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Li Y, Sun X, Wei J, Wu J, Wang Y. Time Trends in Comorbidity and Management of Hypertension and Self-reported Diabetes: A 15-Year Nationwide Longitudinal Study in China. Am J Hypertens 2021; 34:810-820. [PMID: 33492398 PMCID: PMC8385572 DOI: 10.1093/ajh/hpab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/12/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To examine time trends in comorbidity of hypertension and self-reported type 2 diabetes mellitus (T2DM) and their diagnosis, treatment, and management in China during 2000-2015 and study factors associated with these outcomes. METHODS Longitudinal data collected from the China Health and Nutrition Survey (CHNS) during 2000-2015 were analyzed. 143, 351, and 338 had both hypertension and self-reported T2DM were selected in 2000, 2011, and 2015, respectively. Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) and hypertension prevalence among T2DM participants, and treatment and control of hypertension and self-reported T2DM among participants with both conditions were examined for all and by sex and weight status. Poisson regression model assessed the associations. RESULTS From 2000 to 2015, among participants with self-reported T2DM, hypertension prevalence dropped from 88.4% to 83.0% and blood pressures decreased (P < 0.05). Men and overweight/obese participants had greater decreases in hypertension prevalence and DBP, while women had a larger decrease in SBP than men. Over time, among participants with both hypertension and self-reported T2DM, rates of hypertension treatment (45.3%-57.7%), hypertension control (3.0%-10.9%), and self-reported T2DM treatment (90.0%-95.6%) increased (all P < 0.001). Older, women, ever-smoking, heavier drinking, better income level, higher education level, and obesity had higher rates of prevalence, treatment, and control of hypertension, and self-reported T2DM treatment among participants with both hypertension and self-reported T2DM. CONCLUSIONS Rates of hypertension treatment and control among participants with both hypertension and self-reported T2DM have improved in recent years, but were still low.
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Affiliation(s)
- Yixuan Li
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Xiaomin Sun
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Junxiang Wei
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China,Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Correspondence: Youfa Wang ()
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Esteghamati A, Ismail-Beigi F, Khaloo P, Moosaie F, Alemi H, Mansournia MA, Afarideh M, Janbabaei Molla G, Ghadimi T, Shadnoush M, Kermanchi J, Ghaemi F. Determinants of glycemic control: Phase 2 analysis from nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD-2018). Prim Care Diabetes 2020; 14:222-231. [PMID: 31402326 DOI: 10.1016/j.pcd.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/29/2019] [Accepted: 07/16/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of morbidity and mortality worldwide, especially among middle and low income nations. Many diabetic complications and comorbidities are attributable to poor glycemic control. The aim of this study was to update and extend the national diabetes reports on the status of comorbidities, diabetes care and complications in Iran. Moreover, we investigated the risk factors of poor glycemic control in the Iranian population. METHODS National database of 99,651 patients with diabetes who attended university-affiliated clinics between April 1, 2017 and February 30, 2018 was used to carry out a cross-sectional study. Stepwise backward selection logistic regression model was used to examine the associated factors of glycemic control. RESULTS In this study 73.0% and 56.5% of the enrolled population with diabetes, had hypertension and hyperlipidemia, respectively. The prevalence of patients who received education for nutrition therapy or diabetes self-management was 16.3% and 23.3% respectively. Poor glycemic control was associated with male gender (OR=1.06, p=0.001), obesity (OR=1.03, p=0.05), duration of diabetes (OR=1.018, p<0.001), smoking (OR=1.08, p=0.041), hypertension (OR=1.53, p<0.001), hyperlipidemia (OR=1.15, p<0.001), insulin therapy (OR=1.26, p<0.001) and combination of insulin and oral anti-diabetic agents compared to oral anti-diabetic agents alone (OR=2.36, p<0.001). CONCLUSION We demonstrated that the prevalence of diabetes comorbidities is high in Iranian population and that a great proportion of Iranian patients with diabetes had not reached the goal of glycemic control. Our findings provide a starting point from which to investigate the obstacles that prevent patients with diabetes from reaching metabolic targets.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Faramarz Ismail-Beigi
- Department of Medicine, Biochemistry, Physiology and Biophysics, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, OH, United States
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Alemi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Janbabaei Molla
- Department of Deputy of Curative Affaires of Ministry of Health & Medical Education, Tehran, Iran
| | - Teyyeb Ghadimi
- Department of Surgery, Iran Medical University, Tehran, Iran
| | - Mehdi Shadnoush
- Department of Clinical Nutrition, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Jamshid Kermanchi
- Disease Management Advisor-Curative Affair Deputy-Ministry of Health and Medical Education, Tehran, Iran
| | - Fatemeh Ghaemi
- Department of Transplantation and Disease, Ministry of Health & Medical Education, Tehran, Iran.
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Zhang H, Qi D, Gu H, Wang T, Wu Y, Li J, Ni J, Liu J, Tu J, Ning X, Wang J. Trends in the prevalence, awareness, treatment and control of diabetes in rural areas of northern China from 1992 to 2011. J Diabetes Investig 2020; 11:241-249. [PMID: 31172682 PMCID: PMC6944834 DOI: 10.1111/jdi.13095] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 01/06/2023] Open
Abstract
AIMS/INTRODUCTION The worldwide prevalence of diabetes mellitus has been increasing over the past decades, particularly in developing countries. Because of the lack of information regarding changes in diabetes mellitus prevalence, awareness, treatment and control in rural China, we assessed these trends - overall and in the context of related health conditions - to explore the impact of these primary health issues on these rates in a poorly educated, rural population. MATERIALS AND METHODS Diabetes mellitus prevalence, awareness, treatment and control rates were compared between two surveys carried out in 1992 and 2011. The residents of three villages, aged 35-64 years, were recruited for this study. RESULTS In 1992, 1,091 individuals were interviewed and, in 2011, 2,338 individuals were interviewed. Between the two surveys, the overall diabetes mellitus prevalence in the study population was lower in 1992 than that in 2011 (P < 0.001); among men, the prevalence was 5.2-fold higher in 2011 than in 1992 (10.5 vs 1.7%) and nearly 4.3-fold higher (11.2 vs 2.1%) among women. Men aged 35-44 years, with >6 years of education, stage I hypertension and being overweight, had a higher prevalence of diabetes mellitus in 2011 than in 1992. Similarly, for the same time periods, there was also a higher diabetes mellitus prevalence among women aged 55-64 years, with 1-6 years of education, stage III hypertension and who were overweight. However, there were no significant changes in diabetes mellitus awareness, treatment or control in this population. CONCLUSIONS These results suggest that particular efforts must be made to enhance diabetes mellitus prevention, control and public awareness in rural communities in China.
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Affiliation(s)
- Hongyan Zhang
- Department of Endocrinology and MetabolismTianjin Medical University General HospitalTianjinChina
| | - Dongwang Qi
- Department of Endocrinology and MetabolismTianjin Medical University General HospitalTianjinChina
| | - Hongfei Gu
- Department of NeurologyTianjin Haibin People's HospitalTianjinChina
| | - Tao Wang
- Department of NeurologyTianjin Haibin People's HospitalTianjinChina
| | - Yanan Wu
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jingyan Li
- Department of Endocrinology and MetabolismTianjin Medical University General HospitalTianjinChina
| | - Jingxian Ni
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jie Liu
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jun Tu
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Xianjia Ning
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
| | - Jinghua Wang
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
- Laboratory of EpidemiologyTianjin Neurological InstituteTianjinChina
- Key Laboratory of Post‐Neuroinjury Neuro‐Repair and Regeneration in Central Nervous SystemTianjin Neurological InstituteMinistry of Education and Tianjin CityTianjinChina
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De Lorenzo A, Gratteri S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease? J Transl Med 2019; 17:169. [PMID: 31118060 PMCID: PMC6530037 DOI: 10.1186/s12967-019-1919-y] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022] Open
Abstract
Obesity must be considered a real pathology. In the world wide, obesity represent one of the major public health issue associated with increased morbidity and mortality. Overweight or obesity, in fact, significantly increases the risk of contracting diseases, such as: arterial hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, cerebral vasculopathy, gallbladder lithiasis, arthropathy, ovarian polycytosis, sleep apnea syndrome, and some neoplasms. Despite numerous informative campaigns, unfortunately, the fight against obesity does not seem to work: in the last years, the prevalence continued to increase. The progressive and rapid increase in the incidence of obesity, which has characterized most of the economically advanced countries in the last decade, has been the main stimulus for the research of the mechanisms underlying this pathology and the related disorders. The aims of this review is to provide a revision of the literature in order to define obesity as diseases, secondly to highlight the limits and the inaccuracy of common tools used for the diagnosis of obesity, and as a third thing to strengthen the concept of the complexity of obesity as a disease among political health care providers. Obesity may be viewed as a multifactorial pathology and chronic low-grade inflammatory disease. In fact, people affected by obesity have greater risk of developing comorbility and morbility, respect to healthy. Hence, the absolute therapeutic benefit is directly proportional to the basic risk. So, internationally interest on early diagnosis of obesity is growing to avoid under- and overdiagnosis consequences. Therefore, the consequences are an aggravation of the disease and an increase in obesity related pathology like diabetes, cardiovascular disease, and cancer. The most widely used parameter for diagnosis, body mass index (BMI) is not suitable for assessing the body fat. In fact, several studies demonstrate that BMI alone cannot define obesity, which consists not so much in weight gain as in excess fat mass. The use of suitable tools for the assessment of fat mass percentage combined with clinical and genetic analysis allowed to identify different phenotypes of obesity, which explain the various paradoxes of obesity. It is essential to adopt all possible strategies to be able to combat obesity, ameliorate the suffering of patients, and reduce the social and treatment costs of obesity.
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Affiliation(s)
- Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Santo Gratteri
- Department of Surgery and Medical Science, Magna Græcia University, Germaneto, Catanzaro Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Cammarano
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Pierfrancesco Bertucci
- Department of Laboratory Medicine, “Tor Vergata” University Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Management of hypertension and diabetes mellitus by cardiovascular and endocrine physicians: a China registry. J Hypertens 2017; 34:1648-53. [PMID: 27270188 PMCID: PMC4933577 DOI: 10.1097/hjh.0000000000000994] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: We investigated hypertension and diabetes mellitus in two management settings, namely cardiology and endocrinology, and their associations with albuminuria while accounting for the management of these two diseases. Methods: Our multicentre registry included patients (≥20 years) seen for hypertension in cardiology or for diabetes mellitus in endocrinology. We administered a questionnaire and measured blood pressure, glycosylated haemoglobin A1c and albuminuria. Results: Presence of both hypertension and diabetes was observed in 32.9% of hypertensive patients in cardiology (n = 1291) and 58.9% of diabetic patients in endocrinology (n = 1168). When both diseases were present, the use of combination antihypertensive therapy [odds ratio (OR) 0.31, P < 0.0001] and inhibitors of the renin–angiotensin system (OR 0.66, P = 0.0009) was less frequent in endocrinology than cardiology, and the use of combination antidiabetic therapy (OR 0.16, P < 0.0001) was less frequent in cardiology than endocrinology. The control of hypertension and diabetes, however, was not different between the two management settings (P ≥ 0.21), regardless of the therapeutic target (SBP/DBP < 140/90 or 130/80 mmHg and glycosylated haemoglobin A1c <7.0 or 6.5%). The prevalence of albuminuria was higher (P ≤ 0.02) in the presence of both diseases (23.3%) than those with either hypertension (12.6%) or diabetes alone (15.9%). Conclusion: Hypertension and diabetes mellitus were often jointly present, especially in the setting of endocrinology. The management was insufficient on the use of combination antihypertensive therapy and inhibitors of the renin–angiotensin system in endocrinology and for combination antidiabetic therapy in cardiology, indicating a need for more intensive management and better control of both clinical conditions.
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Khosravi-Boroujeni H, Nikbakht E, Natanelov E, Khalesi S. Can sesame consumption improve blood pressure? A systematic review and meta-analysis of controlled trials. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2017; 97:3087-3094. [PMID: 28387047 DOI: 10.1002/jsfa.8361] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/06/2017] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
Hypertension is a major risk factor for cardiovascular disease, myocardial infarction, stroke and renal failure. Sesame consumption may benefit blood pressure (BP) owing to its high polyunsaturated fatty acid, fibre, phytosterol and lignan contents. To clarify this, a systematic review and meta-analysis of controlled trials was conducted. The PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library (Central) databases were systematically searched until August 2016. Eight controlled trials with a total of 843 participants met the eligibility criteria. A random effect meta-analysis showed that sesame consumption can reduce systolic BP (-7.83 mmHg, 95% CI: -14.12, -1.54; P < 0.05, I2 = 99%) and diastolic BP (-5.83 mmHg, 95% CI: -9.58, -2.08; P < 0.01, I2 = 98%). To reduce the heterogeneity, the meta-analysis was limited to high methodology quality trials (n = 4), which resulted in a significant reduction in systolic BP (-3.23 mmHg, 95% CI: -5.67, -0.79; I2 = 33%) and a non-significant reduction in diastolic BP (-2.08 mmHg, 95% CI: -4.85, 0.69; I2 = 62%). This study concluded that sesame consumption can reduce systolic and diastolic BP. However, further investigations with larger sample sizes and better methodology quality are required to confirm the BP-lowering effect of sesame consumption. © 2017 Society of Chemical Industry.
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Affiliation(s)
- Hossein Khosravi-Boroujeni
- Menzies Health Institute Queensland & School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Elham Nikbakht
- Menzies Health Institute Queensland & School of Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - Ernesta Natanelov
- Menzies Health Institute Queensland & School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Saman Khalesi
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
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Padwal R, McAlister FA, Wood PW, Boulanger P, Fradette M, Klarenbach S, Edwards AL, Holroyd-Leduc JM, Alagiakrishnan K, Rabi D, Majumdar SR. Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e107. [PMID: 27343147 PMCID: PMC4938881 DOI: 10.2196/resprot.5775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/03/2016] [Indexed: 12/22/2022] Open
Abstract
Background Diabetes and hypertension are devastating, deadly, and costly conditions that are very common in seniors. Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications. However, blood pressure (BP) must be lowered carefully because seniors are also susceptible to low BP and attendant harms. Achieving “optimal BP control” (ie, avoiding both undertreatment and overtreatment) is the ultimate therapeutic goal in such patients. Regular BP monitoring is required to achieve this goal. BP monitoring at home is cheap, convenient, widely used, and guideline endorsed. However, major barriers prevent proper use. These may be overcome through use of BP telemonitoring—the secure teletransmission of BP readings to a health portal, where BP data are summarized for provider and patient use, with or without protocolized case management. Objective To examine the incremental effectiveness, safety, cost-effectiveness, usability, and acceptability of home BP telemonitoring, used with or without protocolized case management, compared with “enhanced usual care” in community-dwelling seniors with diabetes and hypertension. Methods A 300-patient, 3-arm, pragmatic randomized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors’ residences in greater Edmonton. Consenting patients will be randomized to usual care, home BP telemonitoring alone, or home BP telemonitoring plus protocolized pharmacist case management. Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data. In both telemonitored arms, providers will receive telemonitored BP data summaries. In the case management arm, pharmacist case managers will be responsible for reviewing teletransmitted data and initiating guideline-concordant and protocolized changes in BP management. Results Outcomes will be ascertained at 6 and 12 months. Within-study-arm change scores will be calculated and compared between study arms. These include: (1) clinical outcomes: proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range (110-129 mmHg in patients 65-79 years and 110-139 mmHg in those ≥80 years: primary outcome); additional ambulatory and home BP outcomes; A1c and lipid profile; medications, cognition, health care use, cardiovascular events, and mortality. (2) Safety outcomes: number of serious episodes of hypotension, syncope, falls, and electrolyte disturbances (requiring third party assistance or medical attention). (3) Humanistic outcomes: quality of life, satisfaction, and medication adherence. (4) Economic outcomes: incremental costs, incremental cost-utility, and cost per mmHg change in BP of telemonitoring ± case management compared with usual care (health payor and societal perspectives). (5) Intervention usability and acceptability to patients and providers. Conclusion The potential benefits of telemonitoring remain largely unstudied and unproven in seniors. This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes. Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada. Trial Registration Clinicaltrials.gov NCT02721667; https://clinicaltrials.gov/ct2/show/NCT02721667 (Archived by Webcite at http://www.webcitation.org/6i8tB20Mc)
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Affiliation(s)
- Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Padwal RS, Bienek A, McAlister FA, Campbell NR. Epidemiology of Hypertension in Canada: An Update. Can J Cardiol 2016; 32:687-94. [DOI: 10.1016/j.cjca.2015.07.734] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022] Open
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Liu M, Wang J, He Y, Jiang B, Wu L, Wang Y, Di Z, Zeng J. Awareness, treatment and control of type 2 diabetes among Chinese elderly and its changing trend for past decade. BMC Public Health 2016; 16:278. [PMID: 26987372 PMCID: PMC4797198 DOI: 10.1186/s12889-016-2874-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background This study aims to evaluate the awareness, treatment, control rate of type 2 diabetes and its risk factors among Chinese community elderly, and also examine the changing trend for the past decade. Methods We conducted two population-based cross-sectional studies in a representative urban area of Beijing in 2001 and 2010 respectively, using with the same method. A total of 2,277 participants (943 male, 1,334 female) in 2001 and 2,102 participants (848 male, 1,254 female) in 2010 were recruited. All the participants diagnosed with diabetes were included in this study. Results The prevalence of diabetes was 21.4 % and 24.8 % in 2001 and 2010 respectively. Among participants with diabetes, 74.2 % were aware of the condition, 51.0 % were treated, 20.1 % well controlled the condition in 2001, and the corresponding rates were 78.5 %, 69.3 %,15.9 % in 2010 respectively. Higher education level and a positive family history were related to better management of diabetes, while obesity and alcohol drinking showed a reverse direction. Conclusions The prevalence and awareness of diabetes stayed high for the past decade. The treatment increased 18.3 % while the control rate decreased among community elderly for the past 10 years. It’s urgent to carry out effective measures to raise awareness, treatment, and control rate of diabetes in order to avoid growing disease burden in China.
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Affiliation(s)
- Miao Liu
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jianhua Wang
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yao He
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China. .,State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Bin Jiang
- Department of Chinese Traditional Medicine and Acupuncture, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lei Wu
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yiyan Wang
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhang Di
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing Zeng
- Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
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Doulougou B, Gomez F, Alvarado B, Guerra RO, Ylli A, Guralnik J, Zunzunegui MV. Factors associated with hypertension prevalence, awareness, treatment and control among participants in the International Mobility in Aging Study (IMIAS). J Hum Hypertens 2015; 30:112-9. [PMID: 25833704 DOI: 10.1038/jhh.2015.30] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/23/2015] [Accepted: 02/27/2015] [Indexed: 01/20/2023]
Abstract
The aim of this study is to assess the factors associated with hypertension prevalence, awareness, treatment, and control, in the elderly populations of the International Mobility in Aging Study (IMIAS). Approximately 200 men and 200 women aged 65-74 years were recruited at each site (n=1995) during IMIAS' 2012 baseline survey at five cities: Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Blood pressure and anthropometric measurements were taken at participants' homes. Hypertension prevalence ranged from 53.4% in Saint-Hyacinthe to 83.5% in Tirana. Diabetes and obesity were identified as risk factors in all cities. More than two-thirds of hypertensive participants were aware of their condition (from 67.3% in Saint-Hyacinthe to 85.4% in Tirana); women were more aware than men. Awareness was positively associated with diabetes in Kingston, Manizales and Natal. Though most of those aware of their hypertensive condition were being treated pharmacologically, associations between awareness and physical activity and refraining from smoking were weak. Control among treated hypertensive participants was low, especially in Tirana and Natal. Diabetes and physical inactivity were associated with poor hypertension control. Hypertension is common in the older populations of IMIAS. Diabetes is strongly associated with hypertension prevalence, awareness and lack of control of hypertension. The fact that awareness is not strongly associated with healthy behaviours suggests that antihypertensive medication is not accompanied by non-pharmacological therapies. Improved health behaviours could strengthen hypertension control. Efforts should be made to increase men's awareness of hypertension. Hypertension control in diabetic patients is a challenge.
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Affiliation(s)
- B Doulougou
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada.,Département biomédical et santé publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - F Gomez
- Research Group on Gerontology and Geriatrics, University of Caldas, Manizales, Colombia
| | - B Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - R O Guerra
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - A Ylli
- National Institute of Public Health, Tirana, Albania
| | - J Guralnik
- Department of Epidemiology and Public Health, Division of Gerontology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M V Zunzunegui
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
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12
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Vaidya V, Gangan N, Sheehan J. Impact of cardiovascular complications among patients with Type 2 diabetes mellitus: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2015; 15:487-97. [PMID: 25824591 DOI: 10.1586/14737167.2015.1024661] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Macrovascular and microvascular complications that accompany Type 2 diabetes mellitus (T2DM) add to the burden among patients. The purpose of this systematic review is to conduct a comprehensive search of the medical literature investigating the prevalence of cardiovascular (CV) complications and assess their impact on healthcare costs, quality of life and mortality among patients with T2DM in the context of microvascular complications. A total of 76 studies and reports were used in this systematic review. Hypertension was the most prevalent complication among patients with T2DM. The additional cost burden due to CV complications was higher than any other complication except end-stage renal disease. Quality of life was much lower among patients with CV complications and T2DM, and mortality was higher than either illness alone.
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Affiliation(s)
- Varun Vaidya
- Department of Pharmacy Practice, Pharmacy Health Care Administration, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Health Science Campus 3000 Arlington Ave., Toledo, OH 43614, USA
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13
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Affiliation(s)
- Paul K. Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112;
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14
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Chong E, Wang H, King-Shier KM, Quan H, Rabi DM, Khan NA. Prescribing patterns and adherence to medication among South-Asian, Chinese and white people with type 2 diabetes mellitus: a population-based cohort study. Diabet Med 2014; 31:1586-93. [PMID: 25131338 DOI: 10.1111/dme.12559] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/29/2014] [Accepted: 07/31/2014] [Indexed: 12/27/2022]
Abstract
AIM To determine the prescribing of and adherence to oral hypoglycaemic agents, insulin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statin therapy among South-Asian, Chinese and white people with newly diagnosed diabetes. METHODS The present study was a population-based cohort study using administrative and pharmacy databases to include all South-Asian, Chinese and white people aged ≥ 35 years with diabetes living in British Columbia, Canada (1997-2006). Adherence to each class of medication was measured using proportion of days covered over 1 year with optimum adherence defined as ≥ 80%. RESULTS The study population included 9529 South-Asian, 14 084 Chinese and 143 630 white people with diabetes. The proportion of people who were prescribed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statin or oral hypoglycaemic agents was ≤ 50% for all groups. South-Asian and Chinese people had significantly lower adherence for all medications than white people, with the lowest adherence to angiotensin-converting enzyme inhibitor treatment (South-Asian people: adjusted odds ratio 0.37, 95% CI 0.34-0.39; P<0.0001; Chinese people: adjusted odds ratio 0.50, 95% CI 0.47-0.54; P<0.0001) and statin therapy (South-Asian people: adjusted odds ratio 0.47, 95% CI 0.41 - 0.53, P < 0.0001; Chinese people: adjusted odds ratio 0.72, 95% CI 0.67 - 0.77; P<0.0001) compared with white people. CONCLUSION Adherence to evidence-based pharmacotherapy was substantially worse among the South-Asian and Chinese populations. Care providers need to be alerted to the high levels of non-adherence in these groups and the underlying causes need to be investigated.
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Affiliation(s)
- E Chong
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
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15
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Gorgui J, Gorshkov M, Khan N, Daskalopoulou SS. Hypertension as a Risk Factor for Ischemic Stroke in Women. Can J Cardiol 2014; 30:774-82. [DOI: 10.1016/j.cjca.2014.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/12/2014] [Accepted: 01/13/2014] [Indexed: 12/24/2022] Open
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16
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Dhar I, Dhar A, Wu L, Desai KM. Methylglyoxal, a reactive glucose metabolite, increases renin angiotensin aldosterone and blood pressure in male Sprague-Dawley rats. Am J Hypertens 2014; 27:308-16. [PMID: 24436324 DOI: 10.1093/ajh/hpt281] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The majority of people with diabetes develop hypertension along with increased activity of the renin-angiotensin system. Methylglyoxal, a reactive glucose metabolite, is elevated in diabetic patients. We investigated the effects of methylglyoxal on the renin-angiotensin system and blood pressure. METHODS Male Sprague-Dawley rats were treated with a continuous infusion of methylglyoxal with a minipump for 4 weeks. Organs/tissues and cultured vascular smooth muscle cells (VSMCs) were used for molecular studies. High-performance liquid chromatography, Western blotting, and quantitative real-time polymerase chain reaction were used to measure methylglyoxal, proteins, and mRNA, respectively. Small interfering RNA for angiotensinogen and the receptor for advanced glycation endproducts (RAGE) were used to study mechanisms. RESULTS Methylglyoxal-treated rats developed a significant increase in blood pressure and plasma levels of aldosterone, renin, angiotensin, and catecholamines. Methylglyoxal level and protein and mRNA for angiotensin, AT1 receptor, adrenergic α1D receptor, and renin were significantly increased in the aorta and/or kidney of methylglyoxal-treated rats, a novel finding. Alagebrium attenuated the above effects of methylgloyxal. Treatment of cultured VSMCs with methylglyoxal or high glucose (25 mM) significantly increased cellular methylglyoxal and protein and mRNA for nuclear factor kappa B (NF-κB), angiotensin, AT1 receptor, and α1D receptor, which were prevented by inhibition of NF-κB, and by alagebrium. Silencing of mRNA for RAGE prevented the increase in NF-kB induced by methylglyoxal. Silencing of mRNA for angiotensinogen prevented the increase in NF-κB, angiotensin, AT1 receptor, and α1D receptor. CONCLUSIONS Methylglyoxal activates NF-κB through RAGE and thereby increases renin-angiotensin levels, a novel finding, and a probable mechanism of increase in blood pressure.
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Affiliation(s)
- Indu Dhar
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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17
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Blais C, Rochette L, Hamel D, Poirier P. Prevalence, incidence, awareness and control of hypertension in the province of Quebec: perspective from administrative and survey data. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2014; 105:e79-85. [PMID: 24735701 PMCID: PMC6972276 DOI: 10.17269/cjph.105.4123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 02/12/2014] [Accepted: 01/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Hypertension is a major risk factor for cardiovascular diseases. Nearly one adult in four was diagnosed with hypertension in 2007-2008 in Canada. One of the objectives of this study was to determine whether the prevalence of hypertension in Quebec as assessed using administrative data is comparable to that specifically measured, especially for the elderly population. METHODS Trends in prevalence, incidence and mortality were examined using the Quebec Integrated Chronic Disease Surveillance System built from grouping numerous administrative databases from 1996-1997 to 2009-2010. Blood pressure measurements, hypertension prevalence, awareness and control were obtained in 1,706 Quebecers in the combined cycles of the Canadian Health Measures Survey. RESULTS Using administrative databases, 23.6% [95% confidence interval, 23.5-23.6] of the Quebec population (n=1,433,400) aged ≥20 years was diagnosed with hypertension in 2009-2010, an increase of 32.1% compared to 2000 2001. The incidence decreased by 27.3%. Among people aged ≥65 years, the prevalence rose to 69.0% [95% CI: 68.8 69.2] in women and 61.7% [95% CI: 61.5-61.9] in men. For people aged 20-79 years, the prevalence of hypertension was lower with the administrative data compared to the survey (20.2% and 23.1%, respectively). The level of awareness, treatment and control were 84.3%, 83.1% and 67.9%, respectively. CONCLUSION The prevalence of hypertension derived from administrative data is comparable to that obtained with a health measured survey. Elderly women (≥65 years) are a very high-risk subgroup. The levels of awareness, treatment and control of hypertension in Quebec are very high.
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Affiliation(s)
- Claudia Blais
- Associate professor, Laval University, Institut national de santé publique du Québec.
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18
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Relationship between urinary sodium excretion and serum aldosterone in patients with diabetes in the presence and absence of modifiers of the renin-angiotensin-aldosterone system. Clin Sci (Lond) 2013; 126:147-54. [PMID: 23875766 DOI: 10.1042/cs20130128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although low dietary salt intake has beneficial effects on BP (blood pressure), low 24hUNa (24 h urinary sodium excretion), the most accurate estimate of dietary salt intake, is associated with increased mortality in people with diabetes. In the non-diabetic population, low salt intake is associated with increased RAAS (renin-angiotensin-aldosterone system) activity. In this cross-sectional study, we examined the relationship between 24hUNa, PRA (plasma renin activity), serum aldosterone and BNP (brain natriuretic peptide) in patients with diabetes. Clinical characteristics, 24hUNa, PRA, serum aldosterone and BNP were recorded in 222 consecutive patients (77% with Type 2 diabetes) attending a diabetes clinic at a tertiary hospital. The relationship between 24hUNa, serum aldosterone, PRA, BNP, urinary potassium excretion, serum potassium, serum sodium, eGFR (estimated glomerular filtration rate), urinary albumin excretion and HbA1c (glycated haemoglobin) was examined by a multivariable regression model. Levels of 24hUNa significantly predicted serum aldosterone in a linear fashion (R²=0.20, P=0.002). In the subgroup of patients (n=46) not taking RAAS-modifying agents, this relationship was also observed (R²=0.10, P=0.03), and the effect of 24hUNa on serum aldosterone was found to be more pronounced than in the whole cohort (coefficient=-0.0014, compared with -0.0008). There was no demonstrable relationship between 24hUNa and PRA or BNP. Low 24hUNa is associated with increased serum aldosterone in people with diabetes, in the presence and absence of RAAS-modifying agents. This raises the possibility that stimulation of the RAAS may be a mechanism that contributes to adverse outcomes observed in patients with low 24hUNa.
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Chandra A, Xing W, Kadhim MR, Williamson TH. Suprachoroidal hemorrhage in pars plana vitrectomy: risk factors and outcomes over 10 years. Ophthalmology 2013; 121:311-317. [PMID: 23870800 DOI: 10.1016/j.ophtha.2013.06.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/21/2013] [Accepted: 06/11/2013] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To investigate the rate and risk factors of developing suprachoroidal hemorrhage (SCH) after pars plana vitrectomy (PPV) and the outcomes as a result. DESIGN Retrospective, comparative consecutive series. PARTICIPANTS A total of 5459 patients who underwent pars plana vitrectomies over 10 years in 3 surgical centers. METHODS All patient demographic, medical, and ophthalmic data and operative information from 3 vitreoretinal centers were entered prospectively into an electronic medical record. Univariate analysis was undertaken, comparing risk factors between cases (SCH) and controls. Multivariable logistic regression was performed to test for independence between the risk factors (P < 0.2 in univariate analysis) and SCH. MAIN OUTCOME MEASURES Risk factors for developing SCH. Visual outcome and development of complications. RESULTS A total of 5459 PPVs were undertaken for a wide range of indications. Fifty-six cases of PPV were complicated by SCH (1.03%). Multivariable logistic regression showed that significant risk factors for developing this included advancing age, (mean age, 69 years in cases and 60 years in controls; odds ratio [OR], 1.04; P = 0.001), male sex (76.8% of cases and 58.7% of controls; OR, 2.38; P = 0.008), presence of rhegmatogenous retinal detachment (RRD) (80.3% of cases and 52.5% of controls; OR, 5.92; P < 0.0001), presence of a dropped lens fragment (10.7% of cases and 4.5% of controls; OR, 6.94; P = 0.002), and the use of antiplatelet or anticoagulant drugs (33.9% of cases and 17.7% of controls; OR, 2.29; P = 0.007). Suprachoroidal hemorrhage was more common with increasing quadrants of RRD. The significant operative risk factor was application of an explant (25% of cases and 4.07% of controls; OR, 5.63; P < 0.0001). Phthisis (7.1% of cases and 0.9% of controls; P = 0.002, Fisher exact test) and glaucoma (14.3% of cases and 7.2% of controls; P = 0.044, chi-square test) were more common in cases than in controls. CONCLUSIONS The risk factors for developing intraoperative SCH during PPV are male sex, advancing age, RRD, a scleral explant, a dropped lens fragment, and the use of aspirin or warfarin. Patients with this complication have a greater risk of developing ocular hypertension requiring treatment and phthisis.
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Affiliation(s)
- Aman Chandra
- Vitreoretinal Department, Moorfields Eye Hospital, London, United Kingdom; Research & Development, Moorfields Eye Hospital, London, United Kingdom
| | - Wen Xing
- Research & Development, Moorfields Eye Hospital, London, United Kingdom
| | - Mustafa R Kadhim
- Vitreoretinal Department, Moorfields Eye Hospital, London, United Kingdom
| | - Tom H Williamson
- Department of Ophthalmology, Guy's & St. Thomas' Hospitals, London, United Kingdom.
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Gee ME, Pickett W, Janssen I, Johnson JA, Campbell NR. Health Behaviors for Hypertension Management in People With and Without Coexisting Diabetes. J Clin Hypertens (Greenwich) 2013; 15:389-96. [DOI: 10.1111/jch.12093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/09/2013] [Accepted: 02/21/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Marianne E. Gee
- Department of Community Health and Epidemiology; Queen's University; Kingston ON Canada
- Centre for Chronic Disease Prevention; Public Health Agency of Canada; Ottawa ON Canada
| | - William Pickett
- Department of Community Health and Epidemiology; Queen's University; Kingston ON Canada
- Department of Emergency Medicine; Queen's University; Kingston ON Canada
| | - Ian Janssen
- Department of Community Health and Epidemiology; Queen's University; Kingston ON Canada
- School of Kinesiology and Health Studies; Queen's University; Kingston ON Canada
| | - Jeffrey A. Johnson
- Department of Public Health Sciences; University of Alberta; Edmonton AB Canada
| | - Norman R.C. Campbell
- Departments of Medicine; Community Health Sciences and of Physiology and Pharmacology; Libin Cardiovascular Institute; University of Calgary; Calgary AB Canada
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Tsuyuki RT, Campbell N. Hypertension: Silent and/or ignored / L’hypertension silencieuse ou ignorée. Can Pharm J (Ott) 2013; 146:61-4. [DOI: 10.1177/1715163513482713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Management of Hypertension in People with Diabetes Mellitus: Translating the 2012 Canadian Hypertension Education Program Recommendations into Practice. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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