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Okyere J, Ayebeng C, Owusu BA, Dickson KS. Prevalence and factors associated with hypertension among older people living with HIV in South Africa. BMC Public Health 2022; 22:1684. [PMID: 36064661 PMCID: PMC9446744 DOI: 10.1186/s12889-022-14091-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background People living with HIV (PLHIV) are experiencing increased life expectancy mostly due to the success of anti-retroviral therapy. Consequently, they face the threat of chronic diseases attributed to ageing including hypertension. The risk of hypertension among PLHIV requires research attention particularly in South Africa where the prevalence of HIV is highest in Africa. We therefore examined the prevalence and factors associated with hypertension among older people living with HIV in South Africa. Methods We analysed cross-sectional data on 514 older PLHIV. Data were extracted from the WHO SAGE Well-Being of Older People Study (WOPS) (2011–2013). The outcome variable was hypertension status. Data was analysed using STATA Version 14. Chi-square and binary logistic regression were performed. The results were presented in odds ratio with its corresponding confidence interval. Results The prevalence of hypertension among PLHIV was 50.1%. Compared to PLHIV aged 50–59, those aged 60–69 [OR = 2.2; CI = 1.30,3.84], 70–79 years [OR = 2.8; CI = 1.37,5.82], and 80 + [OR = 4.9; CI = 1.68,14.05] had higher risk of hypertension. Females were more likely [OR = 5.5; CI = 2.67,11.12] than males to have hypertension. Persons ever diagnosed with stroke were more likely [OR = 3.3; CI = 1.04,10.65] to have hypertension when compared to their counterparts who have never been diagnosed with stroke. Compared to PLHIV who had no clinic visits, those who visited the clinic three to six times [OR = 5.3; CI = 1.35,21.01], or more than six times [OR = 5.5; CI = 1.41,21.41] were more likely to have hypertension. Conclusion More than half of South African older PLHIV are hypertensive. The factors associated with hypertension among older PLHIV are age, sex, ever diagnosed with stroke and number of times visited the clinic. Integration of hypertension management and advocacy in HIV care is urgently needed in South Africa in order to accelerate reductions in the prevalence of hypertension among older PLHIV, as well as enhance South Africa’s capacity to attain the Sustainable Development Goal target 3.3.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. .,Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Huber CC, Wang X, Wang H. Impact of Cardiovascular Diseases on Ischemic Stroke Outcomes. J Integr Neurosci 2022; 21:138. [PMID: 36137958 PMCID: PMC9721101 DOI: 10.31083/j.jin2105138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022] Open
Abstract
Stroke induces complex pathological cascades in the affected brain area, leading to brain injury and functional disability. To fight against cerebral ischemia/reperfusion-induced neuronal death, numerous neuroprotective strategies and reagents have been studied. However, translation of these neuroprotective drugs to clinical trials has been unsuccessful. To date, the tissue plasminogen activator is still the only FDA-approved drug for treating ischemic stroke. Thus, it is obligatory to identify and validate additional therapeutic strategies for stroke. A stroke rarely occurs without any other pathophysiological condition; but instead, it often has multi-morbidity conditions, one of which is cardiac disease. Indeed, up to half of the stroke cases are associated with cardiac and large artery diseases. As an adequate blood supply is essential for the brain to maintain its normal function, any pathophysiological alterations in the heart are frequently implicated in stroke outcomes. In this review, we summarize some of the cardiovascular factors that influence stroke outcomes and propose that considering these factors in designing stroke therapies should enhance success in clinical trials. We also highlight the recent advances regarding the potential effect of protein aggregates in a peripheral organ, such as in the heart, on ischemic stroke-caused brain injury and functional recovery. Including these and other comorbidity factors in the future therapeutic strategy designs should facilitate translational success toward developing effective combinational therapies for the disorder.
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Affiliation(s)
- Christa C. Huber
- Division of Basic Biomedical Sciences and Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Xuejun Wang
- Division of Basic Biomedical Sciences and Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Hongmin Wang
- Division of Basic Biomedical Sciences and Center for Brain and Behavior Research, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
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Naqvi IA, Cheung YK, Strobino K, Li H, Tom SE, Husaini Z, Williams OA, Marshall RS, Arcia A, Kronish IM, Elkind MSV. TASC (Telehealth After Stroke Care): a study protocol for a randomized controlled feasibility trial of telehealth-enabled multidisciplinary stroke care in an underserved urban setting. Pilot Feasibility Stud 2022; 8:81. [PMID: 35410312 PMCID: PMC8995696 DOI: 10.1186/s40814-022-01025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension is the most important modifiable risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, hypertension remains poorly controlled in many stroke survivors. Black and Hispanic patients have a higher prevalence of uncontrolled BP and higher rates of stroke. Limited access to care contributes to challenges in post-stroke care. Telehealth After Stroke Care (TASC) is a telehealth intervention that integrates remote BP monitoring (RBPM) including nursing telephone support, tailored BP infographics and telehealth video visits with a multidisciplinary team approach including pharmacy to improve post-stroke care and reduce stroke disparities. Methods In this pilot trial, 50 acute stroke patients with hypertension will be screened for inclusion prior to hospital discharge and randomized to usual care or TASC. Usual care patients will be seen by a primary care nurse practitioner at 1–2 weeks and a stroke neurologist at 1 and 3 months. In addition to these usual care visits, TASC intervention patients will see a pharmacist at 4 and 8 weeks and will be enrolled in RBPM consisting of home BP monitoring with interval calls by a centralized team of telehealth nurses. As part of RBPM, TASC patients will be provided with a home BP monitoring device and electronic tablet that wirelessly transmits home BP data to the electronic health record. They will also receive tailored BP infographics that help explain their BP readings. The primary outcome will be feasibility including recruitment, adherence to at least one video visit and retention rates. The clinical outcome for consideration in a subsequent trial will be within-patient change in BP from baseline to 3 months after discharge. Secondary outcomes will be medication adherence self-efficacy and satisfaction with post-stroke telehealth, both measured at 3 months. Additional patient reported outcomes will include depression, cognitive function, and socioeconomic determinants. Multidisciplinary team competency and fidelity measures will also be assessed. Conclusions Integrated team-based interventions may improve BP control and reduce racial/ethnic disparities in post-stroke care. TASC is a post-acute stroke care model that is novel in providing RBPM with tailored infographics, and a multidisciplinary team approach including pharmacy. Our pilot will determine if such an approach is feasible and effective in enhancing post-stroke BP control and promoting self-efficacy. Trial registration ClinicalTrials.gov NCT04640519 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01025-z.
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Affiliation(s)
- Imama A Naqvi
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,Division of Stroke and Cerebrovascular Diseases, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kevin Strobino
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hanlin Li
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Sarah E Tom
- Department of Neurology Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Olajide A Williams
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Randolph S Marshall
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Doogue R, Hayes P, Tucker K, Fahey T, Sheikhi A, Koshiaris C, Glynn LG. Self-monitoring for improving control of blood pressure in patients with hypertension. Hippokratia 2021. [DOI: 10.1002/14651858.cd010311.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Róisín Doogue
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
| | - Peter Hayes
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
| | - Katherine Tucker
- Department of Primary Care Health Sciences; University of Oxford; Oxford UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice; RCSI Medical School; Dublin 2 Ireland
| | - Ali Sheikhi
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
| | | | - Liam G Glynn
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
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Mugge L, Mansour TR, Krafcik B, Mazur T, Floyd-Bradstock T, Medhkour A. Immunological, vascular, metabolic, and autonomic changes seen with aging possible implications for poor outcomes in the elderly following decompressive hemicraniectomy for malignant MCA stroke: a critical review. J Neurosurg Sci 2018. [PMID: 29527887 DOI: 10.23736/s0390-5616.18.04207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Stroke is one of the leading causes of mortality and morbidity worldwide and requires rapid and intensive treatment to prevent adverse outcomes. Decompressive hemicraniectomy stands as the gold standard for surgical resolution of the intracranial swelling which accompanies cerebral infarction; however, the benefits of this procedure are not as well achieved in the elderly (age >65 years) compared to the younger population. EVIDENCE ACQUISITION This is a critical review performed on all available literature relating to middle cerebral artery (MCA) stroke in the elderly with emphasis on articles examining causality of adverse outcomes in this group over younger populations. Utilizing PRISMA guidelines, we initially identified 1462 articles. EVIDENCE SYNTHESIS After screening, four clear areas of physiological change associated with aging were identified and expounded upon as they relate to MCA stroke. These four areas include: immunological, autonomic, mitochondrial, and vascular changes. Elderly patients have a decreased and declining capacity to regulate the inflammation that develops postinfarction and this contributes to adverse outcomes from a neurological stand point. Additionally, aging decreases the ability of elderly patients to regulate their autonomic system resulting in aberrant blood pressures systemically post infarction. With age, the mitochondrial response to ischemia is exaggerated and causes greater local damage in elderly patients compared to younger populations. Finally, there are numerous vascular changes that occur with age including accumulation of homocysteine and atherosclerosis which together contributed to decreased structural integrity of the vasculature in the elderly and render decreased support to the recovery process post infarction. CONCLUSIONS We conclude that physiological changes inherent in the aging process serve to intensify adverse outcomes that are commonly associated with strokes in the elderly. Identification and subsequent minimization of these risk factors could allow for more effective management of elderly patients, post stroke, and promote better clinical outcomes.
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Affiliation(s)
- Luke Mugge
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Tarek R Mansour
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Brianna Krafcik
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Travis Mazur
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Tonya Floyd-Bradstock
- Interprofessional Immersive Simulation Center, University of Toledo Medical Center, Toledo, OH, USA
| | - Azedine Medhkour
- Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA -
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Pergola PE, White CL, Szychowski JM, Talbert R, Brutto OD, Castellanos M, Graves JW, Matamala G, Pretell EJ, Yee J, Rebello R, Zhang Y, Benavente OR. Achieved blood pressures in the secondary prevention of small subcortical strokes (SPS3) study: challenges and lessons learned. Am J Hypertens 2014; 27:1052-60. [PMID: 24610884 DOI: 10.1093/ajh/hpu027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lowering blood pressure (BP) after stroke remains a challenge, even in the context of clinical trials. The Secondary Prevention of Small Subcortical Strokes (SPS3) BP protocol, BP management during the study, and achieved BPs are described here. METHODS Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: <130mm Hg, or higher: 130-149mm Hg. SBP management over the course of the trial was examined by race/ethnicity and other baseline conditions. RESULTS Mean SBP decreased for both groups from baseline to the last follow-up, from 142.4 to 126.7mm Hg for the lower SBP target group and from 143.6 to 137.4mm Hg for the higher SBP target group. At baseline, participants in both groups used an average of 1.7±1.2 antihypertensive medications, which increased to a mean of 2.4±1.4 (lower group) and 1.8±1.4 (higher group) by the end-study visit. It took an average of 6 months for patients to reach their SBP target, sustained to the last follow-up. Black participants had the highest proportion of SBP ≥150mm Hg at both study entry (40%) and end-study visit (17%), as compared with whites (9%) and Hispanics (11%). CONCLUSIONS These results show that it is possible to safely lower BP even to a SBP goal <130mm Hg in a variety of patients and settings, including private and academic centers in multiple countries. This provides further support for protocol-driven care in lowering BP and consequently reducing the burden of stroke.
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Affiliation(s)
- Pablo E. Pergola
- Department of Medicine, University of Texas Health Sciences Center at San Antonio and Renal Associates PA, San Antonio, Texas
| | - Carole L. White
- School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Jeff M. Szychowski
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert Talbert
- College of Pharmacy, University of Texas at Austin, Austin, Texas
| | - Oscar del Brutto
- Department of Neurological Sciences, Hospital-Clínica Kennedy, and School of Medicine, Universidad Espíritu Santo–Ecuador, Guayaquil, Ecuador
| | - Mar Castellanos
- Department of Neurology, Hospital Universitari Dr. Josep Trueta of Girona, Barcelona, Spain
| | - John W. Graves
- Division of Nephrology and Hypertension College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gonzalo Matamala
- Unidad de Neurologia, Hospital Naval A. Nef, Vina del Mar, Chile
| | | | - Jerry Yee
- Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Rosario Rebello
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Yu Zhang
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Oscar R. Benavente
- Division of Neurology, Department of Medicine, Brain Research Center, University of British Columbia, Vancouver, Canada
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White CL, Pergola PE, Szychowski JM, Talbert R, Cervantes-Arriaga A, Clark HD, Del Brutto OH, Godoy IE, Hill MD, Pelegrí A, Sussman CR, Taylor AA, Valdivia J, Anderson DC, Conwit R, Benavente OR. Blood pressure after recent stroke: baseline findings from the secondary prevention of small subcortical strokes trial. Am J Hypertens 2013; 26:1114-22. [PMID: 23736109 PMCID: PMC3816319 DOI: 10.1093/ajh/hpt076] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/01/2013] [Accepted: 05/04/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypertension is the most powerful risk factor for stroke. The aim of this study was to characterize baseline blood pressure in participants in the Secondary Prevention of Small Subcortical Strokes trial. METHODS For this cross-sectional analysis, participants were categorized by baseline systolic blood pressure (SBP) < 120, 120-139, 140-159, 160-179, and ≥ 180 mm Hg and compared on demographic and clinical characteristics. Predictors of SBP < 140 mm Hg were examined. RESULTS Mean SBP was 143±19 mm Hg while receiving an average of 1.7 antihypertensive medications; SBP ≥ 140 mm Hg for 53% and ≥ 160 mm Hg for 18% of the 3,020 participants. Higher SBP was associated with a history of hypertension and hypertension for longer duration (both P < 0.0001). Higher SBPs were associated with more extensive white matter disease on magnetic resonance imaging (P < 0.0001). There were significant differences in entry-level SBP when participants were categorized by race and region (both P < 0.0001). Black participants were more likely to have SBP ≥ 140 mm Hg. Multivariable logistic regression showed an independent effect for region with those from Canada more likely (odds ratio = 1.7; 95% confidence interval, 1.29, 2.32) to have SBP < 140 mm Hg compared with participants from United States. CONCLUSIONS In this cohort with symptomatic lacunar stroke, more than half had uncontrolled hypertension at approximately 2.5 months after stroke. Regional, racial, and clinical differences should be considered to improve control and prevent recurrent stroke.
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Affiliation(s)
- Carole L White
- School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, TX
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