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Ahn J, Song JH, Shin IS, Cho IY, Kang MY. Systematic review and meta-analysis of the association between long working hours and hypertension risk. J Epidemiol Community Health 2024; 78:367-373. [PMID: 38448227 DOI: 10.1136/jech-2023-220912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Hypertension, a major public health problem worldwide, has been linked to lifestyle factors and work conditions, with conflicting evidence on the association between long work hours and risk of hypertension. METHODS We conducted a systematic review and meta-analysis of observational studies to investigate the relationship between working hours and hypertension or blood pressure, assessed the risk of bias and performed subgroup analyses. The protocol was registered with the International Prospective Register of Systematic Reviews. RESULTS The pooled OR for the association between long working hours and risk of hypertension was 1.09 (95% CI: 0.88 to 1.35) in the 15 studies that used hypertension as the outcome. In the three studies that used blood pressure as the outcome, diastolic blood pressure was higher among those with long working hours compared with those with non-long working hours (1.24 mm Hg, 95% CI: 0.19 to 2.29). In subgroup analysis, the pooled OR for the association between long working hours and risk of hypertension was 1.28 (95% CI: 1.14 to 1.44) and 1.00 (95% CI: 0.64 to 1.56) in women and men, respectively. CONCLUSIONS Although this study could not clearly confirm the relationship between long working hours and hypertension, the subgroup analysis suggests that long working hours may be associated with hypertension, particularly among women. More reliable research is needed to establish causality. PROSPERO REGISTRATION NUMBER CRD42023406961.
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Affiliation(s)
- Joonho Ahn
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hun Song
- Gong-gam Center for Occupational and Environmental Medicine, Hyangnam Gong-gam Clinic, Hwasung, Gyeonggi-do, Republic of Korea
| | - In-Soo Shin
- Graduate School of Education. Dongguk University, Seoul, Republic of Korea
| | - In Young Cho
- Department of Family Medicine, amsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mo-Yeol Kang
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Xu R, Tian Q, Wei J, Ye Y, Li Y, Lin Q, Wang Y, Liu L, Shi C, Xia W, Liu Y. Short-term exposure to ambient air pollution and readmissions for heart failure among 3660 post-discharge patients with hypertension in older Chinese adults. J Epidemiol Community Health 2022; 76:984-990. [PMID: 36198486 DOI: 10.1136/jech-2022-219676] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite ambient air pollution being associated with various adverse cardiovascular outcomes, the acute effects of ambient air pollution on hospital readmissions for heart failure (HF) among post-discharge patients with hypertension remain less understood. METHODS We conducted a time-stratified case-crossover study among 3660 subjects 60 years or older who were admitted to hospital for HF after discharge for hypertension in Guangzhou, China during 2016-2019. For each subject, individualised residential exposures to ambient particulate matter with an aerodynamic diameter ≤1 µm (PM1), ≤2.5 µm (PM2.5), ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone were extracted from our validated grid dataset. RESULTS An IQR increase of lag 04-day exposure to PM1 (IQR: 11.6 μg/m3), PM2.5 (IQR 21.9 μg/m3), PM10 (IQR 35.0 μg/m3), SO2 (IQR 4.4 μg/m3), NO2 (IQR 23.3 μg/m3) and CO (IQR 0.25 mg/m3) was significantly associated with a 9.77% (95% CI 2.21% to 17.89%), 8.74% (95% CI 1.05% to 17.00%), 13.93% (95% CI 5.36% to 23.20%), 10.81% (95% CI 1.82% to 20.60%), 14.97% (95% CI 8.05% to 22.34%) and 7.37% (95% CI 0.98% to 14.16%) increase in odds of HF readmissions, respectively. With adjustment for other pollutants, the association for NO2 exposure remained stable, while the associations for PM1, PM2.5, PM10, SO2 and CO exposures became insignificant. Overall, an estimated 19.86% of HF readmissions were attributable to NO2 exposure, while reducing NO2 exposure to the WHO and China air quality standards would avoid 12.87% and 0.54% of readmissions, respectively. No susceptible populations were observed by sex, age or season. CONCLUSION Short-term exposure to ambient NO2 was significantly associated with an increased odds of HF readmissions among post-discharge patients with hypertension in older Chinese adults.
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Affiliation(s)
- Ruijun Xu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qi Tian
- Department of Statistics, Guangzhou Health Technology Identification and Human Resources Assessment Center, Guangzhou, Guangdong, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland at College Park, College Park, Maryland, USA
| | - Yunshao Ye
- Department of Statistics, Guangzhou Health Technology Identification and Human Resources Assessment Center, Guangzhou, Guangdong, China
| | - Yingxin Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiaoxuan Lin
- Department of Statistics, Guangzhou Health Technology Identification and Human Resources Assessment Center, Guangzhou, Guangdong, China
| | - Yaqi Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Likun Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunxiang Shi
- Meteorological Data Laboratory, National Meteorological Information Center, Beijing, China
| | - Wenhao Xia
- Department of Hypertension and Vascular Disease, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Taylor AH, Taylor RS, Ingram WM, Anokye N, Dean S, Jolly K, Mutrie N, Lambert J, Yardley L, Greaves C, King J, McAdam C, Steele M, Price L, Streeter A, Charles N, Terry R, Webb D, Campbell J, Hughes L, Ainsworth B, Jones B, Jane B, Erwin J, Little P, Woolf A, Cavanagh C. Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT. Health Technol Assess 2020; 24:1-106. [PMID: 33243368 DOI: 10.3310/hta24630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. OBJECTIVES To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. DESIGN A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). SETTING Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. PARTICIPANTS There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. INTERVENTION e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. PRIMARY OUTCOME MEASURE Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. SECONDARY OUTCOMES Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. RESULTS Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. LIMITATIONS A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. FUTURE WORK The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. CONCLUSIONS Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. TRIAL REGISTRATION Current Controlled Trials ISRCTN15644451. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adrian H Taylor
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Rod S Taylor
- University of Exeter Medical School, University of Exeter, Exeter, UK.,Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Wendy M Ingram
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Nana Anokye
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Sarah Dean
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Jeffrey Lambert
- University of Exeter Medical School, University of Exeter, Exeter, UK.,Department for Health, University of Bath, Bath, UK
| | - Lucy Yardley
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Colin Greaves
- University of Exeter Medical School, University of Exeter, Exeter, UK.,School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | - Jennie King
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mary Steele
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Lisa Price
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Adam Streeter
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | | | - Rohini Terry
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Douglas Webb
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Lucy Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ben Ainsworth
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK.,Department of Psychology, University of Bath, Bath, UK
| | - Ben Jones
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ben Jane
- School of Sport, Health and Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Jo Erwin
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Paul Little
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
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Stojan G, Magder LS, Petri M. Blood Pressure Variability and Age-related Blood Pressure Patterns in Systemic Lupus Erythematosus. J Rheumatol 2019; 47:387-393. [PMID: 31203220 DOI: 10.3899/jrheum.181131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite the high prevalence of cardiovascular (CV) disease among patients with systemic lupus erythematosus (SLE), the relationship between age, blood pressure (BP), and BP variability (BPV) is not well understood. We studied visit-to-visit BPV, its relationship to age, clinical, and demographic characteristics, and its potential role as a CV risk factor in patients with SLE. METHODS We analyzed systolic (SBP) and diastolic BP (DBP) measures in our cohort using mixed-effects regression models. From these models, we then obtained estimates of the mean BP, the visit-to-visit SD, and the between-person SD. The estimated means were compared to the general population using data from the National Health Statistics Reports from 2001 to 2008. In addition, we examined the relationship between BP (means, variances), patient demographic and clinical characteristics, and subsequent CV events. RESULTS The mean SBP in SLE increased with age and was significantly higher in younger patients compared to the general population. BPV in SLE was elevated across all ages. BPV was significantly higher in African Americans, in patients with traditional CV risk factors, those with high disease activity, and in patients taking prednisone. Hydroxychloroquine was associated with significantly lower BPV. Within-person variability in DBP of ≥ 9 mmHg was highly associated with CV events in a multivariate analysis. CONCLUSION Age-related BP patterns in SLE differ from the general population. Increased visit-to-visit BPV is affected by many disease-specific and traditional CV factors. Increased DBP variability is highly associated with CV events in SLE.
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Affiliation(s)
- George Stojan
- From the Division of Rheumatology, Johns Hopkins University School of Medicine; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. .,G. Stojan, MD, Assistant Professor, Division of Rheumatology, Johns Hopkins University School of Medicine; L.S. Magder, Professor of Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine.
| | - Laurence S Magder
- From the Division of Rheumatology, Johns Hopkins University School of Medicine; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.,G. Stojan, MD, Assistant Professor, Division of Rheumatology, Johns Hopkins University School of Medicine; L.S. Magder, Professor of Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Division of Rheumatology, Johns Hopkins University School of Medicine; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.,G. Stojan, MD, Assistant Professor, Division of Rheumatology, Johns Hopkins University School of Medicine; L.S. Magder, Professor of Epidemiology, Department of Epidemiology and Public Health, University of Maryland School of Medicine; M. Petri, Professor of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine
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Derakhshan MH, Goodson NJ, Packham JC, Sengupta R, Molto A, Marzo-Ortega H, Siebert S. Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study. J Rheumatol 2019; 46:701-709. [PMID: 30647169 DOI: 10.3899/jrheum.180538] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is associated with a number of cardiovascular (CV) comorbidities. We examined the association of SpA disease duration and delay in diagnosis with CV-related conditions. METHODS Using data from the COMOSPA study, the associations between SpA disease duration and CV-related conditions were evaluated in univariable and multivariable logistic regression models. Each model examined 1 CV-related factor as dependent and "SpA disease duration" as a predictor, adjusted for relevant confounders. RESULTS Data from 3923 subjects (median SpA disease duration 5.1 yrs, interquartile range 1.3-11.8 yrs) were available for analysis. The main CV-related conditions were hypertension (HTN; 22.4%), ischemic heart disease (2.6%), stroke (1.3%), and diabetes mellitus (5.5%). HTN was associated with SpA disease duration in both univariable and multivariable analysis, with an OR of 1.129 (95% CI 1.072-1.189; p < 0.001) for each 5-year increase in SpA disease duration. Other factors associated with HTN were age, male sex, current body mass index, ever steroid therapy, and ever synthetic disease-modifying antirheumatic drug therapy, but not nonsteroidal antiinflammatory drugs (NSAID). In subgroup analysis, the strongest association of HTN and disease duration was seen in subjects with the axial-only SpA phenotype (OR 1.202, 95% CI 1.053-1.372) but not in those with peripheral-only SpA (OR 0.902, 95% CI 0.760-1.070). The other CV conditions were not associated with SpA disease duration. CONCLUSION Duration of SpA disease in the ASAS-COMOSPA cohort is associated with higher odds of HTN, particularly in those with axial disease, but not with other CV-related conditions. The association with HTN does not appear to be related to NSAID exposure.
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Affiliation(s)
- Mohammad H Derakhshan
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Nicola J Goodson
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Jonathan C Packham
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Raj Sengupta
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Anna Molto
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Helena Marzo-Ortega
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Stefan Siebert
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. .,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow.
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Gordon SM, Stitt RS, Nee R, Bailey WT, Little DJ, Knight KR, Hughes JB, Edison JD, Olson SW. Risk Factors for Future Scleroderma Renal Crisis at Systemic Sclerosis Diagnosis. J Rheumatol 2018; 46:85-92. [PMID: 30008456 DOI: 10.3899/jrheum.171186] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a disease of autoimmunity, fibrosis, and vasculopathy. Scleroderma renal crisis (SRC) is one of the most severe complications. Corticosteroid exposure, presence of anti-RNA polymerase III antibodies (ARA), skin thickness, and significant tendon friction rubs are among the known risk factors at SSc diagnosis for developing future SRC. Identification of additional clinical characteristics and laboratory findings could expand and improve the risk profile for future SRC at SSc diagnosis. METHODS In this retrospective cohort study of the entire military electronic medical record between 2005 and 2016, we compared the demographics, clinical characteristics, and laboratory results at SSc diagnosis for 31 cases who developed SRC after SSc diagnosis to 322 SSc without SRC disease controls. RESULTS After adjustment for potential confounding variables, at SSc diagnosis these conditions were all associated with future SRC: proteinuria (p < 0.001; OR 183, 95% CI 19.1-1750), anemia (p = 0.001; OR 9.9, 95% CI 2.7-36.2), hypertension (p < 0.001; OR 13.1, 95% CI 4.7-36.6), chronic kidney disease (p = 0.008; OR 20.7, 95% CI 2.2-190.7), elevated erythrocyte sedimentation rate (p < 0.001; OR 14.3, 95% CI 4.8-43.0), thrombocytopenia (p = 0.03; OR 7.0, 95% CI 1.2-42.7), hypothyroidism (p = 0.01; OR 2.8, 95% CI 1.2-6.7), Anti-Ro antibody seropositivity (p = 0.003; OR 3.9, 95% CI 1.6-9.8), and ARA (p = 0.02; OR 4.1, 95% CI 1.2-13.8). Three or more of these risk factors present at SSc diagnosis was sensitive (77%) and highly specific (97%) for future SRC. No SSc without SRC disease controls had ≥ 4 risk factors. CONCLUSION In this SSc cohort, we present a panel of risk factors for future SRC. These patients may benefit from close observation of blood pressure, proteinuria, and estimated glomerular filtration rate, for earlier SRC identification and intervention. Future prospective therapeutic studies could focus specifically on this high-risk population.
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Affiliation(s)
- Sarah M Gordon
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - Rodger S Stitt
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - Robert Nee
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - Wayne T Bailey
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - Dustin J Little
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - Kendral R Knight
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - James B Hughes
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - Jess D Edison
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center
| | - Stephen W Olson
- From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. .,S.W. Olson, MD, Nephrology Department, Walter Reed National Military Medical Center; S.M. Gordon, MD, Nephrology Department, Walter Reed National Military Medical Center; R. Nee, MD, Nephrology Department, Walter Reed National Military Medical Center; R.S. Stitt, MD, Rheumatology Department, Walter Reed National Military Medical Center; W.T. Bailey, MD, Rheumatology Department, Walter Reed National Military Medical Center; D.J. Little, MD, Nephrology Department, Walter Reed National Military Medical Center; K.R. Knight, MD, Nephrology Department, Walter Reed National Military Medical Center; J.B. Hughes, Medical Student, Uniformed Services University of the Health Sciences; J.D. Edison, MD, Rheumatology Department, Walter Reed National Military Medical Center.
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Midtbø H, Gerdts E, Berg IJ, Rollefstad S, Jonsson R, Semb AG. Ankylosing Spondylitis Is Associated with Increased Prevalence of Left Ventricular Hypertrophy. J Rheumatol 2018; 45:1249-1255. [PMID: 29858235 DOI: 10.3899/jrheum.171124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is associated with increased risk for cardiovascular disease (CVD). Left ventricular (LV) hypertrophy is a strong precursor for clinical CVD. The aim of our study was to assess whether having AS was associated with increased prevalence of LV hypertrophy. METHODS Clinical and echocardiographic data from 139 AS patients and 126 age- and sex-matched controls was used. LV mass was calculated according to guidelines and indexed to height2.7. LV hypertrophy was considered present if LV mass index was > 49.2 g/m2.7 in men and > 46.7 g/m2.7 in women. RESULTS Patients with AS were on average 49 ± 12 years old, and 60% were men. The prevalence of hypertension (HTN; 35% vs 41%) and diabetes (5% vs 2%) was similar among patients and controls, while patients with AS had higher serum C-reactive protein level (CRP; p < 0.001). The prevalence of LV hypertrophy was higher in patients with AS compared to controls (15% vs 6%, p = 0.01). In multivariable logistic regression analysis, having AS was associated with OR 6.3 (95% CI 2.1-19.3, p = 0.001) of having LV hypertrophy independent of the presence of HTN, diabetes, and obesity. In multivariable linear regression analyses, having AS was also associated with higher LV mass (β 0.15, p = 0.007) after adjusting for CVD risk factors including sex, body mass index, systolic blood pressure, diabetes, and serum CRP (multiple R2 = 0.41, p < 0.001). CONCLUSION Having AS was associated with increased prevalence of LV hypertrophy independent of CVD risk factors. This finding strengthens the indication for thorough CVD risk assessment in patients with AS.
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Affiliation(s)
- Helga Midtbø
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. .,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
| | - Eva Gerdts
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Inger Jorid Berg
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Silvia Rollefstad
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Roland Jonsson
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
| | - Anne Grete Semb
- From the Department of Heart Disease and Department of Rheumatology, Haukeland University Hospital; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen; Department of Rheumatology, Diakonhjemmet Hospital; Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,H. Midtbø, Postdoctor, MD, PhD, Department of Heart Disease, Haukeland University Hospital; E. Gerdts, Professor, MD, PhD, Department of Clinical Science, University of Bergen; I.J. Berg, Consultant Rheumatologist, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, Postdoctor, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; R. Jonsson, Professor, DMD, PhD, Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital; A.G. Semb, Consultant Cardiologist, Senior Researcher, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital
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Abstract
Hypertension is among the most important risk factors for cardiovascular diseases and therefore a significant determinant of the most frequent causes of death in adults. According to the GEDA 2014/2015-EHIS survey nearly one in three adults in Germany have self-reported physician-diagnosed hypertension. Men are affected more in the age group of under 65 year olds. Nearly two thirds of all men and women aged 65 and over have hypertension. An educational gradient is particularly evident among women, with a higher prevalence of self-reported hypertension among women with low levels of education. Compared to the German average, prevalence of self-reported hypertension among men is higher in Mecklenburg-Western Pomerania and Saxony-Anhalt and among women in all East German federal states with the exception of Berlin. Only in Bremen is the prevalence among men lower than the national average.
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Affiliation(s)
- Hannelore Neuhauser
- Corresponding author PD Dr. Hannelore Neuhauser, Robert Koch Institute, Department for Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail:
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Abstract
Hypertension is among the most important risk factors for cardiovascular diseases and therefore a significant determinant of the most frequent causes of death in adults. According to the GEDA 2014/2015-EHIS survey nearly one in three adults in Germany have self-reported physician-diagnosed hypertension. Men are affected more in the age group of under 65 year olds. Nearly two thirds of all men and women aged 65 and over have hypertension. An educational gradient is particularly evident among women, with a higher prevalence of self-reported hypertension among women with low levels of education. Compared to the German average, prevalence of self-reported hypertension among men is higher in Mecklenburg-Western Pomerania and Saxony-Anhalt and among women in all East German federal states with the exception of Berlin. Only in Bremen is the prevalence among men lower than the national average.
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Affiliation(s)
- Hannelore Neuhauser
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Berlin, Germany
| | - Ronny Kuhnert
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Berlin, Germany
| | - Sabine Born
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Berlin, Germany
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Abstract
OBJECTIVE Takayasu arteritis (TA) involving the renal artery can result in hypertension (HTN), renal dysfunction, and premature death. The aim of this study was to investigate the longterm outcomes and factors that predict outcomes in patients with TA with renal artery stenosis. METHODS The medical records of patients diagnosed with TA between January 1997 and December 2014 were reviewed retrospectively. Renal artery involvement was based on computed tomography and/or angiography findings. Poor outcome was defined as refractory HTN, chronic renal insufficiency, or death. RESULTS Of the 62 TA patients with renal artery involvement, 11 (17.7%) underwent renal artery revascularization. Younger age, male sex, and more severe stenosis (> 70%) were associated with vascular intervention. After a median followup of 90.6 months, 11 (17.7%) of the 62 patients had refractory HTN and 6 (9.7%) had chronic renal insufficiency. Renal insufficiency [5/15 (33.3%) vs 3/47 (6.4%), p = 0.016] and bilateral involvement [12/15 (80.0%) vs 23/47 (48.9%), p = 0.041] were significantly more frequent in patients with poor than good outcomes. Multivariate Cox analysis revealed that renal insufficiency at presentation (HR 13.778, 95% CI 3.530-53.786, p < 0.001) and bilateral renal artery involvement (HR 5.053, 95% CI 1.179-21.661, p = 0.029) were significant risk factors for poor outcomes at followup, but performance of revascularization procedure was not (HR 0.663, 95% CI 0.176-2.498, p = 0.543). CONCLUSION Bilateral lesions and renal functional impairment at presentation, but not implementation of revascularization procedures, were significant factors for outcomes in TA patients with renal artery involvement.
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Affiliation(s)
- Seokchan Hong
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Ghang, MD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; C.K. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Byeongzu Ghang
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Ghang, MD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; C.K. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Yong-Gil Kim
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Ghang, MD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; C.K. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Chang-Keun Lee
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Ghang, MD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; C.K. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center
| | - Bin Yoo
- From the Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. .,S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Ghang, MD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; C.K. Lee, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center; B. Yoo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center.
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Karmacharya BM, Koju RP, LoGerfo JP, Chan KCG, Mokdad AH, Shrestha A, Sotoodehnia N, Fitzpatrick AL. Awareness, treatment and control of hypertension in Nepal: findings from the Dhulikhel Heart Study. Heart Asia 2017; 9:1-8. [PMID: 28123454 DOI: 10.1136/heartasia-2016-010766] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 11/16/2016] [Accepted: 11/25/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Although previous studies have suggested alarming rise in the prevalence of hypertension in Nepal, there is dearth of information on its awareness, treatment and control. In this cross-sectional study, we assessed awareness, treatment and control of hypertension among 298 hypertensive adults from the suburban town of Dhulikhel, Nepal. METHODS This cross-sectional study is based on Dhulikhel Heart Study, which included 1073 adults, aged ≥18 years, recruited from randomly selected households. Comprehensive health interviews and blood pressure measurements were completed during home interviews. Hypertensives (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or receiving antihypertensive medication) were further evaluated for awareness, treatment and control of hypertension. Multivariate regression model quantified the association of the sociodemographic characteristics and the cardiovascular disease (CVD) risk factors with hypertension awareness. Differences between sociodemographic characteristics and CVD risk factors with treatment and control of hypertension were tested using χ2 tests. RESULTS A total of 43.6% of all hypertensives (n=298) were aware of their hypertension status. In multivariate analyses, hypertension awareness was associated with increasing age (p<0.001). More than three-fourth (76.1%) of those who were aware of their hypertension status (n=130) were currently on treatment. There were significant differences in treatment status by sex, occupation, age, income quartiles and body mass index. Only 35.3% of those on treatment (n=99) had blood pressure control. CONCLUSIONS The levels of awareness, treatment and control of hypertension in this sample of Nepalese adults were low.
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Affiliation(s)
- Biraj M Karmacharya
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Department of Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Rajendra P Koju
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - James P LoGerfo
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kwun Chuen Gary Chan
- Department of Biostatistics, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Archana Shrestha
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Department of Epidemiology, Harvard T.H. Chan School of Public Health, MA, USA
| | - Nona Sotoodehnia
- Division of Cardiology, University of Washington, Seattle, WA, USA; Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Annette L Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA
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12
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Mingji C, Onakpoya IJ, Heneghan CJ, Ward AM. Assessing agreement of blood pressure-measuring devices in Tibetan areas of China: a systematic review. Heart Asia 2016; 8:46-51. [PMID: 27843497 PMCID: PMC5093356 DOI: 10.1136/heartasia-2016-010798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/19/2016] [Accepted: 09/30/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The validity of blood pressure (BP)-measuring tools at very high altitudes is uncertain. Therefore, the objective of this review was to examine the degree of agreement of BP-measuring devices in Tibet. METHODS We conducted electronic searches in Medline, Embase, Cinahl, Cochrane Library, Global Health Library and the ISI Web of Science. Randomised and observational studies were considered for inclusion. The methodological characteristics of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Our primary outcome was the difference in mean BP measurements between the new device and the gold standard. RESULTS We identified three eligible studies, out of which two with a total of 162 participants were included. The studies differed in their methodology. One study reported significantly higher systolic blood pressure (SBP) measurement with electronic sphygmomanometer (Omron) compared with mercury sphygmomanometer (mean difference 5.8±4.7 mm Hg; p<0.001), with no significant difference in diastolic blood pressure (DBP) measurement (0.4±3.9 mm Hg; p=0.23). The second study reported mean differences of 1.0±5.9 mm Hg and -3.1±4.6 mm Hg for SBP and DBP, respectively. CONCLUSION The limited evidence from published studies suggests that automated (Omron) BP monitors show a high degree of agreement for DBP when compared against mercury sphygmomanometer at high altitudes. However, the degree of such agreement for SBP is not consistent. Few studies assessing the validity of automated BP monitors at high altitudes have been conducted, and they differ in design and methodology. Further research assessing the suitability of BP-measuring instruments at high altitudes is therefore warranted.
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Affiliation(s)
- Cuomu Mingji
- Tibetan Medical College, Lhasa, Tibet; Austrian Academy of Science, Vienna, Austria
| | - Igho J Onakpoya
- Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK
| | - Carl J Heneghan
- Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK
| | - Alison M Ward
- Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK
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13
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Fares H, DiNicolantonio JJ, O'Keefe JH, Lavie CJ. Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes. Open Heart 2016; 3:e000473. [PMID: 27752334 PMCID: PMC5051471 DOI: 10.1136/openhrt-2016-000473] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Hypertension is well established as a major risk factor for cardiovascular disease. Although there is undeniable evidence to support the beneficial effects of antihypertensive therapy on morbidity and mortality, adequate blood pressure management still remains suboptimal. Research into the treatment of hypertension has produced a multitude of drug classes with different efficacy profiles. These agents include β-blockers, diuretics, ACE inhibitors, angiotensin receptor blockers and calcium channel blockers. One of the oldest groups of antihypertensives, the calcium channel blockers are a heterogeneous group of medications. METHODS This review paper will focus on amlodipine, a dihydropyridine calcium channel blockers, which has been widely used for 2 decades. RESULTS Amlodipine has good efficacy and safety, in addition to strong evidence from large randomised controlled trials for cardiovascular event reduction. CONCLUSIONS Amlodipine should be considered a first-line antihypertensive agent.
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Affiliation(s)
- Hassan Fares
- Department of Cardiovascular Diseases , John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine , New Orleans, Louisiana , USA
| | | | - James H O'Keefe
- Saint Luke's Mid America Heart Institute , Kansas City, Missouri , USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases , John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine , New Orleans, Louisiana , USA
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14
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Zaheer S, de Boer I, Allison M, Brown JM, Psaty BM, Robinson-Cohen C, Ix JH, Kestenbaum B, Siscovick D, Vaidya A. Parathyroid Hormone and the Use of Diuretics and Calcium-Channel Blockers: The Multi-Ethnic Study of Atherosclerosis. J Bone Miner Res 2016; 31:1137-45. [PMID: 26748479 PMCID: PMC5424889 DOI: 10.1002/jbmr.2779] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 01/05/2023]
Abstract
Thiazide diuretic (TZ) use is associated with higher bone mineral density, whereas loop diuretic (LD) use is associated with lower bone density and incident fracture. Dihydropyridine-sensitive calcium channels are expressed on parathyroid cells and may play a role in parathyroid hormone (PTH) regulation. The potential for diuretics and calcium-channel blockers (CCBs) to modulate PTH and calcium homeostasis may represent a mechanism by which they influence skeletal outcomes. We hypothesized that the use of LD and dihydropyridine CCBs is associated with higher PTH, and TZ use is associated with lower PTH. We conducted cross-sectional analyses of participants treated for hypertension in the Multi-Ethnic Study of Atherosclerosis who did not have primary hyperparathyroidism or chronic kidney disease (n = 1888). We used adjusted regression models to evaluate the independent association between TZ, LD, and CCB medication classes and PTH. TZ use was associated with lower PTH when compared with non-TZ use (44.4 versus 46.9 pg/mL, p = 0.02), whereas the use of LD and CCBs was associated with higher PTH when compared with non-users of each medication class (LD: 60.7 versus 45.5 pg/mL, p < 0.0001; CCB: 49.5 versus. 44.4 pg/mL, p < 0.0001). Adjusted regression models confirmed independent associations between TZ use and lower PTH (β = -3.2 pg/mL, p = 0.0007), and LD or CCB use and higher PTH (LD: β = +12.0 pg/mL, p < 0.0001; CCB: +3.7 pg/mL, p < 0.0001). Among CCB users, the use of dihydropyridines was independently associated with higher PTH (β = +5.0 pg/mL, p < 0.0001), whereas non-dihydropyridine use was not (β = +0.58 pg/mL, p = 0.68). We conclude that in a large community-based cohort with normal kidney function, TZ use is associated with lower PTH, whereas LD and dihydropyridine CCB use is associated with higher PTH. These associations may provide a mechanistic explanation linking use of these medications to the development of skeletal outcomes. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sarah Zaheer
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian de Boer
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego, CA, USA
| | - Jenifer M Brown
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.,Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, CA, USA
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA.,Kidney Research Institute, University of Washington, Seattle, WA, USA
| | | | - Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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15
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Kohli S, Kumar R, Gupta M, Tyagi S, Pasha MAQ. Impact of interactions between risk alleles on clinical endpoints in hypertension. Heart Asia 2016; 8:83-9. [PMID: 27326240 DOI: 10.1136/heartasia-2016-010723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Impairment of the renin-angiotensinogen-aldosterone system (RAAS), one of the characteristics of essential hypertension (EH), imbalances vascular homeostasis. Despite inconsistent reports on individual single nucleotide polymorphisms (SNPs) as a major predictor of EH, interactions among RAAS genetic variants are rarely investigated. METHODS Using SNP markers, we studied potential interactions between angiotensin 1 converting enzyme (ACE), angiotensinogen (AGT), angiotensin II-type 1 receptor (AGTR1), and α adducin (ADD1) variants and their correlation with clinical endpoints in 545 individuals with hypertension and 400 age- and ethnicity-matched unrelated controls. Generalised multifactor dimensionality reduction (GMDR) analysis identified the models for genotype interaction. RESULTS Although the results on single genes were significant, gene-gene interactions were more reliable and promising as markers in predisposing hypertension. The best models to represent association of multi-locus interactions with augmented hypertension susceptibility were: (a) within gene 4-locus model comprised of AGT SNPs -217G/A, -20A/C, -6G/A and 235M/T (p=0.022, OR 6.1); and (b) between genes 5-locus model comprised of AGT -217G/A, -20A/C, -6G/A, 235M/T and ACE I/D (p=0.05, OR 4.6). Stratification of 4- and 5-locus GMDR models on the basis of risk alleles from ≤1 to ≥7 increased the ORs from 2.8 to 36.1 and from 0.9 to 16.1, respectively. Moreover, compared to ≤1 risk alleles the ≥7 interacting risk alleles in both 4- and 5-locus models showed an increment of 14.2% and 11.1% in systolic blood pressure, 7.7% and 1.1% in diastolic blood pressure, and 10.5% and 5.1% in mean arterial pressure, respectively, in patients. CONCLUSIONS Interactions among the genetic loci of RAAS components may be used as a predictor for susceptibility to hypertension.
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Affiliation(s)
- Samantha Kohli
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, Delhi, India; Academy of Scientific and Innovative Research, New Delhi, Delhi, India
| | - Rahul Kumar
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, Delhi, India; Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado, Denver, USA
| | - Mohit Gupta
- Department of Cardiology , G.B. Pant Hospital , New Delhi, Delhi , India
| | - Sanjay Tyagi
- Department of Cardiology , G.B. Pant Hospital , New Delhi, Delhi , India
| | - M A Qadar Pasha
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, Delhi, India; Academy of Scientific and Innovative Research, New Delhi, Delhi, India
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16
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MANDART G, JACQUES M, TENZER C. [DIAGNOSIS OF CHRONIC PYELONEPHRITIS: ANATOMIC AND BIOLOGICAL CORRELATES]. Acta Clin Belg 2016; 18:152-66. [PMID: 14045897 DOI: 10.1080/17843286.1963.11717131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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REGNIERS P, VERMEULEN A. [ADRENAL CORTEX FUNCTION IN HYPERTENSION]. Acta Clin Belg 2016; 19:248-64. [PMID: 14197636 DOI: 10.1080/17843286.1964.11717752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Feldman JM, Waterman PD, Coull BA, Krieger N. Spatial social polarisation: using the Index of Concentration at the Extremes jointly for income and race/ethnicity to analyse risk of hypertension. J Epidemiol Community Health 2015. [PMID: 26136082 DOI: 10.1136/jech-2015-205728:10.1136/jech-2015-205728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Growing spatial social and economic polarisation may be an important societal determinant of health, but only a few studies have used the recently developed Index of Concentration at the Extremes (ICE) to analyse the impact of joint concentrations of privilege and privation on health outcomes. We explore use of the ICE to investigate risk of hypertension in an urban, multiracial/ethnic, and predominantly working-class study population of US adults. METHODS We generated novel ICE measures at the census tract level that jointly assess extreme concentrations of both income and racial/ethnic composition. We then linked the ICE measures to data from two observational, cross-sectional studies conducted in the Boston metropolitan area (2003-2004; 2008-2010; N=2145). RESULTS The ICE measure for extreme concentrations of white compared with black residents was independently associated with lower odds of hypertension (OR=0.76; 95% CI 0.62 to 0.93), controlling for race/ethnicity, age, gender, smoking, body mass index, household income, education and self-reported exposure to racial discrimination. Even stronger associations were observed for the ICE measures that compared concentrations of high-income white residents versus low-income residents of colour (OR=0.61; 95% CI 0.40 to 0.96) and high-income white versus low-income black residents (OR=0.48; 95% CI 0.29 to 0.81). CONCLUSIONS Results suggest public health studies should explore the joint impact of racial/ethnic and economic spatial polarisation on population health.
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Affiliation(s)
- Justin M Feldman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Pamela D Waterman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brent A Coull
- Department of Environmental Health, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Qi SF, Zhang B, Wang HJ, Yan J, Mi YJ, Liu DW, Tian QB. Prevalence of hypertension subtypes in 2011 and the trends from 1991 to 2011 among Chinese adults. J Epidemiol Community Health 2015; 70:444-51. [PMID: 26612877 DOI: 10.1136/jech-2015-206492] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/07/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to estimate the current prevalence and trends of hypertension subtypes among Chinese adults from 1991 to 2011. METHODS We analysed the measurements of systolic and diastolic blood pressure among adults aged ≥18 years from the China Health and Nutrition Survey (CHNS) 1991-2011. The prevalence was age-adjusted to the 2010 census of Chinese adults. RESULTS The adjusted prevalence in 2011 was 20.9% (95% CI 20.2% to 21.6%) of hypertension, 3.30% (95% CI 2.99% to 3.62%) of isolated systolic hypertension, 4.44% (95% CI 4.08% to 4.80%) of isolated diastolic hypertension, 4.11% (95% CI 3.76% to 4.46%) of systolic-diastolic hypertension and 9.01% (95% CI 8.51% to 9.51%) of current use of antihypertensive medication, respectively. From 1991 to 2011, the prevalence increased from 15.6% to 20.9% for hypertension (p<0.001) and from 3.04% to 3.30% for isolated systolic hypertension (p<0.001). However, the prevalence decreased from 4.77% to 4.44% for isolated diastolic hypertension (p=0.023) and from 5.27% to 4.11% for systolic-diastolic hypertension (p<0.001). Consistent with these findings, the percentage of current use of antihypertensive medication increased from 2.55% to 9.01%, which accounted for approximately 43.1% of the total number of cases in 2011. Importantly, only 36.9% (equivalent to 17.5% of the total number of hypertensive people) of cases of current use of antihypertensive medication were adequately controlled. CONCLUSIONS Both the prevalence of hypertension and the percentage of current use of antihypertensive medication significantly increased from 1991 to 2011. Currently, about one-fifth of Chinese adults are hypertensive; however, only 17.5% of hypertension is controlled.
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Affiliation(s)
- Su-Fen Qi
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui-Jun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Yan
- Research Center of Electron Microscope, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ying-Jun Mi
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dian-Wu Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Qing-Bao Tian
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei, China
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Angeli F, Reboldi G, Verdecchia P. The 2014 hypertension guidelines: implications for patients and practitioners in Asia. Heart Asia 2015; 7:21-5. [PMID: 27326216 DOI: 10.1136/heartasia-2015-010639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 01/20/2023]
Abstract
Hypertension is a global public health issue and a major cause of morbidity and mortality. Because of population growth and ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly 1 billion in 2008. Furthermore, the number of adults with hypertension in 2025 has also been predicted to increase by about 60% to a total of 1.56 billion. The prevalence of hypertension in most Asian countries has increased over the last 30 years and more dramatically in the last 10 years. Several factors contributed to such changes in Asia, but acculturation to Western lifestyle, modernisation and urbanisation are considered key contributing factors. There are some unique features in regards to cardiovascular risk in Asia. Specifically, Asian regions have disproportionately higher mortality and morbidity from stroke compared with Western countries. Furthermore, the relationship between blood pressure level and risk of stroke is stronger in Asia than in Western regions. Although evidence-based and qualified guidelines for hypertension diagnosis and management have been released recently from Europe and North America, the unique features of Asian patients with hypertension raise concerns in regards to the real clinical applicability of Western guidelines in Asian populations. Specifically, it is not yet clear to what extent the new blood pressure target proposed by Western guidelines for high risk and elderly hypertensive individuals apply to Asian populations.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology , Hospital 'S.M. della Misericordia' , Perugia , Italy
| | | | - Paolo Verdecchia
- Department of Internal Medicine , Hospital of Assisi , Assisi , Italy
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21
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Trudel X, Brisson C, Milot A, Masse B, Vézina M. Adverse psychosocial work factors, blood pressure and hypertension incidence: repeated exposure in a 5-year prospective cohort study. J Epidemiol Community Health 2015; 70:402-8. [PMID: 26530810 DOI: 10.1136/jech-2014-204914] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/13/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Two main theoretical models have been used to assess the impact of psychosocial work factors on blood pressure (BP): the demand-control (DC) model and the effort-reward imbalance (ERI) model. Previous studies have mostly used a single time point exposure to examine this association. OBJECTIVE To examine the effect of repeated job strain and ERI exposure on (1) ambulatory BP (ABP) evolution over 5 years and (2) hypertension incidence over 5 years. METHOD The design is a prospective cohort study. The study population was composed of 1394 white-collar workers (568 men and 826 women). They were assessed three times during a 5-year period (years 1, 3 and 5). At each time, psychosocial work factors were measured using validated scales and ABP was measured every 15 min during a working day. RESULTS Men who were chronically exposed over 5 years to an active job had a higher cumulative incidence of hypertension (RR=2.05, 95% CI 1.36 to 3.09), compared with never-exposed men. In women, ERI exposure onset was associated with higher increases in systolic ABP (+2.5 mm Hg). No association was found between chronic high-strain exposure and ABP. CONCLUSIONS Chronic exposure to active jobs in men led to a higher risk of hypertension and ERI exposure onset in women led to increases in systolic ABP. Results from the present study highlight the need to consider chronic exposure in order to fully capture the deleterious effect of adverse psychosocial work stressors on cardiovascular health.
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Affiliation(s)
- Xavier Trudel
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Chantal Brisson
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Alain Milot
- Département de médecine, Université Laval, Québec, Canada
| | - Benoit Masse
- École de Santé Publique, Université de Montréal, Montréal, Canada Centre de recherche, CHU Sainte-Justine, Montréal, Canada
| | - Michel Vézina
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
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Malhotra A, DiNicolantonio JJ, Capewell S. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart 2015; 2:e000273. [PMID: 26339496 PMCID: PMC4555071 DOI: 10.1136/openhrt-2015-000273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
- Aseem Malhotra
- Department of Cardiology , Frimley Park Hospital , Surrey , UK ; Consultant Clinical Associate to the Academy of Medical Royal Colleges , London , UK
| | | | - Simon Capewell
- Professor of Clinical Epidemiology , University of Liverpool , Liverpool , UK
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23
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Bernabé-Ortiz A, Carrillo-Larco RM, Gilman RH, Checkley W, Smeeth L, Miranda JJ. Contribution of modifiable risk factors for hypertension and type-2 diabetes in Peruvian resource-limited settings. J Epidemiol Community Health 2015; 70:49-55. [PMID: 26248550 PMCID: PMC4717378 DOI: 10.1136/jech-2015-205988] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/19/2015] [Indexed: 11/05/2022]
Abstract
Background It is important to understand the local burden of non-communicable diseases including within-country heterogeneity. The aim of this study was to characterise hypertension and type-2 diabetes profiles across different Peruvian geographical settings emphasising the assessment of modifiable risk factors. Methods Analysis of the CRONICAS Cohort Study baseline assessment was conducted. Cardiometabolic outcomes were blood pressure categories (hypertension, prehypertension, normal) and glucose metabolism disorder status (diabetes, prediabetes, normal). Exposures were study setting and six modifiable factors (smoking, alcohol drinking, leisure time and transport-related physical activity levels, TV watching, fruit/vegetables intake and obesity). Poisson regression models were used to report prevalence ratios (PR). Population attributable risks (PAR) were also estimated. Results Data from 3238 participants, 48.3% male, mean age 45.3 years, were analysed. Age-standardised (WHO population) prevalence of prehypertension and hypertension was 24% and 16%, whereas for prediabetes and type-2 diabetes it was 18% and 6%, respectively. Outcomes varied according to study setting (p<0.001). In multivariable model, hypertension was higher among daily smokers (PR 1.76), heavy alcohol drinkers (PR 1.61) and the obese (PR 2.06); whereas only obesity (PR 2.26) increased the prevalence of diabetes. PAR showed that obesity was an important determinant for hypertension (15.7%) and type-2 diabetes (23.9%). Conclusions There is an evident heterogeneity in the prevalence of and risk factors for hypertension and diabetes within Peru. Prehypertension and prediabetes are highly prevalent across settings. Our results emphasise the need of understanding the epidemiology of cardiometabolic conditions to appropriately implement interventions to tackle the burden of non-communicable diseases.
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Affiliation(s)
- Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA Área de Investigación y Desarrollo, AB PRISMA, Lima, Peru
| | - William Checkley
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Liam Smeeth
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Feldman JM, Waterman PD, Coull BA, Krieger N. Spatial social polarisation: using the Index of Concentration at the Extremes jointly for income and race/ethnicity to analyse risk of hypertension. J Epidemiol Community Health 2015; 69:1199-207. [PMID: 26136082 DOI: 10.1136/jech-2015-205728] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/17/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Growing spatial social and economic polarisation may be an important societal determinant of health, but only a few studies have used the recently developed Index of Concentration at the Extremes (ICE) to analyse the impact of joint concentrations of privilege and privation on health outcomes. We explore use of the ICE to investigate risk of hypertension in an urban, multiracial/ethnic, and predominantly working-class study population of US adults. METHODS We generated novel ICE measures at the census tract level that jointly assess extreme concentrations of both income and racial/ethnic composition. We then linked the ICE measures to data from two observational, cross-sectional studies conducted in the Boston metropolitan area (2003-2004; 2008-2010; N=2145). RESULTS The ICE measure for extreme concentrations of white compared with black residents was independently associated with lower odds of hypertension (OR=0.76; 95% CI 0.62 to 0.93), controlling for race/ethnicity, age, gender, smoking, body mass index, household income, education and self-reported exposure to racial discrimination. Even stronger associations were observed for the ICE measures that compared concentrations of high-income white residents versus low-income residents of colour (OR=0.61; 95% CI 0.40 to 0.96) and high-income white versus low-income black residents (OR=0.48; 95% CI 0.29 to 0.81). CONCLUSIONS Results suggest public health studies should explore the joint impact of racial/ethnic and economic spatial polarisation on population health.
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Affiliation(s)
- Justin M Feldman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Pamela D Waterman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brent A Coull
- Department of Environmental Health, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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van Durme C, van Echteld IAAM, Falzon L, Aletaha D, van der Heijde DMFM, Landewé RB. Cardiovascular risk factors and comorbidities in patients with hyperuricemia and/or gout: a systematic review of the literature. J Rheumatol Suppl 2015; 92:9-14. [PMID: 25180123 DOI: 10.3899/jrheum.140457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review the available literature on the likelihood of having cardiovascular (CV) risk factors and on developing CV comorbidities in patients with gout and/or asymptomatic hyperuricemia as an evidence base for generating multinational clinical practice recommendations in the 3e (Evidence, Expertise, Exchange) Initiative in Rheumatology. METHODS A systematic literature search was carried out using MEDLINE, EMBASE, and The Cochrane Library, and abstracts presented at the 2010/2011 meetings of the American College of Rheumatology (ACR) and the European League Against Rheumatism, searching for CV risk factors and new CV comorbidities in patients with asymptomatic hyperuricemia and/or a diagnosis of gout. Trials that fulfilled predefined inclusion criteria were systematically reviewed. RESULTS A total of 66 out of 8918 identified publications were included in this review. After assessment of the risk of bias, 32 articles with a high risk of bias were excluded. Data could not be pooled because of clinical and statistical heterogeneity. In general, both for asymptomatic hyperuricemia and for gout the hazard ratios for CV comorbidities were only modestly increased (1.5 to 2.0) as were the hazard ratios for CV risk factors, ranging from 1.4 to 2.0 for hypertension and from 1.0 to 2.4 for diabetes. CONCLUSION Unlike the common opinion that patients with gout or hyperuricemia are at higher risk of developing CV disease, the actual risk to develop CV disease is either rather weak (for hyperuricemia) or poorly investigated (for gout).
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Affiliation(s)
- Caroline van Durme
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center.
| | - Irene A A M van Echteld
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Louise Falzon
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Daniel Aletaha
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Désirée M F M van der Heijde
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
| | - Robert B Landewé
- From the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; and Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Rheumatology Department, St. Elisabeth Hospital, Tilburg, The Netherlands; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria; Rheumatology Department, Leiden University Medical Center, Leiden; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; and Atrium Medical Center, Heerlen, The Netherlands.C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre; Rheumatology Department, Centre Hospitalier Universitaire; I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; Atrium Medical Center
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Butt DA, Mamdani M, Gomes T, Lix L, Lu H, Tu K. Risk of Osteoporotic Fractures With Angiotensin II Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors in Hypertensive Community-Dwelling Elderly. J Bone Miner Res 2014; 29:2483-8. [PMID: 24806397 DOI: 10.1002/jbmr.2271] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 04/18/2014] [Accepted: 04/30/2014] [Indexed: 01/11/2023]
Abstract
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used to treat hypertension; however, in vivo and clinical studies suggest that ARBs and ACE inhibitors may exert different effects on bone. The association between long-term use of ARBs and ACE inhibitors and fracture requiring medical attention is limited. We conducted a population-based, retrospective cohort study with propensity score matching using administrative databases in Ontario, Canada, to examine the risk of osteoporosis-related fractures in hypertensive elderly treated with ARBs versus ACE inhibitors. We identified a cohort of newly treated hypertensive patients aged 66 years and older who initiated an ACE inhibitor from May 1, 2004, to March 31, 2012, and matched them to ARB users on propensity score, sex, and age at drug initiation. The primary outcome was hip fracture, and secondary outcomes were non-hip major osteoporotic fractures (other femoral, clinical vertebral, forearm, wrist, humerus) and other osteoporotic fractures (pelvis, clavicle, patella, shoulder, upper arm, tibia, fibula, ankle, scapula, ribs, sternum, trunk). We calculated hazard ratios (HRs) using Cox proportional hazards model with robust standard errors. Of the 87,635 patients who initiated treatment, 28,819 (32.9%) started ARBs and 58,816 (67.1%) started ACE inhibitors. Among new ARB users, 27,815 (96.5%) were successfully matched to ACE inhibitor users. Without dose adjustment, no significant association was observed for ARBs relative to ACE inhibitor users for hip fractures (HR = 0.88; 95% confidence interval [CI] 0.70-1.11), with a decreased risk of other major osteoporotic fractures (HR = 0.81; CI 0.70-0.93) and no significant association for other osteoporotic fractures (HR = 0.88; CI 0.74-1.05). When adjusted for dosage, there was no significant difference between the effects of ARBs and ACE inhibitors on hip (HR = 0.99; CI 0.78-1.25), other major osteoporotic (HR = 0.87; CI 0.75-1.01), and other osteoporotic fractures (HR = 0.90; CI 0.74-1.08).
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Affiliation(s)
- Debra A Butt
- Department of Family and Community Medicine, University of Toronto, Research Department, Toronto, Canada; Family and Community Medicine, The Scarborough Hospital, Scarborough, Canada
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Jiang X, Liu X, Wu S, Zhang GQ, Peng M, Wu Y, Zheng X, Ruan C, Zhang W. Metabolic syndrome is associated with and predicted by resting heart rate: a cross-sectional and longitudinal study. Heart 2014; 101:44-9. [PMID: 25179964 DOI: 10.1136/heartjnl-2014-305685] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although higher resting heart rate (RHR) has emerged as a predictor for lifespan, the underlying mechanisms remain obscure. The present study investigates whether a positive relationship exists between RHR and metabolic syndrome (MetS) and whether RHR predicts future MetS. METHODS A cohort of 89,860 participants were surveyed during 2006-2007 in Kailuan/Tangshan, China. MetS was diagnosed when a participant presented at least three of the following: abdominal adiposity, low high density lipoprotein-cholesterol, high triglycerides, hypertension or impaired fasting glucose. RHR was derived from ECG recordings and subjects were stratified based on RHR. Some participants without MetS at baseline were followed-up for 4 years. RESULTS At baseline, 23,150 participants (25.76%) had MetS. There was a positive association between RHR and MetS. The OR of having MetS was 1.49 (95% CI 1.32 to 1.69) in subjects with RHR at 95-104 compared with those at 55-64 beats per minute (bpm) (reference), after adjusting for variables including age, sex, education, cigarette smoking, alcohol drinking, physical activities, body mass index, hypertension, diabetes, hyperlipidaemia, inflammatory biomarkers and renal function. More importantly, when 43,725 individuals from the original study without MetS at baseline were followed-up, higher RHR was found to predict greater risk of MetS incidence. The OR of developing MetS 4 years later was 1.41 (95% CI 1.21 to 1.65) in subjects with RHR at 95-104 bpm compared with reference, after all adjustments. CONCLUSIONS Our cross-sectional and longitudinal findings provide evidence that RHR is an independent risk factor for existing MetS and a powerful predictor for future incidence of MetS.
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Affiliation(s)
- Xiongjing Jiang
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxue Liu
- Tangshan People's Hospital, Tangshan, Hebei, China
| | - Shouling Wu
- Kailuan General Hospital, Tangshan, Hebei, China
| | - Gus Q Zhang
- The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Meng Peng
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuntao Wu
- Kailuan General Hospital, Tangshan, Hebei, China
| | | | - Chunyu Ruan
- Kailuan General Hospital, Tangshan, Hebei, China
| | - Weiguo Zhang
- Cardiovascular and Neurological Institute, Irving, Texas, USA
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Abstract
Scleroderma renal crisis (SRC) is characterized by malignant hypertension and oligo-anuric acute renal failure. It occurs in 5% of patients with systemic sclerosis (SSc), particularly in patients with diffuse disease during the first years. SRC is more common in patients receiving corticosteroids, the risk increasing with increasing dose. The disease is sometimes triggered by use of nephrotoxic drugs and/or intravascular volume depletion. Left ventricular insufficiency and hypertensive encephalopathy are typical clinical features. Thrombotic microangiopathy is detected in 43% of cases, and anti-RNA-polymerase III antibodies are present in one-third of patients. Renal biopsy is not necessary if SRC presents classical features. However, biopsy may help to define the prognosis and guide treatment in atypical forms. The prognosis of SRC has greatly improved with the introduction of angiotensin-converting enzyme (ACE) inhibitors. However, the 5-year survival for SSc patients with full SRC remains low (65%). The treatment of SRC relies on aggressive blood pressure control with an ACE inhibitor, combined with other antihypertensive drugs if needed. Dialysis is frequently indicated but can be stopped in about half of patients, mainly those with good blood pressure control. Patients who need dialysis for more than 2 years qualify for renal transplantation.
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Affiliation(s)
- Luc Mouthon
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes.
| | - Guillaume Bussone
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
| | - Alice Berezné
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
| | - Laure-Hélène Noël
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
| | - Loïc Guillevin
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
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Jin CN, Yu CM, Sun JP, Fang F, Wen YN, Liu M, Lee APW. The healthcare burden of hypertension in Asia. Heart Asia 2013; 5:238-43. [PMID: 27326143 DOI: 10.1136/heartasia-2013-010408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/05/2013] [Accepted: 10/29/2013] [Indexed: 01/11/2023]
Abstract
As the leading global risk for mortality, hypertension (HT) is a common healthcare problem in the world. The total number of patients with HT is likely to grow in the next few decades as the population age and the prevalence of obesity and diabetes increase. HT, as a major modifiable risk factor for cardiovascular disease, results in more deaths than any other risk factors, including diabetes and cigarette smoking. High prevalence, inadequate awareness, suboptimal treatment and low rate of achieving guideline-recommended target blood pressure control are key factors leading to severe cardiovascular complications that impose a heavy socioeconomic burden, especially in developing countries. Asia is the world's largest and most populous continent with approximately 4.3 billion people, hosting 60% of the world's current human population, and has a high growth rate. Asia differs very widely from the West with regard to ethnic groups, cultures, environments, economics, historical ties and government systems. Therefore, the purpose of this review is to comprehensively summarise the epidemiology, treatment practice and the status of control of HT in different Asian countries in order to guide the future prevention and management in this part of the world.
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Affiliation(s)
- Chun-Na Jin
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Jing-Ping Sun
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Fang Fang
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Yong-Na Wen
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Ming Liu
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics , Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, NT , Hong Kong
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Manavathongchai S, Bian A, Rho YH, Oeser A, Solus JF, Gebretsadik T, Shintani A, Stein CM. Inflammation and hypertension in rheumatoid arthritis. J Rheumatol 2013; 40:1806-11. [PMID: 23996293 DOI: 10.3899/jrheum.130394] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Hypertension (HTN), a common modifiable cardiovascular risk factor, is more common in patients with rheumatoid arthritis (RA), but the underlying mechanisms are unclear. We examined the hypothesis that mediators of inflammation and markers of cardiovascular risk are associated with HTN in RA. METHODS We compared measures of inflammation [serum C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), homocysteine, and leptin concentrations] and insulin resistance [homeostasis model assessment index (HOMA)] in RA patients with (n = 90) and without HTN (n = 79). HTN was defined as blood pressure ≥ 140/90 mm Hg or treatment with antihypertensive therapy. The independent association of markers of interest with HTN was examined using multivariable logistic regression. RESULTS Patients with HTN were significantly older and had longer disease duration than those without HTN (both p < 0.001). Concentrations of homocysteine [11.1 (8.5-13.5) μmol/l vs 9.3 (7.8-11.0) μmol/l] were significantly higher in patients with HTN (p < 0.001). After adjustment for age, sex, race, smoking, body mass index, and corticosteroid and nonsteroidal antiinflammatory drugs (NSAID) use, increased concentrations of homocysteine (OR 2.9, 95% CI: 1.5-5.5, p = 0.001), and leptin (OR 2.0, 95% CI: 1.0-3.8, p = 0.046) were significantly associated with HTN, but the 28-joint Disease Activity Score, IL-6, CRP, TNF-α, and HOMA index were not (all p > 0.05). CONCLUSION HTN in patients with RA is not associated with generalized systemic inflammation or insulin resistance, but is associated with increasing concentrations of homocysteine and leptin. The pathogenesis of HTN in RA may involve pathways more regularly associated with fat and vascular homeostasis.
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Affiliation(s)
- Siriporn Manavathongchai
- From the Divisions of Clinical Pharmacology and Rheumatology, Departments of Medicine and Pharmacology; Department of Biostatistics; Vanderbilt University, Nashville, Tennessee, USA
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Sridhar A, Subramanyan R, Lakshmi N, Farzana F, Tripathi RR, Premsekar R, Chidambaram Pillai S, Krishna Manohar SR, Agarwal R, Cherian KM. Do preoperative haemodynamic data and reactivity test predict the postoperative reversibility of pulmonary arterial hypertension in patients with large ventricular septal defect and borderline operability? Heart Asia 2013; 5:182-7. [PMID: 27326120 PMCID: PMC4832665 DOI: 10.1136/heartasia-2013-010309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/15/2013] [Accepted: 06/30/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND Decisions to operate on patients with shunt lesions presenting late with severe pulmonary arterial hypertension (PAH) and borderline operability are often not based on precise cut off values of haemodynamic data owing to paucity of studies. OBJECTIVE To assess the reliability of the preoperative haemodynamic data and reactivity test in predicting the postoperative reversibility of PAH in patients with isolated large ventricular septal defects (VSDs) and borderline operability. PATIENTS AND METHOD Between 2004 and 2010, 30 patients underwent VSD closure surgically; no early deaths occurred. Twenty-six patients were followed up regularly (mean 39.6±16 months) and one late postoperative death occurred. Fourteen patients who had been followed up for at least 1 year postoperatively underwent cardiac catheterisation. RESULTS There were 3 responders (asymptomatic patients with pulmonary vascular resistance (PVR) index <3 WU.m(2)) and 12 non-responders. The following were lower among responders: mean age at surgery (3.2±0.42 vs 11.55±3.29 years, p=0.227), mean baseline PVR index (3.69±0.8 vs 10.57±9.1, p=0.204), average resistance ratio (RR=0.25±0.01 vs 0.59±0.25, p=0.049) and ratio of pulmonary and systemic mean pressures (PAm:SAm ratio) (0.70±0.009 vs 0.87±0.118, p=0.003). CONCLUSIONS Preoperative 'base line' PAm:SAm and RR appear to be better predictors of postoperative outcome than other baseline parameters. Preoperative reactivity test had no significant role in predicting postoperative reversibility of PAH at mid-term.
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Affiliation(s)
- Anuradha Sridhar
- Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Raghavan Subramanyan
- Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Nithya Lakshmi
- Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Farida Farzana
- Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Ravi Ranjan Tripathi
- Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Rajasekaran Premsekar
- Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Shanthi Chidambaram Pillai
- Department of Pediatric Cardiology, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Soman Rema Krishna Manohar
- Pediatric Cardiothoracic Surgery, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Ravi Agarwal
- Pediatric Cardiothoracic Surgery, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
| | - Kotturathu Mammen Cherian
- Pediatric Cardiothoracic Surgery, Frontier Life Line Hospital and Dr K M Cherian Heart Foundation, Chennai, India
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Heshmati A, Mishra G, Koupil I. Childhood and adulthood socio-economic position and hypertensive disorders in pregnancy: the Uppsala Birth Cohort Multigenerational Study. J Epidemiol Community Health 2013; 67:939-46. [PMID: 23729327 DOI: 10.1136/jech-2012-202149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Childhood and adulthood socio-economic position (SEP) is associated with cardiovascular disease in later life, but associations with hypertensive disorders in pregnancy are not well established. OBJECTIVE The aim of this study was to investigate the association of childhood and adulthood SEP with hypertensive disorders in pregnancy (chronic hypertension, gestational hypertension and pre-eclampsia/eclampsia). METHOD Study participants were Swedish women (n=9507) from generation 3 of the Uppsala Birth Cohort Multigenerational Study (UBCoS Multigen) who delivered a live singleton offspring between 1982 and 2008. Social and health data were obtained from routine Swedish registers. Associations of own education (adulthood SEP), and parental education and social class (childhood SEP) with hypertensive disorders were studied using logistic regression with adjustments for age, calendar period, parity, smoking and body mass index. RESULTS Low own education was associated with chronic hypertension, but not with gestational hypertension or pre-eclampsia/eclampsia. Increased risk of chronic hypertension was seen in women whose mothers had medium education compared with women whose mothers had high education (OR 2.18, 95% CI 1.03 to 4.62). Women from a manual social class during childhood had twice the risk of chronic hypertension compared with those from non-manual backgrounds (OR 2.19, 95% CI 1.28 to 3.75). Childhood SEP was not associated with gestational hypertension or pre-eclampsia/eclampsia. CONCLUSIONS Childhood and adulthood SEP was associated with chronic hypertension in pregnancy. In contrast, no association with childhood or adulthood SEP was seen for gestational hypertension or pre-eclampsia/eclampsia.
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Affiliation(s)
- Amy Heshmati
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, , Stockholm, Sweden
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GREISMAN SE. The reactivity of the capillary bed of the nailfold to circulating epinephrine and nor-epinephrine in patients with normal blood pressure and with essential hypertension. J Clin Invest 2004; 31:782-8. [PMID: 14955530 PMCID: PMC436474 DOI: 10.1172/jci102663] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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GOVAERTS P, VERNIOBY A. The vasoconstrictor properties of the vena cava blood of dogs with acute and chronic renal hypertension. ACTA ACUST UNITED AC 2004; 266:419-28. [PMID: 14902391 DOI: 10.1111/j.0954-6820.1952.tb13391.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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KAHN JR, SKEGGS LT, SHUMWAY NP, WISENBAUGH PE. The assay of hypertensin from the arterial blood of normotensive and hypertensive human beings. ACTA ACUST UNITED AC 2004; 95:523-9. [PMID: 14946317 PMCID: PMC2212091 DOI: 10.1084/jem.95.6.523] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypertensin has been assayed in the blood of patients with normal blood pressure and in those with essential hypertension in both the benign and malignant phases. 250 ml. samples of arterial blood were obtained, chemically purified, and concentrated to a volume of 1 ml. These extracts were then assayed in anesthetized rats. The concentrations of hypertensin in the blood of patients with the malignant phase of essential hypertension were found to be greatly increased. The concentrations of hypertensin found in patients with benign hypertension had a moderate degree of overlapping with those found in the normotensive group, but the mean concentration of hypertensin in the former group was twice that of the controls. Although these results are statistically significant, the amounts of hypertensin recovered in the benign group are so small that no conclusions can be drawn as to its effectiveness in producing vasoconstriction in these patients.
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FRIEDEN J, STAMLER J, HWANG W, KURAMOTO K, KATZ LN. Effect of chronic salt depletion in blood pressure of renal hypertensive dogs. ACTA ACUST UNITED AC 2004; 168:500-3. [PMID: 14903167 DOI: 10.1152/ajplegacy.1952.168.2.500] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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