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Khosravi A, Pourheidar B, Roohafza H, Moezzi M, Mousavi M, Hajiannejad A, Bidram P, Gharipour M, Shirani S, Golshahi J, Boshtam M, Sarrafzadegan N. Evaluating factors associated with uncontrolled hypertension: Isfahan cohort study, Iran. ARYA ATHEROSCLEROSIS 2014; 10:311-8. [PMID: 25815021 PMCID: PMC4354084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/23/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypertension (HTN) considers as one of the most common risk factors, which potentially raises the risk of cardiovascular disease. Regarding high prevalence of HTN among Iranian population this study designed to examine a range of socio-demographic and clinical variables to determine the association with failure to achieve blood pressure control in a cohort of hypertensive subjects. METHODS This retrospective cohort study is a part of Isfahan cohort study which carried out on adults aged 35 years old or more. Subjects with confirmed HTN entered in this sub-study. For all subjects questionnaire included socio-demographic characteristics, clinical data and lifestyle behavior completed by trained nurses. Uncontrolled HTN was defined as systolic and diastolic blood pressure more than 140/90 in the presence or absent of pharmacological treatment. RESULTS The prevalence of uncontrolled men was significantly higher than controlled in both 2001 and 2007 (P < 0.001). A significant association was found between sex and control of blood pressure: compared with women, being men [odds ratio (OR) = 2.31; 95 % confidence interval (CI) = 1.64-3.24] was significantly associated with uncontrolled HTN in 2001 and (OR = 2.38; 95% CI = 1.78-3.18). Among lifestyle behaviors, tendency for more consumption of salty foods increased the risk of uncontrolled HTN in 2001 by 1.73 times [OR = 1.73, 95% CI = 1.20-2.50, (P = 0.003)]. Patients who were naive to mono-therapy without considering the type of antihypertensive drug were found to be associated with uncontrolled blood pressure (OR = 0.14; 95 % CI =0.1-0.2). CONCLUSION Uncontrolled HTN was sex, marital status, diabetes, tendency to salty foods and medication adherence. Assessment of them presence of these risk factors is warranted to recommend an aggressive HTN management with the goal of reducing excessive risk of cardiovascular events caused by uncontrolled HTN.
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Affiliation(s)
- Alireza Khosravi
- Associate Professor, Interventional Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrouz Pourheidar
- Resident, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran,Correspondence to: Behrouz Pourheidar,
| | - Hamidreza Roohafza
- Assistant Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Moezzi
- Assistant Professor, Department of Community Medicine, Shahrekord University of Medical Science, Shahrekord, Iran
| | - Mehdi Mousavi
- Resident, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Alireza Hajiannejad
- Resident, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Peyman Bidram
- Resident, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Mojgan Gharipour
- Department of Metabolic Syndrome, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahin Shirani
- Associate Professor, Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jafar Golshahi
- Associate Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansoureh Boshtam
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Morra L, Zade D, McGlinchey RE, Milberg WP. Normal aging and cognition: the unacknowledged contribution of cerebrovascular risk factors. AGING NEUROPSYCHOLOGY AND COGNITION 2012; 20:271-97. [PMID: 22708889 DOI: 10.1080/13825585.2012.693905] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Despite the widespread assumption that cognitive decline is an inherent part of the normal aging process, research suggests that part of the variance in age-related cognitive decline is attributable to modifiable factors common in geriatric populations such as cerebrovascular risk factors. We completed a literature search using Science Citation Index and evaluated the most cited articles from the last 10 years to determine the extent to which investigations of normal aging and cognition account for the influence of cerebrovascular risk factors. We found that the majority of the most frequently cited literature does not adequately account for the contribution of cerebrovascular risk factors and therefore, it is possible that many conclusions about normal aging and cognition are flawed or incomplete. Further investigation of the role of cerebrovascular risk factors in age-related cognitive decline is imperative to more accurately understand the effect of aging on cognition.
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Affiliation(s)
- L Morra
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA.
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Abstract
BACKGROUND The association of clinostatic hypertension (CH) and orthostatic hypotension (OH) is described as the "Hyp-Hyp phenomenon," and it has been found in about 5.5% of hypertensive patients and in up to 50% of patients with OH. The importance of CH/OH in clinical practice is mainly due to the presence of troublesome symptoms, end-organ damage, and difficulties in its clinical management. HYPOTHESIS The review focuses on the clinical problem of CH and review the international literature for the best management, including the diagnostic work-up and the taylored treatment for this kind of patients. METHODS A systematic review of the literature was conducted through MEDLINE research to focus the main controversial issues about CH/OH. Included topics: (1) the diagnostic work-up, (2) the association with dysautonomic failure and syncope, and (3) the treatment options and prevention of end-organ damage. RESULTS Current standard reference for OH diagnosis includes functional assessment of the cardiac vagal nervous system and the sympathetic adrenergic system. The association with dysautonomic failure and with syncope needs further investigation. Pharmacologic treatment of OH is aimed at controlling symptoms rather than restoring normotension. Midodrine is the only medication that has been put to multicenter placebo-controlled trial and subsequently approved by the U.S. Food and Drug Administration (FDA) for OH treatment. Short-acting oral antihypertensive agents at bedtime should be considered in patients with severe, sustained CH. CONCLUSIONS Data obtained from the literature review showed that clinical diagnosis of the Hyp-Hyp phenomenon is relatively simple, but it remains more difficult to establish the causal disease. In our opinion, it is advisable to define simple diagnostic standards for the selection of patients at risk of dysautonomic impairment so that a subsequent highly specific diagnostic work-up could be initiated.
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Affiliation(s)
- Alfonso Lagi
- Emergency and Accident Department, Medicine Unit, Ospedale S. Maria Nuova, Florence, Italy.
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