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Ranganathan S, Abramov D, Chew NWS, Mallen C, Marshall M, Kobo O, Mamas MA. Trends in Cardiovascular Mortality Among Patients With Alzheimer's Disease in the United States from 1999 to 2020. Am J Cardiol 2024; 211:326-333. [PMID: 37993040 DOI: 10.1016/j.amjcard.2023.11.044] [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] [Received: 10/09/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
This study aimed to compare the trends in cardiovascular diseases (CVDs)-related mortality in patients with Alzheimer's disease (AD) and in the general population aged ≥65 years. Data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death dataset were used to determine national trends in age-adjusted CVD mortality rates (AAMR) and average annual percent change (AAPC) values in patients with AD and the overall population aged ≥65 years from 1999 to 2020. Data for AAMR and AAPCs were also stratified by age, gender, ethnicity/race, geographical region, urbanization status, and subgroups of CVD. Trends in the overall AAMR stratified by gender, age, ethnicity/race, geographical region, urbanization status, and CVD subgroups were statistically different between patients with AD and the overall population (overall AAPC for CVD mortality rate in patients with AD = -3.5% [confidence interval -4.1% to -2.9%] vs -2.6% [confidence interval -2.3% to -2.9%] in overall population, p = 0.01). Differences in the decrease in the mortality rates between patients with AD and the overall population were found to be statistically different across all stratifications except for the change in the mortality rates for hypertensive diseases (p = 0.05), females (p = 0.2), and Asian or Pacific Islanders (p = 0.09). In conclusion, CVD-related mortality in patients with AD decreased over the last 2 decades, and decreases were more prominent than seen in the general population aged ≥65 years. These results may help focus public health efforts to optimize CVD health in patients with AD.
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Affiliation(s)
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Christian Mallen
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Michelle Marshall
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Kobo
- School of Medicine, Keele University, Staffordshire, United Kingdom; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom.
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Kelly BC, Vuolo M. Trends in Psychotropic Drug-Implicated Cardiovascular Mortality: Patterns in U.S. Mortality, 1999-2020. Am J Prev Med 2023; 65:377-384. [PMID: 36894483 PMCID: PMC10440260 DOI: 10.1016/j.amepre.2023.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 10/24/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Psychotropic drug-implicated (PDI) mortality-deaths in which psychotropic drugs were a contributing but not underlying cause of death-increased over two decades, with circulatory mortality as the primary cause leading to such deaths. Trends in PDI circulatory mortality over a 22-year period and its patterning in U.S. deaths are described. METHODS Deaths extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research Multiple Causes of Death database from 1999 to 2020 were analyzed to generate annual counts and rates for drug-implicated deaths due to diseases of the circulatory system, including by specific drug, sex, race/ethnicity, age, and state. RESULTS During a period when overall age-adjusted circulatory mortality rates declined, PDI circulatory mortality more than doubled, from 0.22 per 100,000 in 1999 to 0.57 per 100,000 by 2020, now representing 1 in 444 circulatory deaths. Although PDI deaths from ischemic heart diseases are proportionally aligned with overall circulatory deaths (50.0% vs 48.5%), PDI deaths from hypertensive diseases represent a larger proportion (19.8% vs 8.0%). Psychostimulants generated the greatest escalation for PDI circulatory deaths (0.029-0.332 per 100,000). The sex gap in PDI mortality rates widened (0.291 females, 0.861 males). PDI circulatory mortality is particularly notable for Black Americans and midlife Americans, with considerable geographic variability. CONCLUSIONS Circulatory mortality with psychotropic drugs as a contributing cause escalated over 2 decades. Trends in PDI mortality are not evenly distributed across the population. Greater engagement with patients about their substance use is needed to intervene in cardiovascular deaths. Prevention and clinical intervention could contribute to reinvigorating previous trends of declining cardiovascular mortality.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, College of Liberal Arts, Purdue University, West Lafayette, Indiana
| | - Mike Vuolo
- Department of Sociology, College of Arts and Sciences, The Ohio State University, Columbus, Ohio.
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Abstract
IMPORTANCE Hypertension, defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg, affects approximately 116 million adults in the US and more than 1 billion adults worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and death. OBSERVATIONS First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption. The BP-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy. The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk. First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic such as hydrochlorothiazide or chlorthalidone, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker such as enalapril or candesartan, and a calcium channel blocker such as amlodipine and should be titrated according to office and home SBP/DBP levels to achieve in most people an SBP/DBP target (<130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years). Randomized clinical trials have established the efficacy of BP lowering to reduce the risk of CVD morbidity and mortality. An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30%. Despite the benefits of BP control, only 44% of US adults with hypertension have their SBP/DBP controlled to less than 140/90 mm Hg. CONCLUSIONS AND RELEVANCE Hypertension affects approximately 116 million adults in the US and more than 1 billion adults worldwide and is a leading cause of CVD morbidity and mortality. First-line therapy for hypertension is lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption. When drug therapy is required, first-line therapies are thiazide or thiazidelike diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers.
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Affiliation(s)
- Robert M Carey
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
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Lu Q, Zhang Y, Geng T, Yang K, Guo K, Min X, He M, Guo H, Zhang X, Yang H, Wu T, Pan A, Liu G. Association of Lifestyle Factors and Antihypertensive Medication Use With Risk of All-Cause and Cause-Specific Mortality Among Adults With Hypertension in China. JAMA Netw Open 2022; 5:e2146118. [PMID: 35103793 PMCID: PMC8808332 DOI: 10.1001/jamanetworkopen.2021.46118] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE The joint association of antihypertensive medication use and healthy lifestyle with mortality among individuals with hypertension is unclear. OBJECTIVE To examine the association of lifestyle factors combined with antihypertensive medication use, as well as changes in lifestyle, with all-cause and cause-specific mortality among individuals with hypertension. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Dongfeng-Tongji cohort, a long-term, prospective cohort including employees at a manufacturer in China, with baseline from 2008 to 2010. Participants with hypertension were followed up for a median (IQR) of 7.3 (5.7-10.3) years, ending in 2018. Data were analyzed from February to April 2021. EXPOSURES Lifestyle factors, including body mass index, smoking status, diet, physical activity, and sleep duration, were coded on a 3-point scale (range, 0-2, with higher score indicating a healthier lifestyle). Lifestyle was evaluated according to the total score of all 5 factors, and categorized into 3 groups: unfavorable (scores 0-4), intermediate (scores 5-7), and favorable (scores 8-10). Antihypertensive medication use was defined as use within the last 2 weeks. MAIN OUTCOMES AND MEASURES All-cause, cardiovascular, and cancer mortality were identified by linking the cohort database with the health care system through December 31, 2018. RESULTS A total of 14 392 participants (mean [SD] age, 65.6 [7.4] years; 7277 [50.6%] men and 7115 [49.4%] women) with hypertension were included, and 2015 deaths were documented, including 761 cardiovascular deaths and 525 cancer deaths. Compared with individuals not using antihypertensive medication and with a lifestyle score of 0 to 4, the combination of using antihypertensive medication and having a lifestyle score of 8 to 10 was associated with the lowest risk of all-cause mortality (hazard ratio [HR], 0.32; 95% CI, 0.25-0.42), cardiovascular mortality (HR, 0.33; 95% CI, 0.21-0.53), and cancer mortality (HR, 0.30; 95% CI, 0.19-0.47). In addition, improvement in lifestyle score after hypertension diagnosis was associated with lower risk of all-cause mortality (HR, 0.52; 95% CI, 0.36-0.76) and cardiovascular mortality (HR, 0.53; 95% CI, 0.30-0.94). CONCLUSIONS AND RELEVANCE These findings suggest that adherence to healthy lifestyle and antihypertensive medication treatment were associated with lower risk of mortality among adults with hypertension. These findings further support that, in addition to antihypertensive medication use, adopting a healthy lifestyle is associated with benefits in the prevention of premature death among individuals with hypertension.
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Affiliation(s)
- Qi Lu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanbo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Geng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Yang
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Kunquan Guo
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Xinwen Min
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Meian He
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Guo
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Handong Yang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wang Y, Wan EYF, Mak IL, Ho MK, Chin WY, Yu EYT, Lam CLK. The association between trajectories of risk factors and risk of cardiovascular disease or mortality among patients with diabetes or hypertension: A systematic review. PLoS One 2022; 17:e0262885. [PMID: 35085329 PMCID: PMC8794125 DOI: 10.1371/journal.pone.0262885] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiometabolic risk factors and renal function are monitored regularly for patients with diabetes mellitus (DM)/ hypertension (HT). In addition to risk factor levels at a single time point, their trajectory (changes over time) can also be differentially related to the risk of cardiovascular diseases (CVD) and mortality. This study aimed to systematically examine the evidence regarding the association between risk factor trajectories and risk of CVD/mortality in patients with DM/HT. Method PubMed, MEDLINE, and Embase were searched for articles from January 1963 to April 2021. Inclusion criteria: studies that 1) analyzed trajectories of risk factors including haemoglobin A1c (HbA1c), blood pressure, estimated glomerular filtration rate (eGFR), body mass index (BMI), and blood lipids; 2) were performed in the DM/HT population and, 3) included risk of CVD/mortality as outcomes. Study quality was assessed using the Newcastle-Ottawa quality assessment scale. Results A total of 22,099 articles were identified. After screening by title and abstract, 22,027 articles were excluded by irrelevant outcomes, exposure, population, or type of articles. Following full-text screening, 11 articles investigating the trajectories of HbA1c (N = 7), systolic blood pressure (SBP) (N = 3), and eGFR (N = 1) were included for data extraction and analysis. No studies were identified examining the association of BMI or lipid trajectories with CVD/mortality. All included studies were of good quality based on the NOS criteria. In general, stable trajectories within optimal ranges of the risk factors (HbA1c: <7%, SBP: 120-139mmHg, eGFR: >60mL/min/1.73m2) had the lowest CVD/mortality risk compared to an increasing HbA1c trajectory (from 8% to 10%), an increasing SBP trajectory (from 120–139 to ≥140mmHg), or a decreasing eGFR trajectory (from 90 to 70mL/min/1.73m2). Conclusion A relatively stable and well-controlled trajectory for cardiometabolic risk factors was associated with the lowest risk of CVD/mortality. Risk factor trajectories have important clinical implications in addition to single time point measurements. More attention should be given to patients with suboptimal control and those with unstable trends of cardiometabolic risk factors.
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Affiliation(s)
- Yuan Wang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- * E-mail:
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Margaret Kay Ho
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Abstract
The COVID-19 pandemic has been widely spread and affected millions of people and caused hundreds of deaths worldwide, especially in patients with comorbilities and COVID-19. This manuscript aims to present models to predict, firstly, the number of coronavirus cases and secondly, the hospital care demand and mortality based on COVID-19 patients who have been diagnosed with other diseases. For the first part, I present a projection of the spread of coronavirus in Mexico, which is based on a contact tracing model using Bayesian inference. I investigate the health profile of individuals diagnosed with coronavirus to predict their type of patient care (inpatient or outpatient) and survival. Specifically, I analyze the comorbidity associated with coronavirus using Machine Learning. I have implemented two classifiers: I use the first classifier to predict the type of care procedure that a person diagnosed with coronavirus presenting chronic diseases will obtain (i.e. outpatient or hospitalised), in this way I estimate the hospital care demand; I use the second classifier to predict the survival or mortality of the patient (i.e. survived or deceased). I present two techniques to deal with these kinds of unbalanced datasets related to outpatient/hospitalised and survived/deceased cases (which occur in general for these types of coronavirus datasets) to obtain a better performance for the classification.
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Affiliation(s)
- Kernel Prieto
- Instituto de Matemáticas, Universidad Nacional Autónoma de México, Mexico City, México
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Bazalar-Palacios J, Jaime Miranda J, Carrillo-Larco RM, Gilman RH, Smeeth L, Bernabe-Ortiz A. Aggregation and combination of cardiovascular risk factors and their association with 10-year all-cause mortality: the PERU MIGRANT Study. BMC Cardiovasc Disord 2021; 21:582. [PMID: 34876013 PMCID: PMC8650245 DOI: 10.1186/s12872-021-02405-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/22/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To estimate the association between the aggregation and pair-wise combination of selected cardiovascular risk factors (CVRF) and 10-year all-cause mortality. METHODS Secondary data analysis of the PERU MIGRANT study, a prospective population-based cohort. Ten-year all-cause mortality was determined for participants originally enrolled in the PERU MIGRANT Study (baseline in 2007) through the National Registry of Identification and Civil Status. The CVRF included hypertension, type 2 diabetes mellitus, hypercholesterolemia, and overweight/obesity. Exposures were composed of both the aggregation of the selected CVRF (one, two, and three or more CVRF) and pair-wise combinations of CVRF. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI). FINDINGS Of the 989 participants evaluated at baseline, 976 (98.8%) had information about vital status at 10 years of follow-up (9992.63 person-years), and 63 deaths were recorded. In the multivariable model, adjusting for sociodemographic and lifestyle variables, participants with two CVRF (HR: 2.48, 95% CI: 1.03-5.99), and those with three or more CVRF (HR: 3.93, 95% CI: 1.21-12.74) had higher all-cause mortality risk, compared to those without any CVRF. The pair-wise combinations associated with the highest risk of all-cause mortality, compared to those without such comorbidities, were hypertension with type 2 diabetes (HR: 11.67, 95% CI: 3.67-37.10), and hypertension with overweight/obesity (HR: 2.76, 95% CI: 1.18-6.71). CONCLUSIONS The aggregation of two or more CVRF and the combination of hypertension with type 2 diabetes or overweight/obesity were associated with an increased risk of 10-year all-cause mortality. These risk profiles will inform primary and secondary prevention strategies to delay mortality from cardiovascular risk factors.
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Affiliation(s)
- Janina Bazalar-Palacios
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 18, Peru.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Stenberg E, Marsk R, Sundbom M, Ottosson J, Jernberg T, Näslund I, Näslund E. Remission, relapse, and risk of major cardiovascular events after metabolic surgery in persons with hypertension: A Swedish nationwide registry-based cohort study. PLoS Med 2021; 18:e1003817. [PMID: 34723954 PMCID: PMC8559928 DOI: 10.1371/journal.pmed.1003817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Several studies have shown that metabolic surgery is associated with remission of diabetes and hypertension. In terms of diabetes, factors such as duration, insulin use, weight loss, and age have been shown to contribute to the likelihood of remission. Such factors have not been determined for hypertension. The aim of this study was to evaluate factors associated with the remission and relapse of hypertension after metabolic surgery, as well as the risk for major adverse cardiovascular event (MACE) and mortality in patients with and without remission. METHODS AND FINDINGS All adults who underwent metabolic surgery between January 2007 and June 2016 were identified in the nationwide Scandinavian Obesity Surgery Registry (SOReg). Through cross-linkage with the Swedish Prescribed Drug Register, Patient Register, and Statistics Sweden, individual data on prescriptions, inpatient and outpatient diagnoses, and mortality were retrieved. Of the 15,984 patients with pharmacologically treated hypertension, 6,286 (39.3%) were in remission at 2 years. High weight loss and male sex were associated with higher chance of remission, while duration, number of antihypertensive drugs, age, body mass index (BMI), cardiovascular disease, and dyslipidemia were associated with lower chance. After adjustment for age, sex, BMI, comorbidities, and education, the cumulative probabilities of MACEs (2.8% versus 5.7%, adjusted odds ratio (OR) 0.60, 95% confidence interval (CI) 0.47 to 0.77, p < 0.001) and all-cause mortality (4.0% versus 8.0%, adjusted OR 0.71, 95% CI 0.57 to 0.88, p = 0.002) were lower for patients being in remission at 2 years compared with patients not in remission, despite relapse of hypertension in 2,089 patients (cumulative probability 56.3%) during 10-year follow-up. The main limitations of the study were missing information on nonpharmacological treatment for hypertension and the observational study design. CONCLUSIONS In this study, we observed an association between high postoperative weight loss and male sex with better chance of remission, while we observed a lower chance of remission depending on disease severity and presence of other metabolic comorbidities. Patients who achieved remission had a halved risk of MACE and death compared with those who did not. The results suggest that in patients with severe obesity and hypertension, metabolic surgery should not be delayed.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- * E-mail:
| | - Richard Marsk
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Abstract
ABSTRACT The novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved into a global pandemic. The substantial morbidity and mortality associated with the infection has prompted us to understand potential risk factors that can predict patient outcomes. Hypertension has been identified as the most prevalent cardiovascular comorbidity in patients infected with COVID-19 that demonstrably increases the risk of hospitalization and death. Initial studies implied that renin-angiotensin-aldosterone system inhibitors might increase the risk of viral infection and aggravate disease severity, thereby causing panic given the high global prevalence of hypertension. Nonetheless, subsequent evidence supported the administration of antihypertensive drugs and noted that they do not increase the severity of COVID-19 infection in patients with hypertension, rather may have a beneficial effect. To date, the precise mechanism by which hypertension predisposes to unfavorable outcomes in patients infected with COVID-19 remains unknown. In this mini review, we elaborate on the pathology of SARS-CoV-2 infection coexisting with hypertension and summarize potential mechanisms, focusing on the dual roles of angiotensin-converting enzyme 2 and the disorders of renin-angiotensin-aldosterone system in COVID-19 and hypertension. The effects of proinflammatory factors released because of immune response and gastrointestinal dysfunction in COVID-19 are also discussed.
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Affiliation(s)
- Mei Peng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; and
- Institute of Hospital Pharmacy, Central South University, Changsha, China.
| | - Jia He
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; and
- Institute of Hospital Pharmacy, Central South University, Changsha, China.
| | - Ying Xue
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; and
- Institute of Hospital Pharmacy, Central South University, Changsha, China.
| | - Xue Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; and
- Institute of Hospital Pharmacy, Central South University, Changsha, China.
| | - Shao Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; and
- Institute of Hospital Pharmacy, Central South University, Changsha, China.
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China; and
- Institute of Hospital Pharmacy, Central South University, Changsha, China.
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Ibrahim HN, Murad DN, Hebert SA, Adrogue HE, Nguyen H, Nguyen DT, Matas AJ, Graviss EA. Intermediate Renal Outcomes, Kidney Failure, and Mortality in Obese Kidney Donors. J Am Soc Nephrol 2021; 32:2933-2947. [PMID: 34675059 PMCID: PMC8806092 DOI: 10.1681/asn.2021040548] [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: 04/23/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Obesity is associated with the two archetypal kidney disease risk factors: hypertension and diabetes. Concerns that the effects of diabetes and hypertension in obese kidney donors might be magnified in their remaining kidney have led to the exclusion of many obese candidates from kidney donation. METHODS We compared mortality, diabetes, hypertension, proteinuria, reduced eGFR and its trajectory, and the development of kidney failure in 8583 kidney donors, according to body mass index (BMI). The study included 6822 individuals with a BMI of <30 kg/m2, 1338 with a BMI of 30-34.9 kg/m2, and 423 with a BMI of ≥35 kg/m2. We used Cox regression models, adjusting for baseline covariates only, and models adjusting for postdonation diabetes, hypertension, and kidney failure as time-varying covariates. RESULTS Obese donors were more likely than nonobese donors to develop diabetes, hypertension, and proteinuria. The increase in eGFR in obese versus nonobese donors was significantly higher in the first 10 years (3.5 ml/min per 1.73m2 per year versus 2.4 ml/min per 1.73m2 per year; P<0.001), but comparable thereafter. At a mean±SD follow-up of 19.3±10.3 years after donation, 31 (0.5%) nonobese and 12 (0.7%) obese donors developed ESKD. Of the 12 patients with ESKD in obese donors, 10 occurred in 1445 White donors who were related to the recipient (0.9%). Risk of death in obese donors was not significantly increased compared with nonobese donors. CONCLUSIONS Obesity in kidney donors, as in nondonors, is associated with increased risk of developing diabetes and hypertension. The absolute risk of ESKD is small and the risk of death is comparable to that of nonobese donors.
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Affiliation(s)
| | - Dina N. Murad
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Sean A. Hebert
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - Hana Nguyen
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Arthur J. Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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Cremer S, Pilgram L, Berkowitsch A, Stecher M, Rieg S, Shumliakivska M, Bojkova D, Wagner JUG, Aslan GS, Spinner C, Luxán G, Hanses F, Dolff S, Piepel C, Ruppert C, Guenther A, Rüthrich MM, Vehreschild JJ, Wille K, Haselberger M, Heuzeroth H, Hansen A, Eschenhagen T, Cinatl J, Ciesek S, Dimmeler S, Borgmann S, Zeiher A. Angiotensin II receptor blocker intake associates with reduced markers of inflammatory activation and decreased mortality in patients with cardiovascular comorbidities and COVID-19 disease. PLoS One 2021; 16:e0258684. [PMID: 34673795 PMCID: PMC8530317 DOI: 10.1371/journal.pone.0258684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS Patients with cardiovascular comorbidities have a significantly increased risk for a critical course of COVID-19. As the SARS-CoV2 virus enters cells via the angiotensin-converting enzyme receptor II (ACE2), drugs which interact with the renin angiotensin aldosterone system (RAAS) were suspected to influence disease severity. METHODS AND RESULTS We analyzed 1946 consecutive patients with cardiovascular comorbidities or hypertension enrolled in one of the largest European COVID-19 registries, the Lean European Open Survey on SARS-CoV-2 (LEOSS) registry. Here, we show that angiotensin II receptor blocker intake is associated with decreased mortality in patients with COVID-19 [OR 0.75 (95% CI 0,59-0.96; p = 0.013)]. This effect was mainly driven by patients, who presented in an early phase of COVID-19 at baseline [OR 0,64 (95% CI 0,43-0,96; p = 0.029)]. Kaplan-Meier analysis revealed a significantly lower incidence of death in patients on an angiotensin receptor blocker (ARB) (n = 33/318;10,4%) compared to patients using an angiotensin-converting enzyme inhibitor (ACEi) (n = 60/348;17,2%) or patients who received neither an ACE-inhibitor nor an ARB at baseline in the uncomplicated phase (n = 90/466; 19,3%; p<0.034). Patients taking an ARB were significantly less frequently reaching the mortality predicting threshold for leukocytes (p<0.001), neutrophils (p = 0.002) and the inflammatory markers CRP (p = 0.021), procalcitonin (p = 0.001) and IL-6 (p = 0.049). ACE2 expression levels in human lung samples were not altered in patients taking RAAS modulators. CONCLUSION These data suggest a beneficial effect of ARBs on disease severity in patients with cardiovascular comorbidities and COVID-19, which is linked to dampened systemic inflammatory activity.
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Affiliation(s)
- Sebastian Cremer
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Berlin, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Lisa Pilgram
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Melanie Stecher
- Department I for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Siegbert Rieg
- Internal Medicine II, Department of Infectious Diseases, Freiburg University Hospital, Freiburg, Germany
| | - Mariana Shumliakivska
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt, Germany
| | - Denisa Bojkova
- Institute of Medical Virology, University of Frankfurt, Frankfurt, Germany
| | | | - Galip Servet Aslan
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt, Germany
| | - Christoph Spinner
- Department of Internal Medicine II, Technical University of Munich, Hospital rechts der Isar, Munich, Germany
| | - Guillermo Luxán
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Berlin, Germany
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt, Germany
| | - Frank Hanses
- University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, Essen, Germany
| | - Christiane Piepel
- Department of Internal Medicine I, Hospital Bremen-Mitte, Bremen, Germany
| | - Clemens Ruppert
- Department of Internal Medicine II, Giessen University, Giessen, Germany
| | - Andreas Guenther
- Department of Internal Medicine II, Giessen University, Giessen, Germany
| | | | - Jörg Janne Vehreschild
- Department I for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai Wille
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, University of Bochum, Minden, Germany
| | | | - Hanno Heuzeroth
- Department of Emergency and Intensive Care Medicine, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Arne Hansen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Eschenhagen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, University of Frankfurt, Frankfurt, Germany
| | - Sandra Ciesek
- Institute of Medical Virology, University of Frankfurt, Frankfurt, Germany
| | - Stefanie Dimmeler
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Berlin, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Andreas Zeiher
- Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Germany
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Berlin, Germany
- Cardiopulmonary Institute, Goethe University Frankfurt, Frankfurt, Germany
- * E-mail:
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Kunnas T, Määttä K, Nikkari ST. Variant rs6749447 (T > G) in the serine threonine kinase gene is associated with cardiovascular complications, the Tampere adult population cardiovascular risk study. Medicine (Baltimore) 2021; 100:e27566. [PMID: 34678896 PMCID: PMC8542165 DOI: 10.1097/md.0000000000027566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/01/2021] [Indexed: 01/05/2023] Open
Abstract
We have previously shown an association of STK39 (serine threonine kinase) rs6749447 (T > G) with hypertension in the Tampere adult population cardiovascular risk study in 50-year-old subjects. These 1196 subjects were followed up to the age of 65 years to determine whether rs6749447 is also associated with coronary artery disease (CAD), transient ischemic attack (TIA), or early cardiovascular death.DNA samples were collected by buccal swabs and genotypes were determined by PCR. Hypertension, TIA, and CAD were determined by questionnaire and the National Hospital Discharge Registry. Outcomes for death were collected from the National Statistics Centre. Linkage disequilibrium analysis and gene expression correlations for rs6749447 were done in silico.After following the subjects up to the age of 60 years the rs6749447 G-allele still associated with hypertension (P = .009). The variation did not associate with CAD (P = .959). The risk for TIA was 5.2-fold among G-allele carriers compared to TT genotype even after adjusting for body mass index (P = .036, 95% CI 1.11-24.59). After follow-up of the subjects to the age of 65 years, adjusting for body mass index, the G-allele was associated with 3.2-fold risk of premature cardiovascular death (P = .049, 95% CI 1.00-10.01).In conclusion, the STK39 genetic variant rs6749447 was significantly associated with TIA and premature cardiovascular death in a Finnish cohort. The in silico results of linkage disequilibrium and gene expression analyses also showed associations that were distinct from the retention of salt effect on kidneys proposed earlier for this intronic variation.
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Matuja SS, Munseri P, Moshiro C, Khanbhai K, Mahawish K. The burden, correlates and outcomes of left ventricular hypertrophy among young Africans with first ever stroke in Tanzania. BMC Cardiovasc Disord 2021; 21:485. [PMID: 34627161 PMCID: PMC8501668 DOI: 10.1186/s12872-021-02297-8] [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: 05/24/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension. Our primary aim was to investigate the magnitude, correlates and outcomes of left ventricular hypertrophy as a surrogate maker for chronic uncontrolled hypertension in young adults ≤ 45 years with stroke. Our secondary aim was to determine the accuracy of electrocardiography using Sokolow-Lyon and Cornell criteria in detecting left ventricular hypertrophy compared to echocardiography. METHODS This cohort study recruited young strokes who had undergone brain imaging, electrocardiography and transthoracic echocardiography at baseline. The modified Poisson regression model examined baseline correlates for left ventricular hypertrophy. The National Institute of Health Stroke Scale assessed stroke severity and the modified Rankin Scale assessed outcomes to 30-days. Performance of electrical voltage criterions was estimated using receiver operator characteristics. RESULTS We enrolled 101 stroke participants. Brain imaging revealed ischemic strokes in 60 (59.4%) and those with intracerebral hemorrhage, 33 (86.8%) were localized to the basal ganglia. Left ventricular hypertrophy was present in 76 (75.3%:95%CI 65.7%-83.3%), and 30 (39.5%) and 28 (36.8%) had moderate or severe hypertrophy respectively. Young adults with premorbid or a new diagnosis of hypertension were more likely to have left ventricular hypertrophy, 47 (61.8%), and 26 (34.2%). On multivariable analysis, left ventricular hypertrophy was independently associated with not being on anti-hypertensive medications among hypertensives participants {adjusted risk ratio 1.4 (95%CI:1.04-1.94). The mean National Institute of Health Stroke score was 18 and 30-day mortality was 42 (43.3%). The sensitivity and specificity for Sokolow-Lyon in detecting left ventricular hypertrophy was 27% and 78%, and for Cornell was 32% and 52% respectively. CONCLUSIONS We identified a high proportion of left ventricular hypertrophy in young adults with stroke associated with chronic undertreated hypertension. While the study methodology does not allow us to determine causation, this association and knowledge of pathophysiological processes supports the notion that chronic hypertension is a major risk factor for young strokes associated with high mortality. Our findings did not support the use of the electrical voltage criteria for detecting left ventricular hypertrophy. We recommend low cost interventions like blood pressure screening and treatment to reduce this burden.
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Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Karim Mahawish
- Department of Internal Medicine, Midcentral District Health Board, Palmerston North, New Zealand
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Hoang VT, Colson P, Levasseur A, Delerce J, Lagier JC, Parola P, Million M, Fournier PE, Raoult D, Gautret P. Clinical outcomes in patients infected with different SARS-CoV-2 variants at one hospital during three phases of the COVID-19 epidemic in Marseille, France. Infect Genet Evol 2021; 95:105092. [PMID: 34571275 PMCID: PMC8462069 DOI: 10.1016/j.meegid.2021.105092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
Objectives To compare the demographics, clinical characteristics and severity of patients infected with nine different SARS-CoV-2 variants, during three phases of the COVID-19 epidemic in Marseille. Methods A single centre retrospective cohort study was conducted in 1760 patients infected with SARS-CoV-2 of Nextstrain clades 20A, 20B, and 20C (first phase, February–May 2020), Pangolin lineages B.1.177 (we named Marseille-2) and B.1.160 (Marseille-4) variants (second phase, June–December 2020), and B.1.1.7 (alpha), B.1.351 (beta), P.1 (gamma) and A.27 (Marseille-501) variants (third phase, January 2021-today). Outcomes were the occurrence of clinical failures, including hospitalisation, transfer to the intensive-care unit, and death. Results During each phase, no major differences were observed with regards to age and gender distribution, the prevalence of chronic diseases, and clinical symptoms between variants circulating in a given phase. The B.1.177 and B.1.160 variants were associated with more severe outcomes. Infections occurring during the second phase were associated with a higher rate of death as compared to infections during the first and third phases. Patients in the second phase were more likely to be hospitalised than those in the third phase. Patients infected during the third phase were more frequently obese than others. Conclusion: A large cohort study is recommended to evaluate the transmissibility and to better characterise the clinical severity of emerging variants.
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Affiliation(s)
- Van-Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Philippe Colson
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Anthony Levasseur
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | | | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Pierre-Edouard Fournier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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Jaffar S, Ramaiya K, Karekezi C, Sewankambo N. Controlling diabetes and hypertension in sub-Saharan Africa: lessons from HIV programmes. Lancet 2021; 398:1111-1113. [PMID: 34506744 DOI: 10.1016/s0140-6736(21)01731-1] [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] [Received: 03/31/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania; Tanzania Non-Communicable Diseases Alliance, Dar es Salaam, Tanzania
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Owusu AY, Kushitor SB, Ofosu AA, Kushitor MK, Ayi A, Awoonor-Williams JK. Institutional mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. PLoS One 2021; 16:e0256515. [PMID: 34496000 PMCID: PMC8425528 DOI: 10.1371/journal.pone.0256515] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. METHODS Institutional mortality data and cause of death from 2014-2018 were sourced from the Ghana Health Service's District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation's 11th International Classification for Diseases (ICD-11) was used to group the cause of death. RESULTS Institutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias. CONCLUSIONS This study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana.
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Affiliation(s)
- Adobea Yaa Owusu
- Institute of Statistical, Social and Economic Research (ISSER), College of Humanities, University of Ghana, Legon, Ghana
- * E-mail: ,
| | | | | | - Mawuli Komla Kushitor
- Department of Health, Policy Planning, and Management, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Atsu Ayi
- Ghana Health Service, Accra, Ghana
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Hickey MD, Ayieko J, Owaraganise A, Sim N, Balzer LB, Kabami J, Atukunda M, Opel FJ, Wafula E, Nyabuti M, Brown L, Chamie G, Jain V, Peng J, Kwarisiima D, Camlin CS, Charlebois ED, Cohen CR, Bukusi EA, Kamya MR, Petersen ML, Havlir DV. Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda. PLoS Med 2021; 18:e1003803. [PMID: 34543267 PMCID: PMC8489716 DOI: 10.1371/journal.pmed.1003803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/04/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension treatment reduces morbidity and mortality yet has not been broadly implemented in many low-resource settings, including sub-Saharan Africa (SSA). We hypothesized that a patient-centered integrated chronic disease model that included hypertension treatment and leveraged the HIV care system would reduce mortality among adults with uncontrolled hypertension in rural Kenya and Uganda. METHODS AND FINDINGS This is a secondary analysis of the SEARCH trial (NCT:01864603), in which 32 communities underwent baseline population-based multidisease testing, including hypertension screening, and were randomized to standard country-guided treatment or to a patient-centered integrated chronic care model including treatment for hypertension, diabetes, and HIV. Patient-centered care included on-site introduction to clinic staff at screening, nursing triage to expedite visits, reduced visit frequency, flexible clinic hours, and a welcoming clinic environment. The analytic population included nonpregnant adults (≥18 years) with baseline uncontrolled hypertension (blood pressure ≥140/90 mm Hg). The primary outcome was 3-year all-cause mortality with comprehensive population-level assessment. Secondary outcomes included hypertension control assessed at a population level at year 3 (defined per country guidelines as at least 1 blood pressure measure <140/90 mm Hg on 3 repeated measures). Between-arm comparisons used cluster-level targeted maximum likelihood estimation. Among 86,078 adults screened at study baseline (June 2013 to July 2014), 10,928 (13%) had uncontrolled hypertension. Median age was 53 years (25th to 75th percentile 40 to 66); 6,058 (55%) were female; 677 (6%) were HIV infected; and 477 (4%) had diabetes mellitus. Overall, 174 participants (3.2%) in the intervention group and 225 participants (4.1%) in the control group died during 3 years of follow-up (adjusted relative risk (aRR) 0.79, 95% confidence interval (CI) 0.64 to 0.97, p = 0.028). Among those with baseline grade 3 hypertension (≥180/110 mm Hg), 22 (4.9%) in the intervention group and 42 (7.9%) in the control group died during 3 years of follow-up (aRR 0.62, 95% CI 0.39 to 0.97, p = 0.038). Estimated population-level hypertension control at year 3 was 53% in intervention and 44% in control communities (aRR 1.22, 95% CI 1.12 to 1.33, p < 0.001). Study limitations include inability to identify specific causes of death and control conditions that exceeded current standard hypertension care. CONCLUSIONS In this cluster randomized comparison where both arms received population-level hypertension screening, implementation of a patient-centered hypertension care model was associated with a 21% reduction in all-cause mortality and a 22% improvement in hypertension control compared to standard care among adults with baseline uncontrolled hypertension. Patient-centered chronic care programs for HIV can be leveraged to reduce the overall burden of cardiovascular mortality in SSA. TRIAL REGISTRATION ClinicalTrials.gov NCT01864603.
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Affiliation(s)
- Matthew D. Hickey
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - James Ayieko
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Nicholas Sim
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Laura B. Balzer
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Jane Kabami
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Fredrick J. Opel
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Erick Wafula
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marilyn Nyabuti
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lillian Brown
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Gabriel Chamie
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Vivek Jain
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - James Peng
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | | | - Carol S. Camlin
- Center for AIDS Prevention Studies & Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies & Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Moses R. Kamya
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Maya L. Petersen
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Diane V. Havlir
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
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Alsagaff MY, Mulia EPB, Maghfirah I, Luke K, Nugraha D, Rachmi DA, Septianda I, A'yun MQ. Association of calcium channel blocker use with clinical outcome of COVID-19: A meta-analysis. Diabetes Metab Syndr 2021; 15:102210. [PMID: 34298269 PMCID: PMC8282943 DOI: 10.1016/j.dsx.2021.102210] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/02/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
AIMS This meta-analysis aims to analyze the association of calcium channel blocker (CCB) use with COVID-19 clinical outcomes. METHODS PubMed, ProQuest, Science Direct, Scopus, and medRxiv databases were searched systematically in a limited period. The primary outcome was mortality. RESULTS A total of 119,298 patients from 31 eligible studies were included. Pooled analysis of the random-effect model revealed CCB was not associated with reduced mortality (OR = 1.21 [95%CI: 0.98-1.49], p = 0.08). Interestingly, subgroup analysis in hypertensive patients revealed significantly reduced mortality (OR = 0.69 [95%CI: 0.52-0.91], p = 0.009). CONCLUSION CCB usage was not associated with the outcome of COVID-19. However, CCB was associated with a decreased mortality rate in hypertensive COVID-19 patients.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia; Universitas Airlangga Hospital, Surabaya, Indonesia.
| | - Eka Prasetya Budi Mulia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Irma Maghfirah
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kevin Luke
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - David Nugraha
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dita Aulia Rachmi
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Imanita Septianda
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Maya Qurota A'yun
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Cardiology and Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
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Jayaswal SK, Singh S, Malik PS, Venigalla SK, Gupta P, Samaga SN, Hota RN, Bhatia SS, Gupta I. Detrimental effect of diabetes and hypertension on the severity and mortality of COVID-19 infection: A multi-center case-control study from India. Diabetes Metab Syndr 2021; 15:102248. [PMID: 34412000 PMCID: PMC8364674 DOI: 10.1016/j.dsx.2021.102248] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023]
Abstract
AIMS This study aims to find a quantitative association between the presence of co-existing diabetes mellitus (DM) and/or hypertension (HTN) with COVID-19 infection severity and mortality. METHODS A total of 813 patients with a positive COVID-19 were included. A case-control design was used to dissect the association between DM and HTN with COVID-19 severity and mortality. RESULTS According to MOHFW guidelines, 535 (65.7%) patients had mild, 160 (19.7%) patients had moderate, and 118 (14.5%) patients had severe disease outcomes including mortality in 52 patients. Age, Neutrophil%, and Diabetes status were significantly associated with severe COVID-19 infection. After adjusting for age, patients with diabetes were 2.46 times more likely to have severe disease (Chi-squared = 18.89, p-value<0.0001) and 2.11 times more likely to have a fatal outcome (Chi-squared = 6.04, p-value = 0.014). However, we did not find evidence for Hypertension modifying the COVID-19 outcomes in Diabetic patients. CONCLUSION COVID-19 severity and mortality both were significantly associated with the status of DM and its risk may not be modified by the presence of HTN.
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Affiliation(s)
- Sneha Kumar Jayaswal
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi, 110016, India.
| | - Shalendra Singh
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, 411040, Maharashtra, India.
| | - Prabhat Singh Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India.
| | - Sri Krishna Venigalla
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, 411040, Maharashtra, India.
| | - Pallavi Gupta
- Department of Biological Sciences, Indian Institute of Science Education and Research, Bhopal, Bhauri, Madhya Pradesh, 462066, India.
| | - Shreyas N Samaga
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi, 110016, India.
| | - Rabi Narayan Hota
- Department of Anesthesiology and Critical Care, Armed Forces Medical College, Pune, 411040, Maharashtra, India.
| | | | - Ishaan Gupta
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi, 110016, India.
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20
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Lin YT, Liu YH, Hsiao YL, Chiang HY, Chen PS, Chang SN, Tsai HC, Chen CH, Kuo CC. Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department. PLoS One 2021; 16:e0251311. [PMID: 34403407 PMCID: PMC8370605 DOI: 10.1371/journal.pone.0251311] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/24/2021] [Indexed: 11/18/2022] Open
Abstract
Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.
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Affiliation(s)
- Yu-Ting Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Hung Liu
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Chen Tsai
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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21
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Liu H, Ding C, Hu L, Li M, Zhou W, Wang T, Zhu L, Bao H, Cheng X. The association between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension. Medicine (Baltimore) 2021; 100:e26693. [PMID: 34397804 PMCID: PMC8341222 DOI: 10.1097/md.0000000000026693] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/17/2020] [Accepted: 06/18/2021] [Indexed: 01/04/2023] Open
Abstract
Previous studies had shown that an increased aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) was associated with cardiovascular disease. This study aimed to assess the relationship between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension.By March 31, 2020, a cohort of 14,220 Chinese hypertensive patients was followed up. The end point was all-cause and cardiovascular death. Hazard ratios (HRs) and 95% CIs were calculated for mortality associated with AST/ALT ratio, using Cox proportional hazards models and competing risk model.In an average of 1.7 years of follow-up, 1.39% (n = 198) of patients died, 55.5% (n = 110) of whom from cardiovascular disease. AST/ALT ratio was associated with increased risk of all-cause death (HR:1.37, 95% CI:1.15-1.63) and cardiovascular death (HR:1.32, 95% CI:1.03-1.68) after adjustment for other potential confounders. Compared with low AST/ALT ratio (Tertile 1), high AST/ALT ratio was associated with high cause mortality (Tertile 2: HR:1.35, 95% CI:0.86-2.10; Tertile 3: HR:2.10, 95% CI:1.37-3.21; P for trend <.001). Compared with low AST/ALT ratio (Tertile 1), a statistically significant increased risk of cardiovascular mortality was also observed (Tertile 2: HR:1.27, 95% CI:0.70-2.29; Tertile 3: HR:1.92, 95% CI:1.09-3.37; P for trend <.001). High AST/ALT ratio was also associated with high cardiovascular mortality (Tertile 2: HR:1.27, 95% CI:0.70-2.29; Tertile 3: HR:1.92, 95% CI:1.09-3.37; P for trend <.001).Present study indicated that increased AST/ALT ratio levels were predictive of all-cause and cardiovascular mortality among Chinese hypertensive patients.Trial registration: CHICTR, CHiCTR1800017274. Registered 20 July 2018.
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Affiliation(s)
- Hui Liu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Congcong Ding
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Lihua Hu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Minghui Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Wei Zhou
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Tao Wang
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Lingjuan Zhu
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Huihui Bao
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
| | - Xiaoshu Cheng
- Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China
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22
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Guo J, Lv J, Guo Y, Bian Z, Zheng B, Wu M, Yang L, Chen Y, Su J, Zhang J, Yao J, Chen J, Chen Z, Yu C, Li L. Association between blood pressure categories and cardiovascular disease mortality in China. PLoS One 2021; 16:e0255373. [PMID: 34329344 PMCID: PMC8323908 DOI: 10.1371/journal.pone.0255373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Blood pressure (BP) categories are useful to simplify preventions in public health, and diagnostic and treatment approaches in clinical practice. Updated evidence about the associations of BP categories with cardiovascular diseases (CVDs) and its subtypes is warranted. METHODS AND FINDINGS About 0.5 million adults aged 30 to 79 years were recruited from 10 areas in China during 2004-2008. The present study included 430 977 participants without antihypertension treatment, cancer, or CVD at baseline. BP was measured at least twice in a single visit at baseline and CVD deaths during follow-up were collected via registries and the national health insurance databases. Multivariable Cox regression was used to estimate the associations between BP categories and CVD mortality. Overall, 16.3% had prehypertension-low, 25.1% had prehypertension-high, 14.1% had isolated systolic hypertension (ISH), 1.9% had isolated diastolic hypertension (IDH), and 9.1% had systolic-diastolic hypertension (SDH). During a median 10-year follow-up, 9660 CVD deaths were documented. Compared with normal, the hazard ratios (95% CI) of prehypertension-low, prehypertension-high, ISH, IDH, SDH for CVD were 1.10 (1.01-1.19), 1.32 (1.23-1.42), 2.04 (1.91-2.19), 2.20 (1.85-2.61), and 3.81 (3.54-4.09), respectively. All hypertension subtypes were related to the increased risk of CVD subtypes, with a stronger association for hemorrhagic stroke than for ischemic heart disease. The associations were stronger in younger than older adults. CONCLUSIONS Prehypertension-high should be considered in CVD primary prevention given its high prevalence and increased CVD risk. All hypertension subtypes were independently associated with CVD and its subtypes mortality, though the strength of associations varied substantially.
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Affiliation(s)
- Jie Guo
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Bang Zheng
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Man Wu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
| | - Ling Yang
- Nuffield Department of Population Health, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, United Kingdom
| | - Jian Su
- Jiangsu Center for Disease Control and Prevention, Nanjing, China
| | | | - Jvying Yao
- Gaoqiao Town Health Center, Tongxiang, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, United Kingdom
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
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23
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Abayomi A, Osibogun A, Kanma-Okafor O, Idris J, Bowale A, Wright O, Adebayo B, Balogun M, Ogboye S, Adeseun R, Abdus-Salam I, Mutiu B, Saka B, Lajide D, Yenyi S, Agbolagorite R, Onasanya O, Erinosho E, Obasanya J, Adejumo O, Adesola S, Oshodi Y, Akase IE, Ogunbiyi S, Omosun A, Erinoso F, Abdur-Razzaq H, Osa N, Akinroye K. Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study. Glob Health Res Policy 2021; 6:26. [PMID: 34325747 PMCID: PMC8319704 DOI: 10.1186/s41256-021-00210-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 06/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described. METHODS In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 62,020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred. Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher's exact tests were used in determining associations between variables. Kaplan-Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant. RESULTS A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P < 0.001). After adjustment for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness: HR = 2.41, P = 0.001, 95%CI = 1.4-4.0, death: HR = 2.30, P = 0.001, 95%CI = 1.2-4.6, for those with hypertension only} {severe/critical illness: HR = 3.76, P = 0.001, 95%CI = 2.1-6.4, death: crude HR = 6.63, P = 0.001, 95%CI = 3.4-1.6, for those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities. CONCLUSION The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.
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Affiliation(s)
- Akin Abayomi
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Akin Osibogun
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria.
- Lagos State Primary Health Care Board, Lagos, Nigeria.
| | | | - Jide Idris
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | - Ololade Wright
- Lagos State University College of Medicine, Lagos, Nigeria
| | - Bisola Adebayo
- Lagos State University College of Medicine, Lagos, Nigeria
| | | | - Segun Ogboye
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Remi Adeseun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Ismael Abdus-Salam
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | | | - Dayo Lajide
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Sam Yenyi
- World Health Organization, Nigeria Office, Abuja, Nigeria
| | - Rotimi Agbolagorite
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | | | | | | | | | | | - Yewande Oshodi
- College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | | | - Adenike Omosun
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Femi Erinoso
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Hussein Abdur-Razzaq
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
| | - Nike Osa
- Lagos State Ministry of Health/Lagos Incident Management Command System, Lagos, Nigeria
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Sharif N, Opu RR, Ahmed SN, Sarkar MK, Jaheen R, Daullah MU, Khan S, Mubin M, Rahman H, Islam F, Haque N, Islam S, Khan FB, Haque N, Ayman U, Shohael AM, Dey SK, Talukder AA. Prevalence and impact of comorbidities on disease prognosis among patients with COVID-19 in Bangladesh: A nationwide study amid the second wave. Diabetes Metab Syndr 2021; 15:102148. [PMID: 34186349 PMCID: PMC8236060 DOI: 10.1016/j.dsx.2021.05.021] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Socio-demographics and comorbidities are involved in determining the severity and fatality in patients with COVID-19 suggested by studies in various countries, but study in Bangladesh is insufficient. AIMS We designed the study to evaluate the association of sociodemographic and comorbidities with the prognosis of adverse health outcomes in patients with COVID-19 in Bangladesh. METHODS A multivariate retrospective cohort study was conducted on data from 966 RT-PCR positive patients from eight divisions during December 13, 2020, to February 13, 2021. Variables included sociodemographic, comorbidities, symptoms, Charlson comorbidity index (CCI) and access to health facilities. Major outcome was fatality. Secondary outcomes included hospitalization, duration of hospital stay, requirement of mechanical ventilation and severity. RESULTS Male (65.8%, 636 of 966) was predominant and mean age was 39.8 ± 12.6 years. Fever (79%), dry cough (55%), and loss of test/smell (51%) were frequent and 74% patients had >3 symptoms. Fatality was recorded in 10.5% patients. Comorbidities were found in 44% patients. Hypertension (21.5%) diabetes (14.6%), and cardiovascular diseases (11.3%) were most prevalent. Age >60 years (OR: 4.83, 95% CI: 2.45-6.49), and CCI >3 (OR: 5.48, 95% CI: 3.95-7.24) were predictors of hospitalizations. CCI >4 (aOR: 3.41, 95% CI: 2.57-6.09) was predictor of severity. Age >60 years (aOR: 3.77, 95% CI: 1.07-6.34), >3 symptoms (aOR: 2.14, 95% CI: 0.97-4.91) and CCI >3 vs. CCI <3 (aOR: 5.23, 95% CI: 3.77-8.09) were independently associated with fatality. CONCLUSIONS Increased age, >3 symptoms, increasing comorbidities, higher CCI were associated with increased hospitalization, severity and fatality in patients with COVID-19.
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Affiliation(s)
- Nadim Sharif
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Rubayet Rayhan Opu
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Shamsun Nahar Ahmed
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Mithun Kumar Sarkar
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Raisah Jaheen
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Muktasid Ud Daullah
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Shahriar Khan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Mir Mubin
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Habibur Rahman
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Faiza Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Nusaira Haque
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Suchana Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Fariha Bushra Khan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Nabila Haque
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Umme Ayman
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Abdullah Mohammad Shohael
- Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Shuvra Kanti Dey
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Ali Azam Talukder
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
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Kurl S, Jae SY, Voutilainen A, Laukkanen JA. The combined effect of blood pressure and C-reactive protein with the risk of mortality from coronary heart and cardiovascular diseases. Nutr Metab Cardiovasc Dis 2021; 31:2051-2057. [PMID: 34090772 DOI: 10.1016/j.numecd.2021.04.004] [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] [Received: 10/15/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Both blood pressure and C-reactive protein (CRP) are individually associated with cardiovascular mortality risk. However, the combined effect of systolic blood pressure (SBP) and CRP on coronary heart disease (CHD) and cardiovascular disease (CVD) mortality risk, has not been studied. METHODS AND RESULTS We evaluated the joint impact of SBP and CRP and the risk of mortality in the Kuopio Ischemic Heart Disease prospective cohort study of 1622 men aged 42-61 years at recruitment with no history of CVD. SBP and CRP were measured. SBP was categorized as low and high (cut-off 135 mmHg) and CRP as low and high (cut-off 1.54 mg/L) based on ROC curves. Multivariable adjusted hazard ratios (HRs) with confidence intervals (CI) were calculated. During a median follow-up of 28 years, 196 cases of CHD and 320 cases of CVD deaths occurred. Elevated SBP (>135 mmHg) combined with elevated (CRP >1.54 mg/L) were associated with CHD and CVD mortality (HR 3.41, 95% CI, 2.20-5.28, p < 0.001) and (HR 2.93, 95% CI, 2.11-4.06, p < 0.001) respectively after adjustment for age, examination year, smoking, alcohol consumption, BMI, Type 2 diabetes, energy expenditure, total cholesterol, serum HDL cholesterol, antihypertensive medication and use of aspirin. CONCLUSION The combined effect of both high systolic blood pressure and high CRP is associated with increased risk of future CHD and CVD mortality as compared with both low SBP and low CRP levels in general male Caucasian population.
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Affiliation(s)
- Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Sae Young Jae
- Department of Sport Science, University of Seoul, Seoul, Republic of Korea; Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari Antero Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Division of Cardiology, Central Finland Health Care District Jyväskylä, Finland
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Ling QS, Zhang SL, Tian JS, Cheng MH, Liu AJ, Fu FH, Liu JG, Miao CY. Allisartan isoproxil reduces mortality of stroke-prone rats and protects against cerebrovascular, cardiac, and aortic damage. Acta Pharmacol Sin 2021; 42:871-884. [PMID: 34002042 PMCID: PMC8149727 DOI: 10.1038/s41401-021-00684-7] [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] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/17/2021] [Indexed: 12/22/2022] Open
Abstract
Stroke is a common cause of death and disability. Allisartan isoproxil (ALL) is a new angiotensin II receptor blocker and a new antihypertensive drug discovered and developed in China. In the present study we investigated the therapeutic effects of ALL in stroke-prone renovascular hypertensive rats (RHR-SP) and the underlying mechanisms. The model rats were generated via two-kidney two-clip (2K2C) surgery, which led to 100% of hypertension, 100% of cerebrovascular damage as well as 100% of mortality 1 year after the surgery. Administration of ALL (30 mg · kg-1 · d-1 in diet, for 55 weeks) significantly decreased stroke-related death and prolonged lifespan in RHR-SP, but the survival ALL-treated RHR-SP remained of hypertension and cardiovascular hypertrophy compared with sham-operated normal controls. In addition to cardiac, and aortic protection, ALL treatment for 10 or 12 weeks significantly reduced cerebrovascular damage incidence and scoring, along with a steady reduction of blood pressure (BP) in RHR-SP. Meanwhile, it significantly decreased serum aldosterone and malondialdehyde levels and cerebral NAD(P)H oxidase expressions in RHR-SP. We conducted 24 h continuous BP recording in conscious freely moving RHR-SP, and found that a single intragastric administration of ALL produced a long hypotensive effect lasting for at least 12 h on systolic BP. Taken together, our results in RHR-SP demonstrate that ALL can be used for stroke prevention via BP reduction and organ protection, with the molecular mechanisms related to inhibition of angiotensin-aldosterone system and oxidative stress. This study also provides a valuable scoring for evaluation of cerebrovascular damage and drug efficacy.
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Affiliation(s)
- Qi-Sheng Ling
- School of Pharmacy, Yantai University, Yantai, 264005, China
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Sai-Long Zhang
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Jia-Sheng Tian
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Ming-He Cheng
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Ai-Jun Liu
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Feng-Hua Fu
- School of Pharmacy, Yantai University, Yantai, 264005, China
| | - Jian-Guo Liu
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Chao-Yu Miao
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China.
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Xu TY, Wang P, Tian JS, Qing SL, Wang SN, Huang YH, Xu JY, Su DF, Liu JG, Miao CY. Pharmacological characterization of MT-1207, a novel multitarget antihypertensive agent. Acta Pharmacol Sin 2021; 42:885-897. [PMID: 33782540 PMCID: PMC8149631 DOI: 10.1038/s41401-021-00636-1] [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] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/28/2021] [Indexed: 12/16/2022] Open
Abstract
Hypertension is a serious public health problem worldwide. MT-1207, chemically named 3-(4-(4-(1H-benzotriazole-1-yl)butyl)piperazine-1-yl) benzisothiazole hydrochloride, is a new chemical entity that has entered into clinical trial as antihypertensive agent in China. In this paper we report the pharmacological profile of MT-1207 regarding its acute, subacute, and long-term effects on hypertensive animal models, and its actions on isolated organs in vitro as well as its molecular targets. Blood pressure (BP) was measured in conscious animals; amlodipine was taken as a positive control drug. We showed that both single dose of MT-1207 (1.25-20 mg/kg, ig) in spontaneously hypertensive rats (SHR) and MT-1207 (0.25-6 mg/kg, ig) in two-kidney one-clip (2K1C) dogs dose-dependently decreased BP. MT-1207 quickly decreased BP within 5 min after administration; the hypotensive effect lasted for 8 and 12 h, respectively, in SHR and 2K1C dogs without reflex increase in heart rate. Multiple doses of MT-1207 (5 mg · kg-1 · d-1 in SHR; 2 mg · kg-1 · d-1 in 2K1C dogs, for 7 days) significantly decreased BP, slightly reduced heart rate, and both of them recovered after withdrawal. Long-term administration of MT-1207 (10 mg · kg-1 · d-1 for 4 months or more time) produced a stable BP reduction, improved baroreflex sensitivity, reduced renal and cardiovascular damage in SHR, and delayed stroke occurrence and death in stroke-prone SHR. In isolated rat aortic rings precontracted by adrenaline, KCl, noradrenaline or 5-hydroxytryptamine (5-HT), MT-1207 (10-9-10-4 M) caused concentration-dependent relaxation. In a panel of enzyme activity or radioligand binding assays of 87 molecular targets, MT-1207 potently inhibited adrenergic α1A, α1B, α1D, and 5-HT2A receptors with Ki < 1 nM. The antagonism of MT-1207 against these receptors was confirmed in isolated rabbit arteries. We conclude that MT-1207 is a novel and promising single-molecule multitarget agent for hypertension treatment to reduce hypertensive organ damage and stroke mortality.
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Affiliation(s)
- Tian-Ying Xu
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Peng Wang
- State Key Laboratory of Natural Medicines and Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China
| | - Jia-Sheng Tian
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Sheng-Li Qing
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Shu-Na Wang
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Ya-Hui Huang
- Department of Medicinal Chemistry, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Jin-Yi Xu
- State Key Laboratory of Natural Medicines and Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China
| | - Ding-Feng Su
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Jian-Guo Liu
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China.
| | - Chao-Yu Miao
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai, 200433, China.
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Yahyavi A, Hemmati N, Derakhshan P, Banivaheb B, Karimi Behnagh A, Tofighi R, TehraniYazdi A, Kabir A. Angiotensin enzyme inhibitors and angiotensin receptor blockers as protective factors in COVID-19 mortality: a retrospective cohort study. Intern Emerg Med 2021; 16:883-893. [PMID: 33085063 PMCID: PMC7576108 DOI: 10.1007/s11739-020-02523-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/27/2020] [Accepted: 09/29/2020] [Indexed: 01/06/2023]
Abstract
Targeting the renin-angiotensin system is proposed to affect mortality due to coronavirus disease 2019 (COVID-19). We aimed to compare the mortality rates in COVID-19 patients who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) and those who did not. In this retrospective cohort study, mortality was considered as the main outcome measure. All underlying diseases were assessed by the chronic use of medications related to each condition. We defined two main groups based on the ACEIs/ARBs administration. A logistic regression model was designed to define independent predictors of mortality as well as a Cox regression analysis. In total, 2553 patients were included in this study. The mortality frequency was higher in patients with a history of underlying diseases (22.4% vs 12.7%, P value < 0.001). The mortality rate in patients who received ACEIs/ARBs were higher than non-receivers (29.3% vs. 19.5%, P value = 0.013, OR = 1.3, 95% CI 1.1, 1.7) in the univariate analysis. However, the use of ACEIs/ARBs was a protective factor against mortality in the model when adjusted for underlying conditions, length of stay, age, gender, and ICU admission (P value < 0.001, OR = 0.5, 95% CI 0.3, 0.7). The Kaplan-Meier curve showed an overall survival of approximately 85.7% after a 120-day follow-up. ACEIs/ARBs are protective factors against mortality in COVID-19 patients with HTN, and these agents can be considered potential therapeutic options in this disease. The survival probability is higher in ACEIs/ARBs receivers than non-receivers.
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Affiliation(s)
- Ashkan Yahyavi
- Minimally Invasive Surgery Research Centre (MISRC), Iran University of Medical Sciences (IUMS), Rasoul-e Akram Hospital, Mansouri Alley, Niyayesh St., Sattarkhan St., Tehran, Iran
| | - Nima Hemmati
- Minimally Invasive Surgery Research Centre (MISRC), Iran University of Medical Sciences (IUMS), Rasoul-e Akram Hospital, Mansouri Alley, Niyayesh St., Sattarkhan St., Tehran, Iran
| | - Pegah Derakhshan
- Minimally Invasive Surgery Research Centre (MISRC), Iran University of Medical Sciences (IUMS), Rasoul-e Akram Hospital, Mansouri Alley, Niyayesh St., Sattarkhan St., Tehran, Iran
| | - Behrooz Banivaheb
- Minimally Invasive Surgery Research Centre (MISRC), Iran University of Medical Sciences (IUMS), Rasoul-e Akram Hospital, Mansouri Alley, Niyayesh St., Sattarkhan St., Tehran, Iran
| | - Arman Karimi Behnagh
- Minimally Invasive Surgery Research Centre (MISRC), Iran University of Medical Sciences (IUMS), Rasoul-e Akram Hospital, Mansouri Alley, Niyayesh St., Sattarkhan St., Tehran, Iran
| | - Rozhin Tofighi
- Minimally Invasive Surgery Research Centre (MISRC), Iran University of Medical Sciences (IUMS), Rasoul-e Akram Hospital, Mansouri Alley, Niyayesh St., Sattarkhan St., Tehran, Iran
| | - Alireza TehraniYazdi
- Department of Energy Engineering and Physics, Amirkabir University of Technology, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Centre (MISRC), Iran University of Medical Sciences (IUMS), Rasoul-e Akram Hospital, Mansouri Alley, Niyayesh St., Sattarkhan St., Tehran, Iran.
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Mostafaei A, Ghojazadeh M, Hajebrahimi S, Abolhasanpour N, Salehi-Pourmehr H. Clinical Presentation of Iranian Patients Affected with COVID-19: A Thousand Faces Disease. Iran J Allergy Asthma Immunol 2021; 20:140-146. [PMID: 33904672] [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] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic in Iran is part of the worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The present study aimed to demonstrate the clinical characteristics of patients affected by COVID-19, in our tertiary teaching hospital. Medical records and compiled data of 668 patients with suspected COVID-19 were obtained retrospectively between January to April 2020. The present study outcomes included demographic features of infected patients, underlying diseases and conditions, the relationship between the results of reverse transcription-polymerase chain reaction (RT-PCR) or CT-scan with the manifestations of the disease, mortality rate, and age distribution of fatalities among men and women. The median age of hospitalized patients was 63 years old (from 18 to 94). The patients' chief complaints in the admission time were cough, dyspnea, fever, and gastrointestinal problems, respectively. Hospitalized patients' common comorbidities were hypertension (HTN), and cardiovascular disease (CVD) (24%), diabetes mellitus (DM) (21.5%), asthma, or chronic obstructive pulmonary disease (COPD) (6%), or other underlying diseases (15.5%). One-third of patients had no comorbidity according to the data of medical records. In hospitalized patients, 169 (84.5%) had positive RT-PCR, and 156 (78%) had positive chest CT findings. The mortality rate of males was higher than females (66.3% vs. 33.3%) and in patients with positive RT-PCR compared to patients with positive chest CT-scan findings. The majority of deaths had a history of DM or HTN/CVD in their medical records. The chief complaint of patients was cough. DM and HTN or CVD were the common underlying disease related to death in hospitalized cases. Besides, the hospitalization and mortality rate in males was higher than in females. About 87% of dead hospitalized cases had positive RT-PCR results, and this rate was 82% for chest CT results.
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Affiliation(s)
- Ali Mostafaei
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran AND Department of Ophthalmology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran AND Department of Urology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Nasrin Abolhasanpour
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
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Rossi L, Malagoli A, Biagi A, Zanni A, Sticozzi C, Comastri G, Pannone L, Gandolfi S, Vergara P, Villani GQ. Renin-angiotensin system inhibitors and mortality in patients with COVID-19. Infection 2021; 49:287-294. [PMID: 33222020 PMCID: PMC7680554 DOI: 10.1007/s15010-020-01550-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/30/2020] [Accepted: 10/29/2020] [Indexed: 01/08/2023]
Abstract
Association of renin-angiotensin system inhibitors with risk of death in patients with hypertension (HTN) and coronavirus disease 2019 (COVID-19) is not well characterized. The aim of this study was to evaluate the outcomes of patients with HTN and COVID-19 with respect to different chronic antihypertensive drug intake. We performed a retrospective, observational study from a large cohort of patients with HTN and with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection admitted to the Emergency Rooms (ER) of the Piacenza Hospital network from February 21, 2020 to March 20, 2020. There were 1050 patients admitted to the ERs of the Piacenza Hospital network with COVID-19. HTN was present in 590 patients [median age, 76.2 years (IQR 68.2-82.6)]; 399 (66.1%) patients were male. Of them, 248 patients were chronically treated with ACEi, 181 with ARBs, and 161 with other drugs (O-drugs) including beta blockers, diuretics and calcium-channel inhibitors. With respect to the antihypertensive use, there was no difference between comorbid conditions. During a follow-up of 38 days (IQR 7.0-46.0), 256 patients (43.4%) died, without any difference stratifying for antihypertensive drugs. Of them, 107 (43.1%) were in ACEi group vs 67 (37%) in ARBs group vs 82 (50.7%) in O-drugs group, (log-rank test: p = 0.066). In patients with HTN and COVID-19, neither ACEi nor ARBs were independently associated with mortality. After adjusting for potential confounders in risk prediction, the rate of death was similar. Our data confirm Specialty Societal recommendations, suggesting that treatment with ACEIs or ARBs should not be discontinued because of COVID-19.
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Affiliation(s)
- Luca Rossi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, "S. Agostino-Estense" Public Hospital, University of Modena and Reggio Emilia, 1355, Via Pietro Giardini - Baggiovara, 41126, Modena, Italy.
| | - Andrea Biagi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alessia Zanni
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Concetta Sticozzi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Greta Comastri
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Luigi Pannone
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy
| | - Stefano Gandolfi
- Health Management, Guglielmo da Saliceto Hospital, ASL Piacenza, Piacenza, Italy
| | - Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy
| | - Giovanni Quinto Villani
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Du Y, Zhou N, Zha W, Lv Y. Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:745-755. [PMID: 33549450 PMCID: PMC7831720 DOI: 10.1016/j.numecd.2020.12.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
AIMS As reported, hypertension may play an important role in adverse outcomes of coronavirus disease-2019 (COVID-19), but it still had many confounding factors. The aim of this study was to explore whether hypertension is an independent risk factor for critical COVID-19 and mortality. DATA SYNTHESIS The Medline, PubMed, Embase, and Web of Science databases were systematically searched until November 2020. Combined odds ratios (ORs) with their 95% confidence interval (CIs) were calculated by using random-effect models, and the effect of covariates was analyzed using the subgroup analysis and meta-regression analysis. A total of 24 observational studies with 99,918 COVID-19 patients were included in the meta-analysis. The proportions of hypertension in critical COVID-19 were 37% (95% CI: 0.27 -0.47) when compared with 18% (95% CI: 0.14 -0.23) of noncritical COVID-19 patients, in those who died were 46% (95%CI: 0.37 -0.55) when compared with 22% (95% CI: 0.16 -0.28) of survivors. Pooled results based on the adjusted OR showed that patients with hypertension had a 1.82-fold higher risk for critical COVID-19 (aOR: 1.82; 95% CI: 1.19 - 2.77; P = 0.005) and a 2.17-fold higher risk for COVID-19 mortality (aOR: 2.17; 95% CI: 1.67 - 2.82; P < 0.001). Subgroup analysis results showed that male patients had a higher risk of developing to the critical condition than female patients (OR: 3.04; 95%CI: 2.06 - 4.49; P < 0.001) and age >60 years was associated with a significantly increased risk of COVID-19 mortality (OR: 3.12; 95% CI: 1.93 - 5.05; P < 0.001). Meta-regression analysis results also showed that age (Coef. = 2.3×10-2, P = 0.048) had a significant influence on the association between hypertension and COVID-19 mortality. CONCLUSIONS Evidence from this meta-analysis suggested that hypertension was independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.
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Affiliation(s)
- Yanbin Du
- MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, Hunan Province, 410081, China
| | - Nan Zhou
- Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province, 410013, China
| | - Wenting Zha
- Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province, 410013, China.
| | - Yuan Lv
- Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province, 410013, China.
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Ruzhentsova TA, Khavkina DA, Chukhliaev PV, Garbuzov AA, Ploskireva AA. [Effect of anticoagulant therapy on the course of COVID-19 in comorbid patients]. Vopr Virusol 2021; 66:40-46. [PMID: 33683064 DOI: 10.36233/0507-4088-14] [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] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases. MATERIAL AND METHODS Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)» (https://static-0.minzdrav.gov.ru/system/attachments/attaches/). RESULTS AND DISCUSSION The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs. CONCLUSION Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.
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Affiliation(s)
- T A Ruzhentsova
- FSBI Gabrichevsky research institute for epidemiology and microbiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - D A Khavkina
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - P V Chukhliaev
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - A A Garbuzov
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - A A Ploskireva
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
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Lee J, Jo SJ, Cho Y, Lee JH, Oh IY, Park JJ, Cho YS, Choi DJ. Effects of renin-angiotensin system blockers on the risk and outcomes of severe acute respiratory syndrome coronavirus 2 infection in patients with hypertension. Korean J Intern Med 2021; 36:S123-S131. [PMID: 32872731 PMCID: PMC8009159 DOI: 10.3904/kjim.2020.390] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS There are concerns that the use of renin-angiotensin system (RAS) blockers may increase the risk of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or progressing to a severe clinical course after infection. This this study aimed to investigate the influence of RAS blockers on the risk and severity of SARS-CoV-2 infection. METHODS We conducted a retrospective cohort study analyzing nationwide claims data of 215,184 adults who underwent SARS-CoV-2 tests in South Korea. The SARS-CoV-2 positive rates and clinical outcomes were evaluated according to the use of RAS blockers in patients with hypertension (n = 64,243). RESULTS In total, 38,919 patients with hypertension were on RAS blockers. The SARS-CoV-2 positive rates were significantly higher in the RAS blocker group than in the control group after adjustments (adjusted odds ratio [OR], 1.22; 95% confidence interval [CI], 1.10 to 1.36; p < 0.001), and matching by propensity score (adjusted OR, 1.16; 95% CI, 1.03 to 1.32; p = 0.017). Among the 1,609 SARS-CoV-2-positive patients with hypertension, the use of RAS blockers was not associated with poor outcomes, such as mortality (adjusted OR, 0.81; 95% CI, 0.56 to 1.17; p = 0.265), and a composite of admission to the intensive care unit and mortality (adjusted OR, 0.95; 95% CI, 0.73 to 1.22; p = 0.669). Analysis in the propensity scorematched population showed consistent results. CONCLUSION In this Korean nationwide claims dataset, the use of RAS blockers was associated with a higher risk to SARS-CoV-2 infection but not with higher mortality or other severe clinical courses.
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Affiliation(s)
- Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Youngjin Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Ouédraogo AR, Bougma G, Baguiya A, Sawadogo A, Kaboré PR, Minougou CJ, Diendéré A, Maiga S, Agbaholou CR, Hema A, Sondo A, Ouédraogo G, Sanou A, Ouedraogo M. [Factors associated with the occurrence of acute respiratory distress and death in patients with COVID-19 in Burkina Faso]. Rev Mal Respir 2021; 38:240-248. [PMID: 33589360 PMCID: PMC7862901 DOI: 10.1016/j.rmr.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/16/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The development of acute respiratory distress syndrome indicates a serious form of COVID-19. Although there have been several studies on the prognostic factors of its severe form, no such study has been conducted in Burkina Faso. METHODS This was a retrospective cohort study conducted from March 9 to June 9, 2020 in Ouagadougou, Burkina Faso which involved 456 patients with COVID-19. RESULTS Nearly a quarter of the patients (23.2%) had presented with acute respiratory distress and 44.3% of them died. Being over 65 years old (HR: 2.7; 95% CI: 1.5-5.1) and having hypertension (HR: 1.9; 95% CI: 1-3.5) were independently associated with the risk of mortality. However, after adjustment, only age over 65 years (HR: 2.3; 95% CI: 1.2-4.3) was a risk factor for death. The survival rate for patients over 65 was 38.5% at 7 days and 30.3% at 15 days. CONCLUSIONS Acute respiratory distress leading to death is mainly found in older people with COVID-19. Close monitoring of these high-risk patients may reduce the risk of death.
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Affiliation(s)
- A R Ouédraogo
- Service de Pneumologie, Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso.
| | - G Bougma
- Service de Pneumologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - A Baguiya
- Institut de Recherche en Sciences de la Santé, Unité de Surveillance Démographique et de Santé de Kaya, Burkina Faso
| | - A Sawadogo
- Service de maladies infectieuses et tropicales du Centre Hospitalier Universitaire Régional de Ouahigouya, Ouahigouya, Burkina Faso
| | - P R Kaboré
- Hôpital de district de Boulmiougou, Ouagadougou, Burkina Faso
| | - C J Minougou
- Service de Pneumologie, Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
| | - A Diendéré
- Service de médecine interne, Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | - S Maiga
- Service de maladies infectieuses et tropicales du Centre Hospitalier Universitaire Régional de Ouahigouya, Ouahigouya, Burkina Faso
| | - C R Agbaholou
- Service de Pneumologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - A Hema
- Service de Pneumologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - A Sondo
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - G Ouédraogo
- Service de Pneumologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - A Sanou
- Service de Chirurgie, Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
| | - M Ouedraogo
- Service de Pneumologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Byrne C, Pareek M, Vaduganathan M, Biering-Sørensen T, Qamar A, Pandey A, Olesen TB, Olsen MH, Bhatt DL. Intensive blood pressure lowering in different age categories: insights from the Systolic Blood Pressure Intervention Trial. Eur Heart J Cardiovasc Pharmacother 2021; 6:356-363. [PMID: 31529024 DOI: 10.1093/ehjcvp/pvz050] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 12/12/2022]
Abstract
AIMS The 2018 ESC/ESH guidelines for hypertension recommend differential management of patients who are <65, 65-79, and ≥80 years of age. However, it is unclear whether intensive blood pressure lowering is well-tolerated and modifies risk uniformly across the age spectrum. METHODS AND RESULTS SPRINT randomized 9361 high-risk adults without diabetes and age ≥50 years with systolic blood pressure 130-180 mmHg to either intensive or standard antihypertensive treatment. The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety endpoint was composite serious adverse events. We assessed whether age modified the efficacy and safety of intensive vs. standard blood pressure lowering using Cox proportional-hazards regression and restricted cubic splines. In all, 3805 (41%), 4390 (47%), and 1166 (12%) were <65, 65-79, and ≥80 years. Mean age was similar between the two study groups (intensive group 67.9 ± 9.4 years vs. standard group 67.9 ± 9.5 years; P = 0.94). Median follow-up was 3.3 years. In multivariable models, age was linearly associated with the risk of stroke (P < 0.001) and non-linearly associated with the risk of primary efficacy events, death from cardiovascular causes, death from any cause, heart failure, and serious adverse events (P < 0.001). The safety and efficacy of intensive blood pressure lowering were not modified by age, whether tested continuously or categorically (P > 0.05). CONCLUSION In SPRINT, the benefits and risks of intensive blood pressure lowering did not differ according to the age categories proposed by the ESC/ESH guidelines for hypertension. TRIAL REGISTRATION SPRINT (Systolic Blood Pressure Intervention Trial); ClinicalTrials.gov Identifier: NCT01206062, https://clinicaltrials.gov/ct2/show/NCT01206062.
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Affiliation(s)
- Christina Byrne
- Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Manan Pareek
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
- Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, 20 York St, New Haven, CT 06510, USA
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Tor Biering-Sørensen
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Arman Qamar
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Ambarish Pandey
- Department of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Thomas Bastholm Olesen
- Department of Internal Medicine, Hospital of Little Belt, Sygehusvej 24, 6000 Kolding, Denmark
| | - Michael Hecht Olsen
- Division of Cardiology, Department of Internal Medicine, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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Abstract
BACKGROUND All major guidelines for antihypertensive therapy recommend weight loss. Dietary interventions that aim to reduce body weight might therefore be a useful intervention to reduce blood pressure and adverse cardiovascular events associated with hypertension. OBJECTIVES Primary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events). Secondary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on change from baseline in systolic blood pressure, change from baseline in diastolic blood pressure, and body weight reduction. SEARCH METHODS For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 3), Ovid MEDLINE, Ovid Embase, and ClinicalTrials.gov. We also contacted authors of relevant papers about further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) of at least 24 weeks' duration that compared weight-reducing dietary interventions to no dietary intervention in adults with primary hypertension. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risks of bias and extracted data. Where appropriate and in the absence of significant heterogeneity between studies (P > 0.1), we pooled studies using a fixed-effect meta-analysis. In case of moderate or larger heterogeneity as measured by Higgins I2, we used a random-effects model. MAIN RESULTS This second review update did not reveal any new trials, so the number of included trials remains the same: eight RCTs involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was 6 to 36 months. We judged the risks of bias as unclear or high for all but two trials. No study included mortality as a predefined outcome. One RCT evaluated the effects of dietary weight loss on a combined endpoint consisting of the necessity of reinstating antihypertensive therapy and severe cardiovascular complications. In this RCT, weight-reducing diet lowered the endpoint compared to no diet: hazard ratio 0.70 (95% confidence interval (CI) 0.57 to 0.87). None of the trials evaluated adverse events as designated in our protocol. The certainty of the evidence was low for a blood pressure reduction in participants assigned to weight-loss diets as compared to controls: systolic blood pressure: mean difference (MD) -4.5 mm Hg (95% CI -7.2 to -1.8 mm Hg) (3 studies, 731 participants), and diastolic blood pressure: MD -3.2 mm Hg (95% CI -4.8 to -1.5 mm Hg) (3 studies, 731 participants). We judged the certainty of the evidence to be high for weight reduction in dietary weight loss groups as compared to controls: MD -4.0 kg (95% CI -4.8 to -3.2) (5 trials, 880 participants). Two trials used withdrawal of antihypertensive medication as their primary outcome. Even though we did not consider this a relevant outcome for our review, the results of these RCTs strengthen the finding of a reduction of blood pressure by dietary weight-loss interventions. AUTHORS' CONCLUSIONS In this second update, the conclusions remain unchanged, as we found no new trials. In people with primary hypertension, weight-loss diets reduced body weight and blood pressure, but the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials.
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Affiliation(s)
- Thomas Semlitsch
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
| | - Cornelia Krenn
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
| | - Klaus Jeitler
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Karl Horvath
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
| | - Andrea Siebenhofer
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
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Malek AM, Wilson DA, Turan TN, Mateus J, Lackland DT, Hunt KJ. Maternal Coronary Heart Disease, Stroke, and Mortality Within 1, 3, and 5 Years of Delivery Among Women With Hypertensive Disorders of Pregnancy and Pre-Pregnancy Hypertension. J Am Heart Assoc 2021; 10:e018155. [PMID: 33619981 PMCID: PMC8174275 DOI: 10.1161/jaha.120.018155] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 07/30/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022]
Abstract
Background Pre-pregnancy hypertension and hypertensive disorders of pregnancy (HDP; preeclampsia, eclampsia, gestational hypertension) are major health risks for maternal morbidity and mortality. However, it is unknown if racial/ethnic differences exist. We aimed to determine the impact of HDP and pre-pregnancy hypertension on maternal coronary heart disease, stroke, and mortality risk ≤1, 3, and 5 years post-delivery and by race/ethnicity ≤5 years. Methods and Results This retrospective cohort study included women aged 12 to 49 years with a live, singleton birth between 2004 to 2016 (n=254 491 non-Hispanic White; n=137 784 non-Hispanic Black; n=41 155 Hispanic). Birth and death certificates and International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) diagnosis codes in hospitalization/emergency department visit data defined HDP, pre-pregnancy hypertension, incident coronary heart disease and stroke, and all-cause mortality. During at least 1 pregnancy of the 433 430 women, 2.3% had pre-pregnancy hypertension with superimposed HDP, 15.7% had no pre-pregnancy hypertension with HDP, and 0.4% had pre-pregnancy hypertension without superimposed HDP, whereas 81.6% had neither condition. Maternal deaths from coronary heart disease, stroke, and all causes totaled 2136. Within 5 years of delivery, pre-pregnancy hypertension, and HDP were associated with all-cause mortality (hazard ratio [HR], 2.21; 95% CI, 1.61-3.03), incident coronary heart disease (HR, 3.79; 95% CI, 3.09-4.65), and incident stroke (HR, 3.10; 95% CI, 2.09-4.60). HDP alone was related to all outcomes. Race/ethnic differences were observed for non-Hispanic Black and non-Hispanic White women, respectively, in the associations of pre-pregnancy hypertension and HDP with all-cause mortality within 5 years of delivery (HR, 2.34 [95% CI, 1.58-3.47]; HR, 2.11 [95% CI, 1.23-3.65]; P interaction=0.001). Conclusions Maternal cardiovascular outcomes including mortality were increased ≤5 years post-delivery in HDP, pre-pregnancy hypertension, or pre-pregnancy hypertension with superimposed HDP. The race/ethnic interaction for all-cause mortality ≤5 years of delivery warrants further research.
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Affiliation(s)
- Angela M. Malek
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
| | - Dulaney A. Wilson
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
| | - Tanya N. Turan
- Department of NeurologyMedical University of South CarolinaCharlestonSC
| | - Julio Mateus
- Atrium HealthDepartment of Obstetrics & GynecologyMaternal‐Fetal Medicine DivisionCharlotteNC
| | | | - Kelly J. Hunt
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
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Abstract
AIMS Nowadays, the ongoing pandemic of COVID-19 caused by the novel coronavirus Syndrome-Coronavirus-2 (SARS-CoV-2) is an emerging, rapidly evolving situation. Complications such as hypertension, diabetes, COPD, cardiovascular disease, and cerebrovascular disease are major risk factors for patients with COVID-19. METHODS No meta-analysis has explored if or not diabetes related to mortality of patients with COVID-19. Therefore, this meta-analysis first aims to explore the possible clinical mortality between diabetes and COVID-19, analyze if diabetes patients infected with SARS-CoV-2 are exposed to the worst clinical prognostic risk, and to evaluate the reliability of the evidence. RESULTS Our results showed a close relationship between diabetes and mortality of COVID-19, with a pooled OR of 1.75 (95% CI 1.31-2.36; P = 0.0002). The pooled data were calculated with the fixed effects model (FEM) as no heterogeneity appeared in the studies. Sensitivity analysis showed that after omitting any single study or converting a random effect model to FEM, the main results still held. CONCLUSIONS Our meta-analysis showed that diabetes increases the mortality of patients with COVID-19. These results indicated the disturbance of blood glucose in the COVID-19 patients. More importantly, this meta-analysis grades the reliability of evidence for further basic and clinical research into the diabetes dysfunction in COVID-19 patients.
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Affiliation(s)
- Zeng-Hong Wu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yun Tang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qing Cheng
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Abstract
PURPOSE Covid-19 is a global threat that pushes health care to its limits. Since there is neither a vaccine nor a drug for Covid-19, people with an increased risk for severe and fatal courses of disease particularly need protection. Furthermore, factors increasing these risks are of interest in the search of potential treatments. A systematic literature review on the risk factors of severe and fatal Covid-19 courses is presented. METHODS The review is carried out on PubMed and a publicly available preprint dataset. For analysis, risk factors are categorized and information regarding the study such as study size and location are extracted. The results are compared to risk factors listed by four public authorities from different countries. RESULTS The 28 records included, eleven of which are preprints, indicate that conditions and comorbidities connected to a poor state of health such as high age, obesity, diabetes and hypertension are risk factors for severe and fatal disease courses. Furthermore, severe and fatal courses are associated with organ damages mainly affecting the heart, liver and kidneys. Coagulation dysfunctions could play a critical role in the organ damaging. Time to hospital admission, tuberculosis, inflammation disorders and coagulation dysfunctions are identified as risk factors found in the review but not mentioned by the public authorities. CONCLUSION Factors associated with increased risk of severe or fatal disease courses were identified, which include conditions connected with a poor state of health as well as organ damages and coagulation dysfunctions. The results may facilitate upcoming Covid-19 research.
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Affiliation(s)
- Dominik Wolff
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany.
| | - Sarah Nee
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
| | - Natalie Sandy Hickey
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
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Wang ZQ, Zhai Y, Li M, Yang XF, Zhang J, Ren ZP, Zhang M, Song PK, Zhao YF, Mi SQ, Zhang L, Yang MX, Zhao WH. Association between Baseline SBP/DBP and All-Cause Mortality in Residents of Shanxi, China: A Population-based Cohort Study from 2002 to 2015. Biomed Environ Sci 2021; 34:1-8. [PMID: 33531102 DOI: 10.3967/bes2021.002] [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] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the association between blood pressure and all-cause mortality in Shanxi, China. METHODS The '2002 China Nutrition and Health Survey' baseline data in Shanxi province was used. A retrospective investigation was performed in 2015. The effects of SBP and DBP on the all-cause mortality were analyzed using the Cox regression model. The hazard ratio ( HR) and 95% confidence interval ( CI) were estimated by the sex and age groups. RESULTS The follow-up rate was 76.52% over 13 years, while the cumulative mortality rate for all participants was 917.12/100,000 person-years. The mortality rose with an increasing SBP ( χ 2 trend = 270.537, P < 0.001) or DBP level ( χ 2 trend = 57.240, P < 0.001). After adjustment for the confounding factors, a significant association between mortality and high SBP (≥ 160 mmHg) and high DBP (≥ 100 mmHg), with adjusted HR ranging from 1.405- to 2.179-fold for SBP and 1.550- to 2.854-fold for DBP, was noted. Significant HRs for most DBP subgroups were found in > 60-year-old participants. Males with DBP ≥ 100 mmHg had a significantly higher mortality, with an HR (95% CI) of 2.715 (1.377-5.351). CONCLUSION Adults with SBP > 160 mmHg and DBP > 100 mmHg had a higher mortality risk. Sex and age difference was noted in both DBP and mortality risk.
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Affiliation(s)
- Zhuo Qun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing 100050, China
| | - Yi Zhai
- Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Man Li
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistic, Hebei Medical University, Shijiazhuang 050017, Hebei, China
| | - Xiu Feng Yang
- Xinfu Center for Disease Control and Prevention, Xinfu 034000, Shanxi, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Ze Ping Ren
- Shanxi Center for Disease Control and Prevention, Taiyuan 030012, Shanxi, China
| | - Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing 100050, China
| | - Peng Kun Song
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yan Fang Zhao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing 100050, China
| | - Sheng Quan Mi
- College of Biochemical Engineering, Beijing Union University, Beijing 100023, China
| | - Lu Zhang
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistic, Hebei Medical University, Shijiazhuang 050017, Hebei, China
| | - Mao Xiang Yang
- Xinfu Center for Disease Control and Prevention, Xinfu 034000, Shanxi, China
| | - Wen Hua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Siebenhofer A, Winterholer S, Jeitler K, Horvath K, Berghold A, Krenn C, Semlitsch T. Long-term effects of weight-reducing drugs in people with hypertension. Cochrane Database Syst Rev 2021; 1:CD007654. [PMID: 33454957 PMCID: PMC8094237 DOI: 10.1002/14651858.cd007654.pub5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/18/2022]
Abstract
BACKGROUND This is the third update of this review, first published in July 2009. All major guidelines on treatment of hypertension recommend weight loss; anti-obesity drugs may be able to help in this respect. OBJECTIVES Primary objectives: To assess the long-term effects of pharmacologically-induced reduction in body weight in adults with essential hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events).. Secondary objectives: To assess the long-term effects of pharmacologically-induced reduction in body weight in adults with essential hypertension on change from baseline in systolic and diastolic blood pressure, and on body weight reduction. SEARCH METHODS For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The searches had no language restrictions. We contacted authors of relevant papers about further published and unpublished work. SELECTION CRITERIA Randomised controlled trials of at least 24 weeks' duration in adults with hypertension that compared approved long-term weight-loss medications to placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risks of bias, and extracted data. Where appropriate and in the absence of significant heterogeneity between studies (P > 0.1), we pooled studies using a fixed-effect meta-analysis. When heterogeneity was present, we used the random-effects method and investigated the cause of the heterogeneity. MAIN RESULTS This third update of the review added one new trial, investigating the combination of naltrexone/bupropion versus placebo. Two medications, which were included in the previous versions of this review (rimonabant and sibutramine) are no longer considered relevant for this update, since their marketing approval was withdrawn in 2010 and 2009, respectively. The number of included studies in this review update is therefore six (12,724 participants in total): four RCTs comparing orlistat to placebo, involving a total of 3132 participants with high blood pressure and a mean age of 46 to 55 years; one trial comparing phentermine/topiramate to placebo, involving 1305 participants with high blood pressure and a mean age of 53 years; and one trial comparing naltrexone/bupropion to placebo, involving 8283 participants with hypertension and a mean age of 62 years. We judged the risks of bias to be unclear for the trials investigating orlistat or naltrexone/bupropion. and low for the trial investigating phentermine/topiramate. Only the study of naltrexone/bupropion included cardiovascular mortality and morbidity as predefined outcomes. There were no differences in the rates of all-cause or cardiovascular mortality, major cardiovascular events, or serious adverse events between naltrexone/bupropion and placebo. The incidence of overall adverse events was significantly higher in participants treated with naltrexone/bupropion. For orlistat, the incidence of gastrointestinal side effects was consistently higher compared to placebo. The most frequent side effects with phentermine/topiramate were dry mouth and paraesthesia. After six to 12 months, orlistat reduced systolic blood pressure compared to placebo by mean difference (MD) -2.6 mm Hg (95% confidence interval (CI) -3.8 to -1.4 mm Hg; 4 trials, 2058 participants) and diastolic blood pressure by MD -2.0 mm Hg (95% CI -2.7 to -1.2 mm Hg; 4 trials, 2058 participants). After 13 months of follow-up, phentermine/topiramate decreased systolic blood pressure compared to placebo by -2.0 to -4.2 mm Hg (1 trial, 1030 participants) (depending on drug dosage), and diastolic blood pressure by -1.3 to -1.9 mm Hg (1 trial, 1030 participants) (depending on drug dosage). There was no difference in the change in systolic or diastolic blood pressure between naltrexone/bupropion and placebo (1 trial, 8283 participants). We identified no relevant studies investigating liraglutide or lorcaserin in people with hypertension. AUTHORS' CONCLUSIONS In people with elevated blood pressure, orlistat, phentermine/topiramate and naltrexone/bupropion reduced body weight; the magnitude of the effect was greatest with phentermine/topiramate. In the same trials, orlistat and phentermine/topiramate, but not naltrexone/bupropion, reduced blood pressure. One RCT of naltrexone/bupropion versus placebo showed no differences in all-cause mortality or cardiovascular mortality or morbidity after two years. The European Medicines Agency refused marketing authorisation for phentermine/topiramate due to safety concerns, while for lorcaserin the application for European marketing authorisation was withdrawn due to a negative overall benefit/risk balance. In 2020 lorcaserin was also withdrawn from the US market. Two other medications (rimonabant and sibutramine) had already been withdrawn from the market in 2009 and 2010, respectively.
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Affiliation(s)
- Andrea Siebenhofer
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for General Practice, Goethe University, Frankfurt am Main, Germany
| | - Sebastian Winterholer
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
| | - Klaus Jeitler
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Karl Horvath
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Cornelia Krenn
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
| | - Thomas Semlitsch
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
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Malo S, Aguilar-Palacio I, Feja C, Lallana MJ, Armesto J, Rabanaque MJ. Effect of patient and treatment factors on persistence with antihypertensive treatment: A population-based study. PLoS One 2021; 16:e0245610. [PMID: 33450744 PMCID: PMC7810514 DOI: 10.1371/journal.pone.0245610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To analyze patterns of antihypertensive drug use among new users in a Southern European population, and identify patient- and treatment-related factors that influence persistence. Methods This is a retrospective observational study of new antihypertensive drug users aged ≥40 years in Aragón, Spain. Information on antihypertensive drugs (2014–2016) prescribed and dispensed at pharmacies via the public health system were collected from a regional electronic population-based pharmacy database. Persistence was assessed using the gap method. Kaplan-Meier and Cox regression analyses were conducted to analyze patterns of use and factors that influence persistence. Results The 25,582 new antihypertensive drug users in Aragón during the study period were prescribed antihypertensive drugs in monotherapy (73.3%), fixed combination (13.9%), free combination (9.1%), or other (3.7%). One in five received antihypertensive drugs within 15 days of the prescription date, but not after. During the first year of follow-up, 38.6% of the study population remained persistent. The likelihood of treatment discontinuation was higher for participants who were male, aged ≥80 years, and received an antihypertensive drug in monotherapy compared with fixed combination. Conclusion Overall persistence with antihypertensive therapy was poor, and was influenced by the sex, age and type of therapy. Fixed combinations appear to be a good choice for initial therapy, especially in patients with a higher risk of discontinuation. Nonetheless, adverse drug effects and the patient’s preferences and clinical profile should be taken into account.
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Affiliation(s)
- Sara Malo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, Spain
- * E-mail:
| | - Isabel Aguilar-Palacio
- Department of Preventive Medicine and Public Health, University of Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, Spain
| | - Cristina Feja
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, Spain
- Directorate of Public Health, Government of Aragon, Zaragoza, Spain
| | - María Jesús Lallana
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, Spain
- Aragon Healthcare Service, Zaragoza, Spain
| | | | - María José Rabanaque
- Department of Preventive Medicine and Public Health, University of Zaragoza, Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, Spain
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Premužić V, Stevanović R, Radić P, Salvetti M, Lovrić-Benčić M, Jelaković A, Miličić D, Capak K, Agabiti-Rosei E, Jelaković B. Chronic kidney disease and cardiovascular mortality in patients with atrial fibrillation: European Society of Hypertension project - ESH A Fib. Medicine (Baltimore) 2021; 100:e23975. [PMID: 33466138 PMCID: PMC7808501 DOI: 10.1097/md.0000000000023975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/30/2020] [Indexed: 01/05/2023] Open
Abstract
Our aim was to analyze characteristics of atrial fibrillation (AF) patients with chronic kidney disease (CKD) from the Croatian cohort of the ESH A Fib survey and to determine the association of estimated glomerular filtration rate (eGFR) with cardiovascular (CV) mortality after 24 months of follow-up.Consecutive sample of 301 patients with AF were enrolled in the period 2014 to 2018. Hypertension was defined as BP > 140/90 mm Hg and/or antihypertensive drugs treatment, CKD was defined as eGFR (CKD Epi) < 60 ml/min/1.73 m2 which was confirmed after 3 months.CKD was diagnosed in 45.2% of patients (13.3% in CKD stage > 3b). CKD patients were older than non-CKD and had significantly more frequent coronary heart disease, heart failure and valvular disease. CKD patients had significantly higher CHA2DS2-VASc score and more CKD than non-CKD patients had CHA2DS2-VASc > 2. Crude CV mortality rate per 1000 population at the end of the first year of the follow-up was significantly higher in CKD vs non-CKD group who had shorter mean survival time. CV mortality was independently associated with eGFR, male gender, CHA2DS2VASc and R2CHA2DS2VASc scores.Prevalence of CKD, particularly more advanced stages of CKD, is very high in patients with AF. Observed higher CV mortality and shorter mean survival time in CKD patients could be explained with higher CHA2DS2VASc score which is a consequence of clustering of all score components in CKD patients. However, eGFR was independently associated with CV mortality. In our cohort, R2CHA2DS2VASc score was not associated significantly more with CV mortality than CHA2DS2VASc score.
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Affiliation(s)
- Vedran Premužić
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb
- School of Medicine, Zagreb, Croatia
| | | | - Petra Radić
- University Hospital Center Sisters of Mercy, Zagreb, Croatia
| | | | - Martina Lovrić-Benčić
- Cardiology Clinic, University Hospital Center Zagreb
- School of Medicine, Zagreb, Croatia
| | - Ana Jelaković
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb
| | - Davor Miličić
- Cardiology Clinic, University Hospital Center Zagreb
- School of Medicine, Zagreb, Croatia
| | | | | | - Bojan Jelaković
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb
- School of Medicine, Zagreb, Croatia
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Park BE, Lee JH, Park HK, Kim HN, Jang SY, Bae MH, Yang DH, Park HS, Cho Y, Lee BY, Nam CW, Lee JB, Kim U, Chae SC. Impact of Cardiovascular Risk Factors and Cardiovascular Diseases on Outcomes in Patients Hospitalized with COVID-19 in Daegu Metropolitan City. J Korean Med Sci 2021; 36:e15. [PMID: 33429474 PMCID: PMC7801150 DOI: 10.3346/jkms.2021.36.e15] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/28/2020] [Accepted: 12/18/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Data regarding the association between preexisting cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs) and the outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) are limited. Therefore, the aim of this study was to investigate the impact of preexisting CVRFs or CVDs on the outcomes of patients with COVID-19 hospitalized in a Korean healthcare system. METHODS Patients with COVID-19 admitted to 10 hospitals in Daegu Metropolitan City, Korea, were examined. All sequentially hospitalized patients between February 15, 2020, and April 24, 2020, were enrolled in this study. All patients were confirmed to have COVID-19 based on the positive results on the polymerase chain reaction testing of nasopharyngeal samples. Clinical outcomes during hospitalization, such as requiring intensive care and invasive mechanical ventilation (MV) and death, were evaluated. Moreover, data on baseline comorbidities such as a history of diabetes, hypertension, dyslipidemia, current smoking, heart failure, coronary artery disease, cerebrovascular accidents, and other chronic cardiac diseases were obtained. RESULTS Of all the patients enrolled, 954 (42.0%) had preexisting CVRFs or CVDs. Among the CVRFs, the most common were hypertension (28.8%) and diabetes mellitus (17.0%). The prevalence rates of preexisting CVRFs or CVDs increased with age (P < 0.001). The number of patients requiring intensive care (P < 0.001) and invasive MV (P < 0.001) increased with age. The in-hospital death rate increased with age (P < 0.001). Patients requiring intensive care (5.3% vs. 1.6%; P < 0.001) and invasive MV (4.3% vs. 1.7%; P < 0.001) were significantly greater in patients with preexisting CVRFs or CVDs. In-hospital mortality (12.9% vs. 3.1%; P < 0.001) was significantly higher in patients with preexisting CVRFs or CVDs. Among the CVRFs, diabetes mellitus and hypertension were associated with increased requirement of intensive care and invasive MV and in-hospital death. Among the known CVDs, coronary artery disease and congestive heart failure were associated with invasive MV and in-hospital death. In multivariate analysis, preexisting CVRFs or CVDs (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.07-3.01; P = 0.027) were independent predictors of in-hospital death after adjusting for confounding variables. Among individual preexisting CVRF or CVD components, diabetes mellitus (OR, 2.43; 95% CI, 1.51-3.90; P < 0.001) and congestive heart failure (OR, 2.43; 95% CI, 1.06-5.87; P = 0.049) were independent predictors of in-hospital death. CONCLUSION Based on the findings of this study, the patients with confirmed COVID-19 with preexisting CVRFs or CVDs had worse clinical outcomes. Caution is required in dealing with these patients at triage.
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Affiliation(s)
- Bo Eun Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Hyuk Kyoon Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hong Nyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bong Yul Lee
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Chang Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jin Bae Lee
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Ung Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Abstract
Previous studies link obesity and components of metabolic health, such as hypertension or inflammation, to increased hospitalizations and mortality of patients with COVID-19. Here, in two overlapping samples of over 1,000 individuals from the UK Biobank we investigate whether metabolic health as measured by waist circumference, dyslipidemia, hypertension, type 2 diabetes, and systemic inflammation is related to increased COVID-19 infection and mortality rate. Using logistic regression and controlling for confounding variables such as socioeconomic status, age, sex or ethnicity, we find that individuals with worse metabolic health (measured on average eleven years prior to 2020) have an increased risk for COVID-19-related death (adjusted odds ratio: 1.75). We also find that specific factors contributing to increased mortality are increased serum glucose levels, systolic blood pressure and waist circumference.
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Charoensri S, Kritmetapak K, Tangpattanasiri T, Pongchaiyakul C. The Impact of New-Onset Diabetes Mellitus and Hypertension on All-Cause Mortality in an Apparently Healthy Population: A Ten-Year Follow-Up Study. J Diabetes Res 2021; 2021:3964013. [PMID: 34778463 PMCID: PMC8589482 DOI: 10.1155/2021/3964013] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The comparative effect of new-onset diabetes mellitus (DM) and hypertension (HT) on long-term mortality is a matter of debate. MATERIALS AND METHODS From 2007 to 2017, a 10-year longitudinal retrospective cohort study was conducted in Thailand's tertiary care setting. As baseline data, health check-up data from apparently healthy participants without underlying disease from 2007 were extracted. The vital status of all participants was determined in 2017, ten years after an initial examination. The impact of new-onset DM and HT at baseline on 10-year all-cause mortality was investigated using multivariable logistic regression analysis. RESULTS The prevalence of new-onset DM and HT was 6.4% and 28.8%, respectively, at baseline. Newly diagnosed diabetes increased the risk of all-cause mortality over 10 years (adjusted OR 4.77 and 95% CI 2.23-9.99). HT, on the other hand, did not increase the risk of death (adjusted OR 1.24 and 95% CI 0.65-2.35). Different HT and DM status combinations were compared to a nondiabetic, nonhypertensive reference. Individuals who were diabetic and hypertensive had a greater risk of death (adjusted OR 6.22 and 95% CI 2.22-17.00). Having DM without HT also increased the risk of death (adjusted OR 4.36 and 95% CI 1.35-12.87). However, having HT without DM did not result in a significant increase in 10-year mortality risk (adjusted OR 1.21 and 95% CI 0.57-2.56). CONCLUSION In an apparently healthy population, new-onset DM is more strongly associated with 10-year all-cause mortality than new-onset HT. Having both DM and HT was associated with a greater risk of death when compared to having DM or HT alone.
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Affiliation(s)
- Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittrawee Kritmetapak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Mejía F, Medina C, Cornejo E, Morello E, Vásquez S, Alave J, Schwalb A, Málaga G. Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PLoS One 2020; 15:e0244171. [PMID: 33370364 PMCID: PMC7769479 DOI: 10.1371/journal.pone.0244171] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [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: 08/13/2020] [Accepted: 12/06/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Peru is among the top ten countries with the highest number of coronavirus disease 2019 (COVID-19) cases worldwide. The aim of the study was to describe the clinical features of hospitalized adult patients with COVID-19 and to determine the prognostic factors associated with in-hospital mortality. METHODS We conducted a retrospective cohort study among adult patients with COVID-19 admitted to Hospital Cayetano Heredia; a tertiary care hospital in Lima, Peru. The primary outcome was in-hospital mortality. Multivariate Cox proportional hazards regression was used to identify factors independently associated with in-hospital mortality. RESULTS A total of 369 patients (median age 59 years [IQR:49-68]; 241 (65.31%) male) were included. Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) values of less than 90% on admission correlated with mortality, presenting 1.86 (95%CI: 1.02-3.39), 4.44 (95%CI: 2.46-8.02) and 7.74 (95%CI: 4.54-13.19) times greater risk of death for SaO2 of 89-85%, 84-80% and <80%, respectively, when compared to patients with SaO2 >90%. Additionally, age >60 years was associated with 1.88 times greater mortality. CONCLUSIONS Oxygen saturation below 90% on admission is a strong predictor of in-hospital mortality in patients with COVID-19. In settings with limited resources, efforts to reduce mortality in COVID-19 should focus on early identification of hypoxemia and timely access to hospital care.
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Affiliation(s)
- Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Carlos Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | - Enrique Cornejo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | | | | | - Jorge Alave
- Hospital Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Unión, Lima, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Abstract
BACKGROUND This is the first update of this review first published in 2009. When treating elevated blood pressure, doctors usually try to achieve a blood pressure target. That target is the blood pressure value below which the optimal clinical benefit is supposedly obtained. "The lower the better" approach that guided the treatment of elevated blood pressure for many years was challenged during the last decade due to lack of evidence from randomised trials supporting that strategy. For that reason, the standard blood pressure target in clinical practice during the last years has been less than 140/90 mm Hg for the general population of patients with elevated blood pressure. However, new trials published in recent years have reintroduced the idea of trying to achieve lower blood pressure targets. Therefore, it is important to know whether the benefits outweigh harms when attempting to achieve targets lower than the standard target. OBJECTIVES The primary objective was to determine if lower blood pressure targets (any target less than or equal to 135/85 mm Hg) are associated with reduction in mortality and morbidity as compared with standard blood pressure targets (less than or equal to 140/ 90 mm Hg) for the treatment of patients with chronic arterial hypertension. The secondary objectives were: to determine if there is a change in mean achieved systolic blood pressure (SBP) and diastolic blood pressure (DBP associated with "lower targets" as compared with "standard targets" in patients with chronic arterial hypertension; and to determine if there is a change in withdrawals due to adverse events with "lower targets" as compared with "standard targets", in patients with elevated blood pressure. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to May 2019: the Cochrane Hypertension Specialised Register, CENTRAL (2019, Issue 4), Ovid MEDLINE, Ovid Embase, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing patients allocated to lower or to standard blood pressure targets (see above). DATA COLLECTION AND ANALYSIS Two review authors (JAA, VL) independently assessed the included trials and extracted data. Primary outcomes were total mortality; total serious adverse events; myocardial infarction, stroke, congestive heart failure, end stage renal disease, and other serious adverse events. Secondary outcomes were achieved mean SBP and DBP, withdrawals due to adverse effects, and mean number of antihypertensive drugs used. We assessed the risk of bias of each trial using the Cochrane risk of bias tool and the certainty of the evidence using the GRADE approach. MAIN RESULTS: This update includes 11 RCTs involving 38,688 participants with a mean follow-up of 3.7 years. This represents 7 new RCTs compared with the original version. At baseline the mean weighted age was 63.1 years and the mean weighted blood pressure was 155/91 mm Hg. Lower targets do not reduce total mortality (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.86 to 1.05; 11 trials, 38,688 participants; high-certainty evidence) and do not reduce total serious adverse events (RR 1.04, 95% CI 0.99 to 1.08; 6 trials, 18,165 participants; moderate-certainty evidence). This means that the benefits of lower targets do not outweigh the harms as compared to standard blood pressure targets. Lower targets may reduce myocardial infarction (RR 0.84, 95% CI 0.73 to 0.96; 6 trials, 18,938 participants, absolute risk reduction (ARR) 0.4%, number needed to treat to benefit (NNTB) 250 over 3.7 years) and congestive heart failure (RR 0.75, 95% CI 0.60 to 0.92; 5 trials, 15,859 participants, ARR 0.6%, NNTB 167 over 3.7 years) (low-certainty for both outcomes). Reduction in myocardial infarction and congestive heart failure was not reflected in total serious adverse events. This may be due to an increase in other serious adverse events (RR 1.44, 95% CI 1.32 to 1.59; 6 trials. 18,938 participants, absolute risk increase (ARI) 3%, number needed to treat to harm (NNTH) 33 over four years) (low-certainty evidence). Participants assigned to a "lower" target received one additional antihypertensive medication and achieved a significantly lower mean SBP (122.8 mm Hg versus 135.0 mm Hg, and a lower mean DBP (82.0 mm Hg versus 85.2 mm Hg, than those assigned to "standard target". AUTHORS' CONCLUSIONS For the general population of persons with elevated blood pressure, the benefits of trying to achieve a lower blood pressure target rather than a standard target (≤ 140/90 mm Hg) do not outweigh the harms associated with that intervention. Further research is needed to see if some groups of patients would benefit or be harmed by lower targets. The results of this review are primarily applicable to older people with moderate to high cardiovascular risk. They may not be applicable to other populations.
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Affiliation(s)
- Jose Agustin Arguedas
- Depto de Farmacologia Clinica, Facultad de Medicina, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica
| | - Viriam Leiva
- Escuela de Enfermeria, Facultad de Medicina, University of Costa Rica, San Jose, Costa Rica
| | - James M Wright
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
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Altonen BL, Arreglado TM, Leroux O, Murray-Ramcharan M, Engdahl R. Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City. PLoS One 2020; 15:e0243343. [PMID: 33315929 PMCID: PMC7735602 DOI: 10.1371/journal.pone.0243343] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
This study reviewed 395 young adults, 18–35 year-old, admitted for COVID-19 to one of the eleven hospitals in New York City public health system. Demographics, comorbidities, clinical course, outcomes and characteristics linked to hospitalization were analyzed including temporal survival analysis. Fifty-seven percent of patients had a least one major comorbidity. Mortality without comorbidity was in 3.8% patients. Further investigation of admission features and medical history was conducted. Comorbidities associated with mortality were diabetes (n = 54 deceased/73 diagnosed,74% tested POS;98.2% with diabetic history deceased; Wilcoxon p (Wp) = .044), hypertension (14/44,32% POS, 25.5%; Wp = 0.030), renal (6/16, 37.5% POS,11%; Wp = 0.000), and cardiac (6/21, 28.6% POS,11%; Wp = 0.015). Kaplan survival plots were statistically significant for these four indicators. Data suggested glucose >215 or hemoglobin A1c >9.5 for young adults on admission was associated with increased mortality. Clinically documented respiratory distress on admission was statistically significant outcome related to mortality (X2 = 236.6842, df = 1, p < .0001). Overall, 28.9% required supportive oxygen beyond nasal cannula. Nasal cannula oxygen alone was required for 71.1%, who all lived. Non-invasive ventilation was required for 7.8%, and invasive mechanical ventilation 21.0% (in which 7.3% lived, 13.7% died). Temporal survival analysis demonstrated statistically significant response for Time to Death <10 days (X2 = 18.508, df = 1, p = .000); risk lessened considerably for 21 day cut off (X2 = 3.464, df = 1, p = .063), followed by 31 or more days of hospitalization (X2 = 2.212, df = 1, p = .137).
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Affiliation(s)
- Brian L. Altonen
- Division of Population Health and Research Administration, NYC Health + Hospitals, New York, New York, United States of America
| | - Tatiana M. Arreglado
- Division of Clinical Informatics, NYC Health + Hospitals, Harlem Hospital, New York, New York, United States of America
| | - Ofelia Leroux
- Department of Surgery, NYC Health + Hospitals, Harlem Hospital, New York, New York, United States of America
| | - Max Murray-Ramcharan
- Department of Surgery, NYC Health + Hospitals, Harlem Hospital, New York, New York, United States of America
| | - Ryan Engdahl
- Department of Surgery, NYC Health + Hospitals, Harlem and Woodhull Hospitals, New York, New York, United States of America
- * E-mail:
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Pantea Stoian A, Pricop-Jeckstadt M, Pana A, Ileanu BV, Schitea R, Geanta M, Catrinoiu D, Suceveanu AI, Serafinceanu C, Pituru S, Poiana C, Timar B, Nitipir C, Parvu S, Arsene A, Mazilu L, Toma A, Hainarosie R, Ceriello A, Rizzo M, Jinga V. Death by SARS-CoV 2: a Romanian COVID-19 multi-centre comorbidity study. Sci Rep 2020; 10:21613. [PMID: 33303885 PMCID: PMC7730445 DOI: 10.1038/s41598-020-78575-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 06/24/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, gender and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection.
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Affiliation(s)
- Anca Pantea Stoian
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
- National Institute of Diabetes, Nutrition and Metabolic Diseases "N. C. Paulescu", 5-7. Ion Movila Str, 030167, Bucharest, Romania
| | - Mihaela Pricop-Jeckstadt
- Department of Applied Mathematics, University POLITEHNICA of Bucharest, Splaiul Independentei 313, 060042, Bucharest, Romania.
- Center for Research and Training in Innovative Techniques of Applied Mathematics in Engineering-Traian Lalescu-(CiTi), University Politehnica of Bucharest, Splaiul Independentei 313, 060042, Bucharest, Romania.
| | - Adrian Pana
- Center for Health Outcomes & Evaluation, Splaiul Unirii 45, 030126, Bucharest, Romania
| | - Bogdan-Vasile Ileanu
- Center for Health Outcomes & Evaluation, Splaiul Unirii 45, 030126, Bucharest, Romania
| | - Ruxandra Schitea
- Center for Innovation in Medicine, Bd. Theodor Pallady, No. 42J, Room 1719, 032266, Bucharest, Romania
| | - Marius Geanta
- Center for Innovation in Medicine, Bd. Theodor Pallady, No. 42J, Room 1719, 032266, Bucharest, Romania
| | - Doina Catrinoiu
- Department of Internal Medicine, Faculty of Medicine, Ovidius University of Constanta, University C2 Street, 900527, Constanţa, Romania
| | - Andra Iulia Suceveanu
- Department of Internal Medicine, Faculty of Medicine, Ovidius University of Constanta, University C2 Street, 900527, Constanţa, Romania
| | - Cristian Serafinceanu
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
- National Institute of Diabetes, Nutrition and Metabolic Diseases "N. C. Paulescu", 5-7. Ion Movila Str, 030167, Bucharest, Romania
| | - Silviu Pituru
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
| | - Catalina Poiana
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
| | - Bogdan Timar
- Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041, Timisoara, Romania
| | - Cornelia Nitipir
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
| | - Simona Parvu
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
| | - Andreea Arsene
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
| | - Laura Mazilu
- Department of Internal Medicine, Faculty of Medicine, Ovidius University of Constanta, University C2 Street, 900527, Constanţa, Romania
| | - Antonela Toma
- Center for Research and Training in Innovative Techniques of Applied Mathematics in Engineering-Traian Lalescu-(CiTi), University Politehnica of Bucharest, Splaiul Independentei 313, 060042, Bucharest, Romania
- Department of Mathematical Methods and Models, University POLITEHNICA of Bucharest, Splaiul Independentei 313, 060042, Bucharest, Romania
| | - Razvan Hainarosie
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
- Prof. Dr. D. Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344, Bucharest, Romania
| | - Antonio Ceriello
- IRCCS MultiMedica, 300 Milanese Str, 20099, Milan, Sesto San Giovanni, Italy
| | - Manfredi Rizzo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of South Carolina, 6311 Garners Ferry Rd, Columbia, SC, 29209, USA
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 61 Piazza Marina Str, 90133, Palermo, Italy
| | - Viorel Jinga
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania
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