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Lee JJ, Lee KH. Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study. JMIR Public Health Surveill 2024; 10:e52182. [PMID: 38861307 DOI: 10.2196/52182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/21/2024] [Accepted: 05/05/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level. OBJECTIVE This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension. METHODS This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ≥160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older). RESULTS A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. CONCLUSIONS The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years.
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Affiliation(s)
- Jae Jun Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Kyung Hee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
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Yan J, Wu B, Lu B, Zhu Z, Di N, Yang C, Xu Q, Fan L, Hu Y. Association between baseline office blood pressure level and the incidence and development of long-term frailty in the community-dwelling very elderly with hypertension. Hypertens Res 2024; 47:1523-1532. [PMID: 38459173 DOI: 10.1038/s41440-024-01614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 03/10/2024]
Abstract
Frailty is the most important risk factor causing disability in the elderly. Hypertension is one of the most common chronic diseases in the elderly and is closely related to frailty, but there is still controversy about the association between blood pressure and frailty. To explore the association between baseline blood pressure level and the incident and development of long-term frailty in the community-dwelling very elderly (i.e., over 80 years old [1]) with hypertension, in order to provide a basis for scientific blood pressure management of very elderly hypertension. In this study, very elderly hypertensive patients who received comprehensive geriatric assessment from January to June 2019 and with complete data were included, and follow-up was conducted from January 1 to February 14, 2023. A total of 330 very elderly individuals with hypertension were enrolled in this study. FRAIL scale was used to evaluate frailty. Binomial logistic regression analysis was used to calculate the OR and 95%CI between baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) levels and long-term incident and development of frailty. The dose-response relationship between baseline office SBP, DBP or PP levels and incident frailty and its development was analyzed by Generalized Additive Model (GAM) using smooth curve fitting and threshold effect analysis. Smooth curve fitting and threshold effect analysis showed that the relationship between baseline office SBP level and incident frailty was U-shaped, with the nadir of the U-shaped curve at 135 mmHg after adjustment. Baseline office SBP, PP level and development frailty was U-shaped and the nadir was 140 mmHg and 77 mmHg. In the community-dwelling very elderly with hypertension, baseline office SBP level had a relationship with long-term incident frailty and its development and PP level had a relationship with long-term development of frailty.
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Affiliation(s)
- Jin Yan
- Graduate School of Chinese PLA General Hospital & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Bing Wu
- Graduate School of Chinese PLA General Hospital & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Bingjie Lu
- Graduate School of Jilin Sport University, 130022, Changchun, China
| | - Zhihui Zhu
- Ningxia University, 750021, Yinchuan, China
| | - Ning Di
- Ningxia University, 750021, Yinchuan, China
| | - Cunmei Yang
- Geriatric Health Care Department 4th of The Second Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Qiuli Xu
- Geriatric Health Care Department 4th of The Second Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Li Fan
- Cardiovascular Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
| | - Yixin Hu
- Geriatric Health Care Department 4th of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
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Xu X, Zeng L, Jha V, Cobb LK, Shibuya K, Appel LJ, Neal B, Schutte AE. Potassium-Enriched Salt Substitutes: A Review of Recommendations in Clinical Management Guidelines. Hypertension 2024; 81:400-414. [PMID: 38284271 PMCID: PMC10863666 DOI: 10.1161/hypertensionaha.123.21343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Excess dietary sodium intake and insufficient dietary potassium intake are both well-established risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving dietary intake have largely failed because the changes required are mostly too hard to implement. Consistent recent data from randomized controlled trials show that potassium-enriched, sodium-reduced salt substitutes are an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths. Yet, salt substitutes are inconsistently recommended and rarely used. We sought to define the extent to which evidence about the likely benefits and harms of potassium-enriched salt substitutes has been incorporated into clinical management by systematically searching guidelines for the management of hypertension or chronic kidney disease. We found incomplete and inconsistent recommendations about the use of potassium-enriched salt substitutes in the 32 hypertension and 14 kidney guidelines that we reviewed. Discussion among the authors identified the possibility of updating clinical guidelines to provide consistent advice about the use of potassium-enriched salt for hypertension control. Draft wording was chosen to commence debate and progress consensus building: strong recommendation for patients with hypertension-potassium-enriched salt with a composition of 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication. We strongly encourage clinical guideline bodies to review their recommendations about the use of potassium-enriched salt substitutes at the earliest opportunity.
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Affiliation(s)
- Xiaoyue Xu
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Ling Zeng
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India (V.J.)
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
- Prasanna School of Public Health, Manipal Academy of Higher Education, India (V.J.)
| | | | | | - Lawrence J. Appel
- Department of Epidemiology, Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Bruce Neal
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
| | - Aletta E. Schutte
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
- Department of Paediatrics, Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (A.E.S)
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Wang X, Dai M, Xu J. Association of living alone and living alone time with hypertension among Chinese men aged 80 years and older: a cohort study. Front Public Health 2024; 11:1274955. [PMID: 38249394 PMCID: PMC10796616 DOI: 10.3389/fpubh.2023.1274955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Objective There is little evidence of the influence of living alone on hypertension risk among men 80 years or older. Additionally, the influence of living alone duration on hypertension risk lacks thorough investigation. Hence, this cohort study examines living alone and its duration's link to hypertension risk in this specific group. Methods We included 2009 older men aged ≥80 years without hypertension from the Chinese Longitudinal Healthy Longevity Survey in the 2008 wave. Follow-up was conducted in the 2011 wave. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) to assess hypertension risk related to living alone and living alone time. Results We included 2,009 older men, with a mean age of 90.7 years (standard deviation: 6.8). Over a median follow-up of 2.9 (1.3-3.0) years, 573 participants (28.5%) developed hypertension. Living alone was significantly associated with a higher hypertension risk than living with family (HR: 1.42; 95% CI 1.11-1.80). When compared to living with family, the hypertension risk was increased in the first quartile of living alone time (0-6.1 years) (HR: 1.76; 95% CI 1.16-2.66), the second quartile (6.1-10.6 years) (HR: 1.56; 95% CI 1.07-2.29), and the third quartile (10.6-19.3 years) (HR: 1.66; 95% CI 1.08-2.55). Surprisingly, no significant association was found in the fourth quartile (≥19.3 years) with hypertension risk. Stratified and Interaction analyses indicated no significant interaction effects between subgroups. Sensitivity analyses yielded consistent results. Conclusion Living alone was independently associated with an increased risk of hypertension in older men. The highest risk was found in those with the least time alone. These findings imply that social isolation and lack of companionship could be pivotal in hypertension development. Furthermore, the study highlights the need to consider living alone duration when assessing its impact on health outcomes.
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Affiliation(s)
- Xiang Wang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Cardiology, Jiujiang First People’s Hospital, Jiujiang, China
| | - Miao Dai
- Department of Geriatrics, Jiujiang First People’s Hospital, Jiujiang, China
| | - Jingsong Xu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Koraćević G, Mićić S, Stojanović M, Zdravkovic M, Simić D, Kostić T, Atanasković V, Janković-Tomašević R. Beta-blockers in Hypertensive Left Ventricular Hypertrophy and Atrial Fibrillation Prevention. Curr Vasc Pharmacol 2024; 22:19-27. [PMID: 38031765 DOI: 10.2174/0115701611264647231110101700] [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: 06/08/2023] [Revised: 09/23/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Hypertensive left ventricular hypertrophy (HTN LVH) is a key risk factor for atrial fibrillation (AF). OBJECTIVE To evaluate the possible role of beta-blockers (BBs) in addition to a renin-angiotensinaldosterone system (RAAS) blocker in AF prevention in patients with HTN LVH. METHODS We performed a PubMed, Elsevier, SAGE, Oxford, and Google Scholar search with the search items 'beta blocker hypertension left ventricular hypertrophy patient' from 2013-2023. In the end, a 'snowball search', based on the references of relevant papers as well as from papers that cited them was performed. RESULTS HTN LVH is a risk factor for AF. In turn, AF substantially complicates HTN LVH and contributes to the genesis of heart failure (HF) with preserved ejection fraction (HFpEF). The prognosis of HFpEF is comparable with that of HF with reduced EF (HFrEF), and, regardless of the type, HF is associated with five-year mortality of 50-75%. The antiarrhythmic properties of BBs are wellrecognized, and BBs as a class of drugs are - in general - recommended to decrease the incidence of AF in HTN. CONCLUSION BBs are recommended (as a class) for AF prevention in several contemporary guidelines for HTN. LVH regression in HTN - used as a single criterion for the choice of antihypertensive medication - does not capture this protective effect. Consequently, it is worth studying how meaningful this antiarrhythmic action (to prevent AF) of BBs is in patients with HTN LVH in addition to a RAAS blocker.
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Affiliation(s)
- Goran Koraćević
- Department of Cardiovascular Diseases, University Clinical Center Niš, Serbia
- Faculty of Medicine, Niš University, Serbia
| | - Sladjana Mićić
- Department of Nephrology, University Clinical Center Niš, Serbia
| | | | - Marija Zdravkovic
- Department of Cardiology, University Hospital Medical Center Bežanijska kosa and Faculty of Medicine, University of Belgrade, Serbia
| | - Dragan Simić
- Department of Cardiovascular Diseases, University Clinical Center Belgrade, Serbia
| | - Tomislav Kostić
- Department of Cardiovascular Diseases, University Clinical Center Niš, Serbia
- Faculty of Medicine, Niš University, Serbia
| | - Vesna Atanasković
- Department of Cardiovascular Diseases, University Clinical Center Niš, Serbia
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Gao Q, Tan NC, Lee ML, Hsu W, Choo J. Comparative effectiveness of first-line antihypertensive drug classes on the maintenance of estimated glomerular filtration rate (eGFR) in real world primary care. Sci Rep 2023; 13:21225. [PMID: 38040765 PMCID: PMC10692108 DOI: 10.1038/s41598-023-48427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
Renin-angiotensin system inhibitors (RASi), particularly angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), are commonly used in the treatment of hypertension and are recommended for kidney protection. Uncertainty remains about the effectiveness of RASi being used as first-line antihypertensive therapy on eGFR maintenance compared to its alternatives, especially for those with no or early-stage chronic kidney disease (CKD). We conducted a retrospective cohort study of 19,499 individuals (mean age 64.1, 43.5% males) from primary care in Singapore with 4.5 median follow-up years. The study cohort included newly diagnosed individuals with hypertension (whose eGFR was mainly in CKD stages G1-G2) and initiated on ACEIs, ARBs, beta-blockers (BBs), calcium channel blockers (CCBs) or diuretics (Ds) as first-line antihypertensive monotherapy. We compared the estimated glomerular filtration rate (eGFR) curve before/after the drug initiation over time of patients under different drug classes and analyzed the time to declining to a more advanced stage CKD. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounding factors. Two key findings were observed. First, after initiating antihypertensive drugs, the eGFR almost maintained the same as the baseline in the first follow-up year, compared with dropping 3 mL/min/1.73 m2 per year before drug initiation. Second, ARBs were observed to be slightly inferior to ACEIs (HR = 1.14, 95% CI = (1.04, 1.23)) and other antihypertensive agents (HR = 1.10, 95% CI = (1.01, 1.20)) in delaying eGFR decline to a more advanced CKD stage in the study population. Our results showed that initiating antihypertensive agents can significantly maintain eGFR for those newly diagnosed patients with hypertension. However, RASi may not be superior to other antihypertensive agents in maintaining eGFR levels for non-CKD or early stages CKD patients.
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Affiliation(s)
- Qiao Gao
- Institute of Data Science, National University of Singapore, Singapore, Singapore.
| | | | - Mong Li Lee
- Institute of Data Science, National University of Singapore, Singapore, Singapore
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Wynne Hsu
- Institute of Data Science, National University of Singapore, Singapore, Singapore
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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Yang S, Zhang N, Liang Z, Han Y, Luo H, Ge Y, Yin J, Ding C, Li C, Zhang Q, Zhang J. Examining the U-shaped relationship of sleep duration and systolic blood pressure with risk of cardiovascular events using a novel recursive gradient scanning model. Front Cardiovasc Med 2023; 10:1210171. [PMID: 37790596 PMCID: PMC10543086 DOI: 10.3389/fcvm.2023.1210171] [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: 05/16/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Background Observational studies have suggested U-shaped relationships between sleep duration and systolic blood pressure (SBP) with risks of many cardiovascular diseases (CVDs), but the cut-points that separate high-risk and low-risk groups have not been confirmed. We aimed to examine the U-shaped relationships between sleep duration, SBP, and risks of CVDs and confirm the optimal cut-points for sleep duration and SBP. Methods A retrospective analysis was conducted on NHANES 2007-2016 data, which included a nationally representative sample of participants. The maximum equal-odds ratio (OR) method was implemented to obtain optimal cut-points for each continuous independent variable. Then, a novel "recursive gradient scanning method" was introduced for discretizing multiple non-monotonic U-shaped independent variables. Finally, a multivariable logistic regression model was constructed to predict critical risk factors associated with CVDs after adjusting for potential confounders. Results A total of 26,691 participants (48.66% were male) were eligible for the current study with an average age of 49.43 ± 17.69 years. After adjusting for covariates, compared with an intermediate range of sleep duration (6.5-8.0 h per day) and SBP (95-120 mmHg), upper or lower values were associated with a higher risk of CVDs [adjusted OR (95% confidence interval) was 1.20 (1.04-1.40) for sleep duration and 1.17 (1.01-1.36) for SBP]. Conclusions This study indicates U-shaped relationships between SBP, sleep duration, and risks of CVDs. Both short and long duration of sleep/higher and lower BP are predictors of cardiovascular outcomes. Estimated total sleep duration of 6.5-8.0 h per day/SBP of 95-120 mmHg is associated with lower risk of CVDs.
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Affiliation(s)
- Shuo Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Nanxiang Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zichao Liang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuduan Han
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hao Luo
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingfeng Ge
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jianan Yin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chonglong Ding
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chao Li
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Qitong Zhang
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jinxin Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Li X, Hu J, Yao Y, Zuo C, Wang Z, Li X, Lv Q. Evaluation of pharmacist-led telemedicine medication management for hypertension established patients during COVID-19 pandemic: A pilot study. Front Public Health 2022; 10:1091484. [PMID: 36589937 PMCID: PMC9800920 DOI: 10.3389/fpubh.2022.1091484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Aim To evaluate the impact of a telemedicine medication management service in patients with hypertension. Methods Participants were allocated to either a telemedicine service (N = 173) or usual care (UC) (N = 179). The primary outcome was blood pressure (BP) reduction from baseline to the 6-month follow-up visit, the proportion of the target BP achievement, overall adherence to prescribed medication as well as a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. Results At 6 months, BP was controlled in 89.6% (n = 155) of intervention patients and 78.8% (n = 141) of UC patients (OR = 1.14, 95% CI = 1.04-1.25, P = 0.006), giving a mean difference of -6.0 (-13.0 to -2.5 mmHg) and -2.0 mmHg (-4.0 to -0.1 mmHg) in SBP and DBP, respectively. 17.9% (n = 31) of the patients in the intervention group were non-adherent with medications, compared with 29.1% (n = 52) in the UC group (P = 0.014). The composite clinical endpoints were reached by 2.9% in the intervention group and 4.5% in the control group with no significant differences (OR = 1.566, 95% CI = 0.528-4.646). Conclusion Telemedicine medication management for hypertension management had led to better BP control and medication adherence improvement than UC during COVID-19 epidemic, resulting in a reduction of overall adverse cardiovascular events occurrence.
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Affiliation(s)
- Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jialu Hu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Yao
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chengchun Zuo
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zi Wang
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Xiaoyu Li ✉
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China,Qianzhou Lv ✉
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Xie PC, Liang QE, Tu WQ, Xie T, Lam LK, Chen LG. The effect of Taohong Siwu decoction combined with antihypertensive medicine in the treatment of hypertension: Meta-analysis. Medicine (Baltimore) 2022; 101:e32133. [PMID: 36626486 PMCID: PMC9750686 DOI: 10.1097/md.0000000000032133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Taohong Siwu Decoction (THSWD) is a classic prescription of traditional Chinese medicine. Recent research has shown that the practical components of THSWD have specific curative effects on various cardiovascular diseases, including hypertension, suggesting THSWD could effectively lower blood pressure (BP) with fewer side effects. However, little information is available regarding the effectiveness of THSWD combined with antihypertensive medicine on hypertension. OBJECTIVE This meta-analysis aimed to study the efficacy and safety of THSWD in treating hypertension. METHODS According to the search strategy, 8 databases were searched, including China Knowledge Network (CNKI), Wanfang Database, VIP Database, Pubmed, China Biomedical Literature Database (CBM), web of science, EMBASE and Cochrane Library, for the randomized controlled trial of THSWD on hypertension. 9 RCTs were included and 827 patients were involved. This meta-analysis used RevMan 5.4 to evaluate the articles. RESULTS This review included 9 RCTs. All studies were THSWD with the antihypertensive drug compared with single antihypertensive western medicine. The total effective rate of THSWD combined with corresponding western medicine was significantly improved (Relative risk = 1.26; 95% CI: 1.16-1.37, P < .00001), which could effectively reduce the systolic BP (MD = -15.28 mm Hg; 95% CI: -20.17 to -10.40, P < .00001=, diastolic BP (MD = -9.70 mm Hg; 95% CI: -12.66 to -6.73, P < .00001), Triglycerides (MD = -1.48, 95%CI: -2.09 to -0.87, P < .00001), total cholesterol (MD = -1.43, 95% CI: -1.63 to -1.24, P < .00001) and low density lipoprotein cholesterol (MD = -0.93, 95% CI: -1.07 to -0.80, P < .00001). Compared with the single routine western medicine group, THSWD combined with the corresponding western medicine increased serum high-density lipoprotein (MD = 0.41, 95% CI: 0.35 to 0.46, P < .00001). CONCLUSION THSWD combined with antihypertensive drugs in treating hypertension was curative in lowering BP, improving blood lipid levels and reducing the incidence of adverse reactions compared to antihypertensive medications treatment. However, more high-quality studies are needed due to the biased results and the small number of studies for further verification of the effectiveness of THSWD, and providing a new treatment for clinical reference.
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Affiliation(s)
- Peng-Cheng Xie
- School of Traditional Chinese Medicine of Jinan University, Guangzhou, China
| | - Qiu-Er Liang
- School of Traditional Chinese Medicine of Jinan University, Guangzhou, China
| | - Wan-Qing Tu
- School of Traditional Chinese Medicine of Jinan University, Guangzhou, China
| | - Ting Xie
- School of Traditional Chinese Medicine of Jinan University, Guangzhou, China
| | - Lai Kwan Lam
- School of Traditional Chinese Medicine of Jinan University, Guangzhou, China
- * Correspondence: Lai Kwan Lam and Li-Guo Chen, School of Traditional Chinese Medicine of Jinan University, No. 601 West Huangpu Avenue, Guangzhou 510632, China (e-mail: and )
| | - Li-Guo Chen
- School of Traditional Chinese Medicine of Jinan University, Guangzhou, China
- * Correspondence: Lai Kwan Lam and Li-Guo Chen, School of Traditional Chinese Medicine of Jinan University, No. 601 West Huangpu Avenue, Guangzhou 510632, China (e-mail: and )
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Zhang M, Yan XN, Hong LF, Jin JL, Dong Q, Qian J, Li JJ. Clinical impact of blood pressure on cardiovascular death in patients 80 years and older following acute myocardial infarction: a prospective cohort study. Hypertens Res 2022; 45:1882-1890. [PMID: 36123399 DOI: 10.1038/s41440-022-01030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Numerous trials have shown that lowering blood pressure (BP) reduces cardiovascular risk and mortality, yet data about the impact of BP on cardiovascular death risk in patients aged ≥80 years with acute myocardial infarction (AMI) are sparse. This study explored the prognostic value of BP for cardiovascular death during the first 48 h after admission following AMI among patients aged ≥80 years. A total of 1005 patients ≥80 years with AMI were enrolled. Average BP parameters, including systolic, diastolic, and pulse BP, over the first 48 h after admission were calculated. The end point was cardiovascular death. Receiver operating curve (ROC) analysis was used to identify whether BP was relevant to cardiovascular death. The relationship between BP levels and cardiovascular death was evaluated by Cox regression models. ROC analysis showed that average diastolic blood pressure (aDBP), but not systolic and pulse BP, was relevant to cardiovascular death, and the optimal cutoff was 65 mmHg. During the 2.9-year follow-up, patients who died from a cardiovascular cause had lower aDBP levels than those who did not (p = 0.002). Patients with aDBP <65 mmHg had a 1.5-fold higher incidence of cardiovascular death than those with aDBP ≥65 mmHg (35.9% vs. 24.0%; p < 0.001). In multivariable regression analysis, low aDBP remained a strong and independent predictor of cardiovascular death (adjusted hazard ratio 1.907; 95% CI 1.303-2.792). aDBP was independently associated with cardiovascular death in patients aged ≥80 years with AMI, suggesting that aDBP may be a useful index to predict worse outcome in these patients.
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Affiliation(s)
- Meng Zhang
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiao-Ni Yan
- Division of Cardiology, The Fifth Hospital of Wuhan & Cardiovascular Institute of Jianghan University, Wuhan, China
| | - Li-Feng Hong
- Division of Cardiology, The Fifth Hospital of Wuhan & Cardiovascular Institute of Jianghan University, Wuhan, China
| | - Jing-Lu Jin
- Department of Endocrinology, Genetics and Metabolism, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qian Dong
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Qian
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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11
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Yu Q, Zuo G. Impact of urbanisation on the gaps of hypertension prevalence, awareness and treatment among older age in China: a cross-sectional study. BMJ Open 2022; 12:e057065. [PMID: 35772814 PMCID: PMC9247652 DOI: 10.1136/bmjopen-2021-057065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine the impact of urbanisation on the prevalence, awareness and treatment of hypertension among elderly in China. DESIGN This cross-sectional study used data from the most recent nationally representative Chinese Longitudinal Healthy Longevity Survey, 2018. SETTING People in urban and rural communities from 500 sample areas in 22 Chinese provinces. PARTICIPANTS After exclusion, this study surveyed 9859 participants in the final analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The main dependent variables were prevalence, awareness and treatment of hypertension defined as (1) systolic blood pressure (BP)≥140 mm Hg, diastolic BP≥90 mm Hg or (2) taking antihypertensive drugs. Hypertension awareness was defined as a previous diagnosis of hypertension by a health professional, and hypertension treatment was defined as undergoing BP treatment. RESULTS The prevalence of hypertension was lower among semiurbanised adults than among non-urbanised rural adults (OR=0.94, 95% CI=0.90 to 0.99; p<0.05). The probabilities of awareness (OR=1.10, 95% CI=1.01 to 1.20; p<0.05) and treatment (OR=1.17, 95% CI=1.08 to 1.26; p<0.001) of hypertension were significantly lower among non-urbanised adults than among urban-born adults. Urbanisation in eastern (OR=0.93, 95% CI=0.88 to 0.99; p<0.05) and western China (OR=1.11, 95% CI=1.01 to 1.23; p<0.05) was associated with the prevalence of hypertension. The urbanisation level was also associated with hypertension awareness and treatment in eastern (OR=1.17, 95% CI=1.04 to 1.32; p<0.01; OR=1.26, 95% CI=1.14 to 1.40; p<0.001), central (OR=1.31, 95% CI=1.05 to 1.63; p<0.05; OR=1.29, 95% CI=1.08 to 1.55; p<0.01) and western China (OR=1.28, 95% CI=1.07 to 1.53; p<0.01; OR=1.34, 95% CI=1.15 to 1.57; p<0.001). The Blinder-Oaxaca decomposition suggested that approximately 42% and 39% of the urban-rural gap in hypertension awareness and treatment, respectively, could be attributed to coefficient difference. CONCLUSIONS Public health programmes and policies for chronic diseases should adjust with urbanisation and combine individual-centred strategies.
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Affiliation(s)
- Qiutong Yu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Genyong Zuo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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12
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Tian Y, Gu C, Yan F, Gu Y, Feng Y, Chen J, Sheng J, Hu L, Jiang P, Guo W, Feng N. Alteration of Skin Microbiome in CKD Patients Is Associated With Pruritus and Renal Function. Front Cell Infect Microbiol 2022; 12:923581. [PMID: 35837475 PMCID: PMC9274276 DOI: 10.3389/fcimb.2022.923581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Dysbiotic gut microbiome in chronic kidney disease (CKD) patients has been extensively explored in recent years. Skin microbiome plays a crucial role in patients with skin diseases or even systemic disorders. Pruritus is caused by the retention of uremic solutes in the skin. Until now, no studies have investigated the role of skin microbiome in CKD and its association with pruritus. Here, we aim to examine the bacterial profile of skin microbiome in CKD and whether it is correlated to pruritus. A total of 105 CKD patients and 38 healthy controls (HC) were recruited. Skin swab was used to collect skin samples at the antecubital fossa of participants. Bacterial 16S rRNA genes V3–V4 region was sequenced on NovaSeq platform. On the day of skin sample collection, renal function was assessed, and numeric rating scale was used to measure pruritus severity. Principal coordinate analysis (PCoA) revealed a significant difference in bacterial composition between the groups of CKD and HC. A depletion of bacterial diversity was observed in CKD patients. Akkermansia, Albimonas, Escherichia–Shigella, etc. showed significant higher abundance in CKD patients, whereas Flavobacterium, Blastomonas, Lautropia, etc. significantly declined in patients. Escherichia–Shigella achieved an acceptable diagnostic biomarker with area under the curve (AUC) value of 0.784 in the receiver operating characteristics (ROC) curve. In addition, CKD patients with pruritus (P-CKD) had a different bacterial community comparing to those without pruritus (non-P-CKD) and HC group. Several bacterial genera showing significant difference between P-CKD and non-P-CKD/HC, such as Oribacterium, significantly declined in P-CKD patients than that in the HC group, and Methylophaga significantly increased in P-CKD patients compared to that in HC subjects. Escherichia–Shigella was positively associated with the levels of pruritus severity, blood urea nitrogen (BUN), uric acid, and urine protein; Oribacterium was negatively associated with pruritus severity, whereas it was positively associated with estimated glomerular filtration rate (eGFR) and 24-h urine volume. The dysbiotic of skin microbiome in CKD patients and its association with pruritus and renal function shed a light on skin probiotics.
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Affiliation(s)
- Yu Tian
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Chaoqun Gu
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Feng Yan
- Department of Nephrology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Yifeng Gu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangkun Feng
- School of Medicine, Nantong University, Nantong, China
| | - Jie Chen
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Jiayi Sheng
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Lei Hu
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Peng Jiang
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
- *Correspondence: Peng Jiang, ; Wei Guo, ; Ninghan Feng,
| | - Wei Guo
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
- *Correspondence: Peng Jiang, ; Wei Guo, ; Ninghan Feng,
| | - Ninghan Feng
- Department of Urology, Wuxi No. 2 People’s Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
- *Correspondence: Peng Jiang, ; Wei Guo, ; Ninghan Feng,
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Zhang H, Tian W, Sun Y. Development, validation, and visualization of a web-based nomogram to predict 5-year mortality risk in older adults with hypertension. BMC Geriatr 2022; 22:392. [PMID: 35509033 PMCID: PMC9069777 DOI: 10.1186/s12877-022-03087-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hypertension-related mortality has been increasing in older adults, resulting in serious burden to society and individual. However, how to identify older adults with hypertension at high-risk mortality remains a great challenge. The purpose of this study is to develop and validate the prediction nomogram for 5-year all-cause mortality in older adults with hypertension. Methods Data were extracted from National Health and Nutrition Examination Survey (NHANES). We recruited 2691 participants aged 65 years and over with hypertension in the NHANES 1999-2006 cycles (training cohort) and 1737 participants in the NHANES 2007-2010 cycles (validation cohort). The cohorts were selected to provide at least 5 years follow-up for evaluating all-cause mortality by linking National Death Index through December 31, 2015. We developed a web-based dynamic nomogram for predicting 5-year risk of all-cause mortality based on a logistic regression model in training cohort. We conducted internal validation by 1000 bootstrapping resamples and external validation in validation cohort. The discrimination and calibration of nomogram were evaluated using concordance index (C-index) and calibration curves. Results The final model included eleven independent predictors: age, sex, diabetes, cardiovascular disease, body mass index, smoking, lipid-lowering drugs, systolic blood pressure, hemoglobin, albumin, and blood urea nitrogen. The C-index of model in training and validation cohort were 0.759 (bootstrap-corrected C-index 0.750) and 0.740, respectively. The calibration curves also indicated that the model had satisfactory consistence in two cohorts. A web-based nomogram was established (https://hrzhang1993.shinyapps.io/dynnomapp). Conclusions The novel developed nomogram is a useful tool to accurately predict 5-year all-cause mortality in older adults with hypertension, and can provide valuable information to make individualized intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03087-3.
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Affiliation(s)
- Huanrui Zhang
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, 110001, China
| | - Wen Tian
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, 110001, China
| | - Yujiao Sun
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, 110001, China.
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Lin H, Wu Y, Wu J, Chen Q, Yu J, Lin Y. Prevalence of Hypertension and 10-Year Cardiovascular Disease Risk Among Older Adults Living in Quanzhou, A Coastal Region of Southeast China. Healthc Policy 2022; 15:1045-1053. [PMID: 35592440 PMCID: PMC9113549 DOI: 10.2147/rmhp.s341148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This study aims to analyze the prevalence of hypertension and 10-year cardiovascular disease (CVD) risk among older adults living in a coastal region of southeast China. Methods A population-based cross-sectional survey of 2018 adults was conducted on 60–98-year-old residents in Quanzhou from September 2016 to March 2018 using multistage stratified cluster random sampling. The 10-year CVD risk was estimated by applying the Chinese model recommended by the Chinese guidelines for CVD prevention. Results The overall prevalence of hypertension, prehypertension, and normotension among older adults in Quanzhou was 29.0%, 18.7%, and 52.3%, respectively. The percentage of participants with low, moderate, and high 10-year CVD risk was 49.7%, 36.8%, and 13.5%, respectively. Older age, low salt awareness, and low levels of physical activity were significantly correlated with hypertension. The 10-year CVD risk was higher for men than women and increased with age. Higher blood pressure was associated with a greater 10-year CVD risk. Conclusion More than half of the older adults in Quanzhou surveyed by this study were normotensive, and approximately half the participants had a moderate or high 10-year CVD risk. We recommend the implementation of regionally targeted interventions, such as screening of blood pressure and other risk factors, to reduce blood pressure and CVD risk in Chinese populations.
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Affiliation(s)
- Huiqin Lin
- Department of Geriatrics, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, People’s Republic of China
| | - Yuting Wu
- Department of Geriatrics, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, People’s Republic of China
| | - Jinying Wu
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People’s Republic of China
| | - Qiang Chen
- Department of General Practice, Fengze Huada Community Medical Center, Quanzhou, People’s Republic of China
| | - Jun Yu
- Outpatient Department, Fujian Military Region Fuzhou No. 9 Cadres Rest and Recuperation Center, Fuzhou, People’s Republic of China
| | - Yongjun Lin
- Department of General Practice, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, People’s Republic of China
- Correspondence: Yongjun Lin, Department of General Practice, The First Hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, Fujian, People’s Republic of China, Tel +86-15059801280, Email
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15
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BMI, Blood Pressure, and Plasma Lipids among Centenarians and Their Offspring. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3836247. [PMID: 35096109 PMCID: PMC8794670 DOI: 10.1155/2022/3836247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022]
Abstract
Background The burden of cardiovascular diseases (CVDs) is increasing substantially due to population growth and aging. Determining effective prevention and understanding the underlying mechanisms remain desirable pursuits for increasing the quality of life. As centenarians and their offspring may have genetic advantages, they may present with healthier cardiovascular-related profiles. Methods We launched a cross-sectional household-based survey of centenarian families, including 253 centenarians, 217 centenarian offspring, and 116 offspring spouses without centenarian parents from county-level Chinese longevity city Rugao. Among offspring and offspring spouses were the following arrangements: 101 paired offspring and offspring spouses who lived together, 116 unpaired offspring, and 16 unpaired spouses. We investigated their cardiovascular-related health status including waist circumference, body mass index (BMI), blood pressure, and plasma lipids and compared results among centenarians, centenarian offspring, and offspring spouses. Results Centenarians ranged from 99 to 109 years with a median age of 100 years. Centenarian offspring, with a median age of 70 years, and offspring spouses, with a median age of 69 years, shared similar age. Results of blood pressure, plasma lipid levels, and BMI displayed no significant difference between centenarian offspring and offspring spouses. However, centenarians appeared to have lower waist circumference, BMI, TC, LDL-C, TG, and diastolic blood pressure but higher levels of systolic blood pressure (p < 0.05). Multivariate analysis showed the prevalence of obesity, hypertension, and dyslipidemia was similar between centenarian offspring and offspring spouses, while centenarians appeared to have a lower prevalence of obesity and a higher prevalence of hypertension (p < 0.05). Conclusions Centenarians and centenarian offspring did not present healthier BMI, blood pressure, or plasma lipids than offspring spouses. Further research on longevity and cardiovascular diseases are desirable.
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Lu J, Liu L, Wang Y, Zhou Z. Social Engagement and Urban-Rural Disparity in Self-Management Behaviors: Study of Middle-Aged and Older Chinese Hypertension Patients. Front Public Health 2022; 9:801307. [PMID: 35155352 PMCID: PMC8828651 DOI: 10.3389/fpubh.2021.801307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study examines the effect of social engagement on urban-rural disparities in self-management behaviors (medication use, self-monitoring, physical activity, and tobacco and alcohol avoidance) among middle-aged and older Chinese patients with hypertension. METHODS Data from 2011 to 2018 were extracted from the four latest waves of the China Health and Retirement Longitudinal Study. Chi-square tests and t-tests were performed to examine urban-rural gaps in self-management behaviors. Random-effects panel logit regression models were adopted to confirm the effect of social engagement on urban-rural disparity in self-management behaviors and to explore whether this effect has narrowed or widened with "bilateral flow" between urban and rural residents. A Fairlie decomposition technique was also used to calculate the extent to which social engagement reflects urban-rural disparities. RESULTS There was significant urban-rural disparity in medication use and tobacco avoidance behaviors among the sampled patients. Medication use behavior (p < 0.001) among urban middle-aged and older patients was significantly better, whereas tobacco avoidance behavior (p < 0.05) was significantly lower compared with the rural population. Social engagement significantly enlarged the urban-rural gap in tobacco avoidance behavior (p < 0.01), but significantly narrowed the urban-rural gap in medication use behavior (p < 0.001). The Fairlie decomposition revealed that ~75.000% and 29.412% of the explained urban-rural gap in tobacco avoidance and medication use, respectively, could be attributed to social engagement. The negative effect of social engagement on urban-rural disparity in medication use increased when urban residents moved to rural areas (p < 0.05). CONCLUSIONS The urban-rural disparities in self-management behaviors of middle-aged and older Chinese hypertensive patients were mainly manifested in medication use and tobacco avoidance behaviors. The gaps in these two behaviors partly changed with social engagement, while the migration of urban population to rural areas weakens the positive role of social engagement in narrowing the urban-rural gap in medication use behavior. The insights of this paper on social engagement and urban-rural disparity in self-management behaviors, and the effect of urban-rural migration thereof, deserve the attention of health policymakers and researchers.
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Affiliation(s)
- Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Linhui Liu
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Yuan Wang
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Baffour-Awuah B, Pearson MJ, Smart NA, Dieberg G. Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study. Hypertens Res 2022; 45:483-495. [PMID: 35017680 PMCID: PMC8752388 DOI: 10.1038/s41440-021-00839-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/18/2021] [Accepted: 11/05/2021] [Indexed: 01/21/2023]
Abstract
Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts' consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.
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Affiliation(s)
- Biggie Baffour-Awuah
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia.
| | - Melissa J. Pearson
- grid.1020.30000 0004 1936 7371Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
| | - Neil A. Smart
- grid.1020.30000 0004 1936 7371Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
| | - Gudrun Dieberg
- grid.1020.30000 0004 1936 7371Biomedical Sciences, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351 Australia
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Koracevic G, Perisic Z, Stanojkovic M, Stojanovic M, Zdravkovic M, Tomasevic M, Djordjevic D, Mladenovic K, Koracevic M, Trkulja J. A Discrepancy: Calcium Channel Blockers Are Effective for the Treatment of Hypertensive Left Ventricular Hypertrophy but Not as Effective for Prevention of Heart Failure. Med Princ Pract 2022; 31:454-462. [PMID: 36044874 PMCID: PMC9801368 DOI: 10.1159/000526792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/25/2022] [Indexed: 01/03/2023] Open
Abstract
Arterial hypertension (HTN) is important due to its high prevalence, morbidity, and mortality rates. Calcium channel blockers (CCBs) are the first-line antihypertensive drugs. HTN can lead to heart failure (HF) by causing hypertensive left ventricular hypertrophy (HTN LVH). CCBs are recommended for the treatment of HTN LVH. The aim of this study was to analyze the status of CCBs regarding (1) HTN LVH treatment and (2) capability to prevent HTN-induced HF in the guidelines. For this narrative review, the following databases were searched: Medline, Scopus, Science Direct, Springer, SAGE, Wiley, Oxford Journals, Cambridge, and Google Scholar. CCBs are effective antihypertensive drugs and a very good therapeutic option for HTN LVH as they can cause reverse LVH remodeling. Consequently, we may expect that CCBs would prevent HF. However, evidence suggests that CCBs confer less protection from HF than other first-line antihypertensive drugs. A negative inotropic action of nondihydropyridine CCBs may contribute to suboptimal protection against HF. This discrepancy is clinically relevant because CCBs are in one of the two recommended (single pill) combinations for the initial treatment of HTN. LVH is a strong risk factor for HF in HTN patients. When LVH arises, the risk of HF increases dramatically. CCBs are inferior to renin-angiotensin-aldosterone system blockers but still very effective in bringing about regression of HTN LVH; consequently, CCBs are expected to protect from HF. On the contrary, CCBs protect from HF less effectively than other first-line antihypertensive drugs. This discrepancy needs to be investigated further to improve clinical practice.
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Affiliation(s)
- Goran Koracevic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Department for Cardiovascular Diseases, University Clinical Center Nis, Nis, Serbia
| | - Zoran Perisic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Department for Cardiovascular Diseases, University Clinical Center Nis, Nis, Serbia
| | | | - Milovan Stojanovic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia
- *Milovan Stojanovic,
| | | | - Miloje Tomasevic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dragan Djordjevic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia
| | - Katarina Mladenovic
- Faculty of Science, Department of Biology and Ecology, University of Kragujevac, Kragujevac, Serbia
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Yan X, Meng T, Liu H, Liu J, Du J, Chang C. The Association Between the Duration, Treatment, Control of Hypertension and Lifestyle Risk Factors in Middle-Aged and Elderly Patients with Mild Cognitive Impairment: A Case-Control Study. Neuropsychiatr Dis Treat 2022; 18:585-595. [PMID: 35342291 PMCID: PMC8942123 DOI: 10.2147/ndt.s353164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Epidemiological studies suggest that the incidence of hypertension in China is causally related to cognitive impairment. However, there is a dearth of information available regarding important factors for the association, including disease duration, therapeutic options, and risk factors associated with mild cognitive impairment (MCI) in patients with hypertension. METHODS We selected a diverse cohort of 572 patients with hypertension and assessed cognitive function using MoCA. Potential risk factors were investigated by a structured questionnaire. Risk factors associated with the hypertension-induced MCI occurring conversion of were analyzed using multifactorial regression analysis. RESULTS MCI was observed in 256 of 572 individuals, which increased with age (OR=1.15, 95% CI 1.10-1.20), but was decreased with high education status (OR=0.47, 95% CI 0.32-0.71). Risk factors independently associated with MCI were diabetes (OR=2.40, 95% CI 1.53-3.76), hyperlipidemia (OR=1.49, 95%=1.01-2.16), high salt diet (OR=2.27, 95% CI 1.34-3.84), and physical activity:>2h/week (OR=0.65, 95%0.44-0.94). However, controlling blood pressure to "normal" target values helped decrease the incidence of MCI (OR=0.44, 95% CI 0.30-0.65): this was not age dependent. CONCLUSION Our results suggest that it is necessary to promote the education of the middle-aged and elderly Chinese population to correctly and effectively use anti-hypertensives to control hypertension to a normal range to prevent cognitive.
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Affiliation(s)
- Xiwu Yan
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Key Laboratory of Cognitive Impairment Research, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Ting Meng
- Key Laboratory of Cognitive Impairment Research, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Huaijun Liu
- Key Laboratory of Cognitive Impairment Research, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Jinfeng Liu
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Juan Du
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Cheng Chang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
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20
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Yu X, Bao H, Shi J, Yuan X, Qian L, Feng Z, Geng J. Preferences for healthcare services among hypertension patients in China: a discrete choice experiment. BMJ Open 2021; 11:e053270. [PMID: 34876431 PMCID: PMC8655589 DOI: 10.1136/bmjopen-2021-053270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Our study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients. DESIGN We identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients' preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients. SETTING The DCE was conducted in Jiangsu province and Shanghai municipality in China. PARTICIPANTS Patients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited. RESULTS Patients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician-patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients' choice (β=-0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial. CONCLUSIONS Our findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients' preferences.
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Affiliation(s)
- Xiaolan Yu
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Haini Bao
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Liangliang Qian
- Department of Family Health Services, Pujiang Community Health Service Center, Shanghai, China
| | - Zhe Feng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Jinsong Geng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
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21
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Gao H, Wang K, Ahmadizar F, Zhao W, Jiang Y, Zhang L, Yu L, Zhou F, Gu J, Zhuang J, Xia ZL. Changes in late-life systolic blood pressure and all-cause mortality among oldest-old people in China: the chinese longitudinal healthy longevity survey. BMC Geriatr 2021; 21:562. [PMID: 34663235 PMCID: PMC8522233 DOI: 10.1186/s12877-021-02492-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background Blood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality. We aimed to investigate the association between changes of late-life systolic blood pressure (SBP), mean SBP and SBP variability (SBPV), and all-cause mortality in oldest-old. Methods Based on the community-based Chinese Longitudinal Healthy Longevity Survey with follow-up conducted in the 3-year interval, we assembled a retrospective cohort of 6639 participants ≥ 80 years with available blood pressure measurements at baseline and second wave. The primary exposures were mean SBP and SBPV (defined as the annual difference in SBP divided by mean SBP) measured between baseline and second wave. The primary outcome was all-cause mortality assessed from the second wave. Results During 21443.1 person-years of follow-up, 4622 death was recorded. U-shaped associations of mortality with mean SBP and SBPV were identified; the value of 137 mmHg and 4.0 %/year conferred the minimum mortality risk, respectively. The associations of a larger SBPV with an increased mortality risk were observed for both rises and large falls in SBP. The hazard ratio was 1.11 (comparing lowest versus middle quintile; 95 % CI: 1.01, 1.22) with large falls in SBPV and 1.08 (comparing highest versus middle quintile; 95 % CI: 0.98, 1.18) with large rises in SBPV. Conclusions U-shaped associations between late-life SBP and SBPV and all-cause mortality were found. Our study suggests that a stable SBP level in the middle range is related to lower mortality risk in the oldest-old. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02492-4.
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Affiliation(s)
- Hui Gao
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Kan Wang
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wensui Zhao
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Yu Jiang
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Lei Zhang
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Li Yu
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Fangjia Zhou
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Jialing Gu
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Jianlin Zhuang
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China.
| | - Zhao-Lin Xia
- School of Public Health, Fudan University, Shanghai, China
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22
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Gao H, Wang K, Ahmadizar F, Zhuang J, Jiang Y, Zhang L, Gu J, Zhao W, Xia ZL. Associations of changes in late-life blood pressure with cognitive impairment among older population in China. BMC Geriatr 2021; 21:536. [PMID: 34627157 PMCID: PMC8501650 DOI: 10.1186/s12877-021-02479-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background The cognitive impact of changes in late-life blood pressure is less clear. We aimed to investigate the association between late-life blood pressure changing pattern and risk of cognitive impairment. Methods Using data from the community-based Chinese Longitudinal Healthy Longevity Survey, change in systolic (SBP) or diastolic (DBP) blood pressure was calculated as the difference between follow-up and baseline, cognitive impairment was defined based on both the Mini-Mental State Examination and education level. The generalized additive model with penalized spline and multivariate logistic regression model were used, respectively, to examine the associations between continuous and categorized blood pressure changes with cognitive impairment at the follow-up wave. Results A total of 8493 Chinese elderly without cognitive impairment were included, with mean (standard deviation) age 80.6 (10.7) years. U-shaped associations between late-life blood pressure changes and risk of cognitive impairment were found, with only stable optimal blood pressure related to the lowest risk. For participants with baseline SBP around 130–150 mmHg, the adjusted odds ratio was 1.48 (1.13–1.93) for increasing follow-up SBP (> 150 mmHg), 1.28 (1.02–1.61) for decreasing follow-up SBP (< 130 mmHg), compared to stable follow-up SBP (130–150 mmHg). For participants with relative lower baseline DBP (< 80 mmHg), increasing their DBP to 80–90 mmHg during follow-up was associated with lower cognitive impairment risk (0.73 (0.58–0.93)), compared to steady low follow-up DBP (< 80 mmHg). Sex-specific analysis suggested that men were more vulnerable in term of SBP change. Conclusions Adhering to a stable optimal level of blood pressure in late-life is related to lower risk of cognitive impairment in Chinese elderly. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02479-1.
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Affiliation(s)
- Hui Gao
- Changning Center for Disease Control and Prevention, P.O. Box 803, 39 Yunwushan Road, Shanghai, 200032, China
| | - Kan Wang
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jianlin Zhuang
- Changning Center for Disease Control and Prevention, P.O. Box 803, 39 Yunwushan Road, Shanghai, 200032, China
| | - Yu Jiang
- Changning Center for Disease Control and Prevention, P.O. Box 803, 39 Yunwushan Road, Shanghai, 200032, China
| | - Lei Zhang
- Changning Center for Disease Control and Prevention, P.O. Box 803, 39 Yunwushan Road, Shanghai, 200032, China
| | - Jialing Gu
- Changning Center for Disease Control and Prevention, P.O. Box 803, 39 Yunwushan Road, Shanghai, 200032, China
| | - Wensui Zhao
- Changning Center for Disease Control and Prevention, P.O. Box 803, 39 Yunwushan Road, Shanghai, 200032, China.
| | - Zhao-Lin Xia
- School of Public Health, & Key Laboratory of Public Health Safety of Ministry of Education of China, Fudan University, Shanghai, 200032, China
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23
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Zhao J, Yuan F, Fu F, Liu Y, Xue C, Wang K, Yuan X, Li D, Liu Q, Zhang W, Jia Y, He J, Zhou J, Wang X, Lv H, Huo K, Li Z, Zhang B, Wang C, Wang X, Li H, Yang F, Jiang W. Hypertension management in elderly with severe intracerebral hemorrhage. Ann Clin Transl Neurol 2021; 8:2059-2069. [PMID: 34587373 PMCID: PMC8528461 DOI: 10.1002/acn3.51455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To explore the effect of individualized blood pressure (BP)‐lowering treatment on the outcomes of elderly patients with severe intracerebral hemorrhage (ICH). Methods We performed an exploratory analysis of Controlling Hypertension After Severe Cerebrovascular Event (CHASE) trial, which was a multicenter, randomized, controlled clinical trial. Patients with severe ischemic or hemorrhagic stroke (defined as GCS ≤ 12 or NIHSS ≥ 11) were randomized into individualized versus standard BP‐lowering treatment in CHASE trial. In this exploratory analysis, patients with severe ICH were included. The primary outcome was the percentage of patients with 90‐day functional independence defined as modified Rankin Scale (mRS) ≤2. Results We included 242 patients with severe ICH in the present analysis, consisting of 142 patients aged <65 years and 100 patients aged ≥65 years. There were significant differences between patients aged ≥65 years and <65 years in the proportion of functional independence (47.9% vs. 15.0%, P < 0.001) and good outcome (73.9% vs. 50.0%, P < 0.001) at day 90. In patients aged ≥65 years, the adjusted individualized BP‐lowering treatment had an unequivocal effect on the functional independence at day 90 (21.6% vs. 8.2%, odds ratio [OR]: 4.309, 95% confidence interval [CI]: 1.040‐17.859, P = 0.044) and improved the neurological deficits at discharge (∆ NIHSS ≥ 4: 64.7% vs. 34.7%, OR: 4.300, 95% CI: 1.599‐11.563, P = 0.004). Interpretation Compared with the younger counterparts, the elderly patients (≥65 years) with acute severe ICH might benefit more from individualized BP‐lowering treatment.
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Affiliation(s)
- Jingjing Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Feng Fu
- Department of Neurology, 215 Hospital of Shaanxi NI, Xianyang, 712021, China
| | - Yi Liu
- Department of Neurology, Ankang Central Hospital, Ankang, 725000, China
| | - Changhu Xue
- Department of Neurology, Xianyang Central Hospital, Xianyang, 712000, China
| | - Kangjun Wang
- Department of Neurology, Hanzhong Central Hospital, Hanzhong, 723000, China
| | - Xiangjun Yuan
- Department of Neurology, Weinan Central Hospital, Weinan, 714000, China
| | - Dingan Li
- Department of Neurology, Hanzhong Central Hospital, Hanzhong, 723000, China
| | - Qiuwu Liu
- Department of Neurology, Xi'an 141 Hospital, Xi'an, 710499, China
| | - Wei Zhang
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Yi Jia
- Department of Neurology, Xi'an Gaoxin Hospital, Xi'an, 710075, China
| | - Jianbo He
- Department of Neurology, Xi'an XD Group Hospital, Xi'an, 710077, China
| | - Jun Zhou
- Department of Neurology, Shangluo Central Hospital, Shangluo, 726000, China
| | - Xiaocheng Wang
- Department of Neurology, Yulin No.2 Central Hospital, Yulin, 719000, China
| | - Hua Lv
- Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Kang Huo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhuanhui Li
- Department of Neurology, 521 Hospital of NORINCO Group, Xi'an, 710000, China
| | - Bei Zhang
- Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, 710021, China
| | - Chengkai Wang
- Department of Neurology, Tongchuan People's Hospital, Tongchuan, China
| | - Xiaomu Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Hongzeng Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.,The Shaanxi Cerebrovascular Disease Clinical Research Center, Xi'an, 710032, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.,The Shaanxi Cerebrovascular Disease Clinical Research Center, Xi'an, 710032, China
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24
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Chen X, Yang Q, Fang J, Guo H. Effects of Different Systolic Blood Pressure Targets on Myocardial Function: A One-Year Follow-Up in Geriatric Hypertension. Int J Gen Med 2021; 14:3775-3785. [PMID: 34326663 PMCID: PMC8315814 DOI: 10.2147/ijgm.s318129] [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: 05/12/2021] [Accepted: 07/09/2021] [Indexed: 02/04/2023] Open
Abstract
Background A lower systolic blood pressure (SBP) target reduces major cardiovascular events and mortality from any cause of geriatric hypertension. However, the effect of different SBP targets on myocardial function remains unclear. This study aimed to determine changes in left ventricular (LV) strain in older hypertensive patients after 1 year of different SBP goals, and to evaluate its effects on myocardial mechanics in this population. Methods We studied 313 hypertensive adults aged 60 years or older after 1 year of the Systolic Blood Pressure Intervention Trial. They were divided into the intensive group (target SBP: 110–130 mmHg) and the standard group (target SBP: 130–150 mmHg). All participants underwent echocardiography within 1 week after enrollment and 1 year after participating in the study. Global longitudinal strain (GLS) of the LV (endocardial, middle, and epicardial layer: GLS-end, GLS-mid, and GLS-epi, respectively) and the improvement of GLS at 1 year (ΔGLS-end, ΔGLS-mid, and ΔGLS-epi) were measured. Results At 1 year, GLS-end in the intensive group was slightly improved compared with that before the trial (−23.78%±3.10% vs −22.58%±3.11%, P<0.05). The ΔGLS-end and ΔGLS-mid in the intensive group were higher than those in the standard group (1.20±0.23 vs 0.58±0.59% and 0.70±0.21 vs 0.52±0.17, P<0.05). Moreover, SBP at 1 year and an angiotensin II type 1 receptor antagonist were independent factors that affected ΔGLS-end (β= −0.005, P=0.004; β= 0.080, P<0.001, respectively). Conclusion These trial results suggest that a lower SBP target can slightly improve myocardial function in older hypertensive patients at 1 year.
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Affiliation(s)
- Xiaoyan Chen
- Department of Ultrasound, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Taiyuan, Shanxi Province, People's Republic of China
| | - Qingmei Yang
- Department of Ultrasound, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Taiyuan, Shanxi Province, People's Republic of China
| | - Jianxiu Fang
- Department of Ultrasound, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Taiyuan, Shanxi Province, People's Republic of China
| | - Haifeng Guo
- Department of Medical Imaging, Shanxi Armed Police Force Hospital, Taiyuan, Shanxi Province, People's Republic of China
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25
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Yang W, Luo H, Ma Y, Si S, Zhao H. Effects of Antihypertensive Drugs on Cognitive Function in Elderly Patients with Hypertension: A Review. Aging Dis 2021; 12:841-851. [PMID: 34094646 PMCID: PMC8139194 DOI: 10.14336/ad.2020.1111] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
Hypertension is a common comorbidity that contributes to the development of various cardiovascular disorders in elderly patients. Moreover, hypertension has been associated with cognitive decline and dementia. Cognitive impairment leads to increased morbidity and mortality in elderly patients with hypertension. However, previous studies investigating the association between blood pressure (BP), BP variability (BPV), and antihypertensive drug use and the risk of cognitive impairment in elderly patients with hypertension have reported inconsistent findings. Given the global burden of hypertension, the aging population, and the low quality of life associated with cognitive impairment, a more comprehensive understanding of the association between hypertension and cognitive decline is needed. In this review, we summarized the current preclinical evidence and clinical research regarding the association of BP control, BPV, and antihypertensive drug use and cognitive function. We particularly focused on the differences among categories of antihypertensive drugs. We concluded that the correlation of BP and risk of cognitive function is non-linear and dependent on a patient’s age. Intensive BP control is generally not recommended, particularly for the oldest-old. Increased BPV and characteristics of orthostatic hypotension in the elderly also increase the risk of cognitive decline. The current evidence does not support one category of antihypertensive drugs as superior to others for preventing dementia in elderly patients with hypertension.
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Affiliation(s)
- Wei Yang
- Department of Geriatric Medicine, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Hongyu Luo
- Department of Geriatric Medicine, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Yixin Ma
- Department of Geriatric Medicine, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Sicong Si
- Department of Geriatric Medicine, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Huan Zhao
- Department of Geriatric Medicine, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
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26
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Philip R, Beaney T, Appelbaum N, Gonzalvez CR, Koldeweij C, Golestaneh AK, Poulter N, Clarke JM. Variation in hypertension clinical practice guidelines: a global comparison. BMC Med 2021; 19:117. [PMID: 33975593 PMCID: PMC8114719 DOI: 10.1186/s12916-021-01963-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension is the largest single contributor to the global burden of disease, affecting an estimated 1.39 billion people worldwide. Clinical practice guidelines (CPGs) can aid in the effective management of this common condition, however, inconsistencies exist between CPGs, and the extent of this is unknown. Understanding the differences in CPG recommendations across income settings may provide an important means of understanding some of the global variations in clinical outcomes related to hypertension. AIMS This study aims to analyse the variation between hypertension CPGs globally. It aims to assess the variation in three areas: diagnostic threshold and staging, treatment and target blood pressure (BP) recommendations in hypertension. METHODS A search was conducted on the MEDLINE repository to identify national and international hypertension CPGs from 2010 to May 2020. An additional country-specific grey-literature search was conducted for all countries and territories of the world as identified by the World Bank. Data describing the diagnosis, staging, treatment and target blood pressure were extracted from CPGs, and variations between CPGs for these domains were analysed. RESULTS Forty-eight CPGs from across all World Bank income settings were selected for analysis. Ninety-six per cent of guidelines defined hypertension as a clinic-based BP of ≥140/90 mmHg, and 87% of guidelines recommended a target BP of < 140/90 mmHg. In the pharmacological treatment of hypertension, eight different first-step, 17 different second-step and six different third-step drug recommendations were observed. Low-income countries preferentially recommended diuretics (63%) in the first-step treatment, whilst high-income countries offered more choice between antihypertensive classes. Forty-four per cent of guidelines, of which 71% were from higher-income contexts recommended initiating treatment with dual-drug therapy at BP 160/100 mmHg or higher. CONCLUSION This study found that CPGs remained largely consistent in the definition, staging and target BP recommendations for hypertension. Extensive variation was observed in treatment recommendations, particularly for second-line therapy. Variation existed between income settings; low-income countries prescribed cheaper drugs, offered less clinician choice in medications and initiated dual therapy at later stages than higher-income countries. Future research exploring the underlying drivers of this variation may improve outcomes for hypertensive patients across clinical contexts.
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Affiliation(s)
- Richu Philip
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nick Appelbaum
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Carmen Rodriguez Gonzalvez
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Charlotte Koldeweij
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jonathan M Clarke
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
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Chuangchai W, Pothisiri W. Postural Changes on Heart Rate Variability among Older Population: A Preliminary Study. Curr Gerontol Geriatr Res 2021; 2021:6611479. [PMID: 33727919 PMCID: PMC7937484 DOI: 10.1155/2021/6611479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE This study aims to investigate an association between body postures and autonomic nervous system (ANS) responses through analysis of short-term heart rate variability (HRV) data obtained through electrocardiography. METHODS Forty older individuals were recruited to form the sample. HRV measurements were taken in three positions-sitting, supine, and standing-and compared. RESULTS Results demonstrated statistically significant differences in the HRV parameters used to examine the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS), specifically in the measurements obtained from the sitting position and the supine position (P < 0.001 for PNS and P = 0.011 for SNS). The differences in these parameters were, however, negligible between the sitting and the standing positions. Moreover, the ANS responses obtained in the sitting position were strongly and positively correlated with those in the standing position (r = 0.854 for PNS and r = 0.794 for SNS). These results suggested that the PNS and SNS parameters obtained while sitting were likely to be affected by orthostatic hypotension in much the same way as those in the standing position, as compared to the supine position. CONCLUSIONS As such, sitting may not be the best position for older individuals in the assessment of their autonomic responses, whereas the supine position is recommended as the baseline posture in the old-age population. These findings are useful for future research in clinical settings that require accuracy in the ANS responses as determined by the HRV measurements.
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Affiliation(s)
| | - Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
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Advances in Journal of Geriatric Cardiology over the course of a decade. J Geriatr Cardiol 2020; 17:733-739. [PMID: 33424940 PMCID: PMC7762697 DOI: 10.11909/j.issn.1671-5411.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zhang J, Zhao A, Wu W, Yang C, Ren Z, Wang M, Wang P, Zhang Y. Dietary Diversity Is Associated With Memory Status in Chinese Adults: A Prospective Study. Front Aging Neurosci 2020; 12:580760. [PMID: 33117146 PMCID: PMC7494158 DOI: 10.3389/fnagi.2020.580760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND AIM Subjective memory complaints are common in elderly people. Nutrition plays an important role in keeping brain health, however, the evidence on dietary diversity and subjective memory status is limited. This study aimed to investigate the effect of dietary diversity score (DDS) on memory status in Chinese adults in a prospective cohort study. METHODS Data of the China Health and Nutrition Survey was used in this study. A total of 4356 participants aged 50 years or older were enrolled in the analysis. DDS was calculated based on the dietary recall data collected in the wave of 2011. Information on self-report memory status (OK, good, or bad) and memory change in the past 12 months (stayed the same, improved, or deteriorated) were obtained from the wave of 2015. A memory score was calculated based on a subset of items of the Telephone Interview for Cognitive Status-modified. Multinomial logistic regression models were used to estimate the associations of DDS with memory status and memory change, and linear regression models were carried out to estimate the association between DDS and memory score. RESULTS In the study population, the percentages of participants who thought their memory was OK, bad, and good were 43.3, 24.3, and 32.4%, respectively. There were 1.4% of participants reported memory improvement in the past 12 months and 47.2% reported memory decline. Average memory score among participants was 12.8 ± 6.1. Compared with participants who thought their memory was OK, a higher DDS was associated with self-reported good memory (Odds Ratio [OR] 1.15, 95%CI 1.07-1.24) and inversely associated with bad memory (OR 0.82, 95%CI 0.75-0.89). In subgroup analysis, however, in participants aged 65 years and above, the association between DDS and self-reported good memory was insignificant (OR 1.09, 95%CI 0.94-1.25). Compared with participants whose memory stayed the same, higher DDS was inversely associated with memory decline (OR 0.85, 95%CI 0.80-0.91). Besides, higher DDS was associated with higher memory score (β 0.74, 95%CI 0.56-0.91). CONCLUSION This study revealed that higher DDS was associated with better memory status and was inversely associated with self-reported memory decline in Chinese adults.
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Affiliation(s)
- Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wei Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Chenlu Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Meichen Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
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Meireles D, Gomes J, Lopes L, Hinzmann M, Machado J. A review of properties, nutritional and pharmaceutical applications of Moringa oleifera: integrative approach on conventional and traditional Asian medicine. ADVANCES IN TRADITIONAL MEDICINE 2020. [PMCID: PMC7430547 DOI: 10.1007/s13596-020-00468-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Moringa oleifera L. from the Moringaceae family is a perennial tree widely cultivated in many tropic regions and easily grown even in adverse conditions. M. oleifera is also known as the miracle tree, which for centuries has been indicated for traditional medicine. With no reports of side effects, in doses achievable by ingestion, different parts of M. oleifera is used to treat several conditions, such as malnutrition, diabetes, blindness, anemia, hypertension, stress, depression, skin, arthritis, joints and kidney stones disorders. This plant also showed capacity of helping in maintenance of the cardiovascular system health, blood-glucose levels and providing anti-oxidant, anti-inflammatory and anti-cancer activity as well as the regulation of urinary tract and lactation in nursing women. The seed and leaves powder has water purification properties through flocculation. It also supplements the food in the human diet and in the fortification of livestock feed, especially in developing countries. So, M. oleifera properties have also been applied to cosmetic and byproducts industries due to the high nutritive and protective properties of its seed oil. According to the holistic or traditional medicine, M. oleifera has very relevant therapeutic properties and applications depending on the constitution, somatic and psychological needs of patients. It is usually referred as a natural product that can treat different physical and psychological health aspects, offering an energetic action and structural rebuilder of the body and promoting emotions of highly positive attitudes towards life. The high and specific immunological potential of M. oleifera leads us to suggest an in-depth study to assess the hypothesis of conferring a supportive effect against Covid-19 disease.
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Affiliation(s)
- Diana Meireles
- ICBAS, Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira no. 228, 4050-313 Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
| | - João Gomes
- YIDAO, Acupuncture and TCM Center, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
| | - Lara Lopes
- ICBAS, Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira no. 228, 4050-313 Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
| | - Mariana Hinzmann
- ICBAS, Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira no. 228, 4050-313 Porto, Portugal
- CIIMAR, Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Porto, Portugal
| | - Jorge Machado
- ICBAS, Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira no. 228, 4050-313 Porto, Portugal
- CIIMAR, Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
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Galimzhanov AM, Sabitov YT, Azizov BS. The implications of blood pressure targets from the 2018 European Society of Cardiology hypertension guidelines in Asian patients: a systematic review and meta-analysis. Ann Saudi Med 2020; 40:234-254. [PMID: 32493048 PMCID: PMC7270621 DOI: 10.5144/0256-4947.2020.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The evidence for optimal blood pressure (BP) targets in Asian patients with hypertension is insufficient and controversial. Western guidelines should be used with caution in clinical practice until there is supporting evidence. OBJECTIVE Systematically synthesize the evidence on the efficacy of achieving the strict 2018 European Society of Cardiology (ESC) guideline BP targets versus standard BP targets in Asian patients. DATA SOURCES We searched PubMed, Web of Science, Scopus, the Cochrane Central Register of controlled trials, and additional databases to retrieve relevant Asian studies. STUDY SELECTION Randomized controlled trials (RCTs) and observational studies that reported clinical endpoints, had a minimal follow-up period of one year and included Asian patients older than 18 years with essential hypertension. DATA EXTRACTION Two investigators independently conducted the study selection with any discrepancies resolved between team members. DATA SYNTHESIS We selected 15 studies for analysis (4 RCTs, 7 observational studies, and 4 post-hoc analyses). The evidence for the strict BP targets in elderly patients was insufficient. In middle-aged patients, the meta-analysis of observational studies revealed a significant reduction in major adverse cardiac events (MACCE) (hazard ratio (HR)=0.78; 95% confidence interval (CI: 0.74-0.81). For studies that reported results for patients of any age, the tight systolic BP-lowering therapy was associated with a decrease in MACCE (HR=0.80; 95% CI: 0.69-0.92), stroke (HR=0.82; 95% CI: 0.71-0.94), but not in cardiac events (HR=0.91; 95% CI: 0.72-1.14, P=.41), all-cause (HR=0.80; 95% CI: 0.57-1.13) and cardiovascular mortality (HR=0.73; 95% CI: 0.40-1.33, P=.30). Similar findings were obtained for the strict diastolic BP targets. CONCLUSION Our findings provide evidence for Asian patients that support the efficacy of the strict antihypertensive treatment with BP targets proposed by the 2018 ESC hypertension guidelines for the prevention of cardiovascular events. However, these data were obtained from only observational studies and the results were not confirmed by RCTs, probably due to insufficient power. Therefore, further high-quality RCTs are crucial. LIMITATIONS Use of aggregated data, the subgroup and meta-regression analyses are inconclusive, limited to English language, unable to estimate summary measures for some outcomes, publication bias difficult to assess, and unclear that results could be extrapolated. REGISTRATION The protocol registered in PROSPERO (CRD42018115570). CONFLICT OF INTEREST None.
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Affiliation(s)
| | - Yersyn Toleutayevich Sabitov
- From the DLaboratory of Roentgen-endovascular Surgery, University Hospital of Semey Medical University, Semey, Kazakhstan
| | - Baurzhan Slymovich Azizov
- From the DLaboratory of Roentgen-endovascular Surgery, University Hospital of Semey Medical University, Semey, Kazakhstan
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Association between serum uric acid level and endothelial dysfunction in elderly individuals with untreated mild hypertension. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:264-269. [PMID: 32547609 PMCID: PMC7276314 DOI: 10.11909/j.issn.1671-5411.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Endothelial dysfunction is the initial stage in atherosclerotic formation and progression and is associated with high serum uric acid (SUA) level. We hypothesized that reactive hyperemia index (RHI), which reflects endothelial function, is associated with SUA levels in elderly individuals with untreated mild hypertension. Methods We recruited 123 patients ≥ 60 years with untreated mild hypertension. The association between SUA level and RHI was analyzed using univariate correlation analysis and multiple regression analysis. The receiver operating characteristic (ROC) curve was performed to validate the cutoff value of SUA that can be used to predict endothelial dysfunction. Results The serum uric acid level significantly increased in the RHI < 1.67 group, and this result was still observed in the subgroup of men. RHI was inversely associated with SUA level (P = 0.006) and the association was still observed after adjusting for factors, such as age, sex, smoking status, and creatinine level (P = 0.014). In the subgroup analysis, a positive association was observed only in men. In the ROC curve analysis, the optimal cutoff values of SUA for predicting endothelial dysfunction was 293.5 µmol/L in elderly mild hypertension patients and 287.0 µmol/L in men. Conclusion A high SUA level was considered an independent predictor of endothelial dysfunction among elderly individuals, particularly men with untreated mild hypertension.
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Song S, Li H. Study on Risk and Influencing Factors of Hypertension in Chinese Elderly. Gerontol Geriatr Med 2019; 5:2333721419877978. [PMID: 31598540 PMCID: PMC6764077 DOI: 10.1177/2333721419877978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/16/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022] Open
Abstract
Objective: The incidence of hypertension in elderly patients in China and influencing
factors. Method: Based on the baseline data in 2013 from the China Health and Retirement
Longitudinal Study (CHARLS), this study used the practical incidence
estimator (PIE) method to estimate incidence of hypertension, and applied
Cox regression to determine the relationship between the hypertension and
influencing factors. Results: In general, the incidence of hypertension in elderly patients decreased with
age, and the risk of hypertension in females was significantly higher than
that in males. The cumulative incidence of hypertension for an individual,
who is hypertension-free before the age of 65 years, could reach 86.21% (95%
confidence interval [CI] = [85.09%, 87.87%]) during one’s survival time. The
status of drinking, pension and work, education background, place of
residence, and gender were verified to influence the onset of
hypertension. Conclusion: For Chinese elderly, developing hypertension during their life span has
almost become an inevitable event, which may become a huge social burden in
China.
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Yongtai L, Jinzhi L, Lixin Z, Feifei Z, Dingding Z, Zhuang T, Yanlin Z, Wei C, Hua B, Hui W, Yicheng Z, Liying C, Zhengyu J, Zhang S. Effect of different ranges of systolic blood pressure on left ventricular structure and diastolic function in a Chinese population: a cross-sectional population-based Shunyi study. BMJ Open 2019; 9:e028398. [PMID: 31481369 PMCID: PMC6731946 DOI: 10.1136/bmjopen-2018-028398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effect of different ranges of systolic blood pressure (SBP) on left ventricular (LV) geometry and diastolic function in Chinese population. DESIGN Cross-sectional study. SETTING Peking Union Medical College Hospital in Beijing, China. PARTICIPANTS All inhabitants aged 35 years or older, living in five villages of Shunyi were invited. Exclusion criteria included individuals who declined participation, presence of moderate to severe valvular heart disease, persistent atrial fibrillation and suboptimal echocardiograms. INTERVENTIONS The baseline data of 1051 participants were analysed. The relationship between SBP and LV geometric and diastolic function assessed by echocardiography was analysed after adjusting for conventional cardiac risk factors. RESULTS The adjusted value of SBP was independently associated with LV hypertrophy (LVH) and LV diastolic dysfunction (LVDDF) (all p<0.01). Setting individuals with SBP <120 mm Hg as the reference group (group 1), those with SBP between 120 mm Hg and 140 mm Hg (group 2) had higher risk odds of LVH and those with SBP ≥140 mm Hg (group 3) had higher risk odds of LVH and LVDDF (all p<0.01). With the increase of SBP, LV mass index (LVMI) and E/e' stepwise increased and e' stepwise decreased significantly from group 1 to 3 (all p<0.05). In the whole population, SBP was independently correlated with LVMI, LVEDD, Left Atrial Volume Index, e', and E/e' (all p<0.01). CONCLUSIONS SBP was independently related to LVH and LVDDF, SBP between 120 and 140 mm Hg was independently related to worse LV remodelling and diastolic function, these findings indicated the potential benefit of intensive SBP control.
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Affiliation(s)
- Liu Yongtai
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Lai Jinzhi
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhou Lixin
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhai Feifei
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhang Dingding
- Central Research Laboratory, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Tian Zhuang
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhu Yanlin
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Chen Wei
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Bai Hua
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Wang Hui
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhu Yicheng
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Cui Liying
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Jin Zhengyu
- Radiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Shuyang Zhang
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
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