, Li J, Liu Z, Liao J, Yao Y, Zhang B, Jiang X. Observational and genetic analyses of the bidirectional relationship between depression and hypertension. J Affect Disord 2024; 348:62-69. [PMID: 38123074 DOI: 10.1016/j.jad.2023.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/20/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND While the association between depression and hypertension has been extensively investigated, the pattern and nature of such association remain inconclusive. We sought to investigate the bidirectional relationship between depression and hypertension and its causal. METHODS We first performed observational analyses using longitudinal data from the UK Biobank. We then performed genetic analyses leveraging summary statistics from large-scale genome-wide association studies (GWASs) conducted in European ancestry for depression and hypertension. RESULTS Observational analysis suggested a significant bidirectional phenotypic association between depression and hypertension (Depression → Hypertension: HR = 1.27, 95 % CI: 1.19, 1.36; Hypertension → Depression: HR = 1.65, 95 % CI: 1.58, 1.72). Linkage disequilibrium score regression demonstrated a positive genetic correlation between the two conditions (rg=0.15, P = 5.75 × 10-10). Bidirectional two-sample Mendelian randomization (MR) suggested that genetic liability to depression was significantly associated with an increased risk of hypertension (OR = 1.27, 95 % CI: 1.12, 1.43), while the genetic liability to hypertension was not associated with the risk of depression (OR = 1.01, 95 % CI: 0.99, 1.03). Multivariate MR, after adjusting for smoking, drinking, and body mass index, further supported an independent causal effect of genetic liability to depression on hypertension risk (OR = 1.10, 95 % CI: 1.02, 1.18). LIMITATIONS (1) interference of confounders, (2) absence of adequate statistical power, and (3) limitation to European populations. CONCLUSION Our study indicates depression is a causal risk factor for hypertension, whereas the reverse maybe not. Findings support that prevention of depression might help in decreasing hypertension incidence.
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Affiliation(s)
- Zhengxing Xu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Xueyao Wu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changfeng Xiao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenqiang Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peijing Yan
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huijie Cui
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingshuang Tang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yutong Wang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Chen
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunjie Liu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanqiu Zou
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Qu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chenghan Xiao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ling Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Iatrical Polymer Material and Artificial Apparatus, School of Polymer Science and Engineering, Sichuan University, Chengdu, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenmi Liu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiaqiang Liao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yuqin Yao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Ben Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Xia Jiang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Amaike C, Salami OF, Bamidele OT, Ojo AM, Otaigbe I, Abiodun O, Adesola O, Adebiyi AO. Association of depression and anxiety with uncontrolled hypertension: A cross-sectional study in Southwest Nigeria. Indian J Psychiatry 2024; 66:157-164. [PMID: 38523755 PMCID: PMC10956585 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_751_23] [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: 09/28/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 03/26/2024] Open
Abstract
Background Hypertension is a medical condition of public health concern that increases the risk of chronic noncommunicable diseases and mortalities. In recent years, understanding its coexistence with other comorbidities has been the focus of better management. However, the relationship between hypertension and depression or anxiety has been contentious issue, with diverse findings reported by different studies. Understanding this relationship will be crucial for blood pressure control and reducing the mortality associated with hypertension. Therefore, this study was conducted to determine the association between depression or anxiety and hypertension control. Methods A cross-sectional study was conducted among 321 hypertensive patients accessing care in two hospitals. Depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). The relationship between blood pressure control and depression or anxiety was assessed using binary logistic regression. Results The prevalence of depression and anxiety was 12.1% and 23.1%, respectively. Up to 261 (81.3%) participants had uncontrolled blood pressure. Of these 261 participants, 14.2% and 23.4% had depression and anxiety, respectively. Depression was associated with an increased risk of uncontrolled blood pressure after adjusting for sex, smoking cigarettes, age, marital status, and exercise (odds ratio (OR) = 7.751, 95% confidence interval (CI) = 1.79-43.4, P = 0.011). Conclusion Depression appears to be independently associated with an increased risk of uncontrolled blood pressure. It is therefore relevant for healthcare providers to assess for depression in patients with hypertension to ensure better hypertensive control.
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Affiliation(s)
- Chikwendu Amaike
- Department of Community Medicine, Babcock University and Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - Omotayo F. Salami
- Department of Surgery, Ben Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, Ogun State, Nigeria
- Department of Anesthesia, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - Olabisi T. Bamidele
- Department of Chemical Pathology, Ben Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Abayomi M. Ojo
- Federal Neuropsychiatric Hospital, Yaba, Lagos State, Nigeria
| | - Idemudia Otaigbe
- Department of Medical Microbiology, School of Basic Clinical Sciences, Benjamin Carson (Snr) College of Health and Medical Science, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Olumide Abiodun
- Department of Community Medicine, Babcock University and Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | | | - Akindele O. Adebiyi
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
- Department of Centre for Research Innovation and Development, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
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Di Giacomo D, Ranieri J, Guerra F, Cilli E, Sciarra L, Romano S. Cardiovascular risk and biopsychosocial interplay: Association among hypertension, anxiety, and emotional dysregulation-observational study in primary care setting for efficient self-care. Clin Cardiol 2024; 47:e24152. [PMID: 37771169 PMCID: PMC10765995 DOI: 10.1002/clc.24152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Aim of the study was to explore the relationship between emotional dimensions of hypertensive patients and the self-care skills; we tried to draw the psychological aspects could impact the health management in hypertension analyzing the effect of emotional regulation on self-care skills: our scope was to highlight the psychological dynamics into behavioral medicine approach. METHODS In an observational study design, patients were collected. Patients with diagnosis of hypertension were recruited in primary care setting. Inclusion criteria included patients older than 18 years, with known and medically treated primary hypertension undergoing antihypertensive medication. RESULTS Statistical analysis was carried out based on the data of 28 primary hypertensive patients (seven females, 21 males, mean age ± SD: 49.8 ± 7.8 years mean; clinic blood pressure: mean systolic blood pressure: 137.2 ± 13.1 mmHg, mean diastolic blood pressure: 82.1 ± 9.9 mmHg). Mean duration of hypertension in the sample was 13.1 years (±8.2 years). Correlations among the main variables of interest showed a positive and significant relationship between emotional dysregulation indexes, psychological distress, and self-care domains: awareness resulted negatively and significantly correlated to self-efficacy; nonacceptance, goals and impulse indexes seemed positively and significantly correlated to anxiety and depression; finally, stress was correlated positively and significantly to awareness and impulse. CONCLUSIONS Evidencing the role of emotion dysregulation on self-care skills and psychological outcomes, and specifically highlighting the impact of emotion dysregulation on self-care, our findings could inform the development and implementation of psychological interventions aimed at promoting psychological well-being and healthy behavior by focusing on the promotion of emotion regulation strategies, to reduce the risk for co-morbidity and/or severe cardiovascular diseases.
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Affiliation(s)
- Dina Di Giacomo
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Jessica Ranieri
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Federica Guerra
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Eleonora Cilli
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
| | - Luigi Sciarra
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
- Di Lorenzo ClinicAvezzanoItaly
| | - Silvio Romano
- Life, Health and Environmental Sciences DepartmentUniversity of L'AquilaL'AquilaItaly
- Heart Failure ClinicASL Avezzano‐SulmonaL'AquilaItaly
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7
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Alwani AA, Singh U, Sankhyan S, Chandra A, Rai SK, Nongkynrih B. Hypertension-related distress and its associated factors: findings from an urban primary health centre of South Delhi, India. J Family Med Prim Care 2023; 12:1885-1892. [PMID: 38024890 PMCID: PMC10657111 DOI: 10.4103/jfmpc.jfmpc_1909_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Living with hypertension (HTN) has been found to cause distress, which adversely affects one's self-care and may lead to elevated blood pressure. There is a paucity of data regarding the prevalence of HTN-related distress. This study was conducted to estimate the prevalence of HTN-related distress among adults with HTN attending an outpatient department in an urban primary health centre and to determine the factors associated with distress. Methods This was a cross-sectional study conducted at the outpatient department of an urban primary health centre in Delhi, India. The enrolled participants were administered a questionnaire, which included a Distress Scale for patients with diabetes mellitus and/or hypertension (DSDH17 M) (to assess for HTN-related distress) and Health-Related Quality of Life, Healthy Days Measure. A descriptive analysis was performed. Factors associated with HTN-related distress were tested using logistic regression. Results One hundred forty-one participants were enrolled in this study. Most were women (73.76%) with a mean age of 60.15 years (standard deviation [SD]: 0.78). The prevalence of HTN-related distress (average DSDH17 M score ≥3) was 14% (95% confidence interval [CI]: 9.30-21.03). Patients with HTN-related distress had significantly poor health and reported a greater number of days where they were physically or mentally unhealthy. Patients with uncontrolled blood pressure had six times the odds (95% CI: 1.69-21.77, P value = 0.006) of HTN-related distress compared to those with controlled blood pressure. Conclusions Hypertension-related distress was present in 14% of adults with HTN. Patients with uncontrolled blood pressure had six times the odds of HTN-related distress.
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Affiliation(s)
- Anam A. Alwani
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Udita Singh
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sujata Sankhyan
- Department of Paediatrics, Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh, India
| | - Ankit Chandra
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjay K. Rai
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
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8
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Hives L, Georgiou RF, Spencer J, Benedetto V, Clegg A, Rutter P, Watkins C, Williams N, Bray EP. Risk reduction intervention for raised blood pressure (REVERSE): protocol for a mixed-methods feasibility study. BMJ Open 2023; 13:e072225. [PMID: 37258072 DOI: 10.1136/bmjopen-2023-072225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Around 40% of adults have pre-hypertension (blood pressure between 120-139/80-89), meaning they are at increased risk of developing hypertension and other cardiovascular disease-related conditions. There are limited studies on the management of pre-hypertension; however, guidance recommends that it should be focused on lifestyle modification rather than on medication. Self-monitoring of blood pressure could allow people to monitor and manage their risk status and may allow individuals to modify lifestyle factors. The purpose of this study is to determine the feasibility and acceptability, to both healthcare professionals and people with pre-hypertension, of blood pressure self-monitoring. METHODS AND ANALYSIS A prospective, non-randomised feasibility study, with a mixed-methods approach will be employed. Eligible participants (n=114) will be recruited from general practices, pharmacies and community providers across Lancashire and South Cumbria. Participants will self-monitor their blood pressure at home for 6 months and will complete questionnaires at three timepoints (baseline, 6 and 12 months). Healthcare professionals and participants involved in the study will be invited to take part in follow-up interviews and a focus group. The primary outcomes include the willingness to engage with the concept of pre-hypertension, the acceptability of self-monitoring, and the study processes. Secondary outcomes will inform the design of a potential future trial. A cost-analysis and cost-benefit analysis will be conducted. ETHICS AND DISSEMINATION Ethics approval has been obtained from London-Fulham NHS Research Ethics Committee, the University of Central Lancashire Health Ethics Review Panel and the HRA. The results of the study will be disseminated via peer-reviewed publications, feedback to service users and healthcare professionals, and to professional bodies in primary care and pharmacy. TRIAL REGISTRATION NUMBER ISRCTN13649483.
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Affiliation(s)
- Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Rachel F Georgiou
- Stroke Research Team, School of Nursing, University of Central Lancashire, Preston, UK
| | - Joseph Spencer
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Andrew Clegg
- Health Technology Assessment Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Paul Rutter
- Faculty of Science and Health, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Caroline Watkins
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emma P Bray
- Stroke Research Team, School of Nursing, Facility of Health and Care, University of Central Lancashire, Preston, UK
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9
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An L, Ma L, Xu N, Yu B. Life satisfaction, depressive symptoms, and blood pressure in the middle-aged and older Chinese population. J Psychosom Res 2023; 170:111367. [PMID: 37196586 DOI: 10.1016/j.jpsychores.2023.111367] [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: 06/07/2022] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Both life satisfaction and depressive symptoms have been proven to be related to blood pressure (BP) separately. This longitudinal study aimed to examine whether these two distinct but related psychological constructs are independent predictors of BP in the middle-aged and older Chinese population. METHODS This study used two waves of data from the China Health and Retirement Longitudinal Study (CHARLS) and the analysis were restricted to those respondents aged 45 and older without hypertension and other cardiometabolic conditions [n = 4055, mean age (SD) = 56.7 (8.3); male, 50.1%]. Multiple linear regression models were used to evaluate the associations between baseline life satisfaction, depressive symptoms, and systolic (SBP) and diastolic blood pressure (DBP) at follow-up. RESULTS Life satisfaction was positively associated with SBP (β = 0.03, p = .03), while depressive symptoms were negatively associated with both SBP (β = -0.04, p = .003) and DBP (β = -0.04, p = .004) at follow-up. The associations for life satisfaction became insignificant when all the covariates including depressive symptoms were taken into account. In contrast, the associations for depressive symptoms remained even after controlling for all the covariates including life satisfaction (SBP: β = -0.04, p = .02; DBP: β = -0.04, p = .01). CONCLUSION The results implied that depressive symptoms, rather than life satisfaction, independently predicted BP changes in the Chinese population after four years. These findings expand our knowledge about the association patterns of depressive symptoms and life satisfaction with BP.
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Affiliation(s)
- Li An
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China; Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China
| | - Ling Ma
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Nan Xu
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Bin Yu
- Institute of Applied Psychology, Tianjin University, Tianjin, China; Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China; Academy of Medical Engineering and Translational Medicine, Tianjin University, China.
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10
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Chrysant SG. The debate over the optimal blood pressure treatment target of less than 130/80 mmHg. Postgrad Med 2023; 135:208-213. [PMID: 35285378 DOI: 10.1080/00325481.2022.2052516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to analyze the controversy regarding the optimal blood pressure (BP) target of <130/80 mmHg as proposed by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) across all age groups. Hypertension is a major risk factor for cardiovascular disease (CVD), stroke, and chronic kidney disease (CKD), and its optimal control is associated with lessening or preventing these complications. A recent study has argued that this BP level is universally accepted as an optimal and safe BP level. However, this argument is not accepted by other investigators, arguing that higher BP levels are as effective and safe. METHODS In order to investigate the current status of this level of BP control, a Medline search of the English literature was conducted between 2017 and February 2022, and 25 pertinent papers were selected. RESULTS The analysis of data from these studies indicates that these BP are effective in lowering the BP and preventing cardiovascular disease, heart failure, and chronic kidney disease, and they are indeed universally accepted. CONCLUSION Based on the current evidence, the current proposed by the 2017 ACC/AHA treatment guidelines are effective in lowering the BP and decreasing its cardiovascular complications and should followed, till perhaps, new data come out to the contrary.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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11
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Said B, Gharawi MO, Dallak FH, Maashi AQ, Hurissi E, Gharawi SO, Tarshi MM, Hayyan AI, Faqihi SA, AlMusawa HI, Hakami GM, Alhazmi AH. Factors Associated with Anxiety During COVID-19 Pandemic and Its Association with Hypertension in Saudi Arabia. Patient Prefer Adherence 2023; 17:905-912. [PMID: 37016675 PMCID: PMC10066885 DOI: 10.2147/ppa.s400168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Patients with chronic diseases such as hypertension (HTN) are considered a vulnerable group, and they are prone to anxiety and other psychological conditions during pandemics. Very few reports discussed factors related to anxiety and how it is associated with HTN during COVID-19 pandemic. In this project, we aimed to identify the prevalence of anxiety among hypertensive patients in Saudi Arabia during the COVID-19 pandemic. Methods A cross-sectional study was conducted, and data were collected using an electronic self-administered pretested questionnaire distributed via trained data collectors. Data were analyzed using t-test and chi-test. Results A total of 2135 participants were enrolled in this study. Anxiety was reported in 5% of all participants and 8% of the hypertensive participants. Older age, marital status, higher body mass index (BMI), smoking, and Khat chewing were strongly associated with anxiety among the general population. In addition, less adherence to medication made participants with HTN significantly more anxious. Conclusion The prevalence of anxiety among hypertensive individuals is higher compared to the general population. Moreover, anxiety is significantly associated with some sociodemographic in the general population, and with less adherence to medications in hypertensive patients. Further studies with data from medical record including more variables are needed to highlight this association.
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Affiliation(s)
- Badria Said
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Afnan Q Maashi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Eman Hurissi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Melia M Tarshi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Suzan A Faqihi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Abdulaziz H Alhazmi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
- Correspondence: Abdulaziz H Alhazmi, Jazan University, Tel +966-7329-5000, Email
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12
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Kawasaki Y, Ishidoya S, Morimoto R, Ono Y, Omata K, Tezuka Y, Kawamorita N, Yamashita S, Mitsuzuka K, Satoh F, Ito A. Laparoscopic Adrenalectomy Is Beneficial for the Health-Related Quality of Life of Older Patients with Primary Aldosteronism. Urol Int 2023; 107:186-192. [PMID: 34419949 DOI: 10.1159/000518165] [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: 02/04/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Laparoscopic adrenalectomy (LADX) improves hypertension in patients with primary aldosteronism (PA). However, the antihypertensive impact of LADX appears restricted in older patients with PA. In this study, we evaluated the impact of LADX in older patients focusing on the health-related quality of life (HRQoL). METHODS A total of 156 patients with PA who underwent LADX in a single institution were enrolled in this prospective cohort study. The patients were divided into 2 groups, with a boundary of 60 years. The HRQoL was evaluated using the Medical Outcomes Study's 36-Item Short-Form Health Survey version 2 (SF-36v2) questionnaire before and after LADX. Demographics, clinical features, antihypertensive drugs before and after surgery, and perioperative evaluation were recorded. We compared all scale scores and summed scores between groups. Multivariate regression models were used to determine the associations between various covariables and the HRQoL. RESULTS In the older PA patients, most subscales of HRQoL at baseline were lower than the national standard values. The antihypertensive drug-free rate by LADX was only 21% in older patients, compared to 58% in younger patients. However, a significant improvement in mental HRQoL was observed after LADX (p = 0.002). The much preoperative antihypertensive drugs, lower preoperative potassium level, and smaller degree of comorbidities were predictors of improved mental HRQoL by LADX on multivariate analyses. CONCLUSION The older PA patients showed lower mental HRQOL than the national standard populations. Although antihypertensive effects were limited for these patients, LADX was beneficial as PA treatment via improvement of mental HRQoL.
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Affiliation(s)
- Yoshihide Kawasaki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Ryo Morimoto
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikiyo Ono
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Omata
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuta Tezuka
- Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Kawamorita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumitoshi Satoh
- Department of Clinical Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
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13
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Mkumbo E, Willows TM, Onyango O, Khalid K, Maiba J, Schell CO, Oliwa J, McKnight J, Baker T. Same label, different patients: Health-workers' understanding of the label 'critical illness'. FRONTIERS IN HEALTH SERVICES 2023; 3:1105078. [PMID: 36811083 PMCID: PMC7614203 DOI: 10.3389/frhs.2023.1105078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background During the course of patients' sickness, some become critically ill, and identifying them is the first important step to be able to manage the illness. During the course of care provision, health workers sometimes use the term 'critical illness' as a label when referring to their patient's condition, and the label is then used as a basis for communication and care provision. Their understanding of this label will therefore have a profound impact on the identification and management of patients. This study aimed to determine how Kenyan and Tanzanian health workers understand the label 'critical illness'. Methods A total of 10 hospitals-five in Kenya and five in Tanzania-were visited. In-depth interviews were conducted with 30 nurses and physicians from different departments in the hospitals who had experience in providing care for sick patients. We conducted a thematic analysis of the translated and transcribed interviews, synthesized findings and developed an overarching set of themes which captured healthcare workers' understandings of the label 'critical illness'. Results Overall, there does not appear to be a unified understanding of the label 'critical illness' among health workers. Health workers understand the label to refer to patients in four thematic ways: (1) those in a life-threatening state; (2) those with certain diagnoses; (3) those receiving care in certain locations; and (4) those in need of a certain level of care. Conclusion There is a lack of a unified understanding about the label 'critical illness' among health workers in Tanzania and Kenya. This potentially hampers communication and the selection of patients for urgent life-saving care. A recently proposed definition, "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility", could be useful for improving communication and care.
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Affiliation(s)
- Elibariki Mkumbo
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania,Correspondence: Elibariki Mkumbo,
| | - Tamara Mulenga Willows
- Health Systems Collaborative, Department of Tropical Medicine and Global Health University of Oxford Health, Oxford, United Kingdom
| | - Onesmus Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Karima Khalid
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania,Department of Anaesthesia, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John Maiba
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden,Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacob McKnight
- Health Systems Collaborative, Department of Tropical Medicine and Global Health University of Oxford Health, Oxford, United Kingdom
| | - Tim Baker
- Department of Health Systems, Ifakara Health Institute, Dar es Salaam, Tanzania,Department of Anaesthesia, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Bhatia M, Dixit P, Kumar M, Dwivedi LK. Comparing socio-economic inequalities in self-reported and undiagnosed hypertension among adults 45 years and over in India: what explains these inequalities? Int J Equity Health 2023; 22:26. [PMID: 36732766 PMCID: PMC9893593 DOI: 10.1186/s12939-023-01833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is a leading cause of mortality and morbidity in developing countries. For India, the hidden burden of undiagnosed hypertension is a major concern. This study aims to assess and explain socio-economic inequalities among self-reported and undiagnosed hypertensives in India. METHODS The study utilized data from the Longitudinal Aging Study in India (LASI), a nationally-representative survey of more than 72,000 older adults. The study used funnel plots, multivariable logistic regression, concentration indices, and decomposition analysis to explain the socio-economic gap in the prevalence of self-reported and undiagnosed hypertension between the richest and the poorest groups. RESULTS The prevalence of self-reported and undiagnosed hypertension was 27.4 and 17.8% respectively. Monthly per capita consumption expenditure (MPCE) quintile was positively associated with self-reported hypertension but negatively associated with undiagnosed hypertension. The concentration index for self-reported hypertension was 0.133 (p < 0.001), whereas it was - 0.047 (p < 0.001) for undiagnosed hypertension. Over 50% of the inequalities in self-reported hypertension were explained by the differences in the distribution of the characteristics whereas inequalities remained unexplained for undiagnosed hypertension. Obesity and diabetes were key contributors to pro-rich inequality. CONCLUSIONS Results imply that self-reported measures underestimate the true prevalence of hypertension and disproportionately affect the poorer MPCE groups. The prevalence of self-reported HTN was higher in the richest group, whereas socio-economic inequality in undiagnosed hypertension was significantly concentrated in the poorest group. As majority of the inequalities remain unexplained in case of undiagnosed hypertension, broader health systems issues including barriers to access to health care may be contributing to inequalities.
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Affiliation(s)
- Mrigesh Bhatia
- grid.13063.370000 0001 0789 5319London School of Economics, London, WC2A 2AE UK
| | - Priyanka Dixit
- grid.419871.20000 0004 1937 0757Tata Institute of Social Sciences, Mumbai, India
| | | | - Laxmi Kant Dwivedi
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
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15
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Shayani Rad M, Moohebati M, Mohajeri SA. Beneficial effects of celery seed extract (Apium graveolens), as a supplement, on anxiety and depression in hypertensive patients: a randomized clinical trial. Inflammopharmacology 2023; 31:395-410. [PMID: 36334223 DOI: 10.1007/s10787-022-01083-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: 08/08/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Anxiety and depression are crucial public health issues, affecting the rising in hospitalizations and death. Anxiety and depression can worsen hypertension and vice versa. OBJECTIVE The current study has investigated the effects of celery seed extract, as a drug supplement, with the active ingredient of 3-n-butylphthalide, on mental problems primarily anxiety and secondary depression in hypertensive patients. DESIGN The current study was a randomized, triple-blind, placebo-controlled, cross-over, 4-week clinical trial with a 4-week washout period. Fifty hypertensive patients received 4 placebo or celery seed extract capsules (1.34 g per day) for 4 weeks as a supplement to their usual medication regimen. The blood pressure parameters were assessed using 24-h ambulatory blood pressure monitoring device. Anxiety and depression and their wide range of symptoms were evaluated using Beck anxiety and depression inventories (BAI and BDI). RESULTS In the celery treatment step, the mean reduction in BAI and BDI scores were 6.78 (P < 0.001) and 3.63 (P < 0.01), respectively. Some symptoms of anxiety including unable to relax, nervousness, numbness, dizziness, flushed face, sweating, and breathing difficulty were significantly improved by celery consumption (P < 0.001). Celery could decrease symptoms of depression such as sadness, crying, loss of energy, insomnia, irritability, fatigue, loss of interest in sex, and punishment feeling (P < 0.01). The mean reduction in blood pressure parameters was also significant during celery therapy (P < 0.001). CONCLUSIONS The psychometric properties of anxiety and depression were investigated and the results were promising. The results indicated the anti-anxiety and anti-depressive properties of celery seed extract as a supplement in hypertensive patients. CLINICAL TRIAL REGISTRATION Registry name: Iranian Registry of Clinical Trials (IRCT), Registration number: IRCT20130418013058N8, Registration link: https://www.irct.ir/trial/30021 . The study was carried out between 2018-09-21 and 2020-07-20.
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Affiliation(s)
- Maryam Shayani Rad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee (SRC), Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Moohebati
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Seyed Ahmad Mohajeri
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Canfora F, Calabria E, Pecoraro G, Leuci S, Coppola N, Mazzaccara C, Spirito F, Aria M, D'Aniello L, Mignogna MD, Adamo D. Prevalence of hypertension and correlation with mental health in women with burning mouth syndrome: A case-control study. Front Cardiovasc Med 2023; 9:969148. [PMID: 36741839 PMCID: PMC9894887 DOI: 10.3389/fcvm.2022.969148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/27/2022] [Indexed: 01/21/2023] Open
Abstract
Background The relationship between hypertension (HTN) and chronic pain is still a matter of debate, and its prevalence in patients with burning mouth syndrome (BMS) has never been evaluated. This study aimed to assess the prevalence of HTN in women with BMS and to evaluate its relationship with potential predictors such as risk factors for cardiovascular diseases, pain, and mental health status analyzing differences with healthy women. Methods In total, 250 women with BMS (WBMS) were prospectively recruited and compared with an equal number of healthy women (HW) matched for age. Education, body mass index, smoke and alcohol consumption, intensity and quality of pain, and psychological profile were further investigated to identify the potential predictors of HTN. Specifically, pain assessment [the Numeric Rating Scale (NRS) and Short-Form McGill Pain Questionnaire (SF-MPQ)] and psychological assessment [Hamilton Rating Scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS)] was carried out for the participants. Results HTN was found in 128 (51.2%) WBMS and 76 (30.4%) HW (p < 0.001**). The scores of the NRS, SF-MPQ, HAM-D, HAM-A, and PSQI were statistically significantly higher in the WBMS than in the HW (p < 0.001**). A strongly linear correlation between HTN and employment status, systemic diseases, and education level (p < 0.001**) was found in WBMS, while a strong correlation between HTN and employment status, hypercholesterolemia, systemic diseases, and drug consumption was found in HW (p < 0.001**). No statistically significant correlation was found between HTN and pain, anxiety, depression, and sleep disturbances. Conclusion These results suggest that WBMS showed a higher prevalence of HTN compared with controls. Unemployed WBMS with lower education and other systemic comorbidities are at an increased risk of developing HTN. HTN is associated with alteration in the vascular structure and function of the brain, and these processes accelerate brain aging, which contributes to a reduction in intracortical connectivity, thus affecting the modulatory system of control of pain in patients with BMS, independently of their mental health assessment. Predictors that may underlie this association remain unclear, taking into account the differences found in HW, and should be further elucidated.
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Affiliation(s)
- Federica Canfora
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Calabria
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy,*Correspondence: Elena Calabria ✉
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Stefania Leuci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University of Naples Federico II, Naples, Italy
| | - Luca D'Aniello
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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The Association between Hypertension and Insomnia: A Bidirectional Meta-Analysis of Prospective Cohort Studies. Int J Hypertens 2022; 2022:4476905. [PMID: 36618449 PMCID: PMC9815923 DOI: 10.1155/2022/4476905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background Studies on bidirectional associations between hypertension and insomnia are inconclusive. The purpose of this meta-analysis was to systematically review and summarize the current evidence from epidemiological studies that evaluated this relationship. Materials and Methods PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP databases were searched for studies published up to May 2021. Prospective cohort studies that reported the relationship between hypertension and insomnia in adults were included. Data were extracted or provided by the authors according to the prevalence rate, incidence rate, unadjusted or adjusted odds ratio (OR), and 95% confidence interval (CI). Heterogeneity was assessed by I2 statistics. ORs were pooled by using random-effects models. Results A total of 23 prospective studies were identified. Twenty cohort studies recorded OR-adjusted value with the outcome for hypertension (OR = 1.11, 95% CI: 1.07-1.16; I2 = 83.9%), and three cohort studies reported OR-adjusted value with the outcome for insomnia (OR = 1.20, 95%CI: 1.08-1.32; I2 = 35.1%). Subgroup analysis showed that early morning awakening and composite insomnia were significantly associated with hypertension. Conclusions The result indicates a possible bidirectional association between hypertension and insomnia. Early identification and prevention of insomnia in hypertension patients are needed, and vice versa.
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18
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Ang CW, Tan MM, Bärnighausen T, Reininghaus U, Reidpath D, Su TT. Mental distress along the cascade of care in managing hypertension. Sci Rep 2022; 12:15910. [PMID: 36151113 PMCID: PMC9508187 DOI: 10.1038/s41598-022-20020-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022] Open
Abstract
Hypertension might be a contributing factor of mental illness. The aim of this study was to investigate the association between different levels of hypertension care and mental distress among hypertensive individuals in Malaysia. We constructed a hypertension care cascade using data of 6531 hypertensive individuals aged ≥ 35 years that were collected as part of the community health survey conducted in 2013 in the South East Asia Community Observatory. We examined the association between the status of hypertension care and mental distress using multiple logistic regressions. Respondents who had not been screened for hypertension and those who had uncontrolled blood pressure (BP) had higher odds of depression, anxiety and, stress compared to those who had been screened and those who had controlled BP, respectively. Respondents who were not taking antihypertensive medication had lower odds of depression and anxiety compared to those who were on medication. There was an association between different levels of hypertension care and mental distress. The application of a hypertension care cascade may help improve the provision of mental health support in primary care clinics. Specific mental health interventions could be provided for patients with particular needs along the cascade.
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Affiliation(s)
- Chiew Way Ang
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Min Min Tan
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,ESRC Centre for Society and Mental Health, King's College London, London, UK.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Reidpath
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia. .,Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany.
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19
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Fang J, Zhang Z, Greenlund KJ. Association of depressive symptoms and hypertension prevalence, awareness, treatment and control among USA adults. J Hypertens 2022; 40:1658-1665. [PMID: 35822590 PMCID: PMC11139467 DOI: 10.1097/hjh.0000000000003163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to measure hypertension prevalence, awareness, treatment and control by depressive symptoms among USA adults. METHOD Using the National Health and Nutrition Examination Survey data from 2007 to 2018 ( n = 28 532), depressive symptoms were categorized as 'none or minimum', 'mild', 'moderate' and 'moderately severe or severe' by the Patient Health Questionnaire. Hypertension was assessed by history, blood pressure measures and antihypertensive medication use. Adjusted prevalence rates and adjusted prevalence ratios (APRs) of hypertension prevalence, awareness, treatment and control were measured. RESULTS By depressive, the adjusted prevalence of hypertension (32.0, 34.2, 37.3 and 36.6%), awareness (80.6, 83.9, 85.7 and 89.8%) and treatment (73.1, 75.2, 78.6 and 83.9%) increased with advanced depressive symptoms, respectively (all P < 0.001). However, no difference in hypertension control was noted after full adjustment. Compared with those with no or minimum depressive symptoms, APRs of hypertension prevalence for mild, moderate and moderately severe or severe depressive symptom were 1.07 (1.02-1.12), 1.16 (1.107-1.262) and 1.15 (1.05-1.26), respectively. The corresponding APRs were 1.04 (1.003-1.08), 1.06 (1.01-1.11) and 1.11 (1.06-1.17) for hypertension awareness, and 1.03 (0.98-1.07), 1.08 (1.02-1.14) and 1.15 (1.08-1.22) for hypertension treatment, respectively. CONCLUSION Among USA adults, depressive symptoms were significantly associated with hypertension prevalence, awareness and treatment, but not with hypertension control. When managing hypertension, healthcare providers should be aware of the mental health status.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention
| | - Zefeng Zhang
- Division for Heart Disease and Stroke Prevention
| | - Kurt J. Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Evaluation of Psychological Distress, Self-Care, and Medication Adherence in Association with Hypertension Control. Int J Hypertens 2022; 2022:7802792. [PMID: 36059588 PMCID: PMC9436608 DOI: 10.1155/2022/7802792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Most of the patients with hypertension (HTN) who undergo medical therapy unaccompanied by psychological and behavioral interventions may not achieve their goal in HTN treatment. Self-care is a key factor in controlling HTN. Given that depression, stress, and anxiety are the most psychological disorders in chronic illnesses. Their impact on self-care, quality of life, and HTN control must be studied more. Methods. We analyzed the difference in medication adherence in 252 patients with low vs. high psychological distress. Also, patients with controlled and uncontrolled HTN were compared according to their psychological distress scores. We further assessed the relation of psychological distress, self-care, and medication adherence with patients’ demographic characteristics. Results. 61.3% of our participants were female with a mean age of 60.6 ± 11.35 and male participants had a mean age of 60.5 ± 11.55. The psychological distress score was significantly higher in women with uncontrolled HTN (
value = 0.044). Also, individuals with controlled HTN tend to have a higher medication adherence score (
value = 0.01) and higher self-care score (
value = 0.033). Hypertensive females had a higher psychological distress score (3.35 ± 2.05) and a lower self-care score (64.05 ± 8.16). There was a positive relationship between age and drug adherence. The self-care score was higher (65.95 ± 7.88) in patients having lower psychological distress levels. Conclusion. A lower psychological distress score can result in better self-care, enhancing the probability of better HTN control; thus, psychological interventions may be necessary for the treatment of HTN. However, more studies are needed to assess the effectiveness of this intervention.
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21
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Loke WH, Ching SM. Prevalence and factors associated with psychological distress among adult patients with hypertension in a primary care clinic: A cross-sectional study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:89-98. [PMID: 35949997 PMCID: PMC9357408 DOI: 10.51866/oa.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Psychological distress worsens the control of hypertension. This study aims to fill the knowledge gap and evaluate the prevalence and factors associated with depression, anxiety, and stress among patients with hypertension in a primary care clinic. METHODS A cross-sectional study was conducted at Klinik Kesihatan Bandar Jerantut on hypertensive patients using a systematic random sampling method. Data were collected from 391 hypertensive patients using a self-administered questionnaire. Multiple logistic regression analysis was performed to identify the associated factors. RESULTS The response rate was 99.5% (389/391). The mean age of respondents was 60.1 years and 44.7% were male. The prevalence of psychological distress was the highest at 28.8%, followed by anxiety (21.3%), depressive (16.2%), and stress symptoms (13.9%). Uncontrolled blood pressure was significantly associated with depressive (OR: 6.4; 95% CI: 3.32-12.28), anxiety (OR: 4.9; 95% CI: 2.75-8.82), and stress symptoms (OR: 6.3; 95% CI: 3.06-12.98). Worry about the complications of hypertension was significantly associated with depressive (OR: 4.5; 95% CI: 2.08-9.94), anxiety (OR: 10.8; 95% CI: 4.15-28.17), and stress symptoms (OR: 5.3; 95% CI: 2.14-13.22). Other associated factors were physical inactivity, employment, lack of formal education, and low household income. CONCLUSION A quarter of hypertensive patients experienced psychological distress in terms of depressive, anxiety, or stress symptoms. We recommend screening for psychological distress among high-risk hypertensive patients, especially those cannot achieve adequate blood pressure control or those who are worried about the complications of hypertension.
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Affiliation(s)
- Wen How Loke
- MD (UPM), MMed (Family Medicine) (UPM), Klinik Kesihatan Temerloh, Temerloh, Pahang, Malaysia
| | - Siew Mooi Ching
- MD (UNIMAS), MMed (Family Medicine) (UM), Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia,
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22
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Sajid IM, Frost K, Paul AK. 'Diagnostic downshift': clinical and system consequences of extrapolating secondary care testing tactics to primary care. BMJ Evid Based Med 2022; 27:141-148. [PMID: 34099498 DOI: 10.1136/bmjebm-2020-111629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 12/21/2022]
Abstract
Numerous drivers push specialist diagnostic approaches down to primary care ('diagnostic downshift'), intuitively welcomed by clinicians and patients. However, primary care's different population and processes result in under-recognised, unintended consequences. Testing performs poorer in primary care, with indication creep due to earlier, more undifferentiated presentation and reduced accuracy due to spectrum bias and the 'false-positive paradox'. In low-prevalence settings, tests without near-100% specificity have their useful yield eclipsed by greater incidental or false-positive findings. Ensuing cascades and multiplier effects can generate clinician workload, patient anxiety, further low-value tests, referrals, treatments and a potentially nocebic population 'disease' burden of unclear benefit. Increased diagnostics earlier in pathways can burden patients and stretch general practice (GP) workloads, inducing downstream service utilisation and unintended 'market failure' effects. Evidence is tenuous for reducing secondary care referrals, providing patient reassurance or meaningfully improving clinical outcomes. Subsequently, inflated investment in per capita testing, at a lower level in a healthcare system, may deliver diminishing or even negative economic returns. Test cost poorly represents 'value', neglecting under-recognised downstream consequences, which must be balanced against therapeutic yield. With lower positive predictive values, more tests are required per true diagnosis and cost-effectiveness is rarely robust. With fixed secondary care capacity, novel primary care testing is an added cost pressure, rarely reducing hospital activity. GP testing strategies require real-world evaluation, in primary care populations, of all downstream consequences. Test formularies should be scrutinised in view of the setting of care, with interventions to focus rational testing towards those with higher pretest probabilities, while improving interpretation and communication of results.
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Affiliation(s)
- Imran Mohammed Sajid
- NHS West London Clinical Commissioning Group, London, UK
- University of Global Health Equity, Kigali, Rwanda
| | - Kathleen Frost
- NHS Central London Clinical Commissioning Group, London, UK
| | - Ash K Paul
- NHS South West London Health and Care Partnership STP, London, UK
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23
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Naisanga M, SekaggyaWiltshire C, Muhwezi WW, Musaazi J, Akena D. Prevalence and factors associated with psychological distress among patients on warfarin at the Uganda Heart Institute, Mulago Hospital. BMC Psychiatry 2022; 22:349. [PMID: 35596217 PMCID: PMC9123720 DOI: 10.1186/s12888-022-03998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are the leading cause of mortality worldwide and are significantly associated with multiple comorbid disorders including mental disorders such as psychological distress (PD). At increased risk of PD are CVD patient sub-categories that not only require chronic therapy but also need follow up with continuous blood tests and dose adjustments (like the patients on warfarin). However, not much has been done to ascertain the burden of PD among patients on warfarin in Uganda. OBJECTIVE To determine the prevalence and factors associated with PD among patients on anticoagulation with warfarin at the Uganda Heart Institute (UHI). METHODS In this analytical cross-sectional study, 197 participants were sampled from adults on warfarin attending the Uganda Heart Institute (UHI) out patient clinic. The Self Reporting Questionnaire (SRQ-20), a tool with a total maximum score of 20 and cutoff for PD at ≥6 was used to determine the presence of PD among participants, and a socio-demographic questionnaire to document the socio-demographic characteristics of the subjects. Additional questions including the underlying CVD diagnosis, medications used (besides warfarin) and presence of chronic illnesess were also assessed. Bi-variable and multi-variabe logistic regression analysis techniques were used to examine the associations between the dependent and independent variables. RESULTS The prevalence of PD was 32%. The unemployed participants were 4.5 times more likely to have PD (adjusted odds ratio [aOR]4.56, 95% confidence interval [CI]: 1.12-18.62, p = 0.04). Participants who had experienced social stressors were more likely to have PD (aOR: 11.38, CI: 3.60-36.04, p < 0.01). Other factors associated with a higher likelihood of having PD included: presence of other chronic comorbidities (aOR: 3.69, CI: 1.24-11.02, p = 0.02) and concomitant use of loop diuretics (aOR: 4.13, CI: 1.67-10.19,p < 0.01). A shorter length of time on warfarin (7-24 months) lowered the likelihood of PD (aOR: 0.23, CI: 0.07-0.74, p = 0.01). CONCLUSION The prevalence of PD was high among patients on warfarin in this low income setting and there is a need to characterize the specific psychiatric disorders in patients with CVD. Interventions that address the high burden of PD are urgently needed in this setting.
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Affiliation(s)
| | | | | | - Joseph Musaazi
- grid.11194.3c0000 0004 0620 0548Infectious Disease Institute, Kampala, Uganda
| | - Dickens Akena
- grid.11194.3c0000 0004 0620 0548Makerere University, Kampala, Uganda
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24
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Sims R, Michaleff ZA, Glasziou P, Thomas R. Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework. Front Public Health 2022; 9:725877. [PMID: 35004561 PMCID: PMC8727520 DOI: 10.3389/fpubh.2021.725877] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies and syntheses of primary studies that explore the consequences of labelling non-cancer diagnoses. Reference lists of included studies were screened, and forward citation searches undertaken. Study Selection: We included peer reviewed publications describing the perceived consequences for individuals labelled with a non-cancer diagnostic label from four perspectives: that of the individual, their family/caregiver, healthcare professional and/or community members. We excluded studies using hypothetical scenarios. Data Extraction and Synthesis: Data extraction used a three-staged process: one third was used to develop a preliminary framework, the next third for framework validation, and the final third coded if thematic saturation was not achieved. Author themes and supporting quotes were extracted, and analysed from the perspective of individual, family/caregiver, healthcare professional, or community member. Results: After deduplication, searches identified 7,379 unique articles. Following screening, 146 articles, consisting of 128 primary studies and 18 reviews, were included. The developed framework consisted of five overarching themes relevant to the four perspectives: psychosocial impact (e.g., positive/negative psychological impact, social- and self-identity, stigma), support (e.g., increased, decreased, relationship changes, professional interactions), future planning (e.g., action and uncertainty), behaviour (e.g., beneficial or detrimental modifications), and treatment expectations (e.g., positive/negative experiences). Perspectives of individuals were most frequently reported. Conclusions: This review developed and validated a framework of five domains of consequences following diagnostic labelling. Further research is required to test the external validity and acceptability of the framework for individuals and their family/caregiver, healthcare professionals, and community.
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Affiliation(s)
- Rebecca Sims
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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25
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Andersson H, Bergh H, Bergman S, Bergsten U. Individuals' Experiences of Being Screened for Hypertension in Dental Health Care - "No Big Deal". Patient Prefer Adherence 2022; 16:1449-1456. [PMID: 35722194 PMCID: PMC9199523 DOI: 10.2147/ppa.s364689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hypertension is a common disease globally that accounts for the highest number of lost healthy life years and strongly associated with sequelae such as stroke and myocardial infarction. Early detection of individuals with high blood pressure can be ensured by screening also those who consider themselves "healthy". Screening has both positive and negative effects where a diagnosis of hypertension can lead to worry about the future. These effects need to be elucidated in order to balance between benefit and harm before screening is introduced. The aim of the study was to describe individuals' experiences of being screened for hypertension in dental health care. METHODS Data from individual semi-structured interviews, with twenty participants screened for cardiovascular risk factors in connection with dental examination and aged 55-80 years, were analysed by means of qualitative content analysis. RESULTS The results describe individuals' experiences of blood pressure screening in dental health care by means of the following theme: "No big deal" based on two categories: "Convenient way of measuring blood pressure" and "Increased awareness of health". CONCLUSION The overall message from the interviews was that having one's blood pressure measured when visiting the dentist was convenient, easy and "No big deal". Blood pressure screening did not create any major concerns and contributed to an increased awareness of health.
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Affiliation(s)
- Helen Andersson
- Hallands Hospital Varberg, Varberg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Correspondence: Helen Andersson, Email
| | - Håkan Bergh
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Research & Development Unit, Hospital Varberg, Region Halland, Varberg, Sweden
| | - Stefan Bergman
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Bergsten
- Department of Research & Development Unit, Hospital Varberg, Region Halland, Varberg, Sweden
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26
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Cardiovascular mortality risk in young adults with isolated systolic hypertension: findings from population-based MONICA/KORA cohort study. J Hum Hypertens 2022; 36:1059-1065. [PMID: 34650215 PMCID: PMC9734041 DOI: 10.1038/s41371-021-00619-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 01/26/2023]
Abstract
The clinical significance of isolated systolic hypertension in young adults (ISHY) remains a topic of debate due to evidence ISHY could be a spurious condition resulting from exageratted pulse pressure amplification in "young tall men with elastic arteries". Hence, we aimed to investigate whether ISHY is associated with an increased risk of cardivascular (CVD) mortality in a sample of 5597 young adults (49.8% men, 50.2% women) between 25 and 45 years old from the prospective population-based MONICA/KORA cohort. ISHY was prevalent in 5.2% of the population, affecting mostly men (73.1%), and associated with increased smoking, obesity, and hypercholesterolemia in comparison to participants with normal blood pressure (BP). Within a follow-up period of 25.3 years (SD ± 5.2; 141,768 person-years), 133(2.4%) CVD mortality cases were observed. Participants with ISHY had a hazard ratio (HR) of 1.89(1.01-3.53, p < 0.05) times higher risk of CVD mortality than participants with normal BP, even following adjustment for CVD risk factors. However, adjustment for antihypertensive medication (HR 0.46; 0.26-0.81, p < 0.001) and increasing height (HR 0.96; 0.93-0.99, p < 0.05) revealed independently protective effects against CVD mortality, suggesting that although ISHY is associated with an increased risk of CVD mortality, the protective effects of increasing height or antihypertensive medication should be considered in treatment rationale.
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Alves AM, Rodrigues A, Sa-Couto P, Simões JL. Effect of an Educational Nursing Intervention on the Mental Adjustment of Patients with Chronic Arterial Hypertension: An Interventional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:170. [PMID: 35010430 PMCID: PMC8750213 DOI: 10.3390/ijerph19010170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
The objective of this analytical and interventional prospective quantitative study was to assess the effect of an educational intervention performed by nurses for mental adjustment to chronic disease in patients with hypertension. A convenience sample was studied, composed of 329 participants with chronic hypertension, followed in a primary healthcare unit in the Central Region of Portugal. Data collection was carried out by applying the Mental Adjustment to Disease Scale (MADS) before and 1 month after the educational nursing intervention between September 2017 and February 2018. Prior to the application of the educational intervention, 43.5% of the participants were classified as "unadjusted" in at least one of the subscales of MADS. After the educational intervention, 21.3% of the participants classified as "unadjusted" became "adjusted" in all MADS subscales. The success rate of the intervention varied from 26.9% (in the fatalism subscale) to 44.6% (for the anxious concern subscale). Participants were more likely to be mentally "unadjusted" to hypertension if they lived with other family members, had an active professional situation before the diagnosis of hypertension, still had an active professional situation now, were under 65 years old, had a shorter time to diagnosis (1-2 years), and measured blood pressure less regularly. The educational intervention performed by nurses is relevant for the mental adjustment of hypertensive patients, contributing to increased knowledge, as well as improvement in preventive and self-care practices, facilitating the experience of the health/disease transition process.
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Affiliation(s)
- Ana Margarida Alves
- Inpatient Service of Surgical Specialties, Centro Hospitalar do Baixo Vouga E.P.E., 3810-164 Aveiro, Portugal;
| | - Alexandre Rodrigues
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-531 Coimbra, Portugal
- Center for Health Studies and Research, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Pedro Sa-Couto
- Centre for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - João Lindo Simões
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
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28
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Cao Y, Sathish T, Haregu T, Wen Y, de Mello GT, Kapoor N, Oldenburg B. Factors Associated With Hypertension Awareness, Treatment, and Control Among Adults in Kerala, India. Front Public Health 2021; 9:753070. [PMID: 34790643 PMCID: PMC8591131 DOI: 10.3389/fpubh.2021.753070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Hypertension, the most significant risk factor for cardiovascular disease, is an increasing contributor to global health burden, particularly in low- and middle-income countries (LMICs) such as India. While the rates of hypertension awareness, treatment, and control in India have been reported in several studies, the factors associated with these rates are less well-understood. Existing studies are predominantly cross-sectional, and the factors examined are limited. Understanding the predictors associated with these rates, using more rigorous study designs, is crucial for the development of strategies to improve hypertension management. Aims: To examine a range of factors associated with hypertension awareness, treatment, and control using both cross-sectional and longitudinal analyses. Methods: Data was derived from a population-based sample of 1,710 participants from Kerala, aged 30–60 years. We examined a comprehensive range of factors, including demographic, behavioral factors, anthropometric, clinical measures, psychosocial factors and healthcare utilization. Multilevel mixed effects logistic regression was used for both cross-sectional and longitudinal analyses (repeated measures for all variables across 2 years) to determine the factors associated with awareness, treatment, and control of hypertension. Results: A total of 467 (27.3%) participants had hypertension at baseline. Among those, the rates of awareness, treatment, and control of hypertension were 54.4, 25.5, and 36.4%, respectively. Being male (OR 0.27, 95% CI 0.14–0.53) and consumption of alcohol (OR 0.49, 95% CI 0.31–0.80) were significant predictors of poorly controlled hypertension (longitudinal analysis). Depression (OR 2.04, 95% CI 1.15–3.61) and fair-to-poor self-perceived health status (OR 1.87, 95% CI 1.15–3.04) were associated with increased hypertension awareness, whereas anxiety (OR 1.97, 95% CI 1.04–3.71) was associated with increased hypertension treatment (cross-sectional analysis). Seeking outpatient service in the past 4 weeks was associated with higher awareness (OR 1.09, 95% CI 1.27–2.87), treatment (OR 1.73, 95% CI 1.20–2.50) and control (OR 1.96, 95% CI 1.37–2.80) (longitudinal analysis). Conclusion: Our findings suggest the importance of considering psychosocial factors and better engagement with health services in hypertension management, as well as giving more attention to body fat control and largely male-related behaviors such as alcohol consumption, taking into account of some Indian specific attributes.
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Affiliation(s)
- Yingting Cao
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Population Health Research Institute (PHRI), McMaster University, Hamilton, ON, Canada
| | - Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yu Wen
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Gabrielli Thais de Mello
- Research Centre for Physical Activity and Health (NuPAF), Federal University of Santa Catarina, Florianópolis, Brazil
| | - Nitin Kapoor
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,School of Psychology and Public Health, LaTrobe University, Melbourne, VIC, Australia
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29
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Han X, Liu X, Zhong F, Wang Y, Zhang Q. Comparison of efficacy and safety of complementary and alternative therapies for essential hypertension with anxiety or depression disorder. PLoS One 2021; 16:e0254699. [PMID: 34270618 PMCID: PMC8284674 DOI: 10.1371/journal.pone.0254699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Essential hypertension (EH) with anxiety or depression belongs to the category of psycho-cardiology. Hypertension is closely related to anxiety and depression. The adverse reactions of Western medicine are apparent and the compliance is poor. Supplementary and replacement therapies have accumulated rich experience in clinical practices, which can reduce side effects and improve clinical efficacy. This study intends to use the Bayesian network meta-analysis (NMA) analysis method for the first time to gather randomized controlled trials (RCTs) related to complementary and alternative therapies in the treatment of hypertension with anxiety or depression disorder and rank efficacy and safety, to provide a reference basis for the treatment of hypertension with anxiety or depression disorder. METHODS All randomized controlled trials (RCTs) and registered and ongoing trials of Chinese and English databases, related to supplementation and replacement therapies of EH with anxiety or depression disorder, published from initial state to February 2021, will be collected in the form of computer retrieval. Two researchers will independently screen the literature, extracting data, assessing bias risk and assessing heterogeneity. We will use software WinBUGS 1.4.3 and Stata 16.0 for pairwise meta-analysis and NMA to comprehensively evaluate various interventions. The quality of evidence will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS This NMA will comprehensively compare and rank the efficacy and safety of a series of complementary and alternative therapies in treating EH with anxiety or depression disorder. CONCLUSION Supplementary and replacement therapies have accumulated rich experience of clinical practices in improving EH with anxiety or depression disorder. We expect that this NMA will guide practice and research by providing reliable evidence of evidence-based medicine for the treatment of EH with anxiety or depression disorder. PROTOCOL REGISTRATION NUMBER INPLASY202120068.
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Affiliation(s)
- Xueyan Han
- Department of First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Xinxin Liu
- Department of First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Fengxing Zhong
- Department of Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yiguo Wang
- Department of Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiming Zhang
- Department of First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- Department of Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing, China
- * E-mail:
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Li Y, Buys N, Li Z, Li L, Song Q, Sun J. The efficacy of cognitive behavioral therapy-based interventions on patients with hypertension: A systematic review and meta-analysis. Prev Med Rep 2021; 23:101477. [PMID: 34285871 PMCID: PMC8278424 DOI: 10.1016/j.pmedr.2021.101477] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/18/2021] [Accepted: 07/03/2021] [Indexed: 01/13/2023] Open
Abstract
CBT-based intervention has a positive effect on health outcomes in patients with hypertension. CBT-based intervention might be more effective for blood pressure management in hypertension patients when it is group-based, long term, and cognitive therapy based.
Recently, the benefits of cognitive behavioral therapy (CBT)-based interventions for patients with hypertension have been recognized, but there has been no systematic review that has comprehensively analyzed the efficacy of CBT on health outcomes in this population. We aimed to explore the therapeutic effect of CBT-based interventions on hypertension patients through a meta-analysis. Relevant randomized controlled trials (RCTs) were obtained by searching electronic databases. The primary outcomes were physiological indicators (blood pressure, blood lipid profile). Secondary outcomes were psychological indicators (anxiety, depression), and the quality of sleep. Stata version 15.0 software was used to analyze the results. A total of 15 RCTs were included. The main analysis revealed that CBT-based interventions reduced systolic pressure: −8.67 (95% CI: −10.67 to −6.67, P = 0.000); diastolic pressure: −5.82 (95% CI: −7.82 to −3.81, P = 0.000); total cholesterol levels: −0.43 (95% CI: −0.76 to −0.10, P = 0.010); depressive symptoms: −3.13 (95% CI: −4.02 to −2.24, P = 0.000); anxiety symptoms: −3.63 (95% CI: −4.40 to −2.87, P = 0.000); and improved quality of sleep: −2.93 (95% CI: −4.40 to −1.47, P = 0.000). Additionally, the results of subgroup analysis indicated that long-term group-based CBT-based interventions were particularly beneficial for blood pressure management in hypertension patients. CBT-based interventions are effective in reducing systolic pressure, diastolic pressure, total cholesterol levels, anxiety symptoms, depressive symptoms, and improving quality of sleep in hypertension patients.
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Affiliation(s)
- Yanni Li
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicholas Buys
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Zhanjiang Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province, China
| | - Qifa Song
- Medical Research Center, Ningbo City First Hospital, Ningbo, Zhejiang Province, China
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Najafipour H, Shahrokhabadi MS, Banivaheb G, Sabahi A, Shadkam M, Mirzazadeh A. Trends in the prevalence and incidence of anxiety and depressive symptoms in Iran: findings from KERCADRS. Fam Med Community Health 2021; 9:fmch-2021-000937. [PMID: 34215671 PMCID: PMC8256739 DOI: 10.1136/fmch-2021-000937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Anxiety and depression (A&D) are common mental disorders with high economical and health burdens. This study aimed to investigate the prevalence and the incidence rate of A&D symptoms and their relationship with sociodemographic and other risk factors and comorbidities in adults living in southeastern Iran. DESIGN A population-based cohort study with random cluster household survey sampling method. SETTING Second round of Kerman Coronary Artery Disease Risk Factors Study (KERCADRS) (2014-2018) performed in Southeastern, Iran. PARTICIPANTS We recruited 9997 participants (15-80 years) in the second round of the study, from whom 2820 persons were the people who also participated in the first round of KERCADRS in 2009-2012. The age-standardised A&D prevalence was measured among all participants, and the 5-year A&D incidence rate was measured in those who were free from A&D in the first round in 2009-2012 and were at risk of A&D in the follow-up. The relationship between A&D and demographic characteristics, smoking, opium use, obesity and physical activity was assessed by logistic regression models. RESULTS Overall, the prevalence of anxiety (48.1% to 16.4%, p<0.001) and depression (5.9% to 1.3%, p<0.001) decreased between the two rounds. The highest prevalence of anxiety was among widowed (31.4%), unemployed (21.3%), obese (19.4%), and opium users (17.4%). Young adults, women, those divorced or widowed, and those with obesity and low physical activity had a higher chance of developing anxiety. The 5-year incidence rate (person/1000 person-years) was 15.0 for anxiety and 3.9 for depression. CONCLUSION Despite the overall decrease in the prevalence of A&D symptoms in last 5 years in the area, young adults, women, unemployed, opium users, people with low physical activity and those with obesity had a higher chance of developing anxiety and are in need of more targeted interventions.
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Affiliation(s)
- Hamid Najafipour
- Department of Physiology and Pharmacology and Cardiovascular Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ghodsyeh Banivaheb
- Department of Psychiatry and Physiology Research center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Abdolreza Sabahi
- Department of Psychiatry and Physiology Research center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Shadkam
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Effects of Behaviorally Supported Exercise and Exercise-Induced Mood Changes on Elevated Blood Pressure and Hypertension in African American Adults with Severe Obesity. J Immigr Minor Health 2021; 24:721-729. [PMID: 34036517 PMCID: PMC8147905 DOI: 10.1007/s10903-021-01220-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 10/29/2022]
Abstract
African Americans with obesity have high rates of hypertension. Exercise has been shown to significantly reduce high blood pressure; however, effects through associated reductions in anxiety and depression are unclear. African American adults with either class 2 or 3 obesity (n = 86; Mage = 43.4 years) and either elevated blood pressure (n = 16) or stage 1 (n = 33) or stage 2 (n = 37) hypertension participated in a theoretically driven community-based weight-management program. There were significant increases in exercise outputs; while systolic and diastolic blood pressure, anxiety, and depression significantly decreased from baseline-month 6. Increased exercise significantly predicted reduced anxiety, depression, and diastolic blood pressure. Change in anxiety significantly mediated the relationship between exercise and both systolic and diastolic blood pressure changes. Increasing exercise from the equivalent of 1.5 to 4.5 moderate bouts/week reduced elevated blood pressure/hypertension in African American adults with severe obesity largely through their exercise-associated improvement in anxiety.
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Zhou J, Lee S, Wong WT, Leung KSK, Nam RHK, Leung PSH, Chau YLA, Liu T, Chang C, Cheung BMY, Tse G, Zhang Q. Gender- and Age-Specific Associations of Visit-to-Visit Blood Pressure Variability With Anxiety. Front Cardiovasc Med 2021; 8:650852. [PMID: 34026870 PMCID: PMC8137912 DOI: 10.3389/fcvm.2021.650852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background: There is a bidirectional relationship between blood pressure variability (BPV) and anxiety, but few studies have examined the gender- and age-specific effects of visit-to-visit BPV on incident anxiety. We examined the predictive value of BPV for the incidence of anxiety in a family clinic cohort. Methods: Consecutive patients with a first attendance to family medicine clinics in Hong Kong between January 1, 2000, and December 31, 2002, with at least three blood pressure measurements available thereafter were included. The primary endpoint was incident anxiety as identified by ICD-9 coding. Results: This study included 48,023 (50% males) patients with a median follow-up of 224 [interquartile range (IQR): 217-229] months. Females were more likely to develop incident anxiety compared to males (incidence rate: 7 vs. 2%), as were patients of older age. Significant univariate predictors were female gender, older age, preexisting cardiovascular diseases, respiratory diseases, diabetes mellitus, hypertension, and gastrointestinal diseases, various laboratory examinations, and the number of blood pressure measurements. Higher baseline, maximum, minimum, standard deviation (SD), coefficient of variation (CV), and variability score of diastolic blood pressure significantly predicted incident anxiety, as did all systolic blood pressure measures [baseline, latest, maximum, minimum, mean, median, variance, SD, root mean square (RMS), CV, and variability score]. Conclusions: The relationships between longer-term visit-to-visit BPV and incident anxiety were identified. Female and older patients with higher blood pressure and higher BPV were at the highest risks of incident anxiety.
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Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | - Yau-Lam Alex Chau
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Carlin Chang
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
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Reply. J Hypertens 2021; 39:1045-1046. [PMID: 33824261 DOI: 10.1097/hjh.0000000000002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Muscat DM, Morris GM, Bell K, Cvejic E, Smith J, Jansen J, Thomas R, Bonner C, Doust J, McCaffery K. Benefits and Harms of Hypertension and High-Normal Labels: A Randomized Experiment. Circ Cardiovasc Qual Outcomes 2021; 14:e007160. [PMID: 33813855 DOI: 10.1161/circoutcomes.120.007160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent US guidelines lowered the threshold for diagnosing hypertension while other international guidelines use alternative/no labels for the same group (blood pressure [BP], <140/90 mm Hg). We investigated potential benefits and harms of hypertension and high-normal BP labels, compared with control, among people at lower risk of cardiovascular disease. METHODS We conducted a randomized experiment using a national sample of Australians (n=1318) 40 to 50 years of age recruited from an online panel. Participants were randomized to 1 of 3 hypothetical scenarios where a general practitioner told them they had a BP reading of 135/85 mm Hg, using either hypertension/high-normal BP/control (general BP description) labels. Participants were then randomized to receive an additional absolute risk description or nothing. Primary outcomes were willingness to change diet and worry. Secondary outcomes included exercise/medication intentions, risk perceptions, and other psychosocial outcomes. RESULTS There was no difference in willingness to change diet across label groups (P=0.22). The hypertension label (mean difference [MD], 0.74 [95% CI, 0.41-1.06]; P<0.001) and high-normal BP label (MD, 0.45 [95% CI, 0.12-0.78]; P=0.008) had increased worry about cardiovascular disease risk compared with control. There was no evidence that either label increased willingness to exercise (P=0.80). However, the hypertension (MD, 0.20 [95% CI, 0.04-0.36]; P=0.014), but not high-normal label (MD, 0.06 [95% CI, -0.10 to 0.21]; P=0.49), increased willingness to accept BP-lowering medication compared with control. Psychosocial differences including lower control, higher risk perceptions, and more negative affect were found for the hypertension and high-normal labels compared with control. Providing absolute risk information decreased willingness to change diet (MD, 0.25 [95% CI, 0.10-0.41]; P=0.001) and increase exercise (MD, 0.28 [95% CI, 0.11-0.45]; P=0.001) in the hypertension group. CONCLUSIONS Neither hypertension nor high-normal labels motivated participants to change their diet or exercise more than control, but both labels had adverse psychosocial outcomes. Labeling people with systolic BP of 130 to 140 mm Hg, who are otherwise at low risk of cardiovascular disease, may cause harms that outweigh benefit. Registration: URL: http://www.anzctr.org.au/; Unique identifier: ACTRN12618001700224.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Georgina May Morris
- Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Katy Bell
- Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Jesse Jansen
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia (R.T., J.D.)
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Jenny Doust
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia (R.T., J.D.)
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
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Gyuricza JV, Christensen KB, d'Oliveira AFPL, Brodersen J. Psychometric properties of a condition-specific PROM for the psychosocial consequences of Labelling hypertension by using Rasch analysis. J Patient Rep Outcomes 2021; 5:19. [PMID: 33538939 PMCID: PMC7862460 DOI: 10.1186/s41687-021-00291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background A previous qualitative assessment of the psychosocial consequences of labelling hypertension describes the diagnosis of hypertension as a labelling event with potential unintended negative long-term psychosocial consequences (labelling effects). Until now, the benefits of diagnosing hypertension have been far more reported than the harms. To obtain the net result of the preventive interventions for cardiovascular disease, such as diagnosing and treating mild hypertension, assessing benefits and harms in the most comprehensive way possible is necessary, including the psychosocial consequences of labelling. When measuring psychosocial consequences of labelling hypertension, a questionnaire with high content validity and adequate psychometric properties is needed. Objectives The aim of this study was to describe the psychometric parameters of face and content-validated pool of items. Other objectives were also to screen the item pool by using Rasch model analysis and confirmatory factor analysis (CFA) for identifying such items with sufficient fit to the hypothesised models. Methods We surveyed the pool of items as a draft questionnaire to Brazilians recruited via social networks, sending e-mails, WhatsApp® messages and posting on Facebook®. The inclusion criteria were to be older than 18 years old, to be healthy and to have only hypertension. We used Rasch model analysis to screen the item pool, discarding items that did not fit the hypothesised domain. We searched for local dependence and differential item functioning. We used CFA to confirm the derived measurement models and complementarily assessed reliability using Cronbach’s coefficient alpha. Results The validation sample consisted of 798 respondents. All 798 respondents completed Part I, whereas 285 (35.7%)—those with hypertension—completed Part II. A condition-specific questionnaire with high content validity and adequate psychometric properties was developed for people labelled with hypertension. This measure is called ‘Consequences of Labelling Hypertension Questionnaire’ and covers the psychosocial consequences of labelling hypertension in two parts, encompassing a total of 71 items in 15 subscales and 11 single items. Conclusion We developed a tool that can be used in future research involving hypertension, especially in scenarios of screening, prevention, population strategies and in intervention studies. Future use and testing of the questionnaire may still be required. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00291-4.
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Affiliation(s)
- János Valery Gyuricza
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo, 455 2 andar. CEP, São Paulo, SP, 01246-903, Brazil. .,Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Øster Farimagsgade 5, building 24, P.O. Box 2099, 1014, Copenhagen K, Denmark.
| | - Karl Bang Christensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, Building 15, P.O. Box 2099, 1014, København K, Denmark
| | - Ana Flávia Pires Lucas d'Oliveira
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo, 455 2 andar. CEP, São Paulo, SP, 01246-903, Brazil
| | - John Brodersen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Øster Farimagsgade 5, building 24, P.O. Box 2099, 1014, Copenhagen K, Denmark.,Primary Health Care Research Unit, Copenhagen, Region Zealand, Denmark
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How Should We Measure and Deal with Office Blood Pressure in 2021? Diagnostics (Basel) 2021; 11:diagnostics11020235. [PMID: 33546474 PMCID: PMC7913758 DOI: 10.3390/diagnostics11020235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/23/2021] [Accepted: 02/01/2021] [Indexed: 12/19/2022] Open
Abstract
Arterial hypertension is a major risk factor for cardiovascular disease worldwide. Office blood pressure measurements (OBPMs) are still recommended for diagnosis and follow-up by all major guidelines; however, the recommended procedures differ significantly. In analogy, major outcome studies usually apply OBPMs, again, with a variety of procedures. This variety of OBPM procedures complicates the comparability between studies and challenges daily clinical practice. In this narrative review, we compile the most recent recommendations for office blood pressure measurement together with the major limitations and strategies and how these could be overcome.
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Elias MF, Goodell AL. Human Errors in Automated Office Blood Pressure Measurement: Still Room for Improvement. Hypertension 2020; 77:6-15. [PMID: 33296246 DOI: 10.1161/hypertensionaha.120.16164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review of the literature and commentary, we examine the literature on automated blood pressure (BP) measurements in the office and clinic. Our purpose is to revisit issues as to the pros and cons of automated BP measurement published in Hypertension in June 2020 and to identify areas needing additional research. Despite initial reservations about automated BP, it is here to stay. A number of experts suggest that human error will be reduced when we move from the more complex skills required by aneroid sphygmomanometer measurement to the fewer skills and steps required by automated BP measurement. Our review indicates there is still need for reduction in errors in automated BP assessment, for example, retraining programs and monitoring of assessment procedures. We need more research on the following questions: (1) which classes of health care providers are least likely to measure BP accurately, usually by ignoring necessary steps; (2) how accurate is BP assessment by affiliated health care providers for example the dental office, the optometrist; and (3) why do some dedicated and well-informed health care professionals fail to follow simple directions for automated BP measurement? We offer additional solutions for improving automated BP assessment in the office and clinic.
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Affiliation(s)
- Merrill F Elias
- Department of Psychology (M.F.E., A.L.G.), The University of Maine, Orono.,Graduate School of Biomedical Science and Engineering (M.F.E.), The University of Maine, Orono
| | - Amanda L Goodell
- Department of Psychology (M.F.E., A.L.G.), The University of Maine, Orono
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Sims R, Kazda L, Michaleff ZA, Glasziou P, Thomas R. Consequences of health condition labelling: protocol for a systematic scoping review. BMJ Open 2020; 10:e037392. [PMID: 33109644 PMCID: PMC7592274 DOI: 10.1136/bmjopen-2020-037392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION When health conditions are labelled it is often to classify and communicate a set of symptoms. While diagnostic labelling can provide explanation for an individual's symptoms, it can also impact how individuals and others view those symptoms. Despite existing research regarding the effects of labelling health conditions, a synthesis of these effects has not occurred. We will conduct a systematic scoping review to synthesise the reported consequences and impact of being given a label for a health condition from an individual, societal and health practitioner perspective and explore in what context labelling of health conditions is considered important. METHODS AND ANALYSIS The review will adhere to the Joanna Briggs Methodology for Scoping Reviews. Searches will be conducted in five electronic databases (PubMed, Embase, PsycINFO, Cochrane, CINAHL). Reference lists of included studies will be screened and forward and backward citation searching of included articles will be conducted. We will include reviews and original studies which describe the consequences for individuals labelled with a non-cancer health condition. We will exclude hypothetical research designs and studies focused on the consequences of labelling cancer conditions, intellectual disabilities and/or social attributes. We will conduct thematic analyses for qualitative data and descriptive or meta-analyses for quantitative data where appropriate. ETHICS AND DISSEMINATION Ethical approval is not required for a scoping review. Results will be disseminated via publication in a peer-reviewed journal, conference presentations and lay-person summaries on various online platforms. Findings from this systematic scoping review will identify gaps in current understanding of how, when, why and for whom a diagnostic label is important and inform future research.
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Affiliation(s)
- Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Luise Kazda
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
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Abstract
The prevalence of isolated diastolic hypertension (IDH) has been increased in hypertensive subjects with the new 2017 ACC/AHA blood pressure treatment guidelines to 6.5% from 1.3% by the JNC-7 guidelines. However, its clinical significance as a cause of adverse cardiovascular (CV) events especially in older subjects has been debated by several investigators, who have demonstrated no adverse CV effects of untreated IDH, but not by others. It is also more common in the young subjects who are at low CV risk and quite rare in the older subjects, who are at increased CV risk. Treatment of IDH in the older subjects could increase the CV complications due to a J-curve effect and, in addition, could increase the incidence of stroke from further lowering the normal systolic blood pressure (SBP). Very low SBP and DBP cannot be sustained by the cerebral blood flow autoregulation and could lead to cerebral ischemia. In order to get a better perspective of the current status of the treatment of IDH, a review of the English language literature of the available studies was conducted and 12 papers with pertinent information were retrieved. The analysis of results from these studies suggests that IDH is associated with adverse CV events in younger persons and it should be treated. In contrast, the prevalence of IDH is low in older subjects and is not associated with adverse CV events in the majority of cases. Thus, its further lowering should be avoided to prevent further decrease in normal SBP and prevent the onset of adverse CV events. However, the decision to treat IDH in older subjects should be individualized.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center , Oklahoma City, OK, USA
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Villarreal-Zegarra D, Bernabe-Ortiz A. Association between arterial hypertension and depressive symptoms: Results from population-based surveys in Peru. Asia Pac Psychiatry 2020; 12:e12385. [PMID: 32119760 DOI: 10.1111/appy.12385] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/19/2019] [Accepted: 02/10/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Approximately 350 million people have depression. The presence of arterial hypertension is a major risk factor for mental health. However, several studies on the association between arterial hypertension and depressive symptoms present controversial evidence. We aimed at identifying whether there is an association between arterial hypertension and depressive symptoms, taking into account the time since hypertension diagnosis. METHODS A secondary analysis of the Demographic and Health Survey in Peru (2014-2016) was conducted. The outcome was depressive symptoms, while hypertension and time since hypertension diagnosis were the exposure of interest. Poisson regression models were created, reporting prevalence ratios (PR) and 95% confidence intervals (95% CI). RESULTS Data from 87 253 participants were analyzed. A total of 2633 (3.0%; 95% CI: 2.8%-3.2%) individuals had depressive symptoms, whereas hypertension was present in 15 681 (19.6%; 95% CI: 19.1%-20.1%) subjects. In the multivariable model, people with less than a year since diagnosis were more than twice as likely to have depressive symptoms (PR = 2.08, 95% CI 1.65-2.63) compared to the group of people without hypertension. This probability decreased for individuals with 1 to 4 years since diagnosis (PR = 1.42, 95% CI 1.13-1.80), and for people with ≥5 years since diagnosis (PR = 1.29, 95% CI 1.01-1.64). CONCLUSIONS There is an association between hypertension and depressive symptoms, but this varies depending on time since diagnosis. Thus, individuals with <1 year since diagnosis had the highest probability of having depressive symptoms; after that, that probability decreased as the time since diagnosis increased.
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Affiliation(s)
- David Villarreal-Zegarra
- Instituto Peruano de Orientación Psicológica, Lima, Peru.,CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Universidad Científica del Sur, Lima, Peru
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Lawan A, Apeyemi C, Chutiyami M, Bello UM, Salihu D, Tafida BA, Abubakar U, Rufa'i AA. Impact of physical activity and traumatic exposure on occurrence of gestational hypertension: a survey of pregnant women in an armed-conflict region in Nigeria. Hypertens Pregnancy 2020; 39:295-301. [PMID: 32419529 DOI: 10.1080/10641955.2020.1765173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare physical activity level and traumatic exposure between normotensive and hypertensive pregnant women in an armed conflict region of Nigeria. METHODS 130 normotensives and hypertensive pregnant women comprising of 65 participants per group participated in the study. Harvard Trauma Questionnaire and Pregnancy Physical Activity Questionnaire were used to assess traumatic events and physical activity respectively. RESULTS Significant difference was observed on total traumatic event (p = 0.008) and all domains and intensities of physical activity except inactivity and sedentary (p > 0.05). Household activities (OR: 0.989; 95% CI: 0.981-0.996), occupational activities (OR: 0.936; 95%CI: 0.879-0.996) and sport/exercise activities (OR: 0.898; 95%CI: 0.832-0.969) were associated with a decrease hypertensive pregnancy. CONCLUSION Despite exposed to traumatic events, physical activity is associated with normotensive pregnancy in an armed conflict region.
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Affiliation(s)
- Aliyu Lawan
- Physiotherapy Department, University of Maiduguri , Maiduguri, Nigeria
| | - Cecelia Apeyemi
- Physiotherapy Department, University of Maiduguri , Maiduguri, Nigeria
| | - Muhammad Chutiyami
- Department of Nursing, Shehu Sule College of Nursing and Midwifery , Damaturu, Nigeria
| | - Umar Muhammad Bello
- Physiotherapy Department, Yobe State University Teaching Hospital (YSUTH) , Damaturu, Nigeria
| | - Dauda Salihu
- Department of Nursing, Shehu Sule College of Nursing and Midwifery , Damaturu, Nigeria
| | | | - Umar Abubakar
- Physiotherapy Department, University of Maiduguri , Maiduguri, Nigeria
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43
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Haider S, Fatima N, Pablos-Heredero CD. A Three-Wave Longitudinal Study of Moderated Mediation between Perceptions of Politics and Employee Turnover Intentions: The Role of Job Anxiety and Political Skills. REVISTA DE PSICOLOGÍA DEL TRABAJO Y DE LAS ORGANIZACIONES 2020. [DOI: 10.5093/jwop2020a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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44
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Jin Y, He P. Antihypertensive treatment and depressive symptoms in Chinese middle-aged and older hypertensive adults: A population-based longitudinal study. Int J Geriatr Psychiatry 2020; 35:312-320. [PMID: 31833587 DOI: 10.1002/gps.5250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/07/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Hypertension is a risk factor for depressive disorders. Although the benefits of lowering blood pressure on the subsequent depressive disorders are supported by biological interpretation, the effect of antihypertensive therapies on depressive disorders is not clear. This study aimed to assess whether blood-pressure-lowering treatment have a protective effect on subsequent depressive symptoms in China. METHODS We used data from the nationally representative survey, including 2428 hypertensive participants free from depressive symptoms at baseline in 2011 to 2012. We assessed the depressive symptoms based on the 10-item Center for Epidemiological Studies Depression scale. We conducted Cox proportional hazards regression models to examine the effect of antihypertensive treatment on the incidence of depressive symptoms in 2011 to 2015. RESULTS In the total sample, all the models resulted in nonsignificant results and an estimated 8% reduction in risk (95% CI, 0·76-1·12) in the model adjusted for all covariates for the antihypertensive treatment takers with blood pressure controlled. In the group of urban residents, the antihypertensive treatment takers with blood pressure controlled had lower odds (HR: 0.68; 95% CI, 0·49-0·96) of depressive disorders. CONCLUSION The protective effect of the antihypertensive therapies might be relative to not only lowering blood pressure per se but also the management of hypertension. We proposed the early intervention to achieve the long-term protective effect of being antihypertensive and the supply of effective and collaborative care of hypertension and depression.
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Affiliation(s)
- Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Jones HJ, Minarik PA, Gilliss CL, Lee KA. Depressive symptoms associated with physical health problems in midlife women: A longitudinal study. J Affect Disord 2020; 263:301-309. [PMID: 31818793 PMCID: PMC6989369 DOI: 10.1016/j.jad.2019.11.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/11/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is unclear if the relationship between depression and physical health problems in women is related to age, reproductive stage, obesity or socio-demographic risk factors. METHODS Longitudinal data were obtained every 6 months for 36 months in 264 midlife African American, Caucasian and Latina women who began the study as healthy regularly menstruating 40 to 50-year-olds; 75 transitioned to peri- or post-menopause by 36 months. Scores of 16 or higher on the Center for Epidemiologic Studies-Depression (CES-D) scale were used to estimate depression risk. RESULTS Depression risk was 28% at study initiation and 25% at 36 months. Significantly more women at risk for depression were unemployed, obese, or hypertensive. Women at risk were more likely to become peri- or post-menopausal during the study period. A higher percentage (38%) of overweight and obese women had CES-D scores ≥ 16 compared to normal weight women (23%; p < .001). Over half (58%) of the 73 women at higher depression risk at the initial visit reported a health problem or chronic illness at 36 months, compared to only 36% of the 191 women with CES-D scores <16 (p = .001). LIMITATIONS This was a secondary analysis of data from a relatively healthy sample of women in the decade before menopause. Chronic illness was self-reported and the CES-D is a screening tool for depressive symptoms rather than a clinical diagnostic tool. CONCLUSIONS Health care providers may be underestimating the impact of unemployment on depressive symptoms, obesity and chronic health problems in midlife women.
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Affiliation(s)
| | | | | | - Kathryn A. Lee
- School of Nursing, University of California, San Francisco
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Gao X, Colicino E, Shen J, Just AC, Nwanaji-Enwerem JC, Wang C, Coull B, Lin X, Vokonas P, Zheng Y, Hou L, Schwartz J, Baccarelli AA. Accelerated DNA methylation age and the use of antihypertensive medication among older adults. Aging (Albany NY) 2019; 10:3210-3228. [PMID: 30414594 PMCID: PMC6286862 DOI: 10.18632/aging.101626] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/27/2018] [Indexed: 02/07/2023]
Abstract
The discrepancy of DNA methylation age (DNAmAge) with chronological age (termed as age acceleration, AA) has been identified to be associated with many aging-related health outcomes including hypertension. Since taking antihypertensive medication (AHM) could prevent aging-related diseases caused by hypertension, we hypothesized that using AHM could also reduce the AA. We examined this hypothesis among 546 males aged 55–85 years by exploring the associations of AHM use with AA and its change rate (ΔAA) in two visits with a median follow-up of 3.86 years. Horvath DNAmAge was derived from DNA methylation profiles measured by Illumina HumanMethylation450 BeadChip and information on AHM use was collected by physician interview. A general decreasing pattern of AA was observed between the two visits. After the fully adjusting for potential covariates including hypertension, any AHM use showed a cross-sectional significant association with higher AA at each visit, as well as a longitudinal association with increased ΔAA between visits. Particularly, relative to participants who never took any AHM, individuals with continuous AHM use had a higher ΔAA of 0.6 year/chronological year. This finding underlines that DNAmAge and AA may not be able to capture the preventive effects of AHMs that reduce cardiovascular risks and mortality.
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Affiliation(s)
- Xu Gao
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jincheng Shen
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT 84132, USA
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jamaji C Nwanaji-Enwerem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Cuicui Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Outdili Z, Marti-Soler H, Bovet P, Chiolero A. Performance of blood pressure measurements at an initial screening visit for the diagnosis of hypertension in children. J Clin Hypertens (Greenwich) 2019; 21:1352-1357. [PMID: 31359590 DOI: 10.1111/jch.13645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 12/21/2022]
Abstract
Hypertension in children is defined as sustained elevated blood pressure (BP) over several visits. For the screening of hypertension, it is standard to obtain several BP readings at the initial visit. There is however no recommendation on the minimum number of readings needed. We evaluated the performance of BP readings obtained at one initial screening visit to predict the diagnosis of hypertension in children. In a school-based study conducted in Switzerland, BP was measured three times on up to three visits in 5207 children. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of elevated BP at the initial screening visit for the identification of hypertension were estimated using the 1st, 2nd, and 3rd BP readings (R1, R2, R3), as well as (R1 + R2)/2 and (R1 + R2 + R3)/3). These performance indices were compared with the reference method (R2 + R3)/2. The ability of BP readings to discriminate children with and without hypertension was evaluated with receiver operating characteristic curve analysis. The prevalence of systolic/diastolic hypertension was 2.2%. The greatest performance to identify children with hypertension was obtained with R2 (sensitivity: 97%; specificity: 88%; PPV: 15%; NPV: 100%) and the reference method, (R2 + R3)/2 (sensitivity: 100%; specificity: 90%; PPV: 18%; NPV: 100%). The ability to discriminate using R1, R2, (R1 + R2)/2, and (R2 + R3)/2 for the identification of hypertension was strong (AUC: 0.89, 0.93, 0.92, and 0.95, respectively). Obtaining two BP readings and using only the second one at a screening visit may be sufficient as initial step for the identification of hypertension in children.
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Affiliation(s)
| | | | - Pascal Bovet
- Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Arnaud Chiolero
- Unisanté, University of Lausanne, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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48
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Jin Y, Luo Y, He P. Hypertension, socioeconomic status and depressive symptoms in Chinese middle-aged and older adults: Findings from the China health and retirement longitudinal study. J Affect Disord 2019; 252:237-244. [PMID: 30991251 DOI: 10.1016/j.jad.2019.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/18/2019] [Accepted: 04/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to examine the effect of diagnosed hypertension on depressive symptoms and socioeconomic status (SES) as moderator in the effect in middle-aged and older adults in China. METHODS We used data from the nationally representative survey of China Health and Retirement Longitudinal Study, including 6273 participants free from depressive symptoms at baseline in 2011-12. We assessed the depressive symptoms based on the 10-item Center for Epidemiological Studies Depression scale. We conducted Cox proportional hazards regression models to examine the effect of baseline diagnosed hypertension status on the subsequent depressive symptoms in 2011-15 with the report of Hazards ratios (HRs). RESULTS The diagnosed hypertensive participants were more likely to have depressive symptoms than non-hypertensive peers (HR = 1.12, 95% CI: 1.02-1.23) after adjusted for controlled variables. The effect only occurred in the group of low SES, with rural residency (HR = 1.13, 95% CI: 1.02-1.26), below-average household income (HR = 1.14, 95% CI: 1.02-1.26) and primary school or below educational attainment (HR = 1.12, 95% CI: 1.00-1.25). LIMITATIONS Measures of the onset or duration of hypertension were not included, which may modify the estimated effects on depressive symptoms. CONCLUSIONS Diagnosed hypertension is a chronic stressor leading to depressive disorders, and the responses to this stressor merely occurred among the low socioeconomic individuals. Our findings underscored the importance of examining the connection between mental and physical health in the context of aging and shed lights on the action to developing strategies for detection and management of hypertension that could cause psychological stress, which may contribute to fighting against depressive symptoms, especially in the low SES population.
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Affiliation(s)
- Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Yanan Luo
- APEC Health Science Academy, Peking University/Institute of Population Research, Peking University, Beijing 100871, China
| | - Ping He
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
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Touyz RM. Hypertension Guidelines: Effect of Blood Pressure Targets. Can J Cardiol 2019; 35:564-569. [PMID: 31030859 DOI: 10.1016/j.cjca.2019.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/17/2019] [Indexed: 11/18/2022] Open
Abstract
There has been an abundance of hypertension guidelines over the years. Their purpose is to convey evidence-based findings from clinical trials to clinicians so that best medical choices can be made for the diagnosis and treatment of patients with hypertension. Over the past 3 years new hypertension guidelines have been published in the United States, Canada, Europe, and elsewhere with new or refined recommendations made regarding diagnosis, therapy, and intensity of treatment. Previous national guidelines were generally well aligned. However, there are major differences in the current North American and European recommendations in terms of the classification of hypertension and treatment goals, with the diagnosis of hypertension starting at 140/90 mm Hg for the European guidelines and 130/80 mm Hg for the American and Canadian guidelines. An important controversial aspect in the updated guidelines relates to a lowered threshold (130/80 mm Hg) at which hypertension is diagnosed and treated, because growing evidence indicates that individuals at low cardiovascular risk might be exposed to incremental harm because of overtreatment with antihypertensive drugs. However, these concerns need to be weighed against the robust evidence from the landmark Systolic Blood Pressure Intervention Trial (SPRINT) study and numerous meta-analyses, which clearly showed that intensive blood pressure-lowering aimed at a systolic blood pressure of 120-130 mm Hg causes ̴a significant, > 25% reduction in cardiovascular morbidity and mortality. This review highlights some of the important discrepancies between the major current guidelines, with a focus on definitions and treatment goals of hypertension. The effect of lower blood pressure targets and intensive antihypertensive treatment on cardiovascular benefit and risk is also discussed.
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Affiliation(s)
- Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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50
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Asgari S, Khaloo P, Khalili D, Azizi F, Hadaegh F. Status of Hypertension in Tehran: Potential impact of the ACC/AHA 2017 and JNC7 Guidelines, 2012-2015. Sci Rep 2019; 9:6382. [PMID: 31011156 PMCID: PMC6476880 DOI: 10.1038/s41598-019-42809-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 04/09/2019] [Indexed: 01/19/2023] Open
Abstract
This study aimed to determine the prevalence of hypertension, the recommended anti-hypertensive therapy and the percentage of hypertensive patients who had achieved the blood pressure (BP) target according to 2017 American College of Cardiology/American Heart Association (ACC/AHA) versus JNC7 and 8 guidelines, among Iranian population. Data of participants aged ≥20 years from the fifth phase (2012-2015) of the Tehran lipid and glucose study (N = 10,576) were analyzed, using survey analysis. The weighted prevalence of hypertension among those not on anti-hypertensive medications was 42.7 and 12.6%, applying the ACC/AHA and JNC7 guideline definitions, respectively; the corresponding values with including BP-lowering medication in definition of hypertension were 47.1% and 20.4%, respectively. However, 90% of these hypertensive people were found to have a 10-year cardiovascular disease risk of <10%. Applying the ACC/AHA guideline, anti-hypertensive medication was recommended for 21.9% of Tehranians, compared to 19.3 and 12.2% according to the JNC7 and 8 guidelines, respectively. Among Tehranians taking anti-hypertensive medication, 20% achieved the BP goal according to the ACC/AHA guideline, compared to the 42.1 and 53.6%, using JNC7 and 8 guidelines, respectively. Despite the tremendous increase in the prevalence of hypertension, most of the newly identified cases did not belong to the high-risk group.
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Affiliation(s)
- Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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