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Martín-Riobóo E, Turégano-Yedro M, Banegas JR. Evidence on the use of alternative substances and therapies in hypertension. Hipertens Riesgo Vasc 2024; 41:40-57. [PMID: 38123388 DOI: 10.1016/j.hipert.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Review of some of the best-known biological and non-biological complementary/alternative therapies/medicines (CAM) and their relationship with blood pressure (BP) and hypertension (HT). SEARCH STRATEGY Narrative review assessing a recent series of systematic reviews, meta-analyses, and clinical trials published in recent years, focusing on the effects of CAM on BP and HT. SELECTION OF STUDIES We searched EMBASE, MEDLINE, Cochrane Library and Google Scholar, obtaining a total of 4336 articles, finally limiting the search to 181 after applying filters. SYNTHESIS OF RESULTS Some studies on biological therapies show some usefulness in BP reduction with an adequate benefit-risk balance, although there is a scarcity of high-quality trials that support these results. Some mind-body therapies have shown hypothetical benefit; in contrast, others lack robust evidence. CONCLUSIONS Although some therapies present a reasonable risk-benefit ratio, they should in no case replace pharmacological treatment when indicated.
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Affiliation(s)
- E Martín-Riobóo
- Especialista en Medicina Familiar y Comunitaria, UGC Poniente, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, IMIBIC, Hospital Reina Sofía Córdoba, Spain.
| | - M Turégano-Yedro
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Casar de Cáceres, Cáceres, Spain
| | - J R Banegas
- Especialista en Medicina Preventiva y Salud Pública, Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz y CIBERESP, Madrid, Spain
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Carrasco-Rios M, Ortolá R, Sotos-Prieto M, Graciani A, Rodríguez-Artalejo F, Banegas JR, García-Esquinas E. Association of blood manganese concentrations with 24-h based brachial and central blood pressure, and pulse-wave velocity. Environ Res 2023; 225:115625. [PMID: 36894115 DOI: 10.1016/j.envres.2023.115625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/24/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Potential environmental determinants of BP and hypertension in older adults are far less known than their lifestyle risk factors. Manganese (Mn) is an essential element for life that may induce changes in blood pressure (BP), but the direction of the association is unclear. We aimed to examine the association of blood manganese (bMn) with 24-h-based brachial, central BP (cBP), and pulse-wave velocity (PWV). With this purpose, we analyzed data from 1009 community-living adults aged >65 years without BP medication. bMn was measured using inductively-coupled plasma-mass spectrometry and 24-h BP with validated devices. The association of bMn (median: 6.77 μg/L; IQR: 5.59-8.27) with daytime brachial and central systolic (SBP) and with diastolic BP (DBP) was non-linear, with BP increases up to around the median of Mn and then stabilization or slight rightward decrease. Mean BP differences (95% confidence interval) comparing Mn Q2 to Q5 (vs Q1 quintile) for brachial daytime SBP were 2.56 (0.22; 4.90), 3.59 (1.22; 5.96), 3.14 (0.77; 5.51) and 1.72 (-0.68; 4.11) mmHg, respectively; and 2.22 (0.70, 3.73), 2.55 (1.01, 4.08), 2.45 (0.91; 3.98), and 1.68 (0.13; 3.24), respectively, for DBP. Daytime central-pressures showed a similar dose-response relationship with bMn as daytime brachial-pressures. The association with nighttime BP was linearly positive for brachial BPs, and only increasing for Q5 for cBP. Regarding PWV, a tendency to significant linear increase along bMn levels was observed (p-trend = 0.042). The present findings extend the scarce evidence on the association between Mn and brachial BP to 2 other vascular parameters, suggesting Mn levels as a candidate risk factor for increasing levels of both brachial and cBPs in older adults, yet further research is needed with larger cohort studies in adults at all age ranges.
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Affiliation(s)
- M Carrasco-Rios
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain
| | - R Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M Sotos-Prieto
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Environmental Health and Nutrition, Harvard T.H. Chan School of Public Health. Boston, MA, USA
| | - A Graciani
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - F Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - J R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - E García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain.
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Craciun OM, Ortolá R, Pascual JA, Pérez-Ortuño R, Galán Labaca I, Banegas JR, Rodríguez Artalejo F, García-Esquinas E. Secondhand Tobacco Smoke and Functional Impairments in Older Adults Living in the Community. Nicotine Tob Res 2022; 24:2026-2034. [PMID: 35569063 DOI: 10.1093/ntr/ntac131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND/AIM There has been no comprehensive examination of the potential association of SHS with broad functional limitation assessment in older adults, where functional limitations are burdensome and challenging. METHODS We examined 2258 community-dwelling non-smoking older adults from the Seniors-Enrica-2-cohort. At baseline (2017) and follow-up (2019) grip strength was measured with a Jamar dynamometer, lower-extremity performance with the Short Physical Performance Battery (SPPB), overall physical function using the physical component summary (PCS) of the Spanish version of the SF-12, frailty with a Deficits Accumulation Index (DAI), and mobility limitations with the Rosow-Breslau scale. Baseline exposure to SHS was assessed by serum cotinine, and past exposure was self-reported. Cross-sectional analyses were performed using linear and logistic regression models, whereas functional performance changes were examined using repeated measures models with robust SE estimates. RESULTS Overall, the median (IQR) serum cotinine concentration was 0.079 (0.035-0.175) ng/ml, with 20 participants presenting concentrations ≥3 ng/ml. Compared to the unexposed, fully-adjusted models showed that the highest exposure group (≥0.239 ng/ml) presented lower grip strength (mean difference: -1.05 kg; 95% CI = -1.80, -0.31) and higher DAI scores (1.52; 95% CI = 0.38, 2.66) at baseline. Similarly, in models of self-reported past exposure, never-smokers who had lived with ≥2 smokers or been exposed to higher SHS cumulative doses showed lower baseline SPPB values, higher DAI scores, and higher prevalence of mobility limitations. In prospective analyses, those in the highest quartile of baseline cotinine presented harmful SPPB [-0.24 (-0.46, -0.02)] and DAI [1.28 (0.00, 2.55)] changes, and higher risk of mobility limitations [hazard ratio: 1.64; 95% CI = 1.01, 2.68] than the unexposed. CONCLUSIONS SHS exposure over the life-course and during old age may accelerate functional decline. IMPLICATIONS This manuscript provides a comprehensive examination of the relationship between secondhand smoke exposure and a broad range of functional limitations in older adults. Results show that: (i) non-smokers who had been exposed to higher cumulative doses of SHS in adulthood show worse physical function than non-exposed. (ii) Exposure to SHS during old age, as measured with cotinine concentrations, is associated with accelerated short-term functional declines. (iii) The effects of SHS are stronger among older adults with chronic morbidities. (iv) Results suggest that more efforts are needed to protect older adults from passive smoking, especially to those with chronic conditions because of their potential greater vulnerability to the effects of SHS.
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Affiliation(s)
- Oana M Craciun
- Department of Preventive Medicine and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERESP, Madrid, Spain
| | - Jose A Pascual
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Raul Pérez-Ortuño
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Iñaki Galán Labaca
- Department of Preventive Medicine and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institutes, Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERESP, Madrid, Spain
| | - Fernando Rodríguez Artalejo
- Department of Preventive Medicine and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERESP, Madrid, Spain.,IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,CIBERESP, Madrid, Spain.,Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institutes, Madrid, Spain
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García-Esquinas E, Ortolá R, Lara E, Pascual JA, Pérez-Ortuño R, Banegas JR, Artalejo FR. Objectively measured secondhand tobacco smoke and cognitive impairment in disability-free older adults. Environ Res 2022; 212:113352. [PMID: 35469856 DOI: 10.1016/j.envres.2022.113352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
Previous studies have suggested that exposure to secondhand smoke (SHS) may be associated with greater risk of cognitive impairment. However, no longitudinal study has examined the association of serum cotinine (as objective measure of SHS exposure) and cognitive function in older adults. We used data from 2087 non-smoking adults aged≥65 years participating in the ENRICA-2 cohort and free from limitations in Instrumental Activities of Daily Living. Cognitive function was assessed through the Mini-Mental State Examination (MMSE), the Digit Span Backwards subtest (DSBT), the Luria's motor series subtest from the Frontal Assessment Battery, the Trail Making Test A (TMT-A), the Free and Cued Selective Reminding Test (FCSRT), and the Categorical Verbal Fluency Test (CFT) of the 7 min test. Cross-sectional analyses were performed using multivariable logistic and ordered logistic models, while analyses on changes in cognition over time used multivariable repeated-measures mixed-effects models. Compared to the unexposed, those in the highest exposure group (≥0.161 ng/ml) were more likely to have cognitive impairment (MMSE<24) (odds ratio [OR]:1.64; 95% confidence interval [CI]:1.04-2.60) and lower DSBT scores (OR:1.25; 95%CI:1.00-1.57), as well as a non-significant higher odds of a lower score in the Luria test (OR:1.23; 95%CI:0.92-1.64) or episodic memory impairment (FCSRT<12, OR:1.38; 95%CI:0.90-2.11). In longitudinal analyses, those with baseline cotinine ≥0.161 ng/ml showed an increased risk of cognitive impairment (MMSE<24,OR:2.23; 95%CI:1.14-4.33; p-trend across cotinine categories = 0.028) and decreased DSBT (OR:1.23; 95%CI:1.01-1.51; p-trend across cotinine categories = 0.046). Findings show an increased risk of global cognitive impairment and declines in working memory performance in older adults exposed to SHS. More efforts are needed to protect older adults from SHS in areas not covered by smoke-free legislation.
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Affiliation(s)
- Esther García-Esquinas
- National Center for Epidemiology, Instituto de Salud Carlos III, Spain; Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, 28049, Madrid, Spain; CIBERESP (CIBER of Public Health), 28029, Madrid, Spain.
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, 28049, Madrid, Spain; CIBERESP (CIBER of Public Health), 28029, Madrid, Spain
| | - Elvira Lara
- Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28049, Madrid, Spain; CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, 28029, Madrid, Spain
| | - Jose A Pascual
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine and Life Sciences: Universitat Pompeu Fabra, Barcelona, Spain
| | - Raul Pérez-Ortuño
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, 28049, Madrid, Spain; CIBERESP (CIBER of Public Health), 28029, Madrid, Spain
| | - Fernando Rodríguez Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, 28049, Madrid, Spain; CIBERESP (CIBER of Public Health), 28029, Madrid, Spain; IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
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5
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Muñoz Laguna J, Banegas JR. Concerning “ The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care”. Rev Panam Salud Publica 2022; 46:e92. [PMID: 35795157 PMCID: PMC9250129 DOI: 10.26633/rpsp.2022.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
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6
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Montero-Salazar Henry X, Guallar-Castillón P, Banegas JR, Åkesson A, Rey-García J, Rodríguez-Artalejo F, Donat-Vargas C. Food consumption based on the nutrient profile system underlying the Nutri-Score and renal function in older adults. Clin Nutr 2022; 41:1541-1548. [DOI: 10.1016/j.clnu.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
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7
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Weber T, Protogerou AD, Agharazii M, Argyris A, Aoun Bahous S, Banegas JR, Binder RK, Blacher J, Araujo Brandao A, Cruz JJ, Danninger K, Giannatasio C, Graciani A, Hametner B, Jankowski P, Li Y, Maloberti A, Mayer CC, McDonnell BJ, McEniery CM, Antonio Mota Gomes M, Machado Gomes A, Lorenza Muiesan M, Nemcsik J, Paini A, Rodilla E, Schutte AE, Sfikakis PP, Terentes-Printzios D, Vallée A, Vlachopoulos C, Ware L, Wilkinson I, Zweiker R, Sharman JE, Wassertheurer S. Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals. Hypertension 2021; 79:251-260. [PMID: 34775789 PMCID: PMC8654125 DOI: 10.1161/hypertensionaha.121.17765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.
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Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Mohsen Agharazii
- Centre de Recherche Du CHU de Québec, Université Laval, Canada (M.A.)
| | - Antonis Argyris
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Sola Aoun Bahous
- Lebanese American University School of Medicine, Byblos, Lebanon (S.A.B.)
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Ronald K Binder
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Jacques Blacher
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre de diagnostic et de thérapeutique, France (J.B., A.V.)
| | | | - Juan J Cruz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Kathrin Danninger
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - Cristina Giannatasio
- School of Medicine and Surgery, Milano-Bicocca University and Cardiology 4, ASST GOM Niguarda, Milan, Italy (C.G., A.M.)
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health, Spain (J.R.B., J.J.C., A.G.)
| | - Bernhard Hametner
- Austrian Institute of Technology, Vienna, Austria (B.H., C.C.M., S.W.)
| | - Piotr Jankowski
- Institute of Cardiology, Jagellonian University, Krakow, Poland (P.J.)
| | - Yan Li
- Centre for Vascular Evaluations, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L.)
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University and Cardiology 4, ASST GOM Niguarda, Milan, Italy (C.G., A.M.)
| | - Christopher C Mayer
- Austrian Institute of Technology, Vienna, Austria (B.H., C.C.M., S.W.).,Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, United Kingdom (C.M.M., I.W.)
| | - Barry J McDonnell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (B.J.M.)
| | - Carmel M McEniery
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | | | | | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell'ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Italy (M.L.M., A.P.)
| | - Janos Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary (J.N.)
| | - Anna Paini
- Department of Clinical and Experimental Sciences, Centro per la Prevenzione e Cura dell'ipertensione Arteriosa, University of Brescia and ASST Spedali Civili, Italy (M.L.M., A.P.)
| | - Enrique Rodilla
- Universidad Cardenal Herrera-CEU, CEU Universities, Hospital de Sagunto, Valencia, Spain (E.R.)
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, Australia (A.E.S.).,The George Institute for Global Health, Sydney, Australia (A.E.S.).,Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa (A.E.S.)
| | - Petros P Sfikakis
- Cardiovascular Prevention and Research Unit, Clinic-Laboratory of Pathophysiology and First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.D.P., A.A., P.P.S.)
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece (D.T.-P., C.V.)
| | - Alexandre Vallée
- AP-HP Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre de diagnostic et de thérapeutique, France (J.B., A.V.)
| | - Charalambos Vlachopoulos
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.).,SAMRC/Wits Developmental Pathways for Health Research Unit, South Africa (L.W.)
| | - Lisa Ware
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, South Africa (L.W.)
| | - Ian Wilkinson
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, United Kingdom (C.M.M., I.W.)
| | - Robert Zweiker
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
| | - James E Sharman
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
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- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., R.K.B., K.D.)
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García-Esquinas E, Ortolá R, Gine-Vázquez I, Carnicero JA, Mañas A, Lara E, Alvarez-Bustos A, Vicente-Rodriguez G, Sotos-Prieto M, Olaya B, Garcia-Garcia FJ, Gusi N, Banegas JR, Rodríguez-Gómez I, Struijk EA, Martínez-Gómez D, Lana A, Haro JM, Ayuso-Mateos JL, Rodríguez-Mañas L, Ara I, Miret M, Rodríguez-Artalejo F. Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain. Int J Environ Res Public Health 2021; 18:ijerph18137067. [PMID: 34281004 PMCID: PMC8297096 DOI: 10.3390/ijerph18137067] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.
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Affiliation(s)
- Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- Correspondence:
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Iago Gine-Vázquez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (B.O.); (J.M.H.)
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
| | - José A. Carnicero
- Foundation for Biomedical Research, Getafe University Hospital, 28905 Getafe, Spain; (J.A.C.); (A.A.-B.); (L.R.-M.)
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
| | - Asier Mañas
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Elvira Lara
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
- Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Alejandro Alvarez-Bustos
- Foundation for Biomedical Research, Getafe University Hospital, 28905 Getafe, Spain; (J.A.C.); (A.A.-B.); (L.R.-M.)
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
| | - German Vicente-Rodriguez
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain;
- CIBEROBN (CIBER of Obesity and Nutrition), 28029 Madrid, Spain
- Faculty of Health and Sport Science, University of Zaragoza, 22001 Huesca, Spain
- Department of Physiatry and Nursing, University of Zaragoza, 22002 Aragón, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (B.O.); (J.M.H.)
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
| | - Francisco José Garcia-Garcia
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- Hospital Virgen del Valle, Complejo Hospitalario de Toledo, 45071 Toledo, Spain
| | - Narcis Gusi
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- AFYCAV (Physical Activity, Quality of Life and Health) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Jose R. Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Irene Rodríguez-Gómez
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Ellen A. Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - David Martínez-Gómez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Alberto Lana
- Department of Medicine, School of Medicine and Health Sciences, Universidad de Oviedo/ISPA, 33003 Oviedo, Spain;
| | - Josep María Haro
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (B.O.); (J.M.H.)
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
| | - José Luis Ayuso-Mateos
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
- Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Foundation for Biomedical Research, Getafe University Hospital, 28905 Getafe, Spain; (J.A.C.); (A.A.-B.); (L.R.-M.)
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
| | - Ignacio Ara
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Marta Miret
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
- Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
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9
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Rodríguez-Sánchez I, Ortolá R, Graciani A, Martínez-Gómez D, Banegas JR, Rodríguez-Artalejo F, García-Esquinas E. Pain Characteristics, Cardiovascular Risk Factors, and Cardiovascular Disease. J Gerontol A Biol Sci Med Sci 2021; 77:204-213. [PMID: 33725724 DOI: 10.1093/gerona/glab079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is unclear evidence that chronic pain may increase the risk of cardiovascular disease (CVD) incidence and mortality. This work evaluated the association between chronic pain, incidence of CVD and changes in CVD risk factors. METHODS Cohort of 1091 community-dwelling individuals ≥60years, free from CVD at baseline, followed up for 6 years. Data on psychosocial factors and CVD risk factors was obtained through validated questionnaires and laboratory measurements. A pain scale ranging from 0 (no pain) to 6 (worst pain) was created according to pain frequency, location and intensity. RESULTS The cumulative incidence of CVD was 4.2% at 3 years, and 7.7% at 5-years of follow-up. Compared to individuals without pain in the first 3 years (2012-2015), those with maintained scores ≥2 showed a mean reduction of 3.57 (-5.77,-1.37) METs-h/week in recreational physical activity; a 0.38-point (0.04,0.73) increase in psychological distress; and a 1.79 (1.03,3.11) higher odds of poor sleep. These associations held in the second follow-up period, when individuals with maintained pain also worsened their diet quality. A 1-point increase in the pain scale in 2012 was associated with a 1.21 (1.03,1.42) and 1.18 (0.97,1.44) increased CVD incidence in 2015 and 2017, respectively; none of the studied factors mediated this relationship. CONCLUSIONS Older adults with chronic pain show important reductions in recreational physical activity and deterioration in mental health, sleep and diet quality, which may well aggravate pain. Future studies should evaluate whether these factors mediate the increased risk of CVD observed in older adults with chronic pain.
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Affiliation(s)
- Isabel Rodríguez-Sánchez
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,Geriatrics Department. Hospital Clínico San Carlos, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - David Martínez-Gómez
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
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10
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García-Esquinas E, Carrasco-Rios M, Ortolá R, Sotos Prieto M, Pérez-Gómez B, Gutiérrez-González E, Banegas JR, Queipo R, Olmedo P, Gil F, Tellez-Plaza M, Navas-Acien A, Pastor-Barriuso R, Rodríguez-Artalejo F. Selenium and impaired physical function in US and Spanish older adults. Redox Biol 2020; 38:101819. [PMID: 33316745 PMCID: PMC7744768 DOI: 10.1016/j.redox.2020.101819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/29/2023] Open
Abstract
Background Selenium (Se) is a trace element with a narrow safety margin. Objectives To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. Design NHANES 2011–2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017–2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. Results Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 μg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 μg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. Discussion In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.
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Affiliation(s)
- E García-Esquinas
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid, Madrid. Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.
| | - M Carrasco-Rios
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid, Madrid. Spain
| | - R Ortolá
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid, Madrid. Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health. Boston, MA, USA
| | - M Sotos Prieto
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid, Madrid. Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - B Pérez-Gómez
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; National Center of Epidemiology. Carlos III Health Institute, Madrid, Spain
| | | | - J R Banegas
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid, Madrid. Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - R Queipo
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; Department of Medicine. School of Biomedical Sciences. Universidad Europea. Madrid, Spain
| | - P Olmedo
- Department of Legal Medicine, Toxicology, and Physical Anthropology, School of Medicine, University of Granada, Granada, Spain
| | - F Gil
- Department of Legal Medicine, Toxicology, and Physical Anthropology, School of Medicine, University of Granada, Granada, Spain
| | - M Tellez-Plaza
- National Center of Epidemiology. Carlos III Health Institute, Madrid, Spain; Biomedical Research Institute Hospital Clinic de Valencia (INCLIVA), Valencia, Spain
| | - A Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - R Pastor-Barriuso
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; National Center of Epidemiology. Carlos III Health Institute, Madrid, Spain
| | - F Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid, Madrid. Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA Research Institute on Food and Health Sciences. Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain
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11
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Blanco-Rojo R, Sandoval-Insausti H, López-Garcia E, Graciani A, Ordovás JM, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. Consumption of Ultra-Processed Foods and Mortality: A National Prospective Cohort in Spain. Mayo Clin Proc 2019; 94:2178-2188. [PMID: 31623843 DOI: 10.1016/j.mayocp.2019.03.035] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the prospective association between ultra-processed food consumption and all-cause mortality and to examine the effect of theoretical iso-caloric non-processed foods substitution. PATIENTS AND METHODS A population-based cohort of 11,898 individuals (mean age 46.9 years, and 50.5% women) were selected from the ENRICA study, a representative sample of the noninstitutionalized Spanish population. Dietary information was collected by a validated computer-based dietary history and categorized according to their degree of processing using NOVA classification. Total mortality was obtained from the National Death Index. Follow-up lasted from baseline (2008-2010) to mortality date or December 31th, 2016, whichever was first. The association between quartiles of consumption of ultra-processed food and mortality was analyzed by Cox models adjusted for the main confounders. Restricted cubic-splines were used to assess dose-response relationships when using iso-caloric substitutions. RESULTS Average consumption of ultra-processed food was 385 g/d (24.4% of the total energy intake). After a mean follow-up of 7.7 years (93,599 person-years), 440 deaths occurred. The hazard ratio (and 95% CI) for mortality in the highest versus the lowest quartile of ultra-processed food consumption was 1.44 (95% CI, 1.01-2.07; P trend=.03) in percent of energy and 1.46 (95% CI, 1.04-2.05; P trend=.03) in grams per day per kilogram. Isocaloric substitution of ultra-processed food with unprocessed or minimally processed foods was associated with a significant nonlinear decrease in mortality. CONCLUSION A higher consumption of ultra-processed food was associated with higher mortality in the general population. Furthermore, the theoretical iso-caloric substitution ultra-processed food by unprocessed or minimally processed foods would suppose a reduction of the mortality risk. If confirmed, these findings support the necessity of the development of new nutritional policies and guides at the national and international level. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01133093.
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Affiliation(s)
- Ruth Blanco-Rojo
- Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain
| | - Helena Sandoval-Insausti
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Esther López-Garcia
- Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Jose M Ordovás
- Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Pilar Guallar-Castillón
- Instituto Madrileño De Estudios Avanzados-alimentacion-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Centro Superior de Investigaciones Científicas, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Centro de Investigación Biomedica en Red of Epidemiology and Public Health, Madrid, Spain; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
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12
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Abstract
The early and accurate diagnosis of hypertension is essential given its importance in the development of cardiovascular disease. The boundaries between normal blood pressure (BP) and hypertension are arbitrary and based on the benefits of treating exceeding those of not treating. Conventional BP measurement at the clinic only offers information of a particular time and presents multiple biases dependent on inherent variability of BP and measurement technique itself. Multiple studies have demonstrated the prognosis superiority in the development of cardiovascular disease of ambulatory blood pressure monitoring (ABPM), allows detection of white coat hypertension, avoiding overdiagnosis and overtreatment, and the detection of patients with masked hypertension who are at risk of underdetection and undertreatment. ABPM also assess nightime BP and circadian variability, providing additional prognostic value. ABPM is recognized in the diagnosis of hypertension in 2011 British NICE Guidelines, very argued at the 2013 European Society of Hypertension guidelines, and recommended in the US Preventive Services Task Force in 2015, 2016 Canadian Guidelines and the 2016 Spanish Program of Preventive Activities and Health Promotion (PAPPS). Its generalization is likely to be only a matter of time.
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Affiliation(s)
- T Gijón Conde
- Centro de Salud Universitario Cerro del Aire, Majadahonda, Madrid. Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | - J R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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13
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De La Sierra A, Banegas JR, de la Cruz JJ, Gorostidi M, Vinyoles E, Segura J, Ruilope LM. Abstract 029: Antihypertensive Treatment and Short-Term Blood Pressure Variability. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure variability (BPV) is recognized as an important prognostic contributor in hypertension. We asseseds differences in short-term BPV in treated patients depending on the number of drugs, drug-classes and combinations, and individual compounds. From the Spanish ABPM Registry, we selected 38188 treated patiens. BPV estimates were obtained from ABPM records, and included weighted, daytime and nighttime SD and average real variability (ARV). Comparisons (general linear models adjusted for age, gender, diabetes, dyslipidemia and CV disease) were carried out depending on the number of drugs (1, 2, 3, and more). In patients treated with monotherapy (13765), BPV estimates were compared depending on the drug classes, as well as on individual compounds inside each class. Additional comparisons were performed depending on the type of combination in patients treated with 2 (12716) and 3 drugs (7888). Systolic BPV increased from monotherapy to treatment with 4 or more drugs (p<0.001 for weighted, daytime, and nighttime SD, and ARV). Among those treated with monotherapy, BPV was increased in those treated with beta blockers, ACEi and ARB, when compared to diuretics or CCB. No differences were observed among diuretics (chlorthalidone, hydrochlorothiazide, indapamide, or loop diuretics). Among betablockers, BPV was increased in those treated with carvedilol, compared to bisoprolol and nevibolol. Among CCB, BPV was lower in treated with amlodipine, with respect to other dihydropyridines. No differences were observed among most frequent used ACEi or ARB. In patients treated with 2-drug combinations, BPV was lower in those treated with diuretic/CCB combinations, compared with other types. Moreover, in those treated with 3-drug combinations, those which included a CCB resulted in a lower BPV in comparison to those which did not include a CCB. Results regarding diastolic BPV were consistent with those observed with systolic BPV. We conclude that antihypertensive treatment is associated with differences in BPV. CCB, specifically amlodipine, used in monotherapy or in combination with other drugs, especially diuretics, is associated with lower short-term BPV. These results may help to explain some benefits of amlodipine observed in clinical trials.
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14
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Laclaustra M, Rodriguez-Artalejo F, Guallar-Castillon P, Banegas JR, Graciani A, Garcia-Esquinas E, Ordovas J, Lopez-Garcia E. Prospective association between added sugars and frailty in older adults. Am J Clin Nutr 2019; 107:772-779. [PMID: 29635421 DOI: 10.1093/ajcn/nqy028] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022] Open
Abstract
Background Sugar-sweetened beverages and added sugars (monosaccharides and disaccharides) in the diet are associated with obesity, diabetes, and cardiovascular disease, which are all risk factors for decline in physical function among older adults. Objective The aim of this study was to examine the association between added sugars in the diet and incidence of frailty in older people. Design Data were taken from 1973 Spanish adults ≥60 y old from the Seniors-ENRICA cohort. In 2008-2010 (baseline), consumption of added sugars (including those in fruit juices) was obtained using a validated diet history. Study participants were followed up until 2012-2013 to assess frailty based on Fried's criteria. Statistical analyses were performed with logistic regression adjusted for age, sex, education, smoking status, body mass index, energy intake, self-reported comorbidities, Mediterranean Diet Adherence Score (excluding sweetened drinks and pastries), TV watching time, and leisure-time physical activity. Results Compared with participants consuming <15 g/d added sugars (lowest tertile), those consuming ≥36 g/d (highest tertile) were more likely to develop frailty (OR: 2.27; 95% CI: 1.34, 3.90; P-trend = 0.003). The frailty components "low physical activity" and "unintentional weight loss" increased dose dependently with added sugars. Association with frailty was strongest for sugars added during food production. Intake of sugars naturally appearing in foods was not associated with frailty. Conclusions The consumption of added sugars in the diet of older people was associated with frailty, mainly when present in processed foods. The frailty components that were most closely associated with added sugars were low level of physical activity and unintentional weight loss. Future research should determine whether there is a causal relation between added sugars and frailty.
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Affiliation(s)
- Martin Laclaustra
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Translational Research Unit, Hospital Universitario Miguel Servet, Universidad de Zaragoza and CIBERCV, Zaragoza, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idipaz and CIBERESP, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idipaz and CIBERESP, Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Pilar Guallar-Castillon
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idipaz and CIBERESP, Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idipaz and CIBERESP, Madrid, Spain
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idipaz and CIBERESP, Madrid, Spain
| | - Esther Garcia-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idipaz and CIBERESP, Madrid, Spain
| | - Jose Ordovas
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain.,US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idipaz and CIBERESP, Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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15
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Gijón-Conde T, Gorostidi M, Banegas JR, de la Sierra A, Segura J, Vinyoles E, Divisón-Garrote JA, Ruilope LM. [Position statement on ambulatory blood pressure monitoring (ABPM) by the Spanish Society of Hypertension (2019)]. Hipertens Riesgo Vasc 2019; 36:199-212. [PMID: 31178410 DOI: 10.1016/j.hipert.2019.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/17/2019] [Indexed: 11/19/2022]
Abstract
Conventional blood pressure (BP) measurement in clinical practice is the most used procedure for the diagnosis and treatment of hypertension (HT), but is subject to considerable inaccuracies due to, on the one hand, the inherent variability of the BP itself and, on the other hand biases arising from the measurement technique and conditions, Some studies have demonstrated the prognosis superiority in the development of cardiovascular disease using ambulatory blood pressure monitoring (ABPM). It can also detect "white coat" hypertension, avoiding over-diagnosis and over-treatment in many cases, as well detecting of masked hypertension, avoiding under-detection and under-treatment. ABPM is recognised in the diagnosis and management of HT in most of international guidelines on hypertension. The present document, taking the recommendations of the European Society of Hypertension as a reference, aims to review the more recent evidence on ABPM, and to serve as guidelines for health professionals in their clinical practice and to encourage ABPM use in the diagnosis and follow-up of hypertensive subjects. Requirements, procedure, and clinical indications for using ABPM are provided. An analysis is also made of the main contributions of ABPM in the diagnosis of "white coat" and masked HT phenotypes, short term BP variability patterns, its use in high risk and resistant hypertension, as well as its the role in special population groups like children, pregnancy and elderly. Finally, some aspects about the current situation of the Spanish ABPM Registry and future perspectives in research and potential ABPM generalisation in clinical practice are also discussed.
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Affiliation(s)
- T Gijón-Conde
- Centro de Salud Universitario Cerro del Aire, Majadahonda, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Madrid, España.
| | - M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, RedinRen, Universidad de Oviedo, Oviedo, Asturias, España.
| | - J R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Madrid, España
| | - A de la Sierra
- Departamento de Medicina Interna, Hospital Mutua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - J Segura
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Vinyoles
- Centre d' Atenció Primària La Mina, Departamento de Medicina, Universidad de Barcelona, Barcelona, España
| | - J A Divisón-Garrote
- Centro de Salud de Casas Ibáñez, Albacete, Universidad Católica San Antonio, Murcia, España
| | - L M Ruilope
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Madrid, España; Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España; Escuela de Estudios de Doctorado e Investigación, Universidad Europea de Madrid, Madrid, España
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16
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Laclaustra M, Rodriguez-Artalejo F, Guallar-Castillon P, Banegas JR, Graciani A, Garcia-Esquinas E, Lopez-Garcia E. The inflammatory potential of diet is related to incident frailty and slow walking in older adults. Clin Nutr 2019; 39:185-191. [PMID: 30737049 DOI: 10.1016/j.clnu.2019.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 12/31/2018] [Accepted: 01/13/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Certain foods and dietary patterns have been associated with both inflammation and frailty. As chronic inflammation may play a role in frailty and disability, we examined the association of the inflammatory potential of diet with these outcomes. METHODS Data were taken from 1948 community-dwelling individuals ≥60 years old from the Seniors-ENRICA cohort, who were recruited in 2008-2010 and followed-up through 2012. Baseline diet data, obtained with a validated diet history, was used to calculate Shivappa's Dietary Inflammatory Index (DII), an "a priori" pattern score which is based on known associations of foods and nutrients with inflammation, and Tabung's Empirical Dietary Inflammatory Index (EDII), an "a posteriori" pattern score which was statistically derived from an epidemiological study. At follow-up, incident frailty was assessed with Fried's criteria, and incident limitation in instrumental activities of daily living (IADL) with the Lawton-Brody index. Statistical analyses were performed with logistic regression, and adjusted for the main confounders. RESULTS Compared with individuals in the lowest tertile of DII, those in the highest tertile showed higher risk of frailty (odds ratio [OR] 2.48; 95% confidence interval [CI]: 1.42, 4.44, p-trend = 0.001) and IADL disability (OR: 1.96; 95% CI: 1.03, 3.86, p-trend = 0.035). By contrast, EDII did not show an association with these outcomes. The DII score was associated with slow gait speed, both as a low score in the Short Physical Performance Battery test (OR: 1.82; 95% CI: 1.27, 2.62, p-trend = 0.001) and as a positive Fried's criterion (OR: 1.64; 95% CI: 1.08, 2.51, p-trend = 0.021), which use different thresholds. CONCLUSIONS DII predicted frailty and IADL while EDII did not. DII is able to measure diet healthiness in terms of physical decline in addition to avoidance of inflammation. REGISTERED ON ClinicalTrials.gov number, NCT01133093.
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Affiliation(s)
- Martin Laclaustra
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), CIBERCV, Agencia Aragonesa para la Investigación y el Desarrollo (ARAID), Translational Research Unit, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain; CIBERESP and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Arzobispo Morcillo, 4, 28029, Madrid, Spain.
| | - Fernando Rodriguez-Artalejo
- CIBERESP and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Arzobispo Morcillo, 4, 28029, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Pilar Guallar-Castillon
- CIBERESP and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Arzobispo Morcillo, 4, 28029, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Jose R Banegas
- CIBERESP and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Arzobispo Morcillo, 4, 28029, Madrid, Spain
| | - Auxiliadora Graciani
- CIBERESP and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Arzobispo Morcillo, 4, 28029, Madrid, Spain
| | - Esther Garcia-Esquinas
- CIBERESP and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Arzobispo Morcillo, 4, 28029, Madrid, Spain
| | - Esther Lopez-Garcia
- CIBERESP and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Arzobispo Morcillo, 4, 28029, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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17
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Lana A, Banegas JR, Guallar-Castillón P, Rodríguez-Artalejo F, Lopez-Garcia E. Association of Dairy Consumption and 24-Hour Blood Pressure in Older Adults with Hypertension. Am J Med 2018; 131:1238-1249. [PMID: 29807002 DOI: 10.1016/j.amjmed.2018.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim was to examine the association between habitual consumption of dairy products and 24-hour ambulatory blood pressure monitoring among older adults with hypertension. METHODS We conducted an analysis of 715 community-living hypertensive adults age ≥60. Habitual dairy consumption was assessed with a validated diet history. Blood pressure was recorded by 24-hour ambulatory blood pressure monitoring; controlled blood pressure was defined as 24-hour blood pressure <130/80mm Hg in those under drug treatment. Analyses were adjusted for main confounders, including diet, hypertension duration, and being on antihypertensive treatment. RESULTS After adjustment for confounders, consumers of ≥7 servings/week of whole-fat milk/yogurt had a diastolic blood pressure 1.40mm Hg higher (95% confidence interval, 0.01, 2.81) than consumers of <1 serving/week. By contrast, consumers of ≥7 servings/week of low-fat milk/yogurt had a diastolic blood pressure 1.74mm Hg lower (95% confidence interval, -3.26, -0.23) than consumers of <1 serving/week. Moreover, the odds ratio (95% confidence interval) for controlled blood pressure was 1.83 (1.05-3.08) for those consuming ≥7 servings/week of low-fat milk/yogurt, when compared with consumers of <1 serving/week. Cheese consumption was not associated with blood pressure. CONCLUSIONS Regular consumption of low-fat milk/yogurt was associated with lower 24-hour diastolic blood pressure and with better blood pressure control among older adults with hypertension.
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Affiliation(s)
- Alberto Lana
- Department of Medicine, Preventive Medicine and Public Health Area, School of Medicine and Health Sciences, Universidad de Oviedo/ISPA, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain.
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18
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Laclaustra M, Lopez-Garcia E, Civeira F, Garcia-Esquinas E, Graciani A, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F. LDL Cholesterol Rises With BMI Only in Lean Individuals: Cross-sectional U.S. and Spanish Representative Data. Diabetes Care 2018; 41:2195-2201. [PMID: 30061315 DOI: 10.2337/dc18-0372] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Elevated LDL cholesterol (LDLc) is not strongly associated with obesity or metabolic syndrome (MS), but this relationship repeatedly has been examined assuming a linear association. This study aimed to assess the dose-response relationship between body mass index (BMI) or waist circumference (WC) and LDLc and to evaluate its link to metabolic impairment. RESEARCH DESIGN AND METHODS Participants in the continuous National Health and Nutrition Examination Survey (NHANES, 1999-2010) (n = 12,383) and the Study on Nutrition and Cardiovascular Risk (ENRICA, 2008-2010) (n = 11,765), representative samples of U.S. and Spanish noninstitutionalized populations, were cross-sectionally investigated. LDLc was modeled with age- and sex-adjusted regressions, with BMI and/or WC as explanatory variables included in models as two-segment linear and natural cubic splines. RESULTS In NHANES and ENRICA, slopes of the BMI-LDLc association changed (P < 0.001) at BMI 27.1 and 26.5 kg/m2, respectively, forming an inverted U shape. Below these BMI inflection points, LDLc rose 2.30 and 2.41 mg/dL per kg/m2 (both P < 0.001). However, above said points, LDLc declined -0.37 and -0.38 mg/dL per kg/m2 (both P < 0.001). The WC-LDLc relationship was similar to the BMI-LDLc relationship. Accumulation of MS traits was associated with a weakening of the positive BMI-LDLc association among lean participants (below the BMI inflection point). Aging shifted the inflection point of the BMI-LDLc relationship to lower BMI values. CONCLUSIONS The BMI- and WC-LDLc relationships have inverted U shapes. Diminishing associations between BMI and LDLc might indicate metabolic impairment as a result of aging or other metabolic diseases. In lean individuals, small weight losses might help to lower LDLc for cardiovascular prevention.
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Affiliation(s)
- Martin Laclaustra
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Translational Research Unit, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Zaragoza, Spain .,Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital La Paz (IDIPAZ), Madrid, Spain
| | - Esther Lopez-Garcia
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital La Paz (IDIPAZ), Madrid, Spain.,Instituto Madrileño de Estudios Avanzados-Alimentación (IMDEA-Food), Centro de Excelencia International UAM+CSIC, Madrid, Spain
| | - Fernando Civeira
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Translational Research Unit, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Zaragoza, Spain
| | - Esther Garcia-Esquinas
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital La Paz (IDIPAZ), Madrid, Spain
| | - Auxiliadora Graciani
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital La Paz (IDIPAZ), Madrid, Spain
| | - Pilar Guallar-Castillon
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital La Paz (IDIPAZ), Madrid, Spain.,Instituto Madrileño de Estudios Avanzados-Alimentación (IMDEA-Food), Centro de Excelencia International UAM+CSIC, Madrid, Spain
| | - Jose R Banegas
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital La Paz (IDIPAZ), Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Instituto de Investigación del Hospital La Paz (IDIPAZ), Madrid, Spain.,Instituto Madrileño de Estudios Avanzados-Alimentación (IMDEA-Food), Centro de Excelencia International UAM+CSIC, Madrid, Spain
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19
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De La Sierra A, Parati G, Banegas JR, de la Cruz JJ, Gorostidi M, Vinyoles E, Segura J, Ruilope LM. Abstract 071: Increased Short-Term Blood Pressure Variability in Patients With Isolated Systolic Hypertension. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated systolic hypertension (ISH) is a clinical condition derived from increased arterial stiffness and associated with a worse cardiovascular prognosis. Increased blood pressure variability (BPV) is also associated to cardiovascular risk. We aimed to estimate short-term BPV in patients with ISH compared to those with systolic and diastolic hypertension (SDH). From the Spanish ABPM Registry database containing 63910 identified patients, we selected 20497 with ISH and 23269 with SDH. BPV estimates were obtained from ABPM records, and included standard deviation (SD), coefficient of variation (CV), weighted SD and average real variability (ARV). Comparisons were carried out by Student’s t test, and by general linear models adjusted for age, gender and office BP. Due to important differences in age between groups, a case-control matching was performed obtaining 14707 pairs matched by gender and with an age difference < 2 years. Comparisons were repeated in this dataset. Patients with ISH were older, more frequently women, with diabetes and with a previous history of CV disease. Office BP was lower (155±13/81±7 vs. 159±16/98±7 mmHg; p<0.001) in comparison to those with SDH. As shown in the table, systolic BPV was increased in ISH (p<0.001 for all comparisons), with respect to SDH. Results were confirmed after adjustments for age, gender and office BP and in the case-control matching comparison (also adjusted for office BP). No differences in diastolic BPV were observed between groups. We conclude that ISH is associated with an increased short-term BPV. This increased BPV could be one of the factors explaining the high CV risk of ISH patients.
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Martinez-Gomez D, Guallar-Castillon P, Higueras-Fresnillo S, Banegas JR, Sadarangani KP, Rodriguez-Artalejo F. A healthy lifestyle attenuates the effect of polypharmacy on total and cardiovascular mortality: a national prospective cohort study. Sci Rep 2018; 8:12615. [PMID: 30135569 PMCID: PMC6105613 DOI: 10.1038/s41598-018-30840-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/07/2018] [Indexed: 01/08/2023] Open
Abstract
This work examines whether the increased all-cause and cardiovascular disease (CVD) mortality associated with polypharmacy could be offset by a healthy lifestyle. We included a prospective cohort of 3,925 individuals representative of the Spanish population aged ≥60 years, who were recruited in 2000–2001 and followed up through 2014. Polypharmacy was defined as treatment with ≥5 medications. The following lifestyle behaviors were considered healthy: not smoking, eating a healthy diet, being physically active, moderate alcohol consumption, low sitting time, and adequate sleep duration. Individuals were classified into three lifestyle categories s: unfavorable (0–2), intermediate (3–4) favorable (5–6). Over a median 13.8-y follow-up, 1,822 all-cause and 675 CVD deaths occurred. Among individuals with polypharmacy, intermediate and favorable lifestyles were associated with an all-cause mortality reduction (95% confidence interval [CI]) of 47% (34–58%) and 54% (37–66%), respectively; 37% (9–56%) and 60% (33–76%) for CVD death, respectively. The theoretical adjusted hazard ratio (95%CI) associated with replacing 1 medication with 1 healthy lifestyle behavior was 0.73 (0.66–0.81) for all-cause death and 0.69 (0.59–0.82) for CVD death. The theoretical adjusted hazard ratio (95%CI) for all-cause and CVD mortality associated with simply reducing 1 medication was 0.88 (0.83–0.94) and 0.83 (0.76–0.91), respectively. Hence, adherence to a healthy lifestyle behavior can reduce mortality risk associated with polypharmacy in older adults.
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Affiliation(s)
- David Martinez-Gomez
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain. .,IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain.
| | - Pilar Guallar-Castillon
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/ IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Sara Higueras-Fresnillo
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/ IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kabir P Sadarangani
- School of Physiotherapy, Faculty of Health Sciences, Universidad San Sebastián, Lota 2465, Santiago, 7510157, Chile.,Escuela de Kinesiología, Facultad de Salud y Odontología, Universidad Diego Portales, Santiago, 8370109, Chile
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/ IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
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21
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Banegas JR, Ruilope LM. [Mortality study from the Spanish Registry of ABPM. An appeal for the transition of ABPM to clinical practice]. Hipertens Riesgo Vasc 2018; 35:S1889-1837(18)30063-1. [PMID: 29908924 DOI: 10.1016/j.hipert.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022]
Affiliation(s)
- J R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ y CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | - L M Ruilope
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ y CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Unidad de Hipertensión y Laboratorio de Hipertensión e Investigación Traslacional Cardiorrenal, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre y CIBER de Enfermedad Cardiovascular (CIBERCV), Madrid, España; Escuela de Estudios Doctorales e Investigación, Universidad Europea de Madrid, Madrid, España
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22
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Gijón-Conde T, Gorostidi M, Camafort M, Abad-Cardiel M, Martín-Rioboo E, Morales-Olivas F, Vinyoles E, Armario P, Banegas JR, Coca A, de la Sierra A, Martell-Claros N, Redón J, Ruilope LM, Segura J. [Spanish Society of Hypertension position statement on the 2017 ACC/AHA hypertension guidelines]. Hipertens Riesgo Vasc 2018; 35:S1889-1837(18)30033-3. [PMID: 29699926 DOI: 10.1016/j.hipert.2018.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 01/14/2023]
Abstract
The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (<120mmHg systolic and <80mmHg diastolic), elevated (120-129 and <80mmHg), stage 1 (130-139 or 80-89mmHg), and stage 2 (≥140 or ≥90mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. In management, cardiovascular risk would be determinant since those with grade 1 hypertension and an estimated 10-year risk of atherosclerotic cardiovascular disease ≥10%, and those with cardiovascular disease, chronic kidney disease and/or diabetes will require pharmacological treatment, the rest being susceptible to non-pharmacological treatment up to the 140/90mmHg threshold. These recommendations would allow patients with level 1 hypertension and high atherosclerotic cardiovascular disease to benefit from pharmacological therapies and all patients could also benefit from improved non-pharmacological therapies. However, this approach should be cautious because inadequate BP measurement and/or lack of systematic atherosclerotic cardiovascular disease calculation could lead to overestimation in diagnosing hypertension and to overtreatment. Guidelines are recommendations, not impositions, and the management of hypertension should be individualized, based on clinical decisions, preferences of the patients, and an adequate balance between benefits and risks.
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Affiliation(s)
- T Gijón-Conde
- Centro de Salud Universitario Cerro del Aire, Majadahonda (Madrid), España; Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Madrid, España.
| | - M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, RedinRen, Universidad de Oviedo, Oviedo (Asturias), España
| | - M Camafort
- Unidad de Hipertensión y Riesgo Cardiovascular, Servicio de Medicina Interna, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
| | - M Abad-Cardiel
- Unidad de Hipertensión, Área de Prevención Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - E Martín-Rioboo
- Centro de Salud Poniente, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España
| | - F Morales-Olivas
- Departamento de Farmacología, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, España
| | - E Vinyoles
- Centre d'Atenció Primària La Mina, Departamento de Medicina, Universidad de Barcelona, Barcelona, España
| | - P Armario
- Área Atención Integrada de Riesgo Vascular, Departamento de Medicina Interna, Hospital Moisès Broggi Sant Joan Despi, Universidad de Barcelona, Barcelona, España
| | - J R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Madrid, España
| | - A Coca
- Unidad de Hipertensión y Riesgo Cardiovascular, Servicio de Medicina Interna, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
| | - A de la Sierra
- Departamento de Medicina Interna, Hospital Mutua Terrassa, Universidad de Barcelona, Terrassa (Barcelona), España
| | - N Martell-Claros
- Unidad de Hipertensión, Área de Prevención Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Redón
- Instituto de Investigación INCLIVA, Universidad de Valencia, Valencia, CIBERObn, Valencia, España; Instituto de Salud Carlos III, Madrid, España
| | - L M Ruilope
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma Madrid/IdiPAZ y CIBERESP, Madrid, España; Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España; Escuela de Estudios de Doctorado e Investigación, Universidad Europea de Madrid, Madrid, España
| | - J Segura
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
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23
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Ruilope LM, Banegas JR. The use of antihypertensive fixed combinations in clinical practice needs a reappraisal. J Clin Hypertens (Greenwich) 2018; 20:716-717. [PMID: 29457378 DOI: 10.1111/jch.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, CIBER of Cardiovascular Disease (CIBERCV), Madrid, Spain.,School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid⁄IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid⁄IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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24
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Armario P, Calhoun DA, Oliveras A, Blanch P, Vinyoles E, Banegas JR, Gorostidi M, Segura J, Ruilope LM, Dudenbostel T, de la Sierra A. Prevalence and Clinical Characteristics of Refractory Hypertension. J Am Heart Assoc 2017; 6:JAHA.117.007365. [PMID: 29217663 PMCID: PMC5779046 DOI: 10.1161/jaha.117.007365] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background We aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients. Methods and Results The present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat RH (26.7% versus 37.1%, P<0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047). Conclusions The prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients.
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Affiliation(s)
- Pedro Armario
- Cardiovascular Risk Area, Internal Medicine Department, Hospital Moisès Broggi Sant Joan Despi, University of Barcelona, Spain
| | - David A Calhoun
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL
| | - Anna Oliveras
- Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Pedro Blanch
- Department of Cardiology, Hospital Moisès Broggi Sant Joan Despi, University of Barcelona, Spain
| | - Ernest Vinyoles
- Department of Medicine, La Mina Primary Care Center, University of Barcelona, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma Madrid/IdiPAZ and CIBERESP, Madrid, Spain
| | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen Oviedo, Spain
| | - Julián Segura
- Hypertension Unit, Hospital Doce de Octubre, Madrid, Spain
| | - Luis M Ruilope
- Instituto de Investigación Hospital Doce de Octubre, Madrid, Spain
| | - Tanja Dudenbostel
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, AL
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25
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Ortolá R, García-Esquinas E, Galán I, Guallar-Castillón P, López-García E, Banegas JR, Rodríguez-Artalejo F. Patterns of alcohol consumption and risk of falls in older adults: a prospective cohort study. Osteoporos Int 2017; 28:3143-3152. [PMID: 28725986 DOI: 10.1007/s00198-017-4157-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/10/2017] [Indexed: 01/29/2023]
Abstract
UNLABELLED Falls are a major health problem in older adults, but their relationship with alcohol consumption in this population remains unclear. In a cohort with 2170 older adults followed up for 3.3 years, both moderate drinking and the Mediterranean drinking pattern were associated with a lower risk of falls and injurious falls. INTRODUCTION This study aims to examine the association between certain patterns of alcohol consumption, including the Mediterranean drinking pattern (MDP), and the risk of falls in older adults. METHODS A prospective cohort with 2170 community-dwelling individuals aged ≥60 years was recruited in Spain in 2008-2010 and followed up through 2012. At baseline, participants reported alcohol consumption and, at the end of follow-up, their falls during the previous year. The MDP was defined as moderate alcohol consumption (threshold between moderate and heavy intake was 40 g/day for men and 24 g/day for women) with preference for wine and drinking only with meals. Analyses were conducted with negative binomial or logistic regression, as appropriate, and adjusted for the main confounders. RESULTS Compared with never drinkers, the number of falls was lower in moderate drinkers (incidence rate ratio (95% confidence interval), 0.79 (0.63-0.99)) and drinkers with MDP (0.73 (0.56-0.96)). Also, moderate drinkers and those with MDP showed a lower risk of ≥2 falls (odds ratio (95% confidence interval), 0.58 (0.38-0.88) and 0.56 (0.34-0.93), respectively) and of falls requiring medical care (0.67 (0.46-0.96) and 0.61 (0.39-0.96), respectively). CONCLUSION Both moderate drinking and the MDP were associated with a lower risk of falls and injurious falls in older adults. However, sound advice on alcohol consumption should balance risks and benefits.
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Affiliation(s)
- R Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain.
| | - E García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - I Galán
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, Calle de Sinesio Delgado 4, 28029, Madrid, Spain
| | - P Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, 28049, Madrid, Spain
| | - E López-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, 28049, Madrid, Spain
| | - J R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - F Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and Idipaz, Calle del Arzobispo Morcillo 4, 28029, Madrid, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Avenida de Monforte de Lemos 3-5, 28029, Madrid, Spain.
- IMDEA Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, 28049, Madrid, Spain.
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26
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De La Sierra A, Armario P, Oliveras A, Banegas JR, Gorostidi M, Vinyoles E, Segura J, De la Cruz JJ, Ruilope LM. Abstract 074: Use of Antihypertensive Drugs, Drug Classes, and Combinations in Resistant versus Non-resistant Hypertension, and in True versus White-coat Resistant Hypertension. Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the use of specific antihypertensive drugs and drug classes, as well as combinations in patients treated with 3 or more drugs classified as having or not resistant hypertension (RH), controlled or uncontrolled RH and true versus white-coat RH. From the Spanish ABPM Registry, we identified 21238 patients treated with 3 (14264) or more (6974) antihypertensive drugs of different classes. Among patients treated with 3 drugs we compared those with controlled (<140/90 mmHg; No RH) or uncontrolled (RH) office BP. In patients treated with 4 or more drugs we compared controlled versus uncontrolled RH. Moreover in uncontrolled RH patients, we compared those with white-coat (normal ABPM) versus true RH. We evaluated the use of different antihypertensive drug classes, specific antihypertensive drugs inside each class, and types of combinations. Results were adjusted for age, gender, and previous history of cardiovascular disease. With respect to RH treated with 3 drugs, those No RH used more frequently aldosterone antagonists (AA; Relative risk: 1.82; 1.40-2.37. They also used more frequently clorthalidone (CTL) among diuretics (RR: 1.54; 1.24-1.91), amlodipine (AML) among calcium channel blockers (CCB; RR: 1.12; 1.00-1.24) and bisoprolol (BIS) among beta blockers (RR: 1.18; 1.03-1.35). In patients treated with 4 or more drugs, controlled RH was also associated with the use of AA (RR: 1.41; 1.14-1.73) and AML (RR: 1.42; 1.25-1.62). No differences were observed in the type of combination used. When comparing patients with true versus white-coat RH, the latter group used more frequently diuretics (RR: 1.31; 1.16-1.47), CTL (RR: 1.79; 1.48-2.16) among diuretics, and AML (RR: 1.44; 1.32-1.57) among CCB. The triple combination of RAS blockers, CCB, and diuretics was also more frequently used in those with white-coat RH (RR: 1.09; 1.00-1.19). In conclusion, controlled office BP among patients treated with 3 or more drugs is associated with AA, CTL, and AML use. White-coat RH is associated with more diuretic use, especially CTL, AML, and the combination of RAS blockers, CCB, and diuretics. These results support the use of such triple combination, preferably including CTL and AML, and the addition of AA in order to reduce the prevalence of RH and true RH.
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De La Sierra A, Banegas JR, Divison JA, Gorostidi M, Vinyoles E, De La Cruz JJ, Segura J, Ruilope LM. Abstract 113: Ambulatory Blood Pressure in Hypertensive Patients with Inclusion Criteria for the SPRINT Trial. Hypertension 2016. [DOI: 10.1161/hyp.68.suppl_1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The SPRINT trial has demonstrated the benefit of intensive BP reduction in hypertensive patients at high cardiovascular risk. Values of ABPM are of potential interest in such patients to better select those who will benefit of a lower BP target. We aimed to evaluate ABPM values in a large cohort of patients potentially candidates (meeting inclusion criteria) for the SPRINT trial. Moreover, in patients on antihypertensive therapy who also fulfill SPRINT criteria, except for clinic SBP ≥ 130 mmHg, we evaluated 24-hour SBP values among those who had clinic SBP < 120; between 120 and 139, or ≥ 140. From the database of the Spanish ABPM Registry containing 115708 patients, we identified 39132 (34%, 51% women, mean age 65 years) who fulfill both inclusion and exclusion criteria of the SPRINT trial. Mean values of clinic SBP were 151±11 mmHg, whereas corresponding values for 24-h SBP were 130±13 mmHg. Overall, 52% of patients had 24-h SBP below 130 mmHg. The proportion varied from 69% in those with clinic BP 130-139 to 34% in those with clinic BP ≥ 170 mmHg. Among 34328 treated patients who fulfilled SPRINT inclusion criteria (except for clinic BP ≥ 130), 1014 (3%) had clinic SBP < 120 mmHg, and 5330 (16%) values between 120 and 139 mmHg. The remaining 27984 patients were not controlled and had clinic SBP ≥ 140 mmHg. Values of 24 h SBP below 130 mmHg were seen in 88% of those with clinic BP < 120, in 74% of those with clinic BP 120-139, and in 47% of those with clinic BP ≥ 140 mmHg. The corresponding proportion of patients having 24-h SBP < 100 mmHg were 7.7%, 1.1%, and 0.6%. We conclude that ABPM assessment could be necessary in the evaluation of hypertensive patients at high CV risk before targeting the BP goal, as roughly half of them may have normal values of 24-h SBP (< 130 mmHg). In addition, targeting clinic BP below 120 mmHg is accompanied by 8% of patients with 24-h SBP below 100 mmHg.
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28
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Ruilope LM, Banegas JR. [SPRINT study in clinical practice: The goal is to change control blood pressure?]. Hipertens Riesgo Vasc 2016; 33:47-50. [PMID: 26935447 DOI: 10.1016/j.hipert.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- L M Ruilope
- Instituto de Investigación y Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, España; Departamento de Medicina Preventiva y Salud Publica, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP, Madrid, España.
| | - J R Banegas
- Departamento de Medicina Preventiva y Salud Publica, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP, Madrid, España
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29
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Orozco-Arbeáez E, Guallar-Castillón P, Graciani A, Banegas JR, Rodriguez-Artalejo F, Lopez-Garcia E. Habitual Chocolate Consumption and 24-Hour Blood Pressure Control in Older Adults with Hypertension. J Am Geriatr Soc 2015; 63:2637-2639. [PMID: 26691708 DOI: 10.1111/jgs.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Edilberto Orozco-Arbeáez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health, Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health, Madrid, Spain
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health, Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health, Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Instituto de Investigaciones Sanitarias Hospital Universitario La Paz, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health, Madrid, Spain
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De la Sierra A, Gorostidi M, Banegas JR, Segura J, Vinyoles E, De la Cruz JJ, Ruilope LM. Abstract P148: Ambulatory Blood Pressure in Hypertensive Patients Treated with Different 2-Drug and 3-Drug Combinations. Hypertension 2015. [DOI: 10.1161/hyp.66.suppl_1.p148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An elevated proportion of patients require 2-drug and 3-drug combinations to achieve BP control. There is scarce evidence regarding if there are differences in such BP control among different types of combinations in daily practice. We aimed to assess office and ambulatory BP values achieved, as well as the proportion of controlled patients, depending on the type of drug combination used.
From the Spanish ABPM Registry we selected 17187 patients treated with the 6 most common types of 2-drug combinations and 9724 treated with the 6 most common types of 3-drug combination. We looked for differences in achieved office and ambulatory BP, as well as nocturnal dip, and the proportion of controlled patients among types of combinations, after adjusting for confounders (age, gender, BMI, smoking, diabetes, dyslipidemia, and previous CV disease).
With respect to the combination of renin angiotensin system (RAS) blockers and diuretics (reference), none of the other combinations achieved lower BP values or better BP control. Ambulatory BP control (including 24-hour, daytime and nighttime) was worse with combinations of RAS blockers/beta blockers (OR: 1.06; 95%CI: 1.01-1.11), with combinations of calcium channel blockers (CCB)/beta blockers (1.1; 1.04-1.16) and with combinations of RAS blockers and CCB (1.38; 1.23-1.55). Nondipping was also more frequent in combinations other than RAS blockers/diuretics. In patients receiving 3-drug combinations, and with respect to RAS blockers/CCB/diuretic combinations (reference), ambulatory BP were higher and non dipping more frequent in other types of combinations. Ambulatory BP control was worse in RAS blockers/CCB/alpha blockers, RAS blockers/diuretics/alpha blockers, and CCB/beta blockers/diuretics combinations. No differences in office BP control were observed among types of 2-drug or 3-drug combinations.
We conclude that RAS/diuretic combinations and RAS/diuretic/CCB combinations are associated with better ambulatory BP control and more pronounced dipping in comparison with other types of 2-drug or 3-drug combinations, even with same rates of office BP control. These results can be helpful in deciding the way to combine antihypertensive agents in patients who require combination therapy.
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31
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Gutiérrez-Misis A, Sánchez-Santos MT, Banegas JR, Castell MV, González-Montalvo JI, Otero A. Walking speed and high blood pressure mortality risk in a Spanish elderly population. J Hum Hypertens 2015; 29:566-72. [PMID: 25880596 DOI: 10.1038/jhh.2015.32] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/01/2015] [Accepted: 03/04/2015] [Indexed: 01/13/2023]
Abstract
This study analyzed the relationship between blood pressure and all-cause mortality according to objectively measured walking speed in a Mediterranean population-based sample of older persons. We used data from the longitudinal 'Peñagrande' Cohort Study, initiated in 2008 in a sex- and age-stratified random sample of 1250 people aged ⩾65 years living in Madrid (Spain). A total of 814 individuals participated in the first study wave. The average of two standardized blood pressure readings was used. Walking speed was measured over a 3-m walk and classified as faster (⩾0.8 m s(-1)) or slower. A total of 314 individuals were slower walkers, 475 were faster walkers and 25 did not complete the walk test. Cox proportional hazards models stratified by walking speed were used to assess the association between blood pressure and all-cause death. Non-linear relationship between BP and mortality was explored by a restricted cubic spline analysis. There were 171 deaths from study entry through 31 March 2013. Systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mmHg were associated with higher mortality than blood pressure values above 140 and 90 mm Hg, respectively, but this association reached statistical significance only for systolic blood pressure and only in the slower walkers. In conclusion, systolic blood pressure levels <140 mm Hg were found associated with higher risk of total mortality among slower walkers in an old Spaniard population cohort.
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Affiliation(s)
| | - M T Sánchez-Santos
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J R Banegas
- 1] Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain [2] IdiPAZ, CIBER of Epidemiology and Public Health, Madrid, Spain
| | - M V Castell
- 1] Centro de Salud Dr Castroviejo, Primary Care, IdiPAZ, Madrid, Spain [2] IdiPAZ, Madrid, Spain
| | - J I González-Montalvo
- 1] IdiPAZ, Madrid, Spain [2] Department of Geriatrics, La Paz University Hospital, Madrid, Spain
| | - A Otero
- 1] Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain [2] IdiPAZ, Madrid, Spain
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32
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Beltrán LM, Fernández AO, Sánchez Del Rivero JA, de la Cruz JJ, Banegas JR. An electronic decision support system for the management of patients at risk of arteriosclerotic cardiovascular disease. Rev Clin Esp 2015; 215:293-5. [PMID: 25640252 DOI: 10.1016/j.rce.2014.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- L M Beltrán
- Unidad Metabólico-Vascular, Hospital Universitario La Paz/IdiPAZ, Madrid, Spain.
| | - A Olmo Fernández
- Treelogic S.L. Parque Tecnológico de Asturias, E33428 Llanera, Asturias, Spain
| | | | - J J de la Cruz
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Segura J, Banegas JR, Ruilope LM. Usefulness of ambulatory blood pressure monitoring (ABPM) in daily clinical practice: Data from the Spanish ABPM registry. Clin Exp Pharmacol Physiol 2013; 41:30-6. [DOI: 10.1111/1440-1681.12126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/19/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Julian Segura
- Hypertension Unit; Department of Nephrology; Hospital 12 de Octubre Madrid Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health; Universidad Autónoma de Madrid; Madrid Spain
| | - Luis M Ruilope
- Hypertension Unit; Department of Nephrology; Hospital 12 de Octubre Madrid Spain
- Department of Preventive Medicine and Public Health; Universidad Autónoma de Madrid; Madrid Spain
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De La Sierra A, Calhoun DA, Vinyoles E, Banegas JR, De La Cruz JJ, Gorotidi M, Segura J, Ruilope,, Madrid LM. Abstract 64: Heart Rate Values and Variability in Controlled versus Resistant Hypertensive Patients and in True versus False Resistant Hypertensives. Hypertension 2013. [DOI: 10.1161/hyp.62.suppl_1.a64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sympathetic nervous system seems to play an important role in resistant hypertension (RH) as both renal denervation and baroreflex stimulation reduce BP in such patients. Heart rate (HR) is an indirect, but probably the only clinical marker of sympathetic activity which can be measured in every hypertensive. We aimed to evaluate differences in clinical and ambulatory HR, as well as in HR variability between RH and those controlled on therapy. Moreover, we examined differences among RH patients, depending on ABPM normalcy.
We included 14627 RH (uncontrolled with 3 drugs or treated with ≥
4 drugs) versus 11951 controlled patients (on ≤ 3 drugs). Moreover, among 13555 patients uncontrolled with ≥ 3 drugs, we compared those with elevated 24h BP (≥ 130 and/or 80 mmHg; 8730 true-RH) versus those with normal 24-h BP (<130/80 mmHg; 4825 white-coat RH). Variables analyzed were office, 24-h, daytime and nighttime HR, and HR variability (nocturnal HR dip, SD and coefficient of variation of HR).
After adjusting for age, gender and the use of beta blockers, HR values and variability were slightly, but significantly elevated in RH vs controlled patients and in true vs false RH (Table shows adjusted means±sem). In logistic regression models a blunted HR dip and elevated HR-SD increased the risk of having RH, whereas elevated nocturnal HR, HR-SD and a blunted HR dip were associated with true RH. In conclusion, RH present increased HR variability, whereas night HR and increased variability are both associated with true RH. The increase in HR and HR variability may suggest the involvement of the sympathetic nervous system in the development of resistance to antihypertensive treatment.
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Gorostidi M, Sarafidis PA, de la Sierra A, Segura J, de la Cruz JJ, Banegas JR, Ruilope LM. Differences between office and 24-hour blood pressure control in hypertensive patients with CKD: A 5,693-patient cross-sectional analysis from Spain. Am J Kidney Dis 2013; 62:285-94. [PMID: 23689071 DOI: 10.1053/j.ajkd.2013.03.025] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 03/07/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous studies have examined control rates of office blood pressure (BP) in chronic kidney disease (CKD). However, recent evidence suggests major discrepancies between office and 24-hour BP values in hypertensive populations. This study examined concordance/discordance between office- and ambulatory-based BP control in a large cohort of patients with CKD. STUDY DESIGN Cross-sectional. SETTING & PARTICIPANTS 5,693 hypertensive individuals with CKD stages 1-5 from the Spanish ABPM (ambulatory BP monitoring) Registry. PREDICTORS Thresholds of 140/90 and 130/80 mm Hg for office BP and 24-hour ambulatory BP, respectively. Age, sex, body mass index, waist circumference, hypertension duration, kidney measures, diabetes, dyslipidemia, target-organ damage, and cardiovascular comorbid conditions. OUTCOMES Misclassification of BP control as "white-coat" hypertension (office BP ≥140/90 mm Hg, 24-hour BP <130/80 mm Hg) or masked hypertension (office BP <140/90 mm Hg, 24-hour BP ≥130/80 mm Hg). MEASUREMENTS Standardized office-based BP and 24-hour ABPM. RESULTS Mean age was 61.0 ± 13.9 (SD) years and 52.6% were men. The proportion with white-coat hypertension was 28.8% (36.8% of patients with office BP ≥140/90 mm Hg) and that of masked hypertension was 7.0% (but 32.1% of patients with office BP <140/90 mm Hg). Female sex, aging, obesity, and target-organ damage were associated with white-coat hypertension; aging and obesity were associated with masked hypertension. Only 21.7% and 8.1% of the CKD population had office BP <140/90 and <130/80 mm Hg, respectively. In contrast, 43.5% of individuals had average 24-hour BP <130/80 mm Hg. LIMITATIONS Cross-sectional design, longitudinal associations cannot be established. CONCLUSIONS Misclassification of BP control at the office was observed in 1 of 3 hypertensive patients with CKD. Ambulatory-based control rates were far better than office-based rates. Nevertheless, the burden of uncontrolled ambulatory BP and misclassification of BP control at the office constitutes a call for wider use of ABPM to evaluate the success of hypertension treatment in patients with CKD.
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Affiliation(s)
- Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Mesas AE, León-Muñoz LM, Guallar-Castillón P, Graciani A, Gutiérrez-Fisac JL, López-García E, Aguilera MT, Banegas JR, Rodríguez-Artalejo F. Obesity-related eating behaviours in the adult population of Spain, 2008-2010. Obes Rev 2012; 13:858-67. [PMID: 22577840 DOI: 10.1111/j.1467-789x.2012.01005.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Knowledge of the socio-demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross-sectional study assessed the frequency of self-reported eating behaviours among 11,603 individuals representative of the non-institutionalized Spanish population aged ≥ 18 years in the period 2008-2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three-fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age- and sex-adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08-1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30-1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47-0.63). In conclusion, the prevalence of several obesity-related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.
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Affiliation(s)
- A E Mesas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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Gutiérrez-Fisac JL, López E, Banegas JR, Graciani A, Rodríguez-Artalejo F. Prevalence of Overweight and Obesity in Elderly People in Spain. ACTA ACUST UNITED AC 2012; 12:710-5. [PMID: 15090641 DOI: 10.1038/oby.2004.83] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To estimate the prevalence of obesity and overweight in the older adult population in Spain by sex, age, and educational level. RESEARCH METHODS AND PROCEDURES A cross-sectional study was carried out in 2001 in a sample of 4009 persons representative of the noninstitutionalized population > or = 60 years of age. Anthropometric measurements (BMI and waist circumference) were obtained using standardized techniques and equipment. Overweight was considered at a BMI of 25 to 29.9 kg/m2 and obesity at a BMI of > or = 30 kg/m2. Central obesity was considered at a waist circumference of >102 cm in men and >88 cm in women. RESULTS The mean BMI was 28.2 kg/m2 in men and 29.3 kg/m2 in women. The prevalence of overweight and obesity in men was 49% and 31.5%, respectively. The corresponding percentages in women were 39.8% and 40.8%. The prevalence of obesity was higher in persons with no education than in those with third level education (i.e., university studies), especially among women (41.8% vs. 17.5%). The prevalence of central obesity was 48.4% in men and 78.4% in women. Differences by educational level were seen in only women, in whom the prevalence of central obesity was 80.9% in those with no education and 59% in those with third-level education. DISCUSSION The prevalence of overweight and obesity in the Spanish adult elderly population is very high. Some other populations show similar prevalences, especially in Mediterranean countries. Socioeconomic conditions in Spain during the years these cohorts were born may partly explain the high-frequency of obesity.
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Affiliation(s)
- Juan L Gutiérrez-Fisac
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Spain.
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De la Sierra A, Gorostidi M, Segura J, Banegas JR, de la Cruz JJ, Ruilope LM. Abstract 288: Nocturnal Blood Pressure Elevation or Abnormal Circadian Pattern. Which is Better Associated with Cardiovascular Risk? Hypertension 2012. [DOI: 10.1161/hyp.60.suppl_1.a288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aim:
A blunted decrease in nighttime BP with respect to daytime values (the non-dipping pattern) and an absolute increase in nocturnal BP have both been related to a worse cardiovascular prognosis. However, these are not independent variables and little is know about which is better related with cardiovascular risk. The aim of the study was to compare clinical data in untreated hypertensives classified on the basis of both absolute nocturnal BP and the dipping pattern.
Methods:
We included 37096 untreated patients from the Spanish ABPM Registry. They were classified in 4 different groups: Group 1: 15743 (42%) with mean nocturnal systolic BP (NSBP) < 120 mmHg and nocturnal systolic dip (NSD) ≥ 10%; Group 2: 6166 (17%) patients with NSBP < 120 mmHg and NSD < 10%; Group 3: 4847 (13%) patients with NSBP ≥ 120 mmHg and NSD ≥ 10%; and Group 4: 10340 (28%) patients with NSBP ≥ 120 mmHg and NSD < 10%. Groups were compared by ANOVA, Kruskal-Wallis or Chi square statistics (p for trend), with specific comparisons between groups 2 and 3 (Bonferroni corrected t-test, Mann Whitney or Chi square statistics).
Results:
Compared to patients with elevated NSBP but normal NSD, those with abnormal NSD but normal NSBP were more frequently women, diabetics, had reduced eGFR and had more frequently previous history of cardiovascular complications. The worse cardiovascular risk profile was seen in those patients with both elevated NSBP and abnormal NSD (table).
Conclusion:
In untreated hypertensive patients an abnormal dipping pattern is more closely related with diabetes and overt cardiovascular and renal disease than nocturnal BP elevation without circadian pattern alterations
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Gutiérrez-Fisac JL, Guallar-Castillón P, León-Muñoz LM, Graciani A, Banegas JR, Rodríguez-Artalejo F. Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study. Obes Rev 2012; 13:388-92. [PMID: 22151906 DOI: 10.1111/j.1467-789x.2011.00964.x] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This is the first study to report the prevalence of general obesity and abdominal obesity (AO) in the adult population of Spain based on measurements of weight, height and waist circumference. The data are taken from the ENRICA study, a cross-sectional study carried out between June 2008 and October 2010 in 12,883 individuals representative of the non-institutionalized population on Spain aged 18 years and older. Anthropometry was performed under standardized conditions in the households by trained interviewers. Overweight was considered as body mass index (BMI) 25-29.9 kg m(-2) , and obesity as BMI ≥ 30 kg m(-2) . AO was defined as waist circumference >102 cm in men and >88 cm in women. The prevalence of obesity was 22.9% (24.4% in men and 21.4% in women). About 36% of adults had AO (32% of men and 39% of women). The frequency of obesity and of AO increased with age and affected, respectively, 35 and 62% of persons aged 65 and over. The frequency of obesity and AO decreased with increasing educational level. For example, 29% of women with primary education or less had obesity vs. only 11% of those with university studies. The prevalence of obesity was very high in the Canary Islands and in the south of Spain.
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Affiliation(s)
- J L Gutiérrez-Fisac
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), C/ Arzobispo Morcillo 2,Madrid, Spain.
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Guallar-Castillón P, Rodríguez-Artalejo F, Tormo MJ, Sánchez MJ, Rodríguez L, Quirós JR, Navarro C, Molina E, Martínez C, Marín P, Lopez-Garcia E, Larrañaga N, Huerta JM, Dorronsoro M, Chirlaque MD, Buckland G, Barricarte A, Banegas JR, Arriola L, Ardanaz E, González CA, Moreno-Iribas C. Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: the EPIC-Spain cohort study. Nutr Metab Cardiovasc Dis 2012; 22:192-199. [PMID: 20708394 DOI: 10.1016/j.numecd.2010.06.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/11/2010] [Accepted: 06/10/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM No previous study has assessed the association between major dietary patterns and the risk of coronary heart disease (CHD) in a large cohort from a Mediterranean country. METHODS AND RESULTS We studied prospectively 40,757 persons, aged 29-69 years, participating in the Spanish cohort of the EPIC study. Food consumption was collected between 1992 and 1996 with a validated history method. Individuals were followed-up until 2004 through record linkage with hospital discharge registers, population-based registers of myocardial infarction, and mortality registers to ascertain CHD events (fatal and non-fatal acute myocardial infarction or angina requiring revascularization). Two major dietary patterns were identified from factor analysis. The first pattern was labeled as Westernized, because of the frequent consumption of refined cereals and red meat; the second was called the evolved Mediterranean pattern, because of the frequent intake of plant-based foods and olive oil. During a median follow-up of 11 years, 606 CHD events were ascertained. No association was found between the Westernized pattern and CHD risk. In contrast, the score for the evolved Mediterranean pattern was inversely associated with CHD risk (p for trend = 0.0013); when compared with the lowest quintile of the evolved Mediterranean pattern score, the multivariable hazard ratios for CHD were 0.77 (95% confidence interval 0.61-0.98) for the second quintile, 0.64 (95% CI 0.50-0.83) for the third quintile, 0.56 (95% CI 0.43-0.73) for the fourth quintile, and 0.73 (95% CI 0.57-0.94) for the fifth quintile. CONCLUSION A Mediterranean diet, as consumed in this study population, was associated with a lower risk of CHD.
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Affiliation(s)
- P Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine. Universidad Autónoma de Madrid, IdiPAZ, Avda. Arzobispo Morcillo, 28029 Madrid. Spain.
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de la Sierra A, Gorostidi M, Segura J, Armario P, Oliveras A, Banegas JR, Ruilope LM. Response to Bedtime Hypertension Treatment Increases Ambulatory Blood Pressure Control and Reduces Cardiovascular Risk in Resistant Hypertension. Hypertension 2011. [DOI: 10.1161/hypertensionaha.111.178764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | - Luis M. Ruilope
- Department of Internal Medicine
Hospital Mutua Terrassa
University of Barcelona
Terrassa, Spain
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Siqués P, Brito J, Banegas JR, León-Velarde F, de la Cruz-Troca JJ, López V, Naveas N, Herruzo R. Blood Pressure Responses in Young Adults First Exposed to High Altitude for 12 Months at 3550 m. High Alt Med Biol 2009; 10:329-35. [DOI: 10.1089/ham.2008.1103] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patricia Siqués
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile
| | - Julio Brito
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile
| | - Jose R. Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, and CIBER en Epidemiología y Salud Pública, Spain
| | - Fabiola León-Velarde
- Department of Biological and Physiological Sciences, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Peru
| | - Juan J. de la Cruz-Troca
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, and CIBER en Epidemiología y Salud Pública, Spain
| | - Vasthi López
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile
| | - Nelson Naveas
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile
| | - Rafael Herruzo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, and CIBER en Epidemiología y Salud Pública, Spain
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Lopez-Garcia E, Faubel R, Guallar-Castillon P, Leon-Muñoz L, Banegas JR, Rodriguez-Artalejo F. Self-reported sleep duration and hypertension in older Spanish adults. J Am Geriatr Soc 2009; 57:663-8. [PMID: 19392958 DOI: 10.1111/j.1532-5415.2009.02177.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the association between self-reported sleep duration, prevalent and incident hypertension, and control of high blood pressure in older adults. DESIGN Logistic regression models were used to investigate the associations of interest in a prospective cohort study conducted from 2001 to 2003. SETTING Cohort representative of the noninstitutionalized Spanish population. PARTICIPANTS Three thousand six hundred eighty-six persons aged 60 and older. MEASUREMENTS Sleep duration was reported in 2001 by asking the participants "How many hours do you usually sleep per day (day and night)" and classified into categories (4-5, 6, 7, 8, 9, and 10-15 h/d. The outcome variables were prevalent hypertension (systolic blood pressure > or =140 mmHg, diastolic pressure > or =90 mmHg, or antihypertensive treatment in 2001), control of blood pressure (systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg in subjects receiving antihypertensive treatment in 2001), and incident hypertension (diagnosis of hypertension during 2001-2003 in individuals with normal pressure in 2001). RESULTS Compared with sleeping 7 hours, sleeping more or fewer hours was not significantly associated with prevalent hypertension (odds ratios (ORs) ranged from 0.82 (95% confidence interval (CI)=0.64-1.05) to 1.10 (95% CI 0.83-1.46)), control of blood pressure (ORs ranged from 0.70 (95% CI 0.46-1.08) to 0.97 (95% CI 0.60-1.56)), or incident hypertension (OR ranged from 0.54 (95% CI 0.29-1.01) to 0.83 (95% CI 0.43-1.60)). The results were similar in both sexes. CONCLUSION Self-reported sleep duration is not associated with hypertension in older adults.
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Affiliation(s)
- Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Affiliation(s)
- A Tobías
- National School of Public Health, Instituto de Salud Carlos III, C/Sinesio Delgado 8, E-28029 Madrid, Spain.
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Herruzo R, Banegas JR, Cruz JJ, Garcia-Torres V, Fernandez-Aceñero MJ. WITHDRAWN: The Etiology of Bacteremia or Pneumonia as a Prognostic Factor for Death in Burn Patients, After a 10-Day in Intensive Care Unit. J Burn Care Res 2008:1. [PMID: 18388572 DOI: 10.1097/bcr.0b013e3181711115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Rafael Herruzo
- From the Departamento de Medicina Preventiva, Catedrático de Medicina Preventiva y Salud Publica, UAM, Madrid, Spain
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Vegazo O, Banegas JR, Civeira F, Serrano Aisa PL, Jiménez FJ, Luengo E. Prevalencia de dislipemia en las consultas ambulatorias del Sistema Nacional de Salud: Estudio HISPALIPID. Med Clin (Barc) 2006; 127:331-4. [PMID: 16987452 DOI: 10.1157/13092314] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE We intended to estimate the prevalence of dyslipidemia among patients attending outpatient clinics of the Spanish health service. PATIENTS AND METHOD HISPALIPID is a multicenter, cross-sectional study performed in 33,913 patients (55.7% women) with a mean age of 54.6 +/- 18.3 years attended in outpatient clinics across 15 of the 17 autonomous communities of Spain. 1,461 physicians (78.8% primary care physicians, and 21.2% specialists) participated in the study. Patients were considered having dyslipidemia if their doctor had established a previous diagnosis. RESULTS A total of 8,256 patients (52.4% women, mean age 62.4 +/- 12.4 years) had been diagnosed with dyslipidemia, representing a global prevalence of 24.3% (CI95%: 23.8-24.8) (M: 26.2%; W:22.9%; P<0.001). The communities with the higher and lower prevalence were the Canary Islands (33.9%) and Cantabria (18.6%), respectively. About 87% dyslipemic patients presented an additional cardiovascular risk factor and 36.7% of dyslipemic patients had an associated cardiovascular disease. CONCLUSIONS The prevalence of dyslipidemia is high in patients attending outpatient clinics of the Spanish health service (one out of four patients). In addition, these patients are at a high cardiovascular risk.
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Affiliation(s)
- Onofre Vegazo
- Departamento Médico, AstraZeneca Farmacéutica Spain.
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García-Pavía P, González Mirelis J, Pastorín R, Bruna M, Raez J, Tabuenca AI, Alonso-Pulpón L, Banegas JR. Análisis de las áreas de mejora del control de la hipertensión arterial en Atención Primaria. Rev Clin Esp 2006; 206:220-4. [PMID: 16750104 DOI: 10.1157/13088560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Most hypertensive patients do not have their blood pressure (BP) under control. This study aims to evaluate Primary Care physicians' management of hypertension by analyzing the four main areas proposed by experts to improve BP control. MATERIAL AND METHODS From February to May 2003 a questionnaire was completed by 195 Primary Care physicians from 33 Primary Care centers of Madrid, Spain. Four aspects of clinical practice were examined: a) knowledge of hypertension guidelines and objectives; b) diagnosis and follow-up of patients; c) hypertension treatment, and d) drug compliance. RESULTS Guidelines were followed by 90.6% of the physicians. Twenty six percent of the physicians perceived that guideline objectives are too strict and only 32% identified systolic BP as the component that provides more risk. Only 14% used automatic devices to measure BP while 89% still use the mercury sphygmomanometer. Diuretics were included among the 3 most used antihypertensive drugs by 94% of the physicians, ACEI by 91%, beta blockers by 62% and combinations only by 24%. Eighty eight percent believed that more than 40% of their patients have their BP under control and 53% felt that less than 20% of their patients were non-compliant with antihypertensive treatment. CONCLUSIONS Hypertension management among Primary Care physicians showed some deficiencies in the 4 analyzed areas. Thus, perception of excessively rigorous guideline objectives, underrating of systolic BP, underuse of automatic devices and drug associations, and the overestimation of BP control and therapeutic compliance are specific areas that should be modified to improve BP control.
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Affiliation(s)
- P García-Pavía
- Servicio de Cardiología, Hospital Univesitario Puerta de Hierro, Madrid, España.
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León-Muñoz LM, Guallar-Castillón P, Banegas JR, Gutiérrez-Fisac JL, López-García E, Jiménez FJ, Rodríguez-Artalejo F. Changes in body weight and health-related quality-of-life in the older adult population. Int J Obes (Lond) 2006; 29:1385-91. [PMID: 16103894 DOI: 10.1038/sj.ijo.0803049] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND No other study has ascertained the short-term impact of weight change on health-related quality-of-life (HRQL) on a national sample of older adults. OBJECTIVE To examine the relationship between change in body weight and HRQL among the older adult population. METHODS We carried out a prospective study from 2001 to 2003 of a cohort of 2364 persons, representative of the noninstitutionalized Spanish population aged 60 y and over. Weight changes during the period 2001-2003 were self-reported, and HRQL in 2003 was measured with the SF-36 questionnaire. Analyses adjusted for the principal confounders. RESULTS Among nonobese women (body mass index (BMI) 18.5-29.9 kg/m(2)), and compared to those who underwent no important weight change, weight loss was associated with a clinically significant worsening in the role-physical, vitality, and social functioning SF-36 scales. Among obese women (BMI> or =30 kg/m(2)), weight gain led to a reduction in HRQL for four of the eight SF-36 scales, while weight loss was associated with worse scores in role-emotional and mental health scales. Results were usually similar for men, though of lower magnitude. In both sexes, weight change was associated with a reduction of over 5 points on several physical and mental scales of the SF-36, which indicates a clinically relevant worsening in HRQL. CONCLUSION Weight change is associated with worse HRQL among the older adults, principally women. From the stance of HRQL, it is desirable to prevent weight gain, especially among the obese, and weight loss, especially among the nonobese.
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Affiliation(s)
- L M León-Muñoz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
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Alonso Moreno FJ, Divisón Garrote JA, Llisterri Caro JL, Rodríguez Roca GC, Lou Arnal S, Banegas JR, Raber Béjar A, de Castellar Sansó R, Gil Guillén VF, Luque Otero M. [Primary care physicians behaviour in inadequate blood pressure control]. Aten Primaria 2005; 36:204-10. [PMID: 16153374 PMCID: PMC7684499 DOI: 10.1157/13078617] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Accepted: 12/07/2004] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the behaviour of primary care (PC) physicians on inadequate hypertension control. DESIGN Cross-sectional and multicentric study. SETTING PC clinics in the whole of Spain. PATIENTS Patients > or =18 years old who followed pharmacological antihypertensive treatment since at least 3 months before, selected by a consecutive sampling. MEASUREMENTS Blood pressure measured by family doctors. The therapeutic diagram used before and after the visit was registered, and in those cases in which some kind of modification was adopted, the reasons why. RESULTS 12,754 hypertensive patients were included. The average age was 63.3+/-10.9 years (57.3% women). A 65% lived in urban areas and the 35% in semi-urban o rural areas. The 63.9% (95% confidence interval, 63.1%-64.8%) showed a bad control of hypertension. The majority of the patients followed a therapeutic regimen of monotherapy (56%) being the ACE inhibitors the most prescribed drug (34.8%), followed by the calcium antagonist (21.3%), and angiotensin II antagonists (17.4%). The percentage of patients with inadequate control of the blood pressure, in which the therapeutic behaviour was modified was 18.3% (95% confidence interval, 17.5%-19.1%) (a change of drug in 47%, association in 34.7% and an increase in the dose in 18.3%). The main reasons for which the therapeutic behaviour was modified was because no drug efficacy (63.7%) and the presence of adverse events (5.5%). The price of the therapy originated 1.2% of the modifications. CONCLUSIONS PC physicians behaviour was conservative in uncontrolled hypertension cases. Amongst the doctors who modified their behaviour, by inadequate blood pressure control, the change of drug was the decision most adopted.
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Regidor E, Banegas JR, Gutiérrez-Fisac JL, Domínguez V, Rodríguez-Artalejo F. Influence of childhood socioeconomic circumstances, height, and obesity on pulse pressure and systolic and diastolic blood pressure in older people. J Hum Hypertens 2005; 20:73-82. [PMID: 16121198 DOI: 10.1038/sj.jhh.1001925] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study assesses the association of childhood socioeconomic circumstances, height, and obesity with components of blood pressure. We selected 4009 people representative of the Spanish population aged 60 years and older, and estimated systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) according to childhood social class, height, and obesity. No association was found between childhood social class and blood pressure. SBP showed an inverse gradient and DBP a direct gradient with height, although an independent association between height and DBP was found only in women. Stature was independently associated with increased DBP in women with central obesity, but there was no association between height and DBP in women without central obesity. Short stature was independently associated with increased PP. Body mass index and waist-to-hip ratio were independently associated with increased DBP in women, and waist-to-hip ratio was independently associated with increased PP in men, while waist circumference was independently associated with increased DBP and increased PP in women. These results do not support the assumed effect of socioeconomic circumstances in early life on blood pressure, which may depend on the context and/or study population. The relations observed between height and blood pressure support the hypothesis that PP could be a mediator of the association between short stature and increased cardiovascular risk. The relationship between obesity measures and components of blood pressure reinforces the recommendation to reduce body weight in order to reduce blood pressure.
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Affiliation(s)
- E Regidor
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
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