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Pan M, Beratarrechea A, Poggio R, He H, Chen CS, Chen J, Irazola V, Rubinstein A, He J, Mills KT. Identifying Who Benefits the Most from a Community Health Worker-Led Multicomponent Intervention for Hypertension. Int J Hypertens 2024; 2024:6311938. [PMID: 39319334 PMCID: PMC11421940 DOI: 10.1155/2024/6311938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 08/02/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
Background Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown. Objective To identify participants who benefit the most from the HCPIA BP control intervention. Methods This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed. Results Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response. Conclusion The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.
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Affiliation(s)
- Meng Pan
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
| | | | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Hua He
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
| | - Chung-Shiuan Chen
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
| | - Jing Chen
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
- Department of MedicineTulane University School of MedicineTulane University, New Orleans, LA, USA
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jiang He
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
- Department of MedicineTulane University School of MedicineTulane University, New Orleans, LA, USA
| | - Katherine T. Mills
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
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Bugeja A, Girard C, Sood MM, Kendall CE, Sweet A, Singla R, Motazedian P, Vinson AJ, Ruzicka M, Hundemer GL, Knoll G, McIsaac DI. Adherence to guideline-recommended care of late-onset hypertension in females versus males: A population-based cohort study. J Intern Med 2024; 296:280-290. [PMID: 38975673 DOI: 10.1111/joim.13821] [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] [Indexed: 07/09/2024]
Abstract
BACKGROUND Sex-based disparities in cardiovascular outcomes may be improved with appropriate hypertension management. OBJECTIVE To compare the evidence-based evaluation and management of females with late-onset hypertension compared to males in the contemporary era. METHODS Design: Retrospective population-based cohort study. SETTING Ontario, Canada. PARTICIPANTS Residents aged ≥66 years with newly diagnosed hypertension between January 1, 2010, and December 31, 2017. EXPOSURE Sex (female vs. male). OUTCOMES AND MEASURES We used Poisson and logistic regression to estimate adjusted sex-attributable differences in the performance of guideline-recommended lab investigations. We estimated adjusted differences in time to the prescription of, and type of, first antihypertensive medication prescribed between females and males, using Cox regression. RESULTS Among 111,410 adults (mean age 73 years, 53% female, median follow-up 6.8 years), females underwent a similar number of guideline-recommended investigations (adjusted incidence rate ratio, 0.997 [95% confidence interval [CI] 0.99-1.002]) compared to males. Females were also as likely to complete all investigations (0.70% females, 0.77% males; adjusted odds ratio, 0.96 [95% CI 0.83-1.11]). Females were slightly less likely to be prescribed medication (adjusted hazard ratio [aHR] 0.98 [95% CI 0.96-0.99]) or, among those prescribed, less likely to be prescribed first-line medication (aHR, 0.995 [95% CI 0.994-0.997]). CONCLUSIONS Compared to males, females with late-onset hypertension were equally likely to complete initial investigations with comparable prescription rates. These findings suggest that there may be no clinically meaningful sex-based differences in the initial management of late-onset hypertension to explain sex-based disparities in cardiovascular outcomes.
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Affiliation(s)
- Ann Bugeja
- Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Celine Girard
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- ICES uOttawa, Ontario, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- ICES uOttawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ally Sweet
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ria Singla
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Amanda J Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Kidney Research Institute, Nova Scotia, Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ontario, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- ICES uOttawa, Ontario, Canada
- Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
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Hanna M, Wabnitz A, Grewal P. Sex and stroke risk factors: A review of differences and impact. J Stroke Cerebrovasc Dis 2024; 33:107624. [PMID: 38316283 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES There is an increase in stroke incidence risk over the lifetime of women, given their longer life expectancy. However, an alarming trend for sex disparities, particularly in certain stroke risk factors, shows a concerning need for focus on sex differences in stroke prevention and treatment for women. In this article, we are addressing sex differences in both traditional and sex-specific stroke risk factors. METHODS We searched PubMed from inception to December 2022 for articles related to sex differences and risk factors for stroke. We reviewed full-text articles for relevance and ultimately included 152 articles for this focused review. RESULTS Women are at increased risk for stroke from both traditional and non-traditional stroke risk factors. As women age, they have a higher disease burden of atrial fibrillation, increased risk of stroke related to diabetes, worsening lipid profiles, and higher prevalence of hypertension and obesity compared to men. Further, women carry sex hormone-specific risk factors for stroke, including the age of menarche, menopause, pregnancy, and its complications, as well as hormonal therapy. Men have a higher prevalence of tobacco use and atrial fibrillation, as well as an increased risk for stroke related to hyperlipidemia. Additionally, men have sex-specific risks related to low testosterone levels. CONCLUSIONS By identifying biological sex-specific risk factors for stroke, developing robust collaborations, researching, and applying the knowledge for risk reduction strategies, we can begin to tailor prevention and reduce the global burden of stroke morbidity and mortality.
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Affiliation(s)
- Mckay Hanna
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Ashley Wabnitz
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Parneet Grewal
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States.
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Arthur G, Poupeau A, Biel K, Osborn JL, Gong M, Hinds TD, Lindner V, Loria AS. Human soluble prorenin receptor expressed in mouse renal collecting duct shows sex-specific effect on cardiorenal function. Am J Physiol Renal Physiol 2024; 326:F611-F621. [PMID: 38385173 PMCID: PMC11208026 DOI: 10.1152/ajprenal.00375.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
Soluble prorenin receptor (sPRR), a component of the renin-angiotensin system (RAS), has been identified as a plasma biomarker for hypertension and cardiovascular diseases in humans. Despite studies showing that sPRR in the kidney is produced by tubular cells in the renal collecting duct (CD), its biological actions modulating cardiorenal function in physiological conditions remain unknown. Therefore, the objective of our study was to investigate whether CD-derived human sPRR (HsPRR) expression influences cardiorenal function and examine sex and circadian differences. Thus, we investigated the status of the intrarenal RAS, water and electrolyte balance, renal filtration capacity, and blood pressure (BP) regulation in CD-HsPRR and control (CTL) mice. CD-HsPRR mice were generated by breeding human sPRR-Myc-tag mice with Hoxb7/Cre mice. Renal sPRR expression increased in CD-HsPRR mice, but circulating sPRR and RAS levels were unchanged compared with CTL mice. Only female littermates expressing CD-HsPRR showed 1) increased 24-h BP, 2) an impaired BP response to an acute dose of losartan and attenuated angiotensin II (ANG II)-induced hypertension, 3) reduced angiotensin-converting enzyme activity and ANG II content in the renal cortex, and 4) decreased glomerular filtration rate, with no changes in natriuresis and kaliuresis despite upregulation of the β-subunit of the epithelial Na+ channel in the renal cortex. These cardiorenal alterations were displayed only during the active phase of the day. Taken together, these data suggest that HsPRR could interact with ANG II type 1 receptors mediating sex-specific, ANG II-independent renal dysfunction and a prohypertensive phenotype in a sex-specific manner.NEW & NOTEWORTHY We successfully generated a humanized mouse model that expresses human sPRR in the collecting duct. Collecting duct-derived human sPRR did not change circulating sPRR and RAS levels but increased daytime BP in female mice while showing an attenuated angiotensin II-dependent pressor response. These findings may aid in elucidating the mechanisms by which women show uncontrolled BP in response to antihypertensive treatments targeting the RAS, improving approaches to reduce uncontrolled BP and chronic kidney disease incidences in women.
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Affiliation(s)
- Gertrude Arthur
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, United States
| | - Audrey Poupeau
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, United States
| | - Katherine Biel
- Department of Nutrition and Dietetics, University of Kentucky, Lexington, Kentucky, United States
| | - Jeffrey L Osborn
- Department of Pathophysiology, Arkansas Colleges of Health Education, Fort Smith, Arkansas, United States
| | - Ming Gong
- Department of Physiology, University of Kentucky, Lexington, Kentucky, United States
| | - Terry D Hinds
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, United States
| | - Volkhard Lindner
- MaineHealth Institute for Research, Scarborough, Maine, United States
| | - Analia S Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, United States
- SAHA Cardiovascular Center, University of Kentucky, Lexington, Kentucky, United States
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Danvers AA, Gurney EG, Panushka KA, Peskin M, Evans TA. Shortcomings and disparities in contraception counseling and use by hypertensive individuals at risk for unintended pregnancy: a comparative analysis of the National Survey of Family Growth. Am J Obstet Gynecol 2024; 230:350.e1-350.e11. [PMID: 37871872 DOI: 10.1016/j.ajog.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/26/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Hypertension is a leading cause of adverse pregnancy outcomes. These outcomes disproportionately affect Black individuals. Reproductive life planning that includes patient-centered contraception counseling could mitigate the impact of unintended pregnancy. OBJECTIVE The primary objective of the study is to compare contraception counseling and use between hypertensive and nonhypertensive individuals at risk for unintended pregnancy. Our secondary objectives are the following: (1) to evaluate the effect of race on the probability of counseling and the use of contraception, and (2) to evaluate the methods used by individuals with hypertension. METHODS Data from the 2015-2017 and 2017-2019 National Survey of Family Growth Female Respondent Files were used to analyze whether individuals who reported being informed of having high blood pressure within the previous 12 months received counseling about contraception or received a contraceptive method. Covariates considered in the analysis included age, race, parity, educational attainment, body mass index, smoking, diabetes, and experience with social determinants of health. The social determinants of health covariate was based on reported experiences within 5 social determinants of health domains: food security, housing stability, financial security, transportation access, and childcare needs. Linear probability models were used to estimate the adjusted probability of receiving counseling and the use of a contraceptive. Using difference-in-difference analyses, we compared the change in counseling and use between hypertensive and nonhypertensive respondents by race, relative to White respondents. RESULTS Of the 8625 participants analyzed, 771 (9%) were hypertensive. Contraception counseling was received by 26.2% (95% confidence interval, 20.4-31.9) of hypertensive individuals and 20.7% (95% confidence interval, 19.3-22.2) of nonhypertensive individuals. Contraception use was reported by 39.8% (95% confidence interval, 33.2-46.5) of hypertensive and 35.3% (95% confidence interval, 33.3-37.2) of nonhypertensive individuals. The linear probability model adjusting for age, parity, education attainment, body mass index, smoking, diabetes, and social determinants of health indicated that hypertensive individuals were 8 percentage points (95% confidence interval, 3-18 percentage points) more likely to receive counseling and 9 percentage points (95% confidence interval, 3-16 percentage points) more likely to use contraception. Hypertensive Black individuals did not receive more counseling or use more contraceptives compared with nonhypertensive Black individuals. The difference in counseling when hypertension was present was 13 percentage points lower than the difference observed for White respondents when hypertension was present (P=.01). The most frequently used contraceptive method among hypertensive individuals was combined oral contraceptive pills (54.0%; 95% confidence interval, 44.3%-63.5%). CONCLUSION Despite the higher likelihood of receiving contraception counseling and using contraception among hypertensive individuals at risk for unintended pregnancy, two-thirds of this population did not receive contraception counseling, and <40% used any contraceptive method. Furthermore, unlike White individuals, Black individuals with hypertension did not receive more contraception care than nonhypertensive Black individuals. Of all those who used contraception, half relied on a method classified as Centers for Disease Control and Prevention Medical Eligibility Criteria Category 3. These findings highlight a substantial unmet need for safe and accessible contraception options for hypertensive individuals at risk for unintended pregnancy, emphasizing the importance of targeted interventions to improve contraceptive care and counseling in this population.
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Affiliation(s)
- Antoinette A Danvers
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY.
| | - Elizabeth G Gurney
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY
| | - Katherine A Panushka
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY
| | - Melissa Peskin
- Department of Obstetrics and Gynecology, New York University Langone Hospital - Long Island, Mineola, NY
| | - Thomas A Evans
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY
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Kozhisseri N, Rajaram D, Cheluvaraj P. Prevalence of Elevated Blood Pressure and Its Relationship With Anthropometric Risk Factors in Students of a Pre-university Girls' College in Bangalore: A Cross-Sectional Study. Cureus 2023; 15:e49774. [PMID: 38161531 PMCID: PMC10757738 DOI: 10.7759/cureus.49774] [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: 10/20/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background There is a growing concern regarding elevated blood pressure in adolescence. Children and adolescents with high blood pressure are at risk for adult hypertension. Being overweight and obese are important risk factors for hypertension. This study aimed to determine the prevalence of elevated blood pressure and its association with anthropometric risk factors among students of a pre-university girls' college. Methodology A cross-sectional study was conducted among 337 students at a pre-university girls' college aged 15-19 years in urban Bangalore. A self-administered, semi-structured, pretested questionnaire collected the sociodemographic details, family history, and lifestyle. Height, weight, waist circumference (WC), and hip circumference were measured. Standard cut-off levels were used for body mass index (BMI), WC, waist-hip ratio (WHR), and waist-height ratio (WHtR). Resting blood pressure was determined using a digital blood pressure monitor. It was classified into normotensive, pre-hypertension (>90th to <95th percentile), and hypertension (>95th percentile). Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Pre-hypertension and hypertension were considered as having elevated blood pressure. Results The prevalence of pre-hypertension and hypertension was 21.4% (n = 72, 95% confidence interval (CI) = 17.0-25.7) and 9.8% (n = 33, 95% CI = 6.6-13.0), respectively. The prevalence of overweight was 20.2% (n = 68, 95% CI = 15.9-24.5) and obesity was 12.2% (n = 41, 95% CI = 8.7-15.7). WC, WHR, and WHtR were abnormal in 34.7% (n = 117, 95% CI = 29.6-39.8), 47.5% (n = 160, 95% CI = 42.1-52.8), and 45.7% (n = 154, 95% CI = 50.4-51.0), respectively. There was a statistically significant correlation between systolic blood pressure and BMI (p < 0.001), WC (p < 0.001), and WHtR (p < 0.001), as well as diastolic blood pressure and BMI (p < 0.001), WC (p = 0.008), and WHtR (p = 0.011). Statistically significant differences in mean BMI (p = 0.004), WC (p < 0.001), WHR (p = 0.007), and WHtR (p = 0.001) between normal, pre-hypertensive, and hypertensive students were also noted. Conclusions Pre-hypertension and hypertension are fundamental problems in pre-university girl students. With a similarly increased prevalence of obesity and other anthropometric risk factors, students must be aware of hypertension and its risk factors.
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Affiliation(s)
| | - Dinesh Rajaram
- Community Medicine, Ramaiah Medical College, Bangalore, IND
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Shah A, Kapcin K, Deicke M, Pappan N, Holden K, Routray SK, Schmetzer A, DuMont T, Nashar K, Bajwa O, Ivanova V. Hypertension in Women and Pregnancy. Crit Care Nurs Q 2023; 46:377-390. [PMID: 37684733 DOI: 10.1097/cnq.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Hypertension has been shown to have long-term cardiovascular effects if left untreated. Hypertension also has been shown to affect women during pregnancy, which can be detrimental not only to the patient but also to the fetus. Early identification and treatment are paramount to prevent adverse outcomes. This article details the epidemiology, clinical presentation, diagnosis, and treatment of essential hypertension in women, gestational hypertension, preeclampsia, and eclampsia.
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Affiliation(s)
- Aaisha Shah
- Divisions of Internal Medicine (Drs Shah, Kapcin, and Deicke), Pulmonary and Critical Care (Drs Holden, Schmetzer, and DuMont), Nephrology and Critical Care Medicine (Dr Routray), Nephrology (Dr Nashar), and Pulmonary and Critical Care Medicine (Dr Bajwa), Allegheny Health Network Medicine Institute, Pittsburgh, Pennsylvania; and Division of Cardiovascular Disease, Allegheny Health Network Cardiovascular Institute (Drs Pappan and Ivanova)
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Kirsztajn GM, Moura AF, Rodrigues CIS, Sanders-Pinheiro H, Moura-Neto JA, Mansur J, Moura LRR, Bastos MG, Facca TA, Pacheco-Silva A. Kidney diseases in women: difference in risks and opportunities. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S117. [PMID: 37556636 PMCID: PMC10411704 DOI: 10.1590/1806-9282.2023s117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/22/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Gianna Mastroianni Kirsztajn
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Universidade Federal de São Paulo, Department of Medicine, Division of Nephrology – São Paulo (SP), Brazil
| | - Ana Flávia Moura
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Escola Bahiana de Medicina e Saúde Pública – Salvador (BA), Brazil
| | - Cibele Isaac Saad Rodrigues
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Department of Medicine, Division of Nephrology – São Paulo (SP), Brazil
| | - Helady Sanders-Pinheiro
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Federal University of Juiz de Fora, Faculty of Medicine, Division of Nephrology – Juiz de Fora (MG), Brazil
| | - José A. Moura-Neto
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Escola Bahiana de Medicina e Saúde Pública – Salvador (BA), Brazil
| | - Juliana Mansur
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Universidade Federal de São Paulo, Department of Medicine, Division of Nephrology – São Paulo (SP), Brazil
- Hospital do Rim, Fundação Oswaldo Ramos – São Paulo (SP), Brazil
| | - Lúcio R. Requião Moura
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Universidade Federal de São Paulo, Department of Medicine, Division of Nephrology – São Paulo (SP), Brazil
- Hospital do Rim, Fundação Oswaldo Ramos – São Paulo (SP), Brazil
| | - Marcus Gomes Bastos
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Federal University of Juiz de Fora, Faculty of Medicine, Division of Nephrology – Juiz de Fora (MG), Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora – Suprema, Faculdade de Medicina, Centro Universitário Governador Ozanam Coelho – Ubá (MG), Brazil
| | - Thais Alquezar Facca
- Universidade Municipal de São Caetano do Sul, Department of Medicine – São Paulo (SP), Brazil
| | - Alvaro Pacheco-Silva
- Sociedade Brasileira de Nefrologia – São Paulo (SP), Brazil
- Universidade Federal de São Paulo, Department of Medicine, Division of Nephrology – São Paulo (SP), Brazil
- Hospital Israelita Albert Einstein – São Paulo (SP), Brazil
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9
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Suen LW, Vittinghoff E, Wu AHB, Ravi A, Coffin PO, Hsue P, Lynch KL, Kazi DS, Riley ED. Multiple substance use and blood pressure in women experiencing homelessness. Addict Behav Rep 2023; 17:100483. [PMID: 36875801 PMCID: PMC9975611 DOI: 10.1016/j.abrep.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/15/2022] [Accepted: 02/12/2023] [Indexed: 02/15/2023] Open
Abstract
Background Substance use increases risk of cardiovascular events, particularly among women with additional risk factors like housing instability. While multiple substance use is common among unstably housed individuals, relationships between multiple substance use and cardiovascular risk factors like blood pressure are not well characterized. Methods We conducted a cohort study between 2016 and 2019 to examine associations between multiple substance use and blood pressure in women experiencing homelessness and unstable housing. Participants completed six monthly visits including vital sign assessment, interview, and blood draw to assess toxicology-confirmed substance use (e.g., cocaine, alcohol, opioids) and cardiovascular health. We used linear mixed models to evaluate the outcomes of systolic and diastolic blood pressure (SBP; DBP). Results Mean age was 51.6 years; 74 % were women of color. Prevalence of any substance use was 85 %; 63 % of participants used at least two substances at baseline. Adjusting for race, body mass index and cholesterol, cocaine was the only substance significantly associated with SBP (4.71 mmHg higher; 95 % CI 1.68, 7.74) and DBP (2.83 mmHg higher; 95 % CI 0.72, 4.94). Further analysis found no differences in SBP or DBP between those with concurrent use of other stimulants, depressants, or both with cocaine, compared to those who used cocaine only. Conclusions Cocaine was the only substance associated with higher SBP and DBP, even after accounting for simultaneous use of other substances. Along with interventions to address cocaine use, stimulant use screening during cardiovascular risk assessment and intensive blood pressure management may improve cardiovascular outcomes among women experiencing housing instability.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Akshay Ravi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Phillip O Coffin
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Department of Public Health, San Francisco, CA, United States
| | - Priscilla Hsue
- Division of Cardiology, Chan Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Elise D Riley
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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10
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Afetor M, Harris E, Der JB, Narh CT. Using routine healthcare data to determine the factors associated with hospital length of stay for hypertensive inpatients in Ghana, 2012-2017. BMJ Open 2023; 13:e066457. [PMID: 37156576 PMCID: PMC10173975 DOI: 10.1136/bmjopen-2022-066457] [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: 05/10/2023] Open
Abstract
OBJECTIVE Hospitalisation for hypertension continues to rise in Ghana. It has been revealed that in Ghana, patients hospitalised for hypertension spend between 1 and 91 days on admission. This study therefore sought to estimate the hospital length of stay (LoS) of hypertensive patients and individual or health-related factors that may influence the hospitalisation duration in Ghana. METHODS We employed a retrospective study design that used routinely collected health data on hospitalised hypertensive patients in Ghana from the District Health Information Management System database between 2012 and 2017 to model LoS using survival analysis. The cumulative incidence function for discharge stratified by sex was computed. To investigate the factors that influence hospitalisation duration, multivariable Cox regression was used. RESULTS Out of a total of 106 372 hypertension admissions, about 72 581 (68.2%) were women. The mean age of the patients was 55.3 (SD=17.5) years. Overall, the median LoS was 3 days with almost 90% of all patients being discharged by the 10th day of admission. Patients admitted in Volta region (HR: 0.89, p<0.001) and Eastern region (HR: 0.96, p=0.002) experienced late discharge as compared with patients admitted in Greater Accra. It was revealed that women (HR: 1.09, p<0.001) were discharged earlier than men. However, having a surgical procedure (HR: 1.07, p<0.001) and having comorbidities such as diabetes (HR: 0.76, p<0.001) and cardiovascular diseases other than hypertension (HR: 0.77, p<0.001) increased the LoS of patients. CONCLUSION This study provides the first comprehensive assessment of factors influencing hospitalisation duration of admissions due to hypertension in Ghana. Female sex, all regions except Volta region and Eastern region, experienced early discharge. However, patients with a surgical intervention and comorbidity experienced late discharge.
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Affiliation(s)
- Maxwell Afetor
- Department of Mathematics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Ghana Health Service, Accra, Volta Region, Ghana
| | - Emmanuel Harris
- Department of Mathematics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joyce B Der
- Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
| | - Clement T Narh
- Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
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11
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Belhadj A, Shimi M, Kort I, Zaara MA, Hamdoun M, Ben Khelil M. Risk factors of sudden cardiac death in women: A 10 years study in Tunisia. J Forensic Leg Med 2023; 96:102517. [PMID: 37004373 DOI: 10.1016/j.jflm.2023.102517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/17/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) represents a frequent etiology of sudden death. It represents a major public health issue. Few data about SCD in women are available from the Arab world. Our work aimed to analyze the risk factors of sudden cardiac death in Tunisian women in comparison with men. METHODS A cross-sectional retrospective study including all sudden cardiac death cases, conducted in the Forensic Medicine Department of the main teaching hospital of Tunis, between January 2010 and December 2019. RESULTS We counted 417 cases of sudden cardiac death in women representing 17.5% of the total number of sudden cardiac deaths recorded during the study period. The average age was 60.03 ± 15.01 years with a predominance of urban married women. The most frequent cardiac risk factors were high blood pressure (50%), diabetes (36.2%), and cardiac disease history (34.2%). Predominately married women with a history of High blood pressure and diabetes, had a high predictive of sudden cardiac death. CONCLUSION Cardiac sudden death is no longer a male focused issue. As a matter of facts Rates of SCD in women are rising with a different pattern. We will highlight the importance of adopting specific preventive measures of SCD in female.
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12
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Meyer M, Niemöller U, Arnold A, Stein T, Erkapic D, Schramm P, Tanislav C. Hypertensive Blood Pressure and Its Impact on Functional Outcomes among Older Adults Receiving Comprehensive Geriatric Care. Geriatrics (Basel) 2023; 8:geriatrics8020032. [PMID: 36960987 PMCID: PMC10037571 DOI: 10.3390/geriatrics8020032] [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: 12/30/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Comprehensive geriatric care (CGC) is a multiprofessional treatment for older people which considers medical conditions and functional status. The aim of the presented study is to investigate the impact of hypertensive blood pressure (BP) on functional outcomes among older adults receiving CGC. METHODS Functional status was documented by the Barthel index (BI), Tinetti test (TBGT), and timed up and go test (TUG) prior to and after CGC. The results were analyzed in relation to hypertensive BP, indicated by mean BP ≥ 130/80 mmHg determined by 24 h blood pressure monitoring (BPM) while hospitalized. RESULTS In the presented monocentric, retrospective, observational study, 490 patients were included (mean age (SD): 83.86 ± 6.17 years, 72.2% females). Hypertension in BPM was found in 302 (61.6%) individuals. Hypertensive BP was associated with the female sex (p < 0.001) and current fracture (p = 0.001), and inversely associated with heart failure (p < 0.001), coronary heart disease (p < 0.001), atrial fibrillation (p < 0.001), urinary tract infection (p = 0.022), and hypocalcemia (p = 0.014). After CGC, improvements in BI (p < 0.001), TBGT (p < 0.001), and TUG (p < 0.001) were observed in patients with both normotensive and hypertensive BP profiles. The proportion of patients with outcome improvements did not differ between the two groups (BI: 84.4% vs. 88.3%, p = 0.285; TBGT: 81.1% vs. 77.7%, p = 0.357; TUG: 50.3% vs. 48.4%, p = 0.711). CONCLUSION Patients both with and without hypertensive BP profiles benefited from comprehensive geriatric care with comparable outcome improvements. Particularly, normotensive BP was associated with chronic cardiovascular comorbidities, indicating increased awareness of the importance of BP management in patients diagnosed with cardiac diseases.
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Affiliation(s)
- Marco Meyer
- Department of Geriatrics, Diakonie Hospital Jung-Stilling Siegen, 57074 Siegen, Germany
| | - Ulrich Niemöller
- Department of Geriatrics, Diakonie Hospital Jung-Stilling Siegen, 57074 Siegen, Germany
| | - Andreas Arnold
- Department of Geriatrics, Diakonie Hospital Jung-Stilling Siegen, 57074 Siegen, Germany
| | - Thomas Stein
- Department of Geriatrics, Diakonie Hospital Jung-Stilling Siegen, 57074 Siegen, Germany
| | - Damir Erkapic
- Department of Cardiology, Rhythmology and Angiology, Diakonie Hospital Jung-Stilling, 57074 Siegen, Germany
| | - Patrick Schramm
- Department of Neurology, Justus Liebig University, 35385 Giessen, Germany
| | - Christian Tanislav
- Department of Geriatrics, Diakonie Hospital Jung-Stilling Siegen, 57074 Siegen, Germany
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13
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D'Ignazio T, Grand'Maison S, Bérubé L, Forcillo J, Pacheco C. Hypertension across a Woman's lifespan. Maturitas 2023; 168:84-91. [PMID: 36549261 DOI: 10.1016/j.maturitas.2022.11.006] [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: 06/04/2022] [Revised: 11/01/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
Hypertension is a leading risk factor for cardiovascular disease in women. Both traditional and sex-specific risk modifiers occurring from menarche to pregnancy to menopause modulate the risk of hypertension and adverse cardiovascular events. This review provides a narrative summary of risk and treatment of hypertension in women across the lifespan, from adolescence to the post-menopausal period, where each period represents a potential window for risk assessment, diagnosis, and appropriate treatment. Management of hypertension throughout a woman's life must be included in a holistic cardiovascular prevention approach for women in order to prevent future cardiovascular complications.
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Affiliation(s)
- Tara D'Ignazio
- Département de médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal H3T 1J4, Qc, Canada
| | - Sophie Grand'Maison
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal H2X 3E4, QC, Canada
| | - Lyne Bérubé
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal H2X 3E4, QC, Canada
| | - Jessica Forcillo
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal H2X 3E4, QC, Canada
| | - Christine Pacheco
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal H2X 3E4, QC, Canada; Hôpital Pierre-Boucher, CISSS Montérégie-Est, 1333 Boulevard Jacques-Cartier E, Longueuil J4M 2A5, QC, Canada.
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14
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Santollo J, Daniels D, Leshem M, Schulkin J. Sex Differences in Salt Appetite: Perspectives from Animal Models and Human Studies. Nutrients 2023; 15:208. [PMID: 36615865 PMCID: PMC9824138 DOI: 10.3390/nu15010208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Salt ingestion by animals and humans has been noted from prehistory. The search for salt is largely driven by a physiological need for sodium. There is a large body of literature on sodium intake in laboratory rats, but the vast majority of this work has used male rats. The limited work conducted in both male and female rats, however, reveals sex differences in sodium intake. Importantly, while humans ingest salt every day, with every meal and with many foods, we do not know how many of these findings from rodent studies can be generalized to men and women. This review provides a synthesis of the literature that examines sex differences in sodium intake and highlights open questions. Sodium serves many important physiological functions and is inextricably linked to the maintenance of body fluid homeostasis. Indeed, from a motivated behavior perspective, the drive to consume sodium has largely been studied in conjunction with the study of thirst. This review will describe the neuroendocrine controls of fluid balance, mechanisms underlying sex differences, sex differences in sodium intake, changes in sodium intake during pregnancy, and the possible neuronal mechanisms underlying these differences in behavior. Having reviewed the mechanisms that can only be studied in animal experiments, we address sex differences in human dietary sodium intake in reproduction, and with age.
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Affiliation(s)
- Jessica Santollo
- Department of Biology, University of Kentucky, Lexington, KY 40506, USA
| | - Derek Daniels
- Department of Biology, University at Buffalo, Buffalo, NY 14260, USA
| | - Micah Leshem
- School of Psychological Sciences, The University of Haifa, Haifa 3498838, Israel
| | - Jay Schulkin
- School of Medicine, University of Washington, Seattle, WA 98195, USA
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15
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Muhammad A, Forcados GE, Yusuf AP, Abubakar MB, Sadiq IZ, Elhussin I, Siddique MAT, Aminu S, Suleiman RB, Abubakar YS, Katsayal BS, Yates CC, Mahavadi S. Comparative G-Protein-Coupled Estrogen Receptor (GPER) Systems in Diabetic and Cancer Conditions: A Review. Molecules 2022; 27:molecules27248943. [PMID: 36558071 PMCID: PMC9786783 DOI: 10.3390/molecules27248943] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
For many patients, diabetes Mellitus and Malignancy are frequently encountered comorbidities. Diabetes affects approximately 10.5% of the global population, while malignancy accounts for 29.4 million cases each year. These troubling statistics indicate that current treatment approaches for these diseases are insufficient. Alternative therapeutic strategies that consider unique signaling pathways in diabetic and malignancy patients could provide improved therapeutic outcomes. The G-protein-coupled estrogen receptor (GPER) is receiving attention for its role in disease pathogenesis and treatment outcomes. This review aims to critically examine GPER' s comparative role in diabetes mellitus and malignancy, identify research gaps that need to be filled, and highlight GPER's potential as a therapeutic target for diabetes and malignancy management. There is a scarcity of data on GPER expression patterns in diabetic models; however, for diabetes mellitus, altered expression of transport and signaling proteins has been linked to GPER signaling. In contrast, GPER expression in various malignancy types appears to be complex and debatable at the moment. Current data show inconclusive patterns of GPER expression in various malignancies, with some indicating upregulation and others demonstrating downregulation. Further research should be conducted to investigate GPER expression patterns and their relationship with signaling pathways in diabetes mellitus and various malignancies. We conclude that GPER has therapeutic potential for chronic diseases such as diabetes mellitus and malignancy.
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Affiliation(s)
- Aliyu Muhammad
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | | | - Abdurrahman Pharmacy Yusuf
- Department of Biochemistry, School of Life Sciences, Federal University of Technology, Minna P.M.B. 65, Nigeria
| | - Murtala Bello Abubakar
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto P.M.B. 2254, Nigeria
- Centre for Advanced Medical Research & Training (CAMRET), Usmanu Danfodiyo University, Sokoto P.M.B. 2254, Nigeria
| | - Idris Zubairu Sadiq
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Isra Elhussin
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
| | - Md Abu Talha Siddique
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
| | - Suleiman Aminu
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Rabiatu Bako Suleiman
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Yakubu Saddeeq Abubakar
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Babangida Sanusi Katsayal
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria P.M.B. 1044, Nigeria
| | - Clayton C Yates
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
| | - Sunila Mahavadi
- Center for Cancer Research, Department of Biology, Tuskegee University, Tuskegee, AL 36088, USA
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Stress Reduction to Decrease Hypertension for Black Women: A Scoping Review of Trials and Interventions. J Racial Ethn Health Disparities 2022; 9:2208-2217. [PMID: 34606073 DOI: 10.1007/s40615-021-01160-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Chronic stress is a potential root cause of racial/ethnic disparities in cardiovascular disease. This review assesses literature surrounding effective stressreduction interventions to reduce hypertension (HTN)-a cardiovascular disease (CVD) risk factor-among an understudied population, non-Hispanic black (NHB) women. METHODS We conducted an electronic search of PubMed and PsycINFO literature published between January 1, 2000 and February 1, 2020, employing the keywords: "blood pressure", "hypertension", and "women", "black", "African-American", "stress", "meditation", "stress-coping", "stress-management", and "faith-based". We manually searched the bibliographies for additional articles. Studies were excluded if they: were published before 2000; were not intervention-based; did not study Black women in the US; did not target stress reduction; or did not measure blood pressure as an outcome. Independent reviewers screened the articles, which were selected based on consensus. Effect sizes and statistical p values were reported as provided in the included articles. RESULTS We identified 109 articles in total. Of those, six articles met inclusion criteria. Stronger evidence presented by a randomized control trial supported the efficacy of transcendental meditation with reductions in systolic and diastolic blood pressure up to 7 mmHg. Relaxation exercises, support groups, and therapeutic massage emerged as potentially beneficial in non-randomized pilot trials with reductions in systolic BP up to 9 mmHg and diastolic BP up to 5 mmHg varying by type and duration of the intervention. CONCLUSIONS This scoping review found that faith-based strategies and meditation can be effective stress reduction techniques to reduce BP among NHB women. However, much remains to be known about how these strategies may be leveraged to reduce blood pressure within this highly vulnerable population.
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Padmambika TS, Deshpande A, Mudunuru AK, Fatima F, Reddy SS. Surface Recording of Aortic Pressure Wave from Aortic Area of Auscultation in Women with Hypertension: A New Idea to Indirectly Monitor Aortic Pressure. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:
Blood pressure recording from the peripheral artery is subject to variations. While blood pressure is said to a modifiable risk factor for many cardiovascular and neurological diseases, the diagnosis of hypertension using Sphygmomanometry must be complemented with other tests to find central blood pressures. A newer, non-invasive method to indirectly record the aortic pressures is required. Aim of the study is to record surface aortic pressure waves (SAP) from aortic area of auscultation during breath holding and to compare the wave characteristics in hypertensive and normotensive women at rest and after mild exercise.
Materials and Methods:
128 women were recruited in the study. Piezoelectric sensor placed in the aortic area was used for getting the SAP waves during breath holding for 30 seconds. ECG was taken to show temporal association of these waves to R waves. Mean arterial pressures from arm (map-a) and from SAP waves (map-s) were calculated. Powerlab 8/35 and Labchart Pro software by AD Instruments were used in the study.
Results:
R waves were followed by the SAP waves by about 31±2.2 ms at rest and 11±2.4 ms after mild exercise in all subjects. In hypertensive women, the map-s values were significantly (p < 0.05) lower in magnitude than in normotensive women both at rest and after exercise. There was no significant correlation between the map-a and map-s in any of the groups at rest or after exercise.
Conclusion:
This new method, with some refinement could prove as a better alternative to blood pressure recording.
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Affiliation(s)
| | - Apurva Deshpande
- Department of Physiology, ESIC Medical College, Hyderabad, Telangana, India,
| | | | - Farheen Fatima
- Department of Physiology, ESIC Medical College, Hyderabad, Telangana, India,
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Li H, Konja D, Wang L, Wang Y. Sex Differences in Adiposity and Cardiovascular Diseases. Int J Mol Sci 2022; 23:ijms23169338. [PMID: 36012601 PMCID: PMC9409326 DOI: 10.3390/ijms23169338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Body fat distribution is a well-established predictor of adverse medical outcomes, independent of overall adiposity. Studying body fat distribution sheds insights into the causes of obesity and provides valuable information about the development of various comorbidities. Compared to total adiposity, body fat distribution is more closely associated with risks of cardiovascular diseases. The present review specifically focuses on the sexual dimorphism in body fat distribution, the biological clues, as well as the genetic traits that are distinct from overall obesity. Understanding the sex determinations on body fat distribution and adiposity will aid in the improvement of the prevention and treatment of cardiovascular diseases (CVD).
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19
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The risk of hypertension among child brides and adolescent mothers at age 20 s, 30 s, and 40 s: Evidence from India. J Hum Hypertens 2022:10.1038/s41371-022-00730-9. [DOI: 10.1038/s41371-022-00730-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
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20
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Elalem EG, Jelani M, Khedr A, Ahmad A, Alaama TY, Alaama MN, Al-Kreathy HM, Damanhouri ZA. Association of cytochromes P450 3A4*22 and 3A5*3 genotypes and polymorphism with response to simvastatin in hypercholesterolemia patients. PLoS One 2022; 17:e0260824. [PMID: 35839255 PMCID: PMC9286239 DOI: 10.1371/journal.pone.0260824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUNDS Inter-individual variability in response to statin was mainly due to genetic differences. This study aimed to investigate the association of CYP3A4*22 (rs35599367), CYP3A5*3 (rs776746) single nucleotide polymorphism (SNP) with response to simvastatin in hypercholesterolemia patients conducted at King Abdulaziz University hospital (KAUH) in Jeddah, Saudi Arabia. PATIENTS AND METHODS A total of 274 participants were registered in the current study. Hypercholesterolemic patients taking simvastatin 20 mg (n = 148) and control subjects (n = 126) were tested for rs35599367 and rs776746 genotypes using Custom Taqman ® Assay Probes. Response to simvastatin in these patients was assessed by determination of low density lipoprotein (LDL-C), total cholesterol (TC) and by measuring statin plasma levels using Liquid Chromatography-Mass Spectrometry (LC-MS). RESULTS None of the participants carried a homozygous CYP3A4*22 mutant genotype, while 12 (4.4%) individuals had a heterozygous genotype and 262 (95.6%) had a wild homozygous genotype. The CYP3A5*3 allele was detected in the homozygous mutant form in 16 (5.8%) individuals, while 74 (27.0%) individuals carried the heterozygous genotype and 184 (67.2%) carried the wildtype homozygous genotype. Of the patient group, 15 (11%) were classified as intermediate metabolizers (IMs) and 133 (89%) as extensive metabolizers (EMs). Plasma simvastatin concentrations for the combined CYP3A4/5 genotypes were significantly (P<0.05) higher in the IMs group than in the EMs group. TC and plasma LDL-C levels were also significantly (P<0.05) higher in IMs than in EMs. CONCLUSION The present study showed associations between CYP3A4*22 (rs35599367) and CYP3A5*3 (rs776746) SNP combination genotypes with response to statins in hypercholesterolemia. Patients who had either a mutant homozygous allele for CYP3A5*3 or mutant homozygous and heterozygous alleles for CYP3A4*22 showed increased response to lower TC and LDL-C levels.
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Affiliation(s)
- Elbatool G. Elalem
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Musharraf Jelani
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alaa Khedr
- Department of Analytical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aftab Ahmad
- Health Information Technology Department, Jeddah Community College, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tareef Y. Alaama
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Nabeel Alaama
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Huda M. Al-Kreathy
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zoheir A. Damanhouri
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Khan MN, Islam MM, Islam RM. Pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension: findings from Bangladesh Demographic and Health Survey. BMC Womens Health 2022; 22:230. [PMID: 35705977 PMCID: PMC9202138 DOI: 10.1186/s12905-022-01822-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/08/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prevalence of chronic conditions such as diabetes and hypertension is increasing among reproductive-aged women in Bangladesh. However, the pattern of contraceptive use among this population remains unknown. We, therefore, explored the pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension in Bangladesh. METHODS We extracted and analysed data of 3,947 women from the 2017/18 Bangladesh Demographic and Health Survey. Women's pattern of contraceptive use was our outcome variable. We first classified the contraceptive using status as no method use, traditional method use (periodic abstinence, withdrawal, other traditional) and modern method use (pill, intra-uterine device, injections, male condom, female sterilization, male sterilization). We later classified these as (i) no contraceptive use vs any contraceptive use, (ii) traditional method or no use vs modern method use, (iii) traditional method vs modern method use. The explanatory variables were diagnosis of diabetes only, hypertension only or both diabetes and hypertension. The multilevel Poisson regression with robust variance was used to explore the associations. RESULTS The overall prevalence of contraceptive use was 68.0% (95% CI 66.3-69.7). The corresponding prevalences were 69.4% (95% CI 61.8-76.1) in women with diabetes only, 67.3% (95% CI 63.5-70.9) with hypertension only, and 62.0% (95% CI 52.8-70.4) in women having both diabetes and hypertension. The prevalence of modern methods of contraceptive use was lower (46.4%, 95% CI 37.4-55.6) and traditional methods use was higher (16.6%, 95% CI 13.8-16.8) in women who had both diabetes and hypertension than in women who did not have these conditions. The fully adjusted regression model showed that the prevalence of traditional method use was 31% (Prevalence ratio: 1.31, 95% CI 1.02-2.01) higher in women having both diabetes and hypertension compared with their counterparts who had none of these conditions. CONCLUSION In Bangladesh, women with both diabetes and hypertension were more likely to use traditional contraception methods. These women are likely to experience increased risks of unwanted pregnancies and associated adverse maternal and child health outcomes. Targeted policies and programs should be undertaken to promote modern contraceptive use among women living with both chronic conditions.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal Mymensingh, 2220, Bangladesh.
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
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Lucà F, Abrignani MG, Parrini I, Di Fusco SA, Giubilato S, Rao CM, Piccioni L, Cipolletta L, Passaretti B, Giallauria F, Leone A, Francese GM, Riccio C, Gelsomino S, Colivicchi F, Gulizia MM. Update on Management of Cardiovascular Diseases in Women. J Clin Med 2022; 11:1176. [PMID: 35268267 PMCID: PMC8911459 DOI: 10.3390/jcm11051176] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Big Metropolitan Hospital, 89129 Reggio Calabria, Italy;
| | | | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I Hospital, 10128 Turin, Italy;
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
| | - Simona Giubilato
- Division of Cardiology, Cannizzaro Hospital, 95121 Catania, Italy;
| | | | - Laura Piccioni
- Italy Cardiology Department, “G. Mazzini” Hospital, 64100 Teramo, Italy;
| | - Laura Cipolletta
- Division of Cardiology, Department of Cardiovascular Sciences, University of Ancona, 60126 Ancona, Italy;
| | - Bruno Passaretti
- Rehabilitation Cardiology Department, Humanitas Gavazzeni, 24125 Bergamo, Italy;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Angelo Leone
- Cardiology Division, Annunziata Hospital Cosenza, 87100 Cosenza, Italy;
| | | | - Carmine Riccio
- Division of Clinical Cardiology, ‘Sant’Anna e San Sebastiano’ Hospital, 81100 Caserta, Italy;
| | - Sandro Gelsomino
- Cardio Thoracic Department, Maastricht University, 6202 AZ Maastricht, The Netherlands;
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00100 Roma, Italy; (S.A.D.F.); (F.C.)
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Seo E, Jung S, Lee H, Kim HC. Sex-Specific Trends in the Prevalence of Hypertension and the Number of People With Hypertension: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 1998-2018. Korean Circ J 2022; 52:382-392. [PMID: 35257521 PMCID: PMC9064695 DOI: 10.4070/kcj.2021.0347] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/05/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As the Korean population ages fast, it is estimated that the people with hypertension, especially female patients, will increase rapidly. However, there are few data comparing the size of female and male hypertensive patients in the Korean population. Thus we assessed sex-specific trends in the prevalence and the number of people with hypertension. METHODS We analyzed data for 128,949 adults aged ≥20 years with valid blood pressure measurements from the 1998 to 2018 Korea National Health and Nutrition Examination Survey (KNHANES). The prevalence and the absolute number of hypertension were estimated with taking into the sampling weights separately for women and men. RESULTS Overall prevalence of hypertension is higher in men than in women. But, in older adults, women show higher prevalence and the number of people with hypertension. Between 1998 and 2018, prevalence of hypertension increased from 61.8% to 65.9% in elderly (age 65+) women, and from 49.0% to 59.4% in elderly men. During the same period, the number of elderly women with hypertension increased from 1.18 to 2.70 million, while the number of elderly men with hypertension increased from 0.57 to 1.78 million. Among hypertensive patients, undiagnosed hypertension and diagnosed-but-untreated hypertension were more common in men, while treated-but-uncontrolled hypertension were more common in women. CONCLUSION The fast-growing number of elderly women with hypertension will be an important public health challenge for the Korean society to solve in order to reduce the burden of cardiovascular disease.
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Affiliation(s)
- Eunsun Seo
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sunjae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Public Health, Yonsei University Graduate School, Seoul, Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular diseases, Yonsei University College of Medicine, Seoul, Korea.
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Gusty R, Effendi N, Abdullah KL, Syafrita Y. Association between Knowledge and Self-care Adherence among Elderly Hypertensive Patient in Dwelling Community. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Hypertension contributes significantly to the increase in cardiovascular disease cases, especially in the elderly. Knowledge and self-care compliance are needed, but in reality, awareness and regularity of control are still lacking in hypertensive patients in urban communities.
AIM: The aim of the study was to determine the relationship of knowledge with self-care and get an overview of existing knowledge and self-care in the elderly with hypertension.
METHODS: This is a quantitative and cross-sectional design recruited 383 hypertensive patients in three community health centers. Sampling with proportional random sampling from three health centers that have the highest cases of hypertension in the city of Padang. Knowledge instrument using hypertension knowledge-level scale. Moreover, hypertension self-care adherence using hypertension self-care activity level effects. Analysis using Chi-square test
RESULTS: The sample of this study was 383 respondents. About 66.3% are women, 88.3% have low education, and 86.9% do not work. 51.2% had duration of hypertension 0–5 years and the average age was 60.89 ± 8.072 years. About 94.8% of respondents have poor knowledge. Self-care practice showed 64% non-adherence to medication, 88.5% non-adherence to the DASH diet, and 82.5% non-adherence to weight management. However, 78.6% indicated non-smoking adherence and 100% alcohol avoidance adherence. There was a relationship between knowledge and adherence to weight management (p=0.000; odds ratio [OR] 6.7 (95% confidence interval [CI] for Exp B; 2.65–16.91)) and physical activity (p=0.000; OR 14.99 (95% CI for Exp B; 5.65–39.79)).
CONCLUSION: Providing comprehensive and repeated health education for the elderly with hypertension can increase their knowledge. The involvement of patients and families is needed to improve self-care behavior.
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Hirsch H, Manson JE. Menopausal Symptom Management in Women with Cardiovascular Disease or Vascular Risk Factors. Maturitas 2022; 161:1-6. [DOI: 10.1016/j.maturitas.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 12/19/2022]
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Das M, Verma M, Shri N, Singh M, Singh RR. Relationship between height and hypertension among women in India: Evidence from the fourth round of National Family Health Survey. Diabetes Metab Syndr 2022; 16:102384. [PMID: 35016040 DOI: 10.1016/j.dsx.2021.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Hypertension (HTN) is associated with significant morbidity and mortality, especially among women. Literature suggests an association between height and hypertension. We did this study to ascertain an association between hypertension and height and explore their determinants among Indian women of reproductive age group (15-49 years). METHODS We did a secondary data analysis of the National Family Health Survey-4 (2015-16) and included 5,36,093 women between 20 and 49 years. Blood pressure and height were measured using the standard procedures. Weighted analysis was done to depict the association between the two variables. RESULTS Overall prevalence of HTN was 13.49%. We observed an inverse association between height and mean blood pressure of the women, and shorter women had a higher prevalence of HTN. The height of women was found to be associated with lower systolic blood pressure but not with diastolic blood pressure. Women's height depicted significant associations with age and other socio-economic and geographical parameters. Prevalence of HTN depicted a significant association with height and across other subgroups stratified by these parameters. CONCLUSION We observed a positive association between the systolic BP and the height of the female. Height is one of the most convenient forms of identifying target groups that should not be missed during screening women for NCDs, especially during pregnancy to prevent premature morbidity and mortality. We recommend disseminating this concept to our primary health care workers, who are also the point of first contact for early screening and halt the burden of disease.
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Affiliation(s)
- Milan Das
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India.
| | - Madhur Verma
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Neha Shri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences (IIPS), Mumbai, India.
| | - Mayank Singh
- Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Mumbai, India.
| | - Rajeev Ranjan Singh
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India.
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Crump C, Sundquist J, Sundquist K. Preterm Delivery and Long-term Risk of Hypertension in Women. JAMA Cardiol 2022; 7:65-74. [PMID: 34643643 PMCID: PMC8515256 DOI: 10.1001/jamacardio.2021.4127] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/24/2021] [Indexed: 12/19/2022]
Abstract
Importance Preterm delivery has been associated with future cardiometabolic disorders in women. However, the long-term risks of chronic hypertension associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment, clinical monitoring, and cardiovascular prevention strategies in women. Objective To examine the long-term risks of chronic hypertension associated with preterm delivery in a large population-based cohort of women. Design, Setting, and Participants This national cohort study assessed all 2 195 989 women in Sweden with a singleton delivery from January 1, 1973, to December 31, 2015. Data analyses were conducted from March 8, 2021, to August 20, 2021. Exposures Pregnancy duration identified from nationwide birth records. Main Outcomes and Measures New-onset chronic hypertension identified from primary care, specialty outpatient, and inpatient diagnoses using administrative data. Cox proportional hazards regression was used to compute hazard ratios (HRs) while adjusting for preeclampsia, other hypertensive disorders of pregnancy, and other maternal factors. Cosibling analyses were assessed for potential confounding by shared familial (genetic and/or environmental) factors. Results In 46.1 million person-years of follow-up, 351 189 of 2 195 989 women (16.0%) were diagnosed with hypertension (mean [SD] age, 55.4 [9.9] years). Within 10 years after delivery, the adjusted HR for hypertension associated with preterm delivery (gestational age <37 weeks) was 1.67 (95% CI, 1.61-1.74) and when further stratified was 2.23 (95% CI, 1.98-2.52) for extremely preterm (22-27 weeks of gestation), 1.85 (95% CI, 1.74-1.97) for moderately preterm (28-33 weeks of gestation), 1.55 (95% CI, 1.48-1.63) for late preterm (34-36 weeks of gestation), and 1.26 (95% CI, 1.22-1.30) for early-term (37-38 weeks of gestation) compared with full-term (39-41 weeks of gestation) delivery. These risks decreased but remained significantly elevated at 10 to 19 years (preterm vs full-term delivery: adjusted HR, 1.40; 95% CI, 1.36-1.44), 20 to 29 years (preterm vs full-term delivery: adjusted HR, 1.20; 95% CI, 1.18-1.23), and 30 to 43 years (preterm vs full-term delivery: adjusted HR, 95% CI, 1.12; 1.10-1.14) after delivery. These findings were not explained by shared determinants of preterm delivery and hypertension within families. Conclusions and Relevance In this large national cohort study, preterm delivery was associated with significantly higher future risks of chronic hypertension. These associations remained elevated at least 40 years later and were largely independent of other maternal and shared familial factors. Preterm delivery should be recognized as a lifelong risk factor for hypertension in women.
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Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jan Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Ramezankhani A, Azizi F, Momenan AA, Hadaegh F. Sex Differences in Cumulative Exposure to Metabolic Risk Factors Before Hypertension Onset: The Cohort of the Tehran Lipid and Glucose Study. J Am Heart Assoc 2021; 10:e021922. [PMID: 34779244 PMCID: PMC9075390 DOI: 10.1161/jaha.121.021922] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Previous studies have shown a sex difference in the association between hypertension and cardiovascular disease; however, the precise mechanism remains unclear. Because there are strong associations between metabolic risk factors (MRFs) and hypertension, a sex‐specific analysis of MRFs before hypertension onset could offer new insights and expand our understanding of sex differences in cardiovascular disease. We evaluated cumulative exposure to major MRFs and rate of change of those factors, including body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, triglycerides, and high‐density lipoprotein cholesterol among individuals who did and did not develop hypertension at follow‐up. Methods and Results We included 5374 participants (2191 men) initially without hypertension with age range of 20–50 years at baseline who participated in the Tehran Lipid and Glucose Study, and had been examined at least 3 times during the study period (1999–2018). In both sexes, the cumulative exposure to all MRFs (except for fasting plasma glucose and high‐density lipoprotein cholesterol in men) were higher in those who developed hypertension, compared with those who did not develop hypertension. However, women experienced greater cumulative exposure to major MRFs, compared with their male counterparts. Also, they experienced a faster increase in waist circumference, systolic blood pressure, diastolic blood pressure, and high‐density lipoprotein cholesterol than men. Furthermore, rapid increase in systolic blood pressure began earlier in women than men, at the age of 30 years. We also found that those men who developed hypertension experienced unfavorable change in major MRFs during young adulthood (<50 years of age). Conclusions Women exhibited more metabolic disturbances than men before onset of hypertension, which may explain the stronger impact of hypertension for major types of cardiovascular disease in women, compared with men.
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Affiliation(s)
- Azra Ramezankhani
- 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
| | - Amir Abbas Momenan
- Prevention of Metabolic Disorders 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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Eldahshan W, Sayed MA, Awad ME, Ahmed HA, Gillis E, Althomali W, Pillai B, Alshammari A, Jackson L, Dong G, Sullivan JC, Cooley MA, Elsalanty M, Ergul A, Fagan SC. Stimulation of angiotensin II receptor 2 preserves cognitive function and is associated with an enhanced cerebral vascular density after stroke. Vascul Pharmacol 2021; 141:106904. [PMID: 34481068 PMCID: PMC8612991 DOI: 10.1016/j.vph.2021.106904] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Angiotensin signaling is known to be sexually dimorphic. Although it is a well-studied target for intervention in stroke and cognitive impairment, female studies are rare. With females suffering a disproportionately greater negative impact of stroke and dementia vs. males, effective interventions are of utmost urgency. The aim of the current study was to determine the impact of activation of the angiotensin II type 2 receptor (AT2R) with the agonist compound 21 (C21) on the development of post-stroke cognitive impairment, after experimental ischemic stroke. Ovariectomized (OVX) spontaneously hypertensive rats (SHRs) were subjected to 1 h of middle cerebral artery occlusion (MCAO). At 24 h, rats with a significant neurologic deficit were randomized to receive either saline or C21 (0.03 mg/kg/day) intraperitoneally (IP) for 5 days, then orally (0.12 mg/kg/day) for a total of 6 weeks. Cognitive function, brain structure by MRI and vascular architecture by microCT angiography were measured. C21 preserved cognitive function, specifically spatial memory, and improved vascular density in the ischemic hemisphere at 6 weeks, reflecting both arteriogenesis and angiogenesis. In conclusion, C21 prevented cognitive impairment after stroke, likely through a mechanism involving vascular protection and restoration.
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Affiliation(s)
- Wael Eldahshan
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America; Charlie Norwood VA Medical Center, Augusta University, Augusta, GA, United States of America
| | - Mohammed A Sayed
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America; Charlie Norwood VA Medical Center, Augusta University, Augusta, GA, United States of America
| | - Mohamed E Awad
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Heba A Ahmed
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America
| | - Ellen Gillis
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Waleed Althomali
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America; Charlie Norwood VA Medical Center, Augusta University, Augusta, GA, United States of America
| | - Bindu Pillai
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America; Charlie Norwood VA Medical Center, Augusta University, Augusta, GA, United States of America
| | - Abdulkarim Alshammari
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America; Charlie Norwood VA Medical Center, Augusta University, Augusta, GA, United States of America
| | - Ladonya Jackson
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America; Charlie Norwood VA Medical Center, Augusta University, Augusta, GA, United States of America
| | - Guangkuo Dong
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Jennifer C Sullivan
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Marion A Cooley
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Mohammed Elsalanty
- Department of Medical Anatomical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Medical Sciences, Pomona, CA, United States of America
| | - Adviye Ergul
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States of America; Ralph H. Johnson VA Medical Center, Charleston, SC, United States of America
| | - Susan C Fagan
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, United States of America; Charlie Norwood VA Medical Center, Augusta University, Augusta, GA, United States of America.
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Gerdts E, de Simone G. Hypertension in Women: Should There be a Sex-specific Threshold? Eur Cardiol 2021; 16:e38. [PMID: 34733358 PMCID: PMC8548871 DOI: 10.15420/ecr.2021.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/18/2021] [Indexed: 12/13/2022] Open
Abstract
Conventionally, hypertension is defined by the same blood pressure (BP) threshold (systolic BP ≥140 and/or diastolic BP ≥90 mmHg) in both women and men. Several studies have documented that women with hypertension are more prone to develop BP-associated organ damage and that high BP is a stronger risk factor for cardiovascular disease (CVD) in women than men. While healthy young women have lower BP than men, a steeper increase in BP is found in women from the third decade of life. Studies have documented that the BP-attributable risk for acute coronary syndromes (ACS), heart failure and AF increases at a lower level of BP in women than in men. Even high normal BP (130–139/80–89 mmHg) is associated with an up to twofold higher risk of ACS during midlife in women, but not in men. Whether sex-specific thresholds for definition of hypertension would improve CVD risk detection should be considered in future guidelines for hypertension management and CVD prevention.
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Affiliation(s)
- Eva Gerdts
- Department of Clinical Science, Center for Research on Cardiac Disease in Women, University of Bergen Bergen, Norway
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences and Hypertension Center, Federico II University Naples, Italy
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Trends and age-period-cohort effects on hypertension mortality rates from 1998 to 2018 in Mexico. Sci Rep 2021; 11:17553. [PMID: 34475436 PMCID: PMC8413460 DOI: 10.1038/s41598-021-96175-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/05/2021] [Indexed: 11/08/2022] Open
Abstract
Arterial hypertension is a major global health problem. It is the main risk factor for preventable death and the leading cause of premature death in the world. This study aims to describe the changes in hypertension-related mortality in Mexico between 1998 and 2018. Using death certificates and national population public data sets, a total of 335,863 deaths due to hypertension were found in Mexico, disaggregated by sex and age, during the time period covered in this study. An age-period-cohort analysis was conducted to show trends in hypertension mortality rates. Mortality due to hypertension in Mexico affects more women than men. In the most recent cohorts, the risk of dying from hypertension is two times higher in men compared to women. Hypertensive kidney disease is found to be the main underlying cause, with an average increase throughout the period studied. Our results indicate that mortality rates due to hypertension continue to grow and point to an alarming trend of mortality shifting towards younger ages, with sex-based disparities in absolute numbers and in changing trends.
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Chalwe JM, Mukherjee U, Grobler C, Mbambara SH, Oldewage-Theron W. Association between hypertension, obesity and dietary intake in post-menopausal women from rural Zambian communities. Health SA 2021; 26:1496. [PMID: 34522391 PMCID: PMC8424718 DOI: 10.4102/hsag.v26i0.1496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Amongst the cardiovascular risk (CVR) factors, hypertension (HT) and obesity appear to be prominent in post-menopausal women. The underlying mechanisms of HT development in menopause are not fully understood. AIM To determine the association between HT, obesity and dietary intakes in post-menopausal women from rural Zambia. SETTING This study was conducted in Twatasha Compound of Kitwe and Ndeke Community of Ndola. METHODS Blood pressure (BP), weight, height and dietary intakes (24-h recall) were measured in 153 women (> 50 years) from households. The South African Hypertension Society (SAHS), the World Health Organization (WHO) and estimated average requirements (EARs) guidelines were followed for HT, obesity and dietary intake definitions, respectively. Statistical Package for the Social Sciences (SPSS) version 26 was used for descriptive and inferential statistical analyses. RESULTS Prevalence of HT was 70%, whilst 37.25% and 28.10% of the participants were overweight and obese, respectively. The median interquartile range (IQR) dietary intakes showed inadequate intakes for most nutrients, except for carbohydrates (170 g [133; 225]). The total fat intake represented 14% of total energy intake. All median fatty acid intakes and sodium intakes (409 mg [169; 662]) were below the recommended levels. Only body mass index (BMI) correlated with HT (r = 0.268; p = 0.001). CONCLUSIONS Despite low dietary intakes, an alarming prevalence of HT and obesity was found in our population. Hormonal changes, a high energy-dense diet and poor treatment adherence, may be possible underlying factors. We recommend measures to better manage HT as a CVR factor. CONTRIBUTION This article supplements evidence on the prevalence of obesity-related hypertension in post-menopausal women and the link to dietary intake.
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Affiliation(s)
- Joseph M Chalwe
- Department of Health Sciences, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Upasana Mukherjee
- Department of Nutritional Sciences, Faculty of Human Sciences, Texas Tech University, Lubbock, Texas, United States of America
| | - Christa Grobler
- Department of Health Sciences, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Saidon H Mbambara
- Department of Biomedical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Faculty of Health Sciences, Texas Tech University, Lubbock, Texas, United States of America
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Skeete J, Ramsey E, Battle S, DiPette DJ. Sex-based differences in hypertension: Understanding the trends. J Clin Hypertens (Greenwich) 2021; 23:1129-1132. [PMID: 33605013 PMCID: PMC8678826 DOI: 10.1111/jch.14230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jamario Skeete
- Division of CardiologyDepartment of Internal MedicineRush University Medical CenterChicagoILUSA
| | - Elizabeth Ramsey
- Department of Internal MedicineUniversity of South Carolina and University of South Carolina School of MedicineColumbiaSCUSA
| | - Sean Battle
- Department of Internal MedicineUniversity of South Carolina and University of South Carolina School of MedicineColumbiaSCUSA
| | - Donald J. DiPette
- Department of Internal MedicineUniversity of South Carolina and University of South Carolina School of MedicineColumbiaSCUSA
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Thu WPP, Sundström-Poromaa I, Logan S, Kramer MS, Yong EL. Blood pressure and adiposity in midlife Singaporean women. Hypertens Res 2021; 44:561-570. [PMID: 33420474 DOI: 10.1038/s41440-020-00600-2] [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: 05/26/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/29/2023]
Abstract
Hypertension is a major risk factor for cardiac events and stroke. Visceral adipose tissue (VAT) is known to increase the risk of incident hypertension in adults. Although adiposity has been linked to markers of inflammation, few studies have examined these markers as potential mediators of the association between visceral adiposity and elevated blood pressure. We evaluated sociodemographic, reproductive, and lifestyle risk factors for elevated blood pressure among midlife Singaporean women. A total of 1189 women, with a mean age of 56.3 ± 6.2 years, from the Integrated Women's Health Program (IWHP) at National University Hospital, Singapore were studied. Hypothesized risk factors and levels of inflammatory markers were examined in relation to systolic blood pressure (SBP) and diastolic blood pressure (DBP) using multivariable linear regression models. Prehypertension (SBP 120-139 mmHg and/or DBP 80-89 mmHg) and hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg) were observed in 518 (43.6%) and 313 (26.3%) women, respectively. Compared to women in the lowest tertiles, women in the middle and upper tertiles of VAT had 7.1 (95% CI, 4.4, 9.8) mmHg and 10.2 (95% CI, 6.7, 13.7) mmHg higher adjusted SBP, respectively. Nulliparous older women with a lower education level and those with no or mild hot flashes also had a significantly higher adjusted SBP. No significant independent risk factors were observed for DBP. Adjustments for IL-6, TNF-α, and hs-CRP did not attenuate the association between VAT and SBP. In summary, we found an independent positive association between VAT and SBP. Elevated levels of inflammatory markers did not mediate the increase in SBP in women with high VAT.
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Affiliation(s)
- Win Pa Pa Thu
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Inger Sundström-Poromaa
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.,Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Susan Logan
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.,Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, H3G 1Y6, Canada
| | - Eu-Leong Yong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
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Romão da Silva LDF, de Oliveira Y, de Souza EL, de Luna Freire MO, Braga VDA, Magnani M, de Brito Alves JL. Effects of probiotic therapy on cardio-metabolic parameters and autonomic modulation in hypertensive women: a randomized, triple-blind, placebo-controlled trial. Food Funct 2021; 11:7152-7163. [PMID: 32756643 DOI: 10.1039/d0fo01661f] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS We assessed the effects of probiotic therapy for 8 weeks on cardiometabolic variables and autonomic function in women medically diagnosed with arterial hypertension. METHODS AND RESULTS Forty women with arterial hypertension, 20-50 years, were assigned to two groups in this randomized, triple-blind, placebo-controlled clinical trial. Patients in the probiotic group received a daily sachet containing Lactobacillus para casei LPC-37, Lactobacillus rhamnosus HN001, Lactobacillus acidophilus NCFM, and Bifidobacterium lactis HN019 (109 CFU of each strain) for 8 weeks. Patients in the placebo group received identical sachets with polydextrose (1 g day-1, for 8 weeks). Anthropometric, BP, electrocardiogram, biochemical measurements, fecal microbiota composition, and glucose hydrogen breath test were assessed at baseline and after 8 weeks intervention. Anthropometric variables (weight, BMI, and waist circumference) were similar between the two groups (p > 0.05). Probiotic supplementation significantly reduced fasting glucose (change -10.3 mg dL-1, p < 0.05) and cholesterol levels (change -23.6 mg dL-1, p < 0.05), and increased the HDL-cholesterol (change 6.5 mg dL-1, p < 0.05) compared with the baseline condition. Probiotic supplementation lowered, although without statistical significance, systolic BP by about 5 mmHg and diastolic BP by about 2 mmHg in hypertensive women. Lastly, probiotic administration reduced the low frequency (LF) oscillation and LF/high frequency (HF) ratio (p < 0.05) in the frequency domain of heart rate variability, suggesting an improvement in autonomic modulation. CONCLUSION Probiotic therapy for 8 weeks reduced fasting glucose levels, and improved the lipid profile and autonomic modulation in hypertensive women.
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Affiliation(s)
| | - Yohanna de Oliveira
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
| | - Evandro Leite de Souza
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
| | | | | | - Marciane Magnani
- Department of Food Engineering, Technology Center, Federal University of Paraíba, Joao Pessoa, Brazil
| | - José Luiz de Brito Alves
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
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Acute Blood Pressure Effects in Older Adults with Hypertension After Different Modalities of Exercise: An Experimental Study. J Aging Phys Act 2021; 29:952-958. [PMID: 33863853 DOI: 10.1123/japa.2020-0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/08/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Abstract
This study investigated the acute blood pressure (BP) effects of different exercise modalities in older adults with hypertension. Sixty volunteers were randomly assigned (n = 15/group) into different exercise protocols: resistance, bike, water-based exercise (WE), and a control session-all for ∼45 min. Clinic BP measurements were taken before, immediately after, and 15 and 30 min after protocols. The data were analyzed by one-way analysis of variance; generalized estimating equations, following Bonferroni post hoc (p < .05). Immediately after exercise, the systolic BP (SBP) increased in all exercise protocols (resistance exercise = Δ10.3, bike exercise = Δ5.8, WE = Δ9.5 mmHg; p < .001), while the diastolic BP was not altered. Afterward, the SBP reached the value observed before exercise. In Minute 30, only WE presented a significant reduction for SBP (WE = Δ-4.6 mmHg; p < .05). This study has important clinical implications in hemodynamic safety for acute BP increases immediately after exercises, as well as, in the SBP, reduction benefits for older adults with hypertension.
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Zibara V, Costanian C, Al Haddad N, Kilani H, Tohme F, Aoun Bahous S. Epidemiology and management of hypertension among refugees in the Middle East: a review of the literature. J Hum Hypertens 2021; 35:657-666. [PMID: 33654233 DOI: 10.1038/s41371-021-00508-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/31/2021] [Accepted: 02/05/2021] [Indexed: 11/09/2022]
Abstract
This review aims to explore the burden of hypertension among refugees in the Middle East by reporting its prevalence, risk factors and access to care. A comprehensive literature search was performed using Web of Science, Ovid MEDLINE, PubMed, SCOPUS, CINHAL+, WHO Regional Office for the Eastern Mediterranean (EMRO) and United Nations High Commissioner for Refugees (UNHCR) on articles spanning from 1948 until 2020. Most studies were cross-sectional in design. After applying eligibility criteria 17 articles and 4 reports were included. Findings showed that hypertension represents a major burden among refugees. Hypertension risk factors present among the refugee population included increased salt intake, physical inactivity, and smoking. The majority of hypertensive refugees sought care for their condition at the public health care services. Barriers to seeking care included high cost of healthcare, accessibility to provided services, and lack of knowledge for the need to seek care. Non-adherence to medication among refugees was primarily linked to cost and lack of symptoms. This review highlights the need for further studies to shed light on the importance of targeting hypertension among refugees, to lower morbidity and mortality, in addition to providing adequate healthcare services to this population.
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Affiliation(s)
- Victor Zibara
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Christy Costanian
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Nadia Al Haddad
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Hala Kilani
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Fadi Tohme
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Sola Aoun Bahous
- Department of Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon. .,Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
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38
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Scott-Sheldon LAJ, Gathright EC, Salmoirago-Blother E, Wu WC. Women's participation in stress management interventions for chronic heart failure: a meta-analysis of randomized controlled trials. PSYCHOL HEALTH MED 2021; 27:761-779. [PMID: 33486993 DOI: 10.1080/13548506.2021.1874436] [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: 10/22/2022]
Abstract
Stress management interventions (SMIs) can alleviate the psychosocial stress often experienced by women with heart failure. The purpose of this meta-analysis was to summarize women's participation rates, and predictors of participation, in SMIs for the management of psychosocial distress in women with chronic HF. Studies were retrieved from bibliographic databases, reference sections of relevant papers, and research registries. Included studies (a) evaluated a SMI approach for the management of chronic HF, (b) sampled chronic HF patients, and (c) used a randomized controlled trial (RCT) design. Independent coders extracted the relevant data. Thirty-five RCTs met inclusion criteria (N = 3,649; mean age = 63.5 ± 7.0 years). All studies sampled both men and women; the mean proportion of women who participated in the trials was 38.8% (95% confidence interval [CI] = 34.5-43.4; I2 = 82.4, 95% CI = 81.0-83.6). Women's participation rates were higher in studies sampling more HF patients with hypertension (B = 1.01, SE = 0.45, P = .046) but fewer HF patients prescribed beta blockers (B = -1.10, SE = 0.33, P = .006), F (2,12) = 6.27, P = 0.014, adjusted R2 = 61%. SMIs may offer women a complementary or integrative approach to standard treatment to help manage the psychological distress associated with HF. Future research should explore the potential benefits of offering stress management approaches to women as part of comprehensive HF care.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Emily C Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI
| | - Elena Salmoirago-Blother
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI.,Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Wen-Chih Wu
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI.,Department of Epidemiology, Brown University School of Public Health, Providence, RI.,Chief of Cardiology, Providence VA Medical Center, Providence, RI.,Medical Director, Center for Cardiac Fitness, The Miriam Hospital, Providence, RI, USA
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39
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Brown MA, Roberts L, Hoffman A, Henry A, Mangos G, O'Sullivan A, Pettit F, Youssef G, Xu L, Davis GK. Recognizing Cardiovascular Risk After Preeclampsia: The P4 Study. J Am Heart Assoc 2020; 9:e018604. [PMID: 33170079 PMCID: PMC7763721 DOI: 10.1161/jaha.120.018604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background There is increased risk of hypertension, early cardiovascular disease, and premature mortality in women who have had preeclampsia. This study was undertaken to determine the upper limit of normal blood pressure (BP) 6 months postpartum and the frequency of women with prior preeclampsia who had BP above these limits, as part of the P4 (Post‐Partum Physiology, Psychology and Pediatric) follow‐up study. Methods and Results BP was measured by sphygmomanometer, 24‐hour ambulatory BP monitoring, and non‐invasive central BP at 6 months postpartum in 302 women who had normotensive pregnancy and 90 who had preeclampsia. The upper limit of normal BP (mean+2 SD) for women with normotensive pregnancy was 122/79 mm Hg for routine BP, 115/81 mm Hg for central BP, and 121/78 mm Hg for 24‐hour ambulatory BP monitoring. Traditional normal values detected only 3% of women who had preeclampsia as having high BP 6 months postpartum whereas these new values detected between 13% and 19%. Women with preeclampsia had greater body mass index (27.8 versus 25.0, P<0.001) and left ventricular wall thickness but similar augmentation index. They also had lower high‐density lipoprotein (59±15 versus 65±16 mg/dL, P=0.002), higher triglycerides (77±51 versus 61±35 mg/dL, P=0.005), and higher homeostatic model assessment score (2.1±1.8 versus 1.3±1.9, P<0.001). Conclusions Clinicians wishing to detect high BP in these women should be aware of the lower than usual upper limit of normal for this young cohort and where possible should use 24‐hour ambulatory BP monitoring to detect these changes. This may define a subgroup of women who had preeclampsia for whom targeted BP lowering therapy would be successful. Registration URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365295&isReview=true; Unique identifier: ACTRN12613001260718.
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Affiliation(s)
- Mark A Brown
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia.,Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - Lynne Roberts
- Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia.,Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia
| | - Anna Hoffman
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia
| | - Amanda Henry
- Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia.,School of Women's and Children's Health UNSW Medicine Sydney New South Wales Australia.,The George Institute for Global Health Sydney New South Wales Australia
| | - George Mangos
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia.,Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - Anthony O'Sullivan
- Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - Franziska Pettit
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia.,Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - George Youssef
- Department of Cardiology St George Hospital Sydney New South Wales Australia
| | - Lily Xu
- Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia
| | - Gregory K Davis
- Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia.,School of Women's and Children's Health UNSW Medicine Sydney New South Wales Australia
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40
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Association between flavonoid intake and risk of hypertension in two cohorts of Australian women: a longitudinal study. Eur J Nutr 2020; 60:2507-2519. [PMID: 33161442 DOI: 10.1007/s00394-020-02424-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Epidemiological evidence suggests higher dietary flavonoid intake is associated with lower risk of several chronic diseases. This study aimed to investigate the association between intake of flavonoids and their subclasses, and incidence of hypertension among Australian women in two age cohorts. METHODS This population-based study included 6599 middle-aged (52.5 ± 1.5 years) and 6099 reproductive-aged (27.5 ± 1.5 years) women from the Australian Longitudinal Study on Women's Health. Food frequency questionnaires were used to quantify intake of flavonoids by cross-referencing with the Phenol-Explorer food composition database. Generalised Estimating Equation analyses investigated associations with incident hypertension, adjusting for demographic and dietary variables and hypertension risk factors. RESULTS There were 1645 cases (24.9%) of hypertension during 15 years follow-up in the middle-aged cohort and 336 cases (5.5%) during 12 years follow-up in the reproductive-aged cohort. Higher intakes of flavones [adjusted relative risk (ARR) for quintile 5 vs. 1: 0.82, 95% CI 0.70-0.97], isoflavones (0.86, 0.75-0.99) and flavanones (0.83, 0.69-1.00) were associated with a lower risk of hypertension in the middle-aged cohort. In the reproductive-aged cohort, higher intakes of flavanols (0.70, 0.49-0.99) were associated with a lower risk of hypertension. Key foods that provided these flavonoids were oranges, orange juice, apples, red wine and soy milk. CONCLUSION Higher intakes of total flavonoids and subclasses were associated with a lower risk of hypertension in Australian women. These findings can be used in nutrition messaging and policies for improved cardiovascular health of women.
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41
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Branyan TE, Sohrabji F. Sex differences in stroke co-morbidities. Exp Neurol 2020; 332:113384. [PMID: 32585156 PMCID: PMC7418167 DOI: 10.1016/j.expneurol.2020.113384] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
Males and females possess distinct biological differences that manifest in diverse risk profiles for acute and chronic diseases. A well-documented example of this is ischemic stroke. It has been demonstrated that older females have greater prevalence of, and worse outcome after, ischemic stroke than do males and younger females. Loss of estrogen after menopause is heavily implicated as a contributing factor for this phenomenon; however, there is mounting evidence to suggest that certain risk factors tend to occur more often in older females, such as hypertension and atrial fibrillation, while others more adversely affect females than they do males, such as diabetes and smoking. Sex-specific risk factors, such as oral contraceptive use and menopause, could also contribute to the discrepancy in stroke prevalence and outcome. Additionally, there is evidence to suggest that females tend to present with more nontraditional symptoms of acute stroke than do males, making it more difficult for clinicians to correctly identify the occurrence of a stroke, which may delay the administration of thrombolytic intervention. Finally, certain sociodemographic factors, such as the fact that females were more likely to live alone prior to stroke, may contribute to poorer recovery in females. This review will explore the various co-morbidities and sociodemographic factors that contribute to the greater prevalence of and poorer outcome after stroke in older females and will highlight the critical need for considering sex as a predisposing biological variable in stroke studies.
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Affiliation(s)
- Taylor E Branyan
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M HSC College of Medicine, Bryan, TX 77807, USA; Texas A&M Institute for Neuroscience, College Station, TX 77840, USA
| | - Farida Sohrabji
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M HSC College of Medicine, Bryan, TX 77807, USA; Texas A&M Institute for Neuroscience, College Station, TX 77840, USA.
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42
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Oliveira‐Silva L, Peçanha T, Fecchio RY, Rezende RA, Abreu A, Silva G, Mion‐Junior D, Cipolla‐Neto J, Forjaz CLM, Brito LC. Poor sleep quality is associated with cardiac autonomic dysfunction in treated hypertensive men. J Clin Hypertens (Greenwich) 2020; 22:1484-1490. [PMID: 32741136 PMCID: PMC8029802 DOI: 10.1111/jch.13949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
Hypertensives present cardiac autonomic dysfunction. Reduction in sleep quality increases blood pressure (BP) and favors hypertension development. Previous studies suggested a relationship between cardiovascular autonomic dysfunction and sleep quality, but it is unclear whether this association is present in hypertensives. Thus, this study evaluated the relationship between sleep quality and cardiac autonomic modulation in hypertensives. Forty-seven middle-aged hypertensive men under consistent anti-hypertensive treatment were assessed for sleep quality by the Pittsburgh Sleep Quality Index (PSQI-higher score means worse sleep quality). Additionally, their beat-by-beat BP and heart rate (HR) were recorded, and cardiac autonomic modulation was assessed by their variabilities. Mann-Whitney and t tests were used to compare different sleep quality groups: poor (PSQI > 5, n = 24) vs good (PSQI ≤ 5, n = 23), and Spearman's correlations to investigate associations between sleep quality and autonomic markers. Patients with poor sleep quality presented lower cardiac parasympathetic modulation (HR high-frequency band = 26 ± 13 vs 36 ± 15 nu, P = .03; HR total variance = 951 ± 1373 vs 1608 ± 2272 ms2 , P = .05) and cardiac baroreflex sensitivity (4.5 ± 2.3 vs 7.1 ± 3.7 ms/mm Hg, P = .01). Additionally, sleep quality score presented significant positive correlation with HR (r = +0.34, P = .02) and negative correlations with HR high-frequency band (r = -0.34, P = .03), HR total variance (r = -0.35, P = .02), and cardiac baroreflex sensitivity (r = -0.42, P = .01), showing that poor sleep quality is associated with higher HR and lower cardiac parasympathetic modulation and baroreflex sensitivity. In conclusion, in treated hypertensive men, poor sleep quality is associated with cardiac autonomic dysfunction.
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Affiliation(s)
- Laura Oliveira‐Silva
- Exercise Hemodynamic LaboratorySchool of Physical Education and SportUniversity of São PauloSão PauloBrazil
| | - Tiago Peçanha
- Exercise Hemodynamic LaboratorySchool of Physical Education and SportUniversity of São PauloSão PauloBrazil
| | - Rafael Y. Fecchio
- Exercise Hemodynamic LaboratorySchool of Physical Education and SportUniversity of São PauloSão PauloBrazil
| | - Rafael A. Rezende
- Exercise Hemodynamic LaboratorySchool of Physical Education and SportUniversity of São PauloSão PauloBrazil
| | - Andrea Abreu
- Hypertension UnitGeneral HospitalUniversity of São PauloSão PauloBrazil
| | - Giovânio Silva
- Hypertension UnitGeneral HospitalUniversity of São PauloSão PauloBrazil
| | - Décio Mion‐Junior
- Hypertension UnitGeneral HospitalUniversity of São PauloSão PauloBrazil
| | - José Cipolla‐Neto
- Neurobiology LaboratoryInstitute of Biomedical ScienceUniversity of São PauloSão PauloBrazil
| | - Claudia L. M. Forjaz
- Exercise Hemodynamic LaboratorySchool of Physical Education and SportUniversity of São PauloSão PauloBrazil
| | - Leandro C. Brito
- Exercise Hemodynamic LaboratorySchool of Physical Education and SportUniversity of São PauloSão PauloBrazil
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Still CH, Tahir S, Yarandi HN, Hassan M, Gary FA. Association of Psychosocial Symptoms, Blood Pressure, and Menopausal Status in African-American Women. West J Nurs Res 2020; 42:784-794. [PMID: 32590927 DOI: 10.1177/0193945919898477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
African-American women have disproportionate rates of hypertension that can be further complicated as they transition through menopause. Stress, coupled with depression and hypertension in perimenopausal African-American women has not been fully explored. This study examines the associations of stress, depression, and social support on systolic blood pressure (SBP) among a sample of 184 perimenopausal African-American women. We used descriptive statistics, Pearson's correlation, and logistic regression to analyze data stratified by menopausal status (perimenopausal or menopausal) and SBP status (<130 mmHg vs. >130 mmHg). Women classified as menopausal reported higher levels of stress and depressive symptoms, and lower levels of social support. Age, body mass index (BMI), health insurance, and perceived health status were significant predictors of SBP in menopausal women. Stress, depression, and social support did not play a role in SBP. It is necessary that future research focus on reducing cardiovascular risk include addressing menopausal health.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Sadia Tahir
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Hossein N Yarandi
- College of Nursing, Office of Health Research, Wayne State University, Detroit, MI, USA
| | - Mona Hassan
- College of Nursing, Prairie View A&M University, Houston, TX, USA
| | - Faye A Gary
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Aryan L, Younessi D, Zargari M, Banerjee S, Agopian J, Rahman S, Borna R, Ruffenach G, Umar S, Eghbali M. The Role of Estrogen Receptors in Cardiovascular Disease. Int J Mol Sci 2020; 21:ijms21124314. [PMID: 32560398 PMCID: PMC7352426 DOI: 10.3390/ijms21124314] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular Diseases (CVDs) are the leading cause of death globally. More than 17 million people die worldwide from CVD per year. There is considerable evidence suggesting that estrogen modulates cardiovascular physiology and function in both health and disease, and that it could potentially serve as a cardioprotective agent. The effects of estrogen on cardiovascular function are mediated by nuclear and membrane estrogen receptors (ERs), including estrogen receptor alpha (ERα), estrogen receptor beta (ERβ), and G-protein-coupled ER (GPR30 or GPER). Receptor binding in turn confers pleiotropic effects through both genomic and non-genomic signaling to maintain cardiovascular homeostasis. Each ER has been implicated in multiple pre-clinical cardiovascular disease models. This review will discuss current reports on the underlying molecular mechanisms of the ERs in regulating vascular pathology, with a special emphasis on hypertension, pulmonary hypertension, and atherosclerosis, as well as in regulating cardiac pathology, with a particular emphasis on ischemia/reperfusion injury, heart failure with reduced ejection fraction, and heart failure with preserved ejection fraction.
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45
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Chowdhury MZI, Rahman M, Akter T, Akhter T, Ahmed A, Shovon MA, Farhana Z, Chowdhury N, Turin TC. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clin Hypertens 2020; 26:10. [PMID: 32514373 PMCID: PMC7262759 DOI: 10.1186/s40885-020-00143-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and three-quarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I2 = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.
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Affiliation(s)
- Mohammad Ziaul Islam Chowdhury
- Department of Community Health Sciences, University of Calgary, TRW Building (3rd Floor), 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Meshbahur Rahman
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tanjila Akter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Tania Akhter
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Arifa Ahmed
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Minhajul Arifin Shovon
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Zaki Farhana
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Nashit Chowdhury
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Tanvir C Turin
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
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Wangdi K, Jamtsho T. Prevalence and predisposing factors for self-reported hypertension in Bhutanese adults. Nepal J Epidemiol 2020; 10:830-840. [PMID: 32257513 PMCID: PMC7112958 DOI: 10.3126/nje.v10i1.25466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/10/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Bhutan underwent a nutrition transition in the last two decades. Diet has changed from high-fibre, high carbohydrate and low-fat diets to food with high sugar, fat, salt and processed foods. This is further compounded by a sedentary lifestyle. This paper aims to determine the national prevalence of hypertension and study the associated correlates in Bhutanese adults. Materials and Methods: This study used secondary data from the Bhutan National Health Survey 2012 (NHS, 2012) which was a nationwide survey covering all 20 districts in Bhutan. The dependent variable was self-reported hypertension under medication. Multivariable logistic regression was undertaken to identify independent correlates of hypertension. Results: The national prevalence of hypertension was 17.4% (5,408). Risk factors for hypertension were female sex, increasing age, occupation of armed forces, manager, technician, service and sales worker, machine operator and monks, diabetes, and feeling worried. Being single was negatively correlated with hypertension. In addition, hypertension is negatively associated with the poverty of the district. Conclusion: Hypertension was associated with age, being women, occupation with less physical activity, being worried and having diabetes. The preventive measures both at community and healthcare facility-based through cost-effective strategies should target these covariates.
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Affiliation(s)
- Kinley Wangdi
- Research Fellow, Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia.,Medical Officer, Phuentsholing General Hospital, Phuentsholing, Chukha Bhutan
| | - Tshering Jamtsho
- PhD Student, School of Demography, ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australia
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Mahajan S, Gu J, Caraballo C, Lu Y, Spatz ES, Zhao H, Zhang M, Sun N, Zheng X, Lu H, Yuan H, Ma ZJ, Krumholz HM. Relationship of Age With the Hemodynamic Parameters in Individuals With Elevated Blood Pressure. J Am Geriatr Soc 2020; 68:1520-1528. [PMID: 32212398 DOI: 10.1111/jgs.16411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Age is known to be associated with the prevalence and pathophysiology of hypertension. However, there is little information on whether age stands as a good proxy for the specific hemodynamic profile of an individual with elevated blood pressure (BP), which could be important in the selection of therapy. DESIGN This is a cross-sectional study. SETTING People who underwent a noninvasive, hemodynamic assessment using impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between January 2012 and October 2018. PARTICIPANTS We included 116,851 individuals, aged 20 to 80 years. MAIN OUTCOMES AND MEASURES Relationship between age and hemodynamic parameters (cardiac index, systemic vascular resistance index [SVRI]), among individuals with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg). RESULTS Final study population included 45,082 individuals with elevated BP: 29,194 men and 15,888 women with a mean (±SD) age of 48 (±13) and 54 (±12) years, respectively. Cardiac index was negatively associated with age with an adjusted, per decade decrease of 0.17 (95% confidence interval [CI] = 0.17-0.18) L/min/m2 in men and 0.24 (95% CI = 0.23-0.25) L/min/m2 in women. SVRI was positively associated with age with an adjusted, per-decade increase of 174.2 (95% CI = 168.8-179.7) dynes·s·cm-5 ·m2 in men and 214.1 (95% CI = 204.3-223.8) dynes·s·cm-5 ·m2 in women. However, there was substantial overlap in the distribution of these parameters across different age groups in both sexes. CONCLUSIONS In this large study, we observed that cardiac index decreased and SVRI increased with age among individuals with elevated BP. Even though there was a general trend with age, we observed heterogeneity within age strata, suggesting that age alone is inadequate to indicate the hemodynamic profile for an individual. J Am Geriatr Soc 68:1520-1528, 2020.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jianlei Gu
- Shanghai Jiao Tong University-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, Shanghai, China
| | - Cesar Caraballo
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Hongyu Zhao
- Shanghai Jiao Tong University-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China.,Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
| | - MaoZhen Zhang
- iKang Healthcare Group, Inc, Shanghai, China.,Department of Cardiology, Xinhua Hospital Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - NingLing Sun
- Department of Hypertension at Heart Center, People's Hospital, Peking University, Beijing, China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Lu
- Shanghai Jiao Tong University-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China.,Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Hong Yuan
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zheng J Ma
- Shanghai Jiao Tong University-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China.,Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut.,Beijing Li-Heng Medical Technologies, Ltd, Beijing, China
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Blanken AE, Nation DA. Does Gender Influence the Relationship Between High Blood Pressure and Dementia? Highlighting Areas for Further Investigation. J Alzheimers Dis 2020; 78:23-48. [PMID: 32955459 PMCID: PMC8011824 DOI: 10.3233/jad-200245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gender differences have been noted in studies linking blood pressure to all-cause dementia, and the two most common forms of dementia: Alzheimer's disease (AD) and vascular dementia (VaD). However, how gender modifies the relationship between blood pressure and dementia remains unclear. OBJECTIVE To review evidence for a gender modifying effect on the link between blood pressure and all-cause dementia. METHODS A systematic review was conducted according to PRISMA guidelines. Sixteen out of 256 reviewed articles met inclusion criteria. RESULTS For women, higher midlife systolic blood pressure (SBP) and hypertension were both associated with greater risk of all-cause dementia, AD, and VaD, in six out of seven studies. Two of these studies reported higher midlife SBP/hypertension were associated with greater risk for all-cause dementia in women, but not men. One study reported higher midlife SBP associated with greater AD risk in women, but not men. However, another study reported that midlife hypertension associated with AD risk in men, but not women. No clear gender differences were reported in the relationship between late-life high blood pressure/hypertension with all-cause dementia or AD. CONCLUSION Studies rarely, and inconsistently, analyzed or reported gender effects. Therefore, interpretation of available evidence regarding the role of gender in blood pressure associated dementia was difficult. Several studies indicated higher midlife SBP was associated with greater risk of all-cause dementia for women, compared to men. Future studies should evaluate women-specific aging processes that occur in midlife when considering the association between blood pressure and dementia risk.
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Affiliation(s)
- Anna E. Blanken
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Daniel A. Nation
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA
- Institute for Memory Disorders and Neurological Impairments, University of California Irvine, Irvine, CA, USA
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Oyekale AS. Effect of Obesity and Other Risk Factors on Hypertension among Women of Reproductive Age in Ghana: An Instrumental Variable Probit Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4699. [PMID: 31779087 PMCID: PMC6926784 DOI: 10.3390/ijerph16234699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022]
Abstract
Background: The growing incidence of mortality as a result cardiovascular diseases (CVDs) is a major public health concern in several developing countries. In Ghana, unhealthy food consumption pattern and sedentary lifestyle are promoting overweight and obesity, with significant consequences on the incidence of CVDs. Specifically, hypertension morbidity is now a public health concern among Ghanaian health policy makers. This paper analysed the effect of body mass index (BMI)/arm circumference and other associated factors on hypertension risk among women of reproductive ages in Ghana. Methods: The data were collected as Demographic and Health Survey (DHS) in 2014. This paper analysed the subset of the data that were collected from eligible women 15-49 years of age. The total sample was 9396, while 9367 gave consents to have their blood pressure measured. Data were analysed with instrumental probit regression model with consideration of potential endogeneity of BMI and arm circumference. Results: The results showed that 25% of the women were either overweight or obese, while 13.28% were hypertensive. Women from the Greater Accra (18.15%), Ashanti (15.53%) and Volta (15.02%) regions had the highest incidences of hypertension. BMI and arm circumferences were truly endogenous and positively associated with the probability of being hypertensive. Other factors that influenced hypertension were age of women, region of residence, urban/rural residence, being pregnant, access to medical insurance, currently working, consumption of broth cubes, processed can meats, salted meat and fruits. Conclusion: It was concluded that hypertension risk was positively associated with being overweight, obesity, age and consumption of salted meat.It was inter aliaemphasized that engagement in healthy eating with less consumption of salted meats, and more consumption of fruits would assist in controlling hypertension among Ghanaian women.
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Affiliation(s)
- Abayomi Samuel Oyekale
- Department of Agricultural Economics and Extension, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
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