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Qi Z, Tang S, Hao Y, Li Y, Hao T, Yang H, Shen Y, Huang L, Tian M, Feng X, Li Z. Effect of salt substitute and antihypertensive medications among high cardiovascular risk patients: A sub-study of Salt Substitute and Stroke Study (SSaSS). J Clin Hypertens (Greenwich) 2024. [PMID: 39012269 DOI: 10.1111/jch.14872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024]
Abstract
The relationship between the differential protective effect of salt substitute between hypertensive and normotensive individuals and the use of cardiovascular medications remains unclear. This study involved 4211 individuals with a history of stroke or hypertension who participated in the Salt Substitute and Stroke Study (SSaSS) from 120 villages in Shanxi Province. The aim of this study was to investigate the differences in major adverse cardiovascular events and blood pressure changes between the salt substitute and the regular salt group in the subgroups of participants taking different antihypertensive medications. Mixed models were employed and adjusted for the cluster effect (village) and potential confounding variables. During the average follow-up period of 4.66 years, a significantly protective effect of salt substitute on reducing the risk of cardiovascular events was observed in the participants who taking antihypertensive medications (rate ratio: 0.81, 95% CI: 0.68 to 0.95. p = 0.011), whereas no significant effect in participants not taking antihypertensive medications (rate ratio: 0.91, 95% CI: 0.62 to 1.32, p = 0.612). Significant effects to lower systolic blood pressure of the salt substitutes were observed in the participants who took different antihypertensive medications. This study emphasized that the use of salt substitutes might enhance the efficacy of anti-hypertensive medications in lowering blood pressure and reducing the risk of adverse cardiovascular events.
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Affiliation(s)
- Zijing Qi
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Shuai Tang
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yubing Hao
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yanxing Li
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Tianyou Hao
- Department of Prevention and Health Care, Affiliated Heping Hospital of Changzhi Medical College, Changzhi, China
| | - Hongmei Yang
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, China
| | - Yijing Shen
- School of Medical Board, Shanxi Datong University, Datong, China
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Xiangxian Feng
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, China
| | - Zhifang Li
- School of Public Health, Shanxi Medical University, Taiyuan, China
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, China
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Mupfuti R, Kabudula C, Francis J. The Association Between Alcohol Use and Chronic Diseases' Treatment Outcomes Among Adults Aged 40 Years and Above in Rural South Africa. RESEARCH SQUARE 2024:rs.3.rs-3385716. [PMID: 38463992 PMCID: PMC10925412 DOI: 10.21203/rs.3.rs-3385716/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Chronic diseases are significant problems in South Africa. Chronic diseases' treatment outcomes are critical to the reduction of morbidity and mortality. There is limited data in South Africa on alcohol use and treatment outcomes of chronic diseases in older people. We analysed data from wave 1 of the Health and Ageing in Africa-a longitudinal Study in an INDEPTH community (HAALSI) study. We performed descriptive analysis to determine the prevalence of optimal chronic diseases' treatment outcomes (suppressed HIV viral load, normal blood pressure and normal blood sugar) and applied multivariate modified Poisson regression to determine the association between alcohol use and chronic diseases' treatment outcomes. The prevalence of optimal treatment outcomes were 87.4% for HIV, 42.7% for hypertension, 53.6% for diabetes mellitus and 52.4% for multimorbidity. Alcohol use did not negatively impact the treatment outcomes for HIV (aRR=1.00, 95%CI:0.93-1.09), hypertension (aRR=0.88, 95%CI:0.68-1.14), diabetes mellitus (aRR=0.73, 95%CI:0.44-1.22), and multimorbidity (aRR=1.00, 95%CI:0.93-1.09). Alcohol use was not significantly associated with treatment outcomes possibly due to underreporting of alcohol use. There is need to incorporate objective alcohol measurements in chronic diseases care settings. Furthermore, there is urgent need to strengthen the management of hypertension and diabetes, by adopting the strategies deployed for HIV management.
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Tam HL, Chung SF, Wang Q. Urban-rural disparities in hypertension management among middle-aged and older patients: Results of a 2018 Chinese national study. Chronic Illn 2023; 19:581-590. [PMID: 35603631 DOI: 10.1177/17423953221102627] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hypertension is a well-known global risk factor associated with significant morbidity and mortality. Medication use and urban-rural disparities in medication usage patterns affect hypertension management. We investigated patient characteristics across different geographical areas to determine factors that affect medication use among Chinese patients aged ≥ 45 years, diagnosed with hypertension. METHODS Data were extracted from the China Health and Retirement Longitudinal Study 2018. We recorded differences in medication use, advice from healthcare providers, and health-related behaviors between urban and rural areas. RESULTS The study included 2115 patients with hypertension (mean age 62.06 years). Advice received and medication use were significantly lower in patients from rural areas than in those from urban areas. Our findings showed that urban residence, comorbidities, advice regarding lifestyle changes, and smoking were positive predictors of medication use, whereas alcohol consumption and regular exercise reduced the likelihood of medication use. DISCUSSION We observed urban-rural disparities in hypertension management, and several strategies, including distribution of reminders and written materials can be integrated into current clinical practice to improve the rate of medication use among rural residents with hypertension.
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Affiliation(s)
- Hon Lon Tam
- Kiang Wu Nursing College of Macau, Macau, China
| | | | - Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, China
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Tam HL, Leung LYL, Chan ASW. Effectiveness of Tai Chi in Patients With Hypertension: An Overview of Meta-analyses. J Cardiovasc Nurs 2023; 38:443-453. [PMID: 35507028 DOI: 10.1097/jcn.0000000000000921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension affects more than 1 billion people worldwide. Hypertension management guidelines recommend regular exercise to control blood pressure. Tai Chi is a low-impact, low- to moderate-intensity exercise that has numerous health benefits. OBJECTIVE The aim of this study is to perform a review of meta-analyses and summarize the existing information on the health benefits of Tai Chi for patients with hypertension. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Eight health-related databases were systematically searched from their inception to March 2021 to identify the relevant meta-analyses. Two reviewers independently assessed the methodological quality of the evidence. RESULTS A total of 6 relevant meta-analyses were included in this review: 3 were rated as critically low in quality, 2 were rated low, and 1 was rated high. In the included meta-analyses, Tai Chi showed many benefits for patients with hypertension. In addition to improving blood pressure, the blood lipid profile, blood sugar, body measurements, and quality of life of patients improved significantly after practicing Tai Chi. CONCLUSION Tai Chi may be considered an effective and safe alternative exercise for patients with hypertension.
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Desjardins C, Cyrenne-Dussault M, Barbier O, Bélanger A, Gangloff A, Guénette L, Leclerc J, Lefebvre J, Zongo A, Drouin-Chartier JP. Are Lipid-Lowering and Antihypertensive Medications Used as Complements to Heart-Healthy Diets? A Scoping Review. Adv Nutr 2023; 14:870-884. [PMID: 37121468 PMCID: PMC10334141 DOI: 10.1016/j.advnut.2023.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/06/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023] Open
Abstract
In cardiovascular disease (CVD) prevention, whether antihypertensive and lipid-lowering medications are used as complements to heart-healthy diets has not been thoroughly assessed. This scoping review aimed to 1) analyze observational studies that assessed the relationship between diet and antihypertensive/lipid-lowering medication use and 2) evaluate whether medication was used as a complement to heart-healthy dietary intakes. We searched MEDLINE, Embase, Web of Science, and CINAHL through 14 January, 2023, for studies that assessed either 1) intraindividual changes in diet associated with lipid-lowering/antihypertensive medication initiation or use or 2) interindividual differences in diet between users and nonusers of these medications. A total of 17 studies were included. Of those, 3 prospectively assessed the intraindividual changes in diet associated with medication initiation or use, but none documented potential changes in diet prior to medication initiation. The 14 other studies compared dietary intakes of medication users and nonusers, most of which also relied on an incomplete assessment of the temporal dynamics between diet and medication use as they employed cross-sectional (n = 12) or repeated cross-sectional (n = 2) designs. Data from 8 studies, including 4 of the 5 studies from Europe, suggested that medication was used as a complement to heart-healthy diets, whereas data from the 9 other studies, including the 4 conducted in the United States, provided no such evidence, indicating potential between-country differences in this relationship. Finally, no studies investigated how the dynamics between diet and medication use influenced the long-term CVD risk. This scoping review suggests that the current literature on the relationship between lipid-lowering/antihypertensive medication use and diet provides an incomplete perspective on how medication may influence diet in CVD prevention. Prospective studies assessing intraindividual changes in diet associated with medication initiation and use and how these dynamics influence the CVD risk are thus needed.
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Affiliation(s)
- Clémence Desjardins
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Marie Cyrenne-Dussault
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Olivier Barbier
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada; CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Amélie Bélanger
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Anne Gangloff
- CHU de Québec-Université Laval Research Center, Québec City, Canada; Faculty of Medicine, Laval University, Québec City, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Québec City, Canada; CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Jacinthe Leclerc
- Faculty of Pharmacy, Laval University, Québec City, Canada; Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Canada
| | - Jean Lefebvre
- Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Laval University, Québec City, Canada; CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Jean-Philippe Drouin-Chartier
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada.
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Tam HL, Chair SY, Leung ISH, Leung LYL, Chan ASW. US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys. JMIR Public Health Surveill 2023; 9:e45697. [PMID: 36940169 PMCID: PMC10131672 DOI: 10.2196/45697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Practicing healthy lifestyles can reduce the risk to develop noncommunicable diseases and the related mortality. Studies showed that practicing healthy lifestyles could enhance disease-free life expectancy and preserve bodily functions. However, engagement in healthy lifestyle behavior was suboptimal. OBJECTIVE This study aimed to define individuals' lifestyle characteristics before and during COVID-19 and determine the factors associated with practicing a healthy lifestyle. This cross-sectional study was conducted using data from the 2019 and 2021 Behavioral Risk Factor Surveillance System surveys. METHODS US individuals aged ≥18 years were interviewed via phone call. Healthy lifestyles were assessed through corresponding questions regarding the maintenance of optimal body weight, physical activity, daily consumption of at least five portions of fruits and vegetables, current smoking status, and alcohol consumption. Missing data were imputed using a package in the R statistical software. The effects of practicing a healthy lifestyle on cases without missing data and those with imputation were reported. RESULTS There were 550,607 respondents (272,543 and 278,064 from 2019 and 2021, respectively) included in this analysis. The rates of practicing a healthy lifestyle were 4% (10,955/272,543) and 3.6% (10,139/278,064) in 2019 and 2021, respectively. Although 36.6% (160,629/438,693) of all 2021 respondents had missing data, the results of the logistic regression analysis for cases without missing data and those with imputation were similar. Of the cases with imputation, women (odds ratio [OR] 1.87) residing in urban areas (OR 1.24) with high education levels (OR 1.73) and good or better health status (OR 1.59) were more likely to practice healthier lifestyles than young individuals (OR 0.51-0.67) with a low household income (OR 0.74-0.78) and chronic health conditions (OR 0.48-0.74). CONCLUSIONS A healthy lifestyle should be strongly promoted at the community level. In particular, factors associated with a low rate of practice of healthy lifestyles should be targeted.
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Affiliation(s)
- Hon Lon Tam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Isaac Sze Him Leung
- Department of Statistics, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Leona Yuen Ling Leung
- The Ronin Institute, Montclair, NJ, United States
- Canadian Academy of Independent Scholars, Vancouver, BC, Canada
| | - Alex Siu Wing Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China (Hong Kong)
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Pupulin A, Ball J, Bajaj R, Alter DA. Evaluating Statin Knowledge-Perceptions and Receptivity Following a Comprehensive Lifestyle Modification Program. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231163129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background Though clinical guidelines for cholesterol-lowering therapies advocate for both a trial of lifestyle modification and the initiation of statin medication when appropriate, the extent to which lifestyle modification may alter a patient’s knowledge-perceptions and receptivity towards statins remains unclear. Methods Following completion of a 6-month comprehensive lifestyle modification program, perceived changes in knowledge and receptivity towards statins were examined across prespecified subgroups of age, sex, and statin eligibility using a mixed-methods questionnaire. Quantitative and qualitative analyses incorporated binomial tests, McNemar’s test, and thematic analyses. Results Among 192 patients who completed the program and exit questionnaire between December 15, 2020 and July 2, 2021, 88.4% of patients indicated a perceived improvement in cholesterol and/or statin knowledge (P < . 0001). 48.2% of patients acknowledged that their receptivity towards taking statins increased (P = . 61). Changes in receptivity were attributed to several identified program themes including improvements in health knowledge and awareness, motivation and empowerment. Patients who noted improvements in their mental health also reported significantly increased receptivity towards statins (P < . 001). Conclusions Patients’ perceived knowledge and receptivity towards statins may improve following participation in a comprehensive therapeutic lifestyle modification program. Future research must evaluate the impact of these programs on statin uptake, compliance and outcomes.
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Affiliation(s)
- Alaina Pupulin
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (AP); Faculty of Art and Science, University of Toronto, Toronto, ON, Canada (JB); Faculty of Medicine, University of Toronto, Toronto, ON, Canada (RB, DAA); Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada (DAA); Rehabilitation Institute-University Health Network, University of Toronto, Toronto, ON, Canada (DAA); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (DAA)
| | - Jillian Ball
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (AP); Faculty of Art and Science, University of Toronto, Toronto, ON, Canada (JB); Faculty of Medicine, University of Toronto, Toronto, ON, Canada (RB, DAA); Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada (DAA); Rehabilitation Institute-University Health Network, University of Toronto, Toronto, ON, Canada (DAA); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (DAA)
| | - Ravi Bajaj
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (AP); Faculty of Art and Science, University of Toronto, Toronto, ON, Canada (JB); Faculty of Medicine, University of Toronto, Toronto, ON, Canada (RB, DAA); Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada (DAA); Rehabilitation Institute-University Health Network, University of Toronto, Toronto, ON, Canada (DAA); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (DAA)
| | - David A. Alter
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (AP); Faculty of Art and Science, University of Toronto, Toronto, ON, Canada (JB); Faculty of Medicine, University of Toronto, Toronto, ON, Canada (RB, DAA); Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada (DAA); Rehabilitation Institute-University Health Network, University of Toronto, Toronto, ON, Canada (DAA); Institute for Clinical Evaluative Sciences, Toronto, ON, Canada (DAA)
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Yates T, Sargeant JA, King JA, Henson J, Edwardson CL, Redman E, Gulsin GS, Brady EM, Ahmad E, Stensel DJ, Webb DR, McCann GP, Khunti K, Davies MJ. Initiation of New Glucose-Lowering Therapies May Act to Reduce Physical Activity Levels: Pooled Analysis From Three Randomized Trials. Diabetes Care 2022; 45:2749-2752. [PMID: 35984425 DOI: 10.2337/dc22-0888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) reduce body weight and improve cardiometabolic health, but their effect on physical activity is unknown. RESEARCH DESIGN AND METHODS We pooled data (n = 148) from three randomized trials to investigate the effect of empagliflozin (SGLT2i) and liraglutide (GLP-1RA), in comparison with sitagliptin (dipeptidyl peptidase 4 inhibitor) and dietary therapies, on accelerometer-assessed physical activity. RESULTS Liraglutide (mean -1,144 steps/day; 95% CI -2,069 to -220), empagliflozin (-1,132 steps/day; -1,739, -524), and sitagliptin (-852 steps/day; -1,625, -78) resulted in reduced total daily physical activity after 6 months (P < 0.01 vs. control). Moderate- to vigorous-intensity physical activity was also reduced. Dietary interventions led to no change or an increase in physical activity. CONCLUSIONS The initiation of all glucose-lowering therapies was associated with reduced physical activity, warranting further investigation.
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Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - James A King
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, U.K
| | - Joe Henson
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Emma Redman
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Gaurav S Gulsin
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Emer M Brady
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - David J Stensel
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, U.K
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Gerry P McCann
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- NIHR Applied Research Collaboration East Midlands, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
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Wong EML, Tam HL, Leung AYM, Cheung ASP, Cheung KC, Leung DYP. Impacts of Educational Interventions with Support of Mobile App versus Booklet for Patients with Hypertension and Metabolic Syndrome: A Secondary Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12591. [PMID: 36231891 PMCID: PMC9565212 DOI: 10.3390/ijerph191912591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hypertension comorbid with metabolic syndrome could increase the development of adverse cardiovascular events. Educational interventions were effective to improve outcomes in patients. METHODS This was a secondary data analysis of participants with hypertension. The original randomized controlled trial aimed to examine the effect of app and booklet versus control among individuals diagnosed with metabolic syndrome living in the community. A 30-min health education was provided to each participant. In addition to the education, the app group received a mobile app while the booklet group received a booklet. Data were collected at baseline, week 4, week 12, and week 24. Intention-to-treat principle was followed, and generalized estimating equations was employed for data analysis. RESULTS A total of 118 participants with hypertension and metabolic syndrome were extracted from the three-arm trial data. The sample size was 36, 42, and 40 in the app group, booklet group, and control group, respectively. Compared to the control group, the app group showed a significant reduction on body weight and waist circumference at week 24, while the total exercise and self-efficacy for exercise were increased at week 12 and week 24 but no significant findings were observed in the booklet group. CONCLUSIONS The educational intervention supported with app was superior to the booklet support on the outcomes of body weight, waist circumference, total exercise, and self-efficacy for exercise among patients with hypertension and metabolic syndrome in the community.
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Affiliation(s)
| | - Hon Lon Tam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Ka Ching Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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10
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Gao Z, Chen S, Huang X, Ye J, Liu J, Huang Z, Chen J, Li L, Liu Y, Lin S. Risk Prediction Model for Uncontrolled Hypertension in Chinese Community. Front Cardiovasc Med 2022; 8:808071. [PMID: 35141294 PMCID: PMC8818737 DOI: 10.3389/fcvm.2021.808071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Uncontrolled hypertension rate was still high across China. This study develops and validates an index to help quantify the combination of socio-behavioral aspects to screen high-risk patients in uncontrolled hypertension in Chinese primary care. Methods A cross-sectional study included 1,039 of patients with hypertension in the Chinese community. We assessed independent risk factors of uncontrolled blood pressure (defined as having a blood pressure ≥140/90 mmHg, even with antihypertensive therapy) and develop a risk prediction model. Results Among the 1,039 patients (53.9% male, the average age was 61 ± 13 years), 452 (43.5%) were uncontrolled hypertensive. Multivariable analysis showed that worker (odds ratio, OR: 1.98, 95% CI: 1.46–2.69), no health insurance (OR: 3.47, 95% CI: 2.08–5.80), non-marital status (OR: 2.01, 95% CI: 1.35–3.27), and other socio-behavioral aspects were independent risk factors of uncontrolled hypertension, which were included the final prediction model (C-static: 0.781). With internal validation by the bootstrap method, the risk score showed good discriminating ability and predicting ability for the incidence of uncontrolled hypertension (C-static: 0.771). Conclusions This study showed that nearly half of the patients suffered from uncontrolled hypertension in the Chinese community. We established a prediction model with good predictability to help quantify the combination of socio-behavioral aspects and screen high-risk patients with uncontrolled hypertension.
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Affiliation(s)
- Zhiping Gao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoyu Huang
- Department of Cardiology, Yangjiang People's Hospital, Yangjiang, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liwen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuguang Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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11
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Schrader B, Schrader J, Koziolek M, Elsässer A, Bünker AM, Hillmann B, Vaske B, Haller H, Lüders S. Influence of individualized prevention recommendations after one year on the control of hypertension in 3,868 follow-up participants of the ELITE study. Cent Eur J Public Health 2022; 29:305-310. [PMID: 35026070 DOI: 10.21101/cejph.a6908] [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: 05/05/2021] [Accepted: 11/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The ELITE study (German acronym for "Nutrition, lifestyle and individual information for prevention of heart attack, stroke and dementia") prospectively collects data on hypertension, cardiovascular risk factors (RF), dietary habits, physical activity, cognitive function, and quality of life in North-West Germany, which will then be improved through targeted individual information. The aim of the study is to improve the health of the participants in the long term and to identify reasons for a lack of implementation of prevention measures. METHODS Of 4,602 included subjects, 3,868 could be studied so far at one-year follow-up. Blood pressure (BP) was measured according to the guidelines at admission and blood pressure history, premedication, sports behaviour and BMI were recorded by means of questionnaires and compared with the data collected in the follow-up examination after one year. RESULTS The participants were evaluated in 4 groups (G): G1 - normotensive patients (n = 1,558), G2 - controlled hypertensive patients (n = 502), G3 - untreated uncontrolled hypertensive patients (n = 1,080), G4 - treated uncontrolled hypertensive patients (n = 728). In G1 blood pressure (RR) remained unchanged from 126.3/77.8 to 127.8/78.5, in G2 there was a significant (p < 0.001) RR increase from 128.1/77.0 to 134.9/79.8. In G3 and G4 RR decreased significantly (p < 0.001) from 149.9/90.0 to 143.5/86.9 and from 153.1/87.5 to 146.2 84.1 mmHg, respectively. In G3 and G4, RR decreased in 56.1% and 56.3% of subjects and increased in 18% and 21%, respectively. In contrast, RR increase was found more frequently in G1 and G2 (34.3% and 51%, respectively), and RR decrease less frequently (25.4 and 20.7%, respectively). The main reasons for RR decrease were weight loss, more exercise, and more antihypertensives. Frequently, improved compliance and dietary changes were given as reasons. As expected, the opposite often led to RR increase. CONCLUSION 56% of the hypertensive participants succeeded in lowering their blood pressure, whereas there was a significant increase in blood pressure, especially in those who were well controlled with antihypertensives. This underlines the need to further motivate normotensive patients to maintain their normotension. The results show that the combination of individual written education and lifestyle interventions are an effective tool for the public health sector to combat hypertension. In our participants, lifestyle interventions have a significant impact on BP change. It should be noted critically that there are still too many patients who have not been reached.
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Affiliation(s)
- Bastian Schrader
- Department of Cardiology, Oldenburg Clinic, University of Oldenburg, Oldenburg, Germany
| | - Joachim Schrader
- Institute for Hypertension and Cardiovascular Research, Cloppenburg, Germany
| | - Michael Koziolek
- Department of Nephrology and Rheumatology, Georg August University Gottingen, Gottingen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, Oldenburg Clinic, University of Oldenburg, Oldenburg, Germany
| | - Anna-Maria Bünker
- Department of Nephrology and Rheumatology, Georg August University Gottingen, Gottingen, Germany
| | - Berit Hillmann
- Institute for Hypertension and Cardiovascular Research, Cloppenburg, Germany
| | - Bernhard Vaske
- Institute for Hypertension and Cardiovascular Research, Cloppenburg, Germany
| | - Hermann Haller
- Clinic for Kidney and Hypertension Diseases, Hannover Medical School, Hannover, Germany
| | - Stephan Lüders
- Department of Nephrology, Internal Medicine, St. Josefs Hospital, Cloppenburg, Germany
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12
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Abstract
Drug treatment to reduce cholesterol to new target levels is now recommended in four moderate- to high-risk patient populations: patients who have already sustained a cardiovascular event, adult diabetic patients, individuals with low density lipoprotein cholesterol levels ≥190 mg/dL and individuals with an estimated 10-year cardiovascular risk ≥7.5%. Achieving these cholesterol target levels did not confer any additional benefit in a systematic review of 35 randomised controlled trials. Recommending cholesterol lowering treatment based on estimated cardiovascular risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals. The negative results of numerous cholesterol lowering randomised controlled trials call into question the validity of using low density lipoprotein cholesterol as a surrogate target for the prevention of cardiovascular disease.
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Affiliation(s)
- Robert DuBroff
- Internal Medicine/Cardiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Aseem Malhotra
- Visiting Professor of Evidence-Based Medicine, Bahiana School of Medicine, Salvador, Brazil
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13
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Hinderliter AL, Smith P, Sherwood A, Blumenthal J. Lifestyle Interventions Reduce the Need for Guideline-Directed Antihypertensive Medication. Am J Hypertens 2021; 34:1100-1107. [PMID: 34107031 PMCID: PMC8557445 DOI: 10.1093/ajh/hpab090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 2017 ACC-AHA Hypertension Guideline recommends initiation of antihypertensive drug therapy based on blood pressure (BP) and an assessment of global cardiovascular disease (CVD) risk, but intensive lifestyle modification may lower BP to below recommended thresholds for treatment in some patients. METHODS We examined the effects of lifestyle modification on calculated CVD risk and on the indications for BP-lowering medications in individuals with untreated hypertension. Participants included 144 adults with BP 130-160/80-99 mm Hg who were randomized to 16 weeks of DASH (Dietary Approaches to Stop Hypertension) diet plus behavioral weight management (DASH + WM), DASH diet alone (DASH), or Usual Care. RESULTS The mean age of the study cohort was 52.0 years; the average baseline BP was 138 ± 9/86 ± 6 mm Hg. The 10-year CVD risk, as calculated by the Pooled Cohort Equations, was 5.7%. The adjusted 10-year risk fell to 4.4% in the DASH + WM group and to 5.0% in the DASH arm, but was not significantly changed (5.7%) in the Usual Care controls. The percentages of participants with guideline-based indications for antihypertensive drugs fell from 51% to 18% in the DASH + WM group and from 48% to 22% in the DASH group; and did not change significantly (49% to 44%) in the Usual Care group (P = 0.010 for the active intervention groups vs. Usual Care; P = 0.042 for DASH + WM vs. DASH). CONCLUSIONS These data demonstrate that in men and women with mildly elevated BP, lifestyle interventions can lower the calculated CVD risk and dramatically decrease the number of individuals for whom guideline-directed antihypertensive medication is indicated.
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Affiliation(s)
- Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - James Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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14
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Tinsel I, Metzner G, Schlett C, Sehlbrede M, Bischoff M, Anger R, Brame J, König D, Wurst R, Fuchs R, Lindinger P, Bredenkamp R, Farin-Glattacker E. Effectiveness of an interactive web-based health program for adults: a study protocol for three concurrent controlled-randomized trials (EVA-TK-Coach). Trials 2021; 22:526. [PMID: 34376228 PMCID: PMC8353439 DOI: 10.1186/s13063-021-05470-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation. METHODS The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program). The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants' data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs. According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15-20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction. The online RCTs' inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT. DISCUSSION We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal's intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020. TRIAL REGISTRATION German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273 . Registered on 11 December 2019.
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Affiliation(s)
- Iris Tinsel
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany.
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Christian Schlett
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Matthias Sehlbrede
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Martina Bischoff
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Robin Anger
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Judith Brame
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Daniel König
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Ramona Wurst
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Peter Lindinger
- Scientific Working Group in Smoking Cessation (WAT), Tübingen, Germany
| | - Rainer Bredenkamp
- Clinical Trials Unit UMG, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
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15
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Guariglia A, Davies IJ, Kanellakis NI. Evaluation of cardiovascular risk in a lung cancer screening cohort: what value does it bring? Breathe (Sheff) 2021; 16:200204. [PMID: 33447290 PMCID: PMC7792827 DOI: 10.1183/20734735.0204-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is a significant opportunity to improve cardiovascular disease (CVD) outcomes in lung cancer screening cohorts with a low-cost, noninvasive assessment of CVD risk, alongside existing assessments https://bit.ly/3a6Ha41.
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Affiliation(s)
- Andrea Guariglia
- Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Iona J Davies
- Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Nikolaos I Kanellakis
- Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
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16
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Lifestyle Changes After Initiating Medication for Cardiovascular Disease. Am J Nurs 2020; 120:56. [PMID: 32443126 DOI: 10.1097/01.naj.0000668748.62693.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Tam HL, Wong EML, Cheung K. Effectiveness of Educational Interventions on Adherence to Lifestyle Modifications Among Hypertensive Patients: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072513. [PMID: 32272601 PMCID: PMC7177836 DOI: 10.3390/ijerph17072513] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022]
Abstract
Controlling blood pressure is a global concern as it is a major risk factor for cardiometabolic diseases and stroke. A flattened control rate was noted in recent decades, which highlighted an issue of adherence to medications and lifestyle modifications. Effectiveness of educational intervention on medication adherence and blood pressure control had been reviewed, but reviews on lifestyle modifications are lacking. This review with meta-analysis aimed to identify the effect of educational interventions on blood pressure control and adherence to lifestyle modifications. In accordance with the PRISMA statement, a search of CINAHL Complete, PubMed, Medline, Embase and Scopus for randomized control trials published between 2009 and 2019 was conducted. Data were extracted for quality synthesis and meta-analysis. Thirteen studies were included. Two forms of educational intervention, individual and group education, were commonly used. Phone calls, message reminders and reading materials after education were identified in the studies as supportive methods, which showed a moderate to large effect on adherence to lifestyle modifications and blood pressure control. Monthly group education lasting 45 min was suggested. Health professionals could integrate the education with supportive methods into community health promotion to improve and reinforce the adherence behavior on medications and lifestyle modifications among hypertensive patients.
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Affiliation(s)
- Hon Lon Tam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China;
- Education department, Kiang Wu Nursing College of Macau, Macau 999078, China
- Correspondence: (H.L.T.); (E.M.L.W.)
| | - Eliza Mi Ling Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China;
- Correspondence: (H.L.T.); (E.M.L.W.)
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China;
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18
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Korhonen MJ, Pentti J, Hartikainen J, Ilomäki J, Setoguchi S, Liew D, Kivimäki M, Vahtera J. Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid-Lowering Medication: A Cohort Study. J Am Heart Assoc 2020; 9:e014168. [PMID: 32019405 PMCID: PMC7070189 DOI: 10.1161/jaha.119.014168] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Lifestyle modification is a key component of cardiovascular disease prevention before and concurrently with pharmacologic interventions. We evaluated whether lifestyle factors change in relation to the initiation of antihypertensive or lipid-lowering medication (statins). Methods and Results The study population comprised 41 225 participants of the FPS (Finnish Public Sector) study aged ≥40 years who were free of cardiovascular disease at baseline and responded to ≥2 consecutive surveys administered in 4-year intervals in 2000-2013. Medication use was ascertained through pharmacy-claims data. Using a series of pre-post data sets, we compared changes in body mass index, physical activity, alcohol consumption, and smoking between 8837 initiators and 46 021 noninitiators of antihypertensive medications or statins. In participants who initiated medication use, body mass index increased more (difference in change 0.19; 95% CI, 0.16-0.22) and physical activity declined (-0.09 metabolic equivalent of task hour/day; 95% CI, -0.16 to -0.02) compared with noninitiators. The likelihood of becoming obese (odds ratio: 1.82; 95% CI, 1.63-2.03) and physically inactive (odds ratio: 1.08; 95% CI, 1.01-1.17) was higher in initiators. However, medication initiation was associated with greater decline in average alcohol consumption (-1.85 g/week; 95% CI, -3.67 to -0.14) and higher odds of quitting smoking (odds ratio for current smoking in the second survey: 0.74; 95% CI, 0.64-0.85). Conclusions These findings suggest that initiation of antihypertensive and statin medication is associated with lifestyle changes, some favorable and others unfavorable. Weight management and physical activity should be encouraged in individuals prescribed these medications.
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Affiliation(s)
- Maarit J Korhonen
- Department of Public Health University of Turku Finland.,Institute of Biomedicine University of Turku Finland.,Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Victoria Australia
| | - Jaana Pentti
- Finnish Institute of Occupational Health Helsinki Finland.,Clinicum Faculty of Medicine University of Helsinki Finland
| | - Juha Hartikainen
- Heart Center Kuopio University Hospital Kuopio Finland.,School of Medicine University of Eastern Finland Kuopio Finland
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Victoria Australia
| | - Soko Setoguchi
- Rutgers School of Public Health and Rutgers Robert Wood Johnson Medical School New Brunswick NJ
| | - Danny Liew
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Mika Kivimäki
- Finnish Institute of Occupational Health Helsinki Finland.,Clinicum Faculty of Medicine University of Helsinki Finland.,Department of Epidemiology and Public Health University College London London United Kingdom
| | - Jussi Vahtera
- Department of Public Health University of Turku Finland.,Turku University Hospital Turku Finland
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19
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[Not Available]. MMW Fortschr Med 2020; 162:3. [PMID: 32072560 DOI: 10.1007/s15006-020-0126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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