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Wang C, Liang L, Luo S, Wang H, Wang X, Cheng Y, Pan G, Peng J, Han S, Wang X. Nomogram-based risk assessment model for left ventricular hypertrophy in patients with essential hypertension: Incorporating clinical characteristics and biomarkers. J Clin Hypertens (Greenwich) 2024; 26:363-373. [PMID: 38430459 PMCID: PMC11007794 DOI: 10.1111/jch.14786] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
Left ventricular hypertrophy (LVH) is a hypertensive heart disease that significantly escalates the risk of clinical cardiovascular events. Its etiology potentially incorporates various clinical attributes such as gender, age, and renal function. From mechanistic perspective, the remodeling process of LVH can trigger increment in certain biomarkers, notably sST2 and NT-proBNP. This multicenter, retrospective study aimed to construct an LVH risk assessment model and identify the risk factors. A total of 417 patients with essential hypertension (EH), including 214 males and 203 females aged 31-80 years, were enrolled in this study; of these, 161 (38.6%) were diagnosed with LVH. Based on variables demonstrating significant disparities between the LVH and Non-LVH groups, three multivariate stepwise logistic regression models were constructed for risk assessment: the "Clinical characteristics" model, the "Biomarkers" model (each based on their respective variables), and the "Clinical characteristics + Biomarkers" model, which amalgamated both sets of variables. The results revealed that the "Clinical characteristics + Biomarkers" model surpassed the baseline models in performance (AUC values of the "Clinical characteristics + Biomarkers" model, the "Biomarkers" model, and the "Clinical characteristics" model were .83, .75, and .74, respectively; P < .0001 for both comparisons). The optimized model suggested that being female (OR: 4.26, P <.001), being overweight (OR: 1.88, p = .02) or obese (OR: 2.36, p = .02), duration of hypertension (OR: 1.04, P = .04), grade III hypertension (OR: 2.12, P < .001), and sST2 (log-transformed, OR: 1.14, P < .001) were risk factors, while eGFR acted as a protective factor (OR: .98, P = .01). These findings suggest that the integration of clinical characteristics and biomarkers can enhance the performance of LVH risk assessment.
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Affiliation(s)
- Chuang‐chang Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Li‐Keng Liang
- Yunkang school of medicine and healthNanfang CollegeGuangzhouChina
| | - Sheng‐ming Luo
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Hui‐Cheng Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xiao‐li Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Ya‐Hui Cheng
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Guang‐ming Pan
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jiang‐Yang Peng
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Shu‐jie Han
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xia Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
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Loponen N, Ylä‐Outinen H, Kallionpää RA, Valtanen M, Auranen K, Järveläinen H, Peltonen S, Peltonen J. Hypertension in NF1: A closer look at the primacy of essential hypertension versus secondary causes. Mol Genet Genomic Med 2024; 12:e2346. [PMID: 38131619 PMCID: PMC10767585 DOI: 10.1002/mgg3.2346] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND We aimed to analyze hypertension in neurofibromatosis type 1 (NF1) in a Finnish population-based cohort in 1996-2014. METHODS A cohort of 1365 individuals with confirmed NF1 was compared with a control cohort of 13,923 individuals matched for age, sex, and area of residence. Diagnoses of hypertension were retrieved from the Finnish Care Register for Health Care. These registered data were separately analyzed for secondary and essential hypertension. Purchases of antihypertensive drugs were queried from the Finnish Register of Reimbursed Drug Purchases. RESULTS We identified 115 NF1 patients with hospital diagnosis of hypertension. Our findings revealed a hazard ratio (HR) of 1.64 (95% CI 1.34-2.00, p < 0.001) in NF1 versus controls. NF1 patients presented with a significantly increased hazard for both secondary hypertension (n = 9, HR 3.76, 95% CI 1.77-7.95, p < 0.001) and essential hypertension (n = 98, HR 1.73, 95% CI 1.39-2.14, p < 0.001). No difference in the HR of hypertension was observed between men and women, while NF1 patients with essential hypertension were, on average, younger than the controls. The proportions of individuals with antihypertensive medication did not differ between NF1 patients and controls (OR 0.85). CONCLUSION NF1 is a risk factor for hypertension. Despite the recognized risk for secondary hypertension, essential hypertension is the predominant type in NF1.
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Affiliation(s)
- Niina Loponen
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
| | - Heli Ylä‐Outinen
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
- Department of Pulmonary DiseasesTurku University HospitalTurkuFinland
| | - Roope A. Kallionpää
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
| | - Mikko Valtanen
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
- Department of Mathematics and StatisticsUniversity of TurkuTurkuFinland
- Department of Public Health and Welfare, Population Health UnitFinnish Institute for Health and WelfareHelsinkiFinland
| | - Kari Auranen
- Department of Mathematics and StatisticsUniversity of TurkuTurkuFinland
- Department of Clinical MedicineUniversity of TurkuTurkuFinland
| | - Hannu Järveläinen
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
- Department of Internal MedicineSatakunta Central HospitalPoriFinland
| | - Sirkku Peltonen
- Department of DermatologyUniversity of Turku and Turku University HospitalTurkuFinland
- Department of Dermatology and VenereologyInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Dermatology and Venereology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
- Department of Dermatology and AllergologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Juha Peltonen
- Department of Cell Biology and AnatomyInstitute of Biomedicine, University of TurkuTurkuFinland
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Hong N, Kim KJ, Yu MH, Jeong SH, Lee S, Lim JS, Rhee Y. Risk of dementia in primary aldosteronism compared with essential hypertension: a nationwide cohort study. Alzheimers Res Ther 2023; 15:136. [PMID: 37568223 PMCID: PMC10416485 DOI: 10.1186/s13195-023-01274-x] [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: 12/22/2022] [Accepted: 07/12/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Although hypertension is a critical risk factor for dementia, the association between primary aldosteronism (PA) and dementia has been scarcely reported. We aimed to investigate whether the risk of dementia in patients with PA was elevated compared with patients with essential hypertension (EH). METHODS From the National Health Insurance Claim database in Korea (2003-2017), 3,687 patients with PA (adrenalectomy [ADX], n = 1,339, mineralocorticoid receptor antagonist [MRA] n = 2,348) with no prior dementia were age- and sex-matched at a 1:4 ratio to patients with EH (n = 14,741). The primary outcomes were all-cause dementia events, including Alzheimer's disease, vascular dementia, or other dementia combined with a prescription of one or more medications for dementia (donepezil, galantamine, memantine, or rivastigmine). Multivariable Cox regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals for the outcome incidence rates between patients with PA and their EH matches. RESULTS During a median follow-up of 5.2 years, there were 156 cases of all-cause dementia (4.2%), 140 cases of Alzheimer's disease (3.8%), and 65 cases of vascular dementia (1.8%). Compared with EH, the risk of all-cause dementia was increased in treated PA (unadjusted hazard ratio [HR] 1.26; p < 0.011). Among PA, MRA group had higher risks of all-cause dementia, especially vascular dementia, adjusted for age, sex, income, comorbidities, and concurrent medication (adjusted HR 1.31; p = 0.027 and adjusted HR 1.62; p = 0.020, respectively) compared to EH. ADX group seemed to have a lower dementia risk than the EH group, but there was no statistical significance after full adjustment. This trend became more prominent when the dementia risks were evaluated from the time of hypertension diagnosis rather than treatment initiation for PA. CONCLUSION The findings of this cohort study suggest that PA, especially the MRA group, is associated with an increased risk of dementia. Monitoring cognitive function in PA patients even after treatment initiation might be warranted to prevent dementia.
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Affiliation(s)
- Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyoung Jin Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Heui Yu
- SENTINEL Team, Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20, Ilsan-Ro, Wonju-Si, Gangwon-Do, 26426, Republic of Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20, Ilsan-Ro, Wonju-Si, Gangwon-Do, 26426, Republic of Korea.
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Seifaei A, Askarinejad A, Bazrafshan Drissi H, Keshtvarz Hesam Abadi A, Sasannia S, Moghadami M, Izadpanah P, Bazrafshan H. General Anxiety Disorder and Primary Hypertension: Is There a Link? J Nerv Ment Dis 2023; 211:525-529. [PMID: 37166043 DOI: 10.1097/nmd.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/12/2023]
Abstract
ABSTRACT Chronic forms of morbidity, including mental disorders and hypertension, play a dominant role in determining a disease load in the developing world. This article investigates the associations between the diagnoses of primary hypertension and generalized anxiety disorder (GAD) and the severity of GAD in individuals with primary hypertension. The association of GAD and age, sex, marriage, education level, income, chronic medical conditions, family history of mental disorders, adverse life events, and hypertension was assessed in 470 patients with the diagnosis of primary hypertension. Data analysis was performed with IBM SPSS Statistics software version 16. A significant relationship was found between the prevalence of GAD and the following variables: history of mental disorders ( p < 0.0001), chronic medical conditions ( p < 0.0001), and adverse life events ( p < 0.0001). The mean anxiety score was higher among patients with uncontrolled blood pressure, and a significant relationship was observed between the prevalence of GAD and blood pressure ( p < 0.0001). Because of the significant association between GAD and primary hypertension, it is recommended that anxiety disorders be considered in patients in whom primary hypertension is not controlled easily. This may lead to more proper control of hypertension while taking fewer antihypertensive medications.
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Affiliation(s)
| | | | | | | | | | | | - Peyman Izadpanah
- Department of Cardiology, School of Medicine, Namazi Teaching Hospital
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Paudel S, Gautam MP, Baral YN, Poudel R, Adhikari KR, Yadav RK, Baral S. Prevalence of Left Ventricular Diastolic Dysfunction in Patients with Essential Hypertension. J Nepal Health Res Counc 2023; 20:659-663. [PMID: 36974853 DOI: 10.33314/jnhrc.v20i3.4283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Left Ventricular Diastolic Dysfunction is considered a critical link between hypertension and heart failure, particularly in individuals with heart failure and preserved ejection fraction. The aim of this study is to assess the prevalence and factors associated with clinical parameters of left ventricular diastolic dysfunction in patients with essential hypertension. METHODS A hospital-based cross-sectional study was done among 68 newly diagnosed and known hypertensive patients visiting out patientdepartmentat Bir hospital. Patients who meet the inclusion criteria were chosen alternatively by referring OPD register. Patients with hypertension had undergone echocardiography to see whether left ventricular diastolic dysfunction was present and was compared to other clinical parameters like age, sex, body mass index, and dyslipidemia using the student t-test/chi-square test. RESULTS The prevalence of left ventricular diastolic dysfunction in essential hypertensive patients was 33.8%. About 25% patients had grade 1; 7.4% and 1.5% of patients had grade 2 and grade 3 diastolic dysfunction respectively. Patients who had a duration of hypertension of more than five years were more than nine times (OR 9.14; 2.89-28.87) more likely to have Left ventricular diastolic dysfunction. Age and Body Mass Index were found statistically significant with diastolic dysfunction (P<0.05). CONCLUSIONS Left ventricular diastolic dysfunction was found prevalent in hypertensive patients. Age, Body mass index, Dyslipidemia and Duration of hypertension were found to be statistically significant with diastolic dysfunction Keywords: Diastolic dysfunction; hypertension; Nepal; prevalence.
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Affiliation(s)
| | | | | | | | | | | | - Sushila Baral
- Provincial Health Training Centre, Gandaki Province, Pokhara
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Marushchak M, Mazur L, Krynytska I. Insulin receptor substrate-1 gene polymorphism and lipid panel data in type 2 diabetic patients with comorbid obesity and/or essential hypertension. Endocr Regul 2023; 57:1-11. [PMID: 36753667 DOI: 10.2478/enr-2023-0001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Objective. The hallmarks of type 2 diabetes mellitus (T2DM) are insulin resistance (IR) and insulin receptor substrate (IRS) proteins essential for the insulin signaling. IRS-1 gene has not only been shown to be associated with T2DM, but also has indicated that it may significantly correlate with diabetic complications, such as coronary heart disease and obesity. The aim of this study was to evaluate changes of the lipid panel data in T2DM patients with comorbid obesity and/or essential hypertension in connection with the IRS-1 (rs2943640) polymorphism. Methods. The study involved 33 T2DM patients and 10 healthy individuals. The IRS-1 (rs2943640) polymorphism was genotyped using a TaqMan real-time polymerase chain reaction method. Blood serum lipid panel data were determined with commercially available kits using a Cobas 6000 analyzer. Results. Analysis of the serum lipid panel data depending on the presence of the C/A alleles of IRS-1 (rs2943640) polymorphism in T2DM patients, regardless of the presence/absence of comorbidities, showed significantly lower level of high-density lipoprotein cholesterol (HDL-C) and significantly higher level of non-HDL-C in the carriers of C allele vs. carriers of A allele. In T2DM patients with comorbid obesity and essential hypertension, proatherogenic lipid changes were found in both C and A alleles carriers. Analysis of the effect of IRS-1 (rs2943640) genotypes on serum lipid panel data in T2DM patients, regardless of the presence/absence of comorbidities, showed that the CC genotype carriers had more pronounced pro-atherogenic changes vs. carriers of СА and АА genotypes. In the comorbid course of T2DM (both in combination with obesity and obesity and essential hypertension), pro-atherogenic changes were found in the carriers of the CA genotype of IRS-1 (rs2943640) polymorphism. Conclusions. The presence of the C allele of IRS-1 (rs2943640) polymorphism in both homo-zygous and heterozygous states indicates increased risk of pro-atherogenic changes in T2DM patients with comorbid obesity and/or essential hypertension.
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Affiliation(s)
- Mariya Marushchak
- Department of Functional and Laboratory Diagnostics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Lyudmyla Mazur
- Department of Higher Nursing Education, Patient Care and Clinical Immunology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Inna Krynytska
- Department of Functional and Laboratory Diagnostics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Solanki P, Gwini SM, Libianto R, Gabb G, Shen J, Young MJ, Fuller PJ, Yang J. Risky business: a single-centre cross-sectional analysis of calculated cardiovascular risk in patients with primary aldosteronism and essential hypertension. BMJ Open 2022; 12:e062406. [PMID: 36375972 PMCID: PMC9664285 DOI: 10.1136/bmjopen-2022-062406] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Primary aldosteronism (PA), the most common endocrine cause of hypertension, is associated with a higher risk of cardiovascular disease (CVD) than blood pressure (BP)-matched essential hypertension (EH). We aimed to compare the calculated risks of CVD in patients who had hypertension with PA or EH using CVD risk calculators, hypothesising that they will fail to recognise the increased CVD risk in PA. DESIGN Cross-sectional analysis. SETTING An endocrine hypertension service in Victoria, Australia. PARTICIPANTS Patients who had hypertension without CVD referred for the investigation of hypertension. OUTCOME MEASURES Calculated 5-year or 10-year CVD risk as predicted by the National Vascular Disease Prevention Alliance (NVDPA) algorithm, Framingham Risk Score, Pooled Cohort Equations and QRISK3. RESULTS Those with PA (n=128) and EH (n=133), did not differ significantly in their calculated CVD risks with the NVDPA algorithm (moderate-to-high 5-year risk 36/100 vs 45/99, p=0.17); the Framingham Risk Score (median 10-year risk 7.72% (4.43%-12.95%) vs 6.84% (3.85%-10.50%), p=0.14); the Pooled Cohort Equations (median 10-year risk 9.45% (4.36%-15.37%) vs 7.90% (2.09%-14.73%), p=0.07); and QRISK3 (median 10-year risk 11.31% (7.22%-20.29%) vs 12.47% (5.10%-19.93%), p=0.51). Similarities persisted on regression analyses accounting for systolic BP. CONCLUSIONS CVD risk algorithms do not reflect the increased risk of CVD in patients with PA, and likely underestimate the true risk of CVD among those with PA. Screening for PA, in addition to using the CVD risk algorithm in patients who had hypertension, may facilitate the targeted treatment of PA and minimisation of cardiovascular risk in affected individuals.
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Affiliation(s)
- Pravik Solanki
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Stella May Gwini
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Genevieve Gabb
- School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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Wu HL, Yang J, Wei YC, Wang JY, Jia YY, Li L, Zhang L, Lu Y, Luo ZJ, Leng XY. Analysis of the prevalence, risk factors, and clinical characteristics of osteoporosis in patients with essential hypertension. BMC Endocr Disord 2022; 22:165. [PMID: 35761253 PMCID: PMC9235169 DOI: 10.1186/s12902-022-01080-w] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study investigated the prevalence of osteoporosis (OP) among patients with essential hypertension (EH) in the Changchun community and analysed the correlation between EH and OP. METHODS The study included 425 subjects with EH and 425 age- and sex-matched healthy controls. Bone mineral density (BMD) and serum creatinine (CR) levels were measured, and the subjects' current EH and OP statuses were surveyed to analyse the correlation between EH and OP. RESULTS The EH group exhibited lower BMD and a higher rate of having OP than the control group, and this difference was statistically significant (p < 0.05). A significant sex difference in the BMD T-score was observed among the subjects (male: - 1.19 ± 1.55, female: - 1.70 ± 1.34). In both the EH group and the control group, the rate of having OP in females was greater than that in males. However, the OP prevalence among subjects with EH varied significantly by age, body weight, fracture history, nocturnal urination frequency, depression and anxiety status, duration of hypertension, and antihypertensive medication use (p < 0.05). Two-way analysis of variance suggested an effect of the interaction between different EH statuses and bone mass conditions on the serum CR values (F = 3.584, p = 0.028, bias η2 = 0.008). CONCLUSIONS The prevalence of OP and low BMD were significantly higher among subjects with EH than among healthy controls. Additionally, the findings indicate that age, weight, fracture history, nocturnal urination frequency, depression and anxiety, duration of hypertension and antihypertensive drug use may be correlated to having OP in EH subjects, requiring further studies. Moreover, serum CR levels in subjects with different bone mass profiles were strongly influenced by the presence or absence of EH, and the serum CR levels differed significantly with the interaction of these two factors.
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Affiliation(s)
- Hai-Long Wu
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jie Yang
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yu-Chi Wei
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jian-Yu Wang
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yu-Yan Jia
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Luan Li
- Changchun Medical College, Changchun, Jilin, China
| | - Lu Zhang
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yan Lu
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zong-Jian Luo
- The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China.
| | - Xiang-Yang Leng
- Changchun University of Chinese Medicine, Changchun, Jilin, China.
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Manosroi W, Atthakomol P, Wattanawitawas P, Buranapin S. Differences in Glycemic Abnormalities Between Primary Aldosteronism and Essential Hypertension: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:870047. [PMID: 35432215 PMCID: PMC9009178 DOI: 10.3389/fendo.2022.870047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background The relationship of glycemic abnormalities between primary aldosteronism (PA) patients and essential hypertension (EH) patients is still debatable. This meta-analysis aimed to explore differences in the prevalence of glycemic abnormalities and levels of abnormal glucose metabolism in PA and EH patients. Methods A search was performed using PubMed, Scopus, Cochrane and Web of Science databases from their inception through January 2022. Inclusion criteria for this study were 1) observational studies which contained specific data of interest, 2) studies including data which compared adult PA and EH patients and 3) studies which used appropriate methods to diagnose PA. Risk ratio (RR) or standardized mean difference (SMD) with a 95% confidence interval (95% CI) was calculated. Results Twenty-six studies involving 53,186 patients were included in the meta-analysis. Patients with PA demonstrated significantly higher overall incidence of glycemic abnormalities than patients with EH [RR 1.54; 95% CI (1.20,1.98)]. Risk of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in PA patients were higher than in EH patients [RR 1.27; 95%CI (1.08, 1.49) and RR 2.99; 95%CI (1.74, 5.16), respectively]. There was no statistically significant difference of risk between these groups for impaired fasting glucose (IFG) [RR 1.70; 95%CI (0.55, 5.26)]. Moderate heterogeneity was observed in overall glycemic abnormalities outcomes. A high level of heterogeneity was observed for IFG, while the level was low for DM and IGT. Conclusions PA patients have a higher risk of glycemic abnormalities than in EH patients. Further study should be conducted to investigate underlying mechanisms of glycemic abnormalities in PA. Systematic Review Registration www.inplasy.com, INPLASY, identifier 202220004.
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Affiliation(s)
- Worapaka Manosroi
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pichitchai Atthakomol
- Orthopaedics Department, Faculty of Medicine, Chiang Mai University, Muang Chiang Mai, Chiang Mai, Thailand
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pittaporn Wattanawitawas
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Supawan Buranapin
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Timerga A, Haile K. Evaluation of uric acid disorders and associated factors in essential hypertensive patients at Wolkite University specialized hospital, Southern Ethiopia. PLoS One 2021; 16:e0256557. [PMID: 34506522 PMCID: PMC8432881 DOI: 10.1371/journal.pone.0256557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Essential hypertension is a condition characterized by a rise in blood pressure of undetermined cause, includes 90% of all hypertensive cases and is a highly important public health challenge with major modifiable cause of morbidity and mortality. Uric acids disorders in particular hyperuricemia are significant problems in essential hypertensive patients and can cause substantial morbidity and mortality. Determination of uric acid disorders may play a major role in the management and early aversion of complications in hypertensive patient. Therefore, this study aimed to determine uric acid disorders and associated factors among essential hypertensive adults in the outpatient department at Wolkite University specialized Hospital, Southern Ethiopia from November 1 to February 30, 2021. METHODS AND MATERIALS An institional based cross sectional study was conducted on 270 essential hypertensive adults on follow-up in outpatient department from November 1 to February 30, 2021. Structured questionnaires through face to face interviews and participants' medical records were used to collect information on determinants related with uric acid disorders. The blood specimen was collected and level of serum uric acid, blood sugar and lipid profile was measured using standard principles and procedures with an ABX Pentra 400 automated chemistry analyzer. Bivariate and multivariate logistic regression analyses were done to identify factors associated with hyperuricemia. The p-value was set at <0.05 with a 95% confidence interval of the adjusted odds ratio. RESULTS A total of 270 adult essential hypertensive patients were participated in the study, among those 196(27.4%) of study participants were hyperuricemic with 95%CI (21.9, 33.3). Being alcoholic [(AOR: 15.68, 95% CI: (5.93, 21.41)], taking antihypertensive medication [(AOR: 11.56, 95% CI: (3.94, 23.80)], BMI > = 30 [(AOR: 4.89, 95% CI: (1.46, 25.5)] and being centrally obese [(AOR: 6.87, 95% CI: (2.53, 18.63)] were factors significantly associated with hyperuricemia. CONCLUSION In this study, the high burden of hyperuricemia (27.4%) was observed in essential hypertensive patients with follow-up in outpatient department. Taking alcohol and antihypertensive medication, being overweight and centrally obese were identified factors of uric acid disorders. The finding of this study should be taken into consideration to implement preventive interventions on identified predictors in hypertensive patients. Taking fruit and vegetable, and promoting physical exercise and determinations of serum uric acid level in adult essential hypertensive patients was recommended to minimize the emergence of hyperuricemia.
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Affiliation(s)
- Abebe Timerga
- Department of Biomedical Science, College of Medicine and Health Sciences, Wolkite University, Wolkite, Southern Ethiopia
| | - Kassahun Haile
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wolkite University, Wolkite, Southern Ethiopia
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Fernández-Argüeso M, Pascual-Corrales E, Bengoa Rojano N, García Cano A, Jiménez Mendiguchía L, Araujo-Castro M. Higher risk of chronic kidney disease and progressive kidney function impairment in primary aldosteronism than in essential hypertension. Case-control study. Endocrine 2021; 73:439-446. [PMID: 33797699 DOI: 10.1007/s12020-021-02704-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 02/13/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the differences in the prevalence, risk, and grade of control of different cardiometabolic comorbidities in patients with primary aldosteronism (PA) and essential hypertension (EH) matched by age, sex, and blood pressure levels at diagnosis. METHODS Case-control study of a secondary base (PA patients in follow-up in a tertiary hospital between 2018 and 2020). Controls were patients with non-functioning adrenal incidentalomas and EH, matched by age, sex, and baseline diastolic blood pressure (DBP) and systolic blood pressure (SBP). RESULTS Fifty patients with PA and 50 controls were enrolled in the study. At diagnosis, PA patients had a higher prevalence of chronic kidney disease (CKD) than controls (18.4% vs. 2.1%, P = 0.008). No differences were detected in the prevalence of other cardiometabolic comorbidities nor in their degree of control (P > 0.05). All patients received antihypertensive medical treatment and 10 PA patients underwent unilateral laparoscopic adrenalectomy. After a median follow-up of 31.9 [IQR = 1.0-254.8] months, PA patients presented a greater degree of declination of kidney function than controls (average decrease in glomerular filtration rate (MDRD-4) -17.6 ± 3.1 vs. -2.8 ± 1.8 ml/min/1.73 m2, P < 0.001). There were no differences in the grade of SBP (P = 0.840) and DBP control (P = 0.191), nor in the risk of developing other comorbidities or in their degree of control. CONCLUSIONS PA patients have a higher prevalence of CKD at the time of diagnosis when compared to EH matched by age, sex, and blood pressure levels. Furthermore, the risk of kidney function impairment throughout the follow-up is significantly greater in PA patients and is independent of the degree of blood pressure control.
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Affiliation(s)
- María Fernández-Argüeso
- Endocrinology and Nutrition Department, Ramón y Cajal University Hospital & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Eider Pascual-Corrales
- Endocrinology and Nutrition Department, Ramón y Cajal University Hospital & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Nuria Bengoa Rojano
- Endocrinology and Nutrition Department, Ramón y Cajal University Hospital & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Ana García Cano
- Biochemical Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Marta Araujo-Castro
- Endocrinology and Nutrition Department, Ramón y Cajal University Hospital & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
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Davoudi M, Barjasteh-Askari F, Sarmadi M, Ghorbani M, Yaseri M, Bazrafshan E, Mahvi AH, Moohebati M. Relationship of fluoride in drinking water with blood pressure and essential hypertension prevalence: a systematic review and meta-analysis. Int Arch Occup Environ Health 2021; 94:1137-1146. [PMID: 34014395 DOI: 10.1007/s00420-021-01714-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/29/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Previous studies showed controversial results of the relationship between fluoride exposure through drinking water and elevated blood pressure. We conducted a systematic review and meta-analysis to assess the direct relationship of drinking water fluoride exposure with blood pressure and essential hypertension prevalence in general populations. METHODS We conducted a systematic search in databases including Web of Knowledge, PubMed, Scopus, and Embase by MeSH and non-MeSH terms for relevant studies with any design published until August 2019, with no limitation in time and language. The pooled effect measure was calculated within a 95% confidence interval (CI). RESULTS Our search retrieved 630 journal articles, six of which were eligible for data extraction. The random-effects model found significantly higher systolic blood pressure (mean difference = 6.49 mmHg; 95% CI 3.73-9.25; p value < 0.01) and diastolic blood pressure (mean difference = 4.33 mmHg; 95% CI 1.39-7.26; p value < 0.01) in groups exposed to high-fluoride drinking water than in groups exposed to normal/low-fluoride drinking water. A significant relationship was also found between high-fluoride drinking water and essential hypertension (odds ratio = 2.14; 95% CI 1.02-4.49; p value = 0.045). CONCLUSION The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.
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Affiliation(s)
- Mojtaba Davoudi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fateme Barjasteh-Askari
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PourSina St., Enghelab St., Tehran, 1417613151, Iran
| | - Mohammad Sarmadi
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohammad Ghorbani
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Edris Bazrafshan
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Amir Hossein Mahvi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PourSina St., Enghelab St., Tehran, 1417613151, Iran.
- Center for Solid Waste Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Moohebati
- Atherosclerosis Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Nardi E, Mulè G, Giammanco A, Mattina A, Geraci G, Nardi C, Averna M. Left ventricular hypertrophy in chronic kidney disease: A diagnostic criteria comparison. Nutr Metab Cardiovasc Dis 2021; 31:137-144. [PMID: 33092976 DOI: 10.1016/j.numecd.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/16/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS CKD patients have a high prevalence of LVH and this leads to an increase of cardiovascular risk. The aim of this study was to assess the prevalence of left ventricular hypertrophy (LVH) and left ventricular geometry in a group of 293 hypertensive patients with stage 2-5 chronic kidney disease (CKD), compared with 289 essential hypertensive patients with normal renal function. METHODS AND RESULTS All patients underwent echocardiographic examination. Patients on stage 1 CKD, dialysis treatment, or with cardiovascular diseases were excluded. LVH was observed in 62.8% of patients with CKD and in 51.9% of essential hypertensive patients (P < 0.0001). We found increasingly higher left ventricular diameters, thicknesses, and mass from stage 2-5 CKD. Distribution of concentric and eccentric LVH was not very different between the two groups. However, after introducing mixed hypertrophy, the difference between the two groups group was disclosed (P = 0.027). Multiple regression analysis confirmed that the association between renal function and left ventricular mass (β -0.287; P < 0.0001) was independent by potential confounders. Diastolic function was significantly worse in patients with CKD, especially in more advanced stages. CONCLUSION Our study confirms that LVH is highly prevalent in patients with CKD, especially by using the most recent cut off; in this population, LVH is often characterized by the simultaneous increase of wall thicknesses and diameters with negative effects on diastolic function.
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Affiliation(s)
- Emilio Nardi
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy.
| | - Giuseppe Mulè
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
| | - Antonina Giammanco
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
| | - Alessandro Mattina
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy; Diabetes and Islet Transplantation Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Giulio Geraci
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy; University of Palermo - Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, Unit of Nephrology and Hypertension, Palermo, Italy
| | - Chiara Nardi
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
| | - Maurizio Averna
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
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Abstract
To audit the young patients referred to the Hypertension Clinic at Groote Schuur Hospital that predominately serves the underprivileged communities of Cape Town.Folders of patients between the ages of 15 and 30 years over a 2 year period were reviewed. The data collected included demographic, clinical and laboratory data, investigations, causes of hypertension, and presence of hypertensive organ damage.Of the 110 patients reviewed, 61 (55.5%) were females, 22 (20%) Black African, and 88 (80%) of Mixed Ancestry. Eight (7.3%) were found to be normotensive, 16 (14.5%) had a secondary cause and 86 (78.2%) had essential hypertension. Thirty five (31.8%) were current or previous smokers, and 11 (10%) admitted to current or prior use of metamphetamines. A family history of hypertension in a first degree relative was present in 80 (72.7%) patients. Comorbidities present were diabetes in 7 (6.4%) patients, metabolic syndrome in 13 (11.8%), and obesity in 26 (23.6%), but 42.6% had a body mass index (BMI) <25 kg/m. Chronic kidney disease (CKD) was present in 29 (26.4%) patients and ECG left ventricular hypertrophy in 56 (50.9%). Overall organ damage was present in 72 (65.5%) patients.In this cohort of young hypertensives most patients had essential hypertension with a strong family history. Significant organ damage was identified. High risk behavior, including smoking and illicit drug use, and obesity were identified as contributing factors. Secondary causes were identified in 14.2%. These results suggest a targeted approach to the investigation of young hypertensives for secondary causes, and significant opportunities for lifestyle intervention.
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15
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Huang Y, Ollikainen M, Muniandy M, Zhang T, van Dongen J, Hao G, van der Most PJ, Pan Y, Pervjakova N, Sun YV, Hui Q, Lahti J, Fraszczyk E, Lu X, Sun D, Richard MA, Willemsen G, Heikkila K, Leach IM, Mononen N, Kähönen M, Hurme MA, Raitakari OT, Drake AJ, Perola M, Nuotio ML, Huang Y, Khulan B, Räikkönen K, Wolffenbuttel BHR, Zhernakova A, Fu J, Zhu H, Dong Y, van Vliet-Ostaptchouk JV, Franke L, Eriksson JG, Fornage M, Milani L, Lehtimäki T, Vaccarino V, Boomsma DI, van der Harst P, de Geus EJC, Salomaa V, Li S, Chen W, Su S, Wilson J, Snieder H, Kaprio J, Wang X. Identification, Heritability, and Relation With Gene Expression of Novel DNA Methylation Loci for Blood Pressure. Hypertension 2020; 76:195-205. [PMID: 32520614 PMCID: PMC7295009 DOI: 10.1161/hypertensionaha.120.14973] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We conducted an epigenome-wide association study meta-analysis on blood pressure (BP) in 4820 individuals of European and African ancestry aged 14 to 69. Genome-wide DNA methylation data from peripheral leukocytes were obtained using the Infinium Human Methylation 450k BeadChip. The epigenome-wide association study meta-analysis identified 39 BP-related CpG sites with P<1×10-5. In silico replication in the CHARGE consortium of 17 010 individuals validated 16 of these CpG sites. Out of the 16 CpG sites, 13 showed novel association with BP. Conversely, out of the 126 CpG sites identified as being associated (P<1×10-7) with BP in the CHARGE consortium, 21 were replicated in the current study. Methylation levels of all the 34 CpG sites that were cross-validated by the current study and the CHARGE consortium were heritable and 6 showed association with gene expression. Furthermore, 9 CpG sites also showed association with BP with P<0.05 and consistent direction of the effect in the meta-analysis of the Finnish Twin Cohort (199 twin pairs and 4 singletons; 61% monozygous) and the Netherlands Twin Register (266 twin pairs and 62 singletons; 84% monozygous). Bivariate quantitative genetic modeling of the twin data showed that a majority of the phenotypic correlations between methylation levels of these CpG sites and BP could be explained by shared unique environmental rather than genetic factors, with 100% of the correlations of systolic BP with cg19693031 (TXNIP) and cg00716257 (JDP2) determined by environmental effects acting on both systolic BP and methylation levels.
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Affiliation(s)
- Yisong Huang
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Miina Ollikainen
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland
| | - Maheswary Muniandy
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland
| | - Tao Zhang
- Department of Biostatistics, Shandong University School of Public Health, Jinan, China
| | - Jenny van Dongen
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081BT, Amsterdam, The Netherlands
| | - Guang Hao
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Peter J. van der Most
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands
| | - Yue Pan
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Natalia Pervjakova
- Estonian Genome Center, Institute of Genomics, University of Tartu, 23 Riia Street, 51010, Tartu, Estonia
| | - Yan V. Sun
- Department of Epidemiology, Emory Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Qin Hui
- Department of Epidemiology, Emory Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jari Lahti
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Eliza Fraszczyk
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands
| | - Xueling Lu
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands
- Laboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, 515041, Guangdong, China
| | - Dianjianyi Sun
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Melissa A. Richard
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine
| | - Gonneke Willemsen
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081BT, Amsterdam, The Netherlands
| | - Kauko Heikkila
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland
| | - Irene Mateo Leach
- University of Groningen, University Medical Center Groningen, Groningen, Department of Cardiology, the Netherlands
| | - Nina Mononen
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland; Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Finnish Cardiovascular Research Center – Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland; Department of Clinical Physiology, Tampere University Hospital, Tampere 33521
| | - Mikko A. Hurme
- Department of Microbiology and Immunology, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku 20520, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20014, Finland
| | - Amanda J Drake
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, UK
| | - Markus Perola
- National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Marja-Liisa Nuotio
- National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Yunfeng Huang
- Department of Epidemiology, Emory Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Batbayar Khulan
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, UK
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Bruce HR Wolffenbuttel
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, the Netherlands
| | - Alexandra Zhernakova
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Jingyuan Fu
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
- University of Groningen and University Medical Center Groningen, Groningen, Department of Pediatrics, The Netherlands
| | - Haidong Zhu
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jana V. van Vliet-Ostaptchouk
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, the Netherlands
- University of Groningen, University Medical Center Groningen, Genomics Coordination Center, Department of Genetics, Groningen, The Netherlands
| | - Lude Franke
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Johan G Eriksson
- Department of General Practice and Primary health Care, Tukholmankatu 8 B, University of Helsinki, Finland and Helsinki University Hospital, Unit of General Practice, Helsinki, Finland
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, Mc Govern Medical School, University of Texas Health Science Center at Houston
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston
| | - Lili Milani
- Estonian Genome Center, Institute of Genomics, University of Tartu, 23 Riia Street, 51010, Tartu, Estonia
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland; Department of Clinical Chemistry, Fimlab Laboratories, Tampere 33520, Finland
| | - Viola Vaccarino
- Department of Epidemiology, Emory Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dorret I. Boomsma
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081BT, Amsterdam, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Groningen, Department of Cardiology, the Netherlands
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eco J. C. de Geus
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081BT, Amsterdam, The Netherlands
| | - Veikko Salomaa
- National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland
| | - Shengxu Li
- Children’s Minnesota Research Institute, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Wei Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Shaoyong Su
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - James Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216 USA
| | - Harold Snieder
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands
- Corresponding authors, Correspondence to:Harold Snieder, University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands, , Jaakko Kaprio, Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland, , Xiaoling Wang, Georgia Prevention Institute, Medical College of Georgia, Augusta, GA, USA,
| | - Jaakko Kaprio
- Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland
- Corresponding authors, Correspondence to:Harold Snieder, University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands, , Jaakko Kaprio, Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland, , Xiaoling Wang, Georgia Prevention Institute, Medical College of Georgia, Augusta, GA, USA,
| | - Xiaoling Wang
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Corresponding authors, Correspondence to:Harold Snieder, University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands, , Jaakko Kaprio, Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, PO Box 20 (Tukholmankatu 8), Helsinki, Finland, , Xiaoling Wang, Georgia Prevention Institute, Medical College of Georgia, Augusta, GA, USA,
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16
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Farbood Z, Sabeti Aghabozorgi A, Nejatizadeh A, Farshidi H, Shams L, Bahreyni A, Mansouri Babamansouri E, Shekari M. Endothelial Nitric Oxide Synthase Gene Polymorphisms (- 922A > G, - 786 T > C, Intron 4 b/a VNTR and 894 G > T) and Essential Hypertension: An Association Study with Haplotypes Analysis. Biochem Genet 2020; 58:518-532. [PMID: 32519277 DOI: 10.1007/s10528-020-09953-2] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Abstract
Endothelial Nitric Oxide Synthase (eNOS) is an indispensable regulator of blood pressure through producing Nitric Oxide (NO). There is some evidence to suggest that eNOS gene polymorphisms are associated with Essential Hypertension (EHT). In this study, the potential association between eNOS 4a/4b, A922G, G894T, T786C gene polymorphisms and EHT as individual risk factors and as haplotypes are examined in the southern population of Iran (Bandar-Abbas). In this study, 200 EHT patients and 200 normotensive subjects which were matched for age and sex were included. Genotyping was performed by either utilizing Polymerase Chain Reaction (PCR) or PCR followed by Restriction Fragment length Polymorphism (RFLP) method. Our results demonstrated statistically significant associations between T786C, G894T, and 4a/4a and EHT (p < 0.05); however, A922G had no significant association with EHT (p > 0.05). Haplotype analysis also suggested that - 786C/- 922A/4a, - 786C/- 922A/4b and - 786C/- 922G/4a haplotypes were more frequent in EHT group than control group, hypothesizing a positive association with EHT. The present study has identified that the eNOS genetic variations are associated with EHT in southern population of Iran (Bandar-Abbas). These findings also suggested that a number of haplotypes of eNOS gene may be a driving factor for EHT susceptibility in respected population.
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Affiliation(s)
- Zahra Farbood
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hossein Farshidi
- Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Leila Shams
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amirhossein Bahreyni
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Mohammad Shekari
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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Chen C, Yang M, Dou LP, Ling DM, Huang S. Association of the interaction between the rs9619311 and rs402007 polymorphisms and smoking with essential hypertension in Chinese Han population. Medicine (Baltimore) 2020; 99:e20552. [PMID: 32502021 PMCID: PMC7306288 DOI: 10.1097/md.0000000000020552] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To assess the association of the interaction between the rs9619311 and rs402007 polymorphisms and smoking with essential hypertension (EH) in a Chinese Han population. METHOD Peripheral blood samples were extracted from 422 EH patients and 280 normotensive (NT) patients in a Chinese Han population. A whole blood genomic DNA extraction kit was used to extract genomic DNA from the blood samples. Polymerase chain reaction restriction fragment length polymorphism was used to detect the rs402007 polymorphism of a disintegrin and metalloproteinase with thrombospondin type motifs 1 gene and the rs9619311 polymorphism of the tissue inhibitor of metalloproteinase-3 gene. The distributions of the genotypes and alleles between the 2 study groups (EH and NT) were compared. The main risk factors for EH were determined by using logistic regression analysis. The effects of gene-gene and gene-smoking interactions on EH were analyzed using multifactor dimensional reduction. RESULTS The frequencies of the rs402007 GC + CC genotype and the C allele were significantly different between the EH and NT groups (0.68 vs 0.57, χ = 8.99, P = .003, odds ratio [OR] = 1.19; 0.45 vs 0.32, χ = 22.16, P < .001, OR = 1.38). The frequencies of the rs9619311 TC + CC genotype and the C allele were also significantly different between the 2 groups (0.33 vs 0.25, χ = 4.51, P = .04, OR = 1.44; 0.18 vs 0.13, χ = 7.03, P = .01, OR = 1.50). Logistic regression analysis suggests that the rs402007 and rs9619311 polymorphisms are independent risk factors for EH (OR = 2.37, 1.86; P < .001, respectively). The multifactor dimensionality redundant analysis results showed that the interaction among rs402007, rs9619311, and smoking was statistically significant (P = .001). CONCLUSIONS A disintegrin and metalloproteinase with thrombospondin type motifs 1 rs402007 and tissue inhibitor of metalloproteinase-3 rs9619311 polymorphisms are associated with EH in a Chinese Han population, and there was a positive interaction among rs402007, rs9619311, and smoking.
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Affiliation(s)
- Chao Chen
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University
| | - Ming Yang
- Zhe Jiang Chinese Medical University, Hangzhou, China
| | - Li-Ping Dou
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University
| | - Dong-Ming Ling
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University
| | - Shuwei Huang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University
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Gad M, Lord J, Chalkidou K, Asare B, Lutterodt MG, Ruiz F. Supporting the Development of Evidence-Informed Policy Options: An Economic Evaluation of Hypertension Management in Ghana. Value Health 2020; 23:171-179. [PMID: 32113622 PMCID: PMC7065042 DOI: 10.1016/j.jval.2019.09.2749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/12/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Universal healthcare coverage in low- and middle-income countries requires challenging resource allocation decisions. Health technology assessment is one important tool to support such decision making. The International Decision Support Initiative worked with the Ghanaian Ministry of Health to strengthen health technology assessment capacity building, identifying hypertension as a priority topic area for a relevant case study. METHODS Based on guidance from a national technical working group of researchers and policy makers, an economic evaluation and budget impact analysis were undertaken for the main antihypertensive medicines used for uncomplicated, essential hypertension. The analysis aimed to address specific policy questions relevant to the National Health Insurance Scheme. RESULTS The evaluation found that first-line management of essential hypertension with diuretics has an incremental cost per disability-adjusted life-year avoided of GH¢ 276 ($179 in 2017, 4% of gross national income per capita) compared with no treatment. Calcium channel blockers were more effective than diuretics but at a higher incremental cost: GH¢ 11 061 per disability-adjusted life-year avoided ($7189 in 2017; 160% of gross national income per capita). Diuretics provide better health outcomes at a lower cost than angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers. Budget impact analysis highlighted the potential for cost saving through enhanced price negotiation and increased use of better-value drugs. We also illustrate how savings could be reinvested to improve population health. CONCLUSIONS Economic evaluation enabled decision makers to assess hypertension medicines in a Ghanaian context and estimate the impact of using such evidence to change policy. This study contributes to addressing challenges associated with the drive for universal healthcare coverage in the context of constrained budgets.
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Affiliation(s)
- Mohamed Gad
- Global Health Development group, School of Public Health, Imperial College London, International Decision Support Initiative, London, England, UK.
| | - Johanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, England, UK
| | - Kalipso Chalkidou
- Global Health Development group, School of Public Health, Imperial College London, International Decision Support Initiative, London, England, UK
| | - Brian Asare
- Ghana National Drugs Programme, Ministry of Health, Accra, Ghana
| | | | - Francis Ruiz
- Global Health Development group, School of Public Health, Imperial College London, International Decision Support Initiative, London, England, UK
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Zhang SL, Gao JW, Guo Y, Feng QL, Tang JY, Yan L, Wang JF, Cheng H, Liu PM. Associations Between Metabolic Profiles and Target-Organ Damage in Chinese Individuals With Primary Aldosteronism. Front Endocrinol (Lausanne) 2020; 11:547356. [PMID: 33101195 PMCID: PMC7546371 DOI: 10.3389/fendo.2020.547356] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Patients with primary aldosteronism (PA) have an increased risk of target-organ damage (TOD), but whether metabolic syndrome (MetS) is more prevalent and contributes to TOD in PA patients remains unresolved. We aimed to evaluate the associations between MetS profiles and TOD in Chinese PA individuals. Methods: Metabolic parameters and pre-clinical TOD including left ventricular hypertrophy, estimated glomerular filtration, and microalbuminuria; insulin sensitivity or resistance; and islet β-cell function were assessed by the homeostasis models (HOMA-IR, HOMA-β) and the other surrogate indexes [composite insulin sensitivity index (ISI), modified β-cell function index (MBCI)] determined from the oral glucose tolerance test were compared in PA vs. matched essential hypertension (EH) patients. Results: A total of 109 PA patients and 109 essential hypertension (EH) controls individually matched for sex, age, and office systolic blood pressure and duration of hypertension were studied. The prevalence of MetS and its individual components in PA was significantly lower than in EH [MetS: 28 (25.6%) vs. 54 (49.5%), P < 0.001]. PA patients had a higher composite ISI but a lower HOMA-IR, HOMA-β, and MBCI than EH controls (all P < 0.05). Concerning TOD, PA patients had significantly higher prevalence of microalbuminuria and left ventricular hypertrophy (LVH), and lower levels of estimated glomerular filtration (eGFR) than EH controls (all P < 0.05). On multivariate logistic regression analysis, female gender and elevated plasma aldosterone levels were significantly associated with TOD in PA. However, there were no significant associations between MetS and its individual components and TOD in PA patients. Conclusions: PA patients had a lower MetS prevalence but exhibited more severe TOD than matched EH controls. The study highlights the deleterious effects of aldosterone excess on the development of TOD, whereas MetS or its individual components might be less influential in PA.
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Affiliation(s)
- Shao-Ling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qi-Ling Feng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ju-Ying Tang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hua Cheng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Pin-Ming Liu
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Weres A, Baran J, Czenczek-Lewandowska E, Leszczak J, Mazur A. Impact of Birth Weight and Length on Primary Hypertension in Children. Int J Environ Res Public Health 2019; 16:ijerph16234649. [PMID: 31766627 PMCID: PMC6926586 DOI: 10.3390/ijerph16234649] [Citation(s) in RCA: 5] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND A child's birth parameters not only enable assessment of intrauterine growth but are also helpful in identifying children at risk of developmental defects or diseases occurring in adulthood. Studies show that children born with a body weight that is small for their gestational age (SGA) are at a greater risk of hypertension though the inverse relation between excessive birth weight and the risk of primary hypertension in children is discussed less frequently. PURPOSE To assess the impact of both birth weight and length on hypertension occurring in children aged 3-15 years. METHODS A total of 1000 children attending randomly selected primary schools and kindergartens were examined. Ultimately, the analyses took into account n = 747 children aged 4-15; 52.6% boys and 47.4% girls. The children's body height and weight were measured; their blood pressure was examined using the oscillometric method. Information on perinatal measurements was retrieved from the children's personal health records. RESULTS Compared to the children with small for gestational age (SGA) birth weight, the children with appropriate for gestational age birth weight (AGA) (odds ratio (OR) 1.31; 95% confidence interval (CI) 0.64-2.65) present greater risk for primary hypertension. Infants born with excessive body weight >4000 g irrespective of gestational age, compared to infants born with normal body weight, show increased risk of primary hypertension (OR 1.19; 95% CI 0.68-2.06). Higher risk of hypertension is observed in infants born with greater body length (OR 1.03; 95% CI 0.97-1.08). CONCLUSIONS The problem of hypertension may also affect children with birth weight appropriate for gestational age. The prevalence of hypertension in children with AGA birth weight decreases with age. Birth length can be a potential risk factor for hypertension in children and adolescents.
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Affiliation(s)
- Aneta Weres
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (J.B.); (E.C.-L.); (J.L.); (A.M.)
- Correspondence:
| | - Joanna Baran
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (J.B.); (E.C.-L.); (J.L.); (A.M.)
| | | | - Justyna Leszczak
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (J.B.); (E.C.-L.); (J.L.); (A.M.)
| | - Artur Mazur
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (J.B.); (E.C.-L.); (J.L.); (A.M.)
- Clinical Regional Hospital No.2 in Rzeszów, Lwowska Street 60, 35-301 Rzeszów, Poland
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Amrani-Midoun A, Kiando SR, Treard C, Jeunemaitre X, Bouatia-Naji N. Genetic association study between T-786C NOS3 polymorphism and essential hypertension in an Algerian population of the Oran city. Diabetes Metab Syndr 2019; 13:1317-1320. [PMID: 31336484 DOI: 10.1016/j.dsx.2019.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Essential hypertension is an important risk factor for the development of cardiovascular disease. Important candidate genes such as NOS3 gene have been widely studied and reported to be associated with essential hypertension (HTN) in human populations. AIM We aim in this study to analyze the relationship between NOS3 -786T/C, a common genetic variant and HTN in a sample of the Algerian population of the Oran city. METHODS A case-control study has been performed in 154 subjects including 77 hypertensives and 77 normotensives. The recruitment of these subjects was done in local Health Centers of the city of Oran, West Algeria. HTN was defined as elevated systolic blood pressure SBD≥140 mmHg and or sustained diastolic blood pressure DBP≥90 mmHg, measured using an Omron® Automatic BP Monitor - M-3W machine. Consents were obtained from all participants. Polymerase chain reaction (PCR) combined with restrictive fragment length polymorphism (RFLP) was used to genotype the NOS -786T/C variant. RESULTS The distribution of the allelic frequencies did not differ between cases and controls (OR = 1.48; 95%CI [0.94-2.32], P = 0.09). However, after adjustment with the age, sex, and body mass index, we observed significant association between NOS -786C allele and HTN status (OR = 2.08; 95%CI [1.18-3.66], P = 0.01). CONCLUSION Our results indicate that the C allele of the NOS3 gene is associated with increased risk of essential hypertension in this sample of the Algerian population of the Oran city. Further validation in larger samples is needed to confirm this finding.
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Affiliation(s)
- Asma Amrani-Midoun
- Biotechnology Department, Faculty of Sciences of Nature and Life, University of Oran 1 Ahmed Benbella, Oran, Algeria.
| | - Soto Romuald Kiando
- INSERM, UMR970 Paris Cardiovascular Research Center (PARCC), Paris, F-75015, France; Paris-Descartes University, Sorbonne Paris Cité, Paris, 75006, France
| | - Cyrielle Treard
- INSERM, UMR970 Paris Cardiovascular Research Center (PARCC), Paris, F-75015, France; Paris-Descartes University, Sorbonne Paris Cité, Paris, 75006, France
| | - Xavier Jeunemaitre
- INSERM, UMR970 Paris Cardiovascular Research Center (PARCC), Paris, F-75015, France; Paris-Descartes University, Sorbonne Paris Cité, Paris, 75006, France; AP-HP, Department of Genetics, Hôpital Européen Georges Pompidou, Paris, F-75015, France
| | - Nabila Bouatia-Naji
- INSERM, UMR970 Paris Cardiovascular Research Center (PARCC), Paris, F-75015, France; Paris-Descartes University, Sorbonne Paris Cité, Paris, 75006, France
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Guedes AF, Moreira C, Nogueira JB, Santos NC, Carvalho FA. Fibrinogen-erythrocyte binding and hemorheology measurements in the assessment of essential arterial hypertension patients. Nanoscale 2019; 11:2757-2766. [PMID: 30672545 DOI: 10.1039/c8nr04398a] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Some studies have reported a positive association between plasma fibrinogen levels, erythrocyte aggregation and essential arterial hypertension (EAH). The aim of this study was to understand how the interaction between fibrinogen and its erythrocyte membrane receptor is altered in EAH. EAH patients (n = 31) and healthy blood donors (n = 65) were enrolled in the study. EAH patients were therapeutically controlled for the disease, presenting a systolic blood pressure between 108 and 180 mmHg and a diastolic blood pressure between 66 and 123 mmHg. Clinical evaluation included blood pressure monitoring, electrocardiography, echocardiography and blood cell count. The hemorheological parameters were also analyzed. Fibrinogen-erythrocyte binding force and frequency were evaluated quantitatively, at the single-molecule level, using atomic force microscopy (AFM). Changes in erythrocyte elasticity were also evaluated. Force spectroscopy data showed that the average fibrinogen-erythrocyte binding forces increase from 40.4 ± 3.0 pN in healthy donors to 73.8 ± 8.1 pN in patients with EAH, despite a lower binding frequency for patients compared to the control group (7.9 ± 1.6% vs. 27.6 ± 4.2%, respectively). Elasticity studies revealed an increase of erythrocyte stiffness in the patients. The stronger fibrinogen binding to erythrocytes from EAH patients and alteration in cell elasticity may lead to changes in the whole blood flow. The patients' altered hemorheological parameters may also contribute to these blood flow perturbations. The transient bridging of two erythrocytes, by the simultaneous binding of fibrinogen to both of them, promoting erythrocyte aggregation, could represent an important cardiovascular risk factor.
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Affiliation(s)
- Ana Filipa Guedes
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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Andriolo V, Dietrich S, Knüppel S, Bernigau W, Boeing H. Traditional risk factors for essential hypertension: analysis of their specific combinations in the EPIC-Potsdam cohort. Sci Rep 2019; 9:1501. [PMID: 30728434 PMCID: PMC6365562 DOI: 10.1038/s41598-019-38783-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022] Open
Abstract
Appropriate interventions might improve the prevention of essential hypertension. This requires a comprehensive view of modifiable lifestyle factors (MLFs) distribution and effect. To determine how six MLFs (general adiposity, abdominal adiposity, alcohol consumption, smoking, diet, physical inactivity) for risk of hypertension are distributed and how their combinations affect the risk, a prospective study cohort of 11,923 healthy participants from the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study was used. Of these, 1,635 developed hypertension during a mean follow-up of 10.3 years. Mutually exclusive combinations, clustering and interactions of MLFs were then investigated stratifying by sex, Hazard Ratios (HRs) and Population Attributable Risks (PARs%) were calculated. General adiposity alone was sufficient to increase the risk of hypertension (HR = 1.86, PAR% 3.36), and in this cohort it played a major role in enhancing the risk of hypertension, together with smoking and physical inactivity. MLFs had a different impact and a different modulation of risk in women and men, and they showed a remarkable tendency to occur in specific patterns with higher prevalence than expected. This indication can help to promote a holistic approach through multifactorial preventive strategies addressing more than a factor at a time. For prevention of hypertension addressing adiposity together with smoking, promoting at the same time physical activity should be the first choice.
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Affiliation(s)
- Violetta Andriolo
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany.
| | - Stefan Dietrich
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
| | - Sven Knüppel
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
| | - Wolfgang Bernigau
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
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Sharma RK, Verma M, Tiwari RM, Joshi A, Trivedi CA, Chodankar DR. Prevalence and real-world assessment of central aortic blood pressure in adult patients with essential hypertension uncontrolled on single anti-hypertensive agents. Indian Heart J 2018; 70 Suppl 3:S213-S220. [PMID: 30595261 PMCID: PMC6310176 DOI: 10.1016/j.ihj.2018.11.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/29/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the prevalence of high central aortic pressure (CAP) in Indian patients with uncontrolled essential hypertension while on anti-hypertensive monotherapy. Also, to determine correlation between brachial blood pressure (BBP) and CAP, and ascertain if it is impacted by anti-hypertensive drug class and patients' age. METHODS In this real-world, observational, prospective study, patients (30-70 years) with uncontrolled BBP (systolic BP [SBP] ≥140 mmHg or diastolic BP [DBP] ≥90 mmHg) were enrolled. Treatment was adjusted at Visit 1 (baseline), based on BBP and at treating physicians' discretion. Primary endpoint was proportion of patients with uncontrolled central aortic SBP (>125 mmHg) at baseline. Secondary endpoints were comparison of BBP and CAP across drugs classes and age groups at baseline and Visit 2 (End-of-study, ∼8 weeks post-baseline), and proportion of patients with uncontrolled central SBP at end-of-study. RESULTS Of 2030 patients screened, 1949 patients reported at baseline and 1740 patients completed end-of-study visit. Central SBP was >125 mmHg for 84.3% patients at baseline, and 48% patients at end-of-study. Interestingly, at end-of-study, 6.6% patients still had uncontrolled brachial SBP and controlled central SBP, while 13.6% patients had uncontrolled central SBP and controlled brachial SBP. At both visits, brachial SBP and central SBP showed positive correlation across most drug classes and age groups. At baseline, ACE inhibitors showed better efficacy than other drug classes. At end-of-study, BP control was better with fixed-dose combinations, though free-drug combinations were more frequently prescribed. CONCLUSION Measurement of CAP along with BBP can be vital in management of hypertension. CTRI REGISTRATION NUMBER CTRI/2015/10/006302.
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Affiliation(s)
- Ranjan Kumar Sharma
- Department of Cardiology, Nil Ratan Sircar Medical College and Hospital, 138, Acharya Jagadish Chandra Bose Road, Kolkata, West Bengal 700014, India.
| | - Manish Verma
- Sanofi House, No 117-B, L & T Business Park, Saki Vihar Road, Powai, Mumbai, Maharashtra 400072, India
| | - Ravi M Tiwari
- Sanofi House, No 117-B, L & T Business Park, Saki Vihar Road, Powai, Mumbai, Maharashtra 400072, India
| | - Abhay Joshi
- Sanofi House, No 117-B, L & T Business Park, Saki Vihar Road, Powai, Mumbai, Maharashtra 400072, India
| | - Chirag A Trivedi
- Sanofi House, No 117-B, L & T Business Park, Saki Vihar Road, Powai, Mumbai, Maharashtra 400072, India
| | - Deepa R Chodankar
- Sanofi House, No 117-B, L & T Business Park, Saki Vihar Road, Powai, Mumbai, Maharashtra 400072, India
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Markabayeva A, Bauer S, Pivina L, Bjørklund G, Chirumbolo S, Kerimkulova A, Semenova Y, Belikhina T. Increased prevalence of essential hypertension in areas previously exposed to fallout due to nuclear weapons testing at the Semipalatinsk Test Site, Kazakhstan. Environ Res 2018; 167:129-135. [PMID: 30014894 DOI: 10.1016/j.envres.2018.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 05/27/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
This study examines the association between environmental radiation exposure and essential hypertension in a series of investigated geographical districts adjacent to the Semipalatinsk nuclear test site in Kazakhstan. The sample consists of 2000 volunteers participants in screening examinations in three administrative districts close to the nuclear test site, which was carried out as part of the Government Programs on Environmental Health Hazard. The cross-sectional study compares prevalence ratios in a population sample with long-term exposure in the low and intermediate dose range. Age-adjusted odds ratios for hypertension were found significantly increased with higher exposure groups. After accounting for main cardiovascular risk factors into the model and stratifying by gender, the prevalence odds ratios for radiation remained significantly increased, with a significant dose-response effect observed for some but not all subgroups. The results support existing evidence of cardiovascular health effects of radiation exposure and of persisting environmental health issues that require attention in both epidemiological surveys and healthcare provision.
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Affiliation(s)
| | | | | | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610 Mo i Rana, Norway.
| | - Salvatore Chirumbolo
- Department of Neuroscience, Biomedicine and Movement Sciences-University of Verona, Verona, Italy
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Collier DJ, Juhasz A, Agabiti‐Rosei E, Lloyd E, Hisada M, Zhao L, Kupfer S, Caulfield MJ. Efficacy and safety of azilsartan medoxomil/chlortalidone fixed-dose combination in hypertensive patients uncontrolled on azilsartan medoxomil alone: A randomized trial. J Clin Hypertens (Greenwich) 2018; 20:1473-1484. [PMID: 30302936 PMCID: PMC8030929 DOI: 10.1111/jch.13376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/17/2018] [Accepted: 08/03/2018] [Indexed: 12/14/2022]
Abstract
Patients with grade 2-3 essential hypertension and postplacebo mean clinic systolic blood pressure (SBP) 160-190 mm Hg and 24-hour SBP 140-175 mm Hg by ambulatory blood pressure monitoring (ABPM) received 40 mg azilsartan medoxomil (AZL-M) monotherapy for 4 weeks. "Nonresponders" were then randomized to 8 weeks of double-blind treatment with AZL-M 40 mg, AZL-M/chlortalidone (CLD) 40/25, or AZL-M/CLD 40/12.5 mg. After 8 weeks, mean clinic SBP change was -21.1 (±1.04) mm Hg for AZL-M/CLD 40/25 mg, -15.8 (±1.08) mm Hg for AZL-M/CLD 40/12.5 mg, and -6.4 (±1.05) mm Hg for AZL-M 40 mg (P < 0.001 for both AZL-M/CLD vs AZL-M, ANCOVA). Drug discontinuation rates were 8.9% (AZL-M/CLD 40/25 mg), 7.5% (AZL-M 40 mg), and 3.9% (AZL-M/CLD 40/12.5 mg). Creatinine increased in 8.1% (AZL-M/CLD 40/25), 3.1% (AZL-M/CLD 40/12.5 mg), and 3.0% (AZL-M 40 mg) of patients. AZL-M/CLD was effective and well tolerated in patients not achieving blood pressure targets with AZL-M.
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Affiliation(s)
- David J. Collier
- William Harvey Research Institute & the NIHR Biomedical Research Centre at BartsQueen Mary University of LondonLondonUK
| | | | | | - Eric Lloyd
- Takeda Development Center Americas, IncDeerfieldIllinois
| | - Michie Hisada
- Takeda Development Center Americas, IncDeerfieldIllinois
| | - Lin Zhao
- Takeda Development Center Americas, IncDeerfieldIllinois
| | - Stuart Kupfer
- Takeda Pharmaceuticals InternationalDeerfieldIllinois
| | - Mark J. Caulfield
- William Harvey Research Institute & the NIHR Biomedical Research Centre at BartsQueen Mary University of LondonLondonUK
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Dantas RCDO, da Silva JPT, Dantas DCDO, Roncalli ÂG. Factors associated with hospital admissions due to hypertension. Einstein (Sao Paulo) 2018; 16:eAO4283. [PMID: 30281763 PMCID: PMC6178859 DOI: 10.1590/s1679-45082018ao4283] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/11/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the temporality of hospital admissions due to arterial hypertension and its associated factors. METHODS An ecological study with secondary data on hospital admissions due to essential arterial hypertension - ICD 10, from the Hospital Information System, the Mortality Information System and and the Primary Care Information System, between 2010 and 2015. Descriptive analysis using means, proportions and linear regression. RESULTS We recorded 493,299 hospitalizations due to arterial hypertension from 2010 to 2015, with an average annual progressive cost decrease of -7.76% and -24.21%. Of the patients admitted, 59.2% were women, 60.2% were non-white and 54.7% were older than 60 years. The mean length of stay was 4.2 days, and the hospitalization cost was R$307.60. The multiple linear regression variables that remained significant were the percentage of admissions due to primary care-sensitive conditions, the per capita income and the City Human Development Index. CONCLUSION Hospital admissions due to arterial hypertension have an impact on the percentage of admissions due to primary care- sensitive conditions. Intensifying primary care activities, raising-awareness among professionals to the importance of integrated care, and investing in social development are crucial to change the reality of hypertension in terms of its control and complications.
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Grassi G, Mancia G. Monographic issue of pharmacological research on hypertension. Pharmacol Res 2018; 134:221-222. [PMID: 29964162 DOI: 10.1016/j.phrs.2018.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Guido Grassi
- Clinica Medica, University of Milano-Bicocca, 20126 Milan, Italy; Istituto a Carattere Scientifico IRCCS Multimedica, 20099 Sesto San Giovanni, Milan, Italy.
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Raina S, Agarwal VK, Kapoor D, Sharma KN, Yadav RS. Hypertension as Determinant of Hyperuricemia: A Case Control Study from the Sub-Himalayan Region in North India. J Assoc Physicians India 2018; 66:14-18. [PMID: 30341839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Association between hyperuricemia and hypertension has been recognized for many years. Whether hyperuricemia is the cause or the effect is debatable. MATERIALS AND METHODS This case control study was conducted to assess serum uric acid (SUA) levels in fifty newly diagnosed essential hypertensive patients and fifty normotensive controls which were matched for age and sex. Detailed anthropometric characteristics including height, weight, body mass index and waist hip ratio were measured. Hypertension was classified according to Joint National Committee (JNC) 7 criteria. Hyperuricemia was defined as SUA level of 6.8mg/dl or more in both men and women. SUA was measured by uricase method. Before collecting the blood samples, patients were advised to proceed on overnight fast of minimum eight hrs. Student's t‑test for mean of continuous variables and Chi‑square test for proportions were used for statistical significance. RESULTS Present study included 50 newly diagnosed cases of essential hypertension and 50 age and sex matched normotensive healthy volunteer. Prevalence of hyperuricemia was 24% among the cases and 6% among the controls (P < 0 .05). Odds ratio was 4.9 (Cl=1.3 to 18.8). The mean SUA was significantly higher in the cases (5.5±1.7 mg/dl) than in the controls (4.9±1.1 mg/dl; P< 0.05). Odds ratio in male hyperuricemic hypertensive versus hyperuricemic normotensive was 6(CI=1.0 to 33.2) and 4.46(CI=0.4 to 42.5) among female hyperuricemic hypertensive versus hyperuricemic normotensives. CONCLUSION Strong positive association was observed between hypertension and hyperuricemia in both male and female patients in this study.
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Affiliation(s)
| | | | | | | | - R S Yadav
- Professor, Dr. Rajendra Prasad Govt. Medical College, Tanda, Kangra, Himachal Pradesh
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Affiliation(s)
- Le Yue
- 1 Department of Cardiovascular Medicine, Daqing Oilfield General Hospital , Daqing, China
| | - Zhiqing Fan
- 1 Department of Cardiovascular Medicine, Daqing Oilfield General Hospital , Daqing, China
| | - Lin Sun
- 2 Department of Cardiovascular Medicine, The First Clinical Hospital Affiliated to Harbin Medical University , Harbin, China
| | - Wei Feng
- 2 Department of Cardiovascular Medicine, The First Clinical Hospital Affiliated to Harbin Medical University , Harbin, China
| | - Jingjie Li
- 2 Department of Cardiovascular Medicine, The First Clinical Hospital Affiliated to Harbin Medical University , Harbin, China
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