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Cutler HR, Barr L, Sattwika PD, Frost A, Alkhodari M, Kitt J, Lapidaire W, Lewandowski AJ, Leeson P. Temporal patterns of pre- and post-natal target organ damage associated with hypertensive pregnancy: a systematic review. Eur J Prev Cardiol 2024; 31:77-99. [PMID: 37607255 PMCID: PMC10767256 DOI: 10.1093/eurjpc/zwad275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 08/24/2023]
Abstract
AIMS Hypertensive pregnancy is associated with increased risks of developing a range of vascular disorders in later life. Understanding when hypertensive target organ damage first emerges could guide optimal timing of preventive interventions. This review identifies evidence of hypertensive target organ damage across cardiac, vascular, cerebral, and renal systems at different time points from pregnancy to postpartum. METHODS AND RESULTS Systematic review of Ovid/MEDLINE, EMBASE, and ClinicalTrials.gov up to and including February 2023 including review of reference lists. Identified articles underwent evaluation via a synthesis without meta-analysis using a vote-counting approach based on direction of effect, regardless of statistical significance. Risk of bias was assessed for each outcome domain, and only higher quality studies were used for final analysis. From 7644 articles, 76 studies, including data from 1 742 698 pregnancies, were identified of high quality that reported either blood pressure trajectories or target organ damage during or after a hypertensive pregnancy. Left ventricular hypertrophy, white matter lesions, proteinuria, and retinal microvasculature changes were first evident in women during a hypertensive pregnancy. Cardiac, cerebral, and retinal changes were also reported in studies performed during the early and late post-partum period despite reduction in blood pressure early postpartum. Cognitive dysfunction was first reported late postpartum. CONCLUSION The majority of target organ damage reported during a hypertensive pregnancy remains evident throughout the early and late post-partum period despite variation in blood pressure. Early peri-partum strategies may be required to prevent or reverse target organ damage in women who have had a hypertensive pregnancy.
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Affiliation(s)
- Hannah Rebecca Cutler
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Logan Barr
- Department of Biomedical and Molecular Sciences, Queens University, Barrie St, Kingston, Canada
| | - Prenali Dwisthi Sattwika
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Bulaksumur, Caturtunggal, Kec, Kabupaten Sleman, Indonesia
| | - Annabelle Frost
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Mohanad Alkhodari
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, Shakhbout Bin Sultan St, Hadbat Al Za'faranah, United Arab Emirates
| | - Jamie Kitt
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Winok Lapidaire
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Adam James Lewandowski
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK
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Kavian JA. White Coat Hypertension: A Benign Finding or a Masked Risk Factor? South Med J 2023; 116:962-963. [PMID: 38051171 DOI: 10.14423/smj.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
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Brobak KM, Andreassen RM, Melsom T, Høieggen A, Norvik JV, Solbu MD. Associations of urinary orosomucoid, N-acetyl-β-D-glucosaminidase, and albumin with blood pressure and hypertension after 7 years. The Tromsø Study. Blood Press 2022; 31:270-283. [PMID: 36193001 DOI: 10.1080/08037051.2022.2128043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Purpose: Subclinical chronic kidney disease is known to exacerbate hypertension and progression of kidney damage. In order to initiate timely interventions, early biomarkers for this vicious circle are needed. Our aim was to describe the cross-sectional associations of urinary orosomucoid and urinary N-acetyl-β-D-glucosaminidase (NAG) with blood pressure and the longitudinal associations of urinary orosomucoid and NAG to hypertension after 7 years, and to compare the strength of these associations to the urinary albumin excretion (UAE).Material and methods: The Tromsø Study is a population-based, prospective study of inhabitants of the municipality of Tromsø, Northern Norway. Morning spot urine samples were collected on three consecutive days in the Tromsø 6 survey (2007-2008). We assessed the cross-sectional associations of urinary orosomucoid, NAG and UAE with blood pressure in Tromsø 6. In a cohort of participants attending Tromsø 6 and Tromsø 7 (2015-2016), we studied whether urinary biomarkers were longitudinally associated with hypertension.Results: A total of 7197 participants with a mean age of 63.5 years (SD 9.2), and a mean blood pressure of 141/78 mmHg (SD 23.0/10.6), were included in the study. Orosomucoid and UAE, but not NAG, was significantly associated with systolic and diastolic blood pressure in all the crude and multivariable cross-sectional analyses. Orosomucoid had consistently, although marginally, stronger associations with blood pressure. Incident hypertension at follow-up (Tromsø 7) was consistently significantly associated with urinary orosomucoid, but not urinary NAG or UAE. However, the standardized regression coefficients for orosomucoid were only marginally stronger than the standardized regression coefficients for ACR.Conclusion: In a cohort from the general population urine orosomucoid had a stronger cross-sectional association with blood pressure than UAE. After 7 years, urine orosomucoid showed the strongest association with incident hypertension. There were varying and weak associations between U-NAG, blood pressure and hypertension.
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Affiliation(s)
- Karl M Brobak
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Runa M Andreassen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Helgeland Hospital Trust, Sandnessjøen, Norway
| | - Toralf Melsom
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aud Høieggen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon V Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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Tannor EK, Nyarko OO, Adu-Boakye Y, Owusu Konadu S, Opoku G, Ankobea-Kokroe F, Opare Addo M, Amuzu EX, Ansah GJ, Appiah-Boateng K, Ansong D. Burden of hypertension in Ghana - Analysis of awareness and screening campaign in the Ashanti Region of Ghana. JRSM Cardiovasc Dis 2022; 11:20480040221075521. [PMID: 35111304 PMCID: PMC8801650 DOI: 10.1177/20480040221075521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/07/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Hypertension is a major risk factor for cardiovascular mortality globally and in Ghana. May Measurement Month (MMM) is a global awareness and screening campaign initiated by the International Society of Hypertension. METHODS Participants were recruited by opportunist sampling in the Ashanti region of Ghana. The blood pressures of participants were measured three times and the mean of the last two readings was used for the analysis. Simple and multiple logistic regression was used to determine the predictors of hypertension. RESULTS The MMM 2018 awareness and screening campaign enrolled 5054 participants with a mean age of 39.4 ± 14.7 years. There were 2553 (50.6%) males, 987 (20.1%) of respondents had never checked their blood pressure and 676 (13.9%) had a prior history of hypertension. The prevalence of hypertension was 37.4%. We found that 589(66.8%) of 822 respondents with high blood pressure did not have a history of hypertension. Respondents with a known history of hypertension on medication were 442 (65.9%) and 219(68.0%) of 322 respondents on medication had uncontrolled hypertension. The predictors of high blood pressure in a multiple logistic regression were increasing age (OR = 1.05 CI 1.05-1.06, p < 0.001), history of alcohol intake (OR = 1.33 CI 1.04 -1.70, p = 0.02), overweight (OR = 1.4 CI 1.14-1.76, p = 0.001) and obesity (OR = 1.32, CI 1.01-1.74, p = 0.047). CONCLUSION There is a high prevalence of hypertension in the Ashanti region in Ghana. Most participants with hypertension were not aware and the majority of those with hypertension on medications were uncontrolled. This calls for more education and screening of hypertension to decrease cardiovascular mortality.
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Affiliation(s)
- Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Obed Ofori Nyarko
- Department of Surgery, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Boakye
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Saabea Owusu Konadu
- Department of Obstetrics and Gynecology, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gilda Opoku
- Department of Surgery, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Mercy Opare Addo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Evans Xorse Amuzu
- Sickle Cell Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Kate Appiah-Boateng
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Daniel Ansong
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Tannor EK, Nyarko OO, Adu-Boakye Y, Owusu Konadu S, Opoku G, Ankobea-Kokroe F, Opare-Addo M, Appiah LT, Amuzu EX, Ansah GJ, Appiah-Boateng K, Ofori E, Ansong D. Prevalence of Hypertension in Ghana: Analysis of an Awareness and Screening Campaign in 2019. Clin Med Insights Cardiol 2022; 16:11795468221120092. [PMID: 36060113 PMCID: PMC9434666 DOI: 10.1177/11795468221120092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Hypertension is an important public health menace globally and in sub-Saharan
Africa. The prevalence of hypertension is on the rise in low- and
lower-middle-income countries (LMIC) such as Ghana. This rise led to the
adoption of the May Measurement Month (MMM) initiative, a global blood
pressure screening campaign. We aimed to create awareness and present the
findings of the 2019 MMM screening campaign in the Ashanti region of
Ghana. Methods: Ghana was 1 of 92 countries that participated in this global community-based
cross-sectional study in May 2019. Participants (⩾18 years) were recruited
by opportunistic sampling. The blood pressures of participants were measured
3 times and the mean of the last 2 was used for the analysis. Summary
statistics were used to describe the data. Simple and multiple logistic
regression models were used to determine the predictors of hypertension. Results: We screened 3080 participants with a mean age of 39.8 ± 16.8 years. The
prevalence of hypertension was 27.3% among participants. Two-thirds of the
hypertensives were unaware of their condition and only 49.5% of participants
with a history of hypertension on medication were controlled. Predictors of
hypertension in a multiple logistic regression were increasing age
(OR = 1.05 (CI 1.04-1.06), P < .001) and high body mass
index (OR = 1.06 (1.02-1.10), P = .005). Conclusion: The MMM initiative is highly commendable and of huge public health importance
in LMICs like Ghana. Population-based health programs such as the MMM
initiative is encouraged to shape appropriate public health policies to
reduce the prevalence of hypertension.
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Affiliation(s)
- Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Obed Ofori Nyarko
- Integrated Physiology Program, University of Colorado Denver Anschutz Medical Campus, USA
| | - Yaw Adu-Boakye
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Gilda Opoku
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Frank Ankobea-Kokroe
- Department of Obstetrics and Gynecology, Kwame Nkrumah University of Science and Technology,Kumasi, Ghana
| | | | - Lambert Tetteh Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Evans Xorse Amuzu
- Sickle cell department Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | - Emmanuel Ofori
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Daniel Ansong
- School of medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Hypertensive Retinopathy and All-Cause Mortality in Older Adults of Amerindian Ancestry. A Population-based Longitudinal Prospective Study. High Blood Press Cardiovasc Prev 2021; 28:613-618. [PMID: 34709584 PMCID: PMC8552426 DOI: 10.1007/s40292-021-00481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/21/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Hypertensive retinopathy (HTRP) predicts all-cause mortality in Asian and Caucasian populations. However, little is known about HTRP impact in other ethnic groups. Aim We sought to estimate the mortality risk according to HTRP severity in older adults of Amerindian ancestry living in rural Ecuador. Methods This prospective study enrolled individuals aged ≥ 60 years with baseline blood pressure ≥ 120/≥ 80 mmHg from the ongoing Atahualpa Project cohort who received retinal photographs (for HTRP grading) and a brain MRI. We ascertained all-cause mortality after a mean of 5.2 ± 1.2 years of follow-up. Cox-proportional hazards models adjusted for demographics, cardiovascular risk factors, neuroimaging signatures of cerebral small vessel disease, blood pressure determinations during follow-up and incident strokes, were obtained to estimate mortality risk according to HTRP severity. Results Analysis included 236 participants (mean age 69.3 ± 7.3 years). HTRP Grade 2 or higher was determined in 42 (18%) individuals. Fifty participants (21%) died during the follow-up, resulting in an overall unadjusted crude mortality rate of 4.1 per 100 person-years. Mortality rate in subjects with HTRP Grade 2 or higher was 7.2 and in those with no HTRP or Grade 1 only was 3.4 per 100 person-years. An adjusted Cox-proportional hazard model showed that individuals with HTRP Grade 2 or higher maintained a greater than two-fold mortality risk (HR 2.08; 95% C.I. 1.04–4.15; p = 0.038) when compared to those with no HTRP or Grade 1 only. Conclusion Study results show that HTRP severity predicts mortality in this population of older adults.
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Andrikou I, Dimitriadis K, Konstantinidis D, Leontsinis I, Andrikou E, Iliakis P, Liatakis I, Manta E, Karaminas N, Tsioufis P, Magkas N, Georgiopoulos G, Chrysohoou C, Thomopoulos C, Tousoulis D, Tsioufis C. Left ventricular mass versus pulse wave velocity as predictors of coronary artery disease in hypertensive patients: data from a 6-year-follow-up study. J Hum Hypertens 2021; 36:617-621. [PMID: 34326471 DOI: 10.1038/s41371-021-00560-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 11/09/2022]
Abstract
In treated hypertensive patients, there is a substantial residual cardiovascular (CV) risk that cannot be assessed by the available prediction models. This risk can be associated with subclinical organ damage, such as increased left ventricular mass (LVM) and arterial stiffness. However, it remains unknown which of these two CV markers better predicts coronary artery disease (CAD). A prospective cohort study was used to answer the above question. The study sample consisted of 1033 patients with hypertension (mean age 55.6 years, 538 males) free of CAD at baseline, who were followed for a mean period of 6 years. At baseline, all subjects underwent a complete echocardiographic study and pulse wave velocity (PWV) measurement. Hypertensive individuals who developed CAD (2.8%) compared to those without CAD at follow-up, had a higher baseline LVM index (by 16.7 g/m2, p < 0.001), higher prevalence of left ventricular hypertrophy (LVH) (21% greater, p = 0.027) and greater prevalence of high PWV levels at baseline (21% greater, p = 0.019). Multivariate Cox regression analysis revealed that baseline age >65 years (HR = 2.067, p = 0.001), male gender (HR = 3.664, p = 0.001), baseline chronic kidney disease (HR = 2.020, p = 0.026), baseline diabetes mellitus (HR = 1.952, p = 0.015) and baseline LVH (HR = 2.124 p = 0.001) turned out to be independent predictors of CAD, whereas high PWV levels were not. LVH proved to be an independent prognosticator of CAD in contrast to arterial stiffness that was not related to CAD after accounting for established confounders. Therefore, LVM can reliably help physicians to identify high-risk hypertensives in whom an intensified therapeutic management is warranted.
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Affiliation(s)
- Ioannis Andrikou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eirini Andrikou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panagiotis Iliakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Liatakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eleni Manta
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikos Karaminas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Magkas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgios Georgiopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Thomopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
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Kho M, Zhao W, Ratliff SM, Ammous F, Mosley TH, Shang L, Kardia SLR, Zhou X, Smith JA. Epigenetic loci for blood pressure are associated with hypertensive target organ damage in older African Americans from the genetic epidemiology network of Arteriopathy (GENOA) study. BMC Med Genomics 2020; 13:131. [PMID: 32917208 PMCID: PMC7488710 DOI: 10.1186/s12920-020-00791-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hypertension is a major modifiable risk factor for arteriosclerosis that can lead to target organ damage (TOD) of heart, kidneys, and peripheral arteries. A recent epigenome-wide association study for blood pressure (BP) identified 13 CpG sites, but it is not known whether DNA methylation at these sites is also associated with TOD. METHODS In 1218 African Americans from the Genetic Epidemiology Network of Arteriopathy (GENOA) study, a cohort of hypertensive sibships, we evaluated the associations between methylation at these 13 CpG sites measured in peripheral blood leukocytes and five TOD traits assessed approximately 5 years later. RESULTS Ten significant associations were found after adjustment for age, sex, blood cell counts, time difference between CpG and TOD measurement, and 10 genetic principal components (FDR q < 0.1): two with estimated glomerular filtration rate (eGFR, cg06690548, cg10601624), six with urinary albumin-to-creatinine ratio (UACR, cg16246545, cg14476101, cg19693031, cg06690548, cg00574958, cg22304262), and two with left ventricular mass indexed to height (LVMI, cg19693031, cg00574958). All associations with eGFR and four associations with UACR remained significant after further adjustment for body mass index (BMI), smoking status, and diabetes. We also found significant interactions between cg06690548 and BMI on UACR, and between 3 CpG sites (cg19693031, cg14476101, and cg06690548) and diabetes on UACR (FDR q < 0.1). Mediation analysis showed that 4.7% to 38.1% of the relationship between two CpG sites (cg19693031 and cg00574958) and two TOD measures (UACR and LVMI) was mediated by blood pressure (Bonferroni-corrected P < 0.05). Mendelian randomization analysis suggests that methylation at two sites (cg16246545 and cg14476101) in PHGDH may causally influence UACR. CONCLUSIONS In conclusion, we found compelling evidence for associations between arteriosclerotic traits of kidney and heart and previously identified blood pressure-associated DNA methylation sites. This study may lend insight into the role of DNA methylation in pathological mechanisms underlying target organ damage from hypertension.
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Affiliation(s)
- Minjung Kho
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Scott M. Ratliff
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Farah Ammous
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Thomas H. Mosley
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - Lulu Shang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Sharon L. R. Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Xiang Zhou
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Jennifer A. Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
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Ahn N, Kim K. Can Active Aerobic Exercise Reduce the Risk of Cardiovascular Disease in Prehypertensive Elderly Women by Improving HDL Cholesterol and Inflammatory Markers? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165910. [PMID: 32824020 PMCID: PMC7459903 DOI: 10.3390/ijerph17165910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/22/2022]
Abstract
This study aims to verify the efficacy of exercise programs designed to prevent and treat hypertension-induced cardiovascular disease (CVD) by analyzing the effects of a 6-month active aerobic exercise program, administered to prehypertensive elderly women, on reducing the risk of developing CVD by enhancing their physical fitness level and improving the detailed markers of high-density lipoprotein cholesterol (HDL-C) and inflammatory markers. We assigned the elderly women (≥65 years) recruited into normal blood pressure (120–129/80–84; NBP, n = 18) and high-normal blood pressure (130–139/85–89; HNBP, n = 12) groups according to the European guidelines for the management of arterial hypertension. The exercise program was made up of combined workouts of elastic band resistance exercise and aerobics with dance music. The program took place three times a week for six months, with each session lasting 60 min. We measured pre- and post-intervention body composition, blood pressure, physical fitness level, blood lipids profile, HDL-C, SAA, TNF-α, IL-6, IL-4, IL-15, CRP, and HSP70 and calculated the Framingham risk scores for comparison. A significant post-intervention reduction in the mean systolic blood pressure (SBP) was observed in the HNBP group (p < 0.001), with significant increase in HDL-C (p < 0.01) and significant decrease in serum amyloid A (SAA) concentration (p < 0.01). A significant improvement in physical fitness factors such as physical efficiency index (PEI) was also observed in the HNBP group (p < 0.05). The post-intervention TNF-α, IL-6, and SAA concentrations were more significantly lower in the HNBP than in the NBP group (p < 0.05). Compared to the baseline values, a significant decrease in SAA concentration (p < 0.01) and significant increase in HSP70 concentration (p < 0.001) were observed in the HNBP group. The HNBP group’s 10-year CVD risk was also significantly reduced (p < 0.05). The pre–post differences in SBP and DBP were significantly correlated with those in the anti-inflammatory markers IL-4 and IL-15 (p < 0.01). In conclusion, the 6-month active aerobic exercise program of moderate intensity administered to prehypertensive elderly women (≥65 years) had the effect of reducing the 10-year CVD risk through a substantial reduction in SBP, overall physical fitness improvement, increase in HDL-C, decrease in SAA concentration, and substantial decrease in inflammatory biomarkers. It was also confirmed that an increase in anti-inflammatory markers, which showed a small range of increase with respect to the decrease in blood pressure, may have a major effect.
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Yildirim E, Ermis E, Allahverdiyev S, Ucar H, Yavuzer S, Cengiz M. Circulating miR-21 levels in hypertensive patients with asymptomatic organ damage. Medicine (Baltimore) 2019; 98:e17297. [PMID: 31574853 PMCID: PMC6775376 DOI: 10.1097/md.0000000000017297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As a modifiable risk factor for cardiovascular disease, presence of hypertension (HT) necessitates the awareness of asymptomatic organ damage (AOD). The aim of this study was to measure plasma micro RNA-21 (miR-21) and the parameters that reflect AOD such as carotid intima-media thickness (CIMT), microalbuminuria (MAU) in hypertensive patients compared with healthy controls. In addition, the aim of this study was to evaluate plasma miR-21 levels in HT patients with AOD.This study was designed as a cross-sectional observational study. The study includes 2 groups: 32 patients with HT and 32 healthy controls. First, we compared these 2 groups. Then, to underline the relationship between plasma miR-21 and HT, hypertensive patients were divided into 2 groups: with AOD and without AOD.Sixteen patients with HT had AOD. MiR-21 levels significantly correlated with clinical systolic and diastolic blood pressure, MAU, C-reactive protein, and CIMT. CIMT, miR-21, and MAU levels were significantly higher in patients with AOD.Our study showed increased miR-21 levels in HT patients with AOD.
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Affiliation(s)
| | | | | | | | - Serap Yavuzer
- Department of Internal Medicine, Biruni University Faculty of Medicine, İstanbul, Turkey
| | - Mahir Cengiz
- Department of Internal Medicine, Biruni University Faculty of Medicine, İstanbul, Turkey
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Herrett E, Gadd S, Jackson R, Bhaskaran K, Williamson E, van Staa T, Sofat R, Timmis A, Smeeth L. Eligibility and subsequent burden of cardiovascular disease of four strategies for blood pressure-lowering treatment: a retrospective cohort study. Lancet 2019; 394:663-671. [PMID: 31353050 PMCID: PMC6717081 DOI: 10.1016/s0140-6736(19)31359-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/24/2019] [Accepted: 06/04/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Worldwide treatment recommendations for lowering blood pressure continue to be guided predominantly by blood pressure thresholds, despite strong evidence that the benefits of blood pressure reduction are observed in patients across the blood pressure spectrum. In this study, we aimed to investigate the implications of alternative strategies for offering blood pressure treatment, using the UK as an illustrative example. METHODS We did a retrospective cohort study in primary care patients aged 30-79 years without cardiovascular disease, using data from the UK's Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality. We assessed and compared four different strategies to determine eligibility for treatment: using 2011 UK National Institute for Health and Care Excellence (NICE) guideline, or proposed 2019 NICE guideline, or blood pressure alone (threshold ≥140/90 mm Hg), or predicted 10-year cardiovascular risk alone (QRISK2 score ≥10%). Patients were followed up until the earliest occurrence of a cardiovascular disease diagnosis, death, or end of follow-up period (March 31, 2016). For each strategy, we estimated the proportion of patients eligible for treatment and number of cardiovascular events that could be prevented with treatment. We then estimated eligibility and number of events that would occur during 10 years in the UK general population. FINDINGS Between Jan 1, 2011, and March 31, 2016, 1 222 670 patients in the cohort were followed up for a median of 4·3 years (IQR 2·5-5·2). 271 963 (22·2%) patients were eligible for treatment under the 2011 NICE guideline, 327 429 (26·8%) under the proposed 2019 NICE guideline, 481 859 (39·4%) on the basis of a blood pressure threshold of 140/90 mm Hg or higher, and 357 840 (29·3%) on the basis of a QRISK2 threshold of 10% or higher. During follow-up, 32 183 patients were diagnosed with cardiovascular disease (overall rate 7·1 per 1000 person-years, 95% CI 7·0-7·2). Cardiovascular event rates in patients eligible for each strategy were 15·2 per 1000 person-years (95% CI 15·0-15·5) under the 2011 NICE guideline, 14·9 (14·7-15·1) under the proposed 2019 NICE guideline, 11·4 (11·3-11·6) with blood pressure threshold alone, and 16·9 (16·7-17·1) with QRISK2 threshold alone. Scaled to the UK population, we estimated that 233 152 events would be avoided under the 2011 NICE guideline (28 patients needed to treat for 10 years to avoid one event), 270 233 under the 2019 NICE guideline (29 patients), 301 523 using a blood pressure threshold (38 patients), and 322 921 using QRISK2 threshold (27 patients). INTERPRETATION A cardiovascular risk-based strategy (QRISK2 ≥10%) could prevent over a third more cardiovascular disease events than the 2011 NICE guideline and a fifth more than the 2019 NICE guideline, with similar efficiency regarding number treated per event avoided. FUNDING National Institute for Health Research.
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Affiliation(s)
- Emily Herrett
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Sarah Gadd
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Krishnan Bhaskaran
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK; Health Data Research UK, London, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, Netherlands
| | - Reecha Sofat
- Institute of Health Informatics University College London, London, UK
| | - Adam Timmis
- Barts Heart Centre, Queen Mary University London, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Health Data Research UK, London, UK
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Effects of dual angiotensin type 1 receptor/neprilysin inhibition vs. angiotensin type 1 receptor inhibition on target organ injury in the stroke-prone spontaneously hypertensive rat. J Hypertens 2019; 36:1902-1914. [PMID: 29916993 DOI: 10.1097/hjh.0000000000001762] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The combination of AT1 blocker/neutroendopeptidase neprilysin inhibition (ARNi) represents an interesting approach to reduce cardiovascular risk in hypertension. We assessed the efficacy of ARNi, compared with angiotensin II type 1 receptor blockade alone, on blood pressure (BP) and on protection from target organ damage development in the stroke-prone spontaneously hypertensive rat (SHRSP). METHODS In high-salt fed SHRSP, we assessed plasma and tissue natriuretic peptides, urinary volume, BP and body weight over a short-term treatment (6 weeks) with either ARNi (sacubitril/valsartan 68 mg/kg per day) or valsartan (30 mg/kg per day), protection from stroke and renal damage (as documented by proteinuria) over 4 months of treatment with either sacubitril/valsartan or valsartan; the ability of either treatment to reduce progression of cerebrovascular and renal damage after 2 weeks of high-salt diet. RESULTS Higher levels of plasma and tissue atrial natriuretic peptide, of urinary cyclic guanosine 3'5'monophosphate and urine volumes, along with lower BP levels, were found upon sacubitril/valsartan as compared with valsartan over the short-term treatment. Sacubitril/valsartan caused a significant reduction of both BP and proteinuria levels and complete prevention of stroke over the long-term treatment. Once organ damage was established, a significant delay of its progression was observed with sacubitril/valsartan. CONCLUSION The dual angiotensin II type 1 receptor/neutroendopeptidase inhibition significantly increased atrial natriuretic peptide level and reduced BP. Complete prevention of stroke was achieved in this model. The ability of sacubitril/valsartan to reduce organ damage progression was superior to that of valsartan alone. ARNi may represent a highly effective therapeutic agent to protect from target organ damage development in hypertension.
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Stavropoulos K, Imprialos KP, Doumas M, Athyros VG. Carotid intima-media thickness as a target-organ damage and treatment-target: Need for a major revision? J Clin Hypertens (Greenwich) 2018; 20:255-257. [DOI: 10.1111/jch.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Vasilios G. Athyros
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
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Target Organ Damage and the Long Term Effect of Nonadherence to Clinical Practice Guidelines in Patients with Hypertension: A Retrospective Cohort Study. Int J Hypertens 2017; 2017:2637051. [PMID: 28695006 PMCID: PMC5485479 DOI: 10.1155/2017/2637051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/22/2017] [Accepted: 04/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients. Methods An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01–1.437], AOR = 1.196 [1.174–1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167–2.024], AOR = 1.636 [1.189–2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 (p = 0.01)]. Conclusion More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications.
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Jung MH, Ihm SH, Lee DH, Chung WB, Jung HO, Youn HJ. Prehypertension is associated with early complications of atherosclerosis but not with exercise capacity. Int J Cardiol 2017; 227:387-392. [DOI: 10.1016/j.ijcard.2016.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/21/2016] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
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16
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Algamal AM. Frequency of masked hypertension and its relation to target organ damage in the heart. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gonzalez-Calero L, Martin-Lorenzo M, de la Cuesta F, Maroto AS, Baldan-Martin M, Ruiz-Hurtado G, Pulido-Olmo H, Segura J, Barderas MG, Ruilope LM, Vivanco F, Alvarez-Llamas G. Urinary alpha-1 antitrypsin and CD59 glycoprotein predict albuminuria development in hypertensive patients under chronic renin-angiotensin system suppression. Cardiovasc Diabetol 2016; 15:8. [PMID: 26772976 PMCID: PMC4715311 DOI: 10.1186/s12933-016-0331-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is a multi-factorial disease of increasing prevalence and a major risk factor for cardiovascular mortality even in the presence of adequate treatment. Progression of cardiovascular disease (CVD) occurs frequently during chronic renin-angiotensin-system (RAS) suppression, and albuminuria is a marker of CV risk. High prevalence of albuminuria in treated hypertensive patients has been demonstrated, but there are no available markers able to predict evolution. The aim of this study was the identification of novel indicators of albuminuria progression measurable in urine of diabetic and non-diabetic patients. METHODS 1143 hypertensive patients under chronic treatment were followed for a minimum period of 3 years. Among them, 105 diabetic and non-diabetic patients were selected and classified in three groups according to albuminuria development during follow-up: (a) patients with persistent normoalbuminuria; (b) patients developing de novo albuminuria; (c) patients with maintained albuminuria. Differential urine analysis was performed by 2D gel electrophoresis (2D-DIGE) and further confirmed by liquid chromatography-mass spectrometry. Non-parametric statistical tests were applied. RESULTS CD59 glycoprotein and alpha-1 antitrypsin (AAT) resulted already altered in patients developing albuminuria de novo, with a similar response in those with maintained albuminuria. A prospective study in a sub-group of normoalbuminuric patients who were clinically followed up for at least 1 year from urine sampling, revealed CD59 and AAT proteins significantly varied in the urine collected from normoalbuminurics who will negatively progress, serving as predictors of future albuminuria development. CONCLUSIONS CD59 and AAT proteins are significantly altered in hypertensive patients developing albuminuria. Interestingly, CD59 and AAT are able to predict, in normoalbuminuric individuals, who will develop albuminuria in the future, being potential predictors of vascular damage and CV risk. These findings contribute to early identify patients at risk of developing albuminuria even when this classical predictor is still in the normal range, constituting a novel strategy towards a prompt and more efficient therapeutic intervention with better outcome.
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Affiliation(s)
- Laura Gonzalez-Calero
- Departamento de Inmunologia, Laboratorio de Inmunoalergia y Proteomica, IIS-Fundacion Jimenez Diaz, UAM, REDinREN, Avda Reyes Catolicos 2, 28040, Madrid, Spain.
| | - Marta Martin-Lorenzo
- Departamento de Inmunologia, Laboratorio de Inmunoalergia y Proteomica, IIS-Fundacion Jimenez Diaz, UAM, REDinREN, Avda Reyes Catolicos 2, 28040, Madrid, Spain.
| | - Fernando de la Cuesta
- Laboratorio de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain.
| | - Aroa S Maroto
- Departamento de Inmunologia, Laboratorio de Inmunoalergia y Proteomica, IIS-Fundacion Jimenez Diaz, UAM, REDinREN, Avda Reyes Catolicos 2, 28040, Madrid, Spain.
| | - Montserrat Baldan-Martin
- Laboratorio de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain.
| | - Gema Ruiz-Hurtado
- Unidad de Hipertension, Instituto de Investigacion i + 12, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
- Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain.
| | - Helena Pulido-Olmo
- Unidad de Hipertension, Instituto de Investigacion i + 12, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Julian Segura
- Unidad de Hipertension, Instituto de Investigacion i + 12, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Maria G Barderas
- Laboratorio de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain.
| | - Luis M Ruilope
- Unidad de Hipertension, Instituto de Investigacion i + 12, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Fernando Vivanco
- Departamento de Inmunologia, Laboratorio de Inmunoalergia y Proteomica, IIS-Fundacion Jimenez Diaz, UAM, REDinREN, Avda Reyes Catolicos 2, 28040, Madrid, Spain.
- Departamento de Bioquimica y Biologia Molecular I, Universidad Complutense de Madrid, Madrid, Spain.
| | - Gloria Alvarez-Llamas
- Departamento de Inmunologia, Laboratorio de Inmunoalergia y Proteomica, IIS-Fundacion Jimenez Diaz, UAM, REDinREN, Avda Reyes Catolicos 2, 28040, Madrid, Spain.
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Klarenbeek P, van Oostenbrugge RJ, Staals J. Ambulatory Arterial Stiffness Index Is Not Associated With Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Lacunar Stroke Patients. J Clin Hypertens (Greenwich) 2015; 17:352-6. [DOI: 10.1111/jch.12504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Pim Klarenbeek
- Department of Neurology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Robert J. van Oostenbrugge
- Department of Neurology; Maastricht University Medical Centre; Maastricht The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM); Maastricht University Medical Centre; Maastricht The Netherlands
| | - Julie Staals
- Department of Neurology; Maastricht University Medical Centre; Maastricht The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM); Maastricht University Medical Centre; Maastricht The Netherlands
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Kabedi NN, Mwanza JC, Lepira FB, Kayembe TK, Kayembe DL. Hypertensive retinopathy and its association with cardiovascular, renal and cerebrovascular morbidity in Congolese patients. Cardiovasc J Afr 2014; 25:228-32. [PMID: 25629539 PMCID: PMC4241591 DOI: 10.5830/cvja-2014-045] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 08/14/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Signs indicating hypertensive retinopathy can help determine the extent of hypertensive cardiovascular, renal and cerebrovascular damage. OBJECTIVES To study the association between hypertensive retinopathy and cardiovascular, renal and cerebrovascular changes, and to determine the predictors of hypertensive retinopathy in Congolese patients. METHODS A total of 159 hypertensive subjects (mean age: 58.9 ± 13.2 years) were enrolled from the cardiology out-patient clinic. Retinopathy grade was assessed on direct ophthalmoscopy. Hypertensive cardiovascular, renal and cerebrovascular changes were indicated by left ventricular hypertrophy (LVH), chronic kidney disease (CKD) and stroke, respectively. RESULTS Hypertensive retinopathy was present in 83.6% of the patients (grade 1: 42.1%; grade 2: 11.3%; grade 3: 23.3%; grade 4: 6.9%). There was no association between hypertensive retinopathy and the presence or absence of LVH (86.5 vs 73.3%, χ(2) = 1.53, p = 0.21), chronic kidney disease (89.3 vs 83.3%, χ(2) = 0.12, p = 0.73) or stroke (85.7 vs 83.2%, χ(2) > 0.001, p = 0.99). On multivariate logistic regression, CKD was the most significant predictor of severe hypertensive retinopathy, with an odds ratio of 4.4. CONCLUSION No association was found between hypertensive retinopathy and LVH, CKD or stroke. CKD was the most significant predictor of hypertensive retinopathy and there was a tendency toward increased risk of target-organ damage among patients with advanced hypertensive retinopathy.
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Affiliation(s)
- Nelly N Kabedi
- Department of Ophthalmology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Jean-Claude Mwanza
- Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - François B Lepira
- Division of Nephrology, School of Medicine, Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Tharcisse K Kayembe
- Department of Neurology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - David L Kayembe
- Department of Ophthalmology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Papademetriou V. Should Target Organ Damage Become a Therapeutic Target? J Clin Hypertens (Greenwich) 2013; 15:710-1. [DOI: 10.1111/jch.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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