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Zhu A, Ostbye T, Naheed A, de Silva HA, Jehan I, Gandhi M, Chakma N, Kasturiratne A, Samad Z, Jafar TH. Ambulatory blood pressure levels in individuals with uncontrolled clinic hypertension across Bangladesh, Pakistan, and Sri Lanka. J Clin Hypertens (Greenwich) 2024; 26:391-404. [PMID: 38450866 PMCID: PMC11007786 DOI: 10.1111/jch.14787] [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: 11/20/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
Hypertension is a leading risk factor for cardiovascular disease in South Asia. The authors aimed to assess the cross-country differences in 24-h ambulatory, daytime, and nighttime systolic blood pressure (SBP) among rural population with uncontrolled clinic hypertension in Bangladesh, Pakistan, and Sri Lanka. The authors studied patients with uncontrolled clinic hypertension (clinic BP ≥ 140/90 mmHg) who underwent ambulatory blood pressure monitoring (ABPM) during the baseline assessment as part of a community-based trial. The authors compared the distribution of ABPM profiles of patients across the three countries, specifically evaluating ambulatory SBP levels with multivariable models that adjusted for patient characteristics. Among the 382 patients (mean age, 58.3 years; 64.7% women), 56.5% exhibited ambulatory hypertension (24-h ambulatory BP ≥ 130/80 mmHg), with wide variation across countries: 72.6% (Bangladesh), 50.0% (Pakistan), and 51.0% (Sri Lanka; P < .05). Compared to Sri Lanka, adjusted mean 24-h ambulatory, daytime, and nighttime SBP were higher by 12.24 mmHg (95% CI 4.28-20.20), 11.96 mmHg (3.87-20.06), and 12.76 mmHg (4.51-21.01) in Bangladesh, separately. However, no significant differences were observed between Pakistan and Sri Lanka (P > .05). Additionally, clinic SBP was significantly associated with 24-h ambulatory (mean 0.38, 95% CI 0.28-0.47), daytime (0.37, 0.27-0.47), and nighttime SBP (0.40, 0.29-0.50) per 1 mmHg increase. The authors observed substantial cross-country differences in the distribution of ABPM profiles among patients with uncontrolled clinic hypertension in rural South Asia. The authors findings indicated the need to incorporate 24-h BP monitoring to mitigate cardiovascular risk, particularly in Bangladesh.
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Affiliation(s)
- Anqi Zhu
- Program in Health Services & Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Truls Ostbye
- Duke University Department of Family Medicine and Community HealthDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Aliya Naheed
- Health Systems and Population Studies DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | - H Asita de Silva
- Department of PharmacologyFaculty of MedicineUniversity of KelaniyaRagamaSri Lanka
| | - Imtiaz Jehan
- Department of Community Health ScienceAga Khan UniversityKarachiPakistan
| | - Mihir Gandhi
- BiostatisticsSingapore Clinical Research InstituteSingaporeSingapore
- Centre of Quantitative MedicineDuke‐NUS Medical SchoolSingaporeSingapore
- Tampere Center for Child Health ResearchTampere UniversityTampereFinland
| | - Nantu Chakma
- Health Systems and Population Studies DivisionInternational Centre for Diarrhoeal Disease Research (ICDDR, B)DhakaBangladesh
| | | | - Zainab Samad
- Department of MedicineMedical CollegeAga Khan UniversityKarachiPakistan
| | - Tazeen Hasan Jafar
- Program in Health Services & Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
- Duke Global Health InstituteDurhamNorth CarolinaUSA
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Liu KH, Chang WH, Lai ECC, Tsai PC, Hsu B, Yang YH, Lin WR, Huang TS, Su FY, Chiang JH, Li CY, Tsai YS, Sung JM. Ambient temperature and the occurrence of intradialytic hypotension in patients receiving hemodialysis. Clin Kidney J 2024; 17:sfad304. [PMID: 38213491 PMCID: PMC10783262 DOI: 10.1093/ckj/sfad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Indexed: 01/13/2024] Open
Abstract
Background Intradialytic hypotension (IDH) is a common hemodialysis complication causing adverse outcomes. Despite the well-documented associations of ambient temperatures with fluid removal and pre-dialysis blood pressure (BP), the relationship between ambient temperature and IDH has not been adequately studied. Methods We conducted a cohort study at a tertiary hospital in southern Taiwan between 1 January 2016 and 31 October 2021. The 24-h pre-hemodialysis mean ambient temperature was determined using hourly readings from the weather station closest to each patient's residence. IDH was defined using Fall40 [systolic BP (SBP) drop of ≥40 mmHg] or Nadir90/100 (SBP <100 if pre-dialysis SBP was ≥160, or SBP <90 mmHg). Multivariate logistic regression with generalizing estimating equations and mediation analysis were utilized. Results The study examined 110 400 hemodialysis sessions from 182 patients, finding an IDH prevalence of 11.8% and 10.4% as per the Fall40 and Nadir90/100 criteria, respectively. It revealed a reverse J-shaped relationship between ambient temperature and IDH, with a turning point around 27°C. For temperatures under 27°C, a 4°C drop significantly increased the odds ratio of IDH to 1.292 [95% confidence interval (CI) 1.228 to 1.358] and 1.207 (95% CI 1.149 to 1.268) under the Fall40 and Nadir90/100 definitions, respectively. Lower ambient temperatures correlated with higher ultrafiltration, accounting for about 23% of the increased IDH risk. Stratified seasonal analysis indicated that this relationship was consistent in spring, autumn and winter. Conclusion Lower ambient temperature is significantly associated with an increased risk of IDH below the threshold of 27°C, irrespective of the IDH definition. This study provides further insight into environmental risk factors for IDH in patients undergoing hemodialysis.
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Affiliation(s)
- Kuan-Hung Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hsiang Chang
- Department of Food Safety/ Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Research Center of Environmental Trace Toxic Substances, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chen Tsai
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Bin Hsu
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Hsuan Yang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Shan Huang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fang-Yi Su
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Hsien Chiang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yau-Sheng Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Junne-Ming Sung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Rossios K, Antza C, Kachtsidis V, Kotsis V. The Modern Environment: The New Secondary Cause of Hypertension? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2095. [PMID: 38138198 PMCID: PMC10744418 DOI: 10.3390/medicina59122095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/15/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
The most important risk factor for cardiovascular disease, the leading cause of death worldwide, is hypertension. Although most cases of hypertension are thought to be essential, the multifactorial associations of the environmental influence on blood pressure seem to play an important role and should be more closely investigated. This review attempts to focus on the recent literature that examines the environmental effects on arterial blood pressure and its management. Seasonal variability and the role of ambient temperature, either occupational or recreational noise pollution, as well as obesity due to environment-caused dietary habits, are recognized as important risk factors, affecting the onset as well as the regulation of hypertension. Furthermore, the effects of seasonal fluctuations in blood pressure, noise pollution, and obesity seem to share a similar pathogenesis, and as such to all further react together, leading to increased blood pressure. The activation of the autonomous nervous system plays a key role and causes an increase in stress hormones that generates oxidative stress on the vascular system and, thus, vasoconstriction. In this review, by focusing on the association of the environmental impact with arterial blood pressure, we come to the question of whether most cases of hypertension-if not all-should, indeed, be considered primary or secondary.
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Affiliation(s)
- Konstantinos Rossios
- Cardiology Clinic, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Christina Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
| | - Vasileios Kachtsidis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
| | - Vasilios Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (C.A.); (V.K.)
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Barbosa ECD, Farina GS, Basso CS, Camafort M, Coca A, Nadruz W. Seasonal variation in blood pressure: what is still missing? Front Cardiovasc Med 2023; 10:1233325. [PMID: 37663410 PMCID: PMC10469506 DOI: 10.3389/fcvm.2023.1233325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Seasonal variation of blood pressure (BP) is a topic in cardiology that has gained more attention throughout the years. Although it is extensively documented that BP increases in seasons coupled with lower temperatures, there are still many gaps in this knowledge field that need to be explored. Notably, seasonal variation of BP phenotypes, such as masked and white coat hypertension, and the impact of air pollution, latitude, and altitude on seasonal variation of BP are still poorly described in the literature, and the levels of the existing evidence are low. Therefore, further investigations on these topics are needed to provide robust evidence that can be used in clinical practice.
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Affiliation(s)
- Eduardo Costa Duarte Barbosa
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
- Department of Hypertension and Cardiometabolism, São Francisco Hospital, Santa Casa de Misericórdia de Porto Alegre, Feevale University, Porto Alegre, Brazil
| | - Giovani Schulte Farina
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | - Carolina Souza Basso
- Hypertension Leagueof Porto Alegre, Porto Alegre, Brazil
- School of Medicine, Lutheran University of Brazil, Canoas, Brazil
| | - Miguel Camafort
- Hypertension and Vascular Risk Unit, Hospital Clínic (IDIBAPS), Department of Internal Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic (IDIBAPS), Department of Internal Medicine, University of Barcelona, Barcelona, Spain
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
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Sun Y, Zhang M, Chen S, Zhang W, Zhang Y, Su S, Zhang E, Sun L, Yang K, Wang J, Yue W, Wu Q, Liu R, Yin C. Potential impact of ambient temperature on maternal blood pressure and hypertensive disorders of pregnancy: A nationwide multicenter study based on the China birth cohort. ENVIRONMENTAL RESEARCH 2023; 227:115733. [PMID: 36965789 DOI: 10.1016/j.envres.2023.115733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Limited evidence exists regarding the association between ambient temperature and blood pressure (BP) level of pregnant women. To investigate the associations of ambient temperature with maternal BP and hypertensive disorders of pregnancy (HDP), we studied 105,063 participants in 38 centers of 17 provinces from November 2017 to December 2021. BP was measured with standardized automated digital sphygmomanometers. Ambient temperature was classified into five classes as very hot, moderate hot, mild, moderate cold, and very cold. Generalized linear mixed models were used to investigate the ambient temperature-BP/HDP associations, controlling for multiple covariates. No significant associations of first-trimester ambient temperature with maternal BP and HDP prevalence were observed. Compared with mild temperature, second-trimester very cold and second-trimester moderate cold were statistically associated with the increase of 1.239 mmHg (95% CI: 0.908, 1.569) and 0.428 mmHg (95% CI: 0.099, 0.757) for second-trimester systolic blood pressure (SBP), respectively. Similar trends were also observed in the association between second-trimester cold exposure and second-trimester diastolic blood pressure (DBP), in the association between second-trimester cold exposure and third-trimester SBP/DBP as well as in the association between third-trimester cold exposure and third-trimester SBP/DBP although some estimates were not statistically significant. Furthermore, in the second and third trimester, very cold [second trimester: adjusted odds ratio (aOR) = 1.298; third trimester: aOR = 1.236) and moderate cold (second trimester: aOR = 1.208; third trimester: aOR = 1.146) exposures also increased the odds of HDP, and these associations were stronger among participants aged ≥35 years or from North China. The second and third trimesters are the critical exposure windows for ambient temperature exposure-BP/HDP associations. During this period, exposure to cold ambient temperature was associated with elevated BP as well as increased HDP prevalence among most Chinese pregnant women, those aged ≥35 years or from North China being more vulnerable.
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Affiliation(s)
- Yongqing Sun
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Man Zhang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Shirui Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Yue Zhang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Shaofei Su
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Enjie Zhang
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Lijuan Sun
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Kai Yang
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Jingjing Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Wentao Yue
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Ruixia Liu
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Chenghong Yin
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
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Li Y, Zhao D, Liu G, Liu Y, Bano Y, Ibrohimov A, Chen H, Wu C, Chen X. Intradialytic hypotension prediction using covariance matrix-driven whale optimizer with orthogonal structure-assisted extreme learning machine. Front Neuroinform 2022; 16:956423. [PMID: 36387587 PMCID: PMC9659657 DOI: 10.3389/fninf.2022.956423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/28/2022] [Indexed: 09/19/2023] Open
Abstract
Intradialytic hypotension (IDH) is an adverse event occurred during hemodialysis (HD) sessions with high morbidity and mortality. The key to preventing IDH is predicting its pre-dialysis and administering a proper ultrafiltration prescription. For this purpose, this paper builds a prediction model (bCOWOA-KELM) to predict IDH using indices of blood routine tests. In the study, the orthogonal learning mechanism is applied to the first half of the WOA to improve the search speed and accuracy. The covariance matrix is applied to the second half of the WOA to enhance the ability to get out of local optimum and convergence accuracy. Combining the above two improvement methods, this paper proposes a novel improvement variant (COWOA) for the first time. More, the core of bCOWOA-KELM is that the binary COWOA is utilized to improve the performance of the KELM. In order to verify the comprehensive performance of the study, the paper sets four types of comparison experiments for COWOA based on 30 benchmark functions and a series of prediction experiments for bCOWOA-KELM based on six public datasets and the HD dataset. Finally, the results of the experiments are analyzed separately in this paper. The results of the comparison experiments prove fully that the COWOA is superior to other famous methods. More importantly, the bCOWOA performs better than its peers in feature selection and its accuracy is 92.41%. In addition, bCOWOA improves the accuracy by 0.32% over the second-ranked bSCA and by 3.63% over the worst-ranked bGWO. Therefore, the proposed model can be used for IDH prediction with future applications.
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Affiliation(s)
- Yupeng Li
- College of Computer Science and Technology, Changchun Normal University, Changchun, China
| | - Dong Zhao
- College of Computer Science and Technology, Changchun Normal University, Changchun, China
| | - Guangjie Liu
- College of Computer Science and Technology, Changchun Normal University, Changchun, China
| | - Yi Liu
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yasmeen Bano
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Alisherjon Ibrohimov
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiling Chen
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, China
| | - Chengwen Wu
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, China
| | - Xumin Chen
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou University, Wenzhou, China
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7
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Wu Z, Lan S, Chen C, Zhang X, Zhang Y, Chen S. Seasonal Variation: A Non-negligible Factor Associated With Blood Pressure in Patients Undergoing Hemodialysis. Front Cardiovasc Med 2022; 9:820483. [PMID: 35369290 PMCID: PMC8971928 DOI: 10.3389/fcvm.2022.820483] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate a seasonal variation in blood pressure (BP) for patients undergoing hemodialysis (HD). Methods In this retrospective study, we exported all BP measurements from the information system to investigate a seasonal variation of BP. We also investigated a seasonal variation in BP for patients of different gender types, of different age groups, with diabetic nephropathy (DN), and with non-DN having HD. Multiple linear regression models were used to explore the associations between BP and climatic parameters. Results In 2019, a total of 367 patients had received HD therapy in the Longwen HD unit. We included nearly 40,000 pre-dialysis BP measurements. The result of our study demonstrated a clear seasonal variation in pre-dialysis BP in general patients with HD, in male and female patients, and patients with DN and non-DN. December seemed to be a peak in the values of pre-dialysis systolic BP (SBP) and diastolic BP (DBP). The nadir values of pre-dialysis SBP and DBP were observed in June and July, respectively. A difference between peak and nadir values of BP is 3.81/2.20 mmHg in patients undergoing HD. Maximal seasonal variation in BP is 9.03/5.08 mmHg for patients with DN. A significant association of SBP and DBP with climatic parameters was found in this study. Pre-dialysis BP was inversely correlated with outdoor temperature, daytime length, and relative humidity. Conclusion A clear seasonal variation in BP is observed for patients with HD. Pre-dialysis SBP and DBP are inversely associated with outdoor temperature, daytime length, and relative humidity. The magnitude of a seasonal variation in BP increases in patients with DN.
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Affiliation(s)
- Zhibin Wu
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Shan Lan
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Chengqiang Chen
- Hemodialysis Unit, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Xiuan Zhang
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Yazhen Zhang
- Hemodialysis Unit, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Shanying Chen
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
- *Correspondence: Shanying Chen
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8
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Greenwood SA, Koufaki P, Macdonald JH, Bulley C, Bhandari S, Burton JO, Dasgupta I, Farrington K, Ford I, Kalra PA, Kumwenda M, Macdougall IC, Messow CM, Mitra S, Reid C, Smith AC, Taal MW, Thomson PC, Wheeler DC, White C, Yaqoob M, Mercer TH. Exercise programme to improve quality of life for patients with end-stage kidney disease receiving haemodialysis: the PEDAL RCT. Health Technol Assess 2021; 25:1-52. [PMID: 34156335 PMCID: PMC8256322 DOI: 10.3310/hta25400] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whether or not clinically implementable exercise interventions in haemodialysis patients improve quality of life remains unknown. OBJECTIVES The PEDAL (PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease) trial evaluated the clinical effectiveness and cost-effectiveness of a 6-month intradialytic exercise programme on quality of life compared with usual care for haemodialysis patients. DESIGN We conducted a prospective, multicentre randomised controlled trial of haemodialysis patients from five haemodialysis centres in the UK and randomly assigned them (1 : 1) using a web-based system to (1) intradialytic exercise training plus usual-care maintenance haemodialysis or (2) usual-care maintenance haemodialysis. SETTING The setting was five dialysis units across the UK from 2015 to 2019. PARTICIPANTS The participants were adult patients with end-stage kidney disease who had been receiving haemodialysis therapy for > 1 year. INTERVENTIONS Participants were randomised to receive usual-care maintenance haemodialysis or usual-care maintenance haemodialysis plus intradialytic exercise training. MAIN OUTCOME MEASURES The primary outcome of the study was change in Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score (from baseline to 6 months). Cost-effectiveness was determined using health economic analysis and the EuroQol-5 Dimensions, five-level version. Additional secondary outcomes included quality of life (Kidney Disease Quality of Life Short Form, version 1.3, generic multi-item and burden of kidney disease scales), functional capacity (sit-to-stand 60 and 10-metre Timed Up and Go tests), physiological measures (peak oxygen uptake and arterial stiffness), habitual physical activity levels (measured by the International Physical Activity Questionnaire and Duke Activity Status Index), fear of falling (measured by the Tinetti Falls Efficacy Scale), anthropometric measures (body mass index and waist circumference), clinical measures (including medication use, resting blood pressure, routine biochemistry, hospitalisations) and harms associated with intervention. A nested qualitative study was conducted. RESULTS We randomised 379 participants; 335 patients completed baseline assessments and 243 patients (intervention, n = 127; control, n = 116) completed 6-month assessments. The mean difference in change in physical component summary score from baseline to 6 months between the intervention group and control group was 2.4 arbitrary units (95% confidence interval -0.1 to 4.8 arbitrary units; p = 0.055). Participants in the intervention group had poor compliance (49%) and very poor adherence (18%) to the exercise prescription. The cost of delivering the intervention ranged from £463 to £848 per participant per year. The number of participants with harms was similar in the intervention (n = 69) and control (n = 56) groups. LIMITATIONS Participants could not be blinded to the intervention; however, outcome assessors were blinded to group allocation. CONCLUSIONS On trial completion the primary outcome (Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score) was not statistically improved compared with usual care. The findings suggest that implementation of an intradialytic cycling programme is not an effective intervention to enhance health-related quality of life, as delivered to this cohort of deconditioned patients receiving haemodialysis. FUTURE WORK The benefits of longer interventions, including progressive resistance training, should be confirmed even if extradialytic delivery is required. Future studies also need to evaluate whether or not there are subgroups of patients who may benefit from this type of intervention, and whether or not there is scope to optimise the exercise intervention to improve compliance and clinical effectiveness. TRIAL REGISTRATION Current Controlled Trials ISRCTN83508514. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharlene A Greenwood
- King's College Hospital NHS Foundation Trust, London, UK
- School of Renal Medicine, King's College London, London, UK
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Jamie H Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Catherine Bulley
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | | | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Indranil Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | | | - Iain C Macdougall
- King's College Hospital NHS Foundation Trust, London, UK
- School of Renal Medicine, King's College London, London, UK
| | | | | | - Chante Reid
- King's College Hospital NHS Foundation Trust, London, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Maarten W Taal
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - David C Wheeler
- School of Medicine, University College London, London, UK
- George Institute for Global Health, Sydney, NSW, Australia
| | - Claire White
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Thomas H Mercer
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Hartwig SV, Hacon SDS, Oliveira BFAD, Jacobson LDSV, Sousa RFV, Ignotti E. The effect of ambient temperature on blood pressure of patients undergoing hemodialysis in the Pantanal-Brazil. Heliyon 2021; 7:e07348. [PMID: 34235283 PMCID: PMC8246300 DOI: 10.1016/j.heliyon.2021.e07348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/15/2022] Open
Abstract
The objective was to analyze the association of changes in pre-dialysis systolic and diastolic blood pressure with air temperature in a municipality in the Brazilian Pantanal, a tropical climate area. Longitudinal panel study, with analysis of mixed effects models of 133 hemodialysis patients in the city of Cáceres-Mato Grosso in 2014. Air temperature showed an inverse association with pre-dialysis systolic and diastolic blood pressure. With each increase of 1 °C in the mean air temperature, the pre-dialysis systolic blood pressure decreases -0.730mmHg (p ≤ 0.000) and the pre-dialysis diastolic blood pressure decreases -0.280mmHg (p ≤ 0.000). The estimated effect was greater for systolic blood pressure, but both pre-dialysis blood pressure measures are reduced with an increase in lag (up to two days), even when adjusted for relative air humidity. Air temperature is determinant for changes in pre-dialysis systolic and diastolic blood pressure in hemodialysis patients. The temperature effect was greater for systolic blood pressure than for diastolic blood pressure.
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10
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Li M, Zhao Y, Tian X, Liu P, Xie J, Dong N, Feng J, Gao Y, Fan Y, Qiu Y, Tian F, Yan X. Fluoride Exposure and Blood Pressure: a Systematic Review and Meta-Analysis. Biol Trace Elem Res 2021; 199:925-934. [PMID: 32602052 DOI: 10.1007/s12011-020-02232-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/31/2020] [Indexed: 12/07/2022]
Abstract
Fluoride exposure may cause changes in blood pressure, but this conclusion is controversial. Therefore, this meta-analysis aims to investigate the potential relationship between fluoride exposure and blood pressure or hypertension. PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), WANFANG MED ONLINE, and Chinese Scientific Journals Full-Text Databases (VIP) were searched; in addition, two related studies were added manually. In total, 7 observational studies were identified, the pooled odds ratios (ORs) for hypertension between high and reference fluoride exposure groups were calculated, and the pooled standardized weighted mean difference (SMD) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was estimated using an inverse-variance weighted random-effects model; next, sensitivity analysis and subgroup analysis were used to assess potential sources of heterogeneity; furthermore, publication bias was assessed using the Begg and Egger test. In brief, there were no statistical differences between exposure groups and control groups in terms of blood pressure or hypertension when all included studies considered. However, subgroup analysis indicated that blood pressure will rise with the increase of fluoride exposure concentrations in endemic fluorosis areas. The corresponding pooled SMD estimates were 0.31 (95% CI 0.11, 0.51) and 0.27 (95% CI 0.11, 0.43) for SBP and DBP. Funnel plots suggested no asymmetry. Our findings support the possibility of a positive correlation between fluoride exposure and blood pressure in endemic fluorosis areas. Additional evidence is needed to assess the dose-response relationship between fluoride exposure and blood pressure.
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Affiliation(s)
- Meng Li
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Yannan Zhao
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xiaolin Tian
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Ecological Animal Science and Environmental Veterinary Medicine, Shanxi Agricultural University, Taigu, 030801, Shanxi, China
| | - Penghui Liu
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Jiaxin Xie
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Nisha Dong
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Jing Feng
- Shanxi Key Laboratory of Experimental Animal and Human Disease Animal Models, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Yi Gao
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Ye Fan
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Yulan Qiu
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Fengjie Tian
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xiaoyan Yan
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
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11
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Ilic Begovic T, Radic J, Radic M, Modun D, Seselja-Perisin A, Tandara L. Seasonal variations in nutritional status and oxidative stress in patients on hemodialysis: Are they related? Nutrition 2021; 89:111205. [PMID: 33836426 DOI: 10.1016/j.nut.2021.111205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/31/2021] [Accepted: 02/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Seasonal variations in body composition and parameters that reflect nutritional status are well established in patients on hemodialysis (HD). However, to our knowledge, no study has assessed the changes in oxidative stress (OS). The aims of this study were to assess seasonal variations in OS, body composition, and other nutritional parameters. METHODS Seasonal variations in fat tissue mass (FTM), fat tissue index (FTI), adipose tissue mass (ATM), lean tissue mass (LTM), lean tissue index (LTI), body cell mass (BCM), overhydration (OH) volume, and OS (blood levels of derivatives of reactive oxygen metabolites [d-ROMs], thiobarbituric reactive substances, plasma protein reduced thiol content [THIOLS], and ferric reducing ability of plasma) were assessed in 45 patients on HD, 70 y of age (60.5-76.5 y). RESULTS FTM (P < 0.001), FTI (P < 0.001), and ATM (P < 0.001) significantly increased, whereas LTI (P < 0.001), LTM (P < 0.001), BCM (P < 0.001), and OH volume (P = 0.004) significantly decreased over the season. Additionally, significant seasonal variations in the levels of d-ROMs (P = 0.02) and THIOLS (P = 0.02) were found. Levels of d-ROMs were found to be a significant predictor of LTM and BCM (β = -0.57; 95% confidence interval [CI], -1.08 to -0.06; P = 0.03; β = -0.04; 95% CI, -0.075 to -0.006; P = 0.02). Furthermore, hip circumference was found to be the most significant predictor of the level of d-ROMs (β = 2.66; 95% CI; 0.28-5.04; P = 0.03) and waist-to-height ratio (β = 251; 95% CI, 16.6-477.2; P = 0.03) and serum prealbumin levels of THIOLS (β = 263; 95% CI, 6.8-521.1; P = 0.04). CONCLUSION These results suggest seasonal variations in OS in patients on HD and a possible interaction between OS and nutritional status in these patients.
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Affiliation(s)
- Tanja Ilic Begovic
- Intensive Care Unit of the Department of Internal Medicine, University Hospital Centre Split, Split, Croatia
| | - Josipa Radic
- Division of Nephrology and Dialysis, University Hospital Centre Split, University of Split School of Medicine, Split, Croatia; Department of Internal medicine, University of Split, School of Medicine, Split, Croatia.
| | - Mislav Radic
- Department of Internal medicine, University of Split, School of Medicine, Split, Croatia; Division of Rheumatology and Clinical Immunology, University Hospital Centre Split, University of Split School of Medicine, Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ana Seselja-Perisin
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Leida Tandara
- Department of Medical Laboratory Diagnostic, University Hospital Centre Split, Split, Croatia
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12
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Greenwood SA, Koufaki P, Macdonald J, Bhandari S, Burton J, Dasgupta I, Farrington K, Ford I, Kalra PA, Kean S, Kumwenda M, Macdougall IC, Messow CM, Mitra S, Reid C, Smith AC, Taal MW, Thomson PC, Wheeler DC, White C, Yaqoob M, Mercer TH. The PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease trial: study design and baseline data for a multicentre randomized controlled trial. Clin Kidney J 2020; 14:1345-1355. [PMID: 33959264 PMCID: PMC8087141 DOI: 10.1093/ckj/sfaa107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background Exercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK. Methods We conducted a prospective, pragmatic multicentre randomized controlled trial in 335 HD patients and randomly (1:1) assigned them to either (i) intradialytic exercise training plus usual care maintenance HD or (ii) usual care maintenance HD. The primary outcome of the study was the change in Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3) Physical Component Score between baseline and 6 months. Additional secondary outcomes included changes in peak aerobic capacity, physical fitness, habitual physical activity levels and falls (International Physical Activity Questionnaire, Duke’s Activity Status Index and Tinetti Falls Efficacy Scale), QOL and symptom burden assessments (EQ5D), arterial stiffness (pulse wave velocity), anthropometric measures, resting blood pressure, clinical chemistry, safety and harms associated with the intervention, hospitalizations and cost-effectiveness. A nested qualitative study investigated the experience and acceptability of the intervention for both participants and members of the renal health care team. Results At baseline assessment, 62.4% of the randomized cohort were male, the median age was 59.3 years and 50.4% were white. Prior cerebrovascular events and myocardial infarction were present in 8 and 12% of the cohort, respectively, 77.9% of patients had hypertension and 39.4% had diabetes. Baseline clinical characteristics and laboratory data for the randomized cohort were generally concordant with data from the UK Renal Registry. Conclusion The results from this study will address a significant knowledge gap in the prescription of exercise interventions for patients receiving maintenance HD therapy and inform the development of intradialytic exercise programmes both nationally and internationally. Trial Registration ISRCTN N83508514; registered on 17 December 2014.
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Affiliation(s)
- Sharlene A Greenwood
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK.,Department of Renal Medicine, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Pelagia Koufaki
- School of Health Sciences, Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
| | - Jamie Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James Burton
- Department of Renal Medicine, University of Leicester, Leicester, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal Hospital, Salford, UK
| | - Sharon Kean
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Mick Kumwenda
- Department of Renal Medicine, Glan Clwyd Hospital, Rhyl, Wales, UK
| | - Iain C Macdougall
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK.,Department of Renal Medicine, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Sandip Mitra
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Chante Reid
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Alice C Smith
- Department of Renal Medicine, University of Leicester, Leicester, UK
| | - Maarten W Taal
- Department of Renal Medicine, University of Nottingham, Nottingham, UK
| | - Peter C Thomson
- Department of Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, UK.,Department of Renal Medicine, The George Institute for Global Health, Newtown, NSW, Australia
| | - Claire White
- Department of Renal Medicine, King's College Hospital NHS Trust, London, UK
| | - Magdi Yaqoob
- Department of Renal Medicine, The Royal London Hospital, London, UK
| | - Thomas H Mercer
- School of Health Sciences, Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
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13
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Weller RB, Wang Y, He J, Maddux FW, Usvyat L, Zhang H, Feelisch M, Kotanko P. Does Incident Solar Ultraviolet Radiation Lower Blood Pressure? J Am Heart Assoc 2020; 9:e013837. [PMID: 32106744 PMCID: PMC7335547 DOI: 10.1161/jaha.119.013837] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
Background Hypertension remains a leading global cause for premature death and disease. Most treatment guidelines emphasize the importance of risk factors, but not all are known, modifiable, or easily avoided. Population blood pressure correlates with latitude and is lower in summer than winter. Seasonal variations in sunlight exposure account for these differences, with temperature believed to be the main contributor. Recent research indicates that UV light enhances nitric oxide availability by mobilizing storage forms in the skin, suggesting incident solar UV radiation may lower blood pressure. We tested this hypothesis by exploring the association between environmental UV exposure and systolic blood pressure (SBP) in a large cohort of chronic hemodialysis patients in whom SBP is determined regularly. Methods and Results We studied 342 457 patients (36% black, 64% white) at 2178 US dialysis centers over 3 years. Incident UV radiation and temperature data for each clinic location were retrieved from the National Oceanic and Atmospheric Administration database. Linear mixed effects models with adjustment for ambient temperature, sex/age, body mass index, serum Na+/K+ and other covariates were fitted to each location and combined estimates of associations calculated using the DerSimonian and Laird procedure. Pre-dialysis SBP varied by season and was ≈4 mm Hg higher in black patients. Temperature, UVA and UVB were all linearly and inversely associated with SBP. This relationship remained statistically significant after correcting for temperature. Conclusions In hemodialysis patients, in addition to environmental temperature, incident solar UV radiation is associated with lower SBP. This raises the possibility that insufficient sunlight is a new risk factor for hypertension, perhaps even in the general population.
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Affiliation(s)
- Richard B. Weller
- Center for Inflammation ResearchUniversity of EdinburghUnited Kingdom
| | - Yuedong Wang
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | - Jingyi He
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | | | - Len Usvyat
- Integrated Care AnalyticsFresenius Medical Care North AmericaWalthamMA
| | | | - Martin Feelisch
- Clinical & Experimental SciencesFaculty of Medicine, and Institute for Life SciencesSouthampton General HospitalUniversity of SouthamptonUnited Kingdom
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14
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Terner Z, Long A, Reviriego-Mendoza M, Larkin JW, Usvyat LA, Kotanko P, Maddux FW, Wang Y. Seasonal and Secular Trends of Cardiovascular, Nutritional, and Inflammatory Markers in Patients on Hemodialysis. KIDNEY360 2020; 1:93-105. [PMID: 35372910 PMCID: PMC8809101 DOI: 10.34067/kid.0000352019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/13/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND All life on earth has adapted to the effects of changing seasons. The general and ESKD populations exhibit seasonal rhythms in physiology and outcomes. The ESKD population also shows secular trends over calendar time that can convolute the influences of seasonal variations. We conducted an analysis that simultaneously considered both seasonality and calendar time to isolate these trends for cardiovascular, nutrition, and inflammation markers. METHODS We used data from adult patients on hemodialysis (HD) in the United States from 2010 through 2014. An additive model accounted for variations over both calendar time and time on dialysis. Calendar time trends were decomposed into seasonal and secular trends. Bootstrap procedures and likelihood ratio methods tested if seasonal and secular variations exist. RESULTS We analyzed data from 354,176 patients on HD at 2436 clinics. Patients were 59±15 years old, 57% were men, and 61% had diabetes. Isolated average secular trends showed decreases in pre-HD systolic BP (pre-SBP) of 2.6 mm Hg (95% CI, 2.4 to 2.8) and interdialytic weight gain (IDWG) of 0.35 kg (95% CI, 0.33 to 0.36) yet increases in post-HD weight of 2.76 kg (95% CI, 2.58 to 2.97). We found independent seasonal variations of 3.3 mm Hg (95% CI, 3.1 to 3.5) for pre-SBP, 0.19 kg (95% CI, 0.17 to 0.20) for IDWG, and 0.62 kg (95% CI, 0.46 to 0.79) for post-HD weight as well as 0.12 L (95% CI, 0.11 to 0.14) for ultrafiltration volume, 0.41 ml/kg per hour (95% CI, 0.37 to 0.45) for ultrafiltration rates, and 3.30 (95% CI, 2.90 to 3.77) hospital days per patient year, which were higher in winter versus summer. CONCLUSIONS Patients on HD show marked seasonal variability of key indicators. Secular trends indicate decreasing BP and IDWG and increasing post-HD weight. These methods will be of importance for independently determining seasonal and secular trends in future assessments of population health.
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Affiliation(s)
- Zachary Terner
- Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, California
| | - Andrew Long
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | | | - John W. Larkin
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | - Len A. Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, New York; and
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | | | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, California
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15
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Kang Y, Han Y, Guan T, Wang X, Xue T, Chen Z, Jiang L, Zhang L, Zheng C, Wang Z, Gao R. Clinical blood pressure responses to daily ambient temperature exposure in China: An analysis based on a representative nationwide population. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 705:135762. [PMID: 31818583 DOI: 10.1016/j.scitotenv.2019.135762] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/03/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Limited evidence is available regarding the potential heterogeneity of ambient temperature on blood pressure (BP) in various climate zones. OBJECTIVES To explore the effect of daily ambient temperature on BP in various climate zones across 31 provinces in China. METHODS A representative population sample (n = 451,770) were obtained from the China Hypertension Survey study (CHS) from October 2012 to December 2015. Survey seasons were divided into warm and cold seasons. Survey sites were divided into three climate zones as subtropical, temperate monsoon and temperate continental zones. RESULTS After adjustment for confounders, an overall 10 °C decrease in ambient temperature was statistically associated 0.74 mmHg (95% CI: 0.69, 0.79) and 0.60 mmHg (95% CI: -0.63, -0.57) rise for SBP and DBP, respectively. In the warm season, U-shaped exposure-response curves were observed between ambient temperature and BP in temperate monsoon and continental zones, and liner curves in other zones. A greater SBP change due to a lower temperature was observed in subtropical zones, so did DBP in temperate continental zones, especially for cold season. Female, rural and elderly populations were more susceptible to cold weather than their counterparts. DISCUSSION There is a geographical disparity between temperature and BP across different climate zones, which should been taken into consideration when maintaining stable blood pressure levels.
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Affiliation(s)
- Yuting Kang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Ying Han
- Department of Cadre Health, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Tianjia Guan
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Tao Xue
- Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Linlin Jiang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102308, China.
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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16
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Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2020; 38:1235-1243. [DOI: 10.1097/hjh.0000000000002341] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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17
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Alencar de Pinho N, Levin A, Fukagawa M, Hoy WE, Pecoits-Filho R, Reichel H, Robinson B, Kitiyakara C, Wang J, Eckardt KU, Jha V, Oh KH, Sola L, Eder S, de Borst M, Taal M, Feldman HI, Stengel B. Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease. Kidney Int 2019; 96:983-994. [PMID: 31358344 DOI: 10.1016/j.kint.2019.04.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.
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Affiliation(s)
- Natalia Alencar de Pinho
- Renal and Cardiovascular Epidemiology Team, Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM U1018, Villejuif, France
| | - Adeera Levin
- BC Renal Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | - Masafumi Fukagawa
- Division of Nephrology and Kidney Center, Tokai University School of Medicine, Isehara, Japan
| | - Wendy E Hoy
- Centre for Chronic Disease, Faculty of Medicine, University of Queensland, Queensland, Australia
| | | | | | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jinwei Wang
- Renal Division, Peking University Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité, Universitätsmedizin Berlin, Berlin, Germany; Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Laura Sola
- NRHP-URU, Centro de Dialisis CASMU, Montevideo, Uruguay
| | - Susanne Eder
- Department of Internal Medicine IV, Nephrology and Hypertension, Innsbruck Medical University, Innsbruck, Austria
| | - Martin de Borst
- Division of Nephrology, Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten Taal
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Harold I Feldman
- Departments of Biostatistics and Epidemiology, and Medicine and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bénédicte Stengel
- Renal and Cardiovascular Epidemiology Team, Paris Saclay University, Paris-Sud Univ, UVSQ, CESP, INSERM U1018, Villejuif, France.
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18
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Macdougall IC, White C, Anker SD, Bhandari S, Farrington K, Kalra PA, McMurray JJ, Murray H, Steenkamp R, Tomson CR, Wheeler DC, Winearls CG, Ford I. Randomized Trial Comparing Proactive, High-Dose versus Reactive, Low-Dose Intravenous Iron Supplementation in Hemodialysis (PIVOTAL): Study Design and Baseline Data. Am J Nephrol 2018; 48:260-268. [PMID: 30304714 PMCID: PMC6262676 DOI: 10.1159/000493551] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intravenous (IV) iron supplementation is a standard maintenance treatment for hemodialysis (HD) patients, but the optimum dosing regimen is unknown. METHODS PIVOTAL (Proactive IV irOn Therapy in hemodiALysis patients) is a multicenter, open-label, blinded endpoint, randomized controlled (PROBE) trial. Incident HD adults with a serum ferritin < 400 µg/L and transferrin saturation (TSAT) levels < 30% receiving erythropoiesis-stimulating agents (ESA) were eligible. Enrolled patients were randomized to a proactive, high-dose IV iron arm (iron sucrose 400 mg/month unless ferritin > 700 µg/L and/or TSAT ≥40%) or a reactive, low-dose IV iron arm (iron sucrose administered if ferritin <200 µg/L or TSAT < 20%). We hypothesized that proactive, high-dose IV iron would be noninferior to reactive, low-dose IV iron for the primary outcome of first occurrence of nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for heart failure or death from any cause. If noninferiority is confirmed with a noninferiority limit of 1.25 for the hazard ratio of the proactive strategy relative to the reactive strategy, a test for superiority will be carried out. Secondary outcomes include infection-related endpoints, ESA dose requirements, and quality-of-life measures. As an event-driven trial, the study will continue until at least 631 primary outcome events have accrued, but the expected duration of follow-up is 2-4 years. RESULTS Of the 2,589 patients screened across 50 UK sites, 2,141 (83%) were randomized. At baseline, 65.3% were male, the median age was 65 years, and 79% were white. According to eligibility criteria, all patients were on ESA at screening. Prior stroke and MI were present in 8 and 9% of the cohort, respectively, and 44% of patients had diabetes at baseline. Baseline data for the randomized cohort were generally concordant with recent data from the UK Renal Registry. CONCLUSIONS PIVOTAL will provide important information about the optimum dosing of IV iron in HD patients representative of usual clinical practice. TRIAL REGISTRATION EudraCT number: 2013-002267-25.
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MESH Headings
- Administration, Intravenous
- Aged
- Anemia, Iron-Deficiency/blood
- Anemia, Iron-Deficiency/drug therapy
- Anemia, Iron-Deficiency/etiology
- Dose-Response Relationship, Drug
- Female
- Ferric Oxide, Saccharated/administration & dosage
- Ferric Oxide, Saccharated/adverse effects
- Ferritins/blood
- Follow-Up Studies
- Hematinics/administration & dosage
- Hematinics/adverse effects
- Humans
- Kidney Failure, Chronic/blood
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Prospective Studies
- Renal Dialysis/adverse effects
- Thrombosis/chemically induced
- Thrombosis/epidemiology
- Treatment Outcome
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Affiliation(s)
- Iain C. Macdougall
- Department of Renal Medicine, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Claire White
- Department of Renal Medicine, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sunil Bhandari
- Hull and East Yorkshire Hospitals and Hull York Medical School, Hull, United Kingdom
| | - Kenneth Farrington
- Lister Hospital, Stevenage, United Kingdom
- University of Hertfordshire, Hertfordshire, United Kingdom
| | | | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Heather Murray
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Retha Steenkamp
- UK Renal Registry, Southmead Hospital, Bristol, United Kingdom
| | | | | | - Christopher G. Winearls
- Oxford Kidney Unit, The Churchill, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
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Echoes from Gaea, Poseidon, Hephaestus, and Prometheus: environmental risk factors for high blood pressure. J Hum Hypertens 2018; 32:594-607. [PMID: 29899375 DOI: 10.1038/s41371-018-0078-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022]
Abstract
High blood pressure (BP) affects over one billion people and is the leading risk factor for global mortality. While many lifestyle and genetic risk factors are well-accepted to increase BP, the role of the external environment is typically overlooked. Mounting evidence now supports that numerous environmental factors can promote an elevation in BP. Broadly speaking these include aspects of the natural environment (e.g., cold temperatures, higher altitude, and winter season), natural disasters (e.g., earthquakes, volcanic eruptions), and man-made exposures (e.g., noise, air pollutants, and toxins/chemicals). This is important for health care providers to recognize as one (or several) of these environmental factors could be playing a clinically meaningful role in elevating BP or disrupting hypertension control among their patients. At the population level, certain environmental exposures may even be contributing to the growing pandemic of hypertension. Here we provide an updated review of the literature linking environment exposures with high BP and outline practical recommendations for clinicians.
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